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O.T. for O.I.

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O.T. for O.I. Evidence-Based Practice: Effective Occupational Therapy Treatments for Children with Osteogenesis Imperfecta Michele Cheng University of Puget Sound – PowerPoint PPT presentation

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Title: O.T. for O.I.


1
O.T. for O.I.
  • Evidence-Based Practice Effective Occupational
    Therapy Treatments for Children with Osteogenesis
    Imperfecta
  • Michele Cheng
  • University of Puget Sound
  • Symposium, December 8, 2003

2
Overview
  • About O.I.
  • Evidence-Based Question
  • Current Evidence
  • Implications for children with O.I., occupational
    therapists, and researchers
  • Recommendations for Best Practice

3
What is O.I.?
  • Incidence 1 in 20,000 live births
  • Inherited disorder
  • Abnormal synthesis of type I collagen that forms
    the framework for bones, tendons, ligaments
  • No cure

4
Classifications of O.I.
O.I. Types Characteristics
I mild occasional bone fractures, minimal bone deformity, normal stature
II most severe fractures in utero lead to perinatal death
III severe frequent fractures, severe deformities, triangular face, short stature
5
Classifications of O.I., continued
O.I. Types Characteristics
IV moderate deformities and dwarfism
V ? incidence of hypertrophic calluses early ossification of interosseous membrane of forearms / legs
Sillence, D. O. (1979) Glorieux, F. H. (1999) Sillence, D. O. (1979) Glorieux, F. H. (1999)
6
Additional Impairments
  • Scoliosis
  • Laxity of ligaments
  • Blue sclerae
  • Dentinogenesis imperfecta
  • Loss of hearing
  • Hernias
  • Easy bruising
  • Excessive sweating

7
WANTEDOccupational Therapistsfor children with
O.I.
8
Evidence-Based Practice Question
  • What current evidence exists regarding effective
    occupational therapy treatments for children with
    osteogenesis imperfecta?

9
Criteria for Evidence Selection
  • Types of Studies
  • Published in the last 10 years .
  • Published in English.
  • Study Designs
  • Quantitative Research Designs
  • Qualitative Research Designs
  • Opinions of respected practitioners

10
Rehabilitation Approaches to Children with O.I.
A Ten-Yr Exp
  • Authors MDs, PT
  • Intervention According to Functional Ability
  • Posture exercises
  • Active ROM and strengthening
  • Therapeutic water activities
  • Developmental progression
  • Coordination activities
  • Results Slow, continued functional improvement
    in most out of 25 children

11
Craig Gets Mobile!
  • Authors PTs
  • Individual Intervention
  • Power Mobility Options
  • Aquatic Therapy
  • Methods for sitting playing
  • Results
  • Dynamic finger steering device
  • Long-leg sitter
  • ? mobility exercise opportunities

12
Chapter 12 Osteogenesis Imperfecta
  • Authors PTs
  • Outcomes
  • Functional independence
  • Play
  • Adjustment to school
  • Intervention
  • Infants
  • Preschool aged children
  • School-aged children

13
Therapeutic Strategies for O.I.
  • Based on work of OTs, PTs, MD
  • Intervention
  • Positioning Handling
  • Maximize or maintain function
  • Education of families
  • Adaptive devices
  • Energy conservation
  • Joint Protection
  • Aquatic activities
  • Reduce fear of movement trying new skills

14
Rehabilitation Functional Outcome in O.I.
  • Author Specialist in Pediatric Rehab
  • Intervention
  • Prevent immobilization osteoporosis
  • Promote weight bearing to ? bone strength
  • Reduce bone pain
  • Results
  • ? stamina
  • ? bone pain fatigue
  • ? muscle strength

15
Rehabilitation of Children Infants with O.I.
  • Author MD
  • Intervention
  • Water Sports
  • Throwing tossing balls
  • Playground activity
  • Wheelchair aerobics
  • Results
  • Recreational activities promote feelings of
    competence, fitness, well-being

16
Summary of Evidence
Reference Study Design Level of Evidence
Binder et al. (1993) Case-Control Study Level III
Paleg et al. (2002) Case Study Level IV
Bleakney et al. (1995) O.I. Chapter in P.T. Book Level IV
17
Summary of Evidence, continued
Reference Study Design Level of Evidence
Dollar, E. P. Guidelines for OTs from The O.I. Foundation Level IV
Ault, J. (1999) Lecture at 7th International Conf. on O.I. Level IV
Gerber, L. H. (1999) Lecture at 7th International Conf. on O.I. Level IV-V
18
Benefits for Children with O.I.
  • Prevention of irreversible deformities and
    disability
  • ? mobility
  • ? ADL skills
  • Adjustment to Environment
  • ? Participation Level

19
Implications for Practitioners
  • Little data are available to help devise a
    sensible, safe, and effective program for
    recreational activities (Gerber, 1999).
  • Higher levels of current evidence to support
    practice in treating children with O.I. are
    needed.

20
Implications for Researchers
  • Research about surgical, medical, drug treatments
    suggest therapy to maintain functional ability
  • Level I and II evidence needed regarding
    effective occupational therapy treatments

21
Recommendations for Best Practice
  • Awareness Judgment of Evidence
  • Focus on childs individual abilities, strengths,
    and limitations unique to child rather than O.I.
    type
  • Multidisciplinary team
  • Creative Problem Solving
  • Listen to the children with O.I. and their
    families

22
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