Lakhasly

Cerebral palsy (CP) describes "a group of permanent dis- orders of the development of movement and posture, causing activity limitation, that are attributed to nonpro- gressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, percep- tion, cognition, communication, and behaviour, by epi- lepsy, and by secondary musculoskeletal problems [1]." The estimated prevalence in the general population is 2/ 1000 [2,3]. The limitations in activity require individual rehabilitation throughout life [4].
Physical therapy (PT) plays a central role in managing the condition; it focuses on function, movement, and optimal use of the child's potential. PT uses physical approaches to promote, maintain and restore physical, psychological and social well-being. Physiotherapists also teach parents how to handle their child at home for feeding, bathing, dressing and other activities, and give advice on mobility devices [5,6].
Physiotherapists emphasize the need for the practice to be evidence based whenever possible [5]. Previous reviews have addressed the effectiveness of PT interventions for children with CP focusing on neurodevelopmental ther- apy (NDT) [7-9], strength training [10,11], conductive education [12-15], various PT interventions [16-19], or orthotic devices [20,21]. These systematic reviews covered various study designs, with only a few assessing the study quality,andonly12randomizedcontrolledtrials(RCTs) were identified between 1973 and 1998. More recent sys- tematic review topics included focused interventions, such as constrained-induced movement therapy [22], pos- tural control [23], passive stretching [24], hydrotherapy [25], hippotherapy [26,27], and orthotic devices [28]. Overall, the effectiveness and efficacy of therapeutic inter- ventions for children with CP has been difficult to deter- mine owing to the lack of high-quality research. Siebes et al [29] identified an improvement in the methodological quality of the therapeutic intervention studies during the last decade, and Kunz et al [30] found the quality of PT tri- als to be better than their reputation.
Therapists, doctors and parents need new knowledge of the effects of widely used PT interventions for evidence- based decision-making. We wanted to evaluate the effec- tiveness of interventions in current use, i.e. published since 1990, as established in well-designed randomized studies.
Methods
Literature searches
We searched Medline, the Physiotherapy Evidence Data- base PEDro [31], CINAHL (a database for allied health
and nursing), and the Cochrane Controlled Trials Register from 1990 to February 2007. The reference lists of the identified studies and reviews were screened for addi- tional references. An experienced medical librarian for- mulated the search strategy for Ovid Medline (see Additional file 1, Word document: search strategy for Ovid Medline) and adapted it to the other database