# APPLES: Early Childhood Constraint Therapy for Sensory/Motor Impairment in Cerebral Palsy

> **NIH NIH R01** · EMORY UNIVERSITY · 2022 · $648,219

## Abstract

PROJECT SUMMARY/ABSTRACT
Long-term goals of this application are to develop safe, effective, and scalable interventions with a strong
basis in neuroscience, to improve the upper extremity (UE) function of children with cerebral palsy (CP). Our
UE intervention called “APPLES” is parent-administered, medical team-directed, uses soft constraint and
“sticky-mittens” and bimanual therapy. Our first R01 showed that it effectively improved UE function, cortical
somatosensory processing, and reach smoothness, while being safe for the developing brain and body in
infants (6-24 months) with CP. Our competing renewal addresses remaining gaps in knowledge: is there an
earliest age at which APPLES is most effective, can APPLES be successfully delivered through telehealth,
and because parents are delivering APPLES, are there evidence-based supports that we can offer them to
be more effective, and do all parents need these supports equally. We also specifically address new
NCMRR priorities for: (1) “multimodal approaches that promote plasticity and sensorimotor function”, (2)
“patient-reported outcomes as ... secondary endpoints in trials”, and (3) “development of scalable
strategies”. We call our new intervention APPLES-tele, as it will be delivered through telehealth and start in
infants as young as 3 months. In addition, we test the relative efficacy of APPLES-tele vs. standard care
group and vs. a novel parent-centered approach (PCA) that is infant- and CP-specific. PCA consists of
education in infant motor learning, adaptive strategies for CP, and positive psychology in parenting (from the
scientifically-proven Triple P Positive Parenting Program model). PCA will help parents develop
“authoritative parenting”, an optimal parenting style proven to promote better long-term developmental
outcomes. The design is a randomized controlled trial with both business-as-usual and active treatment
comparisons; two groups receive PCA and APPLES-tele, but in different order. The other receives standard
care. Both 6- week interventions will have the same weekly-telehealth schedule. Assessments are at
baseline, at 6- weeks and 12 weeks. We use standardized tests of hand function and development, validated
measures of parent-treatment fidelity, and parent-relevant measures of performance. Interventions and
assessments are protocolized and monitored to ensure rigor and reproducibility. We leverage a large cohort
of parents and children across 4 centers already linked through our successful implementation network for
early detection of CP, with diverse socioeconomic and geographic conditions in an area > 11% of the US.
We aim to demonstrate improvements in UE function are greater in the APPLES-tele-first group than in both
control groups after the first 6-weeks of intervention. Conversely, we will show parent CP-specific knowledge
and parent-child emotional connection are greater in the PCA-first group than the other 2 groups. We will
then explore whether relative efficacy o...

## Key facts

- **NIH application ID:** 10491692
- **Project number:** 5R01HD081120-07
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Nathalie Maitre
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $648,219
- **Award type:** 5
- **Project period:** 2015-08-21 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10491692

## Citation

> US National Institutes of Health, RePORTER application 10491692, APPLES: Early Childhood Constraint Therapy for Sensory/Motor Impairment in Cerebral Palsy (5R01HD081120-07). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10491692. Licensed CC0.

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