K. Desloovere, J. De Cat a,b, G. Molenaers, I. Franki, E. Himpens,H. Van Waelvelde, K. Fagard, C. Van den Broeck
Aim: To distinguish the effects of different physiotherapeutic programs in a post BTX-A
regime for children with Cerebral Palsy (CP).
Design: Retrospective, controlled intervention study.
Participants and interventions: A group of 38 children (X ¼ 7y7m, GMFCS I-III, 27 bilateral, 11
unilateral CP) receiving an individually defined Neurodevelopment Treatment (NDT)
program, was matched and compared to a group of children with the same age, GMFCS and
diagnosis, receiving more conventional physiotherapy treatment. All patients received
selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up
treatment, including physiotherapy.
Outcome measures: Three-dimensional gait analyses and clinical examination was performed
pre and two months post-injection. Treatment success was defined using the Goal
Attainment Scale (GAS).
Results: Both groups’ mean converted GAS scores were above 50. The average converted
GAS score was higher in the group of children receiving NDT than in the group receiving
conventional physiotherapy ( p < 0.05). In the NDT group, overall treatment success was
achieved in 76% of the goals, compared to 67% of the goals defined for the conventional
physiotherapy group. Especially for the goals based on gait analyses ( p < 0.05) and in the
group of children with bilateral CP ( p < 0.05), treatment success was higher in the NDT
Conclusion: In a post-BTX-A regime, the short-term effects of an NDT approach are more
pronouncedthan these from a conventional physiotherapy approach.
europ e an j o u r n a l of p a e d i a t r i c neurology 1 6 ( 2 0 1 2 ) 2 0 e2 8
Early detection of childhood disability is possible using clinically available tools and procedures. Earlydetection of disability enables early intervention that maximizes the child’s outcome, prevents the onsetof complications, and supports parents. In this chapter, first we summarize the best-available tools foraccurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy,developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impair-ment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidencefor inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence basefor: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focusedon inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichmentinterventions in the neonatal intensive care and community settings, and (e) parent–child interaction inter-ventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatmentoptions at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosisenables early intervention, which improves child and parent outcomes. We now know which interventionsprovide the biggest gains and the information can be used to help inform parental decision making whendesigning treatment plans for their children
Handbook of Clinical Neurology,Vol. 162 (3rd series) Neonatal Neurology
Background : Cerebralpalsy (CP) is caused by a lesion in the developing infant brain. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commenc eearly, during the critical period of neural development.
Aims : To determine whether “GAME” (Goals-Activity-MotorEnrichment), a motor learning, environmental enrichment intervention, is effective for improving motor skills in infants at high risk of CP.
Methods and procedures : Single blind randomised controlled trial of GAME versus standard care. Primary out come was motor skills on the Peabody Developmental Motor Scales - 2 (PDMS-2). Secondary out comes included Canadian Occupational Performance Measure (COPM) ,Bayley Scales of Infantand Toddler Development (BSID-III) and Gross Motor Function Measure - 66 (GMFM-66). Outcome assessors were masked to group allocation and data analyzed with multiple regression. Outcomes and results : All n=30 infants enrolled received the assigned intervention until 16 weeks postenrolment. At 12 months of age, n=26 completed assessments. Significant between group differences were found in raw scores on the PDMS-2 infavour of GAME (B=20.71,95%CI1.66-39.76,p=0.03) and at 12 months on the total motor quotient (B=8.29,95%CI0.13-16.45,p=0.05). Significant between group differences favored GAME participants at 12 months on the cognitive scale of the BSID-III and satisfaction scores on the COPM.
Conclusion : GAME intervention resulted inadvanced motor and cognitive outcomes when compared with standard care.
Research in Developmental Disabilities 55 (2016) 256–267