Intensive Motor Training After Perinatal Stroke to Enhance Walking
Condition: Perinatal Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Early childhood injuries such as perinatal (around birth) stroke are devastating because the
      child lives with the problem for life, typically close to a normal lifespan. One
      'opportunity' presented by a brain injury early in life compared to later in adulthood is
      that the young brain is much more plastic (malleable) and receptive to interventions. This is
      particularly true for neural circuits that are still under development. We will test the
      hypothesis that early (<2 yr old), intensive leg training will improve walking more than no
      training or training at >2 yr old. We will further determine the changes induced by training
      in motor and sensory pathways.
    

Detailed description: 
      Children 8 mo to 3 yr old with unilateral perinatal stroke will be randomized into either: 1)
      Immediate Training, or 2) Delayed Training groups. The Immediate Group will train for 3 mo
      shortly after recruitment. The Delayed Group will go through the same measurements from the
      time of recruitment and at 3 mo later (with no training in between) to obtain a 3 mo change
      score which will serve as a control measure for the Immediate Group. The Delayed Group will
      also train after the 3 mo delay, when all control measures have been taken. Comparison of the
      improvements made by children who started training <2 yr old with those >2 yr old will answer
      the question if training at <2 yr old is better than >2 yr old. Finally, to determine if
      there are long term effects of this training, we will compare outcomes of these trained
      children with another group of children with the same injuries but no intensive training
      (i.e., too old for the training study), when all children turn 4 yr old. Clinical, kinematic
      and electrophysiological measures will be taken to help us understand not only the efficacy
      of the treatment, but also the neural mechanisms that might underlie improvements in outcome.

      We are measuring outcomes at multiple times because change scores are of most interest. All
      children change as they age, so it is critical that we compare the change score with and
      without intervention.
    

Intervention name(s): Early leg training; Delayed leg training; Parent leg training
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Children will engage in ~1 hour/day, 4 days/week treatment for 3 months. The treadmill will consist of supported walking on a treadmill, over ground, stair climbing, standing, kicking, splashing ... etc. leg activity. Activities will be directed by a physical therapist in the clinical setting.; The training activity will be exactly the same as the Early leg training group, except that it will occur ~3 months after recruitment.; Children will engage in ~1 hour/day, 4 days/week treatment for 3 months. The treadmill will consist of supported walking on a treadmill, over ground, stair climbing, standing, kicking, splashing ... etc. leg activity. Activities will be directed by parents in their home or community environment.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: cerebral palsy; physical therapy; rehabilitation; hemiplegia