The Science Behind Therapy
There is a professional demand for science to be implemented in pediatric therapy. When a child is seen in physical therapy (PT) or occupational therapy (OT) for two hours per week, that is well above average. Traditionally, therapy is given in combination as PT, OT, and speech therapy as well as other things for about 2.2 hours on average per week. We start seeing children who have neuromotor disorders many times when they are a few weeks old. We see them until they are adults and then we pass them off into the adult setting. If you look at the scientific literature for the efficacy of what is produced with these methods, very little scientific evidence can demonstrate that these treatments we provide are actually efficacious. We are moving more and more toward professional demands that require evidence-based practice that can stand up to scientific scrutiny. We have to start thinking about therapies in ways that we can test and promote them. Science is interesting because a lot of good science is not clinically relevant. On the other hand, a lot of good clinical work is not scientifically relevant. Pediatric constraint inducted therapy teaches us how we can combine some of the lessons learned from science and clinical work. This is crucial to the development of both fields.
Constraint Induced Therapy
Constraint induced (CI) therapy was developed initially for adults, primarily after stroke. It is a different process for pediatric CI therapy, but it is based on a lot of similarities of adult CI therapy. Pediatric CI therapy has primarily been done with children who have a diagnosis of cerebral palsy. It has had varying intensity levels and it has been done with various types of restraint. The three protocols that I am going to primarily talk about today are the ACQUIREc therapy protocol, which I participated in creating, the Eco-Model which has been put forward by Eliasson, and then we will talk about a camp model called Hand 2 Hand which has been put forth by Dr. Coker-Bolt at MUSC. I must say at the outset that I am familiar with these protocols, but I am in no means an expert in either the Eco-Model or Hand 2 Hand. I am going to present to you what I know from the literature and then I will compare and contrast that to what we do with our particular protocol, the ACQUIREc. I am also going to talk about the advantages and disadvantages of the various protocols. One protocol is not better than another; there are different needs for the clinical entities and different needs of the children and support people who are involved. All of these factors come into play when comparing protocols.
