02112015 Dr. Pauline Aarts Sint Maartenskliniek Nijmegen Marlous Schnackers MSc Radboud University Nijmegen From effective play in the Pirate group to effectiveness of homebased bimanual training for young children with cerebral palsy 1
Jan 15, 2017
02-‐11-‐2015Dr. Pauline Aarts
Sint Maartenskliniek NijmegenMarlous Schnackers MSc
RadboudUniversity Nijmegen
From effective play in the Pirate group to effectiveness of home-‐based bimanual training for young children with cerebral palsy
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Target Group
Children with a spastic pareses of one arm caused by a brain damage(Unilateral Cerebral Palsy or CP)
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Developmental Disregard
Questionsabout play, self care
and school,
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Play in the Pirategroup
Introduction Pirategroup: the mCIMT-‐BiT interventionIn our studies the approaches modified Constraint InducedMovement Therapy (mCIMT) and Bimanual Training (BiT) are performed consecutively to maximize functional gains in upper extremity. Training in the Pirategroup: Playfullness and flow
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Restraint of the less affected arm and handRepetitive practice of the affected arm and hand
Week 1-‐6 CIMT
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Week 7-‐8 BiT
Challenge to attain own goals: task-‐specific training of bimanual play and daily activities
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Goals Attained!
play, selfcare and school
2 point ore moreGoal Attainment Scale (GAS):
Pirategroup 82% Controlgroup 23%
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COPM (example girl)Canadian Occupational Performance Measure:
five most important daily life problems
(un)dressing
eat/ drink
self-care
play-outdoor games
play-indoor games
(pre)school activities
mobility8
COPM (example girl)Canadian Occupational Performance Measure:
five most important daily life problems
(un)dressing
eat/ drink
self-care
play-outdoor games
play-indoor games
(pre)school activities
mobility10
CO-‐creation At hanD: The road to independence
PhD Project:Marlous Schnackers, MSc Radboud University NijmegenLaura Beckers, MSc, PT Maastricht University
Under the ZonMwIIIeProgramma Revalidatieonderzoek, this project is supported financially by: Johanna KinderFonds
Stichting Rotterdams Kinderrevalidatie Fonds AdriaanstichtingRevalidatiefonds
Home-‐based training
§ Continuation of training effects§ Developmental disregard§ Healthcare independence§ Partnership§ Practical reasons
Explicit -‐ implicit
§ Existing programs– Parental stress– Low compliance
§ Working memory
§ ‘Learning by thinking’ ↔ ‘Learning by doing’
Objective
§ Develop and test two home-‐based training programs
§ Usual care§ Young children with unilateral spastic CP§ Children: bimanual activity§ Parents: stress
Home-‐based training programs
Multidisciplinary team ‘coaching’
Parents ‘teaching’
Child (‘learning’)
Home-‐based training programs
§ Personalized program designed by coachingtherapist
§ Training parents
Home-‐based training programs
• 3.5 hours per week, for 12 weeks
• Task-‐specific
• Weekly contacts with therapist
• Two contact moments with remedial educationalist
Home-‐based training programs
§ 3.5 hours per week, for 12 weeks
§ Task-‐specific
§ Weekly contacts with therapist
§ Two contact moments with remedial educationalist
COAD
Explicit programImplicit program Usual care
Home-based training programs
Preparation • Designing individual program
Home-based training• Explicit teaching approach• ‘Learning by thinking’
Preparation • Designing individual program
Home-based training• Implicit teaching approach• ‘Learning by doing’
Treatment • Therapy by a therapist
Baseline testing
Two weeks
Week 0
Week 12
COAD
Explicit programImplicit program Usual care
Home-based training programs
Preparation • Designing individual program
Home-based training• Explicit teaching approach• ‘Learning by thinking’
Follow-up• Usual care
Preparation • Designing individual program
Home-based training• Implicit teaching approach• ‘Learning by doing’
Follow-up• Usual care
Treatment • Therapy by a therapist
Follow-up• Usual care
Baseline testing
Two weeks
Week 0
Week 6: testing
Week 12: post-testing
Week 24: follow-up testing
Primary outcome measures
Child: § Performance of individual treatment goals:COPM performance scale
Parents: § Parental stress in consequenceof upper limbtreatment child: VAS of parental stress
Take home message
• Development of home-‐based training programs
• Similar goal as the Pirate group
• Explore use of ICT as supporting medium
Thank you for your attention!
See you soon on www.coad-‐project.nl
For more information:Marlous Schnackers [email protected] Aarts [email protected] Beckers [email protected]