Protocol and Feasibility-Randomized Trial of Telehealth Delivery for a Multicomponent Upper Extremity Intervention in Infants With Asymmetric Cerebral Palsy

Abstract

Background: Past work showed that an in-person, therapist-guided, parent-implemented multicomponent intervention increased the motor functioning of the more affected upper extremity (UE) in infants with asymmetric cerebral palsy. The authors document treatment fidelity and provide initial testing of telehealth intervention delivery in a new subject sample. Methods: The authors adapted the intervention manual used in the previous trial for telehealth. Infants (6-24 months) were randomly assigned to intervention (n = 7) or waitlist (n = 6). The intervention prescribed soft-constraint wear on the less affected UE for 6 hours, 5 d/wk, and exercises. After an initial in-person training session, three 15- to 45-minute telehealth sessions were performed. Results: Median weekly constraint wear was 21 hours (interquartile range = 10.3-29.7); average parent-treatment fidelity was 95.7% (SD 11.2). A significant large (Cohen d = 0.92) between-group differences occurred on fine motor functioning of more affected UEs. Conclusion: The telehealth intervention was feasible and potentially effective, but a larger trial is needed to evaluate efficacy.

Effect of Motor Intervention for Infants and Toddlers With Cerebral Palsy: A Systematic Review and Meta-analysis

“…However, the review found no difference in unimanual capacity when CIMT was compared with high-dose or dose-matched occupational therapy or bimanual therapy 31. Consistent with this finding, 2 studies in this review found significant differences in unimanual capacity of the more affected hand when CIMT was compared with low-dose bimanual therapy 25,30. One study in this review found no difference in unimanual capacity of the more affected hand when CIMT was compared with dose-matched bimanual therapy 22.…”

“…All 4 studies with a total of 150 children with CP reported sufficient data on unimanual function of the more affected hand to be pooled for meta-analysis 22,23,25,30. The meta-analysis supported that children with unilateral CP who received CIMT (n = 79) scored an SMD of 0.59 (95% CI −0.18 to 1.37, P = .13; moderate effect) higher on unimanual function of the more affected hand compared with children with unilateral CP who received bimanual play or infant massage (n = 71).…”

“…Two of 4 studies used control interventions that were dose-matched with the experimental groups, 22,23 and the other 2 used a lower dose. 25,30 No adverse events were reported.…”

Patient Satisfaction and Perceived Quality of Care with Telemedicine in a Pediatric Gastroenterology Clinic

“…The varying reported benefits of telemedicine along with the limitations of the clinical exam and the perceived cost of implementation have contributed to limited patient access to telemedicine in the past. However, the COVID-19 pandemic has necessitated the rapid conversion of many pediatric general and subspecialty clinics to telemedicine [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Standardized Neurodevelopmental Surveillance of High-risk Infants Using Telehealth: Implementation Study during COVID-19

“…The research program piloted early interventions for infants with cerebral palsy (CP) through telehealth due to geographic restrictions stemming from a catchment area >150,000 km 2 . 5 Researchers adapted therapist assessments and physician neurological examinations for videoconferencing, even temporarily delivering examination kits, technology, or internet connectivity to homes. The clinical and research teams hypothesized that through collaboration with organizational partners in the hospital’s neonatal service line and experience in leveraging implementation science principles, they could develop an effective telehealth neurodevelopmental surveillance program for the youngest high-risk patients.…”