Elspeth Froude

Children’s participation in home, school and community life after acquired brain injury

AIMS This study aimed to describe participation at home, school and in the community of Australian children who had sustained an acquired brain injury (ABI). Parent ratings regarding the impact of cognitive, motor and behavioural impairments on participation were obtained. In addition, the influence of environmental factors on participation was investigated. METHODOLOGY This study used a cross-sectional design with convenience sampling to recruit 20 children who attended a rehabilitation review clinic between September 2006 and September 2007. Participants completed the Child and Family Follow-up Survey (Bedell, 2004) to describe the participation of their children in home, school and community settings. The CFFS was developed based on the International Classification of Function, and uses parent report to measure the impact of impairments and environmental factors on childrens participation in home, school and community life. RESULTS The children were reported to have the greatest participation restrictions for structured events in the community, and social, play or leisure activities with peers either at school or in the community. Children were least restricted moving about in and around their own homes. CONCLUSIONS This research describes difficulties encountered by Australian children with ABI in participating in community-based activities with their same aged peers. This study adds to the current literature describing patterns of participation of United States children who have sustained brain injuries, and provides useful information for Australian therapists to consider when addressing childrens return to school and engagement with their peers following brain injury.

Impact of Second Skin Lycra Splinting on the Quality of Upper Limb Movement in Children

Spasticity can have serious functional implications for children with neurological deficits. Lycra splints may be recommended by occupational therapists to manage spasticity and improve function. In this study, four children with neurological deficits were assessed for quality of upper limb movement while wearing and not wearing an upper limb lycra splint. Two participants diagnosed with cerebral palsy were long-term splint users. The other two participants had an acquired brain injury and commenced wearing their splints during the intervention phase of the study. Using a single subject research design, 7–12 baseline (non-wearing phase) and intervention (wearing phase) assessments were conducted for each child using the Melbourne Assessment of Unilateral Upper Limb Function. The results show that one long-term user had a statistically significant decline in quality of upper limb movement during the intervention phase. One new user had a statistically significant improvement, but only on initial wearing of the splint. The results suggest that the effectiveness of Second Skin lycra splints was highly variable between individual children with spasticity.

Respecting the evidence: Responsible assessment and effective intervention for children with handwriting difficulties

School students use handwriting, among other media, to demonstrate the depth and breadth of their learning, creativity and knowledge. Composition, or quality of content of written work, is therefore an important outcome of the process of producing written work. Competency in idea generation and organisation, spelling, grammar, sentence construction, punctuation, vocabulary, self-monitoring and motivation contribute to the content of written work (Jones & Christensen, 1999). Research indicates that examiners assign lower marks to written work which is poorly handwritten, but contains content of equal quality to work which is attractively and legibly handwritten (Sweedler-Brown, 1992). Handwriting, therefore, needs to be sufficiently legible for examiners to read and understand the content without effort, and to ascribe marks which accurately reflect and reward a student’s composition. Students should also be able to write sufficient quantity of content within required timeframes to adequately express the extent of their ideas and knowledge. Students who are able to generate handwriting fluently and automatically have greater capacity to access their cognitive, language and attentional resources (Berninger et al., 1997; Graham, Harris & Fink, 2000; Jones & Christensen, 1999; Medwell, Strand & Wray, 2009). Students with handwriting difficulties or developing handwriters have reduced capacity for idea generation, planning and revision when required to focus on the mechanics of handwriting in addition to the demands of composing written work (Medwell et al.). Even for children without handwriting difficulties, more complex tasks such as self-generated formal written work with demanding academic content are associated with decreased legibility when compared with less demanding handwriting tasks such as copying from the board (Graham, Struck, Santoro & Berninger, 2006). This phenomenon is proposed to result from increased demand placed on cognitive and attentional capacity by learning, language and cognitive components of the written task, leaving less available time for generating handwriting (Swanson & Berninger, 1996). Such issues may be amplified for children with coordination, learning or physical disabilities, or disorders of attention and behaviour. Automatic handwriting which is legible, generated at sufficient speed and without need for conscious attention is predicated on effective orthographic-motor integration and not simply on motor processes (Berninger et al., 1997; Jones & Christensen, 1999; Medwell et al., 2009). Orthographic-motor integration involves automatic retrieval of orthographic codes which have been encoded in memory, and automatic and effective transcription of these codes onto paper (Jones & Christensen; Weintraub & Graham, 2000). Orthographic codes are accurate representations in memory of the visual characteristics and verbal labels given to letters and words, as well as processes for forming these letters and words. Transcription of orthographic codes onto paper is presumably dependent on motivation to write and adequate capacity to use writing implements without pain, amongst other factors. Orthographic-motor Margaret Wallen PhD, MA, BAppSc (OT); Senior Occupational Therapist – Research and Adjunct Lecturer. Sharon Duff BAppSc (OT); Senior Occupational Therapist. TraciAnne Goyen PhD, BAppSc (OT); Clinical Specialist – Occupational Therapist. Elspeth Froude PhD, GradDip (NeuroSc), BAppSc (OT); Senior Lecturer.

Prospective study of the participation patterns of Grade 6 and Year 8 students in Victoria, Australia in activities outside of school

BACKGROUND Positive participation outcomes are deemed the ultimate goal of health care and specifically of occupational therapy. Knowledge of the typical participation patterns of children in Australia will provide essential information to support our understanding of participation and the goal of maximising childrens engagement. AIMS This study investigated the participation of Grade 6 and Year 8 Victorian students in activities outside school and explored differences between genders and between students in different year levels. Secondarily, we began to establish Australian normative data on the Childrens Assessment of Participation and Enjoyment and Preferences for Activities of Children. METHODS This cross sectional survey methods study recruited students from a random selection of public schools. Participation was measured using the Childrens Assessment of Participation and Enjoyment and Preferences for Activities of Children questionnaires. RESULTS Participants included 84 (37 female, 47 male) students in Grade 6 (n = 43) and Year 8 (n = 41). Differences between year levels were only evident for participation in Recreational and Active Physical activities. Grade 6 students did more activities, more intensely than Year 8 students, but with no difference in enjoyment. The mean number of Recreational activities done by Grade 6 students was 8.5 (95%CI: 7.9-9.1) compared to Year 8 students 6.9 (95%CI: 6.1-7.7; P = 0.001). Gender differences were evident in the participation patterns within Social, Skill-Based and Self-Improvement activities. CONCLUSION The findings suggested that gender was a more important influence on participation patterns than a 2-year age gap, with participation patterns being relatively stable between Grade 6 and Year 8.

The relationship between physical performance and self‐perception in children with and without cerebral palsy

AIM This study examined the relationship between physical performance and perceived self-competence and global self-worth in children with and without spastic diplegia. METHOD A matched-pairs design, including eight children with spastic diplegia and eight typically developing children, was used to compare the childrens performance and to examine relationships. Children aged 7 to 11 years were assessed to determine their gross and fine motor abilities and they completed a modified version of the Harter Self-Perception Profile for Children. RESULTS Children with diplegia performed at lower levels in all gross and fine motor assessments compared with children without diplegia. Self-perception was lower in children with diplegia in fine motor competence (P = 0.03) and global self-worth (P = 0.05). Clinically important differences (> 10%) in gross motor and athletic competence were also found. Positive correlations between physical performance assessments and some self-perception domains were present, although strength and direction of relationships differed for each group in some instances. CONCLUSION This small study found that in addition to having reduced physical skills, children with spastic diplegia may experience a less positive global self-worth than typically developing children. These findings are in contrast to some previous research. Future research should examine the hypothesised relationship more definitively to determine whether improvement in physical skills results in a higher level of self-competence and consequently a higher global self-worth. This might further justify interventions aimed at improving fine and gross motor skills of children with cerebral palsy. Clinicians should be mindful of addressing both physical issues and self-worth with clients.

Parents experience of undertaking an intensive Cognitive Orientation to daily Occupational Performance (CO-OP) group for children with cerebral palsy

Abstract Purpose: The purpose of this study was to explore the experience of parents of children with cerebral palsy (CP) who participated in an intensive cognitive orientation to daily occupational performance (CO-OP) group program addressing child chosen goals. Method: Participants were six parents of children with CP who participated in a CO-OP upper limb task-specific training program. Parents participated in semi-structured interviews conducted via phone. A grounded theory approach was used. Interviews were transcribed verbatim and coded to identify categories and overarching themes of the parent experience of CO-OP. Results: The theory of CO-OP for children with CP was one of offering a unique and motivating learning experience for both the child and the parent, differing from other therapeutic approaches that families had previously been involved in. Five categories were identified: the unique benefits of CO-OP; the importance of intensity; the child’s motivation; challenging the parent role; and the benefits and challenges of therapy within a group context. Conclusion: Parents felt that CO-OP was a worthwhile intervention that leads to achievement of goals involving upper limb function and had the capacity to be transferred to future goals. Intensity of therapy and a child’s motivation were identified as important factors in improvements. Further studies using quantitative research methods are warranted to investigate the benefits of CO-OP for children with neurological conditions. Implications for rehabilitation The cognitive orientation to daily occupational performance (CO-OP) is a promising upper limb cognitive motor training intervention for children with cerebral palsy. In a small sample, parents perceived that CO-OP leads to achievement of upper limb goals. Intensity of therapy, the child’s motivation and the parents’ ability to “step-back” were identified as important to the success of CO-OP.

Measurement of visual ability in children with cerebral palsy: a systematic review

To identify and evaluate measures of visual ability used with children with cerebral palsy (CP).

An Investigation of Bilateral Isokinematic Training and Neurodevelopmental Therapy in Improving Use of the Affected Hand in Children with Hemiplegia.

Motor impairment in children with hemiplegic cerebral palsy leads to a predominance of use of the unaffected hand. This impedes development of bimanual skills and deprives the affected side of the stimulus needed for normal growth. Occupational therapists aim to improve use of the affected hand, traditionally using Neurodevelopmental Therapy. Empirical evidence is needed to support this treatment choice. Studies examining interlimb coupling in children with hemiplegia and other studies in adult stroke support a bilateral treatment approach. These single-case time-series experiments examined the effects of Neurode-Loretta Sheppard, MOT, BAppSc(OT), is Occupational Therapist at Ballarat Specialist School. velopmental Therapy and Bilateral Isokinematic Training on hand use in three children with hemiplegic cerebral palsy. Two of the three subjects displayed positive changes in use and movement of the affected hand in some tasks with Bilateral Isokinematic Training. Bilateral Isokinematic Training might be a potentially useful means of increasing frequency of use of the affected hand in some children with hemiplegic cerebral palsy.

Building a strong academic workforce: Challenges for the profession

Over the last 20 years Australia has seen a huge growth in new occupational therapy programs. Each new program is an historic event that changes occupational therapy’s national profile. Each new course raises expectations. Governments fund universities expecting a civic and economic return on public investment through teaching, community engagement and research. Universities expect occupational therapy academic staff to fulfil this institutional obligation and bring a return on staffing and infrastructure costs. Students expect their employability, life and career opportunities will be enhanced. The profession expects the program will be high quality and will add to occupational therapy’s esteem. Clients and the community expect ethical, safe and competent graduates will help them.

Translating evidence into practice: The role of scholarly journals

It is now considered commonplace to examine the evidence available that supports practice and most clinicians would consider themselves to be “evidence based”. A study of paediatric occupational therapists attitudes revealed positive attitudes to evidence based practice (Lyons, Brown, Tseng, Casey & McDonald, 2011). There continues however to be a significant lag of some 10–20 years in the utilisation of research knowledge into clinical practice referred to as the “research practice gap” (Hammel, Finlayson, Kielhofner, Helfrich & Peterson, 2002). Scholarly peer reviewed journals are one of the main avenues for sourcing the latest research that can inform practice. Research articles that have been peer reviewed require reviewers to agree that the research, writing and scholarship have been conducted properly. The quality of occupational therapy research has increased substantially over the last 10 years and as we build an evidence base occupational therapy journals need to be much more discerning regarding the type of research that is accepted. Publications such as this need to be trail blazers for the profession leading the way. If journals are to be used as a primary source of evidence these standards need to be continuously re-evaluated as our body of research expands. This is an exciting time for occupational therapy practice as increasingly, we have evidence available that supports effective outcomes for our clients. Increased utilisation of the evidence and confidence that what we are doing is truly making a difference can only come about through well designed high level studies, particularly randomised controlled trials. Whilst dissemination of this research may be broad core occupational therapy evidence can best serve the profession by being published in occupational therapy journals.