Cerebral Palsy in Saudi Pediatric Physiotherapy - Essay Example

A Survey of Saudi Pediatric Physiotherapists: Clinical Reasoning, ICF Knowledge, and Competence for Children with Cerebral Palsy Cerebral Palsy in Saudi Pediatric Physiotherapy Cerebral Palsy (CP) is a familiar chronic neurological health condition in Saudi Arabia Kingdom. CP condition is neurological in nature, and the consequences associated with it extend beyond physical impairment. Al-Saloum (2011) reported that the prevalence of CP is 23 deaths in every 10,000 child birth, which is similar to the range found in developed countries. This finding implies that there is a necessity to carry out research and an education programme alongside healthcare planning. In addition, psychological, social and emotional well-being of children plays a significant role in Cerebral Palsy (Imms et al 2010). This indicates that paediatric physiotherapist practice presents unique challenges to the clinical reasoning processes. Similarly, Darrah 2008 argues that it is crucial for pediatric physiotherapist to put into consideration the possible impact of numerous factors that contribute to the increase of CP in children such as family, age, the level of development and the environmental living conditions. Through these factors, it becomes easier to understand and work on patient or client management model. Clinical reasoning in Pediatric physiotherapy Clinical reasoning is a multidimensional phenomenon that refers to the capacity of Pediatric physiotherapist to think and understand children and their health challenges logically as the basis for taking action and making decisions (Edwards et al 2006; Higgs et al 2006). As such, this phenomenon was revealed by therapist to contribute in clinical knowledge, competence strategies and pattern recognition. Research into clinical reasoning in pediatric physiotherapy has focused more on areas related to Hypothesis - Oriented Algorithm for Clinicians (HOP-FA). HOP-FA was designed to assist clinicians in addressing the physiotherapy needs of their patients and clients in any clinical settings. However, it is worth noting that HOP-FA is independent of any particular theoretical approach (Kenyon 2012). Therefore, Nijhuis et al 2008 ; Andrade et al 2011 asserted that objectives set by rehabilitation professionals did not merge properly with the main challenges and needs that were present with children suffering from CP. ICF and Clinical reasoning The International Classification of Functioning, Disability and Health (ICF) intends to play important roles in systematic documentation according to the assessment and definition of the therapeutic goals, as well as, influencing therapist in clinical decision making and standardizing terminology so that pediatric physiotherapists can communicate among themselves using a neutral and well defined language (Andrade et al 2011). Apparently, 54 pediatric occupational therapists and physical therapists were interviewed to ascertain whether they were familiar with ICF and its usefulness in clinical practice. After the interview, results confirmed that 28 interviewee (52%) were not familiar with ICF while 30 interviewee (56%) are not sure if ICF would be used in clinical practice. Perceived barriers to using the ICF in pediatric physiotherapy The literature describes various difficulties and challenges of using the ICF in pediatric physiotherapy. It is worth noting that the main challenges associated with using ICF in pediatric physiotherapy revolves around distinguishing between goals and interventions that are characterized by activity and participation components. For instance, some therapists have described an ‘activity goal’ as one that assists in improving the mobility of children thus enabling them to be at par with their peers. Conversely, a section of therapists have argued that this is an instance of functional mobility that is best described through participation in activities that enhance peer relationships in school. However, in most cases, numerous practicing therapists concentrate more on code system during learning sessions as they tend to believe that the codes are crucial in their practice (Darrah 2008). Perceived Facilitators to using the ICF in pediatric physiotherapy The WHO-ICF researcher developed a simple practical way to move the knowledge of ICF from theory into practice by designing a chart where the ICF components were represented by each treatment goal and intervention strategy listed. Therapists only put parenthesis beside their written goals and interventions where the ICF component of each goal and intervention strategy is represented (Darrah 2008). Pediatric physiotherapists need to be comfortable with the ICF conceptual framework, terminology and definitions to incorporating the framework into their clinical practice. Therapists should not use the coding structure but rather use the ICF framework as a conceptual model to document and guide their clinical decision making. In addition, therapists do not need to always distinguish between the components of activities and participation when identifying the component of goals, interventions and expected outcomes; there is the option of grouping these two components together. With such deliberation, pediatric physiotherapists are expected to begin utilizing the ICF language during in-service presentations such as research literature review or discussions pertaining to goals and intervention options. In fact, this exercise is equivalent to mastering of second languages in terms of practice and usage (Darrah 2008) Diffusion of innovation theory According to Rogers 2003, diffusion innovation theory denotes an innovation- decision process where untapped knowledge is integrated in an organization with the aim of coming up with a solution between context and new ideas. Additionally, the quality of any innovation is best described through stimulation or inhibition. Ibragimova et al 2009, argues that new routine in organizations must be embraced to avoid bringing up challenges. As such, Rogers, 2003 further argues that decision pertaining to innovation must be given adequate time where professionals adopt to new ideas through the actions and choices they make. The processes that lead to innovation include; understanding new ideas, coming up with their attitudes, and accepting to use the innovation in their organizations. Similarly, individuals affiliated to these new ideas have their motivation varying in relation to change of routines. At some point, professionals decide to accept new ideas once they realize the importance of change especially in solving work related challenges. Adolfsson et al 2010, articulates that it is necessary to undertake research based on how implementation of ICF- CY is perceived by professionals especially on bases of in-services for children and youth, the change of perceptions over time and the rationale within which ICF-CY is continually used in work places. It is for this undoubted reason that clinicians must put into practice the academic knowledge of ICF-CY to make the practice a working experience in the health sector. Darrah 2008 in support of the idea argues that the health practitioners and stake holders ought to comprehend and put into practice the use of the framework. Jelsma 2009 identified a literature review pertaining to limited use of ICF in developing countries. It is apparent that Saudi Arabia lacks ICF knowledge on the subject. This evidence strengthens the argument for the need of greater efforts by researchers and health professionals from Saudi Arabia intending to expand the knowledge of ICF and clinical reasoning model used in rehabilitation services. There has been little that evaluates the impact of ICF knowledge on the pediatric physiotherapists’ clinical reasoning in developing countries. In 2010, Jelsma and Scott evaluated the impact of ICF frameworks as used in pediatric physiotherapy assessment. A retrospective audit for the practices was carried out by third year students from South Africa in 2008 and 2009 from special schools for disabled children. The data collection method adopted was the use of a scorecard, which facilitated assessment by a nonparticipant external person. A notable difference in scores was evident with the 2009 students scoring higher than their control group of 2008 who had not been taught through the ICF frameworks. Therefore, the study showed that the use of ICF frameworks in teaching on pediatric patients enhances reasoning as a necessity for effectiveness in physiotherapy service delivery. In Brazil, Andrade et al 2011 assessed knowledge of the ICF for professionals from the fields of physiotherapy, social work dentistry, nutrition, psychology, speech therapy, occupational therapy and medicine. A questionnaire was used to identify the knowledge of professionals from a rehabilitation service about the terminology and structure of the ICF and to categorize applicable ICF code set for CP from multidisciplinary teamwork perception. In the survey, participants were expected to answer 15 objective questions pertaining to ICF knowledge. In essence, the questions entailed terminologies such as impairment, limitations and restrictions, concepts such as performance and capacity, history in terms of the dates approved by WHO, models which included both multidimensional and biopsychosocial, and the general constituents of ICF involving components, chapters and level numbers. The study indicates that medical practitioners concerned with rehabilitation service has inadequate knowledge on ICF, both through self-reported and test designed knowledge examination. According to Organizacoa et al 2003, this research mostly attached the period of time in which individuals used for the completion of their undergraduate education, as well as, publication of ICF in Portugal. Never the less, most of the Portuguese who had completed their undergraduate program after the publication were not conversant to ICF knowledge as it had not reached the teaching staff. STUDY AIMS AND OBJECTIVES The rehabilitation services provided by the ICF knowledge can be an effective way of assisting pediatric physiotherapist in Saudi Arabia to develop new horizons for effective physiotherapy healthcare based on child needs and child/ family expectation. Currently, we have no information about the Saudi pediatric physiotherapist clinical reasoning and their ICF knowledge. Therefore, we intend to have a national survey of Saudi to describe their clinical reasoning recently used when treating children with cerebral palsy. This will provide information about the scope of practice in Saudi Arabia to establishing in-service training in the ICF. The specific aims of this survey are; I. To describe the current pediatric physiotherapist clinical reasoning and management for children with cerebral palsy. II. To identify the knowledge of the Saudi pediatric physiotherapists about the terminology and structure of the ICF. Read More