Novita Research Report - 2004 to 2007 - Novita Children's Services

19MethodPhase 1: children were recruited and undertook baseline assessment of their neurologicalfunctioning, tone in upper limb, self-perception and activity participation in activities of dailyliving using the Assessment of Motor and Process Skills.Phase 2: Children from Phase 1 aged three to 16 years who met the criteria of a diagnosis ofhemiplegia, passive joint range of motion within defined limits, ability to initiate movement ofthe fingers, a Modified Ashworth Scale (MAS) of greater or equal to two on four at the elbowor wrist became the participants. They were ineligible if they had received BoNT-A in theupper limb less than one year previously, or the lower limb less than six months before thestudy.The children were randomly assigned in blocks of 10 to either OT only or OT and BoNT-Aintervention protocols. All children received a four week block of OT, which commencedwithin two weeks of injection for those children that received BoNT-A. All participants wereassessed at baseline, then at three and six months post-intervention. Measures included;neurological assessment, MAS, Tardieu Scale, subjective report on perception if they were‘worse’, ‘the same’ or ‘better’ since the intervention (in terms of cosmesis and function), PEDI,PedsQOL, Self-Perception Profile for Children, Pictorial Scale of Perceived Competence andSocial Acceptance, Assessment of Motor and Process Skills, Goal Attainment Scaling (GAS),and Pain via visual analogue scale.ResultsPhase 1: 54 of the 77 children with hemiplegia identified through the SACPR were recruitedand consented to the study. They had a mean age of seven years four months (SD 2year 5 m), 33 (61%) had right hemiplegia and 37 (69%) lived within 100km of Adelaide. Allparticipants were found to have significant difficulties with motor and process skills that wouldhave an impact on their ability in daily living tasks. More difficulty was found in motor skills inolder children (nine to 12 years) than younger children (three to eight years), and process skilldeficits may have more impact on development of independence than expected.Phase 2: 43 children (84%) were identified as being eligible and 51 (47%) of the 108 childrenassessed consented to participate and were randomly assigned to either group. At baselinethere were similarities in function, demographic and quality of life characteristics. Significantimprovement was found in the BoNT-A and OT group at three and six months in bodystructure, as well as improvements in activity participation, GAS, and Global Self-Worth atthree months. By six months there was no difference in the activity participation measuresbetween groups. The BoNT-A and OT group also experienced an increase in self-worth,which decreased in the OT only group.ImplicationsFor clients – BoNT-A can have a significant impact on children’s abilities across all levels ofperformance with improved self-worth.For services – OT is an important adjunct to BoNT-A injection to maximise outcomes forchildren with hemiplegia. OT input alone can also have a positive and lasting impact onchildren’s activity participation.StatusCompleted