{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:55:28Z","timestamp":1790610928932,"version":"4.1.0"},"reference-count":56,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>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; &amp;gt;25% participants \u22642 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>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\u20130.72; I2 = 3%; P = .02)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2012-3985","type":"journal-article","created":{"date-parts":[[2013,8,19]],"date-time":"2013-08-19T21:13:03Z","timestamp":1376946783000},"page":"e735-e746","source":"Crossref","is-referenced-by-count":184,"title":["Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis"],"prefix":"10.1542","volume":"132","author":[{"given":"Catherine","family":"Morgan","sequence":"first","affiliation":[{"name":"School of Medicine, and"},{"name":"Cerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Darlinghurst, NSW, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iona","family":"Novak","sequence":"additional","affiliation":[{"name":"Cerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Darlinghurst, NSW, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Badawi","sequence":"additional","affiliation":[{"name":"Cerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Darlinghurst, NSW, Australia;"},{"name":"Grace Centre for Newborn Care, Children\u2019s Hospital Westmead, Westmead; and"},{"name":"University of Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,9,1]]},"reference":[{"issue":"11","key":"2021120902585078500_B1","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1001\/jama.288.11.1357","article-title":"Prognosis for gross motor function in cerebral palsy: creation of motor development curves.","volume":"288","author":"Rosenbaum","year":"2002","journal-title":"JAMA"},{"issue":"Dec 3","key":"2021120902585078500_B2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/1471-2431-9-73","article-title":"Improving the outcome of infants born at &lt;30 weeks\u2019 gestation\u2014a randomized controlled trial of preventative care at home.","volume":"9","author":"Spittle","year":"2009","journal-title":"BMC Pediatr"},{"issue":"3","key":"2021120902585078500_B3","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1038\/35044558","article-title":"Neural consequences of environmental enrichment.","volume":"1","author":"van Praag","year":"2000","journal-title":"Nat Rev Neurosci"},{"issue":"9","key":"2021120902585078500_B4","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1038\/nrn1970","article-title":"Enriched environments, experience-dependent plasticity and disorders of the nervous system.","volume":"7","author":"Nithianantharajah","year":"2006","journal-title":"Nat Rev Neurosci"},{"issue":"4","key":"2021120902585078500_B5","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.tins.2008.12.004","article-title":"Enrich the environment to empower the brain.","volume":"32","author":"Sale","year":"2009","journal-title":"Trends Neurosci"},{"issue":"14","key":"2021120902585078500_B6","doi-asserted-by":"crossref","first-page":"5272","DOI":"10.1523\/JNEUROSCI.21-14-05272.2001","article-title":"Enriched rehabilitative training promotes improved forelimb motor function and enhanced dendritic growth after focal ischemic injury.","volume":"21","author":"Biernaskie","year":"2001","journal-title":"J Neurosci"},{"issue":"3","key":"2021120902585078500_B7","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.pneurobio.2004.03.001","article-title":"Recovery from brain injury in animals: relative efficacy of environmental enrichment, physical exercise or formal training (1990-2002).","volume":"72","author":"Will","year":"2004","journal-title":"Prog Neurobiol"},{"key":"2021120902585078500_B8","volume-title":"Committee on Integrating the Science of Early Childhood Development Board on Children, Youth, and Families. From Neurons to Neighborhoods: The Science of Early Childhood Development","author":"Shonkoff","year":"2000"},{"key":"2021120902585078500_B9"},{"key":"2021120902585078500_B10"},{"issue":"2","key":"2021120902585078500_B11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0387-7604(03)00102-5","article-title":"Clinical disorders of brain plasticity.","volume":"26","author":"Johnston","year":"2004","journal-title":"Brain Dev"},{"issue":"2","key":"2021120902585078500_B12","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1469-7610.2006.01694.x","article-title":"The caregiving context in institution-reared and family-reared infants and toddlers in Romania.","volume":"48","author":"Smyke","year":"2007","journal-title":"J Child Psychol Psychiatry"},{"issue":"3","key":"2021120902585078500_B13","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/j.1540-5834.2008.00498.x","article-title":"Earlier is better: a meta-analysis of 70 years of intervention improving cognitive development in institutionalized children.","volume":"73","author":"Bakermans-Kranenburg","year":"2008","journal-title":"Monogr Soc Res Child Dev"},{"key":"2021120902585078500_B14","doi-asserted-by":"crossref","first-page":"346","DOI":"10.2307\/1131388","article-title":"Early indications of resilience and their relation to experiences in the home environments of low birthweight, premature children living in poverty.","volume":"65","author":"Bradley","year":"1994","journal-title":"Child Dev"},{"issue":"1","key":"2021120902585078500_B15","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/J006v19n01_04","article-title":"The relationship between the home environment and early motor development.","volume":"19","author":"Abbott","year":"1999","journal-title":"Phys Occup Ther Pediatr"},{"issue":"6","key":"2021120902585078500_B16","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1017\/S0012162205000733","article-title":"Influence of supine sleep positioning on early motor milestone acquisition.","volume":"47","author":"Majnemer","year":"2005","journal-title":"Dev Med Child Neurol"},{"issue":"3","key":"2021120902585078500_B17","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1046\/j.1365-2214.2001.00186.x","article-title":"Infant motor development and equipment use in the home.","volume":"27","author":"Abbott","year":"2001","journal-title":"Child Care Health Dev"},{"issue":"3","key":"2021120902585078500_B18","doi-asserted-by":"crossref","first-page":"310","DOI":"10.2522\/ptj.20070145","article-title":"Movement training advances the emergence of reaching in infants born at less than 33 weeks of gestational age: a randomized clinical trial.","volume":"88","author":"Heathcock","year":"2008","journal-title":"Phys Ther"},{"issue":"4","key":"2021120902585078500_B19","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1111\/j.1467-8624.2012.01772.x","article-title":"Enhanced handling and positioning in early infancy advances development throughout the first year.","volume":"83","author":"Lobo","year":"2012","journal-title":"Child Dev"},{"issue":"7","key":"2021120902585078500_B20","doi-asserted-by":"crossref","first-page":"935","DOI":"10.2522\/ptj.20110196","article-title":"Early intensive postural and movement training advances head control in very young infants.","volume":"92","author":"Lee","year":"2012","journal-title":"Phys Ther"},{"issue":"18","key":"2021120902585078500_B21","doi-asserted-by":"crossref","first-page":"6042","DOI":"10.1523\/JNEUROSCI.5548-08.2009","article-title":"Massage accelerates brain development and the maturation of visual function.","volume":"29","author":"Guzzetta","year":"2009","journal-title":"J Neurosci"},{"issue":"1","key":"2021120902585078500_B22","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2009-0990","article-title":"Effect of music by Mozart on energy expenditure in growing preterm infants.","volume":"125","author":"Lubetzky","year":"2010","journal-title":"Pediatrics"},{"issue":"4","key":"2021120902585078500_B23","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1053\/adnc.2002.34546","article-title":"Distilling the evidence on developmental care: a systematic review.","volume":"2","author":"Symington","year":"2002","journal-title":"Adv Neonatal Care"},{"issue":"4","key":"2021120902585078500_B24","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1542\/peds.113.4.846","article-title":"Early experience alters brain function and structure.","volume":"113","author":"Als","year":"2004","journal-title":"Pediatrics"},{"issue":"2","key":"2021120902585078500_B25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00001163-200210000-00003","article-title":"Animal research on effects of experience on brain and behavior: implications for rehabilitation.","volume":"15","author":"Rosenzweig","year":"2002","journal-title":"Infants Young Child"},{"issue":"11","key":"2021120902585078500_B26","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1111\/j.1469-8749.2009.03414.x","article-title":"Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review.","volume":"51","author":"Orton","year":"2009","journal-title":"Dev Med Child Neurol"},{"key":"2021120902585078500_B27"},{"issue":"2","key":"2021120902585078500_B28","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1002\/ddrr.1106","article-title":"Cerebral palsy\u2014don't delay.","volume":"17","author":"McIntyre","year":"2011","journal-title":"Dev Disabil Res Rev"},{"key":"2021120902585078500_B29","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1017\/S0012162201001414","article-title":"Effects of neurodevelopmental treatment (NDT) for cerebral palsy: an AACPDM evidence report.","volume":"43","author":"Butler","year":"2001","journal-title":"Dev Med Child Neurol"},{"issue":"1","key":"2021120902585078500_B30","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1542\/peds.58.1.47","article-title":"Physical therapy as a determinant of change in the cerebral palsied infant.","volume":"58","author":"Scherzer","year":"1976","journal-title":"Pediatrics"},{"issue":"4","key":"2021120902585078500_B31","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/DBP.0b013e31824eaa3c","article-title":"Preventive interventions for preterm children: effectiveness and developmental mechanisms.","volume":"33","author":"Guralnick","year":"2012","journal-title":"J Dev Behav Pediatr"},{"issue":"4","key":"2021120902585078500_B32","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2009-0333","article-title":"Efficacy of interventions to improve motor development in young children: a systematic review.","volume":"124","author":"Riethmuller","year":"2009","journal-title":"Pediatrics"},{"issue":"7","key":"2021120902585078500_B33","doi-asserted-by":"crossref","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"2021120902585078500_B34","unstructured":"Howle J. NDT in the United States: changes in theory advance clinical practice. 2007. Available at: https:\/\/www.ndta.org\/network\/article.php?article_id=109. Accessed July 22, 2012"},{"key":"2021120902585078500_B35"},{"issue":"1","key":"2021120902585078500_B36","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.infbeh.2005.08.003","article-title":"Intervention for infants with brain injury: results of a randomized controlled study.","volume":"29","author":"Badr","year":"2006","journal-title":"Infant Behav Dev"},{"issue":"7","key":"2021120902585078500_B37","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1177\/088307380101600706","article-title":"One-year outcome of auditory-tactile-visual-vestibular intervention in the neonatal intensive care unit: effects of severe prematurity and central nervous system injury.","volume":"16","author":"Nelson","year":"2001","journal-title":"J Child Neurol"},{"issue":"12","key":"2021120902585078500_B38","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/j.1440-1754.2004.00512.x","article-title":"Effect of an early intervention programme on low birthweight infants with cerebral injuries.","volume":"40","author":"Ohgi","year":"2004","journal-title":"J Paediatr Child Health"},{"issue":"7","key":"2021120902585078500_B39","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1111\/j.1469-8749.2011.03962.x","article-title":"Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy.","volume":"53","author":"Law","year":"2011","journal-title":"Dev Med Child Neurol"},{"issue":"13","key":"2021120902585078500_B40","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1056\/NEJM198803313181302","article-title":"The effects of physical therapy on cerebral palsy. A controlled trial in infants with spastic diplegia.","volume":"318","author":"Palmer","year":"1988","journal-title":"N Engl J Med"},{"issue":"2","key":"2021120902585078500_B41","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1542\/peds.113.2.305","article-title":"Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment.","volume":"113","author":"Taub","year":"2004","journal-title":"Pediatrics"},{"issue":"12","key":"2021120902585078500_B42","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/j.1469-8749.2011.04086.x","article-title":"Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial.","volume":"53","author":"Wallen","year":"2011","journal-title":"Dev Med Child Neurol"},{"key":"2021120902585078500_B43","volume-title":"The Bayley Scales of Infant Development","author":"Bayley","year":"1993","edition":"2nd ed."},{"key":"2021120902585078500_B44"},{"key":"2021120902585078500_B45"},{"issue":"6","key":"2021120902585078500_B46","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1017\/S0012162205000824","article-title":"A systematic review of the effects of early intervention on motor development.","volume":"47","author":"Blauw-Hospers","year":"2005","journal-title":"Dev Med Child Neurol"},{"issue":"8","key":"2021120902585078500_B47","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.neubiorev.2007.04.010","article-title":"Does early intervention in infants at high risk for a developmental motor disorder improve motor and cognitive development?","volume":"31","author":"Blauw-Hospers","year":"2007","journal-title":"Neurosci Biobehav Rev"},{"key":"2021120902585078500_B48"},{"issue":"9","key":"2021120902585078500_B49","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.2522\/ptj.20100205","article-title":"Pediatric physical therapy in infancy: from nightmare to dream? A two-arm randomized trial.","volume":"91","author":"Blauw-Hospers","year":"2011","journal-title":"Phys Ther"},{"issue":"9","key":"2021120902585078500_B50","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.2522\/ptj.20100207","article-title":"Differences between the family-centered \u201cCOPCA\u201d program and traditional infant physical therapy based on neurodevelopmental treatment principles.","volume":"91","author":"Dirks","year":"2011","journal-title":"Phys Ther"},{"issue":"5","key":"2021120902585078500_B51","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2007-1924","article-title":"Quality of general movements is related to white matter pathology in very preterm infants.","volume":"121","author":"Spittle","year":"2008","journal-title":"Pediatrics"},{"issue":"2","key":"2021120902585078500_B52","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1542\/peds.2008-0590","article-title":"Predicting motor development in very preterm infants at 12 months\u2019 corrected age: the role of qualitative magnetic resonance imaging and general movements assessments.","volume":"123","author":"Spittle","year":"2009","journal-title":"Pediatrics"},{"issue":"5","key":"2021120902585078500_B53","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.ejpn.2008.09.004","article-title":"The predictive validity of general movements\u2014a systematic review.","volume":"13","author":"Burger","year":"2009","journal-title":"Eur J Paediatr Neurol"},{"issue":"4","key":"2021120902585078500_B54","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","article-title":"Development and reliability of a system to classify gross motor function in children with cerebral palsy.","volume":"39","author":"Palisano","year":"1997","journal-title":"Dev Med Child Neurol"},{"issue":"5","key":"2021120902585078500_B55","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1191\/026921598673571117","article-title":"Functional motor abilities of children with cerebral palsy: a systematic literature review of assessment measures.","volume":"12","author":"Ketelaar","year":"1998","journal-title":"Clin Rehabil"},{"issue":"22","key":"2021120902585078500_B56","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1080\/09638280902822278","article-title":"Activity focused and goal directed therapy for children with cerebral palsy\u2014do goals make a difference?","volume":"31","author":"L\u00f6wing","year":"2009","journal-title":"Disabil Rehabil"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/132\/3\/e735\/1091212\/peds_2012-3985.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/132\/3\/e735\/1091212\/peds_2012-3985.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T23:10:49Z","timestamp":1646349049000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/132\/3\/e735\/31618\/Enriched-Environments-and-Motor-Outcomes-in"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,1]]},"references-count":56,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2013,9,1]]},"published-print":{"date-parts":[[2013,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2012-3985","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,1]]}}}