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Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis
Anna Te Velde1,2, Catherine Morgan1, Megan Finch-Edmondson1
1Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.
Pediatrics
|May 24, 2022
Summary
Neurodevelopmental therapy (NDT) is not more effective than control for cerebral palsy (CP). Activity-based interventions show superior motor function improvements, suggesting NDT deimplementation in CP care.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Evidence-Based Practice
Background:
- Bobath therapy, also known as neurodevelopmental therapy (NDT), is a common intervention for cerebral palsy (CP).
- Existing evidence suggests other interventions may be more effective for children with CP.
- The efficacy of NDT in infants and children with CP or at high risk for CP requires thorough evaluation.
Purpose of the Study:
- To determine the effectiveness of neurodevelopmental therapy (NDT) in children and infants diagnosed with or at high risk of cerebral palsy (CP).
- To compare the efficacy of NDT against control interventions and activity-based approaches.
Main Methods:
- A systematic literature search was conducted across major databases (CINAHL, Cochrane Library, Embase, Medline) up to March 2021.
- Included studies were randomized controlled trials comparing NDT with any or no intervention.
- Meta-analysis was performed using standardized mean differences, with study quality assessed using Cochrane Risk of Bias tool-2 and certainty of evidence by Grading of Recommendations Assessment, Development, and Evaluation.
Main Results:
- Analysis of 34 studies involving 1332 participants revealed no significant effect of NDT compared to control (pooled effect size 0.13).
- Activity-based approaches demonstrated a moderate effect (0.76) and body structure/function interventions showed a similar effect (0.77) in improving motor function compared to NDT.
- Higher-dose NDT was not found to be more effective than lower-dose NDT (0.32), and considerable heterogeneity was noted in NDT versus activity-based comparisons.
Conclusions:
- Activity-based and body structure/function interventions are more effective for improving motor function in CP than NDT.
- NDT shows no superior efficacy compared to control interventions for cerebral palsy.
- A strong recommendation is made for the deimplementation of NDT in CP management due to its lack of demonstrated effectiveness.
