Utilizing Episodic Care to Increase Participation in Valued Activities.

Case Study Report
Population: Pediatric

Jennifer M. Angeli, PT, DPT, PhD, Physical Therapist III, Division of Occupational Therapy and Physical Therapy- Cincinnati Children’s Hospital Medical Center Jenny.Angeli@cchmc.org

Keywords: Participation, Cerebral Palsy, Goal attainment

Background and Purpose: Children with disabilities demonstrate lower levels of physical activity than their typically developing peers. We propose that the episodic model of therapy, targeting the attainment of a functional goal over an intense and finite period of time, may help to increase active participation in this at-risk population. In the present case, we present the results of an individualized coaching plan that that encouraged active behavior in a young man with Cerebral Palsy.

Case Description: A 17-year old male expressed frustration in an annual CP Clinic visit with his performance in gym class. He was unable to keep up with peers during gym class and reported emesis during PACER testing. Through semi-structured interview with a therapy team, he identified interest in completing a 5K race. His valued end of treatment scenario was to do so in a 30 minute time period. Over the course of a six week period, he participated in a fitness program that included community running, with a focus on self-pacing, and social interaction. The therapy dose was augmented by a home activity program.

Outcomes: Assessments completed prior to the therapy episode, and again at completion include the Bruininks-Oseretsky Test of Motor Proficiency Strength & Agility subtest (BOT), oxygen consumption, temporal spatial walking measures, 6-minute walk test, Canadian Occupational Performance Measure (COPM), and Goal Attainment Scaling (GAS). The participant’s BOT percentile rank improved from 21% to 31% for his age group. At baseline testing, his oxygen cost was 20% above average, and at post-testing O2 cost improved to only 5% above average. He also demonstrated the ability to increase his six-minute walking distance from 1546 ft to 1962 ft, a 27% increase. He demonstrated significant changes in performance of valued activity and satisfaction with performance of those activities, as indexed by the COPM. Moreover, he met or exceeded expectations on all goals on the GAS, also demonstrating a clinically meaningful improvement from his baseline performance.

Discussion: Therapies have long emphasized the improvement of “body functions”, like strength or range of motion, through a once weekly model of care. This approach produced only limited gains for the young man described in this case. An intensive episode of care emphasizing the achievement of meaningful, patient-identified goals appears to be associated, in at least this limited case, with many important improvements in the domain of “participation”. We delivered both a satisfying and effective burst of services that have triggered a sequelae of continued gains in activity, including conditioning for high school soccer and bicycle riding in a young man with Cerebral Palsy. Models of care and intervention approaches that accomplish comparable outcomes and associated increases in perceived value and experience with therapy services should continue to be explored in the new, patient-centric healthcare climate.

Angeli, Jennifer M., PT, DPT, PhD. Utilizing Episodic Care to Increase Participation in Valued Activities.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/026_schmit/