Activity Boost Challenge:
Impact of the WalkAide device plus physiotherapy on walking and physical activity in children with hemiplegic cerebral palsy
This project will investigate the impact of a physiotherapy+WalkAide® intervention for children aged 6-17 years old with hemiplegic cerebral palsy (CP). We will learn whether this type of therapy can improve skills like running, jumping and balance, and whether it can help children become more active. We know how the WalkAide works and that it is safe for children to use. We also know that it doesn’t work for all young people with CP. We don’t know if having physiotherapy when using the WalkAide will be any better than physiotherapy alone. This project will help us to find out!
Research aims
The aims of this project are to:
- Investigate whether four specialised physiotherapy sessions + WalkAide use can improve advanced motor skills (e.g. running, jumping, balance) and physical activity participation.
- Find out whether the physiotherapy+WalkAide intervention is better than physiotherapy alone.
- Ask children and their family what they think about using the WalkAide. Do they think it works? Is it easy to use? Are they happy to wear it?
- Develop clinical guidelines for WalkAide use, informed by the experiences of physiotherapists and orthotists who take part in the project.
Background
Many children with cerebral palsy (CP) have weakness or spasticity in their lower leg muscles. This can cause poor clearance of their feet when walking and running, and children often use a brace or orthotic to prevent trips and/or falls. The brace often blocks or restricts ankle movements, impacting on speed or agility, and necessitates larger footwear to accommodate the extra width.
The WalkAide is a small unit that straps around the leg, just under the knee, replacing the need for a brace. This means the child can use any footwear and even go barefoot. The WalkAide also allows for greater freedom in movement and, unlike a brace, does not need to be replaced as the child grows. In contrast to existing orthotics, the WalkAide activates weak muscles of the lower leg through electrical stimulation and can promote a more natural, balanced, and efficient walking pattern.
The WalkAide system has been used extensively to improve walking ability of adults with foot drop. We know that in children with CP, short-term use of the WalkAide can increase muscle size and improve a child’s walking pattern. Research also suggests that the WalkAide may be more acceptable to wear than a traditional orthotic. It is possible that at least some of the beneficial changes in walking pattern could be maintained for several weeks without ongoing use of the device, giving children a break from ‘looking different’. Currently, most children and young people who could benefit from using a WalkAide are not able to access the device due to the high cost of the unit and limited evidence for its effectiveness.
Novita has begun a program of research to explore whether beneficial changes in walking pattern translate to increased physical activity participation and/or achievement of a child’s participation goals. We are also interested to find out how well children and families manage with the WalkAide in everyday life, as well as the clinical utility of the device.
Participants
40 Novita clients will be recruited for the study.
Inclusion criteria:
- Age 6 to 17 years
- A diagnosis of hemiplegic CP, GMFCS I/II (walk/run without a walking device other than ankle brace)
- Passive ankle dorsiflexion range with knee extension of affected ankle of greater than plantargrade
- Score of >1 on the Selective Motor Control of dorsiflexion
- Knee flexion contracture of less than 10* flexion
- Able to cognitively understand the interventions and commit to the program and assessment sessions.
Exclusion criteria:
- Where dystonia is primary contributor to the movement disorder
- Skin allergies or reactions to adhesives/silicon
- Lower limb botulinum toxin in last three months
- Orthopaedic surgery in last 12 months
- Orthopaedic metalware around the knee and leg
- Uncontrolled seizure disorder.
Method
Recruitment Steps: Potentially eligible clients will receive a study information letter. Those interested will attend a screening assessment. Children who meet criteria and consent will undergo baseline assessment and be randomly allocated to the physiotherapy+WalkAide group or the physiotherapy group.
Procedures: Participants will be attend three assessment sessions at Novita’s Regency Park office over four months and have four motor learning, gait focused physiotherapy sessions.
Co-primary outcomes:
- The Challenge-20 will evaluate advanced gross motor abilities related to walking/running/jumping.
- The Canadian Occupational Performance Measure (COPM) will provide child/parent scores for children’s individual physical activity/participation goal achievement.
ANZCTR trial ID: ACTRN12616000701426. For more information please click here.
Potential outcomes and implications?
For children and families
Our feasibility study results suggest that specialised physiotherapy sessions alone are associated with an improvement in gross motor skills and physical activity participation, independent of WalkAide use. Participants and families commented that the use of engaging outcome measures, such as the Challenge 20, and the content of the physiotherapy sessions helped to make taking part in the project a positive and enjoyable experience. Funding priorities dictate that high functioning young people with cerebral palsy may not receive intensive intervention. Feedback from families, as well as from physiotherapists, indicated that they very much valued this opportunity to have increased physiotherapy input.
Based on learnings from our feasibility work, we have refined the inclusion and exclusion criteria and WalkAide acclimatisation protocol for this study to optimise the potential forf success. Many participants in the physiotherapy+WalkAide group are expected to prefer the WalkAide to their previous orthotic management and enjoy having additional control of the device. Our feasibility study also suggested that WalkAide use will encourage participants to take increased responsibility for management of their disability. The overall results of this research are expected to inform best practice intervention for children and young people in this population..
For professionals
Results of this study will inform best practice in WalkAide prescription for this group (including a profile of clients for whom the device is best suited) and development of clinical guidelines for optimal WalkAide use. Long term, results will ensure optimum outcomes for clients and improved efficiency for Novita and other organisations. Results will also provide evidence for future WalkAide prescription to inform funding e.g. from National Disability Insurance Scheme.
Research team
Chief investigator
Kerry Evans, Profession Leader, Physiotherapy, Knowledge & Innovation, Novita Children’s Services
Associate Investigators
Dr Annemarie Wright, Research Officer, Knowledge & Innovation, Novita Children’s Services
Lisa Dodds, Senior Orthotist, Assistive Technology Service, Novita Children’s Services
A/Prof Virginia Wright, Senior Scientist, Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute
Contact person
Annemarie Wright
(08) 8243 8281
annemarie.wright@novita.org.au
Rapid Review Services
Supporting a culture of enquiry where clinical decision making is guided by the latest high quality evidence is integral to Novita’s philosophy of delivering high quality services. This can be challenging in everyday practice given the time pressures on clinical and other staff. Novita’s Knowledge and Innovation department are trialling a Rapid Review Process to guide efficient and effective knowledge translation.
Contact research@novita.org.au
Project aims
- Support Novita to do Evidence Based Practice
- Provide an avenue to develop research questions, regardless of whether a review is conducted or not
- Provide best available evidence in a short time frame
Background
There is a growing demand for quality and best practice in healthcare in general, and particularly in the disability sector. Family-centred practice and the advent of the National Disability Insurance Scheme, where clients and families are active participants and decision makers in their own disability care and support, have resulted in a growing need for accountability in the face of increased service delivery options. For Novita, evidence-based practice is integral to its philosophy of service and strategic directions, and is a key component of high quality service delivery. A trial Rapid Review process is underway (informed by other rapid review processes such as the work of Khangura et al. (2012)) to inform decision making around practices and processes across Novita, to enhance service delivery outcomes through effective use of knowledge.
What is a Rapid Review? It’s a literature review conducted using a streamlined, methodical approach that can be completed usually within one to six months – a lot shorter than the gold standard systematic review that can take up to three years.
Khangura, S., Konnyu, K., Cushman, R., Grimshaw, J., & Moher, D. (2012). Evidence summaries: the evolution of a rapid review approach. Systematic reviews, 1(1), 1-9
Users
Novita Children’s Services staff
Rapid Review team
Kanchana Pathirana, Researcher/ Data Analyst, Department of Knowledge and Innovation, Novita Children’s Services
Dr Toan Nguyen, Senior Rehabilitation Engineer/ Research Officer, Department of Knowledge & Innovation, Novita Children’s Services
Rapid Review Panel members
Kanchana Pathirana, Researcher/ Data Analyst
Dr Toan Nguyen, Senior Rehabilitation Engineer/ Research Officer
Kerry Evans, Profession Leader Physiotherapy
Myriam Sandelance, Profession Leader Occupational Therapy
Amy Martin, Acting Manager Team Leader and Speech Pathologist, Assistive Technology Service – Therapy Team
Prithy Sivaraman, Acting Manager Team Leader and Physiotherapist, Assistive Technology Service – Technical
Have Your Say!
At Novita it is important to us to make sure we’re providing the best services to achieve the goals that are important to our clients and families. One way to do this is by putting in place regular reviews or monitoring of each client’s needs and progress. The ‘Have Your Say!’ project involves a staff and parent survey, as well as staff focus groups, to find out the best way we can implement this process.
Contact research@novita.org.au
Research aim
This project seeks to explore the views of Novita’s families and clinicians to determine what they believe to be the best way to implement regular reviews or monitoring for children and adolescents with a physical disability. The research will focus on supports and strategies required for regular reviews to be embedded in everyday practice at Novita, including how this can happen within a fee for service environment driven by family choice.
Background
Many Novita clients have a movement disorder or physical disability and are at risk of developing complications that can impact on their mobility and functional skills. Active review and monitoring programs delivered early and regularly provide an opportunity for better outcomes for this group through provision of appropriate and timely interventions now and into the future. Although research is ongoing in Australia and elsewhere, there is limited evidence to inform effective implementation of this type of program within a community based and family centered practice model.
Participants
Parents and carers of Novita clients with a physical disability;
Novita Children’s Services therapists, team leaders and managers.
Method
Stage 1: Staff survey – exploring the supports and strategies required for regular reviews to be embedded in everyday practice for clients with physical disabilities.
Stage 2: Parent and carer survey – exploring what families feel are the most important elements of a review program and the type of resources and feedback they would find heplful.
Stage 3: Staff focus group – using the ideas from stages 1 and 2 to translate knowledge into action and implement an effective regular review program at Novita.
Potential outcomes and implications?
For children and families
Clients and families deserve and expect evidence based practice at Novita, part of which is regular review and monitoring of clients’ needs and progress. The results of this project are expected to influence future Novita service delivery and to provide clients/families with relevant and timely assessment and effective intervention. Results will also help to inform families and agencies around the importance of regular reviews and develop resources about the role of such a program in therapy.
For professionals
The project is an important means for Novita clinicians to share their views on regular review and monitoring of their clients. Project results are expected to influence future Novita service delivery and will be the vehicle for staff to have their say on this topic.
Research team & contact person
Dr Annemarie Wright, Research Officer, Knowledge & Innovation, Novita Children’s Services
Kanchana Pathirana, Researcher/ Data Analyst, Department of Knowledge and Innovation, Novita Children’s Services
Kerry Evans, Profession Leader, Physiotherapy, Knowledge & Innovation, Novita Children’s Services
Contact person
Annemarie Wright
(08) 8243 8281
annemarie.wright@novita.org.au
Determining the inter and intra-rater reliability of the Novita Switch Access Solutions Assessment
The Novita Switch Access Solutions Assessment (NSASA) was developed at Novita Children’s Services (Novita) by Occupational Therapists to address the current lack of standardised, valid and reliable evaluation and outcome measures for use of switch access technologies. This study aims to determine the interrater reliability and the clinical utility of the NSASA. It also aims to develop a training package that can be used for future sharing of the NSASA with clinicians internationally.
Research aim
The aims of this study are to:
- determine the inter-rater reliability of the Novita Switch Access Solutions Assessment (NSASA)
- develop a training package that can be used for future training of clinicians in the use of the NSASA
- assess the clinical utility of the NSASA based on the data from the Occupational Therapist (OT) assessors’ feedback survey for each video scored using the Clinician Confidence in Scoring the Novita Switch Access Solution Assessment.
- This latter activity will permit final adjustments to the training protocol and scoring to optimize ease of use of the NSASA.
Background
Children with severe and multiple disabilities may require assistance to fully participate and engage with the world around them. Access to assistive technology enables children to learn, play, and communicate within their home, school or community. Some children need switches to use assistive devices. For access to be successful the prescribed switch must fit the child’s individual needs and abilities. The complexity of switch access presents many challenges for clinicians involved in the assessment and planning for the use of assistive technology by children with severe and multiple disabilities.
The Novita Switch Access Solutions Assessment (NSASA) was developed at Novita Children’s Services (Novita) by OTs with assistive technology expertise to address the current lack of standardised, valid and reliable evaluation and outcome measures for use of switch access technologies.
Participants
A total of 24 Novita clients will be recruited for the study.
Inclusion criteria:
- Ages 12 months to 18 years
- Any neurological/neuromuscular/musculoskeletal condition
- MACS Levels III to V or equivalent level of function if there is no diagnosis of Cerebral Palsy
- Some active movement head/trunk/extremity to enable switch activation.
Exclusion criteria:
- MACS level I to II or equivalent level of function if there is no diagnosis of Cerebral Palsy
- Ability to direct access and use mainstream assistive technology such as touch screen, keyboard, mouse.
Method
The study involves:
1. Further development of the Novita Switch Access Solutions Assessment and Training materials.
Four children who are current switch users will be involved in the training video series. The training video creation process will consist of the child attending a single NSASA session, whereby the child will be asked to do one or more switching activities they are familiar with for 20 – 30 minutes.
2. OT Assessor Training
Two OT assessors will be trained on how to score the NSASA using the training videos to reach a minimum 80% (competence level) test score.
3. Reliability Evaluation
To establish inter-rater reliability of the NSASA, another 20 study videos will be independently scored by the two OT assessors.
Potential outcomes and implications?
For children and families
Successful switch prescription and use of related assistive technology enables children with severe and multiple disabilities to learn, communicate and play. It is anticipated that the better suited the switch set-up is to the child’s abilities and needs, the more likely they are to adopt it and continue its use. The use of a valid and reliable outcome measure will also reduce the likelihood of prolonged, less than optimal trials or repeat trials of previously unsuccessful switch access methods.
For professionals
The ability of clinicians to accurately record a child’s switching ability and monitor this over time will ensure that children are provided with the most appropriate switching technology across the developmental continuum, and training can be tailored to specific areas of skill acquisition. The use of the NSASA as an outcome measure would provide the much-needed opportunity for empirically determining the comparative impact of different switch training programs and also allow comparison of the impact of different switches on a child’s switching abilities/access.
Research team
Chief investigator
Annabelle Tilbrook, Senior Occupational Therapist, Assistive Technology Service, Novita Children’s Services
Associate Investigators
Myriam Sandelance, Profession Leader Occupational Therapy, Knowledge & Innovation, Novita Children’s Services
Dr Toan Nguyen, Senior Rehabilitation Engineer, Knowledge & Innovation, Novita Children’s Services
A/Prof Virginia Wright, Senior Scientist, Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute
Contact person
Annabelle Tilbrook
(08) 8349 2023
annabelle.tilbrook@novita.org.au
Upper Limb Casting for Children with Hypertonia
This study aims provide a clearer picture of how Novita services align with the latest available evidence while highlighting possible inconsistencies in the provision of Upper Limb (UL) casting as an intervention across services sites and client groups. Identification of knowledge gaps and any training requirements would ensure UL casting intervention is provided in a consistent manner to clients across the organisation.
Research aim
The project was directed by the following research questions:
- What is the clinical reasoning used by OTs at Novita to decide when to use UL casting and what are the documented protocols for this?
- What are the documented outcomes of UL casting and how were these measured?
- What, if any, post-casting follow up was documented as being provided to clients?
- Does UL casting practice used at Novita over the past five years match with current best practice evidence?
Background
Children with cerebral palsy or an acquired brain injury frequently present with hypertonia of one or both upper limbs. Hypertonia is a condition marked by an abnormal increase in muscle tone which can impact upon a child’s function and participation in daily activities. Upper Limb (UL) casting is one intervention currently used by OTs at Novita. The clinical aims for casting may include reducing hypertonia, increase range of movement (ROM), reduce and/or prevent contractures, increase ease of night time positioning, increase ease of hygiene management, reduce pain and improve function.
A wide variety of factors are reported to influence clinical reasoning and decision making by OTs. These can be related to:
- The client: e.g. age, individual diversity of UL posture and function, severity of spasticity, presence of contractures and pain.
- The family: e.g. family preferences and capacity to support the intervention, child’s ability to tolerate casting, daily routines, environments the child needs to access.
- The clinician: e.g. limited high level evidence, limited experience and opportunity to become familiar and confident in using casting as an intervention.
Participants
It is anticipated that the coda files of 21 clients will be reviewed. Inclusions: Children aged 3-17 years, MACS Level II-V who are current or previous Novita clients and who have received UL casting over the past 5 years. Some children may have had more than one episode of casting. Exclusions: Past Novita clients whose coda files are no longer readily accessible.
Method
Review client coda files (hard copy and electronic) and G drive to collect retrospective data on UL casting interventions provided to Novita clients over the past 5 years Data collection tool – spreadsheet will be piloted with 6 clients and then reviewed/updated as required. The updated data collection tool will be used to gather the remaining 15 clients’ data.
Potential outcomes and implications?
For children and families: Clients will be offered information on the full range of possible interventions, including casting. Families will be able to access UL casting interventions that are of high quality and evidence based.
For professionals: Novita OTs will have up to date information on best practice relevant to UL casting and clinical reasoning tools to guide their decision making..
For administrators/policy makers: Novita will be seen as a leader in SA in the provision of high quality evidence based services to clients with hypertonia.
Research team
Chief investigator
Anna Klemm, Senior Occupational Therapist, Physical Rehabilitation Program, Novita Children’s Services
Associate Investigators
Sarah Andruchowycz, Senior Occupational Therapist, Physical Rehabilitation Program, Novita Children’s Services
Myriam Sandelance, Profession Leader Occupational Therapy, Knowledge & Innovation, Novita Children’s Services
Dr Toan Nguyen, Senior Rehabilitation Engineer, Knowledge & Innovation, Novita Children’s Services
Contact person
Anna Klemm
(08) 8172 9200
anna.klemm@novita.org.au