Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews

다국어 초록 (Multilingual Abstract)

To perform an overview of systematic reviews and more recent randomized controlled trials (RCTs) on early motor interventions in infants aged 0 to 3 years with or at risk of cerebral palsy to inform current clinical and research efforts and provide a benchmark to assess future interventions ideally initiated within the first 6 months.
Standardized searches of the PubMed, Embase, Scopus, and Web of Science databases were conducted for systematic reviews (2009–2020) and RCTs (2015–2020).
From 840 unique records, 31 full texts were reviewed, yielding three systematic reviews encompassing 46 studies, 16 with comparison groups, and six additional RCTs that met the criteria. Two enrichment‐ and activity‐based approaches had medium effect sizes on motor development, only one with low risk of bias; two others had large task‐specific effect sizes but some bias concerns; and three enriched environment studies with some bias concerns had medium effect sizes on cognitive development. Most had small or no effect sizes, bias concerns, and uncertain diagnostic determinations.
Data synthesis revealed limited data quantity and quality, and suggest, although not yet confirmed, greater benefit from early versus later intervention. Research efforts with greater early diagnostic precision and earlier intervention are accelerating, which may transform future outcomes and practices.



For over 50% of trials within the reviews, the intervention was compared to standard care with only two showing efficacy.

Similar to results in older children, constraint‐induced movement therapy (CIMT) emerged as efficacious with high effect sizes.

CIMT was not superior to similarly intense bimanual training or occupational therapy.

Goals‐Activity‐Motor Enrichment intervention initiated before 5 months of age was superior to equally intense standard care.

Several other enriched environment strategies promoted cognitive and/or motor development.


Realizar un resumen de revisiones sistemáticas y ensayos controlados aleatorios (ECA) más recientes sobre intervenciones motoras tempranas en bebés de 0 a 3 años con o en riesgo de parálisis cerebral para informar los esfuerzos clínicos y de investigación actuales y proporcionar un punto de referencia para evaluar las intervenciones futuras de manera ideal iniciado dentro de los primeros 6 meses.
Se realizaron búsquedas estandarizadas en las bases de datos PubMed, Embase, Scopus y Web of Science para revisiones sistemáticas (2009‐2020) y ECA (2015‐2020).
De 840 registros únicos, se revisaron 31 textos completos, lo que arrojó tres revisiones sistemáticas que abarcaron 46 estudios, 16 con grupos de comparación y seis ECA adicionales que cumplieron con los criterios. Dos enfoques basados ​​en el enriquecimiento y la actividad tuvieron tamaños de efecto medios sobre el desarrollo motor, solo uno con bajo riesgo de sesgo; otros dos tenían grandes tamaños de efecto específicos de la tarea, pero algunos problemas de sesgo; y tres estudios de entornos enriquecidos con algunas preocupaciones sobre el sesgo tuvieron tamaños de efecto medios sobre el desarrollo cognitivo. La mayoría tenía tamaños de efecto pequeños o nulos, problemas de sesgo y determinaciones diagnósticas inciertas.
La síntesis de datos reveló una cantidad y calidad de datos limitadas, y sugiere, aunque aún no se ha confirmado, un mayor beneficio de la intervención temprana frente a la posterior. Se están acelerando los esfuerzos de investigación con una mayor precisión de diagnóstico temprano y una intervención más temprana, lo que puede transformar los resultados y las prácticas futuras.
Realizar uma revisão de revisões sistemáticas e estudos clínicos randomizados (ECRs) sobre intervenções precoces motoras em lactentes de 0 a 3 anos com paralisia cerebral ou de risco, para informar esforços clínicos e de pesquisas atuais e para fornecer uma base para avaliar futuras intervenções idealmente iniciadas nos primeiros 6 meses.
Buscas padronizadas nas bases de dados PubMed, Embase, Scopus, e Web of Science foram realizadas quanto a revisões sistemáticas (2009–2020) e ECRs (2015–2020).
De 840 registros únicos, 31 textos completos foram revisados, reultado em 3 revisões sistemáticas que envolveram 46 estudos, 16 com grupo de comparação, e seis ECRs adicionais que atenderam aos critérios. Duas abordagens de enriquecimento e baseadas em atividades tiveram tamanhos de efeito médios para o desenvolvimento motor, apenas uma com baixo risco de viés; duas outras tiveram grandes tamanhos de efeito tarefa‐específicos mas algumas preocupações com viés; e três estudos com ambientes enriquecidos com algumas preocupações relativas ao viés tiveram tamanhos de efeito médios para o desenvolvimento cognitivo. A maioria tinha tamanhos de efeito pequenos ou inexistentes, preocupações com viés, e determinações diagnósticas incertas.
A síntese de dados revelou limitada quantidade e qualidade de dados e sugere, embora ainda não confirmado, maior benefício da intervenção precoce versus tardia. Esforços de pesquisas com maior precisão diagnóstica precoce e intervenção mais precoce têm se acelerado, o que pode transformar os resultados e práticas futuros.



For over 50% of trials within the reviews, the intervention was compared to standard care with only two showing efficacy.

Similar to results in older children, constraint‐induced movement therapy (CIMT) emerged as efficacious with high effect sizes.

CIMT was not superior to similarly intense bimanual training or occupational therapy.

Goals‐Activity‐Motor Enrichment intervention initiated before 5 months of age was superior to equally intense standard care.

Several other enriched environment strategies promoted cognitive and/or motor development.


This article is commented on by Basu on page 762 of this issue.
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