Effect of Motor Intervention for Infants and Toddlers With Cerebral Palsy: A Systematic Review and Meta-analysis.
Aubrey Baker, Natalie Niles, Lynn Kysh and 1 others
PMID 35671383WHAT IT FOUND
Task-specific motor training gave infants under 3 with CP a small motor advantage over standard care.
CIMT did not show a clear benefit over bimanual play or infant massage. All evidence is very low quality.
Key findings
01Task-specific motor training based on motor learning principles produced a small improvement in motor function (SMD 0.41, 95% CI 0.05 to 0.78, p = 0.03) compared to standard care or another motor intervention, pooled from 4 studies with 121 children. Heterogeneity was low (I² = 0%). The authors rate this very low-quality evidence, downgraded for risk of bias, indirectness, and imprecision.
02CIMT produced a moderate effect on unimanual function of the more-affected hand (SMD 0.59, 95% CI −0.18 to 1.37, p = .13) compared to bimanual play or infant massage, pooled from 4 studies with 150 children. The result did not reach statistical significance and heterogeneity was substantial (I² = 75%). The authors rate this very low-quality evidence, downgraded for inconsistency, indirectness, and imprecision.
03High-intensity treadmill training was no more effective than low-intensity treadmill training for gait function in toddlers with spastic diplegic CP. No between-group outcomes reached statistical significance. The authors rate this very low-quality evidence, downgraded for risk of bias and imprecision.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
All three intervention categories were rated very low-quality evidence by the authors, downgraded for risk of bias, inconsistency, indirectness, and imprecision. Only 11 RCTs were included, with 4 to 5 studies per intervention group and small sample sizes within each study. Heterogeneity of interventions and outcome measures was substantial, particularly in the CIMT meta-analysis (I² = 75%). Fewer than 10 studies were included for each meta-analysis, which precluded an assessment for publication bias. 5 of 11 studies had some concerns for risk of bias and 1 had high risk of bias, with the most common issues being deviations from intended intervention, selection of reported results, and the randomization process. All outcomes were measured immediately after the intervention ended; no follow-up data were available to assess whether any benefit was maintained. 15% of the 363 children were not confirmed to have CP by follow-up, so the findings apply to a mixed group of confirmed and suspected cases.
Declared interests
The authors declare no conflict of interest. The work was supported by NIH extramural funding.
The easy way to misread this
Do not read the CIMT result as evidence that it works for infants. The pooled effect was moderate (SMD 0.59) but did not reach statistical significance (p = .13), the confidence interval crossed zero (−0.18 to 1.37), and heterogeneity was substantial (I² = 75%). The authors themselves rate the evidence very low quality.
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