Effect of Motor Intervention for Infants and Toddlers With Cerebral Palsy: A Systematic Review and Meta-analysis

Abstract

Purpose: To conduct a systematic review and meta-analysis on the effect of motor intervention on motor function of infants and toddlers with cerebral palsy (CP).

Methods: Four databases were searched for randomized controlled trials (RCTs) of motor interventions for children with or at high risk of CP younger than 36 months. Studies were excluded if less than 50% of children developed CP.

Results: Eleven RCTs included 363 children; 85% diagnosed with CP. Very low-quality evidence supports that: (1) task-specific motor training was more effective than standard care for improving motor function (small effect), (2) constraint-induced movement therapy (CIMT) may be more effective than bimanual play or massage for improving function of the more affected hand (moderate effect), and high-intensity treadmill training is no more effective than low-intensity for improving walking.

Conclusions: Very low-quality evidence supports that task-specific motor training and CIMT may improve motor function of infants and toddlers with CP.The Supplemental Digital Content Video Abstract is available at: http://links.lww.com/PPT/A382 .

Figure 1.

PRISMA flow diagram

Figure 2.

Task-Specific Motor Learning based on Motor Learning Principles Forest Plot. Infants and toddlers with or at high risk of cerebral palsy who received task-specific motor training based on motor learning principles (n=59) scored a SMD of 0.41 (95% CI 0.05 to 0.78, p=0.03; small effect) higher on motor function compared to children who received standard care or another motor intervention (n=62). The meta-analysis was significant, and heterogeneity was low. GMFM, Gross Motor Function Measure; PDMS-2, Peabody Developmental Motor Scales 2^nd Edition; TMQ, Total motor quotient; BSID, Bayley Scales of Infant Development; SD, Standard deviation; Std, standard

Figure 3.

Constraint-Induced Movement Therapy Forest Plot. Infants and toddlers with or at high risk of cerebral palsy who received constraint induced movement therapy (n=79) scored a SMD 0.59 (95% CI −0.18–1.37, p=.13, moderate effect). higher on unimanual function of the more affected hand compared to children with unilateral CP who received bimanual play or infant massage (n=71). Although the combined pooled effect was moderate, it only trended towards significance and there was substantial heterogeneity. SD, Standard deviation; Std, standard