Contact Us

Alternative Treatments for Children with CP and Other Neurological Disorders - Q&A - November 2009

< Back to Previous Page

[Image: napa.JPG]

Alternative Treatments for Children with CP and Other Neurological Disorders

By: Rafael Muñoz, PT, DPT, CSCS, NAPA Center

What is intensive suit therapy?

Intensive Suit Therapy is primarily used in the treatment of cerebral palsy. It is based on the Adeli Method- a model utilized by practitioners in Russia and later Poland- consisting of physical therapy interventions lasting up to 4-6 hours per day for 5-6 days per week for 3-4 weeks. The primary components of this method consisted of 90-120 minutes in an Adeli Suit, with the remainder of the time performing various strengthening, conditioning, and developmental activities utilizing a Universal Exercise Unit (also known as a Multifunctional Therapy Unit) the majority of the treatment duration. Purists usually do not combine the terms “intensive suit therapy”, but for simplicity intensive therapy including suit therapy will be referred to as “intensive suit therapy”.

The Adeli Suit’s basis originated in the Russian space program where its precursor was initially applied to the cosmonauts to combat the impairments suffered during and following space travel. In essence, the suit is a dynamic orthotic that must be applied by a trained individual in order to facilitate or inhibit certain movements, assist with the development of optimal posture, assist with or supplement the restoration of proprioception, or used as resistance to increase the strength of the patient. The NeuroSuit and TheraSuit are other suits that are based on the Adeli Suit, and utilize the same principles as the Adeli Suit.

In the Adeli Method, patients are expected to go through a protocol of certain exercises and developmental activities; however, other practitioners of suit therapy have started to apply various treatment paradigms to indicated patients e.g. neurodevelopmental treatment techniques and proprioceptive neuromuscular facilitation techniques/theory among others.

The Multifunctional Therapy Unit is a simple cage that offers many attachment sites for pulleys that will be used for strengthening, flexibility, and reciprocal movement patterning. Additionally, a harness may be placed on a patient, and elastic bungee cords are attached from the harness to the desired level on the cage in order lend the patient increased stability and/or body-weight support without the assistance of the therapist. The key point of the latter intervention is to give the patient the independence to complete tasks they normally would not be able to without the assistance of a person (i.e. the “ah ha!” moment).

How does Intensive Suit therapy benefit children with CP?

The children receive an average of 60 hours of therapy in a three week intensive suit therapy session. Comparitively speaking, in some instances this can be more physical therapy interventions given in an entire year for some children! It is not always the case that “more is better”; however, when services are offered sporadically and inconsistently, the persistence of the intensive physical therapist often times yields dramatic results.

In 1997, Semenova demonstrated a significant benefit in postural control, self care, and walking ability in children with cerebral palsy following a bout of intensive suit therapy. Recently, in 2006 Bar-Haim et al. demonstrated comparable results in children with cerebral palsy performing only suit therapy as compared to performing intensive physical therapy for a prolonged duration. Although this evidence may slightly favor suit therapy instead of an entire intensive therapy session, anecdotal data from parents, therapists, and patients report substantial motor gains (in reference to developmental milestones, strength, balance, and stability) following their intensive therapy session including suit therapy. The evidence to support the efficacy of the interventions on neurological, congenital, orthopedic, or other related disorders at this time is scare to say the least; however, based on the theory behind the Adeli method, the proprioceptive integrity given by the suit yields similar responses in those presenting with various sensory dysfunctions as compared to children with cerebral palsy.

What are the contraindications and indications to intensive suit therapy?

It is incredibly important to properly screen children prior to starting a bout of intensive suit therapy to decipher entrance and exit criteria, but also to develop an appropriate prognosis as to how that specific candidate will do in the program. Children are not candidates for intensive suit therapy based on a specific list of contraindications:
  • Uncontrolled seizures
  • Progressive diseases or disorders
  • Mitochondrial Disease
  • Myositis
  • Active infection
  • Hip dislocation
  • Osteoporosis
  • Scoliosis greater than 55°
  • Cardiorespiratory conditions worsened by activity
  • Any other conditions that will worsen with exercise

Although these are absolute contraindications to intensive suit therapy, there are also some precautions to keep in mind as the amount of repetition and introduction of novel tasks may effect the musculoskeletal integrity of the child if they possess:
  • Hip subluxation
  • Excessive Joint laxity
  • Osteopenia
  • Scoliosis less than 55°

Indications for intensive suit therapy are, but not limited to:
  • Cerebral Palsy
  • Ataxia
  • Post-Stroke
  • Traumatic Brain Injury
  • Spinal Cord Injury
  • Autism
  • Balance disorders
  • Movement disorders not worsened by exercise

Is suit therapy geared toward accomplishing OT goals?

In reference to sensory dysfunction, suit therapy can be used as a tool to address body awareness, and improve sensory integration-most notably improved proprioception- through approximation and compression of the body’s segments and articulations. It is very helpful in children presenting with sensory integration dysfunction to help them accomplish tasks they would normally not be able to with greater ease and efficiency.

The NeuroSuit was created by occupational therapist Patricia Gonzalez who after training in Russia, asked the question, “ What about the arms and the hands” which were not included in the original Adeli suit therapy protocol. The NeuroSuit is equipped with elbow and hand components that serve the same function as the lower extremity components. This gives the therapist the same ability to facilitate or inhibit certain movements, assist with the development of optimal posture, assist with or supplement the restoration of proprioception, or be used as resistance to increase the strength of the upper extremities each patient.

How does auditory training effect speech in children with neurological disorders?

A ten year old boy diagnosed with CP since birth came for suit and sound. He had been to Poland and to NAPA for suit many times, never for auditory work. His tongue was a huge antagonist to his speech as it would constantly thrust forward as if it had a mind of its own. When he returned for his second 15 sessions (30 sessions makes an entire listening program) his tongue had relaxed to where this boy was able to control its movement.

There is a synergistic link between the voice and the ear, the Tomatis Law that states: “The voice mirrors that which the ear can hear”, reflects itself in the sounds all people emit. If an individuals ‘sound’ is very high pitched with few low sounds, this is a clue as to what the inner ear is able to pick up and play back. However, the sounds a person makes are quite different from actual speech. Most persons with CP have a sound, but shaping those sounds into a phoneme, a word and a sentence is a fine motor task that requires the cooperation between the lips, cheeks, tongue, larynx and pharyx.

All of the nerves of speech articulation are innervated in the ear. The Trigeminal nerve(CNS V); The Facial nerve(CNS VII); The Glossopharyngeal nerve (CNS IX); The Vegus nerve(CNS X); The Accessory nerve(CNS XI); and the Hypoglossal nerve(CNS XII) are required to be integral and in cooperation with one another for speech articulation to occur.

Auditory training grows neurons at 1/10 mm per day; these major nerves are stimulated and remediated through listening to the proper frequencies that are delivered through a musical matrix using a Mozart concerto, symphony or waltz. The vestibule is in charge of every muscle in the body including those of the middle ear and eyes; is the master of the sensory team and the motor master. Speech is an executive function that will come into play when those lower neural functions are developed, if for example an individual is still at an oral motor phase auditory work will begin where the central nervous system is at developmentally; and in developmental time, speech articulation will commence.

In what ways does auditory training compliment intensive suit therapy?

As stated above, the vestibule is the master of the sensory team, and in charge of all things motor. The physical therapist and auditory trainer work together on the same goals from different perspectives. Specifically, the physical therapist addresses the external device (i.e. musculoskeletal system) in an attempt to affect the internal device (i.e. the vestibule) through movement. On the other hand, the auditory trainer is working on the internal device to affect the external device as manifested by changing movement patterns and strategies. The effect of the combination of treatment can be described as an awakening for the child who previously would have appeared disconnected from stimuli, but following a combination of the two interventions can attend to that stimuli and react appropriately.


References

Semenova KA. (1997). Basis for a method of dynamic proprioceptive correction in the restorative treatment of patients with residual-stage infantile cerebral palsy. Neurosci Behav Physiol, 27(6), 639-643.

Bar-Haim S, Harries N, Belokopytov M, Frank A, Copeliovitch L, Kaplanski J, Lahat E. (2006) Comparison of efficacy of adeli suit and neurodevelopmental treatments in children with cerebral palsy. Dev Med Child Neurol, 48(5), 325-330.


This Month's Featured Organization: NAPA Center

Our appreciation and thanks to Rafael Muñoz, PT, DPT, CSCS and NAPA Center for providing us with this months Q&A

NAPA Center is a multidisciplinary, non-profit organization designed to assist all those affected by various neuromusculoskeletal disorders. NAPA Center integrates intensive suit therapy, physical therapy, occupational therapy, auditory training, naturopathic medicine, and chiropractic services to all those who are candidates. NAPA Center utilizes the NeuroSuit and Multifunctional Therapy Unitsduring the intensive suit therapy portion of treatment, and is a training facility for suit therapy and intensive therapy. For more information about any topic covered, feel free to call 888-711-NAPA (6272), or email at [email protected]

Rafael Muñoz, PT, DPT, CSCS, is a licensed physical therapist working at NAPA Center in Los Angeles, CA, specializing in intensive suit therapy for pediatric and adult populations. He graduated from Whittier College with a Bachelor’s in Kinesiology in 2004, and from the University of Southern California with a Doctorate of Physical Therapy in 2007. In 2007 he received the NeuroSuit training in intensive suit therapy from the inventor of the suit, Patricia Gonzalez; and was hired on at NAPA Center shortly afterwards. Rafael utilizes a breadth of treatment techniques, and applies manual therapies traditionally reserved for the orthopedic population to the neurologic population. He has a passion for helping his patients and families achieve an improved quality of living, and is dedicated to being a proponent for change in the physical therapy profession.


Please support our contributing organizations and visit their website at NAPA Center

Q&A Alternative Treatments for Children with CP Q&A Cerebral Palsy Q&A SLP Q&A PT Q&A November 2009 Article Alternative Treatments for Children with CP Article SLP Article PT November 2009 Newsletter Q&A

Tags: Q&A Newsletter November 2009 Cerebral Palsy OT PT Article Proprioception