Development of a consensus classification of physiotherapy interventions in paediatric neurorehabilitation

Background and Aims Physiotherapy within paediatric neurorehabilitation is a complex process whereby the relationship between treatments delivered and resultant severity-adjusted patient outcomes have been difficult to demonstrate. An essential prerequisite for analysing physiotherapy input at the point of its delivery to the patient is to have clear descriptions and categories of physiotherapy interventions. Recent work in this area has focussed on grouping treatments based on their common essential ingredients. The aim of this work is to develop an expert-lead consensus classification of physiotherapy interventions used in paediatric neurorehabilitation, categorised according to their essential ingredients, actions and mediators. Method Comprehensive literature searches of five electronic databases (MEDLINE, EMBASE, AMED, CINAHL and PsychINFO) together with supplementary hand searching identified 4,194 studies which were separated into 34 different interventions following cross-referencing with other sources. These were then divided into eight distinct categories according to their essential treatment ingredients. A panel of 13 expert physiotherapists specialising in the field of paediatric neurorehabilitation were consulted in two rounds of an online modifiedDelphi survey (a method commonly used to glean expert consensus). Results In modified-Delphi survey rounds 1 and 2 respectively, eight (62%) and nine (69%) of the experts responded. Utilising a threshold of ≥75% agreement set a priori to represent expert consensus, there was agreement that the eight categories are comprehensive (complete) and unambiguous (easily understood). What remains less clear is the extent to which these categories are independent of one another. Discussion This categorisation of physiotherapy interventions within paediatric neurorehabilitation is the first of its kind to group treatments according to their essential treatment ingredients. Such work adds the potential for gleaning greater understanding regarding how physiotherapy leads to improved patient outcomes within paediatric neurorehabilitation. Further work is required in this area to better understand the extent to which different categories are truly independent or where similarities exist between them

Staff Perspectives of Working with Families of Children and Young People in Paediatric Residential Neurorehabilitation

Background In the UK, paediatric neurorehabilitation services are encouraged to develop a collaborative working relationship with families. This relationship supports effective assessments, rehabilitation and the development of shared goals, interventions and evaluations. It also supports the transition of life after rehabilitation. Children and young people with the most severe acquired brain injuries participate in intensive residential neurorehabilitation. Given the momentum to empower and integrate families, and the challenging context in which relationships between healthcare professionals and families takes place, data is sparse and disparate around this relational experience. This study looked to understand what it is like for healthcare professionals to work with families of children and young people in a residential paediatric neurorehabilitation service and what enables or hinders collaboration. Method 15 participants who work at a residential paediatric neurorehabilitation service in the UK were interviewed. Participants were made up of members of the nursing team, psychosocial team, therapies team and assistive technologies team. Results Interviews were transcribed and analysed using thematic analysis. Five key themes and 13 subthemes were identified, including intentions and hopes, assessment and understanding, what healthcare professionals do and what factors contribute to when things get stuck. Conclusion The study suggests that the working relationship with families is important in order to create meaningful interventions and prepare families to life beyond the service. Healthcare professionals attune to each family in order to join and create as good as working relationships as possible given very challenging contexts of grief, upheaval and stress. There are however a number of barriers to developing collaborative relationships. This study puts forward a psychological stance to understand the experiences, barriers and enablers to collaborative relationships

Parents' experience of children with acquired brain injury undergoing neurorehabilitation:a systematic review

BACKGROUND: This systematic review aims to synthesise the qualitative evidence exploring parents' experiences of children with acquired brain injury (ABI) undergoing neurorehabilitation during the first year post-injury.METHODS: A systematic review of qualitative research was conducted using thematic synthesis with Thomas and Harden's approach. The population, exposure and outcome model was used for the search strategy. The electronic databases Ovid Embase, Ovid MEDLINE, CINAHL, Scopus and PsycINFO were searched from 2009 to 2023. The review included qualitative and mixed-method studies published in English only. Grey literature was excluded. There were no geographical restrictions. Reporting within the review followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guideline. The studies' quality was appraised using the Critical Appraisal Skills Programme tool.RESULTS: Three studies met the inclusion criteria and were included in the synthesis, representing the experiences of 30 parents. The quality assessment showed that the three included studies met most quality indicators. Following thematic synthesis, four analytical themes were identified: school unpreparedness, parents as advocates and navigators, parents as monitors, and parents recognising the impact of ABI on their child. The reviewers proposed a group of recommendations for services reviewing their parental support.CONCLUSION: This review highlights some challenges parents of children diagnosed with ABI experience during their child's neurorehabilitation journey. This review has suggested potential improvements that could be made in paediatric neurorehabilitation services when reviewing their parental support and care pathways. These will ultimately influence parents' and children's experience of paediatric neurorehabilitation services.</p

Outcomes for children with acquired brain injury (ABI) admitted to acute neurorehabilitation

Aim:To evaluate an innovative paediatric neurorehabilitation model in relation to improving quality of neurorehabilitation and reducing length of stay (LOS) for children with acquired brain injury.Method:A process evaluation approach was conducted in line with Medical Research Council evaluation of complex interventions guidance. Analysis was conducted on routinely collected patient data from 2017 to 2018, including LOS and family feedback. Descriptive and inferential statistics were used for quantitative analysis and qualitative data was analysed thematically.Results:Outcomes for 70 children (0–16y, median age 5y, IQR 1–11y, 46 males, 24 females) referred to the service indicated improved function and reduced complexity of need. The mean LOS was 10.6 days compared to baseline mean LOS of 41 days (2011–2012). High satisfaction from the families was recorded; however, ongoing needs and service gaps regarding long‐term support were identified.Interpretation:This service model is effective in delivering quality paediatric neurorehabilitation, demonstrating a sustained impact on LOS, and positive patient outcome data and family feedback for this group of patients

A scoping review of the needs of children and young people with acquired brain injuries and their families

Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) isessential in delivering pathways of care and providing effective rehabilitation.Aim: To identify relevant literature and key themes relating to the nature and extent of needs (met,unmet or unrecognized) of CYP with ABI and their families.Method: Scoping review. Sixteen electronic bibliographic databases were searched using terms relating tochildren, brain injury and need. Papers were screened against eligibility criteria by two independentreviewers. No date limits were applied. Data were extracted by the lead author regarding the needs ofCYP with ABI and their families and thematic analysis conducted to identify the key themes. Methodologicalquality was not assessed.Results: A total of 28 articles were identified including three systematic reviews, one scoping review,two practice recommendation articles, and 22 original research studies. Participants included CYP withABI, parents, siblings, and professionals. Four key themes were identified; CYP-related impairment needs,support needs, return to school and long-term aftercare.Conclusion: CYP with ABI and their families report extensive needs, many of which are often unmet orunrecognized by those supporting the CYP. Needs transcend the health, social care, and education domains

Robot-assisted upper limb training for patients with multiple sclerosis: an evidence-based review of clinical applications and effectiveness

Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusion

Differences in gait parameters when crossing real versus projected everyday life obstacles in healthy children and adolescents

Practicing complex everyday life walking activities is challenging in paediatric neurorehabilitation, although it would prepare patients more comprehensively for the requirements of daily life. Floor projections allow simulation and training of such situations in therapy. Twenty healthy youths aged 6-18 years stepped over a tree trunk and balanced over kerbstones in a real and projected condition. Spatiotemporal and kinematic parameters of the two conditions were compared by equivalence analysis, using the medians of the differences between the two conditions with their bootstrapped 95% confidence intervals. Velocity, step and stride length, step width, and single support time were generally equivalent between the two conditions. Knee and hip joint angles and toe clearance decreased substantially during the execution phase of the projected tree trunk condition. The largest differences were found at the end of the execution phase in both tasks for the ankle joints. As spatiotemporal parameters were equivalent between the conditions, floor projections seem suitable to train precise foot placement. However, differences in knee and hip joint kinematics and toe clearance revealed that floor projections are not applicable for obstacles with a vertical extension. Therefore, exercises aiming at knee and hip flexion improvement should favourably be trained with real objects