Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review

Abstract

Background Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP. Objective This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research. Methods A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children’s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate. Results In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth.

Role of telerehabilitation in the rehabilitation of children with cerebral palsy during COVID-19: A review

“…21 Chen et al [42] 2021 Pediatric rehabilitation perspective New York N/A N/A It is becoming increasingly important in pediatric rehabilitation to use telemedicine as a safe and effective means of communication, evaluation, and treatment, especially amid the current COVID-19 outbreak. 22 Akulwar-Tajane and Bhatt [43] 2021 Prospective quasiexperimental India 3.02 ± 2.1 21 children Clinical results for children have improved as a result of telerehabilitation. Families expressed a desire for in-person sessions despite their happiness with TR services.…”

“…Moreover, this review will contribute to the current evidence base as despite 3 previous reviews having been conducted in this area, 1 was not specific to children with CP, [20] and 1 only focused on therapy for the upper extremities, [21] and 1 review was conducted during COVID-19 which reported studies primarily regarding telerehabilitation before the COVID-19 pandemic occurred. [22] 2. Methodology…”

Ten Years of TeleHealth and Digital Healthcare: Where Are We?

“…Furthermore, even in TH and DH, one can currently count on the use of emerging technologies, such as robotics [ 24 , 25 , 26 , 27 ], augmented reality [ 28 ], virtual reality [ 29 ], and artificial intelligence [ 30 , 31 ]. Moreover, assistive technologies have played a strategic role during the pandemic as they were consolidated in the context of different applications and disabilities relating communication and motion [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ].…”

Outcomes of a Parent-Delivered Baby-mCIMT Model for Infants at High Risk of Unilateral Cerebral Palsy Using Remote Coaching in Telerehabilitation

“…Telerehabilitation has several advantages, such as accessibility, time efficiency, and costeffectiveness, for both families and healthcare providers, as the communication between them occurs digitally and remotely [15,16]. There are few well-controlled studies of telerehabilitation for children with CP, most lacking breadth and methodological quality [17]. However, several studies report positive results for the feasibility of telerehabilitation for children with various diagnoses [18,19].…”

“…Coaching is generally found to be a viable intervention in early intervention studies because the model of parent coaching is strongly aligned with the scope of professional interveners [21] and has commonly also been used in other recent early intervention studies [5,22,23]. Nevertheless, there is a need for further investigations of telerehabilitation, as few studies compare its treatment effects with those of established and evidence-based in-person methods [17][18][19]. The most effective telerehabilitation programs appear to incorporate coaching methods and parental implementation [19].…”