# Feasibility, Safety, and Tolerability of Remote Ischemic Conditioning in Children with Unilateral Cerebral Palsy: A Randomized Controlled Trial

## TL;DR

Remote ischemic conditioning is safe and feasible for children with cerebral palsy, paving the way for future trials to improve recovery.

## Contribution

Demonstrates RIC's safety and feasibility in children with unilateral cerebral palsy, supporting its use in neurorehabilitation.

## Key findings

- RIC was feasible with high recruitment and adherence in children with unilateral CP.
- RIC was safe with stable cardiopulmonary parameters and minor transient adverse events.
- Findings support RIC as a potential priming strategy to enhance neuroplasticity in CP.

## Abstract

What are the main findings?
Remote ischemic conditioning (RIC) was feasible in children with unilateral cerebral palsy (CP), with excellent recruitment, retention, and full adherence to the intervention protocol.Across more than 300 conditioning sessions, RIC was safe and well tolerated, with stable cardiopulmonary parameters and only minor, transient adverse events.

Remote ischemic conditioning (RIC) was feasible in children with unilateral cerebral palsy (CP), with excellent recruitment, retention, and full adherence to the intervention protocol.

Across more than 300 conditioning sessions, RIC was safe and well tolerated, with stable cardiopulmonary parameters and only minor, transient adverse events.

What is the implication of the main finding?
RIC can be delivered reliably and safely in pediatric neurorehabilitation research, supporting its use in future large-scale clinical trials.These findings establish the groundwork for testing RIC as a novel priming strategy to augment neuroplasticity and functional recovery in children with CP.

RIC can be delivered reliably and safely in pediatric neurorehabilitation research, supporting its use in future large-scale clinical trials.

These findings establish the groundwork for testing RIC as a novel priming strategy to augment neuroplasticity and functional recovery in children with CP.

Background: Remote ischemic conditioning (RIC) has shown promise as a neuroprotective strategy, but its application in children with cerebral palsy (CP) remains unexplored. We conducted a randomized controlled trial to evaluate the feasibility, safety, and tolerability of repeated, 6–7 sessions of RIC in children with unilateral CP. Methods: Fifty-one children aged 6–16 years with unilateral CP were randomized (1:1) to receive RIC or sham conditioning on the more affected arm. Primary feasibility outcomes included recruitment metrics, intervention adherence, retention, and protocol fidelity. Safety endpoints included continuous monitoring of oxygen saturation, blood pressure, heart rate, and adverse event incidence. Tolerability was assessed via child-reported pain ratings, conditioning pressure tolerance, skin integrity evaluations, and session adherence. Results: Of 148 children screened, 51 were randomized to RIC (n = 25), sham (n = 26) groups; 48 (94.1%) completed the intervention as allocated. Recruitment yielded 2.04 participants/month. Intervention adherence was 100% in both groups. RIC was well tolerated, with mean pain scores 2.8 ± 3.1 during inflation in RIC and 0.3 ± 0.8 in Sham group. No serious adverse events occurred. Physiological parameters remained stable across 314 conditioning sessions; no clinically significant hypoxemia, blood pressure derangements, or arrhythmias were detected. Minor adverse events (transient erythema, mild discomfort) were rare (2.22%) and self-limiting. Skin integrity was preserved, and no participants required session termination. Conclusions: Repeated RIC is feasible, safe, and tolerable in children with unilateral CP. These findings support the design of future trials using RIC as a priming agent to enhance pediatric neurorehabilitation outcomes.