Rehabilitation techniques to improve lower limb function for children with bilateral spastic cerebral palsy: a systematic review and meta-analysis.

This systematic review and meta-analysis pooled the efficacy of rehabilitation techniques on lower limb function in children with bilateral spastic cerebral palsy (BSCP) based on the International Classification of Functioning, Disability, and Health-Children & Youth version. Controlled trials written in English were searched in five databases (PubMed, Embase, Web of Science, ProQuest, Scopus) from inception to March 2025. PROSPERO registration: CRD 42024510104. A total of 55 trials involving 1501 children with BSCP, aged 3 years and above, were included in the meta-analysis. The rehabilitation techniques analyzed were treadmill training, functional mobility training, strength training, orthosis, non-invasive electrical stimulation, vibration, and home-based exercise programs. Most of the included trials targeted problems on gait parameters, kinematics parameters, and gross motor function for activities and participation. Meta-analysis showed that functional mobility training, such as action observation training, improved sitting, crawling and kneeling in children with BSCP; treadmill training, like platform swing walkway, mainly improved walking ability and velocity; ankle foot orthosis improved dynamic balance and range of ankle dorsiflexion during walking cycle. Subgroup analysis showed that ankle foot orthosis improved stride length within the first month of initial use and elevated walking cadence and velocity after three months of continuous use. Our findings may provide a reference for rehabilitation strategies on lower limb dysfunction in children with BSCP.