Neuroprotection, once just used to characterize compounds that prevent cell death, now encompasses organizational, therapeutic and environment-modifying interventions that promote normal development and prevent disability in children at risk for developmental disorders. At risk children include those of low socioeconomic status, prematurity and/or low birth weight. Early stimulation programs are considered to be an environment-modifying type of neuroprotective interventions.

The ability of the brain to reorganize neural pathways based on new experiences is known as plasticity. Special education therapy programs activate the plasticity of the developing brain. Studies of animal models have established that plasticity allows for reorganization of cortical maps after early brain injury. Cortical plasticity has been described for the auditory, tactile, olfactory and motor systems. Whether and to what extent plasticity can compensate for failure of cognitive functions to develop within the first years of life has been of considerable interest.

Because of the increasing awareness among pediatricians for the role of the environment in mental and cognitive development, early stimulation programs were developed that targeted preservation of the mother-infant relationship and enhanced bonding, provided stress reduction in the hospital, and improved relative lack of stimulation to which preterm infants in neonatal units were exposed.

The infant health and development program (IHDP) was designed for the post-hospital period for premature, low birth weight babies. The program includes home visits by professionals, attendance at a development center between the ages of 1 and 3 years and monthly meetings with the parents. When children from the conventional care program, were compared to the IHDP children, the intervention group showed a significant difference in IQ scores (10 points higher) at 24 and 36 months than the control group even though there was no difference at 12 months.

These two programs targeted different populations, but demonstrated similar effects in that efficacy was greatest when both parent and child were involved, long term stimulation improved cognitive outcomes; cognition showed greater improvements than motor skills and larger benefits were obtained in families that had several risk factors including low education attainment by the mothers. Two hypotheses may explain findings: 1) early stimulation may compensate for loss of exposure to stimulation from the family, 2) and/or it may prevent the relative cognitive decline seen in controls. The optimal duration and timing of early stimulation programs remains to be determined.

*Bonnier, C. ‘Evaluation of early stimulation programs for enhancing brain development’ Acta Paediatrica 2008 97, pp 853-858