Cynthia Tam

Paediatric Application of Individualised Client-Centred Outcome Measures: A Literature Review

A literature review was conducted to identify and compare the clinical utility of client-centred, individualised outcome measures for paediatric rehabilitation. Five measures were identified: the Canadian Occupational Performance Measure (COPM) (28 studies); Goal Attainment Scaling (GAS) (34 studies); Perceived Efficacy and Goal Setting System (PEGS) (2 studies); Target Complaints (TC) (1 study); and the Paediatric Activity Card Sort (PACS) (instruction manual only). The COPM and GAS have been used with children across a wide age range and variety of clinical settings. The PEGS and PACS provided young children direct involvement in the goal-setting process. Little evidence supports the use of TC in paediatrics. Clinicians need to use individualised measures in a way that facilitates the maximal participation of children and families in goal setting and outcome evaluation. Clinicians should document their own role in goal setting. The use of individualised and client-centred measures can motivate children and families and focus their attention on therapy goals.

Effects of Word Prediction and Location of Word Prediction List on Text Entry with Children with Spina Bifida and Hydrocephalus

In this study, a single-subject alternating-treatments design was used to evaluate the effect of word prediction on the rate and accuracy of text entry and to compare the effect of location of a word prediction list on the rate and accuracy of text entry. Three locations were evaluated: upper right corner, following the cursor, and lower middle border. KeyREP© was the word prediction software used in this study. Three girls and one boy aged 10 to 12 years with spina bifida and hydrocephalus participated in the study over a period of 20 days. The rates and accuracy of text entry were measured on a copy-writing task. It was found that word prediction did not improve the rates of text entry but did improve the accuracy of text entry when the prediction list was placed in the lower middle border. Statistically, there was no difference in rate or accuracy when the prediction list was placed in different locations; however, three participants recorded the lowest rate, and all participants achieved lowest accuracy when the prediction list followed the cursor. The findings are discussed in terms of user characteristics, the dictionary used in the software, and the nature of the writing task (copying text) because these are common factors that can affect the effectiveness of word prediction.

Grip force variability and its effects on children's handwriting legibility, form, and strokes.

A comprehensive understanding of the underlying biomechanical processes during handwriting is needed to accurately guide clinical interventions. To date, quantitative measurement of such biomechanical processes has largely excluded measurements of the forces exerted radially on the barrel of the writing utensil (grip forces) and how they vary over time during a handwriting task. An instrumented writing utensil was deployed for a direct measurement of kinematic and temporal information during a writing task, as well as forces exerted on the writing surface and on the barrel of the pen. The writing utensil was used by a cohort of 35 students (19 males), 16 in first grade and 19 in second grade, as they performed the Minnesota Handwriting Assessment (MHA) test. Quantitative grip force variability measures were computed and tested as correlates of handwriting legibility, form, and strokes. Grip force variability was shown to correlate strongly with handwriting quality, in particular for students classified by the MHA as nonproficient writers. More specifically, static grip force patterns were shown to result in poor handwriting quality and in greater variation in handwriting stroke durations. Grip force variability throughout the writing task was shown to be significantly lower for nonproficient writers (t-test, p<0.01) while the number of strokes and per-stroke durations were shown to be higher (p<0.03). The results suggest that grip force dynamics play a key role in determining handwriting quality and stroke characteristics. In particular, students with writing difficulties exhibited more static grip force patterns, lower legibility and form scores, as well as increased variation in stroke durations. These findings shed light on the underlying processes of handwriting and grip force modulation and may help to improve intervention planning.

Perceptions of Writing and Communication Aid Use Among Children with a Physical Disability

ABSTRACT Children with physical disabilities (CPD) often experience decreased opportunities to participate in daily occupations. Occupational therapists (OTs) prescribe writing and communication aids; however, little is known about this populations perceptions of the technology. This qualitative study explored the perceptions that CPD had regarding their writing and communication aids. Children were interviewed; a focus group of one parent and two OTs provided context to the childrens comments. Enablers and barriers to using communication aids were found. Participants reported a greater sense of pride, more self-confidence, and a greater sense of autonomy and productivity with the technology. Analysis of the interviews, focus group, and reflective notes resulted in a model showing how enablers and barriers of on-screen technology usage relates to occupational enhancement or occupational detriment. This study contributes to an understanding of the meaning that CPD associate with writing technology and the factors associated with usage.

Research Issues of Speech Recognition Accuracy Measurements: Response to Bruce Wisenburn

Wisenburn’s feedback highlights an important aspect of measuring speech recognition accuracy. The use of the additional metric, precision, provides valuable information for both clinical and research purposes, especially for those with speech difficulties. In our study, participants had excellent speech and were experienced in using speech recognition. Although precision is important, erroneous addition of a word, such as ‘‘a’’ in Wisenburn’s example, was not observed for our participants.