The following table contains a list of some of the therapy intervention research projects on which TVCC staff members were named investigators. Abstracts, publications, and presentations follow.
Publications that have resulted from these selected projects are also listed. For information on how to obtain a copy of an article, please see Accessing Journal Articles.
List of Therapy Intervention Projects
A survey of chronic and recurring pain in child and youth with disabilities
Investigators: M. Gilpin, J. Sommerfreund, L. Taylor, M. Currie, J. Crotogino, & L. Bolack
Funding: N/A, 2003-2004
Little is know about the prevalence of chronic pain in children generally and specifically in children with disabilities such as cerebral palsy, acquired brain injury, muscular dystrophy, and/or developmental delay. The first step to advancing clinician and family understanding of pediatric pain among children with disabilities is to establish better awareness of its prevalence. The information gathered from this survey of 100 children and families attending medical clinics at Thames Valley Children’s Centre will determine if pain reports were at a level significant enough to merit further clinical attention and formal investigation, if certain diagnostic groups may be at greater risk for pain experiences than others, and if pain experiences vary with age and severity of diagnosis. Depending on the outcome, clinical protocols could be developed that would increase the awareness of pain experiences and serve to clearly identify what pain experiences require more responsive treatment approaches and pain management (e.g., if pain impacts participation in life, then treatment strategies may be introduced).
Bolack, L., Crotogino, J., Taylor, L., Gilpin, M., & Young, C. (2006, September). A survey of chronic and recurrent pain in children and youth with disabilities. Presented at the annual meeting of the Ontario Association of Children’s Rehabilitation Centre, Niagara Falls, ON. Evaluation of two treatments for toe-walking for childrenwith cerebral palsy
Investigators: F. Stephenson, C. Scholtes, T. Carey, & K. Leitch
Affiliation: Children’s Hospital of Western Ontario
Funding: TVCC Research Award, 2005-2006, $1,646
Children with cerebral palsy often have overactive calf muscles that result in the appearance of “toe-walk.” As a result, the calf muscles do not get stretched during walking activities, and lead to restriction in the range of motion at the ankle. This study examined two treatments to stretch out the calf muscles, (1) serial casting and (2) serial casting with Botulinum-toxin A (commonly known as Botox), to determine if one treatment was superior to the other. Serial casting involves casts applied to the ankle to maintain a prolonged period of stretch to the calf muscles. Botox is a chemical injected into the overactive muscles to relax the muscles. Sometimes serial casting and Botox are combined together to treat tight calf muscles.
The focus of this study was to investigate the effectiveness of serial casting treatments with and without Botox injections for tight calf muscles. Treatments that took place between 1997 and 2006 at Thames Valley Children’s Centre (TVCC) were examined in this study. Ankle range of motion and observed walking characteristics were examined for serial casting and serial casting with Botox treatments. In general, both treatments were effective at stretching out the calf muscles and improving walking patterns. Clinical implications and future research suggestions are discussed in the Facts To Go summary.
Stephenson, F., Scholtes, C., Carey, T., & Leitch, K. (2007). Evaluation of two treatments for toe-walking for children with cerebral palsy (Facts To Go, Volume 3, Issue 2). London, ON: Thames Valley Children's Centre.
Is a reduced dose of Deflazacort effective in maintaining strength in children with Duchenne Dystrophy?
Investigators: C. Campbell, L. Bolack, S. Levin, C. Scholtes, C. Mitchell, B. Lyttle, & T. Carey
Affiliation: Children’s Hospital of Western Ontario
Funding: TVCC Research Award, 2004, $5,000
Deflazacort (DFZ) has been shown to be effective in preserving muscle strength and function, as well as pulmonary function, in Duchenne Muscular Dystrophy (DD), however few randomized trials have been completed making observational studies important. This study retrospectively reviewed all DD patients from a regional pediatric neuromuscular clinic. Twenty-eight patients met inclusion criteria with 14 patients treatment with DFZ and 14 untreated. Ambulatory status, pulmonary function and side effects were compared. Eight of the 14 patients treated with DFZ required a wheelchair fulltime. Five of the 6 treatment patients who were still walking were older than 10 years. Ten of the 14 untreated patients required a wheelchair fulltime. Pulmonary function at age 11 years was greater in the treated patients compared to those untreated. Scoliosis surgery was required in 3 of 16 untreated patients versus none of those treated. A non-significant increase in mean weight was noted at age 10 years in the DFZ group. There were an equal number of fractures between the two groups. DFZ did not delay the time to loss of independent ambulation in our sample, which is in contrast to other studies using similar protocols. DFZ significantly improves pulmonary function in DMD patients. Side effects were not substantially different between the groups.
Hung, R., Campbell, C., Levin, S., Bolack, L., Scholtes, C., Lyttle, B., & Mitchell, C. (2005). Analysis of deflazacort treatment of Duchenne muscular dystrophy. The Canadian Journal of Neurological Sciences, 32(2[Suppl1]), S43.
Hung, R., Campbell, C., Levin, S., Bolack, L., Scholtes, C., Lyttle, B., & Mitchell, C. (2005, June). Analysis of deflazacort treatment of Duchenne muscular dystrophy. Presented at the Canadian Congress of Neurological Sciences, Ottawa, ON.
Upper extremity strength in Duchenne Dystrophy
Investigators: L. Bolack, C. Campbell, S. Levin, C. Scholtes, C. Mitchell, C. Shoesmith
Affiliations: Children’s Hospital of Western Ontario1
Funding: TVCC Research Award, 2004-2005, $4,850
Upper extremity (UE) strength and function is known to deteriorate over time in children with Duchenne Muscular Dystrophy (DD), however, it is not clear which UE measures are best correlated with general disease progression. This cross-sectional study explores the relationship between disease characteristics and measures of UE strength and function in children with DD. Self-rating of performance and satisfaction regarding UE function has not been explored before in DD; the Canadian Occupational Performance Measure (COPM) was used to examine this issue. Fifteen patients with DD, attending a regional pediatric neuromuscular clinic participated in a study of UE strength. Participants rotated through 5 stations including: Brooke UE scale, grip strength and quantitative manual muscle testing (Lafayette system), arm MRC score, timed writing and typing tasks, and the COPM. Mean age of participants was 11.17 years. Pearson’s correlation analysis of age with outcome measures revealed: a positive correlation with Brooke scale and a negative correlation with left arm MRC score; and was not significant with grip strength and Lafayette system measures. Writing and typing performance improved with age. The Brooke scale and right and left arm MRC scores were highly predictive of one another. The COPM showed that subjects were generally satisfied with each identified problem testing (mean equals 73.38%). Performance and satisfaction scores of the COPM were strongly correlated however did not correlate with the other measures. MRC scores and the Brooke scale are the best UE measures of stage of disease in this cross-sectional study. Grip strength, writing/typing tasks, and the COPM were not found to be indicators of UE stage of disease in this study; this likely reflects the fact that the sample was relatively young.
Magalhaes, S., Campbell, C, Bolack, L., Scholtes, C., Shoesmith, C., & Levin, S. (2005). Upper extremity strength in Duchenne muscular dystrophy. The Canadian Journal of Neurological Sciences, 32(2[Suppl1]), S44.
Magalhaes, S., Campbell, C, Bolack, L., Scholtes, C., Shoesmith, C., & Levin, S. (2005, June). Upper extremity strength in Duchenne muscular dystrophy. Presented at the Canadian Congress of Neurological Sciences, Ottawa, ON.
Scholtes, C., Campbell, C., & Bolack, L. (2005, October). Canadian Occupational Performance Measure: Results in a sample of children with Duchenne dystrophy. Presented at the Ontario Association of Children’s Rehabilitation Services 2005, Niagara Falls, ON.
A proposal to compare the effects of two methods of pelvic stabilization on occupational performance in children with cerebral palsy
Investigators: J. Miller Polgar, J. Sommerfreund, S. Spaulding, L. Kaladjian-Truscott, J. Kramer, M. Masse, H. McFarlane, & R. Rendell
Affiliation of Collaborators: The University of Western Ontario
Funding: Canadian Occupational Therapy Foundation – MDS Paediatric Award, 1998-2000, $19,895
Seven children aged 7 to 12 years who had cerebral palsy and used a wheelchair compared the effect of pelvic stabilization of a pelvic belt and a sub-ASIS bar on their functional abilities. Results indicated that both children and caregivers found occupational performance to improve with the use of the sub-ASIS bar. Parents felt that their children were able to do more with the sub-ASIS bar and that it was easier to use and provided better positioning. They indicated that the sub-ASIS bar provided a more comfortable sitting position, required them to re-position their child less often, and had greater performance than the pelvic strap.
A proposal to evaluate the effectiveness of assistive technology and augmentative and alternative communication intervention strategies on enhancing the development of writing and reading skills of a child in senior kindergarten with severe physical and speech impairments
Cognitive intervention for children with developmental coordination disorder
Investigators: S. Smith, N. Browning, & J. Polgar
Affiliation of Collaborators: The University of Western Ontario
Funding: N/A, 2001-2002
This single case study investigated the effectiveness of assistive technology (AT) on the development of literacy skills in a senior kindergarten child who had severe speech and physical impairments. Goal attainment scaling (GAS) was used as the outcome measurement tool. A total of 10 comprehensive goals were developed in a collaborative effort between the parents, school, and investigators. A total of 10 intervention sessions spanning 4 months were completed with the child. Both the home and school environments were incorporated in the study. The participant showed improvement on all goals, excluding numeral recognition. The participant benefited from regularly scheduled sessions with the primary investigator. Inconsistencies in scheduling tended to result in less productive sessions and fewer gains. Education provided to the educational assistant regarding the technology and possible applications resulted in gains in goal attainment for the child. This study supports the contention that AT can enhance the development of literacy skills in children with severe physical and speech impairments when a collaborative effort between all parties is applied and adequate support and education regarding the AT are provided.
Investigators: L. Miller, H. Polatajko, C. Missiuna, T. Malloy-Miller, & A. Mandich
Affiliation of Collaborators: The University of Western Ontario
Funding: The Hospital for Sick Children Foundation, 1997-1999, $34,433
Traditional approaches to treating developmental coordination disorder (DCD) have not been every effective. This study compared the task performance, self-perception, adaptive behaviour, and motor ability of 15 children who received a cognitive approach to those of 15 children who received a direct skill training approach. The findings indicated the usefulness of a cognitive approach in improving the day-to-day functioning of children with DCD.
Missiuna, C., Mandich, A., Polatajko, H., & Malloy-Miller, T. (2001). Cognitive orientation to daily occupational performance (CO-OP): Part I, theoretical foundations. Physical & Occupational Therapy in Pediatrics, 20(2-3), 69-81.
Polatajko, H., Mandich, A. D., Missiuna, C., Miller, L., Macnab, J. J., Malloy-Miller, T., & Kinsella, E. A. (2001). Cognitive orientation to daily occupational performance (CO-OP): Part III, the protocol in brief. Physical & Occupational Therapy in Pediatrics, 20(2-3), 107-123.
Development of a toileting system for teenagers and young adults
Investigators: S. Ryan, J. Miller Polgar, M. Doell, S. Mulholland, & V. Metron
Affiliations of Collaborators: Bloorview MacMillan Children’s Centre, The University of Western Ontario
Funding: Ontario Rehabilitation Technology Consortium, 1998-2002, $22,228
There is a need for an economical, simple to use, and adaptable toileting system for teenagers and young adults who have unstable posture while sitting. Members of this research team have successfully developed a toileting system for children approximately four to twelve years of age with mild to moderate seating problems. However, this system for younger children cannot simply be enlarged to accommodate the larger size of adolescents and younger adults. This project asked consumers to assist with the development of an appropriate design for this system, and to try out the design prototypes in their homes. Relevant issues raised by the consumers through focus groups included: the desire for privacy, concern regarding the ease of transfers when using a toileting system, desire for a system that is easy to use, and desire for a system that will meet the needs of different consumers. A prototype was built based on the design criteria and feedback derived from the focus groups. Adolescents, young adults, their parents and caregivers will be asked to use the system for a period of one week. They will be asked to evaluate whether the system effectively provides the intended positioning and function during toileting activities.
Family-centred functional therapy for young children with cerebral palsy
Investigators: M. Law, P. Rosenbaum, M. Piper, J. Darrah, S. Harris, G. King, N. Pollock, J. Watt, & R. Armstrong
Affiliations of Collaborators: CanChild Centre for Childhood Disability Research, University of Alberta, University of British Columbia
Funding: United Cerebral Palsy Association, 1994-1995, $35,805
The purpose of this pilot study was to evaluate a family-centred functional therapy approach to improving motor function in 18-month to 4-year old children with cerebral palsy. The therapy program included identification of constraints within the person, environment, or activity and therapy intervention aimed to change these constraints and enable function.
Children with cerebral palsy typically receive ongoing occupational therapy and physiotherapy to facilitate motor development and enhance independent movement, self care, play and leisure. Emerging concepts of motor development and family-centred service have been proposed as a more appropriate basis for therapeutic intervention for young children with cerebral palsy. Findings indicate that the family-centred functional approach to therapy has the potential to facilitate change in the motor performance of these children. These results will be used to further develop the family-centred functional approach to therapy intervention.
A new framework for the delivery of occupational therapy and physical therapy services has been developed. The new treatment approach aims to maximize the function of these children in completing tasks which are important to them and their family. Initial testing indicates that children receiving this treatment made substantial changes in motor function.
Law, M., Darrah, J., Pollock, N., King, G., Rosenbaum, P., Russell, D., Palisano, R., Harris, S., Armstrong, R., & Watt, J. (1998). Family-centred functional therapy for children with cerebral palsy: An emerging practice model. Physical & Occupational Therapy in Pediatrics, 18(1), 83-102.
Fractures in boys with Muscular Dystrophy
Functional, educationally-relevant therapy outcomes for children with special needs
Investigators: D. Harris, N. Bernhard, C. Mitchell, & S. Levin
Affiliation of Collaborators: Children’s Hospital of Western Ontario
Funding: Thames Valley Children’s Centre Research Award, 2002-2004, $4,596
For over fifteen years, it has been suggested that children affected by Duchenne’s muscular dystrophy have an increased prevalence of bone fractures. This study examined the prevalence and distribution of fractures in boys with muscular dystrophy to try to determine whether there is a subset of boys with muscular dystrophy who are particularly susceptible to fractures. Researchers also assessed the effect of deflazacort treatment on fracture frequency and distribution.
Investigators: G. King, M. A. Tucker, P. Alambets, J. Gritzan, K. Gregory, M. Curran, K. Thomas, T. Malloy-Miller, K. Husted, & J. McDougall
Affiliations of Collaborators: Community Care Access Centre of London & Middlesex, Thames Valley District School Board, London District Catholic School Board, Parent Representative
Funding: The Richard and Jean Ivey Fund, 1995-1996, $35,000; Thames Valley Children’s Centre, 1995-1996, $5,000; CanChild Centre for Childhood Disability Research, 1997-1999, $10,000; Thames Valley Children’s Centre Research Award, 1997-1999, $5,000
Millions of dollars are spent each year on school-based therapy services, yet little is known about whether these services improve the educationally relevant, functional outcomes of children with special needs. This program evaluation study used goal attainment scaling to examine whether 50 children with special needs (ranging in age from 5 to 12 years) attained their therapy goals in the real-world, functional areas of communication, school productivity, or mobility. Sixteen children received speech-language therapy for communication difficulties, 21 received occupational therapy for classroom productivity difficulties, and 13 received physical therapy services for mobility difficulties at school. The service delivery model incorporated direct therapy, monitoring, and collaborative consultation between therapists, teachers, and parents. In addition to goal attainment scaling, standardized measures of functional status were used to examine changes in the function of the children from pretest to posttest and at a five- to six-month follow-up. Measures of parent and teacher satisfaction with the services also were employed. The findings suggest that therapy services targeting communication, productivity, and mobility make a difference in how children with special needs function in the school setting. Children showed statistically and often clinically significant change in their outcomes over the intervention period, with these improved outcomes lasting at the five- to six-month follow-up.
McDougall, J., King, G., Tucker, M. A., Gritzan, J., Malloy-Miller, T., & Alambets, P. (2000). Evaluating functional, school-based therapy services for children with special needs. Proceedings of the American Academy of Cerebral Palsy and Developmental Medicine, 47.
King, G. (1999). School-based practice. Physical & Occupational Therapy in Pediatrics, 19(2), 1-3.
King, G., McDougall, J., Palisano, R., Gritzan, J., & Tucker, M. A. (1999). Goal attainment scaling: Its use in evaluating pediatric therapy programs. Physical & Occupational Therapy in Pediatrics, 19(2), 31-52.
King, G., McDougall, J., Tucker, M. A., Gritzan, J., Malloy-Miller, T., Alambets, P., Cunning, D., Thomas, K., & Gregory, K. (1999). An evaluation of functional, school-based therapy services for children with special needs. Physical & Occupational Therapy in Pediatrics, 19(2), 5-29.
McDougall, J., King, G. A., Gritzan, J., Malloy-Miller, T., Tucker, M. A., & Evans, J. (1999). A checklist to determine the methods of intervention used in school-based therapy: Development and pilot testing. Physical & Occupational Therapy in Pediatrics, 19(2), 53-77.
King, G., McDougall, J., Tucker, M. A., Gritzan, J., Malloy-Miller, T., Alambets, P., Cunning, D., Thomas, K., & Gregory, K. (1999). Do children with special needs benefit from receiving functional, school-based therapy services? (Keeping Current 99-6). Published and distributed by CanChild Centre for Childhood Disability Research. Copies are available from the CanChild website at http://www.canchild.ca/.
King, G., McDougall, J., Tucker, M. A., Gritzan, J., Malloy-Miller, T., Alambets, P., Cunning, D., Thomas, K., & Gregory, K. (1999). An evaluation of functional, school-based therapy services for children with special needs. Published and distributed by CanChild Centre for Childhood Disability Research. Copies are available from the CanChild website at http://www.canchild.ca/.
King, G., McDougall, J., Tucker, M. A., Gritzan, J., Malloy-Miller, T., Alambets, P., Cunning, D., Thomas, K., & Gregory, K. (1997). The evaluation of functional, school-based therapy services for children with special needs: A feasibility study. Published and distributed by CanChild Centre for Childhood Disability Research. Copies are available from the CanChild website at http://www.canchild.ca/.
Neurodevelopmental therapy and casting: A comparison of intensive neurodevelopmental therapy plus casting and a regular occupational therapy program for young children with cerebral palsy
Investigators: M. Law, P. Rosenbaum, D. Russell, S. Walter, G. King, & N. Pollock
Affiliation of Collaborators: CanChild Centre for Childhood Disability Research
Funding: Ontario Ministry of Health, 1990-1993, $223,000
The purpose of this study was to evaluate the combined effect of intensive neurodevelopmental therapy (NDT) and casting in improving hand function, quality of upper extremity movement and range of motion in children 18 months to 4 years of age who have cerebral palsy. Findings indicated there to be no significant differences between intensive NDT plus casting and a less intensive regular occupational therapy program. At the time of this study, children with cerebral palsy in Ontario receiving ongoing therapy at children’s treatment centres often received NDT, a therapy widely practised by occupational therapists. Upper extremity inhibitive casting has also been implemented in conjunction with NDT to improve hand function. A randomized cross-over design was used to evaluate the difference between intensive NDT plus casting and a less intensive regular occupational therapy program.
Blinded assessment of hand function, quality of upper extremity movement and parents’ perception of hand function performance were performed at baseline, four months (end of first intervention period), six months (after a 2 month washout period), and ten months (end of second intervention period). Analysis of the outcomes revealed no significant differences in hand function, quality of upper extremity movement, or parents’ perception of hand function performance between intensive NDT plus casting or regular occupational therapy programs. There does not appear to be any beneficial effect of an increased amount of therapy for the children in this study.
This study demonstrates that occupational therapy for young children with cerebral palsy, with a focus on improving hand function skills and delivered one to three times per month, achieves the same outcomes as a more intensive neurodevelopmental therapy approach with casting provided 6 to 8 times per month. Children appear to benefit equally from less intensive, but functionally focused therapy.
Law, M., Russell, D., Pollock, N., Rosenbaum, P., Walter, S., & King, G. (1997). A comparison of intensive neurodevelopmental therapy plus casting and a regular occupational therapy program for children with cerebral palsy. Developmental Medicine and Child Neurology, 39, 664-670.
Pilot study of biomarkers for spinal muscular atrophy
Investigators: Craig Campbell¹, Rhiannon Taranik², Victoria Siu¹, & Cheryl Scholtes
Affiliation: London Health Sciences Centre¹, The University of Western Ontario²
Funding: Spinal Muscular Atrophy Foundation, 2008-2009, $11,991
Status: Completed, 2008-2009
Spinal Muscular Atrophy (SMA) is a genetic disease affecting the nerves that bring information about movement from the spinal cord to the muscles.
The aim of this study was to identify a biomarker or panel of biomarkers from a wide range of SMA patients. The hypothesis was that using proteonomic and metabolomic techniques there would be, as yet unrecongnized, biomarkers that would provide insight into potential therapeutic targets for this condition.
Using computers for written communication
Investigators: N. Browning, & B. Batorowicz
Funding: Thames Valley Children’s Centre Research Award, 1998-2000, $4,200
Twenty-four individuals aged 6 to 21 who were receiving Augmentative Communication (AC) services were evaluated for their level of independence in using their computers for written communication through observation and self-report. Complexity of access method was not found to be significantly associated with satisfaction with AC services in the written communication. Among other factors, the extent to which clients felt they knew how to use their computers was significantly associated with client/caregiver satisfaction with AC services in written communication.
Browning, N., & Batorowicz, B. (2000). Using computers for written communication: What are the key elements of clients’ and caregivers’ satisfaction with this aspect of Augmentative Communication Services? (Facts To Go, February 2000). London, ON: Thames Valley Children’s Centre.
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