From effective play in the Pirate group to effectiveness of home-based bimanual training for young children with cerebral palsy

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)

2/172

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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Pirate concept: evidence based54 hours mCIMT /6 wks18 hours BiT /2 wks

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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

From Pirate training by therapists to home-‐based training by parents

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

Research group

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’)


§ Personalized program designed by coachingtherapist

§ Training parents


• 3.5 hours per week, for 12 weeks

• Task-‐specific

• Weekly contacts with therapist

• Two contact moments with remedial educationalist


§ 3.5 hours per week, for 12 weeks

§ Task-‐specific

§ Weekly contacts with therapist

§ Two contact moments with remedial educationalist


• Difference implicit and explicit program: teaching approach


§ Difference implicit and explicit program: teaching approach

COAD

Explicit programImplicit program Usual care

Home-based training programs

Preparation • Designing individual program

Home-based training• Explicit teaching approach• ‘Learning by thinking’


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


Home-based training• Explicit teaching approach• ‘Learning by thinking’

Follow-up• Usual care


Home-based training• Implicit teaching approach• ‘Learning by doing’


Treatment • Therapy by a therapist


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

ICT as supporting medium



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]