Intensive training of motor function and functional skills among young children with cerebral palsy: a systematic review and meta-analysis

Hilde Tinderholt Myrhaug, Sigrid Østensjø, Lillebeth Larun, Jan Odgaard-Jensen, Reidun Jahnsen, Hilde Tinderholt Myrhaug, Sigrid Østensjø, Lillebeth Larun, Jan Odgaard-Jensen, Reidun Jahnsen

Abstract

Background: Young children with cerebral palsy (CP) receive a variety of interventions to prevent and/or reduce activity limitations and participation restrictions. Some of these interventions are intensive, and it is a challenge to identify the optimal intensity. Therefore, the objective of this systematic review was to describe and categorise intensive motor function and functional skills training among young children with CP, to summarise the effects of these interventions, and to examine characteristics that may contribute to explain the variations in these effects.

Methods: Ten databases were searched for controlled studies that included young children (mean age less than seven years old) with CP and assessments of the effects of intensive motor function and functional skills training. The studies were critically assessed by the Risk of bias tool (RoB) and categorised for intensity and contexts of interventions. Standardised mean difference were computed for outcomes, and summarised descriptively or in meta-analyses.

Results: Thirty-eight studies were included. Studies that targeted gross motor function were fewer, older and with lower frequency of training sessions over longer training periods than studies that targeted hand function. Home training was most common in studies on hand function and functional skills, and often increased the amount of training. The effects of constraint induced movement therapy (CIMT) on hand function and functional skills were summarised in six meta-analyses, which supported the existing evidence of CIMT. In a majority of the included studies, equal improvements were identified between intensive intervention and conventional therapy or between two different intensive interventions.

Conclusions: Different types of training, different intensities and different contexts between studies that targeted gross and fine motor function might explain some of the observed effect variations. Home training may increase the amount of training, but are less controllable. These factors may have contributed to the observed variations in the effectiveness of CIMT. Rigorous research on intensive gross motor training is needed.

Systematic review registration number: CRD42013004023.

Figures

Figure 1
Figure 1
Selection of studies.
Figure 2
Figure 2
Risk of bias.
Figure 3
Figure 3
Comparison of CIMT versus conventional therapy on unimanual hand function after 3 weeks.
Figure 4
Figure 4
Comparison of CIMT versus conventional therapy on bimanual hand function after 8 weeks.
Figure 5
Figure 5
Comparison of CIMT versus intensive interventions on unimanual hand function after 4 weeks.
Figure 6
Figure 6
Comparison of CIMT versus intensive interventions on bimanual hand function after 8 weeks.
Figure 7
Figure 7
Comparison of CIMT versus conventional therapy on functional skills after 6 weeks.
Figure 8
Figure 8
Comparison of CIMT versus intensive interventions on functional skills after 8 weeks.

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