Spanish eTIPS for Early Therapy in Perinatal Stroke (eTIPS-ES)

Spanish eTIPS: Translation, Cross-Cultural Adaptation, and Pilot Randomized Feasibility Study of Early Therapy in Perinatal Stroke for Spanish-Speaking Families

This study adapts and evaluates the Spanish version of eTIPS, an early home-based therapy program for infants at risk of unilateral cerebral palsy after perinatal stroke. The project has three parts: translation and cultural adaptation of the original materials, a pilot randomized feasibility study comparing eTIPS with usual care, and a qualitative study exploring family experiences, barriers, and facilitators to using the program at home.

In the first part, the study team will translate and culturally adapt the eTIPS materials for Spanish-speaking families, review them with experts, and test whether the content is clear, relevant, and usable. In the second part, families with infants diagnosed with perinatal stroke or at high risk of unilateral cerebral palsy will be assigned to either the eTIPS program or usual clinical care to assess recruitment, retention, adherence, safety, acceptability, and preliminary effects on infant motor development and family outcomes. In the third part, caregivers in the intervention group will take part in interviews to better understand how the program fits into daily life and what could improve future implementation.

Study Overview

• Status: Not yet recruiting
• Conditions: Perinatal Stroke and Risk of Unilateral Cerebral Palsy; Early Parent-delivered Home-based Intervention; Spanish Cross-cultural Adaptation of eTIPS
• Intervention / Treatment: Behavioral: eTIPS; Behavioral: Usual Clinical Care

Detailed Description

This is a mixed-methods study designed to translate, culturally adapt, and evaluate the Spanish version of eTIPS, an early, parent-delivered therapy program originally developed for infants with perinatal stroke and risk of unilateral cerebral palsy. The project follows a staged approach with three linked phases: Phase I, translation and cross-cultural adaptation of the intervention materials; Phase II, a pilot randomized feasibility study; and Phase III, a qualitative study of family experiences and implementation.

Phase I will include forward translation, back-translation, expert review, and feedback from caregivers and professionals to ensure semantic, conceptual, and cultural equivalence of the Spanish materials. Phase II will randomize eligible infants to eTIPS or usual care, with the intervention delivered by caregivers in the home environment and supported by the research team. Outcomes in this phase will focus on feasibility and process measures such as eligibility, recruitment, consent, retention, adherence, usability, safety, and fidelity, as well as exploratory infant and caregiver outcomes.

The infant assessments may include measures of hand function, motor development, neurological status, and stroke-related outcomes, while caregiver outcomes may include well-being, stress, competence, and bonding. Phase III will use semi-structured interviews and thematic analysis to explore how caregivers experience the intervention in everyday routines, including perceived benefits, barriers, facilitators, and suggestions for improvement. The results will be used to refine the Spanish eTIPS program and inform the design of a future definitive multicenter trial.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Infants with confirmed unilateral perinatal stroke diagnosis by neuroimaging, identified within first 3 months of life
• Age at recruitment ≤3 months postnatal (intervention starts when clinically stable, maximum term-equivalent age)
• Written informed consent from parents/legal guardians

Exclusion Criteria:

• Known progressive neurodegenerative disorder or severe medical comorbidity preventing participation (e.g., ventilation-dependent respiratory failure)
• Extensive bilateral intracerebral lesion making lateralized intervention irrelevant
• Concurrent participation in another clinical trial with interfering treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: eTIPS Intervention; Participants assigned to this arm will receive the Spanish-adapted eTIPS program, a parent-delivered, home-based early intervention for infants with perinatal stroke or risk of unilateral cerebral palsy. Families will receive training, adapted materials, and ongoing support to integrate lateralized therapeutic activities into daily routines from enrollment until corrected age 6 months.	Behavioral: eTIPS; Parent-delivered, home-based early therapy for infants with perinatal stroke or risk of unilateral cerebral palsy. Families receive the Spanish-adapted eTIPS materials, training, and ongoing support to integrate lateralized therapeutic activities into daily routines from enrollment until corrected age 6 months. The intervention is delivered alongside usual clinical care
Active Comparator: Usual Care; Participants assigned to this arm will receive usual clinical care according to local practice, including standard neonatal, neurological, and rehabilitation follow-up. This arm serves as the comparator for feasibility, acceptability, and exploratory outcome assessment	Behavioral: Usual Clinical Care; Standard neonatal, neurological, and rehabilitation follow-up according to local clinical practice. Includes routine pediatric neurology monitoring, periodic neurological evaluations to track motor development and detect early signs of unilateral cerebral palsy, and referral to pediatric rehabilitation with physiotherapy sessions (1 session/week or biweekly, 30-45 minutes) focused on mobilizations, muscle tone control, joint range maintenance, general sensory stimulation, and basic postural guidelines.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment Rate	Proportion of eligible infants identified in neonatology/pediatric neurology who accept participation. Success criterion: ≥70% acceptance rate	From identification to enrollment (baseline)
Retention Rate	Percentage of families completing the 6-month follow-up. Success criterion: ≥80% retention	6 months (end of intervention)
Adherence Rate	Days per week and minutes per week of practice recorded in digital diary/app. Success criterion: ≥70% practice days	Daily/weekly during 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Usability (SUS Score)	System Usability Scale (SUS) score for materials and platform. Target: ≥70 points	Post-intervention (6 months)
Safety	Adverse events or incidents related to intervention (excessive fatigue, persistent rejection, feeding worsening)	Throughout 6 months
Parental Satisfaction	Likert-scale questionnaire on experience, confidence gained, and recommendation of program	Post-Intervention (6 months)
Fidelity	Professional observation of correct eTIPS technique application during scheduled visits	Monthly during 6 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hand Assessment for Infants (HAI)	Video-based observational assessment of unimanual and bimanual hand function	Baseline, 3 months, 6 months, 12 months
Infant Motor Profile (IMP)	Structured observation of fine and gross motor patterns	Baseline, 3 months, 6 months
Paediatric Stroke Outcome Measure (PSOM)	Neurological and functional sequelae monitoring post-stroke	Baseline, 3 months, 6 months
Bayley Scales of Infant Development (BSID-IV)	Standardized assessment of cognitive, motor and socio-emotional development in children from 1 to 42 months.	Baseline, 3 months, 6 months, 12 months
Hammersmith Infant Neurological Examination (HINE)	Standardized neurological assessment for infants 2-24 months evaluating motor and neurological development	Baseline, 3 months, 6 months
Parenting Sense of Competence (PSOC)	Questionnaire measuring parental perception of competence in child care and education	Baseline, 3 months, 6 months
Warwick-Edinburgh Mental Well-Being Scale (WEMWBS)	Brief scale measuring psychological and emotional well-being in primary caregivers	Baseline, 3 months, 6 months
Family Empowerment Scale	Measures family perception of empowerment in caring for and supporting child with special needs	Baseline, 6 months
Edinburgh Postnatal Depression Scale (EPDS)	10-item self-report screening for postpartum depressive symptoms (cut-off ≥10/12). Spanish validated	Baseline, 3 months, 6 months
Parenting Stress Index - Short Form (PSI-SF)	36-item measure of parental stress across 3 subscales: Parental Distress, Parent-Child Dysfunctional Interaction, Difficult Child	Baseline, 3 months, 6 months
Postpartum Bonding Questionnaire (PBQ)	25-item questionnaire assessing mother-infant bonding quality. Detects rejection, anger, infantification (cut-off ≥12 factor 1)	Baseline, 3 months, 6 months

Collaborators and Investigators

• Sponsor: University of Castilla-La Mancha
• Collaborators: Newcastle University; Hemiweb

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): July 31, 2028
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: May 18, 2026
• First Submitted That Met QC Criteria: May 18, 2026
• First Posted (Actual): May 26, 2026

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: early intervention; unilateral cerebral palsy; perinatal stroke; eTIPS; infant rehabilitation
• Other Study ID Numbers: Spanish eTIPS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: No plan to share individual participant data (IPD). Data will be stored securely at Universidad de Castilla-La Mancha following Spanish and EU data protection regulations (RGPD/LOPDGDD). Aggregate results will be published in peer-reviewed journals.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No