Evidence Based Practice

We established The Healthy Strides Foundation in 2018, on the back of a research study that we conducted at Princess Margaret Hospital, now Perth Children’s Hospital between 2015 and 2017. This study was designed to address a major gap in interventions for children with cerebral palsy that rely on equipment and physical assistance throughout the day.[1] The results from the study as well as the persistent urge from the families in the study was the sole reason why we, as the research team decided that we had something to contribute to our community. 

As a team, we were committed to bringing the research findings to the wider community so that more children and young people would benefit from what we had found. We were committed to being a not-for-profit organisation, we were committed to being grounded by the research and evidence and we were committed to continually contribute to the research so that more children, not just in Western Australia but Australia wide and globally would benefit from new and effective interventions. We saw first-hand, the impact of research findings derived from well-designed studies on the health and well-being of children with physical disabilities. 

When it comes to motor interventions (i.e., approaches that improve motor skills such as gross motor or fine motor skills) there are some clear principles that have been shown to be the most effective. This relates to the principles of neuroplasticity and the “F-word” framework.[5, 8] When adopting an evidence-based approach, it is vital that we use interventions that have the greatest odds of achieving motor skills.[9] At the core, interventions need to be:

• Motivating and engaging – in a child’s world, this does mean it needs to be fun! The more engaging and motivating the intervention, the more attention the child is paying to it and this is crucial in learning new skills and establishing neuroplastic changes.[4]

• Task-specific practice that is rewarding and enjoyable – to develop new skills, practice needs to be meaningful to the child and the family. If it is meaningful, it will produce spontaneous and regular practice (both in and out of the therapy setting) and this is a wonderful strategy for getting greater intensity and repetition.[4, 9]

These approaches tend to be more “hands-off” in nature. The role of the therapist is less about holding, positioning, aligning and more about setting up the environment and using equipment. This way, it is more about movements that are initiated by children. Child initiated problem solving and child initiated movement is the key to establishing the motor circuitry for neuroplastic changes.[4] In fact, excessive external sensory input has been seen to disrupt this process.[10]

The most current and up to date approach focuses on meaningful activities and participation in daily life. Approaches that focus on what we call “body structure and function” of the ICF framework (Figure 2.0) are less effective in achieving and improving daily, meaningful skills that are needed to be part of the community and to participate in life. As such, researchers and scientists are able to confidently say that these approaches should be “discontinued based on current evidence.”[11] 

These approaches include techniques known as neurodevelopmental therapy (or NDT), Vojta, Cuevas-Medek (or CME) and Dynamic Movement Intervention (or DMI). The basis of these approaches depart from what we know is effective in improving motor outcomes. As such, the decision for us as researchers, scientists and clinicians at Healthy Strides is to not provide these techniques because there are evidence-based interventions that have better odds or greater possibilities of achieving motor outcomes in children. 

This decision is not based on a personal objection by any means. It is guided by the current state of the evidence and highlights the reasoning for Healthy Strides’ core value of providing only evidence-based approaches so that we have the greatest odds of achieving outcomes. This approach optimises the opportunities for children to spend more time out of a therapy setting, and more time in the world with their friends, family and attend school.

There is more published research in the area of cerebral palsy because it is the most common cause of physical disability in childhood.[12] However, we know that the development of new motor skills and the framework for developing interventions (the ‘F-words’) is not diagnostic specific – in fact it relates to all of us! [8, 13]. In the absence of diagnostic specific interventions, we can still apply the active ingredients of effective motor interventions that relate to cerebral palsy. 

What is hugely important is that information about interventions is provided to enable families to make an informed choice. Only families know their own circumstances, their child and what works for them so there is never any judgement about the choices that families make. At the core, families just need to be able to make a choice based on the most relevant information available. An informed choice is ultimately a good choice!