Suit TherapyAdeli Suit

Alyssa Connifey Doug EckJosh Egloff Sarah KibiloskiMaria King Sean McBride

Background● Developed in late 1960s/early 1970s by Russian space

program for astronauts to maintain muscle tone in an anti-gravity environment

● Has been modified and used as an alternative treatment for patients with cerebral palsy and other neuromuscular disorders

● “Adeli” comes from the nickname of the prototype called the penguin suit, based on the Adeli Penguin

Treatment● Consists of a vest, shorts, knee pads, and shoes, connected by a

series of adjustable, elastic bands

● Goal: maintain proper body alignment in order to restrict abnormal movement and ROM

● Provides immediate feedback to patient on normal movement patterns

● Suit is worn throughout intensive sessions to:○ “retrain” the brain using correct muscle movements○ improve body awareness○ support weak muscles○ improve gross motor skills and balance○ provide normal proprioceptive input to the brain

Rationale● Research from the Pediatric Institute of the Russian Academy of Science

showed that AST stimulates the restarting of the vestibular system’s development

● The vestibular system is a processing center for impulses from proprioceptors○ The suit provides normal tactile and proprioceptive stimulation to

normalize afferent vestibular-proprioceptive inputs to the vestibular system

○ Allows CNS to send out normal efferent signals

○ Muscle tone, balance, coordination, body awareness, and proprioception are influenced

Treatment Sessions● The original Russian protocol

○ 30 min-2 hours/day, 5 days/week for 4 weeks○ Massage before fitting the suit○ Passive stretching of all limb muscles○ Application of the suit by placing the body into proper alignment ○ Rigorous exercises in the suit

■ Individualized program ■ Walking activities, sit-to-stands, playing with a ball while standing, walking on

different surfaces, jumping on a trampoline, and climbing stairs and ladders

● Practitioners must be trained in AST application and treatment

● https://youtu.be/77WIkNdQRKw

Continuing Education● Company specific● TheraSuit

○ PT, OT, & other healthcare professionals

○ 5 day, 40 hours - $1,900○ Advanced levels - $850

● PediaSuit○ PT○ 5 days, 40 hours, 48 CEUs

Who is it for?● Originally developed for astronauts● Use in pediatrics

○ Cerebral palsy○ Developmental delay○ TBI○ Ataxia○ Post-CVA○ Spasticity○ Hypotonia

Contraindications/Precautions● Contraindicated in patients with:

○ Hip subluxation greater than 50%○ Severe scoliosis

● Used with precaution in patient with:○ Heart conditions○ Uncontrolled seizure activities○ Hip subluxation○ Hydrocephalus (VP shunt)○ Diabetes○ Kidney problems○ Hypertension

The Effect of Suit Wear During an Intensive Therapy Program in Children With CP

Bailes et al - Pediatric Physical Therapy - 2011

Purpose: To examine the effects of suit wear during an intensive therapy program on motor function among children with cerebral palsy.

Method: 20 children aged 3-8 years old were randomized to an experimental (TheraSuit) or a control (control suit) group and participated in an intensive therapy program (4 hours, 5 days/week for 3 weeks). PEDI and GMFM–66 were administered at baseline, 1 week after intervention and 1 month after intervention.

Conclusions: Children wearing the TheraSuit during an intensive therapy program did not demonstrate improved motor function when compared with those wearing a control suit during the same program.

Limitations: This study has several limitations related to the small sample size and lack of blinding of families and treating therapists.

Comparison of efficacy of Adeli suit and Neurodevelopment treatments in children with cerebral palsy

Bar-Haim et al - Developmental Medicine and Child Neurology - 2006

Purpose: To evaluate the efficacy of AST by comparing it with NDT in children with CP. Gross motor function and energy cost quantified by mechanical efficiency were investigated.

Method: 24 children, GMFCS Levels II - IV, were randomly assigned to the AST or NDT. Both groups were treated 2 hours, 5 days/week, for 4 weeks. To compare treatments, the GMFM and the mechanical efficiency index (EIHB) during stair-climbing were measured at baseline, after 1 month, and at 10 months.

Conclusion: Both intensive treatments accelerated the acquisition of motor abilities compared to normal development. Improvements in motor skills and retention after 9 months were not significantly different between the two treatments. There was a greater increase in EIHB in AST when compared to NDT. Conclude that AST might improve mechanical efficiency without a corresponding gain in gross motor skills.

Changes in Two Children with Cerebral Palsy After Intensive Suit Therapy: A Case Report

Bailes, Greve, Schmitt - Pediatric Physical Therapy - 2010

Purpose: The purpose of this case report was to investigate effects of intensive suit therapy on gait, functional skills, caregiver assistance, and gross motor ability in children with cerebral palsy

Method: Two children with spastic diplegia classified at level III on the GMFCS participated. Outcomes were assessed using standing, walking, running and jumping dimensions of the GMFM, the PEDI, and instrumented gait analysis.

Results: Very small improvements in function were noted in the standing dimension of the GMFM and PEDI (Self-care Domain) with decreased function in other areas. Improved walking speed, cadence, symmetry, joint motion, and posture were found with gait analysis.

Conclusion: Further investigation with larger sample sizes is needed before conclusions can be drawn as to the effectiveness of the program. Finally, this program is available at a substantial cost, and the benefits obtained may not be worth the investment.

ICF Model and Suit TherapyBody Structure & Function:Mixed results. Some studies state AST has been shown to improve mechanical efficiency and could possibly translate to decreased energy expended during stair climbing.

Activity:Mixed results. Limited evidence to suggest small improvements in gait and posture. Other studies suggested no improvement in gross motor function.

Participation:No studies have been published specifically addressing the level of participation after suit therapy intervention.

Personal & Environmental Factors:Time constraint, dependant on family support

Impressions of AST

Positives Negatives● Appears to have some

positive impact on gait mechanics in an extremely small population

● Appears to have a positive effect on body mechanics at the body structure and function level

● No harmful side effects

● Not often chosen by parents ● Not shown to be beneficial at

the activity and participation levels.

● Expensive and requires additional training for anyone interested

Conclusion

● This may not be the best intervention to use clinically○ Not proven to have an effect on the Activity and

Participation levels○ It is expensive○ There is limited evidence to support effectiveness of

treatment

Conclusion

● While it is true that:○ It is always good to have additional tools in our

ever expanding toolbox

○ It is a unique specialty and we would probably be the only AST specialists in the area

Conclusion

● Partner with local gym○ There are no documented adverse effects○ Training doesn’t require a PT degree

■ Less cost for the patient!

ReferencesBailes, A. F., Greve, K., Burch, C. K., Reder, R., & Lin, L. (2011). The effect of suit wear during an intensive

therapy program in children with cerebral palsy. Pediatric Physical Therapy, 23(2), 136-142.

Bailes, A. F., Greve, K., & Schmitt, L. C. (2010). Changes in two children with cerebral palsy after intensive suittherapy: a case report. Pediatric Physical Therapy, 21(1), 76-85.

Bar-Haim S, Harries N, Belokopytov M, Frank A, Copeliovitch L, Kaplanski J, Lahat E. (2006). Comparison ofefficacy of Adeli suit and NDT treatments in children with CP. Developmental Medicine and ChildNeurology. 48, 325-330.

Clinical policy bulletin: Suit therapy (2014, November 7). From Aetna Health Insurance. Retrieved fromwww.aetna.com/cpb/medical/data/600_699/0696.html

Koscielny, I. (n.d.). Training for Therapists. Retrieved April 13, 2015, fromhttp://www.suittherapy.com/training_for_therapists.htm

Mehl-Madrona, L. (2001, January 1). Treatments for Cerebral Palsy: The Adeli Suit. Retrieved April 10, 2015,from http://www.healing-arts.org/children/cp/cpadeli.htm

MyChild. (n.d.) Intensive Suit Therapy for Cerebral Palsy. Retrieved fromhttp://cerebralpalsy.org/about-cerebral-palsy/treatment/therapy/intensive-suit-therapy

Questions?