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Feasibility of improving the motor development of toddlers with congenital heart defects using a home-based
Nicole A Stieber1, Stephanie Gilmour, Angela Morra
1Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON M5G 1V7, Canada. nicole.stieber@utoronto.ca
Insights
Children with superior cavopulmonary connection (SCPC) procedures show early motor delays, while those after arterial switch operation (ASO) have age-appropriate skills. Parent-led rehabilitation improves motor function in post-SCPC children to age-appropriate norms.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Complex congenital heart defects significantly impact child development.
- Motor deficits are common in toddlers following cardiac surgery.
- Early intervention is crucial for optimizing developmental trajectories.
Purpose of the Study:
- To assess the feasibility of parent-led motor assessments and rehabilitation for children with complex congenital heart defects.
- To evaluate and compare gross and fine motor function in toddlers after superior cavopulmonary connection (SCPC) and arterial switch operation (ASO) procedures.
- To identify factors associated with motor outcomes and barriers to rehabilitation adherence.
Main Methods:
- The study involved 20 toddlers (12-26 months) who underwent either SCPC or ASO surgery.
- Motor development was assessed using the Peabody Developmental Scales, version 2 (PDMS-2).
- Feasibility was evaluated through parent interviews, and factors influencing motor scores were analyzed.
Main Results:
- Children after ASO demonstrated significantly higher gross and fine motor scores compared to those after SCPC.
- Lower motor quotient was linked to anticoagulant use, longer/frequent hospitalizations, and shorter time since surgery.
- The rehabilitation program enabled post-SCPC children to achieve age-appropriate developmental rates.
Conclusions:
- Toddlers undergoing ASO generally exhibit age-appropriate motor skills.
- Children post-SCPC procedure experience notable early motor delays.
- Parent-led rehabilitation is feasible and effective in enhancing motor function for children with complex congenital heart defects, particularly those post-SCPC.
Abstract:
This study investigated the feasibility of administering motor assessments, delivering rehabilitation via parent-led activities, and enhancing motor function in children with complex congenital heart defects. Gross and fine motor development were evaluated in 20 toddlers ages 12 to 26 months after either a superior cavopulmonary connection (SCPC) procedure or an arterial switch operation (ASO) using the Peabody developmental scale, version 2 (PDMS-2). Feasibility of assessment and program delivery were examined using open-ended interviews with parents. The ASO group scored consistently higher than the SCPC group in every subscore of the PDMS-2 (ASO gross motor quotient, 96.78 ± 7.396 vs SCPC gross motor quotient, 77.56 ± 7.715 [P < 0.001]; ASO fine motor quotient, 101.20 ± 6.512 versus SCPC fine motor quotient, 87.70 ± 9.945 [P = 0.002]; ASO total motor quotient, 98.78 ± 6.515 versus SCPC total motor quotient, 79.56 ± 8.095 [P < 0.001]). A lower total motor quotient was associated with the use of anticoagulant medication (-20.3 ± 4.6; P < 0.001), longer and more frequent hospital stays (respectively, -3.6 ± 1 .4; P = 0.01 and -0.8 ± 0.4; P = 0.02), and shorter times between the most recent surgery and the assessment date (2.1 ± 0.5; P < 0.001). Age-standardized scores were constant between baseline and follow-up evaluation (baseline gross motor quotient, 87 ± 12 vs. post-intervention gross motor quotient, 88 ± 15 [P = 0.89]; baseline fine motor quotient, 94 ± 11 vs. post-intervention fine motor quotient, 94 ± 12 [P = 0.55]; baseline total motor quotient, 89 ± 12 vs. post-intervention total motor quotient, 90 ± 14 [P = 0.89]), indicating achievement of the expected rate of development. The most common barrier to home activity completion was illness in the SCPC group and lack of interest in the ASO group. Providing enjoyable activities and incorporating the activities into the participants' schedules were keys to compliance. All the children were able to complete the assessments, and the parents reported a positive impact of the intervention on family life. Children who have had the SCPC procedure experience significant motor delays early in life. However, toddlers after ASO have age-appropriate motor skills. Completion of the rehabilitation program enables post-SCPC children to increase their rate of development to age-appropriate norms.