| dc.description.abstract | The most common type of cerebral palsy (CP) is spastic CP, representing around 82% of all CP types. Individuals with spastic CP usually receive intensive physical therapy during childhood years to improve gross motor function. They, however, often encounter complications during adolescence, including a decline in gross motor function, physical inactivity, impaired balance and walking, and poor quality of life. In recent years, telehealth systems in home exercise program have been widely used in patients with various neurological diseases. However, past studies showed mixed results about the effectiveness of telehealth home exercise program (HEP) for adolescents with CP, where most past studies lacked the individualization in training modules to target the individual patient's specific goals.Furthermore, past studies utilized asynchronous telehealth technologies (videos, photos) with very limited interaction between therapist and participants. An individualized HEP along with the use of real-time tele-coaching (i.e., synchronous telehealth) may result in better outcomes of the HEP than traditional HEP. The tele-coaching can provide the continued monitoring and instant feedback on the exercise performance. Benefits of tele-coaching have been established in HEP for adolescents and adults with various disabilities, including improved adherence to HEP and better functional performance. Past studies have not examined the impact of tele-coaching in HEP among individuals with CP. Thus, this dissertation project evaluated the feasibility and trend of functional outcomes after a telehealth HEP, with or without online tele-coaching, for adolescents with spastic CP. In chapter one, we described the definition, classification, primary and secondary complications of the condition of CP, focusing on the decline in motor function and physical activity. We further summarized health-related issues in individuals with CP during adolescence age. We then introduced the current evidence on the adherence of adolescents to therapeutic interventions and the barriers that impact adherence and compliance. We reviewed home exercise programs (HEP) for adolescents with CP in general, and specifically the HEP that utilized telerehabilitation technologies. Finally, we explained the significance of this dissertation project and listed specific aims and hypotheses. This study is a pilot randomized controlled trial and participants were randomized into either tele-coaching experimental group or without tele-coaching control group. The specific aims of the study are listed in the following. Aim 1: To examine the feasibility of an 8-week telehealth HEP for adolescents with spastic CP, with or without tele-coaching. Aim 2: To evaluate the trend of change after the 8-week telehealth HEP to achieve individualized goals by adolescents with spastic CP, with or without tele-coaching. Aim 3: To evaluate the trend of change after 8-week telehealth HEP in physical activity level, physical activity enjoyment, and quality of life in adolescents with spastic CP, with or without tele-coaching. Exploratory aim: To explore the effectiveness of the prescribed telehealth HEP in adolescents with spastic cerebral, with or without tele-coaching, in the improvement of the performance of the prescribed exercise. In chapter two, we reported results of our pilot randomized clinical trial on the feasibility including adherence rate of an 8-week HEP using telerehabilitation technology to deliver an individualized HEP with or without tele-coaching in adolescents with Spastic CP. In this pilot trial, twenty participants with Gross Motor Function Classification System (GMFCS) I-III spastic CP were recruited and randomly allocated to an experimental group or a control group. The experimental group received 8 weeks of individualized HEP with 30-60 minutes per exercise session, three sessions each week. The last exercise session within each week was a tele-coaching exercise session directed by a physical therapist. The control group received the same 8 weeks of individualized HEP without tele-coaching. The experimental group showed significantly higher adherence rates of completed sessions, completed exercises, and completed repetitions compared to the control group. The experimental group also showed a significantly higher acceptance rate for the exercise program and use of Physitrack compared to the control group. Our results suggest the use of telerehabilitation to prescribe HEP with an addition of tele-coaching for adolescents with spastic CP could further improve adherence rates. In chapter 3, we reported the results of our pilot trial about occupational performance and satisfaction measured by Canadian Occupational Performance Measure (COPM) and quality of exercise performance measured by Correctness of Exercise Performance (COEP). The experimental group showed significantly higher mean-differences in Performance score and Satisfaction score compared to the control group. Furthermore, the experimental group showed a significantly higher percentage of exercise completed correctly measured by COEP at the 4th week and at the end of 8-week compared to the control group. Our findings suggest that the individualized home exercise program with tele-coaching could result in further improvement in reaching the individualized goals and in the quality of exercise performance in adolescents with spastic CP. In chapter 4, we reported the results of our pilot trial in physical activity level, physical activity enjoyment, and quality of life. The experimental group showed significantly higher mean-differences in physical activity level measured by Physical Activity Questionnaire (PAQ-A), and in quality of life measured by CP-Quality of life Questionnaire (CP-QOL) compared to the control group. Our findings suggest that an individualized goal-directed home exercise program with tele-coaching could result in better improvement in physical activity level and quality of life in adolescents with spastic CP. In Chapter 5, we summarized our findings and provided our suggestions for future directions of research in the same area. | |
