Standing frames for children with cerebral palsy: a mixed-methods feasibility study

Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study

BACKGROUND

Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP.

METHODS

This is an explanatory sequential mixed methods study. A cross-sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data.

RESULTS

When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits.

CONCLUSION

The healthcare professionals had a child-centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.

How best to support parents in the management of standing frame usage in home settings: A mixed methods study

BACKGROUND

An improved understanding of the current practice of standing frame use may have implications for supporting parents in managing standing frames. We aimed to investigate how parents of children with cerebral palsy perceive and manage standing frame use in home settings.

METHODS

We conducted a mixed methods study with an explanatory sequential design, first collecting and analysing quantitative questionnaire data and then using these results to inform a qualitative follow-up phase to explain them. The questionnaire was answered by 103 parents of children with cerebral palsy across five countries, Denmark, Norway, Great Britain, Canada and the United States, and 12 Danish families participated in the subsequent interviews. A descriptive analysis was conducted using the questionnaire data. The qualitative data were analysed using a directed content analysis, enabling integration of the quantitative and qualitative data.

RESULTS

The quantitative analysis showed that 89% of the parents felt confident with their child's standing frame, and 82% felt they had sufficient knowledge about how their child's standing frame could/should be used. However, the qualitative analysis showed that even when feeling confident, the parents experienced insecurity regarding whether their child was positioned correctly, and being responsible for positioning was challenging.

CONCLUSION

Our study implies a need for providing educational materials to assist the parents in ensuring optimal positioning of their child in the standing frame to decrease insecurity. Additionally, our study suggests a need to provide more thorough information about the benefits of using a standing frame and ensure alignment of expectations in relation to the child's prognosis of functional independence.

Supported standing and stepping device use in young children with cerebral palsy, gross motor function classification system III, IV and V: A descriptive study

This study described and compared use of supported-standing and stepping devices by young children with cerebral palsy, Gross-Motor Function Classification System (GMFCS) levels III-V following power mobility introduction. Data was collected at two time-points, 5-6 months apart, for 42 participants, aged 18-80 months, using the Home Use of Technology for CHildren (HUTCH). Supported-standing and stepping device choice and time in each device remained stable over 6 months. Associations between device use and three functional classifications were examined. Children with more impaired motor, postural and manual abilities were more likely to use a supine stander rather than a prone/upright stander or no stander. Children at GMFCS V tended to use hands-free stepping devices, while support-arms stepping devices were more common for children at GMFCS IV. Only children at GMFCS III used convertible stepping devices. Using power mobility, standers and supported-stepping devices was feasible and 19/34 classified at GMFCS IV/V used all three devices over 6 months. A key finding was that introduction of power mobility did not reduce use of supported-stepping devices at any GMFCS level. Use of multiple upright positioning and mobility devices may assist children with limited mobility to be actively engaged and participate in daily life.

Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus

Children functioning at Gross Motor Function Classification System (GMFCS) levels IV-V cannot maintain an aligned standing position or take steps without support. Upright positioning and mobility devices have psycho-social significance for these children and their families, enhancing use of vision, communication, functioning and emotional well-being. Standers and supported stepping devices facilitate opportunities for biomechanical loading, potentially helping to build and maintain muscle and bone integrity, and they promote physical development. However, families are often required to choose between these two devices for their young child. This study aims to synthesize evidence for use and benefits of both supported standing and stepping devices through the lens of two contemporary theoretical frameworks to support clinical reasoning and implementation. The F-words for childhood development (functioning, family, fitness, fun, friends, future) and the interdependence-Human Activity Assistive Technology (iHAAT) models were combined to illustrate the complex interactions between the child, family, caregivers, peers and contextual factors when implementing standing and stepping devices with children at GMFCS levels IV and V. Supported standing and stepping devices provide complementary benefits, and both may be necessary starting at 9-15 months. We propose they both be included ON-Time, along with other age-appropriate positioning and mobility devices, to promote more equitable developmental opportunities for children with non-ambulant cerebral palsy.

How Does Postural Control of Children with CP Deal with Manipulations on Base of Support and Support Surface? A Systematic Review

AIMS

Systematically review literature addressing the effects of changes in base of support (BoS) configuration and characteristics of support surface (SS) on postural control of children with cerebral palsy (CP).

METHODS

We conducted a tailored electronic database search in PubMed/Web of Science/SCOPUS/Embase.

RESULTS

We identified 15 studies meeting inclusion criteria.

CONCLUSION

The extant literature suggests that when children with CP experience changes in BoS and SS, they engage in fewer adaptive postural control responses than typically developing children. Documented response patterns of children with CP in the literature might guide the selection and development of rehabilitation strategies to appropriately facilitate or challenge postural control in children with CP.

Usability of the dynamic scaffolding system: an adaptive mobility device in children with special needs

PURPOSE

Maintaining vertical position and moving are essential to healthy development. Children with motor difficulties may need assistive devices to stand upright or move. The Dynamic Scaffolding System (DSS) device was developed to support these skills. This study aims to explain the DSS's developmental stages, compare the device's usage times based on diagnoses and motor impairment, and investigate the degree of satisfaction among parents of children using the device.

MATERIALS AND METHODS

The study included children with difficulty standing or stepping and their parents. We compared usage times of DSS depending on diagnosis (cerebral palsy (CP) or other diagnoses) and motor impairment levels. We assessed parental satisfaction by using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) and recorded adverse events.

RESULTS

The ages of the participants (n:100) were between 9 and 108 months (44.94 ± 17.59), and 60% of the children had CP, and 40% had other diagnoses (genetic, metabolic, neuromuscular diseases). The duration of daily use of DSS ranged from 44.17 (±26.16) to 110 (±97.98) minutes, and the duration was similar among children at different levels of motor impairment (p = 0.262). The parents were most satisfied with the size, simplicity of use, and effectiveness, and they were least satisfied with the ease of adjustment, safety, and durability. They did not report any adverse events during the study.

CONCLUSIONS

DSS can be considered a useable assistive device option for children with CP and other diagnoses with difficulty standing or stepping and a satisfactory device for parents of such children.

Reporting involvement activities with children and young people in paediatric research: a framework analysis

BACKGROUND

The active involvement of patients and the public in the design and delivery of health research has been increasingly encouraged, if not enforced. Knowledge of how this is realised in practice, especially where children and young people (CYP) are concerned, is limited, partly due to the low level of reporting of patient and public involvement (PPI) in general. The aim of this work was to assess how researchers funded by the National Institute for Health and Care Research (NIHR) report the involvement of CYP in the design and conduct of child health research to better understand the opportunities offered to CYP, and the realities of involvement in practice.

METHODS

A participation matrix, analysis framework and accompanying tools were adapted from existing frameworks, including a child-rights informed framework, the Guidance for Reporting Involvement of Patients and the Public Checklist Short Form (GRIPP2SF), and NIHR reporting expectations. Child-focused research reports were identified from the NIHR Journals Library, including any interventional or observational study involving CYP aged 0-< 24 years. In two co-design workshops with healthcare professionals and CYP, we tested and refined the participation matrix, analysis framework and accompanying tools.

RESULTS

Only thirty-two NIHR reports out of 169 (19%) were identified as relevant and included reporting of PPI with CYP. We identified significant variability in the way PPI with CYP was reported. Only 4/32 (12%) reports fully met NIHR (and GRIPP2SF) reporting criteria. Only 3/32 (9%) reports formally evaluated or self-reflected on PPI activities with CYP, whilst 15/32 (47%) provided minimal information about CYP involvement. The most common approach to involving CYP (23/32, 72%) was through the medium of existing groups or networks.

CONCLUSION

Despite the NIHR's commitment to increase the quality, transparency, and consistency of reporting PPI, the reporting of involvement with CYP remains sub-optimal. Neglecting to report key details of involvement methods and impacts deprives the research community of knowledge to advance the field of delivering 'meaningful' PPI with CYP. Practical guidance on how researchers can report the processes and outputs of CYP involvement more rigorously may help child health researchers to involve them more meaningfully. This research offers practical tools informed by CYP to aid the reporting process.

Supported-standing interventions for children and young adults with non-ambulant cerebral palsy: A scoping review

AIM

To describe the evidence, outcomes, and lived experience of supported standing for children and young adults with cerebral palsy aged 25 years or younger, classified in Gross Motor Function Classification System levels IV and V.

METHOD

This scoping review included searches in eight electronic databases and manual searching from database inception to May 2020 and updated on 21st February 2022. Two of three reviewers independently screened titles and abstracts and extracted and appraised data. Methodological quality and risk of bias were appraised using tools appropriate to study type. Content analysis and frequency effect sizes were calculated for qualitative and descriptive evidence.

RESULTS

From 126 full-text references, 59 citations (one study was reported over two citations) were included: 16 systematic reviews, 17 intervention studies reporting over 18 citations, eight analytical cross-sectional studies, five descriptive cross-sectional/survey studies, five qualitative studies, and one mixed-methods study were identified, along with six clinical guidelines. Maintenance of bone mineral density and contracture prevention outcomes were supported by the most experimental studies and evidence syntheses, while evidence supporting other outcomes was primarily quasi-experimental or descriptive. Qualitative evidence suggests that programmes are influenced by attitudes, device, child, and environmental factors.

INTERPRETATION

Individualized assessment and prescription are essential to match personal and environmental needs. Although experimental evidence is limited due to many factors, lived-experience and cohort data suggest that successful integration of standing programmes into age-appropriate and meaningful activities may enhance function, participation, and overall health.

Advancing cluster randomised trials in children’s therapy: a survey of the acceptability of trial behaviours to therapists and parents

Background

Randomised controlled trials of non-pharmacological interventions in children’s therapy are rare. This is, in part, due to the challenges of the acceptability of common trial designs to therapists and service users. This study investigated the acceptability of participation in cluster randomised controlled trials to therapists and service users.

Methods

A national electronic survey of UK occupational therapists, physiotherapists, speech and language therapists, service managers, and parents of children who use their services. Participants were recruited by NHS Trusts sharing a link to an online questionnaire with children’s therapists in their Trust and with parents via Trust social media channels. National professional and parent networks also recruited to the survey. We aimed for a sample size of 325 therapists, 30 service managers, and 60 parents. Trial participation was operationalised as three behaviours undertaken by both therapists and parents: agreeing to take part in a trial, discussing a trial, and sharing information with a research team. Acceptability of the behaviours was measured using an online questionnaire based on the Theoretical Framework of Acceptability constructs: affective attitude, self-efficacy, and burden. The general acceptability of trials was measured using the acceptability constructs of intervention coherence and perceived effectiveness. Data were collected from June to September 2020. Numerical data were analysed using descriptive statistics and textual data by descriptive summary.

Results

A total of 345 survey responses were recorded. Following exclusions, 249 therapists and 40 parents provided data which was 69.6% (289/415) of the target sample size. It was not possible to track the number of people invited to take the survey nor those who viewed, but did not complete, the online questionnaire for calculation of response rates. A completion rate (participants who completed the last page of the survey divided by the participants who completed the first, mandatory, page of the survey) of 42.9% was achieved. Of the three specified trial behaviours, 140/249 (56.2%) therapists were least confident about agreeing to take part in a trial. Therapists (135/249, 52.6%) reported some confidence they could discuss a trial with a parent and child at an appointment. One hundred twenty of 249 (48.2%) therapists reported confidence in sharing information with a research team through questionnaires and interviews or sharing routine health data. Therapists (140/249, 56.2%) felt that taking part in the trial would take a lot of effort and resources. Support and resources, confidence with intervention allocation, and sense of control and professional autonomy over clinical practice were factors that positively affected the acceptability of trials. Of the 40 parents, twelve provided complete data. Most parents (18/40, 45%) agreed that it was clear how trials improve children’s therapies and outcomes and that a cluster randomised trial made sense to them in their therapy situation (12/29, 30%).

Conclusions

Using trials to evaluate therapy interventions is, in principle, acceptable to therapists, but their willingness to participate in trials is variable. The willingness to participate may be particularly influenced by their views related to the burden associated with trials, intervention allocation, and professional autonomy.

Effects of Aquatic Therapy for Children with Autism Spectrum Disorder on Social Competence and Quality of Life: A Mixed Methods Study

Autism Spectrum Disorder (ASD) is a constellation of social deficits and repetitive sensory-motor behaviours. Aquatic therapy (AT) may be effective in improving the social interactions and behaviours in children with ASD. The objective of this study was to evaluate the effects of an AT program on social competence and quality of life and to understand participant’s experiences related to the intervention by obtaining qualitative data. A mixed methods intervention study was conducted among 6 children with ASD and their parents, with two research phases in a concurrent embedded design (an aquatic intervention as the quantitative design and a qualitative design in second step). The intervention and qualitative design followed international guidelines and were integrated into the method and reporting subheadings. Significant improvement was observed in the physical competence (p = 0.026) and important improvements in school functioning and aquatic skills, with no adverse events. Qualitative findings described: the meaning of AT intervention, patterns of behaviour and activities changes, social communication and social interaction. The aquatic intervention showed positive results for the social and physical competence, with elements of discordance, expansion, and confirmation between quantitative and qualitative results.

The Impact of Gross Motor Function on the Oral Health-Related Quality of Life in Young Adults with Cerebral Palsy in Saudi Arabia

Background

There is evidence that gross motor function impacts the health-related quality of life of young adults with cerebral palsy. This study aimed to assess gross motor function, oral health and oral health-related quality of life (OHRQoL), and the relationship between them in young adults with cerebral palsy.

Methods

The sample comprised 46 individuals aged between 13 and 17 years with Gross Motor Function Classification Scores (GMFCS) ranging from level I to level III. The individuals and their parents were administered an Arabic version of the child perception questionnaire for adolescents. Parental and child perception scores, DMFT, and gingival index were compared across GMFCS levels using the one-way ANOVA and Scheffe's post hoc test.

Results

Children with level III GMFCS had a significantly higher child perception score (CPQ) and parental perception score (PPQ) than those with level I or level II scores. There was a significant association between function (GMFCS) and the CPQ score in children (p = 0.016). No significant associations were found between the CPQ score and either dental caries (DMFT) or gingival bleeding (GI) scores. Children with GMFCS level III had a significantly higher DMFT (p = 0.016). No significant associations were found between the CPQ score and either dental caries (DMFT) or gingival bleeding (GI) scores. Children with GMFCS level III had a significantly higher DMFT (p = 0.016). No significant associations were found between the CPQ score and either dental caries (DMFT) or gingival bleeding (GI) scores. Children with GMFCS level III had a significantly higher DMFT (

Conclusion

Motor function has a significant impact on both the oral health and the OHRQoL of adolescents and young adults with spastic cerebral palsy.