Jane Galvin

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.

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.

Ecological assessment of cognitive functions in children with acquired brain injury: A systematic review

Background: Childhood acquired brain injury (ABI) often leads to impairment in cognitive functioning, resulting in disabilities in both the home and school environment. Assessing the impact of these cognitive deficits in everyday life using traditional neuropsychological tests has been challenging. This study systematically reviewed ecological measures of cognitive abilities available for children with ABI. Method: Eight databases were searched (until October 2011) for scales: (1) focused on ecological assessment of cognitive functioning; (2) with published data in an ABI population; (3) applicable to children up to 17;11 years of age; and (4) in English. The title and abstract of all papers were reviewed independently by two reviewers. Results: Database searches yielded a total of 12 504 references, of which 17 scales met the inclusion criteria for the review, focusing on executive functions (n = 9), memory (n = 3), general cognitive abilities (n = 2), visuo-spatial skills (n = 2) and attention (n = 1). Four tasks used observation of actual performance in a natural environment, five were proxy-reports and six were functional paper and pencil type tasks, performed in an office. Conclusion: Overall, few measures were found; eight were still experimental tasks which did not provide norms. Executive functions were better represented in ecological assessment, with relatively more standardized scales available.

Does intervention using virtual reality improve upper limb function in children with neurological impairment: A systematic review of the evidence

Background: Virtual reality (VR) is an emerging area of paediatric clinical and research practice, however the majority of research to date has focused on outcomes for adults following stroke. This paper appraises and describes current evidence for use of virtual reality interventions to improve upper limb function of children with neurological impairment. Methods: A comprehensive database search was undertaken to explore literature on the use of VR systems for rehabilitation of upper limb skills of children with neurological impairment. Studies investigating the use of robotics or other mechanical devices were excluded. Five studies were found and were critiqued using the Downs and Black scale for measuring study quality. Results: One randomized control trial and four case studies were found. No study scored over 50% on the Downs and Black scale, indicating methodological limitations that limit generalizability. Conclusions: Current evidence for the use of VR to improve hand and arm skills is at an emerging stage. Small sample sizes and inconsistencies in outcome measurement limit the ability to generalize findings. Further studies are required to investigate the ability to maintain gains made in VR over time and to determine whether gains transfer from the VR to real life tasks and activities.

Functional outcome following paediatric stroke

Background: Paediatric stroke has a significant impact on functional ability; however, few studies describe outcomes using valid and reliable measures. Aim: To describe functional abilities of children following ischemic stroke using a validated outcome measure. Methods: Eighteen children who had sustained an ischemic stroke were recruited from the stroke service of a tertiary childrens hospital. The Pediatric Evaluation of Disability Inventory (PEDI) was used to describe functional abilities in domains of self-care, mobility and social function. Results: All children demonstrated lower functional skills and required more caregiver assistance than would be expected for their age. These findings were seen across all functional areas; however, self-care was more affected than mobility and social functions. Conclusion: The PEDI provides a useful measure of functional outcomes following paediatric stroke. Children in this study demonstrated reduced abilities across all domains. Further research to investigate the relationship between location of injury and functional outcome would assist understanding of paediatric stroke outcomes.

Executive skills and their functional implications: Approaches to rehabilitation after childhood TBI

Background: It is widely acknowledged that children recover differently from adults following traumatic brain injury. The impact of neurological injury in the context of developing skills and changing expectations of behaviour requires a developmental approach to rehabilitation that considers childrens abilities across home, school and community environments. Methods: This article aims to provide an overview of the impact of executive deficits on everyday functioning and to review information about intervention strategies that support long term development of skills. Results and conclusions: While individual disciplines are not directly referred to in this paper, input from a comprehensive and co-ordinated interdisciplinary team is crucial to understanding and reducing the impact of executive deficits on functional performance.

Predictors of functional ability of Australian children with acquired brain injury following inpatient rehabilitation

Objective: Recently, Bedell reported data from the US on functional changes during inpatient rehabilitation for children with ABI. Similar data for Australia is not available. The aim of this study was to measure functional outcomes of children admitted to rehabilitation in Victoria, Australia and to explore predictors of outcome to contribute to international benchmarking of paediatric services. Method: The Pediatric Evaluation of Disability Inventory (PEDI) was administered to 72 children (aged 8 months to 16 years) within 3 days of admission to rehabilitation and again in the 3 days prior to discharge to measure functional skills in self-care, mobility and social function. Outcome data for the three domains are described and baseline and injury characteristics explored as predictors of outcome using linear regression models. Results: Significant improvements in PEDI scores across all domains were demonstrated from admission to discharge. Older age at injury, higher baseline scores and being female were all predictive of better outcomes at discharge. Conclusions: Findings revealed that patterns of recovery in this sample were similar to those reported in previous studies. Continued use of the PEDI for inpatient rehabilitation is recommended to further investigate effects of injury type and the impact of therapy on outcome.

Gross and fine motor skills in children treated for acute lymphoblastic leukaemia

Objective: Chemotherapy treatment for acute lymphoblastic leukaemia (ALL) may disrupt motor development, with suggestions that gross and fine motor deficits are different depending on time since treatment. Methods: Thirty-seven participants aged between 2.5 to 5 years at the time of diagnosis were assessed using the Movement Assessment Battery for Children, 2nd Edition (MABC-2) and the Bruininks–Oseretsky Test of Motor Proficiency, 2nd Edition, Short Form (BOT-2 SF), and divided into groups (i.e. months-off-treatment): (1) 0–12, (2) 13–24, and (3) 25–60 for comparison. Results: MABC-2 and BOT-2 SF mean total scores fell within the average range. Twenty-six percent of the sample performed in the impaired range on the MABC-2. Group 2 had significantly lower Manual Dexterity scores than the normative population and lower BOT-2 SF scores than Group 1. Conclusion: Most children treated for ALL display appropriate motor skills, yet around a quarter experience general motor difficulties. Time-off-treatment did not affect the prevalence of motor impairments on any measure.

Family-centred outcome measurement following paediatric stroke.

BACKGROUND/AIM Therapy programmes aim to provide services that are family-centred and address the specific needs of children. The Canadian Occupational Performance Measure (COPM) and the Perceived Efficacy and Goal Setting system (PEGS) are two measures that are available to assist in determining therapy priorities for children and their parents; however, the use of these measures has not been documented for children who have sustained a stroke. This project aimed to describe the functional concerns identified by children and their parents following paediatric stroke. METHODOLOGY A cross-sectional design was used. A total of 26 children were recruited from a paediatric stroke outpatient clinic, and functional concerns were identified using either the COPM or the PEGS. RESULTS Children and their parents identified similar issues. Of the 26 participants, 23 (88.5%) reported ongoing functional concerns at three months or more following stroke, whereas three participants did not identify any ongoing functional concerns. Functional concerns were grouped into categories of self-care, productivity and leisure as outlined in the Canadian Model of Occupational Performance. Concerns were identified across all functional domains by both children and their parents. CONCLUSIONS The COPM and PEGS provided useful information about functional issues that are important to children and their parents following paediatric stroke. Use of these client-centred measures provides an opportunity to better understand the impact of paediatric stroke on childrens functional abilities, and allows greater scope for service provision and planning for this group of children.

Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Application of a classification framework

Aim: Multiple virtual reality (VR) systems are used to improve motor function in children and youth with neurological impairments. Galvin and Levac developed a classification framework to facilitate clinical decision-making about VR system use. This paper applies the classification framework to identify its strengths and limitations. Method: The classification framework is applied to three case studies where therapists may consider using VR with children involved in paediatric rehabilitation programmes. Results: The classification framework identified VR systems that met each childs individual needs. The relevance of each category to clinical decision-making varied depending on each childs goals. Categories requiring further development and suggestions for additional categories are discussed. Conclusions: The classification framework facilitates child-centred decision-making about the use of VR as a therapeutic intervention. It has shown initial utility but requires further validation with clinicians working in a variety of clinical settings and with a range of client populations.