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Home-based therapy for upper limb activity in children and adolescents with unilateral cerebral palsy: systematic
Cristina Lirio-Romero1,2, Hilde Feys3, Purificación López-Muñoz1,2
1Faculty of Physiotherapy and Nursing, Universidad de Castilla La Mancha, Toledo, Spain.
Insights
Home-based therapy improves upper limb activity in children with unilateral cerebral palsy. High-intensity interventions show promise, though specific characteristics require further study.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Neurology
Background:
- Unilateral cerebral palsy (UCP) significantly impacts upper limb function in children and adolescents.
- Effective therapeutic interventions are crucial for enhancing motor skills and daily living activities.
- Home-based therapy offers a potential solution for consistent and accessible treatment.
Purpose of the Study:
- To systematically review and analyze the efficacy of home-based therapy for improving upper limb activity in pediatric UCP.
- To evaluate the impact of intervention dosage and implementation factors on therapeutic outcomes.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Cochrane, CINAHL, PsycINFO, PEDro) up to March 2026.
- Seventeen experimental studies involving participants aged 2-18 years with UCP were included.
- Pooled estimates of standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using the DerSimonian and Laird method, with subgroup analyses based on intervention dosage.
Main Results:
- Home-based therapies demonstrated a significant positive effect on upper limb activity (SMD = 0.45; 95% CI: 0.30-0.60).
- No significant differences in outcomes were found based on intervention intensity (hours per week).
- Meta-regression indicated that parental involvement, delivery format, dose profile, task relevance, and contextual support did not significantly influence intervention outcomes (p > 0.05).
Conclusions:
- Home-based therapies are effective in improving upper limb activity for children and adolescents with UCP.
- While high-intensity interventions show promise, further research is needed to elucidate the specific intervention characteristics that optimize outcomes.
- Future studies should focus on high-quality research to assess the influence of various intervention components.
Purpose:
To analyze the effect of home-based therapy for upper limb activity in children and adolescents with unilateral cerebral palsy.
Methods:
PubMed, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and PEDro were systematically searched from inception to March 2026 for experimental studies addressing the effect of home-based therapies in participants aged from 2 to 18 years old. The DerSimonian and Laird method was used to compute pooled estimates of the standardized mean differences (SMD) and their respective 95% confidence intervals (CI). Subgroup analyses were performed based on the dosage of interventions.
Results:
Seventeen studies were included in this systematic review. Home-based therapies showed improvement in upper limb activity (SMD = 0.45; 95% CI: 0.30-0.60). No statistically significant differences were observed in relation to the intensity of intervention (hours per week). Meta-regression analysis revealed that none of the implementation-related moderators-including parental involvement, delivery format, dose profile, task relevance and contextual support-had a statistically significant effect on intervention outcomes (p > 0.05).
Conclusions:
High-intensity home-based therapies have demonstrated promising findings in improving upper limb activity in children and adolescents with unilateral cerebral palsy. Further high-quality studies may assess the influence of intervention characteristics.
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