INTESIVE THERAPY-Increase intensity and frequency-Physical activity and strengthening, in combination with functional skills training
The NeuroSuits is a soft dynamic proprioceptive orthotic --made up of a hat, vest, shorts, kneepads, and special shoes --neurosuit has elbow pads and gloves--elastic cords with bungee type characteristics fastened all over flexor and extensor muscles --provides correct body alignmentOnce in proper alignment with support and pressure through all joints, intense movement therapy will re-educated the brain to recognizer correct movement patterns and muscle activity Suggested to provide 30-80 lbs of pressure and approximate through joints Provide dynamic proprioceptive input to improve the neuromuscular and vestibular systems. Compression received in the suit provides strong feedback from the muscles to and from the brain and spinal cord. New pathways are established and new movements and skills begin to occur. UEU serves as a pulley suspension system that consists of pulleys, straps, and splints.The pulley system enables one to isolate the desired muscle group and work on specific movement and function. --can also isolate one extremity form the others, and move it independentlySuspension system “spider” works on vestibular stimulation, proprioception, sensory integration dysfunctionCan be adjusted to provide assistance to weak muscles or resistance to stronger muscles
UEU – Polish Orthopedic Surgeon“The Penguin” Designed to counteract the negative effects that the astronauts experienced due to long-term weightlessness. Astronauts Experience: Muscle atrophy from lack of use, Osteoporosis, Vertigo and spatial disorientation, Decreased endurance, Changes in posture and coordinationSuit was modified resulting in an elasticized suit with bands that create an artificial force against the body for use of positioning, stretching, strengthening muscles -cause of impairment not the same for CP, but scientist noted similar impairmentsThe Koscielny’s, a Poland couple – designed the TheraSuit, & opened an IMOT program in 2003 Both physical therapist, had a daughter in ‘91 diagnosed with CP – took her first steps wearing the suitNeurosuit – Patricia Gonzalez2002: Received training from Izabela & Richard Koscielny2004: Traveled to Russia and Poland for a 2 week training program at the National Adeli Training Center of the Russian Federation2005: 12 week training with the Chief of Staff from the National Center2006: Invented and produced the NeuroSuit, which is the only suit to include arm attachmentsIn 2004 she traveled to Poland and Russia and completed a two week training program in theoretical and application aspects of the Adeli® Suit Methodology and Application for Rehabilitation and Treatment of Cerebral Palsy Patients, given at the Adeli® Methodology National Training Center of the Russian Federation. Poland – Euromed CenterRussia – National Training Center of the Russian Federation
Not caused by problems in muscles or nerves.It is characterized by muscle weakness resulting in abnormal movements such as spasticity and paralysis, and can affect speech, balance, posture and coordination. Early intensive training or rehabilitation is optimal to take advantage of neural plasticity. The early practice of activities in an individual recovering from neurological damage can significantly affect learning and may positively affect neural recoveryStrength training and various forms of intensive therapy have proven to significantly benefit individuals with neurological impairments. One form of strength training is repetition of functional tasks. By breaking down functional movements into simple tasks and repeating them, retention of the task can be increased. This is significant to children diagnosed with CP because it can help develop new motor plans.
A child’s physical development and movement patterns are necessary to promote independence in functional performance of daily activities and overall quality of life. Enhancing underlying components of strength, tone, coordination, and control of movement can lead to enhancement and growth physically, mentally, and socially. Individualize treatment program for each child, modifying activities according to child’s responses, needsEncourage active parent involvement to assist with education for home programFUNCTIONAL ACTIVITIES UTILIZING EQUIPMENT-positioning, handling, weight-shifting, weight-bearing techniques-FM -copying, cutting, drawing, mazes, dot-to-dot, grasp/release toys, handwriting-GM -animal walking, walking on line, stepping, skipping-mvt patterns -obstacle course, throwing a ball-strengthening -dancing-bilateral integration -sequencing -gymnastics -Hand/eye -hitting target, batting ball-equilibrium reactions -positioning on tilt board or therapeutic ball-vestibular stimulation -linear, circular swinging-tactile stimulation -different textures/shapes-ADLS -dressing, brushing teeth, feeding
Cost rarely covered by insuranceSome clinics offer scholarship opportunities or assistance in filing for insurance reimbursementMost cases the money must be paid by the parents up frontTime required 3-4 hours/dayTravel to clinics specially trained and certifiedMay miss work or schoolDiff types, fx levels, and impairments for each childwith CP incorporate equipment utilizing other method – NDT, SIInsurance companies may begin to cover portions with more reliable research regarding efficacy
Space – depends on facility, may/may not need extra space--if adult and peds, may need separate roomsManpower--may 2 therapist to work with one patient during training for novel therapist--training cost, facility may pay or may have to pay out of pocket
Are benefits related…To increased duration and frequency of sessionsUnique inteventions and goalsRepetition of activities with entire body supported in proper alignment through use of the suitDynamic proprioceptive input to muscles and brainCompliance and commitment of patient, family, and therapistUtilize standardized outcome measuresCOPM, PEDI, FIM – assess restrictions in participation or disability of the child.Peabody, BOT-2, PEDI, GMFM – assess function/activity
The National Center for Complementary and Alternative Medicine (NCCAM) is one of the 27 institutes and centers that make up the National Institutes of Health (NIH). NIH has received new funds for Fiscal Years 2009 and 2010 as part of the American Recovery & Reinvestment Act of 2009 (Recovery Act).The NIH has designated at least $200 million in FYs 2009–2010 for a new initiative called the NIH Challenge Grants in Health and Science Research. This new program will support research on topic areas that address specific scientific and health research challenges in biomedical and behavioral research that would benefit from significant 2-year jumpstart funds. Comparative Effectiveness Studies of Complementary and Alternative Medicine. Observational studies or secondary data analyses to compare the effectiveness or cost-effectiveness of: 1) CAM used in addition to standard conventional care; 2) CAM or integrative health care versus standard conventional care; OR 3) one CAM therapy to another. NCCAM, like other NIH institutes and centers, accepts investigator-initiated applications that are based on ideas formulated by the applicant.Scientific review groups at the NIH Center for Scientific Review (CSR) or NCCAM Special Emphasis Panels provide peer review by assessing the scientific merit of all applications.
Intensive Model of Therapy<br />Holly Jarrell<br />
Whatis IMOT?<br />Intensive Model of Therapy (IMOT) is a rehabilitative approach consisting of an intensive, structured treatment while utilizing specific equipment, a Therapy Suit and Universal Exercise Unit<br />3-4 Week Program<br />4 hrs/day, 5 days/week <br />Suggested to improve function at a faster rate than conventional therapy<br />
The History of IMOT<br />1940s: Universal Exercise Unit originated in Poland<br />1970s: Russian Cosmonaut Penguin Suit<br />Modified for neuromuscular disorders and given the name “Adeli”<br />2002: TheraSuit designed by 2 PT’s & FDA approved<br />Opened 1st U.S. IMOT faciility<br />2006: NeuroSuit designed by OT<br />
Current Trends<br />Used by both Physical and Occupational Therapist in U.S.<br />Focus on Cerebral Palsy<br />Other suggested diagnoses that may benefit: Spina Bifida, Developmental Delays, Autism Spectrum & Sensory Processing Disorders, Orthopedics, TBI, CVA<br />
CerebralPalsy<br />Non-progressive disorders of movement and posture<br />Caused by damage to the infantile or fetal brain <br />Characterized by primary or secondary impairments of multiple systems including: Neuromuscular, Musculoskeletal, and Sensory<br />
IMOT Benefits<br />Retrain CNS<br />Provides external stabilization<br />Normalizes muscle tone<br />Provides deep proprioception and tactile stimulation<br />Influences vestibular system<br />Improves balance & coordination<br />Improves body & spatial awareness<br /><ul><li> Provides resistance to</li></ul> muscles enhancing strength<br /><ul><li> Increase ROM
Decreases uncontrolled</li></ul> movements<br /><ul><li> Promotes development of</li></ul> FM & GM skills<br /><ul><li> Promotes motor learning and</li></ul> planning<br />
Need for OT<br />Preparatory Technique<br />Prepare body for functional activities working on underlying components<br />Individualize intervention plans utilizing functional activities in protocol<br />Encourage parental involvement to assist in home program carry-over<br />
Implications<br />Cost of treatment is not covered by insurance<br />Intense treatment’s effect on the child and family<br />Occupational Therapy never implements a “cook book” intervention plan <br />Lack of peer reviewed, evidence-based research<br />
Client/FamilyCosts<br />Cost for 1 Session $6900<br />4 hrs/day, 5 days/week, for 3-4 weeks<br />Insurance Coverage??<br />Duration??<br />Long-term effect??<br />
Therapists/FacilityCosts<br />Space<br />Depends on facility<br />Manpower<br />Extra cost for new therapist<br />Training $1900 (5-day course)<br />Equipment <br />$20,000 for 2 suits and supportive equipment<br />$15,000 for 1 UEU<br />Equipment and Training combined cost at MMPT $60,000 <br />This does not include manpower/space<br />
Mission/Vision <br />Assist individuals with disabilities reach their full potential and greatest independence by providing the highest quality of skilled service that is scientifically sound and represents occupational therapy’s core theoretical foundation<br />
Goals/Objectives<br />Join an established facility that has already incorporated IMOT<br />Collaborate with other disciplines and professionals in order to provide peer-review published research on the Intensive Model of Therapy<br />Demonstrate OT’s contribution<br />
Cost of Project<br />Melanie Massy Physical Therapy provides all funding for the IMOT<br />Ongoing research with doctoral students and MMPT <br />Cost of training<br />Accommodations and Travel<br />Additional OT assessments or equipment <br />
SuggestedResearch<br />Specific benefits of IMOT <br />related to the equipment, intensive therapy, or a combination<br />Frequency, duration, intensity<br />Outcome measures<br />Long-term effect<br />Benefits vs. Risks<br />Possible cost effective method<br />
Public Funding<br />National Center for Complementary and Alternative Medicine (NCCAM)<br />A strong interest in building the scientific evidence base for CAM modalities through rigorous research<br />Challenge Grant – Comparative Effectiveness Research<br />Facilitate rigorous research of CAM practices widely used by the public<br />Compare the effectiveness or cost-effectiveness of CAM used in addition to standard conventional care<br />Fund up to 200 or more grants<br />Deadline: April 27<br />
PrivateFunding<br />Cerebral Palsy International Research Foundation<br />Hausman Award Research Grant Program<br />Provides funding for studies on the prevention and treatment of cerebral palsy, including improvement in the quality of life of persons with disabilities due to CP and closely related developmental brain disorders<br />Scientific merit, scientific and clinical relevance and relevance to CP<br />Reviewed by the Foundation’s Scientific Advisory Council and the Board of Directors<br />
References<br />Aipova, T., Davydov, O., Kuuz, R., Shvarkov, S., & Vein, A. (1997). New approaches to <br /> the rehabilitation of patients with neurological movement defects. Neuroscience and Behavioral Physiology, 27(6), 644-647.<br />Bailes, A., Greve, K., & Schmitt, L. (2010). Changes in two children with cerebral palsy after intensive suit therapy: a case report. Pediatric Physical Therapy, 22, 76-85.<br />Bar-Haim, S., Belokopytov, M., Copeliovitch, L., Frank, A., Harries, N., Kaplanski, J., Lahat, E. (2006). Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy. Developmental Medicine and Child Neurology, 48, 325-330.<br />Burman, G. (2006). Suiting up: a look inside the pediatric fitness center and its suit therapy for kids with cp. Cerebral Palsy Magazine, 4 (2), 27-32.<br /><ul><li>Cerebral Palsy International Research Foundation.http://www.cpirf.org/research/grant-applications</li></ul>Genius 4 Kids Pediatric Therapy Center. http://genius4kids.com/Main/1-HomePage-E1.htm<br />Kaufman, K. (Personal Contact) Melanie Massey Physical Therapy.<br />Koscielny, I. (2004). Therasuit method. Cerebral Palsy Magazine, 2 (2), 8-13.<br />
References<br />Medina-Pacheco, L., Pacheco, A, & Pacheco, R. (2006). A family journey to rehabilitation. Cerebral Palsy Magazine, 4 (2), 23-26. <br />National Center for Complementary and Alternative Medicine http://nccam.nih.gov/grants/challenge/<br />NeuroSuit. http://www.neurosuit.com/<br />Orlin, M., Palisano, R., & Snider, L. (2004). Recent advances in physical and <br /> occupational therapy for children with cerebral palsy. Seminars in Pediatric Neurology, 11 (1), 66-77.<br />Rosenbaum, P. (2003). Controversial treatment of spasticity: exploring alternative therapies for motor function in children with cerebral palsy. Journal of Child Neurology, 18, S89-S94.<br />Semenova, K. (1997). Basis for a method of dynamic proprioceptive correction in the restoration treatment of patients with residual-stage infantile cerebral palsy. Neuroscience and Behavioral Physiology, 27(6), 639-64<br />United Cerebral Palsy. http://www.ucpcleveland.org<br />Weisleder, P. (2010). Unethical prescriptions: alternative therapies for children with cerebral palsy. Clinical Pediatrics, 47 (7), 7-11.<br />
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