Sylvia Rodger

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.

Virtual reality for acute pain reduction in adolescents undergoing burn wound care: A prospective randomized controlled trial

BACKGROUND Effective pain management remains a challenge for adolescents during conscious burn wound care procedures. Virtual reality (VR) shows promise as a non-pharmacological adjunct in reducing pain. AIMS This study assessed off-the-shelf VR for (1) its effect on reducing acute pain intensity during adolescent burn wound care, and (2) its clinical utility in a busy hospital setting. METHODS Forty-one adolescents (11-17 years) participated in this prospective randomized controlled trial. Acute pain outcomes including adolescent self-report, nursing staff behavioral observation, caregiver observation and physiological measures were collected. Length of procedure times and adolescent reactions were also recorded to inform clinical utility. RESULTS Nursing staff reported a statistically significant reduction in pain scores during dressing removal, and significantly less rescue doses of Entonox given to those receiving VR, compared to those receiving standard distraction. For all other pain outcomes and length of treatment, there was a trend for lower pain scores and treatment times for those receiving VR, but these differences were not statistically significant. CONCLUSION Despite only minimal pain reduction achieved using off-the-shelf VR, other results from this trial and previous research on younger children with burns suggest a customized, adolescent and hospital friendly device may be more effective in pain reduction.

Multi-modal distraction. Using technology to combat pain in young children with burn injuries

BACKGROUND The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocols despite ongoing acknowledgement of its role. Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain, as exemplified by the development of multi-modal distraction (MMD). This easy to use, hand held interactive device uses customized programs designed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes. AIM (1) To investigate if either MMD procedural preparation (MMD-PP) or distraction (MMD-D) has a greater impact on child pain reduction compared to standard distraction (SD) or hand held video game distraction (VG), (2) to understand the impact of MMD-PP and MMD-D on clinic efficiency by measuring length of treatment across groups, and lastly, (3) to assess the efficacy of distraction techniques over three dressing change procedures. METHODS A prospective randomised control trial was completed in a paediatric tertiary hospital Burns Outpatient Clinic. Eighty participants were recruited and studied over their first three dressing changes. Pain was assessed using validated child report, caregiver report, nursing observation and physiological measures. RESULTS MMD-D and MMD-PP were both shown to significantly relieve reported pain (p<or=0.05) and reduce the time taken for dressings (p<or=0.05) compared to SD and VG. The positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing changes. CONCLUSIONS The use of MMD as a preparatory or a distraction tool in an outpatient burns clinic offered superior pain reduction across three dressing changes to children when compared to standard practices or hand held video games. This device has the potential to improve clinic efficiency with reductions in treatment lengths.

‘I could do with a pair of wings’: perspectives on physical activity, bodies and health from young Australian children

There is little research that reports childrens perspectives on physical activity, bodies and health. This paper, drawn from a larger multi-method study on physical activity in the lives of seven- and eight-year-old Australian children, attempts to ‘give a voice’ to 13 childrens views. Interviews focused on childrens activity preferences and related decision making and motivations pertaining to these activities, as well as how they thought about the relationships between physical activity, health and their bodies. Data suggest some tensions surrounding the importance of fun for children alongside their awareness of ‘healthist’ discourses that require self-monitoring and improvement.

Where in the world is interprofessional education? A global environmental scan

Despite increasing recognition for the importance of interprofessional education (IPE), little is known about where in the world it occurs, how it is conducted and why it is offered. This international environmental scan was commissioned by the World Health Organization (WHO) to answer these questions and inform efforts to support IPE on a global scale. An internet-based survey targeting educators and researchers in WHOs 193 Member States was conducted between February and April 2008. Participants were recruited by WHO staff through a range of country focal points, collaborating centres, regional networks and partner organizations. The scan garnered 396 responses representing 41 countries from WHOs six regions, various income-economies and many health professions. IPE was often (i) voluntary (22%); (ii) not based on explicit learning outcomes (34%); (iii) not assessed for what was learned (63%); (iv) not offered by trained facilitators (69%); and (v) not formally evaluated (30%). Participants reported many benefits of IPE for education, practice and policy. Results are limited primarily by reliance on self-reports and an English-only, internet-based questionnaire. Significant efforts are required to ensure that IPE is designed, delivered and evaluated in keeping with internationally recognized best practice.

A novel technology approach to pain management in children with burns: A prospective randomized controlled trial

BACKGROUND Non-pharmacological approaches to supporting young children through painful medical procedures are an essential component of burn pain management protocols. New technology developed from collaborations between healthcare professionals and IT teams can enhance the preparation and distraction approaches used with children. This study follows on from previous studies using such technology, and aim to determine whether levels of pain and distress using a combined preparation and distraction content can be further reduced, and offer more efficient clinical outcomes. METHODS Forty children (3-10 years) undergoing acute burn care procedures were randomized to two groups: (1) Standard Distraction (SD) Group and (2) Multi Modal Distraction (MMD) Group (combined protocol of procedural preparation and distraction). Pain intensity and child distress were measured prior to and during the procedure. Clinical utility end points were also included; length of treatment, days to healing and adverse pain events. RESULTS A combined MMD protocol significantly reduced pain intensity (p<0.001) and distress scores (p<0.001) when compared to SD. Length of treatment (p<0.05), days to healing and the number of pain adverse events were also reduced (p<0.05) with the use of the MMD protocol. CONCLUSIONS A combined MMD protocol reduces the pain experiences for young children during burn care procedures. When compared with a previous MMD trial, outcomes reiterated the use of procedural preparation as an essential component of non-pharmacological approaches. In addition to minimizing pain and distress, this innovative technology reduced treatment length and pain adverse events, and may have an impact on reducing days to healing, providing evidence of clinical efficacy and utility.

Enabling Occupational Performance of Children Through Coaching Parents: Three Case Reports

ABSTRACT This study explores the use of occupational performance coaching (OPC) with three parent–child dyads using descriptive case study methodology. OPC is a parent-directed intervention in which parents are coached to improve their own or their childrens performance in home and community contexts. In this study, parent and child performance was examined using a pre–post intervention design with the key outcome measures being the Canadian Occupational Performance Measure (COPM) and goal attainment scaling (GAS). Parent experiences of engaging with a therapist using OPC were explored through thematic analysis of interviews with parents after completing intervention. Themes relating to learning, changes at home, and the challenges and rewards of OPC emerged from interviews with parents. Results indicate that OPC may be a useful intervention for therapists seeking to achieve occupational performance outcomes with children and parents. Further research avenues are described.

A review of the use of self-report assessment with young children

In recent years, there has been an increase in the development of self-report assessments for children, for both clinical and research use. This increase is compatible with the increase in the use of client-centred practice and other frames of reference that give clients – including children – a greater voice in their therapy. Occupation, the focus of therapy, is best understood from the perspective of the child engaged in it (Primeau and Ferguson 1999). There is mounting evidence that the views of children are different from, but as valid as, those of their parents (Sturgess and Ziviani 1996, Bouman et al 1999). The purpose of this paper is to provide a contemporary analysis of self-report assessment for children. An extensive review of the self-report literature found a clear rationale for its use and also evidence about the features of effective self-report tools. The results of this literature review and a critique of some self-report assessments available for young children are included in this paper.

A pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism

The acquisition of social communication skills is a major challenge faced by children with autism. This pilot study investigated the effects of the Stronger Families Project, a social-pragmatic intervention, on the communication and symbolic abilities of 16 children aged 2–4 years with autism. Standardized measures of the childs communication and symbolic behaviour were conducted by independent observers at a university clinic pre and post-intervention, and parents were interviewed to determine the impact of variables such as maternal stress and competence on the childs social communication. Changes in some communication and symbolic behaviours occurred following the Stronger Families Project intervention according to parent report. However, improvements based on ratings by independent observers were not significant. Results are discussed in relation to the assessment of changes in the social communication and symbolic play of children with autism following intervention using clinical observation and parent report.

The Application of Cognitive Orientation to Daily Occupational Performance (CO-OP) with Children 5–7 Years with Developmental Coordination Disorder

There has been an increase in the use of cognitive frameworks in occupational therapy with children with developmental coordination disorder (DCD). Investigations into the utility of one such cognitive approach, namely Cognitive Orientation to (daily) Occupational Performance (CO-OP), with children with DCD have shown the intervention to be effective with children over 7 years. However, there has been limited research into its utility with younger children. This paper presents two case studies to demonstrate the use of CO-OP with children aged 5–7 years. Two boys with DCD engaged in 10 sessions of CO-OP. These younger children were found to be able to use the global framework (Goal, Plan, Do, Check) to improve their task performance, to develop plans using domain-specific strategies and to engage in checking strategies. Issues relating to attention, motivation and goal setting are discussed in the context of the two case studies.