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


METHODS
Systematic review with meta-analysis of randomised trials.


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


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


METHODS
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.


CONCLUSIONS
In children and adolescents with cerebral palsy who are walking, the current evidence suggests that strengthening interventions are neither effective nor worthwhile.
Scianni
Aline
A
Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
Butler
Jane M
JM
Ada
Louise
L
Teixeira-Salmela
Luci F
LF
D000293:Adolescent; D001676:Biofeedback, Psychology / Q000502:physiology; D002547:Cerebral Palsy / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D026741:Physical Therapy Modalities; D055070:Resistance Training; D016896:Treatment Outcome; D055815:Young Adult