Early intervention changes the course for Ivy

Breeanna was told that her 4-month-old daughter Ivy may never walk. However, thanks to the early intervention of the Early Neurodevelopment Clinic at Monash Children’s Hospital, Ivy has defied all odds.

Ivy was born in January 2019. After a complicated birth that resulted in early signs of brain damage, she arrived at Monash Children’s Hospital’s Neonatal Intensive Care Unit (NICU), where she was on a cooling mat for three days to cool her body and reduce the impact of the brain injury.

During her time at NICU, the Early Neurodevelopment Team at Monash Children’s Hospital became involved with Ivy’s care. After the clinic team assessed Ivy’s development at 3 months of age, Breeanna was shocked to learn that Ivy had been diagnosed with early features of cerebral palsy, a neurological disorder that affects a person’s movement and posture.

However, because the Early Neurodevelopment Clinic diagnosed Ivy at such a young age, she was able to commence early intervention treatments at a crucial time.

The introduction of Monash Health’s Early Neurodevelopmental Clinic

The Early Neurodevelopment Clinic was established at Monash Children’s Hospital in 2018 and is dedicated to screening high-risk infants at risk of cerebral palsy, based on international guidelines published in 2017.

Infants who are at a high risk of disability due to extreme premature birth or who present with brain injury after a traumatic or complicated birth are assessed at the clinic.

Head of the Early Neurodevelopment clinic, Associate Professor Atul Malhotra, explains how vital this clinic is for diagnosing cerebral palsy and initiating early intervention and in infants.

“We start the ball rolling for early intervention much earlier than what used to happen in the past. Previously, the average age of diagnosis for cerebral palsy in infants was between nine and 15 months. Now we are diagnosing many of them between three to four months which means the outcomes are better for these babies,” said Associate Professor Malhotra.

The Early Neurodevelopment Clinic follows a multidisciplinary model of care that combines doctors and allied health therapists to assess and diagnose high-risk infants.

Vathana Sackett has been a physiotherapist at the clinic for the last two years and has over 20 years of experience as a Paediatric Physiotherapist.

Vathana explains the complex process of diagnosing an infant with cerebral palsy.

“With infants, the movements and messages we are looking for are extremely subtle, and many of these signs are normally not noticed until a child is one year old, when they are not meeting their milestones and that’s too late,” said Ms Sackett.

“The way the brain changes and rewires in the first two years of life is amazing, and that’s why we do this clinic at three months. If there are any early signs, we can provide treatment early to see if we can change those pathways,” she said.

Ivy defies all odds after her diagnosis

Breeanna can still remember the moment when she was told her daughter had cerebral palsy.

“I remember Atul asked me to take a seat, and he said your baby was displaying early features of moderate to severe cerebral palsy.”

“I nearly cancelled the appointment because I didn’t have my husband with me, and I thought it was another follow-up. I’m so glad I didn’t because that appointment started Ivy’s early intervention journey,” Breeanna said.

Associate Professor Atul Malhotra explains that the trust of parents is central to the assessment and diagnosis of infants at the clinic.

“When we diagnose infants at three months, you can understand for someone like Breeanna, she couldn’t see the difference between Ivy and other babies (at that age). But from our experience and expertise, we can see that it is not quite right. It is critical at this stage for the parents to have the trust and belief in us,” he said.

After Ivy’s diagnosis, Breeanna began working tirelessly to retrain Ivy’s brain by undertaking early brain intervention physiotherapy exercises focused on repetition, strength and balance. Breeanna would put these exercises into work during nappy changes and bottle feeds.

Breeanna said, “I would do 30 knees to chest repetitions and wiggle every toe, just to get that pathway into her brain. I started doing 5-6 hours a day with her. Every moment I could, I would be doing one on one therapy.”

This therapy had dramatic effects on Ivy’s brain pathways, and within the first years of her life, Ivy met every milestone within the average range of a child her age.

“When she met each milestone, even the smallest milestones, it meant so much to us. Usually, a parent wouldn’t realise that their child has turned their hand over for the first time or held their hand out for something. Whereas we spent so many hours getting her to turn her hand over that when she did it herself, it was massive for us.”

After an in-depth MRI when Ivy was two and half years old, it was confirmed that her brain had been rewired successfully, and Ivy’s brain presented with no signs of cerebral palsy.

The results of the scans were a massive relief for her family and a testament to their hard work.

Breeanna said she could not speak highly enough of the Early Neurodevelopment Clinic for providing Ivy with her diagnosis when they did.

“If it weren’t for the support, information and programs that the clinic gave us, Ivy wouldn’t be where she is today, running around with every other three-year-old,” said Breeanna.

“We had been told that she may never walk from all her assessments and scans, and she has defied all odds.

She shouldn’t be walking and running and all those things she is currently doing and it’s because of the early intervention from the Early Neurodevelopment Clinic that she is.”