1
|
Massey J, Tsianakas V, Gordon A, Sadler N, Robert G. Co-designing complex therapy interventions with parents as partners in the care of children with cerebral palsy: An Experience-based Co-design study in England. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 151:104793. [PMID: 38924956 DOI: 10.1016/j.ridd.2024.104793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/07/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Parents of children with hemiplegic cerebral palsy are increasingly involved in therapy intervention delivery. Enhancing the ways that parents are supported in delivery is key to optimising outcomes. This study aimed to refine an existing programme in England to better support parents partnering in their child's intervention delivery. METHODS AND PROCEDURES Experience-based Co-design (EBCD) fostered collaboration between parents and therapists to identify shared improvement priorities and develop solutions. The study included eighteen interviews and sixteen co-design meetings involving twenty parents and eight therapists in total. Intervention development followed the MRC Framework for developing and evaluating complex interventions. OUTCOMES AND RESULTS Themes from parent and therapist interviews informed priority setting for the co-design work. Three key shared priorities emerged a) accessing rehabilitation; b) fostering partnership and c) parent learning. Aligned with these priorities, three mixed parent and therapist co-design teams produced a) a parent booklet; an education outline for healthcare professionals; b) partnership principles; adaptations to intervention logbooks c) an online parent education session. CONCLUSIONS AND IMPLICATIONS Engaging parents and therapists in a structured co-design process using EBCD yielded innovative interventions supporting parents in delivering therapy for children with hemiplegia. This collaborative approach is anticipated to enhance programme implementation and effectiveness.
Collapse
Affiliation(s)
- Jill Massey
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Florence Nightingale School of Nursing Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Vicki Tsianakas
- Florence Nightingale School of Nursing Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Anne Gordon
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Florence Nightingale School of Nursing Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | | | - Glenn Robert
- Florence Nightingale School of Nursing Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| |
Collapse
|
2
|
Souza RFA, Leite HR, Lucena R, Carvalho A. Early Detection and Intervention for Children with High Risk of Cerebral Palsy: A Survey of Physical Therapists and Occupational Therapists in Brazil. Phys Occup Ther Pediatr 2024:1-15. [PMID: 38764324 DOI: 10.1080/01942638.2024.2353124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
AIMS The purpose of this study was to assess the current clinical practice of physiotherapists and occupational therapists on early detection and early intervention for children with cerebral palsy (CP) in Brazil. METHODS This was a cross-sectional study. A purpose-developed electronic survey was disseminated across the country to physiotherapists and occupational therapists working with young children with or at risk of CP. RESULTS A total of 205 anonymous respondents were included. Most participants (64.4%) agree that the diagnosis of CP can be made before 6 months of age. General Movements Assessment (26.8%) and Hammersmith Infant Neurological Examination (37.1%) were used infrequently. Infants at risk for CP receive therapy twice a week or more by 58.5% of therapists, 93.2% identified parents' goals as the most important factor in customizing the early intervention program. The most frequent intervention strategies for this age group were active stimulation of the child (n = 182), family training (n = 161), strategies to optimize the environment (n = 143), and neurodevelopmental treatment/Bobath (n = 99). CONCLUSIONS Currently, pediatric physiotherapists and occupational therapists in Brazil do not fully incorporate best practice tools for early identification of children with CP, nor sufficient best evidence-based interventions.
Collapse
Affiliation(s)
- Rosiane F A Souza
- SARAH Network of Rehabilitation Hospitals, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Hércules R Leite
- School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rita Lucena
- Postgraduate Program in Medicine and Health, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | |
Collapse
|
3
|
Styczen LM, Helseth S, Groven KS, Hauge MI, Dahl-Michelsen T. Interprofessional collaboration for children with physical disabilities: a scoping review. J Interprof Care 2024:1-17. [PMID: 38339970 DOI: 10.1080/13561820.2023.2295922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
Abstract
Interprofessional collaboration is vital in the context of service delivery for children with physical disabilities. Despite the established importance of interprofessional collaboration and an increasing focus on research on this topic, there is no overview of the research. A scoping review was conducted to explore current knowledge on interprofessional collaboration for children with physical disabilities from the point of view of the actors involved. The steps of this review included identifying a research question, developing a protocol, identifying relevant research, selecting studies, summarizing and analyzing the data, and reporting and discussing the results. Through databases and studies from hand-searches, 4,688 records were screened. A total of 29 studies were included. We found that four themes: communication, knowledge, roles, and culture in interprofessional collaboration illustrate current knowledge on the topic. Interprofessional collaboration for children with physical disabilities is shown to be composed of these four themes, depending on the actors involved. Interprofessional collaboration is affected by how these four themes appear; they mainly act as barriers and, to a lesser extent, as facilitators for interprofessional collaboration. Whether and how the themes appear as facilitators need further exploration to support innovation of interprofessional collaboration.
Collapse
Affiliation(s)
- Line Myrdal Styczen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Karen Synne Groven
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Mona-Iren Hauge
- Faculty of Social Studies, VID Specialised University, Oslo, Norway
| | - Tone Dahl-Michelsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
4
|
Huang HH, Chu YW, Chan AT, Chen CL. A pilot randomised controlled trial of ride-on cars and postural combinations of standing and sitting for mobility and social function in toddlers with motor delays. Disabil Rehabil Assist Technol 2024:1-11. [PMID: 38180348 DOI: 10.1080/17483107.2023.2299712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Locomotor experiences in upright postures are essential for developing toddlers' mobility and social functions. This pilot randomised controlled trial aimed to examine the effectiveness of using a modified ride-on car (ROC) with postural combinations of standing and sitting on mobility and social function in toddlers with motor delays. MATERIALS AND METHODS Nineteen participants aged 1-3 years with mild, moderate or severe motor delays were randomly assigned to four ROC groups. The ROC groups had different combinations of standing and sitting, namely standing for 70 min (ROC-Stand70, five participants), standing for 45 min (ROC-Stand45, four participants), standing for 25 min (ROC-Stand25, five participants) and sitting for 70 min (ROC-Sit70, five participants). All participants participated in 2-h sessions twice a week for 12 weeks. The Pediatric Evaluation of Disability Inventory, Goal Attainment Scaling and Bayley-III tests were administered before and after the intervention, and after 12 weeks of follow-up. A mixed-model analysis of variance was used to compare inter- and intra-group differences. This trial was registered at ClinicalTrials.gov (NCT03707405). RESULTS All groups showed significantly improved mobility, social function and goal achievement at the post-test (p < .001). However, no significant changes were observed in Bayley scores. CONCLUSIONS Combining physical and social environmental modifications with active exploration is crucial for early power mobility training in toddlers with motor delays. To enhance the robustness and generalisability of our findings, future studies should include larger sample sizes, consider variations in motor delays, and measure energy expenditure during the intervention.Implications for rehabilitationProviding active exploratory experience using ride-on cars (ROCs) with various postural combinations can improve a child's mobility.The ROC training with various postural combinations can improve social function, and the degree of improvement may depend on the severity of motor delays.Setting goals with caregivers and incorporating their roles in the training process can empower them to interact with children more frequently and actively.
Collapse
Affiliation(s)
- Hsiang-Han Huang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Wen Chu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Occupational Therapy, Hung Da Wei Rehabilitation Clinic, Taichung, Taiwan
| | - Ai-Tzu Chan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Graduate Institute of Early Intervention, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
5
|
Cho J, Park H, Kang D, Park E, Chung CR, Cho J, Kudchadkar SR. Rehabilitation in critically ill children: Findings from the Korean National Health Insurance database. PLoS One 2022; 17:e0266360. [PMID: 35358288 PMCID: PMC8970491 DOI: 10.1371/journal.pone.0266360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/18/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Intensive care unit (ICU) survivors suffer from physical weakness and challenges returning to daily life. With the importance of rehabilitating patients in the pediatric intensive care unit being increasingly recognized, we evaluated the prevalence of physical and occupational therapy (PT/OT)-provided rehabilitation and factors affecting its use. Methods We conducted a retrospective cohort analysis of rehabilitation between 2013 and 2019 using the Korean National Health Insurance database. All patients aged 28 days to 18 years who had been admitted to 245 ICUs for more than 2 days were included. Neonatal ICUs were excluded. Results Of 13,276 patients, 2,447 (18%) received PT/OT-provided rehabilitation during their hospitalization; prevalence was lowest for patients younger than 3 years (11%). Neurologic patients were most likely to receive rehabilitation (adjusted odds ratio [aOR], 6.47; 95% confidence interval [CI], 5.11–8.20). Longer ICU stay (versus ≤ 1 week) was associated with rehabilitation (aOR for 1–2 weeks, 3.50 [95% CI, 3.04–4.03]; 2–3 weeks, 6.60 [95% CI, 5.45–8.00]; >3 weeks, 13.69 [95% CI, 11.46–16.35]). Mechanical ventilation >2 days (aOR, 0.78; 95% CI, 0.67–0.91) and hemodialysis (aOR, 0.50; 95% CI, 0.41–0.52) were negatively affecting factors. Conclusion Prevalence of rehabilitation for critically ill children was low and concentrated on patients with a prolonged ICU stay. The finding that mechanical ventilation, a risk factor for ICU-acquired weakness, was an obstacle to rehabilitation highlights the need for studies on early preventive rehabilitation based on individual patient needs.
Collapse
Affiliation(s)
- Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Esther Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, Charlotte R. Bloomberg Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| |
Collapse
|
6
|
Gmmash AS, Wynarczuk KD, Effgen SK. Parents' Perspectives on the Application of Home Activities in Early Intervention. Phys Occup Ther Pediatr 2022; 42:416-433. [PMID: 35037552 DOI: 10.1080/01942638.2022.2025514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aims: This study explored parents' successes, challenges, and recommendations in relation to the application of home activities in early intervention.Methods: An electronic survey was prepared with Qualtrics software and distributed to parents of children with motor delays. Three open-ended questions were included at the end of the survey. Participants were the child's primary caregiver or guardian and their child must be currently receiving early intervention services or have received early intervention services from a physical or an occupational therapist in the United States in the past 5 years. Two coders used content analysis to analyze parents' responses to open-ended questions.Results: A total of 252 participants responded to at least one of the open-ended questions that were included in the survey. Responses were grouped into codes and categories that lead to the emergence of four themes. The themes indicated parent-reported challenges, successes, and recommendations in relation to team collaboration, individualization of activities, developmental gains, and parental support.Conclusions: The results of this study suggest that more focus should be directed toward parent-therapist partnership, multidisciplinary collaboration, and personalization of activities in early intervention. Parents-reported experiences and recommendation could assist early intervention personnel in advancing services provided for children with motor delays.
Collapse
Affiliation(s)
- Afnan S Gmmash
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.,Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Kimberly D Wynarczuk
- Department of Rehabilitation Sciences, Moravian University, Bethlehem, Pennsylvania, USA
| | - Susan K Effgen
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|