Das Sakti Prasad, Ganesh G Shankar
Department of Physical Medicine and Rehabilitation, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India.
Department of Physiotherapy, Composite Regional Centre for Persons with Disabilities, Lucknow, Uttar Pradesh, India.
Indian J Orthop. 2019 Jan-Feb;53(1):20-34. doi: 10.4103/ortho.IJOrtho_241_17.
Physiotherapy plays a key role in the management of cerebral palsy (CP) and comprises of various therapeutic interventions in enhancing the various physiological and functional outcomes. Though physiotherapy is used widely and recommended by all members of the health-care team, the effectiveness of physiotherapy is inconsistent. The objective of this review was to summarize and evaluate the effectiveness of physiotherapy interventions in children with CP. PubMed and Cochrane database were searched from January 2006 to April 2017 using the Medical Subject Heading and general keywords. Only systematic reviews and meta-analysis on PT interventions in children diagnosed with CP were included. Two reviewers independently assessed the methodological quality and retrieved the results. Thirty-four systematic reviews were identified that distinguished 15 different interventions. Moderate evidence of effectiveness was found for constraint-induced movement therapy for upper limb recovery, goal-directed/functional training, and gait training to improve gait speed. Conflicting evidence was found for the role of exercises on strength training and cardiorespiratory training. Intervention such as neurodevelopmental therapy (NDT) was found ineffective. This review suffer from limitations such as including reviews that had small sample size and that had considered heterogeneity of treatment interventions. Hence, the effectiveness of most PT interventions is found to be limited. On the basis of the present evidence, functional goal-oriented approaches are found to be effective and future research is required to determine the best ways to improve functional outcomes in children with CP.
物理治疗在脑瘫（CP）的管理中起着关键作用，包括各种治疗干预措施以提高各种生理和功能结果。尽管物理治疗被广泛应用且得到了医疗团队所有成员的推荐，但其效果并不一致。本综述的目的是总结和评估物理治疗干预对脑瘫患儿的有效性。使用医学主题词和通用关键词，检索了2006年1月至2017年4月的PubMed和Cochrane数据库。仅纳入了关于诊断为CP的儿童物理治疗干预的系统评价和荟萃分析。两名评价者独立评估方法学质量并检索结果。共识别出34项系统评价，区分出15种不同的干预措施。对于促进上肢恢复的强制性运动疗法、目标导向/功能训练以及提高步速的步态训练，发现有中等程度的有效性证据。对于力量训练和心肺训练中运动的作用，发现存在相互矛盾的证据。发现诸如神经发育疗法（NDT）等干预措施无效。本综述存在局限性，例如纳入了样本量小以及考虑了治疗干预异质性的综述。因此，发现大多数物理治疗干预的有效性有限。基于目前的证据，发现以功能为导向的方法是有效的，未来需要开展研究以确定改善脑瘫患儿功能结果的最佳方法。
