APPLES: Early Childhood Constraint Therapy for Sensory/Motor Impairment in Cerebral Palsy

苹果：针对脑瘫感觉/运动障碍的儿童早期约束疗法

基本信息

批准号：
10704084
负责人：
Nathalie Maitre
金额：
$ 64.44万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-21 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10704084
关键词：
Address Affect Age Area Attention Biological Brain Businesses Cerebral Palsy Child Child Rearing Childhood Consensus Control Groups Cues Data Development Developmental Therapeutics Program Diagnosis Early Diagnosis Early Intervention Education Effectiveness Emotional Ensure Feedback Frequencies Funding Geography Goals Guidelines Hand Hand functions Health Services Accessibility Healthcare Systems Home Infant Institution Intervention Knowledge Link Manipulative Therapies Manuals Measurement Measures Medical Methods Modeling Monitor Motor Motor Activity Motor Skills Movement Disorders Neurosciences Outcome Parents Patient Outcomes Assessments Performance Phase Psychology Psychometrics Public Health Randomized Randomized, Controlled Trials Rehabilitation therapy Reporting Reproducibility Resources Schedule Sensorimotor functions Sensory Severities Site Somatosensory Cortex Standardization Testing Upper Extremity Vision Waiting Lists active method arm function blind cohort coping cost effectiveness design early childhood effective therapy effectiveness study evidence base expectation experience functional outcomes hand rehabilitation improved knowledgebase motor impairment motor learning multimodality novel physically handicapped primary outcome programs psychoeducation psychoeducational remote administration remote health care secondary endpoint sex socioeconomics somatosensory sound standard care standard of care success telehealth treatment comparison treatment effect

项目摘要

PROJECT SUMMARY/ABSTRACT Long-term goals of this application are to develop safe, effective, and scalable interventions with a strong basis in neuroscience, to improve the upper extremity (UE) function of children with cerebral palsy (CP). Our UE intervention called “APPLES” is parent-administered, medical team-directed, uses soft constraint and “sticky-mittens” and bimanual therapy. Our first R01 showed that it effectively improved UE function, cortical somatosensory processing, and reach smoothness, while being safe for the developing brain and body in infants (6-24 months) with CP. Our competing renewal addresses remaining gaps in knowledge: is there an earliest age at which APPLES is most effective, can APPLES be successfully delivered through telehealth, and because parents are delivering APPLES, are there evidence-based supports that we can offer them to be more effective, and do all parents need these supports equally. We also specifically address new NCMRR priorities for: (1) “multimodal approaches that promote plasticity and sensorimotor function”, (2) “patient-reported outcomes as ... secondary endpoints in trials”, and (3) “development of scalable strategies”. We call our new intervention APPLES-tele, as it will be delivered through telehealth and start in infants as young as 3 months. In addition, we test the relative efficacy of APPLES-tele vs. standard care group and vs. a novel parent-centered approach (PCA) that is infant- and CP-specific. PCA consists of education in infant motor learning, adaptive strategies for CP, and positive psychology in parenting (from the scientifically-proven Triple P Positive Parenting Program model). PCA will help parents develop “authoritative parenting”, an optimal parenting style proven to promote better long-term developmental outcomes. The design is a randomized controlled trial with both business-as-usual and active treatment comparisons; two groups receive PCA and APPLES-tele, but in different order. The other receives standard care. Both 6- week interventions will have the same weekly-telehealth schedule. Assessments are at baseline, at 6- weeks and 12 weeks. We use standardized tests of hand function and development, validated measures of parent-treatment fidelity, and parent-relevant measures of performance. Interventions and assessments are protocolized and monitored to ensure rigor and reproducibility. We leverage a large cohort of parents and children across 4 centers already linked through our successful implementation network for early detection of CP, with diverse socioeconomic and geographic conditions in an area > 11% of the US. We aim to demonstrate improvements in UE function are greater in the APPLES-tele-first group than in both control groups after the first 6-weeks of intervention. Conversely, we will show parent CP-specific knowledge and parent-child emotional connection are greater in the PCA-first group than the other 2 groups. We will then explore whether relative efficacy of PCA-then-APPLES vs. APPLES-then-PCA on infants’ UE function across the entire 12 weeks depends on initial level of authoritative parenting.

项目摘要/摘要该应用的长期目标是发展安全，有效且可扩展的干预措施在神经科学的基础上，改善了脑瘫儿童（CP）儿童的上肢（UE）功能。我们的 UE干预称为“苹果”是由父母管理的，由医疗团队指导的，使用软限制和 “粘性床位”和双人疗法。我们的第一个R01表明它有效改善了UE功能，皮质功能体感处理并达到平稳性，同时对发展中的大脑和身体安全婴儿（6-24个月）的CP。我们相互竞争的续约解决知识中剩余差距：是否有苹果最有效的最早年龄，可以通过远程医疗成功地运送苹果吗？而且，由于父母正在提供苹果，所以是否有基于证据的支持，我们可以将其提供给更有效，所有父母都需要平等的支持。我们还专门解决了新的 NCMRR优先级：（1）“促进可塑性和感觉运动功能的多模式方法”，（2） “患者报告的结果为...试验中的次要终点”和（3）“可扩展的开发策略。婴儿年仅3个月。此外，我们测试了苹果 - 泰勒与标准护理的相对效率组和以父母为中心的新方法（PCA）是婴儿和CP特异性的。 PCA包括婴儿运动学习，CP的适应性策略以及育儿的积极心理学教育（从科学证实的三重P阳性育儿计划模型）。 PCA将帮助父母发展 “权威育儿”，一种最佳的育儿方式，旨在促进更好的长期发展结果。设计是一项随机对照试验比较；两组会收到PCA和苹果 - 泰勒，但顺序不同。另一个收到标准关心。这两项为期6周的干预措施将具有相同的每周一次性健康时间表。评估在基线，6周零12周。我们使用手动功能和开发的标准化测试，经过验证父母治疗保真度和与父母相关的绩效测量值的度量。干预和对评估进行协议和监控，以确保严格和可重复性。我们利用大型队列我们成功实施网络已经连接的四个中心的父母和孩子早期发现CP，在美国> 11％的地区，具有潜水员的社会经济和地理条件。我们旨在证明在苹果 - 领先组中，与两者相比，UE功能的改进要大对照组进行了前6周的干预措施。相反，我们将展示父母特定的知识 PCA优先组中的亲子情绪联系和其他两个组更大。我们将然后探索PCA的相对效率 - 然后苹果与苹果的相对效率 - 然后在婴儿的UE功能上在整个12周内，取决于权威育儿的初始水平。

项目成果

期刊论文数量（25）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

On being earnest: a mentor and her mentee's perspective.

关于真诚：导师和她的学员的观点。

DOI：
10.1038/s41390-023-02702-2
发表时间：
2023
期刊：
Pediatric research
影响因子：
3.6
作者：
Maitre,NathalieL;Kjeldsen,CaitlinP
通讯作者：
Kjeldsen,CaitlinP

Parenting style associations with sensory threshold and behaviour: a prospective cohort study in term/preterm infants.

养育方式与感觉阈值和行为的关联：足月/早产儿的前瞻性队列研究。

DOI：
10.1111/apa.14761
发表时间：
2019
期刊：
Acta paediatrica (Oslo, Norway : 1992)
影响因子：
0
作者：
Neel,MaryLauren;Slaughter,JamesC;Stark,AnnR;Maitre,NathalieL
通讯作者：
Maitre,NathalieL

Hammersmith Infant Neurological Examination Clinical Use to Recommend Therapist Assessment of Functional Hand Asymmetries.

Hammersmith 婴儿神经学检查临床用于推荐治疗师评估手部功能不对称。

DOI：
10.1097/pep.0000000000000822
发表时间：
2021-10-01
期刊：
Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association
影响因子：
0
作者：
通讯作者：

Hammersmith Infant Neurological Examination Asymmetry Score Distinguishes Hemiplegic Cerebral Palsy From Typical Development.

DOI：
10.1016/j.pediatrneurol.2018.07.002
发表时间：
2018-10
期刊：
Pediatric neurology
影响因子：
3.8
作者：
Hay K;Nelin M;Carey H;Chorna O;Moore-Clingenpeel Ma Mas M;Maitre N;NCH Early Developmental Group
通讯作者：
NCH Early Developmental Group

Feasibility of event-related potential (ERP) biomarker use to study effects of mother's voice exposure on speech sound differentiation of preterm infants.