Hugh Stewart

Isometric joystick: a study of control by adolescents and young adults with cerebral palsy.

This research was undertaken to determine the best wheelchair driving method for clients with cerebral palsy who were experiencing difficulties using displacement joysticks. The hypothesis was that adolescents with cerebral palsy would perform better in a tracking task using an isometric joystick (which has no moving parts) than a displacement joystick of the type used in commercial wheelchair controllers. A series of single subject case studies was performed in which the activating force of the isometric joystick was individualised for each subject. Comparative evaluation of the isometric joystick and a displacement joystick was then carried out. Results indicate that performance using the displacement joystick was superior to performance with the isometric joystick for the able-bodied subject and four of the five subjects with cerebral palsy. One of the subjects showed significantly better performance on the displacement joystick using his hand, and no significant difference between joysticks using his foot. The remaining subject, who used his foot, showed no significant difference between joysticks. These findings suggest that subjects with cerebral palsy with prior experience using a displacement joystick do not appear to benefit by the use of an isometric joystick compared to a displacement joystick. No difference in the use of the two joysticks was found for subjects with cerebral palsy who had no prior experience using a joystick. This suggests that an isometric joystick is an option for people beginning to learn to drive an electric wheelchair.

Collaboration between occupational therapists and teachers: Definitions, implementation and efficacy

AIM The aim of this article is to present a critical review of available health and education literature to ascertain how collaboration is defined, what the barriers to collaboration are, how effective collaboration between occupational therapists and teachers is, and to determine implications for research and future practice in Australia. METHODS A comprehensive electronic search process was undertaken, identifying studies from health and education databases. Manual searching of reference lists was then conducted for retrieved articles. Studies were reviewed to determine quality and relevance to the review question. RESULTS Nine research articles were reviewed, which included six qualitative and three quantitative articles. An additional seven discussion papers and three literature reviews were also included. It is apparent that the available literature is predominantly written about USA and UK contexts, and empirical evidence is limited. Definitions of collaboration differ, and although professionals agree that it is important to collaborate, the evidence of effectiveness is scant. CONCLUSIONS   Although there is much anecdotal desire for collaboration, empirical evidence is limited, but positive. Professionals express desire for collaboration, but the implementation appears inconsistent, and poorly researched. The literature outlines factors, which support collaboration in practice including interactional, organisational and systemic factors. Using this model, strategies for successful collaboration can be formulated. Results indicate a need for research into appropriate models of practice for an Australian context, and particularly for states, where the health and education systems are not well integrated.

Systematic review of the effectiveness of the Wilbarger protocol with children

Correspondence: Kobie Boshoff University of South Australia, School of Health Sciences, GPO Box 2471, Adelaide, SA 5001, Australia Tel +61 8 8302 1089 Fax +61 8 8302 2645 Email kobie.boshoff@unisa.edu.au Background: Sensory processing disorders have an estimated prevalence of 5%–10% in children without disability and 40%–88% in children with disability. A subtype of sensory processing disorder is sensory overresponsivity, which can result in fear, irritability, aggression, or avoidance behaviors in children. The Wilbarger protocol is the most prescriptive program used to treat sensory overresponsivity in children aged 2–12 years. Strong anecdotal evidence suggests that the Wilbarger protocol successfully reduces challenging behavior in children with sensory overresponsivity. The aim of this systematic review was to identify and appraise the existing evidence for the effectiveness of the Wilbarger protocol with children aged 0–18 years. Methods: A systematic review was conducted of the peer-reviewed literature written in English. The electronic databases searched up to April 2012 included CINAHL, Ovid Medline (R), Embase, Scopus, the Cochrane Library, AMED, and the Web of Science. OT Seeker and Google Scholar were searched for missed literature, along with hand-searching of retained articles. Adult studies were excluded. The Critical Review Form for Quantitative Studies by McMaster University and the levels of hierarchy from the Australian National Health and Medical Research Council were used to appraise the literature. Results: A total of 341 studies were found, and 302 were screened for eligibility after duplicates were removed. Four level IV intervention (case series with pretest/posttest) studies were included for indepth review. All four studies had very small sample sizes, exhibited low methodological quality, differed in outcome measures used, and lacked homogeneity of samples and treatment fidelity. Conclusion: A lack of high quality evidence currently exists to support or refute the use of the Wilbarger protocol with children. While the grade of recommendation, as proposed by the Australian National Health and Medical Research Council, suggests that the Wilbarger protocol should be applied with caution, emerging evidence from these studies warrants future robust research on this topic. Clinicians are advised to use clear outcome measures when using the Wilbarger protocol with clients.

Mothers' perceptions of the introduction of a hoist into the family home of children with physical disabilities

Purpose. This study examined the perspectives of three mothers who used a hoist in the home to assist in the care of a child with a severe physical disability. It sought to identify the effects of hoist introduction on the family as well as factors which influence hoist usage. Method. A qualitative methodology was used to analyse semi-structured interviews with three mothers of teenagers with a disability. Results. The findings from this study have highlighted the positive impact of hoist introduction on the parent and childs quality of life as a result of improved management of care, increased options for the child and increased respite for the parent. Conclusions. Early positive outcomes of hoist use were influential in long-term hoist use and acceptance. The factors of consultation for acquisition of the hoist, early introduction to enable a gradual transition into regular use, appropriate fit in the home, sensitivity to grief and loss, and negotiation with parents about changes in care provision were all important in the introduction of the hoist. The importance of occupational therapists to advocate for early introduction of a hoist with in-depth consultation into the environmental impact prior to prescription, along with close monitoring of use once supplied are explored and implications for practice discussed.

Determining the content validity, inter-rater reliability and usability of the Novita Switch Record Form

BACKGROUND: Accurate assessment and provision of switching technology allows children with physical and multiple disabilities the opportunity of reaching their full potential within chosen occupations, particularly schooling. Senior occupational therapists from Novita Children’s Services designed the Novita Switch Record Form (NSRF) to measure small changes in children’s switching skills over time. OBJECTIVE: The aim of this study is to determine the content validity, inter-rater reliability and usability of the NSRF. METHODS: Six expert occupational therapists analyzed the NSRF by means of a content validity questionnaire. In addition, 24 occupational therapists watched a YouTube video of approx. 5 minutes of a child who used 2 different switches at the same time. No background information was available of the child and occupational therapist in the video. The occupational therapists used the NSRF to assess the switching skills of the child and completed a usability questionnaire that measured the usability of the NSRF. RESULTS: The NSRF has acceptable content validity in regards to its relevance and representativeness of switching skills, but has poor clarity. Poor inter-rater reliability was found. Feedback from usability testing indicated the NSRF was a useful tool that would assist therapists to assess switching skills. CONCLUSIONS: It is recommended that the NSRF, user guide and a training package be further developed and tested to improve clarity and reliability.

Assistive technology assessment tools for assessing switch use of children: A systematic review and descriptive analysis

BACKGROUND: Use of switches enables children with physical and multiple disabilities to mobilise, communicate, play and participate in schooling. A comprehensive and psychometrically sound assessment tool is important to ensure children receive appropriate technology and achieve the best possible outcomes. OBJECTIVE: To systematically review assistive technology assessment tools which assess the switch use of children with physical and multiple disabilities. METHODS: The review was conducted according to PRISMA guidelines. An electronic search of ten databases was performed in February 2013. Assessment tools were included if they met three key eligibility criteria: 1) the tool assessed the assistive technology needs of children with physical or multiple disabilities, 2) the tool could be applied to assess children’s ability to use a switch, 3) the article was published in English in a peer reviewed journal. RESULTS:From eight articles included, six different assessment tools were reviewed for psychometric properties and compared to recommended content from background literature. From this review, it was found there are insufficient validated and reliable assessment tools to assess the switch use of children. CONCLUSIONS: A comprehensive and sensitive tool, with adequate psychometric testing, is required to assess the switch use of children with physical and multiple disabilities.

Conducting Robust Intervention Trials to Address the Sensory Needs of Children with Autism Spectrum Disorder: Design Challenges in an Australian Context

Many occupational therapists administer sensory interventions to address the needs of children with autism spectrum disorder. However, the current evidence regarding the effectiveness of sensory interventions is inconclusive, resulting in calls for more robust testing through randomized controlled trials. Our initial research plan was to conduct a randomized controlled trial that had real-world applications for occupational therapists and children diagnosed with autism spectrum disorder. However, as we conceptualized this study, we identified many uncertainties regarding the criteria required for a robust trial. In this opinion piece we describe and discuss the challenges we encountered when designing a community-clinic-based effectiveness study in an Australian context.

Mapping an Australian Occupational Therapy curriculum: Linking intended learning outcomes with entry-level competency standards

BACKGROUND Curriculum mapping involves systematic charting of programme content against professional competencies. This process can reveal strengths, gaps and redundancies within educational programmes. METHODS Curriculum mapping occurred using intended learning (ILOs) as documented in individual courses and linking them to units and elements within the occupational therapy minimum competency standards (ACSOT) and Millers Framework of competency. Five occupational therapy academics and two impartial research assistants identified links between ILOs and units and elements of the ACSOT. Analysis of each course in the curriculum was completed by two reviewers. A systematic protocol was developed that enabled a transparent process and resolution of discrepancies between reviewers. RESULTS There were many links (47% of total) between the documented curriculum and ACSOT Unit 1 Professional attitudes and behaviours. The other six units of the ACSOT had between 5% (Unit 7) and 16% links (Unit 3). No links were made between ILOs and the elements of evaluation (4.4), cessation (3.7) and quality assurance of services (7.3). Difficulties mapping ILOs to units and elements revealed inconsistencies in specificity and language in the ILOs and also ambiguities and gaps within the standards themselves. Mapping against Millers framework showed a steady increase in performance expectations of students across the four years levels. CONCLUSION Curriculum mapping is recommended for critical reflection about content of occupational therapy programmes and to review pedagogical approaches. This process revealed strengths and weaknesses of the occupational therapy curriculum being mapped but also revealed insight into the current ACSOT that may inform future iterations.

Parental Adherence to a Research Protocol to Investigate the Effect of the Wilbarger Therapressure ProgramTM: A Qualitative Study

Background: The Wilbarger Therapressure ProgramTM is a technique applied by parents at home for sensory overresponsivity in children. The program is anecdotally reported to be demanding on parents, which can affect parental adherence. Currently, there is an absence of high quality research to support the use of the program. This pilot study aimed at developing appropriate research protocols to investigate the effectiveness of the program on the stress response of children with sensory overresponsivity. This article reports on the second phase of the project. Method: After participating in the trial data collection protocols to investigate the effect of the intervention, five participants participated in semi-structured interviews that sought to obtain their perceptions on the data collection protocols and explore their adherence to the protocols. Results: The participants acknowledged the demanding nature of involvement in the study; however, participant adherence was high. The participants were motivated to be involved and to contribute to the intervention outcomes and the research. The participants described the aspects that influenced their adherence. Conclusion: The participants provided suggestions for future, larger studies.

Feasibility of a Research Protocol to Investigate the Effect of the TherapressureTM Program Using Salivary Cortisol

Background: There is an absence of high quality research to support the use of the Therapressure ProgramTM. This pilot study aimed at developing appropriate research protocols to investigate the effectiveness of the Therapressure ProgramTM on the stress response in children with sensory overresponsivity. Method: A one-group pre-test/post-test repeated measures design was conducted using a convenience sample. Six children (6-8 years of age) with sensory overresponsivity received 14 consecutive days of the Therapressure ProgramTM by their parents at home. Parents concurrently collected salivary cortisol samples from their children. Results: Children with sensory overresponsivity displayed both hyperand hypo-cortisolism at baseline. All of the children’s cortisol levels shifted toward a normative range after intervention. Aspects have been identified related to the data collection protocol. Conclusion: When testing children with sensory overresponsivity who are constantly activating their stress response system, we raise awareness of the need to check for both hyperand hypo-cortisolism during statistical analysis. Preliminary pilot data may also show modulation of sympathetic arousal following the intervention. Further research is warranted and recommendations are made related to data collection protocols.