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While innovation is known to catalyse solutions to global sustainable development challenges, lack of engagement from stakeholders during conceptualisation and development may influence the degree of success of implementation. This paper presents a complete and novel engagement methodology, developed from value led business modelling approaches, for working with multi-sector stakeholders. The methodology can be used to determine barriers and facilitators to clinical practice innovations or translational research, within a country-specific context. The approach has then been applied in the Cambodian prosthetics and orthotics sector to provide a practice-based exemplar application of the framework. This approach seeks to ensure the suitability and sustainability of clinical practice and research programmes being implemented within a complex ecosystem. A theoretical basis, drawn from academic and business innovation sectors, has been consolidated and adapted for practical application to design, direct, and inform initiatives in low resource settings. The methods presented provide a way to both develop and articulate the mission, vision, and goals of any proposed change, and to effectively communicate these with stakeholders in a way that engages the personal and professional values that exist in their ecosystem. It provides a structured process through which meaningful conversations can happen, and a basis for relationship management with key stakeholders; intrinsic to enable a sustained legacy from research and development. The engagement from stakeholders during conceptualisation and throughout development can determine the success, or not, of any implementation and scale of innovation. This paper presents a conceptual stakeholder-led engagement methodology, developed from value led business modelling approaches, for determining barriers and facilitators to translational global healthcare research in a country-specific context, in this case the Cambodian prosthetics and orthotics sector. Subsequent research and development work in this area needs to carefully manage and negotiate influencing factors identified through the application of the described methodology, to ensure initiatives (whether research or wider national development work) are sustainable and successful. [ABSTRACT FROM AUTHOR]

This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Rehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement. The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations. Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process. Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run. [ABSTRACT FROM AUTHOR]

This paper authentically represents the voices of non-verbal children with cerebral palsy using a case study design. Policy suggests that children should have the right to play and leisure opportunities, however non-verbal children with cerebral palsy have fewer choices. Additionally, children with communication, learning and mobility limitations are usually excluded from research. The aim of this research was to capture the voices of non-verbal children by exploring their well-being impact in terms of their experiences and choices about their level of participation in recreational activities. A qualitative case series study included interviews, observations, photographs and diaries. Where possible, the diaries were completed by both caregivers and children. Data were analysed thematically, and the lens of positioning theory applied. Seven children aged nine to sixteen years participated. The findings showed how equipment, people and environments enabled or hindered the children's participation. The children also advocated as champions for their own well-being. Positioning theory was applied across the data and was adapted offering a way to better understand the children's well-being responses. The findings demonstrate how these children were able to self-advocate, demonstrating their well-being by their intentional behaviours from their level of participation in a recreational activity. The voices of non-ambulant and non-verbal children are underrepresented in the literature. This study offers an innovative approach to highlight their voices using visual data. The images project the narrative about their choices for participation in recreational activities. The proposed kaleidoscope of well-being offers a way to demonstrate the fluctuations in their emotional responses from their participation. Choices for participation in recreational activities remains limited for non-ambulant and non-verbal children with cerebral palsy. Designers and policy makers should consider how equipment and environments can be adapted or created to increase the choices for non-ambulant and non-verbal children with cerebral palsy. Practitioners in health and social care should consider how to listen to the voices of non-verbal and non-ambulant children with cerebral palsy and their parents/guardians and work towards jointly setting participation goals to affirm their strengths. [ABSTRACT FROM AUTHOR]

Purpose:Scant research has been undertaken to explore in-depth the meaning of bodily change for individuals following stoma formation. The aim of this study was to understand the experience of living with a new stoma, with a focus on bodily change. Method:The study adopted a longitudinal phenomenological approach. Purposeful sampling was used to recruit 12 participants who had undergone faecal stoma-forming surgery. In-depth, unstructured interviews were conducted at 3, 9 and 15 months following surgery. A five-stage framework facilitated iterative data analysis. Results:Stoma formation altered the taken-for-granted relationship individuals had with their bodies in terms of appearance, function and sensation, undermining the unity between body and self. Increasing familiarity with and perceived control over their stoma over time diminished awareness of their changed body, facilitating adaptation and self-acceptance. Conclusions:Stoma formation can undermine an individual’s sense of embodied self. A concept of embodiment is proposed to enable the experience of living with a new stoma to be understood as part of a wider process of re-establishing a unity between body, self and world. In defining a framework of care, individuals with a new stoma can be assisted to adapt to and accept a changed sense of embodied self.Implications for RehabilitationAwareness and understanding of the diverse ways in which stoma formation disrupts the unconscious relationship between body and self can help clinicians to provide responsive, person-centred care.Supporting strategies that facilitate bodily mastery following stoma formation will facilitate rehabilitation and promote adjustment and self-acceptance.A concept of embodiment can help clinicians to deepen their understanding of the experiences of people living with a new stoma and the support they may require during the rehabilitation process.This paper provides clinicians with actionable insight that allows them to better support patients to a smoother adjustment process after stoma formation. [ABSTRACT FROM AUTHOR]

To explore health professionals' acceptance of the guidelines for acute whiplash associated disorders (WAD), and to identify barriers and facilitators to adherence. Qualitative descriptive study involving focus group discussions among health professionals who treat people with WAD in primary and secondary care settings in New South Wales and Queensland, Australia. Twenty-eight health professionals (physiotherapists = 19; chiropractors = 6; osteopaths = 3) participated in six semi-structured focus group discussions that were held in independent offices in Sydney and Brisbane, Australia between September and December 2015. Discussions were audio recorded and verbatim, de-identified transcripts produced. Thematic analysis was conducted using an inductive approach to identify commonly held beliefs. Acceptance of guideline recommendations appeared to be influenced by factors related to the guideline itself, practitioner and practice characteristics, and patient-related factors. Specifically, acceptance was hindered by conflicting belief systems, ambiguity in guideline recommendations, and patient characteristics and expectations. Practitioners demonstrated a positive attitude towards the use of the guidelines in general; however, in some cases, acceptance of key recommendations appeared selective. Future guideline revision and implementation might focus on explaining the underlying principles of the guidelines, providing more detailed recommendations, and involving strategies that challenge inconsistent beliefs and promote informed decision-making. Selective acceptance of guideline recommendations in favour of those not requiring practice change may present a challenge for the implementation of evidence-based practice in the management of whiplash. Participants demonstrated variable, sometimes polar attitudes to guideline key messages and recommendations. Guideline developers need to focus more strongly on changing practitioner beliefs and attitudes, as well as better explaining the underlying principles of the guidelines, and providing more detailed recommendations. [ABSTRACT FROM AUTHOR]

This study explored the experiences of people with acquired brain injury and their families during the COVID-19 pandemic, focusing on how they maintained their communities and sense of belonging, the strategies they found helpful, and advice they have for improving service provision and community connectedness. Semi structured interviews with pictorial mapping were conducted with ten adults with ABI and six of their family members. Participants responded to recruitment information circulated by a state-wide ABI peer support network in South Australia. Four primary themes were identified from the findings: (1) disruptions to routine; (2) social isolation; (3) using technology; and (4) strategies for staying safe and keeping well. Results are discussed using a social and urban geography lens and a conceptual framework of belonging to explore the experiences of people with ABI and their communities. The study reinforces the role of robust peer/support networks to stay connected, stay well and support others. Government, health services and community groups must provide clear and accessible information and supports, and regularly reach out to ensure the safety and wellbeing of people with ABI and their families during the pandemic. People with acquired brain injury and their families experienced increased challenges to maintaining contact with their communities during the COVID-19 pandemic. The main challenges were disruptions to routine, social isolation, and use of technology for health, therapy and social contact. Strategies to support people with ABI to maintain connections, stay engaged, and access technology and information to stay safe and well during lock-down are presented. [ABSTRACT FROM AUTHOR]

Chronic pain and disability after musculoskeletal trauma support the need for non-biomedical perspectives to frame experiences of recovery. Self-management is a specific holistic lens with implications for improving health outcomes. This qualitative study explored how adults made meaning of self-management after distal radius fracture (DRF). Thirty-one individuals aged 45–72 with a unilateral DRF participated in a semi-structured interview 2–4 weeks after discontinuing full-time wrist immobilization. Interviews were audio-recorded and transcribed, and constructivist grounded theory techniques were used to analyze the data. Participants made meaning of self-management as a process of "transitioning from hurting to healing," which occurred via three underlying processes. "Learning because of my injury" included gaining information for empowerment and understanding by physically living through the experience. "Working and hoping toward healing" involved taking active steps to recovery in the face of uncertainty. "Getting back to my normal self" comprised reconnecting to one's body and identity after injury. Participants' lived experiences overlapped with those of self-managing chronic conditions, highlighting the need to consider how individuals actively engage in their recovery after DRF. Findings suggest using supportive interventions to facilitate patients' understanding, activation, and engagement in meaningful activity after DRF. To maximize health outcomes after distal radius fracture, clinicians should move beyond impairment remediation to supporting multiple dimensions of recovery, including emotional distress and functional limitations. Clinicians should routinely provide early and ongoing information, such as expected symptoms and recovery time frames, to minimize loss of control related to uncertainty. Clinicians should emphasize active interventions, such as collaborative goal setting and functional tasks, that engage patients in their own healing. Clinicians should support patients' early return to meaningful activity to maintain or restore connection to the body and identity. [ABSTRACT FROM AUTHOR]

To explore the processes of community reintegration of children and families at least one year following a paediatric brain injury from the perspective of caregivers and outpatient/community service providers. A qualitative analysis of semi-structured interviews from outpatient or community service providers (N = 14; occupational, physical, and speech and language therapists, neuropsychologists, school counsellors, recreational providers) and caregivers of six children (N = 8) at least one year after their injury. Interviews were transcribed and thematically coded using deductive (employing Bronfenbrenner's ecological systems theory) and inductive approaches. Themes from both providers and caregivers indicated additional supports needed at all levels of Bronfenbrenner's ecological systems theory (i.e., individual, microsystem, mesosystem/exosystem, macrosystem, chronosystem). Participants felt that several characteristics would be needed in an ideal service system following paediatric brain injury including: community solutions ("it takes a village"), long-term approaches to care, and new financial approaches. The results suggest that children and families have substantial community reintegration needs following paediatric brain injury. Multi-system interventions are needed to support long-term community reintegration, especially those that increase communication and support transitions. There is also a strong need for alternative funding to support these efforts. Families with a child with a moderate to severe brain injury face challenges with community reintegration a year or more after their child's injury. Effort should be put into helping families navigate the complex medical, insurance, and school systems with a navigator service and step-down care to ensure a continuum of care and to support community reintegration. Special support should be provided during transitions, such as transitions from hospital care to outpatient care, and across school transitions. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the physical, psychological and social wellbeing of veterans who have experienced limb-loss and to ascertain the factors that contribute to the ability of veterans to maintain their independence at various stages in their lives. Methods: Sixty two life-story interviews were conducted with 32 veterans (aged between 40 and 95) who had experienced limb-loss either during or after military service. Results: Three overarching superordinate themes and related sub-themes were generated from a detailed Framework Analysis "Barriers to transition" describes issues related to employment, legal support and compensation, stigma and loss of identity. "Disparity of care" highlights the issues related to military and civilian care and prosthetics service user experience. The final superordinate theme, "Enduring challenge of limb loss," considers stoicism, dealing with pain, mobility, physical isolation and social networks. Conclusions: The outcomes offer an opportunity to shape future health and social care policy around the requirements of veterans who have experienced limb-loss by understanding the complexity, and ascertaining the factors that contribute to, maintaining long-term independence. [ABSTRACT FROM AUTHOR]

The National Disability Insurance Scheme is the new consumer-controlled funding system for people with disability in Australia, and is expected to enhance participation outcomes of people with disability. This research explored participation opportunities for people with disability during the formative period of transition to the scheme, through stakeholder accounts of changes in allied health service contexts. Qualitative data were generated during interviews, workshops and meetings with industry, policy, practice and education stakeholders involved in scheme services. Inductive coding explored key themes within the data. The International Classification of Functioning model was then applied as a deductive coding framework to illuminate how the scheme was perceived to be impacting participation opportunities for recipients of scheme funding. Using the International Classification of Functioning helped us illuminate whether changes resulting from scheme transition posed participation opportunities or barriers for scheme recipients. Research participants often framed these changes negatively, even when examples suggested that changes had removed participation barriers for scheme recipients. Some participants viewed changes as obstructing equitable and quality professional practice. We explore potential opportunities to resolve tensions that also optimise the participation outcomes of individuals who receive services through individualised funding. The introduction of individualised funding has removed barriers to participation for many National Disability Insurance Scheme recipients. Efforts must be made to build the trust of stakeholders involved in National Disability Insurance Scheme service provision regarding how fee-for-service funding can lead to good participation outcomes for scheme recipients. Transparency around the shared processes of clinical governance and equitable service access operating in Australia's individualized disability funding scheme are suggested to build trust. A visible commitment to maintaining a broad range of services is also indicated to build trust for stakeholders involved in the scheme. [ABSTRACT FROM AUTHOR]

One of the challenges for rehabilitation professionals is to discuss sexuality with their clients. The main objective of this study was to explore occupational therapists' perceptions of the factors that influence their practice regarding the domain of sexuality, as well as the prioritization of these factors and the exploration of their needs. Descriptive qualitative study who took place in Montreal, Canada. Two focus groups were realized with seven occupational therapists working in outpatient setting in two different rehabilitation centers for physical disabilities. The focus group guide was based on the Theoretical Domains Framework (TDF). The verbatims were coded using QDA-Miner software and analyzed according to the principles of the Framework approach. The majority of participants were women (n = 6/7). Three main themes to answer the main objective emerged: (1) Occupational therapist's intrinsic factors such as professional identity and knowledge/skills; (2) Contextual and process factors of practice, including assessment/analysis and human resources; (3) Client factors such as identity factors and capabilities. Several influencing factors that have a significant impact on practice have been prioritized, for instance, the perception of the skill level of occupational therapists, interdisciplinary collaboration, culture/language and openness of the client to the subject of sexuality. The needs related to the acquisition of knowledge/know-how, human resources and continuing education were raised by clinicians. There is a need in developing training tools to support clinical practice and to overcome the many barriers encountered by occupational therapists regarding the domain of sexuality. Addressing sexuality domain with their clients remains a challenge for occupational therapists working in outpatient physical disability rehabilitation. Several factors influence the practice of occupational therapists in the domain of sexuality, including occupational therapist's intrinsic factors, their practice process, contextual factors and client-related factors. Improved interdisciplinary practice in sexuality is needed to ensure that sexuality is addressed and that there are referrals to the proper health professionals according to clients' needs. The availability of sexology resources is an important factor for occupational therapists addressing sexuality. [ABSTRACT FROM AUTHOR]

To determine the feasibility of conducting a definitive randomised trial to evaluate the efficacy of custom-fitted footwear for increasing physical activity in children and adolescents with Down syndrome. Assessor-blinded, parallel-group randomised pilot study. Thirty-three children and adolescents with Down syndrome were randomly allocated to a custom-fitted footwear group (Clarks® footwear) or a wait-list control group. Six feasibility domains were evaluated at baseline, 6 and 12 weeks; demand (recruitment), implementation (co-interventions and adherence), acceptability, practicality (adverse events), limited efficacy testing (physical activity, disability associated with foot and ankle problems, and gait parameters), and adaptation (shoe-fit). Three participants were recruited per month. The use of co-interventions was common with six control group participants purchasing new footwear during the study. Mean adherence was 35 h/week in the custom-fitted footwear group, and there were few minor adverse events. There were trends for differences in physical activity favouring the custom-fitted footwear, but no trends for differences in disability associated with foot and ankle problems or gait parameters. The fit of the custom-fitted footwear was no better than participants' regular footwear. A definitive randomised trial is feasible. However, recruitment, use of co-interventions and footwear fit need further consideration. Conducting a definitive randomised trial to determine the efficacy of custom-fitted footwear in increasing physical activity in children and adolescents with Down syndrome is feasible. Custom-fitted footwear may improve physical activity in children and adolescents with Down syndrome. Commercially available footwear may not be suitable for children and adolescents with Down syndrome due to their unique foot shape. [ABSTRACT FROM AUTHOR]

Purpose: To describe and analyse social interactions among the users, partners and stakeholders involved in developing a rehabilitation park to determine a future approach to community-based rehabilitation. Materials and methods: The design was qualitative using the methodology interpretive description and symbolic interactionism as the theoretical framework. Data was generated through a two-year ethnographic fieldwork throughout the development of the SPARK (Sound Park Activities Rehabilitation and Climate) rehabilitation park. The participants were users, partners, and stakeholders of the park and data consisted of participant observations comprising observations, informal conversations, and field notes. Results: Three themes formed an understanding of the significance of involvement; A shared vision reflected the participants' joint overall idea for the rehabilitation park containing possibilities for health promotions for everyone. Perceived solidarity represented an experience of a project where everyone's opinion counted whilst Profound Acknowledgement signified a state of a deeper experience of being valued and heard. Conclusions: The findings suggest consistent and continuous involvement of users, partners, and stakeholders, creating possibilities for co-creation in rehabilitation in new settings. The development of rehabilitation parks like the SPARK park in a shared public arena may benefit people with disability, and everyone and further help reduce stigma around disability. The rehabilitation definition forms the base for co-creation of rehabilitation initiatives among people in need of rehabilitation as such and professionals with different approaches and professions. Conducting rehabilitation practice in a shared outdoor arena may provide professional development and expansion towards interdisciplinary approaches across diagnoses and professions. Outdoor rehabilitation may (despite different target groups) function as a facilitator for professional and chance meetings in the park and thereby create a community for meeting across professional disciplines, founding, and enabling a practice that allows to reflect on and learn from different approaches within rehabilitation. Community-based rehabilitation in a public shared arena may generate possibilities for reducing stigma towards people with disability. [ABSTRACT FROM AUTHOR]

Purpose: We explored which shared aspects of social relations were considered important to the quality of life of persons between the ages of 10 and 40 years living with a disability. We examined how social relations were experienced as affecting quality of life and social participation. Materials and methods: Fifteen focus groups involving 48 persons with disabilities were conducted using photo elicitation, preference ranking and props. Focus group interviews were supplemented with seven individual interviews with individuals unable to participate in focus groups. All focus group interviews and individual interviews were audiotaped, transcribed, and thematic data analysis was conducted. Results: We identified caregiving, dependency, and understanding as essential for quality of life. Acceptance from society, discrimination and prejudice, and the ability to participate in society were also highlighted as affecting quality of life. The use of social tactics to avoid confrontation with certain aspects of their disability was common among participants. Conclusions: Across disabilities, caregiving, dependency, understanding and acceptance, and discrimination and prejudice were all important aspects for the quality of life of the individuals. Social relations were closely related to social participation, and the latter affected the quality of life of the participants. Social tactics were used to navigate social relations. We suggest to formalize the concept of social tactics and use it in patient education to enhance quality of life in individuals living with disabilities. People may accept and learn to cope with the impact of their disability, but how they maintain their social participation and social relations also impact on their quality of life. In their assessment, professionals working with individuals with disabilities should, therefore, give more priority to analyze the impact of social relations. When intervening, an effort to establish and maintain social relations should be considered along with psychological help, allocation of aids and economical support aiming to enhance quality of life and social participation among individuals with disabilities. When evaluating efforts to improve quality of life, it is important to investigate whether the intervention has improved the social relations. [ABSTRACT FROM AUTHOR]

Purpose: To explore and describe clients' needs during a surgical intervention process for Dupuytren's disease. Materials and methods: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren's disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework. Results: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients' life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently. Conclusions: Clients' needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients' needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers' perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients' needs. Implications for rehabilitation: Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole. Need for knowledge is closely connected to patients' experience of being involved in decision making. Patients need support with both general human and specific medical issues during surgery and rehabilitation. Patients' needs change during the care process and can be influenced by the patient's life situation or character. From the carers' perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory study is situated in a critical tradition. It aims to describe and analyse the reliance on percentage assessments of functional capacity among a group of young adults in rehabilitation after serious motor vehicle accidents. Methods: Qualitative interviews and participant observation. Thematic and theoretically informed analysis was carried out. Results: The concept of percentages played a significant role in the study participants' meaning-making processes as they went through rehabilitation. Percentage scores below 100 made a strong impression on them and were associated with strong emotions. They also strove to prove their scores wrong, often by attempting to function in full time (100%) employment positions. Significantly, many talked as if they "were" their percentage scores. Conclusions: The utility of percentage logics is to describe parts of that which is full and whole, and we argue that this logic provides for specific and problematic ways of seeing and understanding impairment and disability. When scored on hierarchical scales, functional tests by necessity rank bodies and bodily functions as better or worse while precluding alternative understandings of affected function. Implications for rehabilitation: Measurements expressed in numbers and percentages are used in rehabilitation by professionals to depict and convey functional capacities to patients, but this "language" also leaks into the wider context of patients' lives and understandings of themselves. The act of measurement may work to rank bodies in specific and normative ways that are unable to express difference as a valuable instance of human diversity, and may make rehabilitees question whether they are complete human beings. Medical professionals should address and take into consideration the wider consequences of the act of measurement when they provide guidance and support for patients' in their rehabilitation processes. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity (PA) provides multiple benefits to children with visual impairments (VI) and their families. However, the empirical literature base is underdeveloped on how family PA experiences impact participation for children with VI. The purpose of this study was two-fold; that is: (a) to explore why families with children with VI seek out and participate in PA, and (b) to describe the strategies and supports needed by families of children with VI to improve PA participation. Method: The research method was descriptive-qualitative positioned in the theoretical framework of the theory of planned behavior. Participants were parents of children with VI (n = 10) who took part in one-on-one semi-structured telephone interviews. Interview recordings were transcribed and analyzed using a thematic line-by-line analysis. Results: Three salient, recurrent, and interrelated themes emerged from the data analyses. These themes were: (a) committed, (b) challenged, and (c) access. Conclusions: Findings revealed that parents valued PA, but they lacked the skills to teach and advocate for their children regarding PA. As a consequence, parents voiced the need for a support system that would allow their families to be more physically active. Implications for Rehabilitation: Results of this study demonstrated that parents valued physical activity, but they lacked the skills necessary to confidently engage their children in physical activity. Physical activity interventions are needed to enhance the quality of life of children with visual impairments and their families. Physical activity programs and interventions are most likely to enhance intentions to engage in physical activity among children with visual impairments and their parents. Results demonstrated that parents of children with visual impairments were interested to work side-by-side with physical activity professionals to enhance recreational physical activity opportunities available to their children. [ABSTRACT FROM AUTHOR]

Purpose: Cross-education is a neural phenomenon where strength of an untrained muscle improves after unilateral training of the opposite homologous muscle. It has been extensively studied in healthy populations and shows promise for post-stroke rehabilitation. The purpose of this study is to understand current post-stroke upper extremity rehabilitation practice; clinician’s perspectives on cross-education and; facilitators and barriers to implementation of a cross-education intervention. Materials and methods: This qualitative study used an interpretive description framework. Twenty-three occupational therapists and two physiotherapists who worked with individuals with stroke were interviewed. Digital audio files were transcribed and then line-by-line coding for units of information was conducted by two investigators. A third investigator, who was not present during the interviews, participated in category development. Results and conclusions: Cross-education is paradoxical yet promising was the primary theme. This theme was elucidated by three descriptive categories: (1) therapists worked in a forced-use paradigm; (2) there was gap in current practice for those with more severe impairments in arm function; and (3) cross-education used as an adjunct could be useful within current practice for specific patients. Therapists suggested that educational materials for clinicians, patients, and patient families would be essential to the success of cross-education to explain training the less affected limb. This study provides important foundational information about clinician perspectives that will facilitate future translational research in this area. Implications for rehabilitation: Cross education, or training the stronger arm to increase strength in the weaker arm, is an intervention particularly appropriate for people with stroke who have severe impairments in arm strength. This intervention should not replace the forced use paradigm, but may be a useful adjunct in rehabilitation. Therapists perceived that education of patients, families, therapists, and doctors would be critical for cross education to be implemented successfully - as it is opposite the forced use paradigm that characterizes most of stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose:The Australian National Disability Insurance Scheme (NDIS) will provide people with individual funding with which to purchase services such as therapy from private providers. This study developed a framework to support rural private therapists to meet the anticipated increase in demand. Method:The study consisted of three stages utilizing focus groups, interviews and an online expert panel. Participants included private therapists delivering services in rural New South Wales (n = 28), disability service users (n = 9) and key representatives from a range of relevant consumer and service organizations (n = 16). We conducted a thematic analysis of focus groups and interview data and developed a draft framework which was subsequently refined based on feedback from stakeholders. Results:The framework highlights the need for a ‘rural-proofed’ policy context in which service users, therapists and communities engage collaboratively in a therapy pathway. This collaborative engagement is supported by enablers, including networks, resources and processes which are influenced by the drivers of time, cost, opportunity and motivation. Conclusions:The framework identifies factors that will facilitate delivery of high-quality, sustainable, individualized private therapy services for people with a disability in rural Australia under the NDIS and emphasizes the need to reconceptualize the nature of private therapy service delivery.Implications for RehabilitationRural private therapists need upskilling to work with individuals with disability who have individual funding such as that provided by the Australian National Disability Insurance Scheme.Therapists working in rural communities need to consider alternative ways of delivering therapy to individuals with disability beyond the traditional one-on-one therapy models.Rural private therapists need support to work collaboratively with individuals with disability and the local community.Rural private therapists should harness locally available and broader networks, resources and processes to meet the needs and goals of individuals with disability. [ABSTRACT FROM PUBLISHER]