Pediatric Occupational Therapy Research Articles

Knowledge, attitudes, practices and barriers of pediatric occupational therapists to evidence-based practice and research utilization

Knowledge about the use of evidence-based practice and research utilization continues to develop and expand within the occupational therapy field. The aim of this study was to investigate and compare the perceived knowledge, attitudes, practices, barriers and orientation to evidence-based practice and research utilization of a group of pediatric occupational therapists from Australia, the United Kingdom, and Taiwan. Questionnaires were received from 696 participants (response rate 56.58%) who completed the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey), the Barriers to Research Utilization Scale (BARRIERS), and the Edmonton Research Orientation Survey (EROS). The results indicated pediatric occupational therapists held positive attitudes towards evidence-based practice but were less confident in their research knowledge and practices. The greatest barriers to research utilization were associated with the “Organization”, with participants rating some engagement in research conduct and utilization. Similarities and differences were noted between countries regarding various aspects of evidence-based practice and utilization. Findings also indicated that evidence-based practice and research utilization in the context of pediatric occupational therapy practice vary from one country to another and that these issues are impacted by both personal and workplace related issues.

Occupational Therapy in Mainstream Primary Schools: An Evaluation of a Pilot Project

This article describes the outcome of an evaluation of a paediatric occupational therapy intervention piloted in two primary schools in East Kent. Two therapists were based in schools and worked in partnership with teachers and teaching assistants (TAs). They spent the equivalent of 2 days a week in the school, with the aim of increasing the knowledge and skills of teachers and TAs in the engagement and participation of children in a range of school-based occupations. Interviews with the teaching team carried out at the conclusion of the intervention explored the impact on the knowledge and skills of the school staff and the quality of the children's school experience. The positive response of the schools has led to the development of a bank of occupational therapy resources for primary schools. The work associated with the development of the resources has been supported by a 2008 Training Development Agency for schools Research and Development Award. The possibilities of extending this approach are explored.

Addressing pediatric wait times using the model of human performance technology

When traditional approaches to waitlist management are unsuccessful, service managers and providers must consider alternatives. To describe how the model of human performance technology was used to address an extensive pediatric waitlist. Data were obtained from in-depth interviews with clinicians, educators, and parents and analyzed according to the model. The need for a paradigm shift from a linear model of service delivery to a continuum of service was identified which could meet the unique needs of each child and family. Services include information, education, and supports, and all are grounded in principles of family-centred care. The model of human performance technology provided a systematic approach with which to reveal the reason for extensive wait times for pediatric occupational therapy service. The model suggested a paradigm shift from a linear model of care to a continuum of care grounded in family-centred care. Implementation and evaluation of this new care model are ongoing.

Reliability reconsidered: Cronbach's alpha and paediatric assessment in occupational therapy

Using reliable outcome measures is a necessity for the occupational therapy profession in enabling valid assessments of clients. Although Cronbach's alpha is the most widely applied index of internal consistency reliability, there are misconceptions about its use and interpretation. This paper aims to guide assessment developers in paediatric occupational therapy, as well as practitioners who are evaluating outcome measures in using and interpreting the Cronbach's alpha estimates appropriately. This will enable them to decide on the tools' clinical value and incorporate them into their practice with children. Previously published papers reporting on internal consistency issues of outcome measures in paediatric occupational therapy were searched through the Allied and Complementary Medicine database. These papers were used as a basis to discuss possible reasons for reporting of low internal consistency. The analysis demonstrates that Cronbach's alpha reports are not always interpreted in a sound way. The paper emphasises that one should be cautious about judging estimates of internal consistency. Low size of the coefficient alpha might not always indicate problems with the construction of the tool; whereas large sizes do not always suggest adequate reliability. Instead, these reports might be related to the data characteristics of the construct. In judging an outcome measure's internal consistency, researchers and practitioners in occupational therapy should report and consider the nature of data, the scale's length and width, the linearity and the normality of response distribution, the central response tendency, the sample response variability and the sample size.

A Reflection on Motor Learning Theory in Pediatric Occupational Therapy Practice

Theory provides a guide to clinical practice. To date, the most prevalent theories in pediatric occupational therapy practice are sensory integration and neurodevelopmental treatment. The purpose of this paper is to present a brief overview and reflection on motor learning theories as well as a summary of motor learning principles that can be used in pediatric practice. Over the past two decades, motor learning theory has been applied in adult occupational therapy practice, but it has been slow to gain popularity in pediatrics. Although therapists may be tacitly applying motor learning principles in practice, conscious and deliberate application of these principles to a variety of pediatric populations is required to determine if motor learning theory provides a viable and effective contribution to evidence-based, occupational therapy pediatric practice. Further research comparing motor learning interventions to other dominant interventions in pediatric occupational therapy is warranted.

Using Transformative Learning Theory to Enhance Professional Development

Purpose: Pediatric occupational therapy and physical therapy interventions for children with disabilities are designed to increase function and often focus on developmental skills instead of on the environmental context and promoting self-determination skills. A professional development course was developed to help therapists develop intervention strategies to meet developmental outcomes, while also promoting children's self-determination and creating opportunities for children to authentically participating in daily routines, including leisure and community play. Transformative learning theory was used as a basis to develop this course. The purpose of this article is to report on course activities and the assessment of participants' "transformation" at the completion of the course. Method: A pre-test/post-test design was used to determine whether participants in this course (n=3) had made transformations in their habits of mind when designing client goals, intervention plans and recommendations for a fictional case study of a child with a disability. Results: Participants wrote pre-test goals that focused on building skill in typical developmental sequences; whereas post-test goals focused on using strengths the child had and changing the environment to encourage authentic participation of the child. In addition post-test goals and interventions focused on determining the child's preference and choice about activities to participate in. Pre-test referrals were for equipment and other programs to address skill development; while post-test referrals focused on play and recreation opportunities. Conclusion: Following completion of a course using transformative learning strategies, participants demonstrated changes in habits of mind upon completion of a post-test case study in which goals, interventions, and referrals were more consistent with themes of the course including self-determination and authentic participation.

Book Reviews

Paediatric therapy practice must continually evolve as new evidence becomes available to guide clinicians working with children with disabilities. For many paediatric therapists, returning to the basics of motor control can prove most helpful in guiding clinical practice. Movement Sciences: Transfer of Knowledge into Pediatric Therapy Practice focuses on the translation of academic research pertaining to movement sciences into information that can be applied in paediatric therapy clinical practice. Written primarily by physical therapists who are both researchers and clinicians, the six chapters in this volume range from comprehensive literature reviews to original research studies. The chapters highlight theoretical models, measurement tools, and interventions relevant to paediatric occupational therapy and physical therapy practice. The authors have done a remarkable job of integrating their research findings into a clinically relevant format, with each chapter presenting conclusions regarding implications for clinical practice. The volume is structured in such a way that even though the content is drawn from separate research papers, the reader can also see the bigger picture. Some of the chapters are quite lengthy, and this may initially dissuade some busy clinicians. However, the practical focus of the chapters makes the book quite reader friendly and relevant to clinicians. For example, one of the chapters on service delivery, which is more theoretical in nature, includes a clinical case study to illustrate its concepts. Offering this content in both book and journal format also makes the materials more accessible to clinicians. (The content may look familiar to some readers, as it was co-published simultaneously as volume 24, numbers 1 and 2, of the journal Physical and Occupational Therapy in Pediatrics in 2004.) Movement Sciences contains chapters pertaining to areas such as postural control, predictors of standing balance, reliability of a measurement of muscle extensibility, activity-based intervention, enhancing prehension skills, and understanding changes in mobility in children with CP over time. For this reason, the book may offer relevant information to clinicians in many different areas of paediatric therapy. Readers may choose to read the book from cover to cover, to read one chapter related to their current practice, or to make use of the clinical implications included at the end of each chapter to get a quick summary or review of the authors’ salient points. Movement Sciences: Transfer of Knowledge into Pediatric Therapy Practice contains information relevant to most paediatric therapists, and it is hoped that review of the contents will encourage clinicians to reflect on their current practice and promote discussion as to which assessment tools and intervention strategies should be integrated into clinical practice. This book will also provide clinicians with examples of how their practice can contribute to further research in paediatric therapy.

Ergotherapeutische Betätigungsziele in der Pädiatrie - welche Faktoren beeinflussen deren Vereinbarung in Deutschland?

INTRODUCTION: In the course of professionalisation of occupational therapy in Germany, the orientation on occupation is regarded as a chance for the profession to establish its position in the health system. However functional concepts of treatment and goals of body functions are mainly employed in occupational practice. It is the aim of this paper to analyse possible factors which are influencing the occupational orientation within the therapeutic goal agreement of the paediatric occupational therapy. METHOD: Within the framework of a qualitative research six paediatric occupational therapists who were familiar with the occupational orientation were interviewed. The interviews were analysed with the help of deductive, theory-orientated categories by means of a qualitative content-analysis according to Mayring with the technique of content structuring. RESULTS: The identified possible factors of influence are to be found in the basic social conditions of therapist and client. They cover legislation, job politics, interdisciplinary cooperation, therapeutic understanding of one’s role and therapeutic knowledge, person-related factors of the therapist, child- and family-related factors and change in circumstances. CONCLUSION: Occupational oriented goals are influenced by a number of factors, which have an effect on the relation of therapist and client. This results in consequences in job politics and affects each therapist in respect of its professional experience and each client concerning its environment and community.

Should Children with ADHD be Routinely Screened for Motor Coordination Problems? The Role of the Paediatric Occupational Therapist

Attention deficit hyperactivity disorder (ADHD) is commonly comorbid with movement difficulties, including developmental coordination disorder (DCD). Compartmentalised service provision may result in children with ADHD not being screened, and assessed if necessary, for DCD and vice versa. In this study, 69 children attending an ADHD clinic were screened for movement problems, using the parent-completed Movement Assessment Battery for Children Checklist (Henderson and Sugden 1992). The results showed that 19% of the children with ADHD were defined as having a ‘movement problem’, with a further 16% defined as ‘at risk’. This paper discusses the results of the study and the implications for paediatric occupational therapy.

A Profile of Canadian Pediatric Occupational Therapy Practice

Purpose: This study established a current profile of Canadian pediatric occupational therapy practice in terms of theories/practice models, assessments, and interventions.Method: Respondents were 272 members of the Canadian Association of Occupational Therapists who indicated that pediatrics was their primary area of clinical practice. A purpose-designed survey was mailed to participants.Results: The response rate was adequate at 27.2% (n = 272/1,000). The primary client groups seen by pediatric therapists were developmental delay, learning disability, neurology, and those requiring rehabilitation. Sensory Integration and Client-Centred Practice were the most frequently utilized theories/practice models. The most commonly used assessments were the Developmental Test of Visual Motor Integration, Peabody Developmental Motor Scales, Bruininks-Oseretsky Test of Motor Proficiency, and the Sensory Profile. The most frequently used intervention techniques with pediatric clients were the instruction of parents/ca...

Deriving Practice Implications From This Issue’s Sample of Pediatric Occupational Therapy Research Literature

Deriving Practice Implications From This Issue’s Sample of Pediatric Occupational Therapy Research Literature

A pilot study of the Video Observations Aarts and Aarts (VOAA): a new software program to measure motor behaviour in children with cerebral palsy

A new computer software program to score video observations, Video Observations Aarts and Aarts (VOAA) was developed to evaluate paediatric occupational therapy interventions. The VOAA is an observation tool that assesses the frequency, duration and quality of arm/hand use in children, in particular those with cerebral palsy. Reliability studies show that the first module, designed to evaluate a forced-use programme, has an excellent content validity index (0.93) and good intra- and inter-observer reliability (Cohen's kappas ranging from 0.62 to 0.85 for the three activities tested). With the built-in statistical package, paediatric occupational therapy departments can conduct therapeutic evaluations with children with impairments in the upper extremities. Further research is recommended to apply the VOAA in clinical studies in paediatric occupational therapy.

Sensory Processing Disorders in a Nonhuman Primate Model: Evidence for Occupational Therapy Practice

Evaluation of sensory processing function serves as a critical component of treatment planning and implementation of intervention in pediatric occupational therapy practice. We developed a Sensory Processing Scale for Monkeys (SPS-M), based on human tests, that measures behavioral responses to a series of tactile stimuli. This assessment has been used to assess sensory processing in adult rhesus monkeys exposed to prenatal alcohol, stress, or postnatal lead. Control monkeys from undisturbed pregnancies showed a habituation pattern, prenatally stressed monkeys showed sensitization, and prenatal alcohol-exposed monkeys showed relatively high responsiveness without habituation across trials. Lead-exposed monkeys showed sensitization compared to nonlead-exposed controls, and chelation reduced the sensitization in lead-exposed animals. Aversive responsiveness was associated with up-regulated striatal dopamine receptor binding measured with positron emission tomography.

A Profile of Canadian Pediatric Occupational Therapy Practice

Purpose: This study established a current profile of Canadian pediatric occupational therapy practice in terms of theories/practice models, assessments, and interventions.Method: Respondents were 272 members of the Canadian Association of Occupational Therapists who indicated that pediatrics was their primary area of clinical practice. A purpose-designed survey was mailed to participants.Results: The response rate was adequate at 27.2% (n = 272/1,000). The primary client groups seen by pediatric therapists were developmental delay, learning disability, neurology, and those requiring rehabilitation. Sensory Integration and Client-Centred Practice were the most frequently utilized theories/practice models. The most commonly used assessments were the Developmental Test of Visual Motor Integration, Peabody Developmental Motor Scales, Bruininks-Oseretsky Test of Motor Proficiency, and the Sensory Profile. The most frequently used intervention techniques with pediatric clients were the instruction of parents/caregivers and children; assistive devices, adaptive equipment, and technology; activities of daily living/self-care skills; and environmental modification/access/structuring/adaptation.Conclusions: Pediatric occupational therapists mainly used theories/ practice models that focused on three areas: Client-Centred practice, practice-oriented theories, and several theories/practice models based on occupation. Interventions focused on teaching, activities unique to occupational therapy, and on the functional needs of the client.

A pilot study of psychopathology in Developmental Coordination Disorder

This paper explores the prevalence of emotional and behavioural disorders in children referred to a Community Paediatric Occupational Therapy service for assessment and treatment of problems with development of motor skills. Parents of 47 children from a clinical sample of children who had been identified with Developmental Coordination Disorder (DCD) returned the Strengths and Difficulties Questionnaire (SDQ)--a brief measure of the pro-social behaviour and psychopathology that can be completed by parents, teachers or youths. Significant emotional and behavioural problems were reported by 29 parents (62%) with a further six (13%) reporting problems in the borderline range. Seven children (15%) were without significant problems in one or more area although only four of these (9%) were outside the borderline range for all of the sub-domains of the SDQ. A significant proportion of children with DCD were reported by their parents to be at risk of psychopathology. Further research is needed to understand the relationship between motor difficulties and emotional and behavioural symptoms; however, it is recommended that interventions for children with DCD should support mental health and behavioural problems as well as motor development.

Searching for Evidence in Pediatric Occupational Therapy Using Free versus Subscription Databases

Objective. This study compared the results of searching free versus subscription databases and using brief versus comprehensive search strategies to locate evidence for three pediatric occupational therapy clinical questions.Method. Three clinical questions were nominated by practicing pediatric occupational therapists. Brief and comprehensive search strategies were then developed. Searches were conducted in three free-to-access databases and four subscription databases. Results. Based on descriptive data, more relevant citations were retrieved using the subscription databases compared with the free data-bases and when using a comprehensive search strategy. Citations that were present in some databases were not always retrieved by the searches. This was mainly due to the inclusion of an insufficient number of search terms in the brief search strategies used in this study and a mismatch between terms used in the search strategies and the databases.Conclusion. Clinicians may need to use both subscription and free databases and use comprehensive search strategies to maximize retrieval of relevant articles to answer pediatric clinical questions.

Impairments in Sensory Modulation in Children with Autistic Spectrum Disorder

The Short Sensory Profile was used to measure a caregiver report of sensory reactivity in a group of children with an autistic spectrum disorder (ASD). Fifty-six of 78 (72%) families invited to participate returned the questionnaires and the data were complete for 44 children. These 44 children represented a stratified sample out of a total of 443 children, identified through nine different data sets maintained for children affected by ASD from a total geographical region in South East Scotland. Clinical information was collected retrospectively from contemporaneous paediatric community child health medical notes and also cross-sectionally from caregivers. Sensory reactivity was outside normal limits in over 70% of the children, with the highest percentage of sensitivities occurring in the auditory filtering and the underresponsiveness and seeking sensation domains. Logistic regression analysis showed no significant relationship between sensory reactivity and the child's age at presentation with autism or parental report of regression. The severity of autism was measured by the Gilliam Autism Rating Scale and related to the Short Sensory Profile (r = 0.39, p = 0.001). These findings suggest that all children affected by ASD, regardless of clinical features or age, may potentially be affected by sensory reactivities and may benefit from appropriate occupational therapy assessment and management. ASDs are relatively common among neurodevelopmental conditions and confer lifelong disabilities. As the majority of affected children will have sensory modulation difficulties, this has significant implications for paediatric occupational therapy services.

Quality and quantity of paediatric research: An analysis of the OTseeker database

Aim: This study aimed to analyse the quantity and quality of paediatric research evidence contained in the OTseeker database and to compare the findings with surveys of paediatric occupational therapy practice. Methods: In June 2005, systematic reviews and randomised controlled trials contained in OTseeker were analysed according to year of publication and the client diagnostic groups and interventions addressed. The internal validity scores of the trials were determined (according to the PEDro scale (partitioned)) and the outcome measures used extracted. Results: Of 3294 papers contained in OTseeker, 372 (11.3%) were related to paediatrics. The mean internal validity score of the trials was 2.5/8. The five most frequently studied diagnostic groups were mental health/psychosocial issues, neurology, learning disabilities, developmental delay and ‘other’. There was much variation in the outcome measures used, with a large number of outcome measures used in only one or a few studies. The five most frequently studied interventions were behavioural interventions, consumer education, psychosocial techniques, interventions for carers/parents and developmental therapy. Conclusion: OTseeker contains a considerable amount of research relevant to paediatric occupational therapy practice. There was some congruence between the papers and practice surveys regarding client diagnostic groups and interventions, but little between the outcome measures used in research and those used in clinical practice.

A Comparison of Paediatric Occupational Therapy University Program Curricula in New Zealand, Australia, and Canada

A Comparison of Paediatric Occupational Therapy University Program Curricula in New Zealand, Australia, and Canada

Home programmes in paediatric occupational therapy for children with cerebral palsy: Where to start?

Aim: Home programmes are used extensively for children with cerebral palsy. Even though there is consensus about the importance of home programme intervention, there is little evidence of efficacy and scant information regarding programme characteristics that might affect family participation. Instead, research to date has focussed on parental compliance with prescribed programmes and parent–child interactions.Methods: Based on reviewed literature, this article proposes a model to guide development of home programmes for children with cerebral palsy. It is a starting point for therapists to consider the way in which they focus and structure their home programmes for children who have cerebral palsy.Results and Conclusions: The paper identifies an urgent need to develop clinical guidelines for home programmes through rigorous formal processes and to evaluate the impact of occupational therapy home programmes.