Getting Everyone in the Same Room: The Combined Therapist Approach to Teaching Independence in Clean Intermittent Catheterization

Abstract

Introduction

Most pediatric patients with neurogenic bladder require clean intermittent catheterization (CIC), several times daily, for maintenance of continence and health. CIC is performed by the caregiver until the child is developmentally ready to learn self-CIC. Children with associated mobility, dexterity, and cognitive deficits tend to take much longer to learn self-CIC. We piloted a combined pediatric urotherapy and occupational therapy clinic to address this problem.

Methods

Five children (6–14 years old) and their parents attended combined therapist sessions for 6 months. Explanation of self-CIC was done using show-and-tell method followed by doll play and/or supervised practice. Patients' mastery difficulties were identified by demonstration and collaborative discussion. Specific tasks and activities were recommended for home practice after task assessment and analysis. Reasons for slow progress in learning self-CIC were documented.

Results

All five children had motor and cognitive difficulties. Previously, caregivers regularly overassisted, which prevented patient practice and exposure. Task assessment, analysis, and recommendation had been suboptimal because patients' different combinations of disabilities caused unique difficulties with self-CIC that were unrecognized when attending individual therapist sessions. After the combined clinic, patients increased participation in the preparatory phase of self-CIC, functional mobility and dressing tasks.

Discussion

Despite longer session duration and scheduling constraints, the combined therapist approach was more efficient and effective for this category of patients, with fewer return sessions needed to achieve the desired outcome. We recommend early identification and referral of appropriate patients for a combined therapy clinic.