Feasibility of High Repetition Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy

Abstract

Aims

In pediatric upper extremity rehabilitation, feasible repetition rates are unknown. Our objectives were to examine repetition rates during rehabilitation and their impact on outcomes.

Methods

Children with unilateral cerebral palsy due to perinatal stroke (n = 55, median 10 y 7 mo, 30 males) received Constraint-Induced Movement Therapy (CIMT) followed by Bimanual Therapy, each for 5 days. Repetitions were documented during one-on-one therapy (1.5 h/day). Outcomes included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF), and Box and Block Test (BBT). Means and standard deviations for motor outcomes and frequencies for repetition rates were calculated. Factors associated with repetition rates and outcome change were explored using standard linear regression.

Results

Repetitions/hour averaged 365 ± 165 during CIMT and 285 ± 103 during Bimanual Therapy. Higher repetition rates were associated with higher baseline function by older age, a main effect of younger age, and improving motor skill (p < .05). Higher repetition rates corresponded with improvement of the AHA and BBT (p < .05, standardized ß = 0.392, 0.358).

Conclusions

Results suggest high repetition therapy is feasible in school-aged children with perinatal stroke, albeit with high individual variability. Multiple associations between repetition rates and baseline function and change point to the clinical importance of this measurable and potentially modifiable factor.

Keywords:

• Neurological rehabilitation
• upper extremity
• stroke
• child
• cerebral palsy
• humans

Disclosure statement

No potential conflict of interest was reported by the authors.

Registration

NCT03216837, Stimulation for Perinatal stroke: Optimizing Recovery Trajectories (SPORT).

Additional information

Funding

The study was sponsored by the CHILD-BRIGHT SPOR Network. Funders had no role in study design, data collection, analysis or interpretation, or writing the report.

Notes on contributors

Megan J. Metzler

Megan Metzler, OT MSc, is an Occupational Therapist and clinician researcher at the Alberta Children’s Hospital in Calgary, Canada. Megan has a research interest in the use of intensive therapy and novel technology to advance participation for children with perinatal stroke.

Kathleen O’Grady

Kathleen O’Grady, BPE BSCOT MSC, is an Occupational Therapist at the Glenrose Rehabilitation Hospital. Kathleen’s research focuses on the treatment of children with perinatal stroke, neonatal brachial plexus injuries and limb differences.

Linda Fay

Linda Fay, M.OT OT Reg. (Ont.), is an Occupational Therapist at the Holland Bloorview Kids Rehabilitation Hospital and holds a Lecturer Status Appointment at the University of Toronto with the Department of Occupational Science and Occupational Therapy. Linda’s collaborations include research evaluating the effectiveness of constraint therapy using fMRI and MEG imaging.

Mia Herrero

Mia Herrero, OT BScOT, is an Occupational Therapist with the Early Childhood Development Program at the Alberta Children’s Hospital in Calgary, Canada. Mia’s expertise and research focuses on perinatal stroke rehabilitation.

Mary Dunbar

Mary Dunbar, MD MSc MSc FRCPC, is a pediatric neurologist at the Alberta Children's Hospital and has a special interest in perinatal brain injury.

Darcy Fehlings

Darcy Fehlings, MD MSc FRCP(C), is Head of the Division of Developmental Paediatrics, a Professor of Paediatrics at the University of Toronto, and a Senior Clinician Scientist with the Bloorview Research Institute. She holds the inaugural Bloorview Children’s Hospital Foundation Chair in Developmental Paediatrics. Her research focuses on the innovation and evaluation of interventions for children with cerebral palsy. She is the principal investigator of CP-NET and leads the CP Discovery Project in the Canadian NeuroDevNet Networks of Centres of Excellence.

John Andersen

John Andersen, MD FRCPC, is Facility Chief for Child Health at the Glenrose Rehabilitation Hospital, Zone Section Chief of Neurodevelopmental Pediatrics with Alberta Health Services, and an Associate Professor in Pediatrics at the University of Alberta. His research focuses on neurorehabilitation for children with neurological injuries.

Adam Kirton

Adam Kirton, MD MSc FRCPC, is Professor of Pediatrics, Radiology, and Clinical Neurosciences at the University of Calgary, and an attending Pediatric Neurologist at the Alberta Children’s Hospital. He holds the Dr. Robert Haslam Chair in Pediatric Neurology. Dr. Kirton’s research applies neurotechnologies to generate new opportunities for life participation for disabled children. He is the board chair of IPSO (internationalpediatricstroke.org, @curekidstroke) and directs the Calgary Pediatric Stroke Program (perinatalstroke.com, @PedStrokeYYC) and ACH Brain Computer Interface Laboratory (BCI4kids.com, @BCI4kids).