Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Knowledge Database
• Slide Presentation for the lecture of: Dido Green
Oxford Brookes University, UK
• Topic of lecture: E...
HOPE
EXPECTATIONS FOR THERAPY AND RELATIONSHIP
TO CONFIDENCE AND COMPETENCE AND
INTERVENTION OUTCOMES FOR CHILDREN WITH
UN...
“They won’t sit next
to me (at school) as
they don’t want to
catch my disease!”
“Games at school – they
always chose me la...
© Breathe Arts Health Research
• Psychosocial factors may influence development of movement
efficacy in children with UCP (Curtain & Clarke 2005,Gilmore ...
Aims and Objectives
A Mixed methods study to:
Explore the expectations and experiences of children
with UCP participating...
Intervention
• 2 week (60 hours) therapy camp for UCP
• Integrating magic tricks
and performing into
Occupational Therapy
...
Methodology
• Children participating in Magic camps
• Within-study
repeated measures
design.
• Assessments, pre,
post camp...
Outcome measures
• The Children’s Hope Scale (Snyder, 1997)
o Self report of positiveness and resilience
o 6 questions of ...
29 activities children
commonly do in daily life
www.cheq.se Skold et al. 2011
Questions:
1) Are the activities performed ...
Sample characteristics
2011-2013 (White, 2014)
Sample
size
Age months
Mean (SD)
MACS
Mean (range)
MAS
Mean (range)
Behavio...
Results (White 2014)
Hand Skill
JTTHF
F(2,31) 8.11
p=0.001
eta2 0.344
 Changes in performance
400
420
440
460
480
500
520...
The effect of positivity on initial perceptions of
Competence and Feeling Bothered n=34 (White, 2014)
Correlations Pre
int...
The effect of positivity on changes in perceptions of
competence and worry n=34 (White, 2014)
Initial positivity to
% Chan...
Correlations between positivity and perceptions of
confidence & competence and hand skill (White, 2014)
HOPE
Post interven...
What do the children say?
 Experiences and self-identity
 Abilities – competitive or playful
 Friendships
 Therapy and...
What do the children say?
Experiences and self-identity
A bit weird, Because I didn’t know that
they had a hand like me. T...
How do they feel about their
hemiplegia before?
Good and Bad.
 Pre camp
 Bit annoying a bit annoying, it doesn't do what...
How do they feel about their
hemiplegia after?
 Post camp
 Umm I just ignore it. I don’t really feel bad about it. I don...
Expectations versus Experience
I really liked this camp …..So like today
they were going to be a bit strict because
it was...
Discussion
 The relationship between perceptions of confidence &
competence is complex.
 Higher initial positivity showe...
‫אותנו‬ ‫דוחפת‬ ‫שאת‬ ‫לך‬ ‫תודה‬,
‫עלינו‬ ‫מוותרת‬ ‫לא‬ ‫שאת‬ ‫תודה‬
‫עלינו‬ ‫מרחמת‬ ‫לא‬ ‫שאת‬ ‫תודה‬
What are Clinicall...
© Breathe Arts Health Research
Maya Weinstein,
Dr Mitchell Schertz,
Dr Shelly Shiran,
Vicky Myers,
Moran Artzi,
Becca Krom
Dr Lian Ben-Sira,
Dr Ronni Gev...
A BIG thank you to our funders, partners
and supporters…
Marnie Kimelman Trust
Dido.Green@brookes.ac.uk
For Films and more information on Breathe Magic
www.breatheahr.org
Curtin M, Clarke G. (2005) Living with impairment: learning from disabled young peoples’ biographies. British
Journal of O...
Knowledge Database
To Exit Full Screen and Return to the
Knowledge Database
Press Esc
Upcoming SlideShare
Loading in …5
×

Dido Green: Expectations for Therapy and Relationship to Confidence and Competence and Intervention Outcomes for Children with Unilateral Cerebral Palsy - Slide presentation

413 views

Published on

AAA

Published in: Services
  • Be the first to comment

  • Be the first to like this

Dido Green: Expectations for Therapy and Relationship to Confidence and Competence and Intervention Outcomes for Children with Unilateral Cerebral Palsy - Slide presentation

  1. 1. Knowledge Database • Slide Presentation for the lecture of: Dido Green Oxford Brookes University, UK • Topic of lecture: Expectations for Therapy and Relationship to Confidence and Competence and Intervention Outcomes for Children with Unilateral Cerebral Palsy • The lecture was given at Beit Issie Shapiro’s 6th International Conference on Disabilities – Israel • Year: 2015
  2. 2. HOPE EXPECTATIONS FOR THERAPY AND RELATIONSHIP TO CONFIDENCE AND COMPETENCE AND INTERVENTION OUTCOMES FOR CHILDREN WITH UNILATERAL CEREBRAL PALSY. Dido Green Unity and Diversity in Action BIS 6th Conference, Tel Aviv 2015 With thanks to Sophie White, MSc Student, Oxford Brookes Univ. © Breathe Arts Health Research
  3. 3. “They won’t sit next to me (at school) as they don’t want to catch my disease!” “Games at school – they always chose me last and then the other side gloats when they win.” About new Friends …” P (older boy) because he’s grown up and he’s OK” I am a one handed boy – I don’t want to be associated with ‘them’. What do the children say? Are we listening?
  4. 4. © Breathe Arts Health Research
  5. 5. • Psychosocial factors may influence development of movement efficacy in children with UCP (Curtain & Clarke 2005,Gilmore etal 2010, Skold etal 2007, Green et al 2013), • Up to 61% of children with UCP may have persistent mental health problems affecting perceptions of confidence, competence and positivity (Goodman & Graham 1996; Parkes et al 2008). • Therapeutic outcomes from interventions for children with UCP are influenced by children’s engagement which may be linked to mastery motivation (Miller et al, 2014). • Yet few studies investigate psychosocial factors Background to current study
  6. 6. Aims and Objectives A Mixed methods study to: Explore the expectations and experiences of children with UCP participating in an intensive 60 hour day- camp using a magic-themed hand-arm bimanual intensive therapy (Magic-HABIT). Explore the perspectives of children through semi-structured interviews © Breathe Arts Health Research
  7. 7. Intervention • 2 week (60 hours) therapy camp for UCP • Integrating magic tricks and performing into Occupational Therapy and the Hand Arm Bimanual Intensive Therapy (HABIT) protocol. © Breathe Arts Health Research
  8. 8. Methodology • Children participating in Magic camps • Within-study repeated measures design. • Assessments, pre, post camp and 3- month follow-up © Breathe Arts Health Research
  9. 9. Outcome measures • The Children’s Hope Scale (Snyder, 1997) o Self report of positiveness and resilience o 6 questions of goal achievement behaviours • Jebsen Taylor Test of Hand Function o timed test of grasp and release across 6 tasks. • Children’s Hand Experience Questionnaire (CHEQ) (Skold et al. 2011) • Semi-Structured Interviews with children (&parents)
  10. 10. 29 activities children commonly do in daily life www.cheq.se Skold et al. 2011 Questions: 1) Are the activities performed independently? 2) Are one or two hands are used in the activities? 3) The experience of doing activities according to • grip efficacy • time taken in comparison to peers • experience of feeling bothered Negative 1----2----3----4 Positive
  11. 11. Sample characteristics 2011-2013 (White, 2014) Sample size Age months Mean (SD) MACS Mean (range) MAS Mean (range) Behaviour Problems Mild(opting out) to significant (affecting own + others participation). n=34 125.2 (32) 2.1 (1-3) 1.9 (0-4) Mild n=10 Moderate n=3 Significant n=1 SD=standard deviation; MACS=Manual Ability Classification System; MAS=Modified Ashworth Scale;
  12. 12. Results (White 2014) Hand Skill JTTHF F(2,31) 8.11 p=0.001 eta2 0.344  Changes in performance 400 420 440 460 480 500 520 540 560 1 2 3 TotalSpeedinSeconds Independence CHEQ F(2,26) 23.27, p<0.001 eta2 0.642 Positivity of thinking HOPE* F(2,32) 13.23, p=0.001 *=Friedman 0 10 20 30 40 50 60 70 80 1 2 3 Percentage 22 23 24 25 1 2 3 MeanTotalScore
  13. 13. The effect of positivity on initial perceptions of Competence and Feeling Bothered n=34 (White, 2014) Correlations Pre intervention CHEQ independent CHEQ grip CHEQ time taken CHEQ bothered JTTHF Positivity (HOPE) .734 .084 .047 .186 .071 .001 .648 .799 .308 .674 34 34 34 34 39 Percentage of Independent Activities HOPETotalScore R² = 0.0391 15 17 19 21 23 25 27 29 31 33 35 0 20 40 60 80 100
  14. 14. The effect of positivity on changes in perceptions of competence and worry n=34 (White, 2014) Initial positivity to % Change pre to Follow up CHEQ Grip % change Pre to FU CHEQ Time % Change Pre to FU CHEQ Bothered % change Pre to FU CHEQ Independ % Change Pre to FU Positivity (HOPE) pre .480 .491 .437 .685 .028 .015 .033 .007 R² = 0.2091 15 17 19 21 23 25 27 29 31 33 35 -60 -40 -20 0 20 40 60 80 HOPETotalScore Percentage change in Feeling Bothered
  15. 15. Correlations between positivity and perceptions of confidence & competence and hand skill (White, 2014) HOPE Post intervention hand skill 3 month FU CHEQ Bothered Post intervention Positivity -0.34 ns 0.049 ns 3 month FU positivity ns 0.484 ns 0.008 HOPETotalScore Feeling Bothered at 3-mfu R² = 0.1324 15 17 19 21 23 25 27 29 31 33 35 0 1 2 3 4 5
  16. 16. What do the children say?  Experiences and self-identity  Abilities – competitive or playful  Friendships  Therapy and exercises  What does having a hemiplegia mean to them  Positive or negative statements  Expectations versus Experience*  What were perceived benefits to the child?  Capacity for change? * (2013 &2014 camps were delivered by Breathe Arts Health Research and the essence of feedback had been moved to extrinsic and external rewards via Magicians)
  17. 17. What do the children say? Experiences and self-identity A bit weird, Because I didn’t know that they had a hand like me. This is my first time in the magic camp….. It felt a bit funny. (….Because) …I feel like, umm fine with my friends now. My new friends and getting to know them … I’d sit with them at lunch time and play with them and do lots of magic tricks and have fun and all that kind of stuff.
  18. 18. How do they feel about their hemiplegia before? Good and Bad.  Pre camp  Bit annoying a bit annoying, it doesn't do what I want it to do all of the time. I want it to be exactly like this hand (showing)  Annoying, I have to do them (exercises) every time and ,…. stretches and things and annoying. I have to go outside of the class with 3 others every day. Annoying lasting for months. (too much?) Yea four months ..12 months we have to do them of months - very annoying (again animated). (every year?) Yea, every year  It is just a bit weird, kid of just weird: Um I don't, (pause) I can't really, because, um I have the right because. The right hand’s got all the goodness in it and all the strongness in it but this hand hasn’t really thing in it because it’s kind of got a bit of weak in it, it’s got weak stuff in it.
  19. 19. How do they feel about their hemiplegia after?  Post camp  Umm I just ignore it. I don’t really feel bad about it. I don’t really talk about anything from it. I don’t really think about it unless I have to, I just ignore it. I think it’s just normal.  It’s cool because you’re different and the things you do, to actually make your hemiplegia easier, are actually really fun. I like being different, so I like having hemiplegia, because you’re different, you’re not the same. You’re different in your own way*  It’s a bit like hands, when you have one hand that is weaker than the other, but then do a bit of practising and will get better probably (so it will get better you think with practice)
  20. 20. Expectations versus Experience I really liked this camp …..So like today they were going to be a bit strict because it was the magic camp that wanted you to do your magic show that stuff that make sure that you can do all the stuff that you want and like do your magic tricks. Yeh so you get better and the magic trick because they want you to get it straight on so you don’t fail the magic trick. So that you can be a great magician!
  21. 21. Discussion  The relationship between perceptions of confidence & competence is complex.  Higher initial positivity showed greater positive changes in perceptions of competence and feeling less bothered by difficulties.  Children with lower initial degree of positivity still made improvement in hand skill.  Children report different experiences from those elicited in questionnaire  Consider whether expectations or perceptions of confidence & competence may influence progress in movement skills
  22. 22. ‫אותנו‬ ‫דוחפת‬ ‫שאת‬ ‫לך‬ ‫תודה‬, ‫עלינו‬ ‫מוותרת‬ ‫לא‬ ‫שאת‬ ‫תודה‬ ‫עלינו‬ ‫מרחמת‬ ‫לא‬ ‫שאת‬ ‫תודה‬ What are Clinically Meaningful Research Outcomes? “It has been fantastic and it has helped me to grip for the first time…” “My hand is feeling much better now and the hemiplegia is coming away!” ‫את‬ ‫שהפכת‬ ‫תודה‬ ‫ליכולת‬ ‫שלי‬ ‫הנכות‬
  23. 23. © Breathe Arts Health Research
  24. 24. Maya Weinstein, Dr Mitchell Schertz, Dr Shelly Shiran, Vicky Myers, Moran Artzi, Becca Krom Dr Lian Ben-Sira, Dr Ronni Geva, Dr Varda Gross-Tsur, Dr. Aviva Fattal-Valevski Dr. Dafna Ben Bashat, Dr. Benni Hozmi Dr Dana Roth Sophie White Prof Bert Steenbergen Dr Maritije Jongsma Amarlie Moore, David Owen, Richard McDougall, Dr Will Houston, Dr Verity McClelland, Dr Gareth Barker, Dr Geoff Charles-Edwards, Prof Andrew Gordon
  25. 25. A BIG thank you to our funders, partners and supporters… Marnie Kimelman Trust
  26. 26. Dido.Green@brookes.ac.uk For Films and more information on Breathe Magic www.breatheahr.org
  27. 27. Curtin M, Clarke G. (2005) Living with impairment: learning from disabled young peoples’ biographies. British Journal of Occupational Therapy. 68, 401-408. Gilmore, R., Ziviani, J., Sakzewski, L., Shileds, N., & Boyd, R. (2010). A balancing act: children’s experience of modified constraint-induced movement therapy. Developmental Neurorehabilitation.13(2), 88-94. Goodman, R. and Graham, P. (1996) Psychiatric problems in children with hemiplegia: a cross sectional epidermalogical study. British medical journal. 312, 1065-1069. Green, D., Scherz, M., Gordon, A., Moore, A., Schejter- Margalit, T., Bashat, D., Weinstein, M., Lin, J-P. and Fattal-Valevski, A. (2013) A multi-site study of functional outcomes following a themed approach to harnd-arm bimanual intensive therapy for children with hemiplegia. Developmental medicine and child neurology. 55(6), 527-533. Majnemer, A. Shevell, M. Law, M. Poulin, C. Rosenbaum, P. (2010) Level of motivation in mastering challenging tasks in children with cerebral palsy. Developmental medicine and child neurology. 52(12): 1120-1126. Parkes, J. White-Koning, M. Dickinson, H. Thyen, U. Arnaud, C. Beckung, E. Fauconnier, J. Marcelli, M. Macmanus, V. Michelsen, S. Parkinson, K. Colver, A. (2008) Psychological problems in children with cerebral palsy: a cross-sectional European study. Journal of child psychology and psychiatry. 49(4): 405-413. Skold, A., Josephsson, S., Fitinghoff, H. and Elliasson, A. (2007) Experiences of use of the cerebral palsy hemiplegic hand in young persons treated with upper extremity surgery. Journal of hand therapy. 20, 262-273. Skold, A., Hermansson, L., Krumlinde-Sundholm, L. and Eliasson, A-C. (2011) Development and evidence of validity for the children’s hand-use experience questionnaire (CHEQ). Snyder, R. C., Hoza, B., Pelham, W., Rapoff, M., Ware, L., Danovsky, M., Highberger., Rubunstein, H. and Stahl, K. (1997) The development and validation of the Children’s Hope Scale. Journal of Paediatric Psychology. 22(3), 349-421. White, S. (2014) Perceptions of Confidence and Competence in children with unilateral Cerebral Palsy. Unpublished MSc Thesis, Oxford Brookes University References
  28. 28. Knowledge Database To Exit Full Screen and Return to the Knowledge Database Press Esc

×