Upper Limb Function of Children with Unilateral Cerebral Palsy After a Magic-Themed HABIT: A Pre-Post-Study with 3- and 6-Month Follow-Up.

Aims: To examine changes in upper limb function, and performance in everyday tasks, for children with unilateral cerebral palsy who participated in a magic-themed hand-arm bimanual intensive therapy (HABIT). Methods: Twenty-eight children participated; mean age 10 y 6 mo (SD 2 y 2 mo), n = 15 male and n = 13 female. Using a single group, pre-and post-test design, the magic-themed HABIT was delivered for 60 hours over 10 days. Bimanual and unimanual hand function were measured using the Assisting Hand Assessment (AHA) and Box and Blocks Test (BBT). Occupational performance was rated using the Canadian Occupational Performance Measure (COPM). Two parent questionnaires explored change in bimanual hand use in everyday activities; ABILHAND-Kids and Children's Hand-use Experience Questionnaire (CHEQ). Assessments were completed pre-, immediately post, 3 months and 6 months after the intervention. Results: Friedman's ANOVA revealed a significant improvement for COPM and CHEQ grasp subscale. Repeated measures ANOVA revealed a significant improvement in BBT, and ABILHAND-Kids, and no significant change for AHA. Conclusions: Children who participated in the magic-themed HABIT experienced improved occupational performance, unimanual skills, and parent ratings of performance in challenging everyday tasks.

A magic-themed upper limb intervention for children with unilateral cerebral palsy: The perspectives of parents.

AIM: To explore parent's perspective of their child's participation in a magic-themed intervention called Amazing Magic Club (AMC), and to further our understanding of motivated engagement and the impact of themed group-based interventions for children with unilateral cerebral palsy (CP). METHODS: Twenty-nine parents of children with unilateral CP completed semi-structured interviews. The child participants (n = 28) attended one of three AMCs; average age of the children was 10y 6mo (SD 2y 2mo). The parent interviews were analysed using thematic analysis. RESULTS: The three themes are: "It's okay to be me", the magic effect and "I can do it". Parents observed their children to belong and learn about their abilities. The importance of the magicians and the performance is described. Parents observed their children to have increased self-belief and a new willingness to attempt difficult tasks. DISCUSSION: AMC appears to capture intrinsic motivation for children with unilateral CP to complete challenging tasks.

Reliability and validity of a new instrument to measure tolerance of everyday risk for children.

BACKGROUND: A modicum of everyday risk provides opportunities for children to extend the limits of their competence. However, increasingly negative perceptions of risk have led to risk-averse behaviours in adults, including severely restricting children's play. The degree to which risk in play is tolerated by adults impacts on the lives and experiences of children. However, no measure of adult tolerance to everyday risk exists. The purpose of this study was to develop a valid and reliable instrument examining adults' tolerances of risk during children's play. METHODS: A 31-item survey of risk tolerance was developed based on a Norwegian model of risky play; 100 parents and teachers of children aged 3 to 13 years completed the instrument. Data were subjected to Rasch analysis. Psychometric properties of the data were examined. RESULTS: Iterative analyses produced an instrument with goodness of fit statistics in the acceptable range, a logical item hierarchy, person separation index >2 and reliability index of 0.87. There was a strong positive relationship between participants' self-perceived risk tolerance and scores on the instrument, and between the age of the child and scores on the instrument. CONCLUSIONS: The Tolerance of Risk in Play Scale (TRiPS) yields valid and reliable data for measuring the success of interventions to change adults' everyday risk beliefs, and for exploring the impact of adults' risk tolerance on children's play and development.

Assessment of play and leisure: delineation of the problem.

This paper discusses current perspectives on play and leisure and proposes that if play and leisure are to be accepted as viable occupations, then (a) valid and reliable measures of play must be developed, (b) interventions must be examined for inclusion of the elements of play, and (c) the promotion of play and leisure must be an explicit goal of occupational therapy intervention. Existing tools used by occupational therapists to assess clients' play and leisure are evaluated for the aspects of play and leisure they address and the aspects they fail to address. An argument is presented for the need for an assessment of playfulness, rather than of play or leisure activities. A preliminary model for the development of such an assessment is proposed.

The contribution of motor skills and playfulness to the play performance of preschoolers.

Consideration of a child's motor proficiency, intrinsic motivation, internal locus of control, and freedom to suspend many of the constraints of objective reality were proposed to provide a more comprehensive assessment of play than would an assessment of play performance alone. For empirical validation of this conceptual model of play, 29 subjects (15 nondisabled children and 14 children with juvenile rheumatoid arthritis) between the ages of 4 years 6 months and 6 years 6 months were given four assessments: (a) the Preschool Play Scale (Bledsoe & Shepherd, 1982, Knox, 1974); (b) the Bruininks-Oseretsky Test of Motor Proficiency (Bruininks, 1978); (c) the Preschool and Primary Internal-External Locus of Control Scale (Nowicki & Duke, 1974); and (d) tests of associative fluency (Wallach & Koogan, 1965; Ward, 1968). Multiple regression procedures revealed that, when considered together, scores on the Bruininks-Oseretsky Test of Motor Proficiency, tests of associative fluency, and the Preschool and Primary Internal-External Locus of Control Scale predicted scores on the Preschool Play Scale, thereby supporting the usefulness of the proposed theoretical model. Further, there was no significant difference in the mean scores of the two groups on the Preschool Play Scale. Although this finding may be an artifact of the small sample size, it also may support the authors' belief that children with motor impairments are able to compensate for their limitations by developing areas of relative strength that allow them to play normally. When this belief was further tested with Pearson product-moment correlations and Fisher's Z transformations, it was found that correlations between the test scores of the nondisabled children were not significantly different from those of the children with juvenile rheumatoid arthritis. Clearly, further research is needed.

Concurrent validity of equilibrium tests in boys with learning disabilities with and without vestibular dysfunction.

Six equilibrium measures were administered to 50 boys with learning disabilities, 25 with and 25 without suspected vestibular system dysfunction. Pearson product moment correlations were computed between test scores for the total sample and for each subgroup to establish concurrent validity between tests. Four correlations for the total sample and three for each of the subgroups were statistically significant. However, only 3 of the 10 correlation coefficients mentioned were greater than r = 0.5. The relatively low magnitude of many of the correlations obtained demonstrates that different tests of equilibrium measure different balance-related competencies, and that competence in one area does not indicate competence in another. Therapists evaluating equilibrium should administer more than one test. The tilt test used in this investigation did not correlate significantly with any other test. This suggests that tilt tests should routinely be included in the evaluation of equilibrium.

Decreasing drooling through techniques to facilitate mouth closure.

A single case ABA experimental design is presented in which techniques to facilitate mouth closure were hypothesized to decrease drooling. The subject was an 11-year-old male with mental retardation and cerebral palsy. Baseline 1 consisted of 10 half-hour sessions of play, followed by 1-hour periods during which the amount of saliva collected on an absorbent bib was measured and recorded. The subsequent treatment phase of 4 weeks was identical to the baseline except that a half-hour period of intervention was substituted for the half-hour of play. Intervention involved providing jaw control with intermittent tapping and jiggling, stroking the upper gum, and giving juice with jaw control. Baseline 2 consisted of 10 sessions identical to baseline 1. Results indicate that the amount of saliva leaving the mouth was a function of the presence or absence of intervention.

The relationship of prone extension to other vestibular functions.

The purpose of this investigation was to examine clinical observations hypothesized to reflect vestibular integrity in children in an attempt to clinically separate otolithic from semicircular canal functioning. Based on the assumption that prone extension is an otolithic function, two experimental groups and one control group were identified; the groups had varying abilities for prone extension. Using a discriminant analysis, four variables (equilibrium sitting, equilibrium kneeling, eyes crossing the midline, and teacher's impression) were found to predict group membership. Only equilibrium sitting by itself was significantly different between groups. The variables selected by the analysis were originally hypothesized to measure semicircular canal functioning. This was thought, at least in part, to reflect insensitivity of scoring and/or lack of validity of the variables measured. Descriptively, tentative support existed for a division of static from dynamic vestibular function. Therefore, further study is indicated.