This study focuses on the fathers of children with chronic illnesses and aims to provide an overview of research trends based on a literature review and clarify the fathers’ psychological characteristics, coping behavior and adaptation. A search was performed using PubMed (web version) and ICHUSHI (web version) and 23 papers from Japan and overseas were analyzed. As a result, it became clear that despite having great anxiety and disappointment as psychological characteristics, they are trying hard to support their children and wives as fathers and husbands. Also, it became clear that while fathers use coping behaviors that focus positively on the problems of the child with the chronic illness and the family, they also use these behaviors to escape from their own negative thoughts and reality. Based on these characteristics, it has been suggested that it is necessary to create “story-telling spaces” where fathers can express their feelings; provide information that leads to problem-solving; and work actively to incorporate fathers into the circle of support.

 The objective of this study was to elucidate the achievements and challenges of multidisciplinary collaboration in the discharge support based on nurses’ perceptions in the neonatal intensive care unit (NICU) and thereby gain insight into the role of NICU nurses. A questionnaire survey was conducted of 145 NICU nurses in prefecture A regarding whether they had experienced multidisciplinary collaboration in discharge support, the achievements that resulted from such collaboration, and the challenges that arose. Responses to free description items were analyzed referring to the content analysis method. Responses were obtained from 72 nurses (recovery rate, 49.7%). Seven categories were generated for the achievements of multidisciplinary collaboration, including “made it possible to share information on the status and care of the child and their family members from the time before discharge” and “provided opportunities for family members to reduce their anxiety and express their feelings.”

 This study elucidated the changes in nursing practice that occurred before and after child rearing, and the changes in perception about pediatric nursing as expressed by nurses with child rearing. Semi-structured interviews were conducted with six nurses working in a pediatric ward before and after child rearing the interview content was structured using KJ method. The results indicated that the nurses were able to “ ‘move the starting point [of nursing]’ to the mother’s stance” instead of “taking a medical stance,” and were also able to get involved in pediatric nursing with the perception of having “many ‘options’ by drawing upon actual experience.” Moreover, the nurses were able to practice nursing that recognized the necessity of mother-inclusive thinking about “nursing intervention for mother and child, based on acceptance by mother and child,” the necessity of “family-inclusive support with due respect to the child” instead of considering the child as an independent individual, and the importance of “nursing intervention giving due respect to the child” as an individual. The nurses were able to foster such improvement in their quality of involvement with the mothers and infants because they were successful in “career development in pediatric nursing through child rearing” based on their own experiences.

 The purpose of this study was to examine factors affecting the perspectives of nurses who do not have experience in the role of instructor on giving pediatric clinical practical training to undergraduates. A cross-sectional, exploratory survey examined 359 nurses who do not have experience taking on the role of instructor. Nurses completed the Perspectives of Pediatric Clinical Nursing Practical Training Scale (PPCNPT). We then suggested that nurses recognize the factor “effectiveness for children and families” the most, followed by the factor “difficulty guiding students.” A multiple linear regression analysis was performed for each factor of the PPCNPT as dependent variables and demographic characteristics with the Job Stressor Scale of Nurses in Pediatric Wards and the Nursing Career Assessment Scale as independent variables. Results suggested that nurses who indicated higher stress levels stemming from a large amount of work and from working with children who dislike their medical treatments tended to feel burdened by not being able to perform their work in the usual manner during training. In addition, those who indicated higher stress when faced with tasks centering on children and family, such as caring for children and families or handling complicated cases were often recognized that children and families could receive effective care from undergraduates and concerned with trainees causing conflict with their patients.

 Aim of this study is to obtain the nursing suggestions regarding FCC in NICU. A descriptive qualitative research design was used. Semi-structured interviews were conducted with 12 nurses working in NICU and analyzed. As a result, six core categories were formed regarding the practice: “supports continuously with prediction for home care”, “judges timings and promotes parents’ participation in care of the child”, “supports the parents’ understanding of the state of the child”, “assesses the family function and provides support”, “promotes the parents’ recognition of their roles and transfers care to the parents”, “respect the family”. Four core categories were formed regarding the challenges: “enrichment and evaluation of family support”, “maintenance of the systems within the facilities and medical team”, “quality improvement in knowledge and skills on FCC”, “development of seamless support system for transitionto-home”. The findings suggest the following three points; reinforcement and improvement of nursing education, establishment of adequate environment and system of the NICU, and improvement of the transition to home care system for children.

 The purpose of this study is obtain the nursing suggestions, at the time of respite hospitalization of children with severe motor and intellectual disabilities (SMID). I make it clear about the nurse’s concerning which is being practiced to get trust from the family of SMID. We selected 11 expert nurse’s and semi structured interviews. Concerning the family of SMID in hospitalization of the respite purpose of an experienced nurse’s. As a result., six categories were constructed: “Intentional intervention that caught little chance”, “Detailed communication of the state those in respite hospitalization SMID.”, “I provided information according to the family’s requests.”, “A way of home care is respected”, “Maintenance of living rhythm at home”, “The environment at home is taken in.” An expert nurse informs the family.

 They show that I touch SMID with affection by the sincere attitude. The thought that I’d like to understand a serious illness child is told. At the coming, detailed information was provided to the family regarding the ways in which the life of a child with a serious illness could be enhanced. And a home care way and the case that it’s important concerning to adjust it after accepting once, to get trust from the family in a short period even if the family’s policy was special, were suggested.

 This research aimed to clarify the relationship between the quality of learning activities and base the bases of nursing practice among college-level nursing students in pediatric nursing practice. In total, 409 undergraduate students, in the Kinki area, took the questionnaire survey. All the students were in their second and third years of nursing practice training. The survey assessed the quality of learning activities used during nursing practice training using an existing scale. The questionnaire was administered before and after the students participated in the learning activities. Of the 123 respondents (recovery rate 30.1%), 110 (effective response rate 26.9%) provided effective responses and were included in the analysis. Descriptive statistics, t-tests, factor analyses, and Pearson’s correlations were used for data analysis. The total scores and average values of all the items were significantly higher after the learning activity, compared to those before. This suggested that the activities had a considerable impact on nursing practice training. Factor analysis of the bases of nursing practice produced four factors with 26 items. There was a positive correlation (r=.25; p<0.01) between the bases of the nursing practice and nursing students’ ratings of the quality of the learning activity. In pediatric nursing exercises, the quality of learning activity and the bases of nursing practice were clarified. In order to foster the bases of nursing practice, it is necessary to support efforts to increase the quality of learning activities through use of practical methods.

 The purpose of this study was to assess nurses’ practice of family-centered care (FCC) for families whose infants have survived acute phases in Neonatal Intensive CareUnit (NICU) and Growing Care Unit (GCU), and to discuss the associated factors. Ananonymous self-assessment questionnaire survey was conducted on 626 nurses working in 26 hospitals in the Kanto Region. We received 215 responses (responserate, 34.3%), of which 213 valid responses were analyzed. Practice of FCC was associated with years of clinical experience, pediatrics experience, obstetrics experience, midwife qualification, certified nurse in neonatal intensive care nursing, conference implementation, and training session attendance, clinical psychologist assignment. There was a positive middle correlation between practice of FCC and selfefficacyin implementing FCC, communication skills; getting information, positive listening, and personal space/eye contact. In particular, communication skills played an important role in nurses’ practice of FCC for families whose infants survived acute phases in NICU・GCU. The findings suggest that improvement of communication skillsis vital in building relationships with families and catering to their feelings and needs.

 The purpose of this study is to elucidate the language and behavior of children who are reluctant to take medicine orally when they receive encouragement to do so, and collect fundamental data for inferring their understanding and perception of taking medicine. The author observed 20 children of 1-3 years of age and their parents taking medicine, interpreted and categorized their understanding and perception of oral administration while considering the development stage at each age. The results of the study state that 1-year-old children were able to “select” one option out of two, and showed “understanding” of things and food used during oral administration. Children of age two and three had “conflicts” against oral administration, but could take medicine when they were “prepared,” and they could “select” and show “self-determination” when they were to make choices. In addition, children showed understanding of more complex stuff as they got older. For instance, 2-year-old children showed understanding of preparation and quantity or volume of medicines, while 3-year-old children understood when to take medicine and which medicine they disliked. Also, children in their early childhood faced oral administration with “motivation” and “interest” even for the medicine they disliked, and were “delighted” and “proud” of it when they were able to take them.

 The purpose of this study was to investigate feelings and the behavior patterns of mothers that stay in the hospital to attend to their children during their scheduled short period hospital stay for the surgery and to discuss the way of how to support a child who is admitted to a hospital and the family. We performed a semi-constitutive interview using an interview guide and qualitatively analyzed the answers in 20 mothers staying in the hospital with their infants and small children that were admitted to the hospital for a scheduled short period. The results revealed the behavior patterns of mothers that stayed in the hospital with their children to be based on a feeling of obligation to their role of taking care of their sick children and bound by ideal mother image. In their real behavior patterns, the mothers accumulated fatigue due to the hospital stay with a minimum level of living in order to prioritize taking care of their children. Then, they encouraged themselves with prospect of relief from a minimum level of living and at the discharge they finally freed themselves from a tolerating minimum level of living. As a conclusion, the needs for the instruction on an overview of the hospital stay and the supports to convert the mother’s obligation feeling of being an ideal mother to be more flexible were suggested to support mothers that stay in the hospital with their children during the scheduled short period hospital stay.

 This study’s objective was to assess the readiness for transition to adult healthcare services among Japanese adolescents with type 1 diabetes. We conducted a self administered questionnaire survey in 27 patients with type 1 diabetes (aged 12-20 years). The survey assessed the patient’s readiness to shift to adult healthcare services using the Am I ON TRAC for Adult Care Questionnaire (Saewyc, 2012), acceptance of disease, and self-efficacy for diabetes. The results of a questionnaire, only 5 patients (18.5%) answered that they were ready for transition. About the median total scores (by stage of growth) for knowledge and behavior about readiness, high school students scored the highest points, and scores of university students were lower than them. The results suggested that patients couldn’t obtain knowledge and behavior of readiness without learning opportunities. This study also revealed that knowledge and behavior of readiness were correlated with acceptance of disease and self-efficacy for diabetes. Especially, self-efficacy for diabetes was correlated with behavior about consult and judgement.

 The objective of this study was to investigate the structures of resilience in adolescents with allergic diseases; evaluate the following three indices of their feelings of trust in family members, friends, teachers, physicians, and nurses; and elucidate the effects of differences on resilience: (ⅰ) “Can they be consulted?” (ⅱ) “Can they be relied upon?” and (ⅲ) “Will they explain things?” or “Will they cooperate?” Factorial analysis of the resilience measures resulted in the identification of a four-factor structure, and among these factors, the fourth factor, usefulness of opinion, which means listening to the advice of other people, finding it to be useful for one’s own thought and judgment, and modifying it for application, is an essential item for adolescents with allergic diseases. It was also found that people associated in various ways with adolescents with allergic diseases take different approaches to increasing the adolescents’ resilience.

 This study aimed to describe the process of nursing students’ practice in terms of respecting children’s feeling, using qualitative inductive research with reference to the grounded theory approach. Participants were 7 students in A University college of nursing (third year university students: 3 participants and fourth year university students: 4 participants) who had completed pediatric nursing practice no more than 9 months before the start of the study. As a result, nursing students revealed the process of practicing nursing respecting the children’s feeling. Nursing students practiced nursing on the basis of prior nursing experiences and the primary attitude they learned through their involvement with nurses “Attitude to tackle nursing practice.” The situation is “nursing students can’t respect children’s feelings while nursing,” and nursing students were experiencing “nursing respecting children’s feeling was shaking”. They regarded this as an ethical dilemma as a nursing student. Further, nursing students implied that they had a responsibility to engage in “ethical behavior as a nursing student respecting children’s feeling.” The findings show that respecting children’s feeling is a process that nursing students undergo. In the future, teachers and clinical leaders nurse should apply this process to practical guidance in nursing practice in order to support students as they acquire nursing practices that respect children’s feeling.

 Semi-structured interviews were conducted among 8 outpatient pediatric nurses with experience providing guidance in growth hormone (GH) treatment for children with small-for-gestational age (SGA) short stature and their families with the aim of revealing the nurses’ awareness of children with SGA short stature and their families as well as ongoing support for GH treatment. Qualitative and inductive analysis resulted in extraction of “I have no relations making me aware of SGA,” “the core of treatment is the parents,” “parents and children quickly adapt to the treatment,” “there are difficulties in this treatment,” “support for mothers and children have been established,” and “there are challenges in outpatient support” as categories in the pediatric outpatient nurses’ awareness and “courteously supporting the introduction of self-injection” and “prevention of troubles associated with treatment continuation and habituation” as categories in support being provided. It was suggested that it is necessary to consider support in line with mothers’ needs immediately after the start of treatment as well as support that encourages proactive parent-child involvement during ongoing treatment.

 In order to better understand the experience of fathers whose children were definitively diagnosed with congenital heart disease during the neonatal period, we conducted semi-structured interviews with seven fathers and qualitatively analyzed responses. As a result, we discovered two perspectives and extracted 10 categories regarding the feelings and attitudes of fathers. These included “the shock and feeling of being unable to accept the diagnosis when I first learned that my child had heart disease”, “the sense of responsibility as a father and helplessness as a man”, and “working with it alone while restraining my feelings or trying not to think about the disease”. We extracted three categories regarding intra-family support. They included “supporting my wife by telling her about how our child is doing and by being by her side” and “raising our child while supporting each other as a couple”. These results suggest that it is important to understand the feelings of fathers, even though these feelings may not be readily expressed in words or facial expressions, and to provide a space where their feelings can be expressed. In addition, providing assistance so that the couples may support one another is necessary, as fathers feel they are helped by intra-family support.

 Purpose: To elucidate the process by which adults with congenital heart disease (hereafter, patients) seek employment, work, and continuing its career while coping with the disease.

 Methods: Semi-structured interviews were conducted with nine patients in their 20 s and 30 s, and the results were analyzed using a Modified Grounded Theory Approach.

 Results: In addition to the core category of living life as a long distance runner, we identified eight other categories: heart disease in its permanent state, facing harsh realities, increasing interest in my heart, meeting people who understand, finding the meaning of existence, cherishing my body, trying to keep working long-term, and premonitions of heart function deteriorating eventually.

 Conclusion: The process of finding a job was multilayered and circular, requiring patients to rebuild relationships, and learn how to continue to survive and find their place in society. Nurses must promote an awareness of the importance of understanding the circumstances of the patients, as they seek employment and explore the meaning of existence.

 Purpose: The objective of this study was to elucidate the cognitions about the post discharge environment of survivors of childhood cancer that developed during adolescence.

 Methods: Data were collected using semi-structured interviews of 8 survivors (4 men, 4 women) of childhood cancer that developed during adolescence. At the time of their cancer diagnosis, 6 participants were in junior high school and 2 participants were in high school. Interview data were analyzed qualitatively and subjected to descriptive analysis.

 Result: In total, 42 sub-categories and 13 categories were extracted. Regarding the post-discharge environment, the survivors had thought about their families, friendships, school and social life, public awareness, and their future. Two cognitions about their families included [I felt support from my family]. Four cognitions about friendships included [I was able to spend my time with my friends as I usually do]. Two cognitions about school and social life included [I felt that my school life was progressing without problems]. Two cognitions about public awareness included [I become agitated when I saw media reports]. Three cognitions about the future included [I remember the disease when thinking about my future].

 Conclusion: The cognitions about the post-discharge environment of survivors of childhood cancer that developed during adolescence suggest that it is essential to provide nursing to support strengthening relationships with the family, spending time with friends while undergoing treatment, enjoying school and social life, living in society as a childhood cancer survivor, and planning for the future.

 This study aimed to clarify the nursing practices of nurses certified as Pediatric Allergy Educators (PAEs) for children undergoing the oral food challenge (OFC) and their parents. Focus group interviews were conducted with nurses certified as PAEs, and the interviews were analyzed using qualitative content analysis, revealing three categories of PAEs’ practice. The first consisted of [support for smooth, challenging food], and they were〈advance support〉and〈support encourage children to eat〉. The second’ category was [Early detection of symptoms and precise response], and it consisted of〈Advance assessment〉, 〈Symptom observation and assessment〉, 〈Attitude during observation and assessment〉, and〈Treatments to ensure safety when symptoms are detected〉. The third category was [Support using OFC time], consisting of〈Support for daily life〉, 〈Education for anaphylaxis〉, and〈Support for facing food allergy care positively〉.

 This study aimed to clarify the disease-related experiences of children with haemophilia. It was a qualitative and recursive analysis of data obtained from semi-structured interviews with seven adolescent patients with haemophilia. The adolescents’ haemophilia-related experiences were organized into 4 categories, 12 subcategories, and 36 codes. The theme [haemophilia is part of my life] indicated that the respondents perceived the disease as a natural part of their lives. Starting to perform self-injections served as an opportunity to start [becoming aware of haemophilia and exploring it]. They went through great pains to learn how to prevent and stop bleeding (haemostatic management) while considering their relationship with this lifelong disease. Occasionally, their behaviour amounted to neglect of treatment and care. Eventually, serious events requiring haemostatic intervention brought them to terms with the limits imposed by their disease, and they understood that they would have to [cope with haemophilia one way or another]. This led them to revise their self-image, forming a new identity in the process, and realizing that [haemophilia is part of who I am]. In addition, their remarks suggested that the actions of their parents working with them to manage the disease helped them live a relatively normal life, and care activities proceeded according to the family’s combined schedule.

 The purpose of this study was to clarify the thoughts of mothers of children with cancer about how to explain the disease to their children. Semi-structured interviews were conducted with 8 mothers of preschool and early school-age children with cancer. Seven categories emerged from the analysis: “I very much want my child to face the disease positively”, “I intend to respect family wishes”, “I want to use expressions that my child can understand”, “I want to prioritize my child’s peace of mind”, “I am conflicted because of my mental confusion”, “I feel dissatisfaction and heavy responsibility with the role of decision making”, “I long for a supportive presence in my unsettled state”. The results suggest that nurses need to support mothers in ways such as the following: provide them with disease information from the time their children go into the hospital, understand that they are in an unsettled state of mind and support their thoughts, and provide them with opportunities where they can talk about the disease with their husbands and doctors.

 This study aimed to describe the process of disease information from mothers to their children with a congenital heart disease until school age. A semi-structured interview was conducted with 4 mothers of children with congenital heart disease aged 10-12 years. We transcribed the interviews verbatim and analyzed the transcripts using Steps for Coding and Theorization (SCAT). Mothers were informed about the disease by the attending physician since their children’s infancy and gathered information by themselves. However, mothers’ improvement in medical knowledge was gradual and intermittent; even if their children reached school age, mothers obtained only an imperfect understanding and persisting in acquiring such information was difficult. The factors of this finding were “inhibition of understanding due to the shock that child had congenital heart disease”, “condition of inadequate improvement in understanding”, and “the situation in which it is difficult to build a trusting relationship with the attending physician”. The mothers moved from providing “information centering on daily life contents” to “information with which the contents of daily life and imperfect medical knowledge coexisted” until children reached school age. Additionally, we clarified factors of information selection that increase and expand with child’s growth. Improvement in mothers’ medical knowledge and support for using the information based on factors of its selection and mothers’ needs is required.

 The purpose of this study was to clarify the contents of support provided by nurses administering allergy outpatient-care to children with food allergies (FA) so they can lead a safe daily life. A semi-structured interview was conducted with 6 outpatient nurses. The qualitative analysis of nurses’ descriptions yielded 8 categories of nursing support: [Build a foundation of trust with the families of FA children to maintain treatment], [Promote a better understanding of treatment among FA children’s families and people around them], [Improve the skin condition of FA children to prevent allergies as much as possible], [Encourage FA children to voluntarily take charge of their own recovery], [Support FA children so they can continue taking responsible food while minimizing the risk of an allergy], [Facilitate FA children to eat well-balanced meals], [Build a system encouraging families to have a talk with medical staff anytime], and [Support the family so they can take care of their child according to the severity of allergic symptoms]. It was found that outpatient care nurses provided various and ongoing support for FA children, their families, and group nursing staff.

 The objective of this study was to elucidate role acceptance and its associated factors among nurses working in nursery schools. The subjects were 759 nurses belonging to the Japanese Association of Health Nurses and Nurses in Nursery School. A self-administered questionnaire was mailed to the members and we received 182 responses back (response rate: 24%). The questions covered the current state of the nursery school, the background of nurses in nursery schools, health-related activities of nurses, and the degree of role acceptance. The role acceptance scale was used to measure the level of role acceptance, and we divided the subjects into three levels based on the mean±0.5 SD. The upper and lower groups were used for comparisons in the analyses. The results showed that significant differences were present in the following items: the presence/absence of disabled children requiring care, they chose to work at the nursery school so they could make use of their experiences, degree of satisfaction with pay, willingness to continue working, and the implementation status of childcare nursing. The results of the binomial logistic regression analysis showed that role acceptance was significantly related to the following items: interpersonal relationships in the workplace, working conditions, they chose to work at the nursery school so they could make use of their experiences, and satisfaction level with their treatment.

 This study aimed to clarify the specific involvement of nursing instructors working with nursing students in a pediatric nursing practicum targeting children with severe motor and intellectual disabilities (hereafter, children with SMID) so that the students are able to understand the characteristics of these children. In this qualitative descriptive study, 12 nursing instructors affiliated with wards or facilities specialized in treating children with SMID underwent semi-structured interviews, and interview contents were analyzed. In order for nursing students to understand the characteristics of children with SMID, nursing instructor involvement with students included the following: “interacting with them in an appropriate way to facilitate an understanding of the importance of being in the body baseline state,” “working alongside students in situations where interacting with children with SMID would be difficult if the student were alone,” “promoting physical touch to encourage children to come closer without fear,” “promoting hugging to shorten psychological distance,” and “communicating the instructor’s hope that students will interact with children with SMID after having considered and understood each child’s background.” Our findings suggest that nursing students must come away with a strong understanding of the importance of anticipatory nursing care that helps to maintain the status quo and prevent a child’s condition from worsening.

 The purpose of this study is to clarify the disaster prevention procedures for mothers with infants who experienced the 2011 Great East Japan Earthquake. The study included semi-structured interviews with 24 mothers. We found that mothers prepared for the disaster through “disaster mitigation methods”, “environmental adjustment”, “training and education”, and “predictions of future disasters”. The mothers learned about evacuation procedures at home, emergency procedures when in danger, collection of information on disasters, keeping children safe, protecting the family, and avoiding mental confusion. The results suggest that these disaster prevention procedures would be useful for mothers with children during massive disasters in the future.

 Here, we aimed to identify the current status and related factors of sitting postural care in severely disabled pre-school children living at home. We collected data using specially developed questionnaires that were distributed to 178 families using the visiting services and rehabilitation centers in the Kinki and Tokai regions of Japan. We obtained 68 completed questionnaires and conducted our final analysis using the responses of 57 families. Our results indicated that children with more severe motor dysfunction had higher medical care needs. The difficulty to perform sitting postural care in daily life is higher among disabled children, particularly in those requiring breathing health care. Younger children or children who required home mechanical ventilation tended not to use the postural care seating system. They received instructions regarding sitting postural care by professionals in multiple places. Our findings also highlighted the need to consider the burden and anxiety experienced by the family of children requiring mechanical ventilation at home. In future, it will be necessary to deliver ongoing sitting postural care that meets the changing needs of severely disabled children and their families, as they grow and develop.

 The purpose of this study was to determine the influence of nurses on the psychological recovery of children from invasive treatment experience by analyzing the involvement of nurses with children who have invasive treatment experience and their families.

 Semi-structured interviews were conducted with nurses with at least 4 years of pediatric nursing experience. Interview data were analyzed qualitatively. In total, 10 categories were extracted. Categories before invasive procedures were: “Easy-to-understand explanations of invasive treatments”, “Consideration of children’s feelings toward invasive treatment”, “Alleviating the physical and mental strain of invasive treatment”, and “Understanding the relationship between the child and mother”. The category during invasive procedures was: “Reducing the fear of invasive procedures”. The categories after invasive treatment were: “Reducing tension due to invasive treatment experiences”, “Supporting the family’s approval for the child’s invasive treatment”, “Accepting the child’s invasive treatment experience”, “Accepting the child’s feelings after invasive treatment experiences”, and “Rebuilding the relationship between children and nurses after invasive treatment experiences”. Nursing for children’s psychological recovery from invasive treatment experiences was revealed at each stage before, during, and after the invasive procedure.

 Support in community life and social participation for children with severe motor disabilities has become an issue in the field of pediatric nursing in recent years. Particularly with regard to social life, there is a great need for support for essential communication. This paper conducts a systematic review of 21 research papers concerning communication support interventions for children with severe motor disabilities. According to research results, the introduction of microswitch and eye-tracking (eye-gaze) technology for the purpose of expressing intent was most likely to be effective as a communication support intervention. The research also revealed that it is difficult to judge the effectiveness of interventions through stimulation such as music and sensory integration or of group interaction. There is currently a need to focus on interventions for expressing intent among children with severe motor disabilities.