Caitlin Hurd1, Donna Livingstone1, Kelly Brunton1, Michelle Teves1, Ephrem Zewdie2, Allison Smith3, Patrick Ciechanski4, Monica A Gorassini5, Adam Kirton6, Man-Joe Watt7, John Andersen8, Jerome Yager9, Jaynie F Yang10. 1. Department of Physical Therapy, University of Alberta. 2. Department of Pediatric Neurology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Department of Pediatrics, University of Alberta; and Department of Clinical Neurosciences, University of Calgary. 3. Neuroscience and Mental Health Institute, University of Alberta. 4. Alberta Children's Hospital Research Institute and Department of Neurosciences, University of Calgary. 5. Department of Biomedical Engineering, University of Alberta; Neuroscience and Mental Health Institute; and Women & Children's Health Research Institute, University of Alberta. 6. Alberta Children's Hospital Research Institute; Department of Pediatrics, University of Calgary; Department of Clinical Neurosciences, University of Calgary; and Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada. 7. Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada. 8. Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital. 9. Department of Pediatrics, University of Alberta; Neuroscience and Mental Health Institute; and Women & Children's Health Research Institute. 10. Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4; Neuroscience and Mental Health Institute; and Women & Children's Health Research Institute.
Abstract
BACKGROUND: Development of motor pathways is modulated by activity in these pathways, when they are maturing (ie, critical period). Perinatal stroke injures motor pathways, including the corticospinal tracts, reducing their activity and impairing motor function. Current intervention for the lower limb emphasizes passive approaches (stretching, braces, botulinum toxin injections). The study hypothesis was that intensive, early, child-initiated activity during the critical period will enhance connectivity of motor pathways to the legs and improve motor function. OBJECTIVE: The study objective was to determine whether early intervention with intensive activity is better than standard care, intervention delivered during the proposed critical period is better than after, and the outcomes are different when the intervention is delivered by a physical therapist in an institution vs. a parent at home. DESIGN: A prospective, delay-group, single-blind, randomized controlled trial (RCT) and a parallel, cohort study of children living beyond commuting distance and receiving an intervention delivered by their parent. SETTING: The RCT intervention was provided in university laboratories, and parent training was provided in the childs home. PARTICIPANTS: Children 8 months to 3 years old with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. INTERVENTION: Intensive, play-based leg activity with weights for the affected leg and foot, 1 hour/day, 4 days/week for 12 weeks. MEASUREMENTS: The primary outcome was the Gross Motor Function Measure-66 score. Secondary outcomes were motion analysis of walking, full-day step counts, motor evoked potentials from transcranial magnetic stimulation, and patellar tendon reflexes. LIMITATIONS: Inter-individual heterogeneity in the severity of the stroke and behavioral differences are substantial but measurable. Differences in intervention delivery and assessment scoring are minimized by standardization and training. CONCLUSIONS: The intervention, contrary to current practice, could change physical therapy interventions for children with perinatal stroke.
BACKGROUND: Development of motor pathways is modulated by activity in these pathways, when they are maturing (ie, critical period). Perinatal stroke injures motor pathways, including the corticospinal tracts, reducing their activity and impairing motor function. Current intervention for the lower limb emphasizes passive approaches (stretching, braces, botulinum toxin injections). The study hypothesis was that intensive, early, child-initiated activity during the critical period will enhance connectivity of motor pathways to the legs and improve motor function. OBJECTIVE: The study objective was to determine whether early intervention with intensive activity is better than standard care, intervention delivered during the proposed critical period is better than after, and the outcomes are different when the intervention is delivered by a physical therapist in an institution vs. a parent at home. DESIGN: A prospective, delay-group, single-blind, randomized controlled trial (RCT) and a parallel, cohort study of children living beyond commuting distance and receiving an intervention delivered by their parent. SETTING: The RCT intervention was provided in university laboratories, and parent training was provided in the childs home. PARTICIPANTS: Children 8 months to 3 years old with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. INTERVENTION: Intensive, play-based leg activity with weights for the affected leg and foot, 1 hour/day, 4 days/week for 12 weeks. MEASUREMENTS: The primary outcome was the Gross Motor Function Measure-66 score. Secondary outcomes were motion analysis of walking, full-day step counts, motor evoked potentials from transcranial magnetic stimulation, and patellar tendon reflexes. LIMITATIONS: Inter-individual heterogeneity in the severity of the stroke and behavioral differences are substantial but measurable. Differences in intervention delivery and assessment scoring are minimized by standardization and training. CONCLUSIONS: The intervention, contrary to current practice, could change physical therapy interventions for children with perinatal stroke.
Authors: Samuel T Nemanich; Chao-Ying Chen; Mo Chen; Elizabeth Zorn; Bryon Mueller; Colleen Peyton; Jed T Elison; James Stinear; Raghu Rao; Michael Georgieff; Jeremiah Menk; Kyle Rudser; Bernadette Gillick Journal: Phys Ther Date: 2019-06-01
Authors: Caitlin Hurd; Donna Livingstone; Kelly Brunton; Allison Smith; Monica Gorassini; Man-Joe Watt; John Andersen; Adam Kirton; Jaynie F Yang Journal: Neurorehabil Neural Repair Date: 2022-04-15 Impact factor: 4.895
Authors: Caitlin L Hurd; Michelle Barnes; Christa M Diot; Elizabeth G Condliffe; Hana Alazem; Lesley Pritchard; Jennifer D Zwicker; Anna McCormick; Man-Joe Watt; John Andersen; Adam Kirton; Jaynie F Yang Journal: BMC Pediatr Date: 2022-08-10 Impact factor: 2.567