Kinematic and Somatosensory Gains in Infants with Cerebral Palsy After a Multi-Component Upper-Extremity Intervention: A
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ORIGINAL PAPER
Kinematic and Somatosensory Gains in Infants with Cerebral Palsy After a Multi‑Component Upper‑Extremity Intervention: A Randomized Controlled Trial Nathalie L. Maitre1,2,11 · Arnaud Jeanvoine1 · Paul J. Yoder3 · Alexandra P. Key2,4 · James C. Slaughter5 · Helen Carey1 · Amy Needham6 · Micah M. Murray2,7,8,9 · Jill Heathcock10 · the BBOP group1 Received: 29 May 2020 / Accepted: 24 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Upper extremity (UE) impairments in infants with cerebral palsy (CP) result from reduced quality of motor experiences and “noisy” sensory inputs. We hypothesized that a neuroscience-based multi-component intervention would improve somatosensory processing and motor measures of more-affected (UEs) in infants with CP and asymmetric UE neurologic impairments, while remaining safe for less-affected UEs. Our randomized controlled trial compared infants (6–24 months) with CP receiving intervention (N = 37) versus a waitlisted group (N = 36). Treatment effects tested a direct measurement of reach smoothness (3D-kinematics), a measure of unimanual fine motor function (Bayley unimanual fine motor raw scores), and EEG measures of cortical somatosensory processing. The four-week therapist-directed, parent-administered intervention included daily (1) bimanual play; (2) less-affected UE wearing soft-constraint (6 h/day, electronically-monitored); (3) reach training on more-affected UE; (4) graduated motor-sensory training; and (5) parent education. Waitlist infants received only bimanual play. Effectiveness and safety were tested; z-scores from 54 posttest-matched typically-developing infants provided benchmarks for treatment effects. Intervention and waitlist infants had no pretest differences. Median weekly constraint wear was 38 h; parent-treatment fidelity averaged > 92%. On the more affected side, the intervention significantly increased smoothness of reach (Cohen’s d = − 0.90; p 6 determined by one of two physicians (physicians had > 90% intra- and inter-rater reliability for HINE administration and scoring). The asymmetry score examined differences in tone, posture, movement and reflexes between UEs. Exclusion criteria were congenital brain malformations, receipt of botulinum toxin to the affected extremity ≤ 3 months before study entry, and any prior prolonged hard constraint programs. Infants were encouraged to continue all developmental therapies in both groups for the 4 week-period, with the exception of therapist-administered training of UE function. The rationale for this was that children already received daily training from their parents that was guided by an experienced therapist on a weekly basis. Infants were screened for eligibility in the electronic medical record of outpatient clinical therapy, Neurology/ Stroke and High-Risk Infant Follow-up clinics at Nationwide Children’s Hospital. Informed consent was obtained for each subject per protocols approved by the hospital’s Institutional Review Board (IRB). A group of 54 TD i
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