Goal setting in CIC training for children with spina bifida

Background

Children with Spina Bifida are late in developing independence in activities of daily living specially toileting. Almost all of them use Clean Intermittent Catheterisation (CIC) which demands competence in fine motor-, perceptual- and cognitive skills. The children need time and structured practice to be independent in this area. This involves the whole family why models of family centred practice and goal setting become important in planning the intervention. In a study that was presented at the SRHSB Conference in Barcelona, 2005 Allbrink Oscarson showed that the children seldom take part in the goal setting process for therapy. The goals are set by parents, caregivers and teachers and only in few cases are the children able to participate, often because the discussions are far too abstract for their cognitive ability. But children know about their occupational performance and they can participate in setting goals and objectives. Missiuna & Pollock (2000) developed an instrument, the Perceived Efficacy and Goal Setting instrument (PEGS), which can be used for goal setting in children age 5–9 years in activities of daily living. By using pictures, verbal instructions and comparing their capacity to that of their peers, it is possible to involve children with cognitive problems in planning intervention and treatment. This is important because motivation facilitates learning.

Methods

Inspired by the PEGS we are developing cards with additional pictures showing the CIC, called the Clean Intermittent Occupational Performance Assessment (CICOPA), in order to involve children in planning interventions for independent CIC through urotherapy and occupational therapy. The instrument is based on an extensive analysis of the CIC procedure resulting in 45 pair of cards describing the process of CIC and additional activities, as mobility and dressing, connected to toileting.

Results

The first validation process of the instrument is done by five children performing the assessment and discussing the content and importance of the cards. The CICOPA cards and protocol will be presented at the SRHSB Conference plus preliminary results from the validity test.

Conclusion

Our preliminary conclusion is that this instrument may be useful in order to involve children with Spina Bifida and cognitive disabilities in the goal-setting process, to motivate and facilitate the early learning of Clean Intermittent Catheterisation, for independence in toileting.