CP intervention Flashcards
F words
fitness
functioning
friends
family
fun
future?
service delivery models
settings: clinical settings, childcare, preschool, school, rec, community based
telehealth
group therapy
frequency for CP
large variability for length of episode
strengthening 5-40 weeks
functional training 6-8 weeks
treadmill training 2-12 weeks
increasing evidence for intensive episodes of care
intensity
2-3+/wk for average 6-8 wks
well tolerated for some, fewer cancellations, some parents prefer
intensive PT is likely more effective in improving motor function
time for CP training
most are 45-60 mins
early intervention (typically 60 min)
school ( sometimes 30 min)
outpatient (45-60)
inpatient (sometimes 30 min)
duration/dischaeg
begin discussion at 1 visit
team decision
consider other activities and interventions
- adjuncts to PT
- typical activities for individuals age
- home programs and community activitities
yellow light intervention means
probably do it and probably dont do it - fewer and lower quality articles
green light PT interventions
Real-life tasks and activities (routine-based)
* Self-generated active movements at high intensity
* Motivation is essential – Goal is set by child
* Successful, task-specific practice that is rewarding and
enjoyable
contracture management - green
serial casting or dynamic bracing
strong evidence for changes in DF
typical protocol for serial casting - green
4-6 weeks with weekly refittings or changes, followed by orthotics
task specific and goal-directed therapy - green
Multiple terms in the literature:
* Activity-focused
* Task-oriented training
* May need to address body
structures/function before task
practice
* Motor control and learning principles
come into play
* Postural control components
10x10x10 inclusion criteria. - green
10 degrees of wrist extension
Other considerations:
cognitive function, spasticity, balance
* 10 degrees of thumb abduction
* 10 degrees of extension for at least two other fingers
other considerations: cognitive function, spasticity, balance
CIMT components - green
typically provided daily over a period of 2 weeks and led by an OT, pT, or both
- constraining the unaffected arm
- repetitive task oriented training (3-6 hrs)
- behavioral techniques for real world situationa
bimanual training - green
promtoes use of both hemiparetic and dominant hand together
aka Hand Arm bimanual intensive training (HABIT)
consider pairing with CIMT
home program for self case - green
practice of goal directed tasks
select routine based activities
support with reinforcement
hippotherapy - green
Green light for balance and symmetry
* Yellow for gross motor and hand function
* PT/OT utilizing horse as modality, so not the same as
therapeutic riding
Typical Protocol: At least 16 hours – 1 hr, 2x/wk for 8 wks
Dewar et al, 2014; https://pubmed.ncbi.nlm.nih.gov/25523410/
pediatric gait interventions - green
mobility training (walking speed)
treadmill training (walking speed, endurance, gross motor)
partial BWSTT (walking speed)
dosing: 2-5x/wk for 2-12 wks at least 10 sessions
strength/power training and protocl
8-12 weeks
2-3 sessions/wk
45-60 min sessions
1RM testing
select weight for movement (guess you think they can complete < 5 times)
adjust weight until child completes 1-5 reps and estimate 1ROM
power training
6 sets of 6 reps
60-80% of 1RM
fast concentric, slow eccentric
strength training
3 sets of 5-8 reps
>80% 1 RM
slow and controlled
functional 1RM testing
choose activity, determine unresisted capacity, determine load, dose, progress
yellow light motor interventions
assistive technology
E stim
orthosis
stretching
assistive technogoly - yellow
standing/WB devices: target 60-90 mins/day
virtual reality and gaming: at least 4 hrs (20min session, 2x/wk, 6 wks)
functional E stim - yellow
for better gait mechanics
- increase strength
- decrease foot drop
- increase DF in swing
- increase heel strike
monitor for comfort and skin reactoins
orthosis - yellow
for better gait mechanics
- increase walking speed, stride length, DF in swing, heel strike
monitor for comfort and skin reactions
what type of shoes should be worn with LE orthosis
extra depth, flexible and lightweight, substantial outsoles, firm heel counter, wider toe box
brands: Stride Rite, New Balance, BILLY, Tsukihoshi, Kizik, SureStep, See Kai Run, Plae, Hatchbacks, Keen, Merrell,
Puma, Converse, Vans
stretching - yellow
Need sustained stretch to make meaningful
changes – think serial casting
Manual stretching is not a skilled activity but can
be used to warm up tissues for activity or for
pain management
Can teach child/family how to incorporate longer
duration stretches into their daily home program
key takeaways
Begin with green light interventions, based on child/family goals
2) Yellow-light interventions may be considered based on child/family goals, interests,
and access
3) Incorporate strength/power training principles
4) Use functional tasks to target reactive and anticipatory postural control
5) Be creative, have fun!
