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Cathy Morgan: GAME

A simple but intensive program is the basis of ground breaking research in Australia to help improve outcomes for infants with cerebral palsy (CP).

Now that children can be diagnosed accurately as ‘high risk of CP’ as early as three months of age, the program takes advantage of brain plasticity to improve their long term fine and gross motor skills, daily function and adaptive behaviour.

GAME: Goals, Activity, Motor Enrichment early intervention for infants with cerebral palsy, involves parent coaching, play and other activities. It starts early, during the period where a baby’s brain is still developing, to make interventions to optimise all aspects of development.

GAME creator and Cerebral Palsy Alliance researcher, Dr Cathy Morgan, said the program is based on recent literature which suggests that intensive, task-specific intervention should commence early, during the critical period of neural development.

“The average age of diagnosis of CP is 19 months. That’s a problem because the first year of life is the most rapid period of motor development. Why wait and see what’s going to happen?” Dr Morgan said.

“If an adult has a stroke, what kind of intervention do they get? The national guidelines for adults say something like 45 mins per day for each domain that’s affected. So when I looked at it, adults were getting as much therapy in 2-3 weeks as an infant with CP would get in the first year total.”

“My research is about trying to identify the babies early enough to get into early intervention. Let’s not wait for them to fail to reach the movement milestones before they get treatment”, she said.

In the past, CP was hard to diagnose. Being a broad condition, it took numerous tests and lots of time to confirm, which has made it difficult to pick up early. That has now changed, and clinical practice guidelines on early intervention and diagnosis of infants are about to be released.

The early intervention program that Dr Morgan along with Professor Novak has developed is based on the best available evidence of interventions that work in older children and that aim to harness the neuroplasticity mechanisms at work in the developing brain.

“We want to find babies early, and influence their outcomes by starting an intensive program that involves their families from three months of age”, Dr Morgan said.

GAME was first tested in a small pilot study, with promising results in improving motor outcomes of participants when compared with standard care.

A second GAME study looked at whether GAME intervention improved motor and cognitive outcomes and parent perception of, and satisfaction with, motor performance after 16 weeks of intervention then again at 12 months (when compared with standard care).

The possibilities are huge for this research, with Dr Morgan now seeking funding for larger trials and the training of professionals to conduct GAME training in various locations.

However, the program’s development hasn’t been without naysayers.

“We’ve faced issues because some doctors are doubtful about how early you can predict CP. The range of the disability makes it hard for people to believe it is possible to detect very early”, Dr Morgan said.

Overwhelmingly, though, results and feedback has been positive.

“Parents say they felt like they were getting taught at the same time as their child, and they liked the way the program was customised to them. They feel grateful as they wouldn’t have known exactly what to do to help their child without it”, Dr Morgan said.

“Parents also liked knowing how to use toys to play with their kids, particularly how different toys can help improve different skills.”

“There is a strong belief that early intervention is better, but we’re still trying to show exactly how”, she said.

The importance of diagnosing and intervening early cannot be denied, and this program is taking great leaps towards making that the norm across the world.


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