Evidence Based Practice Symposium - McMaster University

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Discussion Common Themes from Discussions • Techniques used by clinicians: All Occupational Therapist (OT)s interviewed had a focus on tummy time techniques to promote upper limb development in early infancy. All OTs interviewed also mentioned that tummy time should be initiated as soon as possible, grading the activities (eg. increasing amounts of time) as the infant begins to tolerate the position longer. • All OTs and Physiotherapist (PT)s stated that they photocopy resources available to them to give to parents in regards to different positions that promote upper limb development. Some of these resources were mentioned to be outdated, and not parent-friendly, so many of the clinicians mention producing their own “homework sheets” on triplicates that depict specific positions and play ideas • All of the clinicians use the CDRP printed handout for parents about “Tummy Time” • All clinicians mentioned a lack of an education package that incorporates the necessary information regarding the specific techniques they wished to use, while being easily understood by parents of all backgrounds. • OTs were more likely to work on upper limb development in practice, PTs were more often to work on lower limb development, however they would not neglect the upper limb. • The interviewed PTs reported focusing on balance and strength development through weight bearing in prone/sitting, and the use of equipment. They also noted the importance of being in prone and tummy time techniques, being congruent with the OTs. Other focuses that were specified were: reducing tone, NDT, feeding, fine motor, and righting reactions. • Minimal scholarly evidence was utilized by clinicians. Development of the ‘Prone to Play’ Parent Education Package • Identified that prone was the optimal positioning for upper limb motor development during play. This was through the use of the literature, clinician responses and CDRP ‘Tummy Time’ printed handout • Identified strategies currently being used by clinicians to promote upper limb development • Identified that the most effective method for knowledge dissemination to parents through was through the use of printed information • Created play ideas in the prone position. This was through use of the clinicians’ responses, clinicians’ resources and researchers’ clinical experience • The researchers compiled personally illustrated pictures and information to develop the first draft of the parent education package Future Direction The researchers have made several recommendations for future research • Longitudinal studies would be beneficial to see the long term benefits that play positioning can have on a child, as the current literature does not examine gross motor developmental milestones past the age of two years • Including a range of demographics when sampling, as there have been identified cultural differences that could affect motor development (e.g. swaddling infants) • The exploration into the Prone To Play parent education package usefulness and comprehensiveness Acknowledgements Hamilton Health Sciences: Children’s Developmental Rehabilitation Program Key References Dudek-Schreiber, L., Zalazny, S. (2007). The effects of prone positioning on the quality and acquisition of developmental milestones in four month old infants. Pediatric Physical Therapy, 19(1), 48-55. Jennings, J., Sarbaugh, B., & Payne, N. (2005). Conveying the message about optimal infant positions. Physical & Occupational Therapy In Pediatrics, 25(3), 3-18. Koren, A., Reece, S.M., Kahn-D’angelo, L., & Medeiros, D. (2010). Parental information and behaviours and provider practices related to tummy time and back to sleep. Journal of Pediatric Health Care, 24(4), 222-230. Mildred, J., Beard, K., Dallwitz, A., Unwin, J. (1995). Play position is influenced by knowledge of SlDS sleep position recommendations. J. Paediatr. Child Health 31, 499-502. Monson, RM., Deitz, J. Kartin, D. (2003). The relationship between awake positioning and motor performance among infants who slept supine. Pediatric Physical Therapy, 15, 196-203. Pin, T., Eldridge, B., & Galea, M. (2007). A review of the effects of sleep position, play position, and equipment use on motor development in infants. Developmental Medicine & Child Neurology, 49(11), 858-867. Salls, J., Silverman, L., & Gatty, C. (2002). The relationship of infant sleep and play positioning to motor milestone achievement. American Journal Of Occupational Therapy, 56(5), 577-580. Tremblay, M., LeBlanc, A., Carson, V., Choquette, L., Connor Gorber, S., Dillman, C. … Timmons, W. (2012). Canadian Physical Activity Guidelines for the Early Years (aged 0–4 years). Applied Physiology, Nutrition and Metabolism, 37, 345–356 Zachry, A. H., & Kitzmann, K. M. (2011). Caregiver awareness of prone play recommendations. American Journal Of Occupational Therapy, 65(1), 101-105. doi:10.5014/ajot.2011.09100
THE EXPERIENCE OF THERAPEUTIC RIDING ON CHILDREN WITH AUTISM SPECTURM DISORDER: A PARENT’S PERSPECTIVE Rebecca Baldwin, BA; Megan Meekison, BSc; Bonny Jung, PhD, Med, OT Reg. (Ont.).; Angela Meyer, OT Reg. (Ont.); and Ann Caine, SRN (Eng) ABSTRACT: Therapeutic riding (TR) is an alternative/complementary therapy that is often consulted by parents of children with autism spectrum disorder (ASD) due to potential therapeutic benefits, but there is a scarcity of evidence providing support for these benefits, particularly from a qualitative perspective. The present study used a phenomenological approach to examine the experience of TR on children with ASD, from their parent’s perspective. Four children participated in the typical riding program at Sunrise Therapeutic Riding and Learning Centre. Before and after their child’s involvement in TR, parents participated in semi-structured interviews to provide an understanding of their expectations and experiences, respectively. Thematic analysis was used to develop the overall theme, “TR exceeded parent’s expectations,” and the associated sub-themes, “perceived therapeutic benefits exceeded expectations,” “success was attributed to the TR environment and child’s motivation to participate,” and “importance of TR as an opportunity for participation in meaningful recreation.” This pilot study sheds light on how children with ASD and their families experience TR, the generalizability of the perceived benefits, as well as reasons why TR is perceived to be both an effective leisure and therapeutic activity. These results serve as an important step in gaining a holistic understanding of TR’s impact, and so implications for this research area and OT practice are discussed. INTRODUCTION: Autism Spectrum Disorder (ASD) consists of five neurodevelopmental conditions that are characterized by abnormalities in social interaction, communication, as well as severely restricted interests/highly repetitive behaviours (Phetrasuwan, Shandor-Miles, & Mesibov, 2009). The prevalence of ASD is estimated to be 60 per 10 000 people in developed countries, with an age of onset in childhood (Levy, Mandell, & Schultz, 2009). Functionally, the deficits of ASD may impact the ability of a child to engage in meaningful social activities, leisure pursuits, and self-care and productivity occupations. Epidemiological studies suggest that 13 to 30 percent of children with ASD engage in problem behaviours that warrant intervention (Wing & Potter, 2002). Since no curative treatment exists, it is common for parents to consult alternative and/or complementary therapies, one of which is animal assisted therapy (AAT; Harrington, Rosen, Gamecho, & Patrick, 2006). <strong>Evidence</strong> suggests that AAT results in decreases in various undesirable behaviours and increases in adaptive social and communicative behaviours for individuals with ASD (e.g., Martin & Farmum, 2002). One type of AAT is therapeutic horseback riding (TR). While TR is popular for this population, a debate exists as to whether this is an effective intervention for promoting physical, psychosocial, cognitive, social-behavioural, and emotional benefits, or if these programs should be considered as adapted leisure activities that promote sportsmanship and athleticism (Rosenbaum, 2009). LITERATURE REVIEW: The available evidence indicates that a variety of clinical populations may incur physical benefits from TR, such as improved postural control and balance, fine motor function, and general motor performance, as well as psychosocial benefits related to emotion, socialization, quality of life and self-confidence. With respect to the ASD-specific TR literature, a comprehensive review only uncovered 4 relevant studies. First, a small randomized control trial by Bass, Duchowny and Llabre (2009) found significant improvements in several sensory and psychosocial domains in children with ASD following 12 weekly TR sessions, some of which did not persist at follow-up. Second, Taylor et al. (2009) provided preliminary evidence, through 3 case studies, of improvements in volition following a 16 week hippotherapy program. Third, Wuang, Wang, Huang and Su (2010) found that children with ASD demonstrated improved motor proficiency and sensory integrative functions following participation in 20 weeks of 60-minute mechanically simulated TR sessions. Finally, in a before-after study of 20 children with ASD by Kern et al. (2011), weekly 60-minute TR lessons for 24 weeks demonstrated a reduction in the severity of autism symptoms, significant improvements in measures of parent-child interaction, marginal reductions in negative regard, and good/very good ratings on the Treatment Satisfaction Survey. Parents also stated that their children enjoyed riding and actually began to look forward to their lessons. RATIONALE: Despite much promise of the aforementioned studies, there is a marked scarcity of completed studies and quality evidence in the literature that provide support for the therapeutic value of EAA/T for individuals with ASD. Furthermore, there is a conspicuous lack of qualitative exploration in this field, including investigation into the experiences of riders and/or their families. In addition, the generalizability and transferability of the potential recreational and/or therapeutic benefits of TR to daily functioning in home, school and community contexts has remained unaddressed. Finally, research needs to shed light on the debate between the therapeutic versus recreational benefits of TR, from the consumer’s perspective. PURPOSE: The purpose of this pilot project was to examine the experience of weekly TR on children with ASD, from their parents’ perspectives, and to provide methodological guidance for a future larger scale study of the same topic. In line with phenomenological research, it is believed that occupations, such as TR, are best understood through exploring the individual’s experience of doing it, since the interaction of the person’s ability and the demands of the task, and the meaning they attach to it, is perceived by the individual. RESEARCH QUESTION: From the perspective of a parent who has a child with ASD, how does EAA/T, in the form of therapeutic horseback riding, impact their child’s behaviour, ability to participate in their daily activities, and their family life? DESIGN: This study used a phenomenological approach to examine the lived experience of TR for children with ASD, from their parents’ perspective. As the study participants, the children’s parents were interviewed using semi-structured interviews before and after
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