Is a family-centred initiative a family-centred service? A case of a Conductive Education setting for children with cerebral palsy.

BACKGROUND: From the moment a child is diagnosed as having cerebral palsy, families have to cope on a daily basis with the multifaceted challenges of life-long disability management. Family-centred service is embraced as a 'best practice' model because of accumulating evidence supporting its positive influence on parents and children's outcomes. Nevertheless, research comparing parent and provider perspectives on family-centred practices of educational service providers in education settings is scarce. The aims of this study were to compare the extent to which parents and conductors experience the service delivery in Tsad Kadima, the Association for Conductive Education in Israel, as being family-centred, as well as comparing parents' perception of different educational settings as being family-centred. METHODS: Measurements of family-centeredness, the Israeli Measure of Processes of Care for families (MPOC-20) and for service providers (MPOC-SP), were administrated to 38 teacher conductors and 83 families of children with cerebral palsy (aged 1-14), from different conductive educational settings. RESULTS: Parents and conductors perceive Conductive Education service as being highly family centred in most domains, rating respectful and supportive care the highest and providing general information the lowest, thus indicating an area where improvements should be made. Parents perceived the service they receive to be more family-centred than conductor's perception about their own activities. In addition, educational setting (day care, pre-school and school) was found to be associated with parent's scores. CONCLUSIONS: The current study, which is the first to examine family-centred service provision in a conductive special education setting, from the perspectives of both parents and conductors, provides significant evidence for high-quality services in these settings.

Atypical central pain processing in sensory modulation disorder: absence of temporal summation and higher after-sensation.

Sensory over-responsivity (SOR), a subtype of the proposed sensory modulation disorder (SMD), is characterized by over-responsiveness to stimuli in several sensory modalities. SMD individuals demonstrate abnormal responses to naturally occurring stimuli in a manner that interferes with daily life participation. Previous psychophysical testing of the somatosensory system revealed that SOR individuals rated pain sensations higher than controls, demonstrating hyperalgesia that can be centrally mediated. Temporal summation (TS) of second pain and after-sensation are manifestations of central sensitization; therefore, this study explored these measures for better characterization of central pain processing in SOR. Twelve SOR adults and 12 healthy controls participated. TS was produced by a train of fifteen repetitive heat pulses, 0.7 s duration each, and 2 s of inter-stimulus interval, applied to the thenar-eminence, while four pain ratings were obtained. An after-sensation was then measured for 5 min, obtaining six pain ratings. No TS of pain was indicated in the SOR group (SOR: p = 0.36; control: p < 0.001). Further, while controls reported a gradual disappearance of pain after-sensation, individuals with SOR continued to report pain for the duration of the 5 min measured (p = 0.002). These results demonstrate an atypical response pattern, suggesting alteration in pain processing and/or modulation at a central level in individuals with SOR. These possible neural changes may manifest themselves as interference with daily functioning as well as shed light on some of the between-subject variability seen in psychophysical testing in non-painful subjects.

Somatosensory function in boys with ADHD and tactile defensiveness.

In this study, we tested for deficits in somatosensory function in boys with Attention Deficit Hyperactivity Disorder (ADHD) and tactile defensiveness (TD). The subjects were 67 boys with ADHD, sub-typed as TD (ADHD+TD+) or non TD (ADHD+TD-), matched with 60 "typical" children in the control group. Sixty nine percent of the boys with ADHD were categorized as TD. The groups were compared on three measures: (a) performance scores on subtests of the Sensory Integration and Praxis Test, (b) measurements of the Somatosensory Evoked Potential (SEP) and (c) ratings of the children's affective responses during tactile stimulation. Both ADHD groups differed from the control group on most study measures. No significant differences were found between the two ADHD subgroups on threshold and perceptual tests scores, except for Finger Identification. However, the TD+ group demonstrated significantly higher central SEP amplitudes than did the TD- group. Together, the results support claims that TD is related to central processing of somatosensory information, but not to anomalous tactile perception, with the exception of Finger Identification.

Personal assistance, adaptations and participation in students with cerebral palsy mainstreamed in elementary schools.

PURPOSE: The aims of this study were to examine differences in level of participation of students with CP in full inclusion (FI group) as compared to self-contained classes (SC group), differences in the task supports provided for these two groups, the interrelationships between assistance and adaptation provided and the differential impact of physical task supports vs. cognitive/behavioural task supports on participation. METHOD: 148 elementary school students were divided into two groups: 100 fully included (FI) students with CP, and 48 students with CP in self-contained classes (SC). The School Function Assessment (SFA) was used as the main measurement for assessing the levels of participation and functional performance profiles. RESULTS: Statistically significant differences (p < 0.0001) were found between the two groups on all scales (physical and cognitive/behavioural assistance and adaptations). Supports provided to the SC group were significantly greater than to the FI group and physical task supports provided to both groups were significantly greater than cognitive/behavioural supports. Pearson correlations and Smallest Space Analyses (SSA) revealed significant (p < 0.01) moderate to strong correlations (0.57 > r < 0.77) between all four task supports, and between provided task supports and participation (0.66 > r < 0.82). CONCLUSIONS: This study's focus enhances our understanding of the impact of task supports to the various factors contributing to the dimensions of the ICF, as well as their interrelationship with participation. Devises and cognitive and behavioural adaptations are required in a wider manner in addition or alternative to physical assistance by adults if we are to increase the chance of students with severe CP to become participatory for academic and social tasks required in school.

Participation and activity performance of students with cerebral palsy within the school environment.

PURPOSE: The aims of this study were to investigate the levels of participation and activity performance of students with cerebral palsy within the inclusive school context, to explore the relationships between these two aspects of function and to identify predictors of participation among the various school activities. METHOD: Two hundred and forty-eight elementary school students were divided into three groups: 100 fully included (FI) students with CP, 100 matched by class and gender typical students (TS) and 48 students with CP in self-contained classes (SC). The School Function Assessment (SFA) was used as the main measurement for assessing the levels of participation and functional performance profiles. RESULTS: Significant differences (P<0.0001) in levels of participation were evident across the three study groups using MANOVA and ANOVAs analyses, where the TS level was the highest and the SC was the lowest. Comparison of the mean score of the physical and the cognitive/behavioural tasks performance revealed similar results among the three groups. Positive Pearson correlations were obtained between participation and both motor and cognitive/behavioural activity performance in the FI and the SC groups. Regression models for the FI and the SC groups were found significant (P<0.0001) and explained above 69% of the participation variance with physical activity performance as the most predictive variable. CONCLUSIONS: Significant differences exist between participation and activity performance of typical students and students with CP included in regular schools. Moreover, activity performance limitations were found to impact on school participation. These findings stress the continuing need to provide rehabilitative intervention towards removing existing barriers within the inclusive environment.

Impact of middle ear effusion on balance performance in children.

UNLABELLED: Middle ear effusion (MEE) is a common childhood disease characterized by accumulation of fluid in the middle ear. MEE treatment focuses on the resultant conductive hearing loss. Recently, researchers have investigated the potential effects of MEE on balance. PURPOSE: The purpose of this study was to compare balance of children with MEE to that of healthy children and to examine whether a relation exists between balance skills and the degree of muscle strength. METHODS: Twenty children with MEE and twenty healthy children aged 4.5 - 7.5 years underwent balance and strength sub-tests of Bruininks - Oseretsky Test of Motor Performance (BOTMP) and electronystagmography recordings (ENG). Parents completed a questionnaire designed to elicit their perceptions of their child's balance abilities in daily living activities. RESULTS: MEE children performed significantly worse than did the control group on BOTMP balance sub-test. BOTMP strength subtest indicated that children with MEE had poorer muscle strength than the control group, although the difference was not significant. ENG results showed no pathologic recordings in both study group and control group. Finally, a significant correlation was found between parents' responses on the questionnaire and their child's performance on BOTMP balance subtest. CONCLUSIONS: MEE may negatively impact children's balance, while muscle strength is less affected. Furthermore, the BOTMP appears to be a sensitive assessment of balance disturbances in children with MEE.

Long-term predictive validity of the Miller assessment for preschoolers.

The purpose of this study was to examine the predictive validity of the Miller Assessment for Preschoolers in a sample of children in Israel. 30 children (M age 7 yr., 8 mo.) were selected from a group of typical children registered in 4 Mother and Child Health Care Centers in central Israel; they were originally tested as preschoolers (M age 3 yr., 10 mo.) on this procedure. They were retested after an interval of 5 to 7 yr. on academically related tests. Correlations between the Total scores and most of the follow-up test scores indicate significant correspondence (.41-.70). Regression analysis indicated that visuomotor integration and handwriting accounted for 58% of the variance. These results contribute to the empirical evidence regarding the predictive abilities of this procedure and indicate its validity cross-culturally over an extended follow-up interval of 5 to 7 yr.

Environmental influences on perceptual and motor skills of children from immigrant Ethiopian families.

The purpose of this study was to examine environmental influences on perceptual and motor skills of children from immigrant Ethiopian families in Israel in comparison with those of Israeli-born children. The subjects were divided into groups based on age (6- to 8-yr.-olds and 10- to 12-yr.-olds) and length of time in Israel. The results of this study show that the perceptual and motor performance of 6- to 8-yr.-old, less recent Ethiopian immigrants is similar to that of the recent Ethiopian immigrants of the same age. A difference exists between those two groups and the Israeli-born children of the same age. In the 10- to 12-yr.-old age group, there is a marked difference between the performance of the two groups of Ethiopian immigrants. The difference between the less recent immigrants and the Israeli-born children is smaller for most tasks; however, the less recent immigrants' performance is still poorer than that of the Israeli children. These results are compatible with those of other studies describing the difficulties encountered by children who had not studied in formal educational settings and those who have had that experience.

Developmental correlates of school-age children with a history of benign congenital hypotonia.

In order to clarify the prognosis of benign congenital hypotonia (BCH), 25 children aged 6 to 8 years who had been diagnosed with BCH as infants were examined on a variety of sensory, perceptual-motor, and behavioural measures and compared with 26 control children. There were no significant differences between the two groups on any of the medical or neurological measures of the Touwen Neurological Examination (Touwen 1979), nor were there significant overall differences on any of the sensory or behavioural measures. However, the BCH group showed inferior gross motor performance on the Bruininks-Oseretsky Test of Motor Proficiency (Bruininks 1978). They scored significantly lower on the Gross Motor Composite, and performed worse on each of the four Gross Motor Subtests, reaching significance on two: Bilateral Coordination and Strength. The follow-up of children with BCH should continue even after the apparent resolution of the hypotonia, with particular attention to the gross motor aspects of performance.

Evaluation of balance disturbances in children with middle ear effusion.

OBJECTIVES: Vertigo and dizziness are not common complaints in childhood, but are present more often than formerly thought. These symptoms are usually caused by otitis media (OM) and middle ear effusion (MEE), two of the most common disorders in children, but were not studied until recently. The purpose of this study was to determine objectively the incidence of balance-related symptoms occurring in children with long lasting MEE and to determine if these symptoms resolve following the insertion of ventilation tubes (VT). METHODS: In total 64 children, aged between 4.5 and 7.5 years, were studied using the Bruininks-Oseretsky tests for motor proficiency, before and after insertion of VT. They were compared to 57 healthy children with no history of middle ear diseases. RESULTS: Pathological findings were identified in 39 children with chronic MEE, as compared to only four children of the controls. Following VT insertion the symptoms and signs of balance disturbances resolved in mostly all the operated children. CONCLUSIONS: The results of this study indicate that balance-related symptoms often encountered in young children may result from chronic MEE and that these symptoms resolve following ventilation of the middle ear.

Relation of visual perception and visual-motor integration for clumsy children.

The purpose of this study was to examine the relationship between visual perception and visual-motor integration in 30 normal children compared to 30 clumsy children. Difficulty in visual perception, as assessed by the Test of Visual-Perceptual Skills, accounts for about half the variance in the clumsy children's performance in visual-motor integration, as assessed by the Developmental Test of Visual Motor Integration. In contrast, the correlation between scores on these tests for normal control children was low and not significant. These results suggest that visual perception and visual-motor integration may be separate functions in normally developing children. When considering clumsy children, however, these functions cannot be considered as two independent skills.

Ergonomic factors influencing handwriting performance.

OBJECTIVES: Handwriting is one of the first things children are taught at school and need to perform in an efficient manner throughout life. Various studies have indicated that handwriting skills are related to many different variables including ergonomic factors. The purpose of this study was to investigate the differences between children with good and poor handwriting on ergonomic factors that underlie handwriting (e.g. body and paper positioning, pencil-grip and pressure) and to examine the relationship between the handwriting legibility and speed and these ergonomic factors. STUDY DESIGN: The study included 209 students in Grades 2 and 3 in Israel. The students were identified as good (N=116) and as poor handwriters (N=103) by their teachers. The Hebrew Handwriting Evaluation (HHE) was used to collect data on handwriting quality and speed as well as on ergonomic factors. A Chi square procedure was used to compare the differences between the handwriting groups. Discriminant analysis determined the percent of correct discrimination of subjects with poor or good handwriting based on the ergonomic factors. Finally, Spearman correlation coefficients were employed between the ergonomic variables and speed and quality of handwriting. RESULTS: The results indicated that children with poor handwriting had inferior pencil, paper and body positioning, stabilization of paper and consistency of pressure, compared to children with good handwriting. CONCLUSIONS: The implications of the results in general, and specifically for clinical practice are discussed. Finally, further research related to this topic is suggested.

Does fatigue influence children's handwriting performance?

OBJECTIVES: Handwriting is one aspect of school children's work. This article examines the influence of fatigue on handwriting, through the use of prolonged writing. STUDY DESIGN: The study population included 157 third-grade students with good and poor handwriting. Quality and speed of handwriting, in addition to ergonomic factors, were assessed through the Hebrew Handwriting Evaluation (HHE), prior to writing and after writing for 10 consecutive minutes. RESULTS: RESULTS of this study clearly demonstrate that children with both poor and good handwriting perform more poorly after writing long texts. Although both groups were influenced by the fatigue situation, poor handwriters still scored lower than the good handwriters in both conditions (fatigue and non-fatigue), on most variables. CONCLUSIONS: Continued studies in this area are recommended, and it is suggested that children take 'writing breaks' when writing, in order to improve the quality of their handwriting.

Somatosensory functioning in children with attention deficit hyperactivity disorder.

In order to test the hypothesis that attention deficit hyperactivity disorder (ADHD) is related to deficits in somatosensory processing, 49 ADHD male children and 49 matched controls were tested on a wide range of tactile tasks, and somatosensory evoked potentials (SEP) were also recorded. In addition, parents' and teachers' ratings on the children's typical responses to tactile stimuli were obtained. The results show that the ADHD children were less skilled on suprathreshold, but not on threshold tasks than were the controls. Further, a larger percentage of ADHD children were 'tactile defensive'. Finally, the ADHD children showed larger-than-normal amplitudes of late, but not early components of the SEP. These data suggest that some aspects of somatosensory processing by ADHD children are deficient.

The efficacy of an early prevention program facilitated by occupational therapists: a follow-up study.

OBJECTIVE: This study examined the long-term effect of an early prevention program on mothers' knowledge, attitudes, and practices with regard to their children's development. The prevention program focused on increasing the mothers' sensitivity to their children's needs and their awareness of the importance of their role in their children's early development. METHOD: Fifty-five mothers and their infants received approximately .5 hours of intervention once every 8 weeks during the infants' first year of life. A control group of 54 mothers and their infants did not receive the intervention. Subjects' knowledge of their children's sensory, motor, and language abilities; their beliefs in their ability to influence their children's development; and an indication of whether they implemented their knowledge were all measured with the Knowledge, Attitude, and Practices Questionnaire (KAP) 1.5 years to 2 years after completion of the prevention program. RESULTS: KAP scores of the intervention group were higher than the scores of the control group, suggesting that the prevention program helped mothers acquire greater knowledge and more appropriate attitudes and practices about child development. CONCLUSION: This study supports the theory that the effect of a primary prevention program during the first year of a child's life can be sustained for 1 year to 2 years.

[Balance disturbances in children with middle ear effusions].

Vertigo and dizziness are not common complaints in childhood, but probably present more often than has been thought. These symptoms, caused mainly by otitis media (OM) and middle ear effusion (MEE), are 2 of the most common diseases in children, and until recently had long been neglected in the literature and in practice. We determined objectively the incidence of balance-related symptoms in children with long-lasting MEE, and resolution following insertion of ventilation tubes (VT). 36 children, aged 4-9 years, were studied using electronystagmography (ENG) and the Bruininks-Oseretsky tests for motor proficiency, before and after ventilation of the middle ear. Results were compared to those in 74 healthy children with no history of middle ear disease. Abnormal ENG findings were found in 58%, and 71% had low Bruininks-Oseretsky (BO) test scores. The ENG was abnormal in only 3 of the controls, 1 of whom also had low BO test scores. The symptoms and signs of balance disturbances resolved in 96% following VT insertion. These results indicate that balance-related symptoms often encountered in young children may result from chronic MEE, and that they resolve following evacuation of the effusion and ventilation of the middle ear.

Performance of Israeli versus U.S. preschool children on the Miller Assessment for Preschoolers.

OBJECTIVES: The Miller Assessment for Preschoolers (MAP) is a scale that can be used to evaluate preschool children with suspected preacademic problems. Before implementing the MAP in Israel, it was necessary to determine whether the U.S. norms were applicable to the Israeli preschool population. METHOD: In a pilot study carried out in Israel, the Hebrew version of the MAP was administered to 2 age groups of 30 children each. The scores of Israeli children were compared with the U.S. norms on each of the MAP's 27 subtests, the five performance indices, and the total score. RESULTS: There were no significant differences between the Israeli sample and the U.S. standardization sample in either age group on the MAP total score; significant differences were found in both age groups on the Foundations Index and on some specific subtests. Israeli children performed below U.S. norms on the Foundations Index. CONCLUSION: These findings indicate that the performance of Israeli children overall in these two age groups is not significantly different from the performance of U.S. children. If future research demonstrates that these findings are stable across all age groups and for larger samples, the implication is that the MAP can be administered and scored in Israel with the scoring methodology and normative information developed in the United States. However, because of the poorer performance of Israeli children on the Foundations Index, we recommend that specific Israeli norms be developed.

The reliability and validity of a sensory developmental expectation questionnaire for mothers of newborns.

The purpose of this study was to construct and conduct preliminary reliability and validity studies on a questionnaire designed to measure a mother's ability to provide an adequate sensory environment for her newborn child. The questionnaire was conceptualized as an extension and application of sensory integrative theory into the domain of maternal role preparation. The instrument assessed (a) a mother's knowledge of the sensory capacity of the newborn and (b) a mother's perception of her ability to influence the development of her child. The subjects were 55 primiparas of newborn infants who responded to the questionnaire within 3 days postpartum. The findings demonstrated that the questionnaire measured the two traits reliably. Additionally they indicated that knowledge of the sensory capacity of the newborn correlated positively with perceived influence on development. Maternal age did not correlate with the mothers' knowledge of the sensory capacity of the child, but did correlate with perceived influence of mothers on development. Educational level of the respondent correlated with scores on both subscales. With further research, it is foreseen that this questionnaire may be used by occupational therapists as a part of a screening interview for identifying mothers who may be at risk for failure to provide adequate sensory experiences for their children.

Occupational therapy in mother and child health care centers.

This paper describes the results of an infant stimulation program that involved mothers and their infants registered at Mother and Child Health Care centers in Jerusalem. A questionnaire was used to evaluate the mothers' knowledge, attitudes, and practices regarding the developmental needs of their infants. A developmental assessment was used to evaluate the infants' reaching and grasping abilities at 4 months of age. The questionnaire was completed by 175 mothers in the program (the experimental group) and a control group of 124 mothers. The results showed that, despite demographic differences that were likely to positively affect the control group's scores, the experimental group's scores were significantly higher. The results of the developmental assessment administered to 107 infants in the experimental group and 74 infants in the control group also indicated that, on 4 out of 5 reaching and grasping items, the experimental group performed significantly better. This study emphasizes the value of structuring a developmental curriculum for newborn infants and their mothers within an occupational therapy program.