HEIGHTEN Research Study
HEIGHTEN: Home-based Early Intensive Hemiparesis Therapy: Engaging Nurture.
HEIGHTEN Research Study
HEIGHTEN is a research study that happened in two Canadian cities: Calgary and Edmonton, Alberta.
https://clinicaltrials.gov/ct2/show/NCT05346887
HEIGHTEN is not enrolling new participants. Clinical programs based on HEIGHTEN remain available in Calgary and Edmonton, Alberta.
Study Overview
What is the study about?
The HEIGHTEN study involves home-based upper limb therapy for babies and toddlers who have a less preferred hand/arm. The child’s caregiver delivers therapy, supported by weekly visits with a therapist. These visits may be in-person or virtual (video call). The study will investigate whether the therapy is feasible and effective for achieving goals and improving hand/arm use.
Who can 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’s 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 are the potential benefits?
- Your child may have noticeable improvements in arm and hand function.
- You will learn how to help your child use the less preferred hand.
- This study will help the researchers learn more about hand/arm therapy for infants and toddlers to help treat children in the future.
- Participants will receive a small token of appreciation to thank them for their time.
- We will reimburse parking or transit fare costs.
What are the potential risks?
- Your child may be frustrated sometimes when playing with the less preferred hand.
Therapy Overview
What is the HEIGHTEN therapy?
- The HEIGHTEN therapy aims 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 is 60 hours total over 18 weeks.
- Caregivers deliver therapy at home for 30-minutes each day.
- The 30-minute practice sessions may be divided into smaller time blocks (e.g. two 15 minutes sessions).
- Practice sessions can occur during daily activities like play or meals.
- Weekly visits with a therapy team will support the caregiver in therapy delivery.
What happens during therapy sessions?
Children receiving HEIGHTEN therapy work on goals identified by the therapist and caregiver(s) together. For the first 13 weeks, children wear a soft mitt on their more preferred hand during therapy. By ‘hiding away’ the preferred hand, the assisting hand is used more. This type of therapy is called Constraint-Induced Movement Therapy (CIMT). After 13 weeks of CIMT, children may begin practicing two-handed skills. This is called Bimanual Therapy.
What are the therapy goals?
The overall therapy goal is to achieve improvements that are meaningful to the child and their family. Specific to the assisting hand and arm, therapy may focus 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.
Will the preferred hand be 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 focuses on young children. Importantly, children of all ages have the potential for brain plasticity and can improve hand and arm function.
