Neurodevelopmental Treatment and Cerebral Palsy- Research


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An alternative description of my Critically Appraised Topic on Neurodevelopmental treatment when used on children with cerebral palsy. This presentation focuses more on the process of the research.

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  • Today my objectives are to help you understand what the literature says about the use of NDT for children with cerebral palsy over alternative therapies. I would also like to help you understand a little bit more about how a critically appraised topic if completed.We will discuss what an evidence based question is, what exactly a PICO question is, and the types of evidence-based questions that are available to use. I will then inform you how my topic relates to facility. Finally, I will be discussing my research and what I found about my topic.My PICO question was: Is….
  • My question: Therapy
  • Population that many clinicians at this facility will come accross
  • This is my search strategyMesh terms and formal terms
  • Internal Validity: credibility of the articleTreatment time: My articles did not describe if they controlled this specifically.They gave the time that the clients were scheduled for the therapies, but an analysis was not done on the exact minutes. It is often possible that the treatment times may have been different by 5 or more minutes if the client was late or if something happened during the sessions. This could be a threat to the internal validity of the articles that I reviewed.Maturation/Natural Healing:Control group is used to control thisMy articles used control groups of an alternative therapy (Adeli Suit and SIT). However, with children there is always the possibility of maturation or natural healing which could be a threat to internal validity of the articles reviewed
  • Testing/InstrumentationPsychometrics of instruments (validity, reliability, etc)Most articles reviewed this for GMFM- found good psychometricsHowever, not all articles reported this- could indicate a flaw in the internal validity if the reviewer was not educated on the assessment. But knowing that the psychometrics are good for this instrument prevents this from being a threat to validity.Participant EffectsParticipants might try harder because in the intervention group or in the control group….experimenter attention causes you to perform better.Not likely in my articles, most participants were already receiving some sort of therapy prior to the studies being done.
  • Non-Equivalent Groups: Start of StudyOne article stated similarity at beginningAdeli suit: Included a chart and did statistical analysis- good job controlling for this threat to validitySIT article did not do a statistical analysis, just included a chart so it is not clear if groups were equivalent at start of study- could be a threat to internal validityNon-Equivalent Groups: During StudyDrop out/deaths? Can be controlled by an intent to treatAll participants completed the study in both articles I reviewed…because of this an intent to treat analysis was not performed- this was not a threat in the articles reviewed
  • Experimenter EffectsExperimenter knows who is getting which treatmentHard to blind the therapists giving treatment in this case. It is very obvious when NDT is given. Especially with the Adeli suit! This could have been a threat to validity in all articles on this topic.Researcher supports one interventionNot stated in my articles, unsureExperimenter conducts testingOutside therapists administered the therapiesThere was blinding of the individual who scored the GMFM in the Adeli Suit article, person scoring GMFM did not know who had received which therapy
  • External Validity- can the results be generalized?People- different countries, ages, etcThe results found in my critically appraised topics were based on articles that were written in three different countries.This means that the CAT can be generalized to more countries than just America, however each caution must be taken to generalize each specific article.Place- treatment done in different countriesSame as for people.Clinics that the treatment was given in was different in each article- could be a threat to external validity of this paper, however, treatment was given in the same setting within each of the articles.Time- not a peculiar time reallyDoes not appear to be a threat to external validity in this paper.HOW TO IMPROVE EXTERNAL VALIDITYDescribe people, places, times- map it outThe articles did explain where the treatments were given.Use variety of people places and timesDone in this CAT, not really the articlesReplicate the study!!! 
  • Neurodevelopmental Treatment and Cerebral Palsy- Research

    1. 1. Evidence-Based Practice<br />The Effectiveness of Neurodevelopmental Therapy in Improving Gross Motor Function of Children with Cerebral Palsy<br />Dani Cowan, OTS<br />
    2. 2. Introduction<br />Objectives:<br />Understand the results of a critically appraised topic regarding NDT and its use for children with cerebral palsy.<br />Understand how a critically appraised topic is completed. <br />Overview of what will be covered:<br />What is an evidence-based question?<br />Parts of a PICO question.<br />Overview of the types of evidence-based questions.<br />How does this relate to your facility?<br />How was the research done?<br />How I chose which articles to review specifically<br />Results of my review<br />My PICO Question:<br />Is neurodevelopmental therapy more effective in improving gross motor function of children with spastic cerebral palsy when compared to alternative or no therapy<br />
    3. 3. What is an evidence based question?<br />PICO Question<br />Types of Evidence Based Questions<br />How is this relevant to this facility?<br />
    4. 4. PICO Question<br />Is NDT more effective in improving gross motor function of children with spastic cerebral palsy when compared to alternative or no therapy?<br />PICO Question<br />A focused clinical question with the following parts:<br />P: Patient or client group Children with spastic CP<br />I: Intervention or assessment NDT<br />C: Comparison intervention Alternative/No Therapy<br />O: Outcome Improve Gross Motor Function<br />
    5. 5. Types of Evidence Based Questions:Effectiveness of the Intervention<br />Therapy<br />Of the interventions available, which<br />Does more good than harm?<br />Is worth the effort and cost? <br />Are there specific aspects of the intervention that determine if most clients are likely to experience benefits?<br />Prevention<br />Can the occurrence of future problems be changed by an intervention that is directed a one or more risk factors?<br />Does participation in Fit for Life Programs by elderly women with osteoporosis reduce the risk for falls?<br />Does participation in community programs by children with disabilities increase the likelihood that they will sustain friendships during elementary school?<br />
    6. 6. Types of Evidence Based Questions Continued:Defining or Describing a Clinical Problem <br />Prevalence/Presentation<br />How often are specific profiles seen in clients caused by a clinical disorder or impairment?<br />What is the prevalence of anxiety in children on the autism spectrum?<br />Clinical Assessment<br />What are the most reliable and valid ways to collect and interpret information about the client’s strengths, hindrances, and concerns?<br />What assessment tools are the most accurate to identify developmental delays in children with ADHD?<br />Causes<br />What are the possible causes of my client’s problem? Of these, which are most likely? <br />What methods are best at determining which cause is most likely?<br />What is the best method to determine if the child’s difficulty with attention in school is due to sensory deficits?<br />
    7. 7. What is likely to be the course for my client over time (clinically or developmentally)?<br />Are there any possible complications? What are they?<br />What factors are related to the possible outcomes?<br />What is the likelihood that this two-year-old with severe mobility disabilities will be walking by the age of six? <br />Types of Evidence Based Questions Continued:Predicting Client Outcomes<br />
    8. 8. What methods are most effective for understanding the client’s experience?<br />How does the client’s meaning or understanding influence their participation and their outcome?<br />What are the most common concerns of parents of children with autism?<br />Is the COPM an effective tool to help create goals that will result in client satisfaction compared to standard methods?<br />Types of Evidence Based Questions Continued:Client Experience and Meaning<br />
    9. 9. How is this relevant? <br />Mayo Rochester<br />400 patients with CP treated each year with a majority being at the Rochester location<br />NDT is commonly used in OT and is often taught to the patient care team to use with client’s in order to achieve best results<br />Children’s Hospitals and Clinics<br />Cerebral palsy is a common diagnosis treated at this facility<br />NDT is commonly used in OT and is often taught to the patient care team to use with client’s in order to achieve best results<br />
    10. 10. Locating Evidence<br />Databases Used<br />Databases Available to Mayo/Children’s<br />
    11. 11. Databases<br />
    12. 12. Example Page from UWL<br /><br />
    13. 13. Example Page from Website<br /><br />
    14. 14. Databases Available at Mayo/Children’s<br />
    15. 15. Evaluating the Literature<br />Levels of Evidence<br />Threats to Validity<br />
    16. 16. Levels of Evidence:American Occupational Therapy Association<br />Level 1: Randomized Control Trials<br />Level 2: Non-randomized control groups (two groups)<br />Level 3: Non-randomized control groups (one group) or crossover designs<br />Level 4: Single-subject/Repeated Measures Designs<br />Level 5: Qualitative, Case Study<br />
    17. 17. Threats to Internal Validity<br />History/Multiple Treatment<br />Events in the world that may effect results (war, epidemic, etc)<br />Not a threat in this CAT.<br />Treatment Time<br />Is there equal treatment time between groups? <br />Possibly a threat in the RCT’s reviewed.<br />Maturation/Natural Healing<br />Are results due to the intervention or to the development or natural healing of the participants?<br />Always a possibility with children as the population.<br />Control groups are used to prevent this threat. Or dispersing the threat to all (participants of the same age)<br />
    18. 18. Threats to Internal Validity Continued<br />Testing/Instrumentation<br />Do the instruments used in the study have strong psychometric properties? (validity, reliability, etc)<br />GMFM-66 or GMFM-88<br />Participant Effects<br />Did the participants “try harder” because they are part of a study? Did the attention from the experimenter cause better performance?<br />Controlled for by blinding participants from which group<br />Hard to blind with the intervention used, however this is not a likely threat in the articles reviewed <br />
    19. 19. Threats to Validity Continued<br />Non-Equivalent Groups: Start of Study<br />Are the groups equivalent in demographic characteristics at the beginning of the study?<br />Statistical analysis<br />Non-Equivalent Groups: During/End of Study<br />Are the groups equivalent in demographic characteristics at the end of the study?<br />Statistical analysis<br />Drop outs/death?<br />
    20. 20. Threats to Internal Validity Continued<br />Experimenter Effects<br />Does the experimenter know who is receiving which treatment?<br />Blinding, not possible with the article reviewed<br />Does the researcher support one of the interventions?<br />Unknown in the articles reviewed<br />Did the experimenter conduct the testing?<br />Not a threat in the articles reviewed<br />
    21. 21. To Prevent/Improve Threats to Internal Validity<br />Remove the threat<br />Disperse threat to all participants<br />Statistically remove the threat<br />In statistical analysis account for the threat<br />
    22. 22. Threats to External Validity<br />People: different countries, ages, etc. <br />Place: Where is the treatment done? What country? Setting?<br />Time: Was the treatment done at a peculiar time? Early morning? Late at night? <br />
    23. 23. Results<br />My PICO Question<br />Clinical Bottom Line<br />Implications for Practice, Education, and Future Research<br />
    24. 24. PICO Question<br />Is neurodevelopmental therapy more effective in improving gross motor function of children with spastic cerebral palsy when compared to alternative therapy or no therapy?<br /> P: Children with spastic cerebral palsy ages 5 months-15 years<br /> I: Neurodevelopmental therapy<br /> C: Alternative or no therapy<br /> O: Improvement in gross motor function <br />
    25. 25. Evidence<br />Total of 16 Articles Found Relevant<br />3 Articles were Reviewed<br />
    26. 26. Clinical Bottom Line<br />There is strong evidence that NDT is not more effective in improving gross motor skills of children with spastic cerebral palsy when compared to alternative or no therapy.<br />
    27. 27. Boundaries<br />Generalizable to a variety of cultures and ages (5 months to 15 years).<br />Iran (SIT)<br />Israel (Adeli suit)<br />United States<br />Cannot generalize these results to NDT being used for any other outcome. <br />Variability in treatment strategies and techniques so be cautious before generalizing these results to all aspects and techniques of NDT. <br />None of the three articles reviewed in this paper made it clear as to whether or not protocols were standardized or if equal treatment time was given.<br />Larger sample sizes may be more effective in generalizing results. <br />
    28. 28. Implications for Practice, Education, and Future Research<br />Practice: <br />Critically think: Why is NDT being used over alternative therapies that may be equally or more cost effective?<br /> Extra training and cost of NDT <br />Not concluding that NDT is not effective.<br />
    29. 29. Implications for Practice, Education, and Future Research<br />Future Research<br />Deconstruct the aspects of NDT being used<br />What is helpful? What is not?<br />Various Outcomes<br />Education<br />Ensure students understand the research behind the intervention<br />
    30. 30. Questions?<br />