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Ouellet B, Berthiaume J, Fortin C, Rusu MT, Rushton PW, Dib T, Routhier F, Best KL. User perceptions about resources based on the Wheelchair Skills Training Program for training indoor and community wheelchair skills in pediatrics: a descriptive qualitative study. Disabil Rehabil Assist Technol 2024:1-14. [PMID: 38214481 DOI: 10.1080/17483107.2024.2303464] [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: 05/31/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
PURPOSE The Wheelchair Skills Training Program (WSTP) is underutilized in pediatrics for training manual wheelchair skills because the voluminous manual lacks pediatric specificity and no materials adapted for pediatric manual wheelchair users (PMWUs) are available. A set of resources (storybook, posters, training workbook) based on the WSTP has previously been developed for training basic indoor wheelchair skills with five to 15-year-old PMWUs. Occupational therapists (OTs) and PMWUs expressed a need for additional resources addressing higher-level skills. Two new sets of resources teaching indoor and community wheelchair skills were developed. OBJECTIVE Describe OTs' and PMWUs' satisfaction and perceptions regarding usability, relevance and feasibility in pediatrics with the new resources. METHODS A descriptive qualitative study was conducted. A focus group and interviews were respectively conducted with a convenience sample of OTs and a criterion sample of PMWUs to document perceptions regarding satisfaction, usability, relevance and feasibility. A deductive approach to data analyses was used following the Framework Method. RESULTS Six OTs expressed satisfaction regarding both sets of resources feeling more confident using the WSTP (relevance) and perceiving potential time efficiencies when planning training interventions (feasibility). They provided suggestions to improve the usability of the second set. Six PMWUs participated in the interviews, two of which provided feedback on both sets. They were satisfied with the resources recommending them to novice and temporary PMWUs aged from three to 11 years. CONCLUSION Participants' suggested the resources may contribute to reducing the gap between the evidence supporting the WSTP and its utilization in pediatrics.
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Affiliation(s)
- Béatrice Ouellet
- Rehabilitation Department, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Jade Berthiaume
- Rehabilitation Department, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Charlie Fortin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Maria Teodora Rusu
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Paula W Rushton
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- CHU Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Tatiana Dib
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
- CHU Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - François Routhier
- Rehabilitation Department, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Krista L Best
- Rehabilitation Department, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
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Jovellar-Isiegas P, Cuesta García C, Jaén-Carrillo D, Palomo-Carrión R, Peña Alonso C, Roche-Seruendo LE. Somatosensation and motor performance in the less-affected and more-affected hand of unilateral cerebral palsy children: a cross-sectional study. Disabil Rehabil 2023; 45:3500-3510. [PMID: 36172643 DOI: 10.1080/09638288.2022.2127938] [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] [Received: 12/28/2021] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to examine motor performance and somatosensory processing of unilateral cerebral palsy (UCP) children in both the less-affected hand and the more-affected hand. This study is also aimed at analysing the somatosensory proccessing in the more-affected hand in relation to age and damaged hemisphere. MATERIALS AND METHODS Forty-seven children aged from 6 to 15 years (UCP = 23; TD = 24) were recruited. Grip strength, pinch strength, Box and Block Test and Jebsen Taylor Hand Function Test were used to analyse motor performance. A comprehensive somatosensory assessment battery was included: tactile registration, unilateral, bilateral and spatio-temporal perception, haptic recognition, texture perception, proprioception, pressure pain threshold and functional sensitivity. RESULTS UCP children exhibited lower performance in all aspects of motor performance measured in both the less-affected hand and the more-affected hand, except grip strength in the less-affected hand. Significant differences were found for all tests included in the somatosensory assessment in both the less-affected hand and the more-affected hand, except unilateral perception tests in the less-affected hand. CONCLUSIONS UCP children present difficulties in motor performance and somatosensory processing not only in the more-affected hand, but also in the less-affected hand. Somatosensation may be a critical driver of functional performance.Implications for rehabilitationThe less-affected hand of children with unilateral cerebral palsy should be included in both assessment and intervention programmes.Somatosensory processing should be assessed through a comprehensive battery, both in the less-affected hand and in the more-affected hand of unilateral cerebral palsy children.Somatosensory treatment must be taken into account if functional performance in the activities of daily living of unilateral cerebral palsy children is to be improved.
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Affiliation(s)
| | - César Cuesta García
- Department of Occupational Therapy, Centre for Advanced University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | | | - Rocío Palomo-Carrión
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, Toledo, Spain
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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. [PMID: 36443759 PMCID: PMC9702652 DOI: 10.1186/s12913-022-08803-8] [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] [Received: 03/16/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
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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Affiliation(s)
- J N Bootsma
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.
| | - M Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | | | - K Stadskleiv
- University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - J W Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - S Fiske
- Pedagogical Psychological Services, Municipality of Oslo, Oslo, Norway
| | - B J Cunningham
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- School of Communication Sciences and Disorders, Western University, London, Canada
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Ekwan F, Satink T, Kamwesiga J, Schulze C. Health professionals' experiences with the PEDI-UG: What do Ugandan occupational therapists say about the utility and value of the Pediatric Evaluation of Disability Inventory (PEDI-UG) for children with disabilities? Child Care Health Dev 2022; 49:555-562. [PMID: 36251008 DOI: 10.1111/cch.13071] [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: 11/03/2021] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Uganda version of Pediatric Evaluation of Disability Inventory (PEDI-UG) was culturally adapted and validated from the PEDI-US, a tool used to evaluate the functional capability of children with or without disability aged 6 months to 7.5 years in the areas of self-care, mobility and social domains. A group of Ugandan occupational therapists with experience of using PEDI-UG participated in this study to explore the question: What do Ugandan occupational therapists say about the utility and value of the PEDI-UG for children with disabilities? METHODS A qualitative research design was chosen to explore the participants' viewpoints concerning the utility and value of the PEDI-UG for children with disabilities. Purposive sampling was used to recruit health professionals for the focus group discussions. Focus group discussions were carried out with 18 occupational therapists and nurses. Thematic analysis was performed to establish patterns and themes. RESULTS Several challenges concerning the contextual use of PEDI-UG were reported. For example, PEDI-UG being culturally adapted in two languages (English and Luganda) makes it difficult for health professionals to use it for children whose caregivers are non-English or non-Luganda speakers. In addition, participants reported adapting the way they asked the assessment questions, struggling with how they interpreted the scores and observing the child's skills if required during PEDI-UG interviews with caregivers. CONCLUSIONS The findings of this study suggest that health professionals are challenged with the use of the PEDI-UG assessment in diverse cultural contexts and/or languages. These challenges are important considerations for the PEDI-UG translation in different Uganda cultural languages and training health professionals on the use and value of PEDI-UG for children with disabilities.
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Affiliation(s)
- Francis Ekwan
- Department of Health and Rehabilitation Sciences/Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Department of Occupational Therapy, Mulago National Referral Hospital, Kampala, Uganda
| | - Ton Satink
- HAN University of Applied Sciences, Nijmegen, The Netherlands.,European Masters of Science in Occupational Therapy, Hogeschool van Amsterdam, Amsterdam, The Netherlands
| | | | - Christina Schulze
- European Masters of Science in Occupational Therapy, Hogeschool van Amsterdam, Amsterdam, The Netherlands.,ZHAW University of Applied Sciences, Zurich, Switzerland
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Garbellini S, Randall M, Steele M, Elliott C, Imms C. The Neurological Hand Deformity Classification: Construct validity, test-retest, and inter-rater reliability. J Hand Ther 2021; 35:581-589. [PMID: 34011469 DOI: 10.1016/j.jht.2021.03.005] [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: 03/12/2020] [Revised: 02/04/2021] [Accepted: 03/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Neurological Hand Deformity Classification (NHDC) is an impairment-based tool that classifies hand deformity into one of two ordinal scales: flexion or extension deformities. Classification is made from live observation or from recorded video footage. Differentiation between the levels is determined by wrist position and wrist and finger movement. PURPOSE To examine aspects of validity and reliability of the NHDC. STUDY DESIGN A measurement study design. METHODS Data from a convenience sample of 127 children with cerebral palsy, 66 males: 61 females, ranging in age from 8 months to 15 years, across all Manual Ability Classification System levels I to V, were analyzed. Construct validity was assessed by testing predetermined hypotheses of relationships between the NHDC and measures of body function and activity measures with observed performance using the Chi Squared Test of Independence and Spearman Correlation Coefficient. Test-retest and inter-rater reliability were assessed by calculating agreement between repeated measures and paired raters using weighted kappa and Cohen's kappa with 95% confidence intervals. RESULTS Predicted hypotheses for the NHDC were met in nine of 10 Spearman's rho correlations with body structure measures and in 2 of 7 correlations with activity measures. Test-retest for flexion deformities: κw = 0.84; 95% CI 0.70-0.98; and extension deformities: κ = 1.0; 95% CI 1.0-1.0 was good to excellent; inter-rater reliability for flexion deformities: κw = 0.76; 95% CI 0.67-0.85; and extension deformities κ = 0.75; 95% CI 0.43-1.0 was moderate to excellent. CONCLUSION Expected relationships between the NHDC and other measures, stability between repeated measures and acceptable between-rater agreement supports confidence classifying hand deformity in children with cerebral palsy with the NHDC.
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Affiliation(s)
- Simon Garbellini
- School of Allied Health, Australian Catholic University, Melbourne, VIC, Australia; Department of Pediatric Rehabilitation, Perth Children's Hospital, Perth, WA, Australia.
| | | | - Michael Steele
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Catherine Elliott
- Department of Pediatric Rehabilitation, Perth Children's Hospital, Perth, WA, Australia; School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
| | - Christine Imms
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Caravau H, Rosa AF, Rocha NP, Silva AG. Pain assessment in cerebral palsy: a systematic review of measurement properties and evaluation using the COSMIN checklist. Disabil Rehabil 2020; 44:910-920. [PMID: 32619368 DOI: 10.1080/09638288.2020.1783000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: This systematic literature review aims to analyse the methodological quality of instruments available to assess pain in Cerebral Palsy (CP), according to the COSMIN guidelines and checklist.Materials and methods: Electronic literature searches were conducted in PubMed, ScienceDirect, Web of Science, PEdro, Scielo, Scopus and Academic Search Complete (EBSCO host) for articles on measurement properties of self-report, proxy or observational instruments.Results: A total of 14 instruments were identified. Of these, 8 were self-report instruments, 4 were observational instruments and 2 could be used both as self-report or proxy-report. The quality of the manuscripts was inadequate or doubtful in 45.5%, adequate in 15.9% and very good in 38.6% of the cases. No instrument was assessed for all the properties recommended by COSMIN. The quality of the evidence for the measurement properties of the pain assessment instruments ranged from very low to moderate.Conclusions: There is scarce and low-quality evidence on the measurement properties of instruments used to assess pain in individuals with cerebral palsy. Further research is needed designed in line with the COSMIN recommendations.Implications for rehabilitationThere is scarce and low-quality evidence on the measurement properties of instruments used to assess pain in individuals with cerebral palsy;Clinicians need to carefully choose instruments to assess pain in individuals with cerebral palsy as there is insufficient evidence on the quality of instruments;Self-report pain intensity scales may be a useful instrument for a subgroup of individuals with cerebral palsy.
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Affiliation(s)
- Hilma Caravau
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Campus Universitário de Santiago, Aveiro, Portugal
| | - Ana Filipa Rosa
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Campus Universitário de Santiago, Aveiro, Portugal
| | - Nelson P Rocha
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Campus Universitário de Santiago, Aveiro, Portugal.,Department of Medical Sciences, Universidade de Aveiro - Edifício 30, Agras do Crasto - Campus Universitário de Santiago, Aveiro, Portugal
| | - Anabela G Silva
- School of Health Sciences, University of Aveiro, Universidade de Aveiro - Edifício 30, Agras do Crasto - Campus Universitário de Santiago, Aveiro, Portugal.,Center for Health Technology and Services Research, Universidade de Aveiro (CINTESIS.UA), Campus Universitário de Santiago, Aveiro, Portugal
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Resch C, Van Kruijsbergen M, Ketelaar M, Hurks P, Adair B, Imms C, De Kloet A, Piskur B, Van Heugten C. Assessing participation of children with acquired brain injury and cerebral palsy: a systematic review of measurement properties. Dev Med Child Neurol 2020; 62:434-444. [PMID: 31975385 PMCID: PMC7079076 DOI: 10.1111/dmcn.14465] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 12/24/2022]
Abstract
AIM To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection. METHOD Five databases were searched. Instruments that quantified 'attendance' and/or 'involvement' aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed. RESULTS Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations. INTERPRETATION Instruments to assess participation of children with ABI or CP should be selected carefully, as many available measures do not align with attendance and/or involvement. Evidence for measurement properties is limited, mainly caused by low methodological study quality. Future studies should follow recommended methodological guidelines. WHAT THIS PAPER ADDS Twelve instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) aligned with attendance/involvement. Seven instruments have some psychometric evidence supporting their use with children with CP. For children with ABI, only the Child and Adolescent Scale of Participation has shown preliminary evidence of measurement properties.
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Affiliation(s)
- Christine Resch
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands,Limburg Brain Injury CenterMaastrichtthe Netherlands
| | - Mette Van Kruijsbergen
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center Utrecht, and De Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center Utrecht, and De Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Petra Hurks
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Brooke Adair
- Centre for Disability and Development ResearchAustralian Catholic UniversityMelbourneAustralia,Generation VictoriaMurdoch Children's Research InstituteParkvilleAustralia
| | - Christine Imms
- Centre for Disability and Development ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Arend De Kloet
- Basalt Rehabilitationthe Haguethe Netherlands,The Hague University of Applied Sciencesthe Haguethe Netherlands
| | - Barbara Piskur
- Research Centre for Autonomy and Participation for People with Chronic IllnessesZuyd University of Applied SciencesHeerlenthe Netherlands
| | - Caroline Van Heugten
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands,Limburg Brain Injury CenterMaastrichtthe Netherlands,School for Mental Health and NeuroscienceFaculty of Health, Medicine and Life SciencesMaastricht University Medical CenterMaastrichtthe Netherlands
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Imms C, Kerr C, Bowe SJ, Karlsson P, Novak I, Shields N, Reddihough D. Efficacy of a knowledge translation approach in changing allied health practitioner use of evidence-based practices with children with cerebral palsy: a before and after longitudinal study. Disabil Rehabil 2020; 43:3592-3605. [PMID: 32135069 DOI: 10.1080/09638288.2020.1727576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the effect of a knowledge translation intervention on knowledge and frequency of routine evidence-based assessment behaviours of healthcare professionals working with children with cerebral palsy.Methods: A before-and-after longitudinal study was conducted in five disability organisations. Four organisations (Commencing Knowledge Translation group) implemented a multifaceted intervention: knowledge brokers, targeted education, electronic-evidence library, and clinical outcomes database. These strategies were already in place at the fifth organisation (Comparison group). Outcomes evaluated at 0, 6, 12, and 24 months were health-professional knowledge and routine assessment behaviours (self-report and "completeness" of clinical assessment). Generalised estimating equations determined longitudinal changes.Results: Four hundred and forty-seven professionals involved 861 children in the study. The Comparison group had higher knowledge and routine assessment behaviours at baseline. Professional knowledge in both groups remained stable (differences in change from baseline to 24 months: 0.3 units, 95%CI: -0.76 to 1.36). Assessment completeness of the Comparison group was stable (baseline mean 68 units, 95%CI: 65-71); the Commencing Knowledge Translation group improved from baseline mean 35 units (95%CI: 33-36), peaking at 12 months (mean 68 (95%CI: 65-71).Conclusions: Multifaceted organisational support improved health-professional routine evidence-based assessment behaviours with children with cerebral palsy, despite no change in knowledge. Trial registration: This trial was not a controlled health care intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015 as follows: Imms et al. [6].Implications for rehabilitationA multifaceted knowledge translation intervention increased allied health professionals' assessment behaviours.Knowledge translation strategies can be chosen to target change in knowledge and/or change in behaviour.Knowledge translation interventions should be designed to address organisational barriers and enhance organisational supports.Interventions that target healthcare professionals' behaviour directly can be effective even if their knowledge does not change.
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Affiliation(s)
- Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Australia
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, Northern Ireland, UK
| | - Steven J Bowe
- Faculty of Health, Deakin Biostatistics Unit, Deakin University, Geelong, Australia
| | - Petra Karlsson
- School of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Iona Novak
- School of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Dinah Reddihough
- Murdoch Children's Research Institute, Royal Children's Hospital and the University of Melbourne, Parkville, Australia
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O'Connor B, Kerr C, Shields N, Adair B, Imms C. Steering towards collaborative assessment: a qualitative study of parents' experiences of evidence-based assessment practices for their child with cerebral palsy. Disabil Rehabil 2019; 43:458-467. [PMID: 31230482 DOI: 10.1080/09638288.2019.1629652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To understand parents' experiences of evidence-based assessment by health professionals for their child with cerebral palsy. METHODS A qualitative interpretive description study was undertaken. Primary carers of children with cerebral palsy (aged 3-18 years) from south-eastern Australia were invited to participate. Face-to-face interviews were held using a semi-structured topic guide and data analyzed inductively. Credibility was ensured through: journal reflections; co-author review; audit trail; and, participant member-checking. RESULTS Fourteen parents of children with cerebral palsy, representing Gross Motor Functional Classification System levels I-V, participated. Six themes emerged: (1) Protection; (2) Positively Framed; (3) Bridging the Gap; (4) Involvement; (5) Finding Worth; and (6) Trust. Central to parents' experience was protection of their child's identity and personal self. Assessment can be emotionally confronting, at any stage. Representing the child positively and highlighting possibilities was deemed essential. Parents' involvement ranged from being overlooked spectators to being instigators of assessment. Evidence-based assessment was worthwhile when relevant to parents' direction and family context. The researchers' interpretive description generated a schema and metaphor-the Steering Wheel for Collaborative Assessment. CONCLUSIONS A strengths-based approach to diagnosis and assessment is essential. The resulting interpretive description may assist health professionals align evidence-based assessment practices with family-centred care.Implications for rehabilitationParents of children who have cerebral palsy describe having to protect their child's identity and representation, and their own personal well-being, through evidence-based assessment and diagnostic processes.Involving parents in the process of evidence-based assessment and adopting a strengths-based approach is essential.The interpretive description developed-the Steering Wheel for Collaborative Assessment-may assist health professionals to implement evidence-based assessment tools in ways consistent with family-centred care principles.
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Affiliation(s)
- Bridget O'Connor
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Claire Kerr
- School of Allied Health, Australian Catholic University, Melbourne, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Nora Shields
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Brooke Adair
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia
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Armstrong EL, Boyd RN, Kentish MJ, Carty CP, Horan SA. Effects of a training programme of functional electrical stimulation (FES) powered cycling, recreational cycling and goal-directed exercise training on children with cerebral palsy: a randomised controlled trial protocol. BMJ Open 2019; 9:e024881. [PMID: 31213443 PMCID: PMC6589006 DOI: 10.1136/bmjopen-2018-024881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) experience declines in gross motor ability as they transition from childhood to adolescence, which can result in the loss of ability to perform sit-to-stand transfers, ambulate or participate in leisure activities such as cycling. Functional electrical stimulation (FES) cycling is a novel technology that may provide opportunities for children with CP to strengthen their lower limbs, improve functional independence and increase physical activity participation. The proposed randomised controlled trial will test the efficacy of a training package of FES cycling, adapted cycling and goal-directed functional training to usual care in children with CP who are susceptible to functional declines. METHODS AND ANALYSIS Forty children with CP (20 per group), aged 6-8 years and classified as Gross Motor Function Classification System (GMFCS) levels II-IV will be recruited across South East Queensland. Participants will be randomised to either an immediate intervention group, who will undertake 8 weeks of training, or a waitlist control group. The training group will attend two 1 hour sessions per week with a physiotherapist, consisting of FES cycling and goal-directed, functional exercises and a 1 hour home exercise programme per week, consisting of recreational cycling. Primary outcomes will be the gross motor function measure and Canadian occupational performance measure, and secondary outcomes will include the five times sit-to-stand test, habitual physical activity (accelerometry), power output during cycling and Participation and Environment Measure-Children and Youth. Outcomes will be assessed at baseline, postintervention (8 weeks) and 8 weeks following the intervention (retention). ETHICS AND DISSEMINATION Ethical approval has been obtained from Griffith University (2018/037) and the Children's Health Queensland Hospital and Health Service (CHQHHS) Human Research Ethics Committee (HREC/17/QRCH/88). Site-specific approval was obtained from CHQHHS research governance (SSA/17/QRCH/145). Results from this trial will be disseminated via publication in relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000644369p.
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Affiliation(s)
- Ellen L Armstrong
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan J Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Christopher P Carty
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research Engineering and Education Alliance, Griffith University, Gold Coast, Queensland, Australia
| | - Sean A Horan
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Knox V, Vuoskoski P, Mandy A. Use of outcome measures in children with severe cerebral palsy: A survey of U.K. physiotherapists. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1786. [PMID: 31172663 DOI: 10.1002/pri.1786] [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: 11/13/2018] [Revised: 02/18/2019] [Accepted: 04/07/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the use of outcome measures for children with cerebral palsy (CP) by paediatric physiotherapists (PTs) who are based in the United Kingdom, as limited research exists regarding their use in this population, and to explore therapists' use of measures within different Gross Motor Function Classification System (GMFCS) levels and for different types of CP. METHODS A six-item online survey was advertised through two paediatric therapy special interest groups inviting physiotherapists to participate. Descriptive statistics (range, frequencies, and percentages) were used to analyse survey data. RESULTS Two hundred and seven physiotherapists returned completed survey questionnaires. One hundred and seventy-six (85%) therapists reported using a wide variety of outcome measures (57). Eighty-one per cent of therapists' responses for having "most difficulty" in identifying responsive outcome measures were for children with impaired mobility at GMFCS Levels IV-V and children with more significant body involvement (76%), for example, spastic quadriplegia or dyskinesia. Eighty-six per cent of therapists' responses for having "greatest ease" of identifying responsive outcome measures were for children within GMFCS Levels I-III and for children with less significant body involvement (72%), for example, hemiplegia. The variety of outcome measures used by therapists with children within GMFCS IV-V was less (16). CONCLUSIONS The majority (85%) of the PTs surveyed used outcome measures with children with CP, but 81% perceived a difficulty in identifying responsive measures for children with more severe impairments who are classified as GMFCS IV-V. The reasons for this perceived difficulty warrant investigation and may suggest a need for training regarding relevant measures and/or a need to develop new measures for this group of children.
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Affiliation(s)
- Virginia Knox
- Community Paediatric Physiotherapy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Pirjo Vuoskoski
- Department of Health Sciences, Karelia University of Applied Sciences, Karelia, Finland
| | - Anne Mandy
- Centre for Health Research, University of Brighton, Brighton, UK
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13
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FitzGerald TL, Kwong AKL, Cheong JLY, McGinley JL, Doyle LW, Spittle AJ. Body Structure, Function, Activity, and Participation in 3- to 6-Year-Old Children Born Very Preterm: An ICF-Based Systematic Review and Meta-Analysis. Phys Ther 2018; 98:691-704. [PMID: 29912447 DOI: 10.1093/ptj/pzy050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 04/17/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The World Health Organization's International Classification of Functioning, Disability, and Health framework, Children and Youth Version (ICF-CY), provides a valuable method of conceptualizing the multidomain difficulties experienced by children born very preterm (VP). Reviews investigating motor outcomes at preschool age across ICF-CY domains are lacking. PURPOSE The purpose of this review is to identify and compare motor outcomes of 3- to 6-year-old children born VP and children born full-term (FT) within the ICF-CY framework. DATA SOURCES Four electronic databases and reference lists of included and key articles were searched. STUDY SELECTION Studies comparing motor outcomes of 3- to 6-year-old children born VP (<32 weeks' gestation or birth weight <1500 g) with peers born FT were included. DATA EXTRACTION Two independent authors extracted data and completed quality assessments. DATA SYNTHESIS Thirty-six studies were included. Activity motor performance of children born VP was consistently poorer compared with peers born FT: standardized mean difference (SMD) was -0.71 (95% CI = -0.80 to -0.61; 14 studies, 2056 participants). Furthermore, children born VP had higher relative risk (RR) of motor impairment (RR = 3.39; 95% CI = 2.68 to 4.27; 9 studies, 3466 participants). Body structure and function outcomes were largely unable to be pooled because assessment tools varied too widely. However, children born VP had higher RR of any neurological dysfunction (Touwen Neurological Examination) (RR = 4.55; 95% CI = 1.20 to 17.17; 3 studies, 1363 participants). There were no participation outcome data. LIMITATIONS Limitations include the lack of consistent assessment tools used in VP follow-up at preschool age and the quality of the evidence. CONCLUSIONS Children born VP experience significant motor impairment across ICF-CY activity and body structure and function domains at preschool age compared with peers born FT. Evidence investigating participation in VP preschool-age populations relative to children born at term is sparse, requiring further research.
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Affiliation(s)
- Tara L FitzGerald
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia.,Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia.,Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Rd, Parkville, Melbourne, Victoria 3052, Australia
| | - Amanda K L Kwong
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia.,Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia.,Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Rd, Parkville, Melbourne, Victoria 3052, Australia
| | - Jeanie L Y Cheong
- Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia.,Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Rd, Parkville, Melbourne, Victoria 3052, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women's Hospital
| | - Jennifer L McGinley
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Lex W Doyle
- Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia.,Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Rd, Parkville, Melbourne, Victoria 3052, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women's Hospital.,Department of Paediatrics, The University of Melbourne, The Royal Women's Hospital
| | - Alicia J Spittle
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia.,Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia.,Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Rd, Parkville, Melbourne, Victoria 3052, Australia
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Auld ML, Johnston LM. Getting inTOUCH: outcomes of a knowledge translation intervention for tactile assessment knowledge, barriers, and practice in paediatric therapists working with children with cerebral palsy. Disabil Rehabil 2018; 41:2350-2358. [PMID: 29693473 DOI: 10.1080/09638288.2018.1466202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Tactile impairments are common in children with cerebral palsy (CP), however assessment is not routinely carried out by therapists. We investigated a multi-faceted Knowledge Translation intervention to improve Knowledge, remove Barriers and enhance Practice of tactile assessments by paediatric therapists. Method: Twelve therapists from a state-wide service for children with CP (seven physiotherapists, five occupational therapists; 12 female) received: written information, demonstration videos, a face-to-face workshop, equipment provision, and on-call mentoring. Therapists completed pre-post-intervention questionnaires reporting their perceived tactile assessment Knowledge, current Practices and implementation Barriers. Results: Following intervention, therapists improved Knowledge of correct (1) tactile impairment prevalence in children with CP (pre 3/12; post 9/12), (2) tactile assessment items (e.g. Registration - pre 1/12; post 9/12; Localisation - pre 2/12; post 10/12), and (3) equipment choice (e.g. Monofilaments - pre 1/12; post 10/12). Tactile assessment Practice improved slightly. All major clinician-level implementation Barriers were resolved and less obvious organisational-level Barriers were identified for follow-up. Conclusion: A 12-month multi-faceted Knowledge Translation intervention can improve tactile assessment Knowledge, resolve major clinician-level implementation Barriers, and identify less obvious organisational-level Barriers to be addressed to achieve maximum Practice improvement. Ongoing multi-faceted knowledge translation processes are essential for high-performing organisations. Implications for rehabilitation A multi-faceted knowledge translation intervention significantly improved paediatric therapists' knowledge of the items and equipment necessary for tactile assessment. A 12-month intervention can address clinician-level barriers of knowledge, confidence, and access to equipment and assist in the identification of less obvious organisational-level barriers. Consideration of motivational readiness for change, intervention timelines, monitoring of emergent barriers, and fitting tactile assessment into a broader assessment framework are critical for improving uptake of tactile assessment in practice.
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Affiliation(s)
- Megan L Auld
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia.,b CPL - Choice, Passion, Life , Brisbane , Australia
| | - Leanne M Johnston
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
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Abstract
Synopsis Accurate, reliable, and timely assessment of pain is critical for effective management of musculoskeletal pain conditions. The assessment of pain in infants, children, and adolescents with and without cognitive impairment can be particularly challenging to clinicians for a number of reasons, including factors related to the consultation (eg, heterogeneous patient population, time constraints), the clinician (eg, awareness/knowledge of available pain scales), standardized assessment scales (eg, availability, psychometric properties, and application of each scale), the patient (eg, developmental stage, ability to communicate), and the context in which the interaction took place (eg, familiarity with the setting and physiological and psychological state). As a result, pain is frequently not assessed or measured during the consultation and, in many instances, underestimated and undertreated in this population. The purpose of this article is to provide clinicians with an overview of scales that may be used to measure pain in infants, children, and adolescents. Specifically, the paper reviews the various approaches to measure pain intensity; identifies factors that can influence the pain experience, expression, and assessment in infants, children, and adolescents; provides age-appropriate suggestions for measuring pain intensity in patients with and without cognitive impairment; and identifies ways to assess the impact of pain using multidimensional pain scales. J Orthop Sports Phys Ther 2017;47(10):712-730. doi:10.2519/jospt.2017.7469.
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O’Connor B, Kerr C, Shields N, Imms C. Understanding allied health practitioners’ use of evidence-based assessments for children with cerebral palsy: a mixed methods study. Disabil Rehabil 2017; 41:53-65. [DOI: 10.1080/09638288.2017.1373376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bridget O’Connor
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Claire Kerr
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Nora Shields
- School of Allied Health, La Trobe University, Melbourne, Australia
- Northern Health, Melbourne, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia
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Bailes AF, Gannotti M, Fenchel M. Using the electronic medical record to study the association of child and environmental characteristics on the type of physical therapy services delivered to individuals with cerebral palsy. Physiother Theory Pract 2017; 33:644-652. [DOI: 10.1080/09593985.2017.1328717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amy F. Bailes
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University of Hartford, Hartford, CT, USA
| | - Matthew Fenchel
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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The International Classification of Functioning (ICF) to evaluate deep brain stimulation neuromodulation in childhood dystonia-hyperkinesia informs future clinical & research priorities in a multidisciplinary model of care. Eur J Paediatr Neurol 2017; 21:147-167. [PMID: 27707656 DOI: 10.1016/j.ejpn.2016.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/11/2016] [Accepted: 08/29/2016] [Indexed: 12/12/2022]
Abstract
The multidisciplinary team (MDT) approach illustrates how motor classification systems, assessments and outcome measures currently available have been applied to a national cohort of children and young people with dystonia and other hyperkinetic movement disorders (HMD) particularly with a focus on dyskinetic cerebral palsy (CP). The paper is divided in 3 sections. Firstly, we describe the service model adopted by the Complex Motor Disorders Service (CMDS) at Evelina London Children's Hospital and King's College Hospital (ELCH-KCH) for deep brain stimulation. We describe lessons learnt from available dystonia studies and discuss/propose ways to measure DBS and other dystonia-related intervention outcomes. We aim to report on current available functional outcome measures as well as some impairment-based assessments that can encourage and generate discussion among movement disorders specialists of different backgrounds regarding choice of the most important areas to be measured after DBS and other interventions for dystonia management. Finally, some recommendations for multi-centre collaboration in regards to functional clinical outcomes and research methodologies for dystonia-related interventions are proposed.
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Oeffinger D. Use of standardized outcome measures should be common place in the clinical care of children with cerebral palsy: why isn't it? Dev Med Child Neurol 2016; 58:321. [PMID: 26773442 DOI: 10.1111/dmcn.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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