Early motor training for children with cerebral palsy (CP)

CP is the most common motor disability in children in Sweden. Children with CP often have delayed motor development that requires habilitating interventions, such as motor and functional training.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202320 Registration no: SBU 2022/840

Question

What systematic reviews have been published regarding the effects of early motor training for children (0–3 years) with diagnosed or high risk of CP?

Method

A systematic literature search was performed using the following databases: Medline (Ovid), Scopus och CINAHL.

Two authors independently assessed the abstracts of all identified studies.

Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Two relevant systematic reviews with low to moderate risk of bias were identified [1, 2]. The results and conclusions are presented in Table 1. In three relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [3-5].

Table 1 Systematic reviews with low/moderate risk of bias
* Outcomes from the same NFDR-study

AIMS = Alberta Infant Motor Scale; BSID – PDI = The Bayley Scales of Infant and Toddler Development – Psychomotor Developmental Index; CAMS = Curriculum and Monitoring System; COPCA = COPing with and CAring for Infants with Special Needs; EIP = early intervention program; FI-uhu = Functional Inventory – Unilateral Hand Use; GAME = Goals – Activity – Motor – Enrichment; GMFM = Gross Motor Function Measure; HAI = Hand Assessment of Infants; IMP = The Infant Motor Profile; NBAS = The Neonatal Behavioral Assessment Scale; NDT = neurodevelopmental therapy; NFDR = Neurofacilitation of Developmental Reaction; PDMS-2 TMQ = Peabody Development Motor Scales – (second edition), The Total Motor Quotient; TIME = Toddler Infant Motor Evaluation
Included studies Population Intervention Control Outcome and Results
Baker et al, 2022 [1] Effect of Motor Intervention for Infants and Toddlers With Cerebral Palsy: A Systematic Review and Meta-analysis
In total 11 RCT, 363 participants. Population: Children (0–3 years) diagnosed with or at high risk of CP. Intervention: Motor interventions: task-specific (5 studies), Constraint-Induced Movement Therapy (4 studies), neurofacilitation (1 study), treadmill (1 study) Control intervention: Standard care or another intervention (e.g., bimanual play, infant massage). Task-specific motor training vs. control (4 studies, 121 children) Statistically significant difference in motor function in favour of intervention (GMFM: sitting, PDMS-2: TMQ, BSID: motor). SMD 0.41 (95% CI, 0.05 to 0.78). CIMT vs. control (4 studies, 150 children) Statistically non-significant difference in unimanual function (FI-uhu; HAI; BSID-fine motor). SMD 0.59 (95% CI, 0.18 to 1.37). Note: No meta-analyses were performed on neurofacilitation or treadmill.
Authors' conclusion: ”This review adds that there is very low-quality evidence that task-specific training based on motor learning principles and CIMT may have, respectively, a small and moderate effect on motor function.”
Morgan et al, 2016 [2] Effectiveness of motor interventions in infants with cerebral palsy: a systematic review
In total 34 studies. Relevant studies: 10 RCT and 1 cohort study (level II and level III studies in Results section), with in total 402 participants. Population: Children (0–2 years) diagnosed with or at high risk of CP. Intervention: Motor interventions (e.g., neurodevelopmental therapy, early intervention programme, kicking and treadmill). Control intervention: Standard care or another intervention (e.g., NDT). Effects of interventions NDT vs. control (5 studies) Statistically non-significant difference in motor function (GMFM-88, Motor Assessment of Infants, TIME and PDMS) (3 studies) Statistically significant difference in motor function in favour of intervention (GMFM: sitting subscale) (1 study) Statistically significant difference in motor function in favour of control (BSID - PDI) (1 study)
NFDR resp. GAME vs. control (2 studies) Statistically significant difference in motor function in favour of intervention (GMFM*, PDMS-2 TMQ)
CAMS, NFDR, Exercise, COPCA, resp. EIP vs. control (5 studies) Statistically non-significant difference in motor function (BSID - PDI, Primitive reflexes*, AIMS, IMP, NBAS - motor)
Authors' conclusion: ”Considering the small sample sizes and the heterogeneity identified in intervention approaches, length of interventions, ages of evaluations, and outcome measures in the studies reviewed, recommendations for clinical practice are weak at best.” ”Large RCT or comparative effectiveness study designs with clear replicable descriptions both of experimental and of control interventions are essential to disentangle many of the confounding variables identified in this review. ”

References

  1. Baker A, Niles N, Kysh L, Sargent B. Effect of Motor Intervention for Infants and Toddlers With Cerebral Palsy: A Systematic Review and Meta-analysis. Pediatr Phys Ther. 2022;34(3):297-307. Available from: https://doi.org/10.1097/PEP.0000000000000914.
  2. Morgan C, Darrah J, Gordon AM, Harbourne R, Spittle A, Johnson R, et al. Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Dev Med Child Neurol. 2016;58(9):900-9. Available from: https://doi.org/10.1111/dmcn.13105.
  3. Javier FRF, Antonia GC, Julio PL. Efficacy of Early Physiotherapy Intervention in Preterm Infant Motor Development— A Systematic Review—. J Phys Ther Sci. 2012;24(9):933-40. Available from: https://doi.org/10.1589/jpts.24.933.
  4. Hadders-Algra M, Boxum AG, Hielkema T, Hamer EG. Effect of early intervention in infants at very high risk of cerebral palsy: a systematic review. Dev Med Child Neurol. 2017;59(3):246-58. Available from: https://doi.org/10.1111/dmcn.13331.
  5. Mailleux L, De Beukelaer N, Carbone MB, Ortibus E. Early interventions in infants with unilateral cerebral palsy: A systematic review and narrative synthesis. Res Dev Disabil. 2021;117:104058. Available from: https://doi.org/10.1016/j.ridd.2021.104058.

Search strategies

Medline via OvidSP 19 Jan 2023

Title: Early motor training for children 0-3 with cerebral palsy (Co-search for Motor training for children and adolescents with developmental coordination disorder (DCD), [5])
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp= Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population: Cerebral palsy or developmental coordination disorder in children
1. exp Cerebral Palsy/ 23 239
2. cerebral pals*.ab,bt,kw,ti. 26 931
3. exp Hypoxia-Ischemia, Brain/ 6835
4. ((hypoxic ischemic or neonatal or infant) adj2 encephalopathy).ab,bt,kf,ti. 5258
5. ((arterial ischemic or arterial ischaemic or neonatal or infant) adj2 stroke).ab,bt,kf,ti. 1262
6. ((intraventricular or cerebral) adj2 (hemorrhage or haemorrhage)).ab,bt,kf,ti. 18 366
7. periventricular leukomalacia.ab,bt,kw,ti. 2328
8. exp Infarction, Middle Cerebral Artery/ 10 465
9. (middle cerebral artery) adj2 (embolus or infarct* or thrombosis).ab,bt,kf,ti. 1361
10. Hemiplegia/ 11 932
11. Cerebellar Ataxia/ 5092
12. (hemiplegi* or hydrocephal* or ataxi*).ab.bt.kw.ti. 86 127
13. (spastic* or displegi*).ab.bt.kw.ti. 29 070
14. quadriplegi*.ab,bt,kw,ti. 4536
15. Motor Disorders/ 945
16. Motor Skills Disorders/ 3185
17. (developmental coordination disorder or developmental co-ordination disorder).ab,bt,kw.ti. 1417
18. dyspraxi*.ab,bt,kw,ti. 648
19. ((motor or neuromotor or psychomotor) adj4 (impairment* or dela* or disorder*)).ab,bt,kf,ti. 29 744
20. or/1-19 210 877
22. Pediatrics/ 57 746
22. exp Child/ 2 120 348
23. exp Infant/ 1 237 790
24. Adolescent/ 2 199 051
25. (child or children or infant* or newborn or neonate* or premature or preterm).ab,bt,kw,ti. 1 991 029
26. (adolescent* or teen* or youth or young).ab,bt,kw,ti. 876 971
27. (juvenile or pediatric*).ab,bt,kw,ti. 452 089
28. or/21-27 4 906 286
29. 20 and 28 85 842
Intervention:
30. Occupational Therapy/ 14 622
31. exp Physical Therapy Modalities/ 175 308
32. Physical Therapists/ 2972
33. Early Intervention, Educational/ 3470
34. Physiotherapy.ab,bt,kw,ti. 24 566
35. occupational therapy.ab,bt,kw,ti. 13 242
36. exercis*.ab,bt,kw,ti. 352 373
37. early intervention*.ab,bt,kw,ti. 22 639
38. rehabilitation.ab.bt.kw.ti. 198 298
39. ((Motor or neuromotor or neurodevelopmental or cognitive or task specific or sensory or physical or movement) adj4 (training or therapy or treatment)).ab,bt,kf,ti. 109 018
40. or/30-39 757 015
Study types: systematic reviews and meta-analysis
41. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/))  
Combined sets:
42.  29 and 40 8470
43. 41 and 42 422
Final result
44.   422

Scopus via scopus.com 19 Jan 2023

Title: Early motor training for children 0-3 with cerebral palsy (Co-search for Motor training for children and adolescents with developmental coordination disorder (DCD), [5])
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/ n = Within. Proximity operator retrieving terms within n words from each other.; PRE/ n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings;* = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population: Cerebral palsy or developmental coordination disorder in children
1. TITLE-ABS-KEY ( "cerebral pals*" ) 46 392
2.  TITLE-ABS-KEY ( ( "hypoxic ischemic" OR neonatal OR infant ) W/1 encephalopathy ) 11 998
3. TITLE-ABS-KEY ( ( "arterial ischemic" OR "arterial ischaemic" OR neonatal ) W/1 stroke ) 1517
4. TITLE-ABS-KEY ( ( ( intraventricular; OR cerebral ) W/1 ( hemorrhage OR haemorrhage ) ) OR "periventricular leukomalacia" OR hemiplegi* OR hydrocephal* OR ataxi* OR spastic* OR displegi* OR quadriplegi* ) 265 360
5. TITLE-ABS-KEY ( "middle cerebral artery" W/1 ( embolus OR infarct* OR thrombosis ) ) 10 544
6. TITLE-ABS-KEY ( "developmental coordination disorder" OR "developmental co ordination disorder" ) 2581
7. TITLE-ABS-KEY ( ( motor OR neuromotor OR psychomotor ) W/3 ( impairment* OR dela* OR disorder* ) ) 47 405
8. 1 OR 2 OR […] 7 360 275
9. TITLE-ABS-KEY ( child OR children OR infant* OR newborn OR neonate* OR premature OR preterm ) 4 526 721
10. TITLE-ABS-KEY ( adolescent* OR teen* OR youth OR young ) 3 995 743
11. TITLE-ABS-KEY ( juvenile OR pediatric* ) 891 953
12. 9 OR 10 OR 11 7 249 336
13. 8 AND 12 145 155
Intervention: Motor interventions
14. TITLE-ABS-KEY ( "occupational therapy" OR physiotherapy OR "early intervention" OR exercis* OR rehabilitation ) 1 281 705
15. TITLE-ABS-KEY ( ( motor OR neuromotor OR neurodevelopmental OR cognitive OR "task specific" OR sensory OR physical OR "constraint induced" OR movement ) W/2 ( training OR therapy OR treatment ) ) 246 226
16. 14 OR 15 1 428 696
Study types: systematic reviews and meta-analysis
17. TITLE-ABS-KEY ( ( systematic  W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))  
Combined sets:
18. 13 AND 16 16 549
19. 17 AND 18 731
Final result
20.   731

CINAHL via EBSCO 19 Jan 2023

Title: Early motor training for children 0-3 with cerebral palsy (Co-search for Motor training for children and adolescents with developmental coordination disorder (DCD), [5])
Search terms Items found
Population:
1.  (MH "Hypoxia-Ischemia, Brain, Neonatal") OR (MH "Cerebral Hemorrhage") 8236
2. TI ( "cerebral pals*" OR "intraventricular hemorrhage" OR "intraventricular haemorrhage" OR "periventricular leukomalacia" OR hemiplegi* OR hydrocephal* OR ataxi* OR spastic* OR displegi* OR quadriplegi* ) OR AB ( "cerebral pals*" OR "intraventricular hemorrhage" OR "intraventricular haemorrhage" OR "periventricular leukomalacia" OR hemiplegi* OR hydrocephal* OR ataxi* OR spastic* OR displegi* OR quadriplegi* ) OR SU ("cerebral pals*" OR "intraventricular hemorrhage" OR "intraventricular haemorrhage" OR "periventricular leukomalacia" OR hemiplegi* OR hydrocephal* OR ataxi* OR spastic* OR displegi* OR quadriplegi* ) 46 702
3. TI ( (("hypoxic ischemic" OR neonatal OR infant) N1 encephalopathy) OR (("arterial ischemic" OR "arterial ischaemic" OR neonatal OR infant) N1 stroke) OR ("middle cerebral artery" N1 (embolus OR infarct* OR thrombosis)) ) OR AB ( (("hypoxic ischemic" OR neonatal OR infant) N1 encephalopathy) OR (("arterial ischemic" OR "arterial ischaemic" OR neonatal OR infant) N1 stroke) OR ("middle cerebral artery" N1 (embolus OR infarct* OR thrombosis)) ) OR SU ( (("hypoxic ischemic" OR neonatal OR infant) N1 encephalopathy) OR (("arterial ischemic" OR "arterial ischaemic" OR neonatal OR infant) N1 stroke) OR ("middle cerebral artery" N1 (embolus OR infarct* OR thrombosis)) ) 2740
4. TI ( ( "developmental coordination disorder" OR "developmental co ordination disorder" ) ) OR AB ( ( "developmental coordination disorder" OR "developmental co ordination disorder" ) ) OR SU ( ( "developmental coordination disorder" OR "developmental co ordination disorder" ) ) 1121
5. TI ( ( ( motor OR neuromotor OR psychomotor ) N3 ( impairment* OR delay OR disorder* ) ) ) OR AB ( ( ( motor OR neuromotor OR psychomotor ) N3 ( impairment* OR delay OR disorder* ) ) ) OR SU ( ( ( motor OR neuromotor OR psychomotor ) N3 ( impairment* OR delay OR disorder* ) ) ) 10 016
6. 1 OR 2 OR 3 OR 4 OR 5 64 107
7. TI ( ( child OR children OR infant* OR newborn OR neonate* OR premature OR preterm OR adolescent* OR teen* OR youth OR young OR juvenile OR pediatric* ) ) OR AB ( ( child OR children OR infant* OR newborn OR neonate* OR premature OR preterm OR adolescent* OR teen* OR youth OR young OR juvenile OR pediatric* ) ) OR SU ( ( child OR children OR infant* OR newborn OR neonate* OR premature OR preterm OR adolescent* OR teen* OR youth OR young OR juvenile OR pediatric* ) ) 1 443 817
8. 6 AND 7 29 633
Intervention:
9. (MH "Occupational Therapy+") OR (MH "Therapeutic Exercise+") 91 593
10. (MH "Early Childhood Intervention") 6190
11. TI ( physiotherapy OR "occupational therapy" OR exercis* OR "early intervention*" OR rehabilitation ) OR AB ( physiotherapy OR "occupational therapy" OR exercis* OR "early intervention*" OR rehabilitation ) OR SU ( physiotherapy OR "occupational therapy" OR exercis* OR "early intervention*" OR rehabilitation ) 456 471
12. TI ( (motor OR neuromotor OR neurodevelopmental OR cognitive OR "task specific" OR sensory OR physical OR movement) N3 (training OR therapy OR treatment) ) OR AB ( (motor OR neuromotor OR neurodevelopmental OR cognitive OR "task specific" OR sensory OR physical OR movement) N3 (training OR therapy OR treatment) ) OR SU ( (motor OR neuromotor OR neurodevelopmental OR cognitive OR "task specific" OR sensory OR physical OR movement) N3 (training OR therapy OR treatment) ) 114 434
13. 9 OR 10 OR 11 OR 12 533 561
Study types: systematic reviews and meta-analysis
14. ((TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*)) OR (PT "Systematic Review" OR PT "meta analysis"))NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter")  
Combined sets:
15. 8 AND 13 AND 14 493
Final result
16.   493
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); MH = Exact subject heading, indexed keywords;TX = All text; PT = Publication type; Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
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