Paediatric neurorehabilitation: finding and filling the gaps through the use of the Institute for Manufacturing strategic roadmapping method

Hamilton, Colin; Maw, Anna; Gill, Andrew B.; Brahmbhatt, Mita; Phaal, Robert; Pickard, John D.

doi:10.1136/bmjinnov-2017-000202

Cited by 11 publications

(5 citation statements)

References 27 publications

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“…Prioritization of these goals would be expected, as they contain activities that are tangible and meaningful to the child. Indeed, given that successful participation in activities at home, school, and the community is the overall aim of rehabilitation programmes (Hamilton et al, ), consideration of these types of goals would have been encouraged.…”

Section: Discussionmentioning

confidence: 99%

Using child‐ and family‐centred goal setting as an outcome measure in residential rehabilitation for children and youth with acquired brain injuries: The challenge of predicting expected levels of achievement

Kelly¹,

Dunford

Forsyth

et al. 2019

Child

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Purpose:Collaborative, child-and family-centred goal setting is essential in paediatric, acquired brain injury (ABI) rehabilitation. This study aims to understand which goals children and families prioritize and how accurately therapists predict expected levels of achievement for these goals.Methods: Routinely collected Goal Attainment Scale-Light data from 122 children with severe ABI receiving residential rehabilitation were retrospectively analysed.Goals were mapped onto the International Classification of Functioning, Disability and Health. Descriptive analysis of accuracy of therapists' prediction of goal achievement was conducted.Results: Eight-hundred sixty goals were set: 82% in activities and participation domains, most commonly mobility, self-care, and communication chapters. Forty-six per cent of therapist-set expected levels of achievement for these goals were met at the expected level, and 24% were exceeded. Chapters with the highest prediction accuracy included two environmental chapters and one body structure and function.Accurate prediction of activity and participation goals varied (35% in general tasks and demands to 58.8% in major life areas).Conclusions: Children and families prioritize mobility, self-care, and communication during ABI residential rehabilitation. Setting expected outcomes for these goals is challenging, as demonstrated by the variety in accurate prediction rates between and within chapters. Families need to be aware of this uncertainty during goalsetting discussions.

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Section: Discussionmentioning

confidence: 99%

Using child‐ and family‐centred goal setting as an outcome measure in residential rehabilitation for children and youth with acquired brain injuries: The challenge of predicting expected levels of achievement

Kelly¹,

Dunford

Forsyth

et al. 2019

Child

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“…Acute and post-acute neuro-rehabilitation for CYP with ABI is delivered by 16 regional specialist centres across the UK. National service specifications for paediatric neurorehabilitation aimed for equitable provision across the country, however, there is widespread concern regarding the variability of service provision and a drive towards identifying and commissioning optimum rehabilitation models (2,5,12). Research regarding rehabilitation for adults with brain injury has demonstrated the benefits and cost effectiveness of comprehensive rehabilitation models, this is yet to be fully investigated in paediatric rehabilitation or the impact on the life course of the CYP and family (13,14).…”

Section: Introductionmentioning

confidence: 99%

A scoping review of the needs of children and young people with acquired brain injuries and their families

2019

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Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) is essential in delivering pathways of care and providing effective rehabilitation.Aim: To identify relevant literature and key themes relating to the nature and extent of needs (met, unmet or unrecognised) of CYP with ABI and their families.Method: Scoping review. Sixteen electronic bibliographic databases were searched using terms relating to children, brain injury and need. Papers were screened against eligibility criteria by two independent reviewers. No date limits were applied. Data was extracted by the lead author regarding the needs of CYP with ABI and their families and thematic analysis conducted to identify the key themes. Methodological quality was not assessed.Results: A total of 28 articles were identified including three systematic reviews, one scoping review, two practice recommendation articles and 22 original research studies. Participants included CYP with ABI, parents, siblings and professionals. Four key themes were identified; CYP-related impairment needs, support needs, return to school and long-term aftercare.Conclusion: CYP with ABI and their families report extensive needs, many of which are often unmet or unrecognised by those supporting the CYP. Needs transcend the health, social care and education domains.

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“…This is an important consideration, particularly in an acute hospital setting where making timely assessments and onward referrals are considered to be essential (NHS England, 2014). Such an early indicator may also provide benefit at a ward-based level in order to better orientate and prepare the child and family for what their rehabilitation journey may look like from an early time point; a repeated issue described in the literature (Hamilton et al, 2017). To gain an understanding of the wider validity of the findings related to initial rate of change, further work in other cohorts is required.…”

Section: Rate Of Changementioning

confidence: 99%

“…Acquired brain injuries can lead to a range of both short-and long-term deficits, affecting motor, cognitive and behavioural functions (UKABIF, 2013). Some children admitted to an acute hospital setting will require a period of neurorehabilitation before being able to be discharged (Hamilton et al, 2017). During their acute hospital stay, essential medical care will either precede or run alongside the delivery of acute neurorehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Evaluating functional change using the Physical Abilities and Mobility Scale in acute paediatric neurorehabilitation

Young

Starace

Boddy

et al. 2020

International Journal of Therapy and Rehabilitation

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Background/Aims Childhood acquired brain injury is the leading cause of death and long-term disability among children and young people in the UK. Following a childhood brain injury, function is shown to improve within a specialist neurorehabilitation setting. Little evidence currently exists to demonstrate gross motor functional change within an acute hospital setting. The Physical Abilities and Mobility Scale is a valid and reliable outcome measure for use within inpatient paediatric neurorehabilitation following brain injury. The primary aim of this study was to evaluate how the gross motor function of paediatric patients with a new acquired brain injury changes during an acute hospital admission. Methods Data were collected for all patients admitted as an inpatient to one acute hospital over a 12-month period. The Physical Abilities and Mobility Scale was completed at baseline, at least weekly and again at discharge. Views relating to the utility of the Physical Abilities and Mobility Scale were sought among physiotherapists using the measure in order to inform acceptability. Results A total of 28 patients were included in this study. A Wilcoxon signed rank test was performed, which showed a highly significant improvement in function as scored on the Physical Abilities and Mobility Scale between baseline assessment (median 29.00, interquartile range 25.00–35.50) and discharge (median 85.00, interquartile range 75.00–95.00, Z=-4.624, P<0.001). A total of five patients (17.86%) were referred on for specialist residential neurorehabilitation. A post hoc analysis found that the rate of change of the Physical Abilities and Mobility Scale appeared to have an impact on final discharge destination, with slow improvers 18.60 times more likely to require specialist rehabilitation than others. The Physical Abilities and Mobility Scale was found to be acceptable among physiotherapists using it. Conclusions Children with a new acquired brain injury make significant improvements in gross motor function during a period of acute inpatient neurorehabilitation. Further work should look to refine the measure and gain a full understanding of its clinical utilities.

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Paediatric neurorehabilitation: finding and filling the gaps through the use of the Institute for Manufacturing strategic roadmapping method

Cited by 11 publications

References 27 publications

Using child‐ and family‐centred goal setting as an outcome measure in residential rehabilitation for children and youth with acquired brain injuries: The challenge of predicting expected levels of achievement

Using child‐ and family‐centred goal setting as an outcome measure in residential rehabilitation for children and youth with acquired brain injuries: The challenge of predicting expected levels of achievement

A scoping review of the needs of children and young people with acquired brain injuries and their families

Evaluating functional change using the Physical Abilities and Mobility Scale in acute paediatric neurorehabilitation

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