Strategies to promote activity and participation in children and youths with acquired brain injuries

Strategies used by hospital and community-based rehabilitation and educational professionals and parents for promoting activity performance and participation of children and youths with acquired brain injuries (ABI) in the hospital, at home, at school and in the community are described in this article. Semi-structured interviews with interdisciplinary staff from a pediatric rehabilitation hospital in the Northeast USA and focus groups comprised of hospital and community-based educational and rehabilitation professionals and parents were conducted. Interviews and focus groups were audiotaped, transcribed verbatim and qualitatively analyzed. The strategies described fell into three categories: Routine, Repetition, and Consistency; Supports and Models; and Curriculum and Environmental Modifications. In addition, three broader factors emerged related to the use of strategies: Communication; Age, Development and Recovery Time; and Attitudes and Expectations. Findings may provide insights to professionals and families to promote activity performance and participation in children and youth with acquired brain injuries across the continuum of care.     

Exploring postinjury living environments for children and youth with acquired brain injury

DeMatteo CA, Cousins MA, Lin C-YA, Law MC, Colantonio A, Macarthur C. Exploring postinjury living environments for children and youth with acquired brain injury.

Objectives

To explore and describe the extent to which children and youth (10−18y) with acquired brain injury in Ontario are living in environments considered inappropriate, to describe the nature of services and supports in those environments, and to determine appropriate living environments for children and youth with acquired brain injury.

Design

A mixed-methods approach with a case-study design was used in which the living environment represented the case. This article reports on the qualitative component.

Setting

Community agencies and service providers.

Participants

Forty-four service providers across a wide range of profit and nonprofit services for children and youth with acquired brain injury throughout the province of Ontario.

Interventions

Not applicable.

Main Outcome Measure

Semistructured in-depth interviews with participants.

Results

Seven major themes emerged from the data: kids go home, a continuum of appropriateness, show me the way home, same chapter different story, cracking the acquired brain injury code, who said care was fair, and coping, and managing and advocating: new dimensions for families. Important service recommendations were also reported.

Conclusions

Most children and youth with acquired brain injury are living at home. The level of appropriateness of the environment for children and youth after acquired brain injury can depend on multiple interrelated factors including type and severity of acquired brain injury, existing services and service delivery, acquired brain injury knowledge, and family's ability to cope and manage.     

The use of antidepressants in school-age children.

Approximately 5% of the pediatric population suffers from depression. Children suffering from depression should be treated first with some type of psychotherapy, cognitive therapy, and/or education. Pharmacotherapy (medications) should be used only as a last resort for those children suffering from severe, chronic, or recurring depression. The only antidepressant approved by the U.S. Food and Drug Administration for the treatment of depression in children is fluoxetine (Prozac), a selective serotonin reuptake inhibitor. In the school setting, children should be monitored closely upon the initiation of antidepressant therapy and changes in dosing or medication. They also should be monitored for side effects of the medication, response to therapy, and new signs of depression or worsening symptoms. After starting an antidepressant, children must be monitored closely for any changes in behavior, especially increased preoccupation with suicide. Any changes should be reported to the physician immediately for follow-up.     

Optimizing social participation in community-dwelling older adults through the use of behavioral coping strategies

Purpose: This study aimed to (1) determine the categories of behavioral coping strategies most strongly correlated with optimal seniors’ social participation in different activity and role domains and (2) identify the demographic, health and environmental factors associated with the use of these coping strategies optimizing social participation. Method: The sample consisted of 350 randomly recruited community-dwelling older adults (≥65 years). Coping strategies and social participation were measured, respectively, using the Inventory of Coping Strategies Used by the Elderly and Assessment of Life Habits questionnaires. Information about demographic, health and environmental factors was also collected during the interview. Results: Regression analyses showed a strong relationship between the use of cooking- and transportation-related coping strategies and optimal participation in the domains of nutrition and community life, respectively. Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors’ residence were correlated with greater use of transportation-related strategies. Conclusions: Our study helped to identify useful behavioral coping strategies that should be incorporated in disability prevention programs designed to promote community-dwelling seniors’ social participation. However, the appropriateness of these strategies depends on whether they are used in relevant contexts and tailored to specific needs.

• Implications for Rehabilitation

• Our results support the relevance of including behavioral coping strategies related to cooking and transportation in disability prevention programs designed to promote community-dwelling seniors’ social participation in the domains of nutrition and community life, respectively.

• Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors’ residence were correlated with greater use of transportation-related strategies. These factors should be considered in order to optimize implementation of these useful strategies in disability prevention programs.

• The appropriateness of these selected strategies depends on whether they are used in relevant contexts and tailored to specific needs.

     

Exploring variables among medical center employees with injuries: developing interventions and strategies.

Data for this study were collected via retrospective chart review. The study shows the variables associated with work related injury (WRI) in Central Arkansas Veterans Healthcare System medical center employees from 1998 to 2000 in terms of age, gender, employment type, employment status, shift length, body mass index (BMI), workers' compensation claims prior to current employment, employee health and wellness activity attendance, lost time claims, medical/loss of productivity costs. Notable characteristics of injured employees included advancing age, female gender, long working hours, increased BMI, history of prior back and upper extremity injuries, no health and wellness activity attendance, and lost time with injury. Back and shoulder strain, falling accidents, and repetitive motion injuries were the most severe and costly injuries. Further study of medical center employees is warranted to determine risk factors for WRI and develop appropriate protective interventions and safety promotion strategies.     

Time use of mothers with school-age children: a continuing impact of a child's disability.

OBJECTIVE: The purpose of this study was to compare the time use of mothers of children with disabilities with the time use of mothers of children without disabilities. METHOD: Sixty mothers with children 3 to 14 years of age (30 mothers with children with disabilities and 30 mothers with children without disabilities) completed time diaries over seven 24-hour days. RESULTS: Significant differences were found between the two groups when comparing mean hours spent per week by mothers in occupations involving child-care activities and recreational activities. Mothers of children with disabilities spent significantly more time in child-care activities and significantly less time in recreational activities. In addition, mothers of children with disabilities reported fewer typical days and rated the quality of days as poorer. As children got older, the gap between the time mothers devoted to child care increased between the two groups. CONCLUSION: The type of occupations a mother participates in varies significantly dependent upon whether a child in the family has a disability and the age of the child. Professionals need to work collaboratively with families to assist parents to meet the family's daily needs particularly in light of the time demands of the mother.     

Impact of comprehensive day treatment on societal participation for persons with acquired brain injury

OBJECTIVES: To evaluate comprehensive day treatment (CDT) for survivors of brain injury by time since injury and to identify outcome predictors. DESIGN: Before and after. SETTING: Rehabilitation center. PARTICIPANTS: Ninety-six program graduates; 17 dropouts with acquired brain injury. INTERVENTIONS: Comprehensive Day Treatment Program: daily group sessions to build cognitive and behavioral skills through a transdisciplinary approach, supportive feedback, and a variety of therapeutic modalities. Obtained outcome measures before and after the program, and at 1-year follow-up. MAIN OUTCOME MEASURES: Outcome: Independent living status, vocational independence scale at program end and 1-year follow-up; and Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and goal attainment scaling (GAS) at program end. Predictors: age, education, severity of initial injury, time since injury, and preadmission MPAI-22. RESULTS: Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1-year follow-up for those treated postacutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, and 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury. CONCLUSIONS: CDT improves societal participation even among persons with a long history of limited participation after brain injury. This de facto extended baseline analysis indicates the effectiveness of CDT and paves the way for randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational reintegration are needed for those most severely disabled after brain injury.     

Perceived self-efficacy is associated with social participation in adults with traumatic brain injury

BACKGROUND: Identification of the factors facilitating the social participation of adults who have sustained a traumatic brain injury can help occupational therapists with the direction for their interventions. Earlier studies centered on identifying the socio-demographic characteristics and the disabilities associated with social participation. PURPOSE: The aim of this study was to examine the association between perceived self-efficacy, a positive concept derived from social cognitive theory and social participation. METHODS: A cross-sectional and correlational research design was used with 53 adults who sustained a traumatic brain injury between 1995 and 2000 and lived in their natural environment. Two measuring tools were used: a self-administered questionnaire evaluating the perceived self-efficacy and a questionnaire evaluating social participation, administered by an examiner through a face-to-face interview. RESULTS: The results indicate that the perceived self-efficacy explains 40% of the variance of the social participation. PRACTICE IMPLICATIONS: This association suggests that social cognitive theory can constitute a reference model for occupational therapists working with this clientele.     

Perceptual-motor function of school-age children with slow handwriting speed.

OBJECTIVES: This study investigated differences in perceptual-motor measures and sustained attention between children with slow and normal handwriting speed and the relationship between these factors. METHOD: Thirty-four slow handwriters and 35 normal speed handwriters (7 to 11 years of age) attending elementary schools in Taiwan were given three perceptual-motor tests and a vigilance task to assess sustained attention. Performances on these measures were analyzed using multivariate analysis of variance and regression analyses. RESULTS: A significant difference was found between slow and normal handwriters in upper-limb coordination, visual memory, spatial relation, form constancy, visual sequential memory, figure ground, visual-motor integration, and sustained attention. The three significant predictors of handwriting speed for the slow handwriters were age, visual sequential memory, and visual-motor integration. For the normal speed handwriters, age and upper-limb speed and dexterity were the only two significant predictors. CONCLUSIONS: Slow and normal speed handwriters responded to handwriting demands through different perceptual-motor systems. Whereas upper-limb speed and dexterity seems to play an important role in normal speed handwriters, slow handwriters seem to rely more on visually directed processes, including sequence memory and visual-motor integration.     

Early community outreach intervention in children with acquired brain injury

Ten patients with acquired brain injury were recruited over an 18 month period in the south-western health care region of Sweden in order to evaluate the costs and effectiveness of a multidisciplinary community outreach intervention programme. An experienced multidisciplinary project team was involved and patients underwent detailed functional, cognitive and motor assessments following initial contact within two weeks of injury, within six weeks of injury and at a 12-month follow-up. An individualized counselling programme was also offered. Of an expected recruitment number of 50 patients (based on epidemiological and population based figures) 10 children were reached, evaluated and followed; eight patients with traumatic brain injury (five severe, two moderate and one mild), and two patients with non-traumatic brain injury (both severe). At follow-up there was a significant improvement in motor function. No significant changes were seen in other areas of functional assessment or on neuropsychological measures although there were mild improvements in communication and behaviour functions. The financial costs per patient in the programme were deemed relatively modest compared with cost estimates of shorter-term in-patient rehabilitation. Time intensive interventions included supporting caregivers and school staff and the direct and indirect patient interventions were shown to enhance support and promote active involvement of local services.     

Using video-capture virtual reality for children with acquired brain injury

Objective.?To assess the use of a video-capture projected VR system for children with acquired brain injury (ABI), and to compare their performance to that of matched healthy controls.

Subjects.?Thirty-three children (age range: 6–11.4 years) were divided into two groups: 17 children with ABI and 16 controls matched for age, gender and maternal education.

Methods.?Participants experienced three video-captured virtual environments and completed the SFQ child at the end of each specific environment. Participants with ABI experienced three virtual reality (VR) sessions over a period of 10 days. Attention was evaluated using the TEA-Ch. Upper extremity motor abilities were evaluated with the Melbourne Assessment, and self-care abilities were evaluated with the PEDI.

Results.?The video-capture projected system differentiated between the performance of children with ABI and control participants. There was a correlation between VR performance and some attention factors and self-care abilities. No significant correlations were found between performance in the Melbourne assessment and performance within VR.

Conclusions.?The results highlight the potential of the video-capture virtual reality as a tool in the rehabilitation process of children with ABI.