CP Interventions class lecture

Question 1

Discuss specific interventions for individuals with CP based on levels of evidence from the Novak 2020 systematic review

Question 2

Identify the steps to design strength-focused intervention plans for individuals with CP

Question 3

what do the green, yellow and red light mean for the NOVAK 2020 Systematic review

Answer 3

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

Question 4

what are the green light interventions?

Answer 4

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

Question 5

what is used for contracture management

Answer 5

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.

Question 6

How do your provide task specific and goal driven physical therapy for kids with CP?

Answer 6

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

Question 7

what is the criteria for casting and slings as an adult?

Answer 7

10x10x10

10 wrist extension
10 thumb abduction
10 extension for at least two other fingers

Question 8

what are the components of CIMT

Answer 8

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

Question 9

what does bimanual training look like for CP interventions?

Answer 9

Promotes use of both hemiparetic and dominant hand together

Also known as Hand-Arm Bimanual Intensive Training (HABIT)

Consider pairing with CIMT

Question 10

how can you build a home program for a child with CP to help with self care?

Answer 10

practice of goal directed tasks

select routine based activities

support reinforcement

Question 11

What is Hippotherapy and how would you dose it?

Answer 11

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

Question 12

what are the green light interventions for gait training?

Answer 12

mobility training- walking speed

Treadmill training-
walking speed, walking endurance, gross motor

Partial BWSTT- walking speed

Question 13

what do the therapies for gait training look like

Answer 13

https://www.youtube.com/watch?v=YfrRBRIr7x8&t

https://www.youtube.com/watch?v=zPiioAqmIig&t

https://www.youtube.com/watch?v=JYZyp6rGd_s

Question 14

How can you build a program for a CP child with strength/power training?

Answer 14

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

Question 15

How do you determine 1 RPM for strength and power training?

Answer 15

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

Question 16

If targeting power how do you dose the exercise

Answer 16

POWER
6 sets of 6 reps
60-80% of 1 rep max
FAST concentric, SLOW eccentric

Question 17

if targeting strength how do you dose the exercise?

Answer 17

STRENGTH
3 sets of 5-8 reps
>80% 1 rep max
SLOW and CONTROLLED

Question 18

what does functional 1 rep max testing include

Answer 18

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

Question 19

what are the yellow light interventions

Answer 19

Assistive Technology
Electrical Stimulation
Orthoses
Stretching

Question 20

what does the use of assistive technology look like as a yellow light intervention?

Answer 20

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)

Question 21

what does the functional electrical stimulation look like as a yellow light intervention?

(think about how it benefits gait biomechanics)

Answer 21

For better gait mechanics
↑ strength
↓ foot drop
↑DF in swing
↑heel strike

Monitor for comfort and skin reactions

Question 22

what for orthosis do as a yellow light intervention?

(how does it benefit gait mechanics)

Answer 22

For better gait mechanics
↑ walking speed
↑ stride length
↑ DF in swing
↑ heel strike

Monitor for comfort and skin reactions

Question 23

what type of shoes do you use for orthotics?

Answer 23

extra depth
flexible and light weight
firm heel counter
substantial outsoles
wider toe box

Question 24

what might a stretching program look like as a yellow light therapy?

Answer 24

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

Question 25

what are the major take aways of the intervention lecture?

Answer 25

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!