Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jul;63(7):771-784.
doi: 10.1111/dmcn.14855. Epub 2021 Apr 6.

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

Diane L Damiano  1 , Egmar Longo  2
Affiliations
Review

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

Diane L Damiano et al. Dev Med Child Neurol. 2021 Jul.

Abstract
in English, Spanish, Portuguese

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. What this paper adds 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.

OBJETIVO: Realizar un resumen de revisiones sistemáticas y ensayos controlados aleatorios (ECA) más recientes sobre intervenciones motoras tempranas en bebés de 0 a 3 años con o en riesgo de parálisis cerebral para informar los esfuerzos clínicos y de investigación actuales y proporcionar un punto de referencia para evaluar las intervenciones futuras de manera ideal iniciado dentro de los primeros 6 meses.

MÉTODO: Se realizaron búsquedas estandarizadas en las bases de datos PubMed, Embase, Scopus y Web of Science para revisiones sistemáticas (2009-2020) y ECA (2015-2020).

RESULTADOS: De 840 registros únicos, se revisaron 31 textos completos, lo que arrojó tres revisiones sistemáticas que abarcaron 46 estudios, 16 con grupos de comparación y seis ECA adicionales que cumplieron con los criterios. Dos enfoques basados en el enriquecimiento y la actividad tuvieron tamaños de efecto medios sobre el desarrollo motor, solo uno con bajo riesgo de sesgo; otros dos tenían grandes tamaños de efecto específicos de la tarea, pero algunos problemas de sesgo; y tres estudios de entornos enriquecidos con algunas preocupaciones sobre el sesgo tuvieron tamaños de efecto medios sobre el desarrollo cognitivo. La mayoría tenía tamaños de efecto pequeños o nulos, problemas de sesgo y determinaciones diagnósticas inciertas.

INTERPRETACIÓN: La síntesis de datos reveló una cantidad y calidad de datos limitadas, y sugiere, aunque aún no se ha confirmado, un mayor beneficio de la intervención temprana frente a la posterior. Se están acelerando los esfuerzos de investigación con una mayor precisión de diagnóstico temprano y una intervención más temprana, lo que puede transformar los resultados y las prácticas futuras.

OBJETIVO: Realizar uma revisão de revisões sistemáticas e estudos clínicos randomizados (ECRs) sobre intervenções precoces motoras em lactentes de 0 a 3 anos com paralisia cerebral ou de risco, para informar esforços clínicos e de pesquisas atuais e para fornecer uma base para avaliar futuras intervenções idealmente iniciadas nos primeiros 6 meses.

MÉTODO: Buscas padronizadas nas bases de dados PubMed, Embase, Scopus, e Web of Science foram realizadas quanto a revisões sistemáticas (2009–2020) e ECRs (2015–2020).

RESULTADOS: De 840 registros únicos, 31 textos completos foram revisados, reultado em 3 revisões sistemáticas que envolveram 46 estudos, 16 com grupo de comparação, e seis ECRs adicionais que atenderam aos critérios. Duas abordagens de enriquecimento e baseadas em atividades tiveram tamanhos de efeito médios para o desenvolvimento motor, apenas uma com baixo risco de viés; duas outras tiveram grandes tamanhos de efeito tarefa-específicos mas algumas preocupações com viés; e três estudos com ambientes enriquecidos com algumas preocupações relativas ao viés tiveram tamanhos de efeito médios para o desenvolvimento cognitivo. A maioria tinha tamanhos de efeito pequenos ou inexistentes, preocupações com viés, e determinações diagnósticas incertas.

INTERPRETAÇÃO: A síntese de dados revelou limitada quantidade e qualidade de dados e sugere, embora ainda não confirmado, maior benefício da intervenção precoce versus tardia. Esforços de pesquisas com maior precisão diagnóstica precoce e intervenção mais precoce têm se acelerado, o que pode transformar os resultados e práticas futuros.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Risk of Bias 2 assessment for the randomized controlled trials not evaluated within the systematic reviews and those identified in a separate systematic search from 2015 to 2020.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Graham HK, Rosenbaum P, Paneth N, et al. Cerebral palsy. Nat Rev Dis Primers 2016; 2: 15082. - PMC - PubMed
    1. Hadders-Algra M Challenges and limitations in early intervention. Dev Med Child Neurol 2011; 53(Suppl. 4): 52–5. - PubMed
    1. Herskind A, Greisen G, Nielsen J. Early identification and intervention in cerebral palsy. Dev Med Child Neurol 2015; 57: 29–36. - PubMed
    1. Kolb B, Muhammad A. Harnessing the power of neuroplasticity for intervention. Front Hum Neurosci 2014; 8: 377. - PMC - PubMed
    1. Novak I, Morgan C, Adde L, et al. Early accurate diagnosis and early intervention in CP: advances in diagnosis and treatment. JAMA Pediatr 2017; 171: 897–907. - PMC - PubMed