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Infant stimulation curriculum for infants with cerebral palsy: effects on infant temperament, parent-infant
F B Palmer1, B K Shapiro, M C Allen
1Clinical Research Unit, Kennedy Institute for Handicapped Children, Baltimore, Maryland.
Insights
Adding infant stimulation to physical therapy for cerebral palsy did not improve infant temperament or maternal interaction. Motor and cognitive gains were not linked to changes in these psychosocial factors.
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) affects motor function in infants.
- Early intervention is crucial for managing CP.
- The role of infant stimulation alongside physical therapy in CP requires further investigation.
Purpose of the Study:
- To evaluate the impact of incorporating infant stimulation into physical therapy for infants with spastic diplegia.
- To assess effects on infant temperament, maternal-infant interaction, and home environment.
Main Methods:
- 48 infants (12-19 months) with spastic diplegia were randomized into two groups.
- Test group: 6 months infant stimulation + 6 months physical therapy.
- Contrast group: 12 months neurodevelopmental physical therapy.
Main Results:
- No significant differences were found in infant temperament or maternal-infant relationship measures.
- Mothers in the contrast group showed greater improvement in emotional and verbal responsiveness (HOME scale).
- Motor and cognitive advantages previously reported for the test group were not mediated by psychosocial changes.
Conclusions:
- Including infant stimulation in intervention programs for spastic diplegia does not show short-term benefits on psychosocial variables.
- Observed motor and cognitive benefits of infant stimulation are not explained by changes in temperament or maternal-infant interaction.
- Further research is needed to understand the mechanisms behind infant stimulation's benefits in CP.
Abstract:
To assess the effects of intervention in cerebral palsy, 48 infants 12 to 19 months of age, with mild to severe spastic diplegia, were randomly assigned to receive either 6 months of infant stimulation followed by 6 months of physical therapy (test group) or 12 months of neurodevelopmental physical therapy (contrast group). The infant stimulation protocol consisted of cognitive, motor, sensory, and language activities. Outcome was assessed after 12 months by using Carey Infant Temperament Questionnaire subscores (activity, rhythmicity, adaptability, approach, threshold, intensity, mood, distractibility, and persistence); Roth Mother-Child Relationship Evaluation subscores (acceptance, overprotection, overindulgence, rejection); and Home Observation for Measurement of the Environment subscores (maternal responsiveness, avoidance of restriction and punishment, organization of environment, play materials, maternal involvement, and variety of daily stimulation). Motor and cognitive outcomes suggesting advantage for the test group have been reported previously. After 12 months of intervention, mothers with infants in the contrast group showed a greater improvement in emotional and verbal responsiveness as measured by the Home Observation for Measurement of the Environment (mean score change in control group = 1.2, test group = 0.3 P less than .04). None of the 19 other measures differed significantly between treatment groups in change from baseline. This study demonstrates no short-term systematic effect on temperament, maternal-infant interaction, or home environment attributable to the inclusion of an infant stimulation curriculum in an intervention program for infants with spastic diplegia. It suggests that motor and cognitive advantages associated with infant stimulation are not mediated by measurable changes in the psychosocial variables studied.