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Purpose: The purpose of this study was to explore rehabilitation clinicians' understanding of how sex and gender facilitate or hinder care provided to patients with traumatic brain injury (TBI)., Materials and Methods: Sixteen clinicians from various specialities, attending to patients with TBI from a large rehabilitation hospital in Ontario, Canada, were recruited using purposive sampling. Data was collected through semi-structured interviews and thematic analysis was used to identify reoccurring themes., Results: Three themes that facilitate or hinder care of TBI patients were identified: (1) knowledge and evidence; (2) gender and other aspects of recovery; and (3) family caregiving. Lack of education about the topic and inconsistent scientific evidence limited clinicians' attention to sex and gender topics. Social, financial, and cultural characteristics of patients were considered to be more relevant than their sex and gender. The gendered nature of caregiving and its burden on caregivers' health were acknowledged., Conclusions: Currently, attention to topics of sex and gender as they may influence patients' recovery is limited. However, clinicians are willing to be educated on these topics to enhance rehabilitation care. Further research on the gendered nature of interactions between patient, clinician, and family caregiver during recovery is warranted.IMPLICATIONS FOR REHABILITATIONSex and gender matter for patients undergoing recovery for their traumatic brain injury; however, clinical attention to this topic is limited.Based on the clinicians' perceptions, resources that address patients' psychosocial vulnerabilities should be prioritized (e.g., unequal access to care, financial status, cultural diversity etc.).Clinicians highlighted that psychosocial vulnerability and patients' life roles, before and after injury, are sex and gender specific.Guidelines about sex and gender influences in traumatic brain injury rehabilitation have the potential to enhance clinical practice.

Background: Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers., Methods: This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis., Results: Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training., Conclusions: Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.

Objective: To explore gender and sex differences in experiences of transitioning to adult health care among young adults with acquired brain injury (ABI) who take part in a coordinated model of transitional care., Design: Descriptive design using in-depth semistructured qualitative interviews., Setting: Interviews over the phone and in person., Participants: Participants (N=18) included 10 young adults with a diagnosis of ABI (4 women, 6 men; age range, 19-21y) and 9 parents (8 women, 1 man) from the Greater Toronto Area, Ontario, Canada., Interventions: Not applicable., Main Outcome Measure: Semistructured interviews with participants., Results: Our findings highlight several commonalities and differences relative to sex and gender among young adults with ABI who are transitioning from pediatric to adult care. Both young adult men and women experienced a similar transition process and similar organization, continuity, and availability of care. Sex differences were found in relational factors (eg, communication, family involvement, social support). Young adult men, and parents of the men, differed in their transition regarding relational factors (eg, communication, family involvement)., Conclusions: Our findings show that young adult men and women with ABI who have taken part in a transition preparation program experience similarities in organization, continuity, and availability of care, but they experience differences in relational factors (eg, communication, family involvement)., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Whether young adults with complex care needs live at home with their family, in institutional or group home settings finding appropriate care as they transition from paediatric to adult systems can be difficult. Our objective was to understand the experiences, barriers and enablers entailed in transitioning three young adults with complex care needs from an institutional paediatric hospital setting to an adult community residence., Method: A descriptive design involving in-depth, semi-structured, qualitative interviews and a review of 14 h of meeting minutes. Interviews were conducted over the phone, in participants' homes, and at a paediatric rehabilitation hospital. Twenty-three participants, including 10 clinicians, 11 community partners, two young adults (21-23 years old) with complex care needs from [metropolitan area] Ontario, Canada., Results: Our findings indicate that clinicians, community partners and young adults with complex care needs encountered several enablers and barriers influencing their transition from a paediatric hospital to adult supportive housing. Enablers included structural factors (leadership, advocacy, timing/funding), availability of care (inter-agency partnerships), organization of care (model of care, inter-professional teamwork, extension of roles), and relational factors (communication, development of trust and rapport, family involvement). Barriers included structural factors (timing, funding), availability of care (appropriateness of housing), organization of care (changes in model of care, teamwork, role clarity), relational factors (communication, trust/rapport, family involvement) and personal factors (transition readiness)., Conclusions: There are several challenges to overcome in preparing long-term hospitalized young adults with complex care needs to transition to adult supportive housing; however, these challenges may be overcome with targeted supports in several key areas., (© 2014 John Wiley & Sons Ltd.)

Purpose: Although collaborative, culturally competent care has been shown to increase positive health outcomes and client satisfaction with services, little is known about the ways that clinicians implement service delivery models with immigrant families having a child with a disability. The purpose of this study is to examine the experiences of clinicians working with immigrant families raising a child with a physical disability and to examine the views and experiences of clinicians providing collaborative, culturally competent care to immigrant families raising a child with a physical disability., Method: This study draws on in-depth interviews with 43 clinicians within two pediatric centers in Toronto and Quebec., Results: Our findings show that clinicians remove or create barriers for immigrant families in different ways, which affect their ability to provide culturally competent care for immigrant families raising a child with a physical disability., Conclusions: Our findings suggest that there is a need for more institutional support for collaborative, culturally competent care to immigrant families raising a child with a physical disability. There is a lack of formal processes in place to develop collaborative treatment plans and approaches that would benefit immigrant families. Implications for Rehabilitation Clinicians need greater institutional support and resources to spend more time with families and to provide more rehabilitative care in families' homes. Building rapport with families includes listening to and respecting families' views and experiences. Facilitate collaboration and culturally competent care by having team meetings with parents to formulate treatment plans.

Purpose: Having a mobility-related disability can create numerous challenges in navigating the physical and built environment, especially during winter. Such weather-related challenges can be a significant barrier to participation in everyday activities and are linked with increased physical and psychological morbidities. Unfortunately, mobility research--especially among youth - has often overlooked the effects of winter weather., Methods: This study explores the experiences of daily activities during Canadian winter among a purposive sample of youth, aged 15-22, who have a physical disability requiring the use of a mobility device. The researchers applied a qualitative design, including 12 in-depth interviews., Results: Our findings show that youth encounter several vulnerabilities to participating in social and recreational activities in winter, including: (1) physical barriers and social spatial exclusion; (2) health and safety concerns; and (3) psychosocial issues (i.e., worry, isolation and dependence). Youth also discussed several strategies for adapting to barriers and enhancing their participation during winter, including: (1) wheelchair maintenance; (2) awareness of surroundings; (3) practice using mobility devices and planning; and (4) keeping busy and active., Conclusions: Youth who use a mobility device are vulnerable to health and safety risks and isolation during the winter, but they also display signs of resilience.

Purpose: Having a disability is a barrier to securing and maintaining employment. Most research has focussed on employment barriers among adults, while very little is known about young people's experience finding paid work., Method: Young people aged 15-24 were selected from the 2006 Participation and Activity Limitation Survey to explore the barriers and discrimination they experienced in seeking employment (n = 1898)., Results: Our findings show that teens and young adults with disabilities encountered several barriers and discrimination in seeking paid employment. The types of barriers that these young people encountered varied by age and type of disability. There were fewer yet different types of barriers to working that were encountered between the two age groups (teens and young adults). Several socio-demographic factors also influenced barriers to working. Severity of disability, type and duration of disability, level of education, gender, low income, geographic location and the number of people living in the household all influenced the kind of barriers and work discrimination for these young people., Conclusions: Rehabilitation and life skills counsellors need to pay particular attention to age, type of disability and socio-demographic factors of teens and young adults who may need extra help in gaining employment.

Purpose: Access to assistive devices is critical for most children with disabilities to function in society. Despite this, there remain high levels of unmet needs and an underutilisation of augmentative and alternative communication (AAC) devices. Yet, relatively little is known about the challenges that clinicians encounter in prescribing AAC devices., Method: In-depth qualitative semi-structured interviews were conducted with 11 speech language pathologists and occupational therapists who are current authorisers for AAC devices., Results: The findings suggest that there are several barriers (technical, social and political) influencing clinicians' decision to prescribe AAC devices. Technical challenges include the complexity of devices and viewing technology as a cure. Social barriers involve socio-demographic differences, readiness to use a device, social acceptance, attitudes, family's view of technology, and the priority of communication. Finally, several political barriers such as a shortage of speech pathologists, a complex prescription review process, inconsistent follow-up procedures, limitations of the consultative model, and gaps in funding and policy influenced clinicians' ability to prescribe AAC devices. Differences in philosophy of technology also influenced health providers' decision to prescribe AAC devices., Conclusions: Service providers and policy makers should be cognizant of the contextual factors influencing health provider's decision to prescribe AAC devices.