title: Efficacy of upper limb strengthening in children with Cerebral Palsy: A critical review.
abstract: OBJECTIVE
  This review focuses on the effects of strengthening interventions of the upper limb in children with Cerebral Palsy (CP). The strengthening intervention studies were divided in two categories: those based on stand-alone strength training, and those on strength training combined with other interventions.
  
  
  METHODS
  A search in all relevant databases was performed.
  
  
  RESULTS
  Six articles were included: three randomized controlled trials (RCTs), two clinical trial (CT) and one case study. Effect sizes of strength training on muscle strength and function of the upper limb were calculated.
  
  
  CONCLUSIONS
  There are no coherent recommendations for strength training, based on these studies. The causes include too much variety of types of training, level of intensity and duration. All of the reported upper limb strength training studies found an increase in muscle strength. In addition, the quality of these studies was not high. More RCTs on strength training according to the official strength training guidelines are necessary to assess the impact and potential of strength training of the upper limb to improve the daily activities and participation in children with CP.
authors.affiliation: Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands; University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, The Netherlands. Electronic address: eugene.rameckers@universitymaastricht.nl.
authors.forename: E A A
authors.initials: EA
authors.lastname: Rameckers
authors.affiliation: Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands.
authors.forename: Y J M
authors.initials: YJ
authors.lastname: Janssen-Potten
authors.affiliation: Department of Rheumatology, Maastricht University Medical Center and Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
authors.forename: I M M
authors.initials: IM
authors.lastname: Essers
authors.affiliation: Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands.
authors.forename: R J E M
authors.initials: RJ
authors.lastname: Smeets
keywords: Cerebral Palsy; Guidelines NSCA; ICF-CY; Manual skills; Review; Strength