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.
Dit artikel beschrijft de recente ontwikkeling met betrekking tot de Wet Werk en Bijstand (WWB) en sociale activering in Nederland, en dit in vergelijking met de ontwikkelingen in Vlaanderen.
This text is structured as follows. Section 1 concerns the background to this public lecture: the fact that social participation is becoming increasingly important in our society. This is evident, for example, from the way we are evolving from a protective welfare state into an activational, participative society. This development has consequences for the social sector and therefore also for the professionals who work in it. Social work professionals are not necessarily expected to identify or solve participation problems; they are seen as intermediaries who enable citizens to take responsibility themselves. Social work professionals are therefore expected to provide the individual applicant with less direct support and to focus more on strengthening the social networks of people and the social contexts in which they find themselves. Section 2 connects sections 1 and 3, but may also be read independently. It is about the fact that social work professionals are not yet in the habit of providing systematic insight into the results of their actions, while policy makers, for example, are increasingly looking to them precisely for this. First of all, I set out the reasons why it is so important to make the products of their interventions more visible, not only to policy makers, but also to social work professionals themselves and to the customers/citizens who depend on them. Secondly, I set out how the results of social interventions can be made more visible than they are at present; and what research can contribute. In this, I advocate a change in thinking: from thinking in terms of the evidence to thinking in terms of the evident. This argument forms the basis of the type of research that is being taken up from within the research group. In section 3, I describe a number of research projects that will be conducted during my tenure. I also set out the main proposition of this address, which states that social work professionals should do more with the knowledge that peoples behaviour is determined to a significant degree by contexts. In particular, social contexts could play a bigger role in promoting citizen participation. At present, social work professionals normally intervene directly in peoples behaviour, such as with therapies for combating problem behaviour. Interventions in a broader, social, context are rare. Why is this? And couldnt citizen participation be more effectively promoted by these means than through direct behavioural interventions? I put forward four propositions in this regard, and explain each of them in reference to one of the current research projects within the research group. With this, in combination with the general outlines of the research presented in section 2, I hope to provide a clear and inspiring overview of the research that will be carried out within the research group in the coming years. Finally, in section 4, I will discuss the significance of the research group to the faculty of Society and Law at Hogeschool Utrecht University of Applied Sciences, and to parties outside of Hogeschool Utrecht University of Applied Sciences.
