Randomized clinical trials of physical therapy for cerebral palsy: a review of study outcomes, methodological quality, and publication merits.

The study aimed to examine the main characteristics of clinical trials of motor interventions in physical therapy in children with cerebral palsy (CP). The Physiotherapy Evidence Database (PEDro) was used to collect information on clinical trials regarding motor outcomes in physical therapy in children with CP. Two reviewers independently screened, selected the studies, and extracted data. The characteristics extracted were CP subtype; age group; gross motor function and manual motor ability; methodological quality; open access status; 2020 journal impact factor, Consolidated Standards of Reporting Trials (CONSORT) endorsement; primary outcome; intervention adopted, and assessment instruments. The search strategy resulted in 313 articles from 120 different journals. Most of the clinical trials included participants with spastic bilateral subtype, aged between 6 and 12 years old, and with fewer limitations in gross and manual motor abilities. The most used primary outcomes covering the International Classification of Functioning, Disability and Health (ICF) domain of activity were gross motor function (18.8%) and upper limb and hand function (16.3%), with the Gross Motor Function Measurement being the most frequently used instrument (19.8%). Articles with better scores on the PEDro scale were published in journals with a higher impact factor, and higher rates of CONSORT endorsement, and most were not open access. Clinical trials investigating motor interventions used in physical therapy for children with CP tend to focus on patients with milder gross and manual motor function impairments and often explore the body function domain of the ICF. Furthermore, these studies have moderate methodological quality, and a substantial proportion of them fail to follow adequate reporting and methodological recommendations.

Association of environmental enrichment and locomotor stimulation in a rodent model of cerebral palsy: Insights of biological mechanisms.

Several physiotherapy approaches are used with different aims in the treatment of cerebral palsy (CP), such as the early stimulation and the locomotor training, but their biological effects, isolated or combined, are not completely known. In animals models, these strategies can be compared, with due translational restrictions, to the environmental enrichment (EE), that involves the enhancement of animal's physical and social environment, and locomotor stimulation (LS), that can be performed using the treadmill adapted for rats. This study was designed to describe which biological and functional mechanisms underlying rehabilitative process in clinical practice. Male rat pups were initially divided in two groups: control (healthy) and submitted to a CP model. Then, pups were divided in eight groups: CP, CPEE, CPLS, CPEELS and its respectively control groups. Functional outcomes were assessed at the postnatal day (P) 31 and P52. The tibialis anterior and soleus muscles, tibia bone parameters, the expression of synaptophysin in the primary motor cortex (M1) and ventral horn (VH) of the spinal cord, were evaluated. The association of therapies was able to improve the functional assessments and musculoskeletal parameters. Isolated therapies presented complementary benefits in CP, but the association of therapies proved to be a fundamental and effective strategy to functional recovery, besides alter positively all biological tissues evaluated in this study.