AIM The aim of this study was to develop a valid classification system to describe eating and drinking ability in people with cerebral palsy (CP), and to test its reliability. INTERPRETATION The EDACS provides a valid and reliable system for classifying eating and drinking performance of people with CP, for use in both clinical and research contexts. METHODPeople with cerebral palsy (CP) are affected by a range of activity limitations, attributed to non-progressive disturbances occurring in the developing fetal or infant brain. 1 The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems.1 Impairments can limit the oral skills required for eating, drinking, and swallowing, with consequent risks of respiratory problems linked to direct aspiration of food and fluid into the lungs, 2-4 and inadequate nutrition and hydration. 5,6 Activity limitations also affect the ability to bring food and drink to the mouth. The degree to which a person with CP can control the posture and movement of the trunk and head has a direct impact on the efficient use of the muscle systems which support feeding and breathing. 7,8 The prevalence of eating and drinking difficulties in individuals with CP is unclear.9 Estimates depend on the definitions and tools used, ranging from 27% 10 to 90%. 11Prevalence has been proposed to be related to severity of motor impairment, 12 although eating and drinking problems have also been reported to occur in individuals at Gross Motor Function Classification System (GMFCS) levels I and II. 13,14 There is no agreement in the literature about the definition of the terms mild, moderate, and severe in relation to limitations to eating and drinking ability, or whether focus should be at the level of body functions and structures, activity, and/or participation. A recent systematic review identified the lack of a valid and reliable ordinal scale to classify the eating and drinking abilities of people with CP in both clinical and research contexts. 15The purpose of this study was to develop the Eating and Drinking Ability Classification System (EDACS) for people with CP, and evaluate its validity and reliability, making use of defined quality standards. Content validity is considered positive if there is a clear statement of purpose of the assessment and clear identification of the target population and concepts being measured. Content should be identified with input from the target population as well as experts and investigators. Reliability is considered satisfactory if the intraclass correlation coefficient (ICC; or weighted kappa) is at least 0.7 in a sample size of at least 50 patients. 16The EDACS is analogous and complementary to the GMFCS, 17 the Manual Ability Classification System (MACS) 18 or the Communication Function Classification System (CFCS).19 Thus, the intention is for the EDACS Stage 1: Drafting of the eating and drinking ability classification systemThe initial d...
There is preliminary evidence that the use of an individualized stroke self-management intervention is acceptable and can lead to a change in self-efficacy in this small sample.
An important finding of this study was that individuals all identified a number of specific factors which had supported or hindered their own recovery. There were a diversity of both internal/personal and external factors which may not be surprising, given the complexity of stroke, but all participants stressed the importance of both factors. The findings from this study are preliminary and relate only to this particular group of participants, as such they cannot be generalizable to the stroke population as a whole. However, the interaction between the two themes identified requires further exploration, especially in relation to therapy which could have both a positive and negative influence on personal control. There is a clear need to understand how professionals can, in the first place, take time to identify each individual's preferences and personal goals and secondly, make sure that these are fully addressed in a planned treatment programme. This will ensure that progress in individuals after stroke is supported by professionals with a more eclectic, individualized approach.
Effective interprofessional working is considered to be essential for optimum healthcare delivery. Interprofessional rivalry, tribalism and stereotypes are known to exist within healthcare professions and detract from effective health delivery. Limited literature is available that reports undergraduate healthcare students' stereotypical perceptions of each other. Stereotypes in relation to interprofessional education are commonly explained through the Contact Hypothesis Theory, the Realistic Conflict Theory, or the Social Identity Theory. The aim of this study was to investigate undergraduate physiotherapy and podiatry students' stereotypes of each other's professions before and after a semester of interprofessional education. Stereotypes were measured using the Health Team Stereotype Scale. Results indicated that both professional groups had stereotypical perceptions of each other prior to any education, which were reinforced as a result of the education. The results support the Social Identity Theory, which explains intergroup discrimination and describes an interpersonalintergroup continuum. The timing of the interprofessional education may be critical to reducing such an effect
Physiotherapy education is changing, and educators are increasingly concerned about the levels of stress observed in students. Considerable research has investigated stressors in medical and nursing students; however, studies of physiotherapy students were conducted more than a decade ago. This study examined the sources of stress, perceived course difficulty, and hours of paid employment in undergraduate physiotherapy students in Western Australia (WA) and the United Kingdom (UK). The Undergraduate Sources of Stress questionnaire was administered to students in all years of Bachelor of Science (Physiotherapy) programs (n = 249 WA; n = 161 UK) and a Master of Physiotherapy (graduate entry) program (n = 24 WA) with an overall response rate of 70%. Academic concerns were rated highest for all students, particularly the amount to learn, time demands of the course, and conflict with other activities. The course was perceived to be more difficult than expected by 71% of students. Although the mean (SD) hours per week worked in paid employment by WA and UK students is 12.52 (13.90) and 7.16 (4.02), respectively, there was no correlation between any stress subscale and number of hours worked. Reducing the amount of content and revision of the outcomes of physiotherapy curricula could potentially reduce academic stress.
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