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Published on: February 5, 2019
A randomized controlled trial of early physiotherapy for high-risk infants
A M Weindling1, P Hallam, J Gregg
1Department of Child Health, University of Liverpool, UK.
Insights
Early physiotherapy did not improve outcomes for infants at high risk of cerebral palsy. Reliable prediction of cerebral palsy and its varied nature are crucial for treatment planning and efficacy assessment.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Infants at high risk for cerebral palsy (CP) often receive early interventions.
- The efficacy of early physiotherapy in this population remains under investigation.
- Predicting CP accurately and early is challenging.
Purpose of the Study:
- To test if early physiotherapy benefits infants identified as high-risk for cerebral palsy.
- To compare outcomes between early physiotherapy and standard care in high-risk infants.
Main Methods:
- 105 high-risk infants (abnormal cranial ultrasound) were randomized to early physiotherapy or standard care.
- Clinical and objective assessments were conducted at 12 and 30 months.
- Follow-up data were collected, accounting for mortality and loss to follow-up.
Main Results:
- Cerebral palsy was accurately predicted in only 54% of infants.
- No significant differences in outcomes were observed between the early physiotherapy and standard care groups.
- High infant mortality and loss to follow-up impacted sample size at assessment points.
Conclusions:
- Early physiotherapy did not demonstrate a benefit over standard care for high-risk infants.
- The challenges in reliably predicting cerebral palsy and its heterogeneity necessitate careful consideration in treatment planning and efficacy studies.
Abstract:
The aim of this study was to investigate the hypothesis that infants at high risk of cerebral palsy would benefit from early physiotherapy. In total, 105 infants with abnormal cranial ultrasound scans were randomized at around term to early physiotherapy or standard treatment (delaying physiotherapy until abnormal physical signs became apparent). At 12 and 30 months there were clinical and objective assessments. Nine infants died and nine were lost to follow-up by 12 months when 87 infants were assessed. One other child had died and three others were lost to follow-up by 30 months when 83 children were assessed. Cerebral palsy was only accurately predicted in 45 (54%) infants. There was no difference in outcome. The difficulty of predicting cerebral palsy reliably and the heterogeneity of the condition should be borne in mind when planning treatment and assessing its efficacy.
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