Intensive therapy


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Intensive therapy

  1. 1. What is Intensive Therapy? 45-60 hours of therapy over 3-4 weeks (typically 3-4 hours each day)  Some clinics use a 2 week methods to improve tolerance  2-4 sessions each year is recommended Use strength training combined with repetitive movements to improve functional mobility The sessions are broken up into 2 phases: Preparation and Secondary All participant are given a home exercise program to maintain the results Can include occupational therapy and speech therapy as well
  2. 2. What It Isn’t More hours of standard PT and OT Many types of therapy jammed into one session
  3. 3. Who it can be for? Patients with:  Neurological Disorders  Orthopedic Conditions  Muscle Tone Disorders  Gross Motor Delays  Syndromes (Angelman, Down, and others causing musculoskeletal problems)  Movement Disorders (ataxia, athetosis, chorea)  Post surgical Rehabilitation  Pain
  4. 4. So How Does It Work?
  5. 5. Preparation Phase Activities to prepare the body tailored to the individual Can Include:  Moist Heat  Massage  Manual Therapy  Stretching and Range of Motion- including active, passive, and resisted  Strengthening- often using the Universal Exercise Unit  Sensory Integration
  6. 6. Secondary Phase Activities that are practiced multiple times Includes:  Balance and coordination  Functional activities training  Gait training- with or without assistive device  Suit Therapy- must be approved by physician  Universal Exercise Unit
  7. 7. What special tools are used? Therasuit or Suit Therapy  Used for strength, balance, and functional activities  Helps to improve proprioception (knowing where the body is in space) and positioning for activities  Hip X-rays and doctor’s approval needed for participation
  8. 8. What special tools are used? Universal Exercise Unit  Series of pulleys and weights in a cage system used for stretching and strengthening; also straps and bungees used to provide the assistance needed to allow a child to do an activity as well as target sensory, vestibular and proprioceptive challenges and needs
  9. 9. Pros of Intensive Therapy More immediate results Detailed home exercise program to help maintain the results Noticeable increases in strength and skills Functional focus equals functional gains Possible to take more time off for other activities, like adapted sports
  10. 10. Cost of Intensive Therapy Reimbursement varies with insurance companies, however, more and more companies are reimbursing for intensives
  11. 11. One Basic Theory of How It Helps Phases of Learning Repetition- we learn the way to move and gradually begin to build the coordination, balance, strength, and endurance to do the motion Generalization- we have the basic building blocks but still need a great deal of thought to control the motion Automatization- certain motor tasks can be performed without thinking but requires tens of thousands of repetitions
  12. 12. The Evidence
  13. 13. Trahan and Malouin Pilot Study Based on 5 children with CP Therapy 4 times/week for 4 weeks followed by 8 weeks rest period over 6 months GMFM used to evaluate for changes in motor function Results:  3 children had statistically significant improvements in GMFM scores reflecting improved gross motor skills  All 5 participants maintained their improvements over the 8 week rest periods
  14. 14. Bower and McLellan Series of three studies Showed increasing trend toward intensive therapy The last study was a RCT with the children receiving 6 months of therapy 5 days per week followed by a 6 month rest period  Results were not statistically significant  Results attributed to long therapy period and long rest period
  15. 15. Koscheyev and Leon Unpublished study of 6 adults with CP or stroke 5 days/week, 2 hours per day of intensive therapy with suit therapy for 3 weeks Questionnaire to patients, caregivers, and therapists revealed improvements in motor skills, emotion, stamina, and speech Motion analysis revealed improved posture in standing and in gait kinematics
  16. 16. Euro Peds Pilot Study 9 children with CP 4 hours per day, 5 days per week for two weeks of intensive therapy with Suit therapy Results:  GMFM improvements with the largest being in lying and rolling skills
  17. 17. Stiller, Marcoux, and Olson Study to compare the effects of intensive therapy, conductive education, and special education on function in 19 children with CP over 5 week programs PEDI, GMFM, and Peabody administered before and after interventions Results:  While all groups showed improvements, the intensive group showed the most improvements  The only statistically significant changes noted were in the PEDI self care and socialization sections and the GMFM crawling and kneeling scales
  18. 18. Datorre Case Study 12 year old boy with CP receiving intensive therapy with Suit Therapy 4 hours, 5 times per week for 3 weeks in addition to half and hour of aquatherapy and hippotherapy Results:  The subject improved in all categories of the GMFM at the end of the 3 weeks  The subject maintained improvements in all categories at the end of 6 months after the intervention ended
  19. 19. Braswell Study 47 pediatric subjects with CP participated in intensive therapy 4 hours per day, 5 days per week for 3 weeks. Worked on functional skills and strengthening Results:  GMFM scores improved from pre-intervention to post- intervention  No post studies were completed to determine how long the positive changes endured after the completion of the intervention
  20. 20. Summary of Evidence  The general evidence suggests that what is considered the typical intensive therapy program results in functional gains for the subjects with CP.  Most studies suggested a statistically significant improvement  The few studies that looked into long term results post-intervention found that the results continued through rest breaks
  21. 21. Limitations of the Studies All of the studies only look at subjects with CP There are very few studies looking at intensive therapy, and those that do use very different methods. Time in therapy varies and time for rest periods varies even more. Variations exist between the CP subjects making it difficult to generalize the results Limited number of subjects in each study
  22. 22. Why Is This Important? The evidence shows that intensive therapy is affective in improving functional skills, just as typical therapy does. It offers families another way to do therapy that may better fit their schedule All programs should be tailored to the individual, and the patient’s tolerance should be considered before starting this program.  Some facilities recommend a 2 week intensive therapy cycle to ensure patient tolerance for the program
  23. 23. Got Questions?Contact:
  24. 24. References Bower E Et Al. Randomized Controlled Trial Of Physiotherapy In 56 Children With CP Followed For 18 Months. Dev Med Child Neurol Jan 2001; 43 (1): 4-15. Bower E and Mclellan DL. Effect Of Increased Exposure To Physiotherapy On Skill Acquisition Of Children With CP. Dev Med Child Neurol Jan 1992; 34(1): 25-39. Bower E Et Al. A Randomized Controlled Trial Of Different Intensities Of Physiotherapy And Different Goal-Setting Procedures In 44 Children With CP. Dev Med Child Neurol 1996; 38(3): 226-37. Tsorlakis N Et Al. Effect of Intensive Neurodevelopmental Treatment in Gross Motor Function of Children with Cerebral Palsy. Dev Med Child Neurol 2004; 46: 740-745. Trahan J and Malouin F. Intermittent Intensive Physiotherapy In Children With CP: A PilotStudy. Dev Med Child Neurol Apr 2002; 44(4): 233-9. Stiller C, Marcoux B, Olson R. The effect of conductive education, intensive therapy, and special education services on motor skills in children with cerebral palsy. Phys Occup Ther Pediatr 2003; 23(3): 31-50. Datorre E. Intensive Therapy Combined with Strengthening Exercises Using the Thera Suit in a Child with CP: A Case Report. 2004. Braswell J. The effect of intensive physical therapy for children with cerebral palsy. Peds Ther 2008; 20(1): 100-101. Euro-Peds. Scientific Evidence For The Basis Of The Euro-Pēds Program. Euro-Peds. 2010. American Association of Intensive Pediatric Physical Therapy.