Identifying contribution of rehabilitation to outcomes after acquired brain injury requires quantification of rehabilitation 'dose' and 'content'. Previous approaches to 'parsing' of rehabilitation dose and content may have overemphasized one-to-one sessions with therapists. We present a novel, holistic tool for identification of ingredients of an interdisciplinary rehabilitation package. It supports interdisciplinary communication and has potential as a research tool.
Purpose: To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose. Methods: An observational study of children receiving residential neurorehabilitation after severe ABI. Results: Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists' expectations of recovery. Conclusion: Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.
Overall, environmental manipulations had relatively limited effects on repetitive hand behaviours. Repetitive hand behaviour in Rett syndrome may be maintained by automatic reinforcement or neurochemical processes and may not be primarily influenced by contingent reinforcement.
Introduction:
Intervention outcomes for children and youth with acquired brain injuries should be measured in terms of participation in activities. The aim of this study was to explore the occupational therapy outcome measures used with this group.
Method:
One cycle of an action research study, which focused specifically on occupational therapists, is reported. Ten occupational therapists working with children and youth with acquired brain injuries collated the outcome measures they used and mapped their frequently used measures onto the International Classification of Functioning, Disability and Health — Children and Youth, using established linking rules.
Findings:
Forty-two outcome measures and assessments were identified. Of these, 19 were used frequently and 15 were used as outcome measures. All activity and participation domains were represented, with learning and applying knowledge, mobility, communication and self-care (except looking after one's health) particularly well covered.
Conclusion:
Occupational therapists are using measures that reflect the domains of activity and participation, unlike those previously identified which were linked predominantly to body functions. The importance of occupational therapists working in rehabilitation teams is reiterated in that some of the domains that are not covered by occupational therapists impact on participation, for example, pain.
Aim
To describe cross‐sectional and longitudinal variation in neurorehabilitation content provided to young people after severe paediatric acquired brain injury (pABI) and to relate this to observed functional recovery.
Method
This was an observational study in a cohort of admissions to a residential neurorehabilitation centre. Recovery was described using the Pediatric Evaluation of Disability – Computer Adaptive Testing instrument. Rehabilitation content was measured using the recently described Paediatric Rehabilitation Ingredients Measure (PRISM) and examined using multidimensional scaling.
Results
The PRISM reveals wide variation in rehabilitation content between and during admissions primarily reflecting proportions of child active practice, child emotional support, and other management of body structure and function. Rehabilitation content is predicted by pre‐admission recovery, suggesting therapist decisions in designing rehabilitation programmes are shaped by their initial expectations of recovery. However, significant correlations persist between plausibly‐related aspects of delivered therapy and observed post‐admission recovery after adjusting for such effects.
Interpretation
The PRISM approach to the analysis of rehabilitation content shows promise in that it demonstrates significant correlations between plausibly‐related aspects of delivered therapy and observed recovery that have been hard to identify with other approaches. However, rigorous, causal analysis will be required to truly understand the contributions of rehabilitation to recovery after pABI.
What this paper adds
Rehabilitation content varies widely between, and during, admissions for neurorehabilitation after paediatric acquire brain injury.
Strong correlations are seen between plausibly‐related aspects of rehabilitation content and observed recovery, though careful interpretation is necessary.
Introduction: There is a need for validated and responsive measurement tools to demonstrate changes in functional ability. Existing outcome measurement tools have significant limitations for children and young people with acquired brain injury (ABI). Aim: This study examines the potential of the UK Functional Independence Measure + Functional Assessment Measure (UK FIM+FAM) to detect clinical change in older children and young people with ABI. Methods: Secondary retrospective pretest-post test analysis of 72 children and young people age 8-17 years. Internal responsiveness was examined using Wilcoxon signed-rank tests and effect sizes indices; external responsiveness was examined in relation to the Neurological Impairment Scale (NIS) using Spearman's correlation coefficient. Results: Highly significant changes were detected from admission to discharge on Motor, Cognitive and total UK FIM+FAM scores (p<0.001). Medium to large effect sizes were found on the total scale indicating good internal responsiveness. There was a significant, negative correlation between UK FIM+FAM change scores and NIS change scores (p<0.01) indicating good external responsiveness. Conclusion: The UK FIM+FAM was able to detect clinically meaningful change in functional ability in children and young people with ABI over 8 years. Further validity and reliability must be established before recommending its use in this client group. clinical utility in a children's residential neurorehabilitation setting. Poster
There is little information available about the management of children in a vegetative state and a minimally conscious state (VS and MCS), including diagnosis, assessment and treatment. This study investigated the intervention of occupational therapists in VS and MCS in the United Kingdom paediatric population. A survey design was used and a postal questionnaire was sent to a group of 892 occupational therapists who were members of a paediatric or a neurological specialist section. Two hundred and seventy-one completed questionnaires were returned and the results of these were analysed. Two hundred and six (76%) of the respondents worked in a rehabilitation setting. Twenty-five occupational therapists who worked with children in VS and MCS completed further questions about their assessments and interventions. The results indicate that children in VS and MCS receive fragmented and inconsistent occupational therapy services. Adult assessments are used with a paediatric population and therapists are not wholly satisfied with their interventions. A core group of occupational therapists involved with this population was identified as a result of this survey. It is suggested that these therapists may be able to form a working party to investigate a consistent therapeutic approach for this complex group of children.
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