Monthly Archives

We are excited to offer some different options for your child’s therapy. Of real importance to us, as therapists, is that we do our very best for your child. This involves:

Using evidence based practice to guide our therapy in terms of therapy type, therapy dose (appointment frequency) and the use of parent coaching.

BEST PRACTICE IS:

1. Goals need to be set by the client. When children are little these goals are often set by parents but as a child gets older (from 9 years+) these goals need to be set by child/teenager. Goals need to be functional, meaningful and achievable within a short timeframe.

2. Any factors/barriers limiting goal achievement need to be addressed.

3. Therapy must include direct practice. Practice of goals should occur within the home and community by the child and their supports. A high dose of practice is needed to achieve goals, not a high dose of therapy.

Did you know that 1 hour of home based practice = 1 hour of therapy.

4. Parent delivered intervention is a key component of all intervention .

With this in mind we are trying to encourage a stronger “embedding program” where goals are practiced at home with parents/child to ensure that we are doing what the evidence tells us to do – parents being partners in the therapy, engaging in a structured home program to support practice outside of therapy programs.

5. A team approach should be used. If your child is seeing both OT and Physiotherapy at Optimum Movement then we will be trying to organise team goal setting and intervention planning. If you have other agencies and therapists involved, we will be suggesting a level of case conference or liaison time to ensure we are using a team approach to best support your child.

Early Intervention (EI)

Research strongly supports early intervention and therefore children under 5 remain a priority for therapy at Optimum Movement.

MORE THERAPY DOES NOT EQUAL BETTER!

THERAPY BLOCK / EMBEDDING STRUCTURE

Your therapist may have already suggested this structure to you based on the above evidence for best practice for therapy.

This means a 10 session weekly therapy session “block” rather than fortnightly sessions. This will give your child the same “dose” of therapy but then allow us to really focus closely on goals for the term and then implement an embedding program where your child completes a home program (with support if required) and truly works on their goals within their home and community. Your therapist might have already spoken to you about doing this structure. This structure is not suitable for all children and may not also be suitable for your family. Your therapist will be able to discuss what is best for your family from both an evidence point of view and also include your family routine. If weekly is not possible then a home program for the alternate week and recording of this may be suggested.

Embedding is the process of taking skills developed in therapy then practising and refining them in the child’s every environment. A high dose of repetition is needed for the child to learn to use these skills more independently. The role of parents and other caregivers is to coach the child in using these skills so they can become more independent. When thinking about the embedding program your therapist will work with you to identify the coaches for your child in the most important settings for them.

INTENSIVE THERAPY BLOCKS

Optimum Movement will now be offering Intensive Therapy blocks. This involves more frequent therapy over a 2-3 week program and may involve both OT and Physiotherapy. Goals will be individually set with clients and therapists and aim to be achieved within the intensive block structure.

We will be offering Intensive Therapy to children with physical disabilities and can use a wide range of therapy interventions including:

• Dynamic Movement Intervention (DMI)
• The Therapy Cage (Spider Cage)
• Vibration Plate
• Constraint Induced Movement Therapy (modified)
• Bimanual Therapy Program
• Goal directed training

The structure of the intensives will differ depending on your child’s age, their goals and the therapy involved. It may vary from 2 hours per day up to 4 hours per day. It is usually 4-5 days per week and extends over a 3 week program. It will include pre and post intensive assessments of motor skills, a structured home program and videos of activities for your child. Ensuring the home program is embedded into your home and community is key to ensure that practice of goals and goal achievement is attainable.

SCHOOL AGED CHILDREN AND THERAPY

What works for school aged children?

The evidence tells us that therapy needs to be:

• Family centred which involves the child’s family and other important people in their life
• Individual goals for each client, reviewed at the end of each term or semester. Goals need to be meaningful, functional and achievable within a short timeframe. Being focused on goal attainment allows us to clearly identify how and where the practice of the goals will occur and identify any barriers to achieving these goals.
• Weekly intensity for 10 weeks
• Involves practice of skills in the child’s everyday settings. This might include therapists coming to swimming lessons or karate to ensure therapy can be embedded into this environment.
• Might be goal directed training, CO-OP, executive function training, Superflex, Zones of Regulation
• Peer based interventions for social skills (Secret Agent Society, PEERS program)
• Strength based training

CONSULTANTS

Do you need a second opinion? Optimum Movement now offer consultation appointments either with your treating therapist or without. These appointments will be with a member of our Senior Therapy team and may involve an assessment to aid with a diagnosis or assist with therapy and goal setting:

• Equipment Assessment or review
• Cerebral Visual Impairment
• Hand Function (Hand assessment for Infants (HAI), mini Assisting Hand Assessment (Mini AHA), Assisting Hand Assessment (AHA), or Both Hands Assessment (BOHA)
• Infant Assessments include General Movements, HINE, Hand Assessment for Infants (HAI),
• Developmental Assessment – Bayleys Development Assessment
• Autism Assessment including Social Attention & Communication Surveillance – Revised (early screening tool) and the Autism Diagnostic Observation Schedule 2 (ADOS2)
• Use of switches using the Switch Access Measure (SAM Assessment)

WANT TO KNOW MORE?

Therapy for functional goals.

Goal directed training is an approach suitable for children with a range of diagnoses including cerebral palsy, movement disorders, motor difficulties, autistic spectrum disorder, intellectual difficulties and communication difficulties. Goal directed training involves practicing specific tasks that are found to be challenging in everyday life. Tasks are chosen by the individual together with family and might involve communication, self-care, gross motor skills or school/work-based activities. Your therapist can break down goals in achievable parts, which then are practiced until the main goal is achieved. Practicing in real-life situations is important, so training should ideally be integrated in daily routines with children supported by a coach until they achieve independence. You can read more about goal directed training HERE

Therapy for school-aged children with cerebral palsy.

An international group of researchers, clinicians and parents of children with cerebral palsy have worked together to review all of the research relating to therapy interventions to improve their physical function. You can read the research article HERE or you can ask your therapist for a copy of the summary handouts the researchers have developed.

The recommendations of this analysis of the research is that for therapy to achieve functional goals, it is recommended that intervention includes client-chosen goals, whole-task practice within real-life settings, support to empower families, and a team approach. Age, ability, and child/family preferences also need to be considered.

Therapy needs to incorporate the child learning new skills, any modifications to the activity or assistive technology and achieving enough practice in the natural environment to achieve independence. Children need a coach to support them with their practice in their natural environments and to gradually reduce the support provided as the child becomes more independent.

At Optimum Movement we support children with a block of face to face sessions to develop skills, followed by a period of time to focus on practice in natural environments. Your therapist will support this practice with telehealth reviews with your child and their coach. A parent, other family member, teacher, sporting coach or Allied Health Assistant can coach your child as they work on their independence.

If you have any questions at all regarding any of the information above, please don’t hesitate to speak to your therapist.