Therapy services at Healthy Strides

STRIDE is an intensive walk/step training program also known as Locomotor Training. This program is specifically designed for children and young adults with neurological conditions and injuries.  Locomotor training can include partial body weight support, overground walk training and the possible use of functional electrical stimulation (neuroprosthetics). 

Specialised equipment and techniques are used to provide this therapy. STRIDE is delivered by credentialed therapists highly experienced in specialised methods and techniques of locomotor training.

Aims of the program

1. To improve or develop stepping ability and capacity (with or without a walking frame).
2. To safely promote weight bearing capacity.
3. To develop essential gross motor skills such as walking and running. By being in an upright position, trunk and  head control is also developed in a safe and controlled manner.
4. To improve walking endurance within indoor and outdoor environments.
5. To improve walking speed.
6. To develop and improve community walking ability e.g. independence, uneven surfaces and crowded areas.
7. To improve general health and well-being. Current evidence supports the importance of structured physical activity in line with the current 24 hour physical activity and sedentary behaviour guidelines for long term health and well-being. From a physiological perspective, this is important for cardiometabolic health with evidence to support its importance for the digestive and respiratory systems particularly in children and young adults that are dependent on physical assistance and equipment throughout the day

What is the evidence?

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).

REACH is our intensive upper limb program that focuses on developing specific skills such as school skills, play, dressing and other everyday activities. This is known as intensive bimanual therapy and targets improved coordination of both hands in structured task practice embedded in play and functional activities.

Aims of the program

1. To promote the development of essential hand skills that are needed for everyday life.
2. To promote independence and confidence in the ability to perform a hand or upper limb skill.
3. To increase the capacity of an individual’s ability to perform a hand or upper limb task in the individual’s own environment.
4. To support essential skills that may be used to communication, socialisation and play.
5. To develop essential skills that are needed for school.
6. To develop essential daily living skills such as dressing.

What is the evidence?

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. 

ACTIVATE is an intensive therapy program that utilizes a range of therapeutic supports to learn a skill, promoting independence and participation. This may include targeted and task specific strength training and functional electrical stimulation. Most importantly, each program is individualised and goal focused. The ACTIVATE program may focus on skills that range from floor mobility such as crawling to sitting and standing balance and standing transfers.

Aims of the program

1. To develop individually specific goals that are meaningful to the individual and their family.
2. To promote independence and confidence in the ability to perform a skill.
3. To increase the capacity of an individual’s ability to perform a task in the individual’s own environment.
4. To promote activity that is generated by the person itself. A “hands-off” approach is promoted as much as possible so that individuals are still able to perform the task outside of the therapy environment.

What is the evidence?

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. 

KINDY MOVES is a truly unique and innovative program developed by The Healthy Strides Foundation. It is an intensive school readiness program for preschool aged children aged between 2 and 5 years with complex physical needs. Developed by the very latest research (funded by Telethon7), this program ensures that children have the best opportunity to improve their life, giving them the best start for a brighter future. 

Aims of the program

1. To provide an evidence based, research backed program for pre-school aged children with complex physical disabilities who are preparing to attend school for the first time, optimising inclusion and participation.
2. To develop opportunities for socialisation and play so that children with complex physical disabilities and communication challenges can develop friendships within a safe and supportive environment.
3. To develop gross motor skills using the latest research backed techniques for skills such as sitting or walking in a walking frame to enhance independent movement and maximise opportunities to participate with their peers at school.
4. To provide parents with a safe and supportive environment to develop their capacity and confidence that will in turn optimise opportunities for their child to develop in all environments.
5. To provide opportunities for children to build their confidence and practice important skills that they will need for school.
6. To provide parents of children with complex physical disabilities with a space to be supported, develop friendships and a support network with parents also experiencing a similar journey.
7. To provide at home and virtual solutions to support vulnerable children and their families in the event of a local epidemic outbreak that restricts their ability to access crucial services.
8. To support educators with skills and strategies in supporting children with complex physical disabilities at school, promoting inclusion and participation.

What is the evidence?

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 Singapore.