BACKGROUND Nighttime postural care (NTPC), an intervention using sleep-systems to position the body symmetrically during sleep, is particularly suited for children with severe Cerebral Palsy (CP); however, its impact yields mixed conclusions (Wynn & Wickham, 2009; Gericke, 2006).This variation may be due to the types of assessments used and lack of effective caregiver training. AIM of DISSERTATION: 1) examine sleep-based measures used in previous NTPC research and 2) investigate the "sleep care positioning training program’s" (Lesson A), an online NTPC training program, feasibility to educate caregivers. METHOD Completed studies include: 1) systematic literature review of NTPC sleep-based measures and 2) randomized control trial, comparing caregiver competence pre and post educational intervention. Investigators randomized 38 participants into groups (Lesson A or Lesson B) to complete differently formatted 2-hour online training (interactive video-based or self-guided web-links) on topics of NTPC evidence, risk monitoring, sleep-system types and set up, positioning methods, and outcome measures. RESULTS 1). Systematic review revealed no sleep-based measures used in past NTPC intervention research are fully suitable as outcome measures for children with severe CP. 2) Randomized trial showed Lesson A group had significantly greater change in self-rated competence for NTPC implementation (0.46 points [SE 0.17], p = 0.0078). Subjective themes describe Lesson A as a better lesson matching my learning style and Lesson B as overwhelming, not knowing what I was supposed to learn. Post-training, Lesson A and B groups correctly completed 11.85 [SE 0.83] and 12.60 [SE 0.84] of 16 positioning-tasks, not differing significantly (average difference 0.75 items [SE 0.54], p = 0.17). Professionals performed significantly better than non-professionals (F(1,92.34) = 16.62, p < 0.0001). Commonly missed tasks include “placing head/neck in neutral” and “snugging up parts”, with more error variation among Lesson B group. INTERPRETATION 1) To capture meaningful change and understand NTPC’s impact on sleep, combined use of the Sleep Disturbance Scale for Children-R and triaxial actigraph may be recommended for children with severe CP. 2) Sleep care positioning education caused increased perceived competence for health professionals and non-professionals. Post online-training caregivers accurately completed most sleep-system positioning tasks. Lesson A better prepares NTPC caregivers.
University of Minnesota Ph.D. dissertation. February 2020. Major: Rehabilitation Science. Advisors: LeAnn Snow, Peggy Martin. 1 computer file (PDF); iv, 91 pages.
Nighttime Postural Care Sleep-based Outcome Measures and Education: Preparing Care Providers of Children with Cerebral Palsy.
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