Health and functioning in the everyday lives of young children with cancer: documenting with the International Classification of Functioning, Disability and Health--Children and Youth (ICF-CY)

Communication, academic and social outcomes of childhood cancer survivors with hearing loss: A systematic review

Many children treated for cancer are at risk of hearing loss. However, little is known about how hearing loss impacts their communication, academic and social outcomes. To examine the impact, this systematic review aimed to synthesise and appraise quantitative and qualitative studies reporting on (i) participants with hearing loss treated with platinum-based chemotherapy or cranial radiotherapy during childhood; and (ii) speech, language, academic performance, or social participation findings. Systematic database searches yielded 23 relevant articles that were analysed using narrative synthesis. Difficulties were reported for some but not all communication, academic and social aspects; however, a quality assessment using Grading of Recommendations Assessment, Development and Evaluation (GRADE) revealed low to very low certainty in the findings. Future research should aim to increase the quality of the research evidence and explore how multidisciplinary services can provide evidence-based support for childhood cancer survivors with competing hearing, communication, and social difficulties.

Assessment of Participation in Pediatric Neuropsychology

Abstract: Pediatric patients with chronic health conditions often suffer from social and academic exclusion. Since disease-centered assessments do not allow for differentiated biopsychosocial profiling, this study aims to evaluate the psychometric quality of “The School Participation Scales 24/7,” a novel ICF-CY-based assessment tool. Results show high fit indices for most subscales, signifying structural equality between the tool and the ICF-CY. Acceptable criterion validity is given for established neuropsychological tests. Internal consistency and retest analyses revealed that most subscales reliably and stably measure the intended domains. Finally, the tool was standardized using a representative healthy sample. In summary, the S-PS 24/7 represents a useful tool for measuring school participation in pediatric patients, thereby building a profound basis for effective interventions.

Funcionalidade de Crianças com Leucemia em Tratamento Quimioterápico

Introdução: A leucemia e o tipo de neoplasia mais comumente diagnosticada em crianças no mundo, afetando-as em um período crítico do desenvolvimento neuropsicomotor. Estando diagnosticadas com uma doença ameaçadora da vida, essas crianças necessitam, concomitantemente aos cuidados curativos, de cuidados paliativos. Objetivo: Avaliar a funcionalidade de crianças com leucemia durante o tratamento quimioterápico e compara-la no início e depois de um ano de tratamento em curso. Método: Estudo de corte transversal, do tipo observacional analítico, com 37 crianças avaliadas por meio de entrevista com os pais, utilizando um formulário de pesquisa e o Inventario de Avaliação Pediátrica de Incapacidade (PEDI). A análise estatística foi realizada pelos testes t de Student e de Mann-Whitney. Resultados: Não foram encontradas diferenças estatisticamente significantes entre a funcionalidade de crianças no início e depois de um ano de tratamento, estando todas com a funcionalidade abaixo do esperado para a faixa etária. Conclusão: Como forma de evitar possíveis atrasos e/ou déficits irreversíveis no desenvolvimento dessas crianças, sugere-se a criação de um programa de reabilitação em cuidados paliativos nos serviços especializados para cuidar desse público desde o diagnóstico.

Physical Activity Promotion Programmes in Childhood Cancer Patients and Their Impact on Fatigue and Pain: A Systematic Review

Cancer is one of the main causes of death in children, however, the techniques and interventions applied allow the cure of 80% of diagnosed cases. The aim of this review was to determine the benefits of a health and physical activity promotion programme to reduce pain and fatigue symptoms in children and adolescents with cancer. The databases PubMed, Embase, Scopus, Cochrane, Web of Science and PEDro were searched between December 2020 and January 2021 to elaborate this review, using the keywords child, cancer, exercise, fatigue and pain. The review was preregistered in PROSPERO (ID CRD42021262183). Six studies, out of 937 identified at baseline, were finally included in the review: four randomised controlled trials and two quasi-experimental studies. The total sample size of all the included studies was of 474 participants with very different types of cancer and evolution, and outcome variables were pain, fatigue, physical activity level, self-efficacy and quality of life. A health and physical activity promotion programme seems to improve fatigue in paediatric cancer patients and survivors, but no significant results were found related to pain.

Using ICF to Describe Problems With Functioning in Everyday Life for Children Who Completed Treatment for Brain Tumor: An Analysis Based on Professionals' Documentation

Background: Children treated for brain tumors often experience persistent problems affecting their activity performance and participation in everyday life, especially in school. Linking these problems to the International Classification of Functioning, Disability and Health (ICF) classification system can be described as affecting body function, activity performance, and/or participation. Services involved in the everyday life of the child have different focus and goals when meeting the child in context, which advantage the use of ICF to overcome this impediment to follow-up and provide comprehensive support for children who have completed treatment for a brain tumor.

Aim: The aim of the study was to use the ICF classification system to describe how professionals in healthcare, habilitation, and school document problems with everyday life functioning at body, activity, and participation levels for children who completed treatment for a brain tumor.

Materials and Methods: A retrospective review of records from healthcare, habilitation, and school concerning nine children completed treatment for brain tumor was implemented. Identified problems in everyday life were linked to ICF codes. Descriptive statistics of ICF-linked code frequency supplemented by network visualization diagrams viewing the co-occurrence between codes within the body, activity participation, and environmental components were performed.

Results: Most documented problems were found in healthcare records, whereas the documentation in habilitation and school was sparse. The frequently occurring codes, independent of record source, were linked to the body function component, and ICF-linked problems in habilitation and school were salient in the activity and participation component. To gain a holistic picture of relations between ICF codes and problems, network visualization diagrams were used to illustrate clusters of problems.

Conclusion: Code prevalence likely reflects where healthcare professionals and educators focus their attention when meeting the needs of children treated for a brain tumor in context. To maximize the comprehensive view of functioning and participation of children in everyday life, the full range of difficulties regarding body impairments, activity limitations, and participation restrictions must be identified and linked to each other in patterns of co-occurrence, which the ICF facilitate. However, ICF provides no guidance on how to identify networks of problems within the body, activity, and participation. Identifying such networks is important for building comprehensive interventions for children.

The Indonesian sociocultural contexts related to daily occupations of children with cancer during hospitalisation: The parents’ perspective

Background

The sociocultural phenomenon affecting daily occupations of hospitalised children with cancer in a diverse country like Indonesia is thought-provoking and requires exploration.

Objective

This study aims to explore the sociocultural contexts related to daily occupations of children with cancer during hospital admittance from the parents' perspective.

Methods

Semi-structured interviews were conducted with parents of children with cancer who had been hospitalised for two weeks or more. The data were collected at the paediatric ward of “Dharmais” National Cancer Center Hospital, Jakarta. The study uses interpretative phenomenological analysis (IPA).

Results

Nine parents of children with cancer consented to the study. Three interconnected themes emerged as necessary to the sociocultural context among participants. These involve ‘The surrounding human environment as primary encouragement’, ‘Culture and spirituality as the basic standard’ and ‘Activity adjustments as new habits’.

Conclusions

The themes revealed that the daily occupations of hospitalised children with cancer are strongly encouraged by family and social systems in Indonesia, spiritual aspects of the parents and the occupational changes due to the new settings.

An evaluation of participation restrictions and associated factors via the ICF-CY framework in children with acute lymphoblastic leukemia receiving maintenance chemotherapy

Our aim was to determine impairments in physical functions, activity limitations, and participation restrictions with the International Classification of Functioning, Disability and Health version for Children and Youth (ICF-CY) framework in children with acute lymphoblastic leukemia (ALL) receiving treatment. Physical functions were assessed in terms of pain level, fatigue level, handgrip strength, and motor proficiency. Fine motor activities and lower extremity performance were assessed to determine activity limitations. Participation was assessed with a patient-reported questionnaire. Thirty children with ALL (mean age: 8.45 ± 3.33 years) were included. Pain and fatigue level were mild. Poor handgrip strength was found; their mean handgrip strength was 60% of the normative. Fifty-six percent of the children had below-average motor performance. Participation scores were considerably high, except for sport and physical functioning sub-score. Participation level was positively associated with bilateral coordination and duration after diagnosis, while negatively correlated with pain and fatigue level (p ˂ 0.05).Conclusion: The ICF-CY-based evaluation was useful to understand children's limitations in everyday life. Children with ALL need supportive interventions during treatments in terms of physical functioning and participation in activities. Children with ALL with higher pain and fatigue, poor bilateral coordination, and who were in earlier period after diagnosis had higher risk for participation restriction. What is Known: • Children with ALL had physical functioning limitations on treatments. • Participation restrictions were described in children with ALL off treatment. What is New: • The ICY-CY-based health and functioning evaluation allows health care professionals to globally determine limitations of everyday life in children with ALL on treatment. • Impairments in physical functions, pain severity, fatigue severity, and duration after diagnosis are associated with participation to everyday life in children with ALL on treatment.

The development of the clinical assessment tool "Health and Everyday Functioning in Young Children with Cancer"

BACKGROUND

Young children's experiences of everyday life with cancer are vital in guiding care. The universal and interdisciplinary language of the International Classification of Functioning (ICF) and the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) has wide reaching effects for the care of young children in need. The aim of this study was to select and validate the content of a clinical assessment tool (CAT) for health and everyday functioning in young children with cancer.

METHODS

A comprehensive set of ICF-CY codes (n = 70) mapping everyday function and health was previously identified from the transcripts of 12 interviews with young children with cancer and their parents at a paediatric oncology centre in the west of Sweden. Three transcripts were from data collected shortly after diagnosis, three transcripts from 6 months after diagnosis, three transcripts from 12 months after diagnosis, and three transcripts from 18 months after diagnosis. The present study involved the development of items based on the ICF-CY codes.

RESULTS

The CAT consists of 52 items grouped in four dimensions: "the child herself/himself," "the child's everyday life," "the child's need for support," and "the child's contacts with health care."

CONCLUSION

The questions correlate well with known research results and highlight areas that are important for health and everyday life for young children with cancer. This tool, based on children's experiences, can be used by both parents and health care personnel such as nurses to highlight aspects of health and function in everyday life for the young child with cancer that otherwise might be missed. This novel approach using the ICF-CY could be used to guide the delivery of care towards living an everyday life with a long-term illness.

Physical Rehabilitation Practices for Children and Adolescents with Cancer in Canada

Purpose: Children and adolescents with cancer who undergo cancer treatment are at high risk of developing adverse effects, many of which may be amenable to physical rehabilitation. We aimed to identify the current clinical physical rehabilitation practice patterns, services, and programmes available for children and adolescents with cancer in Canada. Method: A cross-sectional survey in English and French was conducted. Participants were health care professionals (HCPs) who provided physical rehabilitation services to children and adolescents with cancer in Canada. The survey included questions on the HCPs' practice patterns and the programmes and services they provided. Results: A total of 35 HCPs responded: 27 physical therapists (77%), 6 occupational therapists (17%), 1 exercise professional (3%), and 1 speech-language pathologist (3%). Overall, they reported activity limitations, alterations in motor performance, muscle weakness, peripheral neuropathy, and fatigue as the top priorities for rehabilitation services. HCPs believed that interventions were valuable in reducing the burden of cancer effects; however, issues such as space, resources, and lack of clinical practice guidelines were viewed as barriers to providing services. Conclusions: Paediatric oncology rehabilitation services exist in some regions in Canada. HCPs strongly support the need to develop clinical practice guidelines for paediatric oncology rehabilitation.

Applying the ICF-CY to Specialist Speech-Language Pathologists’ Practice With Toddlers With Cleft Palate Speech

Objective:

To evaluate how the practice of specialist speech-language pathologists (SLPs) working with young children with cleft palate ± cleft lip (CP±L) maps onto the International Classification of Functioning, Disability, and Health – Children and Youth version (ICF-CY) and consider the functionality of the categories of the ICF-CY for this specialist area of practice.

Design:

Cross-sectional, qualitative study.

Setting:

Semistructured face-to-face interviews were conducted with SLPs working in tertiary-level hospitals, universities, and public clinics.

Participants:

Six specialist SLPs with 17 to 39 years of experience working with young children with CP±L as researchers and clinicians in Australia, Brazil, Denmark, Ireland, New Zealand, and the United States.

Main Outcome Measure(s):

Specialists’ practices were captured using in-depth, semistructured interviews. Data collected were analyzed by directed content analysis applying the ICF-CY as a coding schema.

Results:

In total, 4077 data points were coded. Most mapped onto Body Structures (684, 16.8%), Body Functions (906, 22.2%), and Environmental Factors (1626, 39.9%) with less emphasis on Activities and Participation (560, 13.7%). A “best fit” approach was taken to topics that did not map exactly onto categories of the ICF-CY (eg, velopharyngeal insufficiency [VPI]); however, there was not always an ideally suitable category available.

Conclusions:

The current study revealed strengths and challenges in categorizing practice within the ICF-CY for children with CP±L, including collaboration with parents and significant others, specificity around speech, language, and articulation, and the different types of VPI. Therefore, future discussion around how best to use the framework with children with CP±L is needed.

Applicability of the ICF-CY in evaluating children with disabilities and family support: an integrative literature review

ABSTRACT Purpose: to verify and update information on the applicability of functional assessment through the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY) in children with disabilities. Methods: a search was carried out on the databases of the Virtual Health Library Research Portal, EBSCOhost and Google Scholar, using a combination of the key words "children with disabilities", "ICF" and "mobility". Results: altogether, 2,773 studies were identified; however, after the filters were applied, only 27 were selected. After an explored analysis of the themes of the articles, this diagnosis revealed four analytical categories: environment (4 articles), quality of movement (3 articles), family (4 articles), and professionals (16 articles). Conclusion: in face of the sufferings experienced by families with disabled people, different possible approaches to this phenomenon were pointed out. Therefore, a greater effort of investigation and intervention in these fields are necessary, further exploring this tool.

Tools for the assessment of neuropsychomotor profile in the rehabilitation of children with central nervous system tumor: a systematic review

Objective:

This study reviews the scientific literature to identify and describe which assessment tools (ATs) are used in pediatric oncology and neuro-oncology rehabilitation and which development neuropsychomotor (DNPM) ATs were built for children with central nervous system (CNS) tumors.

Methods:

A systematic review was performed searching PubMed, CINAHL, PEDro, Science Direct, and Catalog of National Institute of Tumors databases and specialized journals. The search covered 7 years (2010–2017) and used relevant keywords in different combinations. A further search was carried out on DNPM rehabilitation manuals and academic thesis.

Results:

The review retrieved 35 eligible articles containing 63 ATs. The most common ATs were the Behavioral Rating Inventory of Executive Function (BRIEF) and the Wechsler Intelligence Scale for Children (WISC). Most of the ATs covered a single area of child development among behavioral/psychological, cognitive, and motor areas. A total of 159 ATs were found in manuals and thesis, and only 17 of them were already identified in the journal search. None of the ATs identified in both searches had been specifically developed for children with CNS tumor.

Conclusion:

The results highlight the need to develop and validate a global multidimensional AT for children with CNS tumor, overcoming the fragmentation of the assessment procedures and promoting standardized rehabilitation protocols.

The use of the international classification of functioning, disability and health in an interactive perspective: the assessment and intervention of students' additional support needs in Portugal

Purpose: Evaluating the influence of person-environment interactions on students' performance is a fundamental requirement for planning individualized educational interventions. Such understanding grounded the use of the International Classification of Functioning, Disability and Health as a reference framework to support special needs assessment in the Portuguese educational system. This study sought to investigate the extent to which special education teams reported relationships between Body Functions, Activities and Participation, and Environmental Factors in Individualized Education Programmes for students with additional support needs and what types of relations were mostly described.Materials and methods: Using content analysis, 176 Individualized Education Programmes were examined. A coding scheme based on the International Classification of Functioning, Disability and Health was developed to categorize and quantify code-relations.Results and conclusions: Code-relations consisted in 6.1% out of the total of meaning units found in textual segments concerning assessment and intervention processes. Code-relations were chiefly focused on mental functions, learning and applying knowledge, and products and technology. Intervention plans were predominantly presented as separate lists of goals and strategies, focusing Activities and Participation (67.8%), Body Functions (16.1%) and Environmental Factors (16.2%). Within the reduced amount of contents in which there was a match between goals and strategies, only 8.2% were directly connected with assessment data. Recommendations are made for the implementation of an interactive approach when using the International Classification of Functioning, Disability and Health in educational contexts.Implications for rehabilitationThe adoption of the International Classification of Functioning, Disability and Health in the educational context goes beyond the use of a universal language including, as well, the potential to foster a multidimensional and comprehensive approach to students' needs.Professionals' approach in special needs assessment is often partial and segmented, suggesting a narrow understanding of the relationships between body functions, activities and participation, and environmental factors.Our findings support the need for an expanded focus on person-environment interactions, considering students' participation in different domains of life - besides learning - as well as the impact of environmental barriers over students' participation;Training programmes centred on a biopsychosocial understanding of human functioning, the establishment of a transdisciplinary collaborative culture and the use of dynamic assessment tools may equip professionals with appropriate conditions to use the International Classification of Functioning, Disability and Health within an interactive perspective.

Parents' Assessments of Disability in Their Children Using World Health Organization International Classification of Functioning, Disability and Health, Child and Youth Version Joined Body Functions and Activity Codes Related to Everyday Life

AIM

To help parents assess disability in their own children using World Health Organization (WHO) International Classification of Functioning, Disability and Health, Child and Youth Version (ICF-CY) code qualifier scoring and to assess the validity and reliability of the data sets obtained.

METHOD

Parents of 162 children with spina bifida, spinal muscular atrophy, muscular disorders, cerebral palsy, visual impairment, hearing impairment, mental disability, or disability following brain tumours performed scoring for 26 body functions qualifiers (b codes) and activities and participation qualifiers (d codes). Scoring was repeated after 6 months. Psychometric and Rasch data analysis was undertaken.

RESULTS

The initial and repeated data had Cronbach α of 0.96 and 0.97, respectively. Inter-code correlation was 0.54 (range: 0.23-0.91) and 0.76 (range: 0.20-0.92). The corrected code-total correlations were 0.72 (range: 0.49-0.83) and 0.75 (range: 0.50-0.87). When repeated, the ICF-CY code qualifier scoring showed a correlation R of 0.90. Rasch analysis of the selected ICF-CY code data demonstrated a mean measure of 0.00 and 0.00, respectively. Code qualifier infit mean square (MNSQ) had a mean of 1.01 and 1.00. The mean corresponding outfit MNSQ was 1.05 and 1.01. The ICF-CY code τ thresholds and category measures were continuous when assessed and reassessed by parents. Participating children had a mean of 56 codes scores (range: 26-130) before and a mean of 55.9 scores (range: 25-125) after repeat. Corresponding measures were −1.10 (range: −5.31 to 5.25) and −1.11 (range: −5.42 to 5.36), respectively. Based on measures obtained at the 2 occasions, the correlation coefficient R was 0.84. The child code map showed coherence of ICF-CY codes at each level. There was continuity in covering the range across disabilities. And, first and foremost, the distribution of codes reflexed a true continuity in disability with codes for motor functions activated first, then codes for cognitive functions, and, finally, codes for more complex functions.

CONCLUSIONS

Parents can assess their own children in a valid and reliable way, and if the WHO ICF-CY second-level code data set is functioning in a clinically sound way, it can be employed as a tool for identifying the severity of disabilities and for monitoring changes in those disabilities over time. The ICF-CY codes selected in this study might be one cornerstone in forming a national or even international generic set of ICF-CY codes for the benefit of children with disabilities, their parents, and caregivers and for the whole community supporting with children with disabilities on a daily and perpetual basis.

Applying the International Classification of Functioning-Children and Youth Version to Pediatric Neuro-oncology

Given the increased survival rates in patients with pediatric central nervous system tumors, late effects such as treatment- and/or illness-related neurologic sequelae as well as neuropsychological deficits and social difficulties have moved into focus in follow-up care. In order to provide personalized treatment recommendations for pediatric brain tumor survivors, it is crucial not only to assess cognitive impairments but also to measure a patient's functional deficiencies, for example, restricted participation in everyday social activities. Thus, this article introduces the International Classification of Functioning-Children and Youth version (ICF-CY) as a conceptual framework for quantifying functional limitations and informing long-term care in pediatric neuro-oncology. A standardized self-report and proxy-report questionnaire for measuring participation is briefly discussed and specific recommendations based on so-called core sets for clinical practice in pediatric neuro-oncology are provided.

Following Young Children’s Health and Functioning in Everyday Life Through Their Cancer Trajectory

Background: Knowledge of living with childhood cancer, through the trajectory, is sparse. Aim: The aim of this study was to follow young children’s health and functioning in everyday life through their cancer trajectory. Methods: Data were gathered longitudinally from a group of 13 young children and their parents connected to a pediatric oncology unit in Sweden. The International Classification of Functioning, Disability and Health for Children and Youth structure was used to identify difficulties in health and functioning in everyday life, in interview and questionnaire data. Descriptive statistical analysis was performed to show patterns of difficulty over a 3-year period from diagnosis. Results: Difficulties experienced by children declined and changed over time. An increase in difficulties with personal interactions with others and access to and support from health care professionals was seen 2 to 3 years after diagnosis and start of treatment. Similar patterns are seen within individual children’s trajectories in relation to diagnosis but individual patterns were seen for each child. Conclusions and Clinical Implications: Health care professionals need to plan for ongoing contact with school services and information and support pathways, beyond the treatment period. A person-centered philosophy of care is required throughout the cancer trajectory.

Assessing Children With Disabilities Using WHO International Classification of Functioning, Disability and Health Child and Youth Version Activities and Participation D Codes

AIM

Evaluation of the International Classification of Functioning, Disability and Health child and youth version (ICF-CY) activities and participation d code functions in clinical practice with children across diagnoses, disabilities, ages, and genders.

METHODS

A set of 57 codes were selected and worded to describe children's support needs in everyday life. Parents of children aged 1 to 15 years participated in interviews to discuss and rate their child's disability.

RESULTS

Of 367 invited parents, 332 (90.5%) participated. The mean age of their children with disability was 9.4 years. The mean code scores were 50.67, the corrected code-total correlations were .76, intercode correlations had the mean of 0.61, and Cronbach's α was .98. As a result of Rasch analysis, graphical data for disability measures paralleled clinical expectations across the total population of 332 children.

CONCLUSION

The World Health Organization International Classification of Functioning, Disability and Health child and youth version d code data can provide a coherent measure of severity of disability in children across various diagnoses, ages, and genders.