Leveraging Digital Technologies to Advance Rehabilitation for Children with Unilateral Cerebral Palsy - Project Summary Cerebral Palsy (CP) is the primary motor disability of childhood. Over half of all children with CP have upper extremity (UE) deficits. Children with unilateral UE deficits benefit from intensive motor practice using the weaker or affected arm while the dominant or unaffected arm is constrained in a splint or cast. This form of therapy, pediatric constraint induced movement therapy (pCIMT), is one of the most effective treatments for improving UE motor skills, but it is not available in many areas of the country. Telehealth may make pCIMT accessible for families who live in rural areas, under-resourced settings, far away from pCIMT programs, or those who face barriers to in-person visits (e.g., transportation). Early-stage pediatric research trials are exploring telehealth interventions (mostly in infants and young children), but most still require in-person pre- and post- assessments. For telehealth to truly reduce the health accessibility gap, scientists need to 1) determine if telehealth pCIMT is effective in school-aged children, 2) compare telehealth and in-person UE assessments, and 3) measure adherence to protocol dose for any parent-delivered components of treatment. This proposal adds aims to a funded pilot efficacy trail (n=10) of intensive (60 hours in 4 weeks) telehealth pCIMT study, CHAMP-T2, to address each of these needs. First, wrist-worn accelerometers will measure changes in amount, magnitude, and symmetry of UE use. Accelerometers have been successful in measuring change in UE movement and are highly correlated with functional measures. CHAMP-T2 participants and an additional 25 subjects will be enrolled in a sub-study to compare the scores of in-person and telehealth administrations of the Melbourne Assessment-2 and the Assisting Hand Assessment. If telehealth administrations of these assessments have high agreement with in-person assessments, they may be suitable for measuring change in future telehealth trials. Finally, because CHAMP-T2 depends on an on-site parent to facilitate the child’s motor practice through a combination of video-conferencing sessions and at-home practice, accelerometry watches will be used to quantify adherence to pCIMT treatment dose (e.g., frequency, time, and type of intervention). If successful, this offers a low-burden alternative to activity logs or diaries for monitoring adherence to dose during at-home practice. The applicant identifies training goals to advance expertise in: 1) all phases of clinical trials, 2) remote collected UE assessment, 3) training parents in motor intervention principles, and 4) stakeholder-led research. In addition, the applicant will complete lab rotations, workshops, courses, and seminars to meet these training goals and enable the completion of the research plan. The applicant is supported by an interdisciplinary team of mentors in pediatric rehabilitation (physical and occupational therapy), engineering, and medicine, parent stakeholders, and a biostatistician.
