Two systematic reviews by Frank et al published in the May issue of Journal of Rehabilitation Medicine provide an overview of the effectiveness of conceptual approaches, additional therapies, and basic techniques used in lower limb physical therapy in children with cerebral palsy (CP).
For both systematic reviews, the authors searched 5 electronic databases, extracting literature published between 1995 and 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health (ICF). Three independent evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system.
One systematic review included 37 studies that used conceptual approaches (neurodevelopmental treatment [NDT], conductive education, Vojta therapy, sensory integration, functional training and goal-oriented therapy) and 21 studies that focused on additional therapies (aquatic therapy and therapeutic horseback riding). Level II evidence was found for the effectiveness of therapeutic horseback riding on posture and for NDT and functional training on gross motor function. Goal-oriented therapy and functional training were effective on the attainment of functional goals and participation. With level IV evidence, NDT was effective on all levels of ICF. (J Rehabil Med. 2012;44:396-405.)
The other systematic review examined basic techniques and included 83 studies divided into the following categories: stretching; massage; strengthening; electrical stimulation; weight-bearing; and balance, treadmill, and endurance training. Interventions targeting problems at body function and structure level generally influenced this level without significant overflow to activity level and vice versa. The more recent studies evaluating strength training mainly demonstrated level II evidence for improved gait and gross motor function. There was limited evidence for specific information on intensity, duration, and frequency of training. (J Rehabil Med. 2012;44:385-395.)