Effectiveness of Upper Extremity Exoskeletons in Children With Cerebral Palsy Within International Classification of Functioning, Disability and Health Domains: A Systematic Review

ABSTRACT Background Upper extremity impairments in children with cerebral palsy (CP) often lead to activity limitation and participation restrictions. Recent advances in exoskeleton technology offer promising potential for enhancing rehabilitation outcomes. This systematic review investigates the impact of upper extremity exoskeletons on children with CP using the International Classification of Functioning, Disability and Health (ICF) framework. Methods Following PRISMA guidelines, five electronic databases were searched without time limitations (PROSPERO ID: CRD42021282377). Studies included randomized and non‐randomized trials, focusing on upper extremity exoskeleton interventions for children with CP and published in English. Data were screened and extracted by two independent reviewers. The risk of bias was evaluated using the Revised Cochrane Risk of Bias Tool and the Risk of Bias in Non‐Randomized Studies of Interventions for randomized and non‐randomized studies, respectively. Results A review of 22 studies involving 274 participants assessed the effectiveness of upper extremity exoskeletons on children with CP across different ICF domains. The studies employed various designs, including randomized controlled trials, cohort studies and case series, with a primary emphasis on body functions and structures. Conclusion While advancements in body function and structure are noteworthy, they do not inherently lead to improved activity and participation, highlighting the importance of conducting further research to evaluate the effectiveness of exoskeletons, particularly in enhancing participation outcomes among children with CP.