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.

What is recommended for healthy women during pregnancy? A comparison of seven prenatal clinical practice guideline documents.

BACKGROUND: Several countries have developed clinical practice guidelines for the content of prenatal care. This study examines the consistency of recommendations in clinical practice guidelines describing routine prenatal care. METHODS: The recommendations for low-risk women in seven guideline documents were examined: two from Australia, two from the United States, two from Canada, and one from Germany. The recommendations were listed into the four areas of "general health screening and health promotion during pregnancy," "organization of care," "clinical tests and screening," and "education specific for pregnancy." RESULTS: A total of 69 recommendations were identified within the seven documents, most of which fell within the "clinical tests and screening" domain. Notable differences were identified in the number of recommendations made within the same country. Of the 69 recommendations, only four were included in all seven documents. CONCLUSION: Little consistency was demonstrated within or among countries in terms of the content of their prenatal care guidelines, suggesting a need to reexamine their content and the evidence on which such recommendations are based.

Who can provide antenatal care? The views of obstetricians and midwives.

OBJECTIVE: To describe the types of antenatal services in NSW maternity hospitals and examine the views of midwives and obstetricians about who can provide adequate routine antenatal care. MEASUREMENTS: A mail-out questionnaire to nursing unit managers (NUMs) explored the types of antenatal services available in their hospitals. The questionnaire for 196 midwives and 114 obstetricians asked whether they believed six provider/service types could provide adequate antenatal care either alone or in conjunction with an obstetrician. FINDINGS: 80% of hospitals had GPs providing antenatal care, 53% had obstetricians and 3% had visiting midwives; 33% had a public antenatal clinic, 28% a shared care program with GPs and 26% midwives' antenatal clinics. Midwives were more likely than obstetricians to rate the following as able to provide adequate care alone: hospital antenatal clinic (4.7 times more likely); independent midwife (42.9x); and community midwives as an outreach hospital service (17x). Obstetricians were 8.2x more likely than midwives to rate private obstetricians as being able to provide adequate care. Midwives were more likely to perceive that independent midwives (24.7x more likely) and community midwives as an outreach hospital service (15.3x more likely) were able to provide adequate care either alone or in conjunction with an obstetrician. CONCLUSION: Most NSW hospitals have GPs providing care, but midwives' clinics and independent midwives are less available. While midwives and obstetricians hold similar beliefs about GPs providing care, substantial differences emerged about the midwife's role. Such disparity in opinion may be central in providing options and consistency in care for women.

Important components of antenatal care: midwives' and obstetricians views.

This study sought the views of midwives and obstetricians about what they considered to be important aspects of routine antenatal care. Midwives and obstetricians were randomly selected from the NSW membership lists of the Australian College of Midwives and the The Royal Australian College of Obstetricians and Gynaecologists, respectively. Seventy-eight percent of midwives (n = 196) and 52% of obstetricians (n = 114) completed a questionnaire which itemised components of routine care derived from the National Health and Medical Research Council's Guidelines for Antenatal Care. Participants were asked to rate each of the 77 components on a 4-point scale as either: very important; desirable but not essential; not necessary; or, don't know. Twenty-four (31%) of the components were rated as very important by at least 90% of midwives and 19 (22%) were rated as very important by at least 90% of obstetricians. 'Recording details of previous pregnancy complications' was the component most commonly rated as being very important by both groups. On 37 (48%) of the components there was a significant difference between midwives and obstetricians in terms of whether or not they rated the component as very important (p < 0.01). There were considerable differences between midwives' and obstetricians' views about the important components of routine antenatal care and a substantial proportion of both groups did not consider many of the components listed in the guidelines to be essential in routine care. The findings suggest that a revision of the current antenatal care guidelines is necessary.