Danielle Levac

Partnering for Change: An Innovative School-Based Occupational Therapy Service Delivery Model for Children with Developmental Coordination Disorder

Background. Developmental coordination disorder (DCD) is a common, chronic health condition that is poorly recognized and understood in school settings. Without appropriate support, children with DCD are at increased risk of depression, decreased fitness, and obesity. Evidence shows that occupational therapy intervention needs to shift from remediation of impairment to chronic disease management. Purpose. This paper describes Partnering for Change (P4C), an innovative, empirically derived school health service delivery model for children with DCD. Key Issues. The model emphasizes the partnership of the occupational therapist with educators and parents to change the life and daily environment of a child. The P4C partnership focuses on capacity building through collaboration and coaching in context. The model uses a tiered approach which includes whole class instruction, dynamic performance analysis, and monitoring response to intervention. Implications. P4C is a model that responds to the needs of this population, addresses issues identified in research, and provides a continuum of services designed to build capacity.

Exploring children's movement characteristics during virtual reality video game play.

There is increasing interest in the use of commercially-available virtual reality video gaming systems within pediatric rehabilitation, yet little is known about the movement characteristics of game play. This study describes quantity and quality of movement during Nintendo Wii and Wii Fit game play, explores differences in these movement characteristics between games and between novice and experienced players, and investigates whether motivation to succeed at the game impacts movement characteristics. Thirty-eight children (aged 7-12) with and without previous game experience played Wii (boxing and tennis) and Wii Fit (ski slalom and soccer heading) games. Force plate data provided center of pressure displacement (quantity) and processed pelvis motion indicated smoothness of pelvic movement (quality). Children rated their motivation to succeed at each game. Movement quantity and quality differed between games (p<.001). Children with previous experience playing Wii Fit games demonstrated greater movement quantity during Wii Fit game play (p<.001); quality of movement did not differ between groups. Motivation to succeed did not influence the relationship between experience and outcomes. Findings enhance clinical understanding of this technology and inform the development of research questions to explore its potential to improve movement skills in children with motor impairments.

Preferred methods and messengers for delivering physical activity information to people with spinal cord injury: a focus group study.

OBJECTIVE To explore the perceptions of people with spinal cord injury (SCI) regarding preferred messengers and methods for obtaining physical activity (PA) information. DESIGN Using a phenomenological approach and interviewing techniques, five focus groups discussed PA information delivery methods and messengers. PARTICIPANTS Sixteen community-dwelling adults with SCI (62.5% tetraplegia, 37.5% paraplegia; at least one-year postinjury) whose PA levels ranged from sedentary to regularly active. RESULTS Content analyses revealed that the preferred media for obtaining PA information were passive sources (e.g., Internet, DVDs, newsletters). The preferred messengers were peers and health service providers. There were diverse perspectives about the value and types of PA messages to share with people in the acute, rehabilitation, and postdischarge stages. CONCLUSIONS The methods and messengers identified in this study illustrate the need for interdisciplinary engagement among various program and health care providers to work together to effectively deliver PA information to all individuals with SCI. People will be receptive to different messages, from different channels, at different times.

Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Describing and classifying virtual reality systems

Aim: The use of virtual reality (VR) as a therapeutic intervention to improve motor function is an emerging area of rehabilitation practice and research. This paper describes VR systems reported in research literature and proposes a classification framework that categorizes VR systems according to characteristics relevant to motor rehabilitation. Methods: A comprehensive database search was undertaken to explore VR systems used in motor rehabilitation for children. Description of these systems, motor learning literature and expert opinion informed development of a classification framework. Results: Six VR systems are included. The descriptive analysis describes each system according to 12 user, system and context variables. The classification framework identifies three features common to all VR systems. Seven categories are proposed to differentiate between systems. Conclusion: This paper organizes available information to facilitate clinical decision-making about VR systems and identifies areas of research to support the use of VR as a therapeutic intervention.

Integrating virtual reality video games into practice: Clinicians' experiences

The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a childrens rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

The application of motor learning strategies within functionally based interventions for children with neuromotor conditions.

Purpose: To identify and describe the application of 3 motor learning strategies (verbal instructions, practice, and verbal feedback) within 4 intervention approaches (cognitive orientation to daily occupational performance, neuromotor task training, family-centered functional therapy, and activity-focused motor interventions). Methods: A scoping review of the literature was conducted. Two themes characterizing the application of motor learning strategies within the approaches are identified and described. Results: Application of a motor learning strategy can be a defining component of the intervention or a means of enhancing generalization and transfer of learning beyond the intervention. Often, insufficient information limits full understanding of strategy application within the approach. Conclusions: A greater understanding of the application, and perceived nonapplication, of motor learning strategies within intervention approaches has important clinical and research implications.

Usual and virtual reality video game-based physiotherapy for children and youth with acquired brain injuries.

ABSTRACT Little is known about how therapists promote learning of functional motor skills for children with acquired brain injuries. This study explores physiotherapists’ description of these interventions in comparison to virtual reality (VR) video game-based therapy. Six physiotherapists employed at a childrens rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using thematic analysis. Physiotherapists describe using interventions that motivate children to challenge performance quality and optimize real-life functioning. Intervention strategies are influenced by characteristics of the child, parent availability to practice skills outside therapy, and therapist experience. VR use motivates children to participate, but can influence therapist use of verbal strategies and complicate interventions. Physiotherapists consider unique characteristics of this population when providing interventions that promote learning of motor skills. The VR technology has advantageous features but its use with this population can be challenging; further research is recommended.

“Kinect-ing” With Clinicians: A Knowledge Translation Resource to Support Decision Making About Video Game Use in Rehabilitation

Microsofts Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection and implementation that address individual therapeutic goals. This article describes the development and preliminary evaluation of a knowledge translation (KT) resource to support clinical decision making about selection and use of Kinect games in physical therapy. The knowledge-to-action framework guided the development of the Kinecting With Clinicians (KWiC) resource. Five physical therapists with VR and video game expertise analyzed the Kinect Adventure games. A consensus-building method was used to arrive at categories to organize clinically relevant attributes guiding game selection and game play. The process and results of an exploratory usability evaluation of the KWiC resource by clinicians through interviews and focus groups at 4 clinical sites is described. Subsequent steps in the evaluation and KT process are proposed, including making the KWiC resource Web-based and evaluating the utility of the online resource in clinical practice.

Best Practice Recommendations for the Development, Implementation, and Evaluation of Online Knowledge Translation Resources in Rehabilitation

The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, user-centered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion.

Documenting the content of physical therapy for children with acquired brain injury: development and validation of the motor learning strategy rating instrument.

Background A goal of physical therapy interventions for children and youth with acquired brain injury (ABI) is the learning and relearning of motor skills. Therapists can apply theoretically derived and evidence-based motor learning strategies (MLSs) to structure the presentation of a task and organize the environment in ways that may promote effective, transfer-oriented practice. However, little is known about how MLSs are used in physical therapy interventions for children with ABI. Objective The purpose of this study was to develop and validate an observer-rated Motor Learning Strategy Rating Instrument (MLSRI) quantifying the application of MLSs in physical therapy interventions for children with ABI. Design A multi-stage, iterative, item generation and reduction approach was used. Methods An initial list of MLS items was generated through literature review. Seven experts participated in face validation to confirm item comprehensiveness. In a content validation process, 12 physical therapists with pediatric ABI experience responded to a questionnaire evaluating feasibility and importance of items. Six physical therapy sessions with clients with ABI were videotaped at a childrens rehabilitation center. The 12 physical therapists participated in a session where they: (1) rated session videos to test the MLSRI and (2) provided verbal feedback. Results Revisions were made sequentially to the MLSRI based on these processes. Limitations The MLSRI was scored during videotape observation rather than being given a live rating, which may be onerous in certain settings and may influence therapist or child behavior. Conclusions Further reliability investigations will determine whether the 33-item MLSRI is of help in documenting strategy use during intervention, as an evaluation tool in research, and as a knowledge transfer resource in clinical practice.