Parent Therapist Partnership to Provide Early, Intensive Exercise in Perinatal Stroke

Parent Therapist Partnership to Provide Early, Intensive Exercise to Enhance Walking Outcomes in Children With Perinatal Stroke

A prospective, single blind, parallel group, randomized control trial to determine if early, intensive lower extremity activity delivered by a physical therapist and a parent in partnership improves gross motor function more than usual care.

A mixed-methods randomized controlled trial at 3 healthcare centres: Edmonton, Calgary and Ottawa. The period of participation for each child is 12 months. The Immediate Group will have 3 months of intervention and 9 months follow-up. The Delay Group will be followed for 6 months (waitlist-control period), then given the opportunity to receive the same intervention and followed for 3 months after the intervention.

The intervention will be delivered by clinicians in the rehabilitation centres in partnership with the child's parents. Therapists will provide training 2 days a week and will coach the parents to provide the training at home for 2 days a week.

The intervention is ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) and consists of child-initiated, intensive leg activities for one hour a day, four days a week for 12 weeks.

Inclusion Criteria:

• children ages 8 months to 3 years
• medical history and physical exam consistent with perinatal stroke
• hemiparesis in the upper and/or lower extremity
• parental agreement to adhere to the training and testing schedule

Exclusion Criteria:

• bilateral motor impairment
• epileptic seizures that could interfere with training
• cognitive, behavioural or developmental impairments that preclude participation in the protocol
• botulinum toxin A injections or surgery in the lower extremities within the previous six months
• concurrent casting during the intervention phase (including constraint-induced movement therapy with casting)
• diagnosis associated with neurological/developmental regression
• parent unable to communicate (verbal and written) in English or French