Table 1.

Physical therapy treatment in detail.

Authors	RPT	Goal	Frequency	Duration	Intensity	Method of treatment
Åkerstedt14		Mobilization to standing and walking.	2–4 sessions weekly in the first year after surgery. At 2-year follow-up frequency varied between 0.25 and 1 time/week.	30 min to 2 h per session in the 1st year after surgery followed by shorter sessions (45–90 min) weekly in the 2nd year after surgery.	Not mentioned.	Every child had a training program with exercises for daily training. The training was based on individual needs and included different quantity of the components; active and passive movement, muscle strength, stretching, balance and gait towards more complex functional tasks. However, the exact treatment and specific exercises were not described. Instruction and guidance to the child, parents, assistant and teachers were very important and integrated with training sessions.
Khan15		Standing and walking not further specified categorized by the modified functional walking scale of Hoffer et al.*	Two to four times a week. By giving the parents a home programme, which was reinforced each visit, the need of excessive visit became less and the visits gradually became less frequent.	1–3 h per session without mentioning the length of rehabilitation period.	Not mentioned.	All the children were taught exercises to improve their range of movement as outpatients and were provided with post-operative plasters, ankle foot orthoses (AFO ) and ‘long leg Gutter type’ night splints. Nothing was described about the exercise program.
Patikas ext torque16	The article lacked a precise exercise description, duration, frequency and intensity of the RPT. Only the EG is described.	An exercise protocol targeted to muscle strengthening could be assistive for maintaining muscle strength in children with CP after surgery.	At least three times a week, with an optimal target of four times a week.	The parents completed a logbook providing information about the frequency of the training session at home. (duration 8.70 ± 0.95 months). Each training session was 30–45 min long depending on the child.	Each training session consisted of 7 exercises for both sides, Two sets of 5 repetitions each exercise; 1 min rest between each set and drill. Movement velocity was 4–5 sec per repetition progressive resistance exercise method, with and without manual assistance and with elastic bands if needed. Additional rubber-band layers were applied if the child could repeat a whole set without compensatory movements from other muscle groups.	The training for the EG started 3–4 weeks after the surgery when it was no longer painful to perform the exercise and there was no danger of recurring injury. Two physiotherapists taught and supervised the training protocol, which consisted of 7 exercises involving the hip and knee extensors and flexors, the abdominals, in supine, prone, sit and high knee position. For exercises 1 and 7, the tights were fastened together distally with rubber bands prohibit excessive hip abduction. They gave instructions to the children’s parents about executing the exercises after hospital discharge and written instruction about the performance were given. RM method was used.
Patikas and walking17	The content of the exercise program (RPT) remained unexplained.	The effect of RPT [control group (CG)] versus RPT combined with muscle strength training [strength training group (EG) program for home].	Two to four times a week (average 3.2±0.3).	This training program started 3–4 weeks after surgery with a median duration of 40 weeks (40.3 ± 0.4) with a duration of 30–45 min per session until 1 year after operation.	Two sets of five repetitions were performed for 7 exercise with a low velocity to permit movement control and eccentric activation of the muscles. If children succeeded in overcoming the resistance against gravity, elastics bands were used to increase resistance.	The training protocol consisted of 7 exercises involving the hip, knee and ankle extensors and flexors.
Seniorou18	RPT treatment continued uninterrupted during this additional training for both the AE and PRT groups and remained unexplained.	Compared the efficacy of progressive resistance strengthening (PRT) versus active exercises (AE) in children with CP following SEMLS.	Three times a week.	Each of the separate training period lasted 6 weeks. Duration of the training sessions were not mentioned. Frequency and duration of these sessions of RFT were also not mentioned.	Three sets of 10 repetitions for the muscle groups: hip flexors, hip extensors, hip abductors, knee extensors and knee flexors bilaterally.	Weight bearing was delayed 4–6 weeks when derotation osteotomies were performed. No weight-training exercises were included in this initial routine rehabilitation regime in any subject. The PRT group performed progressive resistance training using free weights. The weight was determined using a 10 RM for each muscle group and re-assessment and incremental weight increase were dictated by the child’s progress. The AE group exercised against gravity only.
Thomason19	For the SEMLS group started 3 months after surgery (SEMLS).	Improving the ROM, strength, balance and function.	Three times a week.	12 weeks.	Not mentioned.	Not mentioned.
	PRT group (both groups used custom fitted ankle foot ortheses.)	Strengthening the hip abductors and extensors, knee extensors and ankle plantar flexors.	Three times a week.	12 weeks.	The 3 exercises, involved ankle plantarflexor, knee extensor, and hip extensor with 8–10 repetitions. The training load was adjusted by adding free weights to a backpack worn by the participant.	A progressive resistance strength training mentioned elsewhere.39 RM method was used.

^*Hoffer MM, Feiwell E, Perry R, Perry J, Bonnett C. Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am.1973; 5: 137–148.

AE, active exercise group; CG, control group; CP, cerebral palsy; EG, exercise group; PRT, progressive resistance training; RPT, regular physical therapy; RM, repetion maximum; ROM, range of motion; SEMLS, single event multilevel surgery.