Kinematic and Somatosensory Gains in Infants with Cerebral Palsy After a Multi-Component Upper-Extremity Intervention: A Randomized Controlled Trial.

Details

Serval ID
serval:BIB_0892B1CC3E94
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Kinematic and Somatosensory Gains in Infants with Cerebral Palsy After a Multi-Component Upper-Extremity Intervention: A Randomized Controlled Trial.
Journal
Brain topography
Author(s)
Maitre N.L., Jeanvoine A., Yoder P.J., Key A.P., Slaughter J.C., Carey H., Needham A., Murray M.M., Heathcock J.
Working group(s)
BBOP group
Contributor(s)
Burkhardt S., Emery L., Hague K., Levengood K., Lewandowski D.J., Nelin M.A., Pennington C., Pietruszewski L., Purnell J., Sowers B.
ISSN
1573-6792 (Electronic)
ISSN-L
0896-0267
Publication state
Published
Issued date
11/2020
Peer-reviewed
Oui
Volume
33
Number
6
Pages
751-766
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Upper extremity (UE) impairments in infants with cerebral palsy (CP) result from reduced quality of motor experiences and "noisy" sensory inputs. We hypothesized that a neuroscience-based multi-component intervention would improve somatosensory processing and motor measures of more-affected (UEs) in infants with CP and asymmetric UE neurologic impairments, while remaining safe for less-affected UEs. Our randomized controlled trial compared infants (6-24 months) with CP receiving intervention (N = 37) versus a waitlisted group (N = 36). Treatment effects tested a direct measurement of reach smoothness (3D-kinematics), a measure of unimanual fine motor function (Bayley unimanual fine motor raw scores), and EEG measures of cortical somatosensory processing. The four-week therapist-directed, parent-administered intervention included daily (1) bimanual play; (2) less-affected UE wearing soft-constraint (6 h/day, electronically-monitored); (3) reach training on more-affected UE; (4) graduated motor-sensory training; and (5) parent education. Waitlist infants received only bimanual play. Effectiveness and safety were tested; z-scores from 54 posttest-matched typically-developing infants provided benchmarks for treatment effects. Intervention and waitlist infants had no pretest differences. Median weekly constraint wear was 38 h; parent-treatment fidelity averaged > 92%. On the more affected side, the intervention significantly increased smoothness of reach (Cohen's d = - 0.90; p < .001) and unimanual fine motor skill (d = 0.35; p = .004). Using unadjusted p values, intervention improved somatosensory processing (d = 0.53; p = .04). All intervention effects referenced well to typically developing children. Safety of the intervention was demonstrated through positive- or non-effects on measurements involving the constrained, less-affected UE and gross motor function; unexpected treatment effects on reach smoothness occurred in less-affected UEs (d = - 0.85; p = .01). This large clinical trial demonstrated intervention effectiveness and safety for developing sensory and motor systems with improvements in reach smoothness, and developmental abilities.Clinical Trail Registration: ClinicalTrials.gov NCT02567630, registered October 5, 2015.
Keywords
Cerebral palsy, EEG, Intervention, Kinematics, Motor, Somatosensory
Pubmed
Web of science
Funding(s)
Swiss National Science Foundation / Projects / 320030_169206
Create date
13/08/2020 8:19
Last modification date
03/03/2021 7:25
Usage data