Infants with hemiplegic cerebral palsy who receive early constraint-induced movement therapy (CIMT) have better hand function than controls in the short term and probably substantially better hand function in the long-term. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9641643/

Infants with any type and topography of cerebral palsy who receive Goals-Activity-Motor Enrichment (GAME), which is an early, intense, enriched, task-specific, training-based intervention at home, have better motor and cognitive skills at 1 year than those who receive usual care; and that improvements are even better when intervention occurs at home because children learn best in supported natural settings where training is personalized to their enjoyment. Task-specific, motor training-based early intervention (eg, GAME and CIMT)are recommended as the new paradigm of care for cerebral palsy because they induce neuroplasticity and produce functional gains. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9641643/

All children with cerebral palsy have, by definition, a motor impairment and difficulties with tasks involving motor performance [255]. In high-income countries, severity is lessening, and the rate of co-occurring epilepsy and intellectual disability is falling [2]. Three in four will now walk [2]. This decline in severity is encouraging. Children with cerebral palsy may be more likely than ever to be treatment responsive to motor interventions, because smaller brain injuries result in improved baseline motor, sensory, and perceptual skills and learning capabilities. Thus, understanding current evidence for effective motor interventions is critically important. There is now a clear dichotomy in the evidence base for what works and what does not for improving function and performance of tasks. Substantive clinical trial data support the efficacy of training-based interventions, including action observation training [20, 21], bimanual training [54–56], constraint-induced movement therapy [46, 62–67], functional chewing training [137], goal-directed training [98], home programs using goal-directed training [112], mobility training [123, 127], treadmill training [65, 123, 127], partial body weight support treadmill training [123, 127, 169], and occupational therapy post botulinum toxin [190] (green lights). Moreover, environmental enrichment to promote task performance is effective (green light) [95] and adapting the environment and task to enable task performance via context-focused therapy (yellow light) [77] is a potent modulator of effective care. All these interventions have the following features in common: practice of real-life tasks and activities, using self-generated active movements, at a high intensity, where the practice directly targets the achievement of a goal set by the child (or a parent proxy if necessary). The mechanism of action is experience-dependent plasticity [256]. Motivation and attention are vital modulators of neuroplasticity, and successful task-specific practice is rewarding and enjoyable to children, producing spontaneously regular practice [256]. In stark contrast, bottom-up, generic, and/or passive motor interventions are less effective and sometimes clearly ineffective for improving function and movement for children with cerebral palsy. These include craniosacral therapy [239–241], hyperbaric oxygen [234, 235], neurodevelopmental therapy in the original passive format [108, 129–132], and sensory integration [3] (red lights). When viewed through the lens of neuroplasticity, these results are logical. A passive experience of a movement, provided via a hands-on therapeutic approach from a carer or therapist, does not involve any child-initiated problem solving or any child activation of their motor circuity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035308/

There are also several adjunctive interventions that when combined with task-specific motor training may augment the positive effects of training. These include electrical stimulation [65, 92–94], hydrotherapy [108, 110, 111], taping [159–164], transcranial direct current stimulation [101, 166–168], and virtual reality serious gaming [33–47] (yellow lights, weak positive). These interventions warrant more research as children reported finding gaming interventions rewarding and normalizing, and preferred electrical stimulation to wearing ankle-foot orthoses from a comfort perspective [93]. Also, taping is better tolerated than traditional orthotics with children often reporting discomfort and dissatisfaction with these interventions or disliking the cosmetic effect [73, 140]. Other benefits from these adjunctive interventions include cardiorespiratory fitness and social integration, and the importance of which cannot be underestimated. Adjunctive suit therapy does not appear to have any additive benefit over and above motor training [156, 157]. Some children experience respiratory compromise, overheating, and peripheral cyanosis which resolve after removing the suit (yellow light, weak negative) [156, 157]. Suit therapy is therefore not recommended as a front-line treatment, or stand-alone treatment, nor should it be unsupervised [156, 157]. However, it is very important to recognize that for some families, the process and routine of donning a suit may mean they engage in more intensive therapies and active practice, which may produce positive results. We know that intensive task-specific motor practice is effective and works in a variety of treatment modalities [98]. The theory behind transcranial direct current stimulation having an augmentative effect to motor training, through provision of an additional targeted stimulation of the motor cortex, is logical, and more research is warranted [166–168]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035308/

The available studies about complementary and alternative medicine interventions for childhood cerebral palsy aimed to improve motor skills. Trials suggested efficacy with acupuncture [227, 228] and animal-assisted therapy [102] (yellow lights, weak positive). In contrast, conductive education [231, 232], massage [238], reflexology [243], Vojta [244–246], and Yoga [248] were probably ineffective for improving motor skills (yellow lights, weak negative), and cranial sacral osteopathy [239–241] and hyperbaric oxygen [234] showed no between-group differences for motor skills in moderate-quality trials and serious side effects occurred (red lights). Proponents of conductive education would claim that because the approach is holistic, that it is not reasonable to analyze indicators in isolation; nevertheless, these are the motor outcome results from published clinical trials. It is therefore important to note, conductive education may have benefits for social skills and quality of life outcomes [231]. The manual therapies, including massage (green light) [237] and cranial sacral osteopathy [241] and reflexology [243] (yellow lights, weak positive), appeared to help reduce constipation. Massage also appeared to help reduce pain [3•] (yellow light, weak positive), whereas Yoga did not [248] (yellow light, weak negative). However, Yoga did appear to improve attention, muscle flexibility, and balance (yellow light, weak positive) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035308/ [248].