Pediatricians can advise families that OTHPs developed with a collaborative, evidence-based approach and implemented by parents at home were clinically effective if implemented 17.5 times per month for an average of 16.5 minutes per session.

The objective was to determine the effects of low‐dose, high‐concentration, dual localized botulinum toxin A (BTX‐A) injections on upper limb movement quality and function. Study design was an evaluator‐blinded, randomized, controlled trial. Forty‐two children (31 males, 11 females; range 2–8y, mean 4y [SD 1.6]) with hemiplegic cerebral palsy (Gross Motor Function Classification System level I) participated. All received occupational therapy. The treatment group (n=21) received one injection series (mean muscles injected 6 [SD 1.05]; total dose 82–220 units, mean 139 [SD 37.48]; dilution 100 units/0.5ml). Primary outcome of Quality of Upper Extremity Skills Test (QUEST) at 6 months was not significant (p=0.318). Secondary outcomes were average treatment effects at 1, 3, and 6 months, which favoured the treatment group: QUEST (p<0.001); Canadian Occupational Performance Measure (performance, p=0.002; satisfaction p=0.007); parent Goal Attainment Scaling (GAS; p=0.001), therapist GAS (p<0.001); Pediatric Evaluation of Disability Inventory (PEDI) functional skills (p=0.030); Ashworth (p<0.001). PEDI caregiver assistance was not significant (p=0.140). Therapy alone is effective, but at 1 and 3 months movement quality is better where BTX‐A is also used. Moreover, function is better at 1, 3, and 6 months, suggesting BTX‐A enhances therapy outcomes beyond the pharmacological effect. One‐ and 3‐month Ashworth and QUEST scores suggest precise needle placement accuracy.

Study aim, logistic and resource factors should guide the choice of COPM and/or GAS instruments as both are sensitive to change with a proven intervention and both evaluate different constructs.

The demand for clinical accountability and the documentation of therapeutic effectiveness continues to increase in health-related settings. Therapists are attempting to address this increasing demand by adapting methods based on traditional experimental models of research to evaluate their clinical practice. Experimental and quasi-experimental designs, however, are often limited usefulness in clinical environments for a variety of practical and ethical reasons. This paper presents a method of evaluating the effectiveness of a therapeutic intervention called goal attainment scaling, which involves goal setting procedures and assessment techniques that are practice-based and practitioner-oriented. The procedures are presented and the argument made that goal attainment scaling is a viable method by which one can document therapeutic change and demonstrate clinical accountability.

The adapted COPM is a psychometrically robust tool and the use of half scores is not recommended.

Adolescents with ABI faced the challenge of fitting back in when they returned to school. This was either facilitated or hindered by the extent and quality of organization, communication and support from parents, schoolteachers and the rehabilitation team.

Background and Purpose-Splints are commonly applied to the wrist and hand to prevent and treat contracture after stroke. However, there have been few randomized trials of this intervention. We sought to determine whether wearing a hand splint, which positions the wrist in either a neutral or an extended position, reduces wrist contracture in adults with hemiplegia after stroke. Methods-Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated. They were randomized to either a control group (routine therapy) or 1 of 2 intervention groups (routine therapy plus splint in either a neutral or an extended wrist position). Splints were worn overnight for, on average, between 9 and 12 hours, for 4 weeks. The primary outcome, measured by a blinded assessor, was extensibility of the wrist and long finger flexor muscles (angle of wrist extension at a standardized torque). Results-Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles. After 4 weeks, the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4°(95% CI, Ϫ5.4°to 8.2°), and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3°(95% CI, Ϫ4.9°to 2.4°) compared with the control condition. Conclusions-Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke. These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued.

AIM Research funds for cerebral palsy are scarce and competition for them is strong. This study aimed to identify questions for future research that were agreed to be a high priority.METHOD An expert panel of consumers, researchers, and clinicians was assembled (n=127) and surveyed using a Delphi survey comprising three rounds. In round I, participants identified three important research topics. Three parallel surveys were constructed: (1) consumers; (2) intervention researchers and clinicians; and (3) aetiology and prevention researchers. In rounds II and III, participants rated priorities using a seven-point Likert scale. Questions reaching consensus were itemized and those not reaching consensus were discarded.RESULTS Consumers identified questions in the themes of prevention ⁄ cure, quality of life ⁄ community participation, and service provision ⁄ intervention. Intervention researchers ⁄ clinicians identified questions in the themes of effective outcomes and effective research ⁄ services. Aetiology and prevention researchers identified questions in the themes of infection ⁄ inflammation, focus on timing, haematology, research tools, neuroregeneration, and genetics. Fifty per cent of the consumers' priorities were also identified by professionals. INTERPRETATION Research priorities change as evidence is established. Phase II of this project isto develop a web portal with international collaboration. As evidence builds for one research question, it will be added to the web portal and unanswered questions will become the priority.Cerebral palsy (CP) is the most common physical disability in childhood. Despite clinical and research advances, its incidence remains stable.1 The condition is lifelong with no known cure. There is a need for research in aetiology, prevention, and effective intervention for maximizing potential and optimizing quality of life.No evidence exists of explicit published prioritization for CP research that is itself developed through a scientific process. Many individual research questions are identified at the conclusion of studies. However, no published study could be identified that provides guidance on the relative importance and ranking of the questions or where best to direct limited research funds to drive the field forward.2 The World Health Organization has identified that a collaborative, widely consulted, systematic approach to research priority setting is essential.3 Thus, establishing a unified research agenda for CP and consensus on essential and urgent research topics may provide the possibility of accelerating breakthroughs.Key stakeholder groups exist in CP with an interest in a priority-driven research agenda. Consumers (people with CP and their families) have the most vested interests in research, and must be included on an expert panel for developing research agendas. 4 Additional groups include researchers ⁄ clinicians who provide intervention for people living with CP, those researching the aetiology ⁄ prevention of CP, and policy makers and administrators ⁄ senior ma...