Title

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews

DOI

10.1001/jamapediatrics.2021.0878

Authors

Catherine Morgan, Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.
Linda Fetters, University of Southern California, Los Angeles.
Lars Adde, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Nadia Badawi, Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.
Ada Bancale, IRCCS Fondazione Stella Maris, Pisa, Italy.
Roslyn N. Boyd, The University of Queensland, St Lucia, Queensland, Australia.
Olena Chorna, IRCCS Fondazione Stella Maris, Pisa, Italy.
Giovanni Cioni, IRCCS Fondazione Stella Maris, Pisa, Italy.
Diane L. Damiano, National Institutes' of Health, Bethesda, Maryland.
Johanna Darrah, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Linda S. de Vries, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Stacey Dusing, University of Southern California, Los Angeles.
Christa Einspieler, Division of Phoniatrics, Medical University of Graz, Austria.
Ann-Christin Eliasson, Karolinska Institutet, Stockholm, Sweden.
Donna Ferriero, University of California, San Francisco, San Francisco.
Darcy Fehlings, Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Hans Forssberg, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Andrew M. Gordon, Teachers College, Columbia University, New York, New York.
Susan Greaves, The Royal Children's Hospital, Melbourne, Australia.
Andrea Guzzetta, IRCCS Fondazione Stella Maris, Pisa, Italy.
Mijna Hadders-Algra, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Regina Harbourne, Duquesne University, Pittsburgh, Pennsylvania.
Petra Karlsson, Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.
Lena Krumlinde-Sundholm, Karolinska Institutet, Stockholm, Sweden.
Beatrice Latal, University Children's Hospital Zurich, Zurich, Switzerland.
Alison Loughran-Fowlds, Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Catherine Mak, The University of Queensland, St Lucia, Queensland, Australia.
Nathalie Maitre, Nationwide Children's Hospital, The Ohio State University, Columbus.
Sarah McIntyre, Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.
Cristina Mei, Orygen, Parkville, Victoria, Australia.
Angela Morgan, The Royal Children's Hospital, Melbourne, Australia.
Angelina Kakooza-Mwesige, Makerere University, Kampala, Uganda.

Document Type

Journal Article

Publication Date

8-1-2021

Publication Title

JAMA pediatrics

Volume

175

Issue

8

First Page

846

Last Page

858

Abstract

Importance: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. Objective: To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. Evidence Review: The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. Findings: Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). Conclusions and Relevance: When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.

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