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      Impact of Resistance Therapy on Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis

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          Abstract

          Cerebral palsy is one of the main causes of disability in childhood. Resistance therapy shows benefits in increasing strength and gait in these patients, but its impact on motor function is not yet clear. The objective was to analyze the impact of resistance therapy on the improvement in the motor function using a review and meta-analysis. A comprehensive literature research was conducted in Medline (PubMed), Institute for Scientific Information (ISI) Web of Knowledge, and Physiotherapy Evidence Database (PEDro) in relation to clinical trials in which resistance therapy was used and motor function was assessed. Twelve controlled clinical trials and three non-controlled clinical trials (only one intervention arm) studies were identified. In terms of pre–post difference, the overall intra-group effect was in favor of resistance therapy intervention: standardized mean difference (SMD) = 0.37, 95% confidence interval (CI) = 0.21 to 0.52, p < 0.001 (random-effects model), with moderate heterogeneity ( I 2 = 59.82%). SMDs were also positive by restricting to each of the analyzed scales: SMD = 0.37, 1.33, 0.10, and 0.36 for Gross Motor Function Measure (GMFM), Lateral Step Up (LSU), Time Up and Go (TUG), and Mobility Questionnaire (MobQue) scales, respectively. Regarding the difference between groups, the results showed a high heterogeneity ( I 2 < 99%), with the mean difference (MD) also favorable for the GMFM scale: MD = 1.73, 95% CI = 0.81 to 2.64, p < 0.001 (random-effects model). Our results support a positive impact of resistance therapy on motor function. Further studies should delve into the clinical relevance of these results.

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          The epidemiology of cerebral palsy: incidence, impairments and risk factors.

          Else Odding, Marij Roebroeck, Hendrik J. Stam (2006)
          Describing the epidemiology of cerebral palsy (CP), its impairments and risk factors. Literature review 1965-2004. Search terms: Cerebral palsy, incidence, prevalence, impairments, risk factors. In the last 40 years the prevalence of CP has risen to well above 2.0 per 1000 life births. In this time span the proportion of low-birthweight infants rose, the proportion of diplegia decreased, while the proportion of hemiplegia increased. CP is more prevalent in more deprived socio-economic populations. The majority of people with CP have the spastic syndrome of which the diplegic group is the smallest. Dependent on the subgroup of CP, 25-80% have additional impairments. A large proportion has some kind of cognitive impairment; the prevalence varies with the type of CP and especially increases when epilepsy is present. Epilepsy is present in 20-40%; it is most common among the hemi- and tetraplegics. Sensibility of the hands is impaired in about half. Chronic pain is reported by more than a quarter of the adults. Up to 80% have at least some impairment of speech. Low visual acuity is reported in almost three-quarters of all children. Half of all children have gastrointestinal and feeding problems. Stunted growth occurs in a quarter, while under- or overweight problems are present in half of the children. Almost 70% of people with spastic CP have abnormal brain CT findings; abnormal cranial ultrasounds is most strongly associated with hemiplegia, normal cranial ultrasounds with diplegia. The most important risk factors for CP are low birthweight, intrauterine infections and multiple gestation.
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            Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy.

            Scott Stackhouse, Robert Lee, Stuart Binder-Macleod (2005)
            Cerebral palsy (CP) may lead to profound weakness in affected portions of the extremities and trunk. Knowing the mechanisms underlying muscle weakness will help to better design interventions for increasing force production in children with CP. This study quantified voluntary muscle activation, contractile properties, and fatigability of the quadriceps femoris and triceps surae in children with and without CP. Twelve children with CP (7-13 years) and 10 unaffected children (controls, 8-12 years) were assessed for (1) voluntary muscle activation during maximum voluntary isometric contractions (MVICs); (2) antagonist coactivation during agonist MVICs; (3) contractile properties, and (4) fatigability using electrically elicited tests. Children with CP were significantly weaker, had lower agonist voluntary muscle activation, and greater antagonist coactivation. In children with CP, the quadriceps normalized force-frequency relationship (FFR) was shifted upward at low frequencies and was less fatigable than controls. No differences were seen between groups in the normalized FFR and fatigability of the triceps surae. In addition, no differences were seen in the sum of the time to peak tension and half-relaxation times between groups for either muscle. Because children with CP demonstrated large deficits in voluntary muscle activation, using voluntary contractions for strength training may not produce forces sufficient to induce muscle hypertrophy. Techniques such as enhanced feedback and neuromuscular electrical stimulation may be helpful for strengthening muscles that cannot be sufficiently recruited with voluntary effort.
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              Exercise interventions for cerebral palsy.

              Jennifer M. Ryan, Elizabeth E Cassidy, Stephen G. Noorduyn … (2017)
              Cerebral palsy (CP) is a neurodevelopmental disorder resulting from an injury to the developing brain. It is the most common form of childhood disability with prevalence rates of between 1.5 and 3.8 per 1000 births reported worldwide. The primary impairments associated with CP include reduced muscle strength and reduced cardiorespiratory fitness, resulting in difficulties performing activities such as dressing, walking and negotiating stairs.Exercise is defined as a planned, structured and repetitive activity that aims to improve fitness, and it is a commonly used intervention for people with CP. Aerobic and resistance training may improve activity (i.e. the ability to execute a task) and participation (i.e. involvement in a life situation) through their impact on the primary impairments of CP. However, to date, there has been no comprehensive review of exercise interventions for people with CP.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Environ Res Public Health
                Journal ID (iso-abbrev): Int J Environ Res Public Health
                Journal ID (publisher-id): ijerph
                Title: International Journal of Environmental Research and Public Health
                Publisher: MDPI
                ISSN (Print): 1661-7827
                ISSN (Electronic): 1660-4601
                Publication date (Electronic): 15 November 2019
                Publication date (Print): November 2019
                Volume: 16
                Issue: 22
                Electronic Location Identifier: 4513
                Affiliations
                [1 ]Rehabilitation Service, The Marqués de Valdecilla University Hospital, Valdecilla Avenue s/n. C.P.: 39008 Santander, Cantabria, Spain; luisacolladogarrido@ 123456yahoo.es (L.C.-G.); mpilar.calvo@ 123456scsalud.es (P.C.-M.)
                [2 ]Faculty of Nursing, University of Cantabria, Valdecilla Avenue s/n., 39008 Santander, Cantabria, Spain; miguel.santibanez@ 123456unican.es
                [3 ]Research Nursing Group IDIVAL; Cardenal Herrera Oria Street s/n. C.P., 3901 Cantabria, Spain
                [4 ]Global Health Research Group, University of Cantabria, 39008 Santander, Cantabria, Spain
                Author notes
                [* ]Correspondence: paula.paras@ 123456unican.es
                Author information
                https://orcid.org/0000-0001-7745-3006
                Article
                Publisher ID: ijerph-16-04513
                DOI: 10.3390/ijerph16224513
                PMC ID: 6888121
                PubMed ID: 31731636
                SO-VID: 70a5904f-0ec4-46ee-8d6b-b14bec7a8fba
                Copyright © © 2019 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 27 September 2019
                Date accepted : 11 November 2019
                Categories
                Subject: Review

                ScienceOpen disciplines: Public health
                Keywords: cerebral palsy,resistance therapy,motor skills,child,meta-analysis
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: cerebral palsy, resistance therapy, motor skills, child, meta-analysis

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