Critical review of passive muscle stretch: implications for the treatment of children in vegetative and minimally conscious states

The efficacy of passive muscle stretch in the treatment of children in vegetative (VS) and minimally conscious (MCS) states is reviewed. Seventeen studies are critically reviewed. Study quality was evaluated using a quality filter adapted from Guyatt. Levels of evidence were assigned to each study using criteria based on Sackett's guidelines and a recent adaptation of those guidelines. Based on these levels of evidence, specific recommendations were made. These recommendations were classified as grade A, B, C or D depending on the levels of evidence used to generate them. There is limited evidence to support the efficacy of passive muscle stretch to improve range of motion and reduce spasticity in children in VS and MCS. Caution must be used when interpreting these recommendations because of the limited number of studies available and the extrapolation of study results from a different population. Further research is needed to strengthen these recommendations and establish the efficacy of passive muscle stretch in the treatment of children in VS and MCS.