Access technologies facilitate novel and alternative methods for individuals with disabilities to interact with their environment. Finding suitable access solutions for children with severe spastic quadriplegic cerebral palsy can be difficult because of their poor motor control and targeting abilities due to spasticity at the limbs, neck, and head. In this research a multiple camera tongue switch was developed for a 7 year-old case study participant with severe spastic quadriplegia. Remotely via video, this system reacts to tongue protrusions as cues for single-switch access. Having multiple cameras mitigates targeting problems with the head that conventional single camera systems would present. Results of a usability experiment with the participant show that good sensitivity (82%) and specificity (80%) can be achieved with a non-contact tongue protrusion access modality for a user with spastic quadriplegia. Moreover, the experiment verified that the extra cameras improve utility of video-based access technologies for the target population.

Access technologies facilitate novel and alternative methods for individuals with disabilities to interact with their environment. Finding suitable access solutions for children with severe spastic quadriplegic cerebral palsy can be difficult because of their poor motor control and targeting abilities due to spasticity at the limbs, neck, and head. In this research a multiple camera tongue switch was developed for a 7 year-old case study participant with severe spastic quadriplegia. Remotely via video, this system reacts to tongue protrusions as cues for single-switch access. Having multiple cameras mitigates targeting problems with the head that conventional single camera systems would present. Results of a usability experiment with the participant show that good sensitivity (82%) and specificity (80%) can be achieved with a non-contact tongue protrusion access modality for a user with spastic quadriplegia. Moreover, the experiment verified that the extra cameras improve utility of video-based access technologies for the target population.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Neural tube defects (NTDs) are the world‘s second most common birth defects after cardiovascular defects. In developing countries, poor access to health care services among children with NTDs contributes to early infant deaths, while those who survive live with severe disabilities. In Zambia, all children with NTDs in need of surgery are referred to Lusaka and physiotherapy services are not available in health facilities below the first level hospitals. The aim of the current study was to determine the profile of children with NTDs and to explore the experiences of mothers with accessing health care services for these children. The study which was conducted at the University Teaching Hospital (UTH) in Lusaka consisted of both quantitative and qualitative methods. The quantitative phase consisted of a retrospective record review of children with NTDs, who were admitted to UTH from January to December, 2010. A sample of 50 medical records was used based on available records, and data collection was done using a data extraction sheet which was specifically designed for the study. Analysis of quantitative data was done using Statistical Package for Social Science (SPSS) version 20.0. The qualitative phase had two parts, with the first part involving in-depth interviews with a purposefully selected sample of 20 mothers of children who were admitted to UTH. The second part used a sample of convenience of four mothers who had brought their children for follow up visits. All interviews were audiotaped, transcribed verbatim and translated, and recurring ideas were coded and collapsed into categories and themes. Permission to conduct the study was obtained from the UWC Research Grant and Study Leave Committee, University of Zambia Research Ethics Committee, and University Teaching Hospital management. Informed written consent was obtained from the mothers who accepted to take part in the study. Results from the record review revealed that the majority of children were from Lusaka province, with ages ranging from one day to 48 months and a male predominance of 58%. Myelomeningocele was the most common type of NTD (44%) with the lumbar region being the common site (52%). Hydrocephalus was present in 74% of children, 30% of children had both paraplegia and incontinence and 22% (n=11) of the files had no information on the neurological impairments. Wound infection was present in 40% (n=20) of the children. The majority (66%) of children were lost to follow up. Mothers of children who were admitted in UTH cited transport to UTH and back home as the main challenge. Other challenges included the lack of a prenatal diagnosis, the need for information, uncertainty about future of their children, and concerns about their family. Interviews with mothers on experiences with accessing physiotherapy services found that the lack of knowledge among mothers was the main reason children were not accessing physiotherapy services. Findings on access to health care were related to the ―Four A‘s‖ access theory which consists of four dimensions of access namely geographical accessibility, availability, affordability and acceptability. It is recommended that health care providers and policy makers ensure that all children with NTDs are provided with free transport to and from referral hospitals. Policy makers need to consider involving physiotherapists in out-reach programmes and mobile clinics to ensure access to physiotherapy services for all children in need of the service. Health care providers must also ensure that they give adequate information to mothers of children born with birth defects as this enhances their access to appropriate health care services.

<p>Intervention fidelity examines the degree to which an intervention is delivered as planned. Generic fidelity measures incorporate the active ingredients of more than one intervention and characteristics common to all interventions. Three studies were conducted to define the active ingredients of intervention for children with physical disabilities and generate a generic fidelity measure. These studies involved: (1) describing generic fidelity measures; (2) generating essential attributes of paediatric rehabilitation; and (3) differentiating between two interventions to consistently rate the behaviours of the therapist, child and parent.</p> <p>(1) In a narrative review of generic fidelity measures, five measures were identified within the psychotherapy literature. These measures presented a variety of approaches to examine fidelity, described psychometric property standards, and highlighted 37 non-specific intervention items that were relevant to paediatric rehabilitation.</p> <p>(2) A consensus process with eight experts and interviews with seventeen clinicians working with children with physical disabilities generated 35 attributes that highlighted the general observed therapist and client behaviours essential within a successful intervention session.</p> <p>(3) The Paediatric Rehabilitation Observational measure of Fidelity (PROF) was developed (30 items) to evaluate specific and non-specific behaviours within two occupational therapy and physiotherapy interventions for children with cerebral palsy. Six trained raters examined 25 intervention videos for psychometric testing. Results indicated that the PROF demonstrated good to excellent Inter-rater reliability and early construct validity.</p> <p>These studies present an important starting point to observe and measure the active ingredients within paediatric rehabilitation, incorporating its dynamic nature involving the child and parent within the therapy process.</p> / Doctor of Philosophy (PhD)

Introduction : Une utilisation non-optimale du fauteuil roulant manuel (FRM) peut avoir des répercussions sur différents aspects de la vie des enfants et jeunes qui utilisent cette aide à la mobilité. Malgré la disponibilité et l'efficacité du Wheelchair Skills Program (WSP), l'entraînement des habiletés en FRM est parfois inadéquat ou absent en pratique. Pour combler cette lacune entre les connaissances et la pratique, ce mémoire vise à identifier les besoins et les enjeux concernant l’évaluation et l’entraînement des habiletés en FRM en réadaptation pédiatrique. Méthodes: Guidé par le cadre Knowledge to Action, une étude à devis mixte séquentiel explicatif a été conduite dans un centre de réadaptation pédiatrique et ses écoles affiliées. La phase quantitative comprenait une enquête en ligne auprès d'ergothérapeutes et un questionnaire papier auprès d’usagers pédiatriques et de leurs parents. La phase qualitative comprenait des groupes de discussion avec les ergothérapeutes. L’analyse a utilisé des statistiques descriptives et une méthode déductive basée sur le Consolidated Framework for Implementation Research. Résultats : Les résultats du sondage aux ergothérapeutes (n=35) montrent une divergence entre l’importance perçue à l’égard de l’évaluation et l’entraînement des habiletés en FRM (94% jugent important) et leur prévalence dans la pratique. Peu d’ergothérapeutes utilisent des outils standardisés et forment principalement les enfants aux habiletés de base (c.-à.-d., d’intérieur) et les parents à l'entretien du FRM. Les réponses du questionnaire aux usagers corroborent ces résultats alors que les enfants et parents décrivent des difficultés à l’utilisation du FRM dans la communauté, en plus de rapporter des chutes. Les résultats des groupes de discussion révèlent des barrières à l’utilisation du WSP qui expliquent les lacunes observées dans la pratique. Conclusion : Pour surmonter les barrières à l’utilisation du WSP en réadaptation pédiatrique, des adaptations au WSP et la production d'outils pour le transfert de connaissances (TC) ont été proposées avec la création de nouvelles connaissances par la recherche. / Introduction : Suboptimal manual wheelchair use can have repercussions on different aspects of the lives of children and adolescents who use this mobility aid. Despite the availability and effectiveness of the Wheelchair Skill Program (WSP), manual wheelchair skills training is often inadequate or absent in clinical practice among occupational therapists (OTs). To bridge this evidence-practice gap, this thesis aims to identify and understand the needs and challenges regarding manual wheelchair skills testing and training practices in pediatric rehabilitation. Methods: Guided by the Knowledge to Action Framework, an explanatory sequential mixed methods design was employed. The quantitative phase involved an online survey with OTs working in a pediatric rehabilitation center and its affiliated schools and a paper survey with pediatric manual wheelchair users and their parents. The qualitative phase involved focus groups with the OTs. Data were analyzed using descriptive statistics and a deductive analysis based on the Consolidated Framework for Implementation Research. Results: According to the OT survey results (n=35), there is a discrepancy between the perceived importance of wheelchair skills testing and training (94% consider it important) and their prevalence in practice. Of the training provided, children are primarily trained indoor skills, while parents are primarily educated about wheelchair maintenance. Standardized, evidence-based tools are rarely used. The child survey results corroborate these findings as the children and parent described difficulties with many community and advanced wheelchair skills, as well as falls experienced in these situations. The focus group findings identified barriers to using the WSP which explained the gaps observed in practice. Conclusion: To address the identified barriers, recommendations of WSP adaptations and knowledge translation (KT) tools production were proposed with creation of new knowledge. Findings from this thesis establish a first step towards bridging the evidence-practice gap in manual wheelchair skills testing and training.