Intervention for infants with brain injury: Results of a randomized controlled study

Abstract

A randomized clinical trail (RCT) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury. The control group infants received the State-funded follow-up program provided by the Los Angeles (LA) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System (CAMS) taught by public health nurses (PHNs). The developmental assessments and outcome measures were performed at 6, 12 and 18 months corrected age and included the Bayley motor and mental development, the Home, mother-infant interaction (Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment Teaching Scale (NCATS)), parental stress and social support. At 18 months, 43 infants remained in the study.The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group. Likewise, the intervention did not contribute to less stress or better mother-infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months. There was a significant trend, however, for the control group to have a significant decrease over time on the Bayley mental scores. Although the sample was not large and attrition was at 31%, this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome. Keywords Newborn brain injury; Stimulation; Intervention; OutcomeOver the past 30 years, evidence has been accumulating for the neuro-plasticity of the human brain, allowing for recovery of important brain regions after injury. The organization of interconnected neurons, which make up neural systems, is not structurally or functionally rigid as once believed. Rather, individual neurons are able to modify their intrinsic membrane properties and the strength of their synaptic connections in response to varying levels of stimulation (du Plessis & Volpe, 2002;Kennedy & Marder, 1992). The newborn's brain develops in a stepwise, organized fashion. It involves the unfolding of discrete, sequential embryonic processes that include the division, migration and differentiation of neural elements, dendritic arborization, and maturation of synapses. As the brain develops and matures, behavioral patterns emerge that reflect the integration of complex cerebral networks (Berger & Garnier, 1999;Volpe, 2000).Several factors are implicated in the etiology of brain injury. The most common cause is hypoxic-ischemic encephalopathy (HIE) which has been associated with neuronal reorganization. Current data suggest that about 2-5 of 1000 live term births experience hypoxic-ischemic brain injury or intraventricular hemorrhage (IVH) of those, 30-40% die during the newborn period and 20-50%; of those, who survive develop signif...

Recommendations for the Use of Common Outcome Measures in Pediatric Traumatic Brain Injury Research

“…The core battery consists of five scales: three childassessed scales (cognitive, motor, language) and two scales that derive information from parent questionnaires (socialemotional and adaptive behavior). Earlier versions of this measure have been used extensively in studies assessing outcome after early brain injury (Badr, 2009;Badr et al, 2006;Barlow et al, 2005;Beers et al, 2007;Bonnier et al, 2007;Ewing-Cobbs et al, 1998bLandry et al, 2004;Prasad et al, 1999Prasad et al, , 2002. The Bayley-III also has strong psychometric properties (Bayley, 2005).…”

Efficacy of Early Physiotherapy Intervention in Preterm Infant Motor Development— A Systematic Review—

“…It is important to point out that 5 of the16 studies used in this review had high methodological quality, a score of six or higher on the PEDro scale, 15,25,[29][30][31] five had medium methodological quality, a score of five, 20,22,26,27,33) and six had low methodological quality, with scores of less five, 21,23,24,28,32,34) . Two out of five studies with high methodological quality reported favourable results for the intervention groups 15,29) (40%).…”

“…In those studies where intervention began when children were discharged from the Neonatal Intensive Care Unit, the Bobath method was the main method of physical therapy intervention 26,30,32,33) , but there were also studies with interventions based on the Vojta Method 21,28) , family-focussed physiotherapy 15) , physiotherapy based on motor development 20,27,29,34) , and mixed treatments based on the Vojta and Bobath methods 24) .…”

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

“…Three studies [36][37][38] investigated the effects of EE interventions (as per our definition) on very young hospitalized infants with brain injuries and at high risk of CP and followed their progress post discharge. The remaining 4 studies 39-42 investigated EE interventions (as per our definition) in children older than 1 year with a confirmed diagnosis of CP.…”

“…Six studies provided part of the EE intervention via parent training or coaching. This included ways of interacting with their infant, [36][37][38] strategies for modifying the physical environment for motor task practice, and providing frequent opportunities for task practice. 39,40,42 Only 1 study did not actively train parents but encouraged them to "use newly acquired skills when the therapist was not present."…”