The early rehabilitation issues for the infants at risks of developmental disorders. Proposal for a regional policy.
Dr Renée-Pierre DUPUYa, Mrs Sophie CHAPELLIERb, Mrs Sophie TOURNIERb, Mrs Audrey BERDEUb, Mr Luc DARDONVILLEb, Dr Mélanie PORTEc
a Réseau Grandir en Languedoc-Roussillon, b Cabinet de kinésithérapie, c CHU Caremeau
Children at risk of developmental disorder or disabilities are enrolled for follow-up in the Grandir en Languedoc-Roussillon network, from birth until 7 years old. They are mainly preterm children or full term infants with perinatal pathology that can lead to disability onset. Some of them have early neurological symptoms suggestive of cerebral palsy. For the other, the regular follow up each 3 months in the first year can highlight neurodevelopmental features such as regulation of tone disorder, unbalance axial tone, postural asymmetry, predominance of hyperextension, plagiocephaly, suboptimal general movements.
Based on the brain plasticity concept (1) and the results of early intervention programs(2), physical therapists, pediatricians and rehabilitation doctors developed an early rehabilitation support for those children with minor disabilities and guidance for their parents. They have written a regional reference with indications and recommendations during the first year of life. We propose to introduce this document.
Further investigations will be necessary to evaluate the impact of early physiotherapy on neurodevelopmental outcome of these children. Since the Grandir en Languedoc-Roussillon follow up program collects all of these data until 7 years of age, it will be probably possible to provide a reasoned answer.
(1)WITTENBERG, GF. Neural plasticity and treatment across the lifespan for motor deficits in cerebral palsy. Developmental Medicine & Child Neurology.2009;51: 130-133.
(2)HIELKEMA T, HAMER EG, REINDERS-MESSELINK HA and all. LEARN 2 MOVE 0-2 years: effects of a new intervention program in infants at very high risk for cerebral palsy; a randomized controlled trial. BMC Pediatr. 2010 Nov 2;10:76.
Keywords : early rehabilitation, neonatology, cerebral palsy, tone disorder