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Introduction Thrombolysis with tissue plasminogen activator is a mainstream treatment for ischemic stroke. Known risks with thrombolysis include intracerebral hemorrhage and bleeding elsewhere in the body. There are no specific recommendations for the timing of commencing mobility rehabilitation after thrombolysis. Research evidence for early mobilization (within 24 hours) after thrombolysis is sparse and little is known about physiotherapy practice in the UK. Purpose: This exploratory study aimed to investigate the experiences, including clinical decision-making of physiotherapists in England and Wales regarding early mobilization after thrombolysis. Methods A qualitative study with interpretative paradigm using a phenomenological methodology. Semi-structured interviews were conducted with a purposive sample. Thematic analysis triangulated by participant and researcher review of resultant themes was supported by NVivo software. A reflexive diary was maintained throughout. Results Data saturation was reached after 14 interviews. All participants reported experience of early mobilization after thrombolysis, with no reported harm or serious incident. Themes included descriptions of practice, perceived benefits and harms, and implementation of risk assessment and management strategies. Conclusions Physiotherapists describe a variety of practices with careful implementation of any early mobilization after thrombolysis. Common factors of risk assessment reported by participants could contribute to guideline development.

Key points • This chapter will describe two research projects carried out with disabled children and young people in the United Kingdom (UK) about what it means to the emotional wellbeing of disabled children and young people to join in meaningful recreational activities. • It begins with the links between health, recreation and childhood regarding disabled children. • The perspectives and stories by disabled children and young people presented illustrate the agency and fun enjoyed in recreation as well as relationships with others that includes issues of inclusion. • Recreation is different to therapy and treatments in terms of functional goals, but this chapter suggests that some important goals of therapy and health can be met by recreation and importantly, the objectives of fun are added. • Policy implications include the case for equality of opportunity for disabled children to play and participate in all activities, and to voice their experiences and ideas for future recreational activities. • This chapter shows that a simple cost saving objective for NHS and Social Services needs caution as holistic care and participation requires investment if it is to be successful and have any real impact for disabled children.

Aims: To explore the effect of participation in adapted cycling on quality of life for children with Cerebral Palsy (CP). Methods: Qualitative approach developing Creative Mosaic Methods using interviews and diaries. This study had two groups of children with CP, those who participated in adapted cycling and a control group who had not yet started. Children with CP aged 2-17 years who were already cycling were invited to take part in two interviews at the beginning and end of a 6 week period and keep a cycling diary during this time. The control group of children with CP aged 2-17 years were asked to keep a diary of physical activities over 6 weeks and to take part in one interview at the end. Welsh, English, Bengali and Arabic were the languages spoken and some children used communication aids. Results: Results presented here include the first 25 children’s interviews and diaries. The emergent themes from the analysis are: Learning a new skill, the impact on wider family and friends, social participation and future aspirations. The diaries added an emotional dimension, by illustrations drawn by the children. Conclusion: The children who took part in adapted cycling enjoyed this experience and it improved their sense of well being. Some in the control group went on to participate in adapted cycling. Physiotherapists can carry out creative research to hear the voices of children and young people with CP and incorporate their views and ideas into the development of service model delivery and treatment programmes.

Background: Children with cerebral palsy can have limited activity levels and decreased muscle strength. Adapted dynamic cycling, using adapted cycles, may increase their activity levels and strength. This pilot study investigated the effects of six adapted dynamic cycling sessions on lower limb muscle strength. Method: The School of Healthcare Studies Research Ethics Committee, Cardiff University, provided ethical approval. Parents and children volunteered for participation following written informed consent. In a same-subject experimental design, four bilateral quadriceps and hamstring strength measures were recorded at 90 degrees knee flexion, while seated. Children participated in six adapted dynamic cycling sessions over 8 weeks using an outdoor circuit, increasing time and distance cycled as able. Results/Findings: Eleven children (5 boys, 6 girls) aged 2.6–17.8 years (SD 5.56) participated. Mean strength differences (right quads=11.51N; SD 3.99; left quads=17.43N; SD 14.96; right hamstrings=8.4N; SD 1.80; left hamstrings=7.4N; SD 1.6) were analysed with non-parametric Wilcoxon’s rank sign test; significance level P

Background: As the prevalence of visual impairment rapidly increases, the services offered by the Canadian National Institute for the Blind (CNIB) will become even more important. As most clients are referred to the CNIB by their ophthalmologist or optometrist, maximising the efficiency of these referrals is the first step in the appropriate delivery of CNIB low vision rehabilitation services. This pilot study examined the barriers that prevent ideal referral practices by ophthalmologists in the Greater Toronto Area to the Toronto District CNIB. Methods: A survey questionnaire was completed by 29 Toronto-area ophthalmologists identified in a simple random sample. Results: Key barriers to referral included misconceptions regarding referral criterion and lack of information regarding CNIB services. Interpretation: Resulting recommendations included an educational campaign to teach Toronto-area ophthalmologists about CNIB services, as well as the necessary criteria for referring patients. There is no minimum...

Introduction: Blindness in young children has been shown to lead to significant motor delay. Few studies to date have evaluated the effects of strabismus and its treatment on motor development. Methods: We evaluated nine children prior to and post eye alignment via strabismus surgery to determine the effect of this treatment on motor development. Developmental milestones using the Bayley and modified Denver developmental scale were recorded prior to and post surgery. Results: It was found that in this study sample there was developmental advancement within days of surgery in every case. Conclusion: We feel that eye alignment at an early age in strabismic children is an important factor contributing to age appropriate motor development as measured by developmental milestones. A method for a larger scale objective study to better define the effect of strabismus surgery on motor development is currently being planned. Language: en

Others have suggested that developmentally delayed children, who are frequently esotropic, have a poor prognosis following esotropia surgery. To date, no comparison of success rates in normal and delayed children following similar surgery has been made. We compared our long-term results following graded bilateral medial rectus recessions in consecutive normal (n = 62) and delayed (n=29) children. We defined success as alignment maintained within 10 Δ of orthophoria. Survival curves were compared using the Mantel-Haenszel statistic. Delayed children had a significantly poorer outcome (p=.05) throughout follow up, which ranged from 12 to 120 months (mean = 24 months). Early in the period of study, we observed a large proportion of overcorrections among the delayed children. Subsequent modification in the amount of surgery performed appeared to improve the initial and long-term success in these children. We conclude that delayed children do have a poorer prognosis than normal children following medial rectus recession. This prognosis may be improved by more conservative amounts of surgery.

IntroductionIn addition to optical devices, closed-circuit televisions (CCTVs) and eccentric viewing training are both recognized interventions to improve reading performance in individuals with vision loss secondary to age-related macular degeneration. Both are relatively expensive, however, either in the cost of the device or in the amount of time personnel need to provide training. In this randomized trial, we compared the effectiveness of these two interventions.MethodsParticipants with age-related macular degeneration and visual acuity between 6/48 (20/160) and 6/120 (20/400) first received basic low vision care, including optical devices. At the subsequent baseline visit, they undertook a battery of measures including logMAR visual acuity; reading speed and accuracy for text in 1.3M and 1M fonts; reading information on medicine bottles, utility bills, and food packages; the NEI-VFQ; the Geriatric Depression Scale; and a reading inventory questionnaire. They were then randomized to either obtaining a CCTV for home use or eccentric viewing training over the following six weeks.ResultsRecruitment was more difficult than expected for this population. Of 145 patients referred, 29 met the inclusion-exclusion criteria, 14 were willing to enroll, and 10 completed the trial. For the primary outcome (reading speed for 1.3M print), there was a significant improvement between baseline and outcome for the CCTV group (p = 0.005), but not for the eccentric viewing training group (p = 0.28), and the CCTV group showed significantly greater change (p = 0.04). There was a nonsignificant improvement in reading speed for 1M text and a decrease in the amount of time taken to read utility bill information in the CCTV group. There was a significant improvement in near visual acuity with current glasses with eccentric viewing training. The other measures did not reach statistical significance.DiscussionRandomized clinical trials for low vision rehabilitation, particularly in the elderly population with vision loss, are challenging, but such trials are important for the allocation of resources. This trial showed early indications of more impact on reading performance from CCTV than eccentric viewing training.