Kristin Capone, PT, MEd, Diana Hoopes, PT,Deborah Kiser, MS, PT, and Beth Rolph, MPT 9. M.O.V.E. (Mobility Opportunities Via Education) Curriculum 828

Cloud cushion • Pressure relief for bony prominences

• Contour for pelvic stability Jay back • Pressure relief along spine

• Min/mod lateral and lumbar support and contour

• Built-in capability for growth

Solid back • Upright posture

• Prevent/minimize kyphosis

• Trunk stability

Laterals • Encourage midline trunk position and correct/delay scoliosis

• Compensate for lack of trunk control

• Safety

• Assist with transfer, locks for strength Headrest • Poor head control due to low tone

• Active flexion/hyperextension of head

• Posterior and/or lateral support

• ATNR

• Safety in transport

• Facilitate breathing

Tray (clear) • Upper arm and trunk support

• Functional surface for schoolwork

• Inability to access desks, tables, etc.

• Base for augmentative communication device, computer

Seat belt • Pelvic positioning – prevent sliding out

• Safety

Anti-tippers • Safety

Large casters • Rugged terrain, smoother ride Flat-free fillers • Prevent flat tires

• Reduce maintenance

Should you have any questions regarding these recommendations for Kevin, do not hesitate to call us at (302) 999-9999. We hope that you will be able to accommodate these needs in an expedient manner. Thank you for your co- operation and assistance in this matter.

Sincerely,

Freeman Miller, MD

9. M.O.V.E.

(Mobility Opportunities Via Education) Curriculum

Kristin Capone, PT, MEd, Diana Hoopes, PT, Deborah Kiser, MS, PT, and Beth Rolph, MPT

The M.O.V.E.

Curriculum is an activity-based curriculum designed to teach individuals basic functional motor skills needed for adult life. These skills allow them to enjoy a more inclusive lifestyle because movement is an integral part of everyday life. People with physical disabilities often require assistance to participate in these everyday activities, such as moving to the bed or bath- room, to school, or to their place of work. The MOVE curriculum provides a framework for teaching the skills necessary for individuals with disabilities to gain greater physical independence. It combines functional body move- ments with an instructional process designed to help people acquire increas- ing amounts of independence in sitting, standing, and walking.

828 Rehabilitation Techniques

Linda Bidabe, founder and author of the MOVE curriculum, realized the need for a functional mobility curriculum when she observed that 21-year- old students were graduating from her school with fewer skills than they had when they entered school. She believed that the “developmental model” was not meeting the needs of students with severe disabilities because these stu- dents learned skills at a very slow rate and would take years to develop some of the early developmental skills such as rolling or prone propping on el- bows. Therefore, the students would never accomplish functional mobility skills in sitting, standing, and walking.

This program is for any child or adult who is not independently sitting, standing, or walking. This includes those with both significant motor dis- abilities and mental retardation. Whether in a special school or a regular classroom setting, MOVE provides the student increased opportunities to participate in life activities with their peers without disabilities. Progress in the program can help reduce the time needed for custodial care, increase the child’s self esteem, and promote acceptance by peers.

Contraindications to consider before starting the MOVE curriculum in- clude circulatory disease, respiratory distress, brittle bones, muscle contrac- tures, curvature of the spine, hip dislocation, foot and ankle abnormalities, pain or discomfort, or a head that is too large to be supported by the neck.

Medical or physical therapy consultation is recommended for any student with possible contraindications to obtain clearance for the exercise and weight- bearing activities. Exclusion from the program is limited to those individuals whose medical needs contraindicate the need to sit, stand, or walk.

The MOVE program is based upon the teaming of special education in- struction with therapeutic methods and includes ecologic inventory, priori- tization of goals, chronologically age-appropriate skills, task analysis, prompts for partial participation, prompt reduction, and the four different stages of learning: acquisition, fluency, maintenance, and generalization. It is divided into six steps. In step one, the student participates in the Top-Down Motor Milestone(TM) Test that evaluates his or her ability in 16 basic motor skills that are necessary for functioning in the home and community. The motor skills are age appropriate and based on a top-down model of needs rather than the traditional developmental programs based on sequential motor skills acquisition of infants.

Following the test, the student, parents, and/or caregivers are briefly in- terviewed in step two, to determine activities important to the family at the present time and in the future. An activity is defined as a specific event such as, “ I want to be able to walk across the stage to get my diploma.” Step three analyzes the activities to determine the motor skills (from the Top-Down Motor Milestone

Test) necessary to perform the activity, for example, walking forward or maintaining standing.

In step four, the amount of assistance needed by the student to perform the selected activities at the time of testing is recorded on the Prompt Re- duction Plan Sheets provided in the assessment booklet. A plan is then for- mulated in step five to systematically reduce assistance over the instructional period. In the final step, step six, the skills are taught using the teaching sections of the curriculum to provide suggestions based on individual stu- dent needs.

To teach certain skills the MOVE curriculum utilizes equipment such as regular classroom chairs, adapted chairs, mobile standers, and gait trainers that are designed to support the student while they are practicing a skill (Fig- ures R7 and R8). The equipment is not a substitute for teaching but rather a support to make instruction possible. Dependence upon equipment is contin- ually reduced until the individual achieves as much independence as possible.

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830 Rehabilitation Techniques

Figure R7. The development of gait trainers with a high degree of modularity has been driven in part by the philosophy of the MOVE program to have children up weight bearing and moving in the device, which gives the amount of support the child needs. The goal is then to gradually reduce the amount of support as the child develops strength and motor skills.

Figure R8. An important aspect of the MOVE program is the ability to get individuals into weightbearing positions, which is difficult for adult-sized adolescents. The development of mechanical lift walkers makes this process much easier for the caregivers.

MOVE is designed to embed mobility skill practice into functional every- day routines. As a result, MOVE can occur at school, in a facility, at home, or in the community, thus providing opportunities for multiple repetitions.

MOVE is successfully implemented by therapists, educators, paraprofes- sionals, parents, and anyone who interacts with the individual.

The structured teaching approach used in the MOVE curriculum is val- idated in the article, Mobility Opportunities Via Education (MOVE): Theo- retical Foundations, by Barnes and Whinnery,

which describes its use of natural environments, functional activities, scaffolding, partial participation, and use of contemporary motor theories related to teaching functional mo- bility skills.

The John G. Leach School, the nation’s first MOVE model site, completed a pilot study in 1998 to evaluate the effectiveness of the MOVE curriculum.

Eleven students (ages 4 to 18 years) with a variety of severe disabilities par- ticipated in the six steps of the MOVE program. After a 5-month period of instruction, improvements in sitting, standing, and walking were achieved.

Improvements were also noted in the areas of communication, alertness, and overall health. Because of the success of the pilot program the MOVE cur- riculum was adopted for schoolwide use.

For example, a 5-year-old boy with a diagnosis of Cornelia–DeLang syn- drome began the MOVE program at Leach School because he was nonweight bearing and intolerant of positions other than supine, as well as unable to communicate or play with his peers and siblings. Following daily practice in a mobile stander, he increased his tolerance for weight bearing. As support from the equipment was reduced, the student was able to practice standing as part of his classroom routines such as diaper changes and getting in and out of his classroom chair. Over a 3-year period he progressed from walking with full support in a gait trainer to walking with one hand held or pushing a forward rolling walker. This gain has led to increased social interaction and independent exploration of his environment.

10. Occupational Therapy Extremity Evaluation Marilyn Marnie King, OTR/L

Individuals with CP may present with spasticity that causes dynamic or fixed contractures. Typical orthopaedic deformities include shoulder excessive external rotation, elbow flexion, pronation, ulnar deviation, wrist flexion, thumb adduction, tight finger flexion, and swan neck fingers. Surgery should improve these areas, but some children use their limits for function and may not do better. Examples are children who use augmentative communication aids and need a pronated arm or whose ability to point requires wrist flexion (tight tenodesis).

Brief Description of Surgeries to Treat the Upper Extremity

Surgeries to lengthen tendons or to transfer muscles to balance power and tone are frequently performed on the child with spastic CP, although never on children with dystonia, nor those with undulating fanning of fingers, nor those with rigid extension of the arm and flexion of the wrist. The Green transfer is the transfer of the flexor carpi ulnaris (FCU) to the extensor carpi radialis brevis (ECRB). There are variations that include tying flexors into the finger extensors and the palmaris longus (PL) into the extensor pollicis longus (EPL) thumb extensors. Prognosis is progressively improved with the follow- ing skills of the patient: good intelligence and motivation to follow through

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