Intervention after brain injury to reduce disability

Abstract

After perinatal brain injury, motor function is generally more severely affected than cognition. This article reviews the evidence that intervention after brain injury can reduce disability. There have been few good quality randomized controlled trials. The reasons for this and the difficulties of doing such trials are discussed. The main reasons are: (i) cerebral palsy (CP) is a relatively rare condition; (ii) the patient population is heterogeneous; (iii) different patterns of CP have different prognoses; (iv) a variety of interventions have been used; and (v) outcome measures are relatively poor. Intervention for children considered at risk of developing CP have generally shown no benefit. After children have developed spastic CP, there is a suggestion of some effect due to increasing the frequency of intervention. The precise role of the therapist remains unclear: support of the family may be as important as physical therapy.