Early interventions in infants with unilateral cerebral palsy: A systematic review and narrative synthesis
Lisa Mailleux1, Nathalie De Beukelaer2, Maria-Belén Carbone3
1Centre For Developmental Disabilities, Leuven, Belgium; KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
Insights
Early interventions effectively improve upper limb motor function in infants with unilateral cerebral palsy (uCP). Modified constraint-induced movement therapy (mCIMT) shows promise, highlighting the need for prompt, specialized care.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Developmental Pediatrics
Background:
- Systematic reviews exist on early interventions for at-risk infants.
- No reviews specifically address early interventions for motor outcomes in unilateral cerebral palsy (uCP).
Purpose of the Study:
- To review early intervention programs for infants diagnosed with uCP.
- To assess the impact of these interventions on motor outcomes.
Main Methods:
- Systematic literature search across major databases (PubMed, Embase, etc.).
- Adherence to PRISMA statement guidelines.
- Risk of bias assessment using Cochrane risk-of-bias 2 tool.
Main Results:
- Three single-blinded RCTs involving 88 infants with uCP were identified.
- Modified constraint-induced movement therapy (mCIMT) appears effective and safe for improving upper limb function.
- Bimanual training demonstrated comparable effectiveness to mCIMT in one study.
Conclusions:
- Early interventions are effective, safe, and feasible for improving upper limb motor function in infants with uCP.
- Further high-quality RCTs are essential.
- Prompt referral to specialized centers for early intervention is crucial.
Background:
Recent systematic reviews have already provided an overview of the impact of early interventions on developmental outcomes in infants at risk for cerebral palsy. However, none has thus far focused specifically on how early interventions might improve motor outcome in infants diagnosed with unilateral cerebral palsy (uCP). Hence, the aim of this systematic review was to provide an overview of early intervention programs used in infants with uCP to improve motor outcome.
Methods:
A systematic literature search was performed in PubMed, Embase, Cochrane Central Register of Controlled trials, CINAHL and Web of Science following the PRISMA-statement guidelines. Risk of bias was assessed using the Cochrane risk-of-bias 2 tool.
Results:
Three single-blinded randomized controlled trials (RCTs) were identified, including 88 infants with uCP. These RCTs suggest that modified constraint-induced movement therapy (mCIMT) is effective and safe for improving upper limb function in infants with uCP. Bimanual training compared to mCIMT was found to be equally effective in one study. No clinical or neurological predictors of treatment response could be identified yet.
Conclusion:
Although more high-quality RCTs are urgently needed, early interventions seem effective, safe and feasible to apply in infants with uCP for improving upper limb motor function. This underlines the importance of prompt referral to diagnostic-specific centres to start up such early interventions.
