CP Interventions class lecture Flashcards
Discuss specific interventions for individuals with CP based on levels of evidence from the Novak 2020 systematic review
Identify the steps to design strength-focused intervention plans for individuals with CP
what do the green, yellow and red light mean for the NOVAK 2020 Systematic review
Red light: Don’t do it interventions- not recommended beyond traditional care, may not have enough evidence
Yellow light: Probably do it and probably don’t do it interventions (distinguished by the ‘worth it line’- fewer and lower quality articles
Green light: Effective interventions- more high-quality articles
what are the green light 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
what is used for contracture management
Serial casting or dynamic bracing
Strong evidence for changes in dorsiflexion
Typical Protocol: Serial casting for 4-6 weeks with weekly re-fittings or changes, followed by orthotics.
How do your provide task specific and goal driven physical therapy for kids with CP?
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
what is the criteria for casting and slings as an adult?
10x10x10
10 wrist extension
10 thumb abduction
10 extension for at least two other fingers
what are the components of CIMT
Typically provided daily over a period of 2 weeks and led by an OT, PT, or both
constrain the unaffected arm
receptive task oriented training (3-6 hours a day)
behavioral techniques for real world situations
what does bimanual training look like for CP interventions?
Promotes use of both hemiparetic and dominant hand together
Also known as Hand-Arm Bimanual Intensive Training (HABIT)
Consider pairing with CIMT
how can you build a home program for a child with CP to help with self care?
practice of goal directed tasks
select routine based activities
support reinforcement
What is Hippotherapy and how would you dose it?
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
what are the green light interventions for gait training?
mobility training- walking speed
Treadmill training-
walking speed, walking endurance, gross motor
Partial BWSTT- walking speed
what do the therapies for gait training look like
https://www.youtube.com/watch?v=YfrRBRIr7x8&t
https://www.youtube.com/watch?v=zPiioAqmIig&t
https://www.youtube.com/watch?v=JYZyp6rGd_s
How can you build a program for a CP child with strength/power training?
exercises selection:
complete with min assist or less
single vs. multi-joint
mimics targeted function
adaptable
repeatable
typical protocol:
8-12 weeks
2-3 sessions per week
45-60 minutes a session
How do you determine 1 RPM for strength and power training?
select weight for the movement: choose a weight the patient can perform 5 times
and use the estimate 1 RM calulator
adjust the weight: increase the weight if the child performs 5 decrease if the child can not complete 5
continue adjusting the weight
CHILD COMPLETES 1-5 REPS ESTIMATE THE 1RM
child unable to complete the repetition or complete >5 reps adjust the weight
If targeting power how do you dose the exercise
POWER
6 sets of 6 reps
60-80% of 1 rep max
FAST concentric, SLOW eccentric
if targeting strength how do you dose the exercise?
STRENGTH
3 sets of 5-8 reps
>80% 1 rep max
SLOW and CONTROLLED
what does functional 1 rep max testing include
1) Pushing, pulling, stairs, steps, walking
2)Distance/steps child can cover unweighted in 25 seconds
3)Add weight so the child can perform 50-70% of max effort (ie, distance, steps)
4)Power training in short bursts of approx. 25 seconds, 6-8 reps
5)Increase weight 10% when child can complete all reps in <25 seconds
what are the yellow light interventions
Assistive Technology
Electrical Stimulation
Orthoses
Stretching
what does the use of assistive technology look like as a yellow light intervention?
Standing/Weight-bearing devices
Target 60-90 minutes a day
Virtual Reality & Gaming
At least 4 hours (20 min/session,
2x a week, 6 weeks)
what does the functional electrical stimulation look like as a yellow light intervention?
(think about how it benefits gait biomechanics)
For better gait mechanics
↑ strength
↓ foot drop
↑DF in swing
↑heel strike
Monitor for comfort and skin reactions
what for orthosis do as a yellow light intervention?
(how does it benefit gait mechanics)
For better gait mechanics
↑ walking speed
↑ stride length
↑ DF in swing
↑ heel strike
Monitor for comfort and skin reactions
what type of shoes do you use for orthotics?
extra depth
flexible and light weight
firm heel counter
substantial outsoles
wider toe box
what might a stretching program look like as a yellow light therapy?
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
what are the major take aways of the intervention lecture?
1) 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!
