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Objective: In Australia, the National Disability Strategy provides a framework to guide actions and investment to achieve equity in social inclusion and economic participation for people with disability. We investigated the social outcomes of school leavers with cerebral palsy (CP) in Victoria, Australia and explored the determinants of desirable outcomes. Methods: We used the Victorian CP Register to invite all adults with CP aged 18–25 years (n = 649). On-line and/or paper-based surveys explored participation in education, employment, community activities, living situation, relationships and life satisfaction. Functional and health status data were collected. Social outcomes were summarized descriptively and compared between individuals with CP and non-disabled peers aged 18–25 years from the Household Income and Labor Dynamics in Australia dataset. Within the CP cohort we explored whether physical and mental health and level of functioning were associated with social outcomes. In addition, a descriptive comparison was undertaken between the social outcomes of the current CP cohort with that of a previously reported 2007 cohort. Results: Ninety participants (57% male; mean age 22.4 years (SD: 2.2) in 2020; 61.1% self-reported) provided data for analyses; response rate 16.9%. CP characteristics were similar between respondents and non-respondents. In comparison to similar aged peers, 79.8% had completed secondary school (compared to 83.2%); 32.6% (compared to 75.8%) were in paid work; 87.5% (compared to 48.2%) were living in their parental home; and 3.4% (compared to 31.6%) were married or partnered. Individuals with CP and higher levels of functional capacity and better physical health were more likely to undertake post-secondary education. Higher levels of functional capacity and physical health, as well as lower mental health status were associated with being employed. Conclusions: While foundational education completion rates were similar to non-disabled peers, significant gaps in social outcomes remain, including residence in the parental home and single status. While addressing these issues is challenging, substantial efforts are needed to reduce these disparities—work that needs to be done in collaboration with people with CP and their families. [ABSTRACT FROM AUTHOR]

Purpose: This study identified occupational therapists' viewpoints that guide their practice of upper limb orthosis prescription for children with cerebral palsy (CP). Methods: A qualitative study utilising Q methodology explored participants' viewpoints. Thirty-nine occupational therapists (38 females) were purposively recruited to rank statements generated from interviews of experienced clinicians and peer reviewed and published literature. Statements about reasons for orthoses prescription, were ranked according to what guides decision making the most to least. Data from ranked statements were analysed using by-person factor analysis to reveal the different ways statements were grouped. The resultant factors, based on the average arrangement of statements associated with each factor, were interpreted and named as viewpoints. Results: Viewpoints identified: 1. Potential effect of the orthosis (n = 12 sorts); 2. Biomechanical presentation (n = 12 sorts); and 3. Client/therapist relationship (n = 10 sorts). The "Client's goals" statement was ranked highest across all viewpoints. Conclusions: Viewpoints identified may inform development of clinical guidelines. Further research is required to (i) identify valid and reliable classification and assessment tools to guide decision making; and (ii) establish the mechanism of the effect of orthotic intervention by considering the link between the biomechanical purpose of the orthosis (e.g., mobilise tissue) and aim of intervention (prevent contracture). Q methodology provided an opportunity to identify viewpoints of occupational therapists that guide their upper extremity orthosis prescription decision making. Consistent with best-practice, clients' goals were the primary focus of decision making in each viewpoint. It is recommended that clinicians consider the identified viewpoints; 1) the potential effects of the orthosis, 2) the biomechanical presentation of the child, within 3) an established client/therapist relationship when prescribing upper extremity orthoses. Practice guidelines to inform upper limb orthotic intervention may be developed using the identified viewpoints. [ABSTRACT FROM AUTHOR]

Purpose: To assess the feasibility of an intervention to improve participation in leisure activities of adolescents with physical impairments by changing aspects of the activity or environment.Methods: A pre-test/post-test pilot study of a multi-strategy intervention was used to explore the effectiveness of the strategies and to determine whether the intervention was practical to apply in a community setting. The intervention involved establishing adolescent and family focused goals, measuring and addressing environmental barriers and building activity performance skills. The Goal Attainment Scale (GAS) and the Canadian Occupational Performance Measure measured outcomes.Results: Eight participants (aged 12–19 years; five males) with physical disabilities set participation goals using a structured approach. Analysis of personal and environmental barriers and facilitators for participation guided the choice of intervention strategies to support goal attainment. The natural environment, government policies and availability of transport were identified as the most frequent barriers to participation in leisure. Support to secure appropriate devices to enable participation was commonly required. As a group, attainment of 12 of 17 GAS goals, and progress on four more goals, was demonstrated.Conclusions: The intervention model was applicable and practical to use in a community therapy setting and the majority of the participation goals set were achieved.Implications for RehabilitationThis ICF-based intervention model was applicable and practical to use in a community therapy setting.The majority of the adolescent’s leisure participation goals were achieved following engagement in the multi-strategy intervention.Adolescents with sufficient communication skills (CFCS Levels I–III) benefited from a group-based intervention in addition to individualised support. [ABSTRACT FROM AUTHOR]

OBJECTIVE. We examined the interrater reliability and clinical utility of the Personal Care Participation Assessment and Resource Tool (PC-PART) in a rehabilitation setting. METHOD. Ninety-six patients were recruited from the caseload of four occupational therapists. Patients were assessed on admission. Clinical utility was based on time to complete assessments. RESULTS. Interrater reliability for the total score was very high (intraclass correlation coefficient = .91). Limits of agreement for the program indicated aggregate data from individual scores were within 1.3 units (range = 21.3 to 0.5) but individual scores would be within 10 units (range = 29.3 to 0.2). The PC- PART took 27 min to complete. CONCLUSION. The PC-PART may have sufficient interrater reliability and clinical utility to evaluate program outcomes. The limits of agreement for rating individuals were relatively large, suggesting that it may be difficult to use the PC-PART to make clinical inferences about an individual patient. [ABSTRACT FROM AUTHOR]

Background Positive participation outcomes are deemed the ultimate goal of health care and specifically of occupational therapy. Knowledge of the typical participation patterns of children in Australia will provide essential information to support our understanding of participation and the goal of maximising children's engagement. Aims This study investigated the participation of Grade 6 and Year 8 Victorian students in activities outside school and explored differences between genders and between students in different year levels. Secondarily, we began to establish Australian normative data on the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children. Methods This cross sectional survey methods study recruited students from a random selection of public schools. Participation was measured using the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children questionnaires. Results Participants included 84 (37 female, 47 male) students in Grade 6 (n = 43) and Year 8 (n = 41). Differences between year levels were only evident for participation in Recreational and Active Physical activities. Grade 6 students did more activities, more intensely than Year 8 students, but with no difference in enjoyment. The mean number of Recreational activities done by Grade 6 students was 8.5 (95% CI: 7.9-9.1) compared to Year 8 students 6.9 (95% CI: 6.1-7.7; P = 0.001). Gender differences were evident in the participation patterns within Social, Skill-Based and Self-Improvement activities. Conclusion The findings suggested that gender was a more important influence on participation patterns than a 2-year age gap, with participation patterns being relatively stable between Grade 6 and Year 8. [ABSTRACT FROM AUTHOR]

Aim This paper reports the second phase of a study to extend the Melbourne Assessment for use with children with neurological impairment aged 2 to 4 years. The aim was to establish if (1) children's scores on the Modified Melbourne Assessment (MMA) and the Quality of Upper Extremity Skills Test (QUEST) showed a moderate to high, positive relation, (2) children had comparable behaviours for task and time demands on both tools, and (3) scores on the MMA could discriminate between children with mild, moderate, and severe levels of upper limb impairment. Method An observational study of 30 children (19 males, 11 females) with neurological impairment aged 2 to 4 years. Twenty-four children had spasticity (20 with a unilateral and four with a bilateral impairment) and two children presented with athetosis, two with ataxia, and two with hypotonia. Results A high, positive relation was found between children's scores on the MMA and the QUEST ( ρ=0.90; p=0.001). The clinical use of the MMA was comparable to the QUEST. MMA scores were able to discriminate between children's levels of upper limb impairment as determined by clinicians' ratings ( F2,27=67.76, p=0.001). Interpretation These findings suggest the MMA can be clinically useful for children as young as 2.5 years and has the advantage of being valid for use with older children. Scores from the tool can also provide therapists with a quantitative means of consistently reporting level of upper limb impairment. [ABSTRACT FROM AUTHOR]

OBJECTIVE. This study describes the sensory processing abilities of children ages 3-10 who sustained a moderate or severe traumatic brain injury (TBI). METHOD. We used a prospective, descriptive study design with convenience sampling of 20 children who were admitted to a pediatric neurosurgical unit. Caregivers provided information regarding their child's sensory processing abilities using the Sensory Profile (Dunn, 1999). We also collected demographic information related to the mechanism and severity of injury. Data were analyzed descriptively, and summary statistics were used to describe the Sensory Profiles of the children in comparison to normative data. RESULTS. Proportionally more children with TBI than children in the normative sample demonstrated behaviors outside of the typical range in all sections of the Sensory Profile except for oral sensory processing. CONCLUSION. These findings strongly support the need to include evaluation of sensory processing in any clinical assessment of children who have sustained TBI. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the participation of children with cerebral palsy (CP) in activities outside school and to compare their participation with a large representative sample of children. A population-based survey was conducted of children with CP born in Victoria, Australia in 1994 and 1995. Of 219 living children identified, 114 (52.1%) returned completed surveys. The children (65 males, 49 females) were aged between 10 years 9 months and 12 years 9 months (mean age 11y 9mo, SD 6mo). Thirty-eight per cent had hemiplegia, 23% diplegia, 4% triplegia, 34% quadriplegia, and 1% was of unknown topography. Distribution according to the Gross Motor Function Classification System (GMFCS) was 22.8% Level I, 36% Level II, 10.5% Level III, 8.8% Level IV, and 21.9% Level V. Distribution according to the Manual Ability Classification System (MACS) was: 19.3% Level I, 38.6% Level II, 14.0% Level III, 8.8% Level IV, and 19.3% Level V. Participation was measured using the Children's Assessment of Participation and Enjoyment. Participation in selected sport, cultural, and quiet leisure activities was compared with population-based data for 11-year-olds from the Australian Bureau of Statistics. Children with CP undertook a median of 26.5 activities (interquartile range 10) in 4 months which were commonly informal rather than formal. Intensity of participation was low. Diversity and intensity of participation was similar for children in each level of the MACS and the GMFCS, except for participants in Level V. More children with CP participated in organized sports ( p<0.001) compared with other Australian children, although with lower frequency ( p<0.001). Participation diversity and level of intensity of Australian children with CP were similar to those reported in a Canadian study. [ABSTRACT FROM AUTHOR]

Background: The Personal Care Participation Assessment and Resource Tool (PC-PART) is a 43-item, clinician-administered assessment, designed to identify patients' unmet needs (participation restrictions) in activities of daily living (ADL) required for community life. This information is important for identifying problems that need addressing to enable, for example, discharge from inpatient settings to community living. The objective of this study was to evaluate internal construct validity of the PC-PART using Rasch methods., Methods: Fit to the Rasch model was evaluated for 41 PC-PART items, assessing threshold ordering, overall model fit, individual item fit, person fit, internal consistency, Differential Item Functioning (DIF), targeting of items and dimensionality. Data used in this research were taken from admission data from a randomised controlled trial conducted at two publically funded inpatient rehabilitation units in Melbourne, Australia, with 996 participants (63% women; mean age 74 years) and with various impairment types., Results: PC-PART items assessed as one scale, and original PC-PART domains evaluated as separate scales, demonstrated poor fit to the Rasch model. Adequate fit to the Rasch model was achieved in two newly formed PC-PART scales: Self-Care (16 items) and Domestic Life (14 items). Both scales were unidimensional, had acceptable internal consistency (PSI =0.85, 0.76, respectively) and well-targeted items., Conclusions: Rasch analysis did not support conventional summation of all PC-PART item scores to create a total score. However, internal construct validity of the newly formed PC-PART scales, Self-Care and Domestic Life, was supported. Their Rasch-derived scores provided interval-level measurement enabling summation of scores to form a total score on each scale. These scales may assist clinicians, managers and researchers in rehabilitation settings to assess and measure changes in ADL participation restrictions relevant to community living., Trial Registration: Data used in this research were gathered during a registered randomised controlled trial: Australian and New Zealand Clinical Trials Registry ACTRN12609000973213. Ethics committee approval was gained for secondary analysis of data for this study.

Aim: To test the effectiveness of repeat botulinum toxin A (BoNT-A) injections in the affected arm of 22 children with hemiplegic cerebral palsy (19 males, three females), aged 1 year 10 months to 4 years 10 months (mean 3y 8mo, SD 9mo) in a randomized controlled trial., Method: Children received either three series of BoNT-A injections plus twice-weekly occupational therapy (OT) or OT alone in 16-week cycles. Muscles targeted at each injection cycle in the 11 children receiving BoNT-A+OT were the adductor pollicis (n=9), flexor pollicis longus (n=5), flexor digitorum superficialis (n=8), flexor digitorum profundus (n=8), flexor carpi radialis (n=2), flexor carpi ulnaris (n=6), pronator teres (n=10), and biceps brachii (n=11). Parental perception of treatment efficacy was assessed using the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS), quality of movement using the Quality of Upper Extremity Skills Test (QUEST), fine motor skills using the Peabody Developmental Motor Scale - Fine Motor (PDMS-FM), and spasticity using the Modified Tardieu Scale (MTS). Between-group differences at 12 months were analysed using independent-sample t-tests., Results: All children were at Gross Motor Function Classification System levels I (BoNT-A+OT n=6; OT n=8) or II (n=5 and n=3 respectively) and were too young to be classified using the Manual Ability Classification System. The BoNT-A+OT group had higher COPM performance scores (mean difference -0.8, 95% confidence interval [CI] -1.5-0.0) and higher GAS T scores (mean difference -6.9, 95% CI -13.8 to -0.1]). No significant difference was found for the COPM satisfaction, PDMS-FM, or QUEST scores. The BoNT-A+OT group showed progressive reduction in spasticity compared with the OT group. At study completion MTS mean difference was 50.0 degrees (95% CI 22.4-77.6) for pronators and 20.9 degrees (95% CI 2.4-39.4) for wrist flexors., Interpretation: Repeat BoNT-A injections in the upper limb combined with OT resulted in progressively reduced spasticity and improved parental perception of performance.