Pediatric Physical Therapy Journal Club
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Focus on Function
- We discussed the pros and cons of the primary therapist model which streamlines things for the family and avoids conflicting messages from multiple therapists, but places increased demands on the therapist who may feel out of their scope of practice. Some decisions may be delayed because you have to take questions back to someone for help.
- We talked about how to approach the topic of encouraging compensatory strategies with parents and teachers. Stress variety, that a child can have several different ways of moving or sitting. Get away from "right" vs. "wrong" thinking. Use literature to support the discussion.
- Stretching was briefly discussed but we felt that the since the study did not address it specifically then no strong conclusions can be reached. See the stretching discussion from 2009 for more on this topic.
- Frequency of therapy may be critical to the success of any intervention. We discussed limited family resouces and the huge comittment of time weekly therapy requires. This means less time for other activities. The Glenrose does offer focused episodes of intervention on a once to twice weekly basis. Important to empower parents to engage them in the frequency discussion.
- Many success stories were shared about context based therapy. The simple act of putting a chair designated specifically for a boy at the school mudroom allowed him to dress quickly enough to enjoy recess with his friends. The Learn to bike program sponsored by the Edmonton Bicyclist Commuters society is another great success!
- Some families may want to focus on skill components, others want to work on functional goals. We found that this decision depends on the family's belief systems, cultural views and perception of disability. Lots of emotional issues surround this. We've also found that this decision can be highly influenced by doctors and other professionals working with the child.
- Videotaping is recommended in context therapy. This is an excellent way to communicate between the community therapists and the Glenrose, by videoing the child in his natural environment. It also is a great way to include the parent in the therapy process by analyzing the activity together. Important to consider reaction of the children since they may be self-conscious about it.
- In the study, some therapists reported that focusing on the task and environment was discomforting because they did not feel that it was "true" therapy. We talked about how its important to explain to the family what is going on to get buy in (we're not just playing). Many therapists feel pressured by doctors to focus more on the body structure and function level. Everyone agreed that in their typical practice they combine both the context focused approach along with child based therapy.
