---
title: "Cerebral palsy"
url: "https://acuiq.com/wiki/evidence/cerebral-palsy"
updated: 2026-10-11
last_verified: 2026-10-11
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-11"
reading_minutes: 9
sources: 14
---

# Cerebral palsy

_What the withdrawn Cochrane protocol, six systematic reviews, two trials run with outside researchers and the guidelines report on acupuncture added to rehabilitation for children with cerebral palsy._

Cerebral palsy (CP) is a group of permanent disorders of movement and posture caused by damage to the developing brain. A 2022 review from Harbin describes acupuncture as the main Chinese-medicine treatment for CP, with the emphasis on scalp acupuncture, in which fine needles are placed along lines and areas of the scalp. Almost every trial of it compares rehabilitation with acupuncture against the same rehabilitation without it, and almost every trial was run in China. Several meta-analyses since 2018 pool those trials and report better motor scores with acupuncture added. Of the reviews in the table below, the one that graded the certainty of its evidence rated it low or very low, and an overview of the reviews rated every one it appraised low or very low in quality.

## The Cochrane protocol

Cochrane has no review of acupuncture for CP. A [protocol](https://doi.org/10.1002/14651858.CD007127.pub2) by Mingming Zhang and Jing Li at the Chinese Cochrane Centre in Chengdu, first published in 2008, set out to test whether acupuncture improves movement, daily activities, cognition and quality of life in children with spastic, athetoid or ataxic CP, and what harms it carries. No review followed, and in January 2017 Cochrane’s Developmental, Psychosocial and Learning Problems editors withdrew the protocol because it had been published more than eight years earlier.

## The reviews

| Review | Question | Trials and children | Appraisal of the trials |
| --- | --- | --- | --- |
| [Li 2018](https://doi.org/10.4103/1673-5374.233455) | Any acupuncture plus rehabilitation against rehabilitation alone; searched to April 2017 | 21 randomised trials, 1,718 children; 20 in China, 1 in Egypt | All at moderate or high risk of bias |
| [Xue 2022](https://doi.org/10.21037/tp-22-85) | Scalp acupuncture added to rehabilitation; trials from 2000 to 2021 | 11 randomised trials, 731 children | Two trials unblinded; concerns about outcome measurement in most |
| [Yuanjie 2023](https://doi.org/10.1155/2023/4662788) | Acupuncture plus routine treatment for abnormal muscle tone; searched to August 2022 | 15 trials, all Chinese | Not graded |
| [Cheng 2024](https://doi.org/10.3390/healthcare12171780) | Body, scalp or ear acupuncture, excluding electroacupuncture; searched to June 2023 | 20 randomised trials, 1,797 children; all in China | 25% at high risk of selection bias; 20% at low risk of detection bias |
| [Kang 2024](https://doi.org/10.3389/fneur.2024.1358732) | Jingjin (sinew channel) acupuncture for spastic CP; searched to November 2023 | 20 randomised trials, 1,453 patients | Some studies of low quality |
| [Liu 2025](https://doi.org/10.3389/fneur.2025.1502023) | Acupuncture plus language training against language training alone, for language delay; searched to July 2024 | 56 randomised trials, 4,683 children; all published in Chinese | Mostly high or unclear risk of bias; GRADE low or very low |

Ling-Xin Li and colleagues at West China Hospital, Mingming Zhang of the withdrawn protocol among them, pooled 13 trials for the Gross Motor Function Measure (GMFM), the standard scale of what a child with CP can do with their body, such as sitting, crawling and walking. They report a standardised mean difference of 0.64 in favour of acupuncture plus rehabilitation (95% confidence interval 0.52 to 0.76), and pooled improvements in spasticity on the Modified Ashworth Scale (MAS), which grades how much a muscle resists being stretched, and in daily activities. Three trials reported adverse events: in one, children cried and felt minor pain in the first sessions, and two reported none. The authors asked that their result be read with caution because the trials were few and small.

Yuman Xue and colleagues at Heilongjiang University of Chinese Medicine in Harbin found that the scalp sites differed between trials but every trial needled [`GV20`](/points/GV20) (Baihui) at the crown, along with motor, sensory, balance and language areas of the scalp. They report better effective rates, development indices and GMFM scores with scalp acupuncture added, and one trial that recorded slight bleeding at needle sites. A [letter](https://doi.org/10.21037/tp-22-249) from Qingbo Feng and colleagues at West China Hospital pointed out that the review had searched only PubMed for English-language trials, was not registered in advance, and ran no sensitivity analysis.

Yu-Yen Cheng and colleagues at Chang Gung Memorial Hospital in Taiwan report a mean difference in GMFM score of 5.93 in favour of acupuncture (95% CI 3.67 to 8.19), and better spasticity, balance and daily-activity scores. Two of their 20 trials had a sham acupuncture arm as a second control, one with minimal skin contact and one with a retractable placebo needle; the authors judged them too few and too different to analyse together. Four trials recorded adverse events and none reported a serious one. The authors mapped which points the trials used and found three recurring sets: [`XH01A`](/points/XH01A) (Sishencong), one of four points around the crown catalogued as `XH01A` to `XH01D`, with [`GV24`](/points/GV24) (Shenting) and [`GB13`](/points/GB13) (Benshen) on the forehead; [`GB06`](/points/GB06) (Xuanli), [`GB08`](/points/GB08) (Shuaigu) and [`GB09`](/points/GB09) (Tianchong) on the side of the head; and [`ST36`](/points/ST36) (Zusanli), [`LV03`](/points/LV03) (Taichong) and [`SP06`](/points/SP06) (Sanyinjiao) on the legs and feet.

The narrower reviews follow the same pattern. Yuanjie and colleagues at Hebei University of Chinese Medicine report a pooled MAS difference of −0.52 (95% CI −0.62 to −0.41) in favour of acupuncture. Xin Kang and colleagues report an odds ratio of 4.70 for the overall effective rate with Jingjin acupuncture, and call for better-designed trials. Shuzhen Liu and colleagues in Tianjin report better language comprehension and verbal scores when acupuncture was added to language training, and found that only one of their 56 trials reported on safety. Each of these reviews pooled an “effective rate”, the share of children a trial judged improved, alongside scale scores.

An [overview](https://pubmed.ncbi.nlm.nih.gov/37802530/) by Lu and colleagues, published in Chinese in 2023, appraised 14 of these systematic reviews. On AMSTAR 2, a checklist for how well a review was conducted, it rated 4 low and 10 very low in quality. Of the 37 outcomes they reported, it graded 3 high, 7 moderate, 10 low and 17 very low in certainty under GRADE, the standard scale for how far a body of evidence can be trusted, downgraded mainly for the trials’ limitations, imprecision and publication bias.

## The trials

The pooled trials compare rehabilitation with and without acupuncture, so children in the control group had fewer sessions, less contact and no needles, and neither the children, the parents nor usually the assessors were blinded. [Sham acupuncture](/wiki/research/sham-acupuncture) explains the designs that try to separate needling from everything around it, and [Where the trials come from](/wiki/research/where-the-trials-come-from) sets out why a literature drawn almost wholly from one country is read with care.

Two trials run with researchers outside mainland China tested the comparison differently. In a [2004 trial](https://doi.org/10.1136/jnnp.2003.021485) from the University of Hong Kong, Jun-Gang Sun and colleagues randomised 33 children with CP to tongue acupuncture (22) or sham acupuncture (11); the GMFM rose more in the tongue acupuncture group (p = 0.042). In a [2012 trial](https://doi.org/10.1016/j.apmr.2011.12.009), Burris Duncan and colleagues randomised 75 children aged 12 to 72 months with spastic CP at a children’s hospital in Beijing to 12 weeks of intensive physical, occupational and hydrotherapy, five days a week, with or without acupuncture. Assessments were video-recorded and scored blind at a university in the United States. At 12 weeks the two groups did not differ significantly on the GMFM or the Pediatric Evaluation of Disability Inventory, a measure of self-care and mobility. Taken together, the children improved significantly over the 12 weeks, and the authors concluded that the contribution from acupuncture was unclear.

## Guidelines

The [State of the Evidence Traffic Lights 2019](https://doi.org/10.1007/s11910-020-1022-z) by Iona Novak and colleagues, published in 2020, graded every intervention for children with CP with GRADE and a traffic-light system. It gave acupuncture for motor skills a yellow light, weak positive, the rating it defines as “probably do it”, citing the Li review and a 2012 review. It also notes a substantial rise in the number of systematic reviews of acupuncture for CP since its 2013 edition.

NICE’s guideline on [cerebral palsy in under 25s](https://www.nice.org.uk/guidance/ng62/chapter/Recommendations) (NG62), published in January 2017, does not mention acupuncture. For movement and posture it refers to NICE’s guideline on [spasticity in under 19s](https://www.nice.org.uk/guidance/cg145/chapter/Recommendations) (CG145), published in 2012 and last updated in November 2016, whose recommendations do not mention it either.

## Safety in children

The trials report few adverse events, but most did not report on harms at all: three of the 21 trials in the Li review and one of the 56 in the Liu review did. [Acupuncture for children](/wiki/safety/acupuncture-for-children) covers what the wider paediatric literature records of harms, and [Scalp acupuncture](/wiki/techniques/scalp-acupuncture) describes the lines and areas the trials needled.

## What the reviews could not settle

The reviews could not separate acupuncture from the extra attention and treatment time that came with it, because few trials used a sham arm and the Duncan trial, whose outcomes were scored blind in the United States, found no significant difference at 12 weeks. They could not say which form of acupuncture, which points or how many sessions matter, since protocols differed from trial to trial. The Li review found one trial that followed children for 12 months. With the trials drawn almost wholly from China, the reviews could not say whether the results carry to rehabilitation services elsewhere. The AcuiQ pages for [cerebral palsy](/symptoms/cerebral-palsy) and [spasticity](/symptoms/spasticity) list the protocols published trials prescribed, each with its source, and [Stroke recovery](/wiki/evidence/stroke-recovery) covers the adult literature on scalp acupuncture after brain injury.

### Sources

1. Zhang M, Li J, Acupuncture for children with cerebral palsy (protocol, withdrawn 2017), Cochrane Database of Systematic Reviews 2017, CD007127 — https://doi.org/10.1002/14651858.CD007127.pub2
2. Li LX, Zhang MM, Zhang Y, He J, Acupuncture for cerebral palsy: a meta-analysis of randomized controlled trials, Neural Regeneration Research 2018;13:1107-17 — https://doi.org/10.4103/1673-5374.233455
3. Xue Y, Shi S, Zheng S, Yang Z, Xu J, Gong F, Therapeutic effect of scalp-based acupuncture and moxibustion as an adjunctive treatment on children with cerebral palsy comparing to conventional rehabilitation therapy: a systematic review and meta-analysis of randomized controlled trials, Translational Pediatrics 2022;11:631-41 — https://doi.org/10.21037/tp-22-85
4. Feng Q, Liu X, Ren Q, Liao W, Li J, Is scalp-based acupuncture and moxibustion better than conventional rehabilitation therapy for children with cerebral palsy? (letter), Translational Pediatrics 2022;11:1735-6 — https://doi.org/10.21037/tp-22-249
5. Yuanjie Y, Jianyi X, Jinyan X, Mao H, Siyang Y, Zhenjin Y, Acupuncture in the treatment of abnormal muscle tone in children with cerebral palsy: a meta-analysis, Behavioural Neurology 2023;2023:4662788 — https://doi.org/10.1155/2023/4662788
6. Cheng YY, Huang YY, Yang TH, Chang YJ, Fu RH, Chen HY, Acupuncture and acupoints for managing pediatric cerebral palsy: a meta-analysis of randomized controlled trials, Healthcare 2024;12:1780 — https://doi.org/10.3390/healthcare12171780
7. Kang X, Huang Y, Zheng Y, et al., Meta-analysis of the efficacy of Jingjin acupuncture therapy in the treatment of spastic cerebral palsy, Frontiers in Neurology 2024;15:1358732 — https://doi.org/10.3389/fneur.2024.1358732
8. Liu S, Li Y, Chang J, Shi J, Zhao L, Acupuncture combined with language training for aphasia in children with cerebral palsy: a systematic review with meta-analysis and trial sequential analysis, Frontiers in Neurology 2025;16:1502023 — https://doi.org/10.3389/fneur.2025.1502023
9. Lu XF, Tao YW, Liu F, Xu YQ, Gong MQ, Yang ZX, Re-evaluation of systematic reviews of acupuncture and moxibustion for children with cerebral palsy (in Chinese), Zhongguo Zhen Jiu 2023;43:1209-16 — https://pubmed.ncbi.nlm.nih.gov/37802530/
10. Sun JG, Ko CH, Wong V, Sun XR, Randomised control trial of tongue acupuncture versus sham acupuncture in improving functional outcome in cerebral palsy, Journal of Neurology, Neurosurgery and Psychiatry 2004;75:1054-7 — https://doi.org/10.1136/jnnp.2003.021485
11. Duncan B, Shen K, Zou LP, et al., Evaluating intense rehabilitative therapies with and without acupuncture for children with cerebral palsy: a randomized controlled trial, Archives of Physical Medicine and Rehabilitation 2012;93:808-15 — https://doi.org/10.1016/j.apmr.2011.12.009
12. Novak I, Morgan C, Fahey M, et al., State of the Evidence Traffic Lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy, Current Neurology and Neuroscience Reports 2020;20:3 — https://doi.org/10.1007/s11910-020-1022-z
13. NICE, Cerebral palsy in under 25s: assessment and management (NG62), National Institute for Health and Care Excellence, published January 2017 — https://www.nice.org.uk/guidance/ng62/chapter/Recommendations
14. NICE, Spasticity in under 19s: management (CG145), National Institute for Health and Care Excellence, published July 2012, last updated November 2016 — https://www.nice.org.uk/guidance/cg145/chapter/Recommendations