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University of Puget Sound

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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 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)

6 Additional Impairments
Scoliosis Laxity of ligaments Blue sclerae Dentinogenesis imperfecta Loss of hearing Hernias Easy bruising 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 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 : Results:
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 Level III IV Reference Study Design
Level of Evidence Binder et al. (1993) Case-Control Study Level III Paleg et al. (2002) Case Study IV Bleakney et al. (1995) O.I. Chapter in P.T. Book

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. Gerber, L. H. (1999) 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 child’s 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


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