In this study we combined non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) with 40 h of constraint induced movement therapy (CIMT) in infants. All infants completed the full intervention with no adverse events. Therapists were able to maintain high treatment fidelity and reported high ratings for ease of use and child tolerance. Preliminary results show promising gains on motor outcomes: Mean QUEST increase 19.17 (minimal clinically important difference, MCID 4.89); Mean GMFM increase 13.33 (MCID 1%–3%). Infants also exceeded expectations on Goal Attainment Scores (+1). Early data is promising that taVNS paired with intensive motor CIMT is feasible, reliable, and safe in young infants with hemiplegia, and may help harness activity-dependent plasticity to enhance functional movement.

TheraBracelet is a peripheral vibrotactile stimulation applied to affected upper extremities via a wristwatch-like wearable device during daily activities and therapy to improve upper limb function. The objective of this study was to examine the feasibility of using TheraBracelet for a child with hemiplegic cerebral palsy. Methods: A nine-year-old male with cerebral palsy was provided with TheraBracelet to use during daily activities in the home and community settings for 1.5 years while receiving standard care physical/occupational therapy. Results: The child used TheraBracelet independently and consistently, except during summer vacations and elbow-to-wrist orthotic use from growth spurt-related contracture. The use of TheraBracelet did not impede or prevent participation in daily activities. No study-related adverse events were reported by the therapist, child, or parent. Future research is warranted to investigate TheraBracelet as a propitious therapeutic device with a focus on the potential impact of use to improve the affected upper limb function in daily activities in children with hemiplegic cerebral palsy.

Introduction: Infants born premature or who suffer brain injury at birth are at increased risk for early motor delays, a frequent antecedent of cerebral palsy (CP). Early targeted rehabilitation for these high-risk infants takes advantage of critical windows for neuroplasticity to improve functional outcomes. Constraint Induced Movement Therapy (CIMT) is the gold-standard in pediatric rehabilitation. Transcutaneous auricular Vagus Nerve Stimulation (taVNS) is a form of non-invasive brain stimulation and may boost rehabilitation outcomes when paired with motor activities. Few studies have used neuromodulation combined with intensive motor therapies, such as CIMT, to enhance neuroplasticity and improve functional outcomes in infants. Methods: In a prospective, open label, IRB-approved pilot trial we combined 40 hours of CIMT with taVNS in infants 6-18mo of age with hemiplegia, after parental consent (NCT05101707). We measured improvements in hand grasp (QUEST), and attainment of therapeutic goals with the Goal attainment scales (GAS). Results: We present a case study from the first infant to undergo the combined treatment, a male born at 23-weeks gestation who suffered severe intraventricular hemorrhage resulting in global developmental delay with pronounced left-sided hemiplegia at 11-months corrected gestational age. Pediatric CIMT trained therapists manually triggered taVNS stimulation with active movement, using subthreshold taVNS without adverse events. At baseline the infant showed little spontaneous use of his left arm. Significant improvements were seen on the QUEST in dissociated movement (Δ=40.63 CIMT+taVNS vs expected Δ=5.2 with CIMT alone) and grasping ability (Δ=18.5 vs expected Δ =11.1 with CIMT alone). Goal Attainment Scaling was better-than-expected (+28.3±9.8, p<0.001). Mother reported he was consistently engaged in bimanual play at home after 4 weeks of combined taVNS-CIMT therapy. Conclusions: taVNS-paired with CIMT appears safe and may boost attaining motor goals in less time than CIMT alone in young infants with hemiplegia. Research Category and Technology and Methods Clinical Research: 12. Vagus Nerve Stimulation (VNS) Keywords: Cerebral Palsy, taVNS, CIMT, rehabilitation

ObjectiveTo assess the impact of non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) paired with oral feeding on long-term neurodevelopmental and sensory outcomes.MethodWe tested 21 of 35 children who as infants were gastrostomy tube (G-tube) candidates and participated in the novel, open-label trial of taVNS paired with oral feeding. To evaluate possible effects on development at 18-months after infant taVNS, we performed the Bayley-III (n = 10) and Sensory Profile (SP-2, n = 12) assessments before the COVID pandemic, and Cognitive Adaptive Test (CAT), Clinical Linguistics and Auditory Milestone (CLAMS), Ages and Stages Questionnaire (ASQ), and Peabody Developmental Motor Scales-2 gross motor tests as possible during and after the pandemic. We compared outcomes for infants who attained full oral feeds during taVNS (‘responders’) or received G-tubes (‘non-responders’).ResultsAt a mean of 19-months, taVNS ‘responders’ showed significantly better general sensory processing on the SP-2 than ‘non-responders’. There were no differences in other test scores, which were similar to published outcomes for infants who required G-tubes.ConclusionThis is the first report of neurodevelopmental follow-up in infants who received taVNS-paired feeding. They had similar developmental outcomes as historical control infants failing oral feeds who received G-tubes. Our data suggests that infants who attained full oral feeds had better sensory processing.

Date Presented 04/20/2023 Children with unilateral weakness may demonstrate improved functional goal achievement with less dosage requirement when constraint-induced movement therapy (CIMT) is paired with transcutaneous auricular vagus nerve stimulation (taVNS), indicating less burden to participants and encouraging translation to OT clinical practice. Primary Author and Speaker: Patricia Coker-Bolt Additional Authors and Speakers: Elizabeth Humanitzki Contributing Authors: Kelly McGloon, Julia Schoeder Brennan, Annie Cribb, Bashar W. Badran, Mark George, Dorothea Jenkins

Date Presented 03/31/2022 Infant massage is a beneficial intervention for infants with cardiac defects. No studies have explored how to promote parent engagement in infant massage with these fragile infants. The purpose of this study was to gain an understanding of parent and staff perceptions of infant massage for infants born with congenital heart defects. The results support the need for additional education about the purpose of infant massage, protocols, and how to safely deliver massage to critically ill infants. Primary Author and Speaker: Catherine Flynn Contributing Authors: Patricia Coker-Bolt, Courtney Jarrard

PURPOSE: Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique that may improve oromotor skills when paired with feeding in at-risk infants, but effects on other motor function and how motor function relates to white matter (WM) microstructure are unknown. METHODS: In this prospective study, infants failing oral feeds and slated for gastrostomy tube (G-tube) placement received taVNS paired with bottle feeding daily for 2-3 weeks. The effects of taVNS-paired feeding on general and specific head movements were investigated using the Specific Test of Early infant motor Performance (STEP) and diffusion MRI obtained before and after taVNS treatment. Scores between and within groups (taVNS responders, attained full oral feeds; non-responders, received G-tubes) were compared. RESULTS: Performance on head movement items improved significantly in responders but not in non-responders (p < 0.05). Total STEP scores were significantly higher in responders after taVNS treatment than non-responders (p = 0.04). One STEP item, rolling by arm, was associated with significantly greater change in WMtract microstructure (p < 0.05) in the responders. CONCLUSION: These results suggest that pairing feeding with taVNS may affect specific head and neck movements to a greater extent in infants who are able to attain full oral feeds.

Date Presented 04/02/2022 Early intervention (EI) programs have the potential to ameliorate long-term developmental deficits for infants born extremely premature. The purpose of this study was to determine a need to improve education between neonatal intensive care unit discharge and start of EI services for underrepresented families of extremely premature infants. Results support the need to improve participation of families in EI services. EI providers and families feel that the current EI system is having difficulty fully serving families. Primary Author and Speaker: Daijah Washington Contributing Authors: Patricia Coker-Bolt

Rehabilitation for pediatric stroke survivors can maximize a child's potential through each developmental stage of life. Timely diagnosis and referral to a rehabilitation specialist may harness opportunities to maximize brain plasticity, to help children adapt and learn, and to participate in and enjoy daily life to their capability. The aim of this focused review is to explore current rehabilitation models and evidence-based interventions for pediatric stroke survivors in Low- and Middle- Income Countries (LMICs) and to provide recommendations for future research and focused areas of improvement.There are several published pediatric stroke guidelines from the American Heart Association (AHA), Canada, Australia, and the United Kingdom (UK) which provide specific recommendations for rehabilitation, although the suggested intervention and services vary. There are no current guidelines developed in or contextually adapted for LMICs, although the current pediatric stroke guidelines emphasize the need to develop interventions that fit the cultural and environmental contexts. The World Health Organization (WHO) Rehabilitation 2030 initiative acknowledges profound unmet rehabilitation needs around the world, especially in LMICs. According to the WHO, LMICs have less than ten skilled rehabilitation professionals per one million people. Enhancing the understanding of rehabilitation services in LMICs could lead to nationally supported workforce education initiatives targeted to expand the number of locally trained therapy providers. This could improve access to and delivery of quality rehabilitation interventions to pediatric stroke survivors in these settings.

Stroke is a major problem worldwide that impacts over 100 million adults and children annually. Rehabilitation therapy is the current standard of care to restore functional impairments post-stroke, however its effects are limited and many patients suffer persisting functional impairments and life-long disability. Noninvasive Brain Stimulation (NIBS) has emerged as a potential rehabilitation treatment option in both adults and children with brain injury. In the last decade, Transcranial Magnetic Stimulation (TMS), Transcranial Direct Current Stimulation (tDCS) and Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) have been investigated to improve motor recovery in adults post-stroke. These promising adult findings using NIBS, however, have yet to be widely translated to the area of pediatrics. The limited studies exploring NIBS in children have demonstrated safety, feasibility, and utility of stimulation-augmented rehabilitation. This chapter will describe the mechanism of NIBS therapy (cortical excitability, neuroplasticity) that underlies its use in stroke and motor function and how TMS, tDCS, and taVNS are applied in adult stroke treatment paradigms. We will then discuss the current state of NIBS in early pediatric brain injury and will provide insight regarding practical considerations and future applications of NIBS in pediatrics to make this promising treatment option a viable therapy in children.

Date Presented 04/8/21 Vietnamese therapists developed constraint-induced movement therapy (CIMT) models and completed a prospective nonrandomized study at two hospitals in Vietnam. Therapists at Hanoi Rehab Hospital delivered a low-dose (30-hour) CIMT protocol, and therapists in Ho Chi Minh City Children's Hospital delivered a high-dose (72-hour) CIMT protocol. Children in both low- and high-dose CIMT groups showed improvements in everyday activities and individual therapy goals. This study advances the delivery of evidence-based practice in Vietnam. Primary Author and Speaker: Patricia Coker-Bolt Additional Authors and Speakers: Katherine Breithaupt Contributing Authors: Lauren Williams

Abstract Date Presented 04/23/21 Infants discharged with gastrostomy tubes are more likely to have lower scores in all neurodevelopment outcomes than full-feed infants. A noninvasive application of vagal nerve stimulation (VNS), transcutaneous auricular VNS (taVNS), stimulates the auricular branch of the vagal nerve. Yet, the long-term impact of the application of taVNS remains unknown. Early findings from this study reveal that taVNS could have a positive impact on children's neurodevelopmental and sensory performance observed at 18 months follow-up evaluation. Primary Author and Speaker: Turki Khaild Aljuhani

Infants born prematurely or who suffer a global hypoxic ischemic encephalopathy (HIE) are at high risk for motor problems, which manifest as feeding delays during their hospital admission. Oromotor dyscoordination is common in these infants, and feeding difficulty is the primary reason for delayed discharge [ [1] Adamkin D.H. Feeding problems in the late preterm infant. Clin Perinatol. 2006; 33 (abstract ix): 831-837 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar ]. Many infants who do not master this motor skill before term age (40–42 weeks gestation) will receive a gastrostomy tube (G-tube) for direct gastric feeding. Furthermore, feeding difficulties in infants are associated with later language delays, even in the absence of gross motor impairment [ [2] Adams-Chapman I. Bann C.M. Vaucher Y.E. Stoll B.J. Eunice Kennedy Shriver National Institute of child H and human development neonatal research N. Association between feeding difficulties and language delay in preterm infants using bayley scales of infant development-third edition. J Pediatr. 2013; 163: e1-e3 Google Scholar ].

Recent studies report that Haitian women are concerned about unmet women's health issues. The Days for Girls (DfG) International program features women's health education and personal hygiene kits to ensure women understand the process of menstruation and sanitary hygiene practices. The aim was to train Haitian seamstresses to produce the DfG kits during an in-country workshop and investigate the perceived benefit of the DfG program in young women who used the DfG kits. Posttest only design was used to measure the effectiveness of DfG workshop and postsurvey to study perception of women using DfG kits. It was found that the workshop participants demonstrated an understanding of the DfG program (90% average). Forty-four young women (89.8%) who used the DfG hygiene kits for 2 months agreed that there is a need for feminine hygiene programs in Haiti and that the kits were easy to use and clean (97.1% and 92.1%, respectively). The DfG program could provide a cost-effective feminine hygiene program for Haiti and decrease waste from traditional hygiene products.