Application of Strength Training and Motor Learning in Pediatrics Flashcards
Review: What are the principles of neuroplasticity?
Use it (or lose it) and improve it
Specificity
Repetition matters
Intensity matters
Time matters
Salience matters
Age matters
Interference
What can we improve repetitions in for stroke rehabilitaiton?
Upper extremity!
What is a way to explain the required repetitions/intensity for recovery?
The body wants to take the path of least resistance. So if you have a lesion, you might have some spontaneous recovery. But in order to really unmask and awaken these dormant pathways, you have to push it. You have to really do intense repetition, intense practice in order to make that happen.
What is massed practice?
it’s thought to be a high-dose or high-intense level of practice in the upper extremity
What is a form of unilateral intense practice?
A cast or a splint on your uninvolved side, and you’re getting lots of intense practice with your involved side
What is forced use?
When somebody is in a cast or a splint on their uninvolved upper extremity to try to force the use of their more involved upper extremity
What is a form or bilateral intense practice?
Hand Arm Bilateral Intensive Therapy (HABIT)
Takes from the concepts of constraint-induced therapy and applies it to bilateral
What does the research say about unilateral intense practice?
All models of CIT have shown improvement in UE function
Models have not been directly compared
Many variables demand research direction
What does the research say about bilateral intense practice?
Based on the concept that it is the PRACTICE that matters
Bilateral training may be more appropriate and task specific in young children
Utilize concepts of task practice, shaping, and home program
Pros and cons compared to CIT
What does the research say about intense practice?
Combination approach?!
Unilateral and bilateral intensive had more improvement than conventional
Unilateral demonstrated improved grasp; bilateral demonstrated improved bilateral spontaneous use
and ADLs in younger children
Consistent with HABIT findings
Approach may be individualized based on goals and motivation
What is your role as a PT to implement intense UE therapy?
Direct provider/collaborator in formal protocol
Direct provider of informal protocol
Refer to providers of protocol
Incorporate strategies into overall intervention plan
What may program development of an UE intense look like?
Facility resources
- Policy/procedure
- Formal program vs informal
- Feasibility
- Reimbursement
Type of practice
- Uni or bi
- Individual or group
Pt selection
- Age
- Dx
- Chronicity
- Considerations
Type of constraint
- Ensure safety
- Method of delivery
- Providers of service
- Frequency/duration
Activities
- Protocol vs individualized
Education plan for child and
caregivers
Outcomes
PT role in developing/shaping
program
What is the PT management of a UE intense program?
Examination and evaluation
Task analysis (Target Movement Profile)
Child and Family Goals
Role in care
Design a comprehensive intervention plan
Outcome measures
What is a target movement profile?
Breakdown of movements/motions for each section of the UE
What are some key components of and UE intense program?
Repetition
Shaping
Functional Practice
Behavior change
Describe the three types of repetitions of an intense UE program
“Signature” CIT:
- Constraint wear for 90% of waking hours
- Intense training for at least 3 hrs/day for at least 2 weeks
“Modified” CIT (mCIT)
- Constraint wear 5 hrs/day, 5 days/week
- Intense training 2 hrs/day, 3x/wk, 10 wks
“Hybrid” CIT (hCIT)
- Bimanual; varies
Describe the shaping component of an intense UE program
Individualized tasks to work on specific movements
Training method leading to motor learning that includes:
- Feedback (knowledge of results)
- Coaching (prompting, cueing, priming)
- Modeling
- Encouragement
What are some shaping examples within an UE intense program?
Stacking blocks
Pennies in a bank
Scooping beads
Push pins
Stickers
Clothespins
Rubberbands
Marbles
Hole puncher
Gluing cotton balls
Describe the functional practice component of an intense UE program
Functional real world activities
Contextually appropriate and interesting to participant
Encouragement and coaching at less frequent intervals
Summary feedback (knowledge of results and quality of performance)
What are some functional practice examples within an UE intense program?
Tying shoes
Brushing teeth
Magic tricks
Books in backpack
Texting
Opening baggies
Describe the behavioral change component of an intense UE program
Assures safety
Encourages problem solving
Increased accountability
Concept is to make the participant responsible for their own improvement
What are some behavioral change examples within an UE intense program?
Behavioral contract
Home practice assignment
Home diary
What are some home practice examples within an UE intense program?
Take off covers
Shut off alarm clock
Remove clothing
Open hamper
Put dirty clothes in hamper
On/off lights
Open/close drawer
Open shower curtain
Flush toilet
Apply soap while bathing
Take towel off rack
Dry self
Tear off toilet paper
Remove toothpaste cap
Apply toothpaste
Use tissue to wipe nose
Pick up toys
Open/close fridge
What are some outcome measurements released to impairments within an UE intense program?
ROM
Strength
Tone
Posture
Motor control
What are some outcome measurements released to activities within an UE intense program?
Motor function
GMFM
PDMS-2
BOT-2
Jebsen
Wolf Motor Function
Assisting Hand in Bimanual
What are some outcome measurements released to performance within an UE intense program?
Action Research Arm test
QUEST/Melbourne Participation
PedsQL
Life-H
COPM
PEDI
Motor Activity Log (MAL)/pediatric MAL
Accelerometry
What are some other massed practice in the UE that can be utilized?
Virtual Reality
Bioness Wireless hand
SaeboFlex
Hand mentor
ReoGo
Goal-directed functional practice
What are the take home points for NM recovery in the UE?
Increase repetitions of purposeful movement
Cortical reorganization and behavioral changes
Comprehensive intervention plan including home practice
Collaboration with family and team members
Importance of patient goals for meaningful change
