Muscle strengthening is not effective in children with cerebral palsy: A systematic review
Scianni, Aline A. Butler, Jane Margaret Ada, Louise Teixeira-Salmela, Luci F.
Scianni, Aline A.
Butler, Jane Margaret
Ada, Louise
Teixeira-Salmela, Luci F.
Abstract
Question: Do strengthening interventions increase strength without increasing spasticity and improve activity, and is there any carryover after cessation in children and adolescents with cerebral palsy? Design: Systematic review with meta-analysis of randomised trials. Participants: Children with spastic cerebral palsy between school age and 20 years. Intervention: Strengthening interventions that involved repetitive, strong, or effortful muscle contractions and progressed as ability changed, such as biofeedback, electrical stimulation, and progressive resistance exercise. Outcome measures: Strength was measured as continuous measures of maximum voluntary force or torque production. Spasticity was measured as velocity-dependent resistance to passive stretch. Activity was measured as continuous measures, eg, 10-m Walk Test, or using scales eg, the Gross Motor Function Measure. Results: Six studies were identified and five had data that could be included in a metaanalysis. Strengthening interventions had no effect on strength (SMD 0.20, 95% CI −0.17 to 0.56), no effect on walking speed (MD 0.02 m/s, 95% CI −0.13 to 0.16), and had a small statistically-significant but not clinically-worthwhile effect on Gross Motor Function Measure (MD 2%, 95% CI 0 to 4). Only one study measured spasticity but did not report the between-group analysis. Conclusion: In children and adolescents with cerebral palsy who are walking, the current evidence suggests that strengthening interventions are neither effective nor worthwhile.
Keywords
cerebral palsy, physical therapy techniques, rehabilitation, review systematic, meta-analysis, randomised controlled trials, muscle weakness, children
Date
2009
Type
Journal article
Journal
Australian Journal of Physiotherapy
Book
Volume
55
Issue
2
Page Range
81-87
Article Number
ACU Department
School of Allied Health
Faculty of Health Sciences
Faculty of Health Sciences