Novak Iona, Morgan Catherine
Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
Handb Clin Neurol. 2019;162:483-510. doi: 10.1016/B978-0-444-64029-1.00023-0.
Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and supports parents. In this chapter, first we summarize the best-available tools for accurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy, developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impairment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidence for inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence base for: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focused on inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichment interventions in the neonatal intensive care and community settings, and (e) parent-child interaction interventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatment options at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosis enables early intervention, which improves child and parent outcomes. We now know which interventions provide the biggest gains and the information can be used to help inform parental decision making when designing treatment plans for their children.
利用临床现有的工具和程序可以实现儿童残疾的早期检测。残疾的早期检测能够进行早期干预,从而使儿童的预后最大化,预防并发症的发生,并为家长提供支持。在本章中,首先我们总结目前可用于早期准确预测主要儿童残疾的最佳工具,包括自闭症谱系障碍、脑瘫、发育协调障碍、胎儿酒精谱系障碍、智力残疾、听力障碍和视力障碍。其次,我们概述脑损伤后诱导神经可塑性的临床前和临床证据。第三,我们描述并评估以下方面的证据基础:(a) 诱导神经可塑性的基于训练的干预措施;(b) 不专注于诱导神经可塑性的康复干预措施;(c) 补充和替代干预措施;(d) 新生儿重症监护和社区环境中的环境丰富化干预措施;(e) 新生儿重症监护和社区环境中的亲子互动干预措施。第四,我们探讨临床试验中旨在损伤后诱导脑修复的新兴治疗选择。总之,早期诊断能够实现早期干预,从而改善儿童和家长的预后。我们现在知道哪些干预措施能带来最大的益处,这些信息可用于在为孩子设计治疗方案时帮助家长做出决策。