Facilitating Independence in Self-Care for Pediatric Clients With Amyoplasia: A Case Series.

Abstract

Importance: Joint contractures can lead to significant limitations in participation in activities of daily living and functional mobility. However, evidence regarding occupational therapy self-care interventions for children diagnosed with amyoplasia is limited.

Objective: To provide a detailed observational description of self-care-focused interventions for the pediatric population with amyoplasia.

Design: A retrospective case-series design was used to describe a week-long bout of rehabilitation completed to address functional skills.

Setting: A pediatric outpatient orthopedic specialty hospital.

Participants: Three case series participants were included. Participants were ages 7 to 15 yr, diagnosed with amyoplasia, and completed a week-long bout of therapy.

Intervention: Five 90-min visits on consecutive days, including evaluation and discharge visits, targeted occupational performance. Interventions addressed assistive technology (AT) use, caregiver education, and environmental modifications.

Outcomes and measures: Clients completed the Canadian Occupational Performance Measure (COPM) and the FIM® or Functional Independence Measure for Children (WeeFIM®) at the evaluation and discharge visits to determine changes in independence in completing self-care skills.

Results: All three clients experienced improvements in independence to complete self-care skills. Participants' COPM scores increased from evaluation to discharge. Similarly, FIM and WeeFIM scores indicated improved levels of independence related to targeted goals. It is important to note that changes in outcome measures were only assessed immediately after the therapy episode; longitudinal changes were not tracked.

Conclusions and relevance: The findings emphasize the importance of interventions focused on AT, environmental modifications, and caregiver education to address performance of daily activities of children diagnosed with amyoplasia. Plain-Language Summary: The case series adds evidence regarding the importance of occupational therapy in targeting self-care interventions with children diagnosed with amyoplasia. Short consecutive occupational therapy sessions may improve clients' awareness of assistive technology and environmental modifications. A combination of low and high technology may be vital for improving occupational performance in this population. Additionally, it is important for occupational therapy practitioners to address caregiver education throughout sessions to increase carryover of skills and techniques. Practitioners working with clients with amyoplasia should understand pediatric development in addition to body functions and structures to ensure interventions are appropriate, attainable, and meaningful. This information can guide clinical interventions and occupational therapy didactic education, as well as influence future prospective studies regarding this specific population.