Rachael McDonald

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.

Evidence-based practice and research utilisation: Perceived research knowledge, attitudes, practices and barriers among Australian paediatric occupational therapists

BACKGROUND/AIM Evidence-based practice (EBP) and research utilisation (RU) are promoted as ways for clients to receive the best level of care. However, limited research has evaluated the use of these approaches by occupational therapists. This study investigated the knowledge, attitudes, practices of and barriers to EBP and RU of a group of paediatric occupational therapists from Australia. METHODS Questionnaires were received from 138 participants (response rate 46%) who completed the Research Knowledge, Attitudes and Practices of Research Survey, the Edmonton Research Orientation Survey and the Barriers to Research Utilisation Scale. RESULTS The participants held positive attitudes towards research, and were willing to access new information to guide practice approaches. However, participants were less confident in their research knowledge and practices and implemented research findings into clinical practice. Multiple barriers to RU were perceived, particularly associated with the presentation and accessibility of research. Participants reported limited engagement in conducting research studies, although the majority of the participants reported implementing the findings of research into their clinical practice to some extent. CONCLUSION Additional research education and support within organisations would be beneficial to ensure that children and families are receiving occupational therapy services that are based on sound, high-quality research evidence. The findings of this study provide insight into the perceived research knowledge, attitudes, practices of and barriers to Australian paediatric occupational therapists, enabling specific strategies to be implemented to increase the use of EBP and RU within the profession.

The International Classification of Functioning, Disability and Health provides a Model for Adaptive Seating Interventions for Children with Cerebral Palsy

Children with severe types of cerebral palsy use adaptive seating systems to encourage function and assist in delaying the development of deformity. These systems are often assessed for and provided by occupational therapists. However, there has been no unifying policy or theoretical basis on which these systems are provided and research evidence is lacking, with studies tending to be small and non-controlled. The International Classification of Functioning, Disability and Health (World Health Organisation 2001a,b) aims to establish a common language for clinical practice as well as research, while bringing together the opposing social and medical models of health care delivery. This paper suggests that the ICF model is an ideal theoretical basis for adaptive seating system assessment and provision, given that these systems often conflict between the medical model of reducing or delaying impairment of body functions and structures and the social model of children and families accessing life and environmental situations through mobility and seating equipment. The paper considers all the domains of the ICF with regard to the current literature. It concludes that using the model in the context of providing adaptive seating gives occupational therapists both a powerful tool for communicating with children and families as well as managers and a basis for evaluating practice.

Evidence-based practice in occupational therapy services for children with autism spectrum disorders in Victoria, Australia

BACKGROUND The current practice of occupational therapy services provided for children with autism spectrum disorders in Victoria, Australia was investigated - specifically, practice in terms of the theories, assessments and intervention strategies utilised. Identification of professional development needs was also explored. The purpose was to identify how occupational therapy practice may have changed over the last decade and to explore what additional developments are required in the field. METHOD A self-administered survey was mailed to 322 registered members of Occupational Therapy Australia Limited, Victoria Branch. RESULTS A valid response rate of 20.5% was obtained. The majority of the participants worked in private practice, and had between one and five years of work experience. Theories, assessments and interventions that are associated with or based on, sensory integration and/or processing approaches are highly utilised by the participants in their service delivery with children with autism spectrum disorders. Participants indicated that they felt they needed training and courses around sensory integration. CONCLUSIONS We concluded that there were few changes in occupational therapy practice related to the selection of theoretical models, assessments and interventions by the participants in this study over the last decade. It is essential for occupational therapists not to neglect the goals of providing occupation-based interventions to children with autism spectrum disorders by focusing only on sensory-based approaches. An urgent need for occupation-based approaches to working with children with autism spectrum disorders and their families is required.

Wheelchair skills training programme for children: A pilot study

AIM Wheelchair skills are not typically provided when a child gets a new wheelchair. The purpose of this prospective pilot study was to determine the effectiveness of a two-day modified Wheelchair Skills Programme 3.2 for children. METHODS Six children (ages 6-19 years) with spinal cord injuries or spina bifida were invited to participate in a two-day wheelchair skills programme provided on subsequent Saturdays. Children were tested before and after training using a modified Wheelchair Skills Test 3.2. To assess for the effect of the programme on participation, the Activity Skills for Kids was used before and one month after training. For a more qualitative reflection, an Impact Questionnaire was given at four months post-training. RESULTS There was a significant (14%) increase in skills based on the Wheelchair Skills Test 3.2. No change in participation was measured with the Activity Skills for Kids. The Impact Questionnaire suggests the skill training allowed participants to do more, with less pain and fatigue post-training. CONCLUSIONS A two-day wheelchair skills programme can potentially improve skill level in children with spinal cord injuries or spina bifida.

Research Knowledge, Attitudes, Practices and Barriers among Paediatric Occupational Therapists in the United Kingdom

Evidence-based practice and research utilisation are promoted to enable clients to receive the most current care; however, there is limited research evaluating the use of these approaches within the occupational therapy profession. This study aimed to investigate the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of a group of paediatric occupational therapists in the United Kingdom. Questionnaires were received from 145 participants (response rate 30%), who completed the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey), the Edmonton Research Orientation Survey (EROS) and the Barriers to Research Utilisation Scale (BARRIERS). The results indicated that the respondents held positive attitudes towards research and were willing to access new information and implement research findings to guide clinical practice. However, they were less confident in their research knowledge and practices, and perceived multiple barriers associated with the organisation, accessibility and quality of research. The respondents reported limited engagement in conducting research studies; however, the majority of the sample reported implementing the findings of research in their clinical practice to some extent. Additional research education and support within organisations would be beneficial to ensure that children and families are receiving occupational therapy services that are based on sound research evidence.

Rasch analysis of the assessment of children’s hand skills in children with and without disabilities

The Assessment of Childrens Hand Skills (ACHS) is a new assessment tool that utilizes a naturalistic observational method to capture childrens real-life hand skill performance when engaging in various types of activities. The ACHS also intends to be used with both typically developing children and those presenting with disabilities. The purpose of this study was to further investigate the construct validity of the ACHS using the Rasch analysis. Participants included 64 typically developing children and 70 children with disabilities in the age range of 2-12 years. Rasch analysis results confirmed the appropriateness of the ACHSs 6-level rating scale in this combined group of children. All 22 activity items and 19 of the 20 hand skill items in the ACHS formed a unidimensional scale and were ordered according to difficulty as clinically and developmentally expected. The ACHS also exhibited sufficient response validity and item-difficulty range when applied to children with disabilities as well as typically developing, preschool-age children. Furthermore, less than half of the ACHS items were found to exhibit differential item functioning with regard to gender (5 activity items) and disability (2 activity items and 7 hand skill items). Therefore, the ACHS shows preliminary evidence of construct validity for its clinical use in assessing childrens hand skill performance in real-life contexts.

Health and Disability: Partnerships in Health Care.

BACKGROUND Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care. AIMS This paper outlines health inequalities experienced by people with intellectual disability and focuses on the opportunities medical education provides to address these. Strategies to ensure that health professional education is inclusive of and relevant to people with disabilities are highlighted. CONCLUSIONS The barriers experienced by people with intellectual disabilities to the receipt of high-quality health care include the attitudes, knowledge and skills of doctors. Improving medical education to ensure doctors are better equipped is one strategy to address these barriers. Improving health enhances quality of life, enables engagement and optimizes opportunities to participate in and contribute to the social and economic life of communities. ACCESSIBLE ABSTRACT People with intellectual disabilities sometimes find it difficult to get the healthcare they need to stay well. Teaching student doctors about what people with disabilities want and need can help these students become better doctors. Good doctors help people get well and stay healthy and active. When people feel well they can enjoy their lives and join in activities in their community. This article talks about some of the things doctors need to learn, and some ways to teach them. People with disabilities have a very important role in teaching student doctors.

A comparison between parents' and therapists' views of their child's individual seating systems

Children with cerebral palsy are often prescribed adaptive seating systems for use in their wheelchairs for the purposes of improving posture and to help prevent the development of long-term deformity. However, clinical experience indicates that parents and the therapists who advocate the use of these systems do not always agree about the wheelchairs. This study discusses the development of questionnaires for both parents and therapists to measure differences in their opinions about the wheelchairs. The questions were developed through clinical experience, validation was through interviews to discuss topics important to the participants, and repeated application of the questionnaire ensured consistency. The reliability of the questions appears satisfactory and the interview responses demonstrate that the questions selected are important to both groups of stakeholders. However, it was found that parental concerns over their childrens seating systems concentrated on functional and day-to-day management issues, whereas therapist concerns focused on technical issues and postural management. Both groups of stakeholder agreed that the questionnaires would be a useful precursor to attending a seating clinic appointment, as it could aid communication between the parent and provider and improve the efficiency and satisfaction of such an appointment. It appears the questionnaire has potential as an outcome measurement tool.

DVD-based stories of people with developmental disabilities as resources for inter-professional education.

Purpose. The use of DVD stories about people with developmental disabilities within inter-professional education (IPE) across healthcare disciplines was evaluated. Methods. First year healthcare students (n == 241) from an IPE unit responded to an attitude scale before and after viewing and discussing a DVD portraying the life and healthcare needs of an adult with cerebral palsy; a third round of data collection occurred later. Qualitative data were obtained from four first year and six second year tutors who discussed student reactions to the DVD. Six first year and four second year students participated in focus groups following viewing of a second DVD, about a young girl with developmental disabilities and complex health needs. Results. ANOVA of the attitude scores did not show significant differences from pre- to post-viewing and discussion of the DVD, nor at a third round of data collection. Qualitative analysis revealed that the DVDs did cause students to shift assumptions, perceptions and understanding of the disabilities depicted, and to learn about their own and other professions. Conclusions. DVD scenarios of real people with developmental disabilities in real settings offer a means of providing IPE opportunities. The data also point to the need and directions for the development of a new attitudinal measure.