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The purpose of this study was to: 1) examine existing interprofessional pain management curricula in a DPT and MOT program by mapping pain subject matter to the IASP interprofessional content to determine gaps, vertical and horizontal coherence and integration 2) evaluate pain knowledge and attitudes early and late curriculum within the current pre-licensure Doctor of Physical Therapy (DPT) and Master of Occupational Therapy (MOT) students, and 3) to define changes needed within the existing interprofessional pain management curricula to better prepare students for clinical experiences and professional practice. Pain content was mapped to the IASP core competencies to identify gaps in content and coherence. Students were evaluated on existing pain knowledge and attitudes using the City of Boston's Rehabilitation Professional's Knowledge and Attitudes Survey Regarding Pain (COBS). Two hundred and forty physical and occupational therapy students completed the study. The mean percentage of correct responses of 70.6% +/-25.6% did not significantly change across didactic terms. Curricular mapping can inform planning, design, implementation, and evaluation of the curriculum and alignment with IASP guidelines.

The authors compare pretend play and executive function both in preschool children with an acquired brain injury and in neurotypical preschool children. They find the ability to produce logical, sequenced pretend play actions and object substitutions in play correlates strongly with executive function ability in both groups, and working memory emerges in their study as the most reliable predictor of pretend play in both groups of children. Their investigation highlights the need to include pretend play in rehabilitating children with brain injuries and the importance of pretend play for developing executive function in all children.

Children with developmental disabilities lack sufficient physical activity in their daily lives. The purpose of this study was to see if children with developmental disabilities who participated in stair-climbing exercises had better physical performance and health status than children with developmental disabilities who did not. This study adopted a pre-and-post-test experimental design, enrolling 30 subjects (experimental group, 15; control group, 15) with developmental disabilities aged 5-7 years from pediatric rehabilitation treatment departments of two regional teaching hospitals in Taiwan. The experimental group received stair-climbing exercises and physical therapy twice a week for eight consecutive weeks. The primary outcomes were health-related physical fitness assessment items, including body composition (body mass index: BMI), cardiorespiratory fitness (stair-climbing test), muscular fitness (knee-bend sit-ups), and flexibility (Chair Sit and Reach Test). The post-test measurements of BMI, cardiorespiratory fitness, sit-ups, and muscular flexibility of children in the experimental group were significantly better than the pre-test measurements. The stair-climbing exercise training results for cardiorespiratory fitness, muscular fitness, and muscular flexibility in the experimental group were significantly better than those in the control group. Stair-climbing exercise improves the physical fitness of children with developmental disabilities. The results of this study suggest that children with developmental disabilities should be encouraged to engage in this convenient and easy stair-climbing exercise to improve physical performance and health status.

This research considers Pell grant restoration for incarcerated people for the field of higher education in prison. Using the original data, we outline the limits of Pell funding in the prison context by surfacing persistent funding challenges that the Pell grant alone cannot address and may exacerbate. By providing the necessary investments to support higher education in prison, Pell restoration could be an effective lever for advancing racial and economic justice. Using a lens of racial and socioeconomic justice, we identify gaps in prison program costs and argue that the long-term effects of Pell reinstatement will depend on whether the expansion is accompanied by investments in a range of institutional infrastructures and resources. Concluding are implications and recommendations to adequately and responsibly support the growth and infrastructure of higher education in prison programs.

Background: Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician-specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke. Aim: To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke. Methods & Procedures: We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi-structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method. Outcomes & Results: Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: 'Following what other people have done', (2) need for collaborative learning: 'A safe space to share and train', (3) variation between settings impacts on continuity of care: 'There's a difference between community and acute', and (4) working effectively with multidisciplinary teams (MDT): 'An MDT which can listen to the voice of speech pathology'. Conclusions & Implications: Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke.

Background: Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. Aims: This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. Methods & Procedures: A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. Outcomes & Results: All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). Conclusions & Implications: These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated.

Purpose: Postoperative rehabilitation programs for cochlear implant (CI) recipients primarily emphasize enhancing speech perception. However, effective communication in everyday social interactions necessitates consideration of diverse verbal social cues to facilitate language comprehension. Failure to discern emotional expressions may lead to maladjusted social behavior, underscoring the importance of integrating social cues perception into rehabilitation initiatives to enhance CI users' well-being. After conventional rehabilitation, CI users demonstrate varying levels of emotion perception abilities. This disparity notably impacts young CI users, whose emotion perception deficit can extend to social functioning, encompassing coping strategies and social competence, even when relying on nonauditory cues such as facial expressions. Knowing that emotion perception abilities generally decrease with age, acknowledging emotion perception impairments in aging CI users is crucial, especially since a direct correlation between quality-of-life scores and vocal emotion recognition abilities has been observed in adult CI users. After briefly reviewing the scope of CI rehabilitation programs and summarizing the mounting evidence on CI users' emotion perception deficits and their impact, we will present our recommendations for embedding emotional training as part of enriched and standardized evaluation/rehabilitation programs that can improve CI users' social integration and quality of life. Conclusions: Evaluating all aspects, including emotion perception, in CI rehabilitation programs is crucial because it ensures a comprehensive approach that enhances speech comprehension and the emotional dimension of communication, potentially improving CI users' social interaction and overall well-being. The development of emotion perception training holds promises for CI users and individuals grappling with various forms of hearing loss and sensory deficits. Ultimately, adopting such a comprehensive approach has the potential to significantly elevate the overall quality of life for a broad spectrum of patients.

The Juvenile Justice System was established on the premise of rehabilitative action for behaviors that have led youth to the criminal justice system. However, the system has increasingly moved away from this original concept toward a punitive model. The authors present how this movement resulted in the devolution of human rights for the youth involved, a decrease in public safety, and a radical departure from fiscal responsibility related to the theoretical origins of rehabilitation. Studies on topics ranging from costs of correctional centers to trauma experienced by youth in these systems, along with many others, are compared to identify specific areas for renovation. Evidence-based pathways are presented to address these concerns along with pragmatic strategies for utilization of a constructed theory focused on the relationship between diversionary policies, attrition, and growth through the reinvestment of existing resources.

Physical activity (PA) is an important facet in survivorship care. Standardized curriculum which teaches undergraduate student exercise leaders how to implement PA programs for childhood cancer survivors have not been developed. Delivery of PA programs are limited by resources, so utilizing students to lead PA sessions is a potentially cost-effective approach. The purpose of this study was to learn how to optimize mentorship of student PA leaders in pediatric oncology. The aims were to report on the level of guidance provided to the student PA leaders, share student PA leaders' reflection of their mentorship and the challenges they faced. Student PA leaders designed and delivered a 31-week, virtual PA program to pediatric cancer survivors (5-18-year-olds). Mentors provided feedback on the recorded sessions. PA leaders were interviewed about their perceptions, their experiences and the type of feedback they valued the most. Student PA leaders received the most feedback during the first 2 weeks of the program, suggesting close oversight is needed during this time. Students valued the feedback on improving PA delivery/instruction the most. Students reported feeling anxious prior to sessions, especially when new content would be introduced because they were unsure how the patients would respond to the new activities. Reinforcing that the leaders have the ability to minimize PA barriers and provide support may help to resolve their anxiety of working with this population. Using a similar approach as presented in this paper may be advantageous in the development of high-performing PA leaders.

The news of a 16-year old teenager hacking a 13-year old boy to death in a toilet unprovoked in a secondary school in Singapore shook the whole nation in July 2021. In this article, we analyze the institutionalizing responses to the growing sense of youth mental health crisis in Singapore, catalyzed by River Valley High School incident, as the subjectification of wellbeing. We argue, firstly, that the national schools have become the main site for the production of networked surveillance and internalization of wellbeing. We examine the inclusive production of subjects ­characterized by varying levels of wellbeing in a rehabilitative social ­system exercising authority and control. Secondly, we argue that a totalizing system of surveillance and internalization is emerging in a technocratic heterotopia. We conclude by discussing interdisciplinary and intersectional alternative approaches emerging from the heterotopic space of the school.

Parents of children with disabilities are an important part of their child's special education team. However, parents often have limited involvement in school-based therapies that are provided as part of a child's Individualized Education Program. The field lacks tools to assess the domain and extent of parent needs for optimal engagement in their child's special education therapies. Study one assessed the Parent-Therapist Partnership Survey's (PTPS) (formerly known as the Needs of Parents Questionnaire -School-Based Therapy Version) measure's clarity, fit, and comprehensiveness. Study two assessed the factor structure and internal consistency. Two factors emerged - Need to Be an Informed, Engaged Member of Their Child's Team, and Need for Support and Guidance. Internal consistency was 0.93 for the overall scale. The PTPS can serve as a powerful measure to better identify opportunities to engage parents in school therapeutic goals while improving parent-provider collaboration in school-based therapies.

Capoeira is an effective rehabilitative practice for marginal populations. There is a need to define the essential elements of the trainee's experience, and to conceptualize and define the processes of inclusion and rehabilitation associated with Capoeira training. This study aimed to explore the therapeutic rehabilitative elements of Capoeira pedagogy as perceived by Capoeira instructors who work with youths and young adults who experience social marginalization. Ten Capoeira instructors working with diverse populations were interviewed to gain insights regarding rehabilitative characteristics of Capoeira practice from their experiences. Thematic analysis revealed four components of Capoeira pedagogy that correspond to rehabilitative concepts: an alternative of non-violent aggression, inclusion into a community, promotes diversity and grants the trainee an experience of a significant being in the world and promotes an awareness of freedom and liberation. Combining several rehabilitative paths to a cohesive practice, initiates Capoeira as a fertile terrain for rehabilitation through inclusion.

Background: Despite its potentially significant functional and emotional impact, acalculia is still too rarely assessed and managed by speech and language therapists. Research on the rehabilitation of numerical transcoding remains scarce in the literature and, despite positive results, presents a low level of evidence. Aims: The present study aims to evaluate the effectiveness of a targeted rehabilitation of numerical transcoding in two patients suffering from a chronic secondary acalculia. Methods & Procedures: Two post-brain injury females with secondary acalculia took part in a single-case experimental design with multiple baseline across subjects according to a three-phase experimental protocol: baseline involving global cognitive rehabilitation (5-7 measurements with randomized sequential introduction); targeted intervention (10 measurements); follow-up (2 immediate measurements and 1 month after the end of the intervention). Repeated outcome measures consisted of six lists composed of numbers of equivalent difficulty that were used alternately to assess numerical transcoding. We used a reverse digit span as a control measure to assess the specificity of the intervention. Rehabilitation lasted 5 weeks and consisted of errorless learning with colour cues, tables and number-words cards. Outcomes & Results: During baseline period involving global cognitive rehabilitation, transcoding scores remained unchanged. In contrast, there was a significant improvement in scores for both patients during the intervention phase targeting transcoding and maintenance of benefits 1-month post-intervention. Conclusions & Implications: This study demonstrates that a specific rehabilitation targeting numerical transcoding following chronic secondary acalculia can be effective in improving transcoding skills.

While many university health science programs include physics courses to raise knowledge and understanding of physical science concepts, they are still far from addressing the needs of that science health profession. This study aimed to investigate the effect of an introductory physics course on first-year physiotherapy and rehabilitation (PR) students' conceptual understanding of simple electric circuits. The study participants were students enrolled in the Physics II course. Eighty-two students registered for the course. Sixty students (73%) took the pretest, and 67 (81%) completed the posttest. 53 students (64%) took the pretest and posttest. This study adopts an exploratory research methodology that includes a one-group pretest-posttest design. The Simple Electric Circuits Diagnostic Test (SECDT) was used to assess students' conceptual understanding. The prevalence of misconceptions was relatively low (before and after instruction), and very few students developed sound conceptual understanding after instruction. The local reasoning model was the most frequent misconception PR students held. After instruction, students' overall confidence in their SECDT responses increased significantly. Interestingly, when the students were grouped into three achievement groups, the medium-achievement group fell into more misconceptions as their achievement increased compared to low- and high-achievement groups. These findings suggested that students' low SECDT scores were due to a lack of knowledge rather than misconceptions.

Healthy aging is associated with changes in motor sequence learning, with some studies indicating decline in motor skill learning in older age. Acute cardiorespiratory exercise has emerged as a potential intervention to improve motor learning, however research in healthy older adults is limited. The current study investigated the impact of high-intensity interval exercise (HIIT) on a subsequent sequential motor learning task. Twenty-four older adults (aged 55-75 years) completed either 20-minutes of cycling, or an equivalent period of active rest before practicing a sequential force grip task. Skill learning was assessed during acquisition and at a 6-hour retention test. In contrast to expectation, exercise was associated with reduced accuracy during skill acquisition compared to rest, particularly for the oldest participants. However, improvements in motor skill were retained in the exercise condition, while a reduction in skill was observed following rest. Our findings indicate that high-intensity exercise conducted immediately prior to learning a novel motor skill may have a negative impact on motor performance during learning in older adults. We also demonstrated that exercise may facilitate early offline consolidation of a motor skill within this population, which has implications for motor rehabilitation.

This paper proposes a novel educational approach to epistemic vice rehabilitation. Its authors Gerry Dunne and Alkis Kotsonis note that, like Quassim Cassam, they remain optimistic about the possibility of improvement with regard to epistemic vice. However, unlike Cassam, who places the burden of minimizing or overcoming epistemic vices and their consequences on the individual, Dunne and Kotsonis argue that vice rehabilitation is best tackled via the exemplarist animated community of inquiry zetetic principles and defeasible-reasons-regulated deliberative processes. The vice-reduction method they propose is made up of four distinct yet complementary components: (1) positive exemplarism of epistemic virtue (saints), (2) negative exemplarism of epistemic vice (sinners), (3) direct teaching/instruction, and (4) cognitive apprenticeship. Dunne and Kotsonis argue that this pedagogical intervention appropriately considers learnings deriving from forensic scrutiny of both ideal and non-ideal interpersonally calibrated zetetic features integral to knowledge acquisition as well as wider societal influences impacting the development of agents' epistemic character. It bridges research on vice epistemology (Cassam's obstructivist theory), social epistemology (corrupted social processes mitigating against vice rehabilitation), virtue epistemology, and moral exemplarism.

Positive effects of Positive Behavior Intervention and Supports (PBIS) frameworks have been reported in juvenile justice facilities but have not yet been extended to adult prisons. As part of initial PBIS development in a large prison in the United Kingdom, this study utilized focus groups to investigate the valued outcomes considered most important to prison officers and prisoners. We found that although prisoners and staff largely shared the same values, there were meaningful differences in their relative priorities, reflecting the disparate roles that each play in the functioning of the prison. Focus groups also revealed possible contextual barriers to PBIS implementation in this setting. We conclude that input from both parties is essential in designing values-based support strategies that are aligned across key stakeholders. We discuss how focus groups might inform PBIS intervention planning and how our findings point to specific research gaps in applying PBIS in adult prisons.

This study was an initial step toward planning tele-practice in a South Indian state's public-sector services for childhood hearing and speech-language problems. The aim was to understand the perceptions public-sector health care professionals (HCPs) regarding their willingness and need for tele-practice-based diagnostics and rehabilitation services. Focus group discussions (FGD), semi-structured interviews (SSI), and geo-spatial analysis were employed in a cross-sectional study. Different public-sector HCPs participated in the qualitative study. Data sufficiency was assessed using theoretical saturation and cross-case variance. Data was analyzed using hybrid deductive-inductive thematic analysis. Geo-tags and geo-locations of all children with disabilities and all the public-sector service providers were used to generate geospatial maps. HCPs felt that childhood hearing and speech-language disorder services were inadequate and lacked sufficient qualified professionals. There was inconsistent equipment and professional availability in district-level facilities. HCPs were comfortable using technology, and were willing to investigate tele-practice, but they required training in tele-practice.

Background: There is a growing body of literature that indicates positive outcomes of group treatment approaches to intervention for communication difficulties in chronic traumatic brain injury (TBI). The published research to date examines face-to-face group intervention. Aim: This study draws on one of these approaches, 'Improving Natural Social Interaction: Group reHabilitation after Traumatic brain injury' (INSIGHT), and examines the adaptation of this program to a virtual setting. The principles underlying the program, which involved providing an authentic contextualised and natural environment for group interactions and enhancing opportunities for identity expression, were maintained. Methods & Procedures: Six participants with mild to severe TBI and cognitive communication difficulties participated in an 8-week pilot program of the virtual INSIGHT program. Goal Attainment Scaling (GAS) scores completed over the course of the intervention served as the primary outcome measure. Secondary outcomes measures included The Repeatable Battery for the Assessment of Neuropsychological Status Update, The Awareness of Social Inference Test-Revised, the La Trobe Communication Questionnaire and the Satisfaction with Life Scale. Outcomes & Results: A mixed multilevel analysis revealed significant improvement in GAS scores. A Wilcoxon signed rank test revealed no significant changes in secondary measures. Conclusions & Implications: There is a growing potential for this group treatment approach, in an online medium, and progress towards individualised goals was clear. The data have implications for examining the assessment measures typically used to document functional outcomes in clinical intervention. Future directions indicate a need to pursue more ecologically valid assessment methods.

Background: Speech and language therapists (SLTs) share a collective goal of ensuring that adults with cognitive-communication disorders (CCD) due to acquired brain injuries (ABI) attain their highest possible level of participation and satisfaction in family, community, social, work and academic communications through evidence-based interventions. While there is a considerable evidence base to support SLT cognitive-communication interventions, there are also numerous barriers to its implementation. Aims: The first aim is to describe the development of a comprehensive knowledge translation tool that synthesizes evidence-based practice recommendations for SLT cognitive-communication interventions across the care continuum. The second aim is to critically analyse the barriers to implementation of these interventions and to explore how this knowledge translation tool might assist in overcoming these challenges. Methods & Procedures: We developed a map of 148 clinical practice recommendations extracted from 129 reviews and guidelines called the Cognitive-Communication Evidence Application for SLTs (CCEAS-Map). The process of developing the CCEAS-Map included: (1) examination of implementation science frameworks to inform knowledge tool creation; (2) search and synthesis of the evidence provided in reviews and guidelines that met specific criteria; (3) development of a framework to critically analyse and categorize the barriers and facilitators affecting the implementation of these clinical recommendations; (4) consultation with potential end users of the CCEAS-Map, including 16 expert SLTs and eight persons with lived experience (PWLE), regarding the tool's construction, barriers and facilitators to implementation, and the potential of the CCEAS-Map to address evidence-practice gaps; and (5) refining the CCEAS-Map based on expert input. Main Contribution: To our knowledge this is the first synthesis of all available clinical recommendations for SLT cognitive-communication interventions for ABI, across all severities of injury, stages along the continuum of care, and areas of CCD practice. The paper presents a novel approach to analysing knowledge-practice gaps: drawing on implementation science tools, analysing barriers and facilitators, and collaborating with end users in designing a knowledge translation tool. Conclusions & Implications: The CCEAS-Map provides a comprehensive synthesis of the available evidence in a format that can facilitate clinical application of the evidence, provide education for all stakeholders, serve as a basis for CCD pathway development, support researcher-clinician collaboration and encourage advocacy at the system level. As a knowledge translation tool, the CCEAS-Map can promote the availability of SLT services and has the potential to ultimately improve the lives of those with CCD.

Background: Exploring the perceptions of individuals with traumatic brain injury (TBI) towards their brain injury recovery across the continuum of care may offer insights to support engagement with rehabilitation services. Illness narratives are a potentially valuable avenue for examining perceptions of recovery that may influence engagement. Aims: The aim of this study is to explore the perspective of individuals with severe TBI towards their communication, brain injury and recovery experiences at 6 months, 1 year and 2 years post-injury. Methods & Procedures: Discourse samples were obtained from 12 participants with severe TBI at 6 months, 1 year and 2 years following injury. A standardised protocol was used to elicit responses relating to perceptions of communication, the brain injury narrative, and perceptions of recovery facilitators. A thematic analysis of the discourse samples was completed. Outcomes & Results: Three overarching themes were identified: experiences of communication recovery are diverse (Theme 1), varied experiences of recovery and rehabilitation (Theme 2), and continuous and lifelong journey of recovery (Theme 3). Primary communication concerns included presence of anomia, dysarthria, conversational topic difficulties, impacts of fatigue and memory difficulties. Illness narratives revealed the importance of re-establishing a sense of self and the perceived importance of a strong social network post-injury. Conclusions & Implications: The varied nature of communication challenges and recovery after TBI highlights the need for holistic, multidisciplinary support as well as inclusion of family and friends in the recovery process. Social communication intervention is a perceived priority area for individuals with TBI. Illness narratives may also play a valuable role in therapy and help to shape post-injury identity. Managing the impacts of fatigue on communication and encouraging individuals to take ownership over their recovery and treatment may also help to improve patient outcomes. Supporting individuals to construct positive brain injury narratives that reaffirm a sense of self and include perspectives of family and friends may offer a potential future avenue for rehabilitation. Tailored but flexible, team-based service delivery models for individuals with TBI that span from acute to long-term care are warranted.

Background: Rehabilitation for cognitive-communication impairments following brain injury can be complex given the heterogenous nature of impairments post injury. Project-based intervention has the potential to improve communication skills and create a meaningful real-life context where individuals collaborate to develop a concrete product, which benefits others. While evidence for this intervention is emerging, the COVID-19 pandemic prompted increased use of telehealth interventions to serve people with brain injury. This paper aims to describe a framework for the delivery of project-based intervention via telehealth within community rehabilitation settings; and present several case studies of telehealth groups completed in the United Kingdom and the United States during the COVID-19 pandemic. Methods: A working group was formed to map the components of project-based intervention onto the rehabilitation treatment specification system (RTSS). This system is a conceptual framework that helps to explain the link between treatment theory and ingredients, allowing a clinician to clearly understand how and why a treatment works. First, a literature search was completed to identify eligible studies on project-based intervention after brain injury. Second, those studies were thematically mapped onto the RTSS to identify important intervention components. Third, the presence of these components was assessed for community brain injury groups delivered via telehealth in the United Kingdom and United States. These groups were further described using a taxonomy of social activities that help to describe the degree of meaningful social engagement. Results: The literature was described with a thematic RTSS summary. Treatment aims focus on skills training and self-efficacy, advocacy and self-empowerment, emotional well-being and quality of life, and collaboration and community belonging. Treatment ingredients involve a range of cognitive and behavioural supports to deliver meaningful activities and contexts to complete a project. Mechanisms of action involve learning by doing and cognitive and affective information processing. All four telehealth groups conducted in the United Kingdom and United States involved at least three treatment aims, >7 targets, and >8 treatment ingredients. All groups reported positive experiences from activities that involve working collaboratively to help others and contribute to society. Conclusions: Project-based intervention delivered via telehealth has the potential for supporting people with acquired brain injury to improve their communication skills and engage in meaningful, collaborative activity. Application of the RTSS helps clinicians to understand the aims and therapeutic ingredients (or clinician activities) through which a person with brain injury may achieve specific treatment targets during the rehabilitation process.

Introduction: This review aimed to synthesize and review computerized cognitive rehabilitation studies on children with disabilities to confirm their effectiveness. Methods: In 2021, an electronic search of academic articles was performed using PubMed, CINAHL, Science Direct, and Cochrane databases. Results: First, two experienced researchers selected 325 papers. 85 non-SCI studies published before 2017 were excluded. Further, duplicate studies were removed, remaining with 71 papers. After reviewing the title and abstract, 14 studies were selected. Finally, after performing a full text review, 7 studies were selected. All studies on computerized cognitive rehabilitation in children were randomized clinical trials that showed a positive impact to this therapy. Computerized cognitive rehabilitation targeting children with various diseases improved their memory, math ability, and activities of daily living. Conclusion: Computerized cognitive rehabilitation can be effectively used in clinical practice in line with non-face-to-face treatment of children with various difficulties caused by the coronavirus pandemic.

Background: Adults with traumatic brain injuries (TBI) frequently experience cognitive, emotional, physical and communication deficits that require long-term rehabilitation and community support. Although access to rehabilitation services is linked to positive outcomes, there can be barriers to accessing community rehabilitation related to system navigation, referral processes, funding, resource allocation and communications required to ensure access. Aims: This study aimed to identify barriers to accessing insurer funding for rehabilitation and healthcare services, for adults with TBI injured in motor vehicle collisions (MVCs). Methods: We used a co-design approach to collaborate with persons with lived experience to design a survey of adults who sustained a TBI in an MVC. The survey examined access to insurer funding for rehabilitation services and was disseminated through brain injury networks in Ontario, Canada. Results: Respondents (n = 148) identified multiple barriers to accessing rehabilitation services through insurer funding, including delays of more than 2 years (49%), mandatory duplicative assessments (64%) and invasion of privacy (55%). Speech-language therapy and neuropsychological services were denied most frequently. Negative experiences included insurers' poor understanding of TBI symptoms, denials of services despite medical evidence demonstrating need and unsupportive insurer interactions. Although 70% of respondents reported cognitive-communication difficulties, accommodations were rarely provided. Respondents identified supports that would improve insurer and healthcare communications and rehabilitation access. Conclusion & Implications: The insurance claims process had many barriers for adults with TBI, limiting their access to rehabilitation services. Barriers were exacerbated by communication deficits. These findings indicate a role for Speech-language therapists in education, advocacy and communication supports during the insurance process specifically as well as rehabilitation access processes in general.

Background: Cognitive rehabilitation is a complex and specialized area of practice, as it aims to support individuals with diverse neuropsychological profiles, personal characteristics, and intersectionalities in achieving meaningful, functional change in personally relevant aspects of their everyday lives. In many ways, cognitive rehabilitation is the epitome of a 'black box': it has complicated internal processes that are mysterious to users. We argue that this complex practice has suffered from a lack of specificity of clinical processes and treatment components, resulting in negative consequences for both providers and clients. Aim: To unpack the black box of cognitive rehabilitation by describing a unifying set of frameworks that can effectively direct clinical practice across clinical disciplines: the International Classification of Functioning, Disability, and Health (ICF), the Rehabilitation Treatment Specification System (RTSS), and the Planning, Implementation, and Evaluation framework (PIE). We present a clinical case that illustrates the application of the three frameworks. Conclusion: Implementation of these three integrated frameworks supports clinical reasoning, replication of treatments, and communication across disciplines with the ultimate impact of improving rehabilitation outcomes. The frameworks provide a structure for clinicians to clearly define both the "what" and the "how" of treatment, with a level of specificity to maximize both effectiveness and efficiency of intervention.

We investigated 34 deaf and hard-of-hearing children with hearing devices aged 8-12 years and 30 typical hearing peers. We used the capability approach to assess well-being in both groups through interviews. Capability is "the real freedom people have to do and to be what they have reason to value." Speech perception, phonology, and receptive vocabulary data of the deaf and hard-of-hearing children, that were used retrospectively, showed a large variability. The analysis of the relation between clinical quantitative outcome measures and qualitative capability interview outcomes suggests that at this age, differences in clinical performance do not appear to translate into considerable differences in capability, including capability did offer insight into the factors that appeared to ensure this equivalence of capability. We argue that capability outcomes should be used to determine the focus of (auditory) rehabilitation and support, in line with the United Nations Convention on the Rights of the Child.

Given that approximately 5% of the U.S. population is currently attending college, research is needed to better understand the language that college students use to describe alcohol recovery regardless of their current drinking behavior. College student perceptions of alcohol recovery are important, given that students may experience an alcohol use disorder themselves or may encounter others with an alcohol use disorder. Research on college student perceptions of alcohol recovery in the literature is scarce but is needed to better understand the alcohol recovery process. The current mixed-methods study examines language that college students use to describe alcohol recovery based on findings from two focus group interviews. The focus groups were conducted with college students who reported using alcohol at least once in their lifetime. All participants (N = 18) were asked questions regarding language perceived to be associated with alcohol recovery. Data were examined within a thematic analysis framework. The three central themes related to alcohol recovery that emerged in the study were harm reduction--based recovery, abstinence-based recovery, and social correlates of recovery. College students rated the terms "recovered," "drinking reduction," and "sobriety" as being highly representative of being in recovery, whereas the terms "bars" and "light drinker" were identified as not being representative of recovery. A better understanding of these themes will help the field understand the language that college students use to describe alcohol recovery.

This study aims to conduct a bibliometric analysis of the literature on sports nutrition as recovery published between 1964 and 2022. This study illustrates the structure and trends in sports nutrition publications by using scientific mapping and analyzing publication performance. This study identified the contributions of authors, journals, countries, and widely cited articles. While there was no massive expansion in the first year of publication, the results show that high growth emerged in the 2010s. Several countries have made significant contributions to recovery research in sports nutrition. European countries account for the majority of publications on this subject. Latin American and Asian countries are also keeping an eye on the study's growth. Another finding is that various multidisciplinary publishers publish articles about sports nutrition. The International Journal of Sports Nutrition and Exercise Metabolism, on the other hand, is the journal that publishes the most articles. Burke L.M. has established himself as a prolific writer in this field, producing many documents and total citations. Several keywords have large nodes associated with their frequency of occurrence. The keyword relationship provides information about the relationship between keywords frequently appearing in one study. Visualizations of research trends are presented to provide an up-to-date reference guide for academics, revealing critical research gaps and potential research avenues for future studies to advance the discipline's consolidation.

In this paper, we present the development, implementation, and lessons learned during the 2-year pilot integration of an ePortfolio across a rehabilitation sciences (RS) curriculum within a publicly funded state university. We consider the educational environment and discuss decision points during various stages of the project. Four key aspects of project development and implementation are highlighted, including a contextual analysis of goals, partnerships, curricular positioning, and foundational tools. Contextual analysis of goals includes the process of creating a project vision that aligns with the student population served, programmatic goals, and the guiding frameworks inherent to ePortfolios as a high impact practice. An exploration of partnerships describes the role of diverse stakeholders, within and outside the program, and their contribution to ongoing project development and success. Curricular positioning considers which courses are utilized for the introduction, conclusion, and touch points of the project, and how success is measured in each. A discussion of foundational tools identifies the student-facing resources required to facilitate a clear, relevant, and sustainable ePortfolio across the curriculum. When possible, we highlight student voices, including reflections on motivation, adaptive skill building, and engagement with the ePortfolio process. Ongoing challenges, preliminary outcomes, and next steps are also outlined.

The statistical information that estimates the magnitude of communication disorders among Egyptian children is scarce. At Mansoura University, a prospective study was performed to identify communication disorders among nursery school children in Dakahlia governorate, Egypt to estimate the problem's size among Arabic-speaking Egyptian children (Gad-Allah et al., 2012). A cross-sectional descriptive research design was used to include 852 nursery school children (out of 59000 regularly attending the nursery school) aged between three and less than six years from urban and rural areas and governmental and private nurseries. Two structured questionnaire sheets were designed to identify different types of communication disorders from caregiver and teacher perspectives. [The page range cited (pp. 100-106) on the .pdf is incorrect. The correct page range is pp. 99-105.]

The study's first objective is to present an overview of the demographic information of speech therapists and the current service delivery process provided by government entities in the Kingdom of Bahrain. The second objective is to analyze the caseload and workload of the Speech Unit clinics at Salmaniya Medical Complex. The study takes a descriptive, analytical approach to analyze data collected via a web-based online survey (17 questions) to determine demographic information about speech therapists in the Kingdom of Bahrain. A survey was completed by 59 participants: 45 Bahraini therapists and 45 female therapists. The significant findings show that only 24 therapists were based in medical settings, while the rest were school-based. Most speech therapists have bachelor's degrees, while there are currently seven master's degree holders. Most therapists have less than ten years of experience. Despite the Ministry of Health and the NHRA's support for allied professions, there is a severe shortage of speech therapists in all healthcare facilities and other ministries that offer rehabilitation programs to those with disabilities or in need of services. A cross-national study involving all professionals in the public and private sectors is now required to promote a broader perspective and comprehensive analysis, particularly as the Bahrain health system transitions toward autonomy and health insurance.

Research objectives: specify the framework of using cutting-edge approaches and innovations in the training of rehabilitation physicians; investigate existing innovative technologies; get an insight into the motivation of students majoring in rehabilitation when working with the Gross simulator in sports rehabilitation of patients. The research was conducted at a mixed-type rehabilitation center for disabled adults and children at Soochow University in China. The study was conducted among 200 students majoring in rehabilitation at Soochow University and 100 children from a rehabilitation center with motor disorders: 50 boys and 50 girls. The patients were aged 4-6 years, and the average age of the participating students was 21 years. The students were offered a 6-month training course in rehabilitation of patients with musculoskeletal disorders, by using innovative technology--the Gross simulator. Student motivation analysis yielded the following outcomes: 90% of the students said that training to operate simulators is useful for the rehabilitation specialist, because this affects the proficiency of such specialist; 15% of students reported they did not like innovative technology in teaching because they faced difficulties in understanding it; 80% of students believed such technology facilitated the learning, and 5% of students were neutral. Further studies, conducted on clinical research sites, might address the effectiveness of training rehabilitation specialists, the use of cutting-edge simulators and robotic systems, as well as development of rehabilitation protocols for patients with injuries and musculoskeletal disorders.

An intraverbal assessment was administered to older adults with aphasia, using a hierarchy of questions that required increasingly complex verbal discriminative stimulus control. Five categories of errors were defined and analyzed for putative stimulus control, with the aim to identify requisite assessment components leading to more efficient and effective treatments. Evocative control over intraverbal error responses was evident throughout the database, as shown by commonalities within four distinct categories of errors; a fifth category, representing a narrow majority of errors, was less clear in terms of functional control over responses. Generally, questions requiring increasingly complex intraverbal stimulus control resulted in weaker verbal performance for those with aphasia. A new 9-point intraverbal assessment model is proposed, based on Skinner's functional analysis of verbal behavior. The study underscores that loss or disruption of a formerly sophisticated language repertoire presents differently than the fledgling language skills and errors of new learners, such as typically developing children and those with autism or developmental disabilities. Thus, we would do well to consider that rehabilitation may require a different approach to intervention than habilitation. We offer several thematic topics for future research in this area.

Purpose: The purpose of this scoping review was to synthesize the current evidence-based treatment practices used with school-aged children with any severity of traumatic brain injury (TBI) that could benefit the practice of speech-language pathologists (SLPs). Method: A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Included studies were assigned thematic labels based on a modified version of the Rehabilitation Treatment Specification System. Results: A total of 27 articles that covered 16 different treatment approaches met inclusion criteria for this study. Most studies included adolescent or teenage participants with moderate-severe TBIs. Treatment targets included executive functioning (n = 15), social competence (n = 6), postconcussive symptoms (n = 5), behavior (n = 3), family functioning (n = 1), and health-related quality of life (n = 1). The majority of current interventions for school-aged children with TBI include a multidisciplinary approach and components of family involvement education. Conclusions: Further research is needed on interventions that are specifically implemented by SLPs as well as protocols that include more heterogeneous samples (e.g., varied sociodemographic factors and injury severity) to allow for the development and testing of ecologically valid intervention practice. SLPs can use the results of this scoping review to individualize treatment based on the child's areas of need while considering individual characteristics and to provide person-centered intervention for children with school-aged TBI.

The focus of attention literature has shown robust findings for the benefits of providing statements that focus on the movement effect or outcome (external focus of attention [EFOA]) as opposed to focusing on the movement kinematics (internal focus of attention). Observational studies, however, have revealed that physiotherapists use fewer EFOA statements than internal focus of attention statements in their practice. Most evidence in this regard has been from non-Canadian physiotherapists working in stroke rehabilitation; consequently, we sought to examine whether Canadian physiotherapists working with various rehabilitation populations also use EFOA statements to a lesser extent than internal focus of attention statements. The "Therapists' Perceptions of Motor Learning Principles Questionnaire (TPMLPQ)" was thus designed and data from 121 Canadian physiotherapists showed low relative frequencies of EFOA use (31.3% ± 14%) averaged across six hypothetical scenarios. A higher EFOA was reported, however, for two of the six scenarios: a functional reaching scenario (55.5% ± 37.0%) and pelvic floor task (65.6% ± 32.9%). This data suggest that the findings of EFOA benefits have not been widely translated into Canadian physiotherapy settings; furthermore, the findings of the scenario-dependency warrant future investigation into factors, such as task characteristics, that may influence physiotherapists' FOA use.

This paper examines the stories of transformative learning of two men reflecting on their recovery from addictions and trauma. We employ the Hero's journey as a useful frame within which to understand their stories of becoming more and progressing towards a recovered self. The article challenges the dominant biomedical model of addiction, and of recovery as being primarily about abstinence. It also provides further evidence for understanding transformative learning as a process of (re)integration which is supported through archetypal storytelling.

Product design pedagogical approaches require a specific mix of competences that demand multiplicity of perspectives, hybrid knowledge that exceeds professional field silos, and continuous problem reformulations. To do this, design studio education follows many traditions, among which is design critique. Design critique is believed to provide students with the ability to reframe design problems, but it can also lead to misunderstandings. The necessity of this approach is put into question by assessing the experiences of a group of students in an intensive course structured for interdisciplinary work, intercultural teams, and projects based on challenges from practice, where the critique was not part of the pedagogical program. The course was conducted over four consecutive weeks and supported a hands-on approach based on an interdisciplinary work between the areas of product design and occupational therapy, with the participation of Brazilian and Norwegian bachelor students and professors. Students responded to questionnaires prior to and at the end of the course that addressed their expectations of and experiences in the course. A qualitative analysis of the students' responses was carried out based on content analysis. The joint work with occupational therapy students and professionals, as well as the opportunity to develop projects that targeted demands from people with disabilities, were shown to be factors that contributed to students' engagement in the course and overall gain of knowledge. The experiences reported here indicate that the phenomenological approach to the design studio, which focuses on providing an immersive environment, deserves more attention from educators, and that design critique is not necessarily a crucial ingredient in design education.

This study examines a mixed methods experiment, evaluating the impact of 3D printing on Occupational Therapy student's self-reported technology efficacy levels, before and after an educational module focused on 3D printing technology. Utilizing free and online software and university owned 3D printers, students were challenged to create client centered assistive devices. Software included free computer aided drafting software, slicing software, and an online design repository. Copyright and attribution licensing concepts were also addressed for design modification considerations and use in clinical settings. Participants explored adaptations of 3D designs to meet individualized client needs and integration of rehabilitative theories. Project-based implementation of 3D printing with "real world" clients created increased student "buy-in" and engagement. Participants were recruited from private, rural, higher education, occupational therapy students in pre-clinical lab courses. Comparisons between student groups exposed to 3D printing and a control group without exposure are assessed using quantitative and qualitative data. The control group expressed interest in further technology education in their field. Students show significant increases in technology focused self-efficacy between participant groups.

This article examines the relationship between education and rehabilitation within the prison context. It begins by exploring the concept of rehabilitation, examining if prison rehabilitation is possible or if it is what Pat Carlen describes as a "penal imaginary". Drawing on this idea, it considers how rehabilitation may act as a way of legitimising imprisonment and whether rehabilitation is in fact damaging and criminogenic. It then moves to explore other models of rehabilitation and imprisonment that may offer a more person-centred approach. Section two of the article begins by discussing understandings of adult education. It examines conflicting interpretations of education, settling on an understanding that is underpinned by principles of freedom. It then moves to explore how adult education is practised and understood within the prison context. Finally, this article analyses the relationship between prison education and prison rehabilitation, considering what kinds of education and rehabilitation may be conducive to supporting the holistic development of the person in prison.

To prepare graduate students to implement evidence-based practice effectively, educators must integrate instruction on rational clinical decision-making into course curricula. Three faculty members at different universities adopted an educational approach derived from the Rehabilitation Treatment Specification System (RTSS) to teach and assess clinical decision-making in the context of treating acquired cognitive-communication disorders for people with traumatic brain injury. Using treatment theory illustrated in the RTSS, the authors piloted instruction and assessment materials to examine potential usefulness of the approach and effects on student knowledge and confidence in clinical decision-making. The results indicated that the instructional approach effectively bolstered students' knowledge of and confidence implementing memory-based cognitive-communication intervention. Additionally, using a case-based assessment tool, the authors were able to measure how students modified treatment activities in response to different contextual variables. Implications and suggestions for implementing theory-based instruction in graduate education are discussed.

In some fields, written reflection is commonplace whereas in others it is uncommon. While athletic therapy education aims to produce reflective practitioners, written reflection is not a typical pedagogy employed. In 2014, the athletic therapy program at our institution began the implementation of a clinical presentation (CP) approach to facilitate competency-based curriculum requirements. This innovation to pedagogy required a reimagined approach to teaching, learning, and assessment. We describe one aspect of a larger SoTL study on this transformation, inquiring into the development of reflective practice through reflective writing. Students were asked to regularly reflect on their experiences in the clinic or field as part of their program. In this qualitative component of the study, we were able to gain insight into how students perceived the reflective process, how that evolved over their program, what were enablers and barriers to their reflection, and what was the role of feedback in their learning. The characteristics of student perceptions in each year, which followed a learning arc which we describe sequentially as "confused, conflicted, and convinced," is explored, along with implications for pedagogy in assisting students to develop reflective professional practice.

Investigation of the physical and psychological development challenged individuals receiving water therapy in a private education rehabilitation center. The aim of this study is to investigate the physical and psychological development challenged individuals receiving water therapy in a private education rehabilitation center. 5 children with mentally and physically problems who took water therapy in the Special Education Rehabilitation Center participated in the study. Children aged between 3-8. Children who have mentally problematic, who have participated in the research, have severe, moderate and mild mental problems and who have problems physically also have placenta, quatri plaque, spina bifida etc. children with orthopedic insufficiency. Special mobility training program was prepared for the children to be able to make joint problems for children with mental problems and physical problems. While the program was being prepared, support was received from special educator, water therapist and repertoire people. The study was administered 4 months, 2 days a week and 60-90 minutes. At the beginning of the research, the children who had mental problems were afraid of entering the water, they did not comply with the commands, they did not want to be separated from the mother and father. At the end of the research process, children with mental problems enter the water comfortably and even hurry to enter, they are not afraid of water, they are more adaptable to the commands, they continue to work separately from their parents, they are more willing to enter the water in children who have problems with orthopedic problems. It was observed that most of the children who wanted to move in the water, they were mostly able to perform the movements, and the majority of the children (90%) who had walking pants had walking exercises.

Day habilitation provides informal and non-formal adult education programming for individuals with disabilities, who often go unrecognized by the adult education field because of infantilization that precludes them from common perceptions of "adults," contributing to a dearth of information about day hab access and programming in adult education literature. In this paper, we critically examine day hab access and programming issues in Texas, discussing barriers regarding costs and stigmas toward attendees from adult educators' perspectives. We include practical recommendations for the field, such as embracing person-centered approaches and entering discussions about day habilitation programming to improve outcomes for participants.

Down syndrome (DS) is a chromosomal condition that is affecting an increasing number of infants born in Saudi Arabia. This study investigates the needs of families with children with DS in Saudi Arabia from mothers' perspectives and in a cultural and religious context. An exploratory qualitative research design was used, and semi-structured interviews were conducted with 14 mothers of children with DS. Interview data were thematically analyzed. The most important need was found to be financial or tangible support. An increase in benefits or monthly financial allowances and social security insurance would address these concerns. Societal support is also needed; mothers want DS to be perceived differently and require more support, including better rehabilitation and education services. Informational support is needed to improve the conditions of children with DS. Recommendations for improving the quality of life of children with DS are discussed.

Background: Aphasia therapy is an effective approach to improve language function in chronic aphasia. However, it remains unclear what prognostic factors facilitate therapy response at the individual level. Here, we utilized data from the POLAR (Predicting Outcomes of Language Rehabilitation in Aphasia) trial to (a) determine therapy-induced change in confrontation naming and long-term maintenance of naming gains and (b) examine the extent to which aphasia severity, age, education, time postonset, and cognitive reserve predict naming gains at 1 week, 1 month, and 6 months posttherapy. Method: A total of 107 participants with chronic ([greater than or equal to] 12 months poststroke) aphasia underwent extensive case history, cognitive-linguistic testing, and a neuroimaging workup prior to receiving 6 weeks of impairment-based language therapy. Therapy-induced change in naming performance (measured as raw change on the 175-item Philadelphia Naming Test [PNT]) was assessed 1 week after therapy and at follow-up time points 1 month and 6 months after therapy completion. Change in naming performance over time was evaluated using paired t tests, and linear mixed-effects models were constructed to examine the association between prognostic factors and therapy outcomes. Results: Naming performance was improved by 5.9 PNT items (Cohen's d = 0.56, p < 0.001) 1 week after therapy and by 6.4 (d = 0.66, p < 0.001) and 7.5 (d = 0.65, p < 0.001) PNT items at 1 month and 6 months after therapy completion, respectively. Aphasia severity emerged as the strongest predictor of naming improvement recovery across time points; "mild" ([beta] = 5.85-9.02) and "moderate" ([beta] = 9.65-11.54) impairment predicted better recovery than "severe" ([beta] = 1.31-3.37) and "very severe" ([beta] = 0.20-0.32) aphasia. Age was an emergent prognostic factor for recovery 1 month ([beta] = -0.14) and 6 months ([beta] = -0.20) after therapy, and time postonset ([beta] = -0.05) was associated with retention of naming gains at 6 months posttherapy. Conclusions: These results suggest that therapy-induced naming improvement is predictable based on several easily measurable prognostic factors. Broadly speaking, these results suggest that prognostication procedures in aphasia therapy can be improved and indicate that personalization of therapy is a realistic goal in the near future.

Purpose: Poststroke communication deficits (PSCD) are common following stroke. Early and intensive speech and language therapy is recommended to maximize outcomes. We wanted to test the feasibility of providing telerehabilitation for patients with PSCD using mobile tablet-based technology to bridge the gap between acute stroke care and outpatient speech-language therapy (SLT) services. Method: This was a prospective, randomized, open-label, blinded end-point design. Patients were randomized to either the treatment arm (mobile tablet) or the control arm (standard of care). The study duration was either 8 weeks or when the patient was called to start outpatient SLT services, whichever occurred first. The primary outcome was feasibility, while secondary objective was to assess patient engagement and to explore improvement in communication ability. Results: We had a 38% recruitment rate, with a 100% retention rate for the treatment arm and a 50% retention rate for the control arm. Fifty percent of patients in the treatment arm adhered to the recommended 1 hr per day, whereas none of the control arm did. Patients were engaged in using the mobile tablet and feedback on the protocol was positive. Conclusions: SLT using telerehabilitation via mobile technology is feasible in the very early stages of acute stroke recovery. It is potentially an effective means of bridging the gap between discharge from the acute care setting to the start of outpatient SLT services. Our study supported proceeding to a clinical trial to assess efficacy of the intervention.