Cerebral palsy (CP) is a neuromuscular condition affecting 1 in 400 children that limits activities of daily living. Essential elements to improving function are feedback and repetition. Feedback about a motor performance communicated back to the individual (e.g. biofeedback) can be a powerful tool for improving autonomy and self-efficacy. However, the most effective mechanisms of biofeedback, particularly for people with CP remain unknown. This study aimed to identify the qualities of biofeedback interventions most effective for people with cerebral palsy (CP) through systematic review.

Eight databases and references from relevant articles were searched. Included studies had participants diagnosed with CP and any quantitative study design with N>3. Studies were evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Interventions needed to provide external feedback about the movement or performance. For available studies, effect sizes were compared to study characteristics (intervention duration/intensity, and feedback type).

Fifty-seven of the 205 full-texts reviewed were included. Overall, 79% of studies and 63% of measures showed post-intervention improvement. Studies with positive effects (r=0.47±0.26) were longer, averaging 8 weeks and 150minutes/week compared to studies with no changes (r=0.28±0.26), which were 3 weeks and 80minutes/week (Fig. 1). These studies also used multi-modal feedback (audio and visual) more commonly than unimodal feedback.

This study shows that biofeedback interventions can be effective for people with CP. The confidence in the effect would be strengthened by a thoughtful paradigm, a standardized outcome toolbox, and adequate practice intensity. These insights could raise intervention efficacy to help people with CP improve motor activities.