Episode 129 (Dr Jacqui Barfoot)
INCLUDING A RELATIONSHIP-FOCUS IN PAEDIATRIC OCCUPATIONAL THERAPY INTERVENTIONS: INTRODUCING THE PAIR MODEL
Dr Barfoot is an experienced Occupational Therapist and Postdoctoral Clinical Researcher with the Child Health Research Centre, at the University of Queensland.
Reflections on this episode (Dr Pool)
The importance of parent-child relationships for child developmental outcomes suggests a need to incorporate a relationship focus into early intervention programs for children with developmental delays.
Yet, there is some confusion around the definition and application of relationship focused interventions as many occupational therapists remain more developmentally and child focused. This report provides a new conceptual model, called the Phased Approach to Incorporating a Relationship focus or PAIR that can be used in paediatric clinical settings.
This work is relevant for all therapists. My big takeaway from this was the importance and value of the attachment theory. Many of us would have learnt about this in university days but it is great to revisit this within the context of our work. A child’s emotional regulation and development is intimately related and a parent’s attachment with their child is one that needs to be treasured. Many parents may have had some challenges right from the beginning - from medical trauma, to sleep deprivation and the stress about their child’s well-being.
Therefore, taking a relationship focused lens is vital particularly in the early years. We have talked quite extensively lately about active, self-generated movement as being crucial for learning new motor skills. It’s not just motor though, it is so vital when it comes to fostering strong relationships with important people in the child’s world.
The PAIR model is very practical and provides some wonderful tools on the kinds of questions that can be used particularly when we first meet families.
Episode 128 (Professor Iona Novak)
“THE POTENTIAL OF CELL THERAPIES FOR CEREBRAL PALSY: WHERE ARE WE TODAY?”
Reflections on this episode (Dr Pool)
An incredible and inspiring conversation relevant for clinicians, researchers and families. We started our conversation by asking the question: “is there hope beyond the hype for cell therapies?”
Many of us have heard about cell therapy and if you’re into sci-fi like me, regenerating cells has exciting possibilities when we’re thinking about healing from an injury or curing a disease. Whilst we’re not quite where the movies make it out to be, I must admit, I was surprised by how far the field has come over the last few decades.
In fact, over 2,400 children with cerebral palsy have been involved in clinical trials involving cell therapies. The result is that it is safe with no adverse events with effect sizes twice as great as that reported from rehabilitation therapies. This means that in far less time, children can achieve at least the same results, if not more than our rehabilitation approaches. Why? Cell therapies have powerful anti-inflammatory properties and research has shown that children with cerebral palsy exhibit long lasting inflammation. Therefore, treating the inflammation is a new treatment approach that is yielding significant results.
Whilst there are currently no approved cell therapy centres anywhere in the world, I am comforted by the fact that regulatory bodies are quite possibly very close to approving this treatment both in the USA and Australia.
Imagine the possibilities? If this treatment can become more widely administered, everything changes! Imagine the combination of cell therapies and evidence based therapeutic interventions? This is an exciting space and I hope this conversation inspires you as much as it did me.
Please do check out the link to Stem Cell Australia listed below as well as the patient handbook that Professor Novak spoke about too. I suppose it is safe to say, watch this space!
https://stemcellsaustralia.edu.au/
https://stemcellsaustralia.edu.au/assets/Uploads/Australian+Stem+Cell+Handbook+2015-APRIL24.pdf
Professor Novak is the Cerebral Palsy Alliance Chair of Allied Health, and co-founder of the Cerebral Palsy Alliance Research Institute, affiliated with the Brain and Mind Centre and Faculty of Medicine and Health at The University of Sydney.
Episode 127 (Professor Catherine Elliott)
BUILDING A CLINICAL RESEARCHER’S CAREER - LESSONS FROM A MENTOR
Reflections on this episode (Dr Pool)
What a great way to start season 4!
This episode covered several topics that relate to clinicians that want to get into the world of research, leadership, avoiding burnout, and the life of an early career researcher.
Getting into research isn’t always a conscious decision. For many clinicians, it often begins with a sense of curiosity and perhaps a sense of dissatisfaction with what is currently available. What a brilliant mindset to bring into research because at the end of the day, research is all about discovery in the pursuit of better knowledge. In the area of child health, this inevitably means better outcomes and we’re all about that.
There are many ways to be involved in research and doesn’t mean you have to do a Masters or PhD. A brilliant way to get involved is to join research teams where you can bring your skills as a clinician in the assessment and intervention component. Becoming a mentor or clinical supervisor for honours projects are also great pathways.
Leadership is often a topic that is left for those in positions of authority but we know that through our careers, there is a call for us to be leaders whether within our team of clinicians or within our research teams. I loved our discussion about how leadership roles exist within our clinical and research contexts. Embedded within leadership is being prepared to have not just difficult conversations but also less comfortable chats!
I loved how Professor Elliott spoke about the importance of these conversations because the reality is that these conversations are about being kind to the people involved. Honesty, delivered with care and compassion is a refreshing perspective and goes a long way in cultivating a positive team culture.
The reality of balancing work and life was also a great topic of conversation and I believe this is relevant for all of us! It doesn’t take much to tip the scales sometimes and we do need to be sure to look after ourselves.
I hope this conversation helps to frame your 2024. It is truly a wonderful privilege to do our jobs in an effort to improve the lives of children with neurodisabilities, whether it is in the clinical or research realm. The common theme here is the value and importance of our roles with strong leadership, honest conversations and building a culture that values people first and foremost
Professor Elliott is the Director of Research at Telethon Kids Institute, the Chair of Kids Rehab at Child Adolescent Health Services (CAHS) and a Professor in the School of Allied Health at Curtin University.
Episode 126 (ResearchWorks Live - SSBI23)
A SPECIAL LIVE EPISODE FROM THE SMALL STEPS | BIG IMPACT 2023 CONFERENCE!
Science Communication - an episode recorded live at Small Steps | BIG Impact 2023.
Episode 125 (A thematic analysis)
A THEMATIC ANALYSIS OF SEASON 3 - A WRAPUP, AN INDEX, A REFLECTIVE LOOK AT A SPECIAL BREAKTHROUGH YEAR FOR THE POD!
Reflections on this episode (Dr Pool)
Final episode of the season?!
As Ash and I reflect on this incredible year, we pull together some key themes of the episodes and the ever so wonderful and brilliant guests we have had on the show. We are so grateful for all of the researchers who so generously gave their time to help spread the word on the current state of science in the field. We have learnt so much and we hope you have had some great takeaways too!
In true Ash style, the qualitative researcher in her couldn’t help but to carry out a thematic analysis of the episodes in 2023. I love that she did that though - you can see the transdiagnostic approach really set in because of the common themes that run through so many different areas. I truly believe that if you can grasp all of the themes of the episodes this year, you can so easily translate this knowledge into your practice - staying up to date with the latest and waiting ever so hopefully for more to come.
In this episode, we talk about the powerhouses of the industry who joined us on the show. They are thought provokers for sure - titans of the industry with years of experience, extensive global collaborations and wisdom to impart to clinicians and researchers alike. These researchers include Professor Peter Rosenbaum, Professor Diane Damiano, Professor Andrew Whitehouse, Professor Mark Belgrove and Professor Laurent Servais and of course some of our returning guests which include Professor Ben Jackson, Dr Bhooma Aravamuthan, Dr Ros Ward and Ginny Paleg just to name a few. All of their messaging was around the importance of the ‘F-words’!
We as health professionals need to “be humble” as Bhooma so eloquently described and the real importance of being person centred was a common theme. Starting the season with Emily Prior and later Connor Johnstone truly reinforced this - both incredible young people with lived experience. It always comes down to the consumers and what a compelling reason to bring forth evidence based interventions and approaches. Their lives matter, their dreams matter - and again, the ‘F-words’ framework brings that home.
We loved our conversations with other thought provokers such as Associate Professor Daniel Navon regarding the sociological take on genetic testing (who asked us more questions then we of him!) and most recently Dr Jessica Stokes-Parish on the world of misinformation, disinformation and the value of debunking! (remember the CRABs mnemonic!)
Then there was the whole theme of brain activation and mobility - we loved talking about the functional MRI results with Dr Yannick Bleyenhueff and that self-initiation is vital! More than just the talk about dosage and the number of hours children engage in therapy - it is about ensuring that the right ingredients are in the intervention. This led nicely into a little series with Andrina Sabet, Dr Heather Feldner and Dr Sam Logan on mobility as a human right. For me as a clinician, this whole area was incredibly exciting. We now have these papers to reference and use as a resource when we have to advocate for change.
Then we just talked about our highlights and what a highlight reel too! Going international and bringing the podcast to EACD in Slovenia was an amazing experience. We loved meeting so many people and the opportunity to help bring their work into the broader community. Also, our very first Minister visit with the Honourable Bill Shorten was a highlight for sure. The clinic and our studio was a hive of activity and it was so encouraging to hear the Minister describe the value of evidence based practice and that it is be the way forward for a sustainable scheme.
That was 2023! We are so excited for what 2024 holds! We look forward to meeting more of you at EACD in Bruge and AusACPDM in Cairns in 2024. Have a wonderful holiday season and we will talk to you again soon!
Episode 124 (Dr Jessica Stokes-Parish)
NAVIGATING THE CREDIBILITY OF WEB-BASED INFORMATION DURING THE COVID-19 PANDEMIC: USING MNEMONICS TO EMPOWER THE PUBLIC TO SPOT RED FLAGS IN HEALTH INFORMATION ON THE INTERNET
Reflections on this episode (Dr Pool)
Misinformation creates challenges for the general public and we all know the challenge in differentiating between the truth from fiction when we are on the internet. This was particularly brought to the forefront recently during the COVID-19 pandemic where we saw high volumes of news, ever evolving information changing and of course, misinformation.
Even beyond COVID-19, we know that if we are looking for information about anything for ourselves, our family and friends we have to be able to somehow discern between reliable information and the not so. But if we’re not experts in the area how can we wade our way through the world of information?
This episode is for everyone - whether you are a health professional or not, we are all consumers of content that is posted either on social media or on mainstream media. The CRABs framework is easy to remember and is a great way to talk about evaluating content online. Our discussion also went beyond the CRABs framework and included the vital importance of recognising confirmation bias. This process of stopping and asking ourselves - what would the opposite of that be is healthy!
Our social media feeds can become so curated that seeing content that represents an alternate viewpoint can become rather scarce. Considering another perspective is helpful and at the end of the day, it enables us to understand others and hopefully makes us less susceptible to both misinformation and disinformation. Just like how we need to evaluate quality of research, there is an equal need to apply a model to help us to evaluate all the information that seems to come at us from all angles.
Visit Dr Stokes-Parish's website via the link below!
Episode 123 (Associate Professor Asha Bowen)
BIVALENT PREFUSION F VACCINE IN PREGNANCY TO PREVENT RSV ILLNESS IN INFANTS
Reflections on this episode (Dr Pool)
Respiratory Syncytial Virus or RSV has affected many of us. Whether you are a parent of a young child, teacher or clinician, I’m sure you’ve noticed that some children get quite sick from RSV, resulting in days off or even hospitalisation. Spread just like any virus, the value of hand washing and staying home whilst sick have been our main preventative strategy for limiting infection rates during winter.
This is where this remarkable study comes in and Asha provides such a wonderful perspective from her background as both a scientist and clinician. The science involved in this vaccine is truly remarkable, where the vaccine is provided to pregnant mothers in their third trimester with the primary end point being when the infant is 6 months old.
It is exciting to think that it is entirely possible that we won’t see much of RSV in the coming winters. This vaccine along with the antibody that can be provided to babies in their first year of life gives so much hope - hope that there won’t be the late night runs to ED with a baby struggling to breathe, hope that the risk of hospitalisation is significantly reduced and hope that any long term sequelae associated with RSV is minimised.
With the antibody having been approved by the FDA in the USA with roll out starting any moment now, I’m sure paediatricians and regulatory bodies from around the world will be watching keenfully in order to shape their own public policy. Watch this space!
Episode 122 (Professor Ana Carolina de Campos)
F-WORDS AND EARLY INTERVENTION INGREDIENTS FOR NON-AMBULANT CHILDREN WITH CEREBRAL PALSY: A SCOPING REVIEW
Reflections on this episode (Dr Pool)
The aim of this scoping review was to explore the ingredients of early interventions provided to young children with cerebral palsy, classified in GMFCS levels IV and V as well as to identify the “F-words” addressed by the interventions.
With the 87 papers that were included in the review, it was found that fitness, family and functioning were the ingredients that were most addressed in experimental studies, where as fun, friends and future were rather scarce.
This paper holds so much gold. For me as a clinician, I am so encouraged by this work. The breadth of a scoping review is really quite large, capturing some initial studies that are hopefully on their way to becoming larger scale, controlled trials that will serve to consolidate our practices to achieve the best possible outcome for the child.
We have talked quite extensively now about the key ingredients of motor learning. A few weeks ago in our chat with Yannick about HABIT-ILE, we have some objective brain activity data that shows the high value of self-initiated, goal directed, task specific practice. We can all relate to these processes because people are people - our brains all need these processes in order to learn new skills. It is no different for children with cerebral palsy.
A common concern is that children with CP, classified within GMFCS levels IV and V are unable to participate in self-initiated task specific practice. This is why this group of children in particular engage in more non-evidence based interventions - mainly because of historically well-intentioned interventions from the 1970s and 1980s that utilised manual facilitation techniques (NDT or Bobath, CME (DMI), Vojta). Back then, we had less knowledge about the brain and motor learning so of course, hands on approaches were the main intervention approach.
There is a clear shift now because we have definitive proof that in order for a child to learn anything, they need to be active and self-initiating the movements. This is because the planning involved in moving is also part of the task. We don’t just suddenly appear in standing or suddenly appear in sitting. There is a process or a transition so to speak where the body prepares for the task and this is the element that is often not given adequate attention. Children classified within GMFCS levels IV and V also need to learn to pre-plan their movements and our role is to set up the environment with the right adaptive equipment in place to enable them to participate as maximally as possible.
This leads to my other big thought and that is choice and control. Too often, I see children within GMFCS levels IV and V be subjected to movement or movement experiences by an adult. Children need to be part of the choice making and we know this for any child going through development. Choice is motivating and vital because childhood is where self-identity, autonomy and curiosity is developed. Promoting choice making or simply, providing opportunities for children to decide what they’d like to do will drive movement and thus, functioning, fitness, friends, future and fun right?
Episode 121 (A clinical perspective)
A ROUNDTABLE DISCUSSION WITH MARISSA SMTIH, DAYNA POOL, ASHLEIGH THORNTON AND LOREN WEST
A clinical perspective on Mobility as a Human Right.
Mobility is a fundamental human right and is supported by the United Nations and the ON time mobility framework. The purpose of this study was to understand the effect of a powered mobility intervention on developmental changes in children with cerebral palsy.
In this randomised cross over clinical trial involving 24 children aged between 12 and 36 months, children received both the explorer mini and a modified ride on car in randomised order - each for 8 weeks. The Bayley Scales of Infant and Toddler Development (4th edition) was used at 3 time points.
The results indicated that regardless of device, low use was associated with no significant developmental change and that high use was associated with positive developmental changes. This highlights that mobility access is critical to maximise the development of children with CP and that this may be augmented by using powered mobility devices.
What a wonderful way to follow up from last week’s episode. Mobility is essential to development and I love how this research shows that there are positive developmental changes across the board from an intervention that offers mobility.
Once again, this supports the notion that offering mobility is vital to development and that having alternative ways of moving only enhances rather than removes.
Ausacpdm award winners!
At the recent AusACPDM 2024 Conference, Dr Pool and Dr Thornton were awarded the prestigious Australasian Academy of Cerebral Palsy and Developmental Medicine (AusACDPM) Transformative Practice Award!