Telehealth Program for Infants at Risk of Cerebral Palsy during the Covid-19 Pandemic: A Pre-post Feasibility Experimental Study.

Aim: To verify the effects of a telerehabilitation program for infants at high risk for Cerebral Palsy (CP) during the COVID-19 pandemic.Method: Longitudinal study. Infants were aged 3-18 months corrected age, at risk of developmental delay. The General Movement Assessment or a neurologic examination were performed to identify the risk of CP. Motor function was assessed using the Gross Motor Function Measure-88 (GMFM-88) and the Alberta Infant Motor Scale (AIMS). Caregivers of infants at high risk of CP applied a home-based program supervised by a Physical therapist, five times a week over 12 weeks. The program included guidance for optimal positioning, optimization of goal-directed activities, environmental enrichment, and educational strategies.Results: 100 infants at risk for delayed motor development were recruited. Eighteen infants were classified at high risk of CP, and 10 families completed telerehabilitation (83% final retention rate). No adverse events were reported. Adherence to the telecare program was high (90%). The costs were low. We found increased scores for all dimensions and the total score of the GMFM-88, and the AIMS percentile at the end of the intervention. Most infants presented a clinically significant change for the GMFM-88.Conclusions: The telecare program was feasible.

Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: systematic review and meta-analysis.

AIM: To compare the effects of physical therapy with hippotherapy versus physical therapy alone on the gross motor function of children and adolescents with cerebral palsy (CP). METHOD: Electronic searches were conducted in January 2021. We included controlled trials of the gross motor function of children and adolescents with CP, aged 2 to 18 years. We extracted means, standard deviations, and changes from the baseline to the end of the intervention. We used the Cochrane Collaboration's tool modified by Effective Practice and Organization of Care (EPOC) to assess the methodological quality and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to verify evidence synthesis. We conducted the meta-analysis using Revman 5.3. RESULTS: A total of 315 individuals from six studies were included. Both groups received physical therapy including strength, aerobic, stretch, and mobility exercises, and neurodevelopmental treatment. Studies presented high risk of bias. Both therapies presented similar effects for Gross Motor Function Measure scores, cadence, stride length, and speed during gait. The level of evidence was very low. The change was greater for the physical therapy with hippotherapy group, but inferior to the smallest real difference or the minimal detectable change. INTERPRETATION: Physical therapy with hippotherapy presented similar effects to physical therapy alone on the gross motor function of children and adolescents with CP. Future studies should include larger sample sizes and studies with low risk of bias.