Innovation in managing children with Cerebral Palsy – An Assignment from the CP Course.

As part of the successful Cerebral Palsy Course, which ran in late 2016 and is available on PP+ now, participants were asked to contribute to a discussion channel. The course participants took part in discussing innovative approaches in the management of individuals with Cerebral Palsy. They were encouraged to think outside the box and be creative.

For the final assignment of the course Iqbal Shaharudin submitted this summary of the discussion board, some 667 comments. His work is below and it is brilliant and shows the power of focused discussion boards involving a global community. It allows us to see themes in knowledge, health beliefs and treatment approaches from around the world. Using these insights we can make physiotherapy knowledge more equitable and help those who need us most.

Thanks Iqbal!

 

Introduction

Cerebral palsy defined as a group of disorder that causes impairment in a person ability to move, maintain balance and posture, which is common among children. There was an estimate of one for every 323 children is United State America having cerebral palsy (1).Currently, contemporary intervention procedure does not adequately meet the hopes and dream of children with motor deficits(2). There is a critical need for innovation intervention by performing research and development related to the early motor intervention. Hence this study may provide  an excellent template for the issues to be addressed to enhance the effectiveness of motor intervention services(2).

Aim

To identify the prevalence of innovation intervention method and its effectiveness among cerebral palsy.

Method

Based on comments/ discussion of 665 participants of online course Managing Children with Cerebral Palsy (MCCP MOOC) from various health care professional especially among physiotherapist, occupational therapist and speech therapist. Participants were encouraged to discuss the topic of innovating approach in managing cerebral palsy based on evidence-based practice.

Result

Majority of the participant commented that there were lacking in innovative approach in their intervention. However, most of the participate mention the application of existing methods of intervention such as Neuro-Development Treatment (NDT) and Hydrotherapy. Several innovative approaches received more attention than other such as Thera Suit Approach with conflicting results of effectiveness (3,4), and highly discussed the method of intervention such as kinetic video games with good intervention outcome (5,6). Other meaningful methods of intervention commonly discussed for cerebral palsy were Supervise Floor Time, Hippo-therapy, Robotic Gait training and Musical Approach Therapy. Below indicate lists of innovative intervention approach discussed at least once in the forum.

Lists of Innovative Intervention Approach

• Speech therapy: Application of card to help focus specific sound for Articulation therapy
• Using robotic for gait training in spastic quadriplegia
• Using treadmill for gait training
• Using toys to attract attention
• Using interactive video games to encourage physical activities
• Musical application to promote socialising and movement pattern
• Using mobile application: examples: tablets and smartphone
• Supervise floor time
• Thera suit/ Pedi suit/ spider therapy
• Hippotherapy
• Selective Dorsal Rhizotomy (SDR)
• Constraint-Induced movement therapy

Discussion

The main of reasons among therapist for lacking innovation for cerebral palsy intervention was lack of funding. Besides that, lack of exposure and accessibility to the new technology hampered the innovation of intervention approach. It is vital to choose the most appropriate approach to intervention based on latest evidence.  A review study suggests that the contemporary intervention for several palsy not holistically fulfil the needs for motor intervention. Further innovation interventions were encouraged to provide alternative intervention method(2).

Conclusion

Majority of the therapist agreed on the importance of innovation intervention for cerebral palsy in order to optimise the outcome of interventions approach. The suitability of each intervention is depending on the condition of the cerebral palsy. More research needs to done to determine the best interventions available for cerebral palsy.

Implication to Practice

Innovative intervention is crucial in order to optimise the intervention outcome. Besides that, it may help reduce the burden of workload among healthcare professional especially among cerebral palsy with severe gross motor function. The practice of soaring for innovation may further encourage therapist to improve their intervention approach and enhance intervention effectiveness.  Thus there is a critical need for research and development related to early motor intervention(2).

References

1. Centers for Disease Control and Prevention. Cerebral Palsy (CP) [Internet]. Centers for Disease Control and Prevention. 2017 [cited 2017 Oct 24]. p. 1. Available from: https://www.cdc.gov/ncbddd/cp/index.html
2. Mahoney G, Robinson C. Early Motor Intervention The Need for New Treatment. Infants Young Child. 2004;17(4):291–300.
3. Bailes, Greve, Burch, Reder, Lin, Huth. The effect of suit wear during an intensive therapy program in children with cerebral palsy. Pediatr Phys Ther [Internet]. 2011;23(2):136–42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21552073
4. JB C, CG C, P. M. The effect of intense physical therapy for children with cerebral palsy. J Pediatr Rehabil Med [Internet]. 2012;5(3):159–70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23023248
5. Tarakci D, Ozdincler AR, Tarakci E, Tutuncuoglu F, Ozmen M. Wii-based Balance Therapy to Improve Balance Function of Children with Cerebral Palsy : A Pilot Study. J Phys Ther Sci [Internet]. 2013;25(9):1123–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818755/
6. Gordon C, Roopchand-Martin S, Gregg A. Potential of the Nintendo Wii TM as a rehabilitation tool for children with cerebral palsy in a developing country : a pilot study. Physiotherapy [Internet]. The Chartered Society of Physiotherapy; 2012;98(3):238–42. Available from: http://dx.doi.org/10.1016/j.physio.2012.05.011