Systematic review calls for early targeted interventions to help babies and toddlers with cerebral palsy harness time window with maximum brain plasticity

by

Ear­ly tar­get­ed inter­ven­tion ‘crit­i­cal’ for improv­ing out­comes in cere­bral pal­sy (Healio):

Ear­ly inter­ven­tion for chil­dren with or at high risk for cere­bral pal­sy should begin “as soon as pos­si­ble” in order to build on “a crit­i­cal devel­op­men­tal time,” accord­ing to results of a sys­tem­at­ic review pub­lished in JAMA Pediatrics.

Researchers con­duct­ed the review to devel­op clin­i­cal guide­lines for ear­ly inter­ven­tion among chil­dren at high risk for cere­bral pal­sy (CP) and their fam­i­lies … the researchers searched six data­bas­es for “the best avail­able evi­dence” regard­ing ear­ly inter­ven­tions tai­lored for CP across nine domains relat­ed to motor func­tion, cog­ni­tive skills, com­mu­ni­ca­tion, eat­ing and drink­ing, vision, sleep, man­ag­ing mus­cle tone, mus­cu­loskele­tal health and parental sup­port among chil­dren aged 0 to 2 years at high risk for or with CP.

The strongest evi­dence sup­port­ed 28 rec­om­men­da­tions, of which 24 were for and four were against, relat­ed to the nine domains, with the most rec­om­men­da­tions in the domains of sleep and com­mu­ni­ca­tion at sev­en each and the fewest in the domain of mus­cle tone at one.

“Ear­ly tar­get­ed inter­ven­tion builds on a crit­i­cal devel­op­men­tal time for plas­tic­i­ty of devel­op­ing sys­tems,” Mor­gan (Cather­ine Mor­gan, PhD, a research fel­low at the Cere­bral Pal­sy Alliance Research Insti­tute in Aus­tralia) and col­leagues wrote.

The Study:

Ear­ly Inter­ven­tion in Cere­bral Pal­sy and Beyond (JAMA Pediatrics):

Cere­bral pal­sy (CP) is a group of major neu­rode­vel­op­men­tal dis­abil­i­ties that main­ly affect ear­ly motor devel­op­ment, with move­ment, pos­ture, and sec­on­dar­i­ly mus­cu­loskele­tal impair­ments. The motor dis­or­ders are often asso­ci­at­ed with oth­er neu­rode­vel­op­men­tal dis­eases, such as intel­lec­tu­al dis­abil­i­ty, speech or lan­guage impair­ment, autism spec­trum dis­or­der, atten­tion deficit, or comor­bidi­ties, such as epilep­sy or psy­chi­atric dis­or­ders, rel­a­tive to the gen­er­al pop­u­la­tion. Cur­rent­ly, ear­ly diag­no­sis of high-risk CP offers the oppor­tu­ni­ty for ear­ly inter­ven­tion at a crit­i­cal devel­op­men­tal plas­tic­i­ty win­dow. The ear­li­er we inter­vene, the bet­ter the out­come is. The inter­na­tion­al clin­i­cal guide­line by Mor­gan et al in this issue of JAMA Pedi­atrics advo­cates, based on a high stan­dard of evi­dence, for an ear­ly inter­ven­tion for chil­dren aged 0 to 2 years who have CP or are at high risk of CP. This is a time win­dow that encom­pass­es max­i­mum brain plasticity.

News in Context: