Performance and capacity-based measures of locomotion,compared to impairment-based measures,best predicted participation in individuals with hemiparesis due to stroke

Purpose: To determine the potential predictors of participation of individuals with post-stroke hemiparesis, taking into account modifiable variables of impairments, activity limitations, and environmental factors.

Methods: One hundred and nine individuals (58?±?12 years; 64 men) participated in this study. Outcomes included measures of impairments (depressive symptoms: Geriatric Depression Scale and motor-based impairments: finger-to-nose test, lower extremity (LE) motor coordination test, and handgrip strength, isometric strength of the LE muscles), activity (capacity: 10-meter walking speed test and Test d'Évaluation des Membres Supérieurs de Personnes Agées; performance: locomotion and manual abilities; environmental factors (Measure of the Quality of the Environment); and participation: Assessment of Life Habits (LIFE-H 3.1 Brazil)).

Results: Regression analyses revealed that the explanatory variables accounted for 59% and 49% of the variance in the LIFE-H 3.1 Brazil daily activity and social role sub-scales, respectively. Locomotion performance (R²?=?39%; p?R²?=?32%; p?Conclusions: Performance and capacity-based measures of locomotion showed to be the best predictors of participation. Additionally, depressive symptoms should not be underlooked.

• Implications for Rehabilitation

• Activity-related measures of locomotion showed to be the main predictors of participation in individuals with post-stroke hemiparesis, as assessed by the daily activity and social role sub-scales of the LIFE-H 3.1.

• The daily activity model was best predicted by measures of performance, whereas the social role sub-scale, by measures of capacity.

• Although small, the impact of depressive symptoms on participation should not be underlooked.

• Locomotion appeared to be essential for participation and increases in walking speed and locomotion ability should be the main goals for both professionals and individuals, when the aim is to increase participation.

     

Upper extremity function and activity in facioscapulohumeral dystrophy and limb-girdle muscular dystrophies: a systematic review

Abstract

Purpose: The aims of this review were (1) to provide insight into the natural course of upper-extremity (UE) impairments and UE activity limitations associated with facioscapulohumeral dystrophy (FSHD) and limb-girdle muscular dystrophies (LGMD), and (2) to provide an overview of outcome measures used to evaluate UE function and activity in patients with FSHD and LGMD. Methods: Scientific literature databases (PubMed, MEDLINE, EMBASE, CINAHL and Cochrane) were searched for relevant publications. Inclusion criteria: (1) studies that included persons with a diagnosis of FSHD or LGMD; and (2) studies that reported the natural course of the UE functions and/or activity with outcome measures at these levels. Results: 247 publications were screened, of which 16 fulfilled the selection criteria. Most studies used manual muscle testing (MMT) to evaluate UE function and the Brooke Scale to evaluate UE mobility activities. The clinical picture of UE impairments and limitations of UE activities in FSHD and LGMD patients was highly variable. In general, FSHD and LGMD patients experience difficulty elevating their upper extremities and the execution of tasks takes considerably longer time. Conclusions: The clinical course of UE impairments and activity limitations associated with FSHD and LGMD is difficult to predict due to its high variability. Although measures like MMT and the Brooke Scale are often used, there is a lack of more specific outcome measures to assess UE function and UE capacity and performance in daily life. Measures such as 3D motion analysis and electromyography (EMG) recordings are recommended to provide additional insight in UE function. Questionnaires like the Abilhand are recommended to assess UE capacity and accelerometry to assess UE performance in daily life.

• Implications for Rehabilitation

• There is a need for specific outcome measures on the level of UE activity.

• Both the level of capacity and performance should be assessed.

• Possible outcome measures include 3D motion analysis to assess UE function, questionnaires like the Abilhand to assess UE capacity and accelerometry to assess performance of UE activities in daily life.

     

Measuring social participation: reliability of the LIFE-H in older adults with disabilities

Purpose: Much more attention should be paid to instruments documenting social participation as this area is increasingly considered a pivotal outcome of a successful rehabilitation. The purpose of this study was to document the reliability of a participation measure, the Assessment of Life Habits (LIFE-H), in older adults with functional limitations.

Methods: Eighty-four individuals with physical disabilities living in three different environments were assessed twice with the LIFE-H, an instrument that documents the quality of social participation by assessing a person's performance in daily activities and social roles (life habits).

Results: The intraclass correlation coefficients (ICC) computed for intrarater reliability exceeded 0.75 for seven out of the 10 life habits categories. For interrater reliability, the total score and daily activities subscore are highly reliable (ICC ??0.89), and the social roles subscore is moderately reliable (ICC?=?0.64). ‘Personal care’ is the category with the highest ICC, and for five other categories ICCs are moderate to high (<?0.60).

Conclusion: LIFE-H is a valuable addition to instruments that mostly emphasize the concepts of function or functional independence. It is particularly meaningful to evaluate the participation of older adults in significant social role domains such as recreation and community life. It may be considered among the instruments having the best fit with the ICF definition of participation (the person's involvement in a life situation) and a majority of its related domains.     

Reliability of the LIFE-H satisfaction scale and relationship between participation and satisfaction of older adults with disabilities

Purpose.?To (1) document the test–retest reliability of the Assessment of Life Habits (LIFE-H 3.1) in measuring the satisfaction of older adults with disabilities regarding their level of participation and (2) explore the relationships between level of participation and satisfaction with the level of participation achieved.

Methods.?Thirty older adults having functional disabilities were interviewed twice using the LIFE-H. This questionnaire assesses the (1) participation in daily activities and social roles (life domains), and (2) satisfaction with this participation.

Results.?The test–retest intraclass correlation coefficients (ICC) of the satisfaction total score and its two subscores revealed high reliability (ICCs ≥ 0.84). Moderate to excellent ICCs were also obtained for the life domains (ICCs = 0.65–0.88). Satisfaction was positively associated with participation for the daily activities subscore and LIFE-H total score (p < 0.05) but not the social roles subscore. Half of the life domains showed significant correlations between participation and satisfaction scores (p < 0.01).

Conclusion.?The results support the reliability of the LIFE-H satisfaction scale in older adults having functional disabilities. Also, as satisfaction is only partly related to the level of participation, the study emphasizes the relevance of considering both participation and satisfaction of older adults with disabilities when evaluating their needs.     

Participation in daily life activities and its relationship to strength and functional measures in boys with Duchenne muscular dystrophy

Abstract

Purpose: While most studies of Duchenne muscular dystrophy (DMD) have focused on physical impairment, there is a need to explore how impairment impacts real-life experiences in order to provide intervention strategies focused on participation. Objectives were: (1) to investigate the domains of participation in a sample of boys with DMD; (2) to compare a younger (<10 years) and older (≥10 years) group of boys with DMD with regard to participation; (3) to investigate strength and timed functional tests in a sample of boys with DMD; (4) to compare a younger (<10 years) and older (≥10 years) group of boys with DMD with regard to strength and timed functional tests; and (5) to explore associations between participation and strength and timed functional tests for our DMD cohorts. Methods: This cross-sectional study included 60 boys with DMD (mean 9.3 years?±?0.3). Boys completed strength testing, timed functional tests, the Children’s Assessment of Participation and Enjoyment and the ACTIVLIM. Independent samples t-tests were used to test for differences in all measures between our younger and older cohorts; Spearman’s (rank) correlation was used to assess relationships between participation and strength and time functional tests. Results: Significant differences were found between our younger and older boys with DMD in the areas of recreational (p?<?0.01), social (p?<?0.001), and skill-based activities (p?<?0.05), as well as with whom and where the activities were performed (p?<?0.05 and 0.001, respectively). Older boys with DMD report lower levels of participation in these areas, as well as less engagement in activities with individuals other than family members and less participation outside of the home. Lower levels of strength and slower rates of functional performance correlate with participation in fewer physical activities for our younger cohort and fewer physical and social activities for our older cohort. Conclusions: Strength and function relate to the variability and type of activities in which boys with DMD participate. A key finding is the significant decline in social activities and community-based engagement as the boys with DMD age. The ultimate goal of an intervention is for our children to be as actively engaged in life as they desire. This requires addressing participation when measuring outcomes in order to more fully understand limitations and provide appropriate strategies for continued participation for boys and their families.

• Implications for Rehabilitation

• Duchenne muscular dystrophy is a devastating progressive neuromuscular disorder that leads to significant strength and functional limitations, which affect physical and social participation for these boys.

• The ability to move beyond clinically-based outcomes and assess and monitor a child’s daily activities through participation measures may provide information for therapeutic interventions.

• Rehabilitation specialists have a role as advocates for social and community engagement for children with physical limitations.

• Providing families with information on community-based opportunities, and the strategies and environmental modifications available may increase social participation for our youth growing up with a neuromuscular disorder.

     

Go baby go café: a case study on an immersive rehabilitation environment to improve functional outcomes and quality of life

Purpose: To determine the effectiveness of involving traumatic brain injury survivors in a novel “enriched rehabilitation environment” in which physical, cognitive, social and speech impairments are simultaneously addressed during training within a functioning business.

Method: Participant was a 34-year old with a history of a severe head injury 17?years ago due to a motor vehicle accident. A novel intervention was provided within the Go Baby Go Café at the University of Delaware during her two hour shifts, three times a week for 2?months.

Results: The participant showed improvement in hand function, dynamic mobility, gait speed and cognitive ability. Additionally, changes were also noted across different domains like social activities, feeling of well-being, gross motor function and quality of life.

Conclusions: The Café may be a viable environment for comprehensive intervention. Participation in the Café was associated with wide spread gains in scores on a variety of physical, cognitive, quality-of-life outcomes.

• Implications for rehabilitation

• Long-term impairments after traumatic brain injury often impairs activities of daily living, community integration and return to work.

• The Go Baby Go Café, installed with an overhead harness system serves as an “Immersive Environment” to address various impairments all at once in a real-world setting.

• Individuals with impairments can benefit from this rehabilitation technique, which is structured to improve changes across the International Classification of Functioning Disability and Health spectrum.

     

The relationship between health related quality of life and sensory deficits among patients with diabetes mellitus

Abstract

Purpose: (1) To profile sensory deficits examined in the ability to process sensory information from daily environment and discriminate between tactile stimuli among patients with controlled and un-controlled diabetes mellitus. (2) Examine the relationship between the sensory deficits and patients’ health-related quality of life.

Methods: This study included 115 participants aged 33–55 with uncontrolled (n?=?22) or controlled (n?=?24) glycemic levels together with healthy subjects (n?=?69). All participants completed the brief World Health Organization Quality of Life Questionnaire, the Adolescent/Adult Sensory Profile and performed the tactile discrimination test.

Results: Sensory deficits were more emphasized among patients with uncontrolled glycemic levels as expressed in difficulties to register sensory input, lower sensation seeking in daily environments and difficulties to discriminate between tactile stimuli. They also reported the lowest physical and social quality of life as compared to the other two groups. Better sensory seeking and registration predicted better quality of life. Disease control and duration contributed to these predictions.

Conclusions: Difficulties in processing sensory information from their daily environments are particularly prevalent among patients with uncontrolled glycemic levels, and significantly impacted their quality of life. Clinicians should screen for sensory processing difficulties among patients with diabetes mellitus and understand their impacts on patients’ quality of life.

• Implications for Rehabilitation

• Patients with diabetes mellitus, and particularly those with uncontrolled glycemic levels, may have difficulties in processing sensory information from daily environment.

• A multidisciplinary intervention approach is recommended: clinicians should screen for sensory processing deficits among patients with diabetes mellitus and understand their impacts on patients’ daily life.

• By providing the patients with environmental adaptations and coping strategies, clinicians may assist in optimizing sensory experiences in real life context and elevate patients’ quality of life.

• Relating to quality of life and emphasizing a multidisciplinary approach is of major importance in broadening our understanding of health conditions and providing holistic treatment for patients.

     

“Our child’s significant disability shapes our lives”: experiences of family social participation

Abstract

Purpose: This study explored the stories of parents of youth with severe physical disabilities to understand how they viewed the quality of their family social participation; the barriers to social participation faced as families and the strategies and supports that might be used to reduce these barriers. Method: Ten parents of youth (10–18 years) with severe physical disabilities, recruited through specialist schools, health and disability services, were interviewed using a narratively-oriented interview tool: the Occupational Performance History Interview-II. Interviews were audio-recorded and transcribed verbatim. Narrative and thematic analytic approaches were used to construct each parent’s story of family social participation issues, and to identify themes across stories. Results: Parents used highly structured routines and required substantial resources, particularly adult assistance and financial means, to facilitate family social participation. Needs were greater when the youth was more severely impaired, heavier, incontinent or had fragile health. Parents’ choice of family activities and belief that they could influence the quality, enjoyment and satisfaction derived from family social participation were shaped by past experiences and the perceived benefits of participation. Conclusions: Family social participation relied on flexible supports tailored to families’ needs and preferences. Greater choice and control of resources are central to enabling valued participation.

• Implications for Rehabilitation

• Government resources need to be directed towards improving community based wheelchair accessibility and public toilet facilities for youth with Level V GMFCS-E&R impairments and their families.

• Disability service delivery models need to enable families to choose the types of high quality care and support that will facilitate valued family social participation.

• Clinicians need to be aware that families of the most severely impaired children, who are heavier, incontinent or in fragile health, will require substantially more resources than other families to facilitate their social participation.

     

Factors impacting the household and recreation participation of older adults living in the community

Abstract

Purpose: To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults. Methods: A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression. Results: There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p?<?0.001, p?<?0.001). For recreational participation, higher levels of depression were associated with restricted participation (p?<?0.001). Conclusion: Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail.

• Implications for Rehabilitation

• Depression is significantly correlated with the level of participation in daily activities for older adults.

• Health professionals need to screen for depression when working with older adults.

     

Job stability in skilled work and communication ability after moderate–severe traumatic brain injury

Purpose: Communication deficits may play a critical role in maintaining employment after traumatic brain injury (TBI), but links between specific communication deficits and employment outcomes have not been determined. This study identified communication measures that distinguished stably employed versus unstably employed adults with TBI. Methods: Participants were 31 adults with moderate–severe TBI who were employed full-time for at least 12 consecutive months before injury in skilled jobs and had attempted return to skilled jobs after injury. Sixteen had achieved stable employment (SE) post-injury, defined as full-time employment for ≥12 consecutive months; and 15 had unstable employment (UE). Participants completed a battery of communication tests identified in a prior qualitative study of communication skills required for skilled work. Results: Measures of spoken language comprehension, verbal reasoning, social inference, reading and politeness in spoken discourse significantly discriminated between SE and UE groups. Two nested models were completed and compared. The first model excluded discourse data because of missing data for two UE and one SE participant. This model revealed that measures of verbal reasoning speed (β?=??0.18, p?=?0.05) and social inference (β?=?0.19, p?=?0.05) were predictive independent of the overall model. The second model included discourse politeness data and was a better overall predictor of group membership (Likelihood ratio test, Model 1: 3.824, Model 2: 2.865). Conclusion: Communication measures were positively associated with SE in skilled jobs after TBI. Clinicians should include assessment of communication for adults attempting return to work after TBI, paying specific attention to social inference and speed of verbal reasoning skills.

• Implications for Rehabilitation

• Traumatic brain injury (TBI) often results in communication impairments associated with the cognitive skills underlying interpersonal skills.

• Communication impairment after TBI has been anecdotally associated with job instability. This research associate communication functioning with work stability after TBI in skilled jobs.

• These findings indicate that communication impairment should be assessed in persons with TBI returning to skilled employment after injury.

     

Impact of visual impairment on the lives of young adults in the Netherlands: a concept-mapping approach

Purpose: While the impact of visual impairments on specific aspects of young adults’ lives is well recognised, a systematic understanding of its impact on all life aspects is lacking. This study aims to provide an overview of life aspects affected by visual impairment in young adults (aged 18–25 years) using a concept-mapping approach.

Method: Visually impaired young adults (n?=?22) and rehabilitation professionals (n?=?16) participated in online concept-mapping workshops (brainstorm procedure), to explore how having a visual impairment influences the lives of young adults. Statements were categorised based on similarity and importance. Using multidimensional scaling, concept maps were produced and interpreted.

Results: A total of 59 and 260 statements were generated by young adults and professionals, respectively, resulting in 99 individual statements after checking and deduplication. The combined concept map revealed 11 clusters: work, study, information and regulations, social skills, living independently, computer, social relationships, sport and activities, mobility, leisure time, and hobby.

Conclusions: The concept maps provided useful insight into activities influenced by visual impairments in young adults, which can be used by rehabilitation centres to improve their services. This might help in goal setting, rehabilitation referral and successful transition to adult life, ultimately increasing participation and quality of life.

• Implications for rehabilitation

• Having a visual impairment affects various life-aspects related to participation, including activities related to work, study, social skills and relationships, activities of daily living, leisure time and mobility.

• Concept-mapping helped to identify the life aspects affected by low vision, and quantify these aspects in terms of importance according to young adults and low vision rehabilitation professionals.

• Low vision rehabilitation centres should focus on all life aspects found in this study when identifying the needs of young adults, as this might aid goal setting and rehabilitation referral, ultimately leading to more successful transitions, better participation and quality of life.

     

“It’s fun,but …” Children with cerebral palsy and their experiences of participation in physical activities

Abstract

Purpose: To explore the experiences of children with cerebral palsy (CP) regarding participation in physical activities, and to describe facilitators and barriers. Methods: Sixteen children with CP 8–11 years old who varied in gross motor, cognitive and communicative function participated in either an individual interview or a focus group. Results: Two categories and 10 sub-categories emerged from the content analysis. The category “Being physically active, because?…” describes facilitators for being physically active divided into the sub-categories “Enjoying the feeling”, “Being capable”, “Feeling of togetherness”, “Being aware it is good for me”, and “Using available opportunities”. The second category “Being physically active, but?…” describes barriers to being physically active, divided into the sub-categories “Getting tired and experiencing pain”, “Something being wrong with my body”, “Being dependent on others”, “Not being good enough” and “Missing available opportunities”. Conclusions: Asking children with CP about the physical activities they enjoy, and giving them the opportunity of trying self-selected activities with the right support is important for facilitating an increased participation in physical activities. Having fun with family and friends when being physically active, and enjoying the sensation of speed should be taken into consideration when designing interventions. When supporting children to become and remain physically active, attention should be paid to pain, fatigue and the accessibility of activities and locations.

• Implications for Rehabilitation

• Children want to be physically active together with friends or others.

• Children want to have fun and enjoy the sensation of speed when being physically active.

• Self-selected physical activities and the opportunity of trying new activities with the right support is essential for facilitating an increased participation in physical activities.

• Service planning and design may be facilitated by asking children about the physical activities they enjoy.

     

Health-related quality of life,physical activity,and sedentary behavior of adults with visual impairments

Purpose: Research suggests that physical activity and sedentary behaviors can impact one’s health-related quality of life (HRQoL). However, little is known about the impact that these behaviors can have on the HRQoL of those with visual impairments. Therefore, the primary purpose of this study was to determine the associations of physical activity and sedentary behavior with HRQoL among a sample of adults with visual impairments.

Method: Individuals with visual impairments were invited via email to complete three questionnaires: (a) the international physical activity questionnaire-short form, (b) the Rasch-revised versions of the World Health Organization Quality of Life instrument with the Level of Independence subscale, and (c) a demographic questionnaire. Eighty participants (M_age?=_?47.5) provided usable surveys for analyses.

Results: The results demonstrated that physical activity significantly predicted HRQoL (F(2,79)?=?3.508, p?=?.035, R²_Adjusted=.060), yet, sedentary behavior did not (F(2,79)?=?1.546, p?=?.220, R²?=?.039, R²_Adjusted =.014). Gender differences were uncovered regarding the relationship between physical activity and health-related quality of life.

Conclusions: The findings of this study demonstrate the importance of physical activity in influencing the HRQoL of adults with visual impairments. This study supports the need for additional intervention research to promote physical activity for those with visual impairments.

• Implications for Rehabilitations

• Adults with visual impairments tend to report lower health-related quality of life than peers without visual impairments.

• Regular participation in leisure-time physical activity, and restricted sedentary time, have been demonstrated to positively influence health-related quality of life for adults without disabilities.

• In this study, physical activity shows promise as an effective means of improving health-related quality of life for adults with visual impairments.

     

Activities and participation of children with cerebral palsy: parent perspectives

Abstract

Purpose: To explore parents’ views of the activities and participation of children with cerebral palsy (CP) with a range of communicative abilities and the factors (personal and environmental) that influenced these. Methods: Thirteen parents of children with CP aged 4—9 years participated in semi—structured individual interviews. Interviews were recorded, transcribed and analysed thematically. Identified codes and themes were mapped to the domains of the International Classification of Functioning, Disability and Health — Children and Youth Version (ICF-CY). Results: Parents’ responses reflected all ICF-CY domains comprising activity, participation and environmental factors. Codes were primarily mapped to the domains learning and applying knowledge, communication, mobility and interpersonal interactions and relationships. Key barriers identified included aspects of parents’ own interactions with their child (e.g. not offering choices), unfamiliar people and settings, negative attitudes of others and children’s frustration. Facilitators included support received from the child’s family and school, being amongst children, having a familiar routine and the child’s positive disposition. Conclusions: Despite the barriers experienced, children participated in a range of activities. Parents placed importance on communication and its influence on children’s independence, behaviour and relationships. Barriers and facilitators identified highlight aspects of the environment that could be modified through intervention to enhance communication and participation.

• Implications for Rehabilitation

• Children’s activities and participation were largely related to early learning tasks (e.g. literacy), communication, mobility and interactions.

• Intervention aimed at improving activities and participation may address the various child, impairment, social and environment factors identified here as impacting on activities and participation (e.g. the child’s personal characteristics, communication and physical impairments, the support and attitudes of others and the familiarity of the environment).

• Therapists will need to consider (and manage) the potential negative impact communication deficits may have on children’s behaviour, independence and social skills which may in turn detrimentally impact on activity and participation.

     

Integrative rehabilitation of residents chronic post-stroke in skilled nursing facilities: the design and evaluation of the BrightArm Duo

Purpose: To describe the novel BrightArm Duo bimanual upper extremity (UE) rehabilitation system; to determine its technology acceptance and clinical benefit for older hemiplegic participants. Methods: The system table tilted to adjust arm gravity loading. Participants wore arm supports that sensed grasp strength and wrist position on the table. Wrist weights further increased shoulder exertion. Games were designed to improve UE strength, motor function, cognition and emotive state and adapted automatically to each participant. The system underwent feasibility trials spanning 8 weeks in two skilled nursing facilities (SNFs). Participants were evaluated pre-therapy and post-therapy using standardized clinical measures. Computerized measures of supported arm reach, table tilt and number of arm repetitions were stored on a remote server. Outcomes: Seven participants had significant improvements in their active range of shoulder movement, supported arm reach, shoulder strength, grasp strength and their ability to focus. The group demonstrated higher arm function measured with FMA (p?=?0.01) and CAHAI (p?=?0.05), and had an improvement in depression (Becks Depression Inventory, II). BrightArm Duo technology was well accepted by participants with a rating of 4.4 out of 5 points. Conclusions: Given these findings, it will be beneficial to evaluate the BrightArm Duo application in SNF maintenance programs.

• Implications for Rehabilitation

• Integrative rehabilitation that addresses both physical and cognitive domains is promising for post-stroke maintenance in skilled nursing facilities.

• Simultaneous bilateral arm exercise may improve arm function in older hemiplegic patients several years after stroke.

• Virtual reality games that adapt to the patient can increase attention and working memory while decreasing depression in elderly.

     

A multidimensional model of optimal participation of children with physical disabilities

Abstract

Purpose: To present a conceptual model of optimal participation in recreational and leisure activities for children with physical disabilities. Methods: The conceptualization of the model was based on review of contemporary theories and frameworks, empirical research and the authors’ practice knowledge. A case scenario is used to illustrate application to practice. Results: The model proposes that optimal participation in recreational and leisure activities involves the dynamic interaction of multiple dimensions and determinants of participation. The three dimensions of participation are physical, social and self-engagement. Determinants of participation encompass attributes of the child, family and environment. Experiences of optimal participation are hypothesized to result in long-term benefits including better quality of life, a healthier lifestyle and emotional and psychosocial well-being. Conclusion: Consideration of relevant child, family and environment determinants of dimensions of optimal participation should assist children, families and health care professionals to identify meaningful goals and outcomes and guide the selection and implementation of innovative therapy approaches and methods of service delivery.

• Implications for Rehabilitation

• Optimal participation is proposed to involve the dynamic interaction of physical, social and self-engagement and attributes of the child, family and environment.

• The model emphasizes the importance of self-perceptions and participation experiences of children with physical disabilities.

• Optimal participation may have a positive influence on quality of life, a healthy lifestyle and emotional and psychosocial well-being.

• Knowledge of child, family, and environment determinants of physical, social and self-engagement should assist children, families and professionals in identifying meaningful goals and guiding innovative therapy approaches.

     

Effects of environmental modification on activities of daily living,social participation and quality of life in the older adults: a meta-analysis of randomized controlled trials

Abstract

Purpose: This study aims to provide evidence of the benefits and effects of environmental modification intervention on activities of daily living, quality of life and social participation in older adults.

Methods: This study searched and used randomized controlled trial research studies from the databases of MEDLINE, CINAHL and the Cochrane Library. A systematic review and meta-analysis were conducted using the Jadad scale, risk of bias and the patient, intervention, comparison, outcome (PICO) process. The domains of impact considered in this meta-analysis were activities of daily living, quality of life and social participation. The analysis was completed with the Review Manager software 5.3.

Results: Jadad scores of collected studies were 3–4 in seven studies and 2 in one study, which means that most studies had high levels of quality. This study comprised of 733 subjects in the experimental group and 672 subjects in the control group. The effect size of environmental interventions on basic activities of daily living, instrumental activities of daily living and overall activities of daily living were 0.37, 0.65 and 0.47, respectively. Meanwhile, the environmental intervention was neither effective on quality of life nor social participation.

Conclusions: Environmental modifications are effective in facilitating the daily life activities of older adults. This kind of intervention is shown to be useful for enhancing life performance. In order to confirm intervention effects on the quality of life and social participation of older adults, studies should conduct environmental modifications interventions that take into account contexts such as individual characteristics, lifestyle and physical activities.

• Implications for rehabilitation

• Environmental modifications are effective in improving older adults’ performance of daily activities (ADL).

• Appropriate environmental modification interventions should be considered before the quality of life (QoL) and levels of social participation of older adults decline.

     

An exploratory analysis of the self-reported goals of individuals with chronic upper-extremity paresis following stroke

Purpose: To classify the self-identified goals of individuals post-stroke with chronic upper extremity (UE) paresis, and determine if age, UE functional capacity and pre-stroke hand dominance influence overall goal selection. Method: Sixty-five subjects participated. Using the Canadian Occupational Performance Measure (COPM) to establish treatment goals, the top five goals were categorized using the Occupational Therapy Practice Framework into five categories: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure, work and general UE movement. A Chi-square analysis determined if age, UE functional capacity (measured by the Action Research Arm Test) and UE hand dominance influenced individual goal selection. Results: The majority of goals were in the ADL (37%) and IADL (40%) categories. A small percentage (12%) was related to general UE movement. Individuals with moderate UE functional capacity identified more ADL goals than those with higher UE functional capacity. There was not a difference between age and UE dominance across all five goal areas. Conclusions: Individuals with chronic UE paresis had specific goals that were not influenced by age or hand dominance, but partially influenced by severity. General UE movement goals were identified less than goals related to specific activities.

• Implications for Rehabilitation

• Considering the specificity of individual goals following stroke, it is recommended that clinicians regularly utilize a goal setting tool to help establish client goals.

• It is recommended that clinicians further inquire about general goals in order to link upper extremity deficits to functional activity limitations.

• Age, upper extremity functional capacity and hand dominance have little influence on the rehabilitation goals for individuals with chronic paresis after stroke.

     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

Barriers and facilitators of sports in children with physical disabilities: a mixed-method study

Abstract

Purpose: This study explored barriers and facilitators of sports participation of children with physical disabilities from the perspective of the children, their parents and their health professionals. Method: Thirty children and 38 parents completed a questionnaire, and 17 professionals were interviewed in a semi-structured way. Data from the three groups were combined in a mixed-method design, after which the results were triangulated. Results: Mean age (SD) of the children was 14.1 (2.9) years old, 58% were boys. Sixty-seven percent of the children had cerebral palsy and 77% participated in sports after school. Most commonly practiced sports were swimming, cycling and football. Children specifically experienced dependency on others as a barrier, parents did not have enough information about sports facilities, and professionals observed that the family’s attitude had influence on the child’s sports participation. Facilitators were health benefits, fun and social contacts. Conclusion: Sports participation of children with physical disabilities is a complex phenomenon because children, their parents and professionals reported different barriers. Sports participation is more physically challenging for children with severe physical disabilities, as their daily activities already require much energy. However, the psychosocial benefits of sports are applicable to all children with physical disabilities.

• Implication for Rehabilitation

• Perceived barriers seemed to differ for children, parents and health professionals, suggesting that sports participation is a complex phenomenon.

• Sports might be more physically challenging for children with severe physical disabilities, as their daily activities already take much energy.

• The psychosocial benefits of sports should be emphasized by rehabilitation professionals when advising children with physical disabilities about sports.