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

Tinderholt Myrhaug H, Østensjø S, Larun L, Odgaard-Jensen J, Jahnsen R - BMC Pediatr (2014)

Bottom Line: 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.These factors may have contributed to the observed variations in the effectiveness of CIMT.CRD42013004023.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, St. Olavs plass, Postbox 4, 0130, Oslo, Norway. hitimy@hioa.no.

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.

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Related in: MedlinePlus

Comparison of CIMT versus intensive interventions on bimanual hand function after 8 weeks.
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Fig6: Comparison of CIMT versus intensive interventions on bimanual hand function after 8 weeks.

Mentions: Four meta-analyses based on 10 studies that targeted hand function were performed (Figures 3, 4, 5 and 6). When compared with conventional therapy, CIMT performed for more than one hour per day showed significant effects on unilateral hand function in one meta-analysis (N = 2, [33,60] SMD 0.79 (95% CI 0.03, 1.55), p = 0.04) (Figure 3). The CIMT was practiced at the clinic [60], as home program [33,60], and incorporated into daily activities [33]. The CIMT groups performed 15–28 hours more training per week, which resulted in a difference of 29–84 training hours over two to three weeks compared with the conventional therapy groups. Unilateral hand function was assessed by the Jebsen Taylor hand function and Paediatric arm function tests. The meta-analysis was based on studies of low [60] and unclear [33] risks of bias. With regards to bimanual hand function, no significant differences were found between CIMT performed for more than one hour per day and conventional therapy (Figure 4). The CIMT was practiced as home program [19,22] or incorporated in daily activities [27]. The CIMT group had between 80–108 hours of more training compared with the conventional therapy group during the eight-week intervention period. Comparisons between CIMT performed 2–7 times per week with additional home training, or more than one hour per day at home, compared to intensive bimanual training, showed no significant findings on uni-and bimanual hand function (Figure 5, 6).Figure 3


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

Tinderholt Myrhaug H, Østensjø S, Larun L, Odgaard-Jensen J, Jahnsen R - BMC Pediatr (2014)

Comparison of CIMT versus intensive interventions on bimanual hand function after 8 weeks.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4265534&req=5

Fig6: Comparison of CIMT versus intensive interventions on bimanual hand function after 8 weeks.
Mentions: Four meta-analyses based on 10 studies that targeted hand function were performed (Figures 3, 4, 5 and 6). When compared with conventional therapy, CIMT performed for more than one hour per day showed significant effects on unilateral hand function in one meta-analysis (N = 2, [33,60] SMD 0.79 (95% CI 0.03, 1.55), p = 0.04) (Figure 3). The CIMT was practiced at the clinic [60], as home program [33,60], and incorporated into daily activities [33]. The CIMT groups performed 15–28 hours more training per week, which resulted in a difference of 29–84 training hours over two to three weeks compared with the conventional therapy groups. Unilateral hand function was assessed by the Jebsen Taylor hand function and Paediatric arm function tests. The meta-analysis was based on studies of low [60] and unclear [33] risks of bias. With regards to bimanual hand function, no significant differences were found between CIMT performed for more than one hour per day and conventional therapy (Figure 4). The CIMT was practiced as home program [19,22] or incorporated in daily activities [27]. The CIMT group had between 80–108 hours of more training compared with the conventional therapy group during the eight-week intervention period. Comparisons between CIMT performed 2–7 times per week with additional home training, or more than one hour per day at home, compared to intensive bimanual training, showed no significant findings on uni-and bimanual hand function (Figure 5, 6).Figure 3

Bottom Line: 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.These factors may have contributed to the observed variations in the effectiveness of CIMT.CRD42013004023.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, St. Olavs plass, Postbox 4, 0130, Oslo, Norway. hitimy@hioa.no.

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.

Show MeSH
Related in: MedlinePlus