Preschool HABIT-ILE: A randomised controlled trial to determine efficacy of intensive rehabilitation compared to usual care to improve motor skills of children, aged 2 to 5 years, with bilateral cerebral palsy.

HABIT-ILE is a motor learning approach simultaneously addressing coordination of the upper and lower limbs. Key elements of HABIT-ILE are: Dose: 30 hours of therapy achieved through a 2-week intensive group-delivered model for 3 hrs/day over 10 days in addition to a home program for generalization of learning. Home program dose will aim to achieve a further 10 hours over the two week intervention period for a total dose of preschool HABIT-ILE of 40 hours. Mode: Groups of 4-6 children (1:1 or 2:1 therapist:child ratio according to ability). Content and tailoring: The intervention will be based on the child’s motor abilities (determined at baseline), age, interests and caregiver-identified functional goals. Tasks/activities are made incrementally more challenging. Practice will be embedded in play, using part and whole task practice with high repetition including (i) table top fine motor play-based activities; (ii) activities of daily living when sitting/standing/walking; and (iii) gross motor play. Lower extremity motor abilities and postural control will be progressed from lying to sitting on the floor and then to a small bench, and transitions between floor to sitting, sitting to standing. Intervention providers: Physiotherapists and occupational therapists, who have completed standardized training and are experienced in delivering HABIT-ILE with older children. A speech pathologist will consult with the team if children have specific communication (receptive and/or expressive) or feeding difficulties. The level of intensity (e.g. low, moderate, vigorous) and how this is assessed: Low to vigorous. Will vary across the intervention session. Children will be wearing polar heart rate monitors during the intervention sessions. Strategies used to assess or monitor participant adherence to the intervention, (e.g. session attendance checklists, diary, etc) : Daily sign on/off sheets for caregivers, daily activity log detailing activities throughout course of session completed by one of treating therapists. For 30 minutes, at the conclusion of each session, the child’s treating therapists will meet individually with the child’s caregiver/s (one-on one) and discuss the daily program and make suggestions about activities that could be practised at home. These will be detailed on a written home program form and will include a home practice log completed by the caregiver. The home program activities will be reviewed daily by the child’s treating therapist in collaboration with the child’s caregiver and updated as appropriate. Parents will be able to take short videos/photos of home practice activities on their smart phone if they wish so to have a visual reminder to take home. Location: Centre for Children’s Health Research and QCH, South Brisbane. Fidelity: Standardised therapist training will be provided to therapists employed to deliver the intervention. The training package will include an intervention manual and onsite training during the first Preschool HABIT-ILE camp lead by a master trainer Location: Centre for Children’s Health Research and QCH, South Brisbane.