Improving quality of life for children with cerebral palsy in Vietnam: implementation of intensive models of rehabilitation

Cerebral palsy (CP) is a major cause of childhood disability globally. While there is no cure for CP, treatment can greatly improve the lives of those who are impacted. In Vietnam, it is estimated that 500,000 people live with CP. The proportion of children with CP who receive rehabilitation services in Vietnam is estimated at 30 to 74 percent, and the identification of new rehabilitation models for CP is a major public health priority for the Vietnamese Ministry of Health.

While constraint-induced movement therapy (CIMT) is one of the most effective rehabilitation approaches for children with hemiplegic CP, it is not an approach currently used in Vietnam. This therapy helps children develop motor skills by constraining the dominant side hand and arm while using high repetition arm and hand movements to train the weaker side. This type of high intensity, focused intervention increases the child’s comfort while participating in therapy, and helps improve motor responses on the weaker side.

Patty Coker-Bolt, Ph.D., OTR/L, Professor of occupational therapy in the College of Health Professions at the Medical University of South Carolina, helped pioneer the use of CIMT as a treatment for children with CP. Last year, she traveled to Vietnam frequently, where she worked with in-country collaborators to develop new guidelines for the rehabilitation of children in Vietnam with CP, and to educate therapists on evidence-based rehabilitation techniques. Subsequently, Vietnamese medical professionals developed two models of pediatric CIMT which have the potential to fit into the local healthcare environment.

This pilot study will allow Coker-Bolt to evaluate the use of newly validated assessment measures which have been translated into Vietnamese, and to determine the feasibility of delivering two different, high intensity Vietnamese CIMT models. Both protocols meet the dosage recommendations for pediatric CIMT, requiring between four to six weeks of extensive training with high intensity bursts of therapy.

Therapists from two hospital systems in Vietnam, Ha Noi Rehabilitation Hospital and Ho Chi Minh City Children’s Hospital, will participate in the study. The team will enroll 20 children, between the ages of three to twelve, with hemiplegic CP who will receive one of the therapy models. Currently, therapists in Vietnam use only goal setting to measure outcomes, but in this study, therapists will use pre-and post-assessment to determine effectiveness of therapy services. A fidelity measure will be used to monitor therapists’ compliance with implementing the CIMT protocol, and to assure therapists can reliably use assessment measures.

Data from this pilot has the potential to change the way Vietnamese therapists measure outcomes of rehabilitation services for children with CP by validating newly translated assessments and ensuring the accurate use of these measures.
“I hope I will be able to help change the idea of what cerebral palsy is in Vietnam and that this type of therapy can make a difference for children and families” said Coker-Bolt. “My passion is to be able to show therapists that children with cerebral palsy are capable of improving with this type of therapy”.

This study will be instrumental in helping design future studies among the outcomes of rehabilitation for children with CP and create strategies to significantly improve evidence-based pediatric rehabilitation practices in Vietnam.