Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review.
Véronique F P Plasschaert, Johanna E Vriezekolk, Pauline B M Aarts and 2 others
PMID 30632139WHAT IT FOUND
Evidence on upper limb treatments for children with bilateral cerebral palsy is limited and mixed.
Some programmes showed gains, but most studies were small, low quality, and combined occupational or physical therapy, so no single treatment can be recommended confidently.
Key findings
01Most included studies provided low-level evidence, making firm conclusions difficult.
02Two studies on BoNT-A with or without occupational therapy reported significant beneficial effects in six of seven domains.
03In eight studies, treatment was combined with occupational or physical therapy, so the contribution of any single component could not be established.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included 15 studies, with 288 participants total and 10 to 40 participants per study. Most included studies provided level IV evidence, and methodological quality was weak in nine studies, moderate in four, and strong in two. The interventions and outcome measures were too heterogeneous for meaningful synthesis across studies. Many treatments were combined with occupational or physical therapy, so the contribution of any single component could not be established. Patient classification was inconsistent, with missing or variable information about motor type, GMFCS level, MACS level, and comorbidities. Some outcome measures were not upper limb assessments or were not validated for cerebral palsy, and clinically important outcomes such as palm hygiene and pain were not assessed. The search was limited to English, French, and German publications.
The easy way to misread this
Do not conclude that any treatment is proven effective for upper limb function in children with bilateral cerebral palsy. The review found mostly low-level evidence, small samples, inconsistent outcome measures, and many treatments combined with occupational or physical therapy, so the effect of a single component cannot be separated.