Current Therapeutic Management of Perinatal Stroke with a Focus on the Upper Limb: A Cross-Sectional Survey of UK Physiotherapists and Occupational Therapists

Abstract

Aim: To determine current UK pediatric physiotherapist (PT) and occupational therapist (OT) management of perinatal stroke. Design: Web-based cross-sectional survey. Methods: Participants were members of the Association of Paediatric Chartered Physiotherapists and Occupational Therapists specialist section: children young people and families working with infants. Items covered prioritization of referrals, assessments, therapy approaches aimed at the upper limb, and parental support. Results: 179 therapists responded. 87.2% of PTs and 63.0% of OTs managed infants with perinatal stroke. Infants with clinical signs of motor dysfunction at referral were prioritized for early initial assessment. The most frequently used assessments were the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development (BSID). Of PTs and OTs, 41.9 and 40.0% used no standardized assessments. Frequently used therapy interventions were Bobath/Neurodevelopmental Therapy (NDT), positioning aids and passive movements. 88.1% of therapists would choose a bilateral rather than unilateral (affected side) therapy approach for infants with perinatal stroke aged up to 6 months. Of PTs and OTs, 56.9 and 57.1% provided psychological support to families. Conclusions: Assessment and provision of therapy services following perinatal stroke is variable. Increased use of standardized assessments and centralized data collection regarding service provision for high-risk infants is recommended.

Keywords:

• Assessment
• early intervention
• infant
• occupational therapy
• perinatal stroke
• physiotherapy
• therapy
• upper limb unilateral cerebral palsy

Acknowledgements

We would like to thank all participants and all those who advised on and/or piloted the survey. We are grateful to the Association of Paediatric Chartered Physiotherapists (APCP), the Royal College of Occupational Therapists (Children, Young People and Families Specialist Section), for assistance with survey dissemination.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

A.B. is funded by an NIHR Career Development Fellowship to study early intervention in perinatal stroke; this has also supported J.P. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. C.M. is part funded by the Chartered Society of Physiotherapy (Novice Researcher Award). A.T. received a Research Scholarship from Newcastle University (2015) to undertake the survey.

Notes on contributors

Claire Marcroft

Claire Marcroft, MSc, MCSP, is a clinical specialist neonatal physiotherapist in Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH) with a strong research interest in optimising motor outcomes in high risk preterm infants.

Ayaka Tsutsumi

Ayaka Tsutsumi is a medical student at St. George’s Medical Hospital, Grenada, who was awarded a vacation studentship to take part in this project.

Janice Pearse

Janice Pearse, MPhil, is a specialist paediatric occupational therapist with many years of research and clinical experience in the management of children with cerebral palsy, in particular hemiplegia.

Pat Dulson

Pat Dulson, MCSP, is a specialist neonatal physiotherapist and heads the neonatal rehabilitation team at Newcastle upon Tyne Hospitals NHS Foundation Trust.

Nicholas D. Embleton

Nicholas D. Embleton, MD, BSc, MBBS, FRCPCH, is Consultant in Neonatal Medicine, RVI & Honorary Reader, Newcastle University and leads a broad programme of research that includes movement analysis, brain development and cerebral palsy.

Anna P. Basu

Anna P. Basu, BMBCh, MA, FRCPCH, PhD, is an NIHR Career Development Fellow and Honorary Consultant Paediatric Neurologist at Newcastle, whose research centres on improving outcomes for infants and children with cerebral palsy, in particular those with hemiplegia.