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Demand for post-acute stroke and traumatic brain injury (TBI) rehabilitation outweighs resource availability. Every day, clinicians face the challenging task of deciding which patient will benefit or not from rehabilitation. The objectives of this scoping review were to map and compare factors reported by clinicians as influencing referral or admission decisions to post-acute rehabilitation for stroke and TBI patients, to identify most frequently reported factors and those perceived as most influential. We searched four major databases for articles published between 1946 and January 2021. Articles were included if they reported clinician's perceptions, investigated referral or admission decisions to post-acute rehabilitation and focused on stroke or TBI patients. Twenty articles met inclusion criteria. The International Classification of Functioning, Disability and Health framework was used to guide data extraction and summarizing. Patient-related factors most frequently reported by clinicians were patient's age, mental status prior to stroke or TBI and family support. The two latter were ranked amongst the most influential by clinicians working with stroke patients, whereas age was ranked of low importance. Organizational factors were reported to influence decisions (particularly availability of post-acute care services) as well as clinicians' characteristics (eg, knowledge). Moreover, clinicians' prediction of patient outcome ranked amongst the most important driver of referral or admission decisions by clinicians working with stroke patients. Findings highlight the complex nature of decision-making regarding patient selection for rehabilitation and provide insight on important factors frontline clinicians need to consider when having to make rapid decisions in high-pressured acute care environments. This article is protected by copyright. All rights reserved.

Daily childcare can be challenging for parents with a physical disability who have young children. Occupational therapists are valuable facilitators to family participation. However, occupational therapists have reported significant gaps in knowledge when documenting the parenting role of parents with a physical disability in occupational therapy practice. This study explored and described the parenting assessment methods used with parents with a physical disability in the scientific literature.A scoping review was conducted, and search results were reviewed by two separate reviewers. The search strategy was applied to five databases (Embase, CINAHL, MEDLINE, HaPI, PsycInfo). Numerical and thematic analyses were conducted.Four thousand one hundred fifty articles were screened, and 73 relevant scientific articles were included. Seventy-six assessment methods were identified, including 20 assessment instruments with few reported population-specific psychometric studies. Most assessments were conducted via interviews (n = 45), followed by questionnaires (n = 27), and only six were performance based. Parenting practices and experience were the two dimensions most assessed, with little attention given to parenting responsibility. Mothers with multiple sclerosis, spinal cord injury, rheumatoid arthritis, and cerebral palsy were the most assessed.Further research is needed to develop specific, multidimensional, and validated parenting assessments for all parents with a physical disability, including performance-based assessments. Formal assessments should be conducted by professionals, including occupational therapists, who have the necessary training.

Background. Occupational therapists play a major role in identifying the assistance needs of individuals living with a traumatic brain injury. However, to obtain an accurate assessment, verbal assistance should be provided only when necessary, according to the person's needs. Purpose. This study aimed to understand (1) how verbal assistance is provided during an evaluation of Instrumental Activities of Daily Living and (2) why it is provided in this manner. Method. Interviews were conducted with three expert occupational therapists using their own videotaped evaluation and a “think-aloud” method to explore their clinical reasoning when providing verbal assistance. Data were analyzed using thematic analysis. Findings. The process of providing verbal assistance was recognized as flexible and nonlinear, and influenced by various factors including the participants’ level of understanding of the client's abilities. Implications. This information will help therapists better understand how and when to provide verbal assistance when assessing their clients.

Objectives This study explored difficulties in meal preparation experienced by adults with moderate to severe acquired brain injury (ABI) and available compensatory strategies from both ABI individuals' and caregivers' perspectives. Further, this study investigated their opinions on potential benefits, barriers and facilitators to the use of the Cognitive Orthosis for coOKing (COOK) in their living environment. Methods Using a qualitative descriptive approach, semi-structured individual interviews and focus groups were carried out with adults with moderate to severe ABI (n = 20) and formal and informal caregivers (n = 13) in Ontario and Quebec, Canada. A qualitative analysis based on Miles et al.'s approach was used. Results According to participants, cognitive, physical, psychosocial dysfunctions and lack of availability of supportive caregivers were the main difficulties that impede persons with ABI from engaging effectively in meal preparation tasks. Memory aids on smartphones, and caregivers' direct support were reported as the most commonly used compensatory strategies, though the latter do not provide adequate support. COOK was identified as a technology with great potential to improve independence and increase safety in meal preparation for these clients while decreasing caregiver burden. However, psychosocial issues and limited access to funding were considered as the main barriers to the use of COOK. Providing training and the availability of financial support were mentioned as the main facilitators to the use of this technology. Conclusions Findings of this study on difficulties of meal preparation following ABI and potential benefits and barriers of COOK will help improve this technology and customize it to the needs of clients with ABI and their caregivers. Implications for Rehabilitation Current compensatory strategies are not tailored to the specific needs of clients with ABI and cannot provide sufficient support for caregivers. COOK shows a high potential for increasing independence and safety during meal preparation in a living environment for clients with ABI via a sensor-based autonomous safety system and a cognitive assistance application. COOK has the potential to decrease caregivers' burden by proving remote access to a stove/oven.

A cognitive orthosis named COOK was developed and implemented to facilitate meal preparation for adults with severe traumatic brain injury (TBI) living in an alternative housing unit. This study aimed to explore facilitators and barriers to the potential use and implementation of COOK in a new context (i.e., within the homes of people living with a TBI in the community). For this purpose, 20 stakeholders (e.g., health-care professionals, clinical coordinators, informal caregivers of individuals with TBI) were interviewed. Participants identified various potential benefits of this technology (e.g., improving independence and confidence of people with TBI) and facilitators (e.g., clinical and technical supports, helpful functionalities) that could facilitate the use and implementation of COOK within a home environment. However, numerous questions remained unanswered regarding the logistics surrounding the implementation of such technology. Thus, further studies and modifications are required to facilitate future implementation of this technology among individuals living in their own homes.

Considering the key role of health care providers in integrating assistive technologies into clinical settings (e.g., in/outpatient rehabilitation) and home, this study explored the care providers' perspectives onUsing a qualitative descriptive approach, semi-structured individual interviews and focus groups were carried out with experienced care providers of adults with TBI (According to the participants, COOK could potentially be used with individuals with cognitive impairments (TBI and non-TBI) to increase safety and independence in meal preparation and support healthcare providers. However, limited access to funding, clients' lack of motivation/knowledge, and the severity of their cognitive and motor impairments were perceived as potential barriers. Facilitators to the use of COOK include training sessions, availability of private/provincial financing, and comprehensive assessments by a clinical team prior to use.Health care providers' perspectives will help develop implementation strategies to facilitate the adoption of COOK within homes and clinical contexts for individuals with TBI and improve the next version of this technology.IMPLICATIONS FOR REHABILITATIONCOOK shows a high potential for increasing independence and safety during meal preparation with its sensor-based monitoring of the environment and cognitive-based assistance, for adults with TBI.Comprehensive clinical assessments to identify individuals' therapeutic goals, clinical characteristics, and living environments are necessary to facilitate the deployment of COOK.

User-centered design (UCD) facilitates the creation of technologies that are specifically designed to answer users’ needs. This paper presents the first step of a UCD using a persona, a fictitious character representing the targeted population, which in this case is people having sustained a traumatic brain injury (TBI). The persona is used to better understand the possible interactions of a TBI population with a prototype of a technology that we wish to develop, namely the Cognitive Orthosis for coOKing (COOK). COOK is meant to be an assistive technology that will be designed to promote independence for cooking within a supported-living residence. More specifically, this paper presents the persona’s creation methodology based on the first four phases of the persona’s lifecycle. It also describes how the persona methodology served as a facilitator to initiate an interdisciplinary collaboration between a clinical team and a computer science team. Creation of personas relied on a clinical model (Disability Creation Process) that contextualized the needs of this population and an evaluation tool [Instrumental Activities of Daily Living (IADL) Profile] that presented a wide range of cognitive assistance needs found in this same population. This paper provides an in-depth description of some of the most frequent everyday difficulties experienced by individuals with TBI as well as the persona’s abilities, limitations and social participation during the realization of IADL, and an evaluation of the manifestations of these difficulties during IADL performance as represented through scenarios. The interdisciplinary team used the persona to complete a first description of the interactions of a persona with TBI with COOK. This work is an attempt at offering a communication tool, the persona, to facilitate interdisciplinary research among diverse disciplines who wish to learn to develop a common language, models and methodologies at the beginning of the design process.

INTRODUCTION Direct observation of everyday task performance is considered the most accurate measure of independence for individuals with executive function impairments. However, few observation-based measures have been shown to have sound psychometric qualities and be clinically applicable. The objective of this study was to investigate the Activities of Daily Living (ADL) Profile's structural validity using exploratory factor analyses and internal consistency in order to identify the minimum set of tasks required to achieve reliable scores in each of three ADL environments (personal, home and community). METHODS Ninety-one persons with a severe traumatic brain injury aged 16-40 years (convenience sample) were recruited from a university affiliated level 1 trauma hospital. The 17 observation-based tasks of the ADL Profile were administered by one of five occupational therapists, either in the hospital or in the subjects' home and community environments. This measure of independence considers goal formulation, planning, carrying out and verifying goal attainment. RESULTS Exploratory factor analysis indicated the unidimensionality of the 17 tasks of the ADL Profile. A single factor explained more than 80% of the common variation, which in this case is the concept of independence. Internal consistency of task scores is very high (0.955), suggesting redundancy of the tasks. Approaches used to reduce the number of items, and to optimise the clinical applicability of the tool, showed that a minimum of two tasks per each of three environments (personal, home, community) is required to obtain reliable results that respect the tool's internal structure. Each assessment should contain both simple and familiar and more novel and complex tasks. CONCLUSIONS Findings show that the ADL Profile is a valid and clinically applicable observation-based measure of independence that considers four important task-related components: goal formulation, planning, carrying out and verifying goal attainment.

Background: In Quebec, home care administrators are increasingly open to using Ambient Assisted Living (AAL) technologies as part of services to better support care recipient with a major loss of autonomy. However, little information is available about how these technologies are integrated into clinical practice. Research aim: The present revelatory embedded single-case study aimed to understand how AAL monitoring technologies were integrated in the clinical decision-making process of social and health care professionals to maintain older adults at risk of self-neglect at home (n = 3). Methods: Multiple data collection methods were used for triangulation purposes: semi-structured individual and group interviews, encrypted data from monitoring technologies, medical records, and cognitive and functional evaluations. Data was analyzed using the approach of Miles, Huberman and Saldana (2004). Results: Results show that AAL monitoring technologies were used by social and health care professionals as a means to collect additional and reliable data about home care recipients’ life habits, such as daily patterns related to eating, sleeping, personal care, inactivity and going outside. Professionals wanted to confirm or refute their own hypotheses before developing a comprehensive intervention plan. This information was then used to attribute home care services that correspond to the needs of the care recipient to optimise autonomy and security. Conclusion: Results showed that AAL monitoring technologies provide the professionals with information that would otherwise be inaccessible and are conceptualized as a means of using social and health care resources wisely in a context where resources are scarce.

This study aimed to investigate the feasibility of implementing an assistive technology for meal preparation called COOK within a supported community residence for a person with an acquired brain injury.Using a mixed-methods approach, a multiple baseline single-case experimental design and a descriptive qualitative study were conducted. The participant was a 47-year-old woman with cognitive impairments following a severe stroke. She received 21 sessions of training on using COOK within a shared kitchen space. During meal preparation, independence and safety were evaluated using three target behaviours: required assistance, task performance errors, and appropriate responses to safety issues, which were compared with an untrained control task, making a budget. Benefits, barriers, and facilitators were assessedBoth quantitative and qualitative analyses showed that COOK significantly increased independence and safety during meal preparation but not in the control task. Stakeholders suggested that the availability of a training toolkit to a greater number of therapists at the residence and installation of COOK within the client's apartment would help with successful adoption of this technology.COOK is a promising assistive technology for individuals with cognitive deficits who live in supported community residences.Implication For RehabilitationCOOK is a promising assistive technology for cognition to increase independence and safety in meal preparation for clients with ABI within their supported living contexts.Receiving training from an expert and the availability of technical support are imperative to the successful adoption of COOK.

Introduction In acute care hospitals, clinicians are expected to rapidly provide recommendations regarding patients' rehabilitation potential and candidacy for postacute rehabilitation. Some studies have investigated factors influencing referral to rehabilitation, but few have examined clinical reasoning underlying referral decisions. This study aimed to investigate what occupational therapists were thinking about (factors influencing reasoning), how they reasoned (thought processes) when evaluating stroke or traumatic brain injury patients' rehabilitation potential, and how they decided on referral to postacute rehabilitation. Methods Using a constructivist grounded theory approach, the clinical reasoning of 10 acute care occupational therapists working in a large Canadian city was examined. Participant recruitment, data collection, and analysis were performed simultaneously following theoretical sampling procedures. Therapists' thoughts on patients' rehabilitation potential were collected twice (during chart consultation and initial patient assessment) using think-aloud protocols and semi-structured interviews. Constant comparison, memoing, and diagramming methods were employed during coding to help categorisation and conceptualisation. Findings Numerous patient, clinician, and organisation-related factors were found to influence clinical reasoning. Occupational therapists interpreted these factors in an attempt to (1) predict recovery, (2) estimate rehabilitation potential, and (3) determine rehabilitation candidacy. They used two types of thought processes: (1) building a representation of patients' rehabilitation potential (involving eight steps including gathering and interpreting factors); (2) activating bottom-up and top-down scripts (comparing the expected impact of impairments on activity performance to behaviours observed during activity performance). Furthermore, an algorithm was developed describing how occupational therapists decide on referral to postacute rehabilitation. Conclusion Findings can be used to teach students and novice occupational therapists how to identify and interpret key factors in the assessment of stroke or traumatic brain injury patients' rehabilitation potential. Results also provide insight on cognitive processes that can be taught for efficient assessment of rehabilitation potential and decision-making regarding referral to postacute rehabilitation.

Background Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population. Objective This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users’ profiles and establishing the clinical requirements of the ATC. Methods In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework. Results The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task. Conclusions This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability.

In the last decade, advances in the field of ambient assisted living (AAL) have changed the way services can be provided in smart homes. New possibilities are now offered for addressing complex interaction problems between the technology and users with special needs. Within this context, this study addresses human-computer interactions for cognitive assistance to people with Traumatic Brain Injury (TBI). Interdisciplinary research combining computer science and occupational therapy was conducted to model the interaction between an AAL system (AALS) and a person with cognitive impairments due to TBI residing in an AAL environment. Cognitive assistance is modelled as an interactive exchange where an AALS spreads assistance cues that should induce appropriate behaviours from an assisted person as responses. After an assistance cue is delivered, the AALS should evaluate the user reaction and, stop the interaction if the intended reaction is observed or resume by adapting the assistance. To do so, evidence-based cognitive rehabilitation and speech acts are used to model the interaction content i.e., assistive cues and user feedback, while an ontology formalizes the semantics of this knowledge in a computer readable format. A behavioural model based on behaviour trees informed by the ontological model is then used to enable the cognitive assistant to plan the sequence of cues to be delivered adaptively depending on the circumstances, the assistance goal and the user's behaviour. To show that the proposed interaction model can help an AALS to provide adaptive assistance to people with cognitive impairments, it is exemplified on a cooking safety assistant designed for people with TBI.

Introduction Traumatic brain injury (TBI) is a chronic medical condition with life-long consequences. Meal preparation is one of the most significant activities impacted by TBI even after more than 10 years post-trauma. However, substantial gaps exist in our understanding of how exactly it is affected. This study examines the perceived needs and difficulties regarding meal preparation in individuals with severe TBI living in the community. This is done in an effort to justify long-term community-based interventions offered to the TBI population with regard to a task involving many safety issues. Methods The study used a descriptive qualitative design where five adults (28-50 years old) living with a severe TBI (9-37 years post-injury) were interviewed. Data analysis was completed using an inductive method. Results Participants living alone were all involved in meal preparation to diverse levels. Only two participants lived with a family member. Six categories of perceived needs were identified, of which two emerged as priorities: (i) Need for recipes to be compatible with cognitive abilities, knowledge and energy level to optimise motivation and (ii) Need to adapt complexity of grocery shopping to cognitive abilities and knowledge. The main difficulty expressed by participants was to manage their motivation to cook when tired, as it tends to diminish and fade when the person is exhausted. Conclusion Many situations were considered difficult for our participants, which calls for adaptation of the tasks and of their environment. Considering these unmet needs in the interventions offered will help individualise follow-up and ultimately optimise the social integration of individuals living with severe TBI.

Background User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. Objective The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. Methods This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. Results Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). Conclusions By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology.

BACKGROUND User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. OBJECTIVE The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. METHODS This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. RESULTS Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). CONCLUSIONS By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology.

Introduction: Severe traumatic brain injury (TBI) is a chronic condition associated with an ongoing need to adapt to a multitude of life changes. To ease transitions and optimize occupational development, people with TBI should ideally be provided with equal opportunities to engage in varied and meaningful occupations. Despite this overarching principle, disparities between ideal and actual engagement are common. The objective of this study was to examine the experiences of people living with TBI more than 5 years post injury to explore changes in engagement in their occupations and potential situations of occupational rights’ violations. Methods: For this exploratory qualitative study, in-depth interviews were completed with 5 participants with severe TBI (average time post-injury: 17.6 years). Interviews were analyzed using principles of the critical incident technique. Results: Despite currently being in a relatively stable living situation, all participants had experienced changes in their community integration. These were associated with: high task requirements, quality of support provided by the social environment, accessibility to resources, and level of interest in engaging in occupations. In this context, participants had to decrease their engagement in meaningful occupations, and adapt their occupations, personal expectations, and environments. Conclusions: Following their TBI, participants were prevented from fair and equitable access to numerous occupations, which limited their community integration. Injustices were difficult to overcome as participants lacked the abilities and formal support to do so. These results underline the need for more long-term community services.

BACKGROUND Many older adults choose to live independently in their homes for as long as possible, despite psychosocial and medical conditions that compromise their independence in daily living and safety. Faced with unprecedented challenges in allocating resources, home care administrators are increasingly open to using monitoring technologies known as ambient assisted living (AAL) to better support care recipients. To be effective, these technologies should be able to report clinically relevant changes to support decision making at an individual level. OBJECTIVE The aim of this study is to examine the concurrent validity of AAL monitoring reports and information gathered by care professionals using triangulation. METHODS This longitudinal single-case study spans over 490 days of monitoring a 90-year-old woman with Alzheimer disease receiving support from local health care services. A clinical nurse in charge of her health and social care was interviewed 3 times during the project. Linear mixed models for repeated measures were used to analyze each daily activity (ie, sleep, outing activities, periods of low mobility, cooking-related activities, hygiene-related activities). Significant changes observed in data from monitoring reports were compared with information gathered by the care professional to explore concurrent validity. RESULTS Over time, the monitoring reports showed evolving trends in the care recipient’s daily activities. Significant activity changes occurred over time regarding sleep, outings, cooking, mobility, and hygiene-related activities. Although the nurse observed some trends, the monitoring reports highlighted information that the nurse had not yet identified. Most trends detected in the monitoring reports were consistent with the clinical information gathered by the nurse. In addition, the AAL system detected changes in daily trends following an intervention specific to meal preparation. CONCLUSIONS Overall, trends identified by AAL monitoring are consistent with clinical reports. They help answer the nurse’s questions and help the nurse develop interventions to maintain the care recipient at home. These findings suggest the vast potential of AAL technologies to support health care services and aging in place by providing valid and clinically relevant information over time regarding activities of daily living. Such data are essential when other sources yield incomplete information for decision making.

Clinicians make judgments about patients' rehabilitation potential because it is considered by many as a prerequisite for referral to rehabilitation. However, the concept is rarely defined. This research aimed to clarify the concept of rehabilitation potential in the context of acquired brain injury patient referral to post-acute rehabilitation.Literature search (conducted in Medline, CINAHL and Embase) and article selection followed a scoping review methodology while a concept analysis methodology guided data extraction and analysis.Eighteen documents met inclusion criteria. Findings suggest four defining attributes of the concept. Rehabilitation potential (1) emerges from clinicians' interpretation of patient characteristics and is influenced by the health care environment, (2) involves the prediction of how a patient might improve with rehabilitation interventions, (3) is a multi-level concept and (4) can change over time. The most critical consequence to assessing a patient's rehabilitation potential is the impact on the patient's opportunity to access post-acute rehabilitation services.Rehabilitation potential is a concept rooted in clinical reasoning. We propose an operational definition and a conceptual model to provide a solid foundation for future research to advance policy and clinical decision-making regarding equitable access to post-acute rehabilitation.IMPLICATIONS FOR REHABILITATIONRehabilitation potential is a concept rooted in clinical reasoning and emerges from clinicians' prediction of how a patient might improve with rehabilitation interventions.Rehabilitation potential is not a dichotomous concept but a multi-level concept with each level falling along a continuum.It may be inaccurate/inappropriate to definitively state that a patient has or does not have rehabilitation potential, as patients may demonstrate varying levels of rehabilitation potential.Rehabilitation potential can change with time requiring re-assessment to readjust recommendations accordingly with regards to appropriate rehabilitation interventions at any given time.

Introduction Occupational therapists promote safety and autonomy of older adults with cognitive impairments. A technology, named COOK, offers support on a touch screen installed next to the stove to support task performance while correcting risky behaviors. We aimed to document (1) the functional profiles according the diagnosis (2) the types of interventions used to increase autonomy in the kitchen (3) the facilitators and obstacles to the implementation of COOK with this clientele. Methods Four focus groups were conducted with occupational therapists ( n = 24) and were transcribed and analyzed using thematic analysis, including coding and matrix building. Results Occupational therapists identified different (1) functional profiles and (2) interventions for both diagnoses. The use of COOK (3) could be more beneficial in mild cognitive impairment, as many barriers occur for the use in Alzheimer’s disease. Some parameters, such as digital control of the stove and complex information management, need to be simplified. Discussion According to occupational therapists, this technology is particularly applicable to people with mild cognitive impairment, because this population has better learning abilities. Conclusion This study documented the specific needs of older adults with cognitive impairments as well as interventions used by occupational therapists. The perspectives of caregivers should be captured in future research.

Parents, whose daily activities are limited by a disability, account for 6.2% of the American population with minor children. Considering the prevailing knowledge gaps concerning parents with a physical disability and cognitive impairments, there is an urgency to instigate an investigation of their unmet needs. In this study, we will examine the scope of literature relating to the specific needs of parents with a physical disability and cognitive impairments in early child rearing occupations. A scoping review of peer-reviewed literature was conducted by two independent raters in four databases (CINAHL, EMBASE, Medline, PsycINFO). Data were extracted and analyzed numerically and thematically using the International Classification of Functioning, Disability and Health (ICF). Twenty-nine studies were included for review representing the needs of 113 parents. Emerging needs related to 15 ICF categories and three corresponding themes: parents’ (1) needs when engaging with their young children, (2) personal needs in and outside the home, and (3) needs navigating the health system. The unmet needs of parents with a physical disability and cognitive impairments legitimize the development of clinical services for this population. Future research should focus on developing assessments and interventions specific to parental needs in child rearing occupations.IMPLICATIONS FOR REHABILITATIONAdults with a physical disability and cognitive impairments who parent young children have unmet needs with regards to engaging in child rearing, meeting their personal needs, and navigating the health system.Studies reporting on the impact of impairments on parenting mostly focus on elucidating physical impairments and less so cognitive impairments.Developing a more comprehensive understanding of parental needs will inform further development of targeted assessments and interventions for parents with a physical disability and cognitive impairments. Adults with a physical disability and cognitive impairments who parent young children have unmet needs with regards to engaging in child rearing, meeting their personal needs, and navigating the health system. Studies reporting on the impact of impairments on parenting mostly focus on elucidating physical impairments and less so cognitive impairments. Developing a more comprehensive understanding of parental needs will inform further development of targeted assessments and interventions for parents with a physical disability and cognitive impairments.

To capture the scope of literature exploring interventions for caregivers of aging persons with TBI.A scoping review of peer reviewed literature was conducted in two phases. Phase I: Searching seven databases, two independent raters screened articles using a set of predetermined criteria. Included articles were reviewed, and categorized according to common themes. Phase II: Five stakeholders were engaged in a consultation. A content analysis was performed by extracting statements from each interview using an inductive strategy, and organizing each into themes.A total of 11 articles were included in the final analysis. Inter-rater reliability was assessed at both the title and abstract search [98.8% agreement; k = 0.3425 (95% CI, .246 to .439), p .05]; and the full-text review [83% agreement; k = 0.542 (95% CI, 0.340 to 0.745), p .05] phases. Seven articles identified potential interventions, and four identified and evaluated an intervention. Interventions targeted subjective burden (n = 4) and objective burden (n = 4), with caregiver knowledge and skill development (n = 3) classified as a sub-category of objective burden. Stakeholders overwhelmingly emphasized the need for interventions to reduce objective burden.Included articles were primarily composed of levels six and seven evidence, suggesting that this literature is in an early stage of development. Future research should emphasize the development and evaluation of interventions to reduce objective burden.

In Canada, 100,000 people suffer a traumatic brain injury (TBI) every year. The prevalence of moderate to severe TBI is highest for young men, who will live an average of 50 years with this chronic condition associated with physical, emotional and cognitive deficits. Meal preparation, a complex activity with high safety risks, is one of the most significant activities impacted by TBI. Technology shows great promise to support their overall functioning, but no context-aware technology is available to support meal preparation for this population. The main goal of this study was to design and test a technology to support meal preparation with and for persons with severe TBI living in a supported-living residence.As part of a transdisciplinary technology project linking rehabilitation and informatics, COOK (Cognitive Orthosis for coOKing) was designed with and for future users and stakeholders with a user-centred design methodology. COOK was implemented in three participants' apartments, and its usability was evaluated at 1, 3 and 6 months post-implementation.COOK is a context-aware assistive technology consisting of two main systems: security and cognitive support system. After implementation of COOK, participants were able to resume safe preparation of meals independently. Usability testing showed good effectiveness and an acceptable level of satisfaction.COOK appears promising for rehabilitating clients with cognitive disabilities, improving safety in a home environment, and diminishing the need for human supervision. Future studies will need to explore how COOK can be adapted to a broader TBI population, other environments, and other clienteles.Implications for rehabilitationThis paper presents a promising context-aware assistive technology for cognition designed with and for clients with severe brain injury to support their independence in meal preparation;COOK, (Cognitive Orthesis for coOKing) is the first cooking assistant in which evidence-based cognitive rehabilitation interventions have been translated into smart technological assistance, to support cognition and ensure safety in a real-life context;Its context-aware characteristic ensures that users receive the assistance they need at the right time and at the right moment.The long-term perspective regarding the use of COOK in clinical practice is promising as this technology has the potential of becoming an additional means of supporting the rehabilitation of people with cognitive impairments and becoming part of a comprehensive solution to help them live at home more independently.

Description. Devenir parent implique plusieurs défis quotidiens, particulièrement pour les parents ayant des incapacités physiques et cognitives. Néanmoins, aucun outil d’évaluation n’existe pour soutenir les ergothérapeutes dans l’évaluation de l’indépendance à prendre soin d’un bébé. But. Cette étude visait à (a) développer des activités spécifiques à l’évaluation des habiletés parentales auprès de bébés à l’intérieur du Profil des AVQ et (b) réaliser une étude pilote pour explorer les besoins des parents avec incapacités. Méthodologie. Les activités ont été sélectionnées par une approche participative avec des ergothérapeutes experts ( n = 3) et l’évaluation a été expérimentée auprès de parents ( n = 4) avec incapacités physiques et cognitives. Résultats. Six activités parentales ont été développées et celles-ci ont permis de conclure sur l'indépendance d’un parent à prendre soin de son bébé. Conséquences. Par l’ajout d’activités parentales, le Profil des AVQ a le potentiel d’outiller les ergothérapeutes dans leurs recommandations reliées au rôle de parent.

Purpose: To identify and critically appraise the content, readability, reliability and usability of websites providing information for managing cognitive difficulties in everyday life for the famil...

Background. Very few performance-based measures used in occupational therapy have established test-retest reliability coefficients. Objectives of Study. This study presents the test-retest reliability of the task and operation scores of a performance-based measure of independence in everyday activities called the ADL Profile. Methods. 20 adults with severe traumatic brain injury (mean age 28.4 years; SD 9.9) were tested on two occasions with the 17 tasks (personal care, home, and community) of the ADL Profile. Kappa coefficients were calculated on both task and operation scores (formulating goal, planning, executing, and goal attainment). Findings. Test-retest reliability was moderate to almost perfect on task and operation scores of all 17 tasks. The three tasks with only moderate agreement were more novel and complex (e.g., making a budget) for the participants. Relevance to Clinical Practice. Use of measures that are stable over time is essential for treatment planning and research. Repeat testing is crucial with clients that require long periods of treatment (acute care, rehabilitation, and community integration) and multiple measurements of ADL independence. Limitations. The small sample size is a limit of the study. Recommendations for Further Research. Alternate versions of the three tasks with only moderate agreement would need to be developed and other psychometric properties established.

In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented.This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles.A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec.In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties.Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.L’évaluation du client est primordiale dans la pratique de l’ergothérapie, notamment pour établir les priorités de traitement et pour vérifier l’efficacité des interventions. Les pratiques évaluatives des ergothérapeutes sont cependant peu documentées.Dresser un portrait des pratiques évaluatives des ergothérapeutes du Québec selon les dimensions personne-environnement-occupation et les clientèles.Une enquête transversale a été réalisée à l’aide d’un sondage en ligne envoyé aux ergothérapeutes du Québec.En pédiatrie, les ergothérapeutes utilisent majoritairement des outils standardisés des aptitudes physiques et neurologiques. L’évaluation d’adultes cible principalement les aptitudes physiques et la productivité. Auprès des aînés, l’évaluation repose surtout sur les aspects fonctionnels, particulièrement les aptitudes physiques, les soins personnels et la sécurité à domicile, et sur le dépistage des difficultés cognitives.L’évaluation ergothérapique serait généralement axée sur les aptitudes physiques. Pour assurer une approche holistique, l’occupation et l’environnement devraient être davantage considérés dans l’évaluation.

International audience; Posterior cortical atrophy (PCA) is a neurodegenerative disease affecting the posterior region of the brain. Little is known about both the impact of PCA on functioning and how to support patients on a daily basis. The purpose of this study was to describe the functional profile of DD, a woman diagnosed with PCA, as well as to explore a pilot cognitive rehabilitation program designed to optimize functioning in daily living. The ADL Profile was used to assess the daily tasks that DD chose to undertake. Four operations, i.e. formulate a goal, plan, carry out and verify goal attainment, were scored for each task. Difficulties were observed during the execution of all tasks, as she struggled to find items or showed unsafe behaviors. Impairments were also seen in formulating a goal and planning, especially for less routine tasks. DD identified two tasks to be addressed in rehabilitation: setting the table and dealing cards. Learning was optimized using errorless learning and compensatory aids when setting the table, while dealing cards received no intervention. Only setting the table improved significantly with time. Further studies should be conducted to portray a wider functional profile of people living with PCA and develop effective rehabilitation programs.