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To review the literature on the effects of vestibular training on motor function and balance in children and youth with cerebral palsy. Eight databases (MEDLINE-PubMed, PEDro, Cochrane Library, OTSeeker, Web of Science, Scopus Database, CINAHL and SPORTDiscus.) were searched up to May 15th, 2023. Studies comparing vestibular training with other types of interventions. The DerSimonian and Laird method was employed using random effects models to calculate the pooled estimate of the effect size with confidence intervals of 95%. The risk of bias was assessed with the Cochrane Collaboration's tool and the Grading of Recommendations Assessment, Development and Evaluation approach was used to judge the certainty of the evidence for all outcomes. Eight studies were included comprising 226 participants with cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of vestibular training program compared to other technique(s) for Gross Motor Function Measure (−0.471; 95% confidence intervals: −0.919 to −0.023) and balance (−0.546; 95% confidence intervals: −0.916 to −0.176). Vestibular training has potential benefits in the short-term as a therapeutic approach for improving gross motor function and the balance in children and youth with cerebral palsy, but further research is needed. [ABSTRACT FROM AUTHOR]

Background: While constraint‐induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint‐induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis. Methods: This systematic review with meta‐analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0–6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint‐induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30–60, 61–90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool. Results: Seventeen studies were included. Meta‐analyses revealed significant differences among subgroups. The 30–60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb. Conclusions: Using a dosage ranging from 30 to 60 h when applying a constraint‐induced movement therapy protocol holds promise as the most age‐appropriate and cost‐effectiveness approach for improving upper limb functional outcomes and parent's perception. [ABSTRACT FROM AUTHOR]

Electrical microcurrent therapy (EMT) consists of the application of low intensity (μA) currents that are similar to endogenous electric fields generated during wound healing. To examine the effectiveness and safety of EMT for improving wound healing and pain in people with acute or chronic wounds. Randomized clinical trials (RCTs) assessing the effectiveness of EMT in wound healing published up to August 1st, 2020 were included. The main outcomes were wound surface area, healing time, and number of wounds healed. Secondary outcomes were pain perception and adverse events. A quantitative analysis was conducted using the inverse variance and Mantel-Haenszel methods. Eight RCTs were included in the qualitative summary and seven in the quantitative analysis (n = 337 participants). EMT plus standard wound care (SWC) produced a greater decrease in wound surface [mean difference (MD) = -8.3 cm2; CI 95%: −10.5 to −6.0] and healing time (MD = -7.0 days; CI 95%: −11.9 to −2.1) that SWC alone, showing moderate and low certainty in the evidence, respectively. However, no differences were observed in the number of healed wounds [risk ratio = 2.0; CI 95%: 0.5 to 9.1], with very low quality of evidence. EMT decreased perceived pain (MD = -1.4; CI 95%: −2.7 to −0.2), but no differences in adverse effects were noted between groups (risk difference = 0.05; CI 95%: −0.06 to 0.17). EMT is an effective, safe treatment for improving wound area, healing time, and pain. Further clinical trials that include detailed intervention parameters and protocols should be designed to lower the risk of bias. • First meta-analysis evaluating the effectiveness of external microcurrents devices. • Microcurrents are more effective than standard wound care alone. • Microcurrents are effective and safe in improving wound area, healing time, and pain. • Microcurrents can be equally effective as negative pressure wound therapy. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a major worldwide health concern. The acquisition of bone mass during growth decreases the risk of osteoporosis later in life. Muscular strength is an important and modifiable factor to improve bone development in this period. Objective: The aim of this review was to summarize the relationship between muscular strength and bone health. Methods: Cross-sectional data from studies addressing this association from childhood to young adulthood were systematically searched. The DerSimonian and Laird method was used to compute pooled estimates of effect size and respective 95% CI. The meta-analyses were conducted separately for upper limbs or lower limbs muscular strength and for bone regions. Additionally, a regression model was used to estimate the influence of determinants such as age, lean mass, fat mass, height, weight and cardiorespiratory fitness in this association. Results: Thirty-nine published studies were included in the systematic review. The pooled effect size for the association of upper limbs muscular strength with upper limbs, spine and total body BMD ranged from 0.70 to 1.07 and with upper limbs, spine and total body BMC ranged from 1.84 to 1.30. The pooled effect size for the association of lower limbs muscular strength with lower limbs, spine and total body BMD ranged from 0.54 to 0.88 and with lower limbs, spine and total body BMC ranged between 0.81 and 0.71. All reported pooled effect size estimates were statistically significant. Conclusion: This systematic review and meta-analysis supports that muscular strength should be considered as a useful skeletal health marker during development and a target outcome for interventions aimed at improving bone health. [ABSTRACT FROM AUTHOR]

Abstract Question In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality? Design A systematic review with meta-analysis of randomised controlled trials. Participants Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit. Intervention More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning. Outcomes measures Incidence of ventilator-associated pneumonia (VAP), duration of ICU stay, and mortality. Results Five trials were included in the meta-analysis. Random-effects models were used to calculate pooled weighted mean difference (WMD) for length of ICU stay and pooled risk ratio (RR) for incidence of VAP, and fixed-effects model was used to calculate pooled RR for mortality. The effect on the incidence of VAP was unclear (RR 0.73 in favour of multimodality respiratory physiotherapy, 95% CI 0.38 to 1.07). The effect on length of stay was also unclear (WMD –0.33 days shorter with multimodality respiratory physiotherapy, 95% CI –2.31 to 1.66). However, multimodality respiratory physiotherapy significantly reduced mortality (RR 0.75, 95% CI 0.58 to 0.92). Conclusion Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients. It was unclear whether this occurred via a reduction in the incidence of VAP and/or length of stay because the available data provided very imprecise estimates of the effect of multimodality respiratory physiotherapy on these outcomes. These very imprecise estimates include the possibility of very worthwhile effects on VAP incidence and length of ICU stay; therefore, these outcomes should be the focus of further investigation in rigorous trials. Registration PROSPERO CRD42018094202. [Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V (2018) Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy 64: 222–228] [ABSTRACT FROM AUTHOR]