Stanbridge - T4 - Peds - W5 - Interventions and Therapy Teams

• This study guide covers physical therapy interventions and pediatric therapy teams.
• Chapter 3 provides an overview of physical therapy interventions.
• Chapter 4 discusses pediatric therapy teams.

Learning Objectives for Physical Therapy Interventions:

• Recognize appropriate interventions for specific situations.
• Understand why certain interventions may not suit all situations or children.

Types of Interventions and Philosophies:

• Neurodevelopmental Treatment (NDT).
• Proprioceptive Neuromuscular Facilitation (PNF).
• Conductive Education (CE).
• Strengthening and Stability.
• Therapeutic Taping.
• Sensory Integration.
• Optimal intervention requires therapists to consider child's physiological systems
• Optimal intervention requires therapists to consider commanding, neural control of posture/movement
• Optimal intervention requires therapists to consider regulating and comparing adequate knowledge of performance and for error-detection
• Optimal intervention requires therapists to consider sensorimotor postural orientation, working visual/vestibular systems, environmental adapt, sensory processing skills
• Optimal intervention requires therapists to consider muscle tone/strength postural alignment
• Optimal intervention requires therapists to consider primary habitat/school day/neighborhood
• Optimal intervention requires therapists to consider Cultural family traditions.

Neurodevelopmental Treatment (NDT):

• Originally theorized by Karl and Berta Bobath in the late 1940s.
• Shifted in the 1990s from an orthopedic model to a systems control and biomechanical model.
• The current theory embraces knowledge of motor control.
• Looks at the effects of postural control as a result of interactions between neurologic and physiologic systems.
• Aims to enhance function through hands-on approach.
• Uses key points of control proximally.
• Appropriate for patients with CNS insults or motor disorders like CP or CVA.
• Treatment should be customized.
• The child should be treated as a whole.
• The child's responses to treatment should be reassessed frequently.
• Teamwork is essential.

Proprioceptive Neuromuscular Facilitation (PNF):

• Developed in the 1950s by Dr. Herman Kabot and Maggie Knot.
• Strengthens muscles within functional movement patterns rather than straight planes.
• Movement patterns are “diagonals”.
• PT Dorothy Voss added clinically relevant techniques.
• Based on the hierarchical model of development.
• Based on the developmental sequence and the sequential mastery of motor milestones.
• Works optimally in patients with muscle imbalances (spasticity, flaccidity, weakness, pain).
• Involves transition from prone-on-elbows to quadruped.
• Patients can move trunk or 1 LE.
• Transition enhanced through rhythmic intiation.
• Carefully selected manual contracts at the shoulders or pelvis.
• Individuals with poor lower trunk control have more difficulty completing the transition.
• Manual contacts are near the ischial tuberosities.

Conductive Education (CE):

• Theorized by Andres Peto in 1948 in Budapest, Hungary.
• System to allow a child with motor dysfunction to learn to move within functional skills.
• Based on 4 principles: conductor, group setting, rhythmic intention, task series.
• Session led by conductor or therapist trained in CE.
• Uses designed equipment like slatted plinths, benches, vertical posts, and ladder-back standers.
• An intensive motor training program that practice skills over and over.
• Children go in group settings (ratio of 1:3, 1 adult to 3 children).
• Skills broken down into series of tasks by the conductor.
• Rhythmic intention times the cadence and movement to help child initiate movement.

Strengthening and Stability:

• Several methods to accomplish strength training in children with pathologies.
• Crucial for children with risk of muscle wasting/atrophy and for those with obesity.
• Examples includes:
• Aerobic conditioning,
• Pediatric yoga/Pilates,
• Functional drills such as sit to stand from low bench, ther-ex, activities
• 1 leg activity,
• Single limb stance, and developmental sequence activities.

Therapeutic Taping:

Provides support, input to muscle group.

• Flexible taping is known as Kinesiotaping.
• It helps support weakened muscles, prevent overuse, and help with alignment.
• Kinesiotape is flexible with elastic properties.
• Application from origin to insertion strengthens.
• Application from insertion to origin prevents cramping or overcontraction.
• Rigid taping is known as Leukotaping or strapping.
• Used for joint support in normal alignment.
• Tape laid parallel to muscle fibers.
• Thera Togs are orthotic products that provide the benefits of taping without direct skin adhesion.
• Child wears vest, bodysuit, or shorts made of neoprene-type material.
• Additional arm/leg cuffs or straps can be added.
• Offers input for improved stability, posture. (Essentially where a therapist uses manual input during a therapy session).

Sensory Integration:

• Uses controlled sensory input for children with sensory processing difficulties.
• Includes things like swings, tactile balls, deep pressure, joint compression, lights, and sounds.
• It describes a brain-behavior relationship.
• Originated from Dr. Jean Ayres, PhD, OTR.
• Ayres pioneered the research and practice in sensory integration.
• Learning depends on the ability to process sensory info and self-movement, then organize behavior/movement.
• Individuals with difficulty integrating and processing information will result in deficits.
• This results in: dysfunction in motor learning, sensitivities/ aversions to certain sensory input.
• Examples includes:
• Tactile defensiveness,
• Auditory processing difficulties,
• Visual stimulation aversion,
• Vestibular difficulties,
• Poor body awareness,
• Proprioception deficits
• Remedy dysfunction in motor learning.
• SI intervention must improve ability of CNS to process/integrate sensory inputs.
• Expose the child to stimuli gradually.
• SI treatment encapsulates 3 areas, including theory, evaluation, and treatment.

Other Types of Interventions:

• Rood: based on reflex stimulus model, treatment based on sensorimotor learning developmental sequence, key patterns used + various stimulations to elicit a response.
• Brunnstrom Method: for CNS lesions/hemiplegia; uses proprioceptive and exteroceptive (tapping, rubbing) stimuli + associated reactions, synergies and reflexes.

Additional or Adjunct Interventions:

• Aquatic therapy.
• Pediatric yoga or Pilates.
• Robotics.
• Orthotics.
• Serial casting.
• Bracing.
• Splinting.
• Interactive metronome (IM).
• Assistive technology (AT).
• Constraint-induced movement therapy (CIMT).
• Adaptive Karate.
• Hippotherapy.

Pediatric Therapy Teams (Chapter 4)

• Learning Objectives include the therapy environments.
• Learning Objectives include comparing and contrasting the areas of intervention.
• Learning Objectives include determining the strengths/ weaknesses of the interventional model.
• Medical: inpatient (acute, PICU, NICU) medical rehab teams.
• Out-Patient: Clinical Model.
• School.
• Early Intervention.

Medical System:

• Hospitals/rehabilitation centers.
• The medical team's mission is to promote health/wellness/function in children with physician-lead medical services.
• The medical model includes availability of specialists, allied health care providers (PT/OT, Speech Language Pathologist, social workers, nutritionist, recreational therapists, etc).
• Medial Model is delivered to the child during stay in the the hospital,
• Includes intensive and acute units.
• May include outpatient visits.
• Team interaction is multidisciplinary and interdisciplinary.

Outpatient Clinical Model:

• PT/OT/speech-language services have free-standing clinics.
• consults/services are available such as vision, orthotics, behavioural therapy, and hearing.

Education System:

• Public schools and alternative schools.
• Their mission is to educate children so they become productive members of society.
• The team structure is teacher-led with related services.
• The mode of team interaction is interdisciplinary.

School Model:

• Therapy working in a school will enhance a childs education.
• Services are for children with disabilities and are mandated by federal legislation.
• An example includes safety when navigating.
• An example includes ability to sit.
• An example includes transitioning from room to room.
• An example includes climbing playground equipment.
• Each child has an Individualized Education Plan (IEP).

School Model includes:

• Education For All Handicapped Children Act of 1975.
• The ACT was to ensure children with disabilities can get free and appropriate education as well as programming.
• This also guarantees children special ED services and a developed IEP.
• 1990 changed to Individuals with Disabilities Education Act (IDEA).
• It expanded services for children with autism and traumatic brain injuries.
• It created research and technology centers.

Individualized Education Plan:

• IEP outlines everything (PT, Speech, OT, adaptive PE) a child should be recieving during school.
• Designed to meet the needs of each child.
• Services should be in delivered in a restrictive environment.
• outlines the Amount/ Time of services given to the delivered
• Includes relevant goal setting for the school year.
• school therapists/education teachers or aids/team members work closely together to achieve goals.

Early Intervention System:

• It provides family centered services that promote the development of infants and toddlers.
• Includes mode of team interaction, fluid interagency of a primary service provider.
• Community agencies.
• Homes.
• Childcare centers.

Early Intervention Model:

-Is to provide family centered services that promote and help the infant of child from the disabilities.

• Mandated by guidelines of IDEA.
• It refers to children from birth to 3 years + 6 months when the child is qualified for the program.
• Each state decides eligibility criteria.
• CA example- child is 33.3% delayed in motor development Medical criteria, low birth weight, and syndrome will guarantee/qualify (i.e.,Down syndrome).
• IFSP is created that includes The results of meeting of different strategies and assessments that will prioritize the goals.
• The issues debate is whether it should be at home or if parents work or if parent should work.
• Family in ED are is coping with a child who has special needs to create a better therapy lifestyle that should be implemented into the family.
• ED includes service support, in services, or parental break.

Models of Service Delivery:

• Multidisciplinary= sevices received come from service providers don't communicate.
• Interdiscilplinary= share responsibility for services ( team members), service providers assessment of collaboration.
• Transdicplina= goals based on families and all discaplines asses all together.
• This uses higher levels of training and has 5 step steps from the team.
• Early intervention centers and settings also encourage trandisplinary settings.

California Children's Services.

• Provides CCS(which provides health care service by the state) that gives children up to 21 to the health care.
• CCS is trained to help care for child with heal care.
• CCS also give medical case management as physical and occupational therapy for conditions under age 21

Learning Assessment:

1. Interdisciplinary= results are shared between therapy.
2. IFSP =service provides program.