Important elements of measuring participation for children who need or use power mobility: a modified Delphi survey

RESNA position on the application of power mobility devices for pediatric users

This paper serves as an update to the previous RESNA Position on the Application of Power Wheelchairs for Pediatric Users with more current and additional scientific literature. This document contains typical clinical applications and best evidence from the literature supporting the application of power mobility (PM) for young children and to assist practitioners in decision-making and justification. It is RESNA' s position that age, limited vision or cognition, behavioral issues, and the ability to walk or propel a manual wheelchair short distances should not, in and of themselves, be used as discriminatory factors against providing PM for children. RESNA recommends early utilization of PM for children with mobility limitations as medically necessary, to promote integration and psycho-social development, reduce passive dependency, and to enhance participation, function, and independence.

Exploring young children’s activity and participation change following 6 months’ power mobility experience

Introduction

This pre-post study explored the effect of children’s 6 months’ experience in one of four early power mobility devices.

Method

Satisfaction with parent-selected goal achievement was measured using the wheelchair outcome measure for young people and compared with the assessment of learning powered mobility use, as well as device expectation fulfilment ratings.

Results

Forty-six children with mobility limitations, aged 13–68 months (mean 40.40; SD 15.60) participated. The most common condition was cerebral palsy ( n = 33; 71.74%). The Wilcoxon signed rank test measured the positive change in goal achievement ( z = 4.90; P<0.001; r = 0.51). Fair to good statistically significant Spearman’s correlations were observed between power mobility skill and goal achievement, as well as parent and therapist device expectation scores ( rs = 0.48, 0.46 and 0.66, respectively; P<0.001). Parent and therapist ratings did not differ significantly. No statistically significant associations were found between goal achievement and child (age, diagnosis, abilities) or environmental factors (device, access method, loan length).

Conclusion

Children at all phases of power mobility skill, using various devices and access methods, can demonstrate activity and participation change following power mobility experience. This study adds validity evidence supporting the use of the wheelchair outcome measure for young people with young children by parent-proxy rating.

A Qualitative Photo Elicitation Research Study to elicit the perception of young children with Developmental Disabilities such as ADHD and/or DCD and/or ASD on their participation

Participation, defined as ‘involvement in life situations’ according to the World Health Organisation, is a well-recognized concept and critical indicator of quality of life. In addition it has become an important outcome measure in child rehabilitation. However, little is known about the level of participation of young children with Developmental Disabilities. The aim of this study was to capture their subjective experiences of participation. An adapted informed consent based on a comic strip was used to get the children’s assent. A Photo Elicitation study was used, in which photographs were taken by the children when they were involved in meaningful activities. The photographs were then used to facilitate communication with the children and to initiate in depth-interviews. Forty-seven interviews with 16 children between five and nine years were conducted based on their photographs. This method generated rich data, confirming that young children with Developmental Disabilities were able to inform us accurately on their experiences of participation. Data was analysed by means of an inductive thematic analysis. Results showed that children perceived their participation as satisfying when they can play, learn and join in family gatherings resulting in feelings of inclusion, recognition and belonging. When there are—on occasions—moments that their participation was obstructed, the children used two strategies to resolve it. Or they walked away from it and choose not to participate, or when autonomously motivated for the activity, they relied primarily on their context (i.e. mothers) as enabling their participation. Related to the data, children discussed themes related to their person, activities, connections and mediators between those themes. These themes fit well within earlier and current research on the subject of participation.

The impact of an adult intellectual disability screening questionnaire on service providers and users

BACKGROUND

One contributor to the health inequalities that people with an intellectual disability face is failure to identify their intellectual disability. The Learning Disability Screening Questionnaire (LDSQ) can identify adults who are likely to have an intellectual disability, but little is known about its impact.

METHODS

A modified Delphi approach (literature search, interviews with staff and those using services [n = 28], and completion of an online survey by professionals [n = 29]) was used to develop a framework to evaluate the impact of the LDSQ.

RESULTS

Items endorsed by 60% or more of respondents (9/18) were included in the final framework. These all related to benefits of the LDSQ, including identifying people not previously known to have an intellectual disability; helping prioritize diagnostic assessment; informing support needs; and helping increase wellbeing and life chances.

CONCLUSION

The LDSQ may offer one way of helping address the health inequalities that people with an intellectual disability face.

Screening for intellectual disability with the Child and Adolescent Intellectual Screening Questionnaire: a modified Delphi approach

AIM

To develop a consensus framework to evaluate the impact of screening for intellectual disability, using the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) in paediatric neurodevelopment clinics.

METHOD

A modified Delphi survey with four phases (literature review; initial development of framework [participants=11 parents, 8 professionals]; qualitative interviews [participants=4 parents, 15 professionals]; questionnaire development [participants=31 parents, 14 professionals] was used to develop the consensus framework. The framework was used to evaluate the impact of screening on six paediatricians and 31 parents of children who had participated in a previous paediatric screening project.

RESULTS

Twelve of the original 20 items were retained based on levels of endorsement of 60 per cent or above. Direct benefits of using the CAIDS-Q were: indicating the child's level of functioning, increasing awareness of intellectual disability, helping to identify children with intellectual disability, and identifying potentially vulnerable children. Benefits related to subsequent diagnostic assessment were: promoting greater understanding of the child, identification of support needs, and receipt of support, particularly for the child at school.

INTERPRETATION

The use of the CAIDS-Q had a number of direct and indirect benefits for children, families, and services as reported by parents and paediatricians.

WHAT THIS PAPER ADDS

A 12-item framework was developed to evaluate the impact of screening for intellectual disability. Direct benefits of the Child and Adolescent Intellectual Disability Screening Questionnaire include increasing awareness and identification of intellectual disability. Indirect benefits included increased identification of support needs and receipt of support.

Participation of children with disabilities in school: A realist systematic review of psychosocial and environmental factors

Background

In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4–12 year old children with disabilities to inform the development of participation-fostering interventions.

Methods

A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported.

Results and implications

We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children’s participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.

Virtual community centre for power wheelchair training: Experience of children and clinicians

PURPOSE

To: 1) characterize the overall experience in using the McGill immersive wheelchair - community centre (miWe-CC) simulator; and 2) investigate the experience of presence (i.e., sense of being in the virtual rather than in the real, physical environment) while driving a PW in the miWe-CC.

METHOD

A qualitative research design with structured interviews was used. Fifteen clinicians and 11 children were interviewed after driving a power wheelchair (PW) in the miWe-CC simulator. Data were analyzed using the conventional and directed content analysis approaches.

RESULTS

Overall, participants enjoyed using the simulator and experienced a sense of presence in the virtual space. They felt a sense of being in the virtual environment, involved and focused on driving the virtual PW rather than on the surroundings of the actual room where they were. Participants reported several similarities between the virtual community centre layout and activities of the miWe-CC and the day-to-day reality of paediatric PW users.

CONCLUSION

The simulator replicated participants' expectations of real-life PW use and promises to have an effect on improving the driving skills of new PW users. Implications for rehabilitation Among young users, the McGill immersive wheelchair (miWe) simulator provides an experience of presence within the virtual environment. This experience of presence is generated by a sense of being in the virtual scene, a sense of being involved, engaged, and focused on interacting within the virtual environment, and by the perception that the virtual environment is consistent with the real world. The miWe is a relevant and accessible approach, complementary to real world power wheelchair training for young users.

Exploring suitable participation tools for children who need or use power mobility: A modified Delphi survey

OBJECTIVES

To identify suitable tools for measuring important elements of participation for children, aged 18 months to 12 years, who need or use power mobility, and to indicate which tools should be considered for inclusion in a measurement toolkit.

METHODS

Parents, therapists and researchers with expertise in paediatric power mobility and participation (n = 70) completed an online modified Delphi survey, with consensus set a priori >80% agreement. Existing tools were matched against participation elements ranked most important for those in early childhood (18 months-5 years) and of school-age (6-12 years) by the panel.

RESULTS

Six out of 13 tools demonstrated potential, meeting at least three elements each, although none addressed all elements deemed important to measure by the panel. Only the Participation and Environment Measure for Children and Youth (PEM-CY) reached consensus for inclusion in a participation measure toolkit.

CONCLUSION

Further evaluation of these tools with this population is warranted.

Revised Conceptual Framework of Parent-to-Parent Support for Parents of Children Who Are Deaf or Hard of Hearing: A Modified Delphi Study

BACKGROUND

A scoping review of the literature was conducted, resulting in the development of a conceptual framework of parent-to-parent support for parents with children who are Deaf or hard of hearing. This is the 2nd stage of a dual-stage scoping review.

PURPOSE

This study sought stakeholder opinion and feedback with an aim to achieve consensus on the constructs, components, and design of the initial conceptual framework.

RESEARCH DESIGN

A modified electronic Delphi study was completed with 21 handpicked experts from 7 countries who have experience in provision, research, or experience in the area of parent-to-parent support. Participants completed an online questionnaire using an 11-point Likert scale (strongly disagree to strongly agree) and open-ended questions to answer various questions related to the descriptor terms, definitions, constructs, components, and overall design of the framework.

RESULTS

Participant responses led to the revision of the original conceptual framework.

CONCLUSION

The findings from this dual-stage scoping review and electronic Delphi study provide a conceptual framework that defines the vital contribution of parents in Early Hearing Detection and Intervention programs that will be a useful addition to these programs.

A systematic review of evidence-based assessment practices by allied health practitioners for children with cerebral palsy

AIM

The routine use of psychometrically robust assessment tools is integral to best practice. This systematic review aims to determine the extent to which evidence-based assessment tools were used by allied health practitioners for children with cerebral palsy (CP).

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols 2015 was employed. A search strategy applied the free text terms: 'allied health practitioner', 'assessment', and 'cerebral palsy', and related subject headings to seven databases. Included articles reported assessment practices of occupational therapists, physiotherapists, or speech pathologists working with children with CP aged 0 to 18 years, published from the year 2000.

RESULTS

Fourteen articles met the inclusion criteria. Eighty-eight assessment tools were reported, of which 23 were in high use. Of these, three tools focused on gross motor function and had acceptable validity for use with children with CP: Gross Motor Function Measure, Gross Motor Function Classification System, and goniometry. Validated tools to assess other activity components, participation, quality of life, and pain were used infrequently or not at all.

INTERPRETATION

Allied health practitioners used only a few of the available evidence-based assessment tools. Assessment findings in many areas considered important by children and families were rarely documented using validated assessment tools.