Intervention
Each child in the intervention group is provided with 6 months of parent-led, home and play-based activity plans that follow a standardized format and are individualized to each child’s age and previous visit assessments. The in-hospital intervention begins once the child returns to the regular hospital ward from the ICU, where the kinesiologist provides daily play activities that are focused on maintaining or regaining range of motion (upper and lower limbs) and supporting midline crossing (e.g., hand clapping, reaching for toys). The kinesiologist collaborates with parents to ensure accurate performance and implementation of the in-hospital program. From discharge to week 7, lower body mobility activities are combined with the in-hospital activities, since upper body weight bearing and lifting activities are restricted for children undergoing surgical treatment until the week 7 evaluation (for sternal healing). The kinesiologist contacts parents weekly to provide support, adjust the child’s physical activity, and assess adherence.If physical activity is unrestricted after the week 7 assessment, progressively more difficult, individualized, parent-led, home and play-based activity plans (see 