Bone Abstracts

Patients with moderate to severe osteogenesis imperfecta commonly have functional difficulties following fractures or surgery, which generally result in long periods of immobility. Patients quickly lose range of movement, muscle strength and conditioning, which impacts on daily living activities, mobility, self-confidence and motivation. It is natural for patients to become more dependent on their carers, some not returning to their previous level of independence, nor achieving what they had aspired to. Barriers include fear of pain and injury, as well as potential failure in aiming higher. At Sheffield Children’s Hospital Metabolic Bone Disease Service, we aim to facilitate independence in the areas that matter to our patients, and positively influence other aspects of their life. Patients who are considered to have reached plateau, are offered the opportunity to attend for a week of intensive therapy, involving a minimum of 8 two-hour sessions over 5 days. In order to meet the criteria for this intervention, the patient rather than the family must be prepared to actively engage, and to identify goals prior to therapy. Both a physiotherapist and occupational therapist are present at each session, for multi-facetted intervention, with a combination of problem solving and activity analysis alongside graded exercise programmes that are designed to build the skills to achieve the goals. A variety of gross and fine motor activities are included throughout the week, dependent on patient’s specific interests and needs. Opportunities to develop and practice daily living skills are available. Parents/carers are encouraged to observe each day for reinforcement and continuity, as evening exercises are expected. At the end of the week, a closing assessment is performed, to identify goals that have been met, and to progress onto new goals. A patient evaluation form is completed, to inform better future outcomes. Patients are seen for follow-up review after a six-week period, to establish progress and compliance with the home programme. Many patients have made significant progress from the first episode, often opting to attend a further intensive week; suggestive that when patients are motivated to improve their functional outcomes, intensive therapy provides a good baseline to start from.

Disclosure: The authors declared no competing interests.