Therapies

• The development of early and effective interventions is one of the challenges in the care of children with cerebral palsy. HABIT-ILE (Hand and Arm Bimanual Intensive Therapy Including Lower Extremity) is a new type of intensive rehabilitation involving constant stimulation of the upper and lower limbs. This method has been shown to improve upper and lower limb motor function in children over 6 years of age with unilateral and bilateral cerebral palsy.
• The main objective of the CAP’ project is to evaluate in 100 preschool children (1-4 years) the effect of two weeks of HABIT-ILE
  • on bimanual performance (Assisting Hand Assessement AHA and mini AHA) in 50 children with unilateral cerebral palsy (randomized controlled trial 1) and
  • on gross motor function (Gross Motor Function Measurement) in 50 children with bilateral cerebral palsy (randomized controlled trial 2), compared with two weeks of usual motor activity (control group).

• Children with unilateral or bilateral cerebral palsy, aged 1 to 4 inclusive, who are able to follow instructions and complete age-appropriate tests may be included in the study.

• This project began in early 2019 with internships for children with unilateral CP in Brussels and Brest. A first course for children with bilateral CP also took place in Brussels in March 2020. Due to the outbreak of COVID 19, some courses had to be cancelled and will take place as soon as possible. This project will continue until 2022.
• For further information, visit the Cerebral Palsy Foundation website.

Partners : CHRU de Brest (coordonnateur), Fondation Paralysie Cérébrale, Université Catholique de Louvain, Université de Pise, Hôpital universitaire de Genève (Suisse), Hôpital universitaire de Lausanne (Suisse), CHRU d’Angers, Université des Iles Baléares (Espagne)

Cerebral Palsy (CP) affects movement and posture in developing children. Intensive rehabilitation courses, such as HABIT-ILE, are recommended to improve motor skills and independence. However, families find it difficult to maintain their child’s progress at home. Involving families more in the therapy could help in this respect. A pilot study showed that a PARTNER program, combining the principles of HABIT-ILE therapy with home-based strategies to improve family well-being and child autonomy, could be effective. The multi-center PARTNERSHIP study will compare the PARTNER course with HABIT-ILE therapy to assess its effectiveness and impact on 66 children and their families. The hypothesis is that the PARTNER program will be as effective as usual therapy in improving motor skills in children with CP, but will also improve feelings of competence, adaptation and the relationship between the child and his or her family. The aim is to identify an effective and sustainable approach to help children with CP develop motor skills and independence in daily life. Funding: PHRIP

Partenaires: Fondation Ildys, UBO, IMT Atlantique, CHU Brest, FEHAP, Les capucins
Angers, HCL de Lyons (Service de l’escale)

• The Dis-Handi project was set up to encourage the various professionals working with children with motor disabilities to think about the pain and discomfort caused by everyday activities (hygiene, feeding, mobilization, rehabilitation, nursing, etc.) carried out in health establishments (follow-up care services) or medical-social establishments (IME, IEM).
• The study was carried out in 16 pediatric establishments throughout Brittany, involving 280 children with motor disabilities.
• By scientifically studying the pain induced over a week of care, this study helps to answer the following questions: What daily gestures performed by caregivers in facilities for children with motor disabilities are painful or uncomfortable? How often? What are the profiles of children at risk of induced pain? And which care professionals are most at risk of inducing pain (nurses, physiotherapists, doctors, etc.)?

A similar study was carried out on a population of adults with motor disabilities.

POPBtox “Efficacy and safety of early intramuscular botulinum toxin injections in the prevention of shoulder deformity in infants with obstetric brachial plexus palsy: a multicenter, randomized, double-blind controlled trial” This randomized controlled trial aims to evaluate the efficacy of botulinum toxin injections in the
botulinum toxin injections into the shoulder internal rotator muscles at 12 months of age in preventing worsening of posterior glenohumeral joint subluxation in infants between 11 and 18 months of age, compared with the Sham group. The secondary objectives were to evaluate the efficacy of botulinum toxin injections i/ in preventing worsening of glenoid retroversion, as well as in preventing three-dimensional deformity ii/ in improving active and active joint active and passive joint amplitudes and improved function.
Children are currently being enrolled.

Partners : CH St Maurice, le CHU Nîmes Montpellier, CHU de Rennes, CHU St Etienne, ESEAN.
Funder : DGOS (Call to projet PHRC).

Cognitive disorders are common in childhood neurological pathologies, and require long-term rehabilitation. The child’s motivation is an important factor to take into account, and may diminish over the course of the treatment as a result of repetitive exercises. Fun is important to keep them interested, and board games, with their playful side, are an ideal tool.
This project was set up to provide a fun way of working on cognitive functions. In partnership with the SSR pédiatrique des hôpitaux de Saint-Maurice, the SSR pédiatrique de Kerpape and the SSR pédiatrique de Ty Yann, 30 game cards were created to propose a list of fun games used in the different rehabilitation centers. These cards present the cognitive functions worked on by these different games, and are used by families and rehabilitation professionals.

Project led by Gwenael Gueret (CHRU Brest)

Partners : Centre mutualiste de Kerpape, Hôpitaux de Saint-Maurice

• No pain no gain is a study designed to assess how children perceive their physiotherapy treatment. The study shows that many children regularly experience pain during their physiotherapy sessions, and can attribute this to the effectiveness of the therapy. Distraction and the bond of trust forged between child and therapist appear to be key elements in reducing this sensation of pain. The child’s participation and enjoyment of the sessions should be at the heart of rehabilitation sessions, to limit negative feelings and encourage the child’s involvement. To find out more

Partners : CHRU de Brest , Fondation Ildys, Centre de Kerpape, Université Bretagne Occidentale, Fondation de France, Fondation Paralysie Cérébrale, Fondation APICIL