Effects of Physical Therapist Intervention on Pulmonary Function in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis

Objective. The purpose of this study was to evaluate the effects of physical therapy on pulmonary function and respiratory muscle strength in children with cerebral palsy (CP). Methods. A search of 10 databases was conducted for this systematic review. Initially, there were no language, study design, or time frame restrictions. All studies assessing the effect of physical therapy on the respiratory system in children with CP were included. Two reviewers independently extracted and documented data. The data extracted included description of the intervention (duration, therapeutic method) and study results (change of spirometric parameters, respiratory muscle strength). The effects of physical therapist treatment were calculated using software. Results. A total of 269 children aged 5 to 18 years from 10 studies were included. The included studies consisted of 5 different therapeutic methods (inspiratory muscle training [IMT], aerobic training, swimming, respiratory exercise, exercise with elastic bands). Physical therapist intervention led to a significant increase in the maximal expiratory pressure (MEP) (I-2 = 0%), peak expiratory flow (I-2 = 0%), and maximum oxygen consumption (I-2 = 37%). A separate analysis of the most frequently used therapy (IMT) showed a positive effect on MEP (I-2 = 0%) and maximal inspiratory pressure (I-2 = 35%). Conclusion. Various forms of physical therapy have potential to demonstrate a positive effect on maximal inspiratory pressure, MEP, and peak expiratory flow in children with CP. There is no possibility to recommend the best method and duration of the physical therapy; however, it can be suggested that physical therapy should be applied for at least 4 weeks and include IMT. Impact. CP is one of the most common causes of physical disabilities in children, and pulmonary dysfunction is the leading cause of death in people with CP. Thus, it is warranted to seek different approaches that may improve pulmonary function in people with CP. This review has shown that various forms of physical therapy have potential to improve the pulmonary function of children with CP.