Objectives: Participation is considerably restricted in children and adolescents with acquired brain injury (ABI) as compared to their healthy peers. This systematic review aims to identify which factors are associated with participation in children and adolescents with ABI. Methods: A systematic search in Medline and various other electronic databases from January 2001–November 2014 was performed. All clinical studies describing determinants of participation at least 1 year after the diagnosis of ABI by means of one or more pre-defined instruments in patients up to 18 years of age were included. Extracted data included study characteristics, patient characteristics, participation outcome and determinants of participation (categorized into: health conditions (including characteristics of ABI), body functions and structures, activities, personal factors and environmental factors). The methodological quality of the studies was evaluated based on three quality aspects (selection, information and statistical analysis bias) and scored as low, moderate or high. Results: Eight studies using an explicit participation outcome measure were selected after review, including a total of 1863 patients, with a follow-up ranging from 1 up to 288 months. Three studies included patients with a traumatic or a non-traumatic brain injury (TBI or NTBI) and five studies with only TBI patients. Factors consistently found to be associated with more participation restrictions were: greater severity of ABI, impaired motor, cognitive, behavioural and/or sensory functioning, limited accessibility of the physical environmentand worse family functioning. Fewer participation problems were associated with a supportive/nurturing parenting style, higher household income, acceptance and support in the community and availability of special programmes. The overall methodological quality of the included studies was high in two and moderate in six studies. Conclusion: This systematic review shows that only a few, moderate quality, studies on the determinants of participation after paediatric ABI using recommended explicit measurement instruments are available. Various components of the ICF model: health condition, body functions and structures and environmental factors were consistently found to be associated with participation. More methodologically sound studies, using the recommended explicit outcome measures, a standardized set of potential determinants and longterm follow-up are suggested to increase the knowledge on participation in children and youth with ABI.
Meer dan de helft van de mensen die vanaf 2010 worden geboren in de rijke landen wordt ouder dan 100 jaar, zo voorspelde de Amerikaanse demograaf James Vaupel in oktober 2009 in het gezaghebbende medische tijdschrift Lancet. Recente schattingen door het Nederlands Interdisciplinair Demografisch Instituut (NIDI) bevestigen dit toekomstbeeld: Van alle meisjes die nu geboren worden, bereikt mogelijk de helft de leeftijd van honderd jaar. Van de jongetjes kan worden verwacht dat een derde een eeuw zal leven. In Nederland wordt naar de spectaculaire ontwikkelingen op het gebied van de langlevendheid onderzoek gedaan aan de Leyden Academy on Vitality and Ageing. We worden steeds ouder. Zo is de levensverwachting van mannen en vrouwen in Nederland op dit moment respectievelijk 79 en 83 jaar (bron: CBS, 2012). Is dat goed nieuws of slecht nieuws? Want vooral in de hoge ouderdom neemt de kans op ziekten toe. En een aantal van deze ziekten, waaronder dementie, leidt tot ernstige aftakeling.
Background: Innovative technologies such as game consoles and smart toys used with games or playful approaches have proven to be successful and attractive in providing effective and motivating hand therapy for children with cerebral palsy (CP). Thus, there is an increased interest in designing and implementing interventions that can improve the well-being of these children. However, to understand how and why these interventions are motivating children, we need a better understanding of the playful elements of technology-supported hand therapy.Objective: This scoping review aims to identify the playful elements and the innovative technologies currently used in hand therapy for children with CP.Methods: We included studies that design or evaluate interventions for children with CP that use innovative technologies with game or play strategies. Data were extracted and analyzed based on the type of technology, description of the system, and playful elements according to the Lenses of Play, a play design toolkit. A total of 31 studies were included in the analysis.Results: Overall, 54 papers were included in the analysis. The results showed high use of consumer technologies in hand therapy for children with CP. Although several studies have used a combination of consumer technologies with therapeutic-specific technologies, only a few studies focused on the exclusive use of therapeutic-specific technologies. To analyze the playfulness of these interventions that make use of innovative technologies, we focused our review on 3 lenses of play: Open-ended Play, where it was found that the characteristics of ludus, such as a structured form of play and defined goals and rules, were the most common, whereas strategies that relate to paidia were less common. The most commonly used Forms of Play were physical or active form and games with rules. Finally, the most popular Playful experiences were control, challenge, and competition.Conclusions: The inventory and analysis of innovative technology and playful elements provided in this study can be a starting point for new developments of fun and engaging tools to assist hand therapy for children with CP.
