Family Centred Intervention and Early Diagnosis

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Top Contributors - Robin Tacchetti, Robin Leigh Tacchetti, Jess Bell, Kim Jackson, Naomi O'Reilly, Tarina van der Stockt and Ewa Jaraczewska  

Family Centered Intervention

Cerebral Palsy

The most common physical disability in childhood is cerebral palsy and occurs for every 1 in 500 births. Traditionally, a diagnosis would be concluded between 12 and 24 months of age. Based on a 2017 literature review, signs and symptoms of cerebral palsy appear and develop before 2 years of age. Using a combination of medical history, neuroimaging and standardized motor and neurological assessments, the risk of cerebral palsy can be estimated for infants under 2 years old. One predictive tool that has shown high sensitivity detecting cerebral palsy in infants is the Hammersmith Infant Neurological Examination. This tool shows 98% sensitivity when administered to infants under 5 months old, and 90% sensitivity over 5 months of age.

***** It is important to reassure parents that a diagnosis of CP in very young children does not mean that their child will need a wheelchair and have an intellectual disability.

In high-income countries, population data indicate that 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.

However, in low and middle income countries long-term outcomes tend to be less favorable with over 73% children classified in GMFCS levels III – IV in a recently published survey

Hammersmith Infant Neurological Examination

The Hammersmith Infant Neurological Examination (HINE)

Gross Motor Function Classification System

The Gross Motor Function Classification System (GMFCS) tool classifies children under 2 into 5 distinct levels depending on movement that is self-initiated accenting mobility, transfers and sitting. These criterion relate to functional limitations for the child versus quality of movement.

Gross Motor Function Classification System – Expanded and Revised (GMFCS – E & R)

• LEVEL I: Infants move in and out of sitting and floor sit with both hands free to manipulate objects. Infants crawl on hands and knees, pull to stand and take steps holding on to furniture. Infants walk between 18 months and 2 years of age without the need for any assistive mobility device.

• LEVEL II: Infants maintain floor sitting but may need to use their hands for support to maintain balance. Infants creep on their stomach or crawl on hands and knees. Infants may pull to stand and take steps holding on to furniture.

• LEVEL III: Infants maintain floor sitting when the low back is supported. Infants roll and creep forward on their stomachs.

• LEVEL IV: Infants have head control but trunk support is required for floor sitting. Infants can roll to supine and may roll to prone.

• LEVEL V: Physical impairments limit voluntary control of movement. Infants are unable to maintain antigravity head and trunk postures in prone and sitting. Infants require adult assistance to roll.

The Prechtl General Movement Assessment

The Prechtl General Movement Assessment

r. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.

Hammersmith Infant Neurological Examination

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References

1. Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, De Vries LS. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA pediatrics. 2017 Sep 1;171(9):897-907.

2. Jahan I, Muhit M, Hardianto D, Laryea F, Chhetri AB, Smithers‐Sheedy H, McIntyre S, Badawi N, Khandaker G. Epidemiology of cerebral palsy in low‐and middle‐income countries: preliminary findings from an international multi‐centre cerebral palsy register. Developmental Medicine & Child Neurology. 2021 May 24.

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Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, de Vries LS. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA pediatrics. 2021 May 17.

Ulrich BD. Opportunities for early intervention based on theory, basic neuroscience, and clinical science. Physical therapy. 2010 Dec 1;90(12):1868-80.

Whitall J, Clark JE. A perception–action approach to understanding typical and atypical motor development. Advances in child development and behavior. 2018 Jan 1;55:245-72.

Gordon AM. To constrain or not to constrain, and other stories of intensive upper extremity training for children with unilateral cerebral palsy. Developmental Medicine & Child Neurology. 2011 Sep;53:56-61.

Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. Single blind randomised controlled trial of GAME (Goals⿿ Activity⿿ Motor Enrichment) in infants at high risk of cerebral palsy. Research in Developmental Disabilities. 2016 Aug 1;55:256-67.

Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. GAME (Goals-Activity-Motor Enrichment): protocol of a single blind randomised controlled trial of motor training, parent education and environmental enrichment for infants at high risk of cerebral palsy. BMC neurology. 2014 Dec;14(1):1-9.

Morgan C, Novak I, Dale RC, Badawi N. Optimising motor learning in infants at high risk of cerebral palsy: a pilot study. BMC pediatrics. 2015 Dec;15(1):1-1.

Morgan C, Novak I, Badawi N. Enriched environments and motor outcomes in cerebral palsy: systematic review and meta-analysis. Pediatrics. 2013 Sep 1;132(3):e735-46.

Morgan C, Darrah J, Gordon AM, Harbourne R, Spittle A, Johnson R, Fetters L. Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Developmental Medicine & Child Neurology. 2016 Sep;58(9):900-9.

Jahnsen R, Odgaard-Jensen J, Larun L, Østensjø S, Myrhaug HT. Intensive training of motor function and functional skills among young children with cerebral palsy: a systematic review and meta-analysis.

Nithianantharajah J, Hannan AJ. Enriched environments, experience-dependent plasticity and disorders of the nervous system. Nature Reviews Neuroscience. 2006 Sep;7(9):697-709.

Van Praag H, Kempermann G, Gage FH. Neural consequences of enviromental enrichment. Nature Reviews Neuroscience. 2000 Dec;1(3):191-8.

Valvano J. Activity-focused motor interventions for children with neurological conditions. Physical & occupational therapy in pediatrics. 2004 Jan 1;24(1-2):79-107.