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CP intervention class Flashcards

1
Q

neurological interventions:

A
  • oral baclofen
  • intrathecal baclofen pump
  • botox injections
  • selective dorsal rhizotomy
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2
Q

orthopedic intervention:

A

single event multi-level surgery (SEMLS)

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3
Q

SEMLS: soft tissue procedures

A

tendon release/lengthening

distal rectus femoris transfer

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4
Q

SEMLS: bone procedures

A

femoral extension osteotomy

varus derotation osteotomy (VDRO) and acetabular osteotomy

hemi-epiphysiodesis

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5
Q

Novak 2020 – Evidence Alert Traffic Light System

A

framework for grading the strength of evidence for different interventions, particularly in the field of cerebral palsy (CP)

system uses a traffic light analogy to communicate the quality and effectiveness of interventions, with colors indicating the level of recommendation based on available evidence

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6
Q

Red light:

A

Don’t do it interventions- not recommended beyond traditional care, may not have enough evidence

Strong evidence suggests that the intervention is ineffective or even harmful

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7
Q

Yellow light:

A

Probably do it and probably don’t do it interventions (distinguished by the ‘worth it line’- fewer and lower quality articles

There is mixed or emerging evidence for the intervention, indicating it may be promising but requires further research to confirm its efficacy

Practitioners should proceed with caution and monitor outcomes closely

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8
Q

Green light:

A

Effective interventions- more high-quality articles

Strong evidence supports the intervention as beneficial

These are recommended interventions because high-quality studies, such as systematic reviews or randomized controlled trials

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9
Q

Green light motor interventions:

A

bimanual = hand function

CIMT = hand function, activity & participation

Hippo therapy = balance symmetry

Partial Body Weight Support Treadmill Training = walking speed

Goal directed training = hand function, gross motor

strength training = muscle strength

mobility training = walking speed

task specific training = gross motor

treadmill training = walking speed, walking endurance, gross motor

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10
Q

Bimanual Training (Hand Function):

A

Focuses on improving the coordination and use of both hands together

Significant improvements in dexterity, grip strength, and goal achievement

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11
Q

Constraint-Induced Movement Therapy (CIMT) (Hand Function, Activity, & Participation):

A

Involves restraining the less-affected hand to encourage use of the more-affected hand, promoting hand function and real-life task performance

Increased use of the affected limb, better outcomes in fine motor tasks, and greater engagement in bimanual activities

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12
Q

Hippotherapy (Balance and Symmetry):

A

using the movement of a horse to improve postural control, balance, and symmetry in patients with motor impairments

Positive changes in trunk control, pelvic stability, and overall symmetry in walking and sitting

It can also have a positive emotional and motivational effect

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13
Q

Partial Body Weight Support Treadmill Training (Walking Speed):

A

Involves using a treadmill with partial body weight support to enhance walking ability

Improvements in gait speed, step length, and walking endurance

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14
Q

Goal-Directed Training (Hand Function, Gross Motor Skills):

A

Tailored interventions focusing on specific goals important to the individual’s daily activities, involving practice in meaningful contexts

Improved outcomes in goal-specific tasks, including fine motor tasks (e.g., grasping) and gross motor tasks (e.g., sitting or walking)

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15
Q

Strength Training (Muscle Strength):

A

Focuses on increasing muscle strength through repetitive, resisted exercises

Gains in muscle power, endurance, and functional skills such as standing, walking, and transferring

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16
Q

Mobility Training (Walking Speed):

A

Involves focused practice on walking skills, often using walking aids or support to improve speed and quality of gait

Improved speed, cadence, and walking efficiency

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17
Q

Task-Specific Training (Gross Motor Skills):

A

Repetitive practice of functional tasks to improve gross motor skills, focusing on specific movements relevant to daily activities

Gains in posture, balance, and gait mechanics

Task-specific training increases muscle coordination and task execution by reinforcing neural pathways responsible for the movement

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18
Q

Treadmill Training (Walking Speed, Walking Endurance, Gross Motor Skills):

A

Using a treadmill to promote gait re-training and improve overall walking capacity

Enhances cardiovascular fitness, muscle strength, and walking distance

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19
Q

Green light contracture & alignment interventions:

A

lower limb casting = passive range

BoNT + casting = passive range

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20
Q

Lower Limb Casting (Passive Range of Motion):

A

Serial casting or static positioning of the lower limbs to improve or maintain passive range of motion (PROM) by lengthening shortened muscles and soft tissues

Significant improvement in passive dorsiflexion of the ankle

Often used to manage spasticity-related contractures, casting has been shown to temporarily improve alignment and gait patterns

ollow-up interventions like bracing, stretching exercises, or functional activity training

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21
Q

Botulinum Toxin (BoNT) + Casting (Passive Range of Motion):

A

Combines the effects of Botulinum Toxin (BoNT) injections, which reduce muscle spasticity, with serial casting to improve passive range of motion by further relaxing overactive muscles and lengthening them through casting

Enhanced PROM in targeted muscles (e.g., gastrocnemius for ankle dorsiflexion)

benefits in both joint alignment and muscle flexibilit

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22
Q

Green light self care/ function interventions:

A

goal directed training = self care

home program = self care

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23
Q

Goal-Directed Training (Self-Care):

A

Focuses on practicing and improving skills related to specific personal goals, particularly those essential for daily living and self-care, such as dressing, grooming, or feeding

Improved self-care abilities, such as dressing, bathing, and personal hygiene, through repeated practice of specific tasks

better task performance and independence

improving overall quality of life

facilitates motor learning by focusing on real-life, functional tasks

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24
Q

Home Programs (Self-Care):

A

Structured home-based exercise or activity programs designed to help individuals practice self-care tasks in their natural environment, promoting continuous progress outside of clinical settings

improvements in self-care task performance due to regular practice at home, where children and adults with CP can work on skills like feeding, dressing, or toileting with guidance

Helps maintain progress made in clinical settings and provides opportunities for more frequent repetitions of self-care tasks

better functional outcomes, greater independence, and more participation in daily routine

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25
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
26
Real-Life Tasks and Activities (Routine-Based Interventions):
focus is on using activities that are part of the individual's daily routine or are meaningful to their everyday life walking, dressing, or playing, are integrated into therapy sessions to promote functional skill development Improvements in functional mobility and self-care skills Increased independence in daily tasks and greater participation in social activities
27
Self-Generated Active Movements at High Intensity:
Encourages individuals to generate their own movements actively, focusing on high-intensity, repetitive practice to improve motor control and strength based on neuroplasticity principles, where high-intensity, task-specific movements lead to better motor outcomes Enhanced motor control, muscle strength, and endurance Better outcomes in gross motor skills such as walking, running, or grasping objects improve motor planning and problem-solving
28
Motivation is Essential – Goal is Set by the Child:
Therapy is more effective when the child is motivated by goals that they set themselves Greater adherence to therapy and more enthusiastic participation Higher levels of goal achievement and better functional outcomes Children are more likely to practice independently and remain committed to therapy when the goal is personally meaningful
29
Successful, Task-Specific Practice that is Rewarding and Enjoyable:
meaningful tasks that the child finds enjoyable and rewarding increases motivation, facilitates motor learning, and promotes mastery of specific skills Significant improvements in motor function, such as balance, strength, and coordination faster skill acquisition and better retention boosts self-confidence and encourages continued effort and practice
30
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.
31
Serial Casting and Dynamic Bracing =
widely used for managing contractures, particularly in individuals with conditions like cerebral palsy, stroke, or brain injury focus on improving joint range of motion by progressively stretching tight muscles and soft tissues, typically the lower limbs
32
Strong Evidence for Dorsiflexion Improvement =
especially in cases of equinus deformity (where the foot points downward) due to tight calf muscles improving passive range of motion (PROM), particularly in the ankle joint, which contributes to better gait patterns and overall mobility
33
Typical Protocol Casting:
typically performed over a period of 4-6 weeks casts are usually re-fitted or changed every 7 days to gradually increase the stretch on the tight muscles e-fitting allows for small increases in range of motion as the muscle and soft tissue adapt to the stretch Once the serial casting phase is complete, the patient is often transitioned to orthotic devices (e.g., ankle-foot orthoses, or AFOs) to maintain the gains in range of motion and prevent recurrence of the contracture
34
Task-Specific and 
Goal-Directed Therapy
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
35
Activity-Focused Therapy:
Emphasizes practicing functional activities that are part of daily life
36
Task-Oriented Training:
Refers to repetitive practice of specific tasks that are aimed at improving motor skills and functionality in real-life contexts
37
Motor Control:
The ability of the central nervous system to regulate and direct the mechanisms essential for movement Task-specific therapy is grounded in principles of motor control, which focuses on how the brain controls movement patterns
38
Motor Learning:
Involves acquiring new skills through practice and experience Principles such as repetition, intensity, and feedback are crucial to refining movement patterns and making them more efficient
39
10x10x10 Inclusion Criteria
10 degrees of wrist extension 10 degrees of thumb abduction 10 degrees of extension for at least two other fingers Other considerations: cognitive function, spasticity, balance
40
Components of Constraint-Induced Movement Therapy (CIMT)
emphasizes repetitive, task-oriented practice of the affected arm while constraining the unaffected arm
41
CIMT COMPONENTS
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 hours) Behavioral Techniques for real-world situations
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Behavioral techniques are utilized to promote motivation, engagement, and self-efficacy in real-world situations:
Goal setting: Helping patients set specific, measurable goals for their therapy Positive reinforcement: Providing feedback and encouragement to boost confidence and motivation Task adaptation: Modifying tasks to increase their relevance and challenge level, promoting engagement in meaningful activities Functional transfer: Encouraging patients to apply skills learned in therapy to everyday activities in their home or community settings
43
BIMANUAL TRAINING
Promotes use of both hemiparetic and dominant hand together Also known as Hand-Arm Bimanual Intensive Training (HABIT) Consider pairing with CIMT
44
Home Program for Self Care
Practice of goal-directed tasks Select routine-based activities Support with reinforcement
45
HIPPOTHERAPY
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
46
PEDIATRIC GAIT INTERVENTION: green light
mobility training: walking speed treadmill training: walking speed, walking endurance, gross motor partial BWSTT: walking speed
47
PEDIATRIC GAIT INTERVENTION Dosing:
2-5x/wk for 2-12 wks (at least 10 sessions) Prevention vs Remediation vs Compensation
48
Prevention
prevent the onset of secondary impairments or deterioration of functional abilities Focus on educating families about proper body mechanics, safe mobility practices, and the importance of regular activity. Incorporate activities that promote balance, strength, and coordination in playful and engaging ways.
49
Remediation
address and correct existing gait deviations or impairments that hinder functional mobility Utilize task-specific training, where children engage in repetitive practice of gait-related activities that are functional and meaningful to them Use assistive devices (e.g., walkers, orthotics) if necessary, to support the child in achieving more typical gait pattern Techniques may include motor learning principles, such as feedback, guidance, and varied practice, to help children improve their gait mechanics.
50
Compensation
help children adapt to their limitations and improve functional mobility using alternative strategies or assistive devices Train children to use compensatory strategies that allow them to navigate their environment safely and efficiently despite their gait limitations (e.g., learning to use a wheelchair or scooter) Modify the environment to reduce barriers to mobility (e.g., using ramps instead of stairs, minimizing obstacles).
51
Partial Body Weight Support Treadmill Training
harness system allows for the adjustment of body weight support, typically between 20% to 60% of the individual's body weight reduction helps improve stability and balance during walking Walking on a treadmill provides a controlled environment that allows for repetitive practice of gait patterns
52
Indications for PBWSTT:
Neurological Conditions: Such as stroke, traumatic brain injury, multiple sclerosis, and cerebral palsy. Musculoskeletal Injuries: Where gait retraining is necessary post-surgery or injury. Developmental Disorders: In children with conditions like spastic diplegia or other gait-related issues.
53
STRENGTH/POWER TRAINING Typical Protocol:
8-12 weeks 2-3 sessions per week 45-60 min sessions
54
STRENGTH/POWER TRAINING 1RM Testing:
select weight for movement: guess a weight you think a child can successfully complete <5 times, then use calculator to estimate 1RM adujst weight: child completed >5 reps of previous weight = increase weight, child unable to complete successful attempt = decrease weight continue adjusting weight: child completes 1-5 reps = estimate 1RM, child unable to complete repetition or completes >5 reps = adjust
55
power training:
6 sets of 6 reps 60-80% of 1 rep max FAST concentric, SLOW eccentric
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strength:
3 sets of 5-8 reps >80% 1 rep max SLOW and CONTROLLED
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STRENGTH/POWER TRAINING Functional 1RM Testing:
Pushing, pulling, stairs, steps, walking Distance/steps child can cover unweighted in 25 seconds Add weight so the child can perform 50-70% of max effort (ie, distance, steps) Power training in short bursts of approx. 25 seconds, 6-8 reps Increase weight 10% when child can complete all reps in <25 seconds
58
Yellow Light Motor Interventions:
Assistive Technology Electrical Stimulation Orthoses Stretching
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ASSISSTIVE TECHNOLOGY
Standing/Weight-bearing devices Virtual Reality & Gaming
60
Standing/Weight-bearing devices:
Target 60-90 minutes a day designed to facilitate upright posture, promote weight-bearing through the lower extremities, and support muscle strengthening, balance, and coordination Regular weight-bearing activities can help strengthen bones and reduce the risk of osteoporosis Encouraging upright posture can enhance respiratory function and overall body alignment enable children to engage more actively in their environment, promoting social interaction and participation in daily activities
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Virtual Reality & Gaming:
At least 4 hours (20 min/session, 2x a week, 6 weeks) provide immersive experiences that can motivate and engage children in therapeutic exercises, making rehabilitation more enjoyable and effective improve cognitive skills (e.g., memory, attention) alongside motor skills, promoting dual-task performance which is essential in everyday life
62
FUNCTIONAL ELECTRICAL STIMULATION:
For better gait mechanics ↑ strength ↓ foot drop ↑DF in swing ↑heel strike Monitor for comfort and skin reactions
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ORTHOSES:
For better gait mechanics ↑ walking speed ↑ stride length ↑ DF in swing ↑ heel strike Monitor for comfort and skin reactions
64
What type of shoes should be worn with LE orthoses?
extra depth flexible & lightweight substantial outsoles firm heel counter
65
STRETCHING
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
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Types of Stretching Techniques
Static Dynamic Prolonged
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Static Stretching:
Involves holding a stretch in a comfortable position for an extended period (typically 15-60 seconds). Effective for increasing flexibility and improving muscle length.
68
Dynamic Stretching:
Involves moving parts of the body through a range of motion in a controlled manner. Useful as part of a warm-up to prepare muscles for activity.
69
Prolonged Stretching:
Similar to sustained stretching, it involves holding a stretch for a longer duration (e.g., 30 minutes to several hours). Techniques such as splinting or the use of serial casts can facilitate this type of stretch.
70
Begin with green light interventions, based on ___
child/family goals
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Yellow-light interventions may be considered based on ____
child/family goals, interests, and access
72
Incorporate ___ training principles
strength/power
73
Use functional tasks to target ___ and ___ control
reactive anticipatory postural

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