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Background: Active support (AS) has gained popularity as an approach for assisting people with intellectual disability to engage more fully in everyday activities. Although research has identified changes in the extent that residents are engaged in meaningful activities, the experience of stakeholders such as residents, staff, and family in AS is underexplored. Method: A general inductive approach was used to analyse focus group and interview transcripts of residents (n = 4), staff (n = 13), and family (n = 2) about their experience of involvement in an AS pilot project at one residential care facility in New Zealand. Results: Three superordinate themes common to all stakeholders' experiences emerged: "living normal lives," "caring means doing with," and "engaging with risk." Conclusion: Transitioning to AS had been enriching but at times challenging for all stakeholders. Valuing resident autonomy and preparedness for greater exposure to risk are significant considerations in the implementation of AS.

Purpose: Therapeutic horse riding aims to improve the health of children and young people experiencing disability; however, its benefits across a range of health domains, particularly the impact on participation outcomes, are not well known. This research evaluated to what extent there was a change in riders balance, functional performance, social responsiveness, quality of life and participation outcomes as a result of therapeutic horse riding. Methods: A multiple-baseline across participants (n = 12) single-case experimental design, with randomly allocated baseline phase lengths, quantitatively evaluated how riders responded to a 20-week intervention. Results: Social participation outcomes measured using the Canadian Occupational Performance Measure demonstrated the most consistent positive between-phase differences (performance ES = 1.20, 95% CI [0.82, 1.63]; satisfaction ES = 1.11, 95% CI [0.73, 1.55]). A causal relationship was seen in three riders, but improvements only reached clinical significance for two riders when accounting for phase data trends. No significant outcome patterns were found comparing riders with principally physical impairments to those with principally psychosocial impairments. Conclusions: Being involved in therapeutic horse riding may improve rider's social participation in home, school and community settings. We postulate that rider self-concept development may be a mechanism of treatment effect leading to participation-level changes. Social participation was the health outcome demonstrating the most consistent change following therapeutic horse riding, regardless of rider impairment. Therapeutic horse riding can improve social participation in settings beyond the riding arena. Greater intervention tailoring based on rider responses may enhance therapeutic horse riding intervention effects. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods. Materials and Methods: The quantitative component was a descriptive case–control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods. Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation. Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty. Effectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic. Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources. Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment. [ABSTRACT FROM AUTHOR]

Introduction: Evaluating how therapeutic horse riding improves health for children experiencing disability is made complex by a lack of clarity around mechanisms of treatment effect. This research develops an explanatory theory outlining how health outcomes may be optimised, by exploring what works for which riders, under what conditions and how. Method: Within a realist research framework, we undertook three phases of study using a mix of qualitative and quantitative data collection and analysis approaches. Findings were then integrated into an overall evaluative account. Results: Riders with a range of impairments (n = 32; aged 5 to 17 years), caregivers (n = 29) and therapeutic horse riding providers (n = 16) participated. Three key mechanisms of intervention effect are proposed: (1) therapeutic horse riding facilitates development of a rider's self-concept through opportunities for accessible, meaningful participation; (2) the context in which therapeutic horse riding is provided promotes a focus on riders' capacities and strengths and (3) therapeutic horse riding provides opportunities for a broad range of learning experiences. Conclusion: Therapeutic horse riding provides opportunities for meaningful occupational participation for children experiencing disability. Ensuring that the physical and ideological context in which therapeutic horse riding is provided focuses on a rider's capacities and strengths will enhance self-concept development and participation outcomes. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONMany disabled people require support workers to complete personal care, daily tasks and participate in life roles. Due to the intimate nature of community disability support in domestic environments, understanding what facilitates positive relationships is paramount. We examined the intricate interplay of context and mechanisms that drive positive relationship outcomes for disabled people, their family members and support workers.A realist-informed, participatory methodology involving three participant groups: disabled people, family members, and disability support workers.Sixteen participants participated in two workshops per group (5 disabled people, 5 family members, and 6 disability support workers). All three participant groups prioritised three key generative mechanism processes involved in positive relationship outcomes: (1) having clear communication, (2) building trust, and (3) developing a sense of flow. We describe how each mechanism manifested in a unique way for each group, and also how the activation of each mechanism was influenced by a dynamic resources/tensions balance specific to each group.We describe the interaction between three mechanism processes involved in triadic relationships between disabled people, family members, and support workers. Attention is now required to explore strategies to negotiate the resource/tension balance particular to each group.Clear communication, building trust, and developing flow are crucial mechanisms necessary for positive and sustainable relationships between disabled people, family members, and support workers.However, we need to consider the intricate interplay of these mechanisms within triadic relationships between disabled people, family members, and support workers when enacting strategies to support sustainable relationships.By understanding the specific ways these mechanisms are activated differently for disabled people, family, and support workers, rehabilitation professionals can better tailor community care processes.This will promote greater efficacy of disability support systems and inform more effective, strategic distribution of resources.Clear communication, building trust, and developing flow are crucial mechanisms necessary for positive and sustainable relationships between disabled people, family members, and support workers.However, we need to consider the intricate interplay of these mechanisms within triadic relationships between disabled people, family members, and support workers when enacting strategies to support sustainable relationships.By understanding the specific ways these mechanisms are activated differently for disabled people, family, and support workers, rehabilitation professionals can better tailor community care processes.This will promote greater efficacy of disability support systems and inform more effective, strategic distribution of resources. [ABSTRACT FROM AUTHOR]

Purpose: Qualitative research examining experiences of recovering from mild traumatic brain injury (MTBI) is limited. Findings from quantitative studies regarding predictors of persisting symptoms are inconsistent with limited attention directed to capturing broad perspectives and priorities of the wider stakeholders. More flexible research approaches may help advance the field. We used a mixed method design to generate patient perspectives of MTBI recovery, integrating these with quantitative investigation to isolate factors that might contribute to divergent MTBI outcomes. Methods: The qualitative component reported here involved semi-structured interviews with selected participants (n = 10) from the quantitative study cohort, sampling both recovered and non-recovered adult MTBI participants. Interviews focused on participants' general description and understandings of their recovery and perceptions of what helped or hindered this. Data were analyzed using general thematic analysis. Results and conclusion: Participants regardless of recovery status identified the importance of having a coherent understanding of their injury and recovery. Factors facilitating coherence included social support, validation, reassurance, accessing credible evidence-based information and having a pathway to wellness. Findings suggested that coherence could be a helpful umbrella construct worthy of examination in future MTBI research. This construct appears broad and able to cope with the complexity of individual experiences after injury. [ABSTRACT FROM AUTHOR]

Purpose: While there is a growing body of literature exploring life goals in rehabilitation, little research has been undertaken that includes the voice of the end-user. This study examined the views and experiences of people with severe acquired brain injury regarding the place of 'life goals' in residential rehabilitation. Methods: Interpretative phenomenological analysis was used to collect and analyze data from five semi-structured interviews with participants in a residential rehabilitation setting. Results: Three inter-related themes emerged from this study. Social connectedness ( being 'part of things') emerged as a life goal of central importance for all participants (Theme 1). However, in order to achieve this sense of belonging, the participants needed to tentatively balance the opportunities arising within their environmental milieu (Theme 2) with the interpersonal factors relating to their unchanged, changed and changing self-identity (Theme 3). Conclusions: This study suggests that social identity and social connectedness ought to be primary foci of rehabilitation rather than matters only of secondary concern. Consideration needs to be given to both the environmental contexts and the intrapersonal strategies that support people who require residential rehabilitation services to achieve social connection, and thus their life goals, following a severe acquired brain injury. [ABSTRACT FROM AUTHOR]

22 ALKI • November 2019 We Started an EDI Group in Our Branch and You Could Too by Rachelle Martin; edited by Erika Lehtonen The last few years in American culture have brought the conversation surrounding equity, diversity and inclusion into the mainstream. Our EDI group is our effort to create a foundational knowledge for all staff that will help us create an empowering working environment for all. [Extracted from the article]

Randomized controlled trials (RCTs) are considered the gold standard of evidence guiding intervention selection in rehabilitation. However, conduct of sufficiently powered RCTs in rehabilitation can be expensive, pose ethical and attrition concerns when participants are assigned to ineffective treatment as usual conditions, and are infeasible with low-incidence populations. Single-case experimental designs (SCEDs), including N-of-1 RCTs are causal inference studies for small numbers of participants and not necessarily one participant as the name implies. These designs are increasingly used to evaluate the effectiveness of rehabilitation interventions in diverse clinical settings and employ design features including but not limited to randomization and each participant serving as their own control. These and other internal validity enhancements can increase the confidence in study results coming from these designs. This manuscript discusses the expanded application of SCEDs in rehabilitation contexts to answer everyday clinical rehabilitation research questions with emphasis on strategies to use: 1) to maximize internal validity of this family of designs; 2) improve utility, effectiveness, and acceptability of these designs for rehabilitation end-users (clinicians, policymakers, and participants); 3) build evidence bases in areas of rehabilitation where RCTs are uncommonly used. Primary considerations for situating SCEDs within the continuum of experimental designs include increasing internal validity within designs, improving transparency in conduct and reporting of these studies, and increasing access to advanced research methods training for rehabilitation professionals.

Aims: The purpose of this review was to identify and describe the evidence about children and youth engagement during equine-assisted services (EAS). Methods: Five databases (Scopus, Web of Science, PsycINFO, CINAHL, and MEDLINE) were systematically searched. Included studies reported research about EAS conducted in children and youth and presented findings about in-session engagement or associated concepts such as motivation, involvement, and participation. Extracted data (study type, equine intervention, population, and the studies' key focus) were summarized descriptively, followed by inductive content analysis of the main mechanisms proposed to influence engagement. Results: In total, 30 studies were identified; however, only three centered on rider engagement as the primary focus of research. Other publications addressed in-session engagement within service descriptions or results and discussion sections. Three mechanisms that influence engagement within EAS were derived: (1) the unique EAS landscape, (2) the horse-child relationship and (3) the provider-child relationship. The literature primarily referred to horses as the most important factor influencing child and youth engagement in EAS sessions. Little attention was given to the influence of service providers', parents', or child preferences on engagement. Conclusions: The child/youth-parent-provider relational triad and specific strategies to improve rider engagement within EAS sessions warrants further investigation.