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The relationship between race, disability and criminality is complex and poorly understood. Scant information, and lack of action, exists on how to best keep Indigenous people with disability out of the justice system, and support this cohort while in the system. This systematic scoping review collates grey and peer-reviewed literature in Australia, Aotearoa (New Zealand), the United States and Canada, to gain insight into the current practices in place for justice-involved Indigenous people with disability, and list promising principles which may inform future practice. We identified 1,301 sources, and 19 of these met the inclusion criteria. Across these sources, nine key principles emerged: need for Indigenous designed, led and owned approaches; appropriately identify and respond to disability/needs; appropriate court models; appropriate diversionary options; therapeutic, trauma-informed, strengths-based and agency-building responses; facilitate connection to family, community and support networks; break down communication barriers; protect human rights; and provide post-release support. Points of interest: Internationally, Indigenous people with disability are over-repre.sented in criminal justice systems. The reasons for this are complex and not well understood. Existing evidence suggests that long-lasting effects of colonisation; discrimination on the basis of race and disability; problems identifying and reporting disability; and lack of proper services contribute to this issue. Often, criminal justice systems do not recognise or support a person's disability until they reach crisis point. There is a critical need for culturally-appropriate and disability-appropriate interventions, such as diagnostic tools; training programs for police, correctional officers and other service providers; community court models; and more accessible communication. There is some evidence that Indigenous-led programs – involving country, culture, art, social connection and holistic healing – help prevent Indigenous people with disability from entering and re-entering justice systems. More research and evaluation is needed to determine how to better support Indigenous people with disability in contact with the justice system. [ABSTRACT FROM AUTHOR]

Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation. Australian and New Zealand-based therapists with lower limb exoskeleton experience were recruited to complete an online survey and semi-structured interview. Survey data were transposed into tables and interviews transcribed verbatim. Qualitative data collection and analysis were guided by qualitative content analysis and interview data were thematically analysed. Five participants revealed that the use of exoskeletons to deliver therapy involves the interplay of human elements – experiences and perspectives of use, and mechanical elements – the device itself. Two overarching themes emerged: the "journey", with subthemes of clinical reasoning and user experience; and the "vehicle" with design features and cost as subthemes, to explore the question "Are we there yet?" Therapists expressed positive and negative perspectives from their experiences with exoskeletons, giving suggestions for design features, marketing input, and cost to enhance future use. Therapists are optimistic that this journey will see lower limb exoskeletons integral to rehabilitation service delivery. Further innovation of design features, marketing, and cost are needed to enhance ongoing development and integration. Routine clinical implementation of lower limb exoskeletons is unlikely at this time in Australia and New Zealand. Therapists do expect lower limb exoskeletons to have an ongoing role in future rehabilitation. [ABSTRACT FROM AUTHOR]

There is limited evidence on the costs and outcomes of patients with aphasia after stroke. The aim of this study was to estimate costs in patients with aphasia after stroke according to the aphasia therapies provided. A three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment trial conducted in Australia and New Zealand. Usual ward-based care (Usual Care) was compared to additional usual ward-based therapy (Usual Care Plus) and a prescribed and structured aphasia therapy program in addition to Usual Care (the VERSE intervention). Information about healthcare utilization and productivity were collected to estimate costs in Australian dollars for 2017–18. Multivariable regression models with bootstrapping were used to estimate differences in costs and outcomes (clinically meaningful change in aphasia severity measured by the WAB-R-AQ). Overall, 202/246 (82%) participants completed follow-up at 26 weeks. Median costs per person were $23,322 (Q1 5,367, Q3 52,669, n = 63) for Usual Care, $26,923 (Q1 7,303, Q3 76,174, n = 70) for Usual Care Plus and $31,143 (Q1 7,001. Q3 62,390, n = 69) for VERSE. No differences in costs and outcomes were detected between groups. Usual Care Plus was inferior (i.e. more costly and less effective) in 64% of iterations, and in 18% was less costly and less effective compared to Usual Care. VERSE was inferior in 65% of samples and less costly and less effective in 12% compared to Usual Care. There was limited evidence that additional intensively delivered aphasia therapy within the context of usual acute care provided was worthwhile in terms of costs for the outcomes gained. [ABSTRACT FROM AUTHOR]

Previous literature has applied system-focused structures to understand the success of First Nations Peoples' nutrition and exercise group programmes. Existing system-focused measures have included biomedical outcomes, access and service utilization. By broadening the focus of programme success beyond the system, we can evaluate programmes from a First Nations Peoples' lifeworld perspective. Critical hermeneutics and yarning using a lens of Habermas' Theory of Communicative Action to the literature has the potential to transform understandings of "success" in First Nations Peoples' nutrition and exercise group programmes. In this literature interpretation, we explored the critical success factors from a lifeworld perspective, giving scope to go beyond a system perspective to include a cultural, social or personal perspective. Our yarning led us to understand that there is a communicative relationship between explicit system structures and implicit lifeworld concepts that are critical success factors for First Nations nutrition and exercise group programmes. We have developed a set of reflective questions to guide others in considering a lifeworld perspective. Our findings represent a shift away from success measured by the dominant power structure to respect the lifeworld culture, knowledges and values of First Nations Peoples towards shared understanding and mutual decision-making. [ABSTRACT FROM AUTHOR]