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Optimising motor learning in infants at high risk of cerebral palsy: a pilot study.

Morgan C, Novak I, Dale RC, Badawi N - BMC Pediatr (2015)

Bottom Line: Active motor interventions are effective in some populations, however the effects of active motor interventions on the motor outcomes of infants with CP have not been researched thoroughly, but pilot work is promising.At study conclusion, the GAME group (n = 6) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 (PDMS-2) compared to the standard care group (n = 7) (p < .001).No significant differences existed between groups on any other measure.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, University Of Notre Dame Australia, Darlinghurst, NSW, Australia. cmorgan@cerebralpalsy.org.au.

ABSTRACT

Background: The average age for the diagnosis of cerebral palsy (CP) is 19 months. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commence as early as possible and in an enriched environment, during the critical period of neural development. Active motor interventions are effective in some populations, however the effects of active motor interventions on the motor outcomes of infants with CP have not been researched thoroughly, but pilot work is promising. The aim of this study was to determine the short- term effects of "GAME"; a new and novel goal-oriented activity-based, environmental enrichment therapy programme on the motor development of infants at high risk of CP and test study procedures for a randomized controlled trial (RCT).

Methods: Pragmatic 2-group pilot RCT to assess motor outcomes, goal attainment, parent well-being and home environment quality, after 12-weeks of GAME intervention versus standard care. GAME included: creation of movement environments to elicit motor behaviours; parent training in motor learning and task analysis; frequent practice of motor tasks using a programme that was individualised to the child, was varied and focused on self-initiated movement. Data were analyzed using multiple regression.

Results: Thirteen infants were consented, randomised, treated and completed the study. At study conclusion, the GAME group (n = 6) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 (PDMS-2) compared to the standard care group (n = 7) (p < .001). No significant differences existed between groups on any other measure.

Conclusions: GAME appears to offer a promising and feasible new motor intervention for CP, with favourable short-term motor outcomes. A pressing need exists for an adequately powered RCT with long-term end points, to determine if GAME may advance these children's motor trajectory.

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Related in: MedlinePlus

Flow of participants.
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Fig1: Flow of participants.

Mentions: Thirteen infants from twelve families, mean age 17.6 weeks (SD =3.9), corrected for prematurity, and at very high risk of CP were recruited between September 2011 and September 2012 (Table 1). Six infants were randomised to the GAME and seven to SC. Twins were randomised into the same group, as it would be impossible for parents to operationalize two different treatment approaches without intervention contamination. The flow of participants through the study is summarised in Figure 1. Adherence to study protocols was excellent with no dropouts. Participant characteristics are summarised in Table 1. Groups were equivalent at baseline on infant and parent characteristics. All child outcome data was normally distributed at both baseline and follow-up, therefore meeting the assumption for parametric statistics. The only exception to this was the HOME follow-up data, which was skewed right (kurtosis of 3.24) indicating ceiling effects on the measure.Table 1


Optimising motor learning in infants at high risk of cerebral palsy: a pilot study.

Morgan C, Novak I, Dale RC, Badawi N - BMC Pediatr (2015)

Flow of participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389951&req=5

Fig1: Flow of participants.
Mentions: Thirteen infants from twelve families, mean age 17.6 weeks (SD =3.9), corrected for prematurity, and at very high risk of CP were recruited between September 2011 and September 2012 (Table 1). Six infants were randomised to the GAME and seven to SC. Twins were randomised into the same group, as it would be impossible for parents to operationalize two different treatment approaches without intervention contamination. The flow of participants through the study is summarised in Figure 1. Adherence to study protocols was excellent with no dropouts. Participant characteristics are summarised in Table 1. Groups were equivalent at baseline on infant and parent characteristics. All child outcome data was normally distributed at both baseline and follow-up, therefore meeting the assumption for parametric statistics. The only exception to this was the HOME follow-up data, which was skewed right (kurtosis of 3.24) indicating ceiling effects on the measure.Table 1

Bottom Line: Active motor interventions are effective in some populations, however the effects of active motor interventions on the motor outcomes of infants with CP have not been researched thoroughly, but pilot work is promising.At study conclusion, the GAME group (n = 6) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 (PDMS-2) compared to the standard care group (n = 7) (p < .001).No significant differences existed between groups on any other measure.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, University Of Notre Dame Australia, Darlinghurst, NSW, Australia. cmorgan@cerebralpalsy.org.au.

ABSTRACT

Background: The average age for the diagnosis of cerebral palsy (CP) is 19 months. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commence as early as possible and in an enriched environment, during the critical period of neural development. Active motor interventions are effective in some populations, however the effects of active motor interventions on the motor outcomes of infants with CP have not been researched thoroughly, but pilot work is promising. The aim of this study was to determine the short- term effects of "GAME"; a new and novel goal-oriented activity-based, environmental enrichment therapy programme on the motor development of infants at high risk of CP and test study procedures for a randomized controlled trial (RCT).

Methods: Pragmatic 2-group pilot RCT to assess motor outcomes, goal attainment, parent well-being and home environment quality, after 12-weeks of GAME intervention versus standard care. GAME included: creation of movement environments to elicit motor behaviours; parent training in motor learning and task analysis; frequent practice of motor tasks using a programme that was individualised to the child, was varied and focused on self-initiated movement. Data were analyzed using multiple regression.

Results: Thirteen infants were consented, randomised, treated and completed the study. At study conclusion, the GAME group (n = 6) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 (PDMS-2) compared to the standard care group (n = 7) (p < .001). No significant differences existed between groups on any other measure.

Conclusions: GAME appears to offer a promising and feasible new motor intervention for CP, with favourable short-term motor outcomes. A pressing need exists for an adequately powered RCT with long-term end points, to determine if GAME may advance these children's motor trajectory.

Show MeSH
Related in: MedlinePlus