Injury prevention for children with disabilities

Little injury data exists for children who have disabilities. There is an urgent need to address injury prevention and to improve safety standards for this group. Understanding the epidemiology of injuries will allow clinicians to accurately advise patients and their families on individual risks and counsel them in steps to take to reduce those risks. Safety information must be tailored to consider each child's functional impairments. All children who have disabilities are at risk for maltreatment. Open discussion of this problem is warranted given the immensity of the problem. Identifying parental concerns and supporting parents in the use of respite resources are appropriate. For children who have problems in mobility, falls are the number one concern. Collaboration with reliable vendors and therapists that adhere to standards for safe seating is essential for reducing the risk of wheelchair tips and falls. In addition, therapists should be directed to provide mobility training for activities from safe transfers to street crossing in a community setting. Parents should be counseled to approach their child's injury risk based on the child's cognitive and behavioral level rather than their chronological level. Knowledge of the child's developmental quotient or intelligence quotient will also allow the clinician to accurately formulate an injury prevention plan. Many children will always need supervision for tasks that put them in situations of injury risk (i.e., swimming, street crossing, bathing). Sensorineural deficits such as blindness or deafness create significant alterations in negotiating the environment and an increased risk of injury. Awareness of the special needs for fire risk reduction and street safety are critical in this population. The collection of injury data is critical to define the scope of the problem and to influence changes in policy and the development of technical standards. Educational efforts focused on safety should include pediatricians, rehabilitative therapists, social workers, teachers, parents, and--most importantly--the empowerment of children as they age injury-free into adults. SUGGESTED STRATEGIES: A national injury surveillance system for children who have disabilities should be developed to identify injury risk factors for children with disabilities. Children with disabilities should be monitored as a separate risk group in data collection regarding injuries. Parents should be aware of the cognitive level of their child and its influence on their injury risk. Crash testing on passenger restraints should include crash dummies whose physical characteristics resemble those of children who have disabilities. Families should have an emergency evacuation plan with specific consideration of their disabled child in the event of an emergency. Risk of burns to insensate skin and risks of thermal and friction trauma should be discussed when appropriate. The fire department and the police department should be notified of the presence of a child who has a disability in the home. Parents must be aware of the risk of falls to children who are mobile but cognitively impaired and to those in wheelchairs regardless of cognitive ability. Hospitals must have Child Protective Services teams with specific training in abuse to children with disabilities. Discussion of maltreatment risk should be addressed during routine office visits and appropriate resources should be made available to provide support to families. Educational programs should be developed to alert providers to the risks of abuse of children who have disabilities.     

Safe transportation for children with disabilities

Few guidelines are available on providing safe transportation for children who cannot use conventional auto restraints. This article discusses the misuse of restraints and reviews several modified car seats and other restraints that have been tested and that meet safety standards.     

A fitness program for children with disabilities

BACKGROUND AND PURPOSE: This case report describes a fitness program for children with disabilities and provides preliminary information about the safety and feasibility of the program. CASE DESCRIPTION: Nine children, 5 to 9 years of age with physical or other developmental disabilities, participated in a 14-week group exercise program held 2 times per week followed by a 12-week home exercise program. Energy expenditure index, leg strength (force-generating capacity of muscle), functional skills, fitness, self-perception, and safety were measured before intervention, after the group exercise program, and again after the home exercise program. OUTCOMES: No injuries occurred, and improvements in many of the outcome measures were observed. More improvements were observed after the group exercise program than after the home program, and adherence was better during the group exercise program. DISCUSSION: This case report demonstrates that a group exercise program of strength and endurance training may be a safe and feasible option for children with disabilities. Further research is needed to evaluate the effectiveness of a group fitness program and optimal training parameters.     

Participation-based therapy for children with physical disabilities

Purpose: Optimizing home and community participation of children with physical disabilities is an important outcome of rehabilitation. Method: A review of literature identified research and theory on participation of children with physical disabilities. The authors’ incorporated current knowledge to conceptualize the experience of optimal participation, formulate principles of participation-based physical and occupational therapy, and develop a five-step process for intervention. A case report was completed to illustrate application to practice. Results: Optimal participation involves the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Real-life experiences enable children to learn new activities and develop skills that optimize their participation and self-determination. Interventions are: goal-oriented, family-centered, collaborative, strengths-based, ecological, and self-determined. A distinguishing feature of intervention is that the therapist’s primary role is to support the child and family to identify challenges to participation and solutions to challenges. The therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity. Conclusion: The model may have utility for collaboration with families and community providers, determining goals for participation, and providing evidence-informed interventions.

Implications for Rehabiliation

• Home and community participation of children with physical disabilities is an important outcome of rehabilitation.

• Optimal participation is conceptualized as the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation.

• Participation-based physical and occupational therapy is based on the assumption that real-life experiences enable children to learn new activities and develop skills and that the empowerment of families enables them to advocate for the full inclusion and integration of their children in society.

• In participation-based therapy, the therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity.

     

A model of independence for children with learning disabilities

This article outlines the work undertaken to find a suitable model for planning respite care for children with disabilities. The model 'This is Me' and the informal life events assessment tool 'Hello, This is Me!', which supports it, are described. The use of a person-centred care planning system is well documented in the care of adults with learning disabilities (Sanderson, 1997). This process should begin at the start of a person's life, as recommended by The Children Act 1989, and the documents 'Signposts for Success' (NHS Executive, 1998) and 'Don't Forget Us' (Mental Health Foundation, 1997). The article describes the development of a person-centred approach to respite care which is underpinned with a basic care premise.     

Acute postoperative pain control for children with chronic disabilities

Children have historically been undertreated for pain. Children with chronic disabilities may face multiple, complex surgeries that cause severe postoperative pain. In addition, underlying problems with increased muscle tone can cause painful postoperative spasms. Gillette Children's Specialty Healthcare treats children with chronic disabilities. Our orthopaedic surgeons have developed a single surgical approach referred to as "multiple lower extremity procedures" (MLEPs) to correct the patient's primary, underlying orthopaedic deformities all under one anesthesia. Because of the intensity of postoperative pain caused by this approach, Gillette Children's uses epidural analgesia or patient-controlled/nurse-controlled analgesia to manage postoperative pain.     

Cultural considerations for children with intellectual and developmental disabilities

The United States has been and continues to be a multicultural society. Many children are born into two cultures, sharing a different one with each parent. Children with intellectual and developmental disabilities (I/DD) may belong to a minority culture, the additional culture of disability, and the culture of poverty. After an introduction to culture and its characteristics, the focus of this article is on strategies pediatric nurses can use to assess and intervene with minority children with I/DD and their families in a culturally sensitive manner. Suggestions for future research are provided.     

Learning to communicate with children with disabilities

A positive incident during a placement in a special school is used to illustrate that reflecting on positive incidents helps the student nurse to recognise good practice and personal strengths. The incident involving a child's achievement in mastering new communication skills led to improved understanding of the role of the special educational needs teacher and the speech and language therapist and the positive effect of early professional intervention. It also emphasised the benefits of Makaton and picture aids for children with communication problems. A major benefit of the placement experience was that it improved the student's confidence in approaching and interacting with children with special needs and speech difficulties. It also highlighted the value of nurses learning basic Makaton in order to enhance their communication skills. Using reflection to review positive experiences can be as effective in highlighting strengths and weaknesses as reflecting upon negative experiences.     

Disaster preparedness for children with special healthcare needs and disabilities

Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.     

Assessment training and team functioning for treating children with disabilities

OBJECTIVE: To investigate differences in team functioning before and after assessment training. DESIGN: Before-after trial. SETTING: Outpatient rehabilitation and education program in a university medical center-based rehabilitation institute. PARTICIPANTS: A population-based sample of 19 rehabilitation and education specialists. INTERVENTION: Baseline measures were taken during four meetings using the multidisciplinary team approach. Training in a global measure of child development ensued and staff administered the test to children in their care. Test results were then used during four transdisciplinary team meetings. OUTCOME MEASURES: Behavioral ratings of team participation (Transdisciplinary Team Rating Scale), self-report instruments of team development (Team Assessment Questionnaire), treatment planning and goal development (Staff Perception Questionnaire). RESULTS: Results of t tests confirmed two of three hypotheses. There was more team member participation during transdisciplinary meetings than during multidisciplinary meetings (p = .003) and staff members' perceptions of the efficacy of treatment planning and implementation of goals significantly favored the transdisciplinary model (p < .001). No significant difference was found in team development (p = .254). CONCLUSION: This study provides evidence for the value of training in an assessment tool that requires the use of a common, functional language that is comprehensible to all staff members and promotes a transdisciplinary approach to team work.     

A therapy-relevant casemix classification system for school-age children with disabilities

OBJECTIVE: To develop a clinically meaningful classification system of resource-homogeneous groups to describe therapy resource use for school-age children with disabilities. DESIGN: Work-time allocation survey of therapy services (physical therapists, occupational therapists, and speech pathologists). SETTING: Three main disability agencies in Western Australia. CLIENTS: All children of two agencies, a random sample of children of the third. A total of 644 clients and their services were studied. MAIN OUTCOME MEASUREMENT: Minutes of therapy service time expected over a 10-week school term. RESULTS: Forty-six percent of the variance in a measure of time spent with clients can be explained using a classification system of nine groups, based on splitting a mobility measure (4 major groups), then the nature of primary disorder (2 subgroups), independence in self care (3 subgroups), and expressive communication (3 subgroups). CONCLUSION: This study defines a preliminary classification system for the distribution of therapy resources to school-age children with disabilities. This model has the potential to be used to purchase services on a fairer basis than traditional, historical funding methods have allowed.