LEARN 2 MOVE 0-2 years: effects of a new intervention program in infants at very high risk for cerebral palsy; a randomized controlled trial

Abstract

BackgroundIt is widely accepted that infants at risk for cerebral palsy need paediatric physiotherapy. However, there is little evidence for the efficacy of physiotherapeutic intervention. Recently, a new intervention program, COPCA (Coping with and Caring for infants with special needs - a family centered program), was developed. COPCA has educational and motor goals. A previous study indicated that the COPCA-approach is associated with better developmental outcomes for infants at high risk for developmental disorders. LEARN 2 MOVE 0-2 years evaluates the efficacy and the working mechanisms of the COPCA program in infants at very high risk for cerebral palsy in comparison to the efficacy of traditional infant physiotherapy in a randomized controlled trial. The objective is to evaluate the effects of both intervention programs on motor, cognitive and daily functioning of the child and the family and to get insight in the working elements of early intervention methods.Methods/designInfants are included at the corrected age of 1 to 9 months and randomized into a group receiving COPCA and a group receiving traditional infant physiotherapy. Both interventions are given once a week during one year. Measurements are performed at baseline, during and after the intervention period and at the corrected age of 21 months. Primary outcome of the study is the Infant Motor Profile, a qualitative evaluation instrument of motor behaviour in infancy. Secondary measurements focus on activities and participation, body functions and structures, family functioning, quality of life and working mechanisms. To cope with the heterogeneity in physiotherapy, physiotherapeutic sessions are video-recorded three times (baseline, after 6 months and at the end of the intervention period). Physiotherapeutic actions will be quantified and related to outcome.DiscussionLEARN 2 MOVE 0-2 years evaluates and explores the effects of COPCA and TIP. Whatever the outcome of the project, it will improve our understanding of early intervention in children with cerebral palsy. Such knowledge is a prerequisite for tailor-made guidance of children with CP and their families.Trial registrationThe trial is registered under NTR1428.

Knee jerk responses in infants at high risk for cerebral palsy: an observational EMG study

“…In addition to the above-described phenomena, we clinically observed long-lasting contractions, multiphasic kicks, and contralateral responses when eliciting the knee jerk in some infants at high risk for cerebral palsy, participating in the LEARN2MOVE (L2M) 0-2 y study (7). To the best of our knowledge, long lasting, tonic responses after tapping the quadriceps tendon have not been studied before in infancy.…”

“…The VHR infants participated in the L2M 0-2 y study, a randomized controlled trial on the effect of early intervention in infants at high risk for cerebral palsy (7). Inclusion criteria of the L2M project were age at enrolment 1 to 9 mo corrected age and the presence of at least one of the following conditions: (i) cystic periventricular leukomalacia, (ii) parenchymal lesion of the brain, (iii) neonatal hypoxic-ischaemic encephalopathy (Sarnat 2 or 3) with brain lesions on MRI, and iv) neurological dysfunctions suggestive of the development of cerebral palsy (7). For the present study, we included all infants who were enrolled in the L2M project before the age of 5 mo corrected age.…”

The role of the family in intervention of infants at high risk of cerebral palsy: a systematic analysis

“…[37][38][39][40] Dirks et al 37 noted that 'The family is the cornerstone of COPCA. Therefore COPCA's key elements are family autonomy, family responsibility and family specific parenting.'…”

Associations of biological factors and affordances in the home with infant motor development

“…This idea may have more relevance for infants at risk and those with disabilities. For those infants, the outcome is heavily affected by the diversity and quality of cognitive, social and motor experiences provided in the environment . Each toy and piece of play material affords a new motor action.…”