The evidence-base for conceptual approaches and additional therapies targeting lower limb function in children with cerebral palsy : a systematic review using the International Classification of Functioning, Disability and Health as a framework

Objective: This systematic review provides an overview of the effectiveness of conceptual approaches and additional therapies used in lower limb physical therapy of children with cerebral palsy and supports the development of clinical guidelines. Data sources and study selection: A literature search in 5 electronic databases was performed, extracting literature published between 1995 and 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health (ICF). Data extraction: Three evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system. Data synthesis: A total of 37 studies used conceptual approaches (neurodevelopmental treatment (NDT), conductive education, Vojta therapy, sensory integration, functional training and goal-oriented therapy) and 21 studies focused on additional therapies (aquatic therapy and therapeutic horse-riding). Conclusion: Level II evidence was found for the effectiveness of therapeutic horse-riding on posture and for NDT and functional training on gross motor function. Goal-oriented therapy and functional training were effective on the attainment of functional goals and participation. With level IV evidence, NDT was effective on all levels of the ICF.