Feasibility of HABIT-ILE@home in children with cerebral palsy and adults with chronic stroke: A pilot study.

Abstract

Children with cerebral palsy (CP) and adults with chronic stroke (CS) usually have disabilities in voluntary motor control. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), an evidence-based therapy, has always been provided during day camps. This pilot study investigates if HABIT-ILE@home, a remote neurorehabilitation, is feasible for children with CP and adults with CS. Four children with CP (5-18y) and three adults with CS were recruited. They received 15h (5x3h) of HABIT-ILE@home provided by a caregiver with a remote supervision of 30min at the beginning and end of each session. A large touch screen, the REAtouch Lite, was used as a support for the therapy. An interview based on a questionnaire (n = 73 items for CP/ n = 74 items for stroke patients; scored from 0 "disagree" to 3 "agree", a higher rating meaning a more positive aspect of the therapy) was conducted with patients and their caregivers after 15h of supervised home-therapy to assess their adherence to the treatment and the feasibility of HABIT-ILE@home. Performance and satisfaction in achieving functional goals were assessed before and after the intervention using the Canadian Occupational Performance Measure (COPM). Caregivers felt sufficiently supported by the supervision team (medians = 3) to carry out HABIT-ILE@home sessions thanks to an adequate clinical supervision (CP median = 2.6; CS median = 2.9). HABIT-ILE principles were transferable at patients' home (CP median = 2.6; CS median = 2.8). The impact of the therapy on daily organization was more problematic for children's caregivers (median = 1.5) than for adults' caregivers (median = 3). Children with CP enjoyed the therapy (median = 2) but felt that it was too long (median = 1) and significant fatigue was present (median = 1.3). CS adults did not find the therapy fun (median = 1) but considered it as extremely useful (median = 3). Although the motivational source differed between children and adults, this did not seem to strongly affect adherence to treatment. Performance and satisfaction in achieving functional goals improved over the MCID (2 points) for all CS participants and for 3 out 4 CP children. HABIT-ILE@home seems to be feasible for children with CP and adults with CS. It may allow more patients to benefit from an efficient neurorehabilitation, whatever sanitary conditions or patients' home geographical locations.