Intensive blocks of physiotherapy treatment: Therapists know they work, parents can see they work, and many, many children benefit from them.
You’d think there’s be loads of evidence to scientifically back them up however there isn’t. From many years of clinical experience, here’s some practical evidence instead!
Bobath (neurodevelopmental) therapy is a well known, effective treatment approach often used in the management of children with cerebral palsy. Treatment at a Bobath Centre is provided as an intensive block of therapy and there are different types of blocks available.
This article cites many references from where Bobath base their evidence with the reference to intensive therapy provision as follows:
Treatment at a Bobath Centre is usually more intensive (daily sessions over 2 weeks) than typical local provision. Some comparisons of different intensities of therapy have been shown to correlate with increased improvement in motor skills: weekly more effective than monthly (Mayo, 1991); daily more effective than twice weekly or less (Tsorlakis et al., 2004; Bower & McLellan, 1992; Bower et al., 1996); and intermittent intensive blocks may be an effective strategy for producing long term gains (Trahan & Malouin, 2002; Gagliardi et al., 2008). A few studies have shown no difference (Ustad et al, 2009; Christiansen & Lange 2008; Weindling et al, 2007).
A meta- analysis of studies from Jan 1996-June 2007 of intensive V non-intensive PT for children with CP showed intensive therapy tended to have a greater effect than non-intensive therapy on motor function and the effect was stronger for children 2 years of age, (Arpino et al, 2010).
From my experience, I believe all children with developmental needs could benefit from intensive therapy blocks. This includes but is not limited to, children with cerebral palsy (CP), developmental delay and those children who are pre and post SDR surgery.
1) Therapy is intensely goal focused
At the beginning of the block, two or three goals are set. These are decided on after thorough assessment of the child and discussion with parents and children. Goals are SMART, specific, functional and very importantly, something that the child agrees with (as much as able to).
Therapy over the block is then intensively focused towards achieving these goals and results can be measured and observed at the end.
2) Effects are cumulative and seen quickly
Due to the nature of CP, a child often needs to undergo preparatory work in order to be able to perform and actively participate in the functional aspect of the goal.
For example, if the goal is for your child to be able to stand on his or her own for 30 seconds, work might need to be done to help get more active back, hip and knee extension first so stretches, mobilisations and exercises to work the necessary muscles may be done for most of the session , with only a small part of the session with the child actually standing.
The great thing about seeing a child for a few days in a row is that the effects from one session carry over into the next. This means that it takes less preparatory work each time to get your child to ready to achieve the desired outcome and it is easier to see if therapy is having positive results, or if something needs to be altered.
3) Blocks empower parents and children
What I really enjoy from providing intensive blocks of therapy, is that it gives a chance for parents and children to see the child’s potential. Because we work on such specific goals with positive results, everybody can see that it is possible to make a difference and see a change. Even if it may only be a small one.
It is a useful time for parents to get involved in therapy and the aim is that by the end of the block they will be confident in their own knowledge and skills to be able to help their child with exercises and activities that will continue to benefit them.
Therapy is something that children continue to benefit from their entire lives so it is really important that it fits in with life and is not something that life revolves around.
4) Reduces risk of therapy burnout
Sometimes kids just need a change of scenery, of therapist, of activities or any other aspect of therapy.
Many children with CP have had constant therapy input for their whole little lives and they get to stage when they just don’t want to do it anymore. Understandable but difficult to manage when you as the parent know that it is in their best interest to do it.
Having intermittent blocks of therapy is just one of 6 Tips on preventing therapy burnout (for you & your child).
5) Work in partnership with other therapy providers for best results
With the increasing number of children with CP undergoing selective dorsal rhizotomy, the demand for providing intensive strengthening therapy has increased too.
There are quite a few specialist centres available that offer intensive strengthening courses which is fantastic as children and their parents now have more options open to them. More options will help to alleviate therapy burnout as described in the previous point.
While strength and conditioning coaches and personal trainers may have exceptional knowledge and skills about how to strengthen specific muscles and how to motivate children to work, they do not always have the clinical experience and skills to identify exactly how to manage the neurological aspects of a condition.
As I discussed earlier, preparatory work is an important part of therapy in order to make it easier for children to then be able to activate the muscles that they actually need to strengthen. There are a lot of underlying neurological and sensory issues at play in children with conditions such as CP and paediatric physiotherapists have had specialised training and experience in dealing with these.
Combining intensive blocks of physiotherapy with intensive strength training is a great way of helping a child to reach their potential and will be so much more effective when providers communicate with each other and work towards achieving the same end goals.
6) Create a plan of action
After a block of therapy, your therapist will be able to provide you with advice regarding the next goals to work towards. This information can then be shared with other health professionals, carers, school staff or therapy providers as appropriate.
Intensive blocks of physiotherapy can be a great way of boosting your child’s abilities, confidence and independence, helping them to reach their full potential.
If you feel that your child might benefit from an intensive block of physiotherapy with us at Kids Therapy Wales, contact me to have a chat and to clear up any questions you may still have.
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