| Description |
Cerebral palsy (CP) commonly results in asymmetric upper extremity impairments. Constraint-induced movement therapy (CIMT) is an evidence-based intervention that can improve functional outcomes for children with such impairments. A Positive Parent- Focused Training for Upper Limb Experience with Sensory-Motor Feedback (APPLES) is a multimodal, evidence-based CIMT protocol with positive outcomes on gross motor, fine motor, and somatosensory function. Local Problem: There is a gap in the implementation of evidence-based CIMT protocols, including APPLES, in early intervention programs. DDI Vantage Early Intervention Program is an early intervention (EI) program that provides developmental therapy services for children up to three years of age in Utah areas, including Salt Lake City, Toole, and Roosevelt. Methods: A needs assessment was conducted to determine the need for APPLES intervention for children with asymmetric upper extremity impairments at DDI Vantage. The needs assessment participants included five physical therapists (PTs), five occupational therapists (OTs), and three leadership team members employed at DDI Vantage. Participants engaged in a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis and semi-structured interview. The SWOT analysis assessed DDI Vantages' organizational readiness for a practice change, and the semi-structured interviews assessed the facilitators and barriers to APPLES implementation. Participants completed a mixed-methods survey to identify demographics, an estimate of the number of children who would have qualified for APPLES intervention in the previous year, perceived feasibility and usability of APPLES intervention, and participant satisfaction with the needs assessment. Qualitative data were analyzed using content analysis, and quantitative data were evaluated using descriptive statistics. The findings were summarized in an executive summary with recommendations for future APPLES implementation at DDI Vantage. Results: In the mixed-methods survey, PT and OT participants estimated that approximately 34 children would have qualified to receive APPLES therapy at DDI Vantage in the last year. All participating PTs and OTs (N=10, 100%) reported interest in being trained to implement APPLES therapy. Most needs assessment participants (n=11, 85%) reported that APPLES intervention is usable for PTs and OTs, usable for families, and feasible for implementation at DDI Vantage. All needs assessment participants (N=13, 100%) reported satisfaction with the needs assessment. The SWOT analysis identified that DDI Vantage has many organizational strengths, including skilled and knowledgeable staff, a supportive leadership team, and a mission to support underserved populations. Potential barriers to successful APPLES implementation were high caseloads and funding limitations. Conclusion: The needs assessment identified organizational readiness for APPLES implementation at DDI Vantage; determined potential barriers and threats to successful APPLES implementation; and identified strategies for improving APPLES training, implementation, and sustainability. Disseminating and implementing evidence-based interventions into practice for children with CP with unilateral upper extremity impairments is integral to improving functional outcomes. Based on the needs assessment findings, the recommendation to implement APPLES intervention at DDI Vantage was made to stakeholders. |
