Motor Learning Feeding Interventions for Infants at Risk of Cerebral Palsy: A Systematic Review

Khamis, Amanda; Novak, Iona; Morgan, Catherine; Tzannes, Gloria; Pettigrew, Jane; Cowell, Jeanette; Badawi, Nadia

doi:10.1007/s00455-019-10016-x

Cited by 19 publications

(15 citation statements)

References 37 publications

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“…There were 9 systematic reviews found . One review focused exclusively on children younger than 2 years, with others including broader age groups (eg, 16 months-3 years).…”

Section: Resultsmentioning

confidence: 99%

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy

et al. 2021

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IMPORTANCECerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEWThe literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument.FINDINGS Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5).CONCLUSIONS AND RELEVANCE When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.

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“…There were 9 systematic reviews found . One review focused exclusively on children younger than 2 years, with others including broader age groups (eg, 16 months-3 years).…”

Section: Resultsmentioning

confidence: 99%

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy

et al. 2021

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“…One reviewed the extent to which families were involved in early intervention but did not evaluate the effectiveness of the interventions themselves, 24 one reviewed coaching practices but did not consider child outcomes, 25 and one focused solely on parentchild interactions, not development. 26 One was on older children, 27 two included mixed or other diagnoses, 28,29 and three did not involve younger children and/or were not about CP exclusively. [30][31][32] Table 1 summarizes the data from each of the systematic reviews, including details from each of the included studies and indicating overlap where present.…”

Section: Resultsmentioning

confidence: 99%

Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews

Damiano

Longo

2021

Develop Med Child Neuro

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Aim To perform an overview of systematic reviews and more recent randomized controlled trials (RCTs) on early motor interventions in infants aged 0 to 3 years with or at risk of cerebral palsy to inform current clinical and research efforts and provide a benchmark to assess future interventions ideally initiated within the first 6 months. Method Standardized searches of the PubMed, Embase, Scopus, and Web of Science databases were conducted for systematic reviews (2009–2020) and RCTs (2015–2020). Results From 840 unique records, 31 full texts were reviewed, yielding three systematic reviews encompassing 46 studies, 16 with comparison groups, and six additional RCTs that met the criteria. Two enrichment‐ and activity‐based approaches had medium effect sizes on motor development, only one with low risk of bias; two others had large task‐specific effect sizes but some bias concerns; and three enriched environment studies with some bias concerns had medium effect sizes on cognitive development. Most had small or no effect sizes, bias concerns, and uncertain diagnostic determinations. Interpretation Data synthesis revealed limited data quantity and quality, and suggest, although not yet confirmed, greater benefit from early versus later intervention. Research efforts with greater early diagnostic precision and earlier intervention are accelerating, which may transform future outcomes and practices. For over 50% of trials within the reviews, the intervention was compared to standard care with only two showing efficacy. Similar to results in older children, constraint‐induced movement therapy (CIMT) emerged as efficacious with high effect sizes. CIMT was not superior to similarly intense bimanual training or occupational therapy. Goals‐Activity‐Motor Enrichment intervention initiated before 5 months of age was superior to equally intense standard care. Several other enriched environment strategies promoted cognitive and/or motor development.

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“…Larger, multicenter studies are needed to investigate early biomarkers of neurodevelopmental impairments, not only motor impairment and CP but also sensory, communication, and manual impairments. Evidence supports the benefits of an enriched environment for all high-risk infants, [32][33][34][35] and therefore clinicians should continue to encourage parents to provide exposure to developmentally appropriate activities to optimize outcomes for all infants.…”

Section: Discussionmentioning

confidence: 99%

Early Identification of Cerebral Palsy Using Neonatal MRI and General Movements Assessment in a Cohort of High-Risk Term Neonates

Glass

Gardner

et al. 2021

Pediatric Neurology

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Motor Learning Feeding Interventions for Infants at Risk of Cerebral Palsy: A Systematic Review

Cited by 19 publications

References 37 publications

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy

Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews

Early Identification of Cerebral Palsy Using Neonatal MRI and General Movements Assessment in a Cohort of High-Risk Term Neonates

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