2.3.1. Early Intensive-Upper Limb Intervention (EI-UL)
child-initiated movements
The EI-UL intervention was designed as an intensive home-based intervention with video coaching of the parents. The training consists of unimanual training (nonconstraining) stimulating child-initiated movements (like reaching, grasping, holding, and releasing) to improve contralesional upper limb ability by increasing sensory-motor experiences [The intervention consisted of eight weeks training with a frequency of seven days a week and a duration of 30 minutes each day (divided over three 10-minute sessions). Usual care (mostly paediatric physical therapy) continued during the intervention.During a home visit at the start, the occupational therapist (>10 years of experience in working with children with CP) of the Sint Maartenskliniek provided detailed oral and written instructions to parents. The paediatric physical therapist was invited to join the parent instruction. In addition, parents received a box filled with carefully selected age and ability-appropriate toys to elicit both unimanual and bimanual actions and a stand for their telephone to be able to record the training sessions.During the EI-UL intervention, the occupational therapist's role shifted from trainer to coach by means of video coaching. Parents were asked to record one of the 10-minute sessions every day and to upload this video on a secure website. An occupational therapist of the Sint Maartenskliniek provided parents with written feedback, training suggestions, and emotional support after analysing the videos. Parents received feedback on subsequent steps in motor skill development, how to match the difficulty of the task to the infants' ability level, how to keep practice fun, how to choose the right toys etc. The frequency of the video coaching differed (with a minimum of twice a week) and was led by the needs of the parents and observations of the therapist about treatment fidelity. Once a week, the primary care paediatric physical therapist (PT) visited parents to support parents at home during a training session.