HEIGHTEN Research Study

HEIGHTEN: Home-based Early Intensive Hemiparesis Therapy: Engaging Nurture.

Study Overview Therapy Overview

HEIGHTEN is not enrolling new participants.

Clinical programs based on the HEIGHTEN study remain available in Calgary and Edmonton, Alberta, Canada.

Trial registration: https://clinicaltrials.gov/ct2/show/NCT05346887

What was the study about?

The HEIGHTEN study involved home-based upper limb therapy for babies and toddlers who have a less preferred hand/arm. The child’s caregiver delivered therapy, supported by weekly visits with a therapist. These visits were in-person or virtual (video call). The study investigated whether the therapy was feasible and effective for achieving goals and improving hand/arm use.

Who was eligible to participate?

Children 3 to 24 months old (corrected, if premature).
Children with Cerebral Palsy who have a hand preference (i.e., they use one arm noticeably less often).

What was involved?

30 minutes of daily arm therapy at home for 18 weeks.
30-minute visit with a therapy team each week, either in-person or virtual (video call).
Three 2-hour assessments: before therapy, after therapy, and 8-weeks after therapy.
One 30-minute webinar about play-based therapy, before starting HEIGHTEN therapy.

What was the HEIGHTEN therapy?

The HEIGHTEN therapy aimed to increase the functional use of a child’s less preferred, or “assisting” hand and arm through repetitive, structured practice.
Research suggests that 60 hours of therapy leads to meaningful improvements. The HEIGHTEN program was 60 hours total over 18 weeks.
Caregivers delivered therapy at home for 30-minutes each day.
The 30-minute practice sessions could be divided into smaller time blocks (e.g. two 15 minutes sessions).
Practice sessions could occur during daily activities like play or meals.
Weekly visits with a therapy team aimed to support the caregiver in therapy delivery.

What happened during therapy sessions?

Children receiving HEIGHTEN therapy worked on goals identified by the therapist and caregiver(s) together. For the first 13 weeks, children wore a soft mitt on their more preferred hand during therapy. By ‘hiding away’ the preferred hand, the assisting hand was used more. This type of therapy is called Constraint-Induced Movement Therapy (CIMT). After 13 weeks of CIMT, children may have begun practicing two-handed skills. This is called Bimanual Therapy.

What were the therapy goals?

The overall therapy goal was to achieve improvements that were meaningful to the child and their family. Specific to the assisting hand and arm, therapy may have focused on:

Improving awareness of the hand and arm.
Increasing spontaneous use and amount of time the hand and arm are used.
Improving quality, strength, and/or coordination of hand and arm.
Learning new movement patterns.
Improving the use of two hands in two-handed activity.
Build parent confidence in delivering home therapy through parent education and support.

Why this therapy?

Repetitive, structured practice can help improve movement skills, and may lead to lasting changes. This is because of brain plasticity, the ability of the brain to change itself. With repetitive practice, children’s brains may change to improve movement control of the less preferred hand and arm.

Is the preferred hand damaged by being constrained?

Research has shown that constraining the preferred hand is not harmful.

Does age matter?

Hand preference before 2 years old is an early indicator that a child may need therapy. Starting therapy early may be beneficial, because children under the age of 2 years may have increased potential for brain plasticity. For this reason, HEIGHTEN therapy focused on young children. Importantly, children of all ages have the potential for brain plasticity and can improve hand and arm function.