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One parent said : ‘ The intervention had a good impact . In six weeks , my son started to open and use his hands a lot more , which allowed him to play and interact more with the objects .’ Other parents commented that they felt they were ‘ given ownership ’ and ‘ felt looked after ’.
Clinical outcomes
Following the service redesign , we did see average improvement in the standardised assessment scores . Occupational performance improvements are reflected in the COPM scores , and we saw children ’ s performance scores and parents ’ satisfaction scores increase on average by three points .
Current service offer
All children referred to the upper limb intervention service are now seen by an occupational therapist , to determine if focused upper limb intervention may be beneficial for the child and manageable for the family and / or education settings .
All children participate in an appropriate , standardised assessment of their hand use – using the Mini-Assisting Hand Assessment ( Mini-AHA ), Assisting Hand Assessment ( AHA ), or Both Hands Assessment ( BoHA ) – where available .
Specific movement aims are identified , based on these assessment results . Occupational performance goals are also set in collaboration with the families , using the Canadian Occupational Performance Measure ( COPM ).
Intervention is tailored to the child ’ s age , using mCIMT , Bimanual Therapy or a combination of the two . Intervention includes a weekly session with an occupational therapist and daily sessions conducted by home or school .
Typically , intervention is six to eight weeks long and provided through a blend of face to face and virtual sessions . A follow up standardised assessment takes place and goals are reviewed on completion of the intervention .
Benefits for our service users and their families
Feedback from parents has included that having intensive intervention has helped them to support their child to use their arm to their full potential , while also helping the whole family to support the child to progress in participation .
Next steps
Providing timely intervention for children with upper limb impairments is effective and worthwhile . Children ’ s outcomes and parents ’ feedback was largely positive , while the clinic structure improved therapist consistency and facilitated regular training , supervision and support to improve therapist competence . Next steps for this clinic include :
• In-house training and competencies will be developed and delivered to support the development of occupational therapy staff .
• Skill gaps will continue to be identified and planned for .
• Ongoing education to the multidisciplinary team will be delivered to ensure appropriate referrals .
• Other intervention modalities will be reviewed to ensure we continue to provide high quality evidence-informed interventions .
The intervention being completed in the community setting has also supported many positive outcomes for the children and their families .
Words CATH ALLEN , JENNY CLARKE , ELEANOR COCKELL , VICKY D ’ ABO , with acknowledgement to Judy Archer , Head of Community Occupational Therapy , and the Evelina London Community Occupational Therapy team . If you would like more information on setting up a community based upper limb service please contact Vicky . dAbo @ gstt . nhs . uk
September 2023 OTnews 47