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Engaging the Lower Extremity via Active Therapy Early (ELEVATE) Is Feasible and May Improve Gross Motor Function in
Caitlin L Hurd1, Donna Livingstone1, Allison Smith1
1From the: Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
Insights
This study found that the ELEVATE intervention is feasible and shows preliminary efficacy for young children with spastic bilateral cerebral palsy (CP). Early, intensive rehabilitation improved gross motor function and gait in these children.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Spastic bilateral cerebral palsy (CP) in children born prematurely presents significant motor challenges.
- Early intervention is crucial for optimizing outcomes in children with CP.
- The ELEVATE intervention aims to improve gross motor function in this population.
Purpose of the Study:
- To determine the feasibility and preliminary efficacy of the ELEVATE intervention for children with spastic bilateral CP.
- To assess adherence and preliminary outcomes of an intensive rehabilitation program.
Main Methods:
- A case series design was employed with randomization to immediate or delayed intervention groups.
- Feasibility measures included recruitment, session attendance, and stride counts.
- Preliminary efficacy was assessed using the Gross Motor Function Measure-66 (GMFM-66) and gait analysis.
Main Results:
- All four young participants tolerated the 12-week intervention, with high session attendance (75%-94%).
- Participants showed improvements in GMFM-66 scores (2.4-7.5 points) compared to the delayed group.
- Three participants demonstrated notable improvements in gait kinematics and weight-bearing during treadmill walking.
Conclusions:
- The ELEVATE intervention is feasible and demonstrates preliminary efficacy for improving gross motor function in young children with spastic bilateral CP.
- These findings support the design of larger clinical trials to further evaluate early, active interventions for this population.
Purpose:
The feasibility of ELEVATE with respect to adherence and preliminary efficacy was determined for children with spastic bilateral cerebral palsy (CP) from encephalopathy of prematurity.
Methods:
A case series was used. Participants were randomized to receive ELEVATE immediately or delay the intervention by 3 months before receiving the intervention. The outcomes included feasibility measures of (1) number of children recruited, (2) percentage of sessions attended, (3) stride counts during the intervention, and preliminary efficacy measures of change over the intervention period in (4) Gross Motor Function Measure-66 (GMFM-66), and (5) kinematics and weight-bearing during treadmill walking.
Results:
Four boys under 3 years of age participated. All participants tolerated 60-minute intervention sessions four times/week for 12 weeks, and attended 75%-94% (min-max) of the targeted sessions. The median step count per session ranged from 833 to 2484 steps (min-max) during the final week of training. Participants showed an increase in GMFM-66 score of 2.4-7.5 points (min-max) over the 3-month intervention phase, as compared to a decrease of 1.7 for one participant and an increase of 1.3 for another over the delay period. Three participants demonstrated small improvements in their gait with the intervention.
Conclusions:
Engaging young children with bilateral CP in intensive rehabilitation targeting gross motor function was feasible and demonstrated preliminary efficacy. The results have guided the design of a larger clinical trial to assess efficacy of early, active interventions for children with spastic bilateral CP.
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