Exploring caregiver and participant experiences of the Program for the Education and Enrichment of Relational Skills (PEERS®) for youth with acquired brain injury and cerebral palsy

PURPOSE

This study explored the experience of adolescents with brain injuries and their caregivers who participated in the Program for the Education and Enrichment of Relational Skills (PEERS®) in Australia.

MATERIALS AND METHODS

Twenty-seven adolescents and 31 caregivers, who completed the PEERS® intervention as part of an RCT, contributed to focus groups following the 14-week program. Semi-structed interviews guided focus groups. An interpretive description methodology was used to understand participants' experiences in the program and suggestions for improvements.

RESULTS

Thematic analysis led to the development of five themes. "Challenging families and meeting expectations" explored the challenge and worth of participating. "Learnt new skills" highlighted skills and strategies gained and methods used to achieve these. "Connecting, belonging and understanding that's our normal" represented the value placed on the group experience. "Confidence in knowing and doing" reflected the changes in everyday social experiences and "Where to from here?" provided many suggestions for adaptation to improve practice.

CONCLUSION

After taking part in the PEERS® social skills group intervention, most adolescents with brain injury and their caregivers perceived improvement in their social participation and had suggestions for improving the group experience. Some adolescents didn't enjoy the program.IMPLICATIONS FOR REHABILITATIONOffering adolescents with brain injury and their caregivers the opportunity to participate in a group social skills intervention is an important part of paediatric rehabilitation.Participants of group social skills interventions are likely to perceive improvements in their everyday social functioning following completion.Considering strategies to enhance engagement in the group is expected to be important for outcomes.Participants of group social skills programs may need additional support and adjustments to balance the demands of the intervention with other everyday family and school tasks and requirements.

Engaging children and adolescents with acquired brain injury and their families in goal setting: The family perspective

This study explored the experiences of goal setting in paediatric rehabilitation from the perspectives of children and adolescents with acquired brain injury (ABI) and their parents in paediatric rehabilitation. Using a qualitative research design, 15 semi-structured interviews were conducted with 13 parents and 8 young people with ABI aged between 9 and 18 years who were engaged in outpatient rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and several sub-themes emerged: Experiences of goal setting: The role of professionals; The role of the young person; and The role of the parents. Working as a team: Understanding each other and building trust; Communicating, sharing knowledge and different perspectives; and Being flexible. These themes reflect parent's and young people's experience of goal setting during paediatric rehabilitation for ABI and suggest clinicians play an important role in educating young people and their families about goal setting in the outpatient rehabilitation context. Young people and their parents also perceive the focus of outpatient rehabilitation as working collaboratively with clinicians to gain knowledge to manage the consequences of ABI. Our findings emphasize the importance of the therapeutic consumer-clinician relationship and the need to actively engage young people in goal setting.

Factors for changes in self-care and mobility capabilities in young children with cerebral palsy involved in regular outpatient rehabilitation care

Background

Assessing prognosis of self-care and mobility capabilities in children with cerebral palsy (CP) is important for goal setting, treatment guidance and meaningful professional-caregiver conversations.

Aims

Identifying factors associated with changes in self-care and mobility capabilities in regular outpatient multidisciplinary paediatric CP rehabilitation care.

Methods and procedures

Routinely monitored longitudinal data, assessed with the Paediatric Evaluation of Disability Inventory (PEDI-Functional-Skills-Scale, FSS 0–100) was retrospectively analysed. We determined contributions of age, gross-motor function, bimanual-arm function, intellectual function, education type, epilepsy, visual function, and psychiatric comorbidity to self-care and mobility capability changes (linear-mixed-models).

Outcomes and results

For 90 children (53 boys), in all Gross-Motor-Function-Classification-System (GMFCS) levels, 272 PEDI's were completed. Mean PEDI–FSS–scores at first measurement (median age: 3,2 years) for self-care and mobility were 46.3 and 42.4, and mean final FSS-scores respectively were 55.1 and 53.1 (median age: 6,5 years). Self-care capability change was significantly associated with age (2.81, p < 0.001), GMFCS levels III-V (-9.12 to -46.66, p < 0.01), and intellectual impairment (-6.39, p < 0.01). Mobility capability change was significantly associated with age (3.25, p < 0.001) and GMFCS levels II-V (-6.58 to -47.12, p < 0.01).

Conclusions and implications

Most important prognostic factor for self-care and mobility capabilities is GMFCS level, plus intellectual impairment for self-care. Maximum capability levels are reached at different ages, which is important for individual goal setting and managing expectations.

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Capabilities of children with CP improve modestly over time in outpatient rehabilitation.

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Children with more severe CP reach maximum mobility and self-care levels at an earlier age.

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After this maintaining capabilities is more realistic than improvement.

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Important prognostic factors are GMFCS level and intellectual impairment.

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Routine monitoring can aid goal setting and expectation management in communication with families.

Contextual interference in children with brain lesions: a pilot study investigating blocked vs. random practice order of an upper limb robotic exergame

Introduction

Evidence about contextual interference in children with brain lesions when practising motor tasks is lacking. Our main objective was to evaluate the feasibility of a randomised controlled trial (RCT) comparing blocked with random practice order of an upper limb robotic exergame to improve reaching in children with neuromotor disorders with a pilot trial.

Methods

We recruited children with brain lesions and impaired upper limb functions who underwent a 3-week schedule that consisted of baseline assessments, intervention period (participants were randomised to a blocked or random order group), and follow-up assessment. We evaluated ten feasibility criteria, including the practicability of the inclusion/exclusion criteria, recruitment rate, feasibility of randomisation, scheduling procedure, and the participants’ programme adherence.

Results

The inclusion/exclusion criteria were not completely feasible as patients who were not able to perform the exergames were included. Twelve participants were recruited, and six datasets were used for analysis. The scheduling and randomisation procedures were generally feasible, but the procedure was only partially feasible for the participants, as some sessions were aborted due to lack of motivation and fatigue.

Conclusion

An RCT following this study protocol is not feasible. We formulated suggestions for future studies that aim to investigate contextual interference as in this pilot study.

Trial registration

ClinicalTrials.gov Identifier: NCT02443857, registered on May 14, 2015

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00866-4.

Child, parent, and clinician experiences with a child-driven goal setting approach in paediatric rehabilitation

PURPOSE

To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting.

METHODS

Nine children receiving inpatient and outpatient rehabilitation aged 5.0-12.3 years (x¯ = 8.3, SD = 2.3; 5 females) and their parents (n = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children (n = 7), their parents (n = 9), occupational therapists (n = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting.

RESULTS

Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process.

CONCLUSIONS

Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting.IMPLICATIONS FOR REHABILITATIONChildren are often not optimally involved in setting their own rehabilitation goals.In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy.Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input.Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.

Occupational therapists' and physiotherapists' perceptions of implementing Occupational Performance Coaching

PURPOSE

Occupational Performance Coaching (OPC) has been proposed as an intervention for working with caregivers towards achievement of goals for themselves and their children. Preliminary studies indicate the effectiveness of OPC; however, translation into practice requires an understanding of therapists' perceptions of applying OPC in their service delivery settings. This study explored physio- and occupational-therapists' experiences of using OPC and their perceptions of the contextual factors which influence its implementation.

METHOD

Interviews and a focus group were used to gather physio- (n = 4) and occupational- (n = 12) therapists' perspectives of applying OPC in their work with caregivers of children with disabilities. Data were analysed thematically.

RESULTS

One overarching theme and three major themes emerged. The overarching theme, "Listening better" pervaded all other themes. Three major themes, each with subthemes, were: (1) Sharing power, (2) Reprioritising processes, and (3) Liberating but challenging. Implementing OPC drew on skills that were familiar to therapists and aligned with existing values when working with families but challenged some aspects of their practice.

CONCLUSIONS

From physio- and occupational-therapists' perspectives, OPC is applicable in a range of paediatric service environments. However, therapist and service-level flexibility appeared to be key contextual factors in adhering to intervention principles. Implications for Rehabilitation Occupational Performance Coaching (OPC) is a strengths-focused intervention in which caregiver engagement and active involvement is prioritised. Therapists reported distinct changes to the process of therapy and outcomes achieved following OPC training and implementation. Most therapists indicated that OPC enabled them to operationalisation person-centred principles to a greater extent which they perceived enhanced the way therapy was delivered and the benefit to services users. Some flexibility in service structures may be needed to implement OPC in the way it was intended.