Therapy Staff at Lifescape Paving the Way for Intensive Therapy
By Megan Johnke, OTD, OTR/L, Director of Therapy, LifeScape
Evidence based practice. It is what guides clinicians in all areas of medicine and therapy. What happens when there is little or inconclusive evidence? Therapy staff at LifeScape are paving the way in our region, developing innovative programs, and contributing to the body of evidence whenever possible.
In the area of pediatric therapy, even when research is available regarding a treatment method or modality, there continues to be great variance in dosage of therapy. In simplest terms, dosage is the frequency of therapy sessions and how long each session lasts. An article from Rehabilitation Research and Practice analyzed dosage parameters in pediatric outcome studies from nine peer-reviewed journals over a six-year span. The results? Inconclusive. There was simply too much variability among the 123 studies reviewed in frequency, duration, minutes per session, and more to yield a definitive conclusion.
Evidence based practice, fortunately, also requires clinical judgment. Decades of experience and the desire to meet the unique needs of pediatric patients with therapy needs has led to the expansion of existing therapy programs delivered at a higher, more intense frequency over a shorter period of time. What we have learned, through evidence and experience, is that some interventions are more effective in a more intensive episode of care. Likewise, family needs and dynamics vary dramatically, and some prefer shorter more intensive therapy programs vs ongoing, less frequent interventions.
LifeScape Intensify is comprised of a series of programs that offer intensive therapy and training in multiple areas including tracks for feeding therapy, constraint induced movement therapy (CIMT), power mobility, and functional mobility.
LifeScape was the first to offer a research driven CIMT program in our region, beginning in 2009. During the first phase of CIMT therapy, participants are seen for at least 2-3 hours per day, 3-5 days per week for a two-week period. The first phase also includes casting the unaffected upper extremity 24/7 to focus on improving use of the affected upper extremity by “constraining” the more functional extremity.
The LifeScape Therapy team has developed a research-based intensive feeding program-to create a unique and effective approach to feeding therapy as well as g-tube weaning. Speech-language pathologists, occupational therapists, clinical psychologists, behavior analysts, and registered dieticians work with the child’s primary care provider and pediatric specialists to reach feeding and nutritional goals in a shorter period of time than can be reached with traditional, less intensive feeding programs.
Mobility independence comes in many forms. For some children it requires the added boost of power to wheelchairs and specialized seating systems. Moving from a manual wheelchair to a form of power mobility is a big commitment for some families. This brings with it new challenges for the home environment and transporting the wheelchair into the family vehicle. An intensive program helps children be successful who - may not pick up on driving a power wheelchair quickly-or for whom standard driving controls on a power wheelchair are not likely to work.
A power mobility camp was developed at LifeScape to assist children with achieving increased mobility independence. This program allows patients to work 1:1 with seating and mobility/power mobility specialists. Participants utilize a fleet of power wheelchairs, seating components and driving controls available at LifeScape to identify the perfect combination to fit the child’s needs. Goals typically begin with safety and learning to stop and avoid obstacles. Goals then shift to working on controlling the power wheelchair for longer distances and making smooth directional corrections and turns. Final goals involve higher level skills such as community and outdoor mobility.
Our newest and most comprehensive intensive program focuses on addressing functional mobility. The focus of this intensive program is to improve the child’s strength and conditioning which is required to progress patients through their developmental milestones and functional mobility skills. This intensive mobility program works on individual child and family goals such as crawling, kneeling, standing, and walking. By focusing on specific movement patterns and correct alignment, patients can improve their stability and mobility, allowing them to better participate in activities with their family or peers. Use of special equipment such as the Universal Exercise Unit or Solo Step allow the therapists to effectively facilitate these skills. This intensive therapy program utilizes occupational and physical therapists working together to provide the patient with consistent and collaborative care to optimize results.
LifeScape Intensify was designed to give children and teens the frequency of therapy needed to overcome some of the obstacles they face. LifeScape works to design an individualized program with the intensity that fits the needs of each child and their family. If any of your patients are struggling, or perhaps have not reached their highest potential in the areas of functional limb use, feeding, or mobility of any kind, consider a referral to an intensive program at LifeScape. Additional information is available on our website at LifeScapeSD.org under the “Services” tab.