Monique Hines

Clinical Prognostic Messages From a Systematic Review on Cerebral Palsy

OBJECTIVE: To summarize evidence on the rates of co-occurring impairments, diseases, and functional limitations with cerebral palsy into succinct clinical messages. METHODS: A search was conducted of the databases PubMed, Medline, CINAHL, and PsycINFO, and the results were supplemented with hand searches. Two independent reviewers determined whether retrieved abstracts met the following inclusion criteria: human subjects; >90% were children or adults with cerebral palsy; published after 1999; and population-based data. Articles were appraised, analyzing design, participants, level of evidence, rates of impairments, and functional implications. Methodologic quality was rated by using a standardized checklist. RESULTS: A total of 1366 papers were identified in the search; 82 were appraised and 30 were included in the meta-analyses. High-level evidence existed, as rated on the Oxford 2011 Levels of Evidence: 97% of prevalence studies were level 1. The data were of a moderate to high quality grade (with the exception of sleep disorders), allowing plain English clinical messages to be developed. CONCLUSIONS: Among children with cerebral palsy, 3 in 4 were in pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had a hip displacement; 1 in 4 could not talk; 1 in 4 had epilepsy; 1 in 4 had a behavior disorder; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder; 1 in 5 dribbled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf.

Buried by autism: older parents’ perceptions of autism:

In this study, we explored older parents’ perceptions of their adult sons and daughters with autism in order to gain insights into how parents’ beliefs about autism may influence their coping. Narrative analysis of in-depth interviews held with 16 parents aged 60 years and older of adults with autism revealed that these parents perceived that their son’s or daughter’s intelligence, sense of humour and social personality are blocked by autism. Adherence to these beliefs appeared to comprise important coping strategies that supported these parents in their caregiving roles by assisting them to maintain positive perceptions of their son or daughter with autism. Yet such beliefs also held costs for the parents, including reinforcing the belief that they need to regulate their own behaviour in order to realize the true son or daughter buried by autism.

Pain, pain anxiety and emotional and behavioural problems in children with cerebral palsy

Abstract Purpose: Pain is commonly experienced in those with cerebral palsy (CP), and previous research suggests an increase in behavioural and emotional problems in children experiencing pain and pain anxiety. Therefore, it was hypothesised that pain intensity and pain anxiety would predict behavioural and emotional problems in children with CP. Method: Parents or guardians of 61 children (38 boys, 23 girls) with CP, aged 5–15 years completed an online questionnaire on pain intensity, pain anxiety and behavioural and emotional problems. Correlation and a multiple linear regression analyses were conducted to examine whether pain intensity and/or pain anxiety predicts behavioural and emotional problems. Results: A total of 59% of participants reported that their children with CP currently experiences pain. Multiple regression analyses revealed that pain intensity (p = 0.038) and pain anxiety (p < 0.001) both made a significant and independent contributions in predicting anxiety in children, however, pain anxiety was the only predictor that made a significant and independent contribution to the depression (p = 0.001) and the behavioural and emotional problems measure (p = 0.004). Conclusions: Whilst pain intensity appears to be associated with behavioural and emotional problems in children, pain anxiety may be more strongly associated still. Implications for Rehabilitation Pain intensity and pain anxiety may have strong associations with behavioural and emotional problems in children with Cerebral Palsy (CP) Pain anxiety may be a stronger predictor of behavioural and emotional problems than the actual pain experienced in children with CP Clinicians may need to consider how children’s perception of their pain affects their behavioural and emotional outcomes, as these may significantly affect the outcome of the rehabilitation

Multiple Stakeholder Perspectives on Teletherapy Delivery of Speech Pathology Services in Rural Schools: A Preliminary, Qualitative Investigation

The objective of this study was to investigate stakeholders’ views on the feasibility and acceptability of a pilot speech pathology teletherapy program for children attending schools in rural New South Wales, Australia. Nine children received speech pathology sessions delivered via Adobe Connect® web-conferencing software. During semi-structured interviews, school principals (n = 3), therapy facilitators (n = 7), and parents (n = 6) described factors that promoted or threatened the program’s feasibility and acceptability. Themes were categorized according to whether they related to (a) the use of technology; (b) the school-based nature of the program; or (c) the combination of using technology with a school-based program. Despite frequent reports of difficulties with technology, teletherapy delivery of speech pathology services in schools was highly acceptable to stakeholders. However, the use of technology within a school environment increased the complexities of service delivery. Service providers should pay careful attention to planning processes and lines of communication in order to promote efficiency and acceptability of teletherapy programs.

Communication and AAC in the Lives of Adults with Autism: The Stories of Their Older Parents

The aim of this study was to explore the communication experiences, particularly those related to augmentative and alternative communication (AAC), of older parents who had an adult son or daughter with autism. A narrative analysis of in-depth interviews with 16 older parents indicated that the majority had rarely spontaneously mentioned AAC or other communication interventions. Most did not express the need for such services. Yet, communication breakdown featured prominently in parents’ narratives about interactions with their son or daughter. The quality of the communication between older parents and their offspring with autism constituted important sources of both gratification and strain in parents’ roles as caregivers. Reasons for the current lack of communication interventions are discussed, along with implications for communication and AAC service provision.

Speech pathologists’ perspectives on transitioning to telepractice: What factors promote acceptance?

Little is understood about factors that influence speech-language pathologists’ (SLPs’) acceptance of telepractice. The aim of this study was to investigate SLPs’ perceptions and experiences of transitioning to a school-based telepractice service to identify factors that contributed to positive clinician attitudes. In-depth interviews were conducted with 15 SLPs who recently commenced providing school-based telepractice services. Interviews were recorded and transcribed verbatim and thematic analysis was used to interpret interviews, with themes compared and contrasted across the group. Results indicated that although SLPs reported initially having mixed feelings towards telepractice, they later evaluated telepractice positively and viewed it as a legitimate service delivery mode. The overarching theme was that positive beliefs about telepractice were associated with perceptions of its consistency with the underlying principles of face-to-face therapy. In evaluating telepractice, SLPs considered: (a) therapeutic relationships with children; (b) collaboration with parents and teachers; (c) adequacy of technology and resources; and (d) access to support for learning telepractice. Therapy assistants and specific clinician attributes emerged as key strategies used to manage threats to acceptability. Preparation of SLPs transitioning to telepractice should address factors that support positive experiences with, and attitudes towards, telepractice to ensure that training achieves the greatest, most sustained change.

Interdisciplinary eHealth for the care of people living with traumatic brain injury: A systematic review

ABSTRACT Objective: To identify literature which discusses the barriers and enablers of eHealth technology and which evaluates its role in facilitating interdisciplinary team work for the care of people with a traumatic brain injury (TBI). Design: Systematic review. Data sources: Studies were identified by searching CINAHL, Embase, Medline, PsycINFO, Scopus, and Web of Science. Study selection: Studies included in the review were required to feature an eHealth intervention which assisted interdisciplinary care for people with TBI. Data extraction: Descriptive data for each study described the eHealth intervention, interdisciplinary team, outcomes, and barriers and facilitators in implementing eHealth interventions. Results: The search resulted in 1389 publications, of which 35 were retrieved and scanned in full. Six studies met all the inclusion criteria for the review. Four different eHealth interventions were identified: (i) an electronic goals systems, (ii) telerehabilitation, (iii) videoconferencing, and (iv) a point-of-care team-based information system. Various barriers and facilitators were identified in the use of eHealth. Conclusion: eHealth interventions have been reported to support interdisciplinary teams for the care of TBI. However, there is a substantial gap in existing literature regarding the barriers and enablers which characterize a successful interdisciplinary eHealth model for people with TBI.

Preparedness for eHealth: Health Sciences Students’ Knowledge, Skills, and Confidence

There is increasing recognition of the role eHealth will play in the effective and efficient delivery of healthcare. This research challenges the assumption that students enter university as digital natives, able to confidently and competently adapt their use of information and communication technology (ICT) to new contexts. This study explored health sciences students’ preparedness for working, and leading change, in eHealth-enabled environments. Using a cross-sectional study design, 420 undergraduate and postgraduate students participated in an online survey investigating their understanding of and attitude towards eHealth, frequency of online activities and software usage, confidence learning and using ICTs, and perceived learning needs. Although students reported that they regularly engaged with a wide range of online activities and software and were confident learning new ICT skills especially where they have sufficient time or support, their understanding of eHealth was uncertain or limited. Poor understanding of and difficulty translating skills learned in personal contexts to the professional context may impair graduates ability to confidently engage in the eHealth-enabled workplace. These results suggest educators need to scaffold the learning experience to ensure students build on their ICT knowledge to transfer this to their future workplaces.

Clinicians’ perspectives of therapeutic alliance in face-to-face and telepractice speech–language pathology sessions

Abstract Purpose: To investigate the face validity of a measure of therapeutic alliance for paediatric speech–language pathology and to determine whether a difference exists in therapeutic alliance reported by speech–language pathologists (SLPs) conducting face-to-face sessions, compared with telepractice SLPs or in their ratings of confidence with technology. Method: SLPs conducting telepractice (n = 14) or face-to-face therapy (n = 18) completed an online survey which included the Therapeutic Alliance Scales for Children – Revised (TASC-r) (Therapist Form) to rate clinicians’ perceptions of rapport with up to three clients. Participants also reported their overall perception of rapport with each client and their comfort with technology. Result: There was a strong correlation between TASC-r total scores and overall ratings of rapport, providing preliminary evidence of TASC-r face validity. There was no significant difference between TASC-r scores for telepractice and face-to-face therapy (p = 0.961), nor face-to-face and telepractice SLPs’ confidence with familiar (p = 0.414) or unfamiliar technology (p = 0.780). Conclusion: The TASC-r may be a promising tool for measuring therapeutic alliance in speech–language pathology. Telepractice does not appear to have a negative effect on rapport between SLPs and paediatric clients. Future research is required to identify how SLPs develop rapport in telepractice.

Need for an Australian Indigenous disability workforce strategy: review of the literature

Abstract Purpose: To identify approaches for developing workforce capacity to deliver the National Disability Insurance Scheme (NDIS) to Indigenous people with disability in Australian rural and remote communities. Method: A narrative review of peer-reviewed and gray literature was undertaken. Searches of electronic databases and websites of key government and non-government organizations were used to supplement the authors’ knowledge of literature that (a) focused on Indigenous peoples in Australia or other countries; (b) referred to people with disability; (c) considered rural/remote settings; (d) recommended workforce strategies; and (e) was published in English between 2004 and 2014. Recommended workforce strategies in each publication were summarized in a narrative synthesis. Results: Six peer-reviewed articles and 12 gray publications met inclusion criteria. Three broad categories of workforce strategies were identified: (a) community-based rehabilitation (CBR) and community-centered approaches; (b) cultural training for all workers; and (c) development of an Indigenous disability workforce. Conclusion: An Indigenous disability workforce strategy based on community-centered principles and incorporating cultural training and Indigenous disability workforce development may help to ensure that Indigenous people with a disability in rural and remote communities benefit from current disability sector reforms. Indigenous workforce development requires strategies to attract and retain Aboriginal workers. Implications for Rehabilitation Indigenous people with disability living in rural and remote areas experience significant access and equity barriers to culturally appropriate supports and services that enable them to live independent, socially inclusive lives. A workforce strategy based on community-centered principles has potential for ensuring that the disability services sector meets the rehabilitation needs of Aboriginal people with disability living in rural and remote areas. Cultural training and development of an Indigenous disability workforce may help to ensure a culturally safe disability services sector and workforce.