Extending technology-aided leisure and communication programs to persons with spinal cord injury and post-coma multiple disabilities

Purpose: These two studies extended technology-aided programs to promote leisure and communication opportunities to a man with cervical spinal cord injury and a post-coma man with multiple disabilities. Method: The studies involved the use of ABAB designs, in which A and B represented baseline and intervention phases, respectively. The programs focused on enabling the participants to activate songs, videos, requests, text messages, and telephone calls. These options were presented on a computer screen and activated through a small pressure microswitch by the man with spinal cord injury and a special touch screen by the post-coma man. To help the latter participant, who had no verbal skills, with requests and telephone calls, series of words and phrases were made available that he could activate in those situations. Results: Data showed that both participants were successful in managing the programs arranged for them. The man with spinal cord injury activated mean frequencies of above five options per 10-min session. The post-coma man activated mean frequencies of about 12 options per 20-min session. Conclusions: Technology-aided programs for promoting leisure and communication opportunities might be successfully tailored to persons with spinal cord injury and persons with post-coma multiple disabilities.

• Implications for Rehabilitation

• Technology-aided programs may be critical to enable persons with pervasive motor impairment to engage in leisure activities and communication events independently.

• Persons with spinal cord injury, post-coma extended brain damage, and forms of neurodegenerative disease, such as amyotrophic lateral sclerosis, may benefit from those programs.

• The programs could be adapted to the participants’ characteristics, both in terms of technology and contents, so as to improve their overall impact on the participants’ functioning and general mood.

     

Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson’s disease

Purpose: To evaluate the effect of a communication partner training programme directed to enrolled nurses working with people with communication disorders in nursing homes, using an individualised approach. Method: Five dyads consisting of a person with stroke-induced aphasia (n?=?4) or Parkinson’s disease (PD) (n?=?1) living in different nursing homes and his/her enrolled nurse participated in the study, which had a replicated single-subject design with multiple baselines across individuals. The main element of the intervention was supervised analysis of video-recorded natural interaction in everyday nursing situations and the formulation of individual goals to change particular communicative strategies. Results: Outcome was measured via blinded assessments of filmed natural interaction obtained at baseline, intervention and follow-up and showed an increased use of the target communicative strategies. Subjective measures of goal attainment by the enrolled nurses were consistent with these results. Measures of perceived functional communication on behalf of the persons with communication disorders were mostly positive; four of five participants with communication disorders and two of five enrolled nurses reported improved functional communication after intervention. Conclusions: The use of an individualised communication partner training programme led to significant changes in natural interaction, which contributes importantly to a growing body of knowledge regarding communication partner training.

• Implications for rehabilitation

• Communication partner training can improve the communicative environment of people with communication disorders.

• For people with communication disorders who live in institutions, the main conversation partner is likely to be a professional caretaker.

• An individualised approach for communication partner training that focussed on specific communication patterns was successful in increasing the use of supportive strategies that enrolled nurses used in natural interaction with persons with communication disorders.

• The training also positively affected the perceived functional communication of the persons with communication disorders.

     

The roles of effective communication and client engagement in delivering culturally sensitive care to immigrant parents of children with disabilities

Abstract

Purpose: Delivering pediatric rehabilitation services to immigrant parents of children with disabilities requires the practice of culturally sensitive care. Few studies have examined the specific nature of culturally sensitive care in pediatric rehabilitation, especially the notions of effective communication and client engagement. Method: Interviews were held with 42 therapists (10 social workers, 16 occupational therapists and 16 speech language pathologists) from two locations in Canada (Toronto and Quebec City). Data were analyzed using an inductive content analysis approach. Results: Study themes included the importance and nature of effective communication and client engagement in service delivery involving immigrant parents. Participants discussed using four main types of strategies to engage immigrant parents, including understanding the family situation, building a collaborative relationship, tailoring practice to the client’s situation and ensuring parents’ understanding of therapy procedures. Conclusions: The findings illuminate the importance of effective, two-way communication in providing the mutual understanding needed by therapists to engage parents in the intervention process. The findings also richly describe the engagement strategies used by therapists. Clinical implications include recommendations for strategies for therapists to employ to engage this group of parents. Furthermore, the findings are applicable to service provision in general, as engaging families in a collaborative relationship through attention to their specific situation is a general principle of good quality, family-centered care.

• Implications for Rehabilitation

• Effective communication permeates the delivery of culturally sensitive care and provides mutual understanding, which is fundamental to client engagement.

• The findings illuminate the nature of “partnership” by indicating the role of collaborative therapist strategies in facilitating engagement.

• Four main strategies facilitate effective communication and client engagement, including understanding the family situation, building a collaborative relationship, tailoring practice to the client’s situation and ensuring parents’ understanding of therapy procedures.

• Engaging families in a collaborative relationship through attention to their specific situation is a general principle of good quality, family-centered care.

     

Tele-assistance in patients with amyotrophic lateral sclerosis: long term activity and costs

Purpose: To describe i) nurse’s utilisation and associated costs during 4-year tele-assistance in amyotrophic lateral sclerosis (ALS) ii) optimal time for initiating tele-assistance. Method: 73 ALS patients after hospital discharge were followed up on voice by phone calls conducted by a nurse through a clinical card which was tested for feasibility, efficacy and utility. Number of patients simultaneously assisted/month, calls/patient, fixed and variable costs were calculated. Results: Time between disease’s diagnosis and the beginning of tele-assistance was 720 ± 971 days. ALS patients’ percentage managed by nurses through tele-assistance increased over time by 628%. Tele-assistance integrated care (TAIC) followed up patients with a total of 5073 telephone calls. Steady state activity was reached at the 3rd year employing 5 ± 3 calls/pt/month (time/call 64 ± 44 min). Implementing the card was feasible, useful and effective by operator. Survival from diagnosis of ALS was 1224 ± 1150 days. Survival was related to tracheotomy. Conclusion: TAIC is a feasible tool to manage up to 25 ALS patients/month/nurse and costs about €105.00 per patient per month. Tele-assistance is proposed at 2/3 of time course of the disease.

Implications for Rehabilitation

• People with ALS have a complex time course of their disease necessitating important clinical decisions.

• Individually structured holistic and rehabilitative programmes are required.

• Tele-assistance has been demonstrated to be useful to follow-up providing autonomy of care, psychosocial monitoring, interventions and a source of information.

• Tele-assistance integrated care is a feasible tool to manage up to 25 ALS patients/month/nurse.

• Tele-assistance costs about €105.00 per patient per month.

• Tele-assistance is proposed at 2/3 of time course of the disease.

     

Qualitative perspectives on aquatic exercise initiation and satisfaction among persons with multiple sclerosis

Purpose: To identify the individual and social experiences underlying the initiation and satisfaction with aquatic exercise among persons with MS.

Methods: A convenience sample (n?=?45) of persons aged?≥18 with MS who had engaged in water-based exercise within the previous six months completed a 60–90?min semi-structured telephone interview regarding their aquatic exercise experiences.

Results: An aquatic exercise history was not a prerequisite for the adoption of aquatic exercise. Rather, participants described aquatic exercise routines as stemming from recognition of a decline in physical function combined with encouragement and invitations to join aquatic programs. Despite regular visits, health care providers were not a common source of information regarding the feasibility of aquatic exercise. Participants’ aquatic activities included MS-specific and generalized aquatics courses, with class satisfaction resting on the instructor, class “fit” and a feeling of acceptance.

Conclusion: Communication regarding local aquatic opportunities is critical for ensuring aquatics engagement among persons with MS. Providers could play a stronger role in emphasizing the feasibility and benefits of aquatic programs. In addition, persons with MS should be encouraged to try local MS and more generalized aquatic programs in order to identify a program matching their social and physical goals.

• Implications for Rehabilitation

• Directed communication regarding aquatic opportunities is essential to prompting the initiation of aquatic exercise

• Both MS-specific and general aquatics classes can provide positive exercise experiences for persons with MS

• A history of regular exercise or aquatic experiences is not a prerequisite for the initiation of aquatic exercise among persons with MS

• Health care provider visits may represent missed opportunities for promoting aquatics; providers should consider the suitability of aquatics for all patients with MS, regardless of the patient’s exercise history.

     

The lived experience of engaging in everyday occupations in persons with mild to moderate aphasia

Abstract

Purpose: Impairment of language ability, aphasia, can cause barriers to communication and hence impact on participation in many life situations. This study aimed to describe and explore how persons with aphasia following stroke experience engaging in everyday occupations. Method: Six persons from Southwest Finland who had aphasia due to stroke one to four years previously were interviewed for the study. A modified form of the empirical phenomenological psychological method was used for data analysis. Results: Three main characteristics of experiences of engaging in everyday occupations were identified: (1) encountering new experiences in everyday occupations, (2) striving to handle everyday occupations and (3) going ahead with life. The participants had experienced an altering life-world. Engagement in occupations affected their perceptions of competence and identity, and experiences of belonging and well-being. It was also through engagement in everyday occupations that they had discovered and learnt to handle changes in their everyday life. Conclusion: Aphasia can have a long-term impact on engagement in everyday occupations and participation in society, but conversely, engagement in meaningful occupations can also contribute to adaptation to disability and life changes.

• Implications for Rehabilitation

• Aphasia can have a long-term impact on engagement in everyday occupations and participation in society.

• Health care professionals need to determine what clients with aphasia think about their occupations and life situations in spite of difficulties they may have verbalizing their thoughts.

• Experiences of engaging in meaningful occupations can help clients with aphasia in reconstructing their life stories, thereby contributing to adaptation to disability and life changes.

     

Optimising leisure participation: a pilot intervention study for adolescents with physical impairments

Purpose: To assess the feasibility of an intervention to improve participation in leisure activities of adolescents with physical impairments by changing aspects of the activity or environment. Methods: A pre-test/post-test pilot study of a multi-strategy intervention was used to explore the effectiveness of the strategies and to determine whether the intervention was practical to apply in a community setting. The intervention involved establishing adolescent and family focused goals, measuring and addressing environmental barriers and building activity performance skills. The Goal Attainment Scale (GAS) and the Canadian Occupational Performance Measure measured outcomes. Results: Eight participants (aged 12–19 years; five males) with physical disabilities set participation goals using a structured approach. Analysis of personal and environmental barriers and facilitators for participation guided the choice of intervention strategies to support goal attainment. The natural environment, government policies and availability of transport were identified as the most frequent barriers to participation in leisure. Support to secure appropriate devices to enable participation was commonly required. As a group, attainment of 12 of 17 GAS goals, and progress on four more goals, was demonstrated. Conclusions: The intervention model was applicable and practical to use in a community therapy setting and the majority of the participation goals set were achieved.

• Implications for Rehabilitation

• This ICF-based intervention model was applicable and practical to use in a community therapy setting.

• The majority of the adolescent’s leisure participation goals were achieved following engagement in the multi-strategy intervention.

• Adolescents with sufficient communication skills (CFCS Levels I–III) benefited from a group-based intervention in addition to individualised support.

     

The current implementation status of the integration of sports and physical activity into Dutch rehabilitation care

Purpose: To describe the current status of the nationwide implementation process of a sports and physical activity stimulation programme to gain insight into how sports and physical activity were integrated into Dutch rehabilitation care. Methods: The current implementation status of a sports and physical activity stimulation programme in 12 rehabilitation centres and 5 hospitals with a rehabilitation department was described by scoring fidelity and satisfaction. Seventy-one rehabilitation professionals filled out a questionnaire on how sports and physical activity, including stimulation activities, were implemented into rehabilitation care. Total fidelity scores (in %) were calculated for each organization. Professionals’ satisfaction was rated on a scale from 1 to 10. Results: In most organizations sports and physical activity were to some extent integrated during and after rehabilitation (fidelity scores: median?=?54%, IQR?=?23%). Physical activity stimulation was not always embedded as standard component of a rehabilitation treatment. Professionals’ satisfaction rated a median value of 8.0 (IQR?=?0.0) indicating high satisfaction rates. Conclusions: The fidelity outcome showed that activities to stimulate sports and physical activity during and after rehabilitation were integrated into rehabilitation care, but not always delivered as standardized component. These findings have emphasized the importance to focus on integrating these activities into routines of organizations.

• Implications for Rehabilitation

• Components of an evidence-based programme to stimulate sports and physical activity during and after rehabilitation can be used to measure the current status of the integration of sports and physical activity in rehabilitation care in a structural and effective way.

• The method described in the current study can be used to compare the content of the rehabilitation care regarding the integration of sports and physical activity among organizations both on a national and international level.

• Sports and physical activity are seen as important ingredients for successful rehabilitation care in The Netherlands.

     

Development of a balance,safe mobility and falls management programme for people with multiple sclerosis

Abstract

Purpose: To utilise stakeholder input to inform the structure, format and approach of a multiple sclerosis (MS) balance, safe mobility and falls management programme.

Materials and methods: Using a three-round nominal group technique, participants individually rated their agreement with 20 trigger statements, followed by a facilitated group discussion and re-rating. Three mixed groups included service users (n?=?15) and providers (n?=?19). Quantitative analysis determined agreement, whilst qualitative responses were analysed thematically.

Results: Median scores for each of the 20 trigger statements did not change significantly over sequential rounds, however, deviations around the medians indicated more agreement amongst participants over time.

Key recommendations were:

Aims and approach: The programme should be tailored to the needs of people with MS. Falls and participation-based outcomes are equally important.

Structure and format: The programme should balance expected burden and anticipated benefit, moving away from models requiring weekly attendance and promoting and supporting self-efficacy.

Optimising engagement: Support to maintain engagement and intensity of practice over the long term is essential.

Sustainability: Adequate funding is necessary. Staff should have MS specific knowledge and experience.

Conclusions: Participants collaboratively identified critical components of a MS balance, safe mobility and falls management programme. They also highlighted the importance of a collaborative, user-centred, MS-specific approach.

• Implications for Rehabilitation

• People with multiple sclerosis need condition-specific interventions focussed on maximising balance and safe mobility and reducing falls.

• Programme design should support self-efficacy and flexible engagement.

• Adequate support and funding are seen as essential by both service users and providers.

     

Technology-based programs to improve walking behavior of persons with multiple disabilities: two single-case studies

Purpose: Assessing two technology-based programs for reducing toe walking and breaks during walking of two men with multiple disabilities, respectively.Method: The men were involved in separate single-case studies, each of which was carried out according to an ABAB design. The technology included a microprocessor with specific software, optic sensors, and visual plus vibrotactile or auditory systems for presenting preferred stimuli. In Study I, the man received 1 s of preferred flickering lights and vibratory input for each step performed with the heel of the left foot touching the ground or coming close to it (i.e. within a 2-mm distance). In Study II, the other man received 10 s of preferred music anytime he crossed one of the small marks present along the travel routes. Results: The B phases showed that (a) the man included in Study I increased the percentages of left- and right-foot steps performed with the heels touching or nearing the ground to above 85% and 70%, respectively, and (b) the man included in Study II walked with very few breaks. Conclusion: Technology-based programs can be highly effective in helping persons with multiple disabilities improve their walking behavior.

Implications for Rehabilitation

• A technology-aided program ensuring preferred stimulation for steps performed with adequate foot position might reduce toe walking in persons with multiple disabilities (MD).

• A technology-aided program ensuring preferred stimulation for walking might improve walking continuity in persons with MD.

• Technology-aided programs can be an important resource to improve walking behavior of persons with MD.

     

Effects of a multidisciplinary group rehabilitation programme on participation of the visually impaired elderly: a pilot study

Purpose: To pilot test the newly developed multidisciplinary group rehabilitation programme Visually Impaired elderly Persons Participating (VIPP). Method: A single group pretest–posttest design pilot study included 29 visually impaired persons (≥55 years). The intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counselling and training of problem-solving skills; individual and group goal setting; home-based exercise programme). Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation–Participation (USER-P) and the Impact on Participation and Autonomy (IPA) questionnaire at baseline, immediately and 6 months after the intervention. Results: At scale level, no statistical significant changes over time were found whereas the effect size indicated small effects for restrictions and satisfaction with participation, and a medium effect for autonomy outdoors. At item level, improvements tended to occur in frequency of housekeeping, in restrictions in housekeeping and outdoor activities and in satisfaction with the partner relationship. Satisfaction with leisure indoors and autonomy regarding using leisure time tended to increase as well. Conclusions: The tentative conclusion of this small-scale pilot study is that the VIPP programme modestly benefits perceived restrictions in participation, satisfaction with participation and autonomy outdoors of the visually impaired elderly. These preliminary findings warrant further investigation.

Implications for Rehabilitation

• Visually impaired elderly persons perceive restrictions in participation and participate less in society compared to peers.

• Since participation contributes to quality of life and well-being, it is important that visually impaired elderly persons maintain or enhance their level of participation in society.

• This pilot study showed that the multidisciplinary group rehabilitation programme Visually Impaired elderly Persons Participating (VIPP) modestly benefits perceived restrictions in participation, satisfaction with participation and autonomy outdoors of the visually impaired elderly.

     

An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: the importance of belonging,fun, and control and choice

Abstract

Purpose: The aim was to examine the leisure activity setting experiences of two groups of youth with severe disabilities – those with complex continuing care (CCC) needs and those who have little functional speech and communicate using augmentative and alternative communication (AAC). Method: Twelve youth took part in a mixed methods study, in which their experiences were ascertained using qualitative methods (observations, photo elicitation and interviews) and the measure of Self-Reported Experiences of Activity Settings (SEAS). Data integration occurred using a “following a thread” technique and case-by-case analysis. Results: The analysis revealed several highly valued aspects of leisure activity setting experiences for youth, including engagement with others, enjoying the moment, and control and choice in selection and participation in activity settings. Conclusions: The findings provide preliminary insights into the nature of optimal activity settings for youth with severe disabilities, and the mediators of these experiences. Compared to other youth, the data illustrate both the commonalities of experiences and differences in the ways in which these experiences are attained. Implications for research concern the utility of mixed methods approaches in understanding the complex nature of participation experiences. Implications for clinical practice concern the importance of not assuming the nature of youths’ experiences.

• Implications for Rehabilitation

• Service providers can lose sight of the importance of broader concepts of belonging, fun, and control and choice when providing interventions that focus on “participating” in an “activity” to build specific skills.

• In addition to the skill-based outcomes for youth with disabilities that are valued by the rehabilitation system, we suggest that consideration needs to be given to other types of outcomes that matter to youth, such as participating in a leisure activity for the sake of belonging or having fun.

• It is important not to assume that youth with severe disabilities are not enjoying their participation or are not benefiting from their leisure experiences.

• It is important not to “over-therapize” youth with disabilities and promote a balanced approach to therapy and leisure participation, by discussing with youth and families the beneficial developmental outcomes that can accrue from leisure activities.

     

The speech generating device (SGD) mentoring programme: an evaluation by participants

Purpose: In this paper the perceptions of three mentors and three mentees who took part in a speech generating device (SGD) mentoring programme are presented. The aims of the study were to investigate the participants’ views on taking part in the mentoring programme and their satisfaction with the outcomes.

Method: Information was gathered through semi-structured interviews with the six mentoring programme participants. Interview data were analysed for content themes.

Results: Thematic analysis revealed six themes. Of these themes, five were identified in both the mentor and mentee’s data. These themes were: satisfaction with the SGD mentoring programme, mentee improvement in SGD use, the importance of a role model of SGD use, the SGD mentoring relationship as a helping relationship, and SGD mentoring contributes to mentor self-esteem. The remaining theme, mentors who use an SGD learn from the mentoring experience, was generated from the mentor’s data only.

Conclusions: The results of this study provide initial evidence in support of mentoring among people who use an SGD. A total of five of the six participants perceived that people learning an SGD can benefit from SGD mentoring by experienced users of SGDs and agreed on a need for such mentoring programmes to improve SGD use.

Implications for Rehabilitation

• A mentoring programme involving experienced and new users of speech generating devices (SGDs) has the potential to improve learners’ SGD use.

• The results of this study provide preliminary evidence in support of mentoring from the perspective of people who took part in an SGD mentoring programme.

• Five of the six participants perceived that learners can benefit and agreed on a need for such programmes to improve SGD use.

• Participation in mentoring can contribute to the personal growth of adult mentors and enable them to make a positive contribution to the AAC community.

     

Multi-professional and multi-dimensional group education – a key to action in elderly persons

Purpose: This study was intended to evaluate a multi-professional health-promoting and disease-preventive intervention organized as multi-professional senior group meetings, which addressed home-dwelling, independently living, cognitively intact elderly persons (80±), by exploring the participants’ experiences of the intervention. Method: The focus group methodology was used to interview a total of 20 participants. The informants had participated in four multi-professional senior group meetings at which information about the ageing process and preventive strategies for enhancing health were discussed. Results: The overall finding was that the elderly persons involved in the intervention lived in the present, but that the supportive environment together with learning a preventive approach contributed to the participants’ experiencing the senior meetings as a key to action. Conclusions: Elderly persons who are independent may have difficulty accepting information about preventing risks to health. However, group education with a multi-professional approach may be a successful model for achieving an exchange of knowledge, which may possibly empower the participants, give them role models, the opportunity to learn from each other and a sense of sharing problems with people in similar circumstances.

Implications for Rehabilitation

• Since elderly persons these days are expected to live beyond their 80 s, there is still time for interventions aimed at health promotion and disease prevention to have an effect on functional status and the quality of life of their remaining years.

• Elderly persons who are independent may have difficulty accepting information about preventing risks to health.

• Multi-professional health promoting and disease-preventive senior meetings could motivate elderly persons to act on behalf of their own health.

• Multi-professional collaboration combined with the group model made the participants in our study experience the senior meeting as a key to action.

     

Efficacy of leisure intervention groups in rehabilitation of people with an acquired brain injury

Abstract

Purpose: To determine whether participation in a week-long residential leisure intervention program targeting individuals with an acquired brain injury (ABI) improved the leisure satisfaction, self-esteem and quality of life (QOL) of participants. The program included leisure awareness, leisure resources, social interaction skills and leisure activity skills. Method: Using a pre- and post-intervention design leisure satisfaction, self-esteem and QOL were assessed prior to, immediately following and at three months post program. Data were analyzed using Wilcoxon signed-rank tests. Results: Participants were eight men and four women aged between 19 and 49 years who were recent clients of a rural Brain Injury Rehabilitation Service. The majority (7/12) had acquired their ABI more than two years previously, and for most (10/12) the cause was trauma. Program participants showed clinically important and statistically significant improvements in leisure satisfaction (p?=?0.002), self-esteem (p?=?0.03) and QOL (p?=?0.02 to 0.008 for four domains of the World Health Organisation Quality of Life – Bref scale) three months post program. Conclusion: Adults with an ABI participating in leisure education programs can experience improvements in leisure satisfaction, self-esteem and QOL following the program. The findings suggest that active leisure intervention programs should be included in the ongoing rehabilitative care of adults with an ABI.

• Implications for Rehabilitation

• Leisure participation, leisure satisfaction and social integration can be seriously compromised following an acquired brain injury (ABI).

• Engagement in leisure activities has positive effects on physical and mental health and is increasingly recognised as an important determinant of quality of life (QOL) for people with ABI.

• Participation in a short-term intensive leisure intervention program can improve leisure satisfaction, self-esteem and QOL.

• Active leisure intervention programs should be included in the ongoing rehabilitation and reintegration of adults with ABI.

     

Looking to the future: adolescents with cerebral palsy talk about their aspirations – a narrative study

Purpose: To explore the future hopes and aspirations of adolescents with cerebral palsy (CP) with a particular focus on their reflections on engagement in leisure activities. Method: This qualitative study used narrative inquiry methodology. Ten adolescents, aged 14–16 years with CP and Manual Ability Classification System levels ranging from I–IV, were purposively sampled from a longitudinal study of leisure participation. Data were gathered during two face–face interviews conducted approximately 1 month apart. Between interviews, photographs were taken by the adolescents to represent their visions of their future aspirations. In accordance with narrative inquiry methodology, the results were presented as individual stories constructed by the researcher. These narratives were subsequently analysed to produce themes representing the participants’ reflections on their future. Results: Three themes were developed: (i) Keeping close relationships, (ii) Choosing a future life of one’s own, (iii) Leisure in the years ahead. All the adolescents had aspirations for education, work, leisure and living situation. Conclusion: This study highlights the value of seeking information from adolescents with CP and suggests clinicians be aware of, and work to support their expectations for future study, employment and recreational engagement.

Implications for Rehabilitation

• To our knowledge, this is the first recent study to describe the aspirations of adolescents with cerebral palsy. The study findings reinforce the value of seeking information directly from the adolescents themselves.

• These adolescents with cerebral palsy had clear aspirations for future education, work, fun, friendship and travel. Although these aspirations seem common to us all, recent research into adult outcomes suggests adolescents with cerebral palsy will need focused support to attain their goals.

• The results highlight the need for educational and health professionals to be future-focused, to take a lifespan perspective, when working with adolescents with childhood disability.

     

Reference system of competence and engagement in adapted physical activities of people with recent spinal cord injury

Abstract

Purpose: This study tested whether persons with Recent Spinal Cord Injury (RSCI) who practice adapted physical activities (APA) and those who do not differ with regard to achievement goals, physical self-perceptions, and global self-esteem. Method: Adults with RSCI in rehabilitation centers voluntarily completed questionnaires of achievement goals and self-esteem. Then, based on whether they engaged or not in APA programs, they were considered participants or non-participants in APA. Results: Compared to participants in APA, non-participants were more oriented toward mastery-avoidance goals and had lower scores of physical self-worth and global self-esteem. No differences were found for other achievement goals and for low-level dimensions of physical self. Conclusions: These findings suggest that mastery-avoidance goals are associated with a maladaptive motivational pattern when intrapersonal comparison conveys a threat for the self. Practical implications for rehabilitation programs for persons with RSCI are offered.

• Implications for Rehabilitation

• Adapted Physical Activities (APA) programs are supervised physical activity programs in which the choice of the activity as well as the frequency, the duration, and the intensity of practice are adapted to the inpatients’ capabilities.

• Attempts to master physical activities can be seen as threatening experiences to be avoided by persons with Recent Spinal Cord Injury (RSCI) in rehabilitation centers.

• Comparing one’s capabilities in physical activities with those of other persons with RSCI is not motivationally detrimental with respect to the practice of these activities.

• Upon persons with RSCI’ arrival in rehabilitation centers, physical educators should promote a friendly competitive climate in the practice of APA to help inpatients recover healthy levels of physical self-perceptions and global self-esteem as well as motivation to exercise.

     

How are cognitive impairment,fatigue and signs of depression related to participation in daily life among persons with multiple sclerosis?

Abstract

Purpose: Factors that impact participation are of scientific and clinical importance. Participation in everyday activities among persons with multiple sclerosis (MS) can be compromised by various factors however the combined contribution of these factors to participation has not been explored. The aim of this study was to describe the relationship between cognitive impairment, physical disability and signs of depression and participation in daily life among persons with MS. Methods: Data from 200 participants were collected in an observational, prospective study. The majority was female, had mild physical disability, and an average age of 48.7. The impact of independent variables, including demographic and disease related data, levels of cognitive impairment, signs of depression and fatigue, on participation was investigated using path analysis. Results: Cognitive impairment was associated with restricted participation in domestic, leisure and outdoor domains. Restrictions in leisure and outdoor activities, but not domestic activities were related to signs of depression. Cognitive impairment was associated with the level of education and the level of physical disability. Conclusions: Increasing participation is an important outcome of rehabilitation. The results of this study suggest a multifactorial approach to intervention that considers physical, mental and emotional component to maximize participation among persons with MS.

• Implications for Rehabilitation

• Rehabilitation for persons living with multiple sclerosis (MS) should incorporate careful evaluation of physical disability, cognitive impairment and depression and their impact on participation.

• Clinicians need to evaluate participation in a variety of daily activities, including activities within and outside of the home, and leisure activities.

• Signs of depression may have a greater impact on participation in outdoor and leisure activities then on other activities.