| المستخلص: |
Background: Systematic review is the application of scientific strategies and a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise, and synthesis of all relevant studies on a specific topic. Objective: The aim of this review was to investigate the effectiveness of non-invasive brain stimulation (NIBS) with constraint-induced movement therapy (CIMT) over the primary motor cortex (M1) to probe brain plasticity on upper extremity (UE) function in children after stroke. Subjects: Children (≤ 18 years-old) with hemiplegic cerebral palsy (CP) of different severity. Design: A systematic review and mete-analysis. Our search in electronic database included PubMed, PEDro, Science Direct and Cochrane between 2000 and December 2020 was conducted using the following keywords: “constraint induced movement therapy”, “constraint movement therapy” and “modified constraint movement therapy”, “trans-magnetic stimulation”, “repetitive trans magnetic stimulation” and “trans direct current stimulation”, “cerebral palsy”, “non-invasive brain stimulation”, “motor function”, “upper extremity”. Results: In total, 7 studies involved (pooled participants = 140; mean ±SD 20 ±2.94 / study) met the selection criteria. The meta-analysis revealed a significant treatment effect of the PedsQL in the real group with a significant decrease in the PedsQL in the sham group in compare with the pretreatment baseline values. However, there was no significant change demonstrated by the Assisting Hand Assessment (AHA) between groups at posttest, and 6-months post-treatment evaluations. However, it should be noted that the AHA score values tend to be significant higher (P= 0.12). Also, similar patterns of improvement were noted in the COPM-P, COPM-S with no significant differences. For stereognosis, no significant change was observed between both groups. However, the change in stereognosis tends to be significantly higher (P= 0.24). Conclusion: Hemiparetic children participating in intensive rehabilitation programs can achieve sustained functional gains, but additional randomized controlled trials (RCTs) of CIMT and NIBS with large sample size on hemiplegic CP children are needed.
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