Protocol and Feasibility-Randomized Trial of Telehealth Delivery for a Multicomponent Upper Extremity Intervention in Infants With Asymmetric Cerebral Palsy

Abstract

Background: Past work showed that an in-person, therapist-guided, parent-implemented multicomponent intervention increased the motor functioning of the more affected upper extremity (UE) in infants with asymmetric cerebral palsy. The authors document treatment fidelity and provide initial testing of telehealth intervention delivery in a new subject sample. Methods: The authors adapted the intervention manual used in the previous trial for telehealth. Infants (6-24 months) were randomly assigned to intervention (n ¼ 7) or waitlist (n ¼ 6). The intervention prescribed soft-constraint wear on the less affected UE for 6 hours, 5 d/wk, and exercises. After an initial in-person training session, three 15-to 45-minute telehealth sessions were performed. Results: Median weekly constraint wear was 21 hours (interquartile range ¼ 10.3-29.7); average parent-treatment fidelity was 95.7% (SD 11.2). A significant large (Cohen d ¼ 0.92) between-group differences occurred on fine motor functioning of more affected UEs. Conclusion: The telehealth intervention was feasible and potentially effective, but a larger trial is needed to evaluate efficacy. Even before the access crisis resulting from the SARS-CoV-2 pandemic, decreased access to health care was a widespread problem in the United States and significantly affected health outcomes. 1,2 Those living in rural areas, or with lower socioeconomic status, are still at particular risk of inadequate access to health care. In rural areas, which are more likely to be medically underserved, disparities exist in both the scope of available care and the quality of this care. 3 For patients with specialized medical needs, this means decreased access to medical specialties and subspecialties, including high-quality rehabilitative care, new and experimental treatments, and research trials. Barriers to access for caregivers of children with specialized medical needs can be geographical (due to lack of proximity to centers providing specialized care) or socioeconomic (due to lower insurance coverage, access to paid time off, and transportation). 4 Children with developmental disabilities living in rural areas are less likely to have seen a therapist or have a well-child checkup in the past year compared to those in urban areas. 5 Telehealth in pediatric primary care has the potential to address some of these barriers and is gaining popularity, with high parent satisfaction reported. 1,4 Various models have been explored in