College of Occupational Therapists Annual Conference Glasgow 2003 - PowerPoint PPT Presentation

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College of Occupational Therapists Annual Conference Glasgow 2003

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  1. College of Occupational Therapists Annual Conference Glasgow 2003

  2. Children with developmental co-ordination disorder (DCD): Is screening assessment effective? Elizabeth Stephenson, Clinical Specialist Occupational Therapist, Royal Aberdeen Children’s Hospital Rosemary Chesson Professor of Health Services Research The Robert Gordon University

  3. Structure of presentation • DCD - Terminology • Background • Aims of project • DCD clinic and assessment procedure • Method • Results • Implications and issues

  4. Terminology and definition • More than 20 terms exist • Definition is inconsistent • Heterogeneity of DCD group • Problems for research

  5. Developmental co-ordination disorder (DCD) • Performance in daily activities requiring motor co- • ordination substantially below that expected for age • and cognitive ability. • Motor difficulty affects academic learning and • activities of daily living. • Not due to a medical condition such as CP, nor • meeting the criteria for PDD • Where cognitive delay exists, motor difficulty must be • in excess of it

  6. The study • Investigation of assessment efficacy part of a wider • study • Study included survey of parent and referrer • satisfaction • Extension of study examines outcome for children • with DCD

  7. Collaborative working • collaboration both between departments and staff in • Royal Aberdeen Children’s Hospital & the Robert • Gordon University (RGU) • long term collaboration - grown over the years. • joint working with OT department and Health • Services Research Group, RGU.

  8. Features of collaborative working • Different perspectives • - health services researcher (non clinician) and • clinician • - child specific focus vs broad age spectrum • - different organisational contexts • Common objectives • - commitment to improve patient care • - help establish evidence-based practice • Outcomes • - publications • - future research

  9. Aspects of research • Research includes clinical and non-clinical elements: • Clinical • assessment • screening • One stop clinics • Non-clinical • parental views

  10. Research to date regarding children with DCD High volumeLow volume - Assessment (incl tools) - Screening - Cause - One stop clinics - Treatment - Outcomes

  11. Outcome Studies • Few longitudional studies. • Main emphasis on motor & academic outcome. • Some work on associated emotional/behavioural • problems. • Effects on family neglected • - none longitudinal • - very few studies • earliest and largest • (Chesson, McKay & Stephenson 1990) 31 children

  12. Aims of the project Evaluation of the accuracy and efficacy of the occupational therapy screening within a one stop clinic procedure for children with DCD

  13. Establishing the DCD clinic • Increasing demand on occupational therapy service • ‘One stop’ clinic implemented trial • Medical and occupational therapy screening on same • day • After 3 years (1995-1997) evaluation required

  14. Basic screening procedure • History • Clinical observance • Drawing and writing • Posture imitation

  15. Further assessment • Additional screening tests: motor performance • items; visual-motor skill and visual perception • Fuller assessment: Movement ABC; VMI; • MVPT/TVPS (sensory profile)

  16. Method • Two independent assessors recruited • Records of 36 children scrutinised (15% of three • year study group) • Data entered into SPSS-PC • Kappa values calculated to establish degrees of • concordance in 5 areas.

  17. Areas examined • Accuracy of Clinical Observations • Further tests following screening • Diagnosis - sub-typing • Intervention required • Resource need: clinical/educational

  18. Results • Overall high levels of concordance between clinician screening & two external assessors • Extent of concordance established using Kappa • poor <or = 0.21 • fair 0.21 - 0.40 • Moderate 0.41 - 0.60 • Sustantial 0.61 - 0.80 • Good >0.80

  19. Concordance Highest levels: Clinical observations (at least 0.80) Lowest levels: Intervention required (0.08)

  20. Concordance cont. • Clinical observations • Highest levels of concordance between: • Clinician & Assessor 1 • on neck • reflexes • Clinician & Assessor 2

  21. Additional Tests Tests indicated to supplement basic screening (selection from list) None considered ‘good’ & none ‘poor’ Highest agreement between C & Assessor 1 regarding visual motor test

  22. Types of dysfunction & diagnosis • Types of dysfunction • considerable range in degrees of concordance • Primary diagnosis • 20/36 cases of complete agreement on dx • 11 cases of 2 way agreement • 5 cases where there was no agreement

  23. Intervention Intervention C/A1 C/A2 Therapy 0.11 0.49 Therapy ideas 0.08 0.45 Referral to an. agency 0.05 0.60 reflected also in resource needed (educational or clinical)

  24. Implications • For clinical practice • For future research

  25. Issue raising • Clinical settings • Resources