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There is little evidence on the effect of upper limb strengthening in children with cerebral palsy

Prepared by:

Kirsty  Stewart, Senior Occupational Therapist, Department of Rehabilitation and

Margaret Wallen, Senior Occupational Therapist ? Research, The Children?s Hospital at Westmead  (email: margarew@chw.edu.au)


July 2008

Review Date:

July 2010

Clinical Question:

What is the evidence that upper limb strengthening is effective in increasing active upper limb range of motion, upper limb function and performance of activities of daily living in children with CP?

Clinical Scenario:

A growing body of evidence supports the use of strengthening in children with cerebral palsy (CP). Muscle weakness is a secondary consequence of cerebral palsy and impacts not only on a child?s ability to move but on their ability to participate fully in activities of daily living. It is well documented that children with CP do not move as much as their typically developing peers and as such their muscles do not just atrophy but fail to develop normally (Damiano, 2008). Strengthening programs applied to children with CP are based on guidelines developed for children without disability. These guidelines, applied to lower limb strengthening in children with CP, are effective and safe, and evidence suggests that strengthening programs can improve motor activities as well as strength. Investigation of outcomes following upper limb strengthening programs is warranted.  Clinical best practice guidelines are also required to guide clinicians currently implementing these programs. 

Clinical Bottom Line:

There is scant evidence on the effect of upper limb strength training in children with CP.  Strength training appears to be safe and does not increase spasticity.

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