Carolyn Dunford

How do Computer Assistive Technologies Enhance Participation in Childhood Occupations for Children with Multiple and Complex Disabilities? A Review of the Current Literature

Functional impairments can limit the participation of children with disabilities in childhood occupations, which can be detrimental to their overall development and social and emotional wellbeing. The primary goal of occupational therapy for children with disabilities is to facilitate and enable active participation in meaningful occupations. Computer-based assistive technologies can be used as an enabler, allowing children with severe disabilities access to a variety of activities. The aim of this study was to establish how computer assistive technologies can have an impact on the participation of children with complex and multiple disabilities in childhood occupations and in the development of their occupational roles. A comprehensive and systematic search and review of contemporary literature pertaining to computer use by children with severe and complex disabilities and its impact on a childs participation was undertaken. Articles included were critically appraised and analysed using a conceptual model of occupational therapy, with findings relating to the occupational performance areas of productivity, self-maintenance and leisure (a summary table is included). The findings supported the use of computer technologies for participation to a varying degree in all occupational performance areas, but were particularly positive in the areas of education, communication and play activities for children with disabilities.

Children's Perceptions of the Impact of Developmental Coordination Disorder on Activities of Daily Living

Children with developmental coordination disorder (DCD) have a motor impairment that affects their ability to perform everyday tasks. Although severity of motor impairment can be measured, methods for assessing the perceived impact of DCD on daily activities have not been established. The purpose of this study was to use a child-focused approach to understand childrens views of the impact of DCD on the activities that they perform daily. Children aged 5–10 years, referred with coordination difficulties to occupational therapists, were assessed using the Movement Assessment Battery for Children: children who received scores below the 15th percentile were included. The Perceived Efficacy and Goal Setting System (PEGS), a pictorial scale validated as a method for engaging children with disabilities, was administered to examine the childrens perceptions of their competence in performing everyday activities and to identify goals for therapy. Parent and teacher concerns were collected by a questionnaire. The children, parents and teachers shared many concerns about the impact of DCD on physical tasks and on academic activities such as handwriting. The children expressed additional concerns, however, about their ability to perform daily self-care tasks and leisure activities, which were rarely recognised by the adults. Children require specialised methods to enable them to express their views and the PEGS appears to be suitable for this purpose.

Measuring Activity and Participation Outcomes for Children and Youth with Acquired Brain Injury: An Occupational Therapy Perspective

Introduction: Intervention outcomes for children and youth with acquired brain injuries should be measured in terms of participation in activities. The aim of this study was to explore the occupational therapy outcome measures used with this group. Method: One cycle of an action research study, which focused specifically on occupational therapists, is reported. Ten occupational therapists working with children and youth with acquired brain injuries collated the outcome measures they used and mapped their frequently used measures onto the International Classification of Functioning, Disability and Health — Children and Youth, using established linking rules. Findings: Forty-two outcome measures and assessments were identified. Of these, 19 were used frequently and 15 were used as outcome measures. All activity and participation domains were represented, with learning and applying knowledge, mobility, communication and self-care (except looking after ones health) particularly well covered. Conclusion: Occupational therapists are using measures that reflect the domains of activity and participation, unlike those previously identified which were linked predominantly to body functions. The importance of occupational therapists working in rehabilitation teams is reiterated in that some of the domains that are not covered by occupational therapists impact on participation, for example, pain.

Measuring Participation in Occupation for Children with Acquired Brain Injuries

wary of using paediatric measures that are not validated specifically for a brain injury population. The issue of validation is an important one and holds true for both the adult-derived and the neurodevelopmentally derived measures. In both cases, the sample of children with acquired brain injury has been particularly low. Furthermore, the samples have not been stratified to take into account the important variable of age at injury. It is the period of typical development that differentiates this group and which must be taken into account in any well-structured validation study. So where does this leave us? Given that children are not mini-adults, it is not sufficient to extrapolate from the adult literature without considering specific issues about the developing and maturing brain (Appleton and Baldwin 2009). In addition, given the increasing profile of child and family-centred approaches that are often occupation focused, it is time to synthesise the evidence from both of these approaches and carry out clinical research to build a data-driven body of evidence for this particular client group. Whether we come from an adult or a paediatric tradition, we need to evaluate our interventions and start the long process of building the evidence base to guide practice (Forsyth 2008). In this way, we can start to identify the contents of a basket of measures for children with acquired brain injury that would guide clinical practice and research. We need to ensure that our basket includes measures that evaluate whether our interventions lead to children carrying out the activities that enable participation in everyday life; this is, after all, the definition of the purpose of occupational therapy (Creek 2009).

A Critical Appraisal of How Occupational Therapists Can Enable Participation in Adaptive Physical Activity for Children and Young People

Introduction: Adaptive physical activity (APA) for people with physical disabilities was researched. Barriers to participation were identified, along with potential solutions. The role of occupational therapists in enabling participation in APA was explored. Method: A literature review, using a systematic approach, highlighted a number of barriers to participation. Each article was critically analysed using the Critical Appraisal Skills Programme tool. The information was summarised and analysed, using an iterative approach to identify themes. Findings: Eleven key articles were retrieved from the search and two key themes emerged. The first theme encompassed barriers to participation, lack of role models, family attitudes and transportation. The second theme identified potential solutions through integrating APA into health care interventions. Conclusion: Participation in APA improves physical, social and psychological skills, which in turn impacts on other occupations. There is a role for occupational therapists to enable participation in APA by using their core skills of assessment, collaboration, engagement, adaptation, education and advocating for children and young people. APA is an occupation for many children and adolescents, but there are barriers to participation for individuals with disabilities who are seeking to start APA. Occupational therapists have the skills and knowledge to enable an individual to participate in APA.

Paediatric Rehabilitation Ingredients Measure: a new tool for identifying paediatric neurorehabilitation content

To develop an instrument (Paediatric Rehabilitation Ingredients Measure [PRISM]) for quantitative estimation of contents of interdisciplinary neurorehabilitation for use in studies of relationships between rehabilitation treatment delivered and severity‐adjusted outcomes after acquired brain injury (ABI).

Children and young people’s occupations, health and well being: a research manifesto for developing the evidence base

Abstract Evidence based practice is key to occupational therapists making a difference in professional practice for the people they work with. The challenge is that delivery of evidence based services requires evidence. This paper focuses on the need to develop more evidence to support the practice of occupational therapists working with children and young people. This research needs to reflect the re-focus on occupation in both what occupational therapists do, and what they measure, rather than traditional approaches which are solely directed at impairments and component skills. A research manifesto is presented for developing the evidence base to understand the relationship between children and young people’s occupations and their health. The key issues it addresses are the need to map, plan and coordinate research systematically in order to develop high quality research that will influence practice. This manifesto provides a platform for action for occupational therapists researching children and young people’s occupations to work together strategically.

Occupational Therapy with Children and Young People: A Perspective from the United Kingdom

Occupational therapy practice in the United Kingdom is well established and continues to evolve. Traditional methods of service delivery and intervention techniques have developed into more unified services, integrating child and family-centered approaches, which are often occupation-focused. This article details a historical perspective of the development of occupational therapy services shaped around the development of educational, health, and social care models that are in place today within the United Kingdom. An overview of occupational therapy as a profession defines practice before focusing on the development of childrens occupational therapy services. The development of policy and legislation within the United Kingdom provides a framework for occupational therapy provision, alongside occupational therapy models of practice. Information is provided regarding predominant service delivery models that are currently in use to support children and families. A range of diagnostic groups are seen by occupational therapists in the United Kingdom. Information is presented that details assessment and interventions that are often utilized by occupational therapists working in these areas. The article provides an insight into these issues and current occupational therapy practice with children and young people within the United Kingdom to date.

A reflective case review: Relearning handwriting after a traumatic brain injury

Statement of context A retrospective single case study reflecting on a child relearning handwriting following a traumatic brain injury as part of an inpatient neuro-rehabilitation programme. Applying evidence-based handwriting guidelines and comparisons with community experiences are explored. Critical reflection on practice Relearning to write following a traumatic brain injury showed dramatic improvements in 36 sessions over 12 weeks, supporting the evidence. Progress in this timeframe contrasts with clinical experiences of working with children’s community services. Implications for practice Whilst the literature on handwriting interventions does not include children with traumatic brain injury, following the recommendations was an effective intervention for this individual.

A prototype paediatric rehabilitation ingredients measure (PRISM) for use in studies of severity-adjusted outcomes and rehabilitation treatment received

Background: Acquired brain injury (ABI) is often a lifelong disability that entails a marked change in a person’s life. It involves biopsychosocial levels and return to work (RTW) is one of the mai ...Accepted Abstracts from the International Brain Injury Association’s Eleventh World Congress on Brain InjuryObjective: To investigate whether: 1) traumatic brain injury (TBI) reduces striatal dopamine transporter (DAT) levels; 2) TBI causes structural changes to the substantia nigra and/or nigrostriatal tract; 3) DAT levels following TBI correlate with substantia nigra or nigrostriatal tract damage; 4) DAT levels relate to behavioural measures of apathy and/or speed of processing. Background: Persistent cognitive problems following TBI are common. The heterogeneous nature of TBI means that the basis of cognitive dysfunction is likely to be multi-factorial. Animal and human studies have shown dopaminergic disruption following TBI. However, the cause of this disruption is unclear and may relate to damage to the dopaminergic nuclei or their ascending projections. Design/Methods: 32 moderate/severe TBI patients with persistent cognitive problems and 15 healthy controls had an ioflupane ( 123 I) SPECT scan (DaTscan), MRI and full neuropsychological assessment. DAT levels in the striatum were measured. MRI was used to calculate substantia nigra volumes and nigrostriatal tract diffusion metrics. Results: Quantitative assessment showed reduced DAT levels in TBI patients. Patients had substantia nigra atrophy, as well as increased mean diffusivity in the nigrostriatal tract. There was a significant relationship between (1) DAT levels and substantia nigra volumes in patients and (2) mean diffusivity in the nigrostriatal tract and anterior striatal DAT levels. DAT levels showed a significant relationship with apathy measures but not speed of processing. Conclusions: A proportion of TBI patients with persistent cognitive problems have reduced striatal DAT levels implying a disruption to their dopaminergic system. DAT levels are correlated with structural changes in the substantia nigra and nigrostriatal tract. This supports a causal relationship between damage to these regions by TBI and functional dopaminergic dysfunction. Reduced DAT levels also relate to apathy. Dopaminergic therapies may therefore benefit those patients with evidence of disruption to their dopaminergic systems. Study Supported by: Guarantors of Brain NIHR Disclosure: Dr. Jenkins has nothing to disclose. Dr. De Simoni has nothing to disclose. Dr. Bourke has nothing to disclose. Dr. Cole has nothing to disclose. Dr. Sharp has nothing to disclose.Objectives: The majority of patients with traumatic brain injury (TBI) sustain a mild TBI, of which the prognosis isgenerally favourable. However, patients with moderate-to-severe TBI can experience long-lasting cognitive, emotional and behavioural deficits that interfere with functioning in daily life and the resumption of work. Current literature suggests that executive functioning and coping style are important factors affecting outcome. Moreover, it is suggested that intact executive functioning is a pre-requisite for the use of adaptive coping; as executive processes such as foresight, planning and initiation seem essential for the employment of active coping strategies. So far, the exact association between executive functioning and coping remains unclear, as literature has pro-vided us with mixed results. The aim of the present study is 2-fold. First, we aim to assess the association between executive functioning and coping among patients with TBI at different levels of severity. Second, we aim to investigate to what extent injury severity influences the association between executive ability and coping as a moderating factor.Methods: We included 109 TBI patients from two prospective follow-up studies, of which 53 patients were classified as mild TBI, 19 patients as moderate and 37 patients as severe. Additionally, 33 healthy controls were included. Executive functioning and coping style were assessed by neuropsycho-logical examination in the post-acute and chronic phase after TBI. Results: Greater self-reported executive dysfunction was related to greater use of passive coping styles in all separate levels of severity and in the mixed TBI group (β= 0.591,p<0.001). Additionally, a lower amount of self-reported executive dysfunction was related to higher levels of active coping in the mixed TBI group (β=–0.457,p< 0.001) and the mild and severe TBI groups. Additionally, better performance on an executive test for response inhibition was related to greater use of active coping in the total TBI group (β=–0.178,p=0.047). No evidence for a moderating effect of injury severity on the association between executive functioning and coping was found. Conclusions: Self-reported executive functioning was a significant predictor of coping style at all levels of injury severity inpatients with TBI. Individuals who reported greater executive problems were predisposed to rely on a maladaptive passive coping style. Furthermore, these results suggest that less self-reported executive dysfunction was related to a higher use of an active coping style.Libra Rehabilitation & Audiology Dept. of Neurorehabilitation PO Box 1355, 5602 BJ Eindhoven E info@libranet.nl I www.libranet.nl Correspondence to Ingrid Brands, MD, PhD i.brands@libranet.nl Introduction  Self-efficacy refers to the belief in one’s ability to achieve goals. In patients with acquired brain injury (ABI) higher levels of general self-efficacy and self-efficacy for managing brain injury-specific symptoms have shown to be associated with better quality of life (QoL).1  Being highly self-efficacious in managing one’s health issues is assumed to be a key factor in successful chronic disease selfmanagement.2  Neuropsychological rehabilitation programmes focus on teaching patients to compensate for and manage their cognitive deficits and the social and emotional consequences of ABI. Yet, do these programmes lead to higher levels of self-efficacy in managing brain injury-specific symptoms? Results  QoL and brain injury-specific self-efficacy increased significantly after neuropsychological rehabilitation. Table 2  Both general and brain injury-specific self-efficacy were positively associated with QoL after neuropsychological rehabilitation. Table 3  A lower initial level of cognitive functioning predicted worse QoL after neuropsychological rehabilitation (β = −.63, p = .05).  Cognitive functioning was not significantly associated with initial brain injury-specific self-efficacy (r = .13, p = .60). Objective We examined:  the influence of neuropsychological rehabilitation on general and brain injury-specific self-efficacy and on QoL,  whether initial levels of general and brain injury-specific selfefficacy and cognitive functioning would predict QoL after neuropsychological rehabilitation,  whether cognitive functioning was associated with initial selfefficacy for managing brain injury-related symptoms.Objectives: Disability research as an academic field was established in the 1960s and 1970s in the Nordic countries and in the Anglo-Saxon world. Disability research was studied within the medical model, e.g. in medical and rehabilitation studies, while disability studies became a part of the social model, e.g. in social and psychological studies. It has been a lack of theoretical perspective in disability research and according to that a discussion of theoretical approaches in disability studies that has been raised during recent years. The aim of the study is to describe and illustrate conceptually how vertical and horizontal knowledge integration appear in disability research, exemplified within a case from a person with acquired brain injury.Methods: The study adopted a qualitative approach to answer the research aim, undertaking a literature review to accompany an analysis of the concepts, vertical and horizontal. The concepts were thereafter analysed within theories from disability research and exemplified with a case from brain injury rehabilitation.Results: Tentatively the conceptions, vertical and horizontal, are described and, in addition, a bio-psycho-social perspective is mentioned andtwo theoretical approaches within disability research are described: human functioning sciences and interdisciplinary research. Vertical knowledge integration can be seen as a stratification between differentlevels on a biological, psychological and social level. Horizontal knowledge integration can be understood across varying disabilities. The study indicates that vertical and horizontal knowledge integration in disability research are useful for a broader and deeper understanding of disability and functional impairment where, over the last few years, different theoretical perspectives have become increasingly common. Furthermore, the study shows that acquired brain injury, in a scientific context, has been studied within different levels of society. For example:●On a biological level, e.g. within biochemical bloodanalysis;●On a psychological level, e.g. within neuropsychologicaldiagnostics; and●On a social level, e.g. as a changeover process duringrecovery.Conclusions: The study indicates that a variety of scientific contributions are needful in our understanding of the phenomenon of living withacquired brain injuryin the contemporary society.