Effectiveness of multisensory stimulation and priming (MuSSAP) upper limb training in 3-8 months old infants with
Anke Verhaegh1, Lisa Mailleux2, Maria Nijhuis-van der Sanden3
1Department of Paediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands; IQ Healthcare, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Insights
Multi Sensory Stimulation And Priming (MuSSAP) training improved manual ability in infants at high risk for unilateral cerebral palsy (CP). This early intervention enhanced affected upper limb function and movement initiation in a clinical setting.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Infants at high risk of unilateral cerebral palsy (CP) often exhibit impaired upper limb function.
- Early intervention is crucial for optimizing motor development and functional outcomes.
- Multi Sensory Stimulation And Priming (MuSSAP) is an early upper limb training program designed to improve awareness and goal-directed movements in the affected limb.
Purpose of the Study:
- To assess the effectiveness of an 8-week MuSSAP training program on manual ability in infants at high risk for unilateral CP.
- To evaluate changes in affected hand function and movement initiation following the intervention.
Main Methods:
- A retrospective clinical cohort study included 28 infants (mean corrected age 5.0 months).
- Assessments were conducted pre-training (T0), post-training (T1), and at an 8-week follow-up (T2) using the Hand Assessment for Infants (HAI).
- Primary outcome was the HAI 'affected hand score'; secondary outcomes included 'unit score' and item 1 ('initiates to side'). Data were analyzed using linear mixed models.
Main Results:
- Significant improvements in the 'affected hand score' (estimate: 3.2, p < 0.001) and 'unit score' (estimate: 9.7, p < 0.001) were observed between T0 and T1.
- These improvements were maintained at the 8-week follow-up (T1-T2).
- The proportion of infants spontaneously initiating goal-directed movements increased from T0 to T1, with notable exceptions in three infants with drug-resistant epilepsy.
Conclusions:
- MuSSAP training demonstrates potential in improving manual ability for infants at high risk of unilateral CP within a clinical setting.
- Further investigation with larger randomized controlled trials, including brain-based measures, is warranted to confirm effectiveness and elucidate mechanisms.
- Special attention should be given to infants who do not initiate goal-directed movements, potentially due to factors like epilepsy.
Introduction:
Multi Sensory Stimulation And Priming (MuSSAP) is an early upper limb training for infants at high risk of unilateral cerebral palsy (CP). MuSSAP is designed to enhance awareness of the affected upper limb facilitating initiation of goal-directed movements. This study assesses the effectiveness of an 8-week MuSSAP training on manual ability in a clinical setting.
Participants And Methods:
Twenty-eight infants (mean corrected age at T0: 5.0 months) were included in a retrospective clinical cohort study with assessments pre- (T0), post- (T1) and at 8-week follow-up (T2) using the Hand Assessment for Infants (HAI). The primary outcome was the HAI 'affected hand score', secondary outcomes included the 'unit score' and item 1 ('initiates to side'). Data were analysed using linear mixed models.
Results:
HAI scores improved between T0-T1 (n = 25) for both affected hand score (estimate: 3.2, p < 0.001), and unit score (estimate: 9.7, p < 0.001). Scores remained stable between T1-T2. The number of infants who never initiated or only when restrained/sometimes initiated or only when prompted/almost always spontaneously initiated goal-directed movements changed from 8/13/7 at T0 to 5/5/15 at T1 (three missing). Of the five infants who did not initiate goal-directed movements after training, three had drug-resistant epilepsy.
Conclusion:
MuSSAP appears to improve manual ability in infants at high risk of unilateral CP in a clinical setting. A larger randomized controlled trial incorporating brain-based measures is needed to further investigate its effectiveness and working mechanism, especially for infants who do not initiate goal-directed movements with the affected upper limb.
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