PT, DPT, CSCS, CFMT, FiT, Physical Therapist
While several facilities offer all therapies under one roof, it is rare that clinicians coordinate therapeutic strategies across disciplines to deliver integrated, goal-directed care. Traditionally, each respective therapy focuses on a narrow scope of impairments and addresses those within their discipline’s theory-based framework. This is often the basis of trademarked therapies. For a child with a complex presentation, the result is therapies delivered in silos, with little cross over, and ultimately, limited translation to function. In contrast, functional goals are multidimensional: they require the interplay of several systems to achieve the end objective. The research community is increasingly understanding that therapy is most effective when it is delivered via a functional goal directed approach (as found in interdisciplinary care), as opposed to an impairment based approach (often the approach in traditional care).
For example, difficulties with feeding are often referred to oral-motor therapy. For many children, this may only one piece of the puzzle. The following example illustrates the complexity of feeding, and how an interdisciplinary approach to children with feeding difficulties may more efficiently and effectively address the functional deficit. Feeding requires the postural support to maintain stability of the trunk in a seated position, and provide a stable platform from which the arm can work. Next, a child must have sufficient ability to see and interpret the visual field to identify the food in space. To then get a snack to mouth, the child must have sufficient hand function, and hand-eye coordination. Chewing and swallowing then requires appropriate oral motor control and coordination. A child then must be able to communicate pleasure/displeasure to request what he or she wants and needs during feeding. In a child with complex involvement, several of these component pieces may be affected. A team of clinicians working together can problem solve how the interplay of deficits in the above components may be interfering with feeding. Subsequently, they will create an appropriately tailored, integrated approach to therapy. Working in a collaborative fashion, therapists are able to fully understand a child’s functional deficits, and coordinate to help a child achieve their full potential.
Consider a case example: An intelligent young boy will be entering the school system. Secondary to birth trauma, he experiences frequent falls, and uses a communication system to communicate with others. His parent’s goal is to help their child be safe in transitioning to the school environment. This goal necessitates addressing the interplay of deficits contributes to the falls. His falls may be related to his gross motor strength and ability to appropriately respond to a perturbation. Alternatively, diminished sensory awareness of where his body is in space may contribute. Or, falls may be an indicator of his difficulty motor planning two tasks in order to carry his device and navigate the school environment. Finally, his difficulties could be related to a difficulty processing visual information to scan a busy visual environment and identify obstacles. An inappropriate communication system will not allow him to communicate appropriately to caregivers, and by extension, compromise his participation. Most likely, this child will demonstrate an interplay of these factors, which ultimately limit his transition to school. One provider will identify and work on a couple of these impairments; an interdisciplinary team will problem solve the root cause and how the interplay of contributing factors impacts the function, ultimately offering a targeted approach to care.