Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no‐BWS), trunk‐targeted training, and reactive balance training. 0000000976 00000 n Primarily, studies often lacked a clear description of the specific framework or intervention content of the NDT component provided, or how fidelity was maintained across participants or therapists. Learn more. 0000032182 00000 n Further research is required to determine the minimum required dose, as total training times ranged from 10 to 30 hours in the studies considered by this review. Although numerous theoretical frameworks exist, the contemporary Systems Control Theory is the most comprehensive for this purpose.22, 26, 27 This theory describes postural control as a complex interaction between seven components: (1) neuromuscular synergies; (2) internal representations; (3) adaptive mechanisms (including reactive postural adjustments); (4) anticipatory mechanisms (including anticipatory postural adjustments); (5) sensory strategies; (6) individual sensory systems; and (7) musculoskeletal components.22 Children with motor disorders can show deficits in one or more of these components. Finally, there were no high‐level upper limb interventions suitable for reporting at this stage. The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP). Improved abdominal muscle thickness (RA, OE, OI, and TrA, Ultrasound imaging: resting abdominal muscle thickness, Virtual reality: Nintendo Wii, Wii Fit, and Wii balance board, Stabilometry: mean velocity of COP during modified sensory organization test, Response to perturbation from platform: EMG on distal leg muscles, No change in directional control and synchronization of movement in standing, Bruininks—Oseretsky Test of Motor Proficiency: balance and running speed, and agility subsections, Improved high level functional balance and mobility in everyday function (true change from mean of the baseline significant), Improved functional walking capacity (MDC CI 80%, significant), Improved static and dynamic standing balance: maintaining COP on target (, Stabilometry: (1) time of COP on target and max displacement; (2) maximum, American Academy of Cerebral Palsy and Developmental Medicine, International Classification of Functioning, Disability and Health, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. A systematic literature search of articles published between January 1980 and December 2013 was performed using the following electronic databases: PubMed, EMBASE, EBSCOhost (MEDLINE and CINAHL), the Cochrane Library, and PEDro. Hippotherapy simulators and treadmill training with P‐BWS or F‐BWS have been addressed in previous paragraphs. Anticipatory training for 9 hours (three 30min sessions/wk for 6wks) improved static standing balance (BF&S) and dynamic standing balance (BF&S) in ambulant children with CP, GMFCS I (level II, conduct weak; see Table SIIIa).61 No ‘activity’‐level measures were included. All improvements were maintained after 4 weeks, except resting muscle thickness of the transversus abdominis and internal oblique, and performance on the 1‐minute walk test (evidence level II, conduct moderate; see Table SIIIa). Two studies,41, 42 both evidence level II (Table 1), applied FES to abdominal and lumbar muscles simultaneously, with the aim of improving muscle strength and function. The increased effort needed to control these movements interferes with the ability to think about and complete a fine motor task. 0000004096 00000 n Within the included articles, NDT was used as a comparison treatment in seven (n=7, not adding to the study tally), and appeared in one other where it was used as the sole intervention (n=1). 0000001416 00000 n Archives of Physical Medicine and Rehabilitation. Thirty hours (five 1h sessions/wk for 6wks) of sit‐to‐stand and step‐up exercises improved standing balance (‘activity’) and dynamic postural stability during gait (‘activity’) in children with CP aged between 5 and 12 years (evidence level II, conduct moderate; see Table SIIIa).43 A lower dose of 10 hours (two 1h sessions/wk for 5wks) of walking, standing, sit‐to‐stand, and object pick‐up activities improved dynamic balance during gait (‘activity’) in 4‐ to 11‐year‐old children with CP (evidence level II, conduct moderate; see online Table SIIIa).44, Hippotherapy is the provision of sensory and motor input via the movements of a horse, with programmes designed by professionals with hippotherapy qualifications.53 From 11 studies, three level II or III studies, and two systematic reviews, were identified (Table 1). The use of exercise‐based treatments to improve postural control in children with CP has increased significantly in the last decade. CP (hemi‐ and diplegic ambulatory); 6–10y; Stabilometry (sitting): pathway and velocity of COP while sitting still for 30s with visual fixation, No change in gross motor function overall, or in sitting, Temporal–spatial and kinematic gait parameters, A (d4103, d4104–d4106, d4153‐d4154, d4200, d4452). Both studies used the following FES parameters with a sequence of 10 seconds ‘on’ followed by 12 seconds ‘off’: intensity of 20 to 30mA; pulse width of 250μs; and frequency of 25 to 35Hz. While children with CP receive or participate in a wide range of passive or active interventions aimed to improve movement and posture, often the specific impact on postural control is not well measured or documented. Postural control can be defined as the ability to control the body's position in space for the purposes of stability and orientation.22, 23 Postural stability, or balance, is the ability to maintain and/or regain the centre of mass within the base of support where gravity is the key vector.22, 24 Stability tasks can be considered static, when the body is stationary (e.g. Perceptual (orienting) networks are impacted by deficits including poor registration and/or perception in visual, tactile, proprioceptive, and vestibular systems.3 Individually and collectively, these factors can result in problems with balance and/or orientation in children with CP. Adaptive Activities for Patients with Cerebral Palsy. Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report. It is suggested to fulfil three important requisites for motor learning: (1) movement repetition; (2) active participation; and (3) performance feedback.76 Lack of rigorous research conduct makes it difficult to draw conclusions about the effects of virtual reality on postural control. 48 0 obj <> endobj xref 48 34 0000000016 00000 n Key examples include hippotherapy, treadmill training, upper limb therapy, strength training, and virtual reality technologies. Reactive balance training involves repeated practice of balance recovery, when standing on a support surface that is perturbed without warning in a forward, backward, or lateral direction. Parent and physiotherapist perspectives Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. 0000004298 00000 n Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. Articles were included if (1) they were full articles, published in English, in peer‐reviewed journals, after 1980; (2) study participants were children diagnosed with CP, and aged between 0 and 18 years; (3) they performed a land‐based exercise intervention that required active participation by the child; and (4) they reported the efficacy or effectiveness of the intervention, for improving postural control, using at least one outcome measure of either postural stability (static or dynamic balance), or postural orientation (e.g. Effect of Pilates Intervention on Physical Function of Children and Youth: A Systematic Review. Table SI: Levels of evidence for group and single‐subject design studies. In particular, a focus on improving treatment description and fidelity, establishing dosage and measuring both short‐ and long‐term effects for subgroups in the CP population, is required. $N��a��M��lj�l�n�Y~������U��Ɍ��7��_Sع�MVm���O Learning and transfer of complex motor skills in virtual reality: a perspective review. %PDF-1.4 %���� It involved standing on a balance platform in a laboratory (no specifications provided) and keeping the centre of pressure, represented as a red dot on a computer screen, static, or shifting it to a target. One study (evidence level II) was identified (Table 1). Progressive resistance exercise (one level II study)51 showed no effect on children with CP. Systematic review studies were rated using the classification of Sackett et al.37 Conduct of systematic reviews was evaluated using Oxam and Guyatt's39 classification, which yields a score out of 10.