What Makes Participation Meaningful? Using Photo-Elicitation to Interview Children with Disabilities

The meaning of adapted ice-skating for children and youths with disabilities

PURPOSE

Children and youths with disabilities have low levels of physical activity and limited opportunities to participate in physical activity. This study aimed to explore the lived experiences and meaning of an adapted ice-skating approach with access to a tailored harness system as a physical activity for children and youths with disabilities in Sweden.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 12 guardians, 5 ice-skating trainers and 15 ice-skating children and youths with disabilities. The interviews were supplemented with participant observations of 23 children and youths with disabilities while ice-skating.

RESULTS

Four categories emerged: "To grow as a person," "To arouse zest for life," "To train for life" and "To become part of society." Ice-skating was found to be a source of joy of movement, zest for life and longing, enabling children and youths with disabilities to explore and develop their abilities, social interactions, confidence, identity, and independence in a safe and joy-bringing context.

CONCLUSION

The study highlights social and existential dimensions of an adapted ice-skating approach with access to a harness system tailored for children and youths with disabilities, that enables them to be included in ice-skating, regardless of disabilities, creating increased opportunities for physical activity and movement.

Differences in Meaning of Occupations Between Children With and Without Neurodevelopmental Disorders

Engaging children in meaningful occupations is a means of improving their participation. The objective of this study is to assess differences in dimensions of meaning of occupations-challenge, value, felt time, and autonomy-between children with and without neurodevelopmental disorders and their associations with the participation of each group. Thirty children with neurodevelopmental disorders (autism spectrum disorder [ASD]/attention deficit hyperactive disorder [ADHD]) and 30 typically developing children (M age = 9.37 ± 1.41 years) reported regarding dimensions of meaning of occupations. Their parents reported regarding children's participation. Children with neurodevelopmental disorders attach different meanings to their everyday activities than their typically developing peers, with a large effect size (ηp2 = .07-.12). For children with neurodevelopmental disorders, the value and autonomy dimensions of meaning were correlated with participation. The findings expand knowledge of occupational meaning and participation among children. To optimize the participation of children, occupational therapists should facilitate autonomy and engage children in activities that they value.

Persistence on Task, Executive Functions, and the Perceived Meaning of Occupations Among Children

IMPORTANCE

Persistence on task-the voluntary continuation of a goal-directed action despite difficulties-is described as a behavioral component of involvement in an occupation; however, it has not yet been extensively studied in the context of pediatric occupational therapy.

OBJECTIVE

To describe persistent children, compared with their less persistent peers, in terms of age, sex, executive functions (EF), and perceived meaning of occupations and to assess whether intrapersonal factors, EF, and the perceived meaning of occupations can predict persistence.

DESIGN

Cross-sectional.

SETTING

A community in Israel.

PARTICIPANTS

Typically developing healthy children (N = 180) ages 6.0 to 12.5 yr and their parents.

OUTCOMES AND MEASURES

The Tower of Hanoi task (TOH; seven discs) was used to assess persistence on task. EF were assessed with the TOH (three discs) and the Verbal Working Memory test. Occupational meaning-challenge, value, sense of time, and autonomy-was assessed with the Perceived Meaning of Occupation Questionnaire.

RESULTS

Twenty-six children (14%) completed the task. They were older than their peers, performed better on most of the EF tests, and perceived more autonomy in their everyday activities (Mann-Whitney U = 1,185.0, p < .001). However, only the perceived autonomy of occupations was found to be a statistically significant factor that predicted persistence on task (B = -0.12, SE = 0.05, Wald = 7.60, p = .01).

CONCLUSIONS AND RELEVANCE

Perceived autonomy in everyday activities is crucial for persistence on task. Occupational therapy practitioners can promote children's involvement and persistence in cognitive tasks by supporting a sense of autonomy in everyday activities, although further study is needed. What This Article Adds: This article highlights the contribution of perceived autonomy in everyday activities to children's involvement and persistence on task by providing empirical data on children's persistence on task with regard to their EF and perceived meaning of occupations. Children who persisted longer and completed tasks differed from their less persistent peers in terms of age and EF. However, perceived autonomy in everyday activities was the only predictor of task completion.

Co-development of the CMAP Book: a tool to enhance children's participation in pediatric rehabilitation

PURPOSE

The purpose of the co-development project was to create a tool that enhances children's active participation and agency in rehabilitation and in everyday life.

MATERIALS AND METHODS

Action research was the methodological approach. Participants in the different phases of the process (2015-2017) were children with disabilities, parents and rehabilitation professionals. The co-development process included: (1) designing the tool's first version, (2) piloting the tool, (3) evaluating the tool by collecting feedback and reflection, (4) generating the tool's final version.

RESULTS

Through the co-development process, an accommodating and digital tool called the CMAP Book-a description of the child's meaningful activities and participation-was developed. The CMAP Book is used with an electronic app enabling the identification and description of what is meaningful in daily life from the child's perspective with videos, photos, pictures, recording and writing. The tool enables the child, family and professionals to prepare and build collaboration in rehabilitation with flexibility according to child and family needs.

CONCLUSIONS

Use of the CMAP Book promotes the active involvement of the child and parents in designing the rehabilitation process in daily life in partnership with professionals. The stakeholder involvement in the co-development facilitated meaningful results and a concrete tool for rehabilitation.IMPLICATIONS FOR REHABILITATIONThe CMAP book is a new tool that enhances the child's active participation and agency in the rehabilitation process based on meaningful activities in everyday life expressed by the child.Identifying and utilising meaningful issues in the child's daily life through collaboration increases the child's commitment and motivation, and thus may enhance the benefits and effects of rehabilitation. Through co-development, the child and his/her family can be active and equal partners not only in development projects but also in the rehabilitation process.In the future, child-specific practices and policies should be developed to promote participatory co-research between families and clinicians linked to the daily lives of families with children.

Patient and Parent Experiences with Group Telerehabilitation for Child Survivors of Acute Lymphoblastic Leukemia

BACKGROUND

Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. ALL and its treatment cause altered bone-mineral homeostasis, which can contribute to musculoskeletal late adverse effects (LAEs). With the increasing number of childhood cancer survivors, LAEs are reported often, and are aggravated by inactive lifestyles. A telerehabilitation program is proposed to strengthen the muscle-bone complex and prevent future impairment.

OBJECTIVE

This study aimed to explore and better understand patient and parent experience of a telerehabilitation program after completion of ALL treatment.

METHODS

ALL survivors (n = 12), 75% girls, 7.9 to 14.7 years old, within six months to five years of treatment, were recruited to participate in the proposed study, along with a parent. The 16-week group program included 40 potential home-based physical activities, with monthly progression, supervised by a kinesiologist, through an online telerehabilitation platform. Patients could be included in the study if they joined during the first month of intervention of their group (minimum 12 weeks of intervention). A semi-structured post-intervention interview was conducted with the patients and their parent during the final assessment, along with a review of the kinesiologist's clinical notes, to obtain a portrait of the participants' experience with the telerehabilitation program. Overarching themes were identified by one author and confirmed by two senior authors before extracting the various aspects of each theme.

RESULTS

Of the 12 patients recruited, three were excluded from the analysis because they did not complete the minimum 12 weeks of intervention (one = relapse, one = failure to meet technical requirements, and one = abandoned due to parent's disinterest). The nine patients who completed the program (six girls; 10.93 ± 2.83 years) had a mean adherence of 89%. The overarching themes identified were the program modalities (group approach with patient-parent paired training, supervised by a kinesiologist), the telerehabilitation system, the participants' perception of the benefits, and recommendations and suggestions from the families. Both patients and parents expressed very high satisfaction with the program and perceived benefits.

CONCLUSION

Participants appreciated the program and reported they would all recommend it to other families in similar situations. The telerehabilitation method of service delivery was perceived by some as decisive in choosing to participate, while the supervision and intra- and inter-family interactions were the motivating factors that were key to program adherence.