-
Current Neurology and Neuroscience... Feb 2020Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best...
PURPOSE OF REVIEW
Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019.
RECENT FINDINGS
Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
Topics: Cerebral Palsy; Child; Humans
PubMed: 32086598
DOI: 10.1007/s11910-020-1022-z -
Clinical Rehabilitation Jan 2022This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation.
DATA SOURCES
Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021.
REVIEW METHODS
Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration's tool for assessing the risk of bias and PROSPERO's registration number ID: CRD42020193535.
RESULTS
Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity.
CONCLUSION
A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.
Topics: Adolescent; Cerebral Palsy; Child; Humans; Muscle Strength; Muscles; Resistance Training; Walking Speed
PubMed: 34407619
DOI: 10.1177/02692155211040199 -
Clinical Rehabilitation Nov 2022To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide...
OBJECTIVE
To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients.
DATA SOURCES
MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020.
METHODS
Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067).
RESULTS
Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified ( = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality.
CONCLUSION
The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.
Topics: Bell Palsy; Exercise Therapy; Facial Nerve; Facial Paralysis; Humans; Physical Therapy Modalities
PubMed: 35787015
DOI: 10.1177/02692155221110727 -
Journal of Korean Medical Science Aug 2020This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest.
METHODS
An electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms "Bell's palsy," "Ramsay-Hunt syndrome," "Facial palsy," "Facial paralysis," "Facial paresis," "Guideline," "Meta-analysis," "Systematic review," and "Randomized controlled trial." Only studies written in English were used.
RESULTS
The characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised.
CONCLUSION
For peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.
Topics: Acupuncture Therapy; Acute Disease; Decompression, Surgical; Facial Nerve; Facial Paralysis; Humans; Practice Guidelines as Topic
PubMed: 32743989
DOI: 10.3346/jkms.2020.35.e245 -
Cureus Aug 2023Cerebral palsy is a group of disorders affecting individuals already from birth. It enormously impacts an individual's physical and emotional life and can bring many... (Review)
Review
Cerebral palsy is a group of disorders affecting individuals already from birth. It enormously impacts an individual's physical and emotional life and can bring many challenges to the individual, caregivers, and families. Therefore, it is crucial to investigate interventions that could improve various symptoms in children with cerebral palsy. Our systematic review intends to assess the effect of different exercise and physical therapy interventions in children with cerebral palsy. We used three databases for our article search: PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and PubMed Central (PMC). The combined number of papers found in all databases was 65,412. We then applied our inclusion and exclusion criteria, filters, key terms, and Medical Subheadings (MeSH). After applying our quality assessment tools, we included nine papers in our systematic review. The studies included in our review used various interventions to assess for improvement in symptoms in individuals with cerebral palsy. Interventions included stretching and resistance exercises, horse riding, biking, core stability exercises, slackline training, a home exercise program using an online tool, sit-to-stand exercise program, and functional training. Many studies have shown that interventions improved symptoms like balance, coordination, gait, and cardiovascular endurance in cerebral palsy. This review suggests that some of the included interventions have great potential to improve the symptoms of cerebral palsy and, therefore, can be a great addition to existing training and rehabilitation programs. Given that studies included a relatively small number of participants and were conducted over a short time, more research with a more significant number of participants over a longer time is necessary.
PubMed: 37736433
DOI: 10.7759/cureus.43846 -
Medicina 2021Cerebral palsy and Down syndrome are two conditions that present with a deficit in motor development. Treadmill interventions were found to improve this delay in...
Cerebral palsy and Down syndrome are two conditions that present with a deficit in motor development. Treadmill interventions were found to improve this delay in development. This work aimed to describe and analyze the methodological quality of studies that applied treadmill interventions alone or combined with other therapies to promote gait and balance in children under 12 years of age with cerebral palsy and Down syndrome. A systematic review was made in different databases: PubMed, PEDro, Cochrane and Science Direct. Only randomized clinical trials published to date were selected. The methodological quality of the identified studies was assessed using the PEDro scale. Of the 324 articles initially found, 10 were selected, which met the established inclusion criteria for qualitative analysis. The variables analyzed were gait and balance in both populations after the treadmill intervention, with and without suspension of body weight. The main conclusion was that the application of a treadmill alone is an effective intervention to promote the development of gait and balance in children under 12 years with cerebral palsy and Down syndrome.
Topics: Body Weight; Cerebral Palsy; Child; Down Syndrome; Exercise Test; Exercise Therapy; Gait; Humans
PubMed: 34137695
DOI: No ID Found -
International Journal of Environmental... Apr 2022Cerebral palsy is a neurological condition that is associated with multiple motor alterations and dysfunctions in children. Robotic systems are new devices that are... (Review)
Review
Cerebral palsy is a neurological condition that is associated with multiple motor alterations and dysfunctions in children. Robotic systems are new devices that are becoming increasingly popular as a part of the treatment for cerebral palsy. A systematic review of the Pubmed, Web of Science, MEDLINE, Cochrane, Dialnet, CINAHL, Scopus, Lilacs and PEDro databases from November 2021 to February 2022 was conducted to prove the effectiveness of these devices for the treatment of motor dysfunctions in children who were diagnosed with cerebral palsy. Randomized clinical trials in Spanish and English were included. In total, 653 potential manuscripts were selected but only 7 of them met the inclusion criteria. Motor dysfunctions in the lower limbs and those that are specifically related to gait are the main parameters that are affected by cerebral palsy and the robotic systems , , and are the most commonly used. There is no consensus about the effectiveness of these devices. However, it seems clear that they have presented a good complement to conventional physical therapies, although not a therapy as themselves. Unfortunately, the low quality of some of the randomized clinical trials that were reviewed made it difficult to establish conclusive results. More studies are needed to prove and test the extent to which these devices aid in the treatment of children with cerebral palsy.
Topics: Cerebral Palsy; Child; Gait; Humans; Lower Extremity; Physical Therapy Modalities; Robotic Surgical Procedures
PubMed: 35564511
DOI: 10.3390/ijerph19095116 -
Annals of Physical and Rehabilitation... Sep 2022Hemiplegic shoulder pain (HSP) is a disabling complication affecting stroke survivors. In this context, rehabilitation might play a key role in its clinical management.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hemiplegic shoulder pain (HSP) is a disabling complication affecting stroke survivors. In this context, rehabilitation might play a key role in its clinical management. Recent systematic reviews of the impact of rehabilitative approaches on pain reduction in patients with HSP are lacking.
OBJECTIVE
This systematic review of randomized controlled trials (RCTs) with meta-analysis aimed to investigate the efficacy of rehabilitative techniques in reducing HSP in stroke survivors.
METHODS
PubMed, Scopus, and Web of Science were searched from inception to March 8, 2021 to identify RCTs of stroke survivors with HSP undergoing specific rehabilitative techniques combined with conventional therapy to reduce pain intensity. A network meta-analysis and meta-analysis of the Bayesian network of random effects were performed. The risk of bias of studies was assessed with Version 2 of the Cochrane Risk of Bias tool for randomized trials.
RESULTS
Of 1139 articles identified, 12 were included in the final synthesis. We analyzed data for 723 stroke survivors, reporting a significant overall decrease in pain intensity after a rehabilitative approach by the Bayesian meta-analysis (standardized mean difference 2.78, 95% confidence interval 0.89;-4.59; p = 0.003). We report a significant reduction in HSP with botulinum toxin type A injection (p = 0.001), suprascapular nerve pulsed radiofrequency (p = 0.030), suprascapular nerve block (p = 0.020), and trigger-point dry needling (p = 0.005) as compared with conventional rehabilitation. Concerning the effect size, we identified a Bayesian factor of 97.2, with very strong evidence of superiority of rehabilitative techniques.
CONCLUSIONS
The present systematic review and meta-analysis showed that adding other rehabilitative techniques to conventional rehabilitation was significantly more effective than conventional rehabilitation alone in the complex management of patients affected by HSP.
Topics: Hemiplegia; Humans; Injections, Intra-Articular; Pain Measurement; Shoulder Pain; Stroke; Stroke Rehabilitation
PubMed: 34757009
DOI: 10.1016/j.rehab.2021.101602 -
Neurological Sciences : Official... Jul 2022Kinesiology tape (KT), a water-resistant and elastic tape which is well known measure for preventing musculoskeletal injuries, has recently gained popularity in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Kinesiology tape (KT), a water-resistant and elastic tape which is well known measure for preventing musculoskeletal injuries, has recently gained popularity in neurological rehabilitation. This is a systematic and meta-analysis study, useful both to evaluate the efficacy of kinesiology taping on the functions of upper limbs in patients with stroke and to collect the main outcomes evaluated in the analyzed studies.
METHODS
A comprehensive literature search of electronic databases including Medline, Web of science, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), WANFANG, and the China National Knowledge Infrastructure (CNKI). Additional articles were obtained by scanning reference lists of included studies and previous reviews. Keywords were "kinesiology taping," "kinesio," "kinesio taping," "tape" and "stroke," "hemiplegia," "hemiplegic paralysis," "apoplexy," "hemiparesis," "upper extremity," "upper limb." All the RCTs were included. Quality assessment was performed using Cochrane criteria. Upper extremity function and pain intensity was pooled as the primary outcome, and shoulder subluxation, muscle spasticity, general disability, PROM of abduction, and adverse effects as secondary outcomes.
RESULTS
Twelve articles were included. Pooled data provided evidence that there was significance between kinesiology taping groups and control groups in pain intensity (standardized mean difference - 0.79, 95% CI - 1.39 to - 0.19), shoulder subluxation (standardized mean difference - 0.50, 95%CI - 0.80 to - 0.20), general disability (standardized mean difference 0.35, 95%CI 0.10 to 0.59), upper extremity function (standardized mean difference 0.61, 95%CI 0.18 to 1.04), and the PROM of flexion (standardized mean difference 0.63, 95%CI 0.28 to 0.98).
CONCLUSION
Current evidence suggested that kinesiology taping could be recommended to improve upper limb function in patients with stroke in pain intensity, shoulder subluxation, general disability, upper extremity function, and the PROM of flexion.
ETHICS AND DISSEMINATION
Ethical approval requirements are not necessary for this review. This systematic review and meta-analysis will be disseminated online and on paper to help guide the clinical practice better.
PROSPERO REGISTRATION NUMBER
CRD42020179762.
Topics: Athletic Tape; Hemiplegia; Humans; Stroke; Stroke Rehabilitation; Treatment Outcome; Upper Extremity
PubMed: 35347525
DOI: 10.1007/s10072-022-06010-1 -
Auris, Nasus, Larynx Feb 2024This study aimed to reveal the efficacy of physical therapy for patients with peripheral facial palsy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to reveal the efficacy of physical therapy for patients with peripheral facial palsy.
METHODS
A literature search was conducted using PubMed, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trials comparing the physical therapy versus placebo/non-treatment for peripheral facial palsy such as Bell's palsy, Ramsay Hunt syndrome, and traumatic facial palsy were included for meta-analysis. The primary outcome was non-recovery at the end of the follow-up. Non-recovery was defined according to the authors' definition. The secondary outcomes were the composite score of the Sunnybrook facial grading system and sequelae (presence of synkinesis or hemifacial spasm) at the end of the follow-up. Data was analyzed using Review Manager software and pooled risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated.
RESULTS
Seven randomized controlled trials met the eligible criteria. The data on non-recovery from four studies was obtained and included 418 participants in the meta-analysis. Physical therapy might reduce non-recovery (RR = 0.51 [95% CI = 0.31-0.83], low quality). Pooling the data of composite score of the Sunnybrook facial grading system from three studies (166 participants) revealed that physical therapy might increase the composite scores (MD = 12.1 [95% CI = 3.11-21.0], low quality). Moreover, we obtained data on sequelae from two articles (179 participants). The evidence was very uncertain about the effect of physical therapy on reduction of sequelae (RR = 0.64 [95% CI = 0.07-5.95], very low quality).
CONCLUSION
The evidence suggested that physical therapy reduces non-recovery in patients with peripheral facial palsy and improves the composite score of the Sunnybrook facial grading system, whereas the efficacy of physical therapy in reducing sequelae remained uncertain. The included studies had high risk of bias, imprecision, or inconsistency; therefore, the certainty of evidence was low or very low. Further well-designed randomized controlled trials are needed to confirm its efficacy.
Topics: Humans; Anti-Inflammatory Agents; Facial Paralysis; Bell Palsy; Physical Therapy Modalities; Drug Therapy, Combination
PubMed: 37149416
DOI: 10.1016/j.anl.2023.04.007