Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis

Abstract

BACKGROUND AND OBJECTIVE: Children with unilateral cerebral palsy present with impaired upper limb (UL) function affecting independence, participation, and quality of life and require effective rehabilitation. This study aims to systematically review the efficacy of nonsurgical upper limb therapies for children with unilateral cerebral palsy. METHODS: Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, the Cochrane Central Register of Controlled Trials, and PubMed were searched to December 2012. Randomized controlled or comparison trials were included. RESULTS: Forty-two studies evaluating 113 UL therapy approaches (N = 1454 subjects) met the inclusion criteria. Moderate to strong effects favoring intramuscular injections of botulinum toxin A and occupational therapy (OT) to improve UL and individualized outcomes compared with OT alone were identified. Constraint-induced movement therapy achieved modest to strong treatment effects on improving movement quality and efficiency of the impaired UL compared with usual care. There were weak treatment effects for most outcomes when constraint therapy was compared with an equal dose (amount) of bimanual OT; both yielded similar improved outcomes. Newer interventions such as action observation training and mirror therapy should be viewed as experimental. CONCLUSIONS: There is modest evidence that intensive activity-based, goal-directed interventions (eg, constraint-induced movement therapy, bimanual training) are more effective than standard care in improving UL and individualized outcomes. There is little evidence to support block therapy alone as the dose of intervention is unlikely to be sufficient to lead to sustained changes in UL outcomes. There is strong evidence that goal-directed OT home programs are effective and could supplement hands-on direct therapy to achieve increased dose of intervention.

Effect of parent‐delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial

“…The mean sample size for RCTs of upper limb therapies in UCP is 29.7 (SD 19.1). 23 Our power calculation was based on a standardized effect size of 0.75. A post-hoc power calculation based on our collected data showed that 322 participants would be needed to detect a between-group change difference of five logit-based AHA units (smallest detectable difference) with 80% power.…”

The influence of early modified constraint‐induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy

“…1,2 The effect is maintained for at least 6 months after the therapy ends [3][4][5][6][7] and has been reported to last for up to 1 year. [8][9][10] Because the ultimate goal of treatment is to change the natural course of motor development in a lifetime perspective, it is important to investigate the long-term effect of mCIMT.…”

Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature

“…Hemiparesis is the most frequent manifestation of CP, affecting as many as 38% of cases in one populationbased study 2 , and can lead to disuse of the affected upper limb, with negative consequences for reaching, bimanual tasks and functionality, regarding activities performed in home, school and community settings 3 . In recent years, a large number of randomized clinical trials, investigating particularly CIMT and "modified CIMT" (mCIMT) have emerged 4 . CIMT began with preclinical research involving young male primates and was founded on overcoming "learned non-use" 5 .…”

“…Modifications to the classic protocol (mCIMT) were made to encourage children to perform. The mCIMT protocols similarly involve restraint of the non-affected limb with variations in the type of restriction applied (e.g., glove, glove, sling) and are accompanied by a unimanual repetitive practice, differing in part from the classic CIMT in terms of the model of therapy (short-term intensity, long-term distribution model) and dose intervention 4 . The location, context and provider of training (house/camp, individual/group, therapist/parent) are also differentiated in relation to the classic CIMT 11 .…”

“…The location, context and provider of training (house/camp, individual/group, therapist/parent) are also differentiated in relation to the classic CIMT 11 . Recently, hybrid models have been reported applying sequentially mCIMT followed by bimanual training, significantly altering the unimanual construction of the method 4,11 .…”