Early, intensive rehabilitation improves gross motor function after perinatal stroke: results of a randomized controlled trial

Abstract

Background: Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity (LE) remain infrequent and understudied. Objective: To determine the efficacy of ELEVATE – Engaging the Lower Extremity Via Active Therapy Early – on gross motor function, as compared to usual care. Methods: We conducted a single–blind, two–arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a three–month waitlist-control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI–confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play–based, focused on weight–bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure–66 (GMFM–66). Secondary outcomes included steps and gait analyses. Final follow–up occurred at age four. Results: Thirty–four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM–66 over 12 weeks was greater for the Immediate than the Delay Group (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370–3750 steps/session in the last week of training for all children. Parent–trained children also improved but with greater variability. Conclusions: Early, activity–intensive LE therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention.