Novita Research Report January 1999 - Novita Children's Services

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Serial casting after Botulinum Toxin: A retrospective study of outcomes for dynamic equinus Susan Bostock Senior Clinical Physiotherapist Objective A preliminary retrospective study was undertaken at Novita to (i) review the use of outcome measures currently in use at Novita, and (ii) review Novita’s current practice of serial casting post Botulinum Toxin Type A (BoNT-A). This study was initiated in response to the increasing costs of casting materials and budgetary demands, and the perceived notion that, for optimal results, serial casting routinely follows BoNT-A injections for children with cerebral palsy who present with dynamic equinus. Method A retrospective review of case notes of 29 children who had received BoNT- A injections between May 1998 and May 2002 was undertaken. The data collected included passive range of movement (R2), dynamic range of movement (Modified Tardieu: R1), descriptions of gait and goals set. There was adequate data for only 24 children with cerebral palsy: 12 children with diplegia (D), 10 with hemiplegia (H) and 2 with triplegia (T). BoNT-A had been injected into gastrocnemius only in 24 legs, and to both gastrocnemius and hamstrings in 26 legs (total 50 legs). BoNT-A injections were followed by serial casting to the gastrocnemius muscle in 41 legs. Results R1 scores, PROM and casting protocols were available for 27 legs (D=20, H=5, T=2). For this group, Tardieu scores improved significantly (Wilcoxon Signed Rank test, z = -4.39, p< .01) from a median value of R1 = -15º (Range: -45º to 0º) before casting to R1 = 0º (Range: -25º to 25º) after casting. PROM improved in all subjects; from a median of 5 degrees (Range: -15º to 20º) to 20º (5º to 30º) (Wilcoxon, z = -4.5, p< .01). Overall, there were no significant differences in clinical and functional outcomes for children with diplegia or hemiplegia who underwent individualised spasticity management. Eighty three percent of children with diplegia who had BoNT-A to gastrocnemius alone, and 85% of those with BoNT-A to both hamstrings and gastrocnemius, underwent serial casting post BoNT-A. Seventy five percent of children with hemiplegia who had BoNT-A to gastrocnemius alone also had serial casting. There was a significant difference in dynamic (R1) and passive (R2) dorsiflexion pre serial casting and post serial casting for those children requiring serial casting post BoNT-A. 14 Implications The retrospective study will be useful in helping to formulate a prospective study as this study had several inherent limitations. The most significant finding was the lack of uniform data collection. Some measures were taken for some children, while other measures were used for other children. This made it difficult to compare measures, such as the Observational Gait Scale, as not all children routinely had video data taken. A controlled prospective study, with larger numbers of participants who have complete data sets, may provide further information on the effects of serial casting after BoNT-A injections. Project completed in 2003 Novita Children’s Services Incorporated • Research Report January 1999 – June 2004
Can typically developing preschool children learn the meaning of graphic symbols through play Paul Manson Regional Senior Speech Pathologist Angela Guidera Senior Speech Pathologist, NovitaTech Support Team Sandra Stewart Senior Research Speech Pathologist Kylie Opperman Senior Research Speech Pathologist Parimala Raghavendra Manager , Clinical Research Objective To investigate whether typically developing preschool children can learn the meaning of graphic symbols without structured teaching. Children with complex communication needs (CCN) are increasingly being integrated into regular educational settings. Communication intervention with children who have CCN often involves the use of graphic symbols. If peers are not familiar with a child’s communication method, communication breakdowns are likely to occur. Method Participants were typically developing preschool children aged between 4 years, 3 months and 5 years old. In the pre-test the participants were asked to label 16 symbols. During intervention they were left to play with a speechgenerating device that had an overlay comprised of the 16 symbols. Each time they pressed a symbol a label was spoken. In the post-test the same procedure as the pre-test was used. 18 children completed the three phases of pre-test, intervention and post-test. 12 children completed a retention test 3 weeks after the post-test. Results The mean number of symbols correctly recognised at pre-test was 3.4 and this increased to 7.9 symbols at post-test. There was more gain from pre- to post-test for symbols pressed more frequently (4 words with most key presses – average gain was 7.12) and less gain for those pressed less frequently (4 words with least key presses gained 1.75). Implications The study shows that typically developing children can learn to recognise symbols through play. The findings have implications for the way opportunities can be provided for peers to become familiar with aspects of a child’s communication system. Peers could benefit from a combination of structured teaching and unstructured opportunities. More structured teaching may need to focus particularly on symbols that are less transparent. Project completed in 2000 15 Early Intervention: when is it too late A case study of a 6 year old boy with mild cerebral palsy Sue Durand 1 Regional Senior Physiotherapist Sonya Murchland Senior Research Occupational Therapist 1 Currently employed in private practice Objective Although Early intervention may refer to services for children aged 0 – 8 years it is generally considered to be for children in the 0 – 6 year age group prior to school entry. This case study reports on the outcomes of a consultative therapy programme for a 6 year old boy with mild cerebral palsy who lived in rural South Australia. Method Following parent consent, the participant was assessed by an occupational therapist and physiotherapist with the Peabody Motor Scales (PMS) to determine his current motor abilities. A home and school programme was provided by the therapists based on the results of the initial assessment, with activities that could be included in daily activities. Progress was re-assessed at 6 months using the PMS and the programme was updated to reflect changes in abilities and new priorities for development. The participant was then reassessed at 12 months. Results On initial assessment at age 6 years 10 months his gross motor performance scored an age equivalent of 25 months, and fine motor age equivalent was 35 months, with gains over the year of approximately 18 months in all motor areas. Gross motor gains preceded fine motor development. Implications A consultative therapy approach was appropriate in providing the input to the participant suggesting that early intervention in the form of a targeted therapy programme, was not too late for this child over 6. He received his input within his regular environments, and with the co-operation of his family and carers. It is recognised that the motivation of these people to work with the participant in a positive manner that recognised his individuality, would have contributed to the success of this intervention. Project completed in 2002 Novita Children’s Services Incorporated • Research Report January 1999 – June 2004
Page 1 and 2: Research Report January 1999 - June
Page 3 and 4: foreword Novita Children’s Servic
Page 5 and 6: PRIMARY INVESTIGATOR PROJECT TITLE
Page 7 and 8: esearch evaluations (http://bluewir
Page 9 and 10: Clinical Research Selection Process
Page 11 and 12: Researcher Profiles Susan Bostock B
Page 13 and 14: Society for Augmentative and Altern
Page 15: Paediatric dysphagia and physical d
Page 19 and 20: Handwriting of children who have he
Page 21 and 22: Now I can eat too: The impact of an
Page 23 and 24: School vocabulary in typically deve
Page 25 and 26: Unravelling handwriting: an investi
Page 27 and 28: Convergence of AAC and portable com
Page 29 and 30: Predictors of device abandonment: t
Page 31 and 32: Vocabulary Organiser - enhancement
Page 33 and 34: Vocabulary Organiser - the addition
Page 35 and 36: Movement-to-m usic therapy David Ho
Page 37 and 38: Integrated control of wheelchairs &
Page 39 and 40: Toan Nguyen 1 Master of Engineering
Page 41 and 42: Mobile phone access via an augmenta
Page 43 and 44: Technological options for people wi
Page 45 and 46: Using product features to select ap
Page 47 and 48: Use of the Canadian Occupational Pe
Page 49 and 50: The prevalence of low back pain in
Page 51 and 52: Comparison of feedback conditions i
Page 53 and 54: Evaluation of family centred practi
Page 55 and 56: Motor and functional outcomes of ch
Page 57 and 58: Australian representation on ISO TC
Page 59 and 60: Development and delivery of an unde
Page 61 and 62: Rob Garrett Group Leader, R&D, Engi
Page 63 and 64: Evaluation and scoping of a movemen
Page 65 and 66: Resource allocation project Sonya M
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conference presentations Novita’s
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Australian Cerebral Palsy Associati
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DESIGN AND PRODUCTION CORPORATE PRO
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Novita Research Report January 1999 - Novita Children's Services

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