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Granlund M, Imms C. Participation as a means-implications for intervention reasoning. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1399818. [PMID: 38994330 PMCID: PMC11236800 DOI: 10.3389/fresc.2024.1399818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/06/2024] [Indexed: 07/13/2024]
Abstract
Introduction The increased focus among researchers and professionals on participation as an explicit intervention outcome has prompted a paradigm shift in both thought and practice. However, much research centers on altering participation outcomes in specific life situations and stages. This discussion paper considers "participation as a means" in pediatric rehabilitation and special education interventions, emphasizing its role in achieving lasting outcomes. Method This paper uses a Venn diagram approach to consider relations between three core concepts-participation, intervention, and outcomes-and their intersection. The paper's central theme revolves around the intersection of these concepts, wherein participation serves as a means to achieve enduring participation outcomes within the realms of rehabilitation and special education. The discussion is supported by contemporary empirical work and from literature identified in two recent scoping reviews focusing on the intervention process. Results Achieving enduring participation outcomes through participation in the intervention process necessitates creating a learning experience, with children and families actively participating in every step: identifying participation issues, seeking explanations, prioritizing intervention goals, selecting methods, implementing interventions, and evaluating the process and outcomes. Discussion This structured approach supports professionals and researchers to foster the skills and capacity required for lasting participation outcomes for children with impairments.
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Affiliation(s)
- Mats Granlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Christine Imms
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Reynolds K, Urbanowicz A, Mayston M, Foley S. Kids+ Parent Infant Program (PIP): a community model for supporting partnerships in early developmental follow-up and support. Front Pediatr 2024; 12:1354971. [PMID: 38756970 PMCID: PMC11096506 DOI: 10.3389/fped.2024.1354971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/19/2024] [Indexed: 05/18/2024] Open
Abstract
High-risk infants are discharged home from hospital with increased care needs and the potential for the emergence of developmental disabilities, contributing to high levels of parental stress and anxiety. To enable optimal outcomes for high-risk infants and their families, developmental follow-up programs need to continue following hospital discharge. However, current follow-up care for high-risk infants is variable in terms of type, access and equity, and there seems to be a gap in existing services such as supporting the transition home, parental support, and inclusion of all at-risk infants regardless of causality. Routine follow-up that identifies developmental delays or neuromotor concerns can facilitate timely referral and access to targeted intervention during critical periods of development. The Kids+ Parent Infant Program (PIP) is a unique model of developmental follow-up that shares some characteristics with established programs, but also includes additional key elements for a seamless, wrap-around service for all high-risk infants and their families living in a regional area of Australia. This community-based program provides integrated assessment and intervention of infants, alongside parent support and education, embracing a holistic model that accounts for the complexity and interrelatedness of infant, parent, medical and developmental factors. By prioritising the well-being of high-risk infants and their families, the Kids+ PIP paves the way for improved developmental outcomes and provides an innovative model for developmental follow-up, with the potential for reproduction in other healthcare settings.
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Affiliation(s)
- K. Reynolds
- Kids Plus Foundation (Kids+), Geelong, VIC, Australia
- Childrens Therapy Services, Geelong, VIC, Australia
| | - A. Urbanowicz
- Kids Plus Foundation (Kids+), Geelong, VIC, Australia
- Australian Institute for Health Transformation, Determinants of Health, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - M. Mayston
- Division of Biosciences, Neurosciences, Physiology & Pharmacology, University College London, London, United Kingdom
| | - S. Foley
- Kids Plus Foundation (Kids+), Geelong, VIC, Australia
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Lawler K, Taylor NF, Shields N. Let families decide: Barriers and enablers to participation in family-assisted therapy for older people in transition care. Australas J Ageing 2023; 42:499-507. [PMID: 36527306 DOI: 10.1111/ajag.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To understand the barriers and enablers to participation in family-assisted therapy for older people in Transition Care. METHODS A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members, who either participated in or chose not to participate in a family-assisted therapy trial. Semi-structured interviews were conducted, transcribed verbatim and analysed thematically. RESULTS Forty-four participants were interviewed (17 patients and 27 family members). The unifying theme was to let families decide about participation in family-assisted therapy. The unifying theme was illustrated by three subthemes. The first, what is possible for the family now, described practical considerations including geography, paid and unpaid work structure and commitments and the presence of fit and willing social networks. The second, what is important to the family now, recognised the role of family priorities in deciding. Physical rehabilitation and extra therapy were of high importance to some families. For others, emotional support or searching for a residential aged care bed were more important at the time. Finally, how the family functions described the complexity of relationships and family history that impacted the decision to participate. CONCLUSIONS The decision to participate in family-assisted therapy is complex and is best made by patients and their families. Clinicians offering family-assisted therapy are encouraged to avoid assuming what will or will not work for families and instead, to let families decide.
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Affiliation(s)
- Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Kerr C, Novak I, Shields N, Ames A, Imms C. Do supports and barriers to routine clinical assessment for children with cerebral palsy change over time? A mixed methods study. Disabil Rehabil 2023; 45:1005-1015. [PMID: 35343348 DOI: 10.1080/09638288.2022.2046874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To understand how healthcare professionals' perceptions of supports and barriers to routine clinical assessment, for children aged 3-18 years with cerebral palsy, evolved in the presence of a knowledge translation intervention. METHODS A prospective longitudinal mixed-methods study was completed. The intervention comprised knowledge brokers, an e-evidence library, locally provided education and embedding routine clinical assessment in practice. Healthcare professionals from five disability services completed the Supports and Barriers Questionnaire and focus groups at baseline, 6, 12 and 24 months. Quantitative data were analysed descriptively and qualitative data using longitudinal framework analysis. RESULTS Questionnaire ratings indicated participants felt supported in implementing routine assessment over time. Subtle differences emerged from the longitudinal framework analysis. Participants shifted from 'adopting' to 'embedding' and 'maintaining' routine assessment. Integration of assessment was impacted by a new national disability funding model. Participants highlighted the need to maintain skills and for unambiguous, sustained communication between the organisation, clients, and stakeholders. If, how and why families engaged with routine assessment developed over time. CONCLUSIONS After an initial focus on pragmatic implementation issues, over time healthcare professionals began to reflect more on the complexities of children and families' engagement with assessment and the impact on the therapist-child-family relationship. Trial registration: This trial was not a controlled healthcare intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015.IMPLICATIONS FOR REHABILITATIONHealthcare professionals can be supported over time to embed routine clinical assessment using multifaceted knowledge translation interventions.It takes time and ongoing support for healthcare professionals to embed, maintain and begin to adapt the routine clinical assessment to fit with policy, organisational context and the needs and wishes of children and families.Understanding and tailoring knowledge translation approaches to the policy context are essential.Even in the context of major policy shifts, it is possible to harness the commitment of organisations and professionals to improve their services in line with evidence-based approaches.
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Affiliation(s)
- Claire Kerr
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Alice Ames
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | | | - Christine Imms
- Department of Paediatrics, The University of Melbourne; and Australian Catholic University, Melbourne, Australia
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Bootsma JN, Phoenix M, Geytenbeek JJM, Stadskleiv K, Gorter JW, Fiske S, Cunningham BJ. Implementing the language comprehension test C-BiLLT: a qualitative description study using the COM-B model of behaviour change. BMC Health Serv Res 2022; 22:1421. [PMCID: PMC9702652 DOI: 10.1186/s12913-022-08803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
It is challenging to reliably assess the language comprehension of children with severe motor and speech impairments using traditional assessment tools. The Computer Based instrument for Low motor Language Testing (C-BiLLT) aims to reduce barriers to evidence-based assessment for this population by allowing children to access the test using non-traditional methods such as eye gaze so they can independently respond to test items. The purpose of this study is to develop a contextualized understanding of the factors that influenced clinicians’ implementation of the C-BILLT in practice in the Netherlands and Norway.
Materials and methods
A qualitative approach including semi-structured individual interviews with 15 clinicians (speech-language pathologists, neuropsychologists, and one teacher, counsellor, and vision specialist) was used. Data analysis was conducted in two rounds. First, a deductive approach including a codebook was used to code data within the COM-B components describing clinicians’ capability, opportunity, and motivation for behaviour change. Then, an abductive approach applying thematic analysis was used to identify meaningful patterns within the COM-B components.
Results
Several meaningful barriers and facilitators were identified across the data. Clinicians used the C-BiLLT with two distinct groups of clients: (1) the population it was originally developed for, and (2) clients that could have also been assessed using a traditional language test. Clinicians working with the first group experienced more, and more complex barriers across all COM-B components, to successful C-BiLLT use than the latter.
Conclusion
This study provides timely insights into the capability, opportunity, and motivation factors important for creating and sustaining assessment behaviour change in clinicians who used or attempted to use the C-BiLLT. Potential tailored intervention strategies aimed at improving implementation of novel assessment tools are discussed and may be helpful for others working to improve service delivery for children with complex needs.
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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Ni ZH, Ding S, Wu JH, Zhang S, Liu CY. Family Caregivers’ Experiences of Caring for Children With Cerebral Palsy in China: A Qualitative Descriptive Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221121510. [PMID: 36062607 PMCID: PMC9449510 DOI: 10.1177/00469580221121510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate family caregivers’ experiences of caring for
children with cerebral palsy in China. This study used a descriptive qualitative
design. We selected 18 family caregivers from 3 children’s hospitals in Jiangsu
Province, China, using a purposive sampling method. The following 5 themes
emerged as needs of family caregivers’ experiences of caring for children with
cerebral palsy: overall responsibility, being alone, exhaustion from caring,
being a prisoner of life, and uncertainty regarding the future. The findings of
our research contribute to a better understanding of the life situation of
family caregivers of children with cerebral palsy as we identify the
difficulties they experience as well as their specific needs.
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Affiliation(s)
- Zhi Hong Ni
- Children’s Hospital of Soochow University, Suzhou, China
| | - Sheng Ding
- Children’s Hospital of Soochow University, Suzhou, China
| | - Jin Hua Wu
- Children’s Hospital of Soochow University, Suzhou, China
| | - Shuo Zhang
- Children’s Hospital of Soochow University, Suzhou, China
| | - Chun Yan Liu
- Children’s Hospital of Soochow University, Suzhou, China
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Deramore Denver B, Froude E, Rosenbaum P, Imms C. Measure of early vision use: initial validation with parents of children with cerebral palsy. Disabil Rehabil 2021; 44:4066-4074. [PMID: 33651960 DOI: 10.1080/09638288.2021.1890243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To report initial psychometric evidence on the Measure of Early Vision Use. METHOD Data on performance of the Measure of Early Vision Use scale were collected from 100 parents of children with cerebral palsy aged 0-12 years via online survey. Psychometric evaluation included assessment of scale dimensionality using Classical Test Theory and hypothesis testing for evidence of construct validity. RESULTS Principal components analysis of the 14-item parent-rated Measure of Early Vision Use revealed one component with an eigenvalue of 9.343, explaining 66.7% of variance; internal consistency was high (Cronbach's α = 0.96). Total scores ranged from 15-56 (Mean 42.8, standard deviation = 10.6). The results support seven pre-defined hypotheses including statistically significant differences in MEVU-total scores between children with and without parent-reported cerebral visual impairment. CONCLUSIONS Measure of Early Vision Use is the first assessment tool to describe 'how vision is used' in children with cerebral palsy. Results provide preliminary evidence that the measure comprises a unidimensional construct, sufficient construct validity, and feasibility as a parent-completed online assessment. Findings on internal structure provide foundational evidence and require further testing with Confirmatory Factor Analysis or Rasch Analysis.IMPLICATIONS FOR REHABILITATIONThe Measure of Early Vision Use is a new instrument to describe the use of basic visual abilities and is feasible to use as a parent-completed online questionnaire.The Measure of Early Vision Use is a unidimensional scale with sufficient construct validity to supports its use as a measure of 'how vision is used' without confounding visual ability with the reason why it might be impaired (e.g., cerebral vision impairment, motor limitations, or cognition).There is potential for the Measure of Early Vision Use to support early intervention planning for children with (or at high risk of) cerebral palsy.
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Affiliation(s)
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Peter Rosenbaum
- Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Christine Imms
- Department of Paediatrics,University of Melbourne, Parkville, Australia
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Muñoz-Blanco E, Merino-Andrés J, Aguilar-Soto B, García YC, Puente-Villalba M, Pérez-Corrales J, Güeita-Rodríguez J. Influence of Aquatic Therapy in Children and Youth with Cerebral Palsy: A Qualitative Case Study in a Special Education School. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103690. [PMID: 32456241 PMCID: PMC7277651 DOI: 10.3390/ijerph17103690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
Cerebral palsy results in the progressive loss of motor functions, with a negative impact on daily activities and participation. Despite the well described benefits of aquatic therapy in children, little is known about the effects of the same in school settings. This study aimed to describe the experience of children and youth with cerebral palsy participating in an aquatic therapy program within a special education school considering their educational and therapeutic perspectives. A qualitative descriptive case study with embedded units was developed, comprising 27 participants. This study employed purposeful sampling to include children and youth with cerebral palsy from the Asociación Ayuda a la Paralisis Cerebral (APACE) special education school, together with their parents, the special education teachers, and health care professionals. Data were collected via non-participant observation, semi-structured and informal interviews, focus groups, and researcher field notes. A thematic analysis was conducted, revealing the following themes: (a) the connection with the environment; (b) postural improvements and mobility; (c) the opportunity to perform tasks; (d) learning and transfer. A motivating environment leads to physical, cognitive and social benefits, both at school and in the home. Aquatic therapy was viewed as a means for learning and participation. These findings may enhance understanding regarding the potential benefits of implementing multidisciplinary aquatic therapy programs in specialist school settings.
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Affiliation(s)
- Elisa Muñoz-Blanco
- Department of Physical Therapy, Faculty of Medicine, CEU-San Pablo University, 28003 Madrid, Spain;
- Research and Science Committee of Worldwide Aquatic Bodywork Association (WABA), 6802 Monteceneri, Switzerland
| | - Javier Merino-Andrés
- Faculty of Physical Therapy and Nursing, Universidad de Castilla La Mancha, 45071 Toledo, Spain;
- PedPT Research Lab, Grupo de Investigación de Fisioterapia en Toledo (GIFTO), 45071 Toledo, Spain
| | | | | | | | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain;
- Research Group of Humanities and Qualitative Research in Health Science, Rey Juan Carlos University (Hum&QRinHS), Alcorcón, 28922 Madrid, Spain
| | - Javier Güeita-Rodríguez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain;
- Research Group of Humanities and Qualitative Research in Health Science, Rey Juan Carlos University (Hum&QRinHS), Alcorcón, 28922 Madrid, Spain
- Correspondence: ; Tel.: +34-4888600
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