Early neuroprotective strategies show promise in cerebral palsy

Movement disorders

By Michael Woodhead

14 Feb 2019

Early intervention with neuroprotective strategies in children with cerebral palsy may be key to improving their quality of life, according to Australian researchers.

In a narrative review published in the MJA, clinicians at the Children’s Hospital at Westmead, Concord Centre for Mental Health, Kids Neuroscience Centre and  Royal Children’s Hospital Melbourne, looked at cerebral palsy reviews and studies over the last 20 years to figure out which treatments and guidelines worked the best.

They concluded that while the incidence of cerebral palsy was declining in Australia, early interventions with targeted therapies in cerebral palsy were showing promising results in altering the natural history of cerebral palsy as well as enhancing patient activities.

Currently there were two multicentre Australian trials evaluating the effect of early intervention in infants identified to be at high risk of developing cerebral palsy, according to authors Dr David Graham, Dr Simon Paget and Dr Neil Wimalasundera

GAME (goals, activity, motor enrichment) is a goal-oriented, activity-based, environmental enrichment therapy program for children under 6 months of age who are at high risk of developing cerebral palsy. REACH (Rehabilitation Early for Congenital Hemiplegia) is a trial for children aged between 3 and 9 months who have been identified as having congenital hemiplegia; the study is designed to compare the efficacy of modified constraint-induced movement therapy with infant bimanual therapy.

“The aim of these trials is to establish an evidence base for early intervention; children at high risk or children with an early diagnosis of cerebral palsy can then be streamlined into evidence-based interventions,” they wrote.

Their review also highlighted common challenges in the management of cerebral palsy, which include spasticity and dystonia, management of pain, hip surveillance, sleep and feeding, swallowing and nutrition.

In the meantime, as disease-modifying treatment options are limited, they recommended that treatment should focus on treating disability and managing associated comorbidities, based on the the “six Fs framework:

  • Function: how a child performs an activity is not important, the goal is to allow them to try.
  • Family: the family is the essential environment of the child and they know the child best; supports and resources for the whole family are vital to the child’s health.
  • Fitness: all children need to be physically active, regardless of the disability status; health promotion is more than a focus on remediating disability.
  • Fun: childhood is about fun, and it is incumbent upon caregivers to find out what the child wants to do.
  • Friends: social development is an important aspect of child development, regardless of ability; it is the quality of relationships that matters.
  • Future: child development is all about becoming, and this encompasses the other five Fs; the goals and expectations need to be considered in light of the present realities.”

“Early interventions with targeted therapies are showing promising results in altering the natural history of cerebral palsy as well as enhancing patient activities,” the authors wrote.

“There remain many challenges in the management of a child with cerebral palsy, but there exist a number of interventions with a good evidence base.”

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