2. What is Intensive Therapy?
 45-60 hours of therapy over 3-4 weeks (typically 3-4 hours
each day)
 Some clinics use a 2 week methods to improve tolerance
 2-4 sessions each year is recommended
 Use strength training combined with repetitive movements
to improve functional mobility
 The sessions are broken up into 2 phases: Preparation and
Secondary
 All participant are given a home exercise program to
maintain the results
 Can include occupational therapy and speech therapy as
well

4. What It Isn’t
 More hours of standard PT and OT
 Many types of therapy jammed into
one session

5. Who it can be for?
 Patients with:
 Neurological Disorders
 Orthopedic Conditions
 Muscle Tone Disorders
 Gross Motor Delays
 Syndromes (Angelman, Down, and others causing
musculoskeletal problems)
 Movement Disorders (ataxia, athetosis, chorea)
 Post surgical Rehabilitation
 Pain

6. So How Does It Work?

7. Preparation Phase
 Activities to prepare the body
tailored to the individual
 Can Include:
 Moist Heat
 Massage
 Manual Therapy
 Stretching and Range of Motion-
including active, passive, and
resisted
 Strengthening- often using the
Universal Exercise Unit
 Sensory Integration

8. Secondary Phase
 Activities that are practiced
multiple times
 Includes:
 Balance and coordination
 Functional activities training
 Gait training- with or
without assistive device
 Suit Therapy- must be
approved by physician
 Universal Exercise Unit

9. What special tools are used?
 Therasuit or Suit Therapy
 Used for strength,
balance, and functional
activities
 Helps to improve
proprioception
(knowing where the
body is in space) and
positioning for activities
 Hip X-rays and doctor’s
approval needed for
participation

10. What special tools are used?
 Universal Exercise Unit
 Series of pulleys and
weights in a cage system
used for stretching and
strengthening; also straps
and bungees used to
provide the assistance
needed to allow a child to
do an activity as well as
target sensory, vestibular
and proprioceptive
challenges and needs

11. Pros of Intensive Therapy
 More immediate results
 Detailed home exercise program to help maintain the
results
 Noticeable increases in strength and skills
 Functional focus equals functional gains
 Possible to take more time off for other activities, like
adapted sports

12. Cost of Intensive Therapy
 Reimbursement varies with insurance companies,
however, more and more companies are reimbursing
for intensives

13. One Basic Theory of How It Helps
 Phases of Learning
 Repetition- we learn the way to move and gradually
begin to build the coordination, balance, strength, and
endurance to do the motion
 Generalization- we have the basic building blocks but
still need a great deal of thought to control the motion
 Automatization- certain motor tasks can be performed
without thinking but requires tens of thousands of
repetitions

14. The Evidence

15. Trahan and Malouin Pilot Study
 Based on 5 children with CP
 Therapy 4 times/week for 4 weeks followed by 8 weeks
rest period over 6 months
 GMFM used to evaluate for changes in motor function
 Results:
 3 children had statistically significant improvements in
GMFM scores reflecting improved gross motor skills
 All 5 participants maintained their improvements over
the 8 week rest periods

16. Bower and McLellan
 Series of three studies
 Showed increasing trend toward
intensive therapy
 The last study was a RCT with the
children receiving 6 months of therapy
5 days per week followed by a 6 month
rest period
 Results were not statistically significant
 Results attributed to long therapy
period and long rest period

17. Koscheyev and Leon
 Unpublished study of 6 adults with CP or stroke
 5 days/week, 2 hours per day of intensive therapy with
suit therapy for 3 weeks
 Questionnaire to patients, caregivers, and therapists
revealed improvements in motor skills, emotion,
stamina, and speech
 Motion analysis revealed improved posture in standing
and in gait kinematics

18. Euro Peds Pilot Study
 9 children with CP
 4 hours per day, 5 days per week for two weeks of
intensive therapy with Suit therapy
 Results:
 GMFM improvements with the largest being in lying
and rolling skills

19. Stiller, Marcoux, and Olson
 Study to compare the effects of intensive therapy,
conductive education, and special education on
function in 19 children with CP over 5 week programs
 PEDI, GMFM, and Peabody administered before and
after interventions
 Results:
 While all groups showed improvements, the intensive
group showed the most improvements
 The only statistically significant changes noted were in
the PEDI self care and socialization sections and the
GMFM crawling and kneeling scales

20. Datorre Case Study
 12 year old boy with CP receiving intensive therapy
with Suit Therapy 4 hours, 5 times per week for 3
weeks in addition to half and hour of aquatherapy and
hippotherapy
 Results:
 The subject improved in all categories of the GMFM at
the end of the 3 weeks
 The subject maintained improvements in all categories
at the end of 6 months after the intervention ended

21. Braswell Study
 47 pediatric subjects with CP participated in intensive
therapy 4 hours per day, 5 days per week for 3 weeks.
 Worked on functional skills and strengthening
 Results:
 GMFM scores improved from pre-intervention to post-
intervention
 No post studies were completed to determine how long
the positive changes endured after the completion of the
intervention

22. Summary of Evidence
 The general evidence suggests that
what is considered the typical
intensive therapy program results
in functional gains for the subjects
with CP.
 Most studies suggested a
statistically significant
improvement
 The few studies that looked into
long term results post-intervention
found that the results continued
through rest breaks

23. Limitations of the Studies
 All of the studies only look at subjects with CP
 There are very few studies looking at intensive therapy,
and those that do use very different methods.
 Time in therapy varies and time for rest periods varies
even more.
 Variations exist between the CP subjects making it
difficult to generalize the results
 Limited number of subjects in each study

24. Why Is This Important?
 The evidence shows that intensive therapy is affective
in improving functional skills, just as typical therapy
does.
 It offers families another way to do therapy that may
better fit their schedule
 All programs should be tailored to the individual, and
the patient’s tolerance should be considered before
starting this program.
 Some facilities recommend a 2 week intensive therapy
cycle to ensure patient tolerance for the program

25. Got Questions?
Contact:

26. References
 Bower E Et Al. Randomized Controlled Trial Of Physiotherapy In 56 Children With CP Followed For
18 Months. Dev Med Child Neurol Jan 2001; 43 (1): 4-15.
 Bower E and Mclellan DL. Effect Of Increased Exposure To Physiotherapy On Skill Acquisition Of
Children With CP. Dev Med Child Neurol Jan 1992; 34(1): 25-39.
 Bower E Et Al. A Randomized Controlled Trial Of Different Intensities Of Physiotherapy And
Different Goal-Setting Procedures In 44 Children With CP. Dev Med Child Neurol 1996; 38(3): 226-37.
 Tsorlakis N Et Al. Effect of Intensive Neurodevelopmental Treatment in Gross Motor Function of
Children with Cerebral Palsy. Dev Med Child Neurol 2004; 46: 740-745.
 Trahan J and Malouin F. Intermittent Intensive Physiotherapy In Children With CP: A PilotStudy. Dev
Med Child Neurol Apr 2002; 44(4): 233-9.
 Stiller C, Marcoux B, Olson R. The effect of conductive education, intensive therapy, and special
education services on motor skills in children with cerebral palsy. Phys Occup Ther Pediatr 2003;
23(3): 31-50.
 Datorre E. Intensive Therapy Combined with Strengthening Exercises Using the Thera Suit in a Child
with CP: A Case Report. 2004.
 Braswell J. The effect of intensive physical therapy for children with cerebral palsy. Peds Ther 2008;
20(1): 100-101.
 Euro-Peds. Scientific Evidence For The Basis Of The Euro-Pēds Program.
http://www.europeds.org/pdfs/Scientific_Evidence_PDF.pdf.
 Euro-Peds. www.europeds.org. 2010.
 American Association of Intensive Pediatric Physical Therapy. www.aaippt.org.