Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis

Abstract

BACKGROUND AND OBJECTIVE Bobath therapy, or neurodevelopmental therapy (NDT) is widely practiced despite evidence other interventions are more effective in cerebral palsy (CP). The objective is to determine the efficacy of NDT in children and infants with CP or high risk of CP. METHODS Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, and Medline were searched through March 2021. Randomized controlled trials comparing NDT with any or no intervention were included. Meta-analysis was conducted with standardized mean differences calculated. Quality was assessed by using Cochrane Risk of Bias tool-2 and certainty by using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Of 667 records screened, 34 studies (in 35 publications, 1332 participants) met inclusion. Four meta-analyses were conducted assessing motor function. We found no effect between NDT and control (pooled effect size 0.13 [−0.20 to 0.46]), a moderate effect favoring activity-based approaches (0.76 [0.12 to 1.40]) and body function and structures (0.77 [0.19 to 1.35]) over NDT and no effect between higher- and lower-dose NDT (0.32 [−0.11 to 0.75]). A strong recommendation against the use of NDT at any dose was made. Studies were not all Consolidated Standards of Reporting Trials-compliant. NDT versus activity-based comparator had considerable heterogeneity (I2 = 80%) reflecting varied measures. CONCLUSIONS We found that activity-based and body structure and function interventions are more effective than NDT for improving motor function, NDT is no more effective than control, and higher-dose NDT is not more effective than lower-dose. Deimplementation of NDT in CP is required.

The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy

“…This lack of consensus or clear definition, together with the divergence in practice and teaching, has made interpreting and generalizing any reported findings difficult. This has been compounded by shortcomings in research methodology leading to unfavourable reviews in the literature, including a call to de‐implement the approach 9,10 …”

Short‐term effects of SAFE early intervention approach in infants born preterm: A randomized controlled single‐blinded study

“…However, the results of the studies on the effects of NDT on motor development are contradictory (Damiano, 2013; Te Velde et al., 2022). Although minimal changes occur with NDT in infancy, recent systematic reviews on the effect of early intervention in high‐risk infants have shown that NDT does not improve neurodevelopmental outcomes (Blauw‐Hospers & Hadders‐Algra, 2005; Blauw‐Hospers et al., 2007: Spittle et al., 2012; Te Velde et al., 2022). Also, passive techniques like stretching and passive range of motion exercises are generally provided with “hands‐on” techniques.…”

“…However, the results of the studies on the effects of NDT on motor development are contradictory (Damiano, 2013;Te Velde et al, 2022). Although minimal changes occur with NDT in infancy, recent systematic reviews on the effect of early intervention in high-risk infants have shown that NDT does not improve neurodevelopmental outcomes (Blauw-Hospers & Hadders-Algra, 2005;Blauw-Hospers et al, 2007: Spittle et al, 2012Te Velde et al, 2022). Also, passive techniques like stretching and passive range of motion exercises are generally provided with "hands-on" techniques.…”

Harnessing neuroplasticity to improve motor performance in infants with cerebral palsy: a study protocol for the GAME randomised controlled trial

“…Despite universal beliefs about the benefits of early intervention, systematic reviews6 7 indicate that traditional early intervention is ineffective for infants with CP, with most trials failing to confer any motor gains 6. Significant shortcomings exist within standard early intervention for infants with CP and research studies to date in that: (1) intervention is late, not early due to delayed diagnosis8; (2) many traditional therapy approaches involve hands-on therapist-executed movements, where the infant’s role in movement generation is passive not active, all of which have been proven ineffective and fail to harness neural plasticity7 9; (3) intervention is underdosed10; and (4) major methodological flaws exist in previous trials. In addition, early identification of risk for CP was historically less accurate leading to inadvertently recruiting and treating normal infants within CP trials, reducing statistical power 6…”

“…When usual care eventually starts it is often not evidence-based, as it typically involves traditional passive movement approaches, which have been proven ineffective 7 9. Neuroscience preclinical data strongly support early active movement training as an intervention for improving brain reorganisation and outcomes after early brain damage.…”