Intensive Therapy Services

The Stride ZeroG program utilises the latest understanding of neuroplasticity and rehabilitation technologies to accelerate a child's journey to independence. 

The research evidence is very clear that new skills are gained when learning occurs through active self-generated movement and problem solving, that are continually progressive, repetitive, with varied specific task practice with performance feedback provided on real life meaningful goals. 

Satisfaction of all of these features are critical in facilitating neuroplasticity and are the foundations of the Stride ZeroG program. 

The result is an increase in the skills and confidence necessary to walk and move independently without the fear of falling at school, at home and in the community.

The STRIDE protocols are directly informed by research that was undertaken by the team at Healthy Strides. In our recently published article in Developmental Medicine Children Neurology 2020 titled “Locomotor and Robotic Assistive Gait Training for Children with Cerebral Palsy”, objective data demonstrates that in children with cerebral palsy who are dependent on physical assistance and equipment throughout the day, locomotor training in combination with overground walking improves walking speed, gross motor skills, functional mobility independence and goal attainment.

Whilst the evidence is specifically for children with cerebral palsy, STRIDE is still relevant for children with other neurological conditions or injuries because it is based on the principles of motor learning and neuroplasticity. Locomotor training works because it is based on how the body learns and re-learns new motor skills. We now know that if there is focused attention on specific skills that is practiced consistently and repetitively in a fun and interactive environment with incremental challenges – we can re-teach the brain to make new pathways. 

Essentially, this describes Therapy369: 3 sessions a week for 6 weeks whilst incorporating the 9 principles of neuroplasticity. This dosage represents the minimum time that is needed to promote functional change with lasting effect (up to 6 months).

Task specific and goal directed training along with bimanual skills training have a high level of evidence. Evidence shows that intensive programs can improve functional upper limb skills, especially directly after medical interventions such as botulinum toxin (Botox) injections and upper limb surgery. 

To optimise the practice that is needed to develop the skills, we utilise the latest in upper limb technology for neurological therapy. This includes functional electrical stimulation and sensor technology. The sensor technology promotes self-directed movement in an engaging and motivating way with a variety of therapy video games and challenges.

In a publication published in Australian Occupational Therapy Journal in 2020 titled “What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review”, approaches described above have been shown to be the most effective. In this article, it was also shown that three individual goals can be achieved with a therapy dose of 14 to 25 hours. This is in line with our Therapy369 with Reach sessions occurring 3 times a week over 6 weeks whilst incorporating the 9 principles of neuroplasticity. 

Research supports the effectiveness of focused and specific activity based interventions to learn or relearn a skill. This is the basis of motor learning and neuroplasticity where it is understood that consolidated mass practice of specific tasks has the potential to change neurological pathways. 

In the article published in Physical and Occupational Therapy in Pediatrics in 2019 titled “Defining Functional Therapy in Research Involving Children with Cerebral Palsy: A systematic review”, the key ingredients for effective and functional therapy “emphasises the learning of motor abilities that are meaningful.” 

Therapies must be goal directed, focused on independence in activity or participation, are task specific and most importantly, require active involvement of the child or individual with a “hands-off” approach. These key ingredients are essential in promoting the best outcome and is why it is considered under the National Disability Insurance Scheme to be “evidence based” and “value for money”. Such an approach increases the likelihood for effectiveness which ultimately means a better outcome. 

This contrasts with therapies such as Neurodevelopmental Therapy or NDT (passive form) which has been shown to be ineffective in improving motor skills or non-evidence based approaches such as Cuevas Medek Exercise (or CME) and Dynamic Movement Intervention (or DMI) which are largely “hands on” approaches and departs far from the current research and evidence recommendations (Novak et al 2019: State of the Evidence Traffic Lights: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy). 

ACTIVATE works because it is based on the latest evidence on how the body learns and re-learns new motor skills. We now know that if there is focused attention on specific skills that is practiced consistently and repetitively in a fun and interactive environment with incremental challenges – we can re-teach the brain to make new pathways. The outcome of this is enhanced participation and this is always the ultimate goal.

Throughout 2019 and 2020, our clinical and research teams developed, provided and evaluated outcomes in 50 children with complex physical disabilities, equating to a combined total of 1540 hours of specialised therapy in the areas of communication, hands skills and gross motor skills. 

The program is unique in that it combines proven therapy techniques into the one program whilst set within the gold standard framework of being goal directed and family-centred. As such, it is the first of its kind, uniquely combining all of these approaches into a fun and intensive therapy delivery model, developed in partnership with consumers. Consumer involvement throughout its development and evaluation confirms the need for the program in our community.

In addition to consumer involvement, the formal evaluation of the program (through higher degree research at Curtin University) also demonstrates evidence of the effectiveness in improving socialisation, communication, gross motor skills, fine motor skills and confidence not just immediately after the program but most importantly, beyond the program demonstrating long lasting effects that are observable at home and in the community.

Given the evidence of why this unique program is needed, it is essential for research to now transition to becoming a program that is available to the wider community. This ensures that children with complex physical disabilities can gain access to this program supporting the vital need for school readiness in children with complex physical disabilities in Western Australia.

Research confirms that children with complex physical needs require safe, supportive, social and family-centred contexts with mechanisms like specialised health professionals, friends and fun forming the essential ingredients for promoting inclusion, community and participation. 

PARTICIPATE embraces these essential ingredients and as such, is positioned to have significant impact by optimising inclusion, community and participation in children with complex physical needs.

We do this by providing after school activity and sporting groups set within the community. The unique feature of this group is that it will be led by specialised health professionals and will not only be open to children with physical disabilities but also to their friends or siblings. This approach moves away from the traditional approach of groups for children with disabilities only. 

Rather, to promote inclusion and community, we will adapt and modify the environment and equipment to enable children of all abilities to be included. This is vital in promoting true inclusion within our communities and an understanding of diversity and acceptance for people of all abilities. 

This not only has a positive short-term impact with carry over into school but also has long-term implications for the entire school experience. In the long-term, research suggests that by ensuring a positive start to school (for the child, family and educators), there are a host of positive ramifications for the remaining of their school life.

PARTICIPATE is available for children that have already attended our other programs such as STRIDE, REACH or ACTIVATE. This ensures that our team already knows each child’s individual needs and requirements so that the group can be specifically tailored and adapted.