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Aust J Physiother. 2009;55(2):81-7.

Muscle strengthening is not effective in children and adolescents with cerebral palsy: a systematic review.

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1
Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.

Abstract

QUESTION:

Do strengthening interventions increase strength without increasing spasticity and improve activity, and is there any carryover after cessation in children and adolescents with cerebral palsy?

DESIGN:

Systematic review with meta-analysis of randomised trials.

PARTICIPANTS:

Children with spastic cerebral palsy between school age and 20 years.

INTERVENTION:

Strengthening interventions that involved repetitive, strong, or effortful muscle contractions and progressed as ability changed, such as biofeedback, electrical stimulation, and progressive resistance exercise.

OUTCOME MEASURES:

Strength was measured as continuous measures of maximum voluntary force or torque production. Spasticity was measured as velocity-dependent resistance to passive stretch. Activity was measured as continuous measures, eg, 10-m Walk Test, or using scales eg, the Gross Motor Function Measure.

RESULTS:

Six studies were identified and five had data that could be included in a metaanalysis. Strengthening interventions had no effect on strength (SMD 0.20, 95% CI -0.17 to 0.56), no effect on walking speed (MD 0.02 m/s, 95% CI -0.13 to 0.16), and had a small statistically-significant but not clinically-worthwhile effect on Gross Motor Function Measure (MD 2%, 95% CI 0 to 4). Only one study measured spasticity but did not report the between-group analysis.

CONCLUSION:

In children and adolescents with cerebral palsy who are walking, the current evidence suggests that strengthening interventions are neither effective nor worthwhile.

PMID:
19463078
[Indexed for MEDLINE]
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