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Orriëns LB, van Aarle LGJM, Erasmus CE, van Hulst K, van der Burg JJW. Social and emotional impact of anterior drooling in school-age children and young people with neurodevelopmental disabilities. Eur J Pediatr 2024; 183:4491-4498. [PMID: 39145887 DOI: 10.1007/s00431-024-05714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Anterior drooling is a common comorbidity in children and young people (CYP) with neurodevelopmental disabilities. This study aimed to assess the social and emotional impact of drooling in CYP with a developmental age (DA) of 6 years and older, in whom this impact may differ from those with a lower DA due to their developing sense of self and awareness of their position within social groups. METHODS Questionnaire data collected for routine clinical care were used to assess parental perceptions of the impact of drooling on (1) social interaction; (2) satisfaction with social interaction, appearance, family relations and life in general and (3) the way CYP expressed feelings on appearance, acceptance by peers and acceptance by adults. Fisher's exact tests and Mann-Whitney U tests were applied to identify associations between clinical characteristics and the social and emotional impact of drooling. RESULTS Seventy-nine CYP with an estimated DA ≥ 6 years were included. The majority experienced frequent to constant (83%) and profuse (61%) drooling. Drooling frequently compromised social interaction with peers (49%) and adults (28%), and cognitive abilities were underestimated in 40%. Dissatisfaction with physical appearance (25%) related to drooling was noted. One-fifth of CYP reportedly expressed negative feelings on acceptance by peers related to drooling. CONCLUSIONS These findings underscore the substantial impact of drooling on CYP with a DA of 6 years and older, primarily through avoidance by peers and underestimated cognitive abilities, emphasizing that recognizing and addressing these social-emotional consequences should be integral to clinical care. WHAT IS KNOWN • Anterior drooling is common among children and youth with neurodevelopmental disabilities. WHAT IS NEW • There seems to be a heightened prevalence of impaired social interaction with peers and underestimation of cognitive abilities due to drooling among children with a developmental age of at least 6 years compared to previous studies with more heterogeneous populations. • The impact of drooling can extend to domains that affect self-esteem, although this may not be fully captured with standardized questions, requiring clinicians to address these consequences in a way that is tailored to the child's experiences.
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Affiliation(s)
- Lynn B Orriëns
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
| | | | - Corrie E Erasmus
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jan J W van der Burg
- School of Pedagogical and Educational Science, Radboud University Nijmegen, Nijmegen, the Netherlands
- Department of Paediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
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2
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Knight S, Rodda J, Tavender E, Anderson V, Lannin NA, Scheinberg A. Understanding factors that influence goal setting in rehabilitation for paediatric acquired brain injury: a qualitative study using the Theoretical Domains Framework. BRAIN IMPAIR 2024; 25:IB23103. [PMID: 38593747 DOI: 10.1071/ib23103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Background While goal setting with children and their families is considered best practice during rehabilitation following acquired brain injury, its successful implementation in an interdisciplinary team is not straightforward. This paper describes the application of a theoretical framework to understand factors influencing goal setting with children and their families in a large interdisciplinary rehabilitation team. Methods A semi-structured focus group was conducted with rehabilitation clinicians and those with lived experience of paediatric acquired brain injury (ABI). The 90-min focus group was audio-recorded and transcribed verbatim. Data were thematically coded and mapped against the Theoretical Domains Framework (TDF) to understand influencing factors, which were then linked to the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Results A total of 11 participants (nine paediatric rehabilitation clinicians, one parent and one young person with lived experience of paediatric ABI) participated in the focus group. Factors influencing collaborative goal setting mapped to the COM-B and six domains of the TDF: Capabilities (Skills, Knowledge, Beliefs about capabilities, and Behavioural regulation), Opportunities (Environmental context and resources), and Motivation (Social/professional role and identity). Results suggest that a multifaceted intervention is needed to enhance rehabilitation clinicians' and families' skills and knowledge of goal setting, restructure the goal communication processes, and clarify the roles clinicians play in goal setting within the interdisciplinary team. Conclusion The use of the TDF and COM-B enabled a systematic approach to understanding the factors influencing goal setting for children with acquired brain injury in a large interdisciplinary rehabilitation team, and develop a targeted, multifaceted intervention for clinical use. These represent important considerations for the improvement of collaborative goal setting in paediatric rehabilitation services to ensure that best practice approaches to goal setting are implemented effectively in clinical practice.
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Affiliation(s)
- Sarah Knight
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia; and Melbourne School of Psychological Sciences, The University of Melbourne, Vic., Australia; and Department of Paediatrics, The University of Melbourne, Vic., Australia; and Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital Melbourne, Vic., Australia
| | - Jill Rodda
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Emma Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia; and Melbourne School of Psychological Sciences, The University of Melbourne, Vic., Australia; and Department of Paediatrics, The University of Melbourne, Vic., Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Vic., Australia; and Alfred Health, Melbourne, Vic., Australia
| | - Adam Scheinberg
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia; and Department of Paediatrics, The University of Melbourne, Vic., Australia; and Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital Melbourne, Vic., Australia; and Department of Neuroscience, Monash University, Melbourne, Vic., Australia
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3
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Orriëns LB, van Hulst K, van der Burg JJW, van den Hoogen FJA, Willemsen MAAP, Erasmus CE. Comparing the evidence for botulinum neurotoxin injections in paediatric anterior drooling: a scoping review. Eur J Pediatr 2024; 183:83-93. [PMID: 37924348 PMCID: PMC10858158 DOI: 10.1007/s00431-023-05309-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023]
Abstract
Paediatric anterior drooling has a major impact on the daily lives of children and caregivers. Intraglandular botulinum neurotoxin type-A (BoNT-A) injections are considered an effective treatment to diminish drooling. However, there is no international consensus on which major salivary glands should be injected to obtain optimal treatment effect while minimizing the risk of side effects. This scoping review aimed to explore the evidence for submandibular BoNT-A injections and concurrent submandibular and parotid (i.e. four-gland) injections, respectively, and assess whether outcomes could be compared across studies to improve decision making regarding the optimal initial BoNT-A treatment approach for paediatric anterior drooling. PubMed, Embase, and Web of Science were searched to identify relevant studies (until October 1, 2023) on submandibular or four-gland BoNT-A injections for the treatment of anterior drooling in children with neurodevelopmental disabilities. Similarities and differences in treatment, patient, outcome, and follow-up characteristics were assessed. Twenty-eight papers were identified; 7 reporting on submandibular injections and 21 on four-gland injections. No major differences in treatment procedures or timing of follow-up were found. However, patient characteristics were poorly reported, there was great variety in outcome measurement, and the assessment of side effects was not clearly described. Conclusion: This review highlights heterogeneity in outcome measures and patient population descriptors among studies on paediatric BoNT-A injections, limiting the ability to compare treatment effectiveness between submandibular and four-gland injections. These findings emphasize the need for more extensive and uniform reporting of patient characteristics and the implementation of a core outcome measurement set to allow for comparison of results between studies and facilitate the optimization of clinical practice guidelines. What is Known: • There is no international consensus on which salivary glands to initially inject with BoNT-A to treat paediatric drooling. What is New: • Concluding on the optimal initial BoNT-A treatment based on literature is currently infeasible. There is considerable heterogeneity in outcome measures used to quantify anterior drooling.and clinical characteristics of children treated with intraglandular BoNT-A are generally insufficiently reported. • Consensus-based sets of outcome measures and patient characteristics should be developed and implemented.
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Affiliation(s)
- Lynn B Orriëns
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan J W van der Burg
- Department of Paediatric Rehabilitation, Sint Maartenskliniek, Ubbergen, the Netherlands
- School of Pedagogical and Educational Science, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michèl A A P Willemsen
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
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McLeod KL, Thorley M, Reedman SE, Chatfield MD, Sakzewski L. Effect of Active Motor Learning Interventions on Gross Motor Function and Mobility in Children Aged 2 to 6 Years With Bilateral Cerebral Palsy: A Systematic Review and Meta-analysis. Pediatr Phys Ther 2023; 35:412-428. [PMID: 37656984 DOI: 10.1097/pep.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE The purpose of this systematic review is to identify evidence-based interventions to promote active motor learning in children aged 2 to 6 years with bilateral cerebral palsy. SUMMARY OF KEY POINTS Seven randomized clinical trials of active motor learning interventions targeting gross motor function and mobility were included. Two studies compared context-focused therapy to child-focused therapy. Five studies compared active motor therapy to usual care. Context-focused therapy, child-focused therapy, and active motor therapy were comparable to usual care to improve functional mobility and gross motor function. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE There are limited active intervention studies targeting gross motor function for young children with bilateral cerebral palsy. The authors recommend consideration of the clinical good practice guidelines, dosage parameters, and improved reporting methods when implementing active motor learning interventions targeting gross motor function and mobility for children with cerebral palsy.
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Affiliation(s)
- Kate L McLeod
- Faculty of Medicine (Ms McLeod, Drs Reedman and Sakzewski, and Mr Chatfield), Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia; Queensland Paediatric Rehabilitation Service (Ms McLeod and Dr Thorley), Queensland Children's Hospital, Brisbane, Queensland, Australia
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Bigner K, Greve K, McCamish B. Commentary on "Effect of Active Motor Learning Interventions on Gross Motor Function and Mobility in Children Aged 2 to 6 Years With Bilateral Cerebral Palsy: A Systematic Review and Meta-analysis". Pediatr Phys Ther 2023; 35:429. [PMID: 37747977 DOI: 10.1097/pep.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Kaitlyn Bigner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kelly Greve
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Pritchard-Wiart L, Thompson-Hodgetts S, McKillop AB, Rosychuk R, Mrklas K, Zwaigenbaum L, Zwicker J, Andersen J, King G, Firouzeh P. A multi-center, pragmatic, effectiveness-implementation (hybrid I) cluster randomized controlled trial to evaluate a child-oriented goal-setting approach in paediatric rehabilitation (the ENGAGE approach): a study protocol. BMC Pediatr 2022; 22:375. [PMID: 35764983 PMCID: PMC9241221 DOI: 10.1186/s12887-022-03381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Child-oriented goal-setting in pediatric rehabilitation may improve child motivation, engagement in therapy, child outcomes related to therapy, and service delivery efficiency. The primary objective of this trial is to determine the effectiveness of a principles-driven, child-focused approach to goal-setting, Enhancing Child Engagement in Goal-Setting (ENGAGE), on pediatric rehabilitation outcomes compared to usual practice. The three secondary objectives are to 1) compare costs and secondary outcomes of the ENGAGE approach to usual practice, 2) determine the influence of child, parent and therapist characteristics on child engagement in therapy and rehabilitation outcomes, and 3) identify barriers and facilitators to the implementation of ENGAGE. METHODS This research protocol describes a pragmatic, multi-site, cluster, effectiveness-implementation (hybrid type 1 design) randomized controlled trial. Therapists (n = 12 clusters of two therapists) at participating sites (n = 6) will be randomized to 1) the ENGAGE intervention group, or 2) usual care (control) using a computer-generated, permuted-block randomization sequence with site as a stratification variable designed by a statistician (RR). Each therapist will recruit four children 5-12 years old with neurodevelopmental conditions (n = 96), who will receive ENGAGE or usual care, according to therapist group allocation. ENGAGE therapists will be trained to use a 'toolbox' of evidence-driven, theory-informed principles to optimize child and parent motivation, engagement in the goal-setting process, and performance feedback strategies. Outcomes include goal performance (primary outcome), engagement in therapy, functional abilities, participation, and parent and child quality of life. Qualitative interviews with children, parents, ENGAGE therapists, and managers will explore challenges to implementation and potential mitigation strategies. Mixed effects multiple linear regression models will be developed for each outcome to assess group differences adjusted for clustering. A cost-effectiveness analysis will combine cost and a measure of effectiveness into an incremental cost-effectiveness ratio. Qualitative data on implementation will be analyzed inductively (thematic analysis) and deductively using established implementation science frameworks. DISCUSSION This study will evaluate the effects of collaborative goal-setting in pediatric rehabilitation and inform effective implementation of child-focused goal-setting practices. TRIAL REGISTRATION NCT05017363 (registered August 23, 2021 on ClinicalTrials.gov).
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Affiliation(s)
- Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, University of Alberta, 3-60 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Sandy Thompson-Hodgetts
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-20 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Ashley B McKillop
- Faculty of Rehabilitation Medicine, University of Alberta, University of Alberta, 3-78 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Rhonda Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Kelly Mrklas
- System Innovation and Programs, Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, 1403 29th St NW, T2N 2T9
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Jennifer Zwicker
- Director School of Public Policy, Cumming School of Medicine, University of Calgary, NW University of Calgary, 135 376 Collegiate Blvd 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada
| | - John Andersen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Gillian King
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd, East York, ON, M4G 1R8, Canada
| | - Pegah Firouzeh
- Faculty of Rehabilitation Medicine, University of Alberta, University of Alberta, 3-70 Corbett Hall, Edmonton, T6G 2G4, Canada
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7
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Dermott JA, Wright FV, Salbach NM, Narayanan UG. Development of the gait outcomes assessment list for lower-limb differences (GOAL-LD) questionnaire: a child and parent reported outcome measure. Health Qual Life Outcomes 2021; 19:139. [PMID: 33952260 PMCID: PMC8097808 DOI: 10.1186/s12955-021-01775-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background To develop a priority-based patient/parent reported outcome measure for children with lower-limb differences (LD) by adapting the Gait Outcomes Assessment List (GOAL) questionnaire. Methods Guided by a conceptual framework of patient priorities, the GOAL questionnaire was iteratively modified and its sensibility evaluated by field-testing it on children with LD, and their parents. Cognitive interviews were conducted with a subgroup of these children, and an e-survey administered to a multidisciplinary group of health care professionals with expertise in paediatric LD. Findings were integrated to create the final version of the GOAL-LD. Results Twenty-five children (9–18 years), 20 parents, and 31 healthcare professionals evaluated the content and sensibility of the GOAL, with an emphasis on the relevance and importance of the items to patients’ health related quality of life (HRQL). This resulted in the retention of 26 of the original 50 items, elimination of 12, modification of 12, and addition of seven new items. The new 45-item GOAL-LD questionnaire was shown to be sensible, and its content deemed important. Conclusions The GOAL-LD questionnaire has a high level of face and content validity, and sensibility. It comprehensively captures the HRQL goals and outcomes that matter to children with LD and their parents. Following further psychometric evaluation, the GOAL-LD may serve as a much needed patient and parent reported outcome measure for this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01775-z.
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Affiliation(s)
- Jennifer A Dermott
- Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - F Virginia Wright
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Unni G Narayanan
- Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Surgery and Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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8
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Mathews SB, Mozolic-Staunton B, Jefford E, Salehi N. Canadian Occupational Performance Measure and Early Intervention: A Scoping Review. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2020. [DOI: 10.1080/19411243.2020.1744210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Skye B. Mathews
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
| | - Beth Mozolic-Staunton
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
| | - Elaine Jefford
- School of Health and Human Sciences, Southern Cross University (Midwifery) New South Wales, Lismore, Australia
| | - Nasim Salehi
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
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Mallory K, Barton K, Woodhouse J, Bernstein J, Greenspoon D, Reed N. Occupational Performance Issues of Children with Hemiplegia after Acquired Brain Injury. Phys Occup Ther Pediatr 2020; 40:279-293. [PMID: 31608806 DOI: 10.1080/01942638.2019.1675845] [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: 10/25/2022]
Abstract
Aims: This retrospective, exploratory study aimed to examine the categories and frequency of occupational performance issues (OPIs) identified by children (or their caregivers), who participated in a two-week, group-based modified constraint induced movement therapy program, Helping Hand. The effect of participant age on the OPIs identified was also explored.Methods: OPIs were identified using the Canadian Occupational Performance Measure for 46 Helping Hand participants, prior to program participation. Descriptive statistics including the frequency of identified OPIs were used to categorize the 236 OPIs into occupational areas. Descriptive statistics were also used to determine how the categories of OPIs and relative frequencies differed based on participant age.Results: The identified OPIs were diverse, and differed in frequency of identification and level of specificity. The OPIs identified varied based on participant age, with age groups showing developmentally appropriate differences in OPIs.Conclusions: Identification of OPIs should balance client-centredness with probing for specificity, in order for OPIs to be understood by clinicians. This will guide future program development and interventions that target age-appropriate occupational priorities.
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Affiliation(s)
- Kylie Mallory
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Barton
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Janet Woodhouse
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Janet Bernstein
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Dayna Greenspoon
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Bloorview Research Institute, Toronto, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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10
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Pritchard-Wiart L, Thompson-Hodgetts S, McKillop AB. A review of goal setting theories relevant to goal setting in paediatric rehabilitation. Clin Rehabil 2019; 33:1515-1526. [DOI: 10.1177/0269215519846220] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Goal setting in paediatric rehabilitation is influenced by shifting parent, sibling, caregiver, and child roles over time and evolving child developmental capacity for participation in the process. A theoretical and evidence-informed approach to goal setting, specific to paediatrics, would provide a framework for goal setting in practice and facilitate systematic evaluation of the effects of goal-setting processes on child and family outcomes. Objective: To provide an overview of relevant goal-setting theories and their implications for paediatric rehabilitation. Methods: Prevalent theories were identified from relevant rehabilitation, motivation, behaviour change, and goal-setting literature. Implications for goal setting in paediatrics are summarized according to goal-setting and action-planning phases: (1) preparation, (2) formulation of goals, (3) formulation of action plan, (4) coping planning, and (5) follow up. Results: Social cognitive theory, self-determination theory, Health Action Process Approach, Mastery Motivation, and goal-setting theory are reviewed. Examples of implications for goal setting include, sharing information with families about the purpose of goal setting; identifying goals that are specific, proximal, challenging, and important to the child; and addressing self-efficacy. Conclusion: The theories reviewed have clear implications for paediatric rehabilitation research and practice. They address considerations not typically discussed in adult rehabilitation such as observing children to obtain information about meaningful goals when they are unable to communicate them directly and the importance of establishing flexible processes that will accommodate changing family roles over time. Research is needed to evaluate the effects of goal-setting processes and strategies on outcomes in paediatric rehabilitation.
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Affiliation(s)
- Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sandra Thompson-Hodgetts
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ashley B McKillop
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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11
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Angeli JM, Harpster KL, Hanson E, Sheehan A, Schwab SM. Patient- and caregiver-identified preferences: Dimensions of change in developmental therapy treatment goals. Dev Neurorehabil 2019; 22:39-46. [PMID: 29370557 DOI: 10.1080/17518423.2018.1425754] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe patterns in preferred dimensions of change in therapy goals identified by individuals with developmental disability and their caregivers. METHODS A retrospective chart review of Goal Attainment Scaling (GAS) goals for patients aged 2-32 years (n = 124) participating in a program of episodic care was conducted. Dimensions of change were analyzed through a mixed-methods study design. Co-occurrence rates and descriptor-to-code comparisons were computed in order to relate the dimension of change to diagnosis, International Classification of Functioning, Disability, and Health (ICF) goal domain, gender, age, and goal setter. RESULTS Decreased level of assistance was the most commonly identified preferred dimension of change, cited in 31.0% of goals. Decreased level of assistance remained the most frequently reported dimension of change in multiple subgroup analyses. CONCLUSION Independence is highly valued by parents and individuals with developmental disability. This finding should help guide therapy plans or program development addressing task performance.
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Affiliation(s)
- Jennifer M Angeli
- a Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Rehabilitation Sciences , University of Cincinnati , Cincinnati , OH , USA
| | - Karen L Harpster
- a Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Rehabilitation Sciences , University of Cincinnati , Cincinnati , OH , USA
| | - Elizabeth Hanson
- a Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Rehabilitation Sciences , University of Cincinnati , Cincinnati , OH , USA
| | - Amber Sheehan
- a Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Sarah M Schwab
- a Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Rehabilitation Sciences , University of Cincinnati , Cincinnati , OH , USA
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Dwyer R, Ward R, Richardson E, Davidson SA, Thetford A, Valentine J. Traumatic spinal cord injuries: A retrospective cohort study of children seen in Western Australia between 1996 and 2016. J Pediatr Rehabil Med 2019; 12:235-243. [PMID: 31476174 DOI: 10.3233/prm-180545] [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: 11/15/2022] Open
Abstract
PURPOSE To describe the medical complexity of traumatic spinal cord injury (TSCI) in paediatric patients in Western Australia (WA). Secondly, to determine if Princess Margaret Hospital (PMH) for Children (the tertiary paediatric centre in WA where all TSCI patients are managed) is meeting the requirements of the Australasian Rehabilitation Outcomes Centre (AROC) paediatric rehabilitation minimum data set gathered on each patient. METHODS Retrospective cohort study of patients seen at PMH between 1996-2016. The AROC minimum dataset information data were gathered on each patient. Functional status and rehabilitation outcomes were assessed using Functional Independence Measure for Children (weeFIM), Canadian Occupational Performance Measure (COPM), and Goal Attainment Scaling (GAS). Patient complexity was captured by documenting the specialty teams involved, the number of readmissions, and the International Statistical Classification of Disease and Related Health Problems Z codes. RESULTS Data from 19 patients (13 males, age range 6 months-15 years; 6 females, age range 4 years-13 years) were available. There were 10 cervical TSCIs with a median length of stay of 213 days and 9 thoracic TSCIs with a median length of stay of 49 days. Patients had between zero and six comorbidities prior to their TSCI. CONCLUSIONS Children with medical complexity are responsive to rehabilitation but have a high burden of care, requiring multiple-specialty care and hospital re-admissions. AROC has set a minimum data set recommendation for the collection and examination of patient data. PMH meets the AROC guidelines for patient data collection and descriptive analyses.
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Affiliation(s)
- Rachel Dwyer
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Roslyn Ward
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Australia
| | - Emma Richardson
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Sue-Anne Davidson
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Anna Thetford
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Australia
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Mulligan SE. Initial Studies of Validity of the Children's Occupational Performance Questionnaire. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 39:135-142. [PMID: 30403156 DOI: 10.1177/1539449218808276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies of validity of a new caregiver report measure, the Children's Occupational Performance Questionnaire (COPQ) designed to address children's performance in the domains of personal and instrumental activities of daily living (IADLs), social participation, play/leisure, and education/work are presented. I examined criterion-related and discriminant validity of the COPQ. Criterion-related validity was addressed by correlating children's COPQ scores with those from the Vineland Adaptive Behavior Scale (VABS-II). Quasi-experimental methods were used to compare COPQ scores from a heterogeneous group of children with disabilities with those from neurotypical children matched by age. COPQ scores correlated highly with scores from the VABS-II including social interaction, communication, daily living skills, and motor skills. Capacity of the COPQ to discriminate between children with and without disabilities varied dependent on age, and the occupational domain being considered. Preliminary support for the validity of COPQ as a measure of occupational performance for children was provided. Further study of the tool's psychometrics and with larger samples is needed.
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Clutterbuck GL, Auld ML, Johnston LM. SPORTS STARS study protocol: a randomised, controlled trial of the effectiveness of a physiotherapist-led modified sport intervention for ambulant school-aged children with cerebral palsy. BMC Pediatr 2018; 18:258. [PMID: 30071830 PMCID: PMC6090768 DOI: 10.1186/s12887-018-1190-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/24/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Modified sport interventions run by physiotherapists have shown potential as cost-effective, engaging, and effective interventions to improve gross motor skills and support transition to real-world sports participation for children with cerebral palsy. At present, this population demonstrates decreased participation in physical activities and sport compared to peers due to barriers ranging from body function to accessibility challenges. Sport provides culturally relevant opportunities for social integration, community participation and physical activity and has been shown to improve the fitness, self-esteem, confidence and quality of life of children with disabilities. The Sports Stars physiotherapy group has been designed to support the development of a range of fundamental movement and sports skills through activity skill practice and participation in modified popular Australian sports. METHODS This randomised, waitlist controlled, assessor blinded, superiority trial with two parallel groups will aim to compare the effectiveness of Sports Stars to standard care across all ICF domains. Children in the Sports Stars group are expected to demonstrate greater improvement in their individually-selected, sports related goals measured by the Canadian Occupational Performance Measure. This study will aim to assess sixty ambulant children aged six to 12 years with a diagnosis of cerebral palsy. Children will be excluded if they have had recent Botox or neurological/orthopaedic surgery. The Sports Stars intervention includes eight, one-hour, weekly physiotherapy group sessions with four to six participants and one lead physiotherapist. Outcome measures will be collected pre, post and 12 weeks post the immediate Sports Stars group to assess change immediately after, and at follow up time points. DISCUSSION This will be the first study of its kind to investigate a culturally relevant sports-focussed fundamental movement skills physiotherapy group for ambulant children with cerebral palsy. The findings will add to a growing pool of evidence supporting group physiotherapy for children with cerebral palsy and the Sports Stars group will provide an avenue for children to transition from individual physiotherapy to mainstream and modified recreational and competitive sports. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12617000313336 Registered 28, February 2017. WHO Universal Trial Number: U1111-1189-3355 Registered 1, November 2016.
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Affiliation(s)
- Georgina L. Clutterbuck
- The University of Queensland, School of Health & Rehabilitation Sciences, Brisbane, Australia
- The Cerebral Palsy League, Brisbane, Australia
| | - Megan L. Auld
- The University of Queensland, School of Health & Rehabilitation Sciences, Brisbane, Australia
- The Cerebral Palsy League, Brisbane, Australia
| | - Leanne M. Johnston
- The University of Queensland, School of Health & Rehabilitation Sciences, Brisbane, Australia
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Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review. Clin Rehabil 2018; 32:954-966. [DOI: 10.1177/0269215518758484] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature. Methods: The scoping review process described by Arksey and O’Malley was used to guide article selection and data extraction. Results: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies ( n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families ( n = 49). Conclusion: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes.
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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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Chu S. Supporting children with special educational needs (SEN): An introduction to a 3-tiered school-based occupational therapy model of service delivery in the United Kingdom. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2017. [DOI: 10.1080/14473828.2017.1349235] [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)
- Sidney Chu
- Fellow, Royal College of Occupational Therapists, London, UK
- Honorary Fellow, Brunel University London, Uxbridge, UK
- Honorary Member, Sensory Integration Network – UK & Ireland, Berkshire, UK
- Director, Kid Power Therapy and Training Co. Ltd, London, UK
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18
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Mulligan S. Defining and measuring the occupational performance of children. JOURNAL OF OCCUPATIONAL THERAPY SCHOOLS AND EARLY INTERVENTION 2017. [DOI: 10.1080/19411243.2017.1292863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Costa UM, Brauchle G, Kennedy-Behr A. Collaborative goal setting with and for children as part of therapeutic intervention. Disabil Rehabil 2016; 39:1589-1600. [PMID: 27385635 DOI: 10.1080/09638288.2016.1202334] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study explored collaborative goal setting with children, parents, and teachers, and children's reasons for their goals based on their perceived self-efficacy, using the Austrian-German Perceived Efficacy and Goal Setting System (AG-PEGS). METHOD Thirty-eight children from age 5 to 10 years (referred to occupational therapists because of difficulties in performing everyday activities), their parents and teachers participated in this mixed methods study. Participants' goals were analyzed using descriptive statistics and content analysis. Data were grouped into thematic categories, and attributed to health factors according to the International Classification of Functioning, Disability, and Health-Children & Youth Version (ICF-CY). RESULTS Children's responses underlined the significance of self-efficacy and participation for a child's health and well-being. They gave priority to their independence, competence, and joy in meaningful everyday activities and indicated social motives such as belonging to and being accepted by others for their mainly participation-oriented goals. Parents' main concerns were related to school task performance, whereas teachers mainly chose body functions and school activities to be the focus of occupational therapy intervention. CONCLUSIONS Exploring clients' priorities, the meanings they attributed to activities in daily life, and their underlying motives for goals should be part of therapeutic intervention. Children and their caregivers are valid and important sources for therapeutic goal setting. Basic human needs, e.g., for relatedness, competence (self-efficacy), autonomy, and meaningful personal orientation, should be considered when prioritizing goals for intervention. Implications for Rehabilitation Children are a valid and important source for therapeutic goal setting. Children's goals focused on activities and participation in all life areas, and half of the parents' goals on activities as relevant for productivity (followed by self-care and leisure), while teachers tended to prioritize goals at the body functions and structures level. The experience of their task performance affecting participation, and the basic needs for independence, relatedness (belonging to and being accepted by others), competence (self-efficacy), and joy through engagement in personally meaningful activities are main motives for children with developmental disabilities to choose their goals for intervention. A client-centred approach in working with children with developmental disabilities requires time and attention for exploring meaning-attributed activities for children and their proxies when collaboratively setting goals.
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Affiliation(s)
- Ursula M Costa
- a Department of Occupational Therapy , University of Applied Sciences Tyrol , Innsbruck , Austria
| | | | - Ann Kennedy-Behr
- a Department of Occupational Therapy , University of Applied Sciences Tyrol , Innsbruck , Austria.,c Division of Occupational Therapy , School of Health and Sport Sciences, University of the Sunshine Coast , Australia
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20
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Thomas RE, Johnston LM, Sakzewski L, Kentish MJ, Boyd RN. Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 53-54:267-278. [PMID: 26955912 DOI: 10.1016/j.ridd.2016.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4-3.1; p<0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes.
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Affiliation(s)
- Rachel E Thomas
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
| | - Leanne M Johnston
- Division of Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Megan J Kentish
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
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21
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Gantschnig BE, Nilsson I, Fisher AG, Künzle C, Page J. Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention. Scand J Occup Ther 2015; 23:260-71. [PMID: 26609766 DOI: 10.3109/11038128.2015.1115548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several factors facilitate or hinder efficacy research in occupational therapy. Strategies are needed, therefore, to support the successful implementation of trials. AIM To assess the feasibility of conducting a randomised controlled trial (RCT). The main feasibility objectives of this study were to assess the process, resources, management, and scientific basis of a trial RCT. MATERIAL AND METHODS A total of 10 occupational therapists, between the ages of 30 and 55 (M 43.4; SD 8.3) with seven to 26 years' (M 14.3; SD 6.1) experience, participated in this study. Qualitative data collected included minutes of meetings, reports, and field notes. The data were analysed based on the principles of content analysis, using feasibility objectives as the main categories. RESULTS Data analysis revealed strengths in relation to retention and inclusion criteria of participants, the study protocol, study organisation, and the competence of researchers. Weaknesses were found related to recruitment, randomisation, data collection, time for training and communication, commitment, and design. CONCLUSION The findings indicated that there are several factors which had a considerable impact on the implementation of an RCT in practice. However, it was useful to assess methods and procedures of the trial RCT as a basis to refine research plans.
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Affiliation(s)
- Brigitte E Gantschnig
- a Zurich University of Applied Sciences, School of Health Professions, Institute of Occupational Therapy , Winterthur , Switzerland ;,e Department of Rheumatology, Immunology and Allergology , Bern University Hospital , Bern , Switzerland
| | - Ingeborg Nilsson
- b Faculty of Medicine, Department of Community Medicine and Rehabilitation, Division of Occupational Therapy , Umeå University , Sweden
| | - Anne G Fisher
- b Faculty of Medicine, Department of Community Medicine and Rehabilitation, Division of Occupational Therapy , Umeå University , Sweden ;,c Department of Occupational Therapy , Colorado State University, College of Health and Human Sciences , Fort Collins , USA
| | | | - Julie Page
- a Zurich University of Applied Sciences, School of Health Professions, Institute of Occupational Therapy , Winterthur , Switzerland
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Dunford C, Bannigan K. Children and young people’s occupations, health and well being: a research manifesto for developing the evidence base. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2014. [DOI: 10.1179/otb.2011.64.1.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gustafsson L, de Jonge D, Lai Y, Muuse J, Naude N, Hoyle M. Development of an Activity Card Sort for Australian adults aged 18-64 years. Aust Occup Ther J 2014; 61:403-14. [PMID: 25283973 DOI: 10.1111/1440-1630.12145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Louise Gustafsson
- School of Health and Rehabilitation Sciences; Division of Occupational Therapy; The University of Queensland; St Lucia Queensland Australia
| | - Desleigh de Jonge
- School of Health and Rehabilitation Sciences; Division of Occupational Therapy; The University of Queensland; St Lucia Queensland Australia
| | - Yvonne Lai
- School of Health and Rehabilitation Sciences; Division of Occupational Therapy; The University of Queensland; St Lucia Queensland Australia
| | - Jessica Muuse
- School of Health and Rehabilitation Sciences; Division of Occupational Therapy; The University of Queensland; St Lucia Queensland Australia
| | - Nicola Naude
- School of Health and Rehabilitation Sciences; Division of Occupational Therapy; The University of Queensland; St Lucia Queensland Australia
| | - Melanie Hoyle
- School of Health and Rehabilitation Sciences; Division of Occupational Therapy; The University of Queensland; St Lucia Queensland Australia
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Wright FV, Majnemer A. The concept of a toolbox of outcome measures for children with cerebral palsy: why, what, and how to use? J Child Neurol 2014; 29:1055-65. [PMID: 24820336 DOI: 10.1177/0883073814533423] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/15/2022]
Abstract
Accurate and well-targeted measurement of a child's abilities and participation in daily activities pre- and post-intervention is essential to understanding the effects of therapies provided by pediatric practitioners. There is growing interest in identification of outcome core sets for specified client groups. This article elaborates on the concepts to consider when selecting and interpreting measures from an outcomes toolbox for children with cerebral palsy. Principles discussed include use of self-report measures to open a dialogue with the child/parent; a holistic assessment approach to identify a child's challenges, strengths, and contextual factors that can influence functioning; links between measurement and heightened engagement of the child/family in the rehabilitation process and goals; and the need to plan the evaluation and dialogue aspects of the assessment process. If clinicians across the international rehabilitation community draw from the same toolbox, the end result could be a cohesive approach and common language to outcome measurement.
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Affiliation(s)
- F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Annette Majnemer
- School of Physical & Occupational Therapy, McGill University, Montréal, Quebec, Canada Montreal Children's Hospital-McGill University Health Centre, Montréal, Quebec, Canada
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Mumford L, Lam R, Wright V, Chau T. An access technology delivery protocol for children with severe and multiple disabilities: a case demonstration. Dev Neurorehabil 2014; 17:232-42. [PMID: 23869969 DOI: 10.3109/17518423.2013.776125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study applied response efficiency theory to create the Access Technology Delivery Protocol (ATDP), a child and family-centred collaborative approach to the implementation of access technologies. METHODS We conducted a descriptive, mixed methods case study to demonstrate the ATDP method with a 12-year-old boy with no reliable means of access to an external device. Evaluations of response efficiency, satisfaction, goal attainment, technology use and participation were made after 8 and 16 weeks of training with a custom smile-based access technology. RESULTS At the 16 week mark, the new access technology offered better response quality; teacher satisfaction was high; average technology usage was 3-4 times per week for up to 1 h each time; switch sensitivity and specificity reached 78% and 64%, respectively, and participation scores increased by 38%. CONCLUSION This case supports further development and testing of the ATDP with additional children with multiple or severe disabilities.
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Costa UM. Translation and Cross-Cultural Adaptation of the Perceived Efficacy and Goal Setting System (PEGS): Results from the First Austrian-German PEGS Version Exploring Meaningful Activities for Children. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2014; 34:119-30. [DOI: 10.3928/15394492-20140325-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/27/2014] [Indexed: 11/20/2022]
Abstract
Occupation-based participatory assessment and treatment planning requires appropriate tools to explore clients' perceptions and priorities for their day-to-day lives. Currently, no such instrument is available in German for use with children and their proxies. This study aimed to translate and adapt the Perceived Efficacy and Goal Setting System (PEGS) for use in German-speaking regions. Translation, adaptation, and field testing of the Austrian-German PEGS version followed guidelines for cross-cultural adaptation of self-report assessments. Forty-two children, ages 5 to 10, with various health conditions, their parents, and teachers participated in this study. The Austrian-German PEGS was successfully translated and culturally adapted. Children, their parents, and teachers reported the child's competences related to the addressed items and identified goals for intervention. Participants added specific culturally relevant activities. Data can now be used to further develop the PEGS for German-speaking regions and to continue research on culturally meaningful activities for children and families. [OTJR: Occupation, Participation and Health. 2014; 34(3):119–130.
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Pollock N, Sharma N, Christenson C, Law M, Gorter JW, Darrah J. Change in parent-identified goals in young children with cerebral palsy receiving a context-focused intervention: associations with child, goal and intervention factors. Phys Occup Ther Pediatr 2014; 34:62-74. [PMID: 23713836 DOI: 10.3109/01942638.2013.799627] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to examine the relationship between goal achievement measured by the Canadian Occupational Performance Measure (COPM) and child, goal, and intervention factors. Participants were 41 preschool children with cerebral palsy (CP) who were in the context-focused therapy arm of a randomized controlled trial. Factors including child age, Gross Motor Function Classification System (GMFCS) level, type and complexity of goals, and intervention strategies were analyzed. Children made large, positive mean changes on the COPM over 6 months (Performance = 3.8, SD = 1.9; Satisfaction = 4.3, SD 4.3) with younger children showing greater change. The COPM scores had low to moderate correlations with change on the Pediatric Evaluation of Disability Inventory and the Gross Motor Function Measure (GMFM-66). Regression analysis indicated that age, but not GMFCS level influenced COPM change scores. Goal complexity and intervention strategies were not significantly related to COPM change scores. The results provide support for using the COPM as an individualized measure of change in young children with CP receiving intervention.
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Affiliation(s)
- Nancy Pollock
- 1School of Rehabilitation Science and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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Wiart L. How can qualitative research contribute to the expanding knowledge base in pediatric physical therapy? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Lesley Wiart
- Department of Clinical SupportGlenrose Rehabilitation Hospital, 10230 – 111th Ave. Edmonton, Alberta T5G 0B7, Canada
- Department of Physical TherapyFaculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, University of Alberta, T6G 2G4, Canada
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Brown T. Are performance-based and self-report measures of children's motor skill abilities linked? Occup Ther Health Care 2013; 26:283-305. [PMID: 23899202 DOI: 10.3109/07380577.2012.722749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Traditionally, children's motor skills were assessed using standardized performance-based tests; however, practitioners are now being encouraged to utilize client-centered and child-centered assessment approaches (such as self-report scales). The purpose of the study was to investigate the association between standardized performance-based and child-report measures of children's motor skill abilities using a convenience sample of 93 typically developing school-age children (52 boys and 41 girls with a mean age of 10.3 years [standard deviation = 1.4]). Data obtained from the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2) and the Physical Self-Description Questionnaire (PSDQ) were analyzed using Spearman's rho correlations. Of the eight BOT-2 subscales, the three that significantly correlated with 8 or more of the 11 PSDQ subscales were the BOT-2 Balance, Running Speed and Agility, and Strength subscales. The PSDQ Body Fat and Flexibility subscales did not correlate with any of the BOT-2 subscale scores. This suggests that children offer a unique perspective of their motor skill performance relative to other sources of assessment information. The PSDQ is recommended for inclusion as part of the motor skill assessment repertoire that practitioners use with children.
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Affiliation(s)
- Ted Brown
- Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, Frankston, Victoria, Australia.
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Ricon T, Hen L, Keadan-Hardan A. Establishing reliability and validity for "Make My Day"--a new tool for assessing young Arab-Israeli children's typical daily activities. Occup Ther Int 2013; 20:173-84. [PMID: 23616369 DOI: 10.1002/oti.1350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/02/2013] [Accepted: 03/11/2013] [Indexed: 11/09/2022] Open
Abstract
There is a paucity of literature regarding the daily routines of young children (4-7 years) and their perception of their performance. Research indicates that children's involvement in treatment therapy improves their self-consciousness, which contributes in return to the therapy's progress. Until recently, occupational therapists set goals for children by involving their parents in the planning. However, recent studies indicate that children are aware of their performance and can provide reliable data, given an evaluation that is adapted to their stage of development. "Make My Day" (MMD) is a new evaluation developed for young children, which provides information regarding the child's performance with respect to their daily activities. The MMD incorporates two versions--one for the children's self-report and the other for the parent's report. Participants included 62 healthy 4- to 7-year-old children of Arab-Israeli decent and their parents. They were assessed using the MMD, Perceived Efficacy and Goal Setting (PEGS), Time Organization and Participation (TOPS) and a socio-demographic questionnaire. Correlations between the MMD and the TOPS/PEGS were examined regarding the differences between children's and parents' reports of performance in three age groups (concurrent validity). Results demonstrated that children's self-report of their occupational performance in daily tasks are reliable and valid. Thus, occupational therapists may obtain data from the child himself or herself and not only from the parents. Further research on the MMD is recommended in other clinical populations to increase our knowledge of their daily functioning and of MMD's validity.
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Affiliation(s)
- Tsameret Ricon
- Occupational Therapy, University of Haifa, Haifa, Israel
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Bagatell N, Hartmann K, Meriano C. The Evaluation Process and Assessment Choice of Pediatric Practitioners in the Northeast United States. JOURNAL OF OCCUPATIONAL THERAPY SCHOOLS AND EARLY INTERVENTION 2013. [DOI: 10.1080/19411243.2012.750546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vroland-Nordstrand K, Krumlinde-Sundholm L. The Perceived Efficacy and Goal Setting System (PEGS), part I: translation and cross-cultural adaptation to a Swedish context. Scand J Occup Ther 2012; 19:497-505. [PMID: 22571377 DOI: 10.3109/11038128.2012.684221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To translate, adapt, and evaluate the applicability of the perceived efficacy and goal setting system (PEGS) for use in Sweden. METHOD Based on guidelines for cross-cultural adaptation of self-reports, the study was performed in several phases involving (i) translation and back-translation, (ii) pre-testing of the translated version, (iii) development of adjusted items and, finally, (iv) field testing of the proposed Swedish version. Participants were 63 parent-child dyads recruited through convenience sampling by 19 therapists. RESULTS Overall, five items in the original PEGS required adaptation, and one new item was added. Using the Swedish version of the PEGS, both children and parents were able to identify individual strengths and weaknesses in the child's performance of daily tasks as well as to select goals for intervention. CONCLUSIONS The Swedish version of the PEGS thus showed evidence of validity based on test content and was applicable for use with children enrolled in paediatric rehabilitation who had a variety of disabilities and who were between five and 12 years of age.
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Kennedy J, Brown T, Chien CW. Motor skill assessment of children: is there an association between performance-based, child-report, and parent-report measures of children's motor skills? Phys Occup Ther Pediatr 2012; 32:196-209. [PMID: 22085322 DOI: 10.3109/01942638.2011.631101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Client-centered practice requires therapists to actively seek the perspectives of children and families. Several assessment tools are available to facilitate this process. However, when evaluating motor skill performance, therapists typically concentrate on performance-based assessment. To improve understanding of the information provided by the different approaches, the study investigated correlations between performance-based, child-report, and parent-report measures of children's motor skill performance. A sample of convenience of 38 children 8-12 years of age with no history of motor or intellectual impairments and their parents was recruited from Victoria, Australia. Scores for the Bruininks-Oseretsky Test of Motor Proficiency (performance-based, administered by a therapist), Physical Self-Description Questionnaire (child report), and Movement Assessment Battery for Children Checklist (parent report) were analyzed using Spearman's rho correlation. Several significant moderate-to-large correlations were found between scores for parent-report and scores for performance-based assessments, while few significant correlations were found between scores for child report and scores for the other two measures. The results suggest that children offer a unique perspective which should be integrated with other sources of information to gain a more holistic perspective of their motor skill performance.
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Affiliation(s)
- Johanna Kennedy
- Occupational Science and Therapy Program, School of Health and Social Development, Faculty of Health, Medicine, Nursing, and Behavioural Sciences, Deakin University, Waterfront Campus, Geelong, Victoria, Australia
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Wallen MA, Ziviani JM. Canadian Occupational Performance Measure: Impact of Blinded Parent-Proxy Ratings on Outcome. The Canadian Journal of Occupational Therapy 2012; 79:7-14. [DOI: 10.2182/cjot.2012.79.1.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background. There is potential for unintended effects on intervention outcome when using the Canadian Occupational Performance Measure (COPM) in intervention studies. Purpose. To determine the effect of blinded parent-proxy ratings of the COPM on outcomes at later endpoints. Methods. Data were drawn from a randomized trial of 50 children with hemiplegic cerebral palsy aged 19 months to seven years. Outcomes were measured at baseline, post-intervention, and six months. Parents of 36 children were randomly allocated to complete six-month COPM proxy ratings blinded or unblinded to previous ratings. A group of 32 parents rated the six-month COPM blinded and then re-rated it after access to previous ratings. Findings. There was no statistically significant difference in ratings between those completing the COPM blinded compared to unblinded. Implications. The COPM should continue to be rated blinded at post-intervention endpoints in the absence of further research to the contrary.
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Rodger S, O’Keefe A, Cook M, Jones J. Parents’ and Service Providers’ Perceptions of the Family Goal Setting Tool: A Pilot Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2012; 25:360-71. [DOI: 10.1111/j.1468-3148.2011.00674.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wallen M, Ziviani J, Naylor O, Evans R, Novak I, Herbert RD. Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial. Dev Med Child Neurol 2011; 53:1091-9. [PMID: 21923854 DOI: 10.1111/j.1469-8749.2011.04086.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Conventional constraint-based therapies are intensive and demanding to implement, particularly for children. Modified forms of constraint-based therapies that are family-centred may be more acceptable and feasible for families of children with cerebral palsy (CP)-but require rigorous evaluation using randomized trials. The aim of this study was to determine the effects of modified constraint-induced therapy compared with intensive occupational therapy on activities of daily living and upper limb outcomes in children with hemiplegic CP. METHOD In this assessor-blinded pragmatic randomized trial, 50 children (27 males, 23 females; age range 19 mo-7 y 10 mo) with hemiplegic CP were randomized using a concealed allocation procedure to one of two 8-week interventions: intensive occupational therapy (n = 25), or modified constraint-induced therapy (n = 25). Manual Ability Classification System (MACS) levels of the participants were, level I n = 2, II n = 37, III n = 8, and level IV n = 1; Gross Motor Function Classification System (GMFCS) levels were, level I n = 33, level II n = 15, and level III n = 1. Participants were recruited through three specialist CP centres in Australia and randomized between January 2008 and April 2010. Children randomized to modified constraint-induced therapy wore a mitt on the unaffected hand for 2 hours each day, during which time the children participated in targeted therapy. The primary outcome was the Canadian Occupational Performance Measure (COPM--measured on a 10-point scale) at completion of therapy. Other outcome measures were Goal Attainment Scaling, Assisting Hand Assessment, Pediatric Motor Activity Log, Modified Ashworth Scale, Modified Tardieu Scale, and a parent questionnaire. Assessments were carried out at 10 weeks and 6 months following randomization. RESULTS All participants were included in the analysis. Between-group differences for all outcomes were neither clinically important nor statistically significant. The mean difference in COPM was 0.3 (95% confidence interval [CI] -0.8 to 1.4; p=0.61) and mean difference in COPM satisfaction was 0.1 (95% CI -1.1 to 1.2; p=0.90). Minor adverse events were reported by five of the 25 participants in the modified constraint-induced therapy group and by one of the 25 in the intensive occupational therapy group. All adverse events were related to participants' lack of acceptance of therapy. INTERPRETATION Modified constraint-induced therapy is no more effective than intensive occupational therapy for improving completion of activities of daily living or upper limb function in children with hemiplegic CP.
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Affiliation(s)
- Margaret Wallen
- Occupational Therapy Department, The Children's Hospital at Westmead, Sydney, NSW, Australia.
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Affiliation(s)
- Ted Brown
- Monash University - Peninsula Campus, Frankston, Victoria, Australia
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Egilson S, Hemmingsson H. School Participation of Pupils with Physical and Psychosocial Limitations: A Comparison. Br J Occup Ther 2009. [DOI: 10.1177/030802260907200402] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several features in the school environment affect pupils with disabilities, serving as either supports or barriers to their school participation. The purpose of this study was to investigate and look for differences in the pupil-environment fit of students with physical and psychosocial limitations, using the School Setting Interview (SSI). The SSI is a client-centred instrument, which focuses on school activities where adjustments need to be made to accommodate pupils with disabilities and to enable their participation. Descriptive statistics and Mann-Whitney U tests were employed to compare the fit of the two groups and their school environment. The results reveal that, in order to participate actively, both groups of pupils required adjustments to many school settings. Pupils with physical limitations frequently need adjustments, but their needs were met by the schools to a more satisfactory extent than were the needs of pupils with psychosocial limitations. The findings support the usability of the SSI for pupils with various types of limitations. They also stress the importance of eliciting the perspectives of the pupils themselves in order to facilitate the planning and implementation of client-centred occupational therapy interventions in school.
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