a School of Health and Rehabilitation Sciences , University of Queensland , Brisbane , Australia.
b The Cerebral Palsy League , Brisbane , Australia.
Disabil Rehabil. 2019 May;41(10):1131-1151. doi: 10.1080/09638288.2017.1422035. Epub 2018 Jan 5.
PURPOSE: Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). METHOD: A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters. RESULTS: Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II). INTERPRETATION: Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further research, particularly in interventions that embed real-world participation opportunities like Modified Sport.
目的：评估针对改善伴有脑瘫（CP）的学龄期、可走动/半走动儿童的粗大运动活动/参与度的主动运动干预措施的有效性。
方法：根据 PRISMA 指南进行系统评价。对五个数据库进行了搜索，以寻找包括患有 CP 的学龄儿童、参与主动运动干预措施、以活动/参与水平测量的粗大运动结果的论文。排除了之前有系统评价的干预措施（例如马术疗法）。两名评估者检查证据水平和实施情况。
结果：有 7 项干预措施（34 项研究）符合标准。所有研究均报告了粗大运动功能，但只有少数研究调查了参与结果。有强有力的证据表明，大运动活动训练（n=6，证据水平 II-IV）和大运动活动训练与渐进式阻力运动加额外物理治疗（n=3，均为证据水平 II）有效。大运动活动训练加额外物理治疗（n=2，均为证据水平 II）和身体健身训练（n=4，证据水平 II-V）有中度积极证据。修改后的运动（n=3，证据水平 IV-V）和非沉浸式虚拟现实（n=12，证据水平 II-V）有微弱的积极证据。有强有力的证据表明，大运动活动训练与渐进式阻力运动加无额外物理治疗（n=4，均为证据水平 II）无效。
解释：有可变实践机会的主动、以表现为导向的运动可改善可走动/半走动脑瘫儿童的粗大运动功能。
康复意义：主动运动干预措施可改善可走动/半走动脑瘫儿童的粗大运动功能。大运动活动训练是最常见和最有效的干预措施。实践变异性对于改善粗大运动功能至关重要。很少测量参与度，需要进一步研究，特别是在干预措施中，嵌入了现实世界的参与机会，如修改后的运动。
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