School of Medicine, University of Notre Dame Australia.
Pediatrics. 2013 Sep;132(3):e735-46. doi: 10.1542/peds.2012-3985. Epub 2013 Aug 19.
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).
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.
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; I(2) = 3%; P = .02) CONCLUSIONS: EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required.
动物的神经可塑性证据支持早期丰富环境以促进最佳脑损伤恢复。在婴儿中，系统评价表明环境丰富（EE）可以改善认知结果，但对运动技能的影响了解较少。本综述的目的是评估 EE 对改善高风险脑瘫（CP）婴儿运动结果的有效性证据。
进行了系统评价。 Cochrane 对照试验中心注册库（PubMed）、护理与相关健康文献累积索引、教育资源信息中心、SocINDEX 和 PsycINFO 数据库均针对符合纳入标准的文献进行了搜索：随机对照试验；高风险/CP 诊断；>25%的参与者≤2 岁；出院后进行父母或婴儿干预；以及报告的运动结果。使用 Cochrane 方案提取参与者、干预特征和结局数据。使用偏倚风险评估和 GRADE 评估方法学质量。
共确定了 226 项研究。在去除重复项和不相关的研究后，对 16 篇全文文章进行了审查，其中 7 项研究符合纳入标准。研究之间的偏倚风险存在差异，最近的研究显示出最低的风险。富集干预在类型和重点上存在差异，使得比较困难。对将富集与标准护理进行比较的研究进行了荟萃分析（n = 5），共有 150 名婴儿。富集的效果较小但有统计学意义；标准化均数差 0.39（95%置信区间 0.05-0.72；I² = 3%；P =.02）。
EE 对 CP 似乎很有前景，因此迫切需要高质量、具有明确 EE 策略的研究。
