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Title: The home treatment as a supporting method of Bobath for treatment of children with cerebral palsy in Kuwait
Author: Al-Mater, Mona
ISNI:       0000 0004 7961 117X
Awarding Body: Swansea University
Current Institution: Swansea University
Date of Award: 2019
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Physiotherapy is one of the main management interventions for children with cerebral palsy. The Bobath approach is considered to be the most popular approach of physiotherapy for children with cerebral palsy even though it may not be the most beneficial approach if applied solely. To provide a holistic effective approach of physiotherapy to children with cerebral palsy the families are expected to apply specific handling and management techniques at home to support clinical physiotherapy management. In Kuwait outcomes of clinical management show deterioration with time and lack of home treatment application is suspected to be the main cause of decreased maintenance of achieved clinical physiotherapy functional outcomes. Therefore, the aim of this research was to identify the causes of such deteriorations of outcomes and a method of promoting home treatment adherence by families emphasize the importance of applying the home treatment in Kuwait in addition to identifying the most suitable follow up method to promote adherence to the home management. To achieve this a systematic review was performed to identify the effects of home treatment in supporting the clinical physiotherapy management and the most effective method to promote the adherence of families to the application of home treatment to be applied in Kuwait. Results have shown the home treatment to be a significant method of supporting clinical management and a variety of follow up methods were found to encourage families to apply home treatment. The documentation of physiotherapy procedures in the paediatric department in PMR hospital in Kuwait was then evaluated via an audit retrospectively and limitations in the educational process as well as the validity of goal setting was identified. To overcome these aspects of malpractice a pilot RCT showed the impact of implementing an educational course prior to physiotherapy interventions has had positive results in functional level in children with cerebral palsy in Kuwait especially when an objective outcome measure was applied. Families that received only educational lectures were found to be more adherent to the application of home treatment and their children have scored higher levels of change in functional abilities in the gross motor functional measure, compared to the families that received the educational lecture in addition to a weekly home visit as a follow up method. Families showed a contradictory response to the follow up method in the qualitative questionnaire to evaluate the level of parents' satisfaction, however, all families participating in the pilot study in Kuwait have reported benefits from the educational lecture. The physiotherapists in Kuwait agreed that the family education and home treatment plays an important role in supporting clinical outcomes when opinions were evaluated via an electronic survey. It was concluded that increasing awareness of cerebral palsy outcomes and the role of physiotherapy in the management of the disorder was found to be the main influence in improving home treatment adherence and outcomes, however home visits as a follow-up method did not show the expected effects in improving adherence. The educational lectures were also found to achieve high levels of family satisfaction and positive feedback regarding being part of this study in addition to being agreed upon as an effective method of support by physiotherapists in Kuwait. Overall, the data suggests that physiotherapy, when combined with additional treatment approaches, can be highly beneficial towards children with cerebral palsy, as well as their family.
Supervisor: Clift, Martin J. D. ; Hoon, Alice E. ; Bodger, Owen Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral