Activity, activity, activity new approach in CP

Dear everyone,

As many are aware, the ideas about treating children als paediatric physiotherapists (or pediatric physical therapists) differ greatly at this moment worldwide.

The following link is to a recent lecture mrs Diana Damiano called Activity,activity,activity, rethinking our physical therapy approach to Cerebral Palsy, presented at the AACPDM meeting in 2008.
(American Academy for Cerebral Palsy and Developmental Medicine (AACPDM))
In it all aspects of the new way (scientific) of looking at therapy.

http://depts.washington.edu/isei/ptr...eval.php?x=114

I think mrs Damiano has the gift of being able to describe the background and contents of this "new" approach in a very comprehensive manner.

For people that have been trained to work according to a "method" (as we all were at a certain time), it is a complete eyeopener. To many of us physio´s in the Netherlands, it certainly was when first introduced.

So much has changed since 1990´s. With all the new knowledge about the brain, the muscle, spasticity, plasticity, motor learning and the implementation of the ICF our profession has grown and developed. It is a fantastic time to be in, changing rapidly but for the best.

Hope you are all inspired by what mrs Damiano has to say.

This information and much much more can be found on the website of the International Society on Early Intervention. For more information go to http://depts.washington.edu/isei/.

"The primary purpose of the ISEI is to provide a framework and forum for professionals from around the world to communicate about advances in the field of early intervention. The membership of ISEI is composed of basic and clinical researchers relevant to the field of early intervention representing a diverse array of biomedical and behavioral disciplines, as well as clinicians and policy-makers in leadership positions. As such, linkages between basic science and applied research, interdisciplinary collaborations, and connections between research and practice are emphasized. To foster communication and research collaborations, the ISEI sponsors or co-sponsors international conferences, provides information about conferences relevant to the field of early intervention, publishes a membership directory, and has established an information exchange mechanism through the Internet. From time-to-time, the ISEI will publish books or reprint journal articles of special interest to its members." Quote from their website.

Esther

Unfortunately, most clinicians still do not develop functional or activity-based goals and treatments.

Hi Bobby,

Nice to see you around again here.
This news is certainly sad and disturbing.
Can you say this is the case in the whole of the U.S.A.? and how about Canada?

I would say that things are different in the northern European countries.

I know how difficult it is to let go of something you have done so much with (in my case Vojta and Bobath therapy for example).
But from experience I can say that the knowledge (+ practical bits) I learned from these courses are still implemented (a little)... but coming from a very different thinking process with different goals and as part of functional movement training.

It is not hard to do,
and it actually increases the scope of your practical skills and possibilities if you dare think in function..... :D

I do hope people will be inspired and try.
I have noticed that a number of young physio's I have worked with here in Spain do not find it difficult to think in function because it is so logical. It might even be easiest if you have not had any prior training in a given method.

Parents understand fully straight away and are sometimes even better at creating goals and steps to reach these goals than we are. (sitting on toilet seat alone and sliding off the toilet seat was an example parents came with for their 4 yr old quadriplegic child)

I have been joined here by Pam Versfeld who also has a fantastic site with lots of practical information.
Movement therapy for children web-manual | skillsforaction.com


kind regards

Esther

Dear everyone,

Please give us your imput!

we have had only 4 responses so far.



Esther

Quote:

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Originally Posted by estherderu

Hi Bobby,

Nice to see you around again here.
This news is certainly sad and disturbing.
Can you say this is the case in the whole of the U.S.A.? and how about Canada?

I would say that things are different in the northern European countries.

I know how difficult it is to let go of something you have done so much with (in my case Vojta and Bobath therapy for example).
But from experience I can say that the knowledge (+ practical bits) I learned from these courses are still implemented (a little)... but coming from a very different thinking process with different goals and as part of functional movement training.

It is not hard to do,
and it actually increases the scope of your practical skills and possibilities if you dare think in function..... :D

I do hope people will be inspired and try.
I have noticed that a number of young physio's I have worked with here in Spain do not find it difficult to think in function because it is so logical. It might even be easiest if you have not had any prior training in a given method.

Parents understand fully straight away and are sometimes even better at creating goals and steps to reach these goals than we are. (sitting on toilet seat alone and sliding off the toilet seat was an example parents came with for their 4 yr old quadriplegic child)

I have been joined here by Pam Versfeld who also has a fantastic site with lots of practical information.
Movement therapy for children web-manual | skillsforaction.com


kind regards

Esther

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Hello Esther. Always nice to see you around as well.

Purely based on anecdote, I would say that most clinicians do not treat nor have goals that are activity-based. This a generalization, obviously. I don't have "data." : ) Anyone else in the States might say, "I don't know what Bobby Nabeyama speaks about cause everyone I know emphasizes function."

I beg to differ because I still see kids on physioballs everyday working of "trunk control" and "core strength." Also, I do see goals of "transitioning from half knee to stand." We had a prominent Listserve affiliated with the Pediatric Section of the American Physical Therapy Association (APTA) that did have high traffic. Every other day someone spoke of impairment-based treatments or goals while at the same time speaking of function. This appeared to me as clinicians were unaware whether they are treating on the impairment or activity/functional level. Pure ignorance.

Anyway, there are optimistic signs of changes as the literature has spoken more and more of activity-based treatment and goals. I assume that clinical practice always follows the literature. More and more NDT and SI courses are forced to or just speak of function, too.

to every reader of this thread....

so far 465 people have read this thread and now that the poll has closed, we see that only 4 people responded.

What do the statistics say in this case?
- that the respons was smaller than 1%:eek:
- that 100% of the respondants favoured the "functional methods":)
- that 100% of the people who bothered to answer the poll have read & heard about this topic before and agree. :D
- that we have no idea what the other 99% think:(

I hope that this thread has given people something to think about.
Would all the other 99% please let us know how they work and what they think of this subject.


Esther

Dear Estherderu,

I first wish to appreciate your guidance through the knowledge and information you have been sharing on a regular basis on this forum. I have followed it and found it very helpful.

The views expressed in the presentation regarding the need for focus on Activity, resonate with my growing understanding of what the rationale of therapy approach needs to be.If therapy focus remains on impairments and not on engaging in functional activities, it will remain but a therapy session with minimal scope of translating into a part of the child's daily life.

It has taken a bit of unlearning, but along with the new literature on motor learning, etc. the children have made unlearning easier- giving very clear signs on whats working and whats not!
Also with experience I have understood and am continuing to understand how the therapy ought to be more and more and more child centric, even in aspects we do not automatically relate as affecting therapy. Along these lines the most important trigger is motivation of the child...sure we all use play in therapy, but there is so much more to each child- its essential to put yourself in the childs shoes to ensure optimal participation.

I would like to add though that even though the approach point and agenda has shifted, the intervention through facilitation of functional activities and limitation of secondary impairments continues partly through the traditional methodology. Awaiting better understanding on the relevance of the same.

I do not understand, I have been using NDT for the past year and I have set goals based on the functional activity. My master has declined setting goals on transition.
The whole concept of NDT is refined on the latest model of motor control. Atleast that is how I have been taught. And again to achieve that functional goal we do try lot of facillitatory techs.
Just my opinion.
Regards

@ illuminatidinesh- The reason there is a confusion here- is because of when you first learnt these approaches of therapy- u learnt the current model of ndt which has incorporated the concept of motor control and motor learning (and therefore has a functional approach). My first exposure to therapy intervention was not based on the concepts of motor learning, but that of Neural maturation theory. Though it quickly moved on to Dynamic systems theory from there and currently it stays on models of motor control and learning. And thus it has required/aided a shift in intervention strategies, with every new step towards better understanding of how the normal human brain learns motor control.

I await a better understanding of how an abnormal/ injured infant nervous system learns and develops motor control....

That is obvious, I did study a whole lot of older motor control theories and I understand where they differ from what we achieved today. We make it a point that not to commit the same mistakes which they did. We try to learn from them. Yes U were spot on with that point.
Regards.

Hy everybody,
Just discovered the forum and this thread. Glanced trough all posts and hope to participate and add some to this interesting and important discussion.(thanks esther and all others). I work mainly with children with cp mostly combined with a light to moderate mental handicap. Discovered motor control and learning (shumway-woolacott; schmidt and lee; dynamic systems) about 10 years ago, and found it in the last 5 years a foundation for the therapy I implement. Seeing the Group I work with, I think it is important not to work to cognitively, but use mainly implicit learning and play. I didn’t find to much literature on this. Can anybody help me with that?
Also, In the flemish part of belgium motor learning is a fairly new approach. The main focus on therapy, in my opinion, is still avoiding secundary impairments and practice “normal” movement:(. Definitely when orthopedic docters come into play. Can anybody help me with some supporting literature? This to support my work with evidence based, scientific arguments of the motor control and learning, and being able to discuss with arguments based on literature in this population?
Thanks,
wilfried