Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis

Abstract

BACKGROUND AND OBJECTIVES: Neuroplasticity evidence from animals favors an early enriched environment for promoting optimal brain injury recovery. In infants, systematic reviews show environmental enrichment (EE) improves cognitive outcomes but the effect on motor skills is less understood. The objective of this review was to appraise the effectiveness evidence about EE for improving the motor outcomes of infants at high risk of cerebral palsy (CP). METHODS:A systematic review was conducted. Cochrane Central Register of Controlled Trials (PubMed), Cumulative Index to Nursing and Allied Health Literature, Education Resource Information Center, SocINDEX, and PsycINFO databases were searched for literature meeting inclusion criteria: randomized controlled trials; high risk of /diagnosis of CP; .25% participants #2 years; parent or infant interventions postdischarge; and motor outcomes reported. Data were extracted using the Cochrane protocol regarding participants, intervention characteristics, and outcomes. Methodological quality was assessed using risk of bias assessment and GRADE.RESULTS: A total of 226 studies were identified. After removing duplicates and unrelated studies, 16 full-text articles were reviewed, of which 7 studies met inclusion criteria. The risk of bias varied between studies with the more recent studies demonstrating the lowest risk. Enrichment interventions varied in type and focus, making comparisons difficult. A meta-analysis was conducted of studies that compared enrichment to standard care (n = 5), and totaled 150 infants. A small positive effect for enrichment was found; standardized mean difference 0.39 (95% confidence interval 0.05-0.72; I 2 = 3%; P = .02)CONCLUSIONS: EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required. Ms Morgan and Dr Novak were involved in quality assessment, data extraction, data analysis, and manuscript preparation; Dr Badawi was involved in quality assessment and manuscript critique. All authors were involved in study conception and design, interpretation of data, critical revision, and final approval of the submitted manuscript. Children with cerebral palsy (CP) reach ∼90% of their gross motor potential by age 5 and even younger for the more severely impaired, 1 so effective interventions for optimizing early motor development are vital. As with typically developing children, the first 2 years are critically important for cognitive and motor development 2 because the brain is experiencing continuous spontaneous plasticity. Pediatricians, who are responsible for making the diagnosis of CP and referral to rehabilitation, therefore require up-todate evidence about effective early interventions for children with CP.The value of enriched environments in enhancing brain recovery at both structural and chemical levels has been repeatedly demonstrated in animal studies. 3,4 Effects of enrichment include improved memory and motor function. 4 Replication of animal data findings within humans is still...

Early reach to grasp development of infants with asymmetric brain injury on the Grasp and Reach Assessment of Brisbane (GRAB)

“…[6][7][8] Grasp Grasp involves contacting the toy using all or most fingers with the palm, and closing around the toy (or holding the toy). Grasping may be brief or the toy may be held for a prolonged period of time.…”

“…There is strong evidence for small effects of environmental enrichment (EE) to improve motor outcomes in infants and children up to seven years; however, there were methodological limitations across studies including inconsistent definitions of EE. 6 There is inconclusive evidence for the efficacy of FUT to improve UL outcomes, due to the methodological limitations of available studies. Randomised controlled trials within SRs that met inclusion criteria were then extracted from each SR and analysed quantitatively.…”

“…Dr Robert S Ware, PhD 3,4 Gessica Tealdi, PhT 5 Dr Valentina Burzi, MD 6 Professor Roslyn N Boyd, PhD 1 …”

“…Assessment of reach to grasp to determine delayed motor development in infants with asymmetric brain injury Authors *Micah Perez, MOccThySt 1 Professor Jenny Ziviani, PhD 2 Dr Andrea Guzzetta, PhD 5,6 Dr Robert S Ware, PhD 3,4 Gessica Tealdi, PhT 5 Dr Valentina Burzi, MD 6 Professor Roslyn N Boyd, PhD 1 …”

“…6 Early environmental enrichment (EE) can enhance UL intervention by providing opportunities for motor learning through different modalities such as active motor training, parental education and environmental adaptation. [6][7][8] In contrast to traditional UL interventions, two important components of EE are involvement of the family and optimising the home environment.…”