Seventeen studies (n=704) were included in the review: 2 retrospective studies and 15 of some form of experimental design. Of the latter 15, 6 had no control group, 7 were randomised or quasi-randomised, and 2 were cohort studies with control groups.
Only two studies included children who could be considered to be in a vegetative or minimally conscious state. The quality of the studies and level of evidence varied considerably. There were 4 studies of PROM/PMS, 3 of PMS programmes and 10 of serial casting. The following recommendations were made in the review.
Repeated flexion-extension movements of the elbow may reduce spasticity (grade D).
A prolonged muscle stretch of 10 to 30 minutes' duration is effective in reducing spasticity immediately and for up to 35 minutes following the stretch (grade C).
Manual passive stretching exercises held for 20 to 60 seconds per repetition for five repetitions are as effective when provided twice weekly as when provided five times per week (grade B).
Passive stretching exercises held for 60 seconds per repetition for five repetitions three times weekly may be effective in reducing knee flexion contractures (grade C).
Prolonged stretching of the hip adductor muscles for 5 to 7 hours per day may prevent hip adductor muscle contracture (grade D).
Serial casting is effective in increasing joint range of motion (grade C).
Serial casting might be effective in reducing spasticity (grade D).