Eina! Ouch! Eish! Professionals' Perceptions of How Children with Cerebral Palsy Communicate About Pain in South African School Settings: Implications for the use of AAC

Supporting Early Communication Skills of Children with Developmental Disorders in South Africa: Caregiver and Clinician Perspectives about Mobile Health Applications

Using a mobile health application (i.e. app) to empower primary caregivers of young children with developmental disorders in low- and middle-income countries is opening up new avenues for early childhood intervention. Thirteen caregivers and ten speech-language pathologists participated in three focus groups to explore their perspectives about the potential benefits and suitability of a mobile health app as part of intervention, its features, the likelihood of using and recommending it, as well as potential pitfalls to be avoided. Both participant groups were generally positive, although there was little overlap between their responses. Caregivers generally focused on increased knowledge and skills (of all family members), as well as on empowerment and reduced costs. Speech-language pathologists on the other hand focused on how current service delivery would be enriched by increasing the dosage of therapy and enhancing parental cooperation. They also expected that the reach of service delivery would be expanded as more children and caregivers could potentially benefit. Although technology (i.e. mobile apps) could open up new possibilities for service delivery in this population, the perspectives of all stakeholder groups should be considered to ensure successful adoption of such technologies.

How pain management for children with cerebral palsy in South African schools complies with up-to-date knowledge

Background

Pain in children with cerebral palsy (CP) has its sources in musculoskeletal problems that can influence learning in a school setting. Best pain management is essential for these children, but school staff may not keep up to date with the latest developments and interventions. Therefore, staff's perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions.

Objectives

This study investigated how pain management intervention for children with CP in South African schools complied with international scientific knowledge about evidence-based interventions. The intention was to provide support for an update of knowledge on both individual level (i.e. professionals) and system level (i.e. decision makers).

Method

Five focus groups were conducted with staff members at five schools for children with special educational needs in South Africa. Manifest and latent content analyses of professional statements identified interventions reported as beneficial and related them to higher and lower levels of intervention evidence as reported at the time of data collection.

Results

Most treatment strategies concerned motor functioning that fell within the framework of physiotherapists and occupational therapists. Access to orthopaedic expertise was limited, waiting times were long and medication for spasticity treatment was not offered.

Conclusion

A discrepancy between published evidence and clinical practice for pain management in children with CP in South African school settings was noted. Suggestions for improved early intervention to identify children's hips at risk through surveillance programmes; and orthopaedic management are proposed to prevent deformities and unnecessary suffering in South African children with CP.

Augmentative and Alternative Communication – Scoping Review / Unterstützte Kommunikation – Scoping Review

Introduction

The effective use of Augmentative and Alternative Communication is challenging, not only for persons with complex communication needs, but also for their significant others. There is a need, therefore, for interprofessional collaboration in order to effectively assess, provide, and evaluate services.

Aim

The aim of this scoping review was to summarize current evidence in the field of Augmentative and Alternative Communication and reveal the demands for further research.

Method

We searched in the electronic databases Pubmed, AMED, and CINAHL using following keywords child*, disability, cerebral palsy, augmentative and alternative communication, intervention, and therapy to identify relevant literature. We summarised the content of the included studies.

Results

We included 16 literature reviews and 36 studies in this review. The 36 studies included 11 intervention studies, 20 descriptive studies, two experimental studies, and three studies evaluating assessments. Most of the studies were focussing on children with cerebral palsy and autism in the contexts of home, hospital, and primary school. There were no intervention studies, focusing on secondary and/or tertiary level of education or work. Moreover, we have not found any evidence from German speaking Europe.

Conclusion

In order to support the use of Augmentative and Alternative Communication and to enable participation of persons with complex communication needs, various endeavours are needed: in the practice of care settings interprofessional collaboration is required. Further research is needed in order to evaluate the effectiveness of interventions, focussing on youth and the contexts of secondary and/or tertiary education or work, or on assessments.

Professionals' Perceptions about the Need for Pain Management Interventions for Children with Cerebral Palsy in South African School Settings

Pain is common in children with cerebral palsy (CP) and may have negative consequences for children's success in their studies. Research has shown that pain in childhood negatively influences individuals' participation and quality of life in later years. This study investigated how professionals in South African school settings respond to children's need for pain management in an attempt to enable the children to be active participants in school activities, despite their pain. The study was descriptive and followed a qualitative design (i.e., focus group interviews with semistructured questions and a conventional content analysis). Five government schools for children with special education needs in South Africa's Gauteng province participated. Participants/Subjects: Thirty-eight professionals who represented eight professions. Professional statements on the topic were collected from five focus group sessions conducted during one week. Qualitative content analysis of the data was performed. Similar statements were combined, coded, and sorted into main categories and subcategories. The analysis identified three main categories for pain management: environmental, treatment, and support strategies. In addition, four groups of statements emerged on how contextual factors might affect pain in children with CP and their participation in school settings. It is important to train professionals in pain management and to implement structured models for pain prevention and management to ensure that best practices are adhered to for children with CP who suffer from acute or chronic pain.