Figure 3. Massage therapists receive training through hundreds of existing educational programs across the U.S. (D) Program duration on the GMFM improvement in the therapeutic exercise group. When a child has a mild form of Cerebral Palsy, his or her condition may not require strict respiratory monitoring. Deformities can restrict breathing and proper lung expansion, and interfere with oxygen and nutrient consumption. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. These options may be recommended after a failed attempt of hip reduction with uncontrolled pain. Although cerebral palsy is a lifelong disability, there are many interventions that can help reduce its impact on the body and the individual’s quality of life. Historically, division of the nerve had been used as an adjunct to reduce the recurrence of an adduction contracture, but has been associated with creation of an abduction contracture after surgery. In studies that reported the use of unique interventions or equipment for optimal high-intensity exercise, the issue of compliance after the treatment program ends is inevitable. Experimental (therapeutic exercise) I2 = 0%; Q = 5.779; df = 6. Arch Phys Med Rehabil. Decrease hormones associated with increasing anxiety. Several technical tips for hip surgery are presented. These include: Respiratory therapists provide therapy to a wide range of individuals from children to the elderly. But, sometimes, this can be the last solution. It is estimated that 86% children with Cerebral Palsy have oral-motor dysfunction, which is an inability to control the facial and neck muscles. However, generally the patient is awake and information is biased by malposition of patient and spasticity. Nowadays, CP is also considered “a disorder of the development of movement and posture, causing activity limitations attributed to non-progressive disturbances of the fetal or infant brain that may also affect sensation, perception, cognition, communication, and behavior. |, https://www.frontiersin.org/articles/10.3389/fneur.2019.00657/full#supplementary-material, Creative Commons Attribution License (CC BY). Everyday activity settings, natural learning environments, and early intervention practices. Seven of these studies had specified the participants' Gross Motor Function Classification System (GMFCS) level, but four of these studies included only children with walking ability (level I–III). Primary among these are the anteroposterior (AP) and frog lateral images. In one-group meta-analysis, notably, the GMFM-66 showed significant improvement (MD = 1.922; 95% CI = 1.408–2.436; I2 = 51.334%), when the experimental (therapeutic intervention) group and control (standard care) group were pooled together (Supplementary File 2a). Comprehensive Meta-Analysis Software was used to compute SMDs, perform metaregression analysis, and summarize statistically randomized controlled data if the included studies were comparable in types of training, intensity of training, and clearly defined outcomes. Int J Rehabil Res. Phenol can also be placed directly on the nerve at the time of surgery” [7]. <6 Y-O sub-luxated hip(s) Reimer’s Index between 40 and 60%, reducible after adductor tenotomy alone  adductor tenotomy alone + > 1 month abduction cast/splint. Subgroup analysis in the one-group model showed that both therapeutic intervention (MD = 2.213; 95% CI = 1.702–2.530; I2 = 0%) and standard care (MD = 1.773; 95% CI = 0.937–2.609; I2 = 68.659%) can improve motor function significantly (Figure 3). Divergent definition is a barrier in evidence synthesis and results in non-robust evidence. For cerebral palsy patients, massage serves as an important adjunct to other treatment, particularly physical therapy , which is concerned with some of the same body structures. Massage therapy is centered on manual manipulation of muscles, ligaments, connective tissue and tendons, the body’s soft tissue. When femoral head is deformed in valgus, and when hip reduction is correctly achieved, we verify a discontinuity of the Shenton’s line(that is “infra-leveled”). Simply put, the benefit of diligently monitoring a child’s respiratory health is the opportunity to protect his or her lifespan and improve his or her overall health and comfort. Dislocation can be suspected by leg-length discrepancy, but early subluxation is difficult to assess by physical examination [10]. The Reimer’s migration index measures the degree of subluxation on the AP view. (2004) 46:740–5. It is a simple, reliable, and reproducible measurement, comparing width of femoral head and percentage of head not covered by acetabulum (see Figure 1c). Interventions that were administered less than three times per week are usually considered non-intensive (8). There are several ways to calculate it: we can use a goniometer and an X-ray transfer (always remembering that correction is made more accurately after evaluation under anesthesia), measuring the angle between initial valgus and final planned position, just rotating image/transfer (Figure 6a–c). Characteristics of patients in the included studies. In this study, we assessed the effects of intensive exercise-based therapy on improvement in gross motor function in children with CP. doi: 10.3109/01942638.2010.533746, Keywords: cerebral palsy, physical therapy, exercise intensity, gross motor function, metaregression, Citation: Hsu C-W, Kang Y-N and Tseng S-H (2019) Effects of Therapeutic Exercise Intensity on Cerebral Palsy Outcomes: A Systematic Review With Meta-Regression of Randomized Clinical Trials. Intrinsic stability can be confirmed with an intra-operatory hip radiograph in full adduction. If these muscles are impaired, the body’s ability to function properly in these capacities can lead to a myriad of secondary conditions and the potential for life-threatening associative conditions. A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial. Notably, exercise intensity played a crucial role in improving gross motor function in the patients receiving therapeutic interventions and standard therapies. There is also some discussion about simultaneously performing acetabuloplasty to correct the usual and particular development hip dysplasia in this neuro-muscular context. However, in another meta-analysis, which included four randomized clinical trials (RCT), intensive intervention was defined as “training more than three times per week,” and the duration of the training programs ranged from 2 weeks to 6 months. The MyChild™ call center representatives are not permitted to and do not provide any legal or medical advice. Respiratory function requires a person to breathe properly, cough effectively and treat respiratory infections promptly. Sometimes, after a short period of pain relief, there are, paradoxically, cases of increasing pain; this is observed more frequently when additional treatments are not correctly followed. Experimental duration ranged from 2 (22) to 30 (21) weeks. We can separate walkers and non-walkers in our exam. They reported follow-up durations between 2 and 30 weeks. Typically, the patient will undergo the test sitting upright to ensure that his or her chest is not restricted. Cerebral Palsy Treatment Understanding Cerebral Palsy Treatment. It is important to level both hips as best we can, and, sometimes, we have to perform tenotomies (or even reorientation osteotomies) of the contralateral side. The program duration was also positively correlated with motor function improvement (point estimate = 0.067; 95% CI = −0.007 to 0.140; p = 0.075), but the significance of the positive correlation was marginal (Figures 4A,B, Supplementary File 3c). The context of interventions involved between different techniques, such as motor learning coaching or task-oriented treatment vs. neurodevelopmental treatment (NDT) (12–14), specific techniques vs. standard therapy (14–18), static exercise bike vs. standard care, treadmill vs. standard care (19, 20), intermittent vs. continuous schedules (21), and intensive therapy vs. non-intensive therapy (22, 23).