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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,
3/7
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]