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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.

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Presentation on theme: "O.T. for O.I. Evidence-Based Practice: Effective Occupational Therapy Treatments for Children with Osteogenesis Imperfecta Michele Cheng University of."— Presentation transcript:

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

3 What is O.I.? Incidence: 1 in 20,000 live births Incidence: 1 in 20,000 live births Inherited disorder Inherited disorder Abnormal synthesis of type I collagen that forms the framework for bones, tendons, ligaments Abnormal synthesis of type I collagen that forms the framework for bones, tendons, ligaments No cure 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  incidence of hypertrophic calluses & early ossification of interosseous membrane of forearms / legs * Sillence, D. O. (1979) ** Glorieux, F. H. (1999)

6 Additional Impairments Scoliosis Scoliosis Laxity of ligaments Laxity of ligaments Blue sclerae Blue sclerae Dentinogenesis imperfecta Dentinogenesis imperfecta Loss of hearing Loss of hearing Hernias Hernias Easy bruising Easy bruising Excessive sweating Excessive sweating

7 WANTED: Occupational Therapists for 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 Types of Studies Published in the last 10 years. Published in the last 10 years. Published in English. Published in English. Study Designs Study Designs Quantitative Research Designs Quantitative Research Designs Qualitative Research Designs Qualitative Research Designs Opinions of respected practitioners Opinions of respected practitioners

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

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

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

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

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

15 “Rehabilitation of Children & Infants with O.I.” Author: MD Author: MD Intervention: Intervention: Water Sports Water Sports Throwing & tossing balls Throwing & tossing balls Playground activity Playground activity Wheelchair aerobics Wheelchair aerobics Results: Results: Recreational activities promote feelings of competence, fitness, well-being 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 LevelIII Paleg et al. (2002) Case Study LevelIV Bleakney et al. (1995) O.I. Chapter in P.T. Book LevelIV

17 Summary of Evidence, continued Reference Study Design Level of Evidence Dollar, E. P. Guidelines for OTs from The O.I. Foundation Level LevelIV Ault, J. (1999) Lecture at 7 th International Conf. on O.I. Level LevelIV Gerber, L. H. (1999) Lecture at 7 th International Conf. on O.I. LevelIV-V

18 Benefits for Children with O.I. Prevention of irreversible deformities and disability Prevention of irreversible deformities and disability  mobility  mobility  ADL skills  ADL skills Adjustment to Environment Adjustment to Environment  Participation Level  Participation Level

19 Implications for Practitioners “Little data are available to help devise a sensible, safe, and effective program for recreational activities” (Gerber, 1999). “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. 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 Research about surgical, medical, drug treatments suggest therapy to maintain functional ability Level I and II evidence needed regarding effective occupational therapy treatments Level I and II evidence needed regarding effective occupational therapy treatments

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

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