Daily and Weekly Rehabilitation Delivery for Young Children With Gross Motor Delay: A Randomized Clinical Trial Protocol (the DRIVE Study)

Abstract

The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants. Methods: We will randomize 75 infants with cerebral palsy, 6-24 months of age and GMFCS III-V (higher severity), to determine the short term and long-term effects of 3 dosing protocols consisting of an identical number of 2 hour sessions of the same motor learning based therapy applied over a different total number of calendar weeks. Results and Conclusions: The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation in order to optimize motor function and development of young children with cerebral palsy.

Protocol and Feasibility-Randomized Trial of Telehealth Delivery for a Multicomponent Upper Extremity Intervention in Infants With Asymmetric Cerebral Palsy

“…It is also likely that more than 4 weeks of intervention would be necessary for this new format, as a dosage of early developmental interventions is much debated in the CP literature. [39][40][41] Current practice often involves using therapist-implemented outpatient UE therapy in a clinical setting, sometimes with limited hands-on participation from parents. These programs can be difficult to access due to geographic, economic, or social constraints.…”

“…It is also likely that more than 4 weeks of intervention would be necessary for this new format, as a dosage of early developmental interventions is much debated in the CP literature. 39 – 41 …”

Daily Outpatient Physical Therapy for a Toddler With a Neurodegenerative Disease: A Case Report

“…Although the child was withdrawn from the study, the family wanted to complete the high-dose PT through outpatient health services. At Nationwide Children's Hospital (NCH), high-dose PT interventions have been identified as promising and used as a current model of care 5,6,18,42. We considered logistical issues to successful delivery of high-dose interventions including (1) child characteristics (patient tolerance and ability to improve throughout a high-dose PT intervention), (2) family characteristics (family engagement and commitment to attending therapy sessions), and (3) institutional characteristics (therapist availability as it is a clinical recommendation for the child to have no more than 2 therapists for continuity of care).…”

“…4 There is an emerging body of evidence that supports the efficacy of high-intensity (most days of the week for several weeks) PT interventions to improve motor function for young children with developmental delays. [5][6][7][8] This frequency of therapy is thought to mimic typical motor skill development in which children learn a new skill and then masters it within their natural environment, such as their home, school, or community. 7 We use frequency to define how many times per week the intervention occurred and intensity as the duration of each treatment session.…”

“…This case demonstrates that a daily high-dose intervention may benefit a child with a neurodegenerative disorder. [5][6][7][8][14][15][16][17][18][19]…”