ABSTRACT
Purpose: To evaluate the effect of tele-rehabilitation on balance and coordination training in cerebral palsy children. Relevance: COVID-19 pandemic had significant impact on children with disability due to prolonged confinement at home which influenced negative physical status of children. Tele-rehabilitation can play a major role in the maintenance of function, prevention of worsening disability, and follow up of patient. It can proves beneficial to the family by decreasing time and costs related to travelling, family centered service, home based model of delivery of care which leads to being less prone to infection. Participants: 9 Children with cerebral palsy in the age group of 6–12 years with GMFCS level I and II were recruited from the paediatric out-patient department and child developmental centre of a tertiary care hospital and special schools in Belagavi. Methods: In this pre-post pilot study, pre-treatment and post-treatment outcomes were taken by using balance and bilateral coordination subtest of Bruininks Oseretsky Test of motor proficiency 2 (BOT2). The physiotherapy treatment consisted of conventional balance training exercise via tele-rehabilitation through Whats App video call. The intervention was carried out thrice a week for 4 weeks for one hour which was monitored by the therapist and assistance was provided by the parent. Statistical Analysis: The data was analysed using paired t test. Results: The results indicated a significant improvement in balance (P =0.042) with mean difference-4.25 ± 3.20 and coordination with mean difference-4.25 ± 1.50 (P=0.011). Conclusion: This study showed that tele-rehabilitation as a mode of treatment for children with cerebral palsy is useful for training balance and coordination. Implications: Tele-rehabilitation can be considered as an effective mode of delivering rehabilitation for children with cerebral palsy and that the effect must be studied in a larger sample size.
ABSTRACT
Integrating an early childhood development (ECD) intervention within routine healthcare visits offers an important opportunity for a population-level approach to support ECD in low- and middle-income countries (LMICs) where 250 million children under the age of 5 years fail to reach their full developmental potential. This paper reports on the feasibility of integrating an adapted healthcare-based ECD intervention (Sit Down and Play) in primary health centers (PHCs) serving low-income rural communities in Karnataka, India, and its potential to support research-informed components needed to improve ECD (e.g., opportunities for learning). Using a prospective cluster nonrandomized pilot and feasibility trial, caregivers with infants 6-10 weeks of age were recruited from 2 PHCs: one which delivered the intervention at two subsequent immunization visits (n = 25) and the other as care as usual (n = 28). Feasibility was assessed using the following indicators: implementation, practicality, acceptability, demand, and limited efficacy. Quality of home stimulation and opportunities for learning were explored with key items from the UNICEF Multiple Cluster Index Surveys with generalized estimating equation models. While outcome measures were to be obtained from all participants 3-month post-enrollment, due to COVID19 restrictions, there was variability in timing of follow-up interviews; however, outcome data from all participants were obtained and no significant group differences existed in contact time. Results suggest the feasibility of delivery of SDP during routine immunization visits, high satisfaction with adapted content, and utility of developed training and fidelity measures. Though not powered for hypothesis testing, our exploratory analyses reveal the intervention group demonstrated greater improvements on quality of home stimulation over time than the control group. CONCLUSION: Our findings suggest integrating an ECD intervention with routine healthcare visits is a feasible and promising strategy for supporting ECD in India. Further studies are needed to determine the effectiveness of SDP on children's development. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04167254. WHAT IS KNOWN: ⢠Interventions are increasingly being developed to target responsive caregiving and opportunities for learning because of their potential to support early childhood development (ECD) in low- and middle-income countries where 250 million children under the age of 5 years fail to reach their full developmental potential. ⢠A critical issue in ECD intervention research is the gap between what is known to be effective treatment to protect healthy brain development and what is provided to millions of caregivers during routine care who live in low-income communities. WHAT IS NEW: ⢠We adapted a brief, ECD intervention for use with routine healthcare visits in India as a population-level strategy to support ECD in LMICs. ⢠Our results demonstrate feasibility, acceptability, and improvements in key parenting behaviors that promote ECD.