Presentation on theme: "University of Puget Sound"— Presentation transcript:
1 University of Puget Sound O.T. for O.I.Evidence-Based Practice: Effective Occupational Therapy Treatments for Children with Osteogenesis ImperfectaMichele ChengUniversity of Puget SoundSymposium, December 8, 2003
2 Overview About O.I. Evidence-Based Question Current Evidence Implications for children with O.I., occupational therapists, and researchersRecommendations 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, ligamentsNo cure
4 Classifications of O.I. O.I. Types Characteristics I * mild occasional bone fractures, minimal bone deformity, & normal statureII *most severefractures in utero lead to perinatal deathIII *severefrequent fractures, severe deformities, triangular face, short stature
5 Classifications of O.I., continued O.I. TypesCharacteristicsIV *moderate deformities and dwarfismV ** incidence of hypertrophic calluses & early ossification of interosseous membrane of forearms / legs* Sillence, D. O. (1979)** Glorieux, F. H. (1999)
6 Additional Impairments ScoliosisLaxity of ligamentsBlue scleraeDentinogenesis imperfectaLoss of hearingHerniasEasy bruisingExcessive 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 StudiesPublished in the last 10 years .Published in English.Study DesignsQuantitative Research DesignsQualitative Research DesignsOpinions of respected practitioners
10 “Rehabilitation Approaches to Children with O.I.: A Ten-Yr Exp” Authors: MDs, PTIntervention According to Functional Ability:Posture exercisesActive ROM and strengtheningTherapeutic water activitiesDevelopmental progressionCoordination activitiesResults: Slow, continued functional improvement in most out of 25 children
12 “Chapter 12: Osteogenesis Imperfecta” Authors: PTsOutcomes:Functional independencePlayAdjustment to schoolIntervention:InfantsPreschool aged childrenSchool-aged children
13 “Therapeutic Strategies for O.I.” Based on work of OTs, PTs, MDIntervention:Positioning & HandlingMaximize or maintain functionEducation of familiesAdaptive devicesEnergy conservationJoint ProtectionAquatic activitiesReduce fear of movement & trying new skills
14 “Rehabilitation & Functional Outcome in O.I.” Author: Specialist in Pediatric RehabIntervention:Prevent immobilization osteoporosisPromote weight bearing to bone strengthReduce bone painResults: stamina↓ bone pain & fatigue muscle strength
15 “Rehabilitation of Children & Infants with O.I.” Author: MDIntervention:Water SportsThrowing & tossing ballsPlayground activityWheelchair aerobicsResults:Recreational activities promote feelings of competence, fitness, well-being
16 Summary of Evidence Level III IV Reference Study Design Level of EvidenceBinder et al. (1993)Case-Control StudyLevelIIIPaleg et al. (2002)Case StudyIVBleakney et al. (1995)O.I. Chapter in P.T. Book
17 Summary of Evidence, continued ReferenceStudy DesignLevel of EvidenceDollar, E. P.Guidelines for OTs from The O.I. FoundationLevelIVAult, J. (1999)Lecture at 7th International Conf. on O.I.Gerber, L. H. (1999)IV-V
18 Benefits for Children with O.I. Prevention of irreversible deformities and disability mobility ADL skillsAdjustment 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 abilityLevel I and II evidence needed regarding effective occupational therapy treatments
21 Recommendations for Best Practice Awareness & Judgment of EvidenceFocus on child’s individual abilities, strengths, and limitations unique to child rather than O.I. typeMultidisciplinary teamCreative Problem SolvingListen to the children with O.I. and their families