Early intervention programmes for infants at high risk of atypical neurodevelopmental outcome

Abstract

The purpose of this review is to present a new framework, EI SMART (early intervention: sensorimotor development, attention and regulation, relationships, and therapist support) for identifying key components that could contribute to more effective interventions for infants at high risk of atypical neurodevelopmental outcome. We present a clinical consensus of current challenges and themes in early intervention, based on multidisciplinary group discussions, including parents of high‐risk infants, supported by a literature review. Components to include in early intervention programmes are: (1) promotion of self‐initiated, developmentally appropriate motor activity; (2) supporting infant self‐regulation and the development of positive parent‐infant relationships; and (3) promotion of early communication skills, parent coaching, responsive parenting, and supporting parental mental well‐being. Such multimodal programmes may need to be evaluated as a package. What this paper adds Early intervention programmes should address sensorimotor development, attention, self‐regulation, and early communication skills. Therapist input to the programme should include parent coaching and support for parental mental well‐being.

Movement Imitation Therapy for Preterm Babies (MIT-PB): a Novel Approach to Improve the Neurodevelopmental Outcome of Infants at High-Risk for Cerebral Palsy

“…Recently, a family-based intervention applied in preterm infants with abnormal GMs revealed positive effects on motor function (Kara et al 2019). Together with our own promising results, this adds to recent developments promoting family centred intervention programmes such as GAME (Morgan et al 2016b), COPCA (Hadders-Algra et al 2017), LEAP-CP (Benfer et al 2018), or EI-SMART (Hutchon et al 2019).…”

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

“…The results of our worldwide multicenter study confirm that GMA is advisably considered the reference standard for early identification of a high risk for CP. Infants with an MOS ≤ 14 who do not develop fidgety movements should be confidently referred to targeted early treatment programs during the period of greatest neuroplastic changes [3,4,40,41]. Importantly, infants with marked asymmetry in fidgety expression and segmental movements, indicative of probably unilateral CP, should also be referred for early intervention as they are responsive to treatment in this early phase [42,43,44].…”

“…Although small in numbers and statistically not significant, in the future, we must continue to explore an asymmetry of segmental movements in spite of the presence of normal fidgety movements. Such an asymmetry can be clinically relevant even if brain imaging does not indicate unilateral or indeed any other form of CP [8,66] in order to guarantee allocation to early targeted intervention for improving manual abilities [1,3,4,40,42,43,44]. As a word of caution, we must also be aware that 34 infants with a later diagnosis of unilateral CP (37%) did not show an asymmetry of segmental movements and among them were six infants who had developed fidgety movements.…”

“…Recent guidelines for the early identification of infants at risk for cerebral palsy (CP) recommend the Prechtl General Movement Assessment (GMA) in combination with neonatal magnetic resonance imaging (MRI) and the Hammersmith Infant Neurological Examination (HINE) as the assessments of choice [1]. Early identification aims at immediate referral for intervention to improve functional outcomes [2,3,4].…”

Significado relacional: Una propuesta de integración entre la tradicional observación de bebés y la semiótica

“…Este entrenamiento permite pesquisar patrones de riesgo para el desarrollo psíquico y somático infantil (Minjollet et al, 2018) y considerar derivaciones e intervenciones. (Hutchon et al, 2019).…”