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Purpose: Postoperative rehabilitation programs for cochlear implant (CI) recipients primarily emphasize enhancing speech perception. However, effective communication in everyday social interactions necessitates consideration of diverse verbal social cues to facilitate language comprehension. Failure to discern emotional expressions may lead to maladjusted social behavior, underscoring the importance of integrating social cues perception into rehabilitation initiatives to enhance CI users' well-being. After conventional rehabilitation, CI users demonstrate varying levels of emotion perception abilities. This disparity notably impacts young CI users, whose emotion perception deficit can extend to social functioning, encompassing coping strategies and social competence, even when relying on nonauditory cues such as facial expressions. Knowing that emotion perception abilities generally decrease with age, acknowledging emotion perception impairments in aging CI users is crucial, especially since a direct correlation between quality-of-life scores and vocal emotion recognition abilities has been observed in adult CI users. After briefly reviewing the scope of CI rehabilitation programs and summarizing the mounting evidence on CI users' emotion perception deficits and their impact, we will present our recommendations for embedding emotional training as part of enriched and standardized evaluation/rehabilitation programs that can improve CI users' social integration and quality of life. Conclusions: Evaluating all aspects, including emotion perception, in CI rehabilitation programs is crucial because it ensures a comprehensive approach that enhances speech comprehension and the emotional dimension of communication, potentially improving CI users' social interaction and overall well-being. The development of emotion perception training holds promises for CI users and individuals grappling with various forms of hearing loss and sensory deficits. Ultimately, adopting such a comprehensive approach has the potential to significantly elevate the overall quality of life for a broad spectrum of patients.

Background: Adults with traumatic brain injuries (TBI) frequently experience cognitive, emotional, physical and communication deficits that require long-term rehabilitation and community support. Although access to rehabilitation services is linked to positive outcomes, there can be barriers to accessing community rehabilitation related to system navigation, referral processes, funding, resource allocation and communications required to ensure access. Aims: This study aimed to identify barriers to accessing insurer funding for rehabilitation and healthcare services, for adults with TBI injured in motor vehicle collisions (MVCs). Methods: We used a co-design approach to collaborate with persons with lived experience to design a survey of adults who sustained a TBI in an MVC. The survey examined access to insurer funding for rehabilitation services and was disseminated through brain injury networks in Ontario, Canada. Results: Respondents (n = 148) identified multiple barriers to accessing rehabilitation services through insurer funding, including delays of more than 2 years (49%), mandatory duplicative assessments (64%) and invasion of privacy (55%). Speech-language therapy and neuropsychological services were denied most frequently. Negative experiences included insurers' poor understanding of TBI symptoms, denials of services despite medical evidence demonstrating need and unsupportive insurer interactions. Although 70% of respondents reported cognitive-communication difficulties, accommodations were rarely provided. Respondents identified supports that would improve insurer and healthcare communications and rehabilitation access. Conclusion & Implications: The insurance claims process had many barriers for adults with TBI, limiting their access to rehabilitation services. Barriers were exacerbated by communication deficits. These findings indicate a role for Speech-language therapists in education, advocacy and communication supports during the insurance process specifically as well as rehabilitation access processes in general.

This study aims to conduct a bibliometric analysis of the literature on sports nutrition as recovery published between 1964 and 2022. This study illustrates the structure and trends in sports nutrition publications by using scientific mapping and analyzing publication performance. This study identified the contributions of authors, journals, countries, and widely cited articles. While there was no massive expansion in the first year of publication, the results show that high growth emerged in the 2010s. Several countries have made significant contributions to recovery research in sports nutrition. European countries account for the majority of publications on this subject. Latin American and Asian countries are also keeping an eye on the study's growth. Another finding is that various multidisciplinary publishers publish articles about sports nutrition. The International Journal of Sports Nutrition and Exercise Metabolism, on the other hand, is the journal that publishes the most articles. Burke L.M. has established himself as a prolific writer in this field, producing many documents and total citations. Several keywords have large nodes associated with their frequency of occurrence. The keyword relationship provides information about the relationship between keywords frequently appearing in one study. Visualizations of research trends are presented to provide an up-to-date reference guide for academics, revealing critical research gaps and potential research avenues for future studies to advance the discipline's consolidation.

The focus of attention literature has shown robust findings for the benefits of providing statements that focus on the movement effect or outcome (external focus of attention [EFOA]) as opposed to focusing on the movement kinematics (internal focus of attention). Observational studies, however, have revealed that physiotherapists use fewer EFOA statements than internal focus of attention statements in their practice. Most evidence in this regard has been from non-Canadian physiotherapists working in stroke rehabilitation; consequently, we sought to examine whether Canadian physiotherapists working with various rehabilitation populations also use EFOA statements to a lesser extent than internal focus of attention statements. The "Therapists' Perceptions of Motor Learning Principles Questionnaire (TPMLPQ)" was thus designed and data from 121 Canadian physiotherapists showed low relative frequencies of EFOA use (31.3% ± 14%) averaged across six hypothetical scenarios. A higher EFOA was reported, however, for two of the six scenarios: a functional reaching scenario (55.5% ± 37.0%) and pelvic floor task (65.6% ± 32.9%). This data suggest that the findings of EFOA benefits have not been widely translated into Canadian physiotherapy settings; furthermore, the findings of the scenario-dependency warrant future investigation into factors, such as task characteristics, that may influence physiotherapists' FOA use.

This paper examines the stories of transformative learning of two men reflecting on their recovery from addictions and trauma. We employ the Hero's journey as a useful frame within which to understand their stories of becoming more and progressing towards a recovered self. The article challenges the dominant biomedical model of addiction, and of recovery as being primarily about abstinence. It also provides further evidence for understanding transformative learning as a process of (re)integration which is supported through archetypal storytelling.

In some fields, written reflection is commonplace whereas in others it is uncommon. While athletic therapy education aims to produce reflective practitioners, written reflection is not a typical pedagogy employed. In 2014, the athletic therapy program at our institution began the implementation of a clinical presentation (CP) approach to facilitate competency-based curriculum requirements. This innovation to pedagogy required a reimagined approach to teaching, learning, and assessment. We describe one aspect of a larger SoTL study on this transformation, inquiring into the development of reflective practice through reflective writing. Students were asked to regularly reflect on their experiences in the clinic or field as part of their program. In this qualitative component of the study, we were able to gain insight into how students perceived the reflective process, how that evolved over their program, what were enablers and barriers to their reflection, and what was the role of feedback in their learning. The characteristics of student perceptions in each year, which followed a learning arc which we describe sequentially as "confused, conflicted, and convinced," is explored, along with implications for pedagogy in assisting students to develop reflective professional practice.

In previous research, Canadian physiotherapists identified barriers to effective external focus promotion and recommended the delivery of a focus of attention workshop as a solution. Accordingly, the current research entailed the virtual delivery of such a workshop, consisting of asynchronous Website modules followed by a synchronous group session, to 15 Canadian physiotherapists working mainly with musculoskeletal rehabilitation clients. Assessment of the workshop outcomes was guided by constructs of social cognitive and adult learning theory, and organized based on the four levels of the Kirkpatrick model (KP1-Reaction, KP2-Learning, KP3-Behavior, and KP4-Results). Specifically, participants received links to questionnaire packages at three time points: 1-week preworkshop, immediately postworkshop, and 1-week postworkshop. Results showed that participants (a) reported high satisfaction, engagement, and perceived relevance of the workshop (KP1); (b) experienced significant improvements to their knowledge, skills, attitudes, and self-efficacy from pre- to immediately postworkshop (KP2); and (c) self-reported increases to their external focus promotion in the week following the workshop (modified KP3), and perceived improvements to their clients' outcomes as a result of this external focus encouragement (modified KP4). Taken together, these results serve as a chain of evidence supporting the usefulness of the workshop in translating focus of attention findings into Canadian physiotherapy.

Although researchers have consistently demonstrated the potential benefit of an external focus of attention for rehabilitation, research has shown that this finding has yet to be translated into Canadian physiotherapy. Further, specific barriers to external focus use have been reported by Canadian physiotherapists, and as a solution toward increasing physiotherapists' use of external focus, these same physiotherapists recommended the development of an educational workshop on focus of attention. Considering this, described herein is the process of developing such a workshop, which involved (a) gathering input from physiotherapists concerning content and format via one-on-one interviews and (b) engaging in discussion about content with focus of attention researchers. Analysis of the interview data featured key content for the workshop, the types of activities to include, and a recommended sequencing for the activities: specifically, sharing didactic information on focus of attention research, then providing instruction and demonstration of external focus use, and finally, finishing with opportunities for generating and delivering external focus statements. This input, along with that of the researchers, led to the development of a two-component focus of attention workshop, which includes an asynchronous component, featuring seven self-directed learning modules and a synchronous component, which consists of a virtual group session. [For Part 2, see EJ1398983.]

Although researchers have highlighted the benefits of adopting an external focus of attention for rehabilitation, studies have consistently revealed low external focus use by physiotherapists. Consequently, the purpose of this research was to explore factors influencing physiotherapists' focus of attention use and to gain insight into the barriers, and potential solutions, related to effective external focus use. Eight physiotherapists, working with musculoskeletal rehabilitation clients, first completed the Therapists' Perceptions of Motor Learning Principles Questionnaire and then participated in virtual one-on-one interviews. The interviews followed a semistructured interview guide and were analyzed using a total quality framework approach to qualitative content analysis. Data showed that physiotherapists' focus of attention use was influenced by physiotherapist, client, and task characteristics/experiences, as well as focus of attention statement provision strategies. Furthermore, the main barriers discussed related to educational experiences, reinforcement of internal focus of attention statement use and aspects related to research. Solutions presented to these barriers included the incorporation of focus of attention content into both the Canadian physiotherapy curriculum and continued education. Overall, these results advance our knowledge of factors underlying physiotherapists' focus of attention use and barriers that must be overcome to successfully translate the focus of attention research into physiotherapy. [For Part 1, see EJ1387168.]

This position article proposes that bankruptcy counseling and education should be tailored so that bankrupts and consumer debtors can attain "solvency literacy," a new construct developed for this initiative. They need to (a) handle their financial affairs "during" the insolvency process while (b) concurrently striving for a fresh start, rehabilitation (financial health), and reduced recidivism after discharge. Each of the Canadian and American insolvency education and counseling curricula is described with attendant discussions of financial education (literacy), consumer education (literacy), and credit education (literacy). Intending to keep bankruptcy insolvency education relevant and effective, a specially tailored curriculum is tendered for consideration. The curriculum represents a hybrid of consumer, financial, and credit education. It is relevant to immediate, situation-specific financial needs anticipating that people can strive for more generic consumer and financial literacy after they have attained solvency literacy.

Introduction: Various retinal implants are being developed and appear to be a promising option for improving the visual capacities of individuals with retinal dystrophy. A multidisciplinary approach to both assessment of a candidate's factors and rehabilitation could contribute to improved activity and participation. The purpose of this study was (i) to document the approach taken by a multidisciplinary team in the candidate selection process and in training in the use of the Argus II retinal prosthesis system (RPS), and (ii) to examine the effects of the RPS on sensory and mental functions and on activity and participation. Methods: An A1-B1-A2-B2 experimental case report was used, with repeated measures pre- and post-rehabilitation program design. The A phases represent the periods with the system off, whereas the B phases represent the periods with the system on. A 65-year-old man with retinitis pigmentosa and total blindness was followed by a multidisciplinary team for over 18 months. After receiving the retinal implant, he benefited from a 10-week rehabilitation program (twice per week; B1 phase). Results: Globally, the RPS improved vision in the B phases when the system was on and visual acuity was stable at 2.3 logMAR (functional blindness). The participant's mental and neuromusculoskeletal function scores were generally stable throughout the data collection periods. Lower performance on some measures at the end of phase B2 coincided with a negative mood. Discussion: Use of the RPS improved activity, but this did not transfer into greater participation in the living environment. Despite efforts made by the rehabilitation team to manage the user's expectations concerning the RPS, the interventions reactivated his grieving over his vision loss. Implications for Practitioners: New technologies can make users dream of unrealistic possibilities, and managing their expectations requires problem solving supported by a multidisciplinary team.

Dance as an artform touches the biopsychosocial dimensions of people and as such is increasingly used as a vehicle to improve the quality of life of diverse populations in the community. Yet little is known about how dance classes are experienced by marginalized populations. The purpose of this action research was to explore the potential of dance to contribute to the recovery of women having experienced homelessness. The objectives were to describe: (1) the artistic content (the 'what') and the pedagogical approach (the 'how') of the classes; and (2) the experiences of all the people involved in the action research (women, workers at the women's home, dance facilitators and researcher). Over a three-year period, weekly classes were offered in a women's home. Data was collected through individual interviews, focus groups and observations. A thematic analysis revealed eleven categories of dance activities which were subsequently associated with indicators of recovery. The pedagogical approach was driven by a set of values clearly embedded in the classes; the facilitators deployed numerous adaptations to answers the women's needs. Sufficient evidence supports the claim that dance is a promising practice for individual women's process of recovery. Implications for future research and practice are discussed.

Background: Planning the transition to adulthood of youth with severe to profound intellectual disability (ID) requires professionals from different institutions to work together. However, there are few studies in the literature that focus on professionals involved in this transition. Method: This study documented factors impacting the transition to adulthood of youth with severe to profound ID and potential solutions from the perspective of professionals from different sectors involved in transition planning, using individual interviews. Results: The absence of clear markers to guide professionals, lack of system navigator and recognition of rehabilitation potential of individuals with severe to profound ID were some of the obstacles experienced by professionals. They felt helpless facing the distress of families. Conclusion: Knowledge of the factors that, from the professionals' perspective, impact this transition could help to foster intersectoral collaboration between the many professionals involved and guide future initiatives to develop relevant and realistic solutions.

This article focuses on such a highly relevant subject as the prevention and correction of deviant behavior in the adolescent environment. The study revealed the main vectors for the development of the modern science of deviant behavior, identified the main causes of deviations and carried out a comparative analysis of the work on the prevention of deviant behavior in the CIS countries and abroad. This paper proved that the key factor in the prevention and correction of deviant behavior should be, firstly, the family as the primary and the most important institution of identity formation, and secondly, the pedagogically controlled environment of educational institutions serving as a condition for socialization and personal development for children and adolescents.

Context: The globalization of athletic training and therapy is advancing and professionals have more opportunities to transition to international working environments. Objective: To compare the American, Canadian, and Irish athletic training and therapy education, accreditation, and certification processes. Background: The Mutual Recognition Arrangement recognized the equivalency of athletic training and therapy in the United States, Canada, and Ireland, and thereby provides an avenue for nationally credentialed professionals to obtain equivalent credentials in one of the aforementioned countries. Synthesis: As a comparison, this article demonstrated that there was a commonality among countries, but also highlighted the unique jurisdictional differences that our members should be aware of should they want to transition to partner countries. Results: We performed a comparative analysis of the education, accreditation, and certification processes among the United States, Canada, and Ireland. Specific differences were noted among supervision methods, clinical education methods, and certification exams. All of these are grounded in the Mutual Recognition Agreement. Recommendation(s): We recommend that the Mutual Recognition Agreement be held as a basis for future partnerships with other countries. Conclusion(s): This article provided an overview and highlighted the similarities among academic education, domains, and content areas covered under the Mutual Recognition Agreement among athletic training and therapy programs in the United States, Canada, and Ireland. The education programs, accreditation procedures, and certification systems, although differing in structure, were consistent in delivering content that aligns with the Mutual Recognition Agreement.

This qualitative embedded single-case study sought to describe a dance intervention designed for people in stroke rehabilitation. Recommendations from rehabilitation therapists, and the researcher-dance educator's observations of the therapists' work and of patient participation during the intervention were captured and analyzed, from design to implementation, through various techniques, including a validated descriptive checklist from the health field, namely the Template for Intervention Description and Replication (TIDieR). This methodology enabled us to describe what 'adapted' dance was in this context, in terms of content and pedagogy, and thus to better distinguish such an intervention from the psychotherapeutic models underlying dance therapy. Thirteen rehabilitation themes emerged from the data to inform the dance content (the 'what' of the intervention), while four pedagogical categories subdivided into modalities portrayed the 'how'. These findings suggest a 'more experientially based' intervention distinct from 'more functionally based' therapies. This paper presents the perceived effectiveness/ineffectiveness of the pedagogical modalities from the researcher-dance educator's perspective and highlights the contribution of somatic-sensitive pedagogy. It concludes with some limitations of the TIDieR, such as its weakness in providing detailed and nuanced movement descriptions, leading the authors to recommend the use of complementary audiovisual data that would likely facilitate knowledge transfer.

Children with disabilities require coordinated services to optimise transition into school. This study compared type, frequency and approach to service utilisation for children with primary language impairment transitioning from rehabilitation to the educational system, and examined parent satisfaction. Parents responded to a telephone questionnaire to determine services received during Kindergarten. The Measure of Processes of Care examined parental satisfaction with services received at school. Preschool services received in the rehabilitation setting were extracted from the hospital database. There was a reduction in all services received in the school system with the exception of special education, which was provided to a greater number of children and on a full time basis. More children received occupational therapy and special education individually at the rehabilitation centre. Few factors were associated with a change in received services. Rehabilitation clinicians must provide necessary services to assist children when transitioning to school.

A total of 726 youths presenting a severe addiction were evaluated at the time of their request for services in an addiction rehabilitation center. Results show that the more delinquent youths have a more severe profile of substance use, thus confirming the strong association between psychoactive substance (PAS) use severity and delinquency. Girls being treated for addiction present a more severe profile of substance use than boys treated. No interaction effect was found between gender and level of delinquency. It also appears important that the history of sexual abuse be considered as one of the variables associated with the severity of PAS use.

In the ongoing pursuit for creating safe, nurturing and relational school cultures, educators continue to turn to restorative justice (rj) principles and practice. Predominantly, schools begin to engage with rj in an effort to address harm done, causing its discourse to be situated in literature tied to classroom management and behaviour. However, in this location, the effectiveness of rj can be limited because the power relationships underlying the original punitive, managerial structures maintain their grip. Drawing on a qualitative study that examines the experiences of educators committed to implementing rj principles, this article explores how placing rj in the context of engaged, productive pedagogies better nurtures the hoped for relational and peaceful school culture.

To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi method to identify clinically relevant content to incorporate in a musculoskeletal anatomy curriculum for Physical Medicine and Rehabilitation (PM&R) residents. A two round modified Delphi involving PM&R experts was used to establish the curricular content. The anatomical structures and clinical conditions presented to the expert group were compiled using multiple sources: clinical musculoskeletal anatomy cases from the PM&R residency program at the University of Toronto; consultation with PM&R experts; and textbooks. In each round, experts rated the importance of each curricular item to PM&R residency education using a five-point Likert scale. Internal consistency (Cronbach's alpha) was used to determine consensus at the end of each round and agreement scores were used as an outcome measure to determine the content to include in the curriculum. The overall internal consistency in both rounds was 0.99. A total of 37 physicists from across Canada participated and the overall response rate over two rounds was 97%. The initial curricular list consisted of 361 items. After the second iteration, the list was reduced by 44%. By using a national consensus method we were able to objectively determine the relevant anatomical structures and clinical musculoskeletal conditions important in daily PM&R practice.

Objective: The purpose of the study is to determine if an updated online evidence-based educational programme delivered through Facebook is effective in improving the knowledge, skills, and self-efficacy of patients with arthritis in relation to evidence-based self-management rehabilitation interventions for osteoarthritis (OA) and rheumatoid arthritis (RA). Methods: Adult patients (>18 years old) with self-reported OA or RA were eligible for the study. One-hundred-and-ten participants were recruited from the general public and different arthritis patient organizations throughout Canada. Eleven participants were selected to participate in focus groups to select effective self-management strategies for OA and RA according to level of implementation burden. Ninety-nine participants were then selected to participate in the online Facebook intervention which included a "group" web page providing case-based video clips on how to apply the selected self-management interventions. Over a three-month period participants were asked to complete three online questionnaires regarding their previous knowledge, intention to use/actual use of the self-management strategies, self-efficacy and confidence in managing their condition. Results: Knowledge acquisition scores improved among OA and RA participants with a mean difference of 1.8 (p < 0.01) when compared from baseline to immediate post-intervention. At three months post-intervention, almost all self-management strategies were successful with participants following through on their intention to use the self-management strategies; however, statistically significant results were only demonstrated for "'aquatic jogging" (p < 0.05) and "yoga" (p < 0.05) among OA participants, and "aquatic therapy" (p < 0.01) among RA participants. Self-efficacy was maintained from immediate post-intervention to three months follow-up, and confidence improved as the study progressed. Conclusions: This online programme can provide patient organization representatives with the opportunity to learn about and integrate evidence-based self-management strategies for OA and RA in their daily lives, to increase their awareness of useful community resources, and support their efforts to disseminate the information to others with arthritis.

This article describes a case study of adult learning in a Canadian multisite Community Cardiovascular Hearts in Motion program. The researcher highlights the informal learning of 40 adult participants in this 12-week community-based cardiac rehabilitation/education program in five rural Nova Scotia communities. The effects of this learning and barriers are examined, along with aspects of program design and facilitation that support learning and transformation. The researcher points to the role of emotion in this transformative learning process, and links are made between individual and collective processes in the transformative learning. Transformative learning theorists and health and adult education practitioners can see in this case study how individual and collective health interests can be incorporated into program planning for the community.

This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to improve the quality of services provided to children with disabilities, their families, and their communities. (Contains 2 tables and 3 figures.)

Aims: The study objectives were to: (1) understand the value attributed to the lived experience of addiction and recovery among professionals working in addiction agencies serving women in Canada and (2) describe how lived experience influence practice-related decision-making. Methods: A descriptive qualitative study was conducted with a purposeful sample of 26 addiction professionals from 24 addiction agencies. Subsequently, a secondary analysis was conducted to identify data that would provide greater insight into issues related to the use of lived experience in decision-making. Findings: Participants who either described their personal history of addiction or discussed the influence of others' lived experience on decisions made within the agency indicated that: (1) some professionals perceive lived experience and research evidence as two dichotomous concepts, viewing lived experience as more credible than research evidence; (2) personal experience with a particular treatment can guide treatment decisions; (3) strong adherence to only one source of evidence leads to intra-organizational conflict and (4) different sources of evidence in decision-making need to be acknowledged to inform practice. Conclusion: The addiction field can benefit from increased understanding of decision-making as a multifaceted process involving different sources of evidence, including addiction professionals' lived experiences of addiction and recovery.

Objective: To evaluate Snyder's (2002) hope theory as a motivational model of community participation and life satisfaction. Setting: Manitoba chapter of the Canadian Paraplegic Association. Participants: One-hundred and sixteen participants with spinal cord injuries who were members of the Manitoba chapter of the Canadian Paraplegic Association. Results: The respecified path-analytic hope model of participation and life satisfaction fits the data reasonably well, with chi[superscript 2]/df = 2.58; GFI = 0.95; and CFI = 0.95. Participation--with indirect effects of causality, perceived control, resilience, agency thinking, and pathways thinking--explained 32% of the variance in life satisfaction. Causality and agency thinking--with indirect effects of perceived control, resilience, and pathways thinking--explained 40% of the variance in participation. Conclusion: Snyder's hope theory as a motivational model of participation and life satisfaction was validated with minor modifications to the model. The respecified model indicated that causality had a direct effect on participation; pathways thinking had a direct link to agency thinking; and pathways thinking only had an indirect effect on participation through agency thinking.

Introduction: In the Province of Quebec, Canada, it is estimated that only about one-third of working-age adults with visual impairments are part of the workforce, despite ongoing efforts of rehabilitation and government agencies to integrate these individuals. The present article describes the development and adaptation of a pre-employment program specifically designed for English-speaking visually impaired persons in Quebec. Methods: Based on a model program introduced at the University of Texas in the United States, and further developed with the Royal National Institute of Blind People in the United Kingdom, the MAB-Mackay Rehabilitation Centre (MMRC) adapted the training materials for its pre-employment program to the local requirements. Its effectiveness was appraised using post training employment status as well as responses by participants, using the Canadian National Institute for the Blind (CNIB) Tool to Assess Preparedness for Employment (TAPE) measure of employment readiness. Results: Of the eight participants who completed the four-week program, five had found employment and, of those, four had maintained employment within the eight-month follow-up period (one full-time, three part-time). Further, two of those employed part-time also returned to school part-time. An additional two participants chose to continue their education in order to improve their employability. Scores on the CNIB TAPE subscale of communication showed statistically significant post-training improvement ("p" = 0.01) that was maintained after eight months. A statistical trend indicated improvement on the technology subscale following participation in training ("p" = 0.10). Discussion: MMRC's pre-employment training program was developed to address the need for a structured employment preparation program that was integrated with the available rehabilitation services for English speaking visually impaired individuals in a predominantly French-speaking environment. Implications for practitioners: The multidisciplinary nature of this approach facilitated a common language and shared perspective for practitioners across disciplines that are involved in preparing clients for the job market.

This study extends our knowledge about the rehabilitation of criminal organization offenders by focusing on their community outcomes upon release, and identifying the risk factors related to reoffending for 332 organized crime offenders released from federal penitentiaries in Canada prior to March 31, 2009. Of that group, 12.7% were readmitted to prison, which was about one half the percentage of a matched group of nonorganized crime offenders. These results are especially relevant given that most of these offenders were affiliated with traditional organized crime groups, such as the Mafia or outlaw motorcycle gangs, and, as such, are likely to be admitted to prison with well entrenched criminogenic beliefs and negative peer associations. These findings provide empirical evidence that these offenders do have the potential for successful community reentry. Implications for the development of correctional programs are discussed. (Contains 5 tables and 2 notes.)

Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis was undertaken within a study of 1268 cardiac outpatients recruited from 97 cardiologist practices where clinical data were extracted. Participants completed a survey including the Duke Activity Status Index. They reported CR utilization in a second survey mailed 9 months later, including CR site and program model. Geographic information systems were used to determine the distances and the drive times to the CR site attended from patients' homes. Overall, 469 (37.0%) participants attended CR at one of 41 programs. Of the 373 (79.5%) participants with complete geographic data, 43 (11.5%) reported attending home-based CR. The sole clinical difference was in activity status, where patients attending a hospital-based program had lower activity status (P less than 0.01). There were no differences in model attended on the basis of geographic parameters including urban versus rural dwelling or drive times (P greater than 0.05). In conclusion, only one-tenth of outpatients participated in a home-based program, and this allocation was unrelated to geographic considerations. Although patients should continue to be appropriately triaged on the basis of clinical risk to ensure safety, more targeted allocation of patients to home-based services may be warranted. This may optimize the degree of participation and potentially patient outcomes. (Contains 1 figure and 2 tables.)

Ambulatory children and youth with cerebral palsy have limitations in locomotor capacities and in community mobility. The ability of three locomotor tests to predict community mobility in this population (N = 49, 27 boys, 6-16 years old) was examined. The tests were a level ground walking test, the 6-min-Walk-Test (6MWT), and two tests of advanced locomotor capacities, the 10-meter-Shuttle-Run-Test (10mSRT) and the Timed-Up-and-Down-Stairs-Test (TUDS). Community mobility was measured with the Assessment of Life Habits mobility category. After age and height were controlled, regression analysis identified 10mSRT and TUDS values as significant predictors of community mobility. They explained about 40% of the variance in the Life Habits mobility category scores. The 10mSRT was the strongest predictor (standardized Beta coefficient = 0.48, p = 0.002). The 6MWT was not a significant predictor. Thus, advanced locomotor capacity tests may be better predictors of community mobility in this population than level ground walking tests. (Contains 3 tables.)

Despite a growing number of publications on problematic Internet use (PIU), there is no consensus on the nature of the phenomenon, its constituent criteria, and its clinical threshold. This qualitative study examines the perceptions of addiction counsellors who have managed individuals with PIU in Quebec (Canada). Four focus groups were conducted with 21 addictions counsellors working in public addiction rehabilitation centres. Discussion groups were digitally recorded, transcribed using a word processor, and analyzed using N'vivo 8.0 software. The results present the perceptions of counsellors regarding case management issues, including problematic applications, clinical picture, number of hours of Internet use for assessment, and for treatment.

There has been relatively little research on the degree to which measures of lifetime history of substance abuse add to the prediction of risk based on actuarial measures alone among sexual offenders. This issue is of relevance in that a history of substance abuse is related to relapse to substance using behavior. Furthermore, substance use has been found to be related to recidivism among sexual offenders. To investigate whether lifetime history of substance abuse adds to prediction over and above actuarial instruments alone, several measures of substance abuse were administered in conjunction with the Sex Offender Risk Appraisal Guide (SORAG). The SORAG was found to be the most accurate actuarial instrument for the prediction of serious recidivism (i.e., sexual or violent) among the sample included in the present investigation. Complete information, including follow-up data, were available for 250 offenders who attended the Regional Treatment Centre Sex Offender Treatment Program (RTCSOTP). The Michigan Alcohol Screening Test (MAST) and the Drug Abuse Screening Test (DAST) were used to assess lifetime history of substance abuse. The results of logistic regression procedures indicated that both the SORAG and the MAST independently added to the prediction of serious recidivism. The DAST did not add to prediction over the use of the SORAG alone. Implications for both the assessment and treatment of sexual offenders are discussed. (Contains 3 tables.)

Introduction: Children with acquired brain injury (ABI) often experience cognitive, motor, and psychosocial deficits that affect participation in everyday activities. Cognitive Orientation to Daily Occupational Performance (CO-OP) is an individualized treatment that teaches cognitive strategies necessary to support successful performance. Objective: This study explores the use of CO-OP with children with ABI. Method: Children with ABI, experiencing school and self-care difficulties, were identified from a previous study. Six children, aged 6-15 years, completed 10 weekly intervention sessions with occupational therapists. Children and parents rated the child's performance of challenging everyday tasks and their satisfaction with this performance. Task performance was also evaluated objectively through videotape analysis. Results: Participants showed significant improvement in their ability to perform child-chosen tasks and maintained this performance 4 months later. However, they had difficulty applying the executive problem-solving strategy and discovering cognitive strategies on their own. Issues related to the use of CO-OP with this population are discussed. (Contains 3 tables and 3 figures.)

Offenders sentenced to terms of life imprisonment pose special challenges for correctional systems. The Correctional Service of Canada collaborated with nongovernmental agencies to develop programmatic interventions to better prepare this population to survive their prison sentences and transition to the community. This study describes the characteristics of the Canadian lifer population and illustrates how the LifeLine program, first introduced in 1991, has contributed to low rates of recidivism using National Parole Board statistics from 1994 to 2009. The fact that so many life-imprisoned offenders make a successful transition to the community suggests that not only is this program effective, but that the risk to public safety has been carefully managed. Implications for the management of this growing population of offenders are discussed. (Contains 3 tables and 4 notes.)

Several factors undoubtedly influenced the development of listening and spoken language options for children with hearing loss in Canada. The concept of providing auditory-based rehabilitation was popularized in Canada in the 1960s through the work of Drs. Daniel Ling and Agnes Ling in Montreal. The Lings founded the McGill University Project for Deaf Children in 1966, and through their work brought attention and a research focus to early identification and intervention as well as recognition that parent guidance and participation are fundamental to rehabilitation. Several years later in 1975, Daniel Ling and the McGill University School of Human Communication Disorders established a training program in Auditory/Oral (Re)habilitation and Education of the Hearing-Impaired, the first in Canada and one of few worldwide dedicated to the training of professions in aural rehabilitation. Through teaching, research, and publications, and subsequently through many graduates, the Lings had considerable influence on the development of rehabilitation and education for children with hearing loss in Canada, particularly in central Canada. Professionals and parents who directly trained with the Lings or who interacted with them through other learning opportunities have gone on to become leaders in the field of auditory-verbal studies. Parents who received services from the Lings and who were encouraged by the outcomes undoubtedly influenced and contributed to the development of new programs and parent support groups. Since then, many other regions of Canada have established auditory intervention programs; however, therapy methods and service delivery models are often geographic-specific, with considerable variation between provinces and cities. Parent associations have also had a tremendous impact on developing and shaping new programs throughout Canada. (Contains 1 footnote.)

Community-based occupational therapy (OT) services are intended to promote social integration and minimize disability. The objective of this study was to describe community-based OT services for children in the province of Quebec, Canada. Specific aims included (a) to determine the proportion of Centres Locaux de Services Communautaires (CLSCs) that provide OT services to children, (b) to describe the nature of the services offered, and (c) to identify factors that are associated with the availability of these services. Surveys were sent to all CLSCs where at least one OT was employed. The response rate was 80%. Only 12% of CLSCs offered OT services to children on a regular basis ([greater than or equal to] 1 day/week). Home adaptations were the most frequent service offered, whereas health promotion was rarely addressed. Perceived obstacles to servicing children included prioritization of services to the elderly, limited funding, and shortage of OTs. CLSCs in rural areas and those with a psychologist had significantly more dedicated OT time spent for services to children. The findings suggest that community-based OT services for children in Quebec are poorly developed, which may negatively impact upon timely access to specialized rehabilitation services and may increase activity limitations and family burden. (Contains 2 figures and 3 tables.)

Adolescent methamphetamine use is a prominent concern for Canadian media and government. Few empirical studies, however, have established the scope of adolescent methamphetamine use or associated outpatient substance abuse treatment utilization. The current study aimed to answer the following questions: (1) What was the overall proportion of primary methamphetamine-related cases seen at youth outpatient substance abuse treatment centres in British Columbia in 2005-2006?; (2) What kind of treatment programming did these treatment centres offer primary methamphetamine users?; and (3) How prepared were these treatment programs to provide services to primary methamphetamine users? We developed a comprehensive list of all sites offering outpatient substance-abuse treatment programs for youth in British Columbia. We asked the Executive Director (or designate) of each facility about the program's annual caseload, proportion of primary methamphetamine-related cases, treatment approach, and preparedness to provide effective treatment for methamphetamine users. Responses were received from 68 of the 80 centres on our final master list. Approximately 11% (780/6,840) of all cases at the sites were due primarily to methamphetamine use. The proportion of primary methamphetamine-related cases varied widely across sites in B.C., with contacted centres reporting between 0-65% of their caseload in 2005-2006 as primarily methamphetamine-related. Almost all facilities integrated primary-methamphetamine users into treatment-as-usual, and few centres (12%) felt inadequately prepared to offer treatment for methamphetamine users. The current study found a substantial proportion of all cases seen at youth outpatient substance abuse treatment centres in British Columbia in 2005-2006 were primarily due to methamphetamine misuse. While most treatment sites integrated youth methamphetamine users into regular treatment programming and few treatment directors indicated that their programs were inadequately prepared to offer treatment services to methamphetamine-using clients, more evidence is needed to ascertain the most effective treatment strategies for methamphetamine users.

Introduction: Videoconferencing (VC) is becoming a common method for the delivery of continuing education (CE) to clinicians in remote locations. The purpose of this study was to compare the effectiveness, acceptability, and costs of a full-day training workshop (TW) delivered through two different formats: face-to-face (FTF) and VC. The TW was designed to teach administration and scoring guidelines for the Chedoke-McMaster Stroke Assessment, an outcome measure used by rehabilitation professionals. Methods: The TW was delivered simultaneously in FTF and VC formats to a total of five remote communities on two separate occasions. Participants completed a test of scoring competency at the beginning (pretest) and end (posttest) of the TW as well as a feedback questionnaire. A cost comparison was also undertaken. Results: Forty-four physical and occupational therapists participated. No significant between-group differences were found in posttest scoring competency related to delivery format (FTF or VC): (F[subscript 1,38] = 0.6, MSE = 3.6, p greater than 0.4), or for the two workshops: (F[subscript 1,38] = 1.4, MSE = 3.6, p greater than 0.2). Despite technical difficulties, participant experience was rated as "good" to "excellent." The VC method offered considerable cost savings to participants and their organizations, at a minimum of $7,437 (Canadian). Conclusion: Clinicians participating in the TW via VC performed as well as those in the FTF group on the competency test. Videoconferencing improves access to CE, is well received by participants, and provides a cost-effective method of course delivery. Further evaluation of other CE events delivered through VC is indicated. (Contains 1 figure and 4 tables.)

Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer assessments. Using data from this program, we assessed physician compliance with MMT guidelines and determined whether physician factors (e.g., training, years of practice), practice type, practice location, and/or caseload is associated with MMT guideline adherence. Methods: Secondary analysis of methadone practice assessment data collected by the College of Physicians and Surgeons of Ontario, Canada. Assessment data from methadone prescribing physicians who completed their first year of methadone practice were analyzed. We calculated the mean percentage compliance per guideline per physician and global compliance across all guidelines per physician. Linear regression was used to assess factors associated with compliance. Results: Data from 149 physician practices and 1,326 patient charts were analyzed. Compliance across all charts was greater than 90% for most areas of care. Compliance was less than 90% for take-home medication procedures; urine toxicology screening; screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), tuberculosis, other sexually transmitted infections, and completion of a psychosocial assessment. Mean global compliance across all charts and guidelines per physician was 94.3% (standard deviation = 7.4%) with a range of 70% to 100%. Linear regression analysis revealed that only year of medical school graduation was a significant predictor of physician compliance. Discussion: This is the first report of MMT peer assessments in Canada. Compliance is high. Few countries conduct similar assessment processes; none report physician-level results. We cannot quantify thecontribution of peer assessment, training, or self-selection to the compliance rates, but compared to other areas of practice these rates suggest that peer assessment may exert a significant effect on compliance. A similar assessment process may in other areas of clinical practice improve physician compliance. (Contains 1 table.)

The present paper comprises an overview of techniques using ultrasound in speech (re)habilitation. Ultrasound treatment techniques have been developed for English lingual stops, vowels, sibilants, and liquids. These techniques come from a series of small "n" studies with adolescents and adults with severe hearing impairment, residual speech impairment or accented speech at the Interdisciplinary Speech Research Laboratory at the University of British Columbia. Ultrasound allows excellent visualization of tongue shape features, which is especially useful for feedback during speech (re)habilitation. Further research is needed to evaluate the efficacy of ultrasound in speech (re)habilitation. (Contains 6 figures.)

The writer, a rehabilitation teacher, describes her visit and volunteer work with the Canadian National Institute for the Blind in Canada's Northwest Territories. She describes the area's geography, people, and her experiences including learning to drive on the gravel highway and her rehabilitation teaching subjects. Closing reflections focus on experiences of northern people with retinitis pigmentosa. (Contains one reference.) (DB)

Male federal prisoners who had been students in the postsecondary prison-education program and released 1973-1993 were followed for three years (N=654). Extensive data were available. Subgroups were compared to Canada's Statistical Information on Recidivism risk-prediction scheme to test hypotheses regarding success rates. Conclusions regarding methodology and program effectiveness are discussed. (EMK)