Disablement and eye contact

Standing frames for children with cerebral palsy: a mixed-methods feasibility study

BACKGROUND

Standing frames are recommended as part of postural management for young people with cerebral palsy (CP) Gross Motor Function Classification System (GMFCS) level IV or V. They may have a variety of benefits, including improving bone mineral density, gastrointestinal function and social participation. The NHS needs to know if these benefits are real, given the cost implications of use and the reported negative effects (e.g. pain). The lack of evidence for the clinical effectiveness of standing frames demonstrates the need for evaluative research.

OBJECTIVE(S)

The aim of the study was to explore the acceptability of a future trial to determine the clinical effectiveness of standing frames.

DESIGN

A sequential mixed-methods design was used. The findings of each stage informed the next stage. We conducted surveys, focus groups and in-depth interviews.

PARTICIPANTS

Professionals who work with young people who use standing frames and parents who have a child who uses a standing frame took part in a survey of current standing frame practice (n = 551), a series of focus groups (seven focus groups, 49 participants in total) and a survey of research trial acceptability and feasibility (n = 585). Twelve young people who use a standing frame were interviewed.

RESULTS

Standing frames were widely used as part of postural management for young people with CP both in school and at home but more frequently in school, and particularly by young people in primary school. Achieving the prescribed use was not always possible owing to resources, environment and family factors. Participation and activity engagement were important to young people. The majority of participants believed that standing frames research is necessary. Some reported concern that stopping standing frame use for a trial would cause irreversible damage. The maximum amount of time most health professionals and parents would agree to suspend standing frame use would be 12 weeks.

LIMITATIONS

Owing to the nature of recruitment, we could not calculate response rates or determine non-response bias. Therefore, participants may not be representative of all standing frame users.

CONCLUSIONS

Although parents and professionals who engaged in the qualitative aspect of this research and stakeholders who took part in the design workshops appreciated the lack of clinical evidence, our surveys, qualitative information and PPI demonstrated that most people had strong beliefs regarding the clinical effectiveness of standing frames. However, with key stakeholder engagement and careful planning, a trial would be acceptable.

FUTURE WORK

We recommend a carefully planned trial that includes a pilot phase. The trial should evaluate the following question: 'does using a standing frame in school improve patient-reported outcomes of participation (primary outcome), quality of life, subjective well-being, body function and body structure (secondary outcomes) in young children (aged 4-11 years) with CP GMFCS III-V?'.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy

BACKGROUND

Standing frames are used for children with cerebral palsy (CP). They may improve body structure and function (e.g., reducing risk of hip subluxation, and improving bladder and bowel function), improving activity (e.g., motor abilities) and participation (e.g., interaction with peers), but there is little evidence that they do. We aimed to identify current UK standing frame practice for children with CP and to understand stakeholder views regarding their clinical benefits and challenges to use.

METHOD

Three populations were sampled: clinicians prescribing standing frames for children with CP (n = 305), professionals (health and education) working with children with CP who use standing frames (n = 155), and parents of children with CP who have used standing frames (n = 91). Questionnaires were developed by the co-applicant group and piloted with other professionals and parents of children with CP. They were distributed online via clinical and parent networks across the UK.

RESULTS

Prescribing practice was consistent, but achieving the prescribed use was not always possible. Respondents in all groups reported the perceived benefits of frames, which include many domains of the International Classification of Functioning Disability and Health for Children and Youth. Challenges of use are related to physical space and child-reported pain.

CONCLUSIONS

These survey findings provide information from key stakeholders regarding current UK standing frame practice.

The effects of service dogs on social acknowledgments of people in wheelchairs

Able-bodied people often exhibit behaviors that show them to be socially uncomfortable upon encountering a physically disabled stranger. These behaviors include less eye contact, gaze avoidance, greater personal distance, and briefer social interactions. This study examined whether persons in wheelchairs with service dogs receive more frequent social acknowledgement from able-bodied strangers than people in wheelchairs without dogs receive. Behaviors of passersby were recorded by an observer who followed a person in a wheelchair at a distance of 15 to 30 feet. Observations were made in public areas amid pedestrian traffic, areas such as shopping malls and a college campus. The behaviors of passersby to the person in a wheelchair, with or without a service dog, were recorded, including smiles, conversation, touch, gaze aversion, path avoidance, or no response. Results indicated that both smiles and conversations from passersby increased significantly when the dogs were present. These findings suggest that the benefits of service dogs for their owners extend beyond working tasks to include enhanced opportunities for social exchange. The service dogs substantially reduced the tendency of able-bodied people to ignore or avoid the disabled person.