Caregiving process and caregiver burden: Conceptual models to guide research and practice

BACKGROUND: Parental care for a child with a developmental disability is an enormous responsibility, one that can far exceed that of typical parental care. While most parents adapt well to the situation of caring for a child with a disability, some do not. To understand parents' adaptations to their children's disabilities, the complex nature of stress processes must be accounted for and the constructs and factors that play a role in the caregiving must be considered. DISCUSSION: Evidence suggests that there is considerable variation in how caregivers adapt to their caregiving demands. Many studies have sought to qualify the association between caregiving and health outcomes of the caregivers. Contextual factors such as SES, child factors such as child behaviour problems and severity of disability, intra-psychic factors such as mastery and self-esteem, coping strategies and social supports have all been associated with psychological and/or physical outcome or parents or primary caregivers. In reviewing these issues, the literature appears to be limited by the use of traditional analytic approaches which examine the relationship between a factor and an outcome. It is clear, however, that changes to single factors, as represented in these studies, occur very rarely even in the experimental context. The literature has also been limited by lack of reliance on specific theoretical frameworks. SUMMARY: This conceptual paper documents the state of current knowledge and explores the current theoretical frameworks that have been used to describe the caregiving process from two diverse fields, pediatrics and geriatrics. Integration of these models into one comprehensive model suitable for this population of children with disabilities and their caregivers is proposed. This model may guide future research in this area

Pencil Grasp Pattern: How Critical is it to Functional Handwriting?

This thesis reports the results of a large study to evaluate the kinetics of pencil grasp patterns in terms of speed and legibility of handwriting of children in Grade 4. Current clinical practice as recent as 2008 suggests that teachers identify the dynamic tripod pencil grasp as an optimal pencil grasp for handwriting. Research findings had suggested that three other pencil grasps may be functional for handwriting, though there was still inconclusive evidence upon which to base clinical practice. The purpose of the present study was to: assess the impact of pencil grasp on the speed and legibility of handwriting; to determine the effect of grasp on speed and legibility following a 10-minute copy task intended to induce fatigue; and to describe the axial and grip forces of the four pencil grasps. 120 children were assessed, completing a standardized handwriting assessment before and after a 10-minute copy task. The participants utilized an instrumented pen and wrote on a digitizing tablet, which measured, respectively, the axial and grip forces associated with their grasp patterns. Pencil grasp was not found to impact the speed or legibility of the written product in either short or long duration copy tasks. Fatigue decreased the legibility of the product across all pencil grasps but increased the speed across all pencil grasps equally. Grip and axial forces were only different in grasps with an adducted thumb and mainly during the initial assessment. Collectively, these results suggest that four mature grasps are equally functional for handwriting in children of this age. These findings contradict common clinical impressions that the dynamic tripod pencil grasp is optimal.Ph

The clinical utility of a tool for optimizing written productivity

grantor: University of TorontoOccupational therapists investigating handwriting issues in children have no consistent method of assessment and treatment. This study investigated the usefulness of a decision-making guide, the Tool for Optimizing Written Productivity (TOW-P), for occupational therapists based on current clinical practice. In the first of two stages, 14 participating therapists used the TOW-P to guide the selection of interventions for up to five children currently on their caseloads who had written productivity issues. The therapists responded to two questionnaires about the usefulness of the tool and their clinical reasoning behind the intervention selections. In the second stage, six participants discussed the structure of the tool, the need for including additional information, and the factors considered during the clinical reasoning process of selecting interventions. The results indicated the TOW-P was clinically useful to the therapists. The revised TOW-P structure, along with trends identified during the clinical reasoning process, have potential for further study.M.Sc