Rehabilitation for Pediatric Stroke in Low and Middle Income Countries: A Focused Review.

Rehabilitation for pediatric stroke survivors can maximize a child's potential through each developmental stage of life. Timely diagnosis and referral to a rehabilitation specialist may harness opportunities to maximize brain plasticity, to help children adapt and learn, and to participate in and enjoy daily life to their capability. The aim of this focused review is to explore current rehabilitation models and evidence-based interventions for pediatric stroke survivors in Low- and Middle- Income Countries (LMICs) and to provide recommendations for future research and focused areas of improvement.There are several published pediatric stroke guidelines from the American Heart Association (AHA), Canada, Australia, and the United Kingdom (UK) which provide specific recommendations for rehabilitation, although the suggested intervention and services vary. There are no current guidelines developed in or contextually adapted for LMICs, although the current pediatric stroke guidelines emphasize the need to develop interventions that fit the cultural and environmental contexts. The World Health Organization (WHO) Rehabilitation 2030 initiative acknowledges profound unmet rehabilitation needs around the world, especially in LMICs. According to the WHO, LMICs have less than ten skilled rehabilitation professionals per one million people. Enhancing the understanding of rehabilitation services in LMICs could lead to nationally supported workforce education initiatives targeted to expand the number of locally trained therapy providers. This could improve access to and delivery of quality rehabilitation interventions to pediatric stroke survivors in these settings.

Identifying Occupational Therapy Research Priorities in Trinidad and Tobago: A Group Concept Mapping Study.

In Trinidad and Tobago, occupational therapy is an emerging profession with limitations in the number of practitioners and the scope of practice. With the development of a new Master of Science Occupational Therapy programme in the country, the profession is continuously growing. There has been an increased demand for culturally relevant research to build the occupational therapy evidence base locally. However, the narrow range of occupational therapy literature in the country makes it difficult to highlight research gaps and decipher what research areas should be prioritised to best impact occupational therapy practice at present. This group concept mapping study is aimed at identifying priority areas for occupational therapy research in Trinidad and Tobago from the perspectives of occupational therapy students and practitioners. Participants brainstormed and contributed specific research ideas they would like to see developed in the country. Individually, participants sorted these ideas into themes and rated each idea based on perceived importance and feasibility. Using the GroupWisdom™ software, multidimensional scaling and hierarchical cluster analyses were applied to the sort data to create idea clusters within a concept map. Rating values were analysed to determine priority research themes within the concept map. The resulting concept map illustrated seven research priorities: Contextualising Practitioner Development, The Realities of Emerging OT Practice, Localising Mental Health OT, Occupation and Participation of Children and Youth, School-based OT in the Local Context, OT with Special Populations, and OT Contributions to the Public Health Sector. These findings represent the research needs of the occupational therapy profession in Trinidad and Tobago and will help to focus future researchers' efforts to expand the local evidence base.

Establishing a pediatric occupational therapy clinic in the public-sector in Trinidad: The quest for clinical and professional expansion.

BACKGROUND: Pediatric occupational therapy (OT) in Trinidad is limited to costly private sector provision, which restricts access to only those families that can afford it. Public-sector healthcare, however, is offered free of charge to citizens. Establishing public-sector OT can increase the well-being and quality of life of children with disabilities and their families, as well as broaden the professional paths available to occupational therapists. OBJECTIVE: In the absence of local studies, primary research was undertaken to demonstrate the demand for services. The results of this study will be presented to government officials to argue for the inclusion of pediatric OT into one public-sector hospital in Trinidad. METHODS: Eighty-eight parents/caregivers of a child with special needs were surveyed at one public sector-waiting room or two private-sector therapy clinics. Surveys questioned parents' desire for occupational therapy services for their child, their willingness to use public-sector-provided therapy and their belief that such therapy would benefit families in Trinidad, among other items. RESULTS: Of the 88 participants surveyed, 98.8% believed that occupational therapy offered at one public-sector clinic in Trinidad would benefit families. The main deterrents to accessing the proposed public-sector therapy included satisfaction with the current therapist (40%) and concerns with convenience (33%) and efficiency (27%). Parents whose children were not currently receiving therapy cited cost (67%) and location (38%) as the main barriers. CONCLUSIONS: Primary research findings demonstrate that the vast majority of parents/caregivers believe that public-sector pediatric occupational therapy would benefit families. Service free of charge will increase access for many families who cannot currently afford treatment. Implications of a pediatric public-sector clinic also include the expansion of occupational therapy as a profession in Trinidad.