outcome_workshop_2[1]

Vignettes
Sarah, 18 months old child with CP (spastic hemiplegia)
Sarah is sitting leaning to one side. Sarah enjoys watching the
other children play. The right side of her body seems smaller than the left with slight increase in tone on the right. Sarah scoots on her bottom. Standing, Sarah’s weight is on the left leg, with the right leg bent and the right heel not touching the floor. At home, Sarah cruises along the length of the couch but cannot climb up onto it. To get from standing to sitting she drops down onto her bottom. Sarah has a hard time picking up Cheerios. Sarah cries when you try to move her right arm. There is limited spontaneous use of the right hand. Sarah stabilizes a book with the right forearm while turning several pages at a time with the left hand. Sarah responds to her name, waves bye-bye, and has a ten-word vocabulary. Sarah babbles spontaneously and moves quickly from toy to toy. Mom first became concerned when Sarah wasn’t sitting at 10 months, then a referral was made at the 12-month check-up. Mom is looking into daycare.

Reflective practice, accountability
Program planning, quality assurance
Clinical managers, administrators

Policymakers Resource allocation
Factors to consider when assessing a child with cerebral palsy
Outcome: the end result of a process (clinical
intervention, service, disease process) Outcome measure: used to document characteristics or attributes of an individual
Structure issues Access to services Process issues Satisfaction with services Outcomes Clinically significant change Alignment with program goals
Daniel, 4 years of age
Which key areas would you Which assessment tools
aБайду номын сангаасsess?
would you use?
Actual vs. best practices for young children with CP: A survey of pediatric OT and PT
Sarah, 18 months old
Which key areas would you Which assessment tools
assess?
would you use?
Daniel, 4 year old child with CP (spastic quadriplegia)

To guide short-term and long-term goals
II. Service providers
Concepts to consider:

Areas to assess:


ICF framework Transactive models Dynamic systems Person-EnvironmentOccupation (PEO) Program objectives Your professional role
I. Child & family
Concepts to consider: Areas to assess:


Family-centred care Lifespan perspective Social disability model



Pathology to participation: what and why Personal goals and priorities (what) Current and future Obstacles and barriers (why)

To guide resource allocation
Purpose of “measuring”
To identify the extent and nature of the health
condition (the associated problems)

Disease/disability focus
Reliable and valid tools Guided by intended purpose of use

Discriminate, compare, predict, evaluate
Selecting outcome measures: What should we be measuring?
To understand why the health condition and
associated problems exist

Biopsychosocial focus
To appreciate the impact our services have on
the child’s health

Child factors Impairments and activity limitations Life habits, preferences Environmental factors Home, school, community Family functioning

Partnership, Environment and Participation
Key pieces to the puzzle
Use of the most appropriate outcome
measures



Which outcomes are relevant? Whose perspectives are important? Which outcomes can we change?
Parents work full-time; live in a bungalow with a playroom in the
basement. Mom is concerned about school as Daniel is not yet walking and he still wets himself. Undressing him, he helps by lifting up his left arm. Talking to him, Daniel responds with short sentences with effort. Strangers have a hard time understanding him. Sitting, Daniel supports himself with his right arm to reach for toys with left hand. Daniel “bunny hops” to get to toys. Daniel pulls up to stand using his arms to retrieve objects off the table. He plays with his brother in his adapted walker. On his adapted tricycle, Daniel can peddle, but needs help steering. Daniel enjoys playing with his friends but is easily distracted. Daniel is able to make simple lines and to complete a four-piece puzzle. Daniel uses an adapted spoon, eats small bite-size pieces and drinks from a straw. Daniel is a messy eater especially with liquids. Family rarely goes out. The grandparents can no longer look after him because he has become too heavy. It is difficult to find other babysitters. Daniel occupies himself with his computer games using an adapted mouse.