Evidence-Based Practice: Effective Occupational Therapy Treatments for Children with Osteogenesis Imperfecta

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. • 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.

5. Classifications of O.I., continued

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

7. WANTED:Occupational Therapistsfor 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 : • 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

17. Summary of Evidence, continued

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