Early, Activity-based Physical Therapy to Improve Gross Motor Function in Children with Perinatal Stroke
Creators: Hurd, Caitlin
Publisher: name: University of Alberta Library
Year: 2023

<p>Cerebral palsy is the most common cause of motor disability in childhood, resulting from abnormal development of, or injury to the developing brain. One common form of such brain injury is perinatal stroke, which occurs between 20 weeks’ gestation and 28 days postnatal life and is the leading cause of unilateral cerebral palsy. Perinatal stroke has an estimated incidence of 1 in 1600–3000 live births and can result in motor and sensory impairments to the upper and lower extremity on one side of the body. Preclinical animal studies and an increasing number of human studies have shown that intensive, active interventions after early brain injury may be most efficacious if they are delivered at a young age as the nervous system continues to develop. The evidence for improved motor function with early, active rehabilitation is especially clear for interventions targeting the upper extremity. In contrast, early, active interventions for the lower extremity remain understudied. Passive and infrequent rehabilitation approaches for the lower extremity persist in clinical practice.</p>

<p>The objective of this thesis was to determine the feasibility, potential efficacy and preliminary effectiveness of a physical therapy intervention called ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) for children with perinatal stroke. ELEVATE uses the principles of motor learning and neuroplasticity to engage young children in high-repetition, progressively challenging activities while weight-bearing through the lower extremities. This thesis is comprised of three studies. The first study is a two-centre randomized controlled trial that evaluated the efficacy of ELEVATE, administered by a physical therapist in an academic setting. We found significant improvement in gross motor function for children who received the intervention, as compared to a waitlist-control group. We also found that it was feasible to train parents to administer the intervention at home. The second study in this thesis describes the preliminary results of a multi-centre randomized controlled trial to evaluate the effectiveness of the intervention delivered in a parent-therapist partnership model of rehabilitation with a community-based therapist. We found that parents achieved a similar dose or intensity of the intervention as therapists and participants showed improved gross motor function with the ELEVATE intervention. The final study explores the parents’ perspectives of engaging in early intervention for their child and partnering with therapists to administer the ELEVATE intervention. We found that parents were keen to engage their children in a positive rehabilitation experience in order to maximize their motor development, despite the barriers to participating. Collectively, this dissertation research demonstrates that early, intensive active rehabilitation targeting the lower extremities is feasible and increases gross motor function for children with perinatal stroke. The results of this thesis will contribute to optimizing early interventions for children with injury to the developing nervous system.</p>