P2A087: Baby Boot Camp - Benefits of Implementing an Interdisciplinary Intensive Therapy Program Using an Inpatient Rehabilitation model in the Acute Care Setting For infants with Heart Failure Requiring Ventricular Assist Device

Introduction: Research demonstrates increased risk for developmental delay in children with congenital heart defects as well as increased risk for developmental delay due to prolonged hospitalization. Currently, there is no ventricular assistive device (VAD) in the United States that allows infants requiring VAD support to discharge home from an acute care setting.  These patients must remain admitted until explant or transplant, further increasing their risk for poor neurodevelopmental outcomes. Given this research and the paucity of data in this population related to supporting typical motor development in an inpatient cardiac center, we created an interdisciplinary developmental intensive therapy program for infants requiring a VAD to support overall development and prevent avoidable developmental delays.

Case Description: Four patients, six months corrected age to one year old, without severe static encephalopathy or severe hypoxic ischemic injury with varying causes of heart failure resulting in EXCOR Berlin VAD implantation were enrolled. Patients received 45-60 minutes of Physical Therapy and Occupational Therapy five times per week and baseline speech therapy services.  Baseline functional level and progress was evaluated using the Peabody Developmental Motor Scale – 2 (PDMS-2). A Global Rating of Change (GROC) scale (see Image 1) was used to assess parent reported benefit of intensive therapies.  Patients received intensive therapy until they plateaued, defined by two consecutive re-evaluations without meaningful change in PDMS-2 scores.

Discussion: A multidisciplinary schedule was established for each patient around nursing care and sleep schedules.  Patients participated in daily therapy sessions in their room or therapy gym on the cardiac unit.  Specific focus was placed on mobility and strengthening in the initial weeks with progression to facilitation of gross and fine motor skills. Improvement in most subtests of the PDMS-2 was seen within two weeks and at subsequent reassessments. See Figure 1 below which demonstrates a single patient’s progress over a 4-week period.  For patients with unilateral weakness due to neurologic injury, improved strength and awareness was observed in affected limbs. Parents reported their children were performing “better” or “much better” after four weeks of participation in the program as evidenced by GROC scale scores.

Conclusion: Our case series demonstrates multiple benefits to a program that mimics inpatient rehabilitation for infants requiring VAD support including improvement in overall motor development and parent reported perception of developmental improvement.  The program had unexpected benefits for parents including a more normalized infant experience for patients and parents, improved socialization and participation in activities outside of patient rooms and reports of increased engagement and satisfaction related to patient progress for unit nursing staff. Further investigation of the benefit of more intensive speech therapy services, age of initiation, most effective frequency and duration of intensive therapies, and impact on preventing avoidable developmental delays would be beneficial.