Early Detection and Early Intervention - where are we now (and what does the future hold)?

The last time we had Alicia on the pod, we spoke about the Cochrane Review she led titled “Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants” which was published in 2024. In this week’s episode, we thought we’d ask Alicia about the state of early intervention right now and what the provision of therapy looks like within our current context of early detection and early intervention for children with cerebral palsy.

There have been some rather significant developments in the early detection and early intervention space over the past 20 years. From the rapid technological advances to the value of co-design and involvement of people with lived experience, we now have some impressive evidence to guide our clinical pathways. However, what is very clear now is the vital importance of implementation. The industry has generated substantial knowledge that now needs to be implemented into practice with one particularly important aspect that we must include - family involvement and well-being.

Alicia speaks ever so passionately about our role as therapists and I cannot help but to feel even more compelled to ensure that the family is at the centre of everything we do. It is exciting to know that we have the evidence now, so it’s time to put it into practice and it can start in your very next session.

https://findanexpert.unimelb.edu.au/profile/27041-alicia-spittle

Implementing Clinical Practice Guidelines for Improving Function in Cerebral Palsy: Development of a Fidelity Tool

In this study, the research team developed a 21-item fidelity tool to help clinicians implement evidence-based guidelines for improving function in children with cerebral palsy. Designed for goal setting, intervention, and reflection, the tool was found to be practical and useful but faced challenges like time constraints and family expectations. The study highlights the need for education, self-reflection, and organisational support to bridge the gap between research and practice.

Abstract
Purpose: To develop a fidelity tool to support the implementation of clinical practice guidelines to improve physical function for children and young people with cerebral palsy.

Methods: Fidelity tool development followed a 5-step process: the pilot study, using a mixed-methods action research approach, and including focus groups, questionnaires, and field notes.

Results: A 21-item fidelity tool representing the core components of the clinical practice guidelines was developed, including subsections of goal setting, intervention, and elements seen throughout therapeutic intervention. Clinicians and supervisors reported this tool as acceptable and feasible, especially when used as a self-reflection tool.

Conclusions: A fidelity tool has been developed that clinicians, supervisors and organizations can use to reflect on current practice and plan for changes to align practice with guidelines to improve function in children with cerebral palsy.

https://pubmed.ncbi.nlm.nih.gov/39378353/

Professor Nick Gottardo walks us through medulloblastomas - a comprehensive master class for clinicians and researchers. Expect to learn about early signs and symptoms, diagnosis, treatment and prognosis. Dr Nick breaks this down beautifully.

What was really clear throughout our discussion was that collaboration is key. Given the incidence of medulloblastomas and the specific subtypes that fall within this category, it would not be possible to develop effective treatments that minimise detrimental side effects without coming together with centres across the world.

This episode is truly special so if you want to know the current state of the evidence when it comes to treating medulloblastomas - this is a must listen episode.

All about knowledge translation

A special episode with our illustrious hosts before we catch up with Professor Nick Gottardo, Professor Alicia Spittle, Professor Andrew Whitehouse, Dr Gareth Baynam, Assoc. Professor Nikki Milne and Assoc. Clinical Professor Anita Gross amongst many others!

Randomized Comparison Trial of Rehabilitation Very Early for Infants with Congenital Hemiplegia

Roslyn N Boyd, Susan Greaves, Jenny Ziviani, Iona Novak, Nadia Badawi, Kerstin Pannek, Catherine Elliott, Margaret Wallen, Catherine Morgan, Jane Valentine, Lisa Findlay, Andrea Guzzetta, Koa Whittingham, Robert S Ware, Simona Fiori, Nathalie L Maitre, Jill Heathcock, Kimberley Scott, Ann-Christin Eliasson, Leanne Sakzewski

PMID: 39477009 DOI: 10.1016/j.jpeds.2024.114381

Free article

Abstract
Objective: To compare efficacy of constraint-induced movement therapy (Baby-CIMT) with bimanual therapy (Baby-BIM) in infants at high risk of unilateral cerebral palsy.

Study design: This was a single-blind, randomized-comparison-trial that had the following inclusion criteria: (1) asymmetric brain lesion (2) absent fidgety General Movements, (3) Hammersmith Infant Neurological Examination below cerebral palsy cut-points, (4) entry at 3-9 months of corrected age, and (5) greater than 3-point difference between hands on Hand Assessment Infants (HAI). Infants were randomized to Baby-CIMT or Baby-BIM, which comprised 6-9 months of home-based intervention. Daily dose varied from 20 to 40 minutes according to age (total 70-89.2 hours). Primary outcome measure was the HAI after intervention, with secondary outcomes Mini-Assisting Hand Assessment and Bayley III cognition at 24 months of corrected age.

Results: In total, 96 infants (51 male, 52 right hemiplegia) born median at 37-weeks of gestation were randomized to Baby-CIMT (n = 46) or Baby-BIM (n = 50) and commenced intervention at a mean 6.5 (SD 1.6) months corrected age. There were no between group differences immediately after intervention on HAI (mean difference MD 0.98 HAI units, 95% CI 0.94-2.91; P = .31). Both groups demonstrated significant clinically important improvements from baseline to after intervention (Baby-BIM MD 3.48, 95% CI 2.09-4.87; Baby-CIMT MD 4.42, 95% CI 3.07-5.77). At 24 months, 64 infants were diagnosed with unilateral cerebral palsy (35 Baby-CIMT, 29 Baby-BIM). Infants who entered the study between 3 and 6 months of corrected age had greater change in HAI Both Hands Sum Score compared with those who entered at ≥6 months of corrected age (MD 7.17, 95% CI 2.93-11.41, P = .001).

Conclusions: Baby-CIMT was not superior to Baby-BIM, and both interventions improved hand development. Infants commencing intervention at greater than 6 months corrected age had greater improvements in hand function.

https://pubmed.ncbi.nlm.nih.gov/39477009/

Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework

Susan Greaves, Brian Hoare

PMID: 39598017 PMCID: PMC11594546 DOI: 10.3390/jcm13226873

Abstract

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development.

We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given.

Keywords: bimanual therapy; constraint-induced movement therapy; early intervention; unilateral cerebral palsy; upper limb.

https://pubmed.ncbi.nlm.nih.gov/39598017/

Stacey L Cleary, Prue E Morgan, Margaret Wallen, Ingrid Honan, Nora Shields, Freya E Munzel, James R Plummer, Cassandra Assaad, Petra Karlsson, Evelyn Culnane, Jacqueline Y Ding, Carlee Holmes, Iain M Dutia, Dinah S Reddihough, Christine Imms

• PMID: 39673293
• DOI: 10.1111/dmcn.16196

Abstract

Aim: To synthesize the experiences of 15- to 34-year-olds with cerebral palsy (CP) as they participate in key life situations of young adulthood.

Method: A mixed-methods scoping review was undertaken and six electronic databases searched (January 2001 to August 2023). Participation foci and thematic outcomes were mapped to the International Classification of Functioning, Disability and Health. Results were integrated using a convergent integrated analysis framework, and data analysis completed through thematic synthesis. Themes were mapped to the family of Participation-Related Constructs.

Results: Thirty-eight publications (32 studies; 2759 participants) were included. More participants were male (n = 1435), walked independently (n = 1319), and lived with their families (n = 1171). 'Claiming my adulthood and "doing" life' was the unifying descriptor of participation, conveying the effortful work young people felt necessary to take their places in the adult world. The physical accessibility of the environment was a significant barrier to participation, as were people's negative attitudes or misconceptions about disability. A close-knit 'circle of support', typically family members, formed a supportive foundation during this period.

Interpretation: Young people with CP aim to participate fully in adult life, alongside their peers. Improved community accessibility, inclusion, and more supportive health environments would ensure they could live the lives they choose.

https://www.mycpguide.org.au/

https://upmovement.org.uk/

To round off 2024 and as an extra special lead-in to a stellar 2025 ahead, we have a holiday special - all about the EACD & IAACD 2025 Conference to be held in Heidelberg Germany! 🇩🇪

It's going to be a very unique conference this year as a combined EACD/IAACD event - so join with Dr Sebastian Schroeder and Dr Rainer Blank as they speak with our very own Dr Dayna Pool!

From a behind the scenes look, to what you can expect from the conference this year, the pre-conference sessions at the breathtaking UNESCO Monastery Maulbronn (FREE shuttles included in the conference registration!), be sure to join us for a brilliant conversation with some of Germany's very finest!

Also - are you curious about what a German Christmas looked like? Or what handy german phrases you should be working on before arriving, we've got you covered! 😉

You'll find the audiocast on all good podcast platforms and there's also the videocast on our YouTube channel, if you'd like to put a face to the voice!

youtube.com/@researchworkspodcast

researchworks.net

The ResearchWorks crew will be back again in early 2025 for Season 5 of the pod, with more long form interviews with incredible researchers from across the globe!