Multimodal Approach Works Best for Infants at High Risk of CP, Study Says

Multimodal Approach Works Best for Infants at High Risk of CP, Study Says


Combining a family-centered program and typical infant physiotherapy are likely to work best for effective early interventions in children at very high risk of developing cerebral palsy, according to a study.

The study, “LEARN2MOVE 0–2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy: neuromotor, cognitive, and behavioral outcome,” was published in the journal Disability and Rehabilitation.

In most middle- and upper-income countries, infants at risk for neurodevelopmental disorders such as cerebral palsy (CP) receive early intervention in the form of various programs.

There are several risk factors that can predispose an infant to CP, such as prematurity and serious brain lesions. Currently, little is known about the effects of early intervention in infants who are at  very high risk of CP.

Researchers at Beatrix Children’s Hospital, in the Netherlands, conducted LEARN2MOVE 0–2 to test the benefits of an early-intervention, family-centered program for infants at very high risk for cerebral palsy.

In this randomized controlled trial, the COPCA intervention — “Coping with and caring for infants with special needs” — was compared with regular infant physiotherapy.

COPCA is a relatively new approach that builds on two components: a family part, in which a physiotherapist coaches caregivers to empower them to make their own decisions; and a neurodevelopmental component, based on the Neuronal Group Selection Theory, with a hands-off approach that challenges the infant to find his or her own motor strategies.

The physiotherapist also coaches caregivers to implement interventions in daily life activities.

Researchers evaluated multiple outcomes, including those related to child neurodevelopment (neuromotor, cognition, and behavior), ability to function (daily life, activities, and participation), and family outcomes (family empowerment, coping).

In this study, researchers specifically reported the infants’ neuromotor, cognitive, and behavioral outcomes.

Forty-three infants were assigned to either one year of COPCA (23 children) or typical infant physiotherapy (20 children).  Neuromotor development, cognition, and behavior were assessed until 21 months of age.

Tests on each infant were performed at the beginning of the study (before start of the intervention), after three months, after six months, after 12 months of intervention (the end of the study’s intervention period), and at 21 months.

The study’s primary outcome was the Infant Motor Profile, a video-based measurement to assess motor behavior. Secondary outcomes included the Alberta Infant Motor Scale and the Gross Motor Function Measure, which measure gross motor maturation, and the Bayley Scales of Infant Development-Psychomotor Developmental Index, which provides indices of mental and motor age relative to group norms.

The results showed that during and after the interventions, infant outcomes regarding neuromotor, cognitive, and behavioral skills were similar in both intervention groups. This means that the various elements of both interventions may have a similar effect on developmental outcome.

Infants who had the most severe brain lesions (namely those with cystic periventricular leukomalacia) were at highest risk for impaired motor and cognitive outcome. Age at assessment was also strongly associated with the infant’s developmental outcome.

Caregivers’ educational level or the infant’s gestational age did not influence any of the measured outcomes.

“One year of COPCA and one year of typical infant physiotherapy in infants at high risk of CP resulted in similar neurodevelopmental outcomes,” the researchers stated.

“We suggest that a specific mix of ingredients of different approaches may work best, resulting in comprehensive care including both infant and family needs,” the researchers concluded.