BrightHearts: A pilot study of biofeedback assisted relaxation training for the management of chronic pain in children with cerebral palsy

Abstract

Background: Chronic pain is estimated to impact one-in-three children with cerebral palsy (CP). Psychological interventions including behavioral and cognitive strategies play a key role in chronic pain management, but there is a paucity of research exploring their use in children with CP.Aim: To investigate the acceptability and feasibility of biofeedback assisted relaxation training (BART) for chronic pain management in children with CP using a mixedmethods study design.Methods: Biofeedback assisted relaxation training was delivered via BrightHearts, an iOS application. Inclusion criteria were as follows: CP; self-reported chronic pain; age 9-18 years; and fluent English speaker. Children used BrightHearts for ten minutes daily, over four weeks. Qualitative post-intervention interviews were undertaken (child, parent) and quantitative pre-post measures (child) were gathered including pain intensity (numerical rating scale), and anxiety intensity (numerical rating scale).Content analysis was conducted for qualitative data. Descriptive statistics and exploratory analyses were performed for quantitative data.Results: Ten children participated (n = 3 male, mean age = 13.1 years SD = 2.5 years, GMFCS level I = 4, II = 2, III = 3, IV = 1). Predominant movement disorder was spasticity (n = 7) and dyskinesia, mainly dystonia (n = 3). Content analysis suggested an overarching theme "BrightHearts is a good thing to put in my toolbox" providing an overall representation of participants' experiences. For many, BrightHearts was a valuable supplement to children's pain management strategies: "The source of the pain is still there, but the actual effect of the pain isn't so relevant." Four sub-themes were identified: "Managing my pain;" "Managing my anxiety and stress," "Helping me do what I need to do;" and "Fitting it into my life." Some participants reported improvements in their anxiety management, and others described benefits in sleep and school following improved pain/anxiety management. A range of practical and personal factors within this heterogeneous group presented barriers to using BrightHearts including limited time, attention, and boredom. Seven-out-of-eight children would recommendThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Special issue on pain and intellectual and developmental disabilities

“…Ostojic and colleagues report a mixed methods study assessing the acceptability and feasibility of using a biofeedback-assisted relaxation training as an intervention for chronic pain management in children with CP. 24 This pilot study highlights the ways in which biofeedback-used via an iOS application-was feasible and beneficial as noted by both children and their parents.…”

“…There has been a paucity of research studies broadly exploring pain treatment approaches in IDD, and even less is known about the utility of non‐pharmacological interventions. Ostojic and colleagues report a mixed methods study assessing the acceptability and feasibility of using a biofeedback‐assisted relaxation training as an intervention for chronic pain management in children with CP 24 . This pilot study highlights the ways in which biofeedback—used via an iOS application—was feasible and beneficial as noted by both children and their parents.…”

Cognitive behavioral therapies for individuals with cerebral palsy: A scoping review

“…33,40 However, although all studies included individuals with a diagnosis of CP, not all reported the GMFCS level of participants (n = 4). 34,35,37,41 Most studies included a description of the cognitive abilities of participants (n = 8), 29,30,33,34,[36][37][38]41 with cognitive abilities ranging from mild intellectual impairment (n = 2), 33,41 to low-average (n = 2) 29,30 and average (n = 3) 36-38 levels of intellectual abilities. Others indicated that participants had an additional medical diagnosis (e.g.…”

“…The populations of the included studies were from five different countries (Australia = four; [28][29][30]33 USA = three; [34][35][36] Canada = two; 37,38 Sweden = two; 31,32 Norway = two 39,40 ), with one study not specifying the study location. 41 A total of 107 individuals (46% females) with CP were included in the selected studies (participants in studies reporting the same population were only counted once).…”

“…41 Biofeedback training was used in two interventions with a primary physiological aim of reducing pain. 33,34 For the various CBT interventions, the number of sessions was reported in nearly all of the published studies (n = 12) [28][29][30][31][32][33][34][35][36][37][38]40 ranging between 6 and 24 sessions, with the longest intervention lasting 9 months. 36 According to a recent meta-analysis by Oud et al, 42 the number and frequency of the interventions in the current review was divided into high-dose (sessions ≥10 or hours per week ≥8) and low-dose (sessions <10 or hours per weeks <8).…”