from the lab to the clinic: how research informs practice

Gail Andrew, MDCM, FRCP(C) Clinical Professor, Department of Pediatrics, University of Alberta, Medical Director FASD Clinical Services, Glenrose Rehabilitation Hospital, Alberta Health ServicesJacqueline Pei, Ph.D., R.Psych. Associate Professor, Department of Educational PsychologyAssistant Clinical Professor, Department of PediatricsUniversity of AlbertaEmail: jacqueline.pei@ualberta.ca

•Interventions need to be provided after assessment of strengths and weaknesses to ensure participation in safe and meaningful life•ICF model of changing the environment and personal factors not the medical condition of impairment (external brain)•Research on neuroplasticity supports more interventions focused on changing the brain with the individual living with FASD

•Need opportunities to have bidirectional communication between basic/applied researchers and clinical application (KT function)•Reality of complexity in real life “experiment” in FASD includes multiple variables from prenatal stress factors to adversity/trauma in the early years that impacts brain development •Cannot control all variables in human setting

•Current research identifies impairment in:• Learning challenges, especially math, reading

comprehension, abstract concepts• Attention• Memory• Executive functions: hot and cold• Adaptive function for daily living• Behavioral/sensory regulation• Social skills with immaturity• Functional communication• Key: IQ deficits do not define the extent of impairment• Mental health disability either primary PAE or secondary

•What age group to target•Where to provide the intervention•Intensivity, frequency, duration, 1 on 1 or group settings, caregivers, school staff•Evaluation of outcomes and skills gained•Generalization of skills out of the clinical lab•Maintenance of skills learned over time•Are skills prompt dependent by RA or computer•Need for longitudinal data on function over time•Correlate with neuroimaging studies DTI and fMRI

•Multigenerational trauma and possible FASD in parents or grandparents•Different and changing caregiving situations impact interventions that involve caregiver training (Family Matters)•Epigenetic impact: can interventions reverse?•Medical model or psychosocial determinants of health?•Nutritional rescue: folate, choline, azibutanol?

•Moving from efficacy to effective and feasible practice

•Just because it could work does not mean it will work and does not indicate how it could work

•This is a crucial step towards supporting and justifying our work

•Caribbean Quest•Attention process training: combined computer program and coach•Experience dependent neuroplasticity(Kleim & Jones, 2008)- the brain can learn new behavior in response to rehabilitation through:

•Repetition•Time•Intensity•Salience

•Step one: efficacy in lab•Step two: efficacy in classroom•Step three: efficacy when train the trainer model employed to equip educational assistants to implement (effective and feasible?)•Step four: efficacy using train the trainer and small group administration

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Necessary components to build the needed relationships:

• time … at every step of the way• knowledge of community context• flexibility• integrated knowledge transfer efforts