Project Description
This doctoral capstone project aims to explore and better define the role of occupational therapy (OT) in the treatment of children with cerebral palsy (CP) pre/post selective dorsal rhizotomy (SDR). In partnership with Huntington University, survey research was completed along with the creation of educational resources for students and clinicians to support and advocate for the value of OT services when working with SDR patients.
Mission Statement
To gain comprehensive knowledge and provide resources to promote ways in which occupational therapy can maximize a child with cerebral palsy’s overall success pre/post selective dorsal rhizotomy.
Vision Statement
To demonstrate the value of occupational therapy services in order to further increase the quality of life for children with cerebral palsy pre/post selective dorsal rhizotomy.
Project Planning
Prior to the on-site experience, extensive planning was completed to identify the need for the project. To determine the need, I analyzed evidence-based literature from public and private online domains and collaborated with practitioners of varying professions. In doing so, I created a formal needs assessment and literature review.
Needs Assessment
According to literature and current occupational therapy practitioners (OTPs) in the field, there is a lack of resources and educational materials addressing the treatment and care of SDR patients from an OT perspective. Additionally, there is a large variation in OT intervention, assessments, intensity, duration, and frequency following SDR as well as a lack of knowledge of specific outcomes of OT intervention following SDR.
Continuing to complete research, along with educating and advocating for OT’s role in the treatment and care of SDR patients can allow for a more comprehensive treatment plan and can maximize the child’s overall success and independent function.
Literature Review
- CP is the most common motor disability in childhood and spastic cerebral palsy affects about 80% of the CP population (CDC, 2022; Durkin et al., 2016).
- SDR has been found to effectively reduce lower limb spasticity in children with CP over the last 100 years and was labeled as (“green go”) using the GRADE and the Evidence Alert Traffic Light System (Novack et al., 2020; Tu & Steinbok, 2020).
- In the last 30 years, there has been an increase in SDR for tone management (Tu & Steinbok, 2020).
- Current studies have found significant evidence supporting the short and long-term benefits (Park et al., 2018).
- Occupational therapy practitioners (OTPs) can specifically work with SDR patients to address upper and lower extremity tone and spasticity, pain, functional status, activity-based problems related to mobility and motor skills, postural control, quality of life, and ADLs/IADLs (Anaby et al., 2017).
Project LeaD
As the project lead, I had the responsibility of planning, developing, implementing, and executing my project. I had collaborative correspondence with both my faculty and expert mentor throughout the entirety of my project along with key stakeholders. With the guidance of my mentors, I met my outcome measures and learning objectives through my deliverables. I was responsible for submitting my hours each week and meeting the needs of the capstone course within the specific time frames.
Expert Mentor
Heather Forst provided expertise in her specialty areas of inpatient rehab, SDR patients, and research as a clinical educator. She ensured the project remained occuapation-based and oversaw the overall productivity of this capstone experience.
Faculty Mentor
Dr. Patricia Henton provided assistance and mentorship to this doctoral capstone utilizing her expertise in the pediatric population and extensive experience with research.
Project Outcomes
This capstone project had a total of seven deliverables which are outlined below.
Survey for Pediatric OT Practitioners: Occupational Therapy’s Role in the Treatment of Children with Cerebral Palsy Pre/Post Selective Dorsal Rhizotomy
Infographic of Data Analyzed from Survey Research
Data collection was facilitated by the use of an online survey website. Quantitative data was analyzed using descriptive statistics and graphical representations of data from close-ended questions. Qualitative data from open-ended questions was analyzed using manual coding from researchers and identifying themes and/or trends in responses. Data was analyzed in Microsoft Excel and then infographics were created to display occupational therapy’s role in the treatment of children with CP pre/post SDR.
Occupation-Based Activity Workbook
This workbook aims to provide occupational therapy practitioners with a resource that can help guide treatment for children with CP following an SDR procedure. This resource provides occupation-based activities accompanied by different modifications and suggestions following SDR. The overall goal is to promote function, independence, and participation for SDR patients.
Occupation-Based Presentation
This presentation aims to provide knowledge on this topic from an occupational therapy viewpoint as well as educate and advocate for the value of OT services for these children pre/post SDR. An in-person Lunch & Learn was held for Huntington University’s OTD program in Fort Wayne for students and faculty. The 40-minute presentation was recorded on zoom for those not able to attend.
Analysis of educator effectiveness on the topic
OTD student attendees at Huntington University participated in a pre/post survey to gauge the educator's effectiveness on the topic. The attendees answered the same 4 questions before and after with the addition of one question at the end. The results are shown in the form of pie charts to show their increase of knowledge following the presentation.
Interview summaries with expert practitioners
Future Direction
My doctoral capstone experience has provided me with advanced knowledge, research skills, and professional development, better equipping me to work with the pediatric population directly following graduation. I aim to continue to advocate for the SDR population and educate on the value of OT services following the procedure. If you ever need to reach me in the future, my contact information is as follows:
References
Anaby, D., Korner-Bitensky, N., Steven, E., Tremblay, S., Snider, L., Avery, L., & Law, M. (2017). Current rehabilitation practices for children with cerebral palsy: Focus and gaps. Physical and Occupational Therapy in Pediatrics, 37(1), 1–15. https://doi.org/10.3109/01942638.2015.1126880
Centers for Disease Control and Prevention. (2022). What is cerebral palsy? U.S. Department of Health and Human Services. https://www.cdc.gov/ncbddd/cp/facts.html
Durkin, M., Benedict, R., Christensen, D., Dubois, L., Fitzgerald R., Kirby, R., Maenner, M., Braun, K., Wingate, M., Yeargin-Allsopp, M. (2016). Prevalence of Cerebral Palsy among 8-Year-Old Children in 2010 and Preliminary Evidence of Trends in Its Relationship to Low Birthweight. Pediatric and Perinatal Epidemiology 30(5): 496-510. https://doi.org/10.1111/ppe.12299
Novak I., Morgan C., Fahey M., Finch-Edmondson M,. Galea C., Hines A., Langdon K., Namara MM., Paton MC., Popat H., Shore B., Khamis A., Stanton E., Finemore OP., Tricks A., Te Velde A., Dark L., Morton N., Badawi N. (2020). State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Pediatric Neurology, 20(3). https://doi.org/10.1007/s11910-020-1022-z
Park, T., Dobbs, M., Cho, J. (2018). Evidence supporting selective dorsal rhizotomy for treatment of spastic cerebral palsy. Cureus. 10(10): e3466. https://doi.org/10.7759/cureus.3466
Tu, A., & Steinbok, P. (2020). Long term outcome of selective dorsal rhizotomy for the management of childhood spasticity—functional improvement and complications. Child’s Nervous System, 36(9), 1985–1994. https://doi.org/10.1007/s00381-020-04747-8