Lycra arm splints in conjunction with goal-directed training can improve movement in children with cerebral palsy. Hand function in children with hemiplegic cerebral palsy: prospective follow-up and functional outcome in adolescence. Lycra(®) arm splints improve movement fluency in children with cerebral palsy. Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical activity. Efficacy of forced-use therapy in hemiplegic cerebral palsy. Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. Randomized Trial of Modified Constraint-Induced Movement Therapy With and Without an Intensive Therapy Program in Children With Unilateral Cerebral Palsy Upper limb training using Wii Sports Resort™ for children with hemiplegic cerebral palsy: a randomized, single-blind trial Action Observation Treatment Improves Upper Limb Motor Functions in Children with Cerebral Palsy: A Combined Clinical and Brain Imaging Study Efficacy of constraint-induced movement therapy and electrical stimulation on hand function of children with hemiplegic cerebral palsy: a controlled clinical trial Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Immediate effect of a wrist and thumb brace on bimanual activities in children with hemiplegic cerebral palsy. Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy. Effectiveness of the Michigan splint in reducing functional cervical disturbances: a preliminary study. Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy. Unimanual and Bimanual Intensive Training in Children With Hemiplegic Cerebral Palsy and Persistence in Time of Hand Function Improvement Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy
OBJECTIVES To investigate the effects of lycra ® arm splint wear on goal attainment and three dimensional ( 3D ) kinematics of the upper limb and trunk in children with cerebral palsy ( CP ) . DESIGN R and omised clinical trial whereby participants were r and omised to parallel groups with waiting list control . PARTICIPANTS Sixteen children with CP ( hypertonia ) aged 9 to 14 years . INTERVENTION Three months lycra arm splint wear combined with goal directed training . MAIN OUTCOME MEASURE Goal attainment scale , and 3D upper limb and trunk kinematics across four upper limb movement tasks . RESULTS 17/18 children achieved their movement goals following three months of splinting . Selected joint kinematics improved on immediate splint application . Further improvements in joint kinematics were demonstrated following 3 months of splint wear , particularly in elbow extension , shoulder flexion and abduction and in thorax flexion . Only improvements in movement compensations at the thorax remained following removal of the splint . CONCLUSIONS The lycra ® arm splint , made a quantifiable change to the attainment of movement goals of importance to the child . Furthermore , improvements were demonstrated in selected maximum range of movement and joint kinematics during functional tasks at the elbow and shoulder joints and thorax segment in children with CP The aim of this prospect i ve study was to determine the outcome of affected h and impairment and disability in a group of 31 children ( 16 males , 15 females ) with hemiplegic cerebral palsy who were referred consecutively to our rehabilitation service and followed from a mean age of 2 years and 7 months to a mean age of 12 years and 9 months . The h and function assessment protocol consisted of video-recorded procedures : one to assess grip and the other to assess the extent of spontaneous use of the affected h and . Assessment s at outset and at latest follow-up showed that the series as a whole had greater h and impairment in spontaneous manipulation than in gripping tasks . Comparison of h and function before age 4 years with the latest assessment over age 11 years revealed a non-significant improvement in grip , whereas spontaneous h and use remained stable . All but one of the children who had good grip and h and use scores at first assessment maintained them over time unless they were not treated for h and dysfunction . Among the children with low scores at outset , the improvement over time was more marked in grip than spontaneous h and use and occurred mainly in the early years . These results suggest that to evaluate the real disability of the affected h and in children with hemiplegia , grip assessment is insufficient and that an instrument assessing spontaneous h and use in bilateral manipulation is required . Furthermore , intensive treatment focused on h and function should be planned in the early years for children with more severe h and impairment , whereas regular follow-up is sufficient for less affected children AIMS To determine changes in upper limb movement substructures that denote fluency of movement in children with cerebral palsy ( CP ) following lycra ( ® ) splint wear  . Secondarily , to explore the efficacy of lycra ( ® ) splints for those with spastic and dystonic hypertonia . DESIGN R and omised clinical trial whereby participants were r and omised to parallel groups with waiting list control . METHOD Sixteen children ( mean age 11.5 years SD=2.2 ) with hypertonic upper limb involvement ( 13 hemiplegia , 4 quadriplegia ) were recruited . Children were r and omly allocated either to a control group or to wear the lycra ( ® ) splint for a period of three months . Three-dimensional ( 3D ) upper limb kinematics was used to assess four functional tasks at baseline , on initial lycra ( ® ) splint application , three months after lycra ( ® ) splint wear , and immediately after splint removal . Movement substructures of the motion of the wrist joint center were analysed . RESULTS A significant difference was observed between baseline and three months of lycra ( ® ) splint wear in the movement substructures ; movement time , percentage of time and distance in primary movement , jerk index , normalised jerk and percentage of jerk in primary and secondary movements . The magnitude of changes in normalised jerk and the percentage of jerk in the primary movement from baseline to three months was greatest in children with dystonic hypertonia . CONCLUSIONS The results indicate that lycra ( ® ) arm splinting induced significant changes in movement substructures and motor performance in children with CP . This research demonstrates that fluency of movement can be quantified and is amenable to change with intervention BACKGROUND Previous studies reported controversial results about the efficacy of video-game based therapy ( VGT ) in improving neurorehabilitation outcomes in children with cerebral palsy ( CP ) . AIM Primary aim was to investigate the effectiveness of VGT with respect to conventional therapy ( CT ) in improving upper limb motor outcomes in a group of children with CP . Secondary aim was to quantify if VGT leads children to perform a higher number of movements . DESIGN A cross-over r and omized controlled trial ( RCT ) for investigating the primary aim and a cross-sectional study for investigating the secondary aim of this study . SETTING S Out patients . POPULATION INCLUSION CRITERIA clinical diagnosis of CP , age between 4 and 14 years , level of GMFC between I and IV . EXCLUSION CRITERIA QI<35 , severe comorbidities , incapacity to st and even with an external support . METHODS Twenty-two children with CP ( 6.89±1.91-year old ) were enrolled in a cross-over RCT with 16 sessions of VGT ( using Xbox with Kinect device ) and then 16 of CT or vice versa . Upper limb functioning was assessed using the Quality of Upper Extremities Skills Test ( QUEST ) and h and abilities using Abilh and -kids score . According to the secondary aim of this study a secondary cross-sectional study has been performed . Eight children with CP ( 6.50±1.60-year old ) were enrolled into a trial in which five wireless triaxial accelerometers were positioned on their forearms , legs and trunk for quantifying the physical activity during VGT vs. CT .  RESULTS QUEST scores significantly improved only after VGT ( P=0.003 ) , and not after CT ( P=0.056 ) . The reverse occurred for Abilh and -kids scores ( P=0.165 vs. P=0.013 , respectively ) . Quantity of performed movements was three times higher in VGT than in CT ( + 198 % , P=0.027 ) . CONCLUSION VGT result ed effective in improving the motor functions of upper limb extremities in children with CP , conceivably for the increased quantity of limb movements , but failed in improving the manual abilities for performing activities of daily living which benefited more from CT . CLINICAL REHABILITATION IMPACT VGT performed using the X-Box with Kinect device could enhance the number of upper limb movements in children with CP during rehabilitation and in turn improving upper limb motor skills , but CT remained superior for improving performances in manual activities of daily living OBJECTIVE To determine the efficacy of forced-use therapy ( FUT ) on the improvement of upper-extremity function in children with hemiplegic cerebral palsy ( CP ) . DESIGN Prospect i ve case series . SETTING Outpatient ambulatory clinic in South Korea . PARTICIPANTS Thirty-one patients with hemiplegic CP were assigned to the FUT group ( n=18 ) or to the control group ( n=13 ) . The mean age of the patients in the FUT group was 33.2 months and in the control group it was 43.2 months . INTERVENTIONS The FUT group wore a short-arm Scotchcast on the unaffected arm for 6 weeks and also participated in a conventional rehabilitation program that included stretching exercises and functional occupational therapy for the upper extremity . The control group underwent the conventional rehabilitation program only . MAIN OUTCOME MEASURE H and function tests , including the box and block test ( BBT ) , Erhardt Developmental Prehension Assessment ( EDPA ) , and WeeFIM instrument taken before and after 6 weeks of treatment . RESULTS Before treatment , there was no significant difference between groups in the BBT , EDPA , and WeeFIM scores . After 6 weeks of treatment , however , the FUT group showed significant improvement in the affected arm in the BBT and EDPA scores , compared with the control group ( P<.05 ) . The self-care score on the WeeFIM was also significantly improved in the FUT group ( P<.05 ) . CONCLUSIONS FUT combined with a conventional rehabilitation program appears to be more effective than a rehabilitation program alone in improving affected h and function in children with hemiplegic CP Constraint-induced ( CI ) movement therapy is a promising therapy for improving upper limb function in adults after stroke . It involves restraint of the non-involved limb and extensive movement practice with the involved limb . In this study , a single-blinded , r and omized , control study was performed to examine the efficacy of CI therapy , modified to be child friendly , in children with hemiplegic cerebral palsy ( CP ) . Twenty-two children ( 8 females , 14 males ; mean age 6 y 8 mo [ SD 1 y 4 mo ] ; range 4 - 8 y ) were r and omized to either an intervention group ( n=11 ) or a delayed treatment control group ( n=11 ) . Children wore a sling on their non-involved upper limb for 6 hours per day for 10 out of 12 consecutive days and were engaged in play and functional activities . Children in the treatment group demonstrated improved movement efficiency and dexterity of the involved upper extremity , which were sustained through the 6-month evaluation period , as measured by the Jebsen-Taylor Test of H and Function and fine motor-subtests of the Bruininks-Oseretsky Test of Motor Proficiency ( p<0.05 in both cases ) . Initial severity of h and impairment and testing compliance were strong predictors of improvement . Caregivers reported significant increases in involved limb frequency of use and quality of movement . However , there was no change in strength , sensibility , or muscle tone ( p>0.05 in all cases ) . Results suggest that for a carefully selected subgroup of children with hemiplegic CP , CI therapy modified to be child-friendly , appears to be efficacious in improving movement efficiency of the involved upper extremity Background . Constraint-induced movement therapy ( CIMT ) has gained emerging evidence and popularity in children with unilateral cerebral palsy ( CP ) . However , many issues remain unanswered regarding the best approach . Objective . This study investigated the additional effects of an intensive therapy program to promote h and function combined with home-based modified CIMT ( m-CIMT ) . Methods . Fifty-one children ( mean age 8 years 9 months ) were r and omized to m-CIMT alone or m-CIMT with intensive therapy ( IT ) . All children had to wear a constraint on the unaffected h and for 1 hour , 5 days/week for 10 weeks . Children in the m-CIMT + IT group also received 3 sessions of 45 minutes weekly of intensive therapy for distal muscle strengthening and h and function , using unimanual and bimanual activities . The Assisting H and Assessment ( AHA ) was the primary outcome measure . Secondary outcome measures were muscle tone , strength , Melbourne Assessment , Jebsen – Taylor test , and ABILH AND -Kids question naire . Assessment s were administered at baseline , after intervention , and at 10-week follow-up . Results . Significant between-group differences in AHA were in favor of the m-CIMT + IT group ( P = .04 ) . Both groups demonstrated comparable improvements in muscle tone ( P = .002 ) , strength ( P < .0001 ) , grip strength ( P = .02 ) , and unimanual capacity ( Melbourne Assessment and Jebsen – Taylor , P < .0001 ) . Younger children and children with poorer h and function benefited from both interventions , whereas older children and children with better h and function only benefited from the combined approach . Conclusions . The combination of m-CIMT with an intensive therapy program on distal h and function and strength enhances the effects of m-CIMT alone for improving bimanual performance Objective : To investigate whether Wii Sports Resort ™ training is effective and if any benefits are maintained . Design : R and omized , single-blind trial . Participants : Sixty-two hemiplegic children with cerebral palsy ( 6–13 years ) . Intervention : Experimental group undertook six weeks of home-based Wii Sports Resort ™ training plus usual therapy , while the control group received usual therapy . Main measures : Outcomes were coordination , strength , h and function , and carers ’ perception of h and function , measured at baseline , six , and 12 weeks by a blinded assessor . Results : There was a trend of mean difference ( MD ) for the experimental group to have more grip strength by six ( MD 4.0 N , 95 % confidence interval ( CI ) −0.8 to 8.8 , p = 0.10 ) and 12 ( MD 4.1 N , 95 % CI −2.1 to 10.3 , p = 0.19 ) weeks , and to have a higher quantity of h and function according to carers ’ perception by six ( MD 4.5 N , 95 % CI −0.7 to 9.7 , p = 0.09 ) and strengthened by 12 ( MD 6.4 , 95 % CI 0.6 to 12.3 , p = 0.03 ) weeks than the control group . There was no difference between groups in coordination and h and function by six or 12 weeks . Conclusion : Wii ™ training did not improve coordination , strength , or h and function . Beyond the intervention , carers perceived that the children used their h and s more The aim of the present study was to assess the role of action observation treatment ( AOT ) in the rehabilitation of upper limb motor functions in children with cerebral palsy . We carried out a two-group , parallel r and omized controlled trial . Eighteen children ( aged 5–11 yr ) entered the study : 11 were treated children , and 7 served as controls . Outcome measures were scores on two functional scales : Melbourne Assessment of Unilateral Upper Limb Function Scale ( MUUL ) and the Assisting H and Assessment ( AHA ) . We collected functional scores before treatment ( T1 ) , at the end of treatment ( T2 ) , and at two months of follow-up ( T3 ) . As compared to controls , treated children improved significantly in both scales at T2 and this improvement persisted at T3 . AOT has therefore the potential to become a routine rehabilitation practice in children with CP . Twelve out of 18 enrolled children also underwent a functional magnetic resonance study at T1 and T2 . As compared to controls , at T2 , treated children showed stronger activation in a parieto-premotor circuit for h and -object interactions . These findings support the notion that AOT contributes to reorganize brain circuits subserving the impaired function rather than activating supplementary or vicariating ones Purpose : The purpose of this study is to compare the efficacy of constraint therapy , constraint therapy plus electrical stimulation , and occupational therapy in the treatment of h and dysfunction . Methods : Sixty-eight children with hemiplegic cerebral palsy were r and omly allocated to constraint therapy , constraint therapy plus electrical stimulation , and occupational therapy group . Three groups received 2 weeks of treatment . All participants were measured at baseline and 2 weeks , 3 and 6 months after treatment using measures of active ROM , grip strength , nine-peg hole test , upper extremity functional test , Peabody developmental motor scales ( PDMS ) , globe rating scale , and social life ability scale . Results : Three groups improved significantly ( p < 0.05 ) . The mean improvements between baseline and the end of follow-up were respectively 12.4 , 11.4 and 11.3 degrees for active ROM ; 12.8 , 10.5 and 8.8 mmHg for grip strength ; −22.3 , −30.7 and −14.0 s for nine-peg hole test ; 15.3 , 10.3 and 10.4 for upper extremity functional test scores ; 2.2 , 1.8 and 1.8 for grasping scores of PDMS ; 5.8 , 3.7 and 2.8 for visual-motor integration scores of PDMS ; 2.0 , 2.5 and 0.9 for globe rating scale scores ; 7.7 , 5.7 and 5.3 for social life ability scale scores  in constraint therapy plus electrical stimulation , constraint therapy , and occupational therapy group . The constraint therapy plus electrical stimulation group showed greater rate of improvement in upper extremity functional test scores ( p < 0.05 ) and visual-motor integration scores of PDMS ( p < 0.05 ) than the other two groups after treatment for 6 months . Conclusions : Constraint therapy plus electrical stimulation is likely to be best in improving h and performance in children with hemiplegic cerebral palsy . Implication s for Rehabilitation Children with hemiplegic cerebral palsy have major h and dysfunction problems that not only restrict activity and participation but also lead to secondary impairment . Constraint therapy , constraint therapy plus electrical stimulation and occupational therapy , is the technique available to these children . However , strong evidence for efficacy of the three interventions is still lacking . This study shows that all the three interventions improve h and performance and perceived changes . However , constraint therapy plus electrical stimulation is the most effective . Use of constraint therapy is advantageous in improving involved h and function and perceived changes OBJECTIVE Constraint-Induced Movement ( CI ) therapy has been found to be a promising treatment for substantially increasing the use of extremities affected by such neurologic injuries as stroke and traumatic brain injury in adults . The purpose of this study was to determine the applicability of this intervention to young children with cerebral palsy . METHODS A r and omized , controlled clinical trial of pediatric CI therapy in which 18 children with diagnosed hemiparesis associated with cerebral palsy ( 7 - 96 months old ) were r and omly assigned to receive either pediatric CI therapy or conventional treatment . Pediatric CI therapy involved promoting increased use of the more-affected arm and h and by intensive training ( using shaping ) of the more-impaired upper extremity for 6 hours/day for 21 consecutive days coupled with bivalved casting of the child 's less-affected upper extremity for that period . Children 's functional upper-extremity skills were assessed in the laboratory ( blinded scoring ) and at home ( parent ratings ) just prior , after , and 3 weeks posttreatment . Treated children were followed for 6 months . RESULTS Children receiving pediatric CI therapy compared with controls acquired significantly more new classes of motoric skills ( 9.3 vs 2.2 ) ; demonstrated significant gains in the mean amount ( 2.1 vs 0.1 ) and quality ( 1.7 vs 0.3 ) of more-affected arm use at home ; and in a laboratory motor function test displayed substantial improvement including increases in unprompted use of the more-affected upper extremity ( 52.1 % vs 2.1 % of items ) . Benefits were maintained over 6 months , with supplemental evidence of quality -of-life changes for many children . CONCLUSION Pediatric CI therapy produced major and sustained improvement in motoric function in the young children with hemiparesis in the study AIM The aim of this study was to determine the immediate effect of wearing a wrist and thumb brace on the performance of bimanual activities in children with spastic hemiplegic cerebral palsy . METHOD In a pre- and post-test cohort study of 25 children ( age range 4 - 11y ; mean age 8y 4mo [ SD 2y 2mo ] ; 16 males , 9 females ) with spastic hemiplegic cerebral palsy with a Zancolli classification h and score of I , IIA , or IIB ( mild and moderate h and dysfunction ; children with a Zancolli classification of III - severe h and dysfunction - were excluded from this study ) , performance of bimanual activities was evaluated with the Assisting H and Assessment ( AHA ) on three occasions : one assessment with a static wrist and thumb brace placed on the affected h and and two other assessment s without a brace . The differences between AHA scores obtained at the three assessment s were evaluated using the repeated measures analysis of variance . RESULTS Performance of bimanual activities while wearing the brace improved significantly compared to performance without the brace ( p<0.001 ) . With the brace , the mean AHA score increased by 3.2 ( 95 % confidence interval 2.1 - 4.3 ) from 59.1 to 62.3 . The scores of the two assessment s without the brace did not differ significantly . INTERPRETATION In children with spastic hemiplegic cerebral palsy , bracing of the wrist and thumb immediately improves spontaneous use of the affected upper limb in bimanual activities , possibly because bracing permits a more functional h and position AIM The aim of this r and omized controlled trial was to assess whether action observation treatment may improve upper limb motor functions in children with cerebral palsy ( CP ) . METHOD All children with CP admitted to our unit for rehabilitation from May 2009 to May 2010 were eligible . Inclusion criteria were age between 6 years and 11 years , an IQ of at least 70 , and no major visual and /or auditory deficits . Fifteen children were enrolled and r and omly assigned to either a case group ( n=8 ; four males , four females ; median age 7 y 6 mo ) or control group ( n=7 ; five males , two females ; median age 8 y ) . Six participants had left-sided hemiplegia , six right-sided hemiplegia , and three had tetraplegia ; 10 were independent walkers . Those in the case group were asked to observe video clips showing daily age-appropriate actions , and afterwards to imitate them . Participants in the control group were asked to observe video clips with no motor content and afterwards to execute the same actions as cases . The primary outcome measure was the Melbourne Assessment Scale . Children were scored twice at baseline ( 2 wks apart ) , and at the end of treatment , by a physician blind to group assignment . RESULTS At baseline groups did not differ on functional evaluation . After treatment , the functional score gain ( Δ ) was significantly different in the case and control groups ( p=0.026 ) . INTERPRETATION The present results support the notion that action observation treatment can be an effective part of the rehabilitation programme in children with CP There is controversial evidence for a functional link between the masticatory apparatus and the cervical spine . The aim of this work was to perform a preliminary study to evaluate the effectiveness of the Michigan splint for the treatment of functional cervical disturbances . Forty patients with functional cervical disturbances were r and omly organized into test and control groups . The patients in each group were examined by a physiologist to ascertain the extent of functional changes . The test group underwent splint therapy ( Michigan type ) during a two-month period . The other patients were sent home and did not receive active treatment . After two months , all patients were reassessed physiologically . Cervical pain and pain induced by epispinal or paraspinal pressure were reduced to a statistically significant extent in the treated group , compared with those in the control group This study is the first well- design ed r and omized controlled trial to assess the effects of a novel home-based virtual cycling training ( hVCT ) program for improving muscle strength in children with spastic cerebral palsy ( CP ) . Twenty-eight ambulatory children with spastic CP aged 6 - 12 years were r and omly assigned to an hVCT group ( n=13 ) or a control group ( n=15 ) . Outcome measures , including gross motor function of the Bruininks-Oseretsky Test of Motor Proficiency ( BOTMP ) and muscle strength ( isokinetic torque of knee extensor and flexor muscle ) , were administered before and immediately after the 12-week intervention . Analysis of covariance ( ANCOVA ) at post-treatment showed that , compared to the control group , the hVCT group had significantly higher isokinetic torque in the knee extensor and flexor muscles at 60 ° /s and 120 ° /s angular velocities ( p<0.05 ) . At post-treatment , the hVCT group also showed greater isokinetic strength improvement in the knee flexor than in the knee extensor at 60 ° /s ( knee flexor : 41 % ; knee extensor : 19 % ) and at 120 ° /s ( knee flexor : 36 % ; knee extensor : 30 % ) . However , the BOTMP scores at post-treatment did not differ between the two groups . Although the proposed 12-week hVCT protocol does not improve gross motor function , it enhances knee muscle strength in children with CP . The protocol obtains larger gains in the knee flexor than in the knee extensor at different angular velocities . The study findings will help clinicians to provide more effective and efficient strategies for muscle strength training in children with CP This study aims to compare in hemiplegic children the effectiveness of intensive training ( unimanual and bimanual ) versus st and ard treatment in improving h and function , assessing the persistence after 6 months . A multicenter , prospect i ve , cluster-r and omized controlled clinical trial was design ed comparing 2 groups of children with hemiplegic cerebral palsy , treated for 10 weeks ( 3 h/d 7 d/wk ; first with unimanual constraint-induced movement therapy  , second with intensive bimanual training ) with a st and ard treatment group . Children were assessed before and after treatment and at 3 and 6 months postintervention using Quality of Upper Extremity Skills Test ( QUEST ) and Besta Scales .  One hundred five children were recruited ( 39 constraint-induced movement therapy , 33 intensive bimanual training , 33 st and ard treatment )  . Constraint-induced movement therapy and intensive bimanual training groups had significantly improved h and function , showing constant increase in time . Grasp improved immediately and significantly with constraint-induced movement therapy , and with bimanual training grasp improved gradually , reaching the same result . In both , spontaneous h and use increased in long-term assessment Summary The 12-week home-based virtual cycling training ( hVCT ) improved lower limb muscle strength and areal bone mineral density ( aBMD ) than the control program in children with cerebral palsy ( CP ) . A muscle strengthening program , rather than general physical activity , is more specific in enhancing aBMD for these children . A novel hVCT is an effective and efficient strategy that enhances lower limb bone density in these children . Introduction This is the first study to assess the efficacy of a novel hVCT program on bone density for children with spastic CP using a well- design ed r and omized controlled trial . Methods Twenty-seven ambulatory children with spastic CP , aged 6–12 years , were r and omly assigned to the hVCT group ( n = 13 ) or control group ( n = 14 ) . Outcome measures —motor function [ Gross Motor Function Measure-66 ( GMFM-66 ) ] , muscle strength ( curl up scores and isokinetic torque of knee extensor and flexor muscle ) and aBMD of the lumbar and distal femur — were administered before and immediately after the 12-week intervention . Results Analysis of covariance results show that the hVCT group had greater distal femur aBMD and isokinetic torques of knee extensor and flexor muscles than the control group at posttreatment ( p < 0.05 ) . However , curl up scores , GMFM-66 , and lumbar aBMD at posttreatment did not differ between the two groups . Conclusions Analytical findings suggest that the muscle strengthening program is more specific in enhancing bone density for children with CP than general physical activity . Thus , the proposed 12-week hVCT protocol is an effective and efficient strategy for improving lower limb aBMD in these children
INTERPRETATION In children with CP , h and splints may have a small benefit for upper limb skills .
However , results are diminished after splint wearing stops .
AIM The aim of this review was to determine the effectiveness of h and splinting for improving h and function in children with cerebral palsy ( CP ) and brain injury .