Early Therapy Options for Infants with or at Risk for Cerebral Palsy: A Review of Current Evidence

Objective

This study looked at the most effective early motor therapy options for infants (0-3 years old) who have been diagnosed with, or are at risk for, cerebral palsy. The primary aim was to identify which therapies yield the best outcomes, especially when initiated before the infant is 6 months old. This information will help to inform future treatments and research for cerebral palsy.

Method

The researchers conducted a comprehensive review of studies available on medical databases such as PubMed and Scopus.  They included systematic reviews from 2009 to 2020 and randomized controlled trials (RCTs) from 2015 to 2020.

Results

From an initial pool of 840 studies, 31 were selected for detailed analysis. This analysis included three systemic reviews covering 46 studies (16 had comparison groups) and six additional RCTs. Here’s what they found:

• Activity-Based Therapies: Two therapies emphasizing enrichedhad moderate benefits for motor skills. Only one study demonstrated reliable, reproducible
• Task-Specific Therapies:
• Environmental Enrichment: Three studies targeting environmental factors yielded cognitive benefits for infants but exhibited some bias.
• Many other studies demonstrated little benefits, unreliable results, or unclear diagnoses.

Conclusion

The findings suggest that initiating therapy at an earlier age may lead to better outcomes compared to delayed intervention for infants who have, or are at risk for, cerebral palsy. While results are not definitive, advancements in early diagnosis and treatment approaches for cerebral palsy offer promising directions for improved long-term outcomes for those affected by cerebral palsy.

Key Takeaways: 

• Over 50% of the therapies were compared to standard care, but only two of the therapies studied showedclear benefits.
• Constraint-induced movement therapy (CIMT), effective in older children, was also beneficial for infants, but showed no superiority over similar therapies, such as bimanual training oroccupational therapy.
• The Goals-Activity-Motor Enrichment (GAME), which is started before 5 months of age, worked better than equally intense standard care.
• Environmental enrichment strategies supported improvements in motor and cognitive development of infants affected by cerebral palsy.

Reference:

Damiano DL, Longo E. Early intervention evidence for infants with or at risk for cerebral palsy:  an overview of systematic reviews. Dev Med Child Neurol. 2021;63(7):771-784.  doi:10.1111/dmcn.14855