CP intervention

Question 1

F words

Answer 1

fitness
functioning
friends
family
fun
future?

Question 2

service delivery models

Answer 2

settings: clinical settings, childcare, preschool, school, rec, community based

telehealth

group therapy

Question 3

frequency for CP

Answer 3

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

Question 4

intensity

Answer 4

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

Question 5

time for CP training

Answer 5

most are 45-60 mins

early intervention (typically 60 min)
school ( sometimes 30 min)
outpatient (45-60)
inpatient (sometimes 30 min)

Question 6

duration/dischaeg

Answer 6

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

Question 7

yellow light intervention means

Answer 7

probably do it and probably dont do it - fewer and lower quality articles

Question 8

green light PT interventions

Answer 8

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 9

contracture management - green

Answer 9

serial casting or dynamic bracing

strong evidence for changes in DF

Question 10

typical protocol for serial casting - green

Answer 10

4-6 weeks with weekly refittings or changes, followed by orthotics

Question 11

task specific and goal-directed therapy - green

Answer 11

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 12

10x10x10 inclusion criteria. - green

Answer 12

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

Question 13

CIMT components - green

Answer 13

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

Question 14

bimanual training - green

Answer 14

promtoes use of both hemiparetic and dominant hand together

aka Hand Arm bimanual intensive training (HABIT)

consider pairing with CIMT

Question 15

home program for self case - green

Answer 15

practice of goal directed tasks

select routine based activities

support with reinforcement

Question 16

hippotherapy - green

Answer 16

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/

Question 17

pediatric gait interventions - green

Answer 17

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

Question 18

strength/power training and protocl

Answer 18

8-12 weeks
2-3 sessions/wk
45-60 min sessions

Question 19

1RM testing

Answer 19

select weight for movement (guess you think they can complete < 5 times)

adjust weight until child completes 1-5 reps and estimate 1ROM

Question 20

power training

Answer 20

6 sets of 6 reps
60-80% of 1RM
fast concentric, slow eccentric

Question 21

strength training

Answer 21

3 sets of 5-8 reps
>80% 1 RM
slow and controlled

Question 22

functional 1RM testing

Answer 22

choose activity, determine unresisted capacity, determine load, dose, progress

Question 23

yellow light motor interventions

Answer 23

assistive technology
E stim
orthosis
stretching

Question 24

assistive technogoly - yellow

Answer 24

standing/WB devices: target 60-90 mins/day

virtual reality and gaming: at least 4 hrs (20min session, 2x/wk, 6 wks)

Question 25

functional E stim - yellow

Answer 25

for better gait mechanics - increase strength - decrease foot drop - increase DF in swing - increase heel strike monitor for comfort and skin reactoins

Question 26

orthosis - yellow

Answer 26

for better gait mechanics - increase walking speed, stride length, DF in swing, heel strike monitor for comfort and skin reactions

Question 27

what type of shoes should be worn with LE orthosis

Answer 27

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

Question 28

stretching - yellow

Answer 28

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 29

key takeaways

Answer 29

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!