The effectiveness of Baby-CIMT in infants younger than 12 months with clinical signs of unilateral-cerebral palsy; an explorative study with randomized design

Aim To identify developmental trajectories of hand function in infants aged 3 months to 12 months with unilateral cerebral palsy (CP). Method Infants at high risk of unilateral CP were recruited from 3 months of age from follow‐up programmes and clinics in Sweden, the Netherlands, Italy, and Australia. Measurements on the Hand Assessment for Infants (HAI) were completed until 12 months of age. Group‐based trajectory modelling was used to identify subgroups of infants with similar trajectories of development. Multinomial logistic regression determined associations between demographic variables and trajectory membership. Results Ninety‐seven infants (52 males, 45 females; median gestational age 38wks [interquartile range 30–40wks]) were included. Infants were assessed between two and seven times (mean 4, SD 1.2) with a total of 387 observations. A three‐group trajectory model identified a ‘low‐functioning group’ (n=45: 46%), ‘moderate‐functioning group’ (n=30: 31%), and ‘high‐functioning group’ (n=22: 23%). Mean posterior probabilities (0.91–0.96) and odds of correct classification (26.3–33.2) indicated good model fit. Type of brain lesion, sex, side of hemiplegia, country, gestational age, and access to intensive intervention were not associated with group membership. Interpretation Three trajectories of hand function development for infants with unilateral CP were identified and indicate some greater distinctions between groups with increasing age. The HAI is a valuable measure, capturing development of hand function of infants with unilateral CP over time. What this paper adds Three distinct developmental trajectories of hand function in infants with unilateral cerebral palsy were identified. A low‐functioning group made little progress in development of hand function in the first year of life. The degree of impairment on the impaired hand at 6 months of age is highly associated with trajectory membership. Infants with all types of brain lesion were represented across each trajectory group.

Section: Discussionmentioning

confidence: 75%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Development of hand function during the first year of life in children with unilateral cerebral palsy

Sakzewski

Sicola

Verhage

et al. 2018

“…As the normative reference values are based on raw scores, they will still be applicable to all infants at risk of CP in determining whether the infant has a typical or atypical hand use. However, in order to follow the development of bimanual hand use or to evaluate an effect of an intervention, the group‐specific, logit‐based measure, the BoHM, is recommended …”

Section: Discussionmentioning

confidence: 99%

Hand Assessment for Infants: normative reference values

Eliasson

Sicola

et al. 2019

Self Cite

Aim To create normative reference values for unilateral and bilateral use of the hands, using the Hand Assessment for Infants (HAI), a newly developed criterion‐referenced assessment measuring hand use in infants aged 3 months to 12 months at risk of cerebral palsy (CP). Method In total, 489 HAI assessments of typically developing infants (243 females, 246 males), aged 3 months to 10 months (mean 6mo 14d [SD 2mo 5d]), were collected in Italy and Sweden. Normative growth curves based on mean and SDs were created, as well as skill acquisition curves for each test item. Correlation to age and differences between groups based on sex and nationality, as well as differences between the right and the left hand, were investigated. Results The growth curves showed a steady increase in mean value and a decrease in SD over age. There were no differences between groups based on sex or nationality. There was a negligible mean difference (0.1 raw score) between the right and left hands. Interpretation HAI normative reference values are now available, which can assist in identifying deviating hand use for each month of age, as well as a side difference between hands in infants at risk of CP. What this paper adds A Hand Assessment for Infants (HAI) result greater than 2SD below the mean indicates atypical hand use. Skill acquisition curves describe the age at which typically developing infants master the HAI items. Most typically developing infants do not demonstrate asymmetry in hand use.

“…The potential benefits of earlier intervention continue to be supported in the literature. As an example, a recently published exploratory study found that the use of baby‐constraint induced movement therapy with infants as young as 3 months to 8 months may improve functional outcomes for children with unilateral CP . To effectively target this recommendation it is essential to better understand the current clinical picture for referral practices.…”

Section: Discussionmentioning

confidence: 99%

Age at referral for diagnosis and rehabilitation services for cerebral palsy: a scoping review

Boychuck

Bussières

Goldschleger

et al. 2018

Aim This study sought to: (1) determine what is known about age at referral for diagnosis and rehabilitation services for children suspected of having cerebral palsy (CP); and (2) identify factors associated with earlier referral. Method A scoping review was conducted to summarize existing literature. We systematically searched Allied and Complementary Medicine, CINAHL, Cochrane Library, Embase, and PsycINFO for evidence published between 1979 and 2017 on age at referral for diagnosis or age at referral to rehabilitation services for children suspected of having CP. Quantitative and thematic analyses of the literature were performed. Results Our search yielded 777 articles, of which 15 met the inclusion criteria. Only one study focused on age at referral for diagnosis of CP (mean 16.6mo±19.2mo), with two on age at referral to rehabilitation services (means 13.9mo±15.8mo and 12.4mo). Potential predictors of earlier referral identified include referral source, type of CP, and a complicated birth history. Interpretation Evidence is sparse; however, available studies suggest high variation in the age at which children are being referred for diagnosis, typically ranging from 10 months to 21 months. Evidence indicates that subgroups of children with CP might be experiencing prolonged delays. Findings highlight the need to better understand what contributes to delays in referral for diagnosis and rehabilitation. What this paper adds Evidence on age at referral for diagnosis of cerebral palsy is sparse. Potential predictors of delayed referral represent targets to minimize delays in diagnosis. A subset of children may be experiencing unnecessary delays in referral.