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Evaluations of education technology (ed tech) interventions in humanitarian settings are scarce. We present a proof-of-concept study of Can't Wait to Learn, a digital game-based learning program that combines an experiential, active learning design with meaningful, competency-appropriate, and contextually relevant content. We assessed the feasibility of using this program to address the current education gap in Lebanon by implementing its mathematics component in basic literacy and numeracy classes (n=30) with out-of-school children (n=390) ages 10-14. We estimated changes in numeracy competency and psychosocial wellbeing and conducted focus group discussions (n=16) and key informant interviews (n=19) with children, facilitators, parents, and partner staff members to understand the lived experience, perceived impact, and implementation challenges of the program. Our findings support the feasibility of using ed tech programs to meet the needs of out-of-school children, as we saw significant improvements in numeracy, psychological symptoms, and self-esteem; positive reported experiences with the program; increased motivation among the children; and overall ease of implementation. Our suggested improvements to the game design and implementation model will support ongoing program adaptation and implementation, with the goal of increasing access to quality education for children living in humanitarian settings. Our findings will inform future studies that seek to conclusively determine the program's effectiveness.

Introduction: A key goal for working age stroke survivors is to return to work, yet only around 50% achieve this at 12 months. Currently, there is limited evidence of effectiveness of early stroke-specialist vocational rehabilitation (ESSVR) interventions from randomised controlled trials. This study examined fidelity to ESSVR and explored social and structural factors which may have influenced implementation in the RETurn to work After stroKE (RETAKE) randomised controlled trial. Methods: Mixed-methods process evaluation assessing intervention fidelity and incorporating longitudinal case-studies exploring stroke survivors' experiences of support to return to work. Normalisation Process Theory, and the Conceptual Model for Implementation Fidelity, informed data collection and analysis. Results: Sixteen sites across England and Wales participated in RETAKE. Forty-eight occupational therapists (OTs), supported by 6 mentors experienced in vocational rehabilitation (VR), delivered the intervention (duration 12 months) between February 2018 and April 2022. Twenty-six participants (15 ESSVR, 11 usual care (UC)) were included in longitudinal case-studies. An additional 18 participants (8 ESSVR and 10 UC) were interviewed once. Nineteen OTs, 6 mentors and 19 service managers were interviewed. Fidelity was measured for 39 ESSVR participants; mean fidelity score was 78.8% (SD:19.2%, range 31–100%). Comparison of the experiences of ESSVR and UC participants indicated duration and type of support to return to work were perceived to be better for ESSVR participants. They received early, co-ordinated support including employer liaison and workplace adjustments where appropriate. In contrast, UC participants reported limited or no VR or return to work support from health professionals. Typically, UC support lasted 2–8 weeks, with poor communication and co-ordination between rehabilitation providers. Mentor support for OTs appeared to increase fidelity. Service managers indicated ESSVR would enhance post-stroke services. Conclusions: ESSVR was valued by participants and was delivered with fidelity; implementation appeared to be facilitated by mentor support for OTs. [ABSTRACT FROM AUTHOR]

Returning to work is an important goal after stroke, not only as a recovery indicator but also for facilitating independent living and improved social identity. The aim of this study was to explore the lived experiences of vocational rehabilitation and the return to work pathway after stroke. Qualitative data were collected through semi-structured interviews with purposively selected participants who had participated in a vocational rehabilitation trial. All participants were employed at the time of their stroke and were community-living. Interviews were undertaken by occupational therapists and were transcribed verbatim before data were thematically analysed using a framework approach. Sixteen participants were interviewed, seven received specialist vocational rehabilitation and nine received usual clinical rehabilitation. Three major themes were identified which highlighted the importance of tailored vocational rehabilitation to address the challenges that arise when returning to the workplace. Stroke survivors perceived the most beneficial components of the specialist vocational rehabilitation intervention to be employer liaison support, fatigue management, and support for cognition and executive processing skills. Vocational rehabilitation was perceived to provide an opportunity to influence working after stroke, although areas of unmet need were highlighted. Findings provide direction for the development of future stroke-specific vocational rehabilitation programs. Psychosocial (emotional) and cognitive (memory and planning) changes along with post-stroke fatigue were perceived to be the greatest barriers faced on returning to work and should be key areas for intervention within a vocational rehabilitation program. Vocational rehabilitation interventions should be tailored to each participant, incorporating elements perceived to be important to stroke survivors, including workplace liaison, employer communication and psychological support. Workplaces may benefit from access to information about the range of physical, cognitive and language deficits associated with stroke, and the potential impact these may have on work skills. [ABSTRACT FROM AUTHOR]

This study examines the lateral biases in tongue movements during speech production. It builds on previous research on asymmetry in various aspects of human biology and behavior, focusing on the tongue's asymmetric behavior during speech. The findings reveal that speakers have a pronounced preference toward one side of the tongue during lateral releases with a majority displaying the left-side bias. This lateral bias in tongue speech movements is referred to as tonguedness. This research contributes to our understanding of the articulatory mechanisms involved in tongue movements and underscores the importance of considering lateral biases in speech production research. [ABSTRACT FROM AUTHOR]

Innovations are needed to address the global issue of access to high-quality education, particularly in low- and middle-income countries. This paper shows quasi-experimental evidence that a digital game-based learning programme ('Can't Wait to Learn') led to significantly greater improvements in mathematics competency, Arabic literacy competency, and psychological wellbeing of children aged 7–9 in Sudan, compared to state-provided education for out-of-school children, 6 months after the start of the programme implementation (n = 221). These findings were corroborated and extended by qualitative data from 33 focus group discussions and key informant interviews with children, learning directors, caregivers, community leaders, and supervisory staff. We found no difference between groups on child-reported hope, and we found evidence for a significant negative intervention effect on child-reported self-esteem, though the psychometric properties of these instruments were not adequate. We report several considerations related to the experience of local facilitators, programme implementation challenges, and the importance of community acceptance and engagement for fidelity of implementation. [ABSTRACT FROM AUTHOR]