Muscle strengthening is not effective in children and adolescents with cerebral palsy: a systematic review
Muscle strengthening is not effective in children and adolescents with cerebral palsy: a systematic review
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DOI：
10.1016/s0004-9514(09)70037-6
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发表时间：
2009-01-01
影响因子：
--
通讯作者：
Teixeira-Salmela, Luci F.
中科院分区：
文献类型：
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作者：
Scianni, Aline;Butler, Jane M.;Teixeira-Salmela, Luci F.
强化干预是否能在不增加痉挛的情况下增加力量并改善活动？在脑瘫儿童和青少年中，停止干预后是否有任何延续性？设计：采用随机试验的荟萃分析进行系统评价。研究对象：学龄期至20岁的痉挛性脑瘫儿童。干预：强化干预，包括重复的、强烈的或费力的肌肉收缩，并随着能力的变化而进展，如生物反馈、电刺激和渐进式阻力运动。结果测量：强度测量为最大自主力或扭矩产生的连续测量。痉挛性以速度依赖性被动拉伸阻力测量。通过连续测量测量活动，如10米步行测试，或使用量表，如大运动功能测量。结果：确定了6项研究，其中5项研究的数据可以纳入荟萃分析。强化干预对力量没有影响（SMD为0.20,95% CI为-0.17至0.56），对步行速度没有影响（SMD为0.02 m/s， 95% CI为-0.13至0.16），对大运动功能测量有很小的统计学意义但没有临床价值的影响（SMD为2%，95% CI为0至4）。只有一项研究测量了痉挛，但没有报告组间分析。结论：对于正在行走的脑瘫儿童和青少年，目前的证据表明，加强干预既不有效也不值得。[Scianni A, Butler JM, Ada L, teixera - salmela LF]（2009）脑瘫儿童肌肉强化无效：一项系统综述。澳大利亚物理治疗杂志[55:81-87]
Do strengthening interventions increase strength without increasing spasticity and improve activity, and is there any carryover after cessation in children and adolescents with cerebral palsy? Design: Systematic review with meta-analysis of randomised trials. Participants: Children with spastic cerebral palsy between school age and 20 years. Intervention: Strengthening interventions that involved repetitive, strong, or effortful muscle contractions and progressed as ability changed, such as biofeedback, electrical stimulation, and progressive resistance exercise. Outcome measures: Strength was measured as continuous measures of maximum voluntary force or torque production. Spasticity was measured as velocity-dependent resistance to passive stretch. Activity was measured as continuous measures, eg, 10-m Walk Test, or using scales eg, the Gross Motor Function Measure. Results: Six studies were identified and five had data that could be included in a meta-analysis. Strengthening interventions had no effect on strength (SMD 0.20, 95% CI -0.17 to 0.56), no effect on walking speed (MD 0.02 m/s, 95% CI -0.13 to 0.16), and had a small statistically-significant but not clinically-worthwhile effect on Gross Motor Function Measure (MD 2%, 95% CI 0 to 4). Only one study measured spasticity but did not report the between-group analysis. Conclusion: In children and adolescents with cerebral palsy who are walking, the current evidence suggests that strengthening interventions are neither effective nor worthwhile. [Scianni A, Butler JM, Ada L, Teixeira-Salmela LF (2009) Muscle strengthening is not effective in children with cerebral palsy: a systematic review. Australian Journal of Physiotherapy 55: 81-87]