Baby LE-CIMT (Baby Lower Extremity Constraint Induced Movement Therapy): a feasibility study in infants and toddlers with unilateral cerebral palsy

Those participants allocated to the intervention arm of the study will receive 12 weeks of Baby LE-CIMT (Lower Extremity-Baby Constraint Induced Movement Therapy) with 4 distinct elements. 1. Task Specific, goal directed intervention Baby LE-CIMT is constraint therapy intervention applied to the lower extremity. In order to promote the use of the affected lower extremity; a chosen constraint will be applied to the non-affected limb in children with unilateral or at ‘high risk’ of developing unilateral cerebral palsy. The constraint and the activity chosen will be dependent on the family's chosen participation goals and the child's impairment and neurological insult aetiology. For instance if the child's goal was to walk independently with a trolley for a distance of 5 metres indoors, this may include the use of a leg wrap on their affected limb whilst walking with a trolley indoors. Dosage Those allocated to the intervention arm will receive Baby LE-CIMT via weekly 1 hour home visits in addition to standard care by their relevant therapy team; this will include coaching by the study therapist within this time. In addition to the weekly home visits they will be advised to perform a minimum of 30 mins of home practice on a further 5 days of the week. The total dosage over the intervention period will therefore be a minimum of 42 hours (this includes 12 x 1 hour home visit sessions + 5 days per week of 30 minute sessions x 12 weeks). 2. Task Specific Training in Meaningful environmental contexts Baby LE-CIMT will be provided within the child's own home and community setting. The study physiotherapist will empower the child's family members to create a supportive physical environment to implement each task-specific activity with age and developmentally appropriate toys and equipment 3. Shaping and Coaching The study therapist will empower the family's knowledge and skill in performing Baby LE-CIMT with their child. As the week progresses and the parent's skill and understanding enhances; the parent should be increasingly encouraged to develop the next activity progressions with prompting from motivational interviewing techniques from the therapist. Shaping strategies to enable generalisation and transfer to every day play situations will also be used. 4. Collaborative generation of a home exercise program A set of 2-3 activities to focus on that relate back to the caregiver's goals will be established each week between the study therapist and the caregiver. Videos of the exercises each week will be uploaded into an application program that can be accessed via a smart phone or a web browser. In order to monitor adherence to the intervention, caregivers will then be able to tick the exercises that have been completed daily and include duration and any comments that they have. Caregivers are also encouraged to complete a log of weekly physical activities in addition to the prescribed intervention. This weekly activity log will be completed by children in the standard care and intervention arm.