Effectiveness of Family Collaborative Physiotherapy Programs With High-risk Infants
Condition: Cerebral Palsy; Infant, Newborn, Disease; Infant, Small for Gestational Age; Infant Asphyxia; Infant, Very Low Birth Weight; Infant of Diabetic Mother; Infant, Premature, Diseases; Infant Development
MeSH terms: Cerebral Palsy; Infant, Premature, Diseases; Infant, Newborn, Diseases; Birth Weight; Asphyxia
Study type: Interventional

Summary: 
      High risk infant is defined as infant with a negative history of environmental and biological
      factors, which can lead to neuromotor development problems. It is a heterogeneous group of
      premature infants born under thirty-seven weeks of age, with infants with low birth weight,
      term or developmental retardation for various reasons. Therefore, preterm infants with low
      birth weight can survive with a neurological sequelae such as cerebral palsy (CP), epilepsy,
      hearing and vision loss, mental retardation, speech and speech problems, and learning
      difficulties. The clinical diagnosis of CP, which can be observed in high-risk infants, is
      based on the combination of some neurological and clinical signs. High-risk of infant
      follow-up programs provide guidance for the treatment of neurodevelopmental delays and
      deterioration in terms of early development. Three methods with the best predictable validity
      that can determine CP before the adjusted age of 5-month is Magnetic Resonance Imaging (MRI),
      Prechtl's Assessment of General Movements (GMs), Hammersmith Infant Neurological Evaluation.
      In recent years, the diagnosis of high-risk of CP can be detected at 3 months with predictive
      validity and reliability by evaluating the quality of GMs. GMs are now considered the gold
      standard for early detection of CP because of its high sensitivity and specificity than MRI,
      cranial US and neurological evaluations. It was also found that cognitive or language skills
      may be inadequate in school age in patients with inadequate movement character and in the
      same postural patterns according to age, although GMs are normal. So new clinical care
      guidelines and new intervention research for infants with CP under the age of 2, needed to
      have been shown. High-risk infants who are thought to have developmental disorders need early
      intervention, but it is not yet known which interventions are more effective. In the
      literature, although interventions are generally shown to have a greater impact on cognitive
      development, their contribution to motor development cannot be fully demonstrated. The
      effectiveness of physiotherapy programs in the diagnosis and treatment of CP has not been
      clarified in the past years as a silent period. Therefore, studies involving early
      physiotherapy programs are needed in infants at high risk for CP.
    

Detailed description: 
      High-risk infants who are thought to have developmental disorders need early intervention,
      but it is not yet unknown which interventions are more effective. In the literature, although
      interventions are generally shown to have a greater impact on cognitive development, their
      contribution to motor development cannot be fully demonstrated. Early physiotherapy and
      rehabilitation in CP includes approaches starting from the neonatal period up to 24 months.
      The main aim is to gain normal functional movements and to provide normal sensory input by
      using the rapid learning ability resulting from brain plasticity. Thus, it is aimed to reach
      the most independent level in terms of physical, cognitive, psychological and social aspects
      within the physiological and anatomical deficiencies and environmental limitations of the
      child. In the literature, there are studies including interventions to preterm infants with
      high risk for developmental disorder. However, although the number of samples in the studies
      is high, there is insufficient information about the rate of CP development. The
      effectiveness of physiotherapy programs in the diagnosis and treatment of CP has not been
      clarified in the past years as a silent period. Therefore, studies involving early
      physiotherapy programs are needed in infants at high risk for CP. Preterm infants have been
      shown to have difficulty in most functional areas due to lower academic success, welfare and
      productivity. These difficulties may arise in childhood and adolescence due to brain damage
      and structural changes. The stress of being away from mother contact has been proven in human
      and experimental animal studies. Physical and emotional environment modifications of the
      babies in the incubator environment can also reduce stress. Parent-centered trainings that
      will increase sensitivity in the intensive care unit by reducing stresses in the brain in
      terms of early intervention; it has been shown to have positive reflections on motor and
      cognitive development in the short term. In the literature, it has been shown that the
      specific motor education programs and the interventions that parents learn how to support the
      development of their babies are the most important ways to increase the cognitive development
      of infants at high risk by reducing motor disorders. It is essential to force babies to
      produce motor behavior on their own, knowing the limits of motor behavior. It is then
      essential to ensure that babies continue this activity and to use stimulations for this.
      There may be positive developmental outcomes in physiotherapy models such as COPCA, where
      parental coaching is performed. However, further studies are needed in this area. These
      physiotherapy approaches are necessary to reduce the risk for motor and cognitive development
      and to achieve normal motor development. In particular, the motor and cognitive development
      of infants at high risk of CP should be monitored. In the literature, an early rehabilitation
      model that includes physiotherapy in family routines has shown that some problems with high
      risk of infants need to be focused on by early physiotherapy approach. In our study, the
      effectiveness of family education and family cooperative physiotherapy programs in accordance
      with NDT-based neurodevelopmental treatment principles applied to infants with high risk of
      CP will be examined. The effect of physiotherapy methods applied to infants on motor and
      cognitive development levels will be investigated according to the risk factors and
      physiotherapy model. In addition, the effects of physiotherapy programs on the possibility of
      decreasing the symptoms of CP or preventing the development of CP will be examined.
    

Intervention name(s): exercise
Intervention type(s): Other
Intervention description(s): exercises,play therapy models and positioning, handling and holding principles for babies, daily routins
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Infants will be divided into two groups according to prenatal risk factors (maternal age, intrauterine growth retardation, chronic diseases etc.) by random minimization method and taken into 2 different physiotherapy programs. As the control group, the group participating in the evaluations stating that they cannot participate in the treatment without any intervention will be taken.
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: Family Collaboration,; high risk of CP; physiotherapy