Telerehabilitation during Covid-19 lockdown and gross motor function in cerebral palsy: an observational study

Background: COVID-19 (Coronavirus Disease-2019) refers to a mainly respiratory disease, caused by a new SARS-CoV-2 virus predominantly transmitted through direct or indirect contact with mucous membranes of eyes, mouth, or nose. The main control measures are physical distancing, use of specific protective devices, hand hygiene and disinfection of environments and tools. During this health emergency, telemedicine and telerehabilitation guaranteed patients to receive continuity of care through a virtual support while maintaining physical distance. Aim: The aim of this study is to evaluate the effects of telerehabilitation on gross motor skills in children with Cerebral Palsy (CP) during Covid-19 lockdown. Design: observational study. Setting: Pediatric Outpatient Neurorehabilitation Service. Population: 53 children with Cerebral Palsy aged between 6 months and 12 years classified according to the Gross Motor Function Classification System (GMFCS). Methods: variation on the Gross Motor Function Measure-66 (GMFM-66) score calculated before and after the telerehabilitation period was analyzed. Results: after telerehabilitation there was a statistically significant increase in the median value of GMFM scores both on the total sample (from 54.82% to 63.18%, p-value 0.000005) and in the subgroups. Specifically, in children classified as level I and II at the GMFCS, this value increased more after the telerehabilitation period. Only the GMFCS level V group did not show statistically significant changes and only in two cases a decrease in the GMFM score after the telerehabilitation phase occurred. Conclusions: telerehabilitation can be considered an efficient tool that can temporarily replace the in person therapy. It can allow the patient or caregiver to acquire skills in performing home exercises and to integrate and implement activity carried out at the rehabilitation center. Clinical rehabilitation impact: this study shows a positive effect of telerehabilitation on gross motor function in children with cerebral palsy.