CHALLENGE 5 : Optimising treatment plans for kids in rehab

Critical Concepts 

Kids Rehab WA deliver paediatric rehabilitation services through several programs at PCH and in the community and may be supported by therapists in WA country health services. You may want to talk to Challenge 5’s Mentors about the following ideas as you develop your prototype:

• WA Health is the system manager for public health service providers. The health service providers for children and young people are; the Child and Adolescent Health Service (CAHS), comprised of the Perth Children’s Hosptial (PCH), Child and Adolescent Community Health (CACH), and the Child and Adolescent Mental Health Service (CAMHS). The WA Country Health Services (WACHS) provide primary and secondary paediatric services to children in regional WA and work with CAHS’ teams to optimise outcomes for children and families who access CAHS services.  
• Kids Rehab WA provide tertiary health services for children with neurodisability, including cerebral palsy, acquired brain injury, spinal cord injury and genetic syndromes. Therapy is directed towards specific health needs including rehabilitation after a medical incident, a new diagnosis in an infant or a brain injury in a child, or after a medical or surgical procedure, for example orthopaedic surgery for children with cerebral palsy. 
• • Kids Rehab is a Department of PCH and is divided into multiple clinical programs. iRehab and RiC are two of those programs. 
• Kids Rehab WA provides therapy which is episodic, goal focused, time limited and delivered by a multidisciplinary team of medical, allied health and nursing staff. This is different to NDIS services, which provide maintenance therapy and ongoing support across the lifespan. 
• Intensive (high frequency) intervention is often required to aid recovery and maximise goal attainment, but there are other important activities for children to participate in, such as family time, education, community activities and play. These are often referred to as the F-Words in Childhood Disability.   
• Optimal therapy dosage is the number of therapy sessions in each discipline that will achieve the desired therapy outcomes or goals. Targeted levels of change for iRehab and RiC programs, based on minimal clinically important difference (MCID) measures, are:  
• • Two point or higher change in performance and satisfaction scores on the Canadian Occupational Performance Measure (COPM) 

• • • Goal activity performance and satisfaction rated by child or parent on a 1 to 10 scale, increments of 1 unit 

• • • Pre and post intervention measures completed. Difference between these are the change scores  

• • Attain score of zero or higher using Goal Attainment Scaling (GAS) 
    • Goal activity score more objective, based on pre-determined goal criteria; therapist-assessed score 

• • • -2 to +2 scale, increments of 1 unit 

• • Change of 3-5 points in the raw score for the self-care domain on the Functional Independence Measure for Children (WeeFIM) 

• • • The WeeFIM is an 18-item performance measurement system that documents self-care (8 items), functional mobility (5 items), and cognitive (5 items) abilities as three subcategories, that are summed for a total score. Each item is scored from 1-7, in 1-unit increments, for a possible total score of 126.  

• • • Pre and post intervention measures completed. Difference between these are the change scores 

• • • iRehab uses WeeFIM regularly, RiC does not (see above 2 measures for RiC) 

Some of these assessments are completed on forms purchased from a publisher; we will bring some blank hard copies of the forms to the Hackathon briefing for reference. 

• Information links about: 

• •  Cerebral Palsy (CP) 

• • • Some diagnoses are not CP, but present similarly to CP and undergo some of the same treatment. These are referred to as “CP-like” conditions. Keep an eye out for “HSP” or “hereditary spastic paraplegia”; as the most common CP-like condition. 

• • Aquired Brain Injury (ABI) in children 

• • Spinal Cord Injury (SCI) in children 

• • Others: there are many other causes of childhood disability 

• • • More commonly: Global Developmental Delay (GDD) / Intellectual Disability (ID) and Autism Spectrum Disorder (ASD). Many kids with CP, ABI or SCI may have ID or ASD as well 

• • • There are also many Rare Diseases that, when combined together, make up a significant cause of disability in children 

• iRehab is delivered at PCH and children and families attend up to 5 days (usually 2 – 3 days) per week and receive multiple contiguous sessions from the iRehab team. Factors that influence the offered days per week include: 

• • Age of child 

• • Child fatigue 

• • Family circumstances such as work commitments, school drop-offs, travel time and distance. 

• iRehab scheduling is done manually in multiple excel spreadsheets for each individual child to plan multidisciplinary interventions for up to ten children per day for six to eight weeks, sometimes up to six months.  

• • Scheduling planner – manual entry by iRehab Coordinator of weekly schedule 

• • Year planner – manual entry by administrative assistant, copied from Scheduling planner which provides multi-year view of schedule. Excel data repository. Unstable and unable to export data neatly. 

• • Printable calendar – weekly view generated by year planner 

• Children attend RiC for therapy 1-2 times per week (once week most common) for physiotherapy and/or occupational therapy. RiC scheduling is simpler than iRehab because patients only see one therapist per day. Scheduling is done manually across multiple Outlook calendars. One calendar for each clinic location, with different therapists working on different days.  

• Workforce resources are organised by the types of clinicians (known as “disciplines”) involved: 

• • Allied Health disciplines- Physiotherapy, Occupational Therapy, Speech Pathology 

• • • See the “What therapies are involved?” information sheet 

• • Other resources which we will consider later, but don’t have the data model at present –  

• • • Allied Health Assistant  

• • • Nursing 

• • • Medicine 

• • • Psychology 

• • Another refinement for future work is inclusion of phases of intervention, which inform scheduling of therapy dosage and resources, however we cannot provide data for easily yet.  

• • • Phases of intervention are elicitation, stabilisation, mass practice and generalisation. Elicitation and stabilisation require a highly trained workforce to co-design, implement and modify tailored therapy interventions, while the mass practice stage is suited to use of Allied Health Assistants, who follow a set program with the child, with regular reassessment by specialised clinicians.