Article

Rehabilitation for children with congenital hemiplegia to improve
function in the impaired upper limb and enhance participation may be
time-consuming and costly. OBJECTIVES: To systematically review the efficacy of
nonsurgical upper-limb therapeutic interventions for children with congenital
hemiplegia. The Cochrane Central Register of Controlled Trials, Medline,
CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied
and Complementary Medicine), Embase, PsycINFO, and Web of Science were searched
up to July 2008. Data sources were randomized or quasi-randomized trials and
systematic reviews. RESULTS: Twelve studies and 7 systematic reviews met our
criteria. Trials had strong methodologic quality (Physiotherapy Evidence Database
[PEDro] scale > or = 5), and systematic reviews rated strongly (AMSTAR
[Assessment of Multiple Systematic Reviews] score > or = 6). Four interventions
were identified: intramuscular botulinum toxin A combined with upper-limb
training; constraint-induced movement therapy; hand-arm bimanual intensive
training; and neurodevelopmental therapy. Data were pooled for upper-limb,
self-care, and individualized outcomes. There were small-to-medium treatment
effects favoring intramuscular botulinum toxin A and occupational therapy,
neurodevelopmental therapy and casting, constraint-induced movement therapy, and
hand-arm bimanual intensive training on upper-limb outcomes. There were large
treatment effects favoring intramuscular botulinum toxin A and upper-limb
training for individualized outcomes. No studies reported participation outcomes.
CONCLUSIONS: No one treatment approach seems to be superior; however, injections
of botulinum toxin A provide a supplementary benefit to a variety of
upper-limb-training approaches. Additional research is needed to justify
more-intensive approaches such as constraint-induced movement therapy and
hand-arm bimanual intensive training.

Langue : ANGLAIS

Tiré à part : OUI