Synopsis of resource:
This systematic review provides a comprehensive assessment of available evidence on impact of early intervention in infants at high risk of cerebral palsy. It also attempts to evaluate type and intensity of intervention and the change in effect size. Methodological quality of individual studies and intervention in VHR before 12 months corrected age were the criteria used for selection of studies. Only 13 studies passed the selection criteria and they were published between 1991 and 2015. Of these only seven studies had moderate to high methodological quality for valid results. A meta analysis was not possible because of heterogeneity of study designs [especially nature of interventions]. Analysis of individual studies provided weak evidence of the effect of early intervention. What emerged from this systemic review was an urgent need for RCTs with high methodological quality and some useful hints for same in their Appendix S3.
Key learning outcomes
- Early intervention in very high risk [VHR] infants should be multifaceted and may include: a. Developmental stimulation in an enriched environment, b. promoting parent –infant interaction, c) minimal NDT in the form of assistive postural support.
- No convincing evidence that NDT promotes motor development in VHR. However, content of NDT has not been consistent and what was applied in the 90’s may not reflect current NDTs.
- Intensity of training in early intervention programmes may be a critical factor in motor outcome
Mijna Hadders-Algra MD, PhD is professor of Developmental Neurology at the University Medical Center Groningen, Groningen, the Netherlands.
Her research deals in particular with pathophysiology, early detection of developmental disabilities, and early intervention. The research on pathophysiology focuses on general movements and postural control, that on early detection on general movements, the Infant Motor Profile (IMP) and the Standardized Infant NeuroDevelopmental Assessment (SINDA). Together with Tineke Dirks she developed the early intervention program COPCA (COPing with and CAring for infants with special needs – a family centred program).
She (co)authored >250 publications in internationally peer reviewed journals, and she has published four books. Currently she is working on a book on Early Detection and Early Intervention in Developmental Motor Disorders and the manuals of the IMP and SINDA.
She served ten years on the board of the European Academy of Childhood Disability (2000-2009). She frequently teaches and lectures about early detection and early intervention worldwide.