Exercise therapy delivered through interactive computer play (ICP) has been shown to be effective for improving gross motor skills, and ultimately gait, in children with cerebral palsy (CP). This chapter provides an overview of CP, its impact on, gait and the current physical therapy (PT) standard of care. The history of the home exercise program (HEP) component of standard PT care is described, along with the potential for using ICP to improve HEP. ICP systems are surveyed, and their defining features discussed. The current therapeutic use of ICP is described and directions for further development to enhance therapeutic utility presented. A theoretical framework to support ICP implementation, self-determination theory (SDT), is outlined, and an example of its exploration in a pilot effort is provided. An example of healthcare system barriers to rapid uptake of ICP is presented along with alternative strategies for deployment and recommendations for further research. 

Interactive Computer Play in the Pursuit of Gait Optimization for Children With Cerebral Palsy

Exercise therapy delivered through interactive computer play (ICP) has been shown to be effective for improving gross motor skills, and ultimately gait, in children with cerebral palsy (CP). This chapter provides an overview of CP, its impact on, gait and the current physical therapy (PT) standard of care. The history of the home exercise program (HEP) component of standard PT care is described, along with the potential for using ICP to improve HEP. ICP systems are surveyed, and their defining features discussed. The current therapeutic use of ICP is described and directions for further development to enhance therapeutic utility presented. A theoretical framework to support ICP implementation, self-determination theory (SDT), is outlined, and an example of its exploration in a pilot effort is provided. An example of healthcare system barriers to rapid uptake of ICP is presented along with alternative strategies for deployment and recommendations for further research.

Interactive Computer Play in the Pursuit of Gait Optimization for Children With Cerebral Palsy: Home, Video Games, and Motivation

The value of disposable, single-use catheters has come under scrutiny in recent years with a growing attention on environmental sustainability. Intermittent catheterization (IC) is a widely available and minimally invasive technique for management of lower urinary tract dysfunction. Effective IC for individuals with neurogenic lower urinary tract dysfunction can promote their independence and improve quality of life. Are there alternative options within IC that could minimize environmental impact without compromising the safety and effectiveness of single-use catheters? How does the future of IC look – environmentally friendly, biodegradable, disposable catheters may be complementary to certified reusable catheters? In the midst of this debate, it is important to emphasize that individuals have the right to choose the best evidence-based treatment available. Here we consider the current landscape for IC with a focus on chronic use in individuals with neurogenic lower urinary tract dysfunction.

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Intermittent catheterization: A patient-centric approach is key to optimal management of neurogenic lower urinary tract dysfunction

A narrow interpretation of “medical necessity” can result in poorer health as well as a more restricted life for people with disabilities. We examined the impact of US policy on reimbursement of intermittent catheters (ICs) on the lives of people with neurogenic bladder (NB) who require catheters to urinate. We conducted in-depth, longitudinal interviews with nine stakeholders. Actor-Network Theory was used to describe interactions among human agents, IC products, and policies in the reimbursement arena. Restrictions on the type and quantities of ICs reimbursed emerged as the most potent inhibitor to health and wellbeing among consumers with NB. IC suppliers, due to the large number of other stakeholders with whom they interact in the reimbursement process, emerged as strong enablers of preferred IC use among people with NB. Lack of an impartial central clearinghouse on IC products and coverage impeded consumers’ ability to make informed decisions.

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Alexandra Bennewith

Papers

Intermittent Catheter Reimbursement in the United States: The Experience of Nine Stakeholders Through the Lens of Actor-Network Theory