How TheraTogs Work

TheraTogs were designed by pediatric physical therapist Beverly “Billi” Cusick, PT, MS, C/NDT, COF, to extend and promote clinical changes for children with neuromotor dysfunction. By improving postural control, the somatosensory system is activated. Improved trunk control leads to improved limb use.

Matching clinical function and clinical goals to a dynamic and versatile system allows children (and adults) with neuromotor dysfunction to be individuals who can move with better control and expend less energy doing so.

TheraTogs were also designed to minimize the need for surgeries and pain due to imbalances of joint and muscular systems by identifying a functional deficits in therapy and creating a clinical tool for a population in need.

Therapy Approaches

Movement System [Impairment Syndrome] Analysis and Management

Movement System Impairment Syndromes are the focus of an approach to physical therapy that was developed by Dr. Shirley A Sahrmann, PhD, PT and her associates at the Program in Physical Therapy at Washington University School of Medicine in St Louis, Missouri. The analysis and treatment of movement systems impairments are founded in principles of kinesiology, biomechanics, muscle physiology, and physiologic adaption-to-use history.

Physical therapists trained in this approach will undertake a full evaluation of the status of the musculoskeletal system to identify muscle couple imbalances that can be associated with complaints of pain, and to seek the sources of those imbalances in the context of routine postural and movement strategies. The treatment goal is usually the elimination of pain via the use of targeted therapeutic exercise to restore muscle couple balance and related functioning joint alignments.

A full presentation of this approach is detailed in the text: Sahrmann SA. 2002. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, MO: Mosby.

Proprioceptive Neuromuscular Facilitation (PNF)

PNF techniques were developed by Sister Elizabeth Kenney, an Australian nurse for people with polio, Dr. Herman Kabat, neurophysiologist and physician, Maggie Knott, PT, and Dorothy Voss. The techniques are designed to help develop muscular strength and endurance, joint stability, mobility, neuromuscular control and coordination–all of which are aimed at improving the overall functional ability of patients.

Among the many techniques in PNF, the one that is best realized by TheraTogs systems is rhythmic stabilization, in which proprioception (PPC) is used to build trunk control, and to facilitate sequential, isometric activation of opposing groups of muscles for gaining stability.

Example: To build trunk control, the client is told “Hold! Do not let me move you!” while the therapist quickly presses downward on the upper trunk (sitting or standing), or on the upper pelvis in standing, to deliver a PPC load to supporting joints and then attempts to displace the client in opposing directions, without resting between directions, developing rapid co-activation of the postural muscles.

For more information about PNF, read: PNF in Practice: An Illustrated Guide by Susan Adler, Dominiek Beckers, and Math Buck. Berlin: Springer Verlag, 2014.

Neurodevelopmental Treatment (NDT)

Originated by Karel and Berta Bobath in the 1960s, NDT has since evolved to incorporate emerging theories of sensorimotor learning, and uses guided or facilitated movements as a treatment strategy to ensure correlation with input from tactile, vestibular, and somatosensory receptors within the body.

These assumptions (among others) are inherent in NDT :

  • Primary problems in clients with CP or stroke are impaired patterns of postural control and movement coordination.
  • Identifiable system impairments are changeable with intervention that addresses them in a task-specific context. Left untreated, clients select existing, maladaptive strategies that propagate impairments over time.
  • A working knowledge of typical adaptive motor development provides the framework for assessing functions and planning intervention.
  • Clinician focus on changing movement strategies as a means to achieve quality performance of age-appropriate tasks, and in preparation for future functional tasks.
  • Proximal stability precedes the acquisition of effective limb movement (distal mobility).

Therapeutic handling is integral to NDT, as an evaluative and a treatment tool that allows the therapist to:

  • Feel the client’s responses to changes in posture or movements
  • Facilitate postural control and movement patterns that expand the client’s options for selecting successful actions
  • Limit movements that distract form the treatment goal
  • Inhibit or constrain non-productive, potentially debilitating, or deformity-promoting motor patterns.

Active carry-over of gains made in treatment, essential for motor learning, requires practice by the client throughout the day, independently or with caregivers.

You can find evidence supporting NDT online at: http://paediatricworkshops.com.au/research-articles and at www.bobath.org.uk/content/evidence-base

For more information, read: Neuro-Developmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice, by Janet M Howle. 2002 available from www.ndta.org.

NDT & TheraTogs Are Closely Linked in Scientific Principles

 

NDTA practitioners have long known of the strong link between NDT principles and TheraTogs applications:

TheraTogs systems gently and comfortably support sensorimotor training objectives that are immediately recognizable to NDT clinicians:

    • Cozy tactile input and compression for postural support and increased body awareness
    • Improved resting alignment from which to initiate movement
    • Improved functional alignment from which to experience movement
    • Resistance to undesirable movement patterns, and assistance with gaining desirable movement patterns

By living in a well-designed TheraTogs system, the wearer experiences thousands of repetitions in corrected functional context – repetitions that are essential for optimum neuromotor re-education and optimum skeletal modeling in infants and young children.

Wearable Therapy: TheraTogs Embodies Key NDT Principles
Nancy Dilger, MA, PT, PCS. NDTA Network, January/February 2007

Marlenne Burt illustrated the connections in a related case study:

With an understanding of the principles of applied kinesiology and biomechanics, the current dynamic and motor learning theories, and the concepts of manual facilitation techniques inherent in NDT, therapists will find the TheraTogs orthotic and strapping system offers a live-in, dynamic, and enhancing postural and neuro-motor training modality.

A Strapping Case Study: Linking NDT with TheraTogs Strapping System and Other Orthotics
Marlenne Burt, PT, MS, MBA. NDTA Network, January/February 2007

We invite NDT practitioners to further explore how TheraTogs can embody your practice principles, increase compliance, and improve outcomes by multiplying repetitions.

Perception-Action Approach (P-A) (formerly TAMO – Tscharnuter Akademie for Motor Organization)

(Formerly Tcharnuter Akademie for Motor organization – TAMO)

P-A holds that perception is an active process of seeking information about the environment through all available sensory channels. All human senses can thus be considered as perceptual systems. [1]

A perception-action loop is one in which perception guides actions which are necessary for gathering the perceptual information that, in turn, guides actions. Both parts of the loop seem to operate simultaneously. Actions also provide information about one’s own body, movement, and capabilities. [1]

For example, information from many perceptual systems is needed to maintain postural control. The somatosensory system (touch and pressure) is sensitive enough to easily detect small changes in position and in the rate of postural sway while standing. The P-A Approach takes advantage of this sensitivity by attending to the body-ground interface during movement, and using manual strategies to enhance the PPC input at those sites.

This therapeutic guidance does not conflict with the patient’s current postural control mechanisms, but may add perceptual information that aids the patient in creating better posture or a new movement. In this way, the patient’s ideas and motivations for moving are respected while he or she is provided an opportunity to change a movement pattern. Variability and complexity in movements during exploration and play are considered essential to perceptual-motor learning and are fostered by the therapist.

Evidence supporting the P-A Approach:

Rahlin M. TAMO therapy as a major component of physical therapy intervention for an infant with congenital muscular torticollis: a case report. Pediatr Phys Ther. 2005;17:209-218.

Stergiou N, Harbourne RT, Cavanough JT. Optimal movement variability: a new theoretical perspective for neurologic physical therapy. J Neurol Phys Ther. 2006;30(3):120-129.

Dusing SC, Harbourne RT. Variability in postural control during infancy: implications for development, assessment, and intervention. Phys Ther. 2010;90:1838-1849.

Harbourne RT, Willett S, Kyvelidou A, Deffeyes J, Stergiou N. A comparison of interventions for children with cerebral palsy to improve sitting postural control: a clinical trial. Phys Ther. 2010;90:1881-1898.

Rahlin M. Case report: an individualized intermittent intensive physical therapy schedule for a child with spastic quadriparesis. Physiother Theory Pract. 2011 Oct;27(7):512-520.

For much more information about P-A, go to: http://p-a-approach.weebly.com/theoretical-foundation.html.

References

[1] Tscharnuter I. Clinical application of dynamic theory concepts according to Tscharnuter Akademie for Movement Organization (TAMO) therapy. Pediatr Phys Ther. 2002;14:29-37.

Sensory Integration (SI) Approach

Roley et al (2007) explained the SI theories and approach, and reviewed the work of its originator, A. Jean Ayers PhD, OTR. [1] Drawing on motor control theories, Ayres proposed these hypotheses that underscored her treatment approaches:

  • Perceptual awareness supports and facilitates occupational engagement.
  • Motor learning is influenced by, if not dependent upon, incoming sensation.
  • Body awareness creates a postural model to develop visual-motor skills.
  • Postural control is essential for skilled academic and motor performance.
  • Tactile, vestibular, PPC, and visual systems are key contributors to the development of reading and writing skills.
  • The ability to focus and maintain attention and to keep a steady level of activity is related to the way in which the nervous system responds to tactile sensation.
  • The sensory systems develop in an integrated and dependent manner.
  • Visual and auditory processing depend on foundational body-centered senses.

The SI approach requires that qualified professionals implement these principles (among others): [1]

  • Therapy takes place in a safe environment that includes equipment that will provide vestibular, PPC, and tactile sensations and opportunities for developing coordinated movements.
  • Activities are rich in sensation (especially vestibular, tactile, and PPC sensation), and offer opportunities for integrating that information with other sensations, such as visual and auditory.
  • Activities promote optimal postural control in the body, oral-motor, ocular-motor areas, and bilateral motor control, including maintaining control while moving through space and adjusting posture in response to changes in the center of gravity.
  • Intervention strategies provide the “just-right challenge.”
  • Opportunities exist for the client to make adaptive responses to changing and increasingly complex environmental demands. Highlighted in the Ayres Sensory Integration intervention principles is the “somatomotor adaptive response,” which means that the person is adaptive with the whole body, moving and interacting with people and things in the three-dimensional space.

Evidence supporting SI Therapy:

May-Benson TA, Koomar JA. 2010. Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. Am J Occup Ther. 64(3): 403-14.

Lane SJ, Schaaf RC. 2010. Examining the neuroscience evidence for sensory-driven neuroplasticity: implications for sensory-based occupational therapy for children and adolescents. Am J Occup Ther. 64(3):375-390.

Obstacles to research on SI Therapy:

Paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. Schaaf RC1, Miller LJ. 2005.

Occupational therapy using a sensory integrative approach for children with developmental disabilities. Ment Retard Dev Disabil Res Rev. 11(2):143-148.

References

[1] Roley SS, Mailloux Z, et al. 2007. Understanding Ayers Sensory Integration. OT Practice. 12(17): CE-1 – CE-7.

Designed to minimize pain and the need for surgeries

Research - click here