Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis.

Only three of the 27 trials were rated at low risk of bias when assessed as treated; of the 24 assessed by protocol, most had some concerns and a third had at least one high-risk area, usually blinding or how outcomes were assessed. No study followed children after the training stopped, so it is not known whether any of the gains last. Almost all the research is on the lower limbs and trunk; the authors note that upper-limb strengthening has barely been studied, even though coordination matters most there. Children in the studies were at GMFCS levels I to III, so these results cannot be extended to children at levels IV and V. Several pooled results combined studies with substantial heterogeneity, particularly balance, plantarflexor strength and knee flexor strength, so the pooled estimates mix studies that measured things differently. Many programmes did not follow recommended exercise guidelines, and the authors note that both under-dosing and over-dosing can lead to worse results. Effects on participation were inconsistent across studies, and the authors say more research is needed before anything can be said about it.

The authors declared no potential conflicts of interest with respect to the research, authorship, or publication of the article. The text supplied does not state who funded the work.

Do not apply this to every child with cerebral palsy. The included studies covered only GMFCS levels I to III, and the authors state that children at levels IV and V may need different approaches, such as aquatic strengthening or neuromuscular electrical stimulation. The measured gains were also small and were tested only for the length of the training programme.