ABSTRACT
AIM: To investigate the efficacy of aerobic exercise on the functioning (participation, activities, and body functions and structures) and quality of life (QoL) of children and adolescents with cerebral palsy (CP). METHOD: A systematic review with meta-analysis was performed. A comprehensive search of articles was performed using the electronic databases Embase, PubMed, PEDro, and CINAHL. Methodological quality and certainty of evidence were evaluated with the PEDro and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scales respectively. The effects of aerobic exercise on functioning were assessed using meta-analytic techniques. However, given the broad nature of outcomes related to functioning and QoL, different instruments can be used to measure them; this made it impossible to synthesize results in a meta-analysis for some of the outcomes. RESULTS: Fifteen randomized controlled trials with 414 participants with CP were included. Analysis of the methodological quality of the studies revealed a low risk of bias. The effect of aerobic exercise compared to usual care or other interventions was significant for aerobic capacity (standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.16-1.47; p < 0.002; I2 = 68%), gross motor function (SMD = 0.70; 95% = CI 0.21-1.19; p = 0.005; I2 = 49%), mobility (SMD = 0.53; 95% CI = 0.05-1.05; p = 0.03; I2 = 27%), balance, and participation (SMD = 0.74; 95% CI = 0.10-1.39; p = 0.02; I2 = 0%). Aerobic exercise was not effective for muscle strength, spasticity, gait parameters, and QoL (p > 0.05). The certainty of evidence for most comparisons was moderate to low. INTERPRETATION: This review provides the most up-to-date evidence on the efficacy of aerobic exercise on the functioning and QoL of children and adolescents with CP. WHAT THIS PAPER ADDS: Aerobic exercise improves gross motor function but not gait parameters in cerebral palsy (CP). It improves participation but not quality of life in children and adolescents with CP. It is more effective than usual care or other interventions in improving mobility, aerobic capacity, and balance in CP. It is no more effective than usual care or other interventions in improving muscle strength and spasticity.
Subject(s)
Cerebral Palsy , Quality of Life , Humans , Child , Adolescent , Cerebral Palsy/therapy , Exercise , Muscle Strength , Muscle SpasticityABSTRACT
OBJETIVO: Investigar a eficácia do exercício aeróbico na funcionalidade (participação, atividades e estruturas e funções corporais) e qualidade de vida (QV) de crianças e adolescentes com paralisia cerebral (PC). MÉTODO: Uma revisão sistemática com meta-análise foi realizada. Uma busca abrangente de artigos foi realizada usando os bancos de dados eletrônicos Embase, PubMed, PEDro e CINAHL. A qualidade metodológica e a certeza das evidências foram avaliadas com as escalas PEDro e Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectivamente. Os efeitos do exercício aeróbico na funcionalidade foram avaliados usando técnicas meta-analíticas. No entanto, dada a natureza ampla dos resultados relacionados a funcionalidade e QV, diferentes instrumentos podem ser usados para mensurá-los; isso tornou impossível a síntese dos resultados em uma meta-análise para alguns dos desfechos. RESULTADOS: Quinze ensaios clínicos randomizados com 414 participantes com PC foram incluídos. A análise da qualidade metodológica dos estudos revelou um baixo risco de viés. O efeito do exercício aeróbico comparado aos cuidados habituais ou outras intervenções foi significativo para a capacidade aeróbica (diferença média padronizada [DMP] = 0,81; intervalo de confiança de 95% [IC] = 0,16-1,47; p < 0,002; I2 = 68%), função motora grossa (DMP = 0,70; 95% = IC 0,21-1,19; p = 0,005; I2 = 49%), mobilidade (DMP = 0.53; 95% IC = 0.05-1.05; p = 0.03; I2 = 27%), equilíbro, and participação (DMP = 0.74; 95% IC = 0.10-1.39; p = 0.02; I2 = 0%). O exercício aeróbico não foi eficaz para a força muscular, espasticidade, parâmetros de marcha e QV (p > 0,05). A certeza da evidência para a maioria das comparações foi de moderada a baixa. INTERPRETAÇÃO: Esta revisão fornece as evidências mais atualizadas sobre a eficácia do exercício aeróbico na funcionalidade e na qualidade de vida de crianças e adolescentes com PC.
ABSTRACT
AIM: To evaluate whether children with cerebral palsy (CP) are able to engage in a motor imagery task. Possible associations between motor imagery and functional performance, working memory, age, and intelligence were also investigated. METHOD: This is a case-control study that assessed 57 children (25 females, 32 males) with unilateral CP, aged 6 to 14 years (mean age: 10y 4mo; SD 2y 8mo) and 175 typically developing (control) children, aged 6 to 13 years (87 females, 88 males; mean age: 9y 4mo; SD 1y 11mo). The hand laterality judgment task was used to measure motor imagery ability. Reaction time, accuracy, and the effect of the biomechanical constraints were assessed in this task. RESULTS: Performance in both groups followed the biomechanical constraints of the task, that is, longer reaction times to recognize stimuli rotated laterally when compared to medial stimuli. Reaction time means did not differ significantly between groups (p>0.05). Significant differences between the unilateral CP and control groups were observed for accuracy (p<0.05). Functional performance and working memory were correlates of motor imagery tasks. INTERPRETATION: Results suggest that children with unilateral CP can engage in motor imagery; however, they commit more errors than typically developing controls. In addition, their performance in tasks of motor imagery is influenced by functional performance and working memory.
