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This article is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee and provides educators recommendations for optimizing inclusive education for our students with disabilities. Medical educators are increasingly encountering students with disabilities and have the responsibility of ensuring requirements are met. Medical education committee members from the US and Canada reviewed the literature on disabilities in medical student education to identify best practices and key discussion points. An iterative review process was used to determine the contents of an informative paper. Medical schools are required to develop technical standards for admission, retention, and graduation of their students to practice medicine safely and effectively with reasonable accommodation. A review of the literature and obstetrics and gynecology expert opinion formed a practical list of accommodation strategies and administrative steps to assist educators and students. Medical schools must support the inclusion of students with disabilities. We recommend a collaborative approach to the interactive process of determining reasonable and effective accommodations that includes the students, a disability resource professional and faculty as needed. Recruiting and supporting medical students with a disability strengthens the diversity commitment and creates a more inclusive workforce. Medical School Education Medical schools have the responsibility to train a diverse physician workforce including those with disabilities. The integration of students with disabilities is important and should be done in a structured and timely manner that maximizes the individual's abilities and incorporates reasonable accommodations in the clinical learning environment. Though the definition of disability traverses a wide variety of diagnoses, this review highlights sensory and physical disabilities and the various accommodations to facilitate access and successful completion of required objectives. [ABSTRACT FROM AUTHOR]

The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada. Tracking the details of activity-based therapy (ABT) sessions and programs across the continuum of care and injury trajectory may provide important information to support the development of ABT practice guidelines and implementation strategies. Tracking objective and subjective parameters are needed to provide a comprehensive description of an ABT session and program. Clinicians and individuals with spinal cord injury or disease (SCI/D) should both be able to track ABT to accommodate all settings and types of data. Digital tracking tools, such as an app, may provide an accessible, versatile and efficient way of tracking ABT. [ABSTRACT FROM AUTHOR]

Purpose: Employment participation offers benefits including income, sense of accomplishment, social engagement, and meaningful contribution to society. Rates of competitive employment of youth with disabilities are amongst the lowest in society, despite having capacity and motivation to participate in the workplace. The marginalization of young workers with disability presents a lost opportunity for youth, potential employers, and social care systems. In order to engage young people with disabilities in employment, we present an integrated, community-based model for employment participation preparation. Materials and methods: The employment participation pathway model is based on best available evidence and 15 years of program delivery for youth with disabilities preparing to transition out of school and into employment in the Canadian context. It was conceptualized using the Knowledge to Action framework and presented for consideration in the current paper. Results: Starting early, taking a person-directed approach to planning, and considering the individual and our systems contribute to effective and comprehensive transition to employment. Conclusions: The employment participation model provides evidence and examples for service providers to consider integrating into their repertoire and begin to construct similar pathways to equip their clients and families with skills, capacities, and knowledge as they journey towards workplace participation. [ABSTRACT FROM AUTHOR]

Purpose:In this paper, we have sought to stimulate a critical dialog regarding the ways in which disability has been largely conceptualized and studied in literature addressing age-related vision loss (ARVL). We suggest an expansion of this largely biomedically informed research area to include alternative frameworks, namely critical disability perspectives. Method:To demonstrate the potential contributions of adopting a critical disability approach to enhance understandings of ARVL, this article outlined the primary tenets of the biomedical and social models of disability; the key aims, emphases, and assumptions of critical disability perspectives; and provided examples of how such an approach would lead to new research foci in the study of ARVL. Results:The paper highlighted four qualities of critical disability perspectives that future ARVL research should ascribe to, including (a) a focus on interdependence over traditional notions of independence; (b) a broader conceptualization of 'normalcy'; (c) the influence of language as a means of describing or labeling disabled persons; and (d) the influence of the socio-political environment in the creation and sustainment of disability. Conclusions:This paper encouraged the incorporation of critical disability perspectives to provide new ways of conceptualizing, researching, writing about, and practicing in relation to ARVL. Implications for RehabilitationThe application of critical disability perspectives to expand the boundaries of low vision research can broaden low vision rehabilitation services (LVRS) in ways that more effectively attend to environmental features shaping and perpetuating disability for clients with age-related vision loss (ARVL).Low vision research, informed by critical disability perspectives, would inform a shift away from the exclusive focus on independence towards an acknowledgment of interdependence.The integration of participatory research approaches in ARVL research could generate new insights to inform rehabilitation by enhancing space and respect for the stories and knowledge of older adults aging with vision loss.Greater attention in low vision rehabilitation should be paid to how older adults’ experiences of disability are tied to both the environmental context in which they exist and by the limitations caused by their impairment. [ABSTRACT FROM AUTHOR]

Purpose:In this paper we examine how the intersection of various social and political influences shapes discharge planning and rehabilitation practices in ways that may not meet the espoused aims of rehabilitation programs or the preferences of older adults and their families. Methods:Taking a critical bioethics perspective, we used microethnographic case study methods to examine discharge-planning processes in a well-established older adult inpatient rehabilitation setting in Canada. The data included observations of discharge-planning family conferences and semi-structured interviews conducted with older adults facing discharge, their family members and rehabilitation professionals involved in discharge planning. Results:From the time of admission, a contextual push to focus on discharge superseded program aims of providing interventions to increase older adults’ functional capabilities. Professionals’ primary commitment to safety limited consideration of discharge options and resulted in costly and potentially unnecessary recommendations for 24-hour care. The resulting “rehabilitation” stay was more akin to an extended process of “destination triage” biased towards the promotion of physical safety than optimizing functioning. Conclusions:The resulting reduction of rehabilitation into “destination triage” has significant social, financial and occupational implications for older adults and their families, and broader implications for healthcare services and overarching healthcare systems. Implications for RehabilitationCurrent trends promoting consideration of discharge planning from the point of admission and prioritizing physical safety are shifting the focus of rehabilitation away from interventions to maximize recovery of function, which are the stated aims of rehabilitation.Such practices furthermore promote assessments to determine prognosis early in the rehabilitation stay when accurate prognosis is difficult, which can lead to overly conservative recommendations for discharge from rehabilitation services, thus further negating the impact of rehabilitation.Further work is required to examine the social, occupational and functional implications of superseding rehabilitation interventions to maximize capabilities with practices that prioritize safety over quality of life for older adults and their family members. [ABSTRACT FROM PUBLISHER]

Purpose:In Canada, two counseling services are offered to facilitate physical activity participation among persons with physical disabilities, yet both have encountered concerns related to the recruitment and retainment of clients. The purpose of this paper is to explore factors related to service adoption among nonusers, and the barriers and facilitators to maintaining service participation among adopters. Methods:Individuals who had never enrolled in the services (nonusers,n = 13) as well as current/previous service clients (adopters,n = 26) participated in interviews based on the Theoretical Domains Framework. Transcripts were subjected to deductive thematic analysis according to participant group. Results:Fifteen themes relating to service adoption within 10 of the 12 theoretical domains were identified for nonusers, while 23 themes relating to maintenence of service participation were identified across all 12 theoretical domains for adopters. Conclusions:The findings provide strategies to improve recruitment, adoption, and retention of clients in counseling services and to enhance the experiences of targeted service users. Implications for RehabiliationPeer support and education for equipment use should be built into physical activity programs to encourage participation among persons with physical disabilities.Programs that encourage physical activity among individuals with disabilities should be designed by practitioners to be responsive to a variety of needs, which are addressed in the program’s advertisements and offerings.The Theoretical Domains Framework is a useful framework for providing valuable insight about clients’ experiences of adoption and maintenance of a behavior change service, suggesting merit in other rehabilitation settings. [ABSTRACT FROM PUBLISHER]

Purpose : The purpose of this paper is to offer a descriptive framework to analyse the participation of people with disabilities in policy advocacy over the past 20 years. Methods : The study used a qualitative research design to describe and analyse organizations participating in policy advocacy on behalf of people with disabilities in Canada between 1981 and the present. Data for the study were assembled through interviews with key informants who had participated in three policy cases: the Charter of Rights and Freedoms, 1982 (federal); the Canada Clause of the Charlottetown Accord, 1991 (federal); the Ontario Consent to Treatment, Advocacy and Substitute Decision-making bills, 1993-1995 (provincial). For each of the three cases, key informants were identified who could report with authority on the participation of individuals or groups representing people with disabilities. Interviews with key informants were conducted by the investigators, transcribed and coded to produce five dimensions along which advocates described their organizations. Results : Three ideological dimensions were identified to describe organizations representing people with disabilities: purpose, tactics, and view of disability. Two practical dimensions were also identified: membership and resources. Each of these dimensions is described in detail with quotes from the interviews to illustrate. Discussion and conclusions : These five dimensions result in a descriptive framework for discussion and comparison of organizational characteristics of advocacy organizations representing people with disabilities. Further, the framework affords a vehicle for discussion of the relative success of policy participation on issues affecting the lives of people with disabilities. [ABSTRACT FROM AUTHOR]

This study explored the feasibility, impact and parent experiences of ENVISAGE (ENabling VISions And Growing Expectations)-Families, a parent-researcher co-designed and co-led program for parents/caregivers raising children with early-onset neurodisabilities. Parents/caregivers of a child with a neurodisability aged ≤6 years, recruited in Australia and Canada, participated in five weekly online workshops with other parents. Self-report measures were collected at baseline, immediately after, and 3 months post-ENVISAGE-Families; interviews were done following program completion. Quantitative data were analyzed with generalized estimating equations and qualitative data using interpretive description methodology. Sixty-five parents (86% mothers) were recruited and 60 (92%) completed the program. Strong evidence was found of effects on family empowerment and parent confidence (all p ≤ 0.05 after the program and maintained at 3-month follow-up). The ENVISAGE-Families program was relevant to parents' needs for: information, connection, support, wellbeing, and preparing for the future. Participants experienced opportunities to reflect on and/or validate their perspectives of disability and development, and how these perspectives related to themselves, their children and family, and their service providers. ENVISAGE was feasible and acceptable for parent/caregivers. The program inspired parents to think, feel and do things differently with their child, family and the people who work with them. ENVISAGE (ENabling VISions And Growing Expectations)-Families is a co-designed, validated parent/researcher "early intervention and orientation" program for caregivers raising a child with neurodevelopmental disabilities (NDDs). ENVISAGE-Families empowered parents' strengths-based approaches to their child, family, disability, and parenting. ENVISAGE-Families increased caregivers' confidence in parenting children with NDD's and provided them tools to support connection, collaboration, and wellbeing. Raising children with NDD can have a profound impact on caregivers, who can benefit from strengths-based, future focused supports early in their parenting experience. [ABSTRACT FROM AUTHOR]

This study modelled the factor structure and tested for measurement invariance between youth and parent reports on the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0; estimated agreement between informants; and, examined moderators of youth-parent discrepancies. Data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117). Multiple-group confirmatory factor analysis was used to test for measurement invariance and Wilcoxon signed-rank tests compared informant scores. Intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement plots were used to examine the youth-parent agreement. The WHODAS 2.0 demonstrated measurement invariance [χ2 = 221.8(136), p < 0.01; RMSEA = 0.073 (0.055, 0.091); CFI = 0.962; and, SRMR = 0.078]. Youth typically reported more disability compared to parent proxies, with the exception of item Q5 (emotional). The agreement was low (ICC = 0.08–0.53). Youth sex moderated informant agreement such that more consistent agreement was seen for female youth (β = 0.54, p <.01) compared to male youth (β = 0.11, p =.29). Youth and their parents interpret the construct of disability, as measured by the 12-item WHODAS 2.0, similarly. Thus, informant differences represent real differences that are not a consequence of error. Low parent-youth agreement reinforces the need for collecting multiple perspectives in the pediatric setting, especially for male youth. The WHODAS 2.0 is one of the most widely used measures of disability and functioning. Measurement invariance of the WHODAS 2.0 suggests that youth and parents interpret the construct of disability similarly. Parent-youth agreement was low and youth typically report more disability compared to parent proxies. More consistent agreement with parents was found for female youth compared to male youth. [ABSTRACT FROM AUTHOR]

This study investigated the psychometric properties of the 12-item proxy-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in young children with chronic physical illness in Canada. Data come from the Multimorbidity in Youth across the Life-course, a longitudinal study of Canadian youth with physical illnesses (n = 263). Baseline parent-reported data from children (2–9 years, n = 143) and adolescents (10–16 years, n = 117) were analyzed. Wilcoxon's tests examined differences in WHODAS 2.0 scores between subgroups. Internal consistency was estimated, and confirmatory factor analysis modeled the WHODAS 2.0 factor structure. Regression modeling examined if the WHODAS 2.0 could discriminate between children with vs. without mental comorbidity. Differences were found between children and adolescents regarding self-care and getting along, and for the item on emotional affect. Inter-item correlations were similar between subgroups and internal consistency was strong for children (α = 0.90) and adolescents (α = 0.93). The factor structure of the WHODAS 2.0 was confirmed; parameter estimates were similar between subgroups. The association between mental comorbidity and disability did not differ by age – comorbidity was associated with greater disability (β = 5.87, p < 0.01). The 12-item proxy-administered WHODAS 2.0 appears valid and reliable in young children with physical illness and can be used in this population. The 12-item proxy-administered WHODAS 2.0 has acceptable inter-item correlations and internal consistency in young Canadian children with chronic physical illness, and its factor structure is consistent with previous reports Expansion of its use in measuring disability in young children provides the opportunity to use the WHODAS 2.0 across the life-course, facilitating the interpretation of changes in disability over time or in response to treatment Additional research is needed to determine responsiveness to change and the minimal clinically important difference of the WHODAS 2.0 in this population [ABSTRACT FROM AUTHOR]

People with disabilities experience concerning rates of ableism and are significantly under-represented within healthcare education and professions. Focusing on healthcare professions is important for enhancing the diversity and inclusion of equity-deserving groups within the workforce. The objective of this review was to explore the experiences and impact of workplace discrimination and ableism among healthcare providers and trainees with disabilities. Systematic searches of seven databases from 2000 to January 2022 were conducted. Five reviewers independently applied the inclusion criteria, extracted the data and rated the study quality. 48 studies met our inclusion criteria, representing 13,815 participants across six countries over a 21-year period. The findings highlighted rates and types of workplace ableism, which occurred at the institutional (i.e., inaccessible environments, physical barriers and unsupportive work environments) and individual level (i.e., negative attitudes, bullying, harassment). The impact of ableism on healthcare providers included difficulty disclosing due to fear of stigma, and effects on well-being and career development. Our findings revealed a critical need for more research on the experiences of ableism amongst healthcare providers and the impact it has on their well-being. Further efforts should explore mechanisms for including and welcoming people with disabilities in healthcare professions. Workplace ableism is prevalent in health care professions and could be discouraging people with disabilities from entering or completing health care education and training, leading to an under-representation of this equity-deserving group within health care. More efforts are needed to recruit, retain and support people with disabilities in the health care workforce. Health care providers who have a disability often experience workplace discrimination and inaccessible physical environments which can impact their health and well-being. Managers, senior leadership and health care organizations should advocate for improved social inclusion of employees with disabilities. [ABSTRACT FROM AUTHOR]

The objectives of this study were to translate the Pain Self-Efficacy Questionnaire (PSEQ) into Canadian French (PSEQ-F) and to evaluate its validity, reliability and responsiveness in a French-Canadian sample of patients with persistent rotator cuff related shoulder pain (RCRSP). Translation and cross-cultural adaptation of the original English version of the PSEQ into Canadian French were performed according to standard procedures. Thereafter, 78 adults with RCRSP completed the PSEQ-F on three occasions: baseline, 2 days later to evaluate the reliability and 6 weeks later to evaluate responsiveness. Cross-cultural adaptation was performed without problems with content or language. The PSEQ-F was found to be reliable (Intraclass Correlation Coefficient = 0.96; Minimal Detectable Change = 3 points [5%]), valid (moderate correlations with an abbreviated version of Disability of the Arm, Shoulder and Hand [QuickDASH] and Brief Pain Inventory [BPI] Questionnaires) and responsive (Standardized Response Mean = 0.96; Effect Size = 0.81; Minimal Clinically Important Difference = 6 points [10%]). The PSEQ-F is a reliable, valid and responsive questionnaire that can be used to assess pain self-efficacy in French-speaking individuals with RCRSP. Further studies should use a self-efficacy-specific Global Rating of Change scale to estimate its responsiveness more thoroughly. Higher levels of pain self-efficacy have been associated with increased odds of symptom resolution in those with persistent rotator cuff related shoulder pain (RCRSP). The Pain Self-Efficacy Questionnaire (PSEQ) has been identified as the most frequently used tool by clinicians to assess pain self-efficacy in patients at risk of developing persistent musculoskeletal pain. The Canadian French version of the PSEQ (PSEQ-F) is a reliable, valid and responsive questionnaire that can be used to assess pain self-efficacy in French-speaking individuals with RCRSP. [ABSTRACT FROM AUTHOR]

Dystonia is a neurological disorder characterised by involuntary muscle contractions. Pain is the primary non-motor symptom, and limited studies have investigated how dystonic pain is experienced. This study aimed to investigate how people with isolated dystonia describe their pain and compare across subgroups of dystonia. Anonymous online survey via social media asking participants to describe their pain in their own words, complete the McGill Pain Questionnaire (MPQ), and answer demographic questions. Thematic analysis identified common themes and frequencies were calculated for demographic and MPQ data. One-hundred and sixty-five respondents were included (mean age 51 years, 85% female). Thematic analysis identified four major themes "Physical sensations", "Temporal features", "Destruction", "Impact on life" with several sub-themes. The most chosen MPQ descriptor was "exhausting" followed by "tight," "sharp," "pulling," and "aching". The most common descriptors showed similar prevalence across subgroups of dystonia. As no objective tests for pain exist, pain sufferers must use language to describe their pain experience. People with isolated dystonia used sensory words combined with metaphorical language to detail temporal features of pain, as well as destructive internal battles or feelings of external forces acting upon them, and the significant toll pain has on everyday life. Pain is a common and debilitating non-motor symptom for people living with dystonia and should be discussed in a persons treatment plan. Pain sufferers use language to discuss their pain experience with others and report they don't feel well understood by others including health professionals. People with dystonic pain commonly described physical sensations, temporal features, destructive forces, and the impact on life caused by their pain. Findings suggest the experience of pain with dystonia is varied and better pain management options for people with dystonia are needed. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to determine the effects of hearing disability on employment rates; examine how various factors are associated with employment; and identify workplace accommodations available to persons with hearing disabilities in Canada. Material and methods: A population-based analysis was done using the data collected through the 2017 Canadian Survey on Disability (CSD), representing 6 million (n = 6 246 640) Canadians. A subset of the complete dataset was created focusing on individuals with a hearing disability (n = 1 334 520). Weighted descriptive and multivariate logistic regression analyses were performed. Results: In 2017, the employment rates for working-age adults with a hearing disability were 55%. Excellent general health status (OR: 3.37; 95% CI: 2.29–4.96) and daily use of the internet (OR: 2.70; 95% CI: 1.78–4.10) had the highest positive effect on the employment rates. The top three needed but least available accommodations were communication aids (16%), technical aids (19%), and accessible parking/elevator (21%). Conclusion: Employment rates for persons with a hearing disability are lower than the general population in Canada. Employment outcomes are closely associated with one's general health and digital skills. Lack of certain workplace accommodations may disadvantage individuals with a hearing disability in their employment. People with severe hearing disabilities and those with additional disabilities may need additional and more rigorous services and supports to achieve competitive employment. It is important for the government to improve efforts toward inclusive education and develop strategies that promote digital literacy for job seekers with hearing disabilities. Officials concerned with implementing employment equity policies in Canada should focus on finding strategies that enable employees to have supportive conversations with their employers regarding disability disclosure and obtaining required accommodations. [ABSTRACT FROM AUTHOR]

There is a lack of high-quality evidence about the effects of exercise or physical activity interventions for adults with lower limb amputations (LLAs). A planning meeting involving stakeholders (i.e., people with LLA, community advocates, health care providers, researchers) was organized to identify key research priorities related to exercise and physical activity for people with LLAs. We used a collaborative prioritized planning process with a pre-meeting survey and 2-day virtual meeting that included: identification and prioritization of challenges or gaps; identification and consolidation of solutions; and action planning. This process integrated a modified Delphi approach, including anonymous feedback in two surveys. Thirty-five stakeholders participated. Six challenges related to exercise and physical activity for people with LLA were prioritized. One solution was prioritized for each challenge. After consolidation of solutions, participants developed five research action plans for research including: developing an on-line interface; developing and evaluating peer-support programs to support physical activity; examining integration of people with LLA into cardiac rehabilitation; development and evaluation of health provider education; and determining priority outcomes related to physical activity and exercise. This collaborative process resulted in an action plan for amputation research and fostered collaborations to move identified priorities into action. Lower limb amputations impact mobility leading to lower levels of physical activity. There are research gaps in our understanding of the effects of exercise or physical activity interventions for adults with lower limb amputations. Through a collaborative planning process, participants prioritized research directions on physical activity and exercise for people with LLA to advance research in the field. Action plans for research focused on developing online resources, peer support, cardiac rehabilitation for people with LLA, health provider education and determining priority outcomes related to physical activity and exercise. [ABSTRACT FROM AUTHOR]

To establish consensus regarding principles that should be used to guide spinal cord injury (SCI) research partnerships between researchers and research users. A three-round Delphi consensus exercise was carried out with researchers and/or research users involved in one or more SCI research partnerships. Participants considered a list of 125 partnership principles. In rounds 1 and 2, participants rated their agreement that a principle should guide SCI research partnerships on an 11-point Likert scale. After each round, principles that received a mean score of ≥8.0 or 70% of participants rated the principle ≥8.0 were retained. In round 3, participants categorized principles as essential, desirable, irrelevant, or unsure. At least 20 individuals participated in each round. In round 1, 103 principles met consensus criteria and eight principles were added. In round 2, 93 principles met the criteria. In round 3, 29 principles were categorized as essential and eight as desirable. Recommended principles focused on the interpersonal, relational, and logistical aspects of partnerships. Principles that did not reach consensus related to social justice and actionable impact. Findings provide insight into 37 principles that could be used to combat tokenism and inform future guidance to meaningfully engage partners in SCI research. Consensus-based research partnership principles (i.e., norms or beliefs) were identified and could be prioritized to help support spinal cord injury (SCI) researchers and research users combat tokenism and meaningfully engage research users as partners in the co-creation of knowledge. The resulting list of recommended research partnership principles was used to inform the development of guidance to support quality partnerships between SCI researchers and research users within and outside the rehabilitation context (). Guidance supporting meaningful research partnerships may accelerate the time between discovery and use of research in practice. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore how parents support the health behaviours of their child with a disability, and their motivations for registering their child in a health promotion program for children with physical and/or intellectual disabilities. Using a descriptive qualitative design, semi-structured face-to-face interviews were conducted with individual parents (n = 8) and one group (n = 3) to explore their experiences of health promotion for their child with a disability. Data were analyzed using thematic analysis to identify themes and patterns to develop an understanding of parental perspectives. Three themes were identified in the analysis of parents' experiences supporting their children in health behaviours and registering them in a disability health promotion program: (1) Parents struggle to meet all of their child's health promotion needs; (2) Parents recognize the social components of healthy behaviours; and (3) Health promotion opportunities tailored for children with disabilities are limited. These themes were not mutually exclusive and had overlapping factors that influenced parental experiences. Parents experience many challenges supporting the health behaviours of their children with disabilities. This study reinforces the need for accessible, developmentally appropriate, social health promotion programs for children with disabilities. Children with disabilities frequently demonstrate significantly higher sedentary behaviours, lower rates of physical activity and consumption of high-fat foods than their typically developing peers. Promoting healthy behaviours such as healthy eating and physical activity among children with disabilities and their families is therefore crucial to the child's physical and psychosocial wellbeing. Parents of children with disabilities have sufficient health literacy and knowledge but report a lack of appropriate opportunities and strategies to support their child in developing healthy behaviours. Parents need increased availability and accessibility of socially inclusive programs that promote healthy behaviours for children of all physical and cognitive abilities. [ABSTRACT FROM AUTHOR]

Validate the factor structure and establish internal consistency reliability of the French-Canadian version of the Mayo-Portland Adaptability Inventory (MPAI-4), using a Canadian sample of adults with traumatic brain injury (TBI) receiving post-acute rehabilitation services. Psychometric analysis of French-Canadian MPAI-4 data from TBI adults (N = 1012) who received rehabilitation interventions and for whom a first French-Canadian MPAI-4 measure was completed between 2016 and 2020. Exploratory factor analysis was used to evaluate the factor structure of the French-Canadian MPAI-4. The final and best solution revealed three factors, which accounted for 48.68% of the variance. Using Cronbach's alpha, all subscales showed good internal consistency (all 0.70 ≤ α ≤ 0.89). Reference norms for the TBI sample are provided, as well as descriptive raw data according to sex, age, TBI severity and rehabilitation setting. The French-Canadian MPAI-4 factor structure is validated. The three factors extracted are similar to the three subscales of the original MPAI-4. The questionnaire shows good psychometric properties and represents a suitable tool for TBI adults receiving rehabilitation services in a French-Canadian context. The provided reference norms will also help guide the clinical use of the MPAI-4 in French-Canadian TBI populations. The MPAI-4 questionnaire measures functional abilities, global outcome and community integration following traumatic brain injury (TBI). The questionnaire can be used in inpatient, outpatient and vocational rehabilitation settings to assess TBI patients' progress and outcomes, plan interventions and evaluate the effect of rehabilitation. The French-Canadian version of the MPAI-4 is validated and suitable to be used in French-Canadian post-acute TBI rehabilitation settings. [ABSTRACT FROM AUTHOR]

The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation. We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre- and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively. All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT (p ≤ 0.004). Qualitative findings highlighted that theory-based toolkit features and implementation strategies likely facilitated engagement with toolkit components, contributing to observed improvements in PTs' knowledge, attitudes, skill, self-efficacy, and clinical practice. The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity. Toolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations. Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach. This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation. Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke. [ABSTRACT FROM AUTHOR]

Sexual health, a basic human right, maybe disrupted after a spinal cord injury (SCI) and is often not addressed in rehabilitation. This quality improvement initiative embedded sexual health education and support for patients with SCI into clinical practice. In 2017–2018 a team of clinicians, researchers and persons with SCI developed and implemented a new sexual health practice in SCI rehabilitation. A systematic process was undertaken which included implementation science principles; the PLISSIT model and Sexual Rehabilitation Framework were foundational to the new practice. Adult inpatients with SCI began receiving the sexual health practice in June 2018. After 6 months, patient and health care provider surveys were conducted. Patients reported increased awareness of sexual health resources and increased satisfaction with sexual health concerns being addressed. Clinicians reported increased comfort in addressing patients' sexual health concerns and increased awareness of sexual health resources. Embedding the new sexual health practice facilitates the reintegration of sexual health into the daily lives of SCI patients and supports a more comprehensive and holistic rehabilitation. It normalizes sexual health concerns and questions in an SCI rehabilitation facility. Sexual health is noted to be a top priority among persons with spinal cord injury, however, this area of care is often overlooked by healthcare providers across the rehabilitation continuum. A team of clinicians, researchers, and persons with SCI used a systematic process to address this gap by developing and implementing a new sexual health practice in the SCI rehabilitation program. This quality improvement initiative resulted in increased clinician knowledge and confidence in this domain of practice and greater patient satisfaction in having their sexual health needs to be addressed during rehabilitation. [ABSTRACT FROM AUTHOR]

Rehabilitation clinicians need information about patient activities in the home/community to inform care. Despite active efforts to develop technologies that can meet this need, clinicians' perspectives regarding how information is collected and used in outpatient rehabilitation have not been comprehensively described. Therefore, we aimed to describe: (1) what data pertaining to a patient's health, function and activity in their home/community are currently collected in outpatient rehabilitation, (2) how these data can impact clinical decisions, and (3) what challenges clinicians encounter when they manage the care of outpatients based on this information. Eight clinicians working in outpatient rehabilitation programs completed qualitative interviews that were analyzed using an inductive thematic analysis. Four themes were identified: "Nature of data about a patient's health, function and activity in the home/community and how it is collected by clinicians," "Value of data from the home/community," "Perceived drawbacks of current data collection methods," and "Improving data collection to understand patient trajectory." Clinicians described the importance of understanding patient activities in the home/community, but perspectives varied regarding the suitability of current methods. These perceptions may inform the design of solutions to bridge the gap between the clinic and the community in outpatient rehabilitation. Clinical decision-making in outpatient rehabilitation is guided by verbal and written reports about a patient's health and function in the community and adherence to treatment plans. Differing perceptions on the suitability of current data collection methods indicate that the development of new solutions, such as rehabilitation technologies, needs to carefully consider clinician workflows and what data are perceived as meaningful. Potentially impactful directions for new solutions include providing well validated data on adherence, movement quality, or longitudinal progression, presented in formats that match clinical decision criteria. [ABSTRACT FROM AUTHOR]

We explored the experiences of working-age and older adults with acquired vision impairment who pursued braille rehabilitation training, and the facilitators and barriers they encountered throughout this process. Semi-structured interviews of up to 90 min in length were conducted with 14 participants from across Canada who learned braille between the ages of 33 and 67 (Mdn = 46). Transcripts were analyzed by two researchers using interpretive phenomenological analysis. A variety of personal, social and institutional factors characterize the adult braille learning experience. Among these, participants highlight the role of prior identity and experience, the impact of access to resources and the cost of materials and devices needed to maintain braille skills. Findings also emphasize invisible barriers, including the role of societal perceptions towards braille, the level of support provided by family and friends, and the influence of unconscious biases towards braille and aging held by both adult learners and those around them. These findings provide important context to improve policies and practice in adult braille rehabilitation. As the prevalence of age-related vision impairment continues to increase, it will become imperative to understand the unique needs of working-age and older adults with acquired vision impairment who pursue braille. This study is one of the first to explore the experiences of working-age and older adults with acquired visual impairment who pursue braille rehabilitation training. Rehabilitation professionals must take into account prior learning and reading experiences which may shape the braille learning process. Family members require greater access to resources and support during the training process. There is a significant need for public education to address societal misconceptions about braille and blindness that can lead to a reluctance to use braille. Interactions with other braille users foster more empowering definitions of braille that align with the social model understanding of disability. [ABSTRACT FROM AUTHOR]

To examine household income trajectories of children with and without neurodisability over a period of 6 years. We used four cycles of the Canadian National Longitudinal Survey of Children and Youth, a longitudinal study of the development and well-being of Canadian children from birth into adulthood. While household income increased over time for both groups, families of children with neurodisability had consistently lower household income compared to families of children without neurodisability even after controlling for child and family socio-demographic characteristics. The presence of an interaction effect between parent work status and child with neurodisability at baseline indicated that among children whose parent(s) were not working at baseline, household incomes did not differ between children with and without neurodisability. The association between child with neurodisability and lower household income may not hold for all types of parents', working status is an important consideration. Findings support the health selection hypothesis that health status shapes diverging economic conditions over time: children with a ND have lower household incomes than children without a ND child across all waves of the Canadian National Longitudinal Survey of Youth. Income gaps did not increase or decrease over time; rehabilitation services and policies must consider the lower average incomes associated with raising a child with a ND. Social assistance support likely plays a key role in closing the gap, especially for non-working families. [ABSTRACT FROM AUTHOR]

Lower limb exoskeletons are a recent intervention promoted to improve gait disorders. Available research has focused on clinical outcomes; however, little is known about therapists' experiences using the device in practice. We explored the implementation of an exoskeleton at a tertiary rehabilitation center. In this longitudinal qualitative study we conducted semi-structured interviews with 10 therapists. One group of therapists was formally trained using the device, whereas the other group only had clinical exposure to the device. The interviews were transcribed, coded, and analyzed for themes. Three main themes emerged: (1) A steep learning curve described challenges in learning to use the exoskeleton. (2) One step at a time illustrated the complex process of incorporating the exoskeleton in daily work. (3) Not a magic bullet revealed the tensions using this emergent technology in practice. The exoskeleton represents one of the most complicated and labor-intensive interventions provided by therapists. Implementation requires substantial resources, raising questions regarding its efficacy and cost-effectiveness relative to other approaches. Until more evidence becomes available around the use and effectiveness of this rapidly evolving technology, therapists must contend with a high degree of uncertainty. Using a lower limb exoskeleton may reduce physical demands on therapists in high-intensity rehabilitation programs that involve repetitive, effortful movements. However, a number of potential barriers to implementing the exoskeleton into practice need to be taken into consideration, including calibration time, intensive training required to become qualified to administer the intervention, the cost of the device, and comfort and safety of the device affecting user acceptance and uptake. Therapists also need to manage patient expectations related to outcomes related to use of exoskeletons. [ABSTRACT FROM AUTHOR]

The focus of this scoping review was to identify the extent, range, and nature of studies that have been published regarding community integration programs and interventions that support people during the transition home from hospital following spinal cord injury. Four electronic databases and one search engine were searched for articles published between 2010 and 2020. Grey literature and manual searches were also done. Of the 16 articles included, 8 were published in peer-reviewed journals. Two of these did not include an evaluation. Study designs included but were not limited to pilot studies (n = 2); mixed methods evaluations (n = 2); single-site randomized controlled trials (n = 3); and, non-randomized single-arm study design (n = 1). The articles were from the United States (n = 12), Canada (n = 2), Australia (n = 1), and the United Kingdom (n = 1). The majority of interventions focused on addressing health-related educational needs, followed by community mobility. Goal setting and promoting self-efficacy were identified as important components, and the importance of involvement of people with lived experience was also highlighted. There was a lack of focus on management of relationships, including addressing sexuality needs. This review highlights the need for further empirical evaluation of implemented programs and interventions in this area, particularly in countries other than the USA, to inform service development. Successful community integration is an important outcome of spinal cord injuries rehabilitation. The majority of published programs focus on health-related educational needs, followed by community mobility. It is recommended that goal setting and promoting self-efficacy are included in programs. It is recommended that people with lived experience of spinal cord injuries are involved in interventions. It is recommended that programs include a focus on management of relationships, including addressing sexuality needs. [ABSTRACT FROM AUTHOR]

To identify current practices related to the assessment, monitoring and discussion of bodyweight, growth and obesity in neuromuscular clinics for children with Duchenne muscular dystrophy (DMD). A cross-sectional, online survey was distributed using snowball sampling to healthcare providers working with children with DMD across Canadian neuromuscular clinics. Summary and descriptive statistics were calculated. Content analysis was performed on open text responses. Thirty-seven responses were received, representing a range of healthcare disciplines. Height and weight were routinely assessed by 32/37 (87%) respondents, although only 21/37 (57%) responses reported having a clinic standard for measuring height and 23/37 (62%) for weight. While 32/36 (89%) reported discussing weight during consultations, only 13/37 (35%) felt confident doing so. Dietitians were considered the most appropriate person to discuss and manage weight with children and families, although only 17/37 (46%) reported having a dietitian involved in their clinic. Neuromuscular clinics could benefit from implementing consistent and recommended growth assessment practices. The development of evidence-based tools, training and protocols tailored to Duchenne muscular dystrophy should be a priority. Growth and weight monitoring approaches vary within and between neuromuscular clinics. Additional training on discussing and managing weight are warranted across disciplines. Advocacy is required to ensure access to dietetic expertise within neuromuscular clinics. [ABSTRACT FROM AUTHOR]

Research has yet to examine the experiences of paddle boarders, or of kayakers with disabilities other than spinal cord injuries. The goal of this study was to explore the experiences of kayakers and paddle boarders in two adaptive paddling programs. Participants were children and adults requiring physical, cognitive, and/or psychosocial supports. Using an ethnographic approach, participant observations (n = 24) and semi-structured interviews (n = 11) were completed. Data were analyzed thematically. We identified three main themes. "Different Strokes" described the personal meaning participants ascribed to aspects of paddling, including valuing fun, exercise and relaxation. "Turning the Tide" illustrated the process of becoming a paddler, from doubting capacity to feeling competent. "Headwinds" explored paddlers' interactions with the broader social, institutional, and economic environments, such as inadequate funding and program aversion to risk. Programs offering a variety of adaptive paddle boarding and kayaking configurations enable paddlers to make valued choices about their participation. In addition to providing equipment and support to meet paddlers' functional abilities, program developers and clinicians should also consider individual preferences for exercise, socialization, risk taking, self-presentation of disability, and independence. People living with physical, cognitive, and/or psychosocial impairments perceive kayaking and paddle boarding as meaningful activities offering opportunities to exercise, have fun, achieve goals, socialize, and/or relax on the water. Kayakers and paddle boarders value equipment options that meet their physical and disability-disclosure preferences. Despite the existence of adaptive paddling programs, participation may be restricted by program availability, risk management policies, and leisure funding. [ABSTRACT FROM AUTHOR]

Compared to other patient population groups, the field of amputation research in Canada lacks cohesion largely due to limited funding sources, lack of connection among research scientists, and loose ties among geographically dispersed healthcare centres, research institutes and advocacy groups. As a result, advances in clinical care are hampered and ultimately negatively influence outcomes of persons living with limb loss. To stimulate a national strategy on advancing amputation research in Canada, a consensus-workshop was organized with an expert panel of stakeholders to identify key research priorities and potential strategies to build researcher and funding capacity in the field. A modified Delphi approach was used to gain consensus on identifying and selecting an initial set of priorities for building research capacity in the field of amputation. This included an anonymous pre-meeting survey (N = 31 respondents) followed by an in-person consensus-workshop meeting that hosted 38 stakeholders (researchers, physiatrists, surgeons, prosthetists, occupational and physical therapists, community advocates, and people with limb loss). The top three identified research priorities were: (1) developing a national dataset; (2) obtaining health economic data to illustrate the burden of amputation to the healthcare system and to patients; and (3) improving strategies related to outcome measurement in patients with limb loss (e.g. identifying, validating, and/or developing outcome measures). Strategies for moving these priorities into action were also developed. The consensus-workshop provided an initial roadmap for limb loss research in Canada, and the event served as an important catalyst for stakeholders to initiate collaborations for moving identified priorities into action. Given the increasing number of people undergoing an amputation, there needs to be a stronger Canadian collaborative approach to generate the necessary research to enhance evidence-based clinical care and policy decision-making. Limb loss is a growing concern across North America, with lower-extremity amputations occurring due to complications arising from diabetes being a major cause. To advance knowledge about limb loss and to improve clinical care for this population, stronger connections are needed across the continuum of care (acute, rehabilitation, community) and across sectors (clinical, advocacy, industry and research). There are new surgical techniques, technologies, and rehabilitation approaches being explored to improve the health, mobility and community participation of people with limb loss, but further research evidence is needed to demonstrate efficacy and to better integrate them into standard clinical care. [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 investigate client (youth/caregiver) and service provider engagement in outpatient pediatric rehabilitation therapy sessions. In an ethnographic study, five research assistants attended 28 outpatient sessions, mostly delivered by occupational, physical, and speech-language therapists, and rated signs of client, provider, and relational engagement using the Pediatric Rehabilitation Intervention Measure of Engagement – Observation version. Post-session interviews were conducted individually with 13 youth, 15 caregivers, and 26 providers. Overall, there was a moderate to great extent of engagement. Provider engagement was rated as higher than client engagement, particularly in sessions with activities focusing on body structure/function. The interviews indicated associations among engagement-related constructs: (a) expectations influenced engagement/disengagement and therapy progress, (b) engagement was associated with positive affect and relationships, and (c) engagement was strongly associated with relationships and collaboration. Engagement is a central process within a complex system of psychosocial constructs operating in therapy. Engagement is emergent, synergistic, and change-inducing – it emanates from, involves, and influences multiple aspects of therapy. Notably, engagement ties two pivotal elements – positive expectations and positive affect – to positive relationships, collaboration, and therapy progress. Implications for practice include an understanding of how providers manage the therapeutic context and work to foster engagement. Engagement, and its various elements, plays a central role in shaping how clients, parents, and clinicians value therapeutic encounters. Optimal therapy is often thought to include engagement, relationships, and collaboration; the importance of therapy expectations, positive affect, and perceptions of progress are frequently overlooked. Engagement and motivation may be maximized when youth and caregivers are asked explicitly about how they view their engagement in therapy. In addition to clarifying and aligning expectations with youth and caregivers, service providers can enhance engagement and motivation by intentionally creating enjoyable and meaningful interactions, developing relationships, negotiating consensus on goals and plans, and demonstrating therapy progress. Service providers can harness engagement and the system of related constructs by listening and communicating effectively, by entering the world of the client and family, and by being aware of, anticipating, and responding to engagement and disengagement. [ABSTRACT FROM AUTHOR]

To conduct a mixed methods, pre-post, retrospective study on the feasibility, acceptability, and effectiveness of the LoveYourBrain Yoga program. People were eligible if they were a traumatic brain injury survivor or caregiver, age 15–70, ambulatory, and capable of gentle exercise and group discussion. We analyzed attendance, satisfaction, and mean differences in scores on Quality of Life After Brain Injury Overall scale (QOLIBRI-OS) and four TBI-QOL/Neuro-QOL scales. Content analysis explored perceptions of benefits and areas of improvement. 1563 people (82.0%) participated ≥1 class in 156 programs across 18 states and 3 Canadian provinces. Mean satisfaction was 9.3 out of 10 (SD 1.0). Mixed effects linear regression found significant improvements in QOLIBRI-OS (B 9.70, 95% CI: 8.51, 10.90), Resilience (B 1.30, 95% CI: 0.60, 2.06), Positive Affect and Well-being (B 1.49, 95% CI: 1.14, 1.84), and Cognition (B 1.48, 95% CI: 0.78, 2.18) among traumatic brain injury survivors (n = 705). No improvement was found in Emotional and Behavioral Dysregulation, however, content analysis revealed better ability to regulate anxiety, anger, stress, and impulsivity. Caregivers perceived improvements in physical and psychological health. LoveYourBrain Yoga is feasible and acceptable and may be an effective mode of community-based rehabilitation. People with traumatic brain injury and their caregivers often experience poor quality of life and difficulty accessing community-based rehabilitation services. Yoga is a holistic, mind-body therapy with many benefits to quality of life, yet is largely inaccessible to people affected by traumatic brain injury in community settings. Participants in LoveYourBrain Yoga, a six-session, community-based yoga with psychoeducation program in 18 states and 3 Canadian provinces, experienced significant improvements in quality of life, resilience, cognition, and positive affect. LoveYourBrain Yoga is feasible and acceptable when implemented on a large scale and may be an effective mode of, or adjunct to, community-based rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: Although relatively unknown within the field of rehabilitation, qualitative longitudinal research is ideal for rehabilitation and disability research that aims to understand health-related challenges over time. We describe the strengths and challenges of longitudinal qualitative research using two concrete examples. Materials and methods: Qualitative longitudinal research often involves in-depth interviews of participants on multiple occasions over time. Analytic approaches are complex, summarizing data both cross-sectionally and longitudinally. We present two detailed analytic approaches used in research with people living with HIV in Zambia and Canada. Results: Our experiences provide three recommendations. First, development of the initial analytic coding framework should include both inductive and deductive approaches. Second, given the large quantity of data generated through longitudinal qualitative research, it is important to proactively develop strategies for data analysis and management. Third, as retention of participants is challenging over time, we recommend the use of a consistent interviewer over the duration of the study to promote a trusting relationship. Conclusions: Longitudinal qualitative research has much to offer researchers and can provide clinicians with insights on the challenges of living with chronic and episodic disability. The flexibility in analytic approaches allows for diverse strategies to best address the rehabilitation and disability research questions and allow for insights into living with disability over time. [ABSTRACT FROM AUTHOR]

Purpose: To establish proof-of-concept of a novel rehabilitation self-management program that aims to optimize walking recovery after stroke through engaging patients in independent walking-related practice outside of supervised physiotherapy sessions. Materials and Methods: The Independent Mobility-related Physical ACTivity (IMPACT) Program is a coach-supported intervention that uses self-management strategies to empower patients to engage in additional autonomous walking-related activities after stroke during and after inpatient rehabilitation. The aim of this study was to assess whether implementation of this intervention would be associated with targeted patient behaviors; goal setting, negotiation and completion of a walking-related practice plan outside of formal therapy sessions. Using a pre-intervention/post-intervention design, the Independent Mobility-related Physical Activity program was implemented with a convenience sample of 10 adults (mean age 62.3; SD 11.7 years) within an inpatient stroke rehabilitation unit (mean stroke onset 25.3 [SD 10.5] days). Results: All participants were able to set a personal goal, negotiate an autonomous walking-related activity practice plan, and partially or completely adhere to that plan. Patients completed an average of 36 min/day of practice outside of supervised physiotherapy, practicing on weekdays and weekend days. All patients indicated that the Independent Mobility-related Physical Activity program helped them increase their activity, and indicated they would continue to practice walking-related activities beyond the coaching period. The IMPACT program is a feasible self-management strategy to facilitate walking-related practice outside of supervised therapy time during inpatient stroke rehabilitation. Patients were able to engage in goal-setting and practice plan development with support of a therapist-coach. Patients who are able to stand and walk with minimal assist were able to practice walking-related activities outside of formal therapy sessions. Therapists may benefit from specific training and support to adopt self-management strategies into practice. [ABSTRACT FROM AUTHOR]

Purpose: Persons with a developmental disability have the lowest rate of labour force participation relative to other disabilities. The widening gap between the labour force participation of persons with versus without disability has been an enduring concern for many governments across the globe, which has led to policy initiatives such as labour market activation programs, welfare reforms, and equality laws. Despite these policies, persistently poor labour force participation rates for persons with developmental disabilities suggest that this population experiences pervasive barriers to participating in the labour force. Materials and methods: In this study, a two-phase qualitative research design was used to systematically identify, explore and prioritize barriers to employment for persons with developmental disabilities, potential policy solutions and criteria for evaluating future policy initiatives. Incorporating diverse stakeholder perspectives, a Nominal Group Technique and a modified Delphi technique were used to collect and analyze data. Results: Findings indicate that barriers to employment for persons with developmental disabilities are multi-factorial and policy solutions to address these barriers require stakeholder engagement and collaboration from multiple sectors. Conclusions: Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities. Policy and decision makers need to address barriers to employment for persons with developmental disabilities more holistically by designing policies considering employers and the workplace, persons with developmental disabilities and the broader society. Findings call for cross-sectoral collaboration using a Whole of Government approach. Persons with a developmental disability face lower levels of labour force participation than any other disability group. Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities. Decision and policy makers need to address barriers to employment for persons with developmental disabilities holistically through policies guiding employers and broader societal behaviour in addition to those aimed at the individuals (such as skill development or training). Due to multi-factorial nature of barriers to employment for persons with developmental disabilities, policy solutions are wide-ranging and fall under the responsibility of multiple sectors for implementation. This calls for cross-sectoral collaboration using a "Whole of Government" approach, with shared goals and integrated responses. [ABSTRACT FROM AUTHOR]

Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers. Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis. Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community. Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation. Traumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitation Yoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community level Participants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefits Group-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors [ABSTRACT FROM AUTHOR]

Purpose: A family-centered approach to developmental rehabilitation services emphasizes that children grow and develop in their family environment, and that parents are an integral part of therapy. The purpose of this study was to develop a theory of how parents attend, participate and engage in their child's developmental rehabilitation services. Methods: A constructivist grounded theory study was conducted. Recruitment was done at a single children's treatment center in Ontario, Canada and data collection included parent and clinician interviews, policy collection and child-health record review. Grounded theory methods of constant comparison and theoretical sampling were applied. Credibility was enhanced through reflexivity, triangulation, and peer debriefing. Results and conclusions: The results show that in order to understand how parents engage in therapy, we must understand the conditions related to family health and service complexity that affect parent engagement. This contextual understanding may increase service providers' sensitivity to the conditions that affect engagement as they join families on their journey towards child health and happiness. Service providers can understand the ease or difficulty that parents may experience in attending, participating and engaging in their child's therapy if they ask about (i) who is a part of the family, (ii) the health of all family members, and (iii) the number of services and professionals that are involved with the family Asking parents about their own mental health and ensuring they are connected with appropriate resources may help them to attend, participate and engage in their child's rehabilitation service. When families are involved with multiple services and professionals, they may benefit from support with service navigation and a collaborative interprofessional approach to care. [ABSTRACT FROM AUTHOR]

Background: The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (MIDVAQ) is the Canadian–French adaptation of the Melbourne Low-Vision ADL Index. It measures performance, personal importance and handicap situation in 16 instrumental activities requiring near vision (standardized material, part A) and in 9 self-care and domestic activities (self-report questionnaire, part B). This study aimed at measuring the MIDVAQ reliability and its relationship with measures of visual functions and functional vision. Methods: The MIDVAQ was administered twice to 100 visually impaired participants, at home, with their personal visual and non-visual aid. A second rater was present at T1. Two different versions of part A were used alternately at T1 and T2. Results: The total Handicap scale demonstrates good internal reliability (Cronbach's alpha coefficient = 0.82) and very high inter-rater and test-retest reliability (ICCs = 1.00 and 0.86). Part A alternative versions are highly comparable. Vision function measures are significantly correlated with total Handicap score, for which 48% of the variance is explained by functional vision estimates, age, and education. Conclusions: The MIDVAQ is highly valid and reliable. It can be useful to measure the functional impact of the visual impairment, its progression, and the outcomes of low vision rehabilitation services. Even if administered at home in an ecological way, this measure of the impact of the visual impairment in daily activities is very reliable. Given its good metric properties, this tool can be confidently used to assess the functional impact of visual impairment, outcomes of the low vision rehabilitation services, etc. This measurement tool provides complementary information to those obtained from clinical measures of visual functions, by reflecting the interaction between the functional abilities with the requirements of the environment. [ABSTRACT FROM AUTHOR]

Purpose: To describe the change in spatiotemporal gait asymmetry after discharge from stroke rehabilitation and examine the relationship with change in other clinical outcome measures. Methods: Secondary analysis of a prospective cohort study was conducted. Swing time and step length symmetry, balance, mobility, gait speed, and motor impairment were assessed at discharge and 6 months later. Participants (n = 61) were classified by shift in symmetry status (Asymmetric-to-Symmetric, Symmetric-to-Asymmetric, No Shift) and magnitude of difference scores (Improved, Worse, No Difference). Correlations between change in spatiotemporal symmetry and the other clinical measures of physical status were calculated. Results: At discharge, 61% (37/61) and 36% (22/61) of participants were asymmetric in swing time and step length, respectively. Of this subgroup, 43% (16/37) and 50% (11/22) shifted to symmetric gait by follow-up. In contrast, only six individuals significantly improved in swing and/or step symmetry according to minimal detectable change. Change in spatiotemporal symmetry was not significantly correlated with change in the clinical outcome measures. Conclusions: Despite overall gains in physical function and decreased prevalence of asymmetry, most individuals with stroke do not improve in swing or step symmetry following discharge from rehabilitation. Further research is necessary to elucidate factors that affect recovery of gait quality. Asymmetric gait after stroke is a major concern for patients and their therapists but can be resistant to intervention. Spatiotemporal asymmetry persists for many individuals following discharge from hospital stay despite improvement in other gait-related measures. While the determinants of change remain unclear, gait quality should be specifically monitored and addressed to avoid long-term negative effects. [ABSTRACT FROM AUTHOR]

Introduction: Overweight and obesity (OW/OB) rates are increasing among Canadian children and youth, with rates currently affecting one-third of 5–17 year olds. OW/OB is associated with numerous physical and psychosocial consequences, which are compounded when a child has a pre-existing disability. This is concerning considering children with disabilities experience OW/OB at two to three times the rate of their typically developing peers. While the number of weight management programs have been increasing, they are generally designed to meet the needs of typically developing children and often exclude children with disabilities. This review identifies existing weight management programs for youth with disabilities, and examines their characteristics and outcomes. Methods: A scoping review was conducted using rapid review principles. Three health and social science databases were searched using terms related to "disabilities", "obesity", and "weight management", limited to 2007–2017. Articles meeting the inclusion criteria were summarized and analyzed thematically. Results: Five articles met inclusion criteria, and described four separate weight management programs. All included children and youth with intellectual disabilities, with one including children with physical disabilities. Programs had three traits in common: (1) utilizing inter/multidisciplinary teams; (2) using technology to deliver the program; and (3) engaging the family during the entire program. All articles reported that the programs reduced body mass index. Conclusion: The scarcity of programs designed to meet the unique needs of youth with disabilities is alarming. Although a robust evidence base is lacking, current research provides some directions into components that should be considered when designing future interventions. 1. Clinicians should be aware of the high prevalence of overweight and obesity and the resultant consequences in children with disabilities. 2. The use of inter/multidisciplinary teams, technology, and family engagement all appear to be promising approaches to creating successful weight management programs: a. Weight-management programs should utilize inter/multidisciplinary teams to consider physical, social and psychological aspects of weight and health, to allow treatment plans to encompass a wider range of suggestions and recommendations. b. Health care providers should consider using technology as a platform to deliver weight-management programs and services and/or to directly track progress. c. Families are powerful agents of change, and should be consulted and involved in the delivery of weight-management programs. [ABSTRACT FROM AUTHOR]

Purpose: Workers who are injured or become ill on the job are best able to return-to-work when stakeholders involved in their case collaborate and communicate. This study examined health care providers' and case managers' engagement in rehabilitation and return-to-work following workplace injury or illness. Method: In-depth interviews were conducted with 97 health care providers and 34 case managers in four Canadian provinces about their experiences facilitating rehabilitation and return-to-work, and interacting with system stakeholders. Results: A qualitative thematic content analysis demonstrated two key findings. Firstly, stakeholders were challenged to collaborate as a result of: barriers to interdisciplinary and cross-professional communication; philosophical differences about the timing and appropriateness of return-to-work; and confusion among health care providers about the workers' compensation system. Secondly, these challenges adversely affected the co-ordination of patient care, and consequentially, injured workers often became information conduits, and effective and timely treatment and return-to-work was sometimes negatively impacted. Conclusions: Communication challenges between health care providers and case managers may negatively impact patient care and alienate treating health care providers. Discussion about role clarification, the appropriateness of early return-to-work, how paperwork shapes health care providers' role expectations, and strengthened inter-professional communication are considered. Administrative and conceptual barriers in workers' compensation systems challenge collaboration and communication between health care providers and case managers. Injured workers may become conduits of incorrect information, resulting in adversarial relationships, overturned health care providers' recommendations, and their disengagement from rehabilitation and return-to-work. Stakeholders should clarify the role of health care providers during rehabilitation and return-to-work and the appropriateness of early return-to-work to mitigate recurring challenges. Communication procedures between health care specialists may disrupt these challenges, increasing the likelihood of timely and effective rehabilitation and return-to-work. [ABSTRACT FROM AUTHOR]

Purpose: This study described how the Dutch and Canadian governments promote high performance sports, recreational sports, and physical activity (PA) among adults with disabilities on a national level. Methods: An internet-based study was conducted to identify and select relevant documents and websites containing information about the national approach to promote disability sports and physical activities in the Netherlands and Canada. Results: Both governments promote high performance sports in similar ways, but use different strategies to promote recreational sports and physical activities. The Dutch approach is characterized by using time-limited programs focusing on enhancement of sports infrastructure and inter-sector collaboration in which municipalities have key roles. The Canadian government promotes recreational sports in disabled populations by supporting programs via bilateral agreements with provinces and territories. Furthermore, the level of integration of disability sports into mainstream sports differs between countries. Conclusions: The findings of this study may inspire policy makers from different countries to learn from one another's policies in order to optimize national approaches to promote disability sports and PA on all levels. It is recommended for policy makers of national governments to develop and implement policy programs that promote sports and physical activities among people with disabilities because of its potential impact on functioning, participation, quality of life, and health. Insight into national approaches to promote sport and physical activities is relevant for rehabilitation practice to understand ongoing opportunities for people with disabilities to stay physically active after rehabilitation through participation in home and/or community-based sport and physical activities. It seems worthwhile to integrate activities to promote sport and physical activities in rehabilitation in such a way that it fits with the current governmental approach. It is recommended to set up international collaborations to develop and share knowledge about effective and sustainable national approaches to promote sports and physical activities among people with disabilities. [ABSTRACT FROM AUTHOR]

Background: Hemineglect, defined as a failure to attend to the contralesional side of space, is a prevalent and disabling post-stroke deficit. Conventional hemineglect assessments lack sensitivity as they contain mainly non-functional tasks performed in near-extrapersonal space, using static, two-dimensional methods. This is of concern given that hemineglect is a strong predictor for functional deterioration, limited post-stroke recovery, and difficulty in community reintegration. With the emerging field of virtual reality, several virtual tools have been proposed and have reported better sensitivity in neglect-related deficits detection than conventional methods. However, these and future virtual reality-based tools are yet to be implemented in clinical practice. Objectives: The present study aimed to explore the barriers/facilitators perceived by clinicians in the use of virtual reality for hemineglect assessment; and to identify features of an optimal virtual assessment. Methods: A qualitative descriptive process, in the form of focus groups, self-administered questionnaire and individual interviews was used. Results: Two focus groups (n = 11 clinicians) were conducted and experts in the field (n = 3) were individually interviewed. Several barriers and facilitators, including personal, institutional, client suitability, and equipment factors, were identified. Clinicians and experts in the field reported numerous features for the virtual tool optimization. Conclusion: Factors identified through this study lay the foundation for the development of a knowledge translation initiative towards an implementation of a virtual assessment for hemineglect. Addressing the identified barriers/facilitators during implementation and incorporating the optimal features in the design of the virtual assessment could assist and promote its eventual adoption in clinical settings. Implications for rehabilitation: A multimodal and active knowledge translation intervention built on the presently identified modifiable factors is suggested to be implemented to support the clinical integration of a virtual reality-based assessment for post-stroke hemineglect. To amplify application and usefulness of a virtual-reality based tool in the assessment of post-stroke hemineglect, optimal features identified in the present study should be incorporated in the design of such technology. [ABSTRACT FROM AUTHOR]

Purpose: Compared to groups with other disabilities, people with a severe mental illness face the greatest stigma and barriers to employment opportunities. This study contributes to the understanding of the relationship between workplace social support and work productivity in people with severe mental illness working in Social Enterprises by taking into account the mediating role of self-stigma and job tenure self-efficacy. Method: A total of 170 individuals with a severe mental disorder employed in a Social Enterprise filled out questionnaires assessing personal and work-related variables at Phase-1 (baseline) and Phase-2 (6-month follow-up). Process modeling was used to test for serial mediation. Results: In the Social Enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems. When testing serial multiple mediations, the specific indirect effect of high workplace social support on work productivity through both low internalized stigma and high job tenure self-efficacy was significant with a point estimate of 1.01 (95% CI = 0.42, 2.28). Conclusions: Continued work in this area can provide guidance for organizations in the open labor market addressing the challenges posed by the work integration of people with severe mental illness. Implications for Rehabilitation:: Work integration of people with severe mental disorders is difficult because of limited access to supportive and nondiscriminatory workplaces. Social enterprise represents an effective model for supporting people with severe mental disorders to integrate the labor market. In the social enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems. [ABSTRACT FROM AUTHOR]

Purpose: Systemic sclerosis or scleroderma is a chronic, rare connective tissue disease with negative physical and psychological implications. Coping strategies used by scleroderma patients have not been studied in-depth. The objective of the present study was to gain a greater understanding of the coping strategies employed by people living with scleroderma. Method: Three semi-structured focus group discussions were conducted with a total of 22 people with scleroderma. Interviews were recorded, transcribed, and analyzed using content analysis. Coping strategies discussed were analyzed through Lazarus and Folkman’s theoretical model of coping, including: (1) problem-focused, (2) emotion-focused, and (3) meaning-focused coping. Results: Participants reported using a combination of problem-focused (e.g., professional help; seeking disease-related information), emotion-focused (e.g., social support; adaptive distraction techniques), and meaning-focused coping strategies (e.g., benefit finding; goal reappraisal) to help them to cope with and manage their disease. However, many patients reported having difficulty in accessing support services. Conclusions: Scleroderma patients use similar coping strategies as patients with more common diseases, but they may not have access to the same level of support services. Accessible interventions, including self-management programs, aimed at improving problem- and emotion-focused coping are needed. Further, increased access to support groups may provide patients with opportunities to obtain social support and enhance coping. [ABSTRACT FROM AUTHOR]

Purpose: It has been argued that social security disability assessments should directly assess claimants’ work capacity, rather than relying on proxies such as on functioning. However, there is little academic discussion of how such assessments could be conducted. Method: The article presents an account of different models of direct disability assessments based on case studies of the Netherlands, Germany, Denmark, Norway, the United States of America, Canada, Australia, and New Zealand, utilising over 150 documents and 40 expert interviews. Results: Three models of direct work disability assessments can be observed: (i) structured assessment, which measures the functional demands of jobs across the national economy and compares these to claimants’ functional capacities; (ii) demonstrated assessment, which looks at claimants’ actual experiences in the labour market and infers a lack of work capacity from the failure of a concerned rehabilitation attempt; and (iii) expert assessment, based on the judgement of skilled professionals. Conclusions: Direct disability assessment within social security is not just theoretically desirable, but can be implemented in practice. We have shown that there are three distinct ways that this can be done, each with different strengths and weaknesses. Further research is needed to clarify the costs, validity/legitimacy, and consequences of these different models. Implications for rehabilitation: It has recently been argued that social security disability assessments should directly assess work capacity rather than simply assessing functioning - but we have no understanding about how this can be done in practice. Based on case studies of nine countries, we show that direct disability assessment can be implemented, and argue that there are three different ways of doing it. These are “demonstrated assessment” (using claimants’ experiences in the labour market), “structured assessment” (matching functional requirements to workplace demands), and “expert assessment” (the judgement of skilled professionals). While it is possible to implement a direct assessment of work capacity for social security benefits, further research is necessary to understand how best to maximise validity, legitimacy, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: To understand the awareness of sedentary behavior, as well as the perceived facilitators and barriers to reducing sedentary behaviors from the perspectives of patients undertaking an exercise-based cardiac rehabilitation program, and from staff involved in supporting patient self-management. Materials and methods: A qualitative study was conducted at a large cardiac rehabilitation program in a metropolitan city in Canada. Guided by an ecological framework, semi-structured interviews were conducted individually with 15 patients, and in two focus groups with six staff. Transcribed interviews were analyzed by thematic analysis. Results: Patients placed little importance on reducing sedentary behavior as they were unconvinced of the health benefits, did not perceive themselves to be sedentary, or associated such behaviors with enjoyment and relaxation. While staff were aware of the risks, they saw them as less critical than other health behaviors. Intrapersonal factors (physical and psychosocial health) and environment factors (the information environment, socio-cultural factors) within leisure time, the home, and work, influenced sedentary behavior. Conclusions: While these findings require further testing, future interventions may be effective if aimed at increasing awareness of the health benefits of reducing sedentary behavior, utilizing existing behavior change strategies, and using a participatory approach to tailor strategies to patients. [ABSTRACT FROM AUTHOR]

Objective: To compare workers with and without disabilities on their reported workplace hazard exposure and the presence of occupational health and safety vulnerability factors. Methods: Working-aged adults in Ontario or British Columbia were recruited to participate in a cross-sectional survey (n = 1988). Self-reported measures included demographic factors, work-related variables, perceived level of activity limitation at work, and presence of work safety vulnerability factors utilizing a novel framework. Results: Reporting a disability at work was significantly associated with greater hazard exposure than those without a disability. In addition, those reporting a disability at work were more likely to be employed in conditions where hazard exposure was combined with inadequate policies and procedures, or hazard exposures were combined with inadequate empowerment. Conclusions: Work safety vulnerability is one way that health inequalities can be perpetuated even among those with disabilities who have found work. Our results suggest that employers and policy makers need to focus on assessing and addressing hazard exposures and targeting occupational health and safety resources in the workplace in a way that includes workers with disabilities. [ABSTRACT FROM AUTHOR]

Introduction:This study aimed at exploring the perceived benefits and drawbacks of practicing tai chi, an alternative therapy that can be implemented in the community, as part of upper-limb rehabilitation following stroke. Methodology:Semistructured interviews were carried out with participants with chronic stroke (>6 months). The participants took part in 16 tai chi sessions over 8 weeks. Interviews were conducted in person using an interview guide based on the theory of planned behavior (TPB), and a thematic analysis was conducted. Results:Eight interviews were carried out with participants at various stages of motor recovery. Participants perceived a number of physical, functional, and psychological benefits. They found tai chi to be a global exercise, including both physical and mental aspects, and suggested that it can be included as part of rehabilitation for stroke patients. Many participants expressed a desire to continue practicing tai chi after completion of the study because it exceeded their expectations, among other reasons. Conclusion:This study can serve to guide future tai chi interventions and research on tai chi for rehabilitation in terms of the characteristics of the intervention and the various areas to assess in order to measure the overall benefits.IMPLICATIONS FOR REHABILITATIONTai chi was perceived as a good way of integrating various skills learned during rehabilitation.Despite having different functional abilities, all the participants noted various physical, functional, and psychological benefits from participating in the tai chi sessions.Tai chi seems to be a form of exercise that stroke patients would perform more long-term since all the participants in this study expressed the desire to continue practicing tai chi. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study was to determine if time to claim closure was similar to time to self-reported recovery in a no fault motor vehicle collision insurance system. Method: A prospective cohort of traffic injured adults with a whiplash-associated disorder (WAD) was assembled. We excluded participants who applied for benefits after 42 days of the collision, who were in hospital for more than two days and participants who were not followed up at least once after their injury. Questionnaires were completed at baseline, six weeks, three-, six-, nine- and 12-months after the collision. Results: The mean age of the cohort was 39 years and 66% were female. The mean number of days until claim closure and for self-reported recovery was 291days and 134 days, respectively. We found those who had their claim closed at each follow-up period had lower levels of disability and were more likely to report they were recovered than participants with open claims. Conclusion: We conclude that time to claim closure could be used as an outcome measure in traffic collision; however, this measure should be used with caution since it over-estimates the true time to recovery. Time to claim closure as an outcome measure for whiplash-associated disorders has been criticized in the literature because it is thought that closure is not reflective of the health status of the individual. We found that claim closure was associated with lower levels of disability, but the time to claim closure was significantly longer than the time to self-reported recovery. Time to claim closure may be used with caution as a "proxy" measure of recovery from an injury; however, it must be noted that it over-estimates the true time of recovery [ABSTRACT FROM AUTHOR]

Purpose:To test a model of child, family and service determinants of participation in family and recreational activities for young children with cerebral palsy (CP). Methods:Participants were a convenience sample of 429 children (242 males) with CP, aged 18 to 60 months, representing all levels of the Gross Motor Function Classification System (GMFCS). Children were divided into two groups by GMFCS levels, levels I to II and levels III to V. Data on impairments and gross motor function were collected by therapists; parents provided information about children’s health conditions and adaptive behaviour. Seven months later, parents reported on family life and services received. One year after the beginning of the study, parents reported their children’s participation. Data from the two groups of children were analysed separately using structural equation modelling. Results:The model explained 35% and 40% of the variance of frequency of participation in family and recreation and 28% and 38% of enjoyment in participation, for the two groups of children, respectively. Children’s adaptive behaviour, family ecology, and number of community recreational programs were associated with the frequency of participation for both groups. Gross motor function was only associated with the frequency of participation for children in levels III–V. Adaptive behaviour was associated with enjoyment for both groups. The extent services met children’s needs was associated with enjoyment for children in levels I to II and family ecology was a determinant of enjoyment for children in levels III to V. Conclusion:Supporting children’s adaptive behaviour, family ecology, and access to community recreational programmes may foster participation in family and recreational activities for young children with CP.Implications for RehabilitationParticipation in family and recreational activities for young children with CP is complex and influenced by child, family and environmental factors.Practitioners are encouraged to support children’s adaptive behaviour and access to community programs and family relationships, involvement in community activities and expectations of their children.Optimizing gross motor function for children who have limitations in self-mobility may enhance their participation in family and recreational activities.For children with a good prognosis for walking, providing services perceived by parents to meet their children’s needs may enhance children’s enjoyment of participation. [ABSTRACT FROM PUBLISHER]