A comparative exploration of the thoughts of parents and therapists regarding seating equipment for children with multiple and complex needs

Current clinical practice in 24-hour postural management and the impact on carers and service users with severe neurodisability

Introduction

The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions. The aim of this research was to investigate the use of 24-hour postural management by occupational therapists and to explore its impact on service users with neurodisability and their carers.

Methods

Quantitative and qualitative methods were employed in two phases: (a) online survey with 96 occupational therapists across one UK region, with data analysed by descriptive statistics and correlations; (b) focus groups with service users and/or carers ( n = 9), with data analysed by thematic analysis.

Results

Findings showed moderate positive correlation between frequency of use and (a) all key intervention skills and (b) knowledge of night-time positioning ( p < 0.001). Moderate positive correlations were found between level of training and (a) assessment skills and (b) knowledge of night-time positioning ( p < 0.001). The overarching theme from focus groups was ‘reliance on individualised equipment’, with overwhelming frustration from lack of support, loss of identity, equipment cost, insufficient focus on preventative strategies and accessibility issues.

Conclusion

A clinical practice guideline, including training, is crucial to direct practice. Providers must engage with service users and carers to address their frustrations.

Children's complex care needs: a systematic concept analysis of multidisciplinary language

Complex care in the arena of child health is a growing phenomenon. Although considerable research is taking place, there remains limited understanding and agreement on the concept of complex care needs (CCNs), with potential for ambiguity. We conducted a systematic concept analysis of the attributes, antecedents, and consequences of children's CCNs from a multidisciplinary perspective. Our data sources included PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Inclusion criteria included publications in peer-reviewed journals between January 1990 and December 2017, written in the English language. One hundred and forty articles were included. We found that children's CCNs refer to multidimensional health and social care needs, in the presence of a recognized medical condition or where there is no unifying diagnosis.Conclusion: Children's CCNs are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. There remain extensive challenges to caring for these children and their families, precluding the possibility that any one profession can possess the requisite knowledge or scope to singularly provide high-quality competent care. What is Known: • Complex care is a growing phenomenon and population prevalence figures show that there is an increasing number of children with complex care needs (CCNs). However, the concept has not been systematically analyzed before, leaving it generally ill-defined and at times confusing. What is New: • This is the first time this concept has been systematically analyzed and this analysis provides a much-needed theoretical framework for understanding the multidimensional nature of CCNs in children. • Children's CCNs refer to multidimensional health and social care needs in the presence of a recognized medical condition or where there is no unifying diagnosis. They are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. It is clear that the very nature of CCNs precludes the possibility that any one profession or discipline can possess the requisite knowledge or scope for high-quality competent care for this population.

Continuous postural management and the prevention of deformity in children with cerebral palsy: an appraisal

Continuous postural management programmes are commonly used for children with cerebral palsy (CP) in Gross Motor Function Classification System levels IV and V, with the aim of preventing musculoskeletal deformity. There is a lack of evidence to support their use in this capacity and a possibility that children with CP who are most likely to develop deformity may be least able to comply with a continuous postural management programme. The implications for the child and family of such a programme in terms of increased demands and potential discomfort are discussed within the framework of the International Classification of Functioning, Disability and Health. A shift in focus in the use of postural management from an emphasis on body structure towards the environment and participation of the child with CP is suggested.