Aim To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews’ conclusions. Method A comprehensive search of 22 databases identified eligible systematic reviews with and without meta‐analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews‐2 (AMSTAR‐2) to appraise methodological quality. Results Eighty‐three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR‐2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR‐2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. Interpretation Most of these systematic reviews are considered unreliable according to AMSTAR‐2. Current recommendations for treating children with CP based on these flawed systematic reviews need re‐evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high‐level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non‐randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta‐analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.

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Objective To investigate motor cortical map patterns in children with diplegic and hemiplegic cerebral palsy (CP), and the relationships between motor cortical geometry and motor function in CP. Methods Transcranial magnetic stimulation (TMS) was used to map motor cortical representations of the first dorsal interosseus (FDI) and tibialis anterior (TA) muscles in 13 children with CP (age 9–16 years, 6 males.) The Gross Motor Function Measure (GMFM) and Melbourne upper extremity function were used to quantify motor ability. Results In the hemiplegic participants (N=7), the affected (right) FDI cortical representation was mapped on the ipsilateral (N=4), contralateral (N=2), or bilateral (N=1) cortex. Participants with diplegia (N=6) showed either bilateral (N=2) or contralateral (N=4) cortical hand maps. The FDI and TA motor map center-of-gravity mediolateral location ranged from 2–8 cm and 3–6 cm from the midline, respectively. Among diplegics, more lateral FDI representation locations were associated with lower Melbourne scores, i.e. worse hand motor function (Spearman’s Rho = −0.841, p=0.036) Conclusions Abnormalities in TMS-derived motor maps cut across the clinical classifications of hemiplegic and diplegic CP. The lateralization of the upper and lower extremity motor representation demonstrates reorganization after insults to the affected hemispheres of both diplegic and hemiplegic children. Significance The current study is a step towards defining the relationship between changes in motor maps and functional impairments in CP. These results suggest the need for further work to develop improved classification schemes that integrate clinical, radiologic, and neurophysiologic measures in CP.

Although these procedures are not without adverse effects, this series suggests that the potential benefits outweigh the risks.