Determinants of Manual Abilities of Children with Cerebral Palsy: A National Registry-Based Study.

PURPOSE: This cross-sectional study aimed to identify determinants of manual abilities of children with cerebral palsy (CP), as measured by the Manual Ability Classification System (MACS), in terms of intrinsic (child-related) and extrinsic (service-related) variables. METHODS: The participants were 106 children with a confirmed diagnosis of CP (aged 4-16 years). Two ordinal logistic regression models were conducted to identify intrinsic and extrinsic determinants of manual abilities. RESULTS: Four child-related (intrinsic) variables were found to be significant determinants of manual abilities: bimanual ability, ability to maintain and assume chair sitting, presence of seizures, and gross motor function, and only one service-related (extrinsic) significant variable was identified, which was receiving spasticity medications. DISCUSSION: The results highlight several determinants that should be considered when assessing and intervening to improve manual abilities of children with CP. The findings are discussed in relation to the intervention approach, contextual modification, and assistive device prescription.

Occupational changes during the COVID-19 lockdown in Jordan.

BACKGROUND: Measures to limit the spread of COVID-19 have disrupted the lives of countless millions of individuals worldwide. OBJECTIVE: To explore the experiences of occupational disruption and changing social roles among Jordanians during COVID-19 lockdown in 2020. The specific aim was to explore the changing occupations, routines, roles and coping strategies. MATERIAL AND METHODS: This qualitative study used a digital ethnographic approach. Data collection included online observations of Jordanian's posts of comments, photos and videos on six public Facebook pages during the COVID-19 lockdown for the initial 3-week period. In addition, 150 Jordanians participated in an online interview answering four open-ended questions to achieve triangulation. Qualitative analyses included open coding of the photos, videos and text as well as the interviews independently and blindly by the research team. RESULTS: Four themes were identified: changing daily occupations; changing family roles; missing pre-lockdown life and coping strategies under lockdown. CONCLUSION: The COVID-19 lockdown restrictions caused direct, significant and immediate changes to Jordanians' occupations, routines and roles; enforcing new obligatory occupations and eliminating desired ones. SIGNIFICANCE: Knowledge from this study highlight the kinds of strategies and supports during and after lockdowns that need to be considered in future planning of occupational therapy practice in Jordan.

Participation patterns and determinants of participation of young children with cerebral palsy.

INTRODUCTION: Understanding participation patterns of young children with cerebral palsy (CP) will enable occupational therapists to tailor family- and child-centred services. This study compares participation patterns and participation barriers of young children with CP with those of typically developing (TD) children. In addition, effect of age and gender on participation were examined as well as child-related determinants of participation for young children with CP. METHODS: Participants were a convenience sample of 110 young children with CP and 150 TD children, aged 36-72 months. Children with CP represented different levels of the Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). The Arabic Preschool Activity Card Sort was used to measure participation level as well as barriers of participation. T-tests, ANOVA, and exploratory regressions were employed. Significance was set at p < .05. RESULTS: Young children with CP showed significant decreased overall and domain-specific participation compared to TD children (p < .001). Perceived barriers of participation were mostly related to child-factors for young children with CP compared to greater variability in barriers in TD children. Gender had no significant effect on participation regardless of diagnosis; however, pattern of the effect of age was different among the two groups. MACS was found to be the only significant predictor of participation for children with CP (p = .001). CONCLUSION: Occupational therapists should focus on enhancing participation for young children with CP and consider participation barriers when designing their interventions. Several factors need to be considered when aiming to enhance participation of children with CP. The use of the MACS could contribute to better intervention planning.

COVID-19 Quarantine-Related Mental Health Symptoms and their Correlates among Mothers: A Cross Sectional Study.

BACKGROUND: One of the strictest quarantines worldwide to limit the spread of coronavirus was enforced in Jordan during the COVID-19 pandemic. OBJECTIVES: This study investigated reported mental health and changes in lifestyle practices among Jordanian mothers during COVID-19 quarantine. The specific objectives included studying the level of depression, anxiety, and stress symptoms and their potential statistical associations with demographic and lifestyle variables. Furthermore, the study aimed to investigate differences in mental health between different demographic and socio-economic groups and to examine the major lifestyle changes that occurred on mothers during the quarantine. METHODS: An online survey was developed and administered to 2103 mothers. Participants were asked to complete a sociodemographic data form, Depression, Anxiety, and Stress Scale (DASS-21), and a lifestyle section comparing the life of mothers before and during the quarantine. Reported scores of depression, anxiety, and stress were calculated and compared across different levels of demographics including income, education level, employment status, and city of residence. RESULTS: This study found that mothers with lower income, lower education, not employed, or living in cities outside the capital of Jordan reported having more depression, anxiety, and stress symptoms (p < .005). Changes in their lifestyle practices included weight gain, increased time allocated for teaching children at home, increased familial violence at home, and increased time allocated for caring for their family members (average increase of 5 hours daily). CONCLUSIONS FOR PRACTICE: The unprecedented times of quarantine have put mothers in unprecedented reported mental health problems. Providing psychological support to this group might be a priority.

The Influence of Culture on Occupational Therapy Practice in Jordan.

BACKGROUND: Occupational therapy's origins draw from Western culture, values, and beliefs which may impact the application of traditional occupational therapy practice in non-Western cultures. PURPOSE: This study explored how occupational therapists in Jordan facilitate occupational therapy practice within Islamic Eastern culture. METHOD: A phenomenological approach was used in this study. Semistructured interviews were conducted with eleven occupational therapists that work in Jordan and have at least two years of experience. Data were analyzed using thematic analysis methods. RESULTS: Three central themes emerged: impact of Jordanian culture and Islamic beliefs about independence and disability on occupational therapy practice, the therapists' notions of ideal occupational therapy practice vs. daily reality, and challenges posed by workspace and the availability of equipment. CONCLUSION: This study highlights the growing need to translate and expand the core values of occupational therapy to align with cultures in non-Western countries and cultures.

Associations between impairments and activity limitations components of the international classification of functioning and the gross motor function and subtypes of children with cerebral palsy.

[Purpose] Cerebral palsy (CP) encompasses a group of disorders of movement and posture with wide ranges of impairments, activity limitations and participation restrictions. Guiding management of children with CP by the ICF model is important to deliver quality services. This study aimed to explore relationship between CP subtypes and the Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) and to examine differences in distribution of impairments and activity limitations across CP subtypes and GMFCS-E&R levels. [Participants and Methods] 70 children with CP (mean age: 6.5 ± 2.9 years) were classified using CP subtypes and GMFCS-E&R. Research assistants examined impairments including: scoliosis, scissoring, and inability to bear weight. Parents described their children's transfers and functional mobility. [Results] CP subtypes and GMFCS-E&R levels were significantly associated. Scissoring and scoliosis were predominant in children in levels IV and V of the GMFCS-E&R. Only scoliosis was predominant in children with quadriplegia. Transfer activities and functional mobility were more limited in children with quadriplegia and in level V of the GMFCS-E&R. [Conclusion] Impairments and activity limitations components of the ICF can be differentiated by CP subtypes and GMFCS-E&R. Clinicians can use the two classification in providing comprehensive and individualized services for children with CP and their families.

Functional profiles of children with cerebral palsy in Jordan based on the association between gross motor function and manual ability.

BACKGROUND: Cerebral palsy (CP) is the most common cause of physical disability in childhood. A major challenge for delivering effective services for children with CP is the heterogeneity of the medical condition. Categorizing children into homogeneous groups based on functional profiles is expected to improve service planning. The aims of this study were to (1) to describe functional profiles of children with CP based on the Gross Motor Function Classification System-Expanded & Revised (GMFCS-E & R) and the Manual Ability Classification System (MACS); and (2) to examine associations and agreements between the GMFCS-E & R and the MACS for all participants then for subgroups based on subtypes of CP and chronological age of children. METHODS: A convenience sample of 124 children with CP (mean age 4.5, SD 2.9 years, 56% male) participated in the study. Children were classified into the GMFCS-E & R and the MACS levels by research assistants based on parents input. Research assistants determined the subtypes of CP. RESULTS: Thirty six percent of the participants were able to ambulate independently (GMFCS-E & R levels I-II) and 64% were able to handle objects independently (MACS levels I-II). The most common functional profile of children with CP in our study is the "manual abilities better than gross motor function". An overall strong correlation was found between the GMFCS-E & R and the MACS (rs = .73, p < .001), the correlations vary significantly based on subtypes of CP and chronological age of children. A very strong correlation was found in children with spastic quadriplegia (rs = .81, p < .001), moderate with spastic diplegia (rs = .64, p < .001), and weak with spastic hemiplegia (rs = .37, p < .001). CONCLUSIONS: The GMFCS- E & R and the MACS provide complementary but distinctive information related to mobility and manual abilities of children with CP. Subtypes of CP and chronological age differentiated functional profiles. Functional abilities of children with CP in Jordan have similar patterns to children with CP in other countries. Functional profiles can inform clinicians, researchers, and policy makers.

The Psychometric Properties of the Arabic Preschool Activity Card Sort.

BACKGROUND: The Preschool Activity Card Sort (PACS) is an interview-based assessment tool to measure participation of preschool children with age range from 3 to 6 years. OBJECTIVE OF STUDY: The purpose of this study was to establish the psychometric properties of the recently translated Arabic PACS (A-PACS). METHODS: One hundred fifty-one Jordanian parents participated in the study representing different geographical areas. Children were almost equally distributed between males and females and into three age groups. Construct and concurrent validity were examined as well as the internal consistency of the scale and the test-retest reliability. FINDINGS: The A-PACS was able to differentiate between the participation level of young and old children in the domains of education, community mobility, and low demand leisure of the A-PACS giving evidence to its construct validity and it significantly correlated with some aspects of the Vineland Adaptive Behavior Scale (VABS) giving evidence to its concurrent validity. The A-PACS showed excellent overall internal consistency (α = .859) for all domains and good test-retest reliability (r = .976, p < .001). CONCLUSION: The A-PACS can be considered as a valid and reliable tool to measure participation of preschool children with normal development from Arabic cultures. Future studies should focus on the validity of the A-PACS for use with children with disabilities.