{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:39:17Z","timestamp":1790696357771,"version":"4.1.0"},"reference-count":42,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,6,1]]},"abstract":"<jats:p>CONTEXT. Rehabilitation for children with congenital hemiplegia to improve function in the impaired upper limb and enhance participation may be time-consuming and costly.<\/jats:p><jats:p>OBJECTIVES. To systematically review the efficacy of nonsurgical upper-limb therapeutic interventions for children with congenital hemiplegia.<\/jats:p><jats:p>METHODS. 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.<\/jats:p><jats:p>RESULTS. Twelve studies and 7 systematic reviews met our criteria. Trials had strong methodologic quality (Physiotherapy Evidence Database [PEDro] scale \u2265 5), and systematic reviews rated strongly (AMSTAR [Assessment of Multiple Systematic Reviews] score \u2265 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.<\/jats:p><jats:p>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\u2013training approaches. Additional research is needed to justify more-intensive approaches such as constraint-induced movement therapy and hand-arm bimanual intensive training.<\/jats:p>","DOI":"10.1542\/peds.2008-3335","type":"journal-article","created":{"date-parts":[[2009,5,19]],"date-time":"2009-05-19T00:45:37Z","timestamp":1242693937000},"page":"e1111-e1122","source":"Crossref","is-referenced-by-count":211,"title":["Systematic Review and Meta-analysis of Therapeutic Management of Upper-Limb Dysfunction in Children With Congenital Hemiplegia"],"prefix":"10.1542","volume":"123","author":[{"given":"Leanne","family":"Sakzewski","sequence":"first","affiliation":[{"name":"Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine"},{"name":"Brain Research Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Ziviani","sequence":"additional","affiliation":[{"name":"School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roslyn","family":"Boyd","sequence":"additional","affiliation":[{"name":"Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine"},{"name":"Brain Research Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,6,1]]},"reference":[{"key":"2021120902451207300_R1","unstructured":"Stanley F, Blair E, Alberman E. Cerebral Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000"},{"key":"2021120902451207300_R2","doi-asserted-by":"crossref","unstructured":"Boyd RN, Morris ME, Graham HK. Management of upper limb dysfunction in children with cerebral palsy: a systematic review. Eur J Neurol.\u20082001;8(suppl 5):150\u2013166","DOI":"10.1046\/j.1468-1331.2001.00048.x"},{"key":"2021120902451207300_R3","doi-asserted-by":"crossref","unstructured":"Hoare B, Wasiak J, Imms C, Carey L. Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy. Cochrane Database Syst Rev.\u20082007;(2):CD004149","DOI":"10.1002\/14651858.CD004149.pub2"},{"key":"2021120902451207300_R4","doi-asserted-by":"crossref","unstructured":"Wasiak J, Hoare B, Wallen M. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy. Cochrane Database Syst Rev.\u20082004;(4):CD003469","DOI":"10.1002\/14651858.CD003469.pub3"},{"key":"2021120902451207300_R5","doi-asserted-by":"crossref","unstructured":"Gordon AM, Schneider JA, Chinnan A, Charles JR. Efficacy of a hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial. Dev Med Child Neurol.\u20082007;49(11):830\u2013838","DOI":"10.1111\/j.1469-8749.2007.00830.x"},{"key":"2021120902451207300_R6","doi-asserted-by":"crossref","unstructured":"Average A. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol.\u20081998;51(12):1235\u20131241","DOI":"10.1016\/S0895-4356(98)00131-0"},{"key":"2021120902451207300_R7","doi-asserted-by":"crossref","unstructured":"Maher C, Sherrington C, Herbert R, Elkins M. Reliability of the PEDro scale for rating quality of randomised controlled trials. Phys Ther.\u20082003;83(8):713\u2013721","DOI":"10.1093\/ptj\/83.8.713"},{"key":"2021120902451207300_R8","doi-asserted-by":"crossref","unstructured":"Moseley A, Herbert R, Sherrington C, Maher C. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother.\u20082002;48(1):43\u201349","DOI":"10.1016\/S0004-9514(14)60281-6"},{"key":"2021120902451207300_R9","doi-asserted-by":"crossref","unstructured":"Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol.\u20082007;7:10. Available at: www.biomedcentral.com\/1471\u20132288\/7\/10. Accessed March 7, 2008","DOI":"10.1186\/1471-2288-7-10"},{"key":"2021120902451207300_R10","unstructured":"Cohen J. Statistical Power Analysis for the Behavioural Sciences. New York, NY: Academic Press; 1977"},{"key":"2021120902451207300_R11","doi-asserted-by":"crossref","unstructured":"Higgins J, Green S, eds. Cochrane handbook for systematic reviews of interventions: version 5.0.1. Available at: www.cochrane-handbook.org. Accessed September 3, 2008","DOI":"10.1002\/9780470712184"},{"key":"2021120902451207300_R12","doi-asserted-by":"crossref","unstructured":"Higgins J, Thompson S, Deeks J, Altman D. Measuring inconsistency in meta-analyses. BMJ.\u20082003;327(7414):557\u2013560","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2021120902451207300_R13","unstructured":"Reid D, Campbell K. The use of virtual reality with children with cerebral palsy: a pilot randomized trial. Ther Recreation J.\u20082006;40(2):255\u2013268"},{"key":"2021120902451207300_R14","doi-asserted-by":"crossref","unstructured":"Law M, Cadman D, Rosenbaum P, Walter S, Russell D, DeMatteo C. Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy. Dev Med Child Neurol.\u20081991;33(5):379\u2013387","DOI":"10.1111\/j.1469-8749.1991.tb14897.x"},{"key":"2021120902451207300_R15","doi-asserted-by":"crossref","unstructured":"Law M, Russell D, Pollock N, Rosenbaum P, Walter S, King G. A comparison of intensive neurodevelopmental therapy plus casting and a regular occupational therapy program for children with cerebral palsy. Dev Med Child Neurol.\u20081997;39(10):664\u2013670","DOI":"10.1111\/j.1469-8749.1997.tb07360.x"},{"key":"2021120902451207300_R16","doi-asserted-by":"crossref","unstructured":"Corry IS, Cosgrove AP, Walsh EG, McClean D, Graham HK. Botulinum toxin A in the hemiplegic upper limb: a double blind trial. Dev Med Child Neurol.\u20081997;39(3):185\u2013193","DOI":"10.1111\/j.1469-8749.1997.tb07408.x"},{"key":"2021120902451207300_R17","doi-asserted-by":"crossref","unstructured":"Fehlings D, Rang M, Glazier J, Steele C. An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy. J Pediatr.\u20082000;137(3):331\u2013337","DOI":"10.1067\/mpd.2000.108393"},{"key":"2021120902451207300_R18","doi-asserted-by":"crossref","unstructured":"Speth LA, Leffers P, Janssen-Potten YJ, Vles JS. Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy. Dev Med Child Neurol.\u20082005;47(7):468\u2013473","DOI":"10.1017\/S0012162205000903"},{"key":"2021120902451207300_R19","doi-asserted-by":"crossref","unstructured":"Lowe K, Novak I, Cusick A. Low-dose\/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy. Dev Med Child Neurol.\u20082006;48(3):170\u2013175","DOI":"10.1017\/S0012162206000387"},{"key":"2021120902451207300_R20","doi-asserted-by":"crossref","unstructured":"Wallen M, O'Flaherty S, Waugh M. Functional outcomes of intramuscular botulinum toxin type A and occupational therapy in the upper limbs of children with cerebral palsy: a randomized controlled trial. Arch Phys Med Rehabil.\u20082007;88(1):1\u201310","DOI":"10.1016\/j.apmr.2006.10.017"},{"key":"2021120902451207300_R21","doi-asserted-by":"crossref","unstructured":"Russo RN, Crotty M, Miller MD, Murchland S, Flett P, Haan E. Upper-limb botulinum toxin A injection and occupational therapy in children with hemiplegic cerebral palsy identified from a population register: a single-blind, randomized, controlled trial. Pediatrics.\u20082007;119(5). Available at: www.pediatrics.org\/cgi\/content\/full\/119\/5\/e1149","DOI":"10.1542\/peds.2006-2425"},{"key":"2021120902451207300_R22","doi-asserted-by":"crossref","unstructured":"Taub E, Ramey S, DeLuca S, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics.\u20082004;113(2):305\u2013312","DOI":"10.1542\/peds.113.2.305"},{"key":"2021120902451207300_R23","doi-asserted-by":"crossref","unstructured":"Sung IY, Ryu JS, Pyun SB, Yoo SD, Song WH, Park MJ. Efficacy of forced-use therapy in hemiplegic cerebral palsy. Arch Phys Med Rehabil.\u20082005;86(11):2195\u20132198","DOI":"10.1016\/j.apmr.2005.05.007"},{"key":"2021120902451207300_R24","doi-asserted-by":"crossref","unstructured":"Deluca SC, Echols K, Law CR, Ramey SL. Intensive pediatric constraint-induced therapy for children with cerebral palsy: randomized, controlled, crossover trial. J Child Neurol.\u20082006;21(11):931\u2013938","DOI":"10.1177\/08830738060210110401"},{"key":"2021120902451207300_R25","doi-asserted-by":"crossref","unstructured":"Charles J, Wolf S, Schneider J, Gordon A. Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. Dev Med Child Neurol.\u20082006;48(8):635\u2013642","DOI":"10.1111\/j.1469-8749.2006.tb01332.x"},{"key":"2021120902451207300_R26","doi-asserted-by":"crossref","unstructured":"Brown GT, Burns SA. The efficacy of neurodevelopmental treatment in paediatrics: a systematic review. Br J Occup Ther.\u20082001;64(5):235\u2013244","DOI":"10.1177\/030802260106400505"},{"key":"2021120902451207300_R27","doi-asserted-by":"crossref","unstructured":"Steultjens EM, Dekker J, Bouter LM, van de Nes JC, Lambregts BL, van den Ende CH. Occupational therapy for children with cerebral palsy: a systematic review. Clin Rehabil.\u20082004;18(1):1\u201314","DOI":"10.1191\/0269215504cr697oa"},{"key":"2021120902451207300_R28","doi-asserted-by":"crossref","unstructured":"Autti-Ra\u0308mo\u0308 I, Suoranta J, Anttila H, Malmivaara A, Ma\u0308kela\u0308 M. Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy: an overview of review articles. Am J Phys Med Rehabil.\u20082006;85(1):89\u2013103","DOI":"10.1097\/01.phm.0000179442.59847.27"},{"key":"2021120902451207300_R29","doi-asserted-by":"crossref","unstructured":"Reeuwijk A, van Schie PEM, Becher JG, Kwakkel G. Effects of botulinum toxin type A on upper limb function in children with cerebral palsy: a systematic review. Clin Rehabil.\u20082006;20(5):375\u2013387","DOI":"10.1191\/0269215506cr956oa"},{"key":"2021120902451207300_R30","doi-asserted-by":"crossref","unstructured":"McCubbin JA, Shasby GB. Effects of isokinetic exercise on adolescents with cerebral palsy. Adapt Phys Activ Q.\u20081985;2(1):56\u201364","DOI":"10.1123\/apaq.2.1.56"},{"key":"2021120902451207300_R31","doi-asserted-by":"crossref","unstructured":"Kawamura A, Campbell K, Lam-Damji S, Fehlings D. A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity. Dev Med Child Neurol.\u20082007;49(5):331\u2013337","DOI":"10.1111\/j.1469-8749.2007.00331.x"},{"key":"2021120902451207300_R32","doi-asserted-by":"crossref","unstructured":"Lowe K, Novak I, Cusick A. Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy. Dev Med Child Neurol.\u20082007;49(11):823\u2013829","DOI":"10.1111\/j.1469-8749.2007.00823.x"},{"key":"2021120902451207300_R33","doi-asserted-by":"crossref","unstructured":"Eliasson AC, Krumlinde-Sundholm L, Shaw K, Wang C. Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model. Dev Med Child Neurol.\u20082005;47(4):266\u2013275","DOI":"10.1017\/S0012162205000502"},{"key":"2021120902451207300_R34","doi-asserted-by":"crossref","unstructured":"Jannink MJ, van der Wilden GJ, Navis DW, Visser G, Gussinklo J, Ijzerman M. A low-cost video game applied for training of upper extremity function in children with cerebral palsy: a pilot study. Cyberpsychol Behav.\u20082008;11(1):27\u201332","DOI":"10.1089\/cpb.2007.0014"},{"key":"2021120902451207300_R35","doi-asserted-by":"crossref","unstructured":"Ozer K, Chesher SP, Scheker LR. Neuromuscular electrical stimulation and dynamic bracing for the management of upper-extremity spasticity in children with cerebral palsy. Dev Med Child Neurol.\u20082006;48(7):559\u2013563","DOI":"10.1111\/j.1469-8749.2006.tb01315.x"},{"key":"2021120902451207300_R36","doi-asserted-by":"crossref","unstructured":"Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil.\u20082002;83(8):1157\u20131164","DOI":"10.1053\/apmr.2002.34286"},{"key":"2021120902451207300_R37","doi-asserted-by":"crossref","unstructured":"Saleh M, Korner-Bitensky N, Snider L, et al. Actual vs. best practices for young children with cerebral palsy: a survey of paediatric occupational therapists and physiotherapists in Quebec, Canada. Dev Neurorehabil.\u20082008;11(1):60\u201380","DOI":"10.1080\/17518420701544230"},{"key":"2021120902451207300_R38","doi-asserted-by":"crossref","unstructured":"Bly L. A historical and current view of the basis of NDT. Pediatr Phys Ther.\u20081991;3(3):131\u2013135","DOI":"10.1097\/00001577-199100330-00005"},{"key":"2021120902451207300_R39","doi-asserted-by":"crossref","unstructured":"Charles J, Gordon AM. Development of hand-arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy. Dev Med Child Neurol.\u20082006;48(11):931\u2013936","DOI":"10.1111\/j.1469-8749.2006.02039a.x"},{"key":"2021120902451207300_R40","doi-asserted-by":"crossref","unstructured":"Gilmore R, Boyd R, Sakzewski L. A systematic review of upper limb activity measures for 5\u201316 year old children with congenital hemiplegia. Dev Med Child Neourol.\u20082008;50(Suppl 4):66","DOI":"10.1111\/j.1469-8749.2009.03369.x"},{"key":"2021120902451207300_R41","doi-asserted-by":"crossref","unstructured":"Novak I, Cusick A, Lowe K. A pilot study on the impact of occupational therapy home programming for young children with cerebral palsy. Am J Occup Ther.\u20082007;61(4):463\u2013468","DOI":"10.5014\/ajot.61.4.463"},{"key":"2021120902451207300_R42","doi-asserted-by":"crossref","unstructured":"Kuhnke N, Juenger H, Walther M, Berweck S, Mall V, Staudt M. Do patients with congenital hemiparesis and ipsilateral corticospinal projections respond differently to constraint-induced movement therapy?Dev Med Child Neurol.\u20082008;50(12):898\u2013903","DOI":"10.1111\/j.1469-8749.2008.03119.x"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/123\/6\/e1111\/1007966\/zpe006090e1111.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/123\/6\/e1111\/1007966\/zpe006090e1111.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T14:24:24Z","timestamp":1710339864000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/123\/6\/e1111\/71610\/Systematic-Review-and-Meta-analysis-of-Therapeutic"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,6,1]]},"references-count":42,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2009,6,1]]},"published-print":{"date-parts":[[2009,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-3335","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,6,1]]}}}