How do I know if I should seek an intensive at Little Tracks for my child?

Little Tracks specializes in intensive treatment for children with neuromotor disabilities, which includes the following diagnoses: Cerebral Palsy, Ischemic or Hemorrhagic Stroke, Traumatic Brain Injury, Congenital Brain malformation, and other injuries affecting neuromotor development. Please reach out in the “contact us” section if you have ANY questions about if your child falls within the scope of Little Tracks’ intensives.

Intensive treatment works best if you have 1-2 specific motor goals to address for your child.

Examples of specific goals for a Pediatric Constraint Induced Movement Therapy (P-CIMT) intensive are: awareness and initiation of the weak side for movement, reaching, accepting weight on the weak arm or leg, and grasping items with the weak hand. Just to name a few.

Examples of specific goals for a Whole Body intensive are: independent sitting, crawling, standing, or taking steps with or without an assistive device.

What type of therapy has the most evidence in Pediatrics?

Current research emphasizes individualized goal-directed and task specific training as the most effective therapies for children with neuromotor disability. This means that therapy sessions involving practice of functional tasks are the most effective! For example, if a family has a goal of their child being able to dress themselves, the therapy session should include practicing getting dressed as “whole practice”. Practicing aspects of getting dressed throughout the session as “part practice” should also be included. Examples of part practice for getting dressed are: sitting while reaching up to get items off their head (like a silly hat!) or practice grasping cloth items with their weaker hand and pulling them in all directions. In short, your child’s session should consist of relevant, real life practice of the skills they want (and you want for them!) to do.

Current research also shows that children respond best to “cognitive interventions that include active, self-initiated, self generated movements of real tasks with observable consequences.” (Morgan et.al) So rather than focusing on reflexive movements, your child’s body and brain should be engaged throughout their entire therapy session! Trained therapists are key to selecting activities based on child interest to keep engagement sharp. Therapists should also be skilled in grading and shaping tasks to allow for the child to maximize a child’s motor learning.

Read more about evidence for effective therapy treatments in these articles below!

1. Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, Toovey RAM, Greaves S, Thorley M, Novak I. Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Dev Med Child Neurol. 2022 May;64(5):536-549. doi: 10.1111/dmcn.15055. Epub 2021 Sep 21. PMID: 34549424.

2. Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, de Vries LS, Dusing S, Einspieler C, Eliasson AC, Ferriero D, Fehlings D, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Mak C, Maitre N, McIntyre S, Mei C, Morgan A, Kakooza-Mwesige A, Romeo DM, Sanchez K, Spittle A, Shepherd R, Thornton M, Valentine J, Ward R, Whittingham K, Zamany A, Novak I. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatr. 2021 Aug 1;175(8):846-858. doi: 10.1001/jamapediatrics.2021.0878. PMID: 33999106; PMCID: PMC9677545.

3. Heathcock JC, Baranet K, Ferrante R, Hendershot S. Daily Intervention for Young Children With Cerebral Palsy in GMFCS Level V: A Case Series. Pediatr Phys Ther. 2015 Fall;27(3):285-92. doi: 10.1097/PEP.0000000000000149. PMID: 25974119.

What is ACQUIRE Therapy?

ACQUIRE Therapy is a framework developed by a team of therapists, psychologists and researchers at Virginia Tech and the University of Alabama-Birmingham (UAB). The ACQUIRE framework has been refined through clinical work at The Fralin Biomedical Research Institute at Virginia Tech, and through NIH funded trials entitled the CHAMP study, the babyCHAMP study, and the I-ACQUIRE study. Medical University of South Carolina participated as a site for the I-ACQUIRE study which was a national multi-site trial. Julia was trained as an intervention therapist in this study in 2021 and has been actively implementing this treatment for 500+ hours a year since.

The ACQUIRE framework combines high-dosage intensive therapy with the evidence-based concepts of goal-directed, task-specific, and child active engagement. There is an emphasis on the therapist-child interaction, where the therapist learns to individualize tasks based on how the child reacts to the activity. It treats each child as the individual they are and makes it FUN to participate each day together.

ACQUIRE framework also incorporates motor learning concepts with grading, shaping and refinement of skill progression. Basically, ACQUIRE therapists are experts in adjusting tasks to create the “just right” challenge for your child based on their skill level. Then they are able to gradually increase task difficulty in a way that makes sense to the child and feels relevant to them!

Read more about the ACQUIRE protocol in the articles cited below!

1. DeLuca S, Mary Rebekah Trucks, Wallace D, Sharon Landesman Ramey. Evidence for Using ACQUIRE Therapy in the Clinical Application of Intensive Therapy: A Framework to Guide Therapeutic Interactions. Behavioral sciences. 2023;13(6):484-484. doi:https://doi.org/10.3390/bs13060484

2. Ramey SL, DeLuca S, Stevenson RD, Case-Smith J, Darragh A, Conaway M. Children with Hemiparesis Arm and Movement Project (CHAMP): protocol for a multisite comparative efficacy trial of paediatric constraint-induced movement therapy (CIMT) testing effects of dosage and type of constraint for children with hemiparetic cerebral palsy. BMJ Open. 2019 Jan 15;9(1):e023285. doi: 10.1136/bmjopen-2018-023285. PMID: 30782701; PMCID: PMC6340418.

3. Ramey SL, DeLuca SC, Stevenson RD, Conaway M, Darragh AR, Lo W; CHAMP. Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial. Pediatrics. 2021 Nov;148(5):e2020033878. doi: 10.1542/peds.2020-033878. Epub 2021 Oct 14. PMID: 34649982; PMCID: PMC11632840.

What is Pediatric Constraint-Induced Movement Therapy (P-CIMT)?

Pediatric Constraint Induced Movement Therapy (P-CIMT) is a type of therapy treatment for children with one-sided weakness following a central nervous system injury (like a stroke or a brain bleed) or a peripheral system injury (like a brachial plexus injury). A true P-CIMT protocol includes all of the following:

1. Constraint of the less affected arm using a splint or a cast

2. High Dosage therapy (daily therapy of 2-6 hours a day for 4 weeks)

3. High quality therapy with shaping techniques and repetitive practice with task variation led by a trained therapist

4. Sessions taking place in a child’s natural environment

5. A Transition or Discharge Plan is provided for carryover of skill after the high dosage protocol has finished.

Little Tracks’ P-CIMT treatments include all of the above evidence-based elements while having the added component of adhering to the ACQUIRE framework which has been utilized in multiple national multi-site research trials. This will only add to the efficacy and potential success of your child’s treatment!

See the sources below for more information!

1. Ramey, S., Coker-Bolt, P., & DeLuca, S. (2013). A Handbook of Pediatric Constraint-Induced Movement Therapy (P-CIMT): A Guide for Occupational and Physical Therapists, Researchers, and Clinicians. Bethesda, MD: American Occupational Therapy Association Press.

2. DeLuca S, Mary Rebekah Trucks, Wallace D, Sharon Landesman Ramey. Evidence for Using ACQUIRE Therapy in the Clinical Application of Intensive Therapy: A Framework to Guide Therapeutic Interactions. Behavioral sciences. 2023;13(6):484-484. doi:https://doi.org/10.3390/bs13060484

What does a typical day look like during an intensive?

3 hour intensive:

7:30AM-10:30AM

Goals: 1. Grasp pants waistband to pull up with both hands in standing. 2. Squat to the floor and stand back up without falling.

7:30-8:00AM- Initial play session in living room. Child and therapist practice reaching with the child’s weak arm and pushing on the floor with the weak arm to move. Utilizing music toys to motivate transitioning.

8:00-8:30AM- Eat breakfast. Therapist and child work on grasping a handled cup, grasping utensils and reaching to choose preferred items to eat. Alternative for younger child: drink milk from a bottle with handles.

8:30-9:00AM- Brush Teeth, Get Dressed, Wash Face. Child works on grasping toothbrush and turning hand in different directions while grasping. Grasp clothes out of the couch cushions to keep the couch from “eating the clothes!” Work on grasp to pull shirt overhead and pull pants up. Grasp washcloth and wipe face.

9:00-9:30- Focused Movement. Incorporation of sit to stands, squats, and weight shift to weaker side. Picking up mickey mouse figurines from various surfaces and bringing them over to a slide!

9:30-10:00- Play doh activity. Strengthening arm by pushing play doh onto a cookie sheet to “make cookies for the dinosaur”. Picking up the play doh pieces to “feed to the dinosaur”.

10:00-10:30 Floor activities. Side sitting towards weak side to reach to pop bubbles. Transitioning to tall kneeling and half kneeling to get bubbles up high! Grasping by opening and closing a shoebox with bubbles and other surprise toys inside to “help pop the bubbles!”

All done!

6 Hour Intensive

7:30AM-1:30PM

Goals: 1. Grasp pants waistband to pull up with both hands in standing. 2. Squat to the floor and stand back up without falling.

7:30-8:00AM- Initial play session in living room. Child and therapist practice reaching with the child’s weak arm and pushing on the floor with the weak arm to move. Utilizing music toys to motivate transitioning.

8:00-8:45AM- Eat breakfast. Therapist and child work on grasping a handled cup, grasping utensils and reaching to choose preferred items to eat. Alternative for younger child: drink milk from a bottle with handles.

8:45-9:15AM- Brush Teeth, Get Dressed, Wash Face. Child works on grasping toothbrush and turning hand in different directions while grasping. Grasp clothes out of the couch cushions to keep the couch from “eating the clothes!” Work on grasp/reaching to pull shirt overhead and pull pants up. Grasp washcloth and wipe face.

9:15-10:15- Focused Movement. Incorporation of sit to stands, squats, and weight shift to weaker side. Picking up mickey mouse figurines from various surfaces and bringing them over to a slide!

10:15-11:00- Prepare and eat a snack together. Right hand grasps measuring cups with different fruit pieces inside and dumps them onto child’s tray table. Therapist and child work on grasping a large spoon or shovel and spooning fruit into a bowl. Practice grasp of fork and poking large fruit pieces on tray table.

Alternate to snack: Sensory activity in water. Utilize sponges to grasp and squeeze water out. Utilize measuring cups to scoop water in the sink and manipulate plastic figurines that go in and out of cups/buckets.

11:00-11:45 Play doh activity. Strengthening arm by pushing play doh onto a cookie sheet to “make cookies for the dinosaur”. Picking up the play doh pieces to “feed to the dinosaur”.

11:45-12:30 Floor activities. Side sitting towards weak side to reach to pop bubbles. Transitioning to tall kneeling and half kneeling to get bubbles up high! Grasping by opening and closing a shoebox with bubbles and other surprise toys inside to “help pop the bubbles!”

12:30-1:00 Eat lunch. Therapist and child work on grasping a handled cup, grasping utensils and reaching to choose preferred items to eat. Alternative for younger child: drink milk from a bottle with handles.

1:00-1:30: Wind down by reading books. Focus on wrist extension to turn board book pages placed in front of child and to manipulate flaps.

All done!