Article

Development of motor pathways is modulated by activity in these
pathways, when they are maturing (ie, critical period). Perinatal stroke injures
motor pathways, including the corticospinal tracts, reducing their activity and
impairing motor function. Current intervention for the lower limb emphasizes
passive approaches (stretching, braces, botulinum toxin injections). The study
hypothesis was that intensive, early, child-initiated activity during the critical period will enhance connectivity of motor pathways to the legs and
improve motor function.
The study objective was to determine whether
early intervention with intensive activity is better than standard care,
intervention delivered during the proposed critical period is better than after,
and the outcomes are different when the intervention is delivered by a physical
therapist in an institution vs. a parent at home. Design: A prospective,
delay-group, single-blind, randomized controlled trial (RCT) and a parallel,
cohort study of children living beyond commuting distance and receiving an
intervention delivered by their parent. Setting: The RCT intervention was
provided in university laboratories, and parent training was provided in the
childs home. Participants: Children 8 months to 3 years old with MRI-confirmed
perinatal ischemic stroke and early signs of hemiparesis. Intervention:
Intensive, play-based leg activity with weights for the affected leg and foot, 1
hour/day, 4 days/week for 12 weeks. Measurements: The primary outcome was the
Gross Motor Function Measure-66 score. Secondary outcomes were motion analysis of
walking, full-day step counts, motor evoked potentials from transcranial magnetic
stimulation, and patellar tendon reflexes.
Limitations: Inter-individual
heterogeneity in the severity of the stroke and behavioral differences are
substantial but measurable. Differences in intervention delivery and assessment
scoring are minimized by standardization and training. Conclusions: The intervention, contrary to current practice, could change physical therapy interventions for children with perinatal stroke.
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Langue : ANGLAIS