Can, Want and Try: Parents' Viewpoints Regarding the Participation of Their Child with an Acquired Brain Injury

An Evaluation of the Use of the Child and Adolescent Scale of Participation (CASP) to Measure Social Participation After Pediatric ABI in a Specialist Service in East Anglia

Pediatric acquired brain injury (ABI) can lead to lifelong challenges restricting social participation, which is an important goal for rehabilitation due to associations with improved wellbeing. This evaluation considered the utility of the Child Adolescent Scale of Participation (CASP) in ABI rehabilitation services. The 20-item measure is rated on a Likert scale with reference to what the rater would expect of their child at that age, including "not applicable" (N/A). It showed high internal consistency (α = 0.954-0.968). Two-step cluster analysis indicated greater difficulties in children with lower participation, including more impairments of executive function and higher staff involvement. Between-group analysis indicated higher rates of N/A answers for younger children and those of ethnic minorities. Overall, the CASP is reliable and clinically useful on an individual level, helping identify people who may need prioritizing for neurorehabilitation; however, group-level analyses were more challenging due to high frequency of N/A responses.

Returning to education after childhood acquired brain injury: Learning from lived parental experience

BACKGROUND

Returning to education (RtE) after an acquired brain injury (ABI) can be stressful for children/young people (CYP) and families. While much can be done to support RtE, there has been limited exploration of the lived experience of parents/carers about what can both help and hinder the process.

OBJECTIVE

The aim was to understand more about RtE from parents' perspectives to inform best practice and facilitate improvements in service delivery.

METHODS

A service evaluation explored parent/carer views about the RtE process and the support received from healthcare professionals at a regional centre in the UK. Questionnaires (n = 59) were sent to parents of patients treated for an ABI in the last two years.

RESULTS

31 parents (response rate = 51%) completed the survey. Results highlight the many challenges of RtE. Thematic analysis of responses revealed six key themes: Parental mindset and growth; What do they need know?; Specialist support and information; Talk and share; Challenges of new and hidden needs; and Don't forget them!

CONCLUSION

Parents offer crucial insight into the challenges of the RtE process. Their feedback highlights important factors for service development and reminds professionals of the key components of an effective return.

Exploring Occupational Therapists' Professional Identity: A Q-Method Study

(1) Background: This study examines the nature of the rarely studied factors of the professional identity from an occupational therapist's perspective. (2) Methods: Q-methodology was applied to identify the different perspectives. Participants were selected through a non-probability sampling procedure in the whole Spanish territory. Different assessment tools were considered, in order to develop an ad hoc tool which had 40 statements classified into four categories. A factor analysis was performed by applying Ken-Q analysis v.1.0. (3) Results: Thirty-seven occupational therapists participated in the study. Their diverse approaches revealed different perspectives that influence the professional identity of occupational therapists: professional identity, due to referents, a grey field on professional identity, reaffirming a common professional identity, the role of education and mentors on professional identity and the outcome of ongoing training, in order to develop the abovementioned identity. (4) Conclusions: Once the different aspects of the professional identity have been understood, future educational initiatives can be designed to adapt curricula to the professional scene.

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

BACKGROUND

Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions.

OBJECTIVE

This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery.

METHODS

The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes.

RESULTS

Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion.

CONCLUSIONS

The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.

A Q-method approach to perceptions of professional reasoning in occupational therapy undergraduates

BACKGROUND

Professional reasoning provides a firm basis for the development of teaching and assessment strategies to support the acquisition of skills by healthcare students. Nevertheless, occupational therapy educators should use diverse methods of learning assessment to examine student learning outcomes more fully with an evaluation that supports the overall complexity of the process, particularly learners' subjective experience. The aim of this article is to identify the range of perspectives among occupational therapy undergraduates regarding terms or concepts that are key for improving their professional reasoning.

METHODS

Q-methodology was used to address the aim of the study. A concourse relating to a series of ideas, phrases, terminology, and concepts associated with various studies on professional reasoning in occupational therapy, specifically on students in this field, was generated. The terms that had the clearest evidence, the most relevance or the greatest number of citations in the literature were collected (n = 37). The P-set was assembled by non-probabilistic sampling for convenience. It comprised undergraduate university students in occupational therapy. Factor analysis was conducted using Ken-Q Analysis v.1.0.6, reducing the number of Q-sets to smaller groups of factors representing a common perspective.

RESULTS

Through statistical analysis of the Q-sorts of 37 occupational therapy students, 8 default factors were identified. The four factors in accordance with the selection criteria were rotated by varimax rotation to identify variables that could be grouped together. Each viewpoint was interpreted, discussed and liked to different aspects of professional reasoning in occupational therapy.

CONCLUSIONS

The observed perceptions were linked to the various aspects of professional reasoning that have been widely discussed in the occupational therapy literature. For most of the students, there was a strong correspondence between the narrative, interactive and conditional aspects of the various components.

Exploring participation after paediatric acquired brain injury

This study aimed to explore the levels of participation in a UK sample of children and young people (CYP) with an acquired brain injury (ABI) at home, school and in the community through a cross-sectional study. The Child and Family Follow-Up Survey was distributed to parents/carers of 134 CYP with ABI (CYP-ABI) who received neuro-rehabilitation from 2014 to 2016. Access and recruitment were problematic resulting in a low response rate (4%). Widespread restrictions in participation were reported by four of the five respondents with community-structured events/activities and educational activities being the most restricted. Factors impacting on participation were cognitive-based and movement skills, family stress and lack of support/encouragement in the community. Study results provide information pertaining to the feasibility of undertaking research with this population while also highlighting the restrictions to participation experienced by CYP-ABI more than two years after injury.

Activities and Participation in the First 6 Months After Mild Traumatic Brain Injury in Children and Adolescents

OBJECTIVE

To investigate the natural course of activities and participation of children up to 6 months after a mild traumatic brain injury (mTBI).

METHODS

A prospective longitudinal cohort study with complete data sets of 231 children diagnosed with mTBI and their caregivers.

MAIN MEASURES

Activities and participation assessed with the Child and Adolescent Scale of Participation (CASP) and the Children's Assessment of Participation and Enjoyment (CAPE) measured at 2 weeks, 3 months, and 6 months post-mTBI. Because of a ceiling effect, the primary outcome measure (CASP) was divided into deviant (not maximum score) or full functioning.

RESULTS

Friedman's, Cochran's Q, and McNemar's tests (CASP) and repeated-measures analyses of variance (CAPE) showed significant increases in activities and participation between 2 weeks and 3 and 6 months after mTBI. Based on the parents' perspective, 67% of the children returned to full functioning at 6 months postinjury, with only 38% of the children describing themselves as functioning at their premorbid level.

DISCUSSION

Findings indicate that most children return to maximum level of activities and participation over time after mTBI. In a substantial number of children, however, the level of activities and participation at 6 months postinjury is evaluated as lower than that of peers. The importance of investigating predictors for child and caregiver perspectives is emphasized.

Unpacking the application of Q methodology for use in occupational therapy research

BACKGROUND

Occupational therapy research has not fully utilized available research methods when exploring occupational therapists' views on specific interventions and service provision nor when exploring consumer priorities and the impact of occupational therapy services. Q methodology, a quantitative method for the systematic assessment of qualitative data, is an approach that can be used to examine viewpoints related to occupational therapy.

AIMS/OBJECTIVES

To add experiential knowledge to guide researchers new to navigating Q methodology and encourage researchers to consider the application of Q methodology when exploring viewpoints pertinent to occupational therapy practice and research.

MATERIAL AND METHODS

The application of Q methodology in published occupational therapy and occupational science research is identified, and an experience-based review of Q methods undertaken.

RESULTS

More detailed explanation and reflection on each stage of Q methodology, including the factor analysis stage, than is currently available in the literature is presented to support successful implementation of this method.

CONCLUSION

Sharing experience in implementing Q methodology may inform and encourage researchers in its use as one method for bridging the gap between qualitative and quantitative data.

SIGNIFICANCE

The rigor of the method's processes may add credibility to identified viewpoints and how they could inform occupational therapy practice.Key messagesQ methodology can be used in occupational therapy research to explore consumer and therapist viewpoints regarding interventions, service provision, priorities and the profession itself.Q methodology employs a specific, repeatable process within each stage of the research process to ensure rigour.Q methodology provides an approach to combining qualitative research methods with quantitative analysis techniques to understand the viewpoints of interest.

Prescribing upper limb orthoses for children with cerebral palsy: a Q methodology study of occupational therapists' decision making

Purpose: This study identified occupational therapists' viewpoints that guide their practice of upper limb orthosis prescription for children with cerebral palsy (CP).Methods: A qualitative study utilising Q methodology explored participants' viewpoints. Thirty-nine occupational therapists (38 females) were purposively recruited to rank statements generated from interviews of experienced clinicians and peer reviewed and published literature. Statements about reasons for orthoses prescription, were ranked according to what guides decision making the most to least. Data from ranked statements were analysed using by-person factor analysis to reveal the different ways statements were grouped. The resultant factors, based on the average arrangement of statements associated with each factor, were interpreted and named as viewpoints.Results: Viewpoints identified: 1. Potential effect of the orthosis (n = 12 sorts); 2. Biomechanical presentation (n = 12 sorts); and 3. Client/therapist relationship (n = 10 sorts). The "Client's goals" statement was ranked highest across all viewpoints.Conclusions: Viewpoints identified may inform development of clinical guidelines. Further research is required to (i) identify valid and reliable classification and assessment tools to guide decision making; and (ii) establish the mechanism of the effect of orthotic intervention by considering the link between the biomechanical purpose of the orthosis (e.g., mobilise tissue) and aim of intervention (prevent contracture).Implications for rehabilitationQ methodology provided an opportunity to identify viewpoints of occupational therapists that guide their upper extremity orthosis prescription decision making.Consistent with best-practice, clients' goals were the primary focus of decision making in each viewpoint.It is recommended that clinicians consider the identified viewpoints; 1) the potential effects of the orthosis, 2) the biomechanical presentation of the child, within 3) an established client/therapist relationship when prescribing upper extremity orthoses.Practice guidelines to inform upper limb orthotic intervention may be developed using the identified viewpoints.

Participation seven years after severe childhood traumatic brain injury. Disabil Rehabil 2019;42:2402-2411. [PMID: 30950661 DOI: 10.1080/09638288.2019.1594398]

Purpose: Participation in home, school and community activities is considered as the ultimate aim of rehabilitation. The aims of this study were to examine participation seven years post-severe childhood traumatic brain injury and factors associated with participation.Materials and methods: Participants were enrolled in the Traumatisme Grave de l'Enfant (Severe Childhood Injury) cohort study following severe accidental childhood traumatic brain injury. Participation seven years post-injury, was examined using parent- and self-report forms of the Child and Adolescent Scale of Participation among 37 patients [62% males, mean age 15.4 years (SD = 4.4), mean length of coma 6.68 days (SD = 4.96)] and 33 matched controls.Results: Parent reports indicated significantly lower participation among patients compared to controls, but the self-reports did not. In the traumatic brain injury group, parent-reported participation was variable, with 22% of the patients clearly showing greater restrictions than controls. Participation restrictions were significantly associated with injury severity, poor functional outcome one-year post-injury, executive and behavioral difficulties and higher fatigue levels seven years post-injury, but not with pre-injury nor family factors.Conclusions: Several years after severe childhood traumatic brain injury, participation appears to depend more on injury-related factors than on environmental factors. In self-reports assessments of participation, it could be difficult for children and adolescents to distinguish capacity from performance.Implications for rehabilitationParticipation outcomes were highly variable in a sample of patients who sustained severe childhood traumatic brain injury.Participation should be assessed systematically following severe traumatic brain injury, both initially but also in the long-term, ideally using a combination of self- and proxy-report measures.Among patients with severe injuries, the influence of initial brain injury severity markers on participation seems much stronger than that of social/family environment factors.Children's and adolescents' self-reported participation assessed with the Child and Adolescent Scale of Participation may be difficult to interpret.

What do Kids with Acquired Brain Injury Want? Mapping Neuropsychological Rehabilitation Goals to the International Classification of Functioning, Disability and Health

OBJECTIVE

To increase understanding of the community neuropsychological rehabilitation goals of young people with acquired brain injuries (ABIs).

METHOD

Three hundred twenty-six neuropsychological rehabilitation goals were extracted from the clinical records of 98 young people with ABIs. The participants were 59% male, 2-19 years old, and 64% had a traumatic brain injury. Goals were coded using the International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY). Descriptive statistical analysis was performed to assess the distribution of goals across the ICF-CY. Chi-squared and Cramer's V were used to identify demographic and injury-related associations of goal type.

RESULTS

The distribution of goals was 52% activities and participation (AP), 28% body functions (BF), 20% environmental factors (EF), and <1% body structures (BS). The number of EF goals increased with age at assessment (V = .14). Non-traumatic causes of ABIs were associated with more EF goals (V = .12). There was no association between sex or time post-injury and the distribution of goals across the ICF-CY.

CONCLUSIONS

Young people with ABIs have a wide range of community neuropsychological rehabilitation goals that require an individualized, context-sensitive, and interdisciplinary approach. Community neuropsychological rehabilitation services may wish to ensure they are resourced to focus intervention on AP, with increasing consideration for EF as a young person progresses through adolescence. The findings of this research support models of community neuropsychological rehabilitation that enable wellness by combining direct rehabilitative interventions with attention to social context and systemic working across agencies. (JINS, 2019, 25, 403-412).

'It's important that we learn too': Empowering parents to facilitate participation in physical activity for children and youth with disabilities

AIM

The actions and behaviors of parents have been identified as key factors that influence a child's participation in physical activity. However, there is limited knowledge of how parents can be supported to embody facilitative roles. This study aimed to explore how an ecological intervention encourages parents of children with disabilities to develop as facilitators, to enable ongoing physical activity participation in a child's local environment.

METHODS

A qualitative design using grounded theory was employed. Forty four parents (26 mothers, 18 fathers) of 31 children with a range of disabilities (mean age 12y 6m (SD 2y 2m); 18 males) partaking in the Local Environment Model intervention at Beitostolen Healthsports Centre in Norway participated in the study. Data were derived from the triangulation of semi-structured interviews and participant observation. Data analysis was an iterative approach of constant comparison, where data collection, memo writing, open, axial and selective coding analysis, were undertaken simultaneously. Findings were consolidated into a model describing the central phenomenon and its relationship to other categories.

RESULTS

Thematic concepts uncovered in this study describe a social process of parent learning and empowerment, comprising three primary components; (i) active ingredients of the intervention that enabled learning and empowerment to transpire, (ii) parent learning and empowerment as a process, and (iii) related outcomes.

CONCLUSION

A family-centered approach, encompassing family-to-family support, may enhance physical activity participation outcomes for children and youth with disabilities.