Episode 38 and 39 (Holiday Specials)
It's the end of Season 1 of the ResearchWorks podcast.
After nearly 40 episodes - 10's of thousands of downloads and an avid listener base from across Australia and throughout the globe, we have been overwhelmed with the level of support for research presented in this kind of format.
That means that we've been renewed for a follow up season! Dayna, Ash and the RWP team will be back in 2022 for season 2 with even more interviews, behind the scenes stories and information that didn't quite make the publication.
If you would like to recommend a paper for the team to cover or would like to make an introduction for the team - we'd love to hear from you. You can find our contact details on the contact us page - and you can even just drop us an email to tell us about your thoughts on the pod too!
We've produced 2 holiday specials, a compilation of Ed's favourite episodes and a full episode run down from both Ash and Dayna. It's a nice way of looking back at the highlights and maybe a chance to re-visit an episode you might have missed.
Happy Holidays, take care and we will see you in early 2022!
Episode 37 (Professor Sonya Girdler)
KONTAKT® SOCIAL SKILLS GROUP TRAINING FOR AUSTRALIAN ADOLESCENTS WITH AUTISM SPECTRUM DISORDER: A RANDOMIZED CONTROLLED TRIAL
Reflections on this episode (Dr Pool)
In this study, 90 verbal autistic students aged between 12 and 17 years participated in this pragmatic two armed randomised controlled trial to evaluate the efficacy of 16, 90 minute sessions of Social Skills Group Training known as KONTAKT in comparison to a manualised interactive group cooking program of equal dosage.
The primary outcome was the adolescents’ progress toward achieving their personally meaningful social goals as rated by them (not parents). Secondary outcomes included changes in autistic traits, quality of life, facial emotion recognition skills, social anxiety and loneliness.
These measures were taken at baseline, post intervention and 12 week follow-up. The findings suggest that KONTAKT is efficacious in supporting autistic adolescents to achieve their personally meaningful social goals when compared to other prosocial group activities.
For me, this study highlights the importance of interventions that are specific. Yes - social groups can serve a purpose but for individual needs to be met, interventions need to be specific, targeted and adequately dosed. It is something we are quite familiar with in areas like strength training or motor based interventions and this study shows that it is no different for social skill training.
To implement this into our practice, we are continually being grounded on the value of a strengths based approach with interventions that are specific, individualised and measurable.
Episode 36 (Dr Dave Parsons)
A RANDOMISED CONTROLLED TRIAL OF AN INFORMATION COMMUNICATION TECHNOLOGY DELI VERED INTERVENTION FOR CHILDREN WITH AUTISM SPECTRUM DISORDER LIVING IN REGIONAL AUSTRALIA
Reflections on this episode (Dr Pool)
We would all love for technology to be the answer to so many of our barriers and challenges in the provision of effective therapies. We know that technology has a certain appeal and theoretically, it ticks a lot of boxes. This is why this article is so vital.
Firstly, it is wonderful that this work involved families living in rural and remote areas - there really isn’t enough work done within this context.
Secondly, publication of research that shows limited or perhaps no significant differences between conditions are equally as vital as ones that do! We need to know what works but equally, we also need to know what doesn’t work because that then sets us on the path to find other interventions and other ways to spend precious time and funding.
The value of specificity is once again highlighted and the value of clinical expertise is also supported. This in essence is what evidence based practice is. Choosing what we adopt in our practices requires clinical expertise. Taking something off the shelf may work in some instances but more often than not - the “off the shelf” versions need some adaptation or individualisation and no application can take that role.
Our role as clinicians is to put together as many of the active ingredients as possible to address the goal of the treatment. What ingredients we put into the basket is informed by research - evidence based practice! In this instance of adopting technology - this work highlights that I would adopt this for families who are able to commit some daily time toward using the app for a period of 3 months and as an adjunct to face to face interventions.
This app would work for families that are looking to be more up skilled in their treatments at home and have a team that can then support the natural environment component of the skills that may be acquired through the app.
We have to think long and hard about what technology we want to adopt. We are understanding more than ever, that it has its limitations so we need to be careful about what are recommending and what we are hoping to achieve as a result.
Episode 35 (Dr Michael Trevarrow)
MICROSTRUCTURAL CHANGES IN THE SPINAL CORD OF ADULTS WITH CEREBRAL PALSY.
Reflections on this episode (Dr Pool)
This work represents a significant contribution to our knowledge and understanding of the neural mechanisms involved in individuals with cerebral palsy. The reason why this is such an exciting piece of work is because it helps us to understand what neural structures we may be able to influence in our treatments.
Neuroplasticity isn’t just isolated to brain structures and neural pathway reorganisation. Significant work in the area of spinal cord injury rehabilitation has already demonstrated the neuroplastic changes that can occur at the level of the spinal cord. This was actually a paradigm shift and transformational in the therapeutic approach for spinal injury rehabilitation. The notion of activity based rehabilitation took hold in this field and the evidence quickly accumulated on the functional impact as well as the microstructural impact on the spinal cord. Specificity of treatment was more important than ever and the concept of early intervention i.e., treatment soon after injury or the timing of treatment became vital.
This paper really resonates with me because of the work I have done in locomotor training in children with cerebral palsy. The technique and approach of locomotor training in spinal cord injury rehabilitation is specific to influence the spinal pathways. Hence, locomotor training in cerebral palsy isn’t just treadmill training nor is it just partial body weight supported treadmill training. It is so much more specific than that because the focus of the intervention is to influence the structures of the spinal cord.
This article will prove to be foundational in our understanding and approaches to treatment in cerebral palsy and it is exciting to see what the possibilities could be for better functional outcomes in the patients that we work with.
Episode 34 (Dr Jodie Armstrong)
RANDOMISED CONTROLLED TRIAL OF A THERAPEUTIC PLAYGROUP FOR CHILDREN WITH DEVELOPMENTAL DELAYS
Reflections on this episode (Dr Pool)
I love how practical this research study is and how easy it is to draw on some of the key ingredients from this study and implement it into my practice. This study involved 71 children with developmental delay and a mean age of 28.8 months (SD 5.4 months). There were two groups in this randomised controlled trial - an intervention group and control or Treatment as Usual group.
Children in the intervention group received the LEAP playgroup and Treatment as usual.
LEAP sessions ran for 2 hours, once a week for 8 weeks at a community centre with each group consisting of a maximum of 8 families at any one time and was facilitated by 2 allied health clinicians providing a trans-disciplinary approach.
The outcome measures in this study included the Parenting Stress Index, The Tool to Measure Parenting Self-Efficacy, Goal Achievement using the Canadian Occupational Performance Measure and Goal Attainment Scale, Family Support Scale, the Medical Outcome Study Short Form Health Survey and the MacArthur Bates Communicative Developmental Inventories Words and Sentences.
Though this first randomised control trial to evaluate a therapeutic playgroup for children with developmental delay did not demonstrate that LEAP playgroup significantly reduced parent stress over treatment as usual, it did indicate that LEAP contributed to improved outcomes in family support and goal achievement for children with developmental delay and their families when compared to treatment as usual only within a community early intervention service. This means that LEAP in addition to usual care may support improved outcomes for children and families.
What a wonderful result!
Some simple practicalities is that there is so much value in offering “tea and coffee” facilities - a space for parents to support each other. Also - what a wonderful cost effective way to support families that may not have funding yet as they wait for a diagnosis. It really meets people where they are at and provides support during a period of uncertainty and stress.
Episode 33 (Dr Rachel Toovey)
TASK SPECIFIC TRAINING FOR BICYCLE RIDING GOALS IN AMBULANT CHILDREN WITH CEREBRAL PALSY: A RANDOMIZED CONTROLLED TRIAL
Reflections on this episode (Dr Pool)
Riding a bike is a skill that represents such a “right of passage”. So of course, developing an intervention that supports children with cerebral palsy to learn to ride a bike is of huge significance!
What is even more impressive in this study is the value of physiotherapy led programs in achieving goals. The results indicated that children in the physiotherapy led task specific training group had greater odds of goal attainment than those in the parent led home program at 1 week after intervention with evidence for superiority retained at 3 months. Building on this, retention is such a vital component to intervention efficacy. There is certainly more value when skill attainment can be seen beyond a therapeutic setting.
Participation is key!
The “F-words” are once again highlighted and I love that we can see the clinical guidelines in cerebral palsy in action through this intervention. Our knowledge of what works best or shall we say, has the best odds of working in children with cerebral palsy is ever growing. Our communication with families regarding best practices now has a streamlined message. So let’s embrace task specific and goal directed interventions that involve friends, family and fun!
Episode 32 (Jen Prior - article by L. Moll & C. Cott )
THE PARADOX OF NORMALISATION THROUGH REHABILITATION: GROWING UP AND GROWING OLDER WITH CEREBRAL PALSY
Reflections on this episode (Dr Pool)
This discussion forms the foundations of why we do what we do. At the end of the day, as clinicians and researchers, it is the consumer that we serve. I love the quote “nothing without us” because it is genuinely true. We need to be informed by consumers and this means we need to have a relationship that is based on trust and mutual respect.
For me as a clinician, trust and mutual respect mean that I am honest and provide the most relevant information for that child and family at the right time. So being evidence based is important and it is my responsibility to be kept up to date as much as I can so that I can be a source of information and that my “consumer” can trust that I am providing the very best care indicated by research that is matched with my clinical expertise and skill.
The F-words are seemingly so simple - almost sometimes I think, too simple!
What I mean by that is that it can be so easy to overlook the importance of each of the F-words. There is a great deal of science behind each element and if we can delve into each of the elements in an individualised way we are yet another step closer to providing best level care for our consumers.
I encourage everyone to listen to this and yes, Jen represents one parent with a child with cerebral palsy. There are so many stories out there but I do believe that the conversation, language and the implementation of the F words is something we can all draw from and mould into our practice.
Episode 31 (Dr Terence Sanger)
DEEP BRAIN STIMULATION FOR CEREBRAL PALSY: WHERE ARE WE NOW?
Reflections on this episode (Dr Pool)
As many of you might recall, we spoke with Dr Bhooma Aravamuthan not so long ago about dystonia in cerebral palsy. There was so much interest in this topic because dystonia in cerebral palsy is an impairment that has a profound influence on function and is such a challenge to treat. A lot of this has been due to both the definition of movement disorders and identification of movement patterns. Deep brain stimulation or DBS is often an intervention we hear alongside dystonia within the broader medical management context.
I love that in this podcast, Dr Sanger helps us to set the scene about some core fundamental definitions of tone. The use of terminology like positive and negative signs are really important and understanding the two different elements of dystonia is fantastic. As I continue to develop my knowledge, I understand more and more that definitions are important because it provides the framework for assessment and treatment and in a topic as complex as dystonia, definitions are crucial.
DBS requires a neurosurgical procedure and has been used for the best part of 40 years now with modern technology improving both the safety and efficacy of the procedure. I absolutely loved that Dr Sanger took the time to give us a condensed masterclass on neurology! Sometimes, it can be very easy just to refer to the brain at a higher level. But DBS is specific and this is where the definitions and understanding of neurology comes in.
So, our main questions that we covered were - what is DBS, what does it achieve, who is it best suited for and what is the future? Importantly, the answers to these questions all involve and highlight the importance of a multidisciplinary team!
Episode 30 (Dr Michelle Jackman)
INTERVENTIONS TO IMPROVE PHYSICAL FUNCTION FOR CHILDREN AND YOUNG PEOPLE WITH CEREBRAL PALSY: INTERNATIONAL CLINICAL PRACTICE GUIDELINE
Reflections on this episode (Dr Pool)
It is so exciting that we are now at a point where research in the area of physical functioning in children with cerebral palsy has led to clinical guidelines. The rigorous process of systematic reviews, expert and consumer consultation over a period of many years provides clinicians with best practice recommendations throughout the world.
This is a wonderful document that provides clinicians with the tools they need to communicate with the children and families that we work with, enabling clinicians and families to make informed decisions. This is such a vital component of evidence based practice and cannot be underestimated.
The 13 recommendations are beautifully set out and lead logically from one to the other. The good practice guidelines are the foundations to our practice and the evidence based recommendations provide some specific parameters on key areas of physical functioning at the activity and participation level.
Reflecting on these guidelines I realise that a lot of my practice has already aligned with the recommendations so many of these are not new to us. However, when they are all here in one document, we have the context and the ability to really understand not just the state of the evidence (knowledge), but also the implementation of the knowledge (the how!) and I know this is what many of us as clinicians thirst for.
For me, this document empowers me as a clinician to know that some of the simple things we do have so much science to support it. The simplicity of setting goals, practicing the task (whole task and goal directed practice at the Activity and Participation level), keeping the child and family as the decision makers and providing interventions with the right dosage is backed by decades of research in motor learning and neuroscience. These are important principles and there is value in being aligned with these approaches.
Be sure to visit cerebralpalsy.org.au for all the information relating to this paper. You'll find below some supporting PDF's to the guideline.
Episode 200!
The team at the ResearchWorks Podcast are celebrating 200 episodes! With over 4 seasons, invited collaborators with the EACD and AusACPDM conferences and Transformative Practice Award Winners for 2024, it has been a stellar journey. 🚀