MOVE-ING FORWARD: A THERAPEUTIC ALTERNATIVE FOR ADULTS WITH MULTIPLE SEVERE DISABILITIES. A CASE REPORT

J. Jacob Gonzalez¹, C. Cahana²

Background: Most treatment programs for adult patients with physical and intellectual severe disabilities focus mainly on maintaining and preventing complications, instead of  improvement of the patient’s functional abilities. Research on this topic is limited. A treatment that fits these needs is the MOVE (Mobility Opportunities Via Education) program. The program focuses simultaneously on: task-oriented motor learning, motivational support and the use of external aids (prompts) to facilitate people with multiple disabilities to learn functional motor skills such as sitting, standing, walking and making transitions.

Purpose: To demonstrate the effectiveness of the MOVE program in improving gross motor skills in adults with multiple severe disabilities.

Methods: Eleven patients from a daycare treatment center, between the ages of 21 to 50 were recruited, the majority were diagnosed with cerebral palsy with spastic tetraplegia, intellectual disability and other health conditions. All participants were inactive and completely dependent at basis according to the FIM™ assessment. They participated in a 6-month program and took part in individual sessions of one hour, 3 times per week. Additionally, participants practiced the skills in their classroom divided into groups according to their ability levels. They did not receive additional physical therapy. Participants’ results were tracked and evaluated by measuring the amount of aid needed to maintain the different positions (sitting, standing and walking) with the MOVE Prompt Review Plan™ and using the Top Down Motor Milestone Test™ before and after the intervention.

Results: At baseline, none of the participants were able to maintain any of the positions independently. They were also unable to complete voluntary movements.  After six months, seven participants were able to maintain a sitting position on the edge of a bed without support and four with minor support for 5 minutes. On daily bases while participating in routine group activities all eleven participants were able to maintain a sitting position on a regular chair for 45 minutes while performing various activities with upper limbs. Participants that were able to maintain a sitting position were able to maintain a standing position with the support of a Gait trainer/walker. Two were able to perform voluntary movements in lower limbs without shifting and eight managed to move up to three meters nonstop and performed 30 minutes walks 3-4 times a week.

Conclusion(s): Despite existing for three decades, it is a relevant and current alternative for this specific group, allowing adult patients who received only maintenance treatment and with low functional levels the opportunity to begin their motor learning process not matter their age. Furthermore, the new paradigm of the importance of functionality and group participation is adopted according to the ICF model. Further controlled studies are needed to confirm with evidence-based treatment options that recommend the use of this tool for the benefit of other patients.

Implications: Inactive and completely dependent patients show that their capabilities for learning gross motor skills could be developed. The program shows potential to enhance quality of life in these patients by being able to realize daily functions, be more physically active and interact more effectively with others.

Funding, acknowledgements: None

Keywords: motor skills, MOVE program, adults with multiple disabilities

Topic: Disability & rehabilitation

Did this work require ethics approval? No

Institution: North Star Organization

Committee: Ministry of Social Welfare and Social Services of Israel

Reason: According to our regulatory authority: Ministry of Social Welfare and Services, ethics approval wasn't required, not RCT, patients' consent was signed.