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Hurd CL, Livingstone D, Smith A, Yang JF. Engaging the Lower Extremity via Active Therapy Early (ELEVATE) Is Feasible and May Improve Gross Motor Function in Children with Spastic Bilateral Cerebral Palsy: A Case Series. Physiother Can 2023; 75:311-321. [PMID: 38037582 PMCID: PMC10686296 DOI: 10.3138/ptc-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/15/2023] [Indexed: 12/02/2023]
Abstract
Purpose The feasibility of ELEVATE with respect to adherence and preliminary efficacy was determined for children with spastic bilateral cerebral palsy (CP) from encephalopathy of prematurity. Methods A case series was used. Participants were randomized to receive ELEVATE immediately or delay the intervention by 3 months before receiving the intervention. The outcomes included feasibility measures of (1) number of children recruited, (2) percentage of sessions attended, (3) stride counts during the intervention, and preliminary efficacy measures of change over the intervention period in (4) Gross Motor Function Measure-66 (GMFM-66), and (5) kinematics and weight-bearing during treadmill walking. Results Four boys under 3 years of age participated. All participants tolerated 60-minute intervention sessions four times/week for 12 weeks, and attended 75%-94% (min-max) of the targeted sessions. The median step count per session ranged from 833 to 2484 steps (min-max) during the final week of training. Participants showed an increase in GMFM-66 score of 2.4-7.5 points (min-max) over the 3-month intervention phase, as compared to a decrease of 1.7 for one participant and an increase of 1.3 for another over the delay period. Three participants demonstrated small improvements in their gait with the intervention. Conclusions Engaging young children with bilateral CP in intensive rehabilitation targeting gross motor function was feasible and demonstrated preliminary efficacy. The results have guided the design of a larger clinical trial to assess efficacy of early, active interventions for children with spastic bilateral CP.
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Affiliation(s)
- Caitlin L. Hurd
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Donna Livingstone
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Smith
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Jaynie F. Yang
- From the:
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
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Hurd CL, Barnes M, Diot CM, Condliffe EG, Alazem H, Pritchard L, Zwicker JD, McCormick A, Watt MJ, Andersen J, Kirton A, Yang JF. Parent-therapist partnership to ELEVATE gross motor function in children with perinatal stroke: protocol for a mixed methods randomized controlled trial. BMC Pediatr 2022; 22:480. [PMID: 35948896 PMCID: PMC9364526 DOI: 10.1186/s12887-022-03525-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is increasing evidence for early, active rehabilitation to enhance motor function following early brain injury. This is clear for interventions targeting the upper extremity, whereas passive treatment approaches for the lower extremity persist. The purpose of this trial is to evaluate the effectiveness of early, intensive rehabilitation targeting the lower extremity and delivered in a parent-therapist partnership model for children with perinatal stroke. Methods We describe a protocol for a waitlist-control, single-blind, mixed methods effectiveness randomized controlled trial, with an embedded qualitative study using interpretative description. Participants are children with perinatal stroke aged eight months to three years with signs of hemiparesis. Participants will be randomly allocated to an immediate ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) intervention group, or a waitlist-control group, who will receive usual care for six months. The ELEVATE intervention involves one hour of training four days per week for 12 weeks, with a pediatric therapist and a parent or guardian each delivering two sessions per week. The intervention targets the affected lower extremity by progressively challenging the child while standing and walking. The primary outcome measure is the Gross Motor Function Measure-66. Secondary outcomes include the Pediatric Quality of Life Inventory™, Young Children's Participation and Environment Measure, and an instrumented measure of spasticity. A cost-effectiveness analysis and qualitative component will explore benefit to costs ratios and parents’ perspectives of early, intensive rehabilitation, and their role as a partner in the rehabilitation, respectively. Discussion This study has the potential to change current rehabilitation for young children with perinatal stroke if the ELEVATE intervention is effective. The parent interviews will provide further insight into benefits and challenges of a partnership model of rehabilitation. The mixed methods design will enable optimization for transfer of this collaborative approach into physical therapy practice. Trial registration ClinicalTrials.gov NCT03672864. Registered 17 September 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03525-6.
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Affiliation(s)
- Caitlin L Hurd
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Michelle Barnes
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | | | - Elizabeth G Condliffe
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Hana Alazem
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Jennifer D Zwicker
- School of Public Policy and Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Man-Joe Watt
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Adam Kirton
- Department of Pediatrics and Department of Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jaynie F Yang
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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Sogbossi ES, Sotindjo Adon S, Adjagodo L, Dossou S, Dakè H, Ebner-Karestinos D, Araneda R, Saussez G, Paradis J, Kpadonou TG, Bleyenheuft Y. Efficacy of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in young children with bilateral cerebral palsy (GMFCS III-IV) in a low and middle-income country: protocol of a randomised controlled trial. BMJ Open 2021; 11:e050958. [PMID: 34610941 PMCID: PMC8493925 DOI: 10.1136/bmjopen-2021-050958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is highly prevalent in sub-Saharan Africa, where clinically-based studies have shown a considerable over-representation of the severe bilateral subtype. However, children's access to rehabilitation care is limited by many local factors, notably the lacking of rehabilitation services, insufficient knowledge of caregivers and financial constraints. In such a context there is an urgent need for studies of the evidence-based rehabilitation approach. Here, we describe the protocol of a randomised controlled study to investigate the efficacy of Hand-Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in young children with bilateral CP in Benin Republic, a representative low and middle-income country of western Africa. METHODS AND ANALYSIS Forty children with bilateral CP aged between 24 and 59 months and with level III-IV in the gross motor function classification will be randomised to either a high intensity conventional therapy or HABIT-ILE therapy. Both therapies will be delivered as a day-camp model over 2 weeks to a total of 50 hours (5 hours per day). The assessor-blinded primary outcomes will include the gross motor function measure and both hands assessment. Secondary outcomes will be the adapted version of the ACTIVLIM-CP questionnaire, the Canadian Occupational Performance Measure, and a perception of CP interview form. Children will be assessed at baseline, after intervention and at 6-week follow-up. A 2 (group)×3 (test sessions) repeated analysis of variance will evaluate changes after the interventions. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of the rehabilitation department of the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, Benin (approval decision: N°01-2019/MS/CNHU-HKM/CEI/CUMPR). All participants' parents/caregivers will provide their written informed consent. Data will be managed with confidentiality. TRIAL REGISTRATION NUMBER PACTR201911894444879.
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Affiliation(s)
- Emmanuel Segnon Sogbossi
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
- School of Physiotherapy, Université d'Abomey-Calavi, Faculté des Sciences de la Santé, Cotonou, Benin
| | - Solange Sotindjo Adon
- Service de Kinésithérapie et d'Appareillage Orthopédique, Centre Hospitalier Universitaire Départemental de Borgou/Alibori, Parakou, Benin
| | | | - Solange Dossou
- Centre Medico-social Sainte Elisabeth de la Trinité, Calavi, Benin
| | - Hyppolite Dakè
- Clinique universitaire de médecine physique et réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin
| | | | - Rodrigo Araneda
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
| | - Geoffroy Saussez
- Physical and Occupational Therapy, Haute Ecole Louvain en Hainaut - Montignies-sur-Sambre, Montignies-sur-Sambre, Belgium
| | - Julie Paradis
- Département Ergothérapie, HE Vinci, Italia, Vinci, Italy
| | - Toussaint G Kpadonou
- School of Physiotherapy, Université d'Abomey-Calavi, Faculté des Sciences de la Santé, Cotonou, Benin
- Clinique universitaire de médecine physique et réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
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