Evidence Based Practice Symposium - McMaster University

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control, and level of physical function. Five articles in the scoping review summary included self-determination as a critical skill for successful independent living. Selfdetermination incorporates self-realization, self-awareness, empowerment and autonomy (Wehmeyer, Palmer, Soukup, Garner, & Lawrence, 2007). Four articles demonstrated a link between independent living and social skills (social problem solving, peer support, communication, cooperation, assertion, responsibility, empathy, engagement and self control). Several assessments measuring social skills and self-determination were reviewed to determine suitability for the ILP based on population, purpose of measure, and ease of use. Two assessments fit the needs of the program, and psychometric properties and clinical utility were reviewed further. The revised assessment protocol, including current and recommended additions is detailed in Table 1. Table 1. Revised ILP Assessment Protocol Assessment (Authors) Description Arc’s Self- 72 item evaluative self-report Determination Scale* measure that assesses an (Wehmeyer, 1995) adolescent’s overall level of selfdetermination, designed for youth with cognitive, development, or physical disabilities. Canadian Occupational An evaluative, semi-structured Performance Measure interview tool that addresses (COPM) occupational performance and (Law, Baptiste, Carswell, satisfaction in occupation self- McColl, Polatajko, & Pollock, 1990) care, productivity, and leisure. Goal Attainment Scale An evaluative method for (GAS) determining personalized goal (Kiresuk, Smith, & achievement over time, typically Cardillo, 1994) using a five-point scale. Perceived Self-Efficacy 8 item evaluative self-report Scale measure that assesses level of self- (Chen, Gulley, & Eden, 2001) efficacy. Social Skills An evaluative measure of youth Improvement System social skills designed to assess Rating Scale (SSIS- several dimensions of social skills RS)* using an optional multi-rater (Gresham & Elliot, questionnaire format. Self-report 2008) form includes seven sub-scales of social skills. * Recommended additions to the current ILP protocol Discussion & Implications The above recommendations for the ILP assessment protocol will provide ErinoakKids with valid and reliable standardized assessments. These measures are clinically useful, fit the needs of the program and assess the key characteristics identified in the scoping review. In addition, programs similar to ErinoakKids ILP can include these assessments within their protocol. The standardized assessments will enable ErinoakKids to conduct high-quality longitudinal studies with appropriate outcome measures. The authors recommend that future research projects compare self-determination and social skills between adolescents who attend the ILP and those who do not. Although this scoping review focused on personal characteristics, the authors recognize the important role of environmental factors in predicting successful independent living outcomes. Environmental factors could potentially impede or improve independent living outcomes. It is important to recognize the interaction between personal characteristics, environmental contexts, and the demands of an individual’s independent living goals. The Person, Environment, Occupation framework (PEO; Law, Cooper, Strong, Stewart, Rigby & Letts, 1996) can be a useful tool for occupational therapists to address barriers to independent living and capitalize on client strengths. The authors recommend that future research incorporate the examination of environmental factors, personal characteristics, and the occupational demands of transitioning to independent living. Limitations Overall, there is limited conclusive research regarding personal characteristics and independent living. This scoping review did not exclude studies on the basis of study design or methodology. Due to lack of updated research, some studies included within this review used designs that were less rigorous, such as narrative reviews. While the inclusion of low quality studies is acceptable for a scoping review, future research should strive for higher methodological rigour. Conclusion This study has presented a review of the literature on skills and characteristics that promote successful independent living for youth with disabilities. This scoping review identified that selfdetermination and social skills are important predictors of independent living outcomes. The Arc’s Self-Determination Scale and the Social Skills Improvement System Rating Scale are recommended additions to the current assessment protocol at the ErinoakKids ILP. References • Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19-32. • Centre for Independent Living in Toronto. (2012). Retrieved March 29, 2012, from: http://cilt.ca/what_is_il.aspx • ErinoakKids. (2012). Retrieved March 29, 2012, from: http://www.ErinoakKids.ca/index.cfm?pgID=182 • Healy, H., & Rigby, P. (1999). Promoting independence for teens and young adults with physical disabilities. Canadian Journal of Occupational Therapy, 66, 240-250. • Law, M. (2008). Outcome Measures Rating Form Guidelines. [PDF Document]. Retrieved March 19, 2012, from: http://www.canchild.ca/en/canchildresources/resources/measguid.pdf • Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9-23. • Levac, D., Colquhoun, H., & O’Brien, K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, 69-78. • Stewart, D.A. Law, M.C., Rosenbaum, P., & Willms, D.G. (2001). A qualitative study of the transition to adulthood for youth with physical disabilities. Physical & Occupational Therapy in Pediatrics, 21, 3-21. • Test, D.W., Mazzoti, V.L., Mustian, A.L., Fowler, C.H., Kortering, L., & Kohler, P. (2009). Evidence-Based secondary transition predictors for improving post school outcomes for students with disabilities. Career Development for Exceptional Individuals, 32, 160-181. • Wehmeyer, M. L., Palmer, S. B., Soukup, J.H., Garner, N.W., & Lawerence, M. (2007). Self-determination and student transition planning knowledge and skills: Predicting involvement. Exceptionality, 15, 31-44. Acknowledgements We would like to thank our supervisors at ErinoakKids for their continued support and guidance throughout the project.
Development of Education Material for Parents: Play Positions to Enhance Upper Limb Development in Infants Lowana Lee, OT Reg. Ont, Sarah Cain, M.Sc. OT Candidate, Mallory Carson, M.Sc. OT Candidate Abstract The researchers conducted a literature review and held discussions with clinicians to identify the optimal position for children to be in during awake or “play” time that promotes upper limb development, and to identify caregivers’ current knowledge of the topic. With this information, the researchers created a first draft of a parent education package. Introduction In 1995, a public awareness campaign entitled “Back to Sleep” was created to give guidelines for parents for the recommendation of placing infants on their backs to sleep to avoid the risk of Sudden Infant Death Syndrome (SIDS) (Zachry, & Kitzmann 2011). With the increasing amount of attention on SIDS, and prone sleeping being its number one risk factor, caregivers of infants have avoided putting their infants in prone all together (2011). Tremblay et al. (2012) published a systematic review to create Canadian recommendation guidelines for activity of children from birth to four years old. The guidelines that were developed stated that infants (less than 1 year of age) should be physically active several times a day, particularly through floor-based play (i.e. in prone) (2012). Literature Review Search Strategy Databases Searched: CINAHL, MedLine, OTseeker, PEDro, EMBASE Keywords: upper limb, upper extremity, play, positioning, tummy time, prone, infant, toddler, weight bearing Inclusion Criteria: Articles had to be published after 1992, as this was when the AAP released sleep position guidelines, articles also had to be relevant to infants and toddlers. A total of 8 articles were appraised using the McMaster critical review forms for qualitative and quantitative research Main Findings Physical Activity and Play Positioning for Infants Overall, the literature on positioning infants during awake (or play) time suggests that prone (or tummy time) is the most advantageous to motor development, especially in the earlier stages of infancy (Dudek-Schreiber, & Zalazny, 2007; Monson, Deitz, & Kartin, 2003; Pin, Elderidge, & Galea, 2007; Salls, Silverman, & Gatty, 2002). Caregiver Awareness Overall, caregivers of infants are not typically aware of the benefits of being in prone position for play and ‘tummy time’ (Koren, Reece, Kahn-D’angelo, & Medeiros, 2010; Mildred, Beard, Dallwitz, & Unwin, 1995; Zachry, & Kitzmann, 2011). Knowledge Dissemination Overall, parents do not typically receive a lot of information regarding play positioning. The most beneficial type of communication tool is the use of printed materials (Jennings, Sarbaugh and Payne, 2005). Conclusion There has been an identified need for infants to be engaged in physical activity for motor development and that playtime in the prone position helps infants reach developmental motor milestones quicker. Parents are not aware of the details of infant play positioning, and are more likely to have their children in a supine position due to the fear of SIDS. Overall, this review has identified the following gaps in the literature: play positions to promote upper limb development and how to disseminate this information to caregivers and those within their circle of care. Methods To address the gaps within the literature, the researchers created questions to be discussed with an interprofessional group of clinicians that have experience with positioning to promote upper limb development with infants, and their caregivers. A total of two physiotherapists and three occupational therapists from Children’s Developmental Rehabilitation Program (CDRP) were contacted. Questions: 1. What population of children do you work with? 2. Do you believe you work on upper or lower limb development more often in practice? 3. What techniques do you use to promote upper limb development? 4. Do you provide any upper limb development education packages to parents? 5. What evidence have you used to support your practices regarding upper and lower limb development? • Each discussion was between 30-60 minutes • Notes were taken by researchers during discussions • Notes were informally analyzed by researchers to identify common responses • Common utilized resources were given to researchers by the therapists
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