This article presents a model to guide activity-focused physical therapy and occupational therapy interventions for children with neurological conditions. Activity-focused interventions involve structured practice and repetition of functional actions and are directed toward the learning of motor tasks that will increase independence and participation in daily routines. According to this model, the pediatric therapist: (1) develops activity-related goals in collaboration with the child and the family; (2) plans activity-focused interventions by adapting knowledge of motor learning to the child's individual learning strengths and needs; and (3) integrates impairment-focused intervention with activity-focused intervention.
This article presents a model to guide activity-focused motor interventions as a component of early intervention services for physical and occupational therapists working with infants and young children with neurological conditions and other developmental disabilities. Activity-focused interventions involve structured practice and repetition of functional actions, and are directed toward the learning of motor tasks that will increase the child's participation in daily routines. According to this model, the pediatric physical therapist or occupational therapist, as a member of the intervention team, develops activity-related goals in collaboration with the child's family. The therapist plans activity-focused interventions by (1) using guidelines based on principles from motor learning and motor development, (2) adapting these guidelines, when necessary, to address the young child's individual strengths and needs, and (3) integrating impairment-focused interventions with activity-focused interventions, optimally within the context of everyday routines and activities. The elements of this model will be discussed through an example that is applicable to early intervention. Key words: early intervention, pediatric occupational therapy, pediatric physical therapy A CTIVITY-FOCUSED motor interventions for infants and young children with neurological-based motor conditions emphasize the need for practice and repetition of purposeful motor actions to increase the child's participation in daily routines. These movement experiences are, optimally, incorporated into the infant's or young child's daily routines by parents and other caretakers with support of their physical and occupational therapists through the provision of early intervention services. Activity-focused interventions are consistent with current models of intervention for children with neurological
The ability to produce and sustain a criterion level of precision isometric grip force was studied in a group of 7‐ to 12‐year‐old children with cerebral palsy (CP) and in a control group. On‐line visual feedback of the forces produced relative to a stationary target was provided for each 5‐second trial. Subjects practised 48 trials on each of 3 consecutive days. Measures of accuracy and variability revealed significantly reduced accuracy and increased variability in isometric force production for the group with CP. Both groups demonstrated improvement with practice, with the significantly greater change in the control subjects. There was substantial variability in performance among subjects with CP. Gains associated with practice were sustained over a 5‐day retention interval for both groups. The requirement to control proximal segments of the upper extremity was not associated with increased error in grip‐force production of the group with CP.
The purpose of this special report is to present recommendations for the clinical management of children with cerebral palsy, spastic diplegia when increased functional mobility is the identified outcome. These recommendations provide a framework that allows physical therapists to increase their accountability and promote effective interventions for improved patient outcomes. The key components of this special report on clinical management are: a) the Major Recommendations that provide the background and evidence for clinical management; b) a flow chart to assist in clinical decision-making; and c) a Table of Tests and Measures for information on useful tools in the management of children with spastic diplegia. These recommendations are suggestions for clinical management, not an all-inclusive document on physical therapy for children with cerebral palsy. These recommendations may help therapists develop systematic approaches to service delivery and documentation.
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