Intensive rehabilitation therapies used for children with cerebral palsy under 2 years of age : A systematic review of the literature

Introduction: Cerebral palsy describes a group of disorders that appear in early childhood provoking impairments in movement control. Lack of movement can have a negative impact on the development of neural circuits and the acquisition of skills. However, the high brain plasticity of the infants could be a fundamental asset that can improve the chances of recovery. Given the considerable plasticity of the young brain, early interventions have been proven to promote better recovery. Objective: To describe early intensive interventions that have been cited throughout the literature and evaluate their efficiency on upper limb motor recovery if applied to children with unilateral cerebral palsy under 2 years old. Methods: A search was carried out through seven electronic databases: Embase, PubMed, Scopus, PEDro, EBSCO, Science direct, and PsycINFO. Only randomized controlled trials published in English and identified according to the PICO criteria were selected. Four RCTs were included in this study. Results: Based on rigorous inclusion criteria, 4 RCTs were included in this review. The studies were globally homogeneous in several aspects such as the age of participants, quality of articles, and outcomes. All included articles focused on intensive upper extremity rehabilitation methods. Three studies used mCIMT as an experimental treatment. Two of the three studies were unanimous about the effectiveness of this technique compared to the control interventions. One that used bimanual therapy as a control intervention showed that there was no significant difference between the two groups. GAME therapy was used in only one study out of the 4 RCTs. In contrast to the control group, improvements in gross motor function, cognition, and participation were observed in the children who received GAME therapy. Conclusion: Neurorehabilitation programs such as mCIMT, Bimanual therapy, and GAME therapy are feasible and effective in improving upper limb motor function for children diagnosed with hemiparetic cerebral palsy under the age of 2 years old.