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Purpose: To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities. Method: Participants (4–17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group. Results: Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = −21.2; 95% CI, −33.6 to −8.7) than children. More daily steps were taken by boys than girls (mean difference = −1040; 95% CI, −1465 to −615) and individuals with a nonphysical disability than a physical disability (mean difference = −1120; 95% CI, −1474 to −765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school. Conclusion: The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention. [ABSTRACT FROM AUTHOR]

Purpose: The Wheelchair Skills Training Program (WSTP) is underutilized in pediatrics for training manual wheelchair skills because the voluminous manual lacks pediatric specificity and no materials adapted for pediatric manual wheelchair users (PMWUs) are available. A set of resources (storybook, posters, training workbook) based on the WSTP has previously been developed for training basic indoor wheelchair skills with five to 15-year-old PMWUs. Occupational therapists (OTs) and PMWUs expressed a need for additional resources addressing higher-level skills. Two new sets of resources teaching indoor and community wheelchair skills were developed. Objective: Describe OTs' and PMWUs' satisfaction and perceptions regarding usability, relevance and feasibility in pediatrics with the new resources. Methods: A descriptive qualitative study was conducted. A focus group and interviews were respectively conducted with a convenience sample of OTs and a criterion sample of PMWUs to document perceptions regarding satisfaction, usability, relevance and feasibility. A deductive approach to data analyses was used following the Framework Method. Results: Six OTs expressed satisfaction regarding both sets of resources feeling more confident using the WSTP (relevance) and perceiving potential time efficiencies when planning training interventions (feasibility). They provided suggestions to improve the usability of the second set. Six PMWUs participated in the interviews, two of which provided feedback on both sets. They were satisfied with the resources recommending them to novice and temporary PMWUs aged from three to 11 years. Conclusion: Participants' suggested the resources may contribute to reducing the gap between the evidence supporting the WSTP and its utilization in pediatrics. IMPLICATIONS FOR REHABILITATION: Two sets of knowledge transfer resources based on the Wheelchair Skills Training Program (WSTP) are pediatric-friendly materials that could be used in rehabilitation settings to train wheelchair skills among novice and temporary manual wheelchair users. Both sets of knowledge transfer resources may help bridge the gap between the evidence supporting the WSTP and its utilization in pediatrics by responding to clinicians' needs for playful, easy-to-use and condensed materials to use in their interventions. The perspectives of occupational therapists and pediatric manual wheelchair users are important to improve the wheelchair skills training resources so that they align with both knowledge users' needs and preferences. [ABSTRACT FROM AUTHOR]

Children who use a manual wheelchair (WC) or a power WC may not receive adequate WC skills training. Clinicians report knowledge as a barrier to the provision of paediatric WC skills training. The purpose of this study was to explore the breadth and depth of specific factors clinicians consider when providing WC skills training for children. Data in this modified Think Aloud study were gathered via one-on-one, Zoom-based, audio-recorded Think Aloud Sessions. Sessions consisted of participants viewing four videos, each of different children performing a different WC skill while thinking aloud (verbally expressing) about the factors they recognized, observed, and considered while watching the video. After each video, participants also responded to questions regarding the specific WC skill and the provision of WC skills training for the child in the video. Factors participants reported were independently identified by three researchers through a deductive process of directed content analysis and categorized using the International Classification of Functioning, Disability and Health (ICF) coding system. Twenty-eight English-speaking clinicians participated in the study. A total of 1246 distinct factors were mapped to 352 unique ICF codes spanning all four ICF Domains. The largest number of identified factors mapped to codes within the Activities and participation Domain (42.25%). Participants reported considering multiple factors across the ICF in the provision of WC skills training for children. Providing paediatric WC skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities. Providing paediatric wheelchair (WC) skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities. Clinicians should consider the child's Mental Functions, Activities and Participation, and Environmental Factors when providing wheelchair skills training for children. A lack of wheelchair-specific International Classification of Functioning, Disability, and Health codes was noted. Revising these codes to better capture the diverse range of the benefits and challenges involved in learning to use and using a wheelchair would be beneficial. [ABSTRACT FROM AUTHOR]

To describe the use of mobile devices after acquired brain injury (ABI), from the perspectives of injured individuals and significant others, and to examine factors associated with mobile device use for cognition. Cross-sectional study with 50 adults with moderate/severe traumatic brain injury or stroke (42% women; mean of 50.7 years old, 4.6 years post-ABI), and 24 significant others. Participants completed questionnaires on mobile technology, cognitive functioning and the impact of technology. Of 45/50 adults with ABI who owned a smartphone/tablet, 31% reported difficulties in using their device post-injury, 44% had received support, and 46% were interested in further training. Significant others reported motor/visual impairments and the fear of becoming dependent on technology as barriers for mobile device use, and 65% mentioned that their injured relative needed additional support. Mobile device use for cognition was common (64%), predicted in a regression model by lower subjective memory and more positive perception of the psychosocial impacts of technology, and also associated in univariate analyses with younger age, lower executive functioning, and greater use of memory strategies. Using mobile devices for cognition is common post-ABI but remains challenging for a significant proportion. Developing training approaches may help supporting technology use. Using mobile electronic devices (smartphones and tablets) is common after acquired brain injury (ABI) but is challenging for a significant proportion of individuals. After the ABI, close to 50% of individuals receive support in using their mobile device, mostly from family members and friends, but rarely from rehabilitation clinicians or technology specialists. In a sample of 50 adults with ABI, more frequent use of mobile devices to support cognition was associated with poorer subjective memory and executive functioning, greater use of memory strategies, more positive perception of the psychosocial impacts of technology, and younger age. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility and the clinical applicability of administering the COMET (cognition, occupation, mobility, evaluation and training) intervention. A pilot research was conducted with adults who were being considered for power wheelchair (PWC) provision, or who were recently provided a PWC, and who had been identified to benefit from a PWC training. The COMET intervention applies a goal directed, client-centred and occupation-based approach. Feasibility and applicability indicators were collected for: process, resources, management and treatment. Indicators were evaluated as "successful/unsuccessful". Clinical outcomes included the Goal Attainment Scale (GAS), the Canadian Occupational Performance Measure (COPM), the Power mobility Indoor Driving Assessment (PIDA) and the Wheelchair Skills Test (WST). Four females (62.5 ± 3.5 years) with cognitive impairment participated in the study. Among the 13 indicators, 10 were successfully achieved. Indicators that did not meet the criteria for success were adherence rate, safety and treatment for the PIDA. Two adverse events were reported, with one minor injury. Participants demonstrated better than expected results on the GAS, the COPM scores and the WST. However, only two reported an improvement beyond 4% of the PIDA. With few modifications, the COMET intervention and the study protocol will be feasible and applicable in clinical practice. Individuals with complex cognitive and mobility impairment demonstrated abilities to learn PWC use. Further investigation of the COMET intervention is required to evaluate its efficacy. A novel power wheelchair (PWC) training approach adapted to individual with complex mobility and cognitive impairments was developed: the COMET (cognition, occupation, mobility, evaluation and training) intervention. The COMET intervention applies a goal directed, client-centred and occupation-based approach. With minor modifications, the COMET intervention may be feasible and clinically applicable to train individuals with complex motor and cognitive impairments how to use a PWC. Further evaluation of the COMET intervention and lager control trialsare suggested. [ABSTRACT FROM AUTHOR]

Multiple healthcare professionals fit walking aids (WA) and train individuals on their use. The purpose of this investigation was to describe curricula on WA fitting and training in Canadian entry-to-practice professional programs. An online survey was administered to leads from all accredited programs (n = 199). Seventeen questions asked about the importance of WA education, instructional methods and time dedicated to WA fitting and skills training, and how the pandemic had affected WA curriculum delivery. Responses were received from 97 programs. While most occupational therapy (OT, 8/15), physiatry (PM&R, 5/9), and physical therapy (PT, 12/19) trainees received more than 3 h of instruction on WA fitting, most nursing (29/40) and pharmacy (7/8) programs spent less than 3 h on this topic. Most OT (9/15) and PT (15/19) programs spent more than 3 h on WA skills training whereas most nursing (25/40), pharmacy (4/8), and PM&R (5/9) programs spent less than 3 h on this subject. Across all programs, 52% educated students on adapting activities of daily living for WA while 18% provided education on WA maintenance and repair. Only 19/89 programs consulted a formal WA skills training resource for curriculum development. Seventeen of 55 programs modified their WA curricula due to the pandemic. There is a wide range in curricular approaches to WA education in Canadian professional programs. This highlights the need for a standardised WA education program to guide curricular development to ultimately improve safe WA use for clients with short- and long-term mobility impairments. Curricula on walking aids is extremely variable within and between programs. Navigating terrains, adapting activities of daily living, and maintenance are poorly taught. There is a need for a national standardized curriculum on walking aids. This curriculum should be modular and designed for practitioners, students, and patients. [ABSTRACT FROM AUTHOR]

Background: Individuals with spinal cord injury (SCI) in less-resourced settings reported barriers to community integration, including inaccessible rehabilitation services, restricted environments and limited social integration. Peer training and entrepreneurial skills training are provided by Motivation, a nonprofit organisation, and Moshi Cooperative University to enhance occupational engagement of individuals with SCI in less-resourced settings. Objective: This study aimed to explore the impact of peer training and entrepreneurial skills training on the social participation of individuals with SCI living in Tanzania. Method: Using a qualitative photovoice approach, 10 participants captured meaningful photos and provided captions according to five standardised questions (PHOTO technique) to convey their messages. Participants selected up to 34 photos that best illustrated their experiences in the community. A mixed inductive–deductive thematic analysis was guided by the International Classification of Functioning, Disability and Health. Results: Two interrelated themes emerged: (1) 'influencing factors', which revealed how participants' inclusion in the community was influenced by their activities and personal and environmental factors and (2) 'empowerment', which highlighted participants' desire to advocate and promote awareness of needs and hopes. Conclusion: Participants emphasised the importance of accessibility and equal opportunities. Whilst some were able to overcome obstacles, others experienced continued inaccessibility that inhibited meaningful occupations. Daily participation challenges of individuals with SCI in rural Tanzania were highlighted. Although the Motivation programmes were perceived to have powerful impacts on social participation, continued efforts and advocacy are needed to overcome accessibility issues and to meet the physical, psychological and social needs of Tanzanians living with SCI. Contribution: This article highlights the importance of accessibility and equal opportunities for individuals with disability living in rural Tanzania. Peer-training and entrepreneurial programs offer community-based rehabilitation services that were perceived by people with disabilities to have a powerful impact on social participation and vocation. However, continued efforts and advocacy are needed to meet the needs of Tanzanians living with spinal cord injury. [ABSTRACT FROM AUTHOR]

Approximately 22% of Canadian children with physical disabilities meet the daily physical activity recommendations. Physical activity is attributed to physical literacy, a conceptualization of the domains required to be physically active throughout life. In Canada, pediatric rehabilitation professionals' and coaches' roles are essential for developing physical literacy. The aim of the study was to explore knowledge of physical literacy and strategies for developing physical literacy for children with physical disabilities among pediatric rehabilitation professionals, students, and coaches in Quebec. Semi-structured interviews were conducted with pediatric rehabilitation professionals, students and coaches and thematically analyzed using NVivo. Twenty professionals and students reported having variable knowledge about physical literacy, but suggested that adaptation, play and interdisciplinarity were essential in the development of physical literacy for children with physical disabilities. Participants highlighted the need to redefine fundamental movement skills for children with physical disabilities. Despite perceiving varied knowledge of the physical literacy concept, pediatric rehabilitation professionals and coaches described essential domains to foster physical literacy in children with disabilities. Pediatric rehabilitation professionals and coaches play a vital role in fostering physical literacy. Therefore, it is essential to support the development of knowledge that may support professionals, such as through training programs and continuing education. [ABSTRACT FROM AUTHOR]

Blind spot sensor systems can improve power wheelchair (PWC) safety. This research (1) compared accuracy of obstacle detection in the rear of a wheelchair with and without a sensor system, and (2) explored cognitive task load and perceived usability, safety, confidence and awareness in a laboratory setting, and (3) PWC users' perceptions in real-world settings. A mixed-method design was used. PWC users were provided with the sensor system. In laboratory accuracy of obstacle detection with and without a sensor system, cognitive task load and perceived usability, safety, confidence and awareness were evaluated. Participants then used the sensor system at home for two-months before completing semi-structured interviews. Statistical and thematic analyses were conducted. Among 11 PWC users (age = 67.5 ± 7.5y), obstacles were detected more accurately with sensor system than without (p < 0.001). Using the sensor system required lower cognitive task loads (p = 0.005). The system was perceived by most users as easy to use (9/11) and its capabilities meeting their requirements (8/11). Most users did not perceive safety (9/11), confidence (9/11) or increased awareness (10/11) in the laboratory. Three themes emerged in the follow-ups: perceived usefulness, barriers to use, and recommendations. Four participants reported continued use after 2 months, reporting perceived increased awareness, convenience, and independence using the system. Those who discontinued use reported perceived lack of usefulness and technical issues. Recommendations included types of users who can benefit and sensor improvements. Sensor systems may improve obstacle detection accuracy while reducing cognitive task load. However, larger scale implementation should consider recommendations for PWC service provision. Blind spot sensors systems increased speed and accuracy of obstacle detection when using a power wheelchair. Technical and hardware issues encountered by PWC users highlight the need for training and support services. Technical support was out of scope for the current research project and will be explored in future research given the critical role it might play in the usability and adoption of assistive technologies. PWC users perceived there to be practical uses for blind spot sensor systems. [ABSTRACT FROM AUTHOR]

Few studies have demonstrated that peer-led manual wheelchair (MWC) skills training can increase MWC skills, MWC use self-efficacy and satisfaction with participation of MWC users. Limited information is available on MWC skills training in the community. The primary objective was to measure the influence of Roulez avec confiance (RAC, which translated to "Wheeling with confidence"), a peer-led community-based wheelchair skills training program, on satisfaction with participation. The secondary objectives were to explore the: (1) influence of RAC on MWC use self-efficacy, MWC skills, and quality of life; (2) experiences of the participants who completed RAC and (3) three-month retention of outcomes. A parallel mixed design was used with validated questionnaires on satisfaction with participation (WhOM), MWC use self-efficacy (WheelCon-M), MWC skills (WST-Q), quality of life (SWLS) and a semi-structured interview on participants' experiences. Non-parametric longitudinal analyses of the questionnaires and thematic content analysis of the interviews were completed. Nineteen community-dwelling MWC users participated. There was a statistically significant increase (p < 0.0001) in all outcomes except quality of life (p = 0.16). Improvements were retained after three months. Participants mentioned their background influenced their experiences in RAC. Positive elements about RAC and areas for improvement were discussed. Participants reported overall positive social experiences and stated that the physical environment influenced RAC. Finally, participants spoke about what they learned and emotions they felt during RAC. Peer-led community-based MWC training influenced satisfaction with participation, MWC skills, and MWC use self-efficacy. This study was a first step in demonstrating the efficiency of RAC. Limited information is available on manual wheelchair skills training in the community. Peer-led community-based manual wheelchair training influenced satisfaction with participation, manual wheelchair skills and use self-efficacy. This study was a first step in demonstrating the efficiency of Roulez Avec Confiance. [ABSTRACT FROM AUTHOR]

This commentary is on the original article by Naaris et al. on pages 1653–1663 of this issue. [ABSTRACT FROM AUTHOR]

Although approximately 45% of adults with Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) are permanent wheelchair users, this sub population has been less studied. The purpose of this study was to document wheelchair mobility, motor performance, and participation in a cohort of adult wheelchair users with ARSACS. We recruited 36 manual and powered wheelchair users with ARSACS, aged between 34 and 64 years, for this cross-sectional study. Participants completed measures regarding wheelchair mobility (Wheelchair Skills Test Questionnaire [WST-Q-F], Wheelchair Use Confidence Scale [WheelCon-F] and Wheelchair Outcome Measure [WhOM-F]), motor performance (Scale for the Assessment and Rating of Ataxia [SARA], Disease Severity Index for adults with ARSACS [DSI-ARSACS], Upper Extremity Performance Test for the Elderly [TEMPA], Standardised Finger to Nose Test [SFNT], grip strength, pinch strength, Lower Extremity Motor Coordination Test [LEMOCOT], Berg Balance Scale [BBS], Timed Up and Go [TUG] and 10-meter Walk Test [10mWT]), and participation (Barthel Index, LSA-F and LIFE-H). Results were compared between age groups (≤49 years and ≥50 years), types of wheelchair used, and available reference values. Correlations were computed between wheelchair mobility, upper limb function, and participation. Participants presented limitations regarding wheelchair skills, motor performance, and participation in daily activities. Despite preserved upper limb strength, wheelchair skills, upper and lower limb coordination, standing balance, and functional independence were generally more impaired after 50 years of age and among powered wheelchair users. Significant moderate correlations were found between wheelchair skills and self-efficacy, upper limb strength and coordination, and participation in daily and social activities. This study provided the first data sets describing specific characteristics of manual and powered wheelchair users with ARSACS. It supports a need to offer wheelchair skills training interventions to adults with ARSACS, which could increase their daily and social participation. Adult wheelchair users with ARSACS present with limited wheelchair skills, significantly impaired motor performance, and reduced participation that generally decreases with age. This profile may serve as comparative data for clinicians to anticipate disease progression. This study provides the first data on distinguishing characteristics between PWC users and MWC users with ARSACS. The main characteristics of PWC users include more severe functional limitations and motor impairments, as well as limited grip strength that contrasts with the general preservation of this function among other adults with ARSACS. There is a need to offer and evaluate wheelchair skills training interventions in the future for adults with ARSACS. The general preservation of grip and pinch strength observed in this population suggests a potential for improvement. Considering the associations found between wheelchair mobility and participation, such interventions may increase users' daily and social participation. [ABSTRACT FROM AUTHOR]