Background and Objective(s): Children with Cerebral Palsy (CP) have decreased gross motor (GM) capacity, which restricts their participation in functional activities. This systematic review aims to identify and evaluate the effectiveness of active exercise interventions on GM function for ambulant and semi-ambulant children with CP. Study Design: Systematic Review. Study Participants & Setting: Systematic review according to PRISMA guidelines. Materials/Methods: Five electronic databases (PubMed, Medline CINAHL, Web of Science, EMBASE and PEDro) were searched from 1980 to 2017. Search terms included the population (CP) AND intervention type (gross motor) AND (intervention∗ OR therapy∗ OR treatment∗ OR exercise∗). Reference lists of included articles and relevant systematic reviews were hand-checked for additional articles. Articles were accepted if they (1) were published in full text in English; (2) included children aged 5-16 years; (3) with ambulant or semi-ambulant CP (GMFCS-E&R I-III); (4) included an active, land-based, gross motor exercise intervention; and (5) evaluated at least one gross motor outcome. Articles were excluded if intervention was (1) not exercise (e.g., medication); (2) not land-based (e.g., hydrotherapy); (3) reported on specialised therapy addressed by previous reviews (e.g. treadmill); or (4) did not adequately define the intervention. Two independent reviewers rated level of evidence for all studies (CEBM criteria) and quality for Level I-III studies (Group designs - AACPDM criteria; Single subject designs - Logan criteria). Results: Searches identified 6 different exercise interventions (49 studies with isolated data for children GMFCS I-III). Data showed moderate positive evidence for Physical Fitness Training (PFT) (n=7, Level II-V) and Functional Task Practice (FTP) (n=7, Level II-IV), weak positive evidence for Virtual Reality (VR) (n=11, Level II-V) and emerging positive evidence for Modified Sport (n=3, Level IV-V). There was strong conflicting evidence for Functional Strength Training (n=9, all Level II) and weak conflicting evidence for Isolated Strength Training (n=12, Level II-V) for improving GM function. Across studies, there were wide variations in intervention dose (e.g., VR=5-70h, FTP=6-90h) and effect on GM function (e.g., PFT most improved running, Modified Sport most improved fundamental movement skills). Studies also often lacked details of control groups, power calculations, attrition, reliability and sampling rate. Conclusions/Significance: Active exercise interventions are effective for improving gross motor function in ambulant children with CP. However, higher study quality and higher level GM assessments are needed to evaluate true functional gains and overcome ceiling effects in children with ambulant CP. Further studies are necessary to resolve conflicting evidence and provide clarity for emerging interventions such as Modified Sports which have potential to improve GM function, as well as participation for children with CP.
|Publication status||Published - 2017|
|Event||71st Annual Meeting American Academy of Cerebral Palsy and Developmental Medicine 2017 - Palais des congres de Montreal, Montreal, Canada|
Duration: 13 Sep 2017 → 16 Sep 2017
http://www.aacpdm.org/meetings/2017 (conference website)
|Conference||71st Annual Meeting American Academy of Cerebral Palsy and Developmental Medicine 2017|
|Abbreviated title||Dare Greatly: Enter the Arena|
|Period||13/09/17 → 16/09/17|