Jenny Ziviani

Environmental correlates of children's active transportation: a systematic literature review

This systematic review investigated the environmental (physical, economic, socio-cultural and political) correlates of active transportation (AT) among young people aged 5-18 years to better inform the promotion of active living. Greater distance, increasing household income and increasing car ownership are consistently associated with lower rates of AT among children. Having a non-white ethnic background has a convincing positive association with AT. Having recreation facilities and walk or bike paths present are possibly associated with higher rates of AT. Further research requires longitudinal and intervention studies, utilizing multi-level design methodologies and objective measures of environmental attributes.

Systematic Review and Meta-analysis of Therapeutic Management of Upper-Limb Dysfunction in Children With Congenital Hemiplegia

CONTEXT. Rehabilitation for children with congenital hemiplegia to improve function in the impaired upper limb and enhance participation may be time-consuming and costly. OBJECTIVES. To systematically review the efficacy of nonsurgical upper-limb therapeutic interventions for children with congenital hemiplegia. METHODS. The Cochrane Central Register of Controlled Trials, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine), Embase, PsycINFO, and Web of Science were searched up to July 2008. Data sources were randomized or quasi-randomized trials and systematic reviews. RESULTS. Twelve studies and 7 systematic reviews met our criteria. Trials had strong methodologic quality (Physiotherapy Evidence Database [PEDro] scale ≥ 5), and systematic reviews rated strongly (AMSTAR [Assessment of Multiple Systematic Reviews] score ≥ 6). Four interventions were identified: intramuscular botulinum toxin A combined with upper-limb training; constraint-induced movement therapy; hand-arm bimanual intensive training; and neurodevelopmental therapy. Data were pooled for upper-limb, self-care, and individualized outcomes. There were small-to-medium treatment effects favoring intramuscular botulinum toxin A and occupational therapy, neurodevelopmental therapy and casting, constraint-induced movement therapy, and hand-arm bimanual intensive training on upper-limb outcomes. There were large treatment effects favoring intramuscular botulinum toxin A and upper-limb training for individualized outcomes. No studies reported participation outcomes. CONCLUSIONS. No one treatment approach seems to be superior; however, injections of botulinum toxin A provide a supplementary benefit to a variety of upper-limb–training approaches. Additional research is needed to justify more-intensive approaches such as constraint-induced movement therapy and hand-arm bimanual intensive training.

Clinimetric properties of participation measures for 5- to 13-year-old children with cerebral palsy: a systematic review

This study systematically reviewed the validity, reliability, sensitivity to change, and clinical utility of measurements of participation for children with cerebral palsy. Sixteen measures were identified and seven met the inclusion criteria of having 30% content measuring participation, for use with children aged 5 to 13 years with physical disability, and were condition specific. The Childrens Assessment of Participation and Enjoyment (CAPE) assessed participation in leisure and recreation, while the School Function Assessment (SFA) and School Outcome Measure addressed participation in the school environment. The Assessment of Life Habits for Children (LIFE‐H) measured participation in home, school, and community life, and the Children Helping Out: Responsibilities and Expectations assessed childrens participation in household duties. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were individualized tools used to evaluate goal achievement. Results showed most instruments had adequate reliability and validity. The COPM and GAS were the only measures that reported adequate responsiveness to detect clinically significant change. Limited data are currently available to determine the responsiveness of the CAPE, LIFE‐H, and SFA. A combination of assessments is required to capture participation of children in home, school, and community environments.

Randomized trial of constraint-induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia

Aim  To determine if constraint‐induced movement therapy (CIMT) is more effective than bimanual training (BIM) in improving upper limb activity outcomes for children with congenital hemiplegia in a matched‐pairs randomized trial.

Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis

BACKGROUND AND OBJECTIVE: Children with unilateral cerebral palsy present with impaired upper limb (UL) function affecting independence, participation, and quality of life and require effective rehabilitation. This study aims to systematically review the efficacy of nonsurgical upper limb therapies for children with unilateral cerebral palsy. METHODS: Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, the Cochrane Central Register of Controlled Trials, and PubMed were searched to December 2012. Randomized controlled or comparison trials were included. RESULTS: Forty-two studies evaluating 113 UL therapy approaches (N = 1454 subjects) met the inclusion criteria. Moderate to strong effects favoring intramuscular injections of botulinum toxin A and occupational therapy (OT) to improve UL and individualized outcomes compared with OT alone were identified. Constraint-induced movement therapy achieved modest to strong treatment effects on improving movement quality and efficiency of the impaired UL compared with usual care. There were weak treatment effects for most outcomes when constraint therapy was compared with an equal dose (amount) of bimanual OT; both yielded similar improved outcomes. Newer interventions such as action observation training and mirror therapy should be viewed as experimental. CONCLUSIONS: There is modest evidence that intensive activity-based, goal-directed interventions (eg, constraint-induced movement therapy, bimanual training) are more effective than standard care in improving UL and individualized outcomes. There is little evidence to support block therapy alone as the dose of intervention is unlikely to be sufficient to lead to sustained changes in UL outcomes. There is strong evidence that goal-directed OT home programs are effective and could supplement hands-on direct therapy to achieve increased dose of intervention.

Concurrent validity of the Functional Independence Measure for Children (WeeFIM) and the Pediatric Evaluation of Disabilities Inventory in children with developmental disabilities and acquired brain injuries.

TheFunctional IndependenceMeasure forChildren (WeeFIM(tm)) and the Pediatric Evaluation of Disability Inventory (PEDI) are the most commonly used measures of functional performance in children. The purpose of this study was to determine the concurrent validity of the instruments when used with children with developmental disabilities and acquired brain injury. The subjects were 41 children, age 1.3 to 9.5 years, who were receiving inpatient or outpatient services at a pediatric rehabilitation unit in Brisbane, Australia. Spearman correlation coefficients between the two tests were greater than 0.88 for self care, transportation/locomotion, and communication/social function. The high correlations indicate that the two tests measure similar constructs. Choosing between the tests depends on situational requirements and depth of information required.

An Evaluation of Handwriting Performance

Abstract The legibility components (letter formation, spacing, alignment and size) and speed of handwriting were assessed for 575 children in grades 3 to 7. Inter‐rater reliabilities were high (−69 to −97) and test‐retest reliability over one week was lower for legibility (−44 to −84) than for speed (−93). In general, reliabilities were higher for the older children. Correlations among legibility components ranged from −46 to •76, though a principal factor analysis indicated that letter formation, spacing, alignment and size were discriminable elements of legibility. Correlations of legibility component scores with teacher ratings ranged between −52 and −76. Norms for speed were consistent with Groffs data and girls wrote significantly faster and smaller than boys. Girls also made fewer errors in letter formation than boys in grades 3, 4 and 5. Graphs indicating normative performance on the handwriting tasks were prepared.

Coaching parents to enable children's participation: an approach for working with parents and their children.

In this paper, Occupational Performance Coaching (OPC) is presented as a means whereby occupational therapists can support parents in achieving goals for themselves and their children. OPC is a coaching intervention that assists parents to recognise and implement social and physical environment changes that support more successful occupational performance for themselves and their children. OPC utilises collaborative problem-solving within a coaching relationship in which parents are guided towards identifying and implementing effective, autonomous solutions to occupational performance dilemmas. OPC is described in relation to the principles of contemporary practice; in particular that intervention is both family- and occupation-centred, and leads, as directly as possible, to the enablement of childrens participation at home and in the community. Tentative empirical support for coaching parents draws on the supporting evidence for similar interventions in cognate disciplines. The unique features of OPC, namely, overt collaborative analysis of performance with parents and parent-initiated solution finding, are highlighted and their potential contributions to interventions currently employed by therapists are outlined. Recommendations are advanced as to how further research can support the adoption of this intervention strategy.

Meeting in the middle: improving communication in primary health care consultations with people with an intellectual disability

The increased presence and participation in Australian society of people with an intellectual disability provides challenges for the provision of primary health care. General practitioners (GPs) identify themselves as ill equipped to provide for this heterogeneous population. A major obstacle to the provision of appropriate health care is seen as inadequate communication between the GP and the person with an intellectual disability, who may or may not be accompanied by a carer or advocate. This qualitative study in which five GPs, three people with intellectual disability, seven carers and two advocates (parent and friend) were interviewed was conducted in Brisbane, Australia. The aim was to better understand the factors that have an impact upon the success of communication in a medical consultation. Findings suggested that GPs were concerned with the aspects of communication difficulties which influenced their ability to adequately diagnose, manage and inform patients. Implications for practice management were also identified. People with intellectual disability reported frustration when they felt that they could not communicate adequately with the GP and annoyance when they were not included in the communication exchange. Carers were strong advocates for the person with intellectual disability, but indicated insufficient skill and knowledge to provide the level of assistance required in the consultation. The outcome was a model of cooperation that outlined the responsibilities of all players in the medical encounter, prior to, during and after the event.

Modified Constraint-Induced Therapy for Children with Hemiplegic Cerebral Palsy: A Randomized Trial.

Aim  Conventional constraint‐based therapies are intensive and demanding to implement, particularly for children. Modified forms of constraint‐based therapies that are family‐centred may be more acceptable and feasible for families of children with cerebral palsy (CP)‐but require rigorous evaluation using randomized trials. The aim of this study was to determine the effects of modified constraint‐induced therapy compared with intensive occupational therapy on activities of daily living and upper limb outcomes in children with hemiplegic CP.