Lessons Learnt from the REACH Rehabilitation Early for Infants at High Risk of Congenital Hemiplegia – Informing Clinical Practice and Future Research

Aims: This instructional course focuses on two early approaches to upper limb rehabilitation for infants at high risk of unilateral cerebral palsy (UCP). Workshop members have tested the efficacy of modified constraint-induced movement therapy (Baby-mCIMT) and bimanual therapy (Baby-BIM) in a large, single-blind randomised trial in Australia and USA. Objectives: Intervention aimed to improve unimanual and bimanual hand use, and commenced from 3-9 months corrected age (c.a.) up till 12-15 months c.a. It was provided as a home-based program using a coaching model with caregivers. The REACH trial included 96 infants at high risk of UCP.

Target audience: Early interventionists and researchers

Workshop outline:

· Highlight entry criteria for early upper limb rehabilitation for infants at high risk of UCP including early identification tools (General Movements Assessment, Motor Optimality Score (MOS), asymmetric brain lesions on MRI, early asymmetries (MOS, Hammersmith Infant Neurological Exam) and the Hand Assessment of Infants (HAI).

· Describe the two upper limb interventions including commencement at the correct level of ability and incrementation of the program using the HAI.

· Describe how the interventions were implemented in the home including use of a caregiver coaching model

· Provide case studies for discussion of Baby-mCIMT and Baby-BIM in infants with UCP.