2. 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
3.
4. What It Isn’t
More hours of standard PT and OT
Many types of therapy jammed into
one session
5. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. Cost of Intensive Therapy
Reimbursement varies with insurance companies,
however, more and more companies are reimbursing
for intensives
13. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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
26. 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.
http://www.europeds.org/pdfs/Scientific_Evidence_PDF.pdf.
Euro-Peds. www.europeds.org. 2010.
American Association of Intensive Pediatric Physical Therapy. www.aaippt.org.
