Reviewing the evidence for goal oriented early intervention in CP

Wallen et al (2017)  have published a commentary in the Australian OT Journal  on two papers (Hadders Algra 2017, Novak et al 2016) which reviewed the evidence for early intervention in cerebral palsy.

Both these papers conclude that there is evidence, albeit weak at this stage, for the implementation of intensive goal oriented intervention for infants at high risk for CP. 

The commentary by Wallen et al (2017) makes the following recommendations:

"While evidence remains weak, the consistent outcomes and emerging evidence described by both reviews, have important implications for occupational therapists. Working with infants with CP means focussing on occupation, rather than using neuro-maturational approaches that seek to normalise movement. The core philosophies of our occupation-based profession are entirely consistent with the key ingredients of evidence-based models of early intervention proposed in these reviews including child-initiated movement, task specificity, environmental modification and parent support and education."

"Paediatric occupational therapists should abandon generalized, low intensity models of intervention. Alongside a specific, targeted, therapist-guided program, interventions should include a goal-directed home program as a pragmatic solution to achieving optimal intensity and to ensure generalisation of skills (Novak, Cusick & Lannin, 2009).'

Wallen M, Imms C, Hoare B, Greaves S. Weak evidence supports intensive, task-oriented, early intervention with parent support for infants with, or at high risk of, cerebral palsy. Aust Occup Ther J. 2017 Oct;64(5):423-425.  PDF via Researchgate

Hadders-Algra M, Boxum AG, Hielkema T, Hamer EG. Effect of early intervention in infants at very high risk of cerebral palsy: a systematic review. Dev Med Child Neurol. 2017 Mar;59(3):246-258. doi: 10.1111/dmcn.13331. Epub 2016 Dec 7. Review. PubMed PMID: 27925172.

Morgan C, Darrah J, Gordon AM, Harbourne R, Spittle A, Johnson R, Fetters L. Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Dev Med Child Neurol. 2016 Sep;58(9):900-9. doi: 10.1111/dmcn.13105. Epub 2016 Mar 29. Review. PubMed PMID: 27027732.

Novak, I., Cusick, A. & Lannin, N. (2009). Occupational therapy home programs for cerebral palsy: Double-blind, randomized, controlled trial. Pediatrics, 124, e606–e614.