Intervention and neurodevelopment

Cerebral palsy is a disorder caused by early brain lesion. It influence the children life to different extent.

The main focus for the research is to get increased knowledge of how development and intervention may influence this children life.The research group has a broad and multidisciplinary approach related to Neuropediatric Clinic at Astrid Lindgren Children's Hospital, Handikapp and Habilitering, Department of Neuroscience and Stockholm Brain Institute. The overall strategy is to make a bridge between different disciplines of knowledge.

Aims of the research

To develop methods for the treatment of children with cerebral palsy based on motor control and principles of motor learning. To further stress the question how children with cerebral palsy learn new skills.
To develop assessment tools for measuring the effects of treatment and with which to follow the course of the children's development.
To explore the relation between the development of functional ability, brain lesion and reorganization.
To describe factors influencing the children's ability in daily life: vision, hand functioning and cognition.
To use the knowledge gained from our erarlier research to support the development of research in developing countries.

Research projects

CI-terapi

Constraint Induced Movement therapy – an intervention for children with unilateral CP

Constraint Induced Movement therapy (CI-therapy) has been evaluated in several research project both in our research group and in other international studies. There are two important principles for the treatment, it is restricted use of the non-involved hand and intensive training during a certain time period. Today, CI-therapy is one of the few evidenced based treatment methods for increased hand function in children with unilateral CP. There is still remaining research questions, like; to what extent is the effect long lasting and to what extent needs it to be repeated. We are also interested in which children do benefit the most of therapy and what factors are crucial for its effectiveness. An additional important aspects is the implementation of CI-therapy in clinical practice in collaboration with Habilitering och hälsa. One of this activities is to develop a method book, helping occupational therapist to start to use the training, so far only in Swedish, likewise there is a small book for the children, a ferry tail as can be used to explain the reason for intervention for the child and their friends.

Responsible investigator: Professor Ann-Christin Eliasson

Hand function in Infants

Early intervention – How does the children’s hand function develops during the first year of life when there is a risk of developing unilateral CP?

We have been able to show that it is possible to improve hand function from two years of age in our earlier CI-therapy studies. We are now interested to investigate whether even earlier intervention is more efficient. We will start this new project from about 4 month of age, as soon there is any sign of asymmetric hand function. It is known that the plasticity of the brain is age dependent and therefore we have developed an early intervention program, baby-CIMT (constraint-induced movement therapy). The data is collected with our newly developed assessment, Hand Assessment for Infants (HAI). The babies at risk can be infants, born prematurely with unilateral brain lesion, neonatal stroke or children demonstrating asymmetric hand function of unknown reason. In an ongoing randomized controlled trial, the effect of baby-CIMT is compared to a baby-massage. We are also following the infants in a longitudinal study during the first year of life and the impact of different types of brain lesion. By using HAI, it will be possibilities for early detection of asymmetries and this increase the possibilities for an early diagnosis unilateral CP. For more information about HAI see Lena Krumlinde-Sundholm.

Below is also a manual, to be done downloaded for free. It include some background information and worksheets.

Trial Registration: SFO-V4072/2012, 05/22/2013

Responsible investigator: Professor Ann-Christin Eliasson
PhD student: Linda Ek occupational therapists
Collaborators: Associated professor Lena Krumlinde-Sundholm, Associated professor Kristina Tedroff, dr Linda Nordstrand and occupational therapist Lena Sjöstrand.
International collaboration: Professor Giovani Cioni, Pisa University, Italy.

Small step

A Small-step program for development of new treatment principles for children with cerebral palsy and other neurodevelopmental disorders

Preterm children or children as otherwise are at risk of developing functional limitations need support and intervention. There are however few studies demonstrating long lasting result of early interventions. In this randomized controlled study, we will include children as shows symptom as are expected to lead to cerebral palsy. This children will be randomized to a 30 week intervention home program including three parts, gross motor function, hand use and communication or usual care at the hospital and habilitation services. The children will be follow up until 2 years of age. The project started 2014.

Responsible investigator: Professor Ann-Christin Eliasson
PhD student: Research assistant Catarina Furmark
Collaborators: Kristina Löwing, PhD; Linda Holmström, PhD; Ann-Louise Weiland, physiotherapist; Lena Sjöstrand, occupational therapist; Lena Lindberger, speech and language therapist; Päivikki Aarne, speech and language therapist and PhD student.

Longitudinal development of hand function

We have a long time follow-up program of hand function for children with unilateral CP. This project started 2000. The program includes children from 3 month to 18 year. The assessment is Assisting Hand Assessment from 18 month of age and HAI for the younger children. For AHA, the children are assessed 1-2 times a year and for the younger ones, at least 3 times before 12 month of age. We have about 150 older children and some less for the younger once. The first publication was 2010 and describe the development up to 7 year of age and we have ongoing study on older as well as younger children. We have been able to show different development depending on severity. In general, the development is faster at younger age, however even children with severe impairment demonstrate development of using the hand. The question is was happens over age. This longitudinal project will continuously give us good possibilities to investigate how other factors, such as brain lesion and treatment influence the development. Both aspects are published in recent articles.

Responsible investigator: Linda Nordstrand , occupational therapist
PhD student: Linda Ek, occupational therapists
Collaborators: Marie Holmefur, PhD, Örebro University; Professor Ann-Christin Eliasson

MACS and Mini-MACS

Manual Ability Classification System (MACS) is a classification of hand function for children 4-18 year. MACS classify how children use their hands in daily life. This classification is developed in our research group and there is several publications supporting its validity, reliability and stability. MACS is translated to 25 language and internationally well recognized. To facilitate the implementation, it is free to use on the internet together with a flow chart. There is also an instructional video to be purchased. For the movement, there is a Mini-MACS version during development for children up to 4 years of age. Studies investigating the psychometric properties is ongoing.

Responsible investigator: Professor Ann-Christin Eliasson
Collaborators: Associated Professor Lena Krumlinde-Sundholm; Ann-Marie Öhrwall, PhD; Britt-Marie Zethraeus, MsSc; Anna Ullenhag Med dr.
Other collaborators: Ulla Walhström, MsSc, Östergötlands habilitering
International collaborators: Peter Rosenbaum Mc Master University, Canada

Find more information about MACS here

CHEQ

Children’s experience of using the hand in bimanual activities

Experience Hand Use Experience Questioner (CHEQ), is a questioner for children with unilateral functional limitation in the age of 6-18 years. The questioner is developed in our research group and is continuously investigated for increased validity and reliability. A version for younger children are during development

Responsible investigator: Professor Ann-Christin Eliasson
PhD student: Ahmed Amer.
Collaborators: Associated professor Liselott Hermansson, Örebro University and Marie Peny-Dahlstrand, PhD, Göteborgs University
Collaborator: Ulrike Ryll, MsSc

Prediction and early diagnosis of Cerebral palsy

Infants with risk of cerebral palsy commonly do not get the diagnosis until the second year of life or even later. Recent possibilities of early intervention and the recent developed assessments HAI (Hand Assessments for Infants) in our research group will make it possible to identify and treat infants with unilateral CP from 3 month of age. By the HAI, there will also be possibilities to learn more about early development in infants with high risk of cerebral palsy.

We have several ongoing studies where we investigate how HAI and other patient information will contribute to prediction of unilateral cerebral palsy during their first year of life. We have also collected longitudinal data of infants and will be able to describe this development for the first time.

Responsible investigator: Senior professor Ann-Christin Eliasson
PhD student: Ulrike Ryll
Collaborators: Leanne Sakzewski, University of Queensland. Brisbane, Linda de Vries, Wilhelmina Children’s Hospital of the University Medical Center in Utrecht (UMCU), the Netherlands och Giovani Cioni, IRCCS Fondazione Stella Maris, Pisa, Italy.

Interactive Internet based CIMT

In previous study investigating the effect of Baby-CIMT, it was possible to show the early intervention have good effect on hand function. The tested model require several home visits. We are now going to investigate whether an interactive internet model will give similar effect. The new model is based on both personal and interactive video meetings. It will be based on a patient secure platform, 1177. The result will be compared to previous study and we will also make a cost effective analysis

Responsible investigator: Senior professor Ann-Christin Eliasson
PhD student: Katarina Svensson, Linköpings universitet
Collaborators: Habilitering och Hälsa, Stockholm; Helen Sundelin Linköpings universitet