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Intensive Neurophysiological Rehabilitation System for children with cerebral palsy: a quasi-randomized controlled
Insights
Intensive Neurophysiological Rehabilitation System (INRS) improves gross motor and hand function in children with bilateral cerebral palsy (CP). This intensive treatment shows significant benefits over standard home-based care.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Intensive rehabilitation is effective for children with cerebral palsy (CP).
- Intensive Neurophysiological Rehabilitation System (INRS) is a multi-component rehabilitation approach.
- This study evaluated INRS effectiveness in children with bilateral CP.
Purpose of the Study:
- To examine the effectiveness of the INRS treatment in children with bilateral CP.
- To compare INRS treatment with standard home treatment.
Main Methods:
- Quasi-randomized controlled study of 48 children with spastic bilateral CP (ages 5-12).
- Experimental group received 10 days of intensive INRS plus 4 weeks of home treatment.
- Control group received home treatment for 4 weeks, then INRS.
- Outcome measures included GMFM, Jebsen-Taylor Hand Function Test, Box and Blocks Test, ABILHAND-Kids, PEDI, and ankle range of motion.
Main Results:
- Significant improvement in Gross Motor Function Measure (GMFM) scores in both groups post-treatment.
- INRS treatment showed statistically significant superiority over home treatment in GMFM scores.
- Significant improvements in hand function (Jebsen-Taylor, Box and Blocks) were observed with INRS.
Conclusions:
- INRS treatment is beneficial for improving gross motor and hand function in children with bilateral CP.
- Further longitudinal studies are needed to assess INRS impact on participation levels.
Background:
Recent research indicates that intensive rehabilitation tends to be effective for children with cerebral palsy (CP). Intensive Neurophysiological Rehabilitation System (INRS) is a multi-component approach that combines various interventions and addresses different functional goals.. This study aimed to examine the effectiveness of the INRS treatment in children with bilateral CP.
Methods:
In this quasi-randomized controlled study, 48 children with spastic bilateral CP (age 5-12 years, GMFCS Levels I-IV, MACS Levels I-IV) were assigned to an experimental or control group in order they have been enrolled. The experimental group underwent INRS treatment in the tertiary care facility for about four hours daily for ten days and continued routine home treatment for four weeks. After the first evaluation, participants from the control group stayed on the waiting list for four weeks receiving home treatment and then starting the INRS treatment. Thereby, all participants were assessed three times. The primary outcome measure was a Gross Motor Function Measure 66 Item Set (GMFM). The secondary outcome measures included the Jebsen-Taylor Hand Function test, Box and Blocks test, ABILHAND-Kids Questionnaire, Self-care and Mobility domain of the Pediatric Evaluation of Disability Inventory, and the ankle dorsiflexion passive range of motion.
Results:
There was a statistically significant increase in the GMFM score after the INRS treatment in both the experimental group (mean difference (MD) 2.0, P < 0.01) and control group (MD 1.5, P < 0.05), with a large size effect (partial eta squared (η2) = 0.21 and η2 = 0.14). The mean difference between groups during the first study period was 2.89 points (p < 0.01) in the GMFM score with a medium effect size (η2 = 0.12). Statistically significant superiority of the INRS treatment over home treatment was also obtained by Jebsen-Taylor Hand Function Test and the Box and Blocks Test in both dominant and non-dominant hands.
Conclusions:
The study indicates that the INRS treatment can be beneficial for improving both gross motor functions and hand function in children with bilateral CP. Further longitudinal studies are required to evaluate the effects of the INRS treatment on the participation level of children with CP.
Trial Registration:
The study protocol was registered on ClinicalTrials.gov under the identifier: NCT04093180 on 17/09/2019.
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