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Lower Limb Training Threshold Dose and Motor Learning Strategy Reporting in Children With Cerebral Palsy
Matthew Haddon1, Isabella Pessóta Sudati, Jizelle Kenworthy-Groen
1The Healthy Strides Foundation, Perth, Western Australia, Australia (Mr Haddon, Dr Pool, and Ms Dolling); Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia (Mr Haddon, Ms Kenworthy-Groen, and Ms O'Connor); Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil (Dr Sudati); School of Allied Health, Curtin University, Perth, Western Australia, Australia (Dr Pool); Kids Rehab WA, Perth Children's Hospital, Perth, Western Australia, Australia (Ms O'Connor); Biostatistics Unit, Griffith University, Brisbane, Queensland, Australia (Prof Ware); Rocky Bay, Perth, Western Australia, Australia (Ms Lee); Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia (Prof Sakzewski).
Insights
This review found optimal active lower limb training doses for children with cerebral palsy (CP) to improve walking and motor function. Reporting of motor learning strategies was low, indicating a need for better intervention details in future studies.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Clinical Trials Methodology
Background:
- Cerebral palsy (CP) significantly impacts motor function in children.
- Active lower limb training is a key intervention for improving outcomes in pediatric CP.
- Understanding optimal training dosage is crucial for effective rehabilitation.
Purpose of the Study:
- To determine the threshold dose of active lower limb training for improving outcomes in children with CP.
- To assess the reporting quality of motor learning strategies in relevant studies.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) from five databases.
- Independent assessment of study selection, data extraction, and risk of bias.
- Dose thresholds established based on clinically significant mean group changes.
Main Results:
- 101 studies involving 3566 children with CP were included.
- Identified threshold doses: 12h for walking speed, 7.5h for endurance, 23.33h for gross motor function, 21h for goal performance.
- Low reporting of motor learning strategies and high risk of bias in most studies.
Conclusions:
- Preliminary guidance provided for optimizing therapy duration to enhance functional outcomes in pediatric CP.
- Highlights the need for higher-quality research with detailed intervention reporting.
- Emphasizes the importance of incorporating motor learning principles in CP interventions.
Purpose:
This systematic review investigated the threshold dose of active lower limb training required to improve outcomes in children with cerebral palsy (CP) and to evaluate the reporting of motor learning strategies.
Methods:
Five databases were searched for randomized controlled trials on active lower limb training in children with CP. Independent assessors conducted study selection, data extraction, and risk of bias assessment. Clinically significant mean group changes established dose thresholds, while motor learning strategies were assessed based on 11 common strategies.
Results:
One hundred and one studies (3566 participants, mean age 8.8 years) met inclusion criteria. Threshold doses were 12 hours for walking speed, 7.5 hours for walking endurance, 23.33 hours for gross motor function, and 21 hours for goal performance. Motor learning strategy reporting was low. Most studies had a high risk of bias.
Conclusions:
These results provide preliminary guidance for optimizing therapy time to improve walking speed and endurance, gross motor function, and goal performance. More high-quality studies with detailed intervention reporting are needed.
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