How to Increase Home Exercise Program Compliance

How to increase home exercise program compliance for parents of children with disabilities can be a tough question to answer.  Parents have a tough job today.  Juggling work, home life, children’s schedules, homework assignments and more can feel impossible on some days.  Add home exercise programs for parents to perform with their children in between therapy sessions and it can certainly feel like overload.  As therapists, we know that parental participation in a home exercise program can have positive effects on the children and even themselves.  For example, it can be very difficult to teach a child to get dressed independently, but once they can do the skill by themselves, it is one less skill a parent has to help with.  We need to be cognisant of the fact that parents need all the help they can to make carry over of home exercise programs easier.  According to the recent research below, the therapist’s delivery of the home exercise program can make a big difference!

Recent research investigated whether the different behaviors of health professionals and parents influenced home exercise compliance in terms of frequency and duration for children with disabilities.  Parents completed a survey in 18 different early intervention facilities to determine how physicians and therapists interventions influence parents regarding their adherence to a home exercise program (HEP).  The results indicated the following:

• rate of adherence to the prescribed frequency and duration of the HEP was similar (about 61%)
• parents who were comfortable integrating the exercises into their daily routine had a higher probability of adherence to the frequency and duration
• there was a significant impact on the frequency of the HEP being completed when the professional provided information about: the progress, evolution and usefulness of the exercises, ways to include them into the daily routine, checking on skills during follow up and asking about HEP adherence.

The researchers concluded that physicians and therapists can help to increase HEP compliance by providing information on the purpose of the exercises, instructions for the HEP, tips on incorporating the HEP into the daily routine and following up by checking skills and asking about HEP adherence.

Reference:  Medina-Mirapeix, F., Lillo-Navarro, C., Montilla-Herrador, J., Gacto-Sanchez, M., Franco-Sierra, M. Á., & Escolar-Reina, P. (2017). Predictors of parents’ adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design. European journal of physical and rehabilitation medicine.

Therapeutic Activities for Home and School provides pediatric therapists with over forty, uncomplicated, reproducible activity sheets and tips that can be given to parents and teachers. Each activity sheet is written in a simple format with no medical terminology. The therapist is able to simply mark the recommended activities for each child. By providing parents and teachers with these handy checklists, therapists will be encouraging therapeutic activities throughout the entire day rather than time set aside for traditional home exercise programs. This book is an essential tool for all school based therapists to facilitate carry over of therapeutic activities in the home and classroom.  FIND OUT MORE INFORMATION.

The post How to Increase Home Exercise Program Compliance appeared first on Your Therapy Source.

Survey Results Are In.....

The results are in from the latest survey when we asked pediatric OTs, PTs, parents and teachers this question –  “what characteristics of activities or exercises influences successful carry over of recommendations at home or in the classroom”?

We had a whopping 320 responses!  Not surprisingly close to 70% were pediatric occupational therapists and occupational therapy assistants.  I was hoping for more parents and teachers to respond to hear their opinions but no such luck.

Here are the top 5 responses of what makes an occupational or physical therapy carry over activity successful (each participant could choose more than one response):

1.  Activities are incorporated into the daily routine

2.  Requires a short amount of time (less than 5 minutes)

3.  The overall benefit of the exercise program or activity

4.  Child can complete activity/exercises independently

5.  How well the activities were explained by the therapist

Check out the rest of the results at http://yourtherapysource.com/surveyotptcarryover.html

Participate in the current survey here http://yourtherapysource.com/survey.html

Therapeutic Activities for Home and School provides pediatric therapists with over forty, uncomplicated, reproducible activity sheets and tips that can be given to parents and teachers.  Available in print or immediate electronic delivery at http://yourtherapysource.com/therexbook.html.

Follow Through with Home Physical Therapy Programs

Musculoskeletal Care published research on adherence to home physiotherapy in children and young people with joint hypermobility.  Twenty eight families participated in a qualitative study that included multidisciplinary treatment interventions including physical therapy for children (5-17 years old).  The parents and the children reported that exercise helped the symptoms of joint hypermobility. 

There was increased follow through to exercise programs with the following:

• Parental motivation
• adapting family routines
• making exercise a family activity
• seeing benefit increased adherence to exercise

When exercise programs were not adhered to the following was reported:

• lower levels of parental supervision
• not understanding the treatment
• not seeing benefit 
• not having specific time to dedicate to doing the exercises.

Reference:   Birt, L., Pfeil, M., MacGregor, A., Armon, K. and Poland, F. (2013), Adherence to Home Physiotherapy Treatment in Children and Young People with Joint Hypermobility: A Qualitative Report of Family Perspectives on Acceptability and Efficacy. Musculoskelet. Care. doi: 10.1002/msc.1055

5 Simple Reminders for Exercise Programs

Therapists frequently recommend exercise programs for the classroom, home or community.  It can be difficult for individuals, teachers and parents to remember to perform the activities.  Here are a few simple reminders to increase the likelihood of completing the exercises:

1.  Set an alarm - Get an inexpensive alarm clock and set it to go off one time per day when it is convenient to perform the activities.  Each day that it goes off it is time to perform the exercises.

2.  Provide the child with a wristwatch - There are inexpensive digital wrist watches that you can set an alarm on.  When the child is at school they can receive the reminder to perform the activities.

3.  Apps - There are many apps that can provide push notifications to remember to perform certain tasks.  For example, Remember the Milk is free and allows you to customize online or via the app to get reminders via text messaging and email.

4.  Match it up with a daily activity - recommend that the exercises be performed each day when changing into pajamas.  Too busy at that time, try after lunch.  This will help the exercises to become part of the daily routine.

5.  Provide written instructions to hang on the refrigerator or stick inside a binder - Make sure you provide simple exercises with written instructions that the individual can refer to if necessary.  Keep the exercises simple in order to remember to do the set of the exercises each day.
Therapeutic Exercises for Home and School offers simple ideas for exercise programs that can be reproduced.

Set Goals for Yourself in 2012

With the start of a new year, how about setting some basic goals for yourself to accomplish in 2012. Here are a few suggestions:

1. Realistic Home/Classroom Programs - I will make every effort to provide parents and teachers with activities that are easy to carry out in the home or classroom (see below for ideas).

2. Take the time to observe - I will take the time to just observe. I will document observations in the classroom or home in writing or with photographs. It is very difficult to determine needs if you do not have an idea of baseline issues.

3. Make the children part of the therapy process - I will incorporate the children in each therapy session by allowing them to make choices. I will discuss goal setting with each child.

4. Be patient - I will encourage children to think critically and problem solve independently by allowing them enough time to form a motor response without interfering. Therapy sessions usually only last 30 minutes and we want to jam pack them with activities. Slow down and let the children respond - quality is better than quantity. Let me re-phrase that...independence is better than dependence (regardless of quality at times).

5. Document correctly in a timely manner - I will document therapy sessions immediately following the session so that the documentation is accurate.

6. Set a goal for each therapy session - I will set small, realistic goals for each therapy session.

7. Keep it fun, fun, fun!!!! - I will keep therapy sessions fun. Some children have to attend therapy sessions for years, keep it novel, motivating and fun.

Care to add to the list with your goals for 2012?





Need some easy activities for Goal #1? Try these reproducible forms from Therapeutic Activities for Home and School.

Occupational Therapy Home Programs Effective for CP

Pediatrics has published a study on the benefits of providing occupational therapy home programs for children with cerebral palsy.  A double blind, randomized controlled trial was done with 36 children with cerebral palsy (mean age 7.7 years old).  The children were GMFCS Levels I through V.  One group was to receive and follow the OT home program for 8 weeks, one group to follow OT home program for 4 weeks and the control group received no OT home program.  The parents of the children in the OT home program for 4 weeks did not discontinue the home program after 4 weeks and continued to do the program for the full 8 weeks.  Following the 8 weeks, the groups that received the OT home program showed a significant difference in function and parent satisfaction with function.  The researchers concluded that occupational therapy home programs:

"developed with a collaborative, evidence-based approach and implemented by parents at home were clinically effective if implemented 17.5 times per month for an average of 16.5 minutes per session".

 You can read the full article at Pediatrics.

Reference:   Iona Novak, Anne Cusick, and Natasha Lannin. Occupational Therapy Home Programs for Cerebral Palsy: Double-Blind, Randomized, Controlled Trial. Pediatrics October 2009; 124:4 e606-e614; published ahead of print September 21, 2009, doi:10.1542/peds.2009-0288

Physical Education and Section 504 or IEP's

There was an interesting news story this week in the Philideplphia Inquirer. A sixth grade boy with diabetes and his parents are requesting daily physical education under Section 504. The parents say that the daily exercise of physical education have helped their son "to maintain his health and alertness" to participate in school. The school has turned down daily physical education and offered other suggestions to increase daily physical activity for the student. This issue is going to a due process hearing.

Please take a minute to vote on this issue at the poll on the right hand side of this blog. Should physical education be mandated on a Section 504 or IEP for a student with a disability?

If a similar issue has occurred in your district please comment below.

Need some ideas in your district to encourage movement and diabetes prevention? Download this free guide from the National Diabetes Education Program.

OT Home Programs Make a Difference!

I was so excited to find this recent research. Finally, some strong statistics supporting that occupational therapy home programs make a significant difference in a child's life. Pediatrics published research on children with cerebral palsy who received occupational therapy home programs. There was 36 children in the study (mean age of 7.7 years old) with gross motor classification levels I through V. Eighty five percent of the children exhibited spasticity, 14% dyskinesia and 3% with ataxia. A double blind, randomized controlled study was done comparing groups of children who received 8 weeks of an OT home program and a control group. At the end of the 8 week session, the children who participated in the OT home program exhibited statistically significant improvements in function and parent satisfaction with function. The researchers concluded that pediatricians should recommend a collaborative, evidence based OT home program which should be carried out 17.5 times per month for 16.5 minutes per session.

Reference: Novak, Iona, Cusick, Anne, Lannin, Natasha Occupational Therapy Home Programs for Cerebral Palsy: Double-Blind, Randomized, Controlled Trial Pediatrics 2009 124: e606-e614

Need activity ideas for occupational therapy home programs? Check out Therapeutic Activities for Home and School.