CareToy - A Modular Smart System for Infants' Rehabilitation at Home Based on Mechatronic Toys
Condition: Preterms at Risk for Developmental Disorders
MeSH terms: Developmental Disabilities
Study type: Interventional

Summary: 
      Stroke and other neurological conditions affect the population of infants in percentages that
      cannot be considered marginal. Preterm infants are the highest infants at risk for
      neurological damage. Currently, infants have rehabilitation sessions few times a week in
      rehabilitation centres but according to basic neuroscience it would be necessary to provide
      them with an early, intensive and multiaxial intervention. One option to reduce the cost of
      the entire European Healthcare System while increasing the practice of rehabilitation is to
      devise therapies and technologies that can be administered at home by caregivers and
      telemonitored by rehabilitation staff. The aim of this proposal is to promote early
      intervention in the first year of life and to reinforce therapy by "CareToy": a portable low
      cost smart system telemonitored thus augmenting the clinical effectiveness of the therapy
      while reducing the cost. The smart system is based on a common baby gym, composed of
      different modules: a) an instrumented baby gym with mechatronic hanging toys, so that the
      infants' actions on the gym can be measured and stimulated, b) a vision module, for measuring
      and promoting infants' attention and gaze movements and c) a sensorized mat for measuring and
      promoting postural control. Each module will also incorporate built-in signal processor,
      memory and wireless communication. A fourth telerehabilitation module completes the system
      that allows the system to remotely communicate with the rehabilitation staff for monitoring
      and assessing the rehabilitation techniques. CareToy and the effectiveness of home
      rehabilitation based on this system will be validated by clinical trials on at least 50
      preterm infants. The result of this project could have a large impact. CareToy may become a
      commercial product, manufactured on a large scale and distributed not only in rehabilitation
      centres but also at homes, sold or rented by the Health Care System to families as a
      therapeutic tool for care intensity.
    

Detailed description: 
      Study population will be made up of premature infants recruited at the local Department of
      Neonatology. The eligibility of infants, i.e. children who meet the criteria for inclusion
      and exclusion, will be evaluated by the Neonatology team. Recruitment should take place after
      discharge from Neonatal Intensive Care Unit (NICU) until the age stated by inclusion criteria
      and will begin with the signing of the participation agreement by the parents. During the
      recruitment extensive perinatal data will be collected from medical records. Each clinical
      centre will maintain these data in an internal database storing. Every child will be
      evaluated on the basis of a standard neurological examination supplemented by movement
      analysis on video recording using Prechtl's Method Qualitative Assessment of General
      Movements.

      The sample will be randomized in two groups in order to compare the effectiveness of the
      CareToy intervention program vs standard care on motor, cognitive and visual development. We
      designed the study as randomized clinical trial. The sample size was calculated on the basis
      of the primary outcome measure (Infant Motor Profile [IMP], see Outcome measures).

      Before the starting of the RCT we have planned a short pilot phase where few infants in order
      to assess the feasibility of the CareToy training and to tune and set-up the CareToy system
      and the rehabilitation packages. These cases will follow the same steps planned for the RCT.
    

Intervention name(s): CareToy; Standard Care
Intervention type(s): Device; Other
Intervention description(s): Infants randomized in the Intervention Group will begin the habilitation intervention immediately after evaluation at baseline. Rehabilitation staff, in accordance with each infant's needs and clinical characteristics, will set up the CareToy System to perform individualized intervention packages and its user's manual. So a personalized CareToy System will be delivered at infant's home. Moreover parents will attend a training course to use it. During each daily home - session (about 30 - 45 minutes overall) it will be proposed to the child various interactive activities in supine, prone and sitting position. The intervention phase lasts 4 weeks and each session will be remotely monitored by the rehabilitation staff.; Current care advices in the management of preterm infants in the first months of life
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: preterm infants; early intervention; enrichment; cognitive, motor, visual development; tele-rehabilitation