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American Academy of Pediatrics
Review Article

Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis

Catherine Morgan, Iona Novak and Nadia Badawi
Pediatrics September 2013, 132 (3) e735-e746; DOI: https://doi.org/10.1542/peds.2012-3985
Catherine Morgan
aSchool of Medicine, and
bCerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Darlinghurst, NSW, Australia;
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Iona Novak
bCerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Darlinghurst, NSW, Australia;
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Nadia Badawi
bCerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Darlinghurst, NSW, Australia;
cGrace Centre for Newborn Care, Children’s Hospital Westmead, Westmead; and
dUniversity of Sydney, NSW, Australia
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Abstract

BACKGROUND AND OBJECTIVES: Neuroplasticity evidence from animals favors an early enriched environment for promoting optimal brain injury recovery. In infants, systematic reviews show environmental enrichment (EE) improves cognitive outcomes but the effect on motor skills is less understood. The objective of this review was to appraise the effectiveness evidence about EE for improving the motor outcomes of infants at high risk of cerebral palsy (CP).

METHODS: A systematic review was conducted. Cochrane Central Register of Controlled Trials (PubMed), Cumulative Index to Nursing and Allied Health Literature, Education Resource Information Center, SocINDEX, and PsycINFO databases were searched for literature meeting inclusion criteria: randomized controlled trials; high risk of /diagnosis of CP; >25% participants ≤2 years; parent or infant interventions postdischarge; and motor outcomes reported. Data were extracted using the Cochrane protocol regarding participants, intervention characteristics, and outcomes. Methodological quality was assessed using risk of bias assessment and GRADE.

RESULTS: A total of 226 studies were identified. After removing duplicates and unrelated studies, 16 full-text articles were reviewed, of which 7 studies met inclusion criteria. The risk of bias varied between studies with the more recent studies demonstrating the lowest risk. Enrichment interventions varied in type and focus, making comparisons difficult. A meta-analysis was conducted of studies that compared enrichment to standard care (n = 5), and totaled 150 infants. A small positive effect for enrichment was found; standardized mean difference 0.39 (95% confidence interval 0.05–0.72; I2 = 3%; P = .02)

CONCLUSIONS: EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required.

  • cerebral palsy
  • infants
  • enrichment
  • motor learning
  • Abbreviations:
    CIMT —
    constraint-induced movement therapy
    COPCA —
    Coping with and Caring for Infants with Special Needs, CP, cerebral palsy
    EE —
    environmental enrichment
    GMFCS —
    Gross Motor Function Classification System
    NDT —
    neurodevelopmental therapy
    PDI —
    Psychomotor Developmental Index
    PEDI —
    Pediatric Evaluation Disability Inventory
    PVL —
    periventricular leukomalacia
    QUEST —
    Quality of Upper Extremity Skills Test
    RCT —
    randomized controlled trial
    • Accepted June 20, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 132, Issue 3
    1 Sep 2013
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    Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis
    Catherine Morgan, Iona Novak, Nadia Badawi
    Pediatrics Sep 2013, 132 (3) e735-e746; DOI: 10.1542/peds.2012-3985

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    Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis
    Catherine Morgan, Iona Novak, Nadia Badawi
    Pediatrics Sep 2013, 132 (3) e735-e746; DOI: 10.1542/peds.2012-3985
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