Date of Award

2015

Degree Name

Doctor of Philosophy (College of Medicine)

Schools and Centres

Medicine

First Supervisor

Professor Iona Novak

Second Supervisor

Professor Nadia Badawi

Abstract

Background and aims: Cerebral palsy (CP) is the most common physical disability of childhood occurring in 1 in 500 live births in developed countries. Although CP starts in infancy because of a lesion in the developing brain, it is usually not diagnosed until about 19 months. The problem with late detection has meant that early neurorehabilitation is not accessed until motor impairment is evident. Consequently the dose of active intervention during the critical period for brain plasticity is often inadequate. Little evidence exists for the effectiveness of early intervention (EI) protocols for infants with CP. In particular, interventions that take a motor learning approach and focus on the task and environment as well as the child, are rarely used. The aim of this research was to evaluate the effectiveness of a motor learning intervention on infants at high risk of CP who were identified early in infancy.

Method: A literature review was conducted to explore current practice and evidence regarding how and when CP is diagnosed. Then a systematic review and meta-analysis was carried out to evaluate the effectiveness of environmental enrichment interventions on the motor outcomes of infants with CP. A prospective study assessed the feasibility of detecting CP in an Australian context using the General Movements Assessment (GMA). An EI enrichment programme “GAME” (Goals, Activity and Motor Enrichment) was then developed based on contemporary motor learning theory and within the framework of family centred practice. GAME was tested in a feasibility 12-week pilot (n=13) and then in a larger (n=30) randomised controlled trial (RCT).

Results: Meta-analysis of five studies demonstrated a small positive effect (SMD=0.39) for environmental enrichment interventions compared to standard care. Accuracy for detecting CP using the GMA was 98% (sensitivity) and 94% (specificity). Results of both RCTs demonstrated an advantage in motor outcomes for infants in GAME at all time points on both norm referenced and criterion referenced outcome measures.

Conclusion: Early identification of infants with CP is possible using evidence based tools. Motor outcomes for infants with CP can be advanced by early and specific motor learning interventions offered in an enriched home environment.

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