Focus on Function – a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy

<p>Abstract</p> <p>Background</p> <p>Children with cerebral palsy receive a variety of long-term physical and occupational therapy interventions to facilitate development and to enhance functional independence in movement, self-care, play, school activities and leisure. Considerable human and financial resources are directed at the "intervention" of the problems of cerebral palsy, although the available evidence supporting current interventions is inconclusive. A considerable degree of uncertainty remains about the appropriate therapeutic approaches to manage the habilitation of children with cerebral palsy. The primary objective of this project is to conduct a multi-site randomized clinical trial to evaluate the efficacy of a task/context-focused approach compared to a child-focused remediation approach in improving performance of functional tasks and mobility, increasing participation in everyday activities, and improving quality of life in children 12 months to 5 years of age who have cerebral palsy.</p> <p>Method/Design</p> <p>A multi-centred randomized controlled trial research design will be used. Children will be recruited from a representative sample of children attending publicly-funded regional children's rehabilitation centers serving children with disabilities in Ontario and Alberta in Canada. Target sample size is 220 children with cerebral palsy aged 12 months to 5 years at recruitment date. Therapists are randomly assigned to deliver either a context-focused approach or a child-focused approach. Children follow their therapist into their treatment arm. Outcomes will be evaluated at baseline, after 6 months of treatment and at a 3-month follow-up period. Outcomes represent the components of the International Classification of Functioning, Disability and Health, including body function and structure (range of motion), activities (performance of functional tasks, motor function), participation (involvement in formal and informal activities), and environment (parent perceptions of care, parental empowerment).</p> <p>Discussion</p> <p>This paper presents the background information, design and protocol for a randomized controlled trial comparing a task/context-focused approach to a child-focused remediation approach in improving functional outcomes for young children with cerebral palsy.</p> <p>Trial registration</p> <p>[clinical trial registration #: NCT00469872]</p

Pathways to Positive Futures: State-Of-The-Science Conference Proceedings

Over the last decade, evidence has mounted showing that young people with serious mental health conditions experience a variety of challenges as they mature into adulthood. On average, their educational, economic and vocational outcomes are distinctly worse than their peers’, and they are more likely to experience homelessness, to struggle with substance use, and to be involved with corrections systems. In 2009, researchers at the Regional Research Institute at Portland State University applied for and received a grant from the National Institute for Disability Rehabilitation Research (NIDRR, US Department of Education) and the Center for Mental Health Services (CMHS, US Department of Health and Human Services) to create the Research and Training Center on Pathways to Positive Futures. This Center, known as “Pathways RTC” or, simply, “Pathways,” included eight research projects and related training, dissemination and technical assistance activities, all focused on improving outcomes for older adolescents and young adults who experienced serious mental health conditions (SMHCs). Prior to the State-of-the-Science Conference, Pathways staff joined with young people, family members, researchers and service providers to develop a conceptual model that describes how providers can work productively and effectively with young people who experience SMHCs. This “Pathways model” also builds on evidence drawn from programs and interventions that have demonstrated success in promoting positive outcomes among emerging adults. The overall aim was to produce a “common elements and common factors” model that would be useful for guiding practice and shaping interventions that are developmentally appropriate, attractive to young people, and effective in achieving recovery- oriented outcomes