Moving from Assessment to Treatment for Pediatric Patients

Pediatric motor therapists see children of all ages with a variety of diagnoses. It can be overwhelming to decide how to evaluate and treat any given patient. In addition, each child is unique, and a "cookie cutter" approach to assessment and treatment should be avoided. One must base the treatment plan on the child's particular attributes, the family's wants and needs, and the therapeutic environment.

This course will introduce therapists to the use of the ICF model and Evidence-Based Practice (EBP) and show how these can be utilized to move from the initial evaluation until discharge, keeping the child, family, and environment as fundamental pieces of this process. This will be done in a case study format that will encourage general discussion and input from those in attendance. Diagnoses to be discussed include cerebral palsy, developmental delay, idiopathic toe walking, and Developmental Coordination Disorder.

Course Content

FOUR CURRENT MODELS FOR DECISION-MAKING

u          International Classification of Functioning, Disability, and Health (ICF)

•      description of short lists

u          Evidence-Based Practice/Rehabilitation

•      important concepts
  • awareness
  • consultation
  • creativity
  • judgment
    • contradiction and quality of studies
      • Botox in children
      • stretching in children with CP
      • strengthening in children with CP

u          Positive Deviance

            •           description

            •           components

u          APTA Guide with Practice Patterns and OATA Therapy Practice Guidelines

CASE STUDY #1: CHILD WITH CEREBRAL PALSY

u          Description of child

• diagnosis/background/video
• patient’s/family’s goals (SMART format)

§LTGs and STGs

• Goal Attainment Scale (GAS)

u          Use of observation as evaluation tool

• PIQ form

u          Use of ICF template to discuss evaluation and treatment ideas

• evaluation tools for infants to older children

• GMFCS
• MACS
• GMFM
• spasticity vs. hypertonicity
• Oregon Project
• cortical visual impairment scale
• Caroline Curriculum
• UE assessments
• SCALE
  • intervention ideas

• Kinesiotape
• aerobic exercise
• adaptive equipment
• electrical stimulation
• partial body weight training
• Theratogs ^TM

Break Out Groups

            •           what to evaluate and how to evaluate

                                    -           ICF template

                                                         Need to examine? Why? Related to which goal(s)?

                                                         How to test?

            •           interventions 

                                    -           tie in with ICF Model

                                                         related to which goal

                                                         type

                                                         intensity

u          Whole Group Discussion

            •           evaluation and intervention ideas

                                    -           spasticity

                                    -           botox

                                    -           aerobic exercise

                                    -           stretching

                                    -           adaptive equipment

                                    -           electrical stimulation

                                    -           selective dorsal rhizotomy

                                    -           partial body weight training

                                    -           Theratogs™

u          When to discharge, discontinue, decrease therapy

CASE STUDY #2: CHILD WITH IDIOPATHIC TOE WALKING (ITW) Developmental Delay

u          Description  of diagnosis child

·causes of—need to know true diagnosis!

·long-term sequelae

·goals:

• diagnosis
• background

• video

• family's goals

patient’s/family’s       

                                    -           LTGs; STGs

u          ICF Format

            •           methods for assessment

                                    -           evidence-based practice related to ITW assessment

            •           interventions

                                    -           evidence-based practice related to ITW treatment

                                                         motor control sequence ideas (related to which goal;                                                                        intensity)

                                                         casting, orthotics, surgery, (related to which goal; intensity)

u          Use of observation as an evaluation tool

• PIQ form

u          Use of ICF template to discuss evaluation and treatment ideas

• evaluation tools for infants to preschoolers

• BSIDIII
• PDMS-2
• TIMP/TIMPS
• DAYC
• HELP
• Lois Bly's checklist
  • intervention ideas
    • facilitation of normal movement patterns
    • family involvement
    • Baby Play by Gymboree
    • home exercise program ideas
    • sensory input

u          when to discharge, decrease, change in frequency

CASE STUDY #3: CHILD WITH IDIOPATHIC TOE WALKING (ITW)

u          Description  of diagnosis

·causes of—need to know true diagnosis!

• evidence-based practice related to ITW diagnosis and assessment
  • toe walking tool
  • visually-related issues
  • weakness related to biomechanics
  • sensory processing issues
• long-term sequelae
• goals:
  • patient’s/family’s   

§LTGs; STGs

• clinical outcomes desired

u          ICF Format for assessment and interventions

• methods for assessments

§Evidence-based practice related to ITW assessment

• body function
• structure
• activities and participation
• interventions
  • evidence-based practice related to ITW treatment
• separation by etiology
• Cincinnati Children's Hospital Algorithm
• motor control sequence ideas (related to which goal; intensity)
• lengthen and strengthen
• casting
• orthotics
• surgery
• weight on heels
• sensory approach

CASE STUDY #4: CHILD WITH DEVELOPMENTAL COORDINATION

DISORDER (DCD)

u          Deciding on this diagnosis

ouse of www.canchild.ca website

                        -           DCD questionnaire for parents

                        -           other resources on this website

oAPTA Practice Guide for DCD

                        -           diagnostic classification and ICD-9 code

                        -           DQD questionnaire for parents

• Definition and diagnostic code
• Research related to co-morbidities
• Profile of child with DCD
• DCD questionnaire for parents

u          Assessment

• tests most commonly used
  • M-ABC2
  • BOT-2
  • COPM
  • COMPS
    • evidence-based research on assessment
    • tennis ball test
    • dual-task
    • sensory systems
    • response times
    • other problem areas

            examination, evaluation from APTA practice guide

u          Intervention

• intervention from research
  • dynamic systems vs. deficit-oriented

            other research ideas

            interventions from APTA practice guide

            specific areas for intervention

            discharge vs. discontinuation

• neuromuscular task training
• cognitive orientation to occupational performance
• deficit-oriented
  • proprioception
  • strength
  • timing

u          Other research ideas

• use of aquatic therapy and protocol
• rhythmic movement training
• motor imagery
• infinity walk

u          Case Study