Goal Directed OT Programs Effective for Unilateral Cerebral Palsy

A systematic review of the efficacy of nonsurgical upper limb therapies for children with unilateral cerebral palsy was published in Pediatrics.  There were 42 randomized control or comparison trials that met the inclusion criteria.  The results indicated the following:

• 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.

The researchers concluded that there is:

• 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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