Advancements in technology represent hope for children with complex neurologic conditions and their families. Clinical specialists, patients, their families and experts in assistive technology development must work together to advance this technology for unique populations with the greatest need. This paper highlights an excellent example of collaboration, following appropriate research protocol, to study the use of a power walker (the Solowalk) for the first time in a child with cerebral palsy. The result was impressive. A child with cerebral palsy, and associated significant weakness and contractures, who hadn't walked in over two years, was able to walk using this device. This led to feedback from family stating "I have read articles over the years since my grandson was born and dreaming of the day that this might occur. Your group is to be commended." This impressive positive result and heartfelt feedback has fueled ongoing team work to further study this device. We aime to determine which children can most benefit, what modifications to the device would enhance its use and how it can be most effectively utilized to improve function, participation, health and wellbeing.
Background There is increasing evidence for early, active rehabilitation to enhance motor function following early brain injury. This is clear for interventions targeting the upper extremity, whereas passive treatment approaches for the lower extremity persist. The purpose of this trial is to evaluate the effectiveness of early, intensive rehabilitation targeting the lower extremity and delivered in a parent-therapist partnership model for children with perinatal stroke. Methods We describe a protocol for a waitlist-control, single-blind, mixed methods effectiveness randomized controlled trial, with an embedded qualitative study using interpretative description. Participants are children with perinatal stroke aged eight months to three years with signs of hemiparesis. Participants will be randomly allocated to an immediate ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) intervention group, or a waitlist-control group, who will receive usual care for six months. The ELEVATE intervention involves one hour of training four days per week for 12 weeks, with a pediatric therapist and a parent or guardian each delivering two sessions per week. The intervention targets the affected lower extremity by progressively challenging the child while standing and walking. The primary outcome measure is the Gross Motor Function Measure-66. Secondary outcomes include the Pediatric Quality of Life Inventory™, Young Children's Participation and Environment Measure, and an instrumented measure of spasticity. A cost-effectiveness analysis and qualitative component will explore benefit to costs ratios and parents’ perspectives of early, intensive rehabilitation, and their role as a partner in the rehabilitation, respectively. Discussion This study has the potential to change current rehabilitation for young children with perinatal stroke if the ELEVATE intervention is effective. The parent interviews will provide further insight into benefits and challenges of a partnership model of rehabilitation. The mixed methods design will enable optimization for transfer of this collaborative approach into physical therapy practice. Trial registration ClinicalTrials.gov NCT03672864. Registered 17 September 2018.
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