Participation in Physical Play in children with motor impairments

   BACK

Summary

Motor impairments (e.g. difficulties with motor control, muscle tone) affect between 6-9% of children. These children are often diagnosed with conditions such as developmental coordination disorder or cerebral palsy. They experience significant difficulties in participating in everyday life and are at high risk of long-term health and social problems. Despite this high burden of disease, interventions to manage these problems have been subject to little systematic research.

Current interventions for these children consist of 'therapeutic activities' (e.g. exercises) that aim to increase what the children do in their daily lives. The interventions are poorly defined, lack explicit hypotheses about why or how they might work, and have insufficient evidence to support their effectiveness. The proposed research will identify:

  •  The 'key ingredients' of an effective intervention to increase participation in physical leisure pursuits and play in children with motor impairments.
  •  How these ingredients can be combined in a feasible and acceptable intervention.

Research in stroke and chronic pain has shown that incorporating behaviour change strategies (e.g. confidence-building techniques) into therapeutic interventions significantly improves what patients can do (i.e. activity) and actually do (i.e. participation). Carers have also been shown to have an important role, suggesting that effective interventions should systematically incorporate therapeutic, personal (e.g. child's confidence) and environmental (e.g. parents' beliefs) components.

This project draws on the WHO International Classification of Functioning, Disability and Health - a conceptual framework that integrates biomedical, personal and environmental perspectives on illness and health. The methodology is based on the MRC guidance for developing complex interventions. The project covers the following five steps, and studies within them. Steps 1 and 3i are currently on-going.

1.    Identify biomedical, personal and environmental factors proposed to predict children's participation in leisure pursuits and play: (i) a systematic review of parents’ views about children’s participation in life at home, school and in the community; (ii) a survey of children with motor impairments regarding their participation in physical play and leisure; (iii) a survey of parents’ beliefs about the same children’s participation in physical play and leisure; (iv) a survey of clinicians about their views of the same children’s difficulties (e.g. impairments and activity limitations); and (iv) an interview study with a sub-sample of the children.

2.    Build a theoretical model of the key predictors of participation in physical play in children with motor impairments: a synthesis of the above evidence and existing theory and evidence.

3.    Select therapeutic and behaviour change strategies to target the proposed predictors: (i) a systematic review of the ‘active ingredients’ and mechanisms of change in occupational therapy and physiotherapy interventions for children with motor impairments; and (ii) use of the behaviour change matrix (Michie et al 2008) to select behaviour change techniques.

4.  Operationalise the strategies in a feasible and acceptable intervention: a collaborative study with children, families and service providers.

5. Investigate the feasibility of using the intervention in practice, and model the intervention processes and outcomes: three mixed-methods interrupted-time-series single-case studies with children with motor impairments and with their families.

The primary output will be a detailed protocol for an intervention that is based on empirical evidence and a theoretical model of disability in terms of behaviour (i.e. what children actually do). The intervention, if subsequently found to be effective, will support children with motor difficulties in attaining life-long well-being and participation in society. The project will also be an exemplar for the development of rehabilitation interventions.

The project is funded by MRC through a Population Health Scientist Fellowship

Contact Person

Niina Kolehmainen – n.kolehmainen@abdn.ac.uk

Collaborators: the Project

Jill Francis, Aberdeen Health Psychology Group, University of Aberdeen
Craig Ramsay, Health Services Research Unit, University of Aberdeen

Christine Owen, Children’s Occupational Therapy, NHS Lothian
Lorna McKee, Health Services Research Unit, University of Aberdeen
Peter Rosenbaum, CanChild Centre of Childhood Disability Research, McMaster University

Marjolijn Ketelaar, Rehabilitation Centre de Hoogstraat, Utrecht, Netherlands

Collaborators: Specific Studies within the Project

NHS organisations in Fife, Forth Valley, Glasgow, Lanarkshire, Leeds, Mid-Yorkshire

Cynthia Fraser, Health Services Research Unit, University of Aberdeen

Maureen Bult, Rehabilitation Centre de Hoogstraat, Utrecht, Netherlands

Cheryl Missiuna, CanChild Centre of Childhood Disability Research, McMaster University

Annemarie Tissen, Rehabilitation Centre de Hoogstraat, Utrecht, Netherlands

Jennifer McAnuff, NHS Leeds Community Health Care

Advisors: The Project

Mark Davidson (parent perspective)

Children with motor impairments (an advisory group)

Heather Angilley (clinician perspective – physiotherapy)

Michelle LaBarre (clinician perspective – occupational therapy)

Allan Colver (clinical academic perspective)

Marie Johnston (behaviour change perspective)

Status

Steps 1 and 3i are currently on-going.

Publications

Study newsletters:

[to be added soon]

Presentations:

Kolehmainen N, Francis J, Owen C, McKee L, Ramsay C. Participation in Physical Play Study: an MRC study to develop a theory- and evidence-based intervention. European Academy of Childhood Disability. Rome, Italy. June 2011. [Poster]

Kolehmainen N, Francis J, Owen C, McKee L, Ramsay C. Participation in Physical Play Study: an MRC study to develop a theory- and evidence-based intervention. Rehabilitation and Participation in Long-Term Conditions. Dundee, UK. April 2011. [Poster]

Peer reviewed papers:

Kolehmainen N, Francis JJ, Ramsay CR, Owen C, McKee L, Ketelaar M, Rosenbaum P. Participation in physical play and leisure: developing a theory- and evidence-based intervention for children with motor impairments. BMC Pediatrics 2011 11:100doi:10.1186/1471-2431-11-100