Search

The COVID-19 pandemic restrictions have been associated with increased social isolation and reduced participation in older adults. This longitudinal qualitative study drew on life course theory to analyse data from a series of four sequential semi-structured interviews conducted between May 2020–February 2021 with adults aged 65+ ( n = 12) to explore older adults’ experiences adjusting to the COVID-19 pandemic. We identified three themes: (1) Struggling ‘You realize how much you lost’ describes how older adults lost freedoms, social connections and activities; (2) Adapting ‘whatever happens, happens, I’ll do my best’, revealing how older adults tried to maintain well-being, participation and connection; and (3) Appreciating ‘enjoy what you have’, exploring how older adults found pleasure and contentment. Engagement in meaningful activities and high-quality social interactions supported well-being during the COVID-19 pandemic for older adults. This finding highlights the need for policies and services to promote engagement during longstanding global crises.

Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.

Background Our research team developed a mobile application (app) to facilitate health-related self-management behaviors for secondary conditions among individuals with spinal cord injury (SCI). To facilitate mobile app adoption and ongoing use into the community, it is important to understand potential users’ expectations and needs. Objectives The primary objective of this study was to explore user expectations of a mobile app intervention designed to facilitate self-management behavior among individuals with SCI. Methods Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a six-phase process of thematic analysis. Results Our analysis identified three main themes for expectations of the mobile app intervention. The first theme, desiring better health outcomes, identified participants’ expectation of being able to improve their psychological, behavioral, and physical health outcomes and reduce associated secondary conditions. The second theme, wanting to learn about the mobile app’s potential, identified participants’ interest in exploring the functionality of the app and its ability to promote new experiences in health management. The third theme, desiring greater personal autonomy and social participation, identified participants’ desire to improve their understanding of their health and the expectation for the app to facilitate social engagement with others in the community. Conclusion By exploring end-users’ expectations, these findings may have short-term effects on improving continued mobile health app use among SCI populations and long-term effects on informing future development of mobile app interventions among chronic disease populations.

Study design Non-randomized crossover trial. Objectives The objective of this study was to assess the oxygen uptake during exercise using the Adapted ROWing machine (AROW) compared to the more commonly used Arm Crank Ergometry (ACE) for people with spinal cord injury/disease (SCI/D) with or without trunk stability. Setting Canada, Vancouver. Methods Participants were from a convenience sample of 14 adults with SCI/D (age 21–63 y) which include those with lumbar to low cervical impairments currently exercising at least once per week using cardiovascular exercise equipment at our Physical Activity Research Centre. The interventions were non-randomized steady-state exercise bouts at self-selected low and moderate workloads on the AROW and ACE for 5 min each. Our primary outcomes were the rate of oxygen consumption (mL/kg/min) and the Borg 0–10 Rating Scale of Perceived Exertion (RPE). Results A repeated measures two-way ANOVA (p

Purpose To explore the experience and acceptability of an exoskeleton-based physiotherapy program for non-ambulatory patients during subacute stroke rehabilitation from the perspective of patients and therapists. Materials and methods This was a qualitative descriptive study using semi-structured interviews and thematic analysis. Fourteen patients with stroke who participated in the experimental arm of a randomized controlled trial investigating the efficacy of exoskeleton-based physiotherapy were recruited. Six physiotherapists who provided the intervention were also recruited. Results Three themes were identified relating to the experience and acceptability of an exoskeleton-based physiotherapy program: (1) A matter of getting into the swing of things depicted the initial and ongoing learning process of using an exoskeleton; (2) More of a positive experience than anything else described the participants' mostly favorable attitude toward exoskeleton-based gait training; and (3) The best step forward captured participant-identified recommendations and considerations for the future integration of exoskeleton training into stroke rehabilitation. Conclusions Patients with stroke were even more optimistic than therapists toward the experience and benefits of exoskeleton-based gait training during subacute stroke rehabilitation. Future clinical practice should consider the balance between actual and perceived benefits, as well as the potential barriers to integrating an exoskeleton into stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONPowered robotic exoskeletons can be used to provide higher duration and more repetitious walking practice for non-ambulatory patients with stroke.Patients with stroke view exoskeleton-based physiotherapy highly favorably, attributing greater opportunity and benefit to using the device during subacute rehabilitation.Physiotherapists should consider learning challenges, patient characteristics, and implementation barriers when integrating exoskeleton-based training within a treatment program.

Background Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke. Methods An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke ( Results Thirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported. Conclusions This study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes. Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016)

Objective We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments. Design Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale and self-reported functional independence scale. Participants The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 years, 53% were female, 52% lived alone and were functionally independent with the use of assistive technology. Results We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments. Conclusions Age is associated with psychosocial outcomes for assistive device users and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.

Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of "living in a reshaped reality" was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) "there's nothing that's the same" highlighted the daily challenges individuals faced post-injury, (2) "rebuilding and restarting" described how individuals with TBI navigated through their unfamiliar reality, and (3) "embrace it and run with it" explored participants' reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme ("living in a reshaped reality") with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.

In some legal and societal circumstances, people freely and capably plan, organize, and precipitate their own death. Drawing on published literature, we critically reflect on how deliberately ending one’s own life fits with the current definitions of the concept of occupation. Using an occupational science and occupational therapy theoretical reflection, we argue that deliberately dying can for some people be considered a purposeful and meaningful occupation. Implications for such an occupational therapy practice are discussed: attending to the occupational needs of specific groups of people, reconsidering definitions and conceptual work, advocating for occupational justice in ending life activities, reflecting on ethical conundrums around self-harm activities within the scope of practice, and exploring deliberate death as a purposeful and meaningful occupation. Because deliberately dying is something that some people do, in this article we aim to open a dialogue within the field of occupational science and occupational therapy about this sensitive and potentially controversial issue.

Objective To address a gap between spinal cord injury (SCI) research and practice by rigorously and systematically co-developing integrated knowledge translation (IKT) guiding principles for conducting and disseminating SCI research in partnership with research users. Design The process was guided by the internationally accepted The Appraisal of Guidelines for REsearch & Evaluation (AGREE) II Instrument for evaluating the development of clinical practice guidelines. Setting North American SCI research system (ie, SCI researchers, research users, funders). Participants The multidisciplinary expert panel (n=17) and end users (n=35) included individuals from a North American partnership of SCI researchers, research users, and funders who have expertise in research partnerships. Interventions Not applicable. Main Outcome Measures Clarity, usefulness, and appropriateness of the principles. Results Data regarding 125 principles of partnered research were systematically collected from 4 sources (review of reviews, scoping review, interviews, Delphi consensus exercise). A multidisciplinary expert panel held a 2-day meeting to establish consensus, select guiding principles, and draft the guidance. The panel reached 100% consensus on the principles and guidance document. The final document includes a preamble, 8 guiding principles, and a glossary. Survey data showed that the principles and guidance document were perceived by potential end users as clear, useful, and appropriate. Conclusions The IKT Guiding Principles represent the first rigorously co-developed, consensus-based guidance to support meaningful SCI research partnerships. The principles are a foundational tool with the potential to improve the relevance and impact of SCI research, mitigate tokenism, and advance the science of IKT.

Arm crank ergometry and adaptive rowing are existing exercise options for wheelchairs users, but not commonly available. This study was conducted to explore exercise participation of wheelchair users, as well as the usability of the adaptive rowing ergometer (aROW) and arm crank ergometer (ACE).This mixed-methods study used a concurrent triangulation design. Following completion of both exercise sessions (5 min each), participants (Wheelchair users exercised for improved physical and mental health, as well as for functional independence, and community participation; however, lack of accessible equipment was a prominent barrier. Both the aROW and ACE have high usability, but the aROW was perceived as more enjoyable and effective for cardiovascular exercise.The implementation of the aROW into community gyms has the potential to help close the existing gap in inclusive equipment and may help people with disabilities to be more fully included in their community and lead healthier lives.Implications for rehabilitationWheelchair users perceive exercise as a meaningful activity that enhances physical health and risk of disease, functional independence, community participation, and overall social and emotional health.The adapted rowing machine was perceived as highly usable and was felt to be more enjoyable and effective for cardiovascular exercise compared to traditional arm crank ergometers.The adaptive rower provides an additional accessible equipment option for wheelchair users to obtain effective cardiovascular exercise.More available equipment may increase community participation and promote inclusion for wheelchair users.

While the “situatedness” of occupation in the context of migration has been explored using various approaches, there remains a need for a holistic and dynamic understanding of the concept of space and the spatiality of occupation. Adopting Lefebvre’s theory of the production of space and taking a transactional approach to occupation, we examined the role of immigrants’ occupational engagement in the production of Francophone minority community spaces in Metro Vancouver, Canada. We completed a critical ethnography and focus on findings from participant observations and in-depth and go-along interviews with French-speaking immigrants. Findings shed light on the influence of immigrants’ occupational engagement on the production of minority spaces. To study the spatiality of occupation comprehensively, we need to move beyond an examination of the immediate environment to address other components of the production of space as well as the interrelation of spaces through occupation.

Background. The Performance Assessment of Self-Care Skills (PASS) is a standardized assessment of the ability to perform daily activities. Purposes. This preliminary exploratory study aimed to 1) explore the ability of four PASS tasks to predict adverse events (readmissions and injuries) in older adults following hospitalization; 2) compare PASS's predictive validity to that of a generic tool (SMAF) and OT clinical judgement. Method.Twenty-two older patients were assessed in hospital at discharge and at home one week later. Adverse events were documented for six months post-discharge. Sensitivity and specificity analyses (ROC curves, Fisher's exact tests) were performed. Findings. Two PASS tasks (telephone, medication), the SMAF-Social and OT clinical judgement could identify individuals at risk of readmission (AUC > 0.7; p < 0.05). Implications. Using the PASS to assess more cognitively demanding tasks could be a promising way to predict adverse events after discharge, as a complement to clinical judgment.

Objectives: Loneliness and depression are of increasing concern in long-term care homes made more urgent by viral outbreak isolation protocols. An innovative program called Java Mentorship was deve...

Powered wheelchair use promotes participation in individuals with limited mobility, however training is required for safe and effective use. There is limited evidence on the task demands of powered wheelchair use to inform an evidence-based skills training programme.To conduct a systematic exploration of the task demands of indoor powered wheelchair use to identify frequently used skills, abilities, and knowledge.We used a two-phased think aloud process to conduct a task analysis of powered wheelchair use with experienced powered wheelchair users (One-hundred and ten (110) distinct skills and abilities were identified and mapped to the ICF; 80 in the Body Structures and Functions domain, and 30 in the Activities and Participation domain. Approximately 50% of skills and abilities were mental functions. Four thematic knowledge domains were identified: knowledge of self, environment, wheelchair, and task.Powered wheelchair use is complex and requires a variety of skills and abilities from all areas of human functioning, in addition to a wide range of knowledge. Training programmes should address a range of areas of skill development.IMPLICATIONS FOR REHABILITATIONPowered wheelchair use is a complex skill; training should develop skills from all.Domains of the ICF, including mental and physical functions.A range of knowledge is used while operating a powered wheelchair; training programs.Should include the development and application of necessary knowledge.Clinicians may consider a range of factors when assessing suitability for powered.Wheelchair user, however should acknowledge that while the range of skills idenotified.May be useful, they may not be critical for success in powered wheelchair use.

Evidence-informed healthcare (EIHC) is a systematic approach to clinical problem solving that facilitates the integration of the best available research evidence with clinical expertise and our patient’s unique values and circumstances.1 To become an EIHC practitioner requires knowledge, skills and practice. The five-step model of EIHC (asking answerable clinical questions, acquiring the evidence, appraising the evidence, applying the evidence and assessing performance as an EIHC practitioner) forms the basis for both teaching EIHC and clinical practice.2 Despite many EIHC success stories, variation in the adoption of evidence-based practice remains a problem.3 Barriers to implementing EIHC are well documented, with lack of resources being the most common barrier,4 followed by lack of knowledge and skills about appraisal, negative perceptions about research, lack of resources and time, low self-efficacy, inadequate access to the literature and financial barriers.4 5 Some of these barriers are directly related to the steps of EIHC, indicating that there is a clear need to improve the teaching of EIHC across all professions. Interventions using multiple methods are most likely to improve knowledge and skills compared with single interventions or no interventions,6 with the most effective teaching strategies being those that are interactive and clinically integrated.7 Online learning with high levels of interactivity is increasingly used as a learning intervention8 and is as effective a strategy as lecture-based teaching.9 Online learning has the added advantage of providing learner-centred access to course materials at a time and place convenient to them and to tailor their learning to their own timing, pace and needs.8 Virtual patient cases are designed to represent real-life clinical scenarios and are well suited for facilitating the development of clinical reasoning skills,10 an essential element of EIHC. Cases designed using a problem-oriented training approach increase the …

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)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.IMPLICATIONS FOR REHABILITATIONUsing 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.

Wheelchair users typically receive little training about wheelchair maintenance. Therefore, we developed a peer-led, manual wheelchair skills maintenance training programme, with the intention of evaluating its efficacy in a future experimental study.The purpose of this feasibility study was to examine how well we were able to implement the training programme and to evaluate the feasibility of conducting a larger scale clinical trial.Spinal cord injury research centre.Five mentors and fifteen mentees were recruited to complete this feasibility study.We collected information about recruitment capability and sample characteristics, data collection procedure, acceptability of the training programme, resources required, and participants' responses to the intervention. Participants completed all the items and we had little missing data. Participants did not face any difficulty answering the questionnaires or performing the tests. Therefore, we could conclude data collection was feasible moving forward to perform larger efficacy trials. The acceptability of the wheelchair maintenance programme was more than 90%. There was a statistically significant improvement in wheelchair maintenance knowledge test and total rolling resistance. Confidence of mentees increased significantly after the training. Improvements in the 3-cone test and the 6-min push test results were not significant.If recruitment and scheduling challenges can be overcome, our data suggested that it is feasible to conduct a larger experimental study to test the efficacy of the programme.Implications for RehabilitationWheelchair maintenance skills are important to help wheelchair users keep their wheelchairs working safely and efficiently.The findings from this study suggest that a peer-led wheelchair maintenance training programme may improve participants' wheelchair maintenance knowledge and maintenance self-confidence.The study also suggests that a peer-led wheelchair maintenance training programme may decrease the rolling resistance of participants' wheelchairs.A larger clinical trial is needed to demonstrate the efficacy of this intervention authoritatively.

Loneliness, depression, and social isolation are common among people living in long-term care homes, despite the activities provided. We examined the impact of a new peer mentoring program called Java Mentorship on mentees’ loneliness, depression, and social engagement, and described their perceptions of the visits. We conducted a mixed-methods approach in 10 homes in Ontario, Canada, and enrolled residents as mentees ( n = 74). We used quantitative surveys and qualitative interviews to understand their experience. After 6 months, mentees ( n = 43) showed a 30% reduction in depression ( p = .02, d = .76), a 12% reduction in loneliness ( p = .02, d = .76), and a 60% increase in the number of monthly programs attended ( p = .01, d = .37), with small-to-medium effect sizes. The analysis of mentee’s interviews revealed positive perceptions. This program offers an innovative, nonpharmacological alternative to the treatment of loneliness and depression.

Purpose: 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.Method: 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.Result: 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.Conclusions: 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.IMPLICATIONS FOR REHABILITATIONPeople 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.

Pushrim-activated power-assisted wheels (PAPAWs) are assistive technologies that use force sensor data to provide on-demand propulsion assistance to manual wheelchair users. However, available data about kinetic and kinematic of PAPAW use are mainly limited to experiments performed on a treadmill or using a dynamometer. In this work, we performed experiments to gather kinetics of wheelchair propulsion and kinematics of wheelchair motion for a variety of over-ground wheelchair maneuvers with a manual wheelchair with and without PAPAWs. Our findings revealed that using PAPAWs can significantly reduce the propulsion effort and push frequency. Both linear and angular velocities of the wheelchair were significantly increased when using PAPAWs. Less force and push frequency could potentially reduce risk of chronic upper limb injury. Higher linear velocity could be desirable for various daily life activities, however, the increase in the angular velocity could lead to unintended deviations from a desired path. Future research could investigate PAPAW controllers that amplify the desired intentions of users while mitigating any unwanted behaviours.

Background As eHealth technologies become a more prevalent means to access care and self-manage health, it is important to identify the unique facilitators and barriers to their use. Few studies have evaluated the use or potential use of eHealth technologies in spinal cord injury (SCI) populations. Objectives The primary objective of this study was to explore and identify barriers and facilitators to engagement with eHealth technologies among individuals with SCI. Methods A qualitative descriptive study was conducted. Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger clinical trial. Analysis of the transcripts was undertaken using a four-phase process of content analysis. Results Our analysis identified three barriers to engagement with eHealth technologies, including (1) overcoming a digital divide to comprehending and utilizing eHealth technologies, (2) navigating internet resources that provide too much information, and (3) interacting with these technologies despite having limited hand function. Our analysis also identified three facilitators to using eHealth technologies, including (1) having previous successful experiences with eHealth technologies, (2) being able to use voice activation features, and (3) being able to interact in an online community network. Conclusion By exploring barriers and facilitators to eHealth technology use, these findings may have a short-term impact on informing researchers and clinicians on important factors affecting engagement of individuals with SCI with telemedicine, mobile, and web applications (apps) and a long-term impact on informing future development of eHealth interventions and tools among chronic disease populations.

Mixed-methods.(1) To explore psychosocial and quality of life outcomes between those injured early versus later in life, and (2) to explore their post-injury experiences.GF Strong Rehabilitation Centre, Vancouver, Canada.For this community-based study, we recruited individuals with SCI (55 years of age) who were either injured between the ages of 15-30 (n = 15) or after the age of 50 (n = 15). We collected quantitative data about participants' sociodemographics and participants completed standardised questionnaires assessing personal factors, environmental factors, life habits, and quality of life. An independent samples t test was performed for continuous variables and the Chi-square test was conducted for the categorical variables. Qualitative data were collected via semi-structured interviews. Thematic content analysis was performed on the interview transcripts.We found no statistically significant differences between the two groups on any of the psychosocial outcomes. However, those injured later in life were significantly more likely to be female, have a higher income, and live in residential care. We identified three main qualitative themes that were consistent across the two groups: 'dealing with health and changes in occupation', 'enacting interdependence', and 'living in the community'. Some sub-themes varied between groups.To facilitate better rehabilitation, clinicians need to be aware of disparities among people with SCI relating to age of injury. Across age cohorts, it is important to increase independence, provide greater support when entering or returning to the workforce, and reduce societal stigma.

Objective The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization. Methods In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization. Results For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11–14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82–2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission. Conclusion Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability. Impact An early assessment of walking function within days of stroke admission can help to streamline discharge planning. Lay Summary Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.

Background Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke. Methods This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis. Discussion This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change. Trial registration ClinicalTrials.govNCT04232163. January 18, 2020., Trials, 23, ISSN:1468-6694, ISSN:1745-6215, ISSN:1468-6708

Background: There is growing interest in the use of wearable devices that track upper limb activity after stroke to help determine and motivate the optimal dose of upper limb practice. The purpose of this study was to explore clinicians’ perceptions of a prospective wearable device that captures upper limb activity to assist in the design of devices for use in rehabilitation practice. Methods: Four focus groups with 18 clinicians (occupational and physical therapists with stroke practice experience from a hospital or private practice setting) were conducted. Data were analyzed thematically. Results: Our analysis revealed three themes: (1) “Quantity and quality is ideal” emphasized how an ideal device would capture both quantity and quality of movement; (2) “Most useful outside therapy sessions” described how therapists foresaw using the device outside of therapy sessions to monitor homework adherence, provide self-monitoring of use, motivate greater use and provide biofeedback on movement quality; (3) “User-friendly please” advocated for the creation of a device that was easy to use and customizable, which reflected the client-centered nature of their treatment. Conclusions: Findings from this study suggest that clinicians support the development of wearable devices that capture upper limb activity outside of therapy for individuals with some reach to grasp ability. Devices that are easy to use and capture both quality and quantity may result in greater uptake in the clinical setting. Future studies examining acceptability of wearable devices for tracking upper limb activity from the perspective of individuals with stroke are needed., Journal of NeuroEngineering and Rehabilitation, 18 (1), ISSN:1743-0003

Introduction: Manual wheelchairs with spontaneous, user-initiated seating adjustability allow users to independently adjust both rear seat height and backrest angle on-the-fly to optimize positioni...

Introduction: Wheelchair users deploy a variety of strategies to increase their visibility to motorists. Unfortunately, there is no empirical evidence supporting the use of any of these visibility strategies with this population.Objectives: To investigate the effectiveness of four different visibility strategies (i.e., light emitting diode (LED) lighting system, reflective safety vest, orange flag, or control (i.e., black clothing)) for wheelchair users in nighttime and daytime conditions.Methods: Participants were shown videos from the driver's perspective depicting a wheelchair user waiting to cross the street while using one of the four visibility strategies in isolation during nighttime and daytime. Participants indicated when, if at all, they first saw the wheelchair user at the roadside. Results were compared to determine which strategy allowed for the longest reaction time.Results: In nighttime conditions, the most effective strategy was the LED lighting system followed by the reflective vest. Neither the orange flag nor black clothing provided an adequate stopping distance when a vehicle was traveling at 32km/h at night. During daytime conditions, all visibility strategies were effective when a vehicle was traveling at this speed.Conclusions: These results will help clinicians and enable wheelchair users to make informed choices about the best visibility strategies to use.

Objective To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users. Design Longitudinal study. Setting Community. Participants Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user. Intervention Not applicable. Main Outcome Measures The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes. Results The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study. Conclusion Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration.

We evaluated perceived autonomy among users of different types of wheeled mobility assistive devices (WMADs) across five environments and identified the effect on user autonomy due to specific device characteristics. A study-specific questionnaire was used to assess satisfaction with autonomy of WMAD users in the Home, Buildings Outside of the Home, Outdoor Built, Outdoor Natural Environment, and Transportation. For each environment, 15 contextual factors were rated for their impact on participants' autonomy. Our results revealed that manual wheelchair with add-on (MWC+AO) users had higher overall satisfaction with their autonomy compared to other WMAD users. MWC+AO users reported higher satisfaction with autonomy due to their health conditions compared to other WMAD users across all environments. In Outdoor Natural Environments, MWC+AO users had the highest satisfaction with autonomy across all factors except for negotiating hills. When performing activities in Buildings, MWC users with and without add-ons reported higher satisfaction for all factors compared to power wheelchair users, except for maneuverability on different surfaces. Satisfaction with autonomy regarding contextual factors varied among WMAD users, however, MWC+AO(s) appeared to provide a more balanced sense of autonomy across most factors and environments. More in-depth investigations are required to evaluate impacts of add-on use on autonomy.

The use of motorized mobility scooters has become increasingly prevalent. Drawing on the critical-phenomenology and disability-studies literature, this study explored the embodied nature of scooter use among 20 new scooter users. The analysis revealed four themes: 1) Navigating the social environment and being (un)seen presented a paradox of how hypervisibility and invisibility can both exist; 2) Transitioning to scooter use revealed the affective component of becoming a scooter user despite the underlying desire to avoid unwanted attention; 3) Experiencing accessibility challenges en route and at destinations demonstrated that the inconsistency in accessibility along different routes unavoidably makes disability more visible; 4) Strategic and personalized use of devices for mobility illustrated how reliance on other mobility devices (e.g. canes and walkers) can be used as a strategy to circumvent the barriers and lessen the visibility of disability. The lifeworlds of "lived relation", "lived body", "lived space", and "lived things" encapsulated the multi-faceted experiences of new scooter users. The critical phenomenology of scooter use emphasized the need for creative strategies to address the physical and attitudinal barriers as well as scooter design-related concerns.

OBJECTIVE The objective of this review is to review the existing evidence on definitions, concepts, measurement instruments, and interventions for chronic fatigue in spinal cord injury. INTRODUCTION Chronic fatigue in people with spinal cord injury is an under-studied issue that affects between 25% and 56.6% of people with spinal cord injury. There are questions about how it is defined and managed due to its complex, multifactorial nature and relationship with related conditions. No overview of chronic fatigue in spinal cord injury exists and we are in need of a shared definition of chronic fatigue, as well as a comprehensive review of concepts and evidence supporting outcome instruments and interventions. INCLUSION CRITERIA This review will include empirical and non-empirical studies that focus on definitions, concepts, measurement instruments, and interventions for chronic fatigue in spinal cord injury. Studies that focus on peripheral muscle fatigue will only be included if they include chronic fatigue as a secondary outcome. METHODS This review will be done in three phases. Phase I will provide an overview of definitions of chronic fatigue in spinal cord injury and will include a qualitative analysis of concept attributes and characteristics. Phase II will focus on factors related to chronic fatigue and measurement instruments used to measure chronic fatigue, and phase III will focus on interventions. Full texts will be screened by two independent reviewers against inclusion criteria. Results will be presented in tabular form with a narrative summary.

Background and Objectives Recent critical evaluations of age-friendly efforts have highlighted the need to prioritize the disenfranchised, including people with mobility limitations. This article examines the validity of a 13-item Stakeholders Walkability/Wheelability Audit in Neighborhoods (SWAN13) scale to measure the “walk/wheelability” of street segments from the perspectives of people with mobility limitations. Research Design and Methods Data were drawn from preliminary studies of the SWANaudit which was conducted in 2 Canadian metropolitan areas. Sixty-one participants who use mobility devices (e.g., walkers, power wheelchairs) and older adults from community organizations audited 195 street segments. We factor analyzed the data from their audits. Results SWAN13 has a 1-factor structure. 13 items were retained from 85 SWANaudit items. SWAN13 encompassed both physical and social aspects of walk/wheelability. The alpha for the scale was .79. Convergent validity was found with the University of Alabama Life-Space Assessment (ρ = .22, p = .003), especially at the neighborhood level (ρ = .23, p = .002). Significant correlation was also found with subjective assessments of a priori walk/wheelability domains (ρ = .63, p < .001). Discussion and Implications Walk/wheelability affects the life space of older adults and people with mobility limitations. It is an important latent variable that should be addressed to promote well-being and social participation. SWAN13 may be used in city-wide surveys to identify neighborhoods that may require age-friendly interventions from mobility perspectives. Detailed audits and interventions may be carried out in tandem using the paired SWANaudit instrument. Walk/wheelability is an inclusive and measurable concept that accounts for the needs of people with various mobility needs.

Importance: Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person’s ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. Objective: To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. Design: Retrospective chart reviews were conducted over a 6-mo period. Setting: Four Canadian driver rehabilitation programs. Participants: Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. Outcomes and Measures: Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. Results: The ScanCourse had an AUC of .702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. Conclusions and Relevance: Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. What This Article Adds: Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people.

Online decision support systems (DSS) may help older adults self-select assistive technology (AT) by offering recommendations. User interactions with DSSs may change the recommendations they receive. Objective: We evaluated recommendations stability and usability of an online DSS. Methods: Middle-aged and older adults (n = 43) were observed while using the DSS. The stability of DSS recommendations (ATs and advice) was compared between two time points, using a three-point scale: no, partial, or full agreement. Usability was coded, referencing ISO standards. Results: Half (51%) of participants received AT recommendations from the DSS in both sessions, with full (14%) or partial (12%) agreement. All but one participant received advice, and almost all of them had full (40%) or partial (56%) agreement between sessions. Many of the usability issues appear to be the result of the users inaccurately measuring their environment, challenges in understanding the questions being asked, and improperly making selections from the system. Discussion: Strict AT matching rules versus generic advice, and usability issues, likely reduced the matching rate and stability of AT recommendations. Conclusion: It appears that some users may require assistance with the system, and we suggest changes to the DSS format and content to improve stability and usability.

The ability to move about the community safely and easily plays a key role in the lives of people who use mobility devices. This study explored how personal characteristics, mobility device use, transportation, and environmental factors affected the size of their activity spaces (i.e., daily path area). Seventy-eight people who used manual wheelchairs, power wheelchairs, scooters, walkers, canes, and/or crutches tracked their movements in the community using a geographical positioning system device over a 7-day period. Participating in productive activities, walkability, the interaction between access to a vehicle and walkability, seasonality, and location helped to explain 43% of the variability in daily path area. The type of mobility device used and years using a device were associated with activity space size in bivariate analysis but not significantly significant in the regression model. The findings underscore the complex challenges that people who use mobility devices face moving about the community. Implications for researchers and transportation planners are discussed.

Urban areas offer many opportunities for people with disabilities, but limited accessibility may prevent their full engagement in society. It has been recommended that the experience-based perspective of people with disabilities should be an integral part of the discussion on urban accessibility, complementing other stakeholder expertise to facilitate the design of more inclusive environments. The goals of this mixed-method study were to develop knowledge mobilization (KM) strategies to share experience-based findings on accessibility and evaluate their impact for various urban stakeholders. Using a participatory approach, various KM strategies were developed including videos, a photo exhibit and an interactive game. These strategies were evaluated based on various impact indicators such as reach, usefulness, partnerships and practice changes, using quantitative and qualitative methods. The findings suggested that the KM strategies were effective in raising the awareness of various urban stakeholders and providing information and guidance to urban planning practices related to accessibility.

Participation in outdoor recreation is associated with improvements in mental, emotional, and physical health. Individuals with impairments affecting mobility, such as wheelchair users, face environmental, physical, and social barriers to participation in outdoor recreation. There is limited research on outdoor recreation participation among wheelchair users, especially concerning informal recreational opportunities. Formal programmes that offer access to outdoor recreation are often oversubscribed and also do not enable opportunities to participate more spontaneously.(1) To explore the experiences and impact of participation in outdoor recreation activities by wheelchair users, with an emphasis on more informal activities; and (2) to identify perceived barriers and facilitators to participation in outdoor recreation activities.Semi-structured interviews were the main means of data collection in this interpretive description study; this was supplemented by photographs of activity involvement provided by participants. These data were analysed thematically.Fifteen Canadian wheelchair users participated in the study. Three themes emerged following analysis: (1) Into the Woods explores participants' current outdoor recreation experiences, (2) Ain't No Mountain High Enough looks at the barriers and challenges participants face, and (3) Just Around the Riverbend discusses participants' desired changes to enable their further participation.The study highlighted participants' current experiences, their perceived barriers, and several ways to enhance outdoor recreation participation among wheelchair users, including: developing new adaptations, creating policies, increasing access to affordable equipment and programmes, and reducing barriers in built and natural environments.Implications for rehabilitationWheelchair users participate in a wide variety of outdoor activities.Wheelchair users experience various barriers and challenges when participating in outdoor recreation.Despite recent improvements, environmental changes are needed to allow wheelchair users to access outdoor recreation.Further development of adaptive equipment is needed in order for wheelchair users to access their desired outdoor recreation activities.

Importance: Powered wheelchairs provide independence for people with mobility impairments; however, current training practices may not meet the needs of those with cognitive impairments. Shared-control teleoperation may have utility in a clinical setting when developing training suited to this population. Objective: To explore the clinical utility of a shared-control teleoperation device for powered wheelchair assessment and training. Design: In this qualitative study, we used two sequential semistructured interviews conducted a minimum of 2 wk apart. Thematic analyses were used with member checking, reflexive journaling, and triangulation of researchers to establish trustworthiness of the data. Setting: Rehabilitation center and residential care and community settings. Participants: Using purposive sampling, we recruited occupational therapists and physical therapists who were mostly female and who had a range of practice experience. Results: Fifteen participants were interviewed, and two primary themes were identified: (1) “A big enabler” described how shared control provides opportunities to train people who may otherwise be denied powered mobility, and (2) “changing the learner experience” described how shared control may promote success in skill development through an alternative learning experience. Conclusions and Relevance: Shared-control technology may have the potential to broaden the scope of therapeutic intervention by reducing risk to the driver and others in the environment and by facilitating alternative training approaches. What This Article Adds: Technological advances that allow more control over a powered wheelchair by a clinician, known as shared control, may provide learning opportunities for people who are otherwise denied access to powered mobility. Shared control may also allow the use of new instructional techniques, increase safety in the training process, and reduce anxiety associated with learning.

Purpose: Providing care to older adults using assistive technology can be challenging for family caregivers. To inform the development of an Internet-based intervention, this study aimed to identify older assistive technology users and family caregivers’ needs related to assistive technology procurement, and to explore how to offer remote support through an Internet-based intervention. Methods: Based on an iterative user-centered design approach, 30 semi-structured interviews were conducted with stakeholders about their experiences with assistive technology procurement/attribution and their perceptions of a proposed intervention. A modified content analysis approach was used, with a mix of emerging and a priori concepts. Results: Participants view assistive technology procurement as an ongoing cyclical process, with potential unmet needs at key moments before and after assistive technology procurement. Assistive technology user-family caregiver dyads needs focus on assistive technology information, access, assistive technology-person-context match, training and support. While participants felt there were benefits to the proposed intervention they also identified potential implementation barriers. Conclusion: Assistive technology Internet-based interventions dedicated to family caregivers should ensure systematic and tailored follow-up while integrating some form of human support. This study guides the prototype design of the proposed intervention towards a graded support approach, empowering assistive technology users and family caregivers to resolve assistive technology-related challenges.Implication for rehabilitationProviding home-based care to older adults using assistive technology (e.g., mobility aids, communication aids) can be challenging for family caregivers.Using a user-centered design approach, an Internet-based intervention is under development to support older assistive technology users and their family caregivers.Through interviews with diverse stakeholders, this study explores unmet needs related to assistive technology procurement and perceptions about the proposed intervention. Providing home-based care to older adults using assistive technology (e.g., mobility aids, communication aids) can be challenging for family caregivers. Using a user-centered design approach, an Internet-based intervention is under development to support older assistive technology users and their family caregivers. Through interviews with diverse stakeholders, this study explores unmet needs related to assistive technology procurement and perceptions about the proposed intervention.

BACKGROUND People living in long-term care frequently have inadequate access to properly fitted wheelchairs. This can lead to potential problems with mobility, positioning, comfort, and skin integrity. A provincial programme to provide individually fitted lightweight wheelchairs to residents started in January 2016; however, no research has evaluated programme outcomes. OBJECTIVES To identify seating needs of residents before and after implementation of a provincial wheelchair programme at two long term care facilities in Vancouver and to explore stakeholders experiences with this programme. METHODS A pre/post study design was used which involved chart reviews to collect Seating Identification Tool (SIT), and interviews with stakeholders having experience with the provincial programme to gather information on their experiences. SIT data were analysed using a Wilcoxon Signed-Rank test and interviews were analysed thematically. FINDINGS SIT scores improved by 2 (median) which was statistically significant for the 22 residents with pre/post data available. Prevalence of seating needs decreased on average by 18%. Among the six stakeholders interviewed, themes identified included: wheelchairs/cushions provided addressed many residents' needs; and saved residents and their families money and stress; and there is still ongoing need for more specialised equipment for frail residents (not covered by this programme). CONCLUSION This study provides some evidence regarding the benefits of the introduction of this programme in two care homes and identifies potential changes that might improve wheelchair seating among residents with more severe seating needs. Further research is required on how these equipment changes might affect their mobility or participation in activities. Implications for rehabilitationThese findings appear to support the provision of lightweight individually fitted wheelchairs and moderate pressure redistribution cushions by occupational therapists in long-term care through this programme.Regular use of the SIT (i.e., on admission, condition change, annual care conference, and as needed) may be beneficial to ensure residents are properly screened for seating needs.Collaboration with the resident appears to be important to ensure equipment on provision and follow-up are meeting residents' needs.Recommend future research on the use of tilt in space wheelchairs for residents' in long-term care.

New geared wheelchair wheels have been developed allowing the user to pull backwards on the rims to move forward. Theoretically, this utilizes larger muscle groups compared to conventional propulsion preventing repetitive stress injuries. This study compared the gross mechanical efficiency (GME), perceived effort and energy expenditure of propelling the wheelchair using two types of these geared wheels and standard forward propulsion wheels. A within participants repeated measures design was used. Participants' energy expenditure and perceived exertion were measured. GME was calculated based on power output and energy expenditure values. Ten able-bodied participants were enrolled in the study. Standard wheels required the least energy expenditure and were perceived as the lightest to propel for nine of the participants; while the low-geared wheels were perceived as the hardest to propel. Results favored the standard wheels under these conditions. Research is needed to explore the effect of training and different slope angles.

Purpose The purpose of this study was to describe occupational therapy weight-shifting practices and explore recommended strategies for patients, healthcare staff, and family/caregivers across healthcare settings. Design Cross-sectional survey. Subjects and setting Respondents included 97 currently practicing occupational therapists working in 5 main practice settings (ie, acute care, inpatient rehabilitation, outpatient rehabilitation, home and community care, and residential) from 9 out of 10 Canadian provinces. Methods We created a 25-item questionnaire that included forced choice and open-ended queries. Items queried demographic information, weight-shifting techniques taught to patients, frequency and duration of weight shifting recommended, educational approaches used to teach weight shifting, and resources used to guide decision making. Participants were recruited via professional organizations and health authorities across Canada. Participants were excluded if they were not currently working with manual or power wheelchair users. Descriptive statistics were used to analyze quantitative data, and content analysis was used for qualitative data (responses to open-ended queries). Results The most frequently recommended weight-shifting techniques were tilt (83.3%-92.8%), leaning to one side (47.9%-87.5%), and forward leaning (46.9%-83.3%). Study findings revealed a wide range of recommendations regarding frequency (every 10 minutes or less to >2 to 3 hours) and duration (≤30 seconds to as long as tolerated) of weight shifting. Weight-shifting interventions were most commonly guided by clinical experience (81.7%), practice guidelines (62.4%), and expertise of other team members (54.8%). Conclusions Results from this study highlight the need for further research to inform weight-shifting techniques and to build a more comprehensive understanding of weight-shifting education practices.

The principal aim of this study was to investigate whether a caregiver-inclusive assistive technology intervention improved older care recipients’ functional autonomy and decreased the perceived burden of their family caregivers compared to customary care. The study was a single-blind, mixed-methods, randomized controlled trial with baseline data collection and follow-ups at 6-, 22-, and 58-weeks after baseline evaluation, which was prospectively registered ( ClinicalTrials.gov Identifier: NCT01640470. Registered 11/21/2011). Dyads comprising a care recipient and family caregiver were randomly assigned to either a caregiver-inclusive experimental group (N = 44) or a customary-care comparison group (N = 46). Eligible care recipients were aged ≥55 years and had one or more limitations with mobility or daily activities, and family caregivers provided at least four hours per week of assistance. Outcome measures were administered to both groups at baseline and at the three follow-up time points. The data collectors were blinded regarding participants’ intervention group. The primary outcome measures were the Functional Autonomy Measurement System to assess care recipients’ functional performance, and the Caregiver Assistive Technology Outcome Measure to assess caregivers’ burden. Qualitative interviews examined participants’ perceptions of the caregiver-inclusive and customary care interventions. The experimental intervention addressed significantly more dyad-identified problematic activities, but caregiver involvement was evident in both groups and outcomes were not significantly different over time. In both groups, care recipients’ functional autonomy declined significantly (P

A rear mounted, powered, drive wheel has been developed to assist with mobility for manual wheelchairs. The version tested operates in two modes (indoor and outdoor). To start in the indoor mode users must initiate propulsion with sufficient force to trigger the motor. To stop users must apply a braking force through the handrims. . The objectives of this study were to compare (1) the minimum force required to start a wheelchair with and without the drive, and (2) the distances and forces needed to stop a wheelchair at different treadmill speeds with and without the device. We used a crossover study design with 24 able-bodied persons. The main outcome measures were starting force single push speed, stopping distance, and stopping force. Participants did not have significantly increased starting force or single push speed using the drive. Participants had significantly shorter absolute stopping distance (p = 0.045 and reduced stopping force (p = 0.02) using the add-on at both treadmill speeds. Given the decreased stopping distances, the add-on may be a viable option for wheelchair users with limited upper limb strength.

Qualitative data from a mixed-methods clinical trial are used to examine caregivers' experiences with the selection and use of assistive technology to facilitate care recipients' independence. Through a thematic analysis of interviews from 27 caregivers, three broad themes were identified. "A partial peace of mind" described the generally positive psychological impacts from assistive technology, mainly reduced stress and a shift in caregiving labour from physical tasks to a monitoring role. "Working together" explored the caregivers' experiences of receiving assistive technology and the sense of collaboration felt by caregivers during the intervention process. Finally, "Overcoming barriers" addressed two impediments to accessing assistive technology: lack of funding and appointment wait times for service providers. The findings suggest that assistive technology provision by prescribers plays a beneficial role in the lives of caregivers, but access to such benefits can be hampered by contextual constraints. Implications for rehabilitation The study findings have a number of implications for rehabilitation practice: Family caregivers can be instrumental in determining what assistive technology is needed and then procured. Their involvement in the selection process is desirable because assistive technology may have both positive and negative impacts on them, and they themselves may use the devices chosen. Involving family caregivers as more active partners in the process of assistive technology provision may represent a greater time investment in the short term, but may contribute to better long-term outcomes for care recipients and caregivers as well. Limited access to funding and long appointment wait times are potential barriers to obtaining necessary assistive technologies.

Les jeux sont une activite de loisirs importante qui peut contribuer a la qualite de vie et a l'interaction sociale. Bien qu'il y ait eu de nombreuses recherches sur les effets des jeux video sur la cognition et le comportement, peu de recherches ont explore des formes non-numeriques de jeu qui ne necessitent pas l'utilisation d'ordinateurs ou de systemes de jeu, en particulier parmi les personnes âgees. Dans le cadre d'un plus grand sondage sur le jeu, 886 repondants masculins et feminins (≥ 55 ans) ont rempli des questionnaires sur jouant de jeux non-numeriques. Les objectifs de l'etude etaient de determiner les avantages percus de jouer a jeux non-numeriques, ainsi que de determiner les facteurs socio-demographiques predictifs des benefices percus. Les resultats de l'enquete indiquent que jouant des jeux non-numeriques est courant chez les personnes âgees (73% des repondants). Pour la plupart, les jeux sont de nature sociale: les adultes plus âges jouent pour s'amuser, mais aussi pour aider a maintenir leur connaissance. Les analyses de regression ont indique que divers facteurs sociodemographiques, y compris l'âge, l'education, le genre et la race, etaient independamment associes aux avantages percus des jeux. Les resultats soulignent donc l'importance de jouer a jeux non-numeriques dans cette population, et suggerent que les efforts visant a faciliter ces jeux peuvent ameliorer les interactions sociales et la qualite de vie. Research on video games' effect on cognition and behaviour has been extensive, yet little research has explored non-digital forms of game playing, especially among older adults. As part of a larger survey on game playing, 886 respondents (≥ age 55) filled out questionnaires about non-digital game play. The study aims were to determine perceived benefits of non-digital game play and to determine socio-demographic factors that might predict perceived benefits. Survey results indicate that non-digital game playing is social in nature and common (73% of respondents) among older adults. Older adults play for fun, but also to help maintain their cognition. Regression analyses indicated various socio-demographic factors–age, education, gender, and race–were independently associated with perceived benefits from game playing. The results thus emphasize the importance of non-digital game playing in this population and suggest that efforts to facilitate game playing may improve social interactions and quality of life.

Outdoor activities in natural settings have been found to be beneficial for overall health and well-being. However, people with disabilities may have different experiences accessing outdoor activities in natural settings. This research explored the experiences of users, volunteers, and staff, and perspectives of non-users about an adapted hiking program that uses a specialized mobility device called a TrailRider. The research had three objectives: 1. Describe the experiences of users, volunteers, and staff; 2. Identify perceived barriers to or limitations of participating for users, volunteers, staff, and non-users; and 3. Explore the impact of participation for users, volunteers, and staff.This ethnographic study used a combination of observations and in-depth interviews as a means of data collection.Researchers accompanied 38 participants on five hikes and conducted semi-structured interviews with 20 participants. Analysis identified three themes: "Let the Good Times Roll" described how TrailRider users and volunteers enjoyed the opportunity to explore the great outdoors. "An Uphill Battle" acknowledged perceived physical and psychological barriers to participation. "Clearing the Path" addressed potential areas for program improvement.This study emphasized how volunteers and users appreciated the outdoor and social opportunities the program afforded. The study identified a number of potential improvements that could be implemented to improve access to the program. Implications for Rehabilitation Outdoor recreation programs create positive experiences, as well as unique social opportunities for users and volunteers. Identifying and considering physical and psychological barriers would improve wilderness access for individuals with disabilities. Despite the fact that outdoor recreation programs, like the adaptive hiking program, are in place, deficient marketing and promotion limit users and volunteers from taking part.

Within the context of physical disability, participation has typically been conceptualized in terms of one's performance of different roles and activities. This perspective, however, ignores the meanings and satisfactions that a person derives from participating. Without an accepted conceptualization of participation that accounts for people's subjective perceptions and experiences, it is challenging for decision-makers and service providers to design meaningful participation-enhancing services, programs, and policies. Accordingly, our objectives were (1) to conduct a review of definitions and conceptualizations of participation that extend beyond performance and capture people's subjective experiences of participating and (2) to identify key experiential aspects of participation that can be used as a basis for conceptualizing and operationalizing the concept more broadly. The project involved a systematic, configurative review of relevant literature. Ten relevant articles were identified. Information on characteristics associated with experiential aspects of participation was extracted and subjected to a thematic analysis. The following 6 themes emerged: autonomy, belongingness, challenge, engagement, mastery, and meaning. Drawing on these findings, it is recommended that the individual's subjective perceptions of autonomy, belongingness, challenge, engagement, mastery, and meaning associated with participating be incorporated into conceptualizations and operationalizations of the participation construct. This recommendation provides a starting point for clinicians, researchers, and policymakers to conceptualize and measure the participation concept more consistently and more broadly.