Dealing with multisystem disease in people with a developmental disability

Experiences of Family Resource Utilization Among Taiwanese Parents of Children with Developmental Delay

PURPOSE

To describe the experiences of the utilization of family resources by parents of children with developmental delay (DD) when receiving early intervention (EI) services.

DESIGN AND METHODS

A Descriptive phenomenological approach was applied to conduct this study. Purposive sampling was utilized to select 17 parents of children with DD from a teaching hospital in northern Taiwan. Data were collected from January 2015 to March 2016 through face-to-face interviews that lasted between 55 and 80 min. Data analysis was performed using Giorgi's phenomenological method.

RESULTS

Four themes emerged: parents receiving EI services feel as if they are admitting that their child has an abnormality; parents' dedication in helping their children to progress; parents feel that they are needing to extend their resources in an already limited environment; and lastly, parents expressed that they are facing an uncertain future.

CONCLUSIONS

The findings highlight the dedication of parents in utilizing family resources to help their children progress. Constrained by the environment and an uncertain future, parents utilized family strengths to help them respond to stressful family situations and maintain family functions.

PRACTICE IMPLICATIONS

Health professionals could assist by providing more EI resources to parents to help cope with family stress arising from having children with DD. It's recommended that health professionals pay attention to Taiwanese culture and how it influences family acceptance for EI services, and work toward establishing friendly EI environments that meet the needs of these children and their families.

Lived experiences of Jordanian mothers caring for a child with disability

PURPOSE

Caring for a child with a disability in the family is associated with a major increase in care-giving demands and burden. This qualitative study explores the perspectives, challenges and adaptations of Jordanian mothers living with a child with disability.

METHODS

Phenomenological qualitative tradition was utilized. Seven Jordanian mothers of children with disability were purposefully selected as having rich experiences for caring for a child with a disability. In-depth interviews were conducted using a semi-structured guide, audio-taped and transcribed verbatim. Interpretive phenomenological analysis was used to extract main themes and subthemes.

RESULTS

Mothers' experiences were reflected into four main themes: (1) increased perceived stigma, (2) fear for the future, (3) increased perceived care-giving burden and (4) adaptations to the child's disability.

CONCLUSIONS

This study highlights key gaps in the provision of family-centered services for this population as well as multiple sociocultural issues impacting participation and quality of life. Healthcare professionals must deal with the child's disability from a family-centered and cultural perspective. Implications for rehabilitation When therapists meet the whole family's needs through a family-centered approach, the child with disability is less likely to be ignored, maltreated or abused. Family-centered practice adopts a sociocultural model which looks at the child from a wider point of view rather than just the disability itself. It requires therapists to review the context in which the child lives and address the specific needs of parents, siblings and other involved family members. Culture plays a huge role in shaping the family's perspective on disability and has a huge impact and implications for service delivery and development, quality of life and participation for children with disability and their families. Rehabilitation professionals must accommodate their time schedules to provide families with the communication, education, advocacy and consultations needed.

Non-pharmaceutical management of respiratory morbidity in children with severe global developmental delay

BACKGROUND

Children with severe global developmental delay (SGDD) have significant intellectual disability and severe motor impairment; they are extremely limited in their functional movement and are dependent upon others for all activities of daily living. SGDD does not directly cause lung dysfunction, but the combination of immobility, weakness, skeletal deformity and parenchymal damage from aspiration can lead to significant prevalence of respiratory illness. Respiratory pathology is a significant cause of morbidity and mortality for children with SGDD; it can result in frequent hospital admissions and impacts upon quality of life. Although many treatment approaches are available, there currently exists no comprehensive review of the literature to inform best practice. A broad range of treatment options exist; to focus the scope of this review and allow in-depth analysis, we have excluded pharmaceutical interventions.

OBJECTIVES

To assess the effects of non-pharmaceutical treatment modalities for the management of respiratory morbidity in children with severe global developmental delay.

SEARCH METHODS

We conducted comprehensive searches of the following databases from inception to November 2013: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Allied and Complementary Medicine Database (AMED) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We searched the Web of Science and clinical trials registries for grey literature and for planned, ongoing and unpublished trials. We checked the reference lists of all primary included studies for additional relevant references.

SELECTION CRITERIA

Randomised controlled trials, controlled trials and cohort studies of children up to 18 years of age with a diagnosis of severe neurological impairment and respiratory morbidity were included. Studies of airways clearance techniques, suction, assisted coughing, non-invasive ventilation, tracheostomy and postural management were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures as expected by The Cochrane Collaboration. As the result of heterogeneity, we could not perform meta-analysis. We have therefore presented our results using a narrative approach.

MAIN RESULTS

Fifteen studies were included in the review. Studies included children with a range of severe neurological impairments in differing settings, for example, home and critical care. Several different treatment modalities were assessed, and a wide range of outcome measures were used. Most studies used a non-randomised design and included small sample groups. Only four randomised controlled trials were identified. Non-randomised design, lack of information about how participants were selected and who completed outcome measures and incomplete reporting led to high or unclear risk of bias in many studies. Results from low-quality studies suggest that use of non-invasive ventilation, mechanically assisted coughing, high-frequency chest wall oscillation (HFCWO), positive expiratory pressure and supportive seating may confer potential benefits. No serious adverse effects were reported for ventilatory support or airway clearance interventions other than one incident in a clinically unstable child following mechanically assisted coughing. Night-time positioning equipment and spinal bracing were shown to have a potentially negative effect for some participants. However, these findings must be considered as tentative and require testing in future randomised trials.

AUTHORS' CONCLUSIONS

This review found no high-quality evidence for any single intervention for the management of respiratory morbidity in children with severe global developmental delay. Our search yielded data on a wide range of interventions of interest. Significant differences in study design and in outcome measures precluded the possibility of meta-analysis. No conclusions on efficacy or safety of interventions for respiratory morbidity in children with severe global developmental delay can be made based upon the findings of this review.A co-ordinated approach to future research is vital to ensure that high-quality evidence becomes available to guide treatment for this vulnerable patient group.