Feasibility trial of an early therapy in perinatal stroke (eTIPS)

Basu, Anna Purna, Pearse, Janice, Watson, Rose, Dulson, Pat, Baggaley, Jessica, Wright, Blythe, Howel, Denise, Vale, Luke, Mitra, Dipayan, Embleton, Nick and Rapley, Tim (2018) Feasibility trial of an early therapy in perinatal stroke (eTIPS). BMC Neurology, 18 (1). ISSN 1471-2377

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Background: Perinatal stroke (PS) affects up to 1/2300 infants and frequently leads to unilateral cerebral palsy (UCP). Preterm-born infants affected by unilateral haemorrhagic parenchymal infarction (HPI) are also at risk of UCP. To date no standardised early therapy approach exists, yet early intervention could be highly effective, by positively influencing processes of activity-dependent plasticity within the developing nervous system including the corticospinal tract. Our aim was to test feasibility and acceptability of an "early Therapy In Perinatal Stroke" (eTIPS) intervention, aiming ultimately to improve motor outcome. Methods: Design: Feasibility trial, North-East England, August 2015-September 2017. Participants were infants with PS or HPI, their carers and therapists. The intervention consisted of a parent-delivered lateralised therapy approach starting from term equivalent age and continuing until 6 months corrected age. The outcome measures were feasibility (recruitment and retention rates) and acceptability of the intervention (parental questionnaires including the Warwick-Edinburgh Mental Wellbeing Scale (WEBWMS), qualitative observations and in-depth interviews with parents and therapists). We also reviewed clinical imaging data and undertook assessments of motor function, including the Hand Assessment for Infants (HAI). Assessments were also piloted in typically developing (TD) infants, to provide further information on their ease of use and acceptability. Results: Over a period of 18 months we screened 20 infants referred as PS/HPI: 14 met the inclusion criteria and 13 took part. At 6 months, 11 (85%) of those enrolled had completed the final assessment. Parents valued the intervention and found it acceptable and workable. There were no adverse events related to the intervention. We recruited 14 TD infants, one of whom died prior to undertaking any assessments and one of whom was subsequently found to have a condition affecting neurodevelopmental progress: thus, data for 12 TD infants was analysed to 6 months. The HAI was well tolerated by infants and highly valued by parents. Completion rates for the WEBWMS were high and did not suggest any adverse effect of engagement in eTIPS on parental mental wellbeing. Conclusion: The eTIPS intervention was feasible to deliver and acceptable to families. We plan to investigate efficacy in a multicentre randomised controlled trial.

Item Type: Article
Uncontrolled Keywords: Early intervention, Feasibility trial, Haemorrhagic parenchymal infarction, Hand function, Infant, Parent-delivered therapy, Perinatal stroke, Therapy
Subjects: A300 Clinical Medicine
A900 Others in Medicine and Dentistry
B100 Anatomy, Physiology and Pathology
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Sport, Exercise and Rehabilitation
Depositing User: Rachel Branson
Date Deposited: 18 May 2021 14:16
Last Modified: 31 Jul 2021 16:18
URI: http://nrl.northumbria.ac.uk/id/eprint/46202

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