Date Presented 04/23/21
The mixed-methods study of 122 OT practitioners in the continental United States revealed current practice trends for the use of common assessments, interventions, outcome measures, and referral sources for children diagnosed with pediatric stroke. The study provided relevant information based on practice setting, type of stroke, and time of stroke that informed the selection of resources included in a Pediatric Stroke Resource Guide for OT Practitioners.
Primary Author and Speaker: Aarone M. Cefalo
Additional Authors and Speakers: Lisa Jaegers
Contributing Authors: Lisa Jaegers
PURPOSE: The researchers identified a need to investigate current OT practice trends for evaluating and providing treatment to children diagnosed with pediatric stroke, in order to inform the selection of a resource guide.
DESIGN: The researchers used a mixed methods design with purposive and snowball sampling methods and a cross-sectional survey instrument to investigate current OT practice resources for pediatric stroke. The non-randomized purposive sample consisted of 122 occupational therapy practitioners throughout the United States. The researchers set specific criteria for the participants and selected locations to yield meaningful data.
METHODS: Following university IRB approval, researchers emailed the OT Practitioners Pediatric Stroke Assessment and Treatment Survey to OT practitioners in selected pediatric settings. The study employed an anonymous online survey consisting of demographic, closed-ended, and open-ended questions to yield quantitative and qualitative data on assessments, interventions, and outcome measures currently used by OT practitioners for children with pediatric stroke. Analysis of the survey data included descriptive statistics and graphical representations of quantitative data, and manual coding and content analysis of the qualitative data.
RESULTS: The survey results and findings revealed current practice trends reported in six different pediatric settings. Overall, most OT practitioners reported using performance and development based assessments to evaluate pediatric stroke. All settings except the community or research settings, reported goniometric measurements as the most utilized outcome measure to track progress during treatment. The community or research setting reported a predominant use of an occupation-based outcome measure. The most reported intervention or treatment among all settings, except for the inpatient hospital setting, was constraint-induced movement treatment (CIMT). The more commonly used interventions within the inpatient hospital setting were static orthoses and kinesiology taping. Kinesiology taping was also commonly reported among the other five settings. Practitioners within the outpatient private, outpatient hospital, and school-based settings also reported a common use of static orthoses as an intervention. Neuromuscular electrical stimulation (NMES) was another commonly used intervention reported among the outpatient private, outpatient hospital, and inpatient hospital settings. Practitioners within the home-based and community or research settings reported using Hand-Arm Bimanual Intensive Training (HABIT) commonly as an intervention. Mirror therapy was also reported as being commonly used among multiple settings. The most reported referrals included aquatic therapy, CIMT/unilateral approach camp/program, hippotherapy, and mixed unilateral or bilateral approach camps. Additional results and findings of the study included similar trends related to type of stroke, and time of stroke.
CONCLUSIONS: The study provided relevant information on current practice trends for the use of common assessments and treatments of pediatric stroke. Although the data provided a basis for informing the selection of resources within a Pediatric Stroke Resource Guide for OT Practitioners, the study reported several limitations which require future research investigation. Additional research is needed to explore the reasoning for the predominant selection of performance-based assessments, instead of occupation-based assessments, for evaluating children with pediatric stroke. Furthermore, future research is necessary to determine best practice recommendations for OT practitioners on pediatric stroke.
References
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Guideline Development Group, Royal College of Paediatrics and Child Health. (2017). Stroke in childhood - clinical guideline for diagnosis, management and rehabilitation. London (United Kingdom): Royal College of Paediatrics and Child Health.
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