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Interventions to improve sensory and motor outcomes for young children with central hypotonia: A systematic review
Ginny Paleg1, Mark Romness2, Roslyn Livingstone3
1Montgomery County Infants and Toddlers Program, Rockville, MD, USA.
Insights
Physical and occupational therapy can improve outcomes for children with central hypotonia. Treadmill training and massage show promise, particularly for infants with Down syndrome, while orthoses effectiveness varies by age and ability.
Area of Science:
- Pediatrics
- Developmental Neurology
- Rehabilitation Medicine
Background:
- Central hypotonia in children (0-6 years) presents significant challenges to sensory and motor development.
- Effective therapeutic interventions are crucial for optimizing functional outcomes in this population.
Purpose of the Study:
- To systematically evaluate the evidence for physical and occupational therapy interventions aimed at improving sensory and motor outcomes in children aged 0-6 years with central hypotonia.
Main Methods:
- A comprehensive literature search was conducted across four electronic databases (1996-March 2017).
- Interventions were assessed for level of evidence and study quality using American Academy of Cerebral Palsy and Developmental Medicine criteria.
- A traffic light classification system (green, yellow, red) categorized intervention effectiveness.
Main Results:
- Thirty-seven articles were analyzed, focusing on interventions including orthotics, treadmill training, compression garments, massage, and various motor/sensory approaches.
- Treadmill training and massage received 'green light' (proven effective) for infants with Down syndrome regarding specific outcomes.
- Orthoses demonstrated 'green light' evidence for foot alignment in ambulatory children but potential negative impacts on motor development in pre-ambulatory children.
Conclusions:
- Treadmill training and massage are supported by strong evidence for specific populations (e.g., infants with Down syndrome) and are considered possibly effective for others.
- Orthotic interventions show benefit for foot alignment but require careful consideration regarding motor development in younger, pre-ambulatory children.
- Most other evaluated interventions are rated as possibly effective, underscoring the need for therapists to utilize sensitive outcome measures for monitoring progress.
Objective:
To evaluate evidence supporting physical and occupational therapy interventions used to improve sensory and motor outcomes for children 0-6 years with central hypotonia.
Methods:
Four electronic databases were searched from 1996 to March 2017. Level of evidence and study conduct was evaluated using American Academy of Cerebral Palsy and Developmental Medicine criteria. Traffic lighting classification identified interventions that were green (proven effective), yellow (possibly effective) or red (proven ineffective or contraindicated).
Results:
Thirty-seven articles were included. Nine studies measured orthotic interventions while four distinct studies published over nine articles measured treadmill interventions. Remaining studies measured impact of compression garments, massage, motor and sensori-motor interventions, positioning and mobility interventions.
Conclusions:
Green light evidence supports treadmill training (to promote ambulation and gait characteristics) and massage (to positively affect muscle tone, motor development and use of vision) for infants with Down syndrome. These interventions are considered Yellow (possibly effective) for other populations. Green light evidence supports impact of orthoses on foot alignment for ambulatory children with hypotonia, while impact on gait characteristics is Yellow light and motor development may be negatively impacted (Red light) in pre-ambulatory children. All other interventions rated Yellow (possibly effective) and therapists should monitor using sensitive outcome measures.
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