CAP'
Intensive rehabilitation program for young children for more autonomy
Context
An urgent priority in the field of paediatric neurorehabilitation is the development of effective early motor interventions. Hand and Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) applies the concepts of motor skill learning and intensive training to both the upper (UE) and lower extremities (LE) and has been shown to improve aspects of motor function of the UE and LE in school age children with unilateral2 and bilateral3 cerebral palsy across the 3 levels of the International Classification of Functioning, Disability and Health (ICF).
Objectives
The primary objectives are to evaluate the effect of two weeks of early HABIT-ILE on:
- bimanual performance in pre-school children (1-4 years old) with unilateral CP (Randomized Controlled Trial 1=RCT1 N= 50 children), and on
- gross motor function of children with bilateral CP (RCT 2, N= 60 children)
Status and Results
The first results of the study in children with unilateral CP were published in November 2023 in the journal JAMA Pediatrics.
Compared to children with unilateral CP following their usual motor activities, after 50h of HABIT-ILE, the children
- used more frequently and more effectively both hands to play
- improved more in gross motor skills (sitting, standing, walking, climbing stairs)
While the AHA score, the main endpoint of this study, is not changed in the control group, it increases significantly by about 10% in the HABIT-ILE therapy group and the difference between the 2 groups is significant at 3 months.
The first results of the study in children with unilateral CP were published in the international reference journal JAMA Pediatrics.
- The intensive HABIT-ILE therapy improves the bimanual performance evaluated by the AHA (Assisting Hand Assessment). Children used more frequently and more effectively boths hands to play
- The children also improved more in gross motor skills (sitting, standing, walking, climbing stairs.... ), evidence through an improvement of the Gross Motor Function Measure (GMFM 66)
- The Melbourne assessment results for evaluating upper limb movement quality also showed improvements
Highest improvements were achieved by the youngest children ( 6 years).
With this first study "we have just proved that a 50h course of HABIT-ILE therapy brings more progress on fine motor skills than an usual rehabilitation in children with unilateral CP. And we have shown that it is probably the features of the therapy that allow this improvement compared to the usual motor activity of children,” says Pr Sylvain Brochard, coordinator of the project.
While so far, most clinical studies evaluating the effectiveness of this intensive rehabilitation have been conducted in children over the age of six and usually with unilateral cerebral palsy with excellent results, the results of this study show for the first time that it can be offered to the toddlers and that it is effective. We know that most brain growth and development occurs before the age of two and that brain plasticity is maximal at that age.
“The results of this study must change not only the current techniques of rehabilitation of children with cerebral palsy in early childhood but also the policies of rehabilitation organization.” says Dr Alain Chatelin, President of the Cerebral Palsy Foundation.