Measuring balance in children aged 4 to 12 years of age using the Balance Master: Normative values and associations.

Ms Jessica Kolic1, Ms Kaitlyn O’Brien1, Dr Kelly-Anne Bowles2, Dr Ross Iles1,4, Dr Cylie Williams1,3

1Department of Physiotherapy, School of Primary Health Care, Faculty of Nursing, Medicine and Health Sciences, Monash University Peninsula Campus, Frankston, Australia, 2Department of Paramedicine, School of Primary Health Care, Faculty of Nursing, Medicine and Health Sciences, Monash University Peninsula Campus, Frankston, Australia, 3Department of Allied Health, Peninsula Health, Frankston, Australia, 4Insurance, Work and Health Group, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia

Abstract:

Aims:To establish normative values for children aged four to twelve years for three common clinical balance tests on the Balance Master®. The secondary aim was to analyse the influence of age, gender, height and BMI on balance.

Methods: Ninety-one typically developing children with a mean age of 8 years ± 4 (46% female) were recruited in Victoria, Australia. Data collected, generated normative values for the Rhythmic Weight Shift (RWS), modified Clinical Test of Sensory Integration (m-CTSIB) and Limits of Stability (LOS) balance tests on the Balance Master®. Backward stepwise multiple regression analysis was performed to determine the association between balance variables against age, gender, height and BMI.

Results:Normative values for the RWS, m-CTSIB and LOS on the Balance Master® machine were established for each age year. Balance and postural control was shown to improve with age (p<0.05), with girls demonstrating mature balance strategies earlier (p<0.05). Increased BMI was associated with poor balance and postural control, particularly when vision was occluded (p<0.05).

Discussion:Adequate static and dynamic balance is a prerequisite for participation in many childhood activities essential for development. The Balance Master® is a portable and clinically feasible system that accurately and reliably measures balance in adults, however there exists limited normative data for children. The normative values established by this study may be used to support clinical paediatric assessment. Natural variation in balance ability exists as children continue to develop and clinicians should consider the individual impact of anthropometry in children when assessing balance.


Biography:

Recent graduate of the Bachelor of Physiotherapy (Honours) Advanced Research stream from Monash University. Currently working as a physiotherapist in the graduate program at Cabrini Health. Has a special interest in Indigenous health and neurological rehabilitation, and would love the opportunity to extend this pilot study being presented today to rural and remote communities.

Telerehabilitation: Supporting Change in SA Health

Mr Chris Leung1

1SA Health, Bedford Park, Australia

Abstract:

SA Health need to meet increasing demands for rehabilitation services across the state, improve consumer access and enhance clinical safety and quality. This paper explores the implementation of telehealth in rehabilitation (telerehabilitation) as a service modality across SA Health to enhance care pathways.

Supported by growing national and international evidence for telerehabilitation, SA Health committed to embed telehealth in rehabilitation services across the state, investing significantly in new roles and technology.

Access to specialist rehabilitation services in SA Health has been limited to 4 key metropolitan sites and 3 regional sites. Consumers are now able to loan SA Health iPads, or use their own technology, to connect with rehabilitation teams for consultations, assessments and therapy as well as utilise therapeutic apps to engage with extra goal-oriented activities, from their own homes.

A target was set for 5% of all IPHA Tier 2 rehabilitation activity to be provided by telehealth. Additional measures include: monitoring of incidents and sentinel events, establishing appropriate and relevant measures for technical issues impacting on clinical care, and continual monitoring of consumer, as well as clinician satisfaction.

The 70:20:10 learning and development model and various change management philosophies were used to introduce new concepts, skills and procedures to clinical staff.

In 10 months, telerehabilitation services have exceeded the 5% target for Tier-2 activity. The program has enabled unprecedented access to rehabilitation services for rural and remote patients.

The program team recognised and balanced the subjective and objective, individual and collective elements required for system-wide reform.


Biography:

Chris works for SA Health, as the Statewide Telerehabilitation Clinical Lead – Allied Health. Over the last 12 years, he has enjoyed various roles in clinical physiotherapy and allied health clinical governance, from metropolitan to country and rural services across SA and the NT. His clinical passions lie in serving the community as a general ruralist physiotherapist and in promoting greater access to quality services for rural and remote Australians. In his current role, Chris is proud to be serving as a bridge between ICT and clinical care, and to be planning, implementing and promoting statewide initiatives through technology.

Stories from Experience, a new portal for safe storytelling

Ms Hilary Smith1

1National Eating Disorders Collaboration, Glen Iris, Australia

Abstract:

This poster presentation will give an overview of a new online tool that health professionals can use in their work with people recovering from eating disorders.
Stories from Experience (SFE) is a learning resource, designed to guide individuals who are recovering or have recovered from an eating disorder in telling their story. Research shows that many people view writing their story as an important process in eating disorder recovery, whether they write it for personal reasons or to share with others.
SFE provides an online space where people can experiment with ways to tell their story. Individuals create a user account and then step through modules that cover topics ranging from the meaning of a story, the process of crafting a story, steps for sharing a story and how to stay safe when sharing, as well as how to ensure that stories are told in ways that keep other safe such as avoiding triggering content.
Once a story has been created, the writer can choose whether or not to share it, and who to share it with. SFE includes guidance and suggestions for sharing stories with loved ones, health professionals and the general public, to help the person use their story in the way that works best for them.
This poster presentation will give a brief overview of why and how to use SFE and how to access it online.


Biography:

Hilary Smith is the NEDC Workforce Development Coordinator. Her role is focused on introducing specific competencies for safe and effective responses to eating disorders in health and other workforces across the country.

Robotic rehabilitation: A public regional health service model of care

Mrs Andrea Voogt1, Mrs Lisa Peters1, Mrs Bronwyn Connelly1

1Northeast Health Wangaratta, Wangaratta, Australia, 2Better Care Victoria, Melbourne, Australia

Abstract:

Rural Australians face distinct health challenges compared to their metropolitan counterparts. Factors contributing to such disparities include an allied health workforce lacking in specialist skills and lack of access to state-of-the-art technologies. Northeast Health Wangaratta (NHW) received philanthropic grants and community raised funds to purchase robotic equipment in 2017. Utilising robotics we aimed to provide consistent, intensive, repetitive and task specific rehabilitation to patients with motor deficits post neurological injuries.
Whilst trying to implement the new equipment we realised that there was no gold standard model of care (MOC) for Robotic equipment post neurological injury, let alone a publically funded MOC that would consider the unique needs of regional health in Australia. So, NHW completed a business case to Better Care Victoria (BCV) to undertake the development of a model of care for robotic based upper limb rehabilitation.
Systemic changes to our sub-acute ambulatory care service (SACS) were required to support the trials of intensive robotic groups. A detailed assessment about staff competence and confidence to use robotic equipment is being undertaken, as well as evaluation of the broader economic implications of having this technology available to regional patients.
We believe we offer a unique regional and public perspective of undertaking a quality improvement project of this scale and significance.


Biography:

Andrea Voogt is a senior physiotherapist at Northeast Health Wangaratta, where she speicalises in the management of complex neurological and cardiac clients.  Andrea has a wealth experience in service delivery planning and coordination and has recently commenced as a project coordinator for the robotics program. Andrea sees robotics as the way of the future and is excited to have the opportunity to have access to state of the are technology within a rural setting. Andrea is currently using her experience and knowledge to develop a model of care for upper limb robotics program within the public health system.

Rural eMeds: achieving Smarter Safer Better approaches to medications

Angela Firth1, Miss Miriam Tan1

1NSW Health, Dubbo, Australia

Abstract:

Introduction: Medication-related incidents are the third highest reported incident type in Australian hospitals. Errors can be reduced by more than 55% with the introduction of electronic medication management (eMeds) systems to help manage medication prescribing, dispensing and administration. eMeds improves patient safety by reducing medication errors and adverse drug events during their stay in hospital. Automating the medication ordering process produces standardised, legible, complete orders and when combined with clinical decision support systems, can reduce medication errors.
Aim: To introduce the eMeds application to all inpatient hospital sites through a joint project involving six rural Local Health Districts (LHD). Rolling out in 2018-2019, the project is tackling the tyranny of distance: covering 150 inpatient facilities, across 650,000 km2, serving 1.3 million people
Method: This innovative and collaborative approach involving the six rural LHDs is a first for eHealth NSW. With a single design, governance model and a joint project team, we can ensure greater standardisation across rural NSW, removing clinical variation and practice therefore improving patient’s safety. We acknowledge differences in workflows between rural and metropolitan inpatient wards. Subsequently, we have consulted extensively, with over 400 clinicians across 31 locations, from base hospitals to small, remote facilities to residential aged care units to ensure the eMeds system works smoothly with rural workflows.
Conclusion: This approach will make eMeds a reality for the communities of rural and regional NSW sooner resulting in greater patient safety and outcomes of care.


Biography:

Miriam grew up in Singleton, a small country town and moved to Dubbo, a regional centre, to pursue a career in rural health. She is passionate about health in rural and remote communities and introducing technology solutions into the healthcare sector in aim to improve patient outcomes and improve their satisfaction with their health care experience.

Tele-audiology: A digital solution to a clinical problem

Amanda Wilson1

1Cairns and Hinterland Hospital and Health Service, Cairns , Australia, 2Allied Health Professions’ Office of Queensland, Clinical Excellence Division, Department of Health, Brisbane, Australia, 3School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia

Abstract:

An outsourced, student-assisted tele-audiology service has been implemented and evaluated in response to a significant unmet need for on-site audiology services to support Ear, Nose and Throat (ENT) specialists in the Cairns and Hinterland Hospital and Health Service. Prior to the introduction of tele-audiology there was no Queensland Health audiology service available in the health service and audiology was outsourced to a private provider. The aim of the study was to assess the acceptability of the new model to patients and other stakeholders (e.g. ENTs), and to investigate its effectiveness.

Patients were offered audiology appointments conducted via telehealth at the hospital, on the same day as their face-to-face ENT consultation. Tele-audiology assessments were conducted by students and clinical educators from the University of Queensland, and facilitated by a local allied health assistant.

The outcomes of the service will be presented, including patient waiting times, attendance rates, success or otherwise of remote testing, length of audiology appointments, and outcomes of the consecutive audiology/ENT appointments. The satisfaction of patients, staff, students and specialists with the new service will also be described. Preliminary findings indicate that the majority of patients are able to access a co-located tele-audiology assessment on the same day as their ENT appointment (94%). The assessment was successfully completed in 95% of cases with results immediately available to the specialists. To date, 96% of participants have indicated positive satisfaction with the service. Staff, student, and specialist satisfaction data collection is ongoing and will be presented.


Biography:

Amanda is a Speech Pathologist from Cairns, with diverse experience across hospital, community health and remote Aboriginal and Torres Strait Islander communities. Amanda is interested in service development and innovative solutions that improve access to quality integrated healthcare.

Changing connections: parent/caregiver engagement and therapeutic alliance in paediatric teletherapy

Mr Glenn Fairweather1, Prof. Michelle Lincoln1, Dr. Robyn Ramsden2

1The University of Sydney, Lidcombe, Sydney, Australia, 2Deakin University, Burwood, Melbourne, Australia

Abstract:

Background: Allied health teletherapy services are being provided through internet videoconferencing to Australian rural and remote communities to address inequities of access, and fiscal priorities. No study had examined the development and relationship of parent-therapist therapeutic alliance and parent engagement in paediatric teletherapy. Research has indicated both have significant impacts on the outcomes of in-person paediatric therapy.

Aims: The aims of this study were: 1) To determine what parents/carers of children who have completed paediatric teletherapy programs, provided by speech pathologists, occupational therapists and psychologists, believe are factors that influence their own engagement and therapeutic alliance, 2) To provide empirical data which may inform improved teletherapy program design and delivery.

Method: Semi-structured telephone interviews, which included completion of the Therapeutic Alliance Scales for Caregivers and Parents (TASCP), were conducted with parents in rural NSW, whose children had completed paediatric teletherapy programs provided by one of three allied health disciplines. Participants described factors that affected aspects of their engagement and alliance. Thematic analysis generated a conceptual model of their subjective experience. Relevant quantitative data was derived from analysis of TASCP ratings.

Results: Parents’ repeated evaluations of the therapists’ communication, partnering, and rapport were crucial to the development of their parent-therapist alliance and engagement. The TASCP was an easily administered measure, reflective of affective bonds and collaboration.

Conclusion/Relevance: There are significant quality improvement implications for teletherapy design, and workforce up-skilling. The TASCP is potentially useful for tracking the effects on alliance of program changes. Important research questions are highlighted.


Biography:

Glenn has been a speech pathologist for 34 years. He was Speech Pathology Team Leader at Royal Far West, a children’s charity servicing NSW’s rural and remote families and communities, for 28 years. He and his staff established a network of outreach clinics across NSW and provided telepractice services to numerous rural schools, public and private. He has also managed a part-time private practice since 1989, and is now a PhD candidate at the University of Sydney, with a number of published articles relevant to teletherapy. Glenn is passionate about overcoming inequities in access to healthcare.

Massive Online Open Courses as a way of engaging rural health professionals and communities in open discussions about death and dying.

Dr Lauren Miller-Lewis1, Professor Jennifer Tieman1, Deb Rawlings1, Professor Deborah Parker2, Dr Christine Sanderson3

1College Of Nursing And Health Sciences, Flinders University., Adelaide, Australia, 2Faculty of Health, University of Technology Sydney, Sydney, Australia, 3Faculty of Health, University of Technology Sydney; and Calvary Health Care Kogarah, , Australia

Abstract:

Background: Massive-Open-Online-Courses (MOOCs) have changed the way in which geographically-dispersed health professionals and the community can engage with each other. MOOCs are freely available short online courses that make use of the digital environment to deliver educational content and create socially-constructed learning and exchange. CareSearch, an evidence based palliative care website, offered the Dying2Learn MOOC, which aimed to build community awareness and acceptance of death as a natural part of life.

Methods: The free five-week course provided the opportunity to discuss and collaboratively learn about issues around living, dying and palliative care. The platform enabled evaluation of participant engagement, learning gains and pre-post attitudinal change. Data was examined using mixed-methods.

Results: 1156 people joined the online course in 2016, and 1960 joined in 2017, demonstrating a need for online forums offering the chance to explore death and dying from social perspectives. In 2017, most MOOC participants resided in Australia, with 38% living in regional and rural areas. Over two-thirds of participants identified as health professionals (19% of which were in Allied Health), with the remainder being members of the general community. Both health professional and general community course participants reported feeling motivated and empowered, became more comfortable with talking about death, and reported high levels of satisfaction with the experience.

Conclusions:The Dying2Learn MOOC was well-utilised by health professionals and the general community in rural Australia. This highlights the potential of these innovative online digital platforms for increasing community awareness of death and palliative care, and for health professional education.


Biography:

Lauren’s background is in health and developmental psychology, with a PhD in this field. Dr Miller-Lewis is part of the CareSearch team at Flinders University. CareSearch is a website that aims to provide trustworthy information about palliative care to the Australian community, and the best palliative care research evidence to health professionals. In her position at CareSearch, Lauren brings experience in psychology, health research, and health professional education. Her role at CareSearch involves website content development, research, and facilitating online learning and engagement for health professionals and the community.

Electronic records and telehealth facilitate safe, equitable and quality dietetics care closer to home to remote Torres Strait communities

Ms  Marissa Arnot1, Miss Kiah  Peterie1

1Queensland Health, Thursday Island , Australia

Abstract:

The geographical nature of the Torres Strait and Northern Peninsula Area (NPA) presents challenges for the delivery of health care. Thursday Island (TI) is the hub of the Northern Sector of the Torres and Cape Hospital and Health Service (TCHHS) and provides a base from which services are provided to 20 distinct communities with primary health centres (PHC) accessible only by combination of ferry, light aircraft and helicopter.

Prior to 2012, paper based medical records were used and sharing of clinical information across sites was suboptimal. In 2012 an electronic medical record was established across all PHC sites in the Northern TCHHS. Infrastructure and clinical support in PHC for telehealth became established at this same time.

A generalist dietetics service, based on TI, provides services across the region predominately by outreach. The installation and use of both electronic medical records and telehealth infrastructure have facilitated a change in service delivery model to a combination model of outreach and telehealth. Benefits include more equitable access, more timely response to referrals, improved caseload management, increased frequency of follow up, along with a reduction in travel costs and time with reduced outreach travel.

Early service evaluation indicates increase in telehealth occasions of service, now accounting for 7% of the total OOS with further increase expected. Additionally, a snapshot in 2016 showed less than 5% of category 2 and 3 referrals were actioned within recommended timeframes. This was increased to over 50% in 2017 with additional FTE and the change in service delivery model.


Biography:

Marissa Arnot is the senior Dietitian for the Northern Torres and Cape Hospital and Health Service (TCHHS). Marissa has a Bachelor degree in Nutrition and Dietetics, a Graduate Certificate in Remote health Practice and a Graduate Certificate in Diabetes Education. Marissa is the sole permanent dietitian for the Northern Torres and Cape HHS servicing 25 distinct communities. In 2017 Kiah Peterie joined Marissa in the Northern TCHHS as an allied health rural generalist trainee. Kiah has a Bachelor degree in Clinical Science and a Masters degree in Nutrition and Dietetics.

Achieving Equity, Effectiveness and Efficiency – Digital health in Allied Health

Ms Angela Firth1

1Western Nsw Local Health District, Kelso, Australia

Abstract:

Background: A review of the distribution of Allied Health resources in western NSW commenced in 2014 incorporating the development and application of an algorithm quantifying the relative health needs of communities, to inform equitable distribution and service provision. Implementation planning identified service delivery incorporating telehealth modalities as crucial to maximising use of the available workforce hours, and an important step towards strengthening equity of access to Allied Health services. This presentation explores the development of a virtual allied health service in a rural and remote District of NSW.

Aim:The Virtual Allied Health Service – incorporating Dietetics, Pharmacy, Physiotherapy, Psychology, Occupational Therapy, Social Work and Speech Pathology aims to:
• enhance access
• improve quality and safety
• enrich patient experience, and
• strengthen efficiency and effectiveness of allied health services.

Methodology:Project development applied Appreciative Inquiry principles to Discover current practice in telehealth service provision, Dream of the future, and Design and Deliver virtual allied health services. Concurrently, program logic methodology was utilised to formulate a rigorous evaluation strategy. Measures were framed in the domains of:
• access
• quality and safety
• patient experience, and
• efficiency.

Results:Clinical pilot results indicate increased efficiency via reduced inter-facility transfers, and improved safety through interventions that prevent and ameliorate hospital acquired complications, for example, interventions for patients identified as at risk of malnutrition and pressure injuries.

Conclusion:Providing services via telehealth is central to the delivery of safe, effective and efficient and equitable allied health services.


Biography:

Angela commenced her career as a Speech Pathologist in 1998, and has worked in clinical roles in community, acute, rehabilitation and education settings in NSW and the ACT. She has also worked in a range of areas including education, workforce planning, management and more recently taking a lead role in clinical governance and strategic planning initiatives.

Angela works as associate to the Executive Director Allied Health in Western NSW Local Health District, with a portfolio of responsibilities leading clinical and workforce governance initiatives, including achieving innovative and sustainable workforce models to promote equitable access to services. Angela is committed to realizing equity of access to safe high quality allied health services across a sparsely populated regional and rural Local Health District.

Angela holds a Bachelor of Applied Science – Speech Pathology, a Master of Public Health and a Graduate Certificate in Business.

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