Upper limb training for young children with unilateral cerebral palsy using video coaching: An explorative retrospective clinical study

Introduction

Young children with unilateral cerebral palsy (CP) received a home-based training program using video coaching for parents. The primary aim of our study was to evaluate the effectiveness of unilateral training on the use of the affected arm and hand during bimanual activities and to explore factors that affect treatment response. Secondary, we evaluated whether effects were retained after an 8-week break, and if data were available, we explored the effects of a second uni- or bimanual training block. Furthermore, adherence was evaluated.

Methods

Explorative retrospective clinical study evaluating the effectiveness of the first 8-week training block on the (Mini-) Assisting Hand Assessment ((Mini-) AHA) unit score in 81 children aged 8–36 months. Pre- and post-intervention (T0–T1) and 8-week follow-up measurements (T2) were evaluated, and factors influencing treatment response were explored, using linear mixed models (LMM). Additionally, effects of a second training block were explored in 31 of the original 81 children, contingent upon data availability, with T3–T4 measurements included. Adherence, measured as percentage of treatment duration, was explored.

Results

Mini-AHA and AHA unit scores significantly improved between T0 and T1, but did not change between T1 and T2. In children aged 18 months and older, baseline AHA scores were related to change scores. In children aged <18 months, no predictors of treatment response were identified. LMM showed significant improvement between T1–T3 and T1–T4 in Mini-AHA scores in children with a second training block. Adherence rates were 85% in the first and 81% in the second block.

Conclusions

Our data suggest that upper limb training using video coaching can improve hand use in infants and toddlers with unilateral CP, with retained effects after an 8-week break and further enhancement following a second training block. Individual results differed, and controlled studies are needed to strengthen the evidence. High adherence rates suggest the program's feasibility.

Consumer and Community Involvement Statement

There was no direct consumer and community involvement in the study design.

PLAIN LANGUAGE SUMMARY

Cerebral palsy is caused by a brain injury around birth and is the most common physical disability in children, affecting their movement. Children with one side of the body affected often use that side less, making daily activities harder. Training the affected arm in the first 2 years of life is important because the brain is still very adaptable. In our study, we evaluated a home-based training program for young children with cerebral palsy, with blocks of 8 weeks of therapy using video coaching for parents. We looked at how well the first training block improved the use of the affected arm and hand. We also looked at whether the effects lasted after an 8-week break and whether a second training block further improved hand use. Lastly, we looked at how well families continued to train. We found an improvement of the use of the affected hand after the first training block. Children older than 18 months with poorer hand use at the start made more progress, while especially children younger than 18 months demonstrated further improvement after the second training block. Most parents and children were able to continue the training program using video coaching. Early upper limb home-based training with video coaching can help young children with cerebral palsy to improve the use of their affected arm and hand. Video coaching seems effective to motivate parents to continue with the program. Individual results varied. There is a need for larger studies.