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

JAMA Pediatrics, Journal Year: 2021, Volume and Issue: 175(8), P. 846 - 846

Published: May 17, 2021

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

Language: Английский

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Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline

Developmental Medicine & Child Neurology, Journal Year: 2021, Volume and Issue: 64(5), P. 536 - 549

Published: Sept. 21, 2021

Aim To provide recommendations for interventions to improve physical function children and young people with cerebral palsy. Method An expert panel prioritized questions patient‐important outcomes. Using Grading of Recommendations Assessment, Development Evaluation (GRADE) methods, the assessed certainty evidence made recommendations, international consumer consultation. Results The guideline comprises 13 (informed by three systematic reviews, 30 randomized trials, five before–after studies). achieve functional goals, it is recommended that intervention includes client‐chosen whole‐task practice within real‐life settings, support empower families, a team approach. Age, ability, child/family preferences need be considered. walking overground can supplemented treadmill training. Various approaches facilitate hand use goals: bimanual therapy, constraint‐induced movement goal‐directed training, cognitive approaches. For self‐care, combined assistive devices increase independence reduce caregiver burden. Participation in leisure goals combine strategies address environmental, personal, social barriers. Interpretation Intervention palsy needs include goals. Clinicians should consider preferences, age, ability when selecting specific interventions.

Language: Английский

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Early Diagnostics and Early Intervention in Neurodevelopmental Disorders—Age-Dependent Challenges and Opportunities

Journal of Clinical Medicine, Journal Year: 2021, Volume and Issue: 10(4), P. 861 - 861

Published: Feb. 19, 2021

This review discusses early diagnostics and intervention in developmental disorders the light of brain development. The best instruments for detection cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2–4 months from onwards, Hammersmith Infant Neurological Examination Standardized NeuroDevelopmental Assessment. Early autism spectrum (ASD) is difficult; its first signs emerge end year. Prediction Modified Checklist Autism Toddlers Toddler possible to some extent improves during second year, especially children familial risk ASD. Thus, prediction substantially when transient structures have been replaced by permanent circuitries. At around 3 cortical subplate has dissolved primary motor sensory cortices; 12 prefrontal parieto-temporal cortices cerebellar external granular layer disappeared. stresses that families pivotal intervention. It summarizes evidence on effectiveness medically fragile neonates, infants low moderate risk, high CP

Language: Английский

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A Review on Recent Advances of Cerebral Palsy

Oxidative Medicine and Cellular Longevity, Journal Year: 2022, Volume and Issue: 2022, P. 1 - 20

Published: July 30, 2022

This narrative review summarizes the latest advances in cerebral palsy and identifies where more research is required. Several studies on were analyzed to generate a general idea of prevalence of, risk factors associated with, classification (CP). Different systems used for CP functional basis also analyzed. Diagnosis along with prevention techniques discussed. State-of-the-art treatment strategies Statistical distribution was performed based selected studies. Prevalence found be 2-3/1000 lives; that can correlated are gestational age birth weight. The identified preconception, prenatal, perinatal, postnatal categories. According evidence, classified into spastic (80%), dyskinetic (15%), ataxic (5%) forms. approaches clinical investigation neurological examinations include magnetic resonance imaging (MRI), biomarkers, cranial ultrasound. procedures medical surgical interventions, physiotherapy, occupational therapy, umbilical milking, nanomedicine, stem cell therapy. Technological advancements most common neuromotor disability lives. highest contributing factor prematurity being underweight. preventions diagnostic like MRI ultrasound used. Treatment cord blood nanomedicine therapy needs investigated further future apply practice. Future indicated context technological among children.

Language: Английский

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Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

Toxins, Journal Year: 2024, Volume and Issue: 16(2), P. 98 - 98

Published: Feb. 10, 2024

This article aims to provide a concise overview of the best available evidence for managing post-stroke spasticity. A modified scoping review, conducted following PRISMA guidelines and Extension Scoping Reviews (PRISMA-ScR), involved an intensive search on Medline PubMed from 1 January 2000 31 August 2023. The focus was placed high-quality (GRADE A) medical, rehabilitation, surgical interventions. In total, 32 treatments spasticity were identified. Two independent reviewers rigorously assessed studies, extracting data, evaluating bias using GRADE criteria. Only interventions with considered. data included study type, number trials, participant characteristics, interventions, parameters, controls, outcomes, limitations. results revealed eleven supported by evidence, comprising 14 studies. Thirteen systematic reviews meta-analyses, one randomized control trial. stretching exercises, static positional orthosis, transcutaneous electrical nerve stimulation, extracorporeal shock wave therapy, peripheral magnetic non-invasive brain botulinum toxin injection, dry needling, intrathecal baclofen, whole body vibration, localized muscle vibration. conclusion, this review highlights multimodal as being effective improving functional recovery quality life in Further research exploration new therapeutic options are encouraged.

Language: Английский

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Long-term impact of early identification of cerebral palsy

Current Opinion in Pediatrics, Journal Year: 2025, Volume and Issue: 37(2), P. 205 - 210

Published: Jan. 10, 2025

Early identification of cerebral palsy (CP), as in all neurologic conditions, has a profound impact on the ability to initiate interventions, support education and empowerment parents, ameliorate effect importantly identifies cohorts for neuroprotection or repair address primary injury. CP is life span condition. Rapid initiation services, anticipatory guidance essential maximize functional outcomes, prevent manage complications improve quality life. diagnosis should not be delayed. imaging well motor evaluation can aid early detection before age 5 months. therapeutic intervention influence function assist prevention that abilities. There important ongoing research with efforts alter phenotype Literature review provides evidence change standard care diagnosing CP. are published guidelines how pursue during infancy. results purpose enhancing skill development, complications, establishing parental support. an optimistic view opportunity intervene immediately hopes have outcome improving

Language: Английский

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Neuromodulation for Children With Hemiparesis and Perinatal Stroke

JAMA Neurology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 3, 2025

Importance Current upper-extremity therapies provide inconsistent outcomes for children with unilateral cerebral palsy. Noninvasive brain stimulation, specifically transcranial direct current may enhance motor gains when combined therapy. Objective To determine whether the addition of neurostimulation to therapy enhances function in perinatal stroke and Design, Setting, Participants This multicenter, randomized, sham-controlled phase 3 trial was conducted from July 2017 through March 2023. Investigators, treating therapists, outcome assessors, parents, participants were blinded intervention allocation. The study took place at tertiary care Canadian pediatric rehabilitation hospitals. From a population-based sample 6 18 years old disabling palsy, 196 approached 107 excluded. Intervention randomly assigned permuted blocks 2 (1:1) receive daily sham or cathodal stimulation contralesional cortex during 10 days high-dose, child-centered intensive Main Outcomes Measures primary end points changes baseline months posttherapy affected hand attainment child-identified functional goals assessed by Assisting Hand Assessment Occupational Performance Measure. Safety assessed, including any decrease either hand. Analysis intention treat. Results Eighty-nine enrolled 45 randomized (62% male, 38% female; mean [SD] age, 10.7 [2.8] years) 44 (52% 48% [2.1] years). Eighty-three had complete data (42 sham, 41 stimulation). High proportions both groups demonstrated significant sustained ( P < .001) large effect size (Cohen d > 1). There no differences between (SD) change (5.2 [5.3] vs 4.6 [5.7]; = .63) goal (3.0 [2.0] 3.6 [2.3]; .25). Procedures safe well tolerated serious adverse events. Conclusions Relevance In this study, results showed that patient-centered learning programs could produce marked improvements 1 milliampere did not improve compared stimulation. Trial Registration ClinicalTrials.gov Identifier: NCT03216837

Language: Английский

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Neonatal Encephalopathy: Beyond Hypoxic-Ischemic Encephalopathy

NeoReviews, Journal Year: 2021, Volume and Issue: 22(3), P. e148 - e162

Published: March 1, 2021

Neonatal encephalopathy is a clinical syndrome of neurologic dysfunction that encompasses broad spectrum symptoms and severity, from mild irritability feeding difficulties to coma seizures. It vital for providers understand the term “neonatal encephalopathy” simply description neonate’s status agnostic underlying etiology. Unfortunately, hypoxic-ischemic (HIE) has become common vernacular describe any neonate with encephalopathy, but this can be misleading. The should not used unless there evidence perinatal asphyxia as primary cause encephalopathy. HIE neonatal encephalopathy; differential diagnosis also includes conditions infectious, vascular, epileptic, genetic/congenital, metabolic, toxic causes. Because estimated affect 2 6 per 1,000 births, which accounts approximately 1.5 (1)(2)(3)(4)(5)(6) neonatologists child neurologists familiarize themselves evaluation, diagnosis, treatment diverse causes This review begins by discussing HIE, helps practitioners extend consider array other emphasizing epidemiology, presentations, diagnostics, imaging findings, therapeutic strategies each potential category.

Language: Английский

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

Developmental Medicine & Child Neurology, Journal Year: 2021, Volume and Issue: 63(7), P. 771 - 784

Published: April 6, 2021

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

Language: Английский

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Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review

JMIR Serious Games, Journal Year: 2021, Volume and Issue: 9(2), P. e23822 - e23822

Published: March 13, 2021

Background Increasing evidence supports the use of virtual reality systems to improve upper limb motor functions in individuals with cerebral palsy. While offers possibility include key components promote learning, it remains unclear if and how learning principles are incorporated into development rehabilitation interventions using reality. Objective The objective this study was determine extent which integrated targeting function Methods A systematic review conducted according PRISMA (Preferred Reporting Items for Systematic Reviews Meta-Analyses) guidelines. search performed 10 databases a combination keywords related palsy, reality, video games, rehabilitation. Studies were divided 2 categories: commercial game platforms devices custom systems. Study quality assessed modified Downs Black checklist. Results initial yielded 1497 publications. total 26 studies from 30 publications included, most classified as “fair” majority provided enhanced feedback variable practice used functionally relevant motivating tasks. dosage varied greatly (total training time ranged 300 3360 minutes), only 6 reporting number movement repetitions per session. difficulty progression assessment skills retention transfer poorly incorporated, especially games. Conclusions Motor should be better future optimal recovery Trial Registration PROSPERO International Prospective Register CRD42020151982; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151982

Language: Английский

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