Systematic review and meta-analysis of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia

Sakzewski, Leanne, Ziviani, Jenny and Boyd, Roslyn (2009) Systematic review and meta-analysis of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia. Pediatrics, 123 6: e1111-e1122. doi:10.1542/peds.2008-3335


Author Sakzewski, Leanne
Ziviani, Jenny
Boyd, Roslyn
Title Systematic review and meta-analysis of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia
Journal name Pediatrics   Check publisher's open access policy
ISSN 1098-4275
Publication date 2009-06-01
Year available 2009
Sub-type Article (original research)
DOI 10.1542/peds.2008-3335
Open Access Status
Volume 123
Issue 6
Start page e1111
End page e1122
Total pages 12
Place of publication Elk Grove Village, IL, United States
Publisher American Academy of Pediatrics
Language eng
Subject C1
920201 Allied Health Therapies (excl. Mental Health Services)
110321 Rehabilitation and Therapy (excl. Physiotherapy)
Abstract CONTEXT. Rehabilitation for children with congenital hemiplegia to improve function in the impaired upper limb and enhance participation may be time-consuming and costly.
Formatted abstract
CONTEXT. Rehabilitation for children with congenital hemiplegia to improve function in the impaired upper limb and enhance participation may be time-consuming and costly.

OBJECTIVES. To systematically review the efficacy of nonsurgical upper-limb therapeutic interventions for children with congenital hemiplegia.

METHODS. The Cochrane Central Register of Controlled Trials, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine), Embase, PsycINFO, and Web of Science were searched up to July 2008. Data sources were randomized or quasi-randomized trials and systematic reviews.

RESULTS. Twelve studies and 7 systematic reviews met our criteria. Trials had strong methodologic quality (Physiotherapy Evidence Database [PEDro] scale ≥ 5), and systematic reviews rated strongly (AMSTAR [Assessment of Multiple Systematic Reviews] score ≥ 6). Four interventions were identified: intramuscular botulinum toxin A combined with upper-limb training; constraint-induced movement therapy; hand-arm bimanual intensive training; and neurodevelopmental therapy. Data were pooled for upper-limb, self-care, and individualized outcomes. There were small-to-medium treatment effects favoring intramuscular botulinum toxin A and occupational therapy, neurodevelopmental therapy and casting, constraint-induced movement therapy, and hand-arm bimanual intensive training on upper-limb outcomes. There were large treatment effects favoring intramuscular botulinum toxin A and upper-limb training for individualized outcomes. No studies reported participation outcomes.

CONCLUSIONS. No one treatment approach seems to be superior; however, injections of botulinum toxin A provide a supplementary benefit to a variety of upper-limb–training approaches. Additional research is needed to justify more-intensive approaches such as constraint-induced movement therapy and hand-arm bimanual intensive training.
Keyword Cerebral palsy
Systematic review
Meta-analysis
Upper-limb rehabilitation
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 384488
Institutional Status UQ

 
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Created: Tue, 02 Jun 2009, 00:13:04 EST by Meredith Downes on behalf of Faculty Of Health Sciences