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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.

Background and objectives Whilst the evidence base supports the physical health benefits, less is known about the emotional wellbeing effects from participation in recreational activities for children and young people with cerebral palsy. Especially for those who need assistance to walk, are non-ambulant or have difficulty with communication and learning. In Wales, although investment in adapting sporting activities has increased, wider participation in recreational activities remains limited for this group. This lack of choice for meaningful participation for children and young people with cerebral palsy, can lead to less participation in adulthood. This is thought to reduce their health related quality of life. The objectives were to explore how children and young people with cerebral palsy and their carers viewed, experienced and chose their level of participation in recreational activities and how they think this impacts upon their emotional wellbeing. Study Design Comparative case study design- Those who participated a lot and those whose participation was limited. Study participants and setting 7 children and young people were recruited via schools, charities and community groups (age range 9-16 years, Levels III-V Gross motor Function Classification System: 4 at IV, 2 at III, 1 at V; Communication Function Classification System: 4 at IV, 2 at III, 1 at V; 4 boys, 3 girls; 4 who participated a lot and 3 whose participation was limited). Materials and methods A qualitative approach was devised. Each case study was comprised of 2 semi-structured interviews 12 weeks apart, a diary written in between, plus some observations at one of their usual activities during this time. Visual images were taken during the observations as well as field notes written. Some parents took images to add to the diary. Two of the participants were interviewed via their communication aids which gave insight into their experiences and choices. However to ascertain their views it had to be reported by proxy via the parents, as it was not possible to probe further with their limited vocabulary. The 5 who were not able to communicate directly were observed and the parents were interviewed. The data was managed with NVIVO and analysed according to Braun and Clark’s six stages of thematic analysis. Results The 7 cases generated 212,843 words, 220 images, from 18 hours of interviews, 7 diaries and 15 hours of observation across both data sets. Themes were identified that reflected both Intrinsic factors with their Idiosyncratic ways to communicate well-being and Extrinsic factors including People’s Attitudes towards Disabled Children. Those in the participatory group had a vast range of experiences that supported a positive emotional well-being state. These activities included surfing, skiing, bike riding, Race Running, swimming, horse riding, uniformed clubs, trampolining and some craft activities. These were attributed to innovative designs. Those who participated less encountered barriers from pervasive ‘Can’t do’ attitudes and environments or equipment that had not been adapted for their needs. Only 1 child had evidence of the Leuven Scale for emotional well-being and involvement for non-verbal children, being used in school. Conclusion/Significance The case study method enabled rich data to be collected to represent their views, experiences and choices. More needs to be developed to reliably capture this group of children and young people’s emotional well-being.

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.

Children and youth with Cerebral Palsy (CP) have limited opportunities for participation. These qualitative results are part of a mixed methods study exploring the effects of participation in physical activities including adapted cycling.\ud Objectives:\ud The first aim was to explore physical activity participation of children and youth with CP. The second aim was to introduce information about adapted cycling and explore if they would participate in the future.\ud Methods:\ud Mosaic methods were adapted and this involved the use of puppetry, pictures and drawing and they also kept a written diary.\ud Results:\ud 18 participants were recruited aged 2–13, 11 male, 7 female resulting in 17 interviews and 15 diaries. The participants had a range of communication abilities, 10 spoke verbally, 3 were nonverbal, 2 used Makaton signing and 3 had dysarthria. The data were managed in NVIVO and analysed with coding using a template approach. The themes which emerged revealed some barriers and encouragers of physical activity participation represented by a ‘Wheel of Participation’. The interview and diary data enabled their voices to be heard as their ‘Mosaic’ was built up through this iterative analytic process. 11 of the 18 children actually tried adapted cycling following the provision of written information.\ud Conclusion:\ud This change behaviour was positive and further research should explore habitual participation in physical activities such as adapted cycling. By hearing their perspectives about participation in physical activities and cycling, the experiences described suggest there are now some enjoyable opportunities for participation for children and youth with CP.

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...

The study aims to explore the effect of participation in adapted cycling on quality of life for children with cerebral palsy (CP).The study used a 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 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.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.

This chapter will describe the challenges of designing rigorous research studies with disabled children and young people. The issues of gaining consent /assent are explored as well as seeking ways to represent children’s views who do not have spoken language. Ethical issues that impact on the rigour of research studies with children and young people with disabilities will be outlined. Examples of research done with children who have cerebral palsy will be used. This will illustrate decisions not to include children where coercion was felt to take advantage of their vulnerability and assent could not be assumed. Carrying out research with children without the parent’s present was not considered good practice; a discussion around the age for consent will be outlined. Finding ways to manage data protection, lone working and child protection were areas requiring strategies for safe practice. Transferable skills are identified from physiotherapy practise to research, including skills in communicating with children and young people with disabilities and team working. There is a need to recognise that boundaries change when working in different environments. The change of role for the researcher to an ‘enquirer’ of the topic rather than a ‘service provider’ requires some adaption. New skills need to be developed in completing applications for National Research Ethical Service and NHS Trust Research and Development requiring patience and perseverance and infinitely more time than one can imagine.

Purpose Children and young people with Cerebral Palsy have limited opportunities for participation and there has been limited research to explore this concept. Adapted dynamic cycling (ADC) is one activity that can enable them to participate in the community. The aim of this paper is to report the views and experiences of children and young people with CP and their families regarding their participation in (ADC). Methods This was part of a mixed methods study of which the qualitative findings are reported here. Iterative creative methods were developed which involved semi structured interviews and diaries about the ADC experience. Results The themes that emerged were the staff and the environment at the cycling hire project, the facilitators and barriers to ADC, the technical set up of the bike and the impact on the child and family in terms of developments over time, future aspirations, learning cycling skills, social participation and health benefits. Conclusions The data showed that children’s experiences of ADC were fun and enjoyable. This fun exercise should be incorporated into a physiotherapy programme as part of the child or young person with CP’s rehabilitation. Policy makers and parents may find the information useful to increase the child’s participation.

This paper describes the experience of 'Pamela*, mother of a child with spina bifida, diagnosed prenatally. It was disclosed during a research project exploring 'Family Centred Care' (FCC) with disabled children, and a very challenging ethical dilemma arose. This mother felt unsupported in her decision to go ahead with having her baby with spina bifida; this was in contrast to the support she received for her disabled child, once born. The discussion will focus around the challenge of supporting parents in decision making in midwifery and health care practice.

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

The use of observation, child conferencing, interviews, and the child’s own photographs can contribute to a mosaic about their early years nursery experiences. The pre-school children gave the observer a tour of their nursery and made maps of the different rooms, meaning the mosaic encompassed what was important to them from their perspective; parental views were added to this. Paige-Smith and Rix (2011) adapted the mosaic approach by using photographs to listen to children with Down’s syndrome. They describe in detail how the pictures were used as the basis for the interview discussion with children and their parents. The researchers gave an example of how the child made choices within a physiotherapy session, but they suggest the child disengaged

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.