A model for the assessment and management of children with multiple disabilities

A computerized tool to assess reading skills of students with motor impairment

Conventional tests for assessing the early reading skills of preschool children on school entry are not accessible to students with motor limitations of upper limbs. This paper presents a game-like computerized test featuring an appealing scenario that is accessible to these students. It was developed on a platform that creates 2D vector graphics and contains three phases of interactive content accessible through an adapted peripheral. A conventional card-based test was also used to validate the effectiveness of the computerized test. Both tests were performed by thirty-three preschool children without mobility impairment all aged between four years and six months and six years and two months (x¯ = 5,33; σ = 0,44). The Wilcoxon signed-rank test was used to compare the nonparametric data from the computerized test with the card-based test in the first and second phase, yielding results of p = 0.11 and p = 0.21, respectively. The Student's t-test was conducted to compare the parametric data of the third phase of the computerized test with the data from the third phase of the card-based test yielded results of p = 0.07.Three gaming experts considered the computerized test to be fun and engaging, and three teachers concluded that the computerized test meets educational goals. Additionally, seven volunteers with moderate mobility impairment (group T), aged between eight and seventeen years old (x¯=11.8; σ = 3.5), accompanied by two physical therapists, took the computerized test using the adapted peripheral device and performed the required tasks without difficulty and without showing signs of fatigue. Based on the results obtained it can be concluded that the computerized test may enable educators to include students with mobility difficulties in literacy assessments and to design teaching strategies that are appropriate given their levels of knowledge.

What do parents of children with dysphagia think about their MDT? A qualitative study

OBJECTIVES

To seek the experiences and perspectives of parents caring for children with dysphagia, with emphasis on their experiences of working within their child's multidisciplinary team (MDT).

SETTING

This research was completed in community settings, within families' homes across the UK.

PARTICIPANTS

14 families self-selected to participate in the study. Criteria specified that participants must care for a child under the age of 18 and to decrease ambiguity the term 'diagnosis of dysphagia' was defined as the need for modified (thickened) fluids.

EXCLUSION CRITERIA

caring for an adult over the age of 18; diet and fluid modifications for reasons other than dysphagia (eg, for symptomatic treatment of gastro-oesophageal reflux disease. Participants were interviewed within their homes using a semistructured questionnaire and data was analysed using a descriptive phenomenological approach through use of thematic coding and constant comparison. Themes and relationships were inductively generated from the data.

RESULTS

Participants universally expressed a desire to be involved with their child's MDT; this study identified the following facilitators and barriers to collaboration: accessing services, professional knowledge and professional skillset. Participants described three means of responding to these barriers: reacting emotionally, seeking solutions and making decisions.

CONCLUSIONS

This study recorded in-depth reports of participants' experiences of working with healthcare providers. Despite government-driven efforts towards person-centred healthcare and social care, participants shared accounts of times when this has not occurred, describing a negative impact on the well-being and quality of life of their child and family.

How well do care providers know the children with developmental disabilities they care for?

AIM

To assess the knowledge from memory of caregivers about the most significant impairments contributing to additional care needs in children with developmental disabilities in therapeutic toddler groups.

METHODS

Children's needs for additional care due to impairments of physical health, motor, sensory, mental and voice and speech functions were separately classified using the capacity profile (CAP). Twenty-three therapists and teachers of toddler groups in two regional centres for paediatric rehabilitation assessed the CAP individually, unprepared and without consulting their notes or the clinical record. These CAP scores (150 CAPs of 44 children) were compared with those based on the clinical record using weighted kappa statistics.

RESULTS

Weighted kappa values for the two sets of CAP scores ranged from 0.22-0.74 (median 0.53), with the lowest scores for the sensory domain (median 0.32, range 0.22-0.52) and the highest scores for the motor domain (median 0.62, range 0.56-0.74).

CONCLUSION

Team members in general had only moderate remembered knowledge of the current impairments determining need of additional care. Remembered knowledge was the poorest for domains not easily observable, such as sensory functions. As this knowledge is essential for optimizing the child's daily environment, improvement of this type of knowledge should be facilitated.

Exploring multi-agency working in services to disabled children with complex healthcare needs and their families

Children with complex healthcare needs typically require technical and/or medical equipment in the home. This growing group of children and families need support that crosses agency and professional boundaries, necessitating effective multi-agency working. There are many examples of multi-agency working around the United Kingdom (UK), some specifically designed to meet the needs of children with complex healthcare needs and their families. Recent legislation and policy statements have highlighted the importance of joint planning and working. Currently no research exists that examines the impact of these initiatives on disabled children with complex healthcare needs and their families. The "Working Together" project is an ongoing research study based at the Norah Fry Research Centre, University of Bristol, Bristol, UK. The project aims to explore the impact of multi-agency work on children with complex healthcare needs and their families. This paper examines the literature on barriers to disabled children and the need for multi-agency working. It also considers the concept of multi-agency working and how different approaches to working together might be perceived by children and families.

Technical aspects of feeding the disabled child

Children with neurological impairment frequently have difficulties in consuming sufficient energy and other nutrients to maintain adequate nutritional status. Under-nutrition is a significant contributory factor to growth failure. Eating may be distressing and time-consuming for the child and carer. Aspiration of feeds is common and may predispose to chronic chest infections. Gastro-oesophageal reflux is also common and may contribute to significant morbidity. This paper discusses some of the issues involved in the nutritional management of neurologically impaired children.