Materials and methods: Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017.
Results: Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services.
Conclusions: There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level.
- Implications for rehabilitation
There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases.
This scoping review shows that the need for rehabilitation considerably outstrips the provision of services.
There are substantial unmet needs for rehabilitation and numerous barriers to accessing services.
Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries.
Methods: This scoping review involved a systematic search of electronic databases using a combination of subject headings and/or keywords related to child disability, rehabilitation, and low- and middle-income countries. Charting involved an iterative process whereby the full text of articles meeting the inclusion criteria were abstracted using a charting form. Data were charted according to pre-selected and emerging characteristics deemed relevant to the scoping review’s purpose.
Results: Eighty-one articles were included in the final analysis. Forty-three articles explored the use of screening and/or diagnostic tools in identifying children with disabilities in low and middle income countries, and 38 articles evaluated rehabilitation services for these children.
Conclusions: A number of rehabilitation strategies are available that have the potential to improve the identification of and outcomes for children with disabilities in low and middle income countries. Future research ought to advance the development, implementation, and evaluation of training programs for non-rehabilitation specialists (e.g., doctors, nurses, and teachers), non-specialist community members (e.g., community health workers), and caregivers in the area of rehabilitation, and evaluate the effectiveness of rehabilitation interventions in improving participatory outcomes and quality of life for children with disabilities.
- Implications for Rehabilitation
Additional research is needed to understand the influence of rehabilitation on personal factors (e.g., self-efficacy and quality of life) and participation for children with disabilities.
There is limited availability of experienced rehabilitation service providers, especially in rural areas, warranting additional research into the development and evaluation of non-specialist training programs, and the integration of rehabilitation concepts across health workforce education programs.
Researchers from low and middle income countries appear to be underrepresented in published rehabilitation research, indicating a need to further promote the inclusion of this group through community-based participatory research.
Methods: We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35?years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year.
Results: Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost?=??$17,255; incremental effect?=?1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care.
Conclusions: The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods.
- Implications for Rehabilitation
Ongoing rehabilitation following stroke is imperative for optimal recovery.
Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.
The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.
Methods: A systematic quantitative literature review methodology was utilized, wherein papers’ characteristics were extracted and categorized in a database according to their topics, employment outcome indicators, populations, locations, and methods. Frequency tables were generated and cross-tabulated to yield conclusions about the outcomes of the studies and the methods and samples used to yield these outcomes.
Results: The review highlighted three key themes; the emergence of broader employment outcome measures that go beyond employment rate; a lack of consistency in the reporting of sample characteristics such as time since injury or ethnicity; and the relative lack of research focusing on people with newly acquired spinal cord injury.
Conclusions: The literature review identified a number of limitations in the existing research including the lack of standardized reporting of employment outcomes and a need for increased consistency in reporting sample characteristics. In addition, there are gaps in the research about people with newly acquired spinal cord injury, particularly regarding the timing of interventions.
- Implications for Rehabilitation
Spinal cord injury has the potential to disrupt a person’s career across their lifespan.
Employment rate is the gold standard for evaluating employment outcomes.
Broader measures of employment, including job retention and hours worked, have potential in evaluating and improving the quality of employment outcomes for this population.
Further research with people with newly acquired spinal cord injuries would better support the provision of vocational rehabilitation services earlier in a person’s rehabilitation, potentially preserving jobs.
Design: Qualitative and semi-structured interviews.
Setting: Australian burn and rehabilitation units.
Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings.
Results: The data portrayed the health professionals’ perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care.
Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes.
- Implications for rehabilitation
Burn care and rehabilitation remains a complex and challenging area of care.
Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase.
Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.
Methods: A scoping review was conducted, beginning with a systematic search of relevant databases using key search terms. Studies with a focus on the role of the working alliance in shaping rehabilitation outcomes, and factors influencing perceptions of the working alliance were included and key information extracted.
Results: A total of 10 quantitative studies met inclusion criteria. In most studies, ratings of the working alliance were compared with other process variables or outcome measures. The working alliance was linked to positive activity and participation outcomes, including return to work, school, and driving. Client related factors such as age, level of education and approach to rehabilitation tasks were associated with client and therapist perceptions of the working alliance.
Conclusions: The working alliance emerged as a complex process that interacts with many factors and processes at play in the rehabilitation environment. Notwithstanding the limitations of the research base, findings indicate that enhancement of the working alliance may indeed influence rehabilitation outcomes. Allowing time for the development of the working alliance, and consideration of factors such as therapist skill, may support therapists to strengthen their alliances in ABI rehabilitation.
- Implications for Rehabilitation
Allowing time for the development of the working alliance has the potential to enhance the alliance and thereby influence rehabilitation outcomes.
Factors such as the client’s age and level of education may influence the strength of the working alliance, and hence, awareness of these factors may assist clinicians in maintaining strong alliances with all clients.
A strong working alliance is possible in the presence of client cognitive impairment, however, the skill of the therapist may be important in managing the potential impact of cognitive impairment on the working alliance.
Method: A qualitative study using a phenomenological approach was undertaken. Eight adults (18–59 years) were recruited from disability service organizations in Nigeria. Telephone interviews were recorded and transcribed, and thematic content analysis was used to analyze the data gathered in this study.
Results: Three broad themes were developed from participants’ accounts of their experiences: (1) changes to relationships with friends and others; (2) finding strength in family relationships; and (3) rehabilitation and the confidence to interact. The findings indicate that the relationship between participants and their family members improved post vision impairment, enhancing bonding social capital. However, participants experienced reduced bridging and linking social capital due to diminished or broken relationships with managers, coworkers, friends, and others in the community.
Conclusions: As social connectedness and relationships are highly valued in Nigeria’s diverse society, we suggest that adults with visual impairment would significantly benefit from visual rehabilitation services placing greater emphasis on addressing the social goals of participants.
- Implications for Rehabilitation
Visual impairment in working-age adults can strengthen family relationships (homogenous groups), creating bonding capital that is associated with access to important resources including emotional and moral support, and some financial and material resources.
Visual impairment can negatively impact relationships with managers, coworkers, and others in the community (heterogeneous groups), resulting in diminished bridging and linking capital.
Visual impairment can reduce access to resources such as an income, social status, and reduces participation in the wider community.
Visual Rehabilitation Services could significantly benefit participants by placing greater emphasis on social goals, such as building and maintaining social networks, particularly with diverse (heterogeneous groups), which are valued in Nigeria’s diverse cultural climate.
Methods: Stroke survivors receiving in-patient rehabilitation were randomised to receive eight art participation sessions (n?=?41) or usual care (n?=?40). Recruitment, retention, preference for art participation and change in selected outcomes were evaluated at end of intervention outcome assessment and three-month follow-up.
Results: Of 315 potentially eligible participants 81 (29%) were recruited. 88% (n?=?71) completed outcome and 77% (n?=?62) follow-up assessments. Of eight intervention group non-completers, six had no preference for art participation. Outcome completion varied between 97% and 77%. Running groups was difficult because of randomisation timing. Effectiveness cannot be determined from this feasibility study but effects sizes suggested art participation may benefit emotional wellbeing, measured on the positive and negative affect schedule, and self-efficacy for Art (d?=?0.24–0.42).
Conclusions: Undertaking a RCT of art participation within stroke rehabilitation was feasible. Art participation may enhance self-efficacy and positively influence emotional wellbeing. These should be outcomes in a future definitive trial. A cluster RCT would ensure art groups could be reliably convened. Fewer measures, and better retention strategies are required.
- Implications for Rehabilitation
This feasibility randomised controlled trial (RCT) showed that recruiting and retaining stroke survivors in an RCT of a visual arts participation intervention within stroke rehabilitation was feasible.
Preference to participate in art activities may influence recruitment and drop-out rates, and should be addressed and evaluated fully.
Art participation as part of rehabilitation may improve some aspects of post-stroke wellbeing, including positive affect and self-efficacy for art.
A future definitive cluster RCT would facilitate full evaluation of the value art participation can add to rehabilitation.
Methods: This study drew on in-depth interviews with a purposive sample of 33 participants (23 youth and 10 clinicians). The youth in our sample included 13 females (mean age 22.9) and 10 males (mean age 21.3) who had various types of physical disabilities. The person–environment–occupation (PEO) model informed our analysis.
Results: Our research showed several similarities and some differences between young males and females with physical disabilities as they transition to employment and adulthood at the person, environment, and occupational level. At the person level, issues included managing their condition, self-advocacy, and willingness to ask for help. At the environment level, themes focused on parental and social support, accommodations, stigma and discrimination, and transportation challenges. Finally, in the occupation component of the PEO model, we found that males and females with disabilities had different levels of engagement in employment. Although most clinicians commented on gender differences, many reported that they did not tailor their clinical practice accordingly.
Conclusions: Gender sensitive vocational approaches are needed for youth with disabilities as they transition to employment.
- Implications for rehabilitation
Clinicians, educators, and parents should encourage independence and self-advocacy skills among youth so that they are prepared to ask for accommodations that they need to succeed in a work environment.
Clinicians and educators should present a variety of career and job options to youth, including science, technology, engineering, and math disciplines, an area where youth with disabilities, particularly females, are under-represented.
Males may feel less able to self-advocate and seek support and may need additional assistance from clinicians, educators, and parents.
Clinicians should tailor their vocational rehabilitation practices to the gender-specific needs of youth with disabilities.
Clinicians and parents should ensure that both males and females have the resources and supports they need to be successful in their transition to employment.
Materials and methods: A historical cohort of Finnish workers with a severe occupational injury during 2008 (N?=?11,585) were followed up annually on the outcomes of return to work over a 5-year observation period. We examined transition probabilities from one life situation to another with Markov chain analysis, and applied logistic regression with generalized estimating equations to assess the effect of register-based determinants on return to work.
Results: Within the five anniversaries, 85% of the injured were working, 9% were unable to work (fully or partly) and 2% received rehabilitation. Age, gross annual income, type of work, injured body part, injury type and the injured’s annual condition subsequent to the work injury were significant determinants of return to work.
Conclusions: The probability of return to work decreased with time, but, on average, one-fifth of the injured workers succeeded in return to work after being unable to work on the previous anniversary, which indicates that it is worthwhile to conduct efforts for this target group in order to promote return to work.
- Implications for Rehabilitation
The current life situation of the injured should be taken into account when promoting return to work, as it is a strong predictor of later working after a serious occupational injury.
Rehabilitation and return to work programs should start in time due to declining return to work rates as the disability continues.
Return to work on a part-time basis could be a good option during the early phases of recovery, since a notable proportion of those partly unable to work on the first anniversary returned later to full-time workers.
The probability of recovery is relatively high even for those with long-term disabilities, so the promotion of return to work is highly recommended also for this target group.
Method: Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test.
Results: The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed.
Conclusion: Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future.
- Implications for rehabilitation
Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty:
??Enhances quadriceps strength.
??Alleviates pain.
??Enhances range of motion.
??Does not have any effect on basic functional mobility.
??Does not have any effect on knee girth.
Aim: To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation.
Materials and methods: A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach.
Results: Patients reported (1) Time to diagnose: “Finally I’m in the right place;” (2) Awareness: “They gave me a mirror;” (3) Partnership: “There was real contact with the therapists; we made decisions together;” (4) Close collaboration: “Overlapping scopes of practice; doing the same from a different perspective;” and finally (5) Self-management: “Now I can do it myself.” Therapists reported (1) “Patients knowledge and understanding is critical to success;” (2) “Activate problem solving and decision making;” (3) “Personalize your therapy; it’s more than just giving exercises and information;” (4) “Constant consultation within the team; consistency in messages and approach;” and (5)” Ultimately the patient is in charge.”
Conclusions: The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme.
- Implications for rehabilitation
Both patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries.
A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions.
Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient–therapist and within the team; patient activation and self-reflection; and personalised care.
Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.
Methods: Eight databases were searched from their start-date up to January 2017 using the key terms Parkinson’s Disease and augmented visual feedback. Two independent raters screened the abstracts and full articles for inclusion. Relevant data were extracted and summarized, and methodological quality of accepted articles was assessed.
Results: Eight single-group studies and 10 randomized control trials were included in the review. Augmented visual feedback-based treatments resulted in improved outcomes with small to large effect sizes post-treatment for the majority of impairment, activity, participation, and global motor function measures, and these improvements were often superior to traditional rehabilitation/education programs. Enhanced treatment outcomes were observed in studies that provided large amounts and high intensities of treatment; gamified feedback; and provided knowledge of performance feedback in real-time on 100% of practice trials.
Conclusion: Augmented visual feedback appears to be a useful motor rehabilitation tool in Parkinson’s disease; however, high-quality, rigorous studies remain limited. Future studies should consider factors that enhance rehabilitation outcomes when designing augmented visual feedback-based interventions.
- Implications for rehabilitation
Augmented visual feedback is a useful tool for motor rehabilitation in Parkinson’s disease; augmented visual feedback-based treatments are often superior to traditional programs.
These treatments are associated with improved outcomes in impairment, activity, participation, and global motor function domains.
Rehabilitation professionals can optimize their use of augmented visual feedback-based treatments by providing large amounts and a high intensity of treatment, gamifying feedback, and providing knowledge of performance feedback in real-time and at a high frequency.
Methods: An internet-based study was conducted to identify and select relevant documents and websites containing information about the national approach to promote disability sports and physical activities in the Netherlands and Canada.
Results: Both governments promote high performance sports in similar ways, but use different strategies to promote recreational sports and physical activities. The Dutch approach is characterized by using time-limited programs focusing on enhancement of sports infrastructure and inter-sector collaboration in which municipalities have key roles. The Canadian government promotes recreational sports in disabled populations by supporting programs via bilateral agreements with provinces and territories. Furthermore, the level of integration of disability sports into mainstream sports differs between countries.
Conclusions: The findings of this study may inspire policy makers from different countries to learn from one another’s policies in order to optimize national approaches to promote disability sports and PA on all levels.
- Implications for rehabilitation
It is recommended for policy makers of national governments to develop and implement policy programs that promote sports and physical activities among people with disabilities because of its potential impact on functioning, participation, quality of life, and health.
Insight into national approaches to promote sport and physical activities is relevant for rehabilitation practice to understand ongoing opportunities for people with disabilities to stay physically active after rehabilitation through participation in home and/or community-based sport and physical activities.
It seems worthwhile to integrate activities to promote sport and physical activities in rehabilitation in such a way that it fits with the current governmental approach.
It is recommended to set up international collaborations to develop and share knowledge about effective and sustainable national approaches to promote sports and physical activities among people with disabilities.
Materials and methods: A qualitative study employing a phenomenological approach explored the lived experience of incurable cancer. A purposive sample of six people participated in semi-structured interviews. The data were analysed thematically at a semantic level to identify the functional difficulties experienced by people living with incurable cancer, the meanings of those difficulties, and participants perceived rehabilitation needs.
Results: People living with incurable cancer described cancer-related issues spanning all five domains of the International Classification of Functioning, Disability and Health (ICF). Although highly valued amongst study participants, rehabilitation services were difficult to access, poorly utilised, and referrals were sporadic and consequential; indicative of poor awareness of rehabilitation for people with incurable cancer amongst potential referrers.
Discussion: Participants valued a change in terminology away from “palliative” towards more positive language in line with enhanced supportive care movements. Validated tools such as the Palliative Care Therapy Outcome Measure, which align with the ICF, would allow rehabilitation professionals to demonstrate maintenance or improvement in participation and wellbeing.
- Implications for Rehabilitation
Incurable cancer leads to a fluctuating multifactorial disability.
People living with incurable cancer can benefit from rehabilitation input throughout their illness.
Offering flexible and varied rehabilitation options for people living with incurable cancer will increase physical and emotional well-being, function, and coping.
Allied health professionals should take and create opportunities to promote rehabilitation for people living with incurable cancer and their services to other potentially referring healthcare professionals to increase understanding of benefits and utilisation of available services for people living with incurable cancer.
Methods: In the fall of 2016, we searched Psycinfo (OVID), ERIC, CINAHL and Web of Science to identify studies that used participatory photography with children with disabilities. The search was repeated in January 2018 to retrieve any new publications. The first author extracted data that described the characteristics of each study and the modifications used.
Results: Of the 258 articles identified, 19 met inclusion criteria. Participants ranged from 4–21?years old and had a variety of disabilities. Study topics included education, leisure activities and adulthood. Researchers modified participatory photography to enhance accessibility by: modifying cameras; providing individual training; teaching consent through role play; allowing children to direct adults to take photographs; including additional forms of media; using diaries and questionnaires; providing individual interviews with simplified questions; using multiple forms of communication; and modifying how photographs are shared.
Conclusions: Participatory photography can be an effective method for studying the lived experiences of children with disabilities, particularly those with communication impairments. Methodological modifications can enhance the accessibility of this approach for this population.
- Implications for Rehabilitation
Participatory photography may be an effective qualitative research method for learning about the perspectives and experiences of children with disabilities on a wide array of topics.
There are many specific modifications that researchers can use to support the inclusion of children with disabilities in participatory photography research.
The findings of studies that use participatory photography methodology may provide rehabilitation professionals with important insights into the lives of children with disabilities.
Method: Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14–25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl–Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.
Results: Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p?<?0.05 for all measures).
Conclusions: Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability.
- Implications for rehabilitation
To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need.
Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation.
Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment.
Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.
Study design: Cross-sectional.
Methods: Forty eight participants with traumatic brain injury (Age M?=?40.50 SD?=?14.62, 77% male, post-traumatic amnesia days M?=?28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures.
Results: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills.
Conclusions: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs.
- Implications for rehabilitation
Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries.
Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres.
Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury.
Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.
Method: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines.
Results: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin “ultra”, beyond, to “habilitare”, make fit. The resulting term, “ultrabilitate”, commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning.
Conclusions: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas.
- Implications for rehabilitation
Despite significant progress, rehabilitation limits some people with disabilities.
Modern health systems still benchmark therapy for rehabilitation against “normal” or species-typical standards to aid recovery.
“Ultrabilitation”, meaning “beyond fitness”, promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery.
Biological, social and technological conditions are needed to support ultrabilitation.
Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth.
Methods: Interpretative phenomenological analysis was employed to collect and analyze data from six semi-structured interviews with participants regarding their experiences of living in nursing homes.
Results: Two themes were identified, including “Corporeal prison of acquired brain injury: broken selves” and “Existential prison of the nursing home: stagnated lives”. Results illustrated that young adults with acquired brain injury can experience aged care as an existential prison in which their lives feel at a standstill. This experience was characterized by feelings of not belonging in a terminal environment, confinement, disempowerment, emptiness and hope for greater autonomy through rehabilitation.
Conclusion: It is hoped that this study will provide relevant professionals, services and policy-makers with insight into the challenges and needs of young adults with brain injury facing these circumstances.
- Implications for rehabilitation
This study supports the contention that more home-like and age-appropriate residential rehabilitation services for young adults with acquired brain injury are needed.
As development of alternative accommodation is a lengthy process, the study findings suggest that the interim implementation of rehabilitative care in nursing homes should be considered.
Taken together with existing research, it is proposed that nursing home staff may require training to deliver evidence-based rehabilitative interventions to those with brain injury.
The present findings add support to the call for systemic change in Ireland, to clarify the acquired brain injury care pathway and establish integrated rehabilitation services.