Abstract
BackgroundGross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. The aim of this study was to systematically review the literature to investigate the effectiveness of conservative interventions to improve gross motor performance in children with a range of neurodevelopmental disorders.MethodsA systematic review with meta-analysis was conducted. MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PEDro, Cochrane Collaboration, Google Scholar databases and clinical trial registries were searched. Published randomised controlled trials including children 3 to ≤18 years with (i) Developmental Coordination Disorder (DCD) or Cerebral Palsy (CP) (Gross Motor Function Classification System Level 1) or Developmental Delay or Minimal Acquired Brain Injury or Prematurity (<30 weeks gestational age) or Fetal Alcohol Spectrum Disorders; and (ii) receiving non-pharmacological or non-surgical interventions from a health professional and (iii) gross motor outcomes obtained using a standardised assessment tool. Meta-analysis was performed to determine the pooled effect of intervention on gross motor function. Methodological quality and strength of meta-analysis recommendations were evaluated using PEDro and the GRADE approach respectively.ResultsOf 2513 papers, 9 met inclusion criteria including children with CP (n = 2) or DCD (n = 7) receiving 11 different interventions. Only two of 9 trials showed an effect for treatment. Using the least conservative trial outcomes a large beneficial effect of intervention was shown (SMD:-0.8; 95% CI:-1.1 to −0.5) with “very low quality” GRADE ratings. Using the most conservative trial outcomes there is no treatment effect (SMD:-0.1; 95% CI:-0.3 to 0.2) with “low quality” GRADE ratings. Study limitations included the small number and poor quality of the available trials.ConclusionAlthough we found that some interventions with a task-orientated framework can improve gross motor outcomes in children with DCD or CP, these findings are limited by the very low quality of the available evidence. High quality intervention trials are urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0731-6) contains supplementary material, which is available to authorized users.
Highlights
Gross motor skills are fundamental to childhood development
The systematic review included a total of nine published intervention trials [10, 43,44,45,46,47,48,49,50], all of which were included for consideration in the meta–analysis for the least and most conservative forest plots (Fig. 1)
Participants included children diagnosed with Cerebral Palsy (CP) Gross Motor Function Classification System (GMFCS) I (n = 2) [44, 47] or Developmental Co-ordination Disorder (DCD)
Summary
Gross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. Development of motor function is important for skill acquisition, and enabling children to participate fully in school and leisure activities [1]. It is important for establishing lifelong, physical activity patterns for healthy development into adulthood [2]. Gross motor skills use large muscle groups for coordinated body movements such as walking, running, jumping and the maintenance of balance. They are fundamental to childhood development as they underpin functional activities, play and social interaction and in older aged children support complex movement skills required for sport and fitness [3]. Poor gross motor performance may incline children towards activity avoidance and sedentary behaviors linked to an increased risk of chronic disease in adulthood [6,7,8]
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