- moderate to strong effects were in favor of intramuscular injections of botulinum toxin A and occupational therapy (OT) to improve UL and individualized outcomes compared with OT alone were identified.
- constraint-induced movement therapy achieved modest to strong treatment effects on improving movement quality and efficiency of the impaired UL compared with usual care.
- weak treatment effects were reported for most outcomes when constraint therapy was compared with an equal dose of bimanual OT; both yielded similar improved outcomes.
- action observation training and mirror therapy should be viewed as experimental.
- modest evidence for intensive activity-based, goal-directed interventions (eg, constraint-induced movement therapy, bimanual training) being more effective than standard care in improving UL and individualized outcomes.
- little evidence to support block therapy alone as the dose of intervention is unlikely to be sufficient to lead to sustained changes in UL outcomes.
- strong evidence that goal-directed OT home programs are effective and could supplement hands-on direct therapy to achieve increased dose of intervention.
Reference: Leanne Sakzewski, Jenny Ziviani, and Roslyn N. Boyd. Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis. Pediatrics 2014; 133:1 e175-e204; published ahead of print December 23, 2013, doi:10.1542/peds.2013-0675
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