Complexities during transitions to adulthood for youth with disabilities: person–environment interactions

Abstract

Purpose: The purpose of this qualitative study was to explore the experiences of youth with different disabilities from across Canada during their transitions from adolescence to adulthood. Methods: Qualitative methods, using a phenomenological tradition, explored the meaning of the lived experiences of youth with disabilities in transition to adulthood. Purposeful sampling was used to select people with a range of experiences, background, location and demographic characteristics. Individual interviews with key informants and a focus group with an “expert panel” of participants were the methods of data collection. Data analysis was iterative and followed established practices of phenomenology. Results: Over 50 people, including youth with different disabilities, parents/caregivers and service providers from different organizations and systems across Canada participated in individual and/or focus group interviews. An overarching theme of “complexities” emerged from the data analysis. Complexities were related to the interactions between person and environment during transition experiences. Six subthemes about complexities were explored in depth to describe the primary person–environment interactions that were identified by study participants. Conclusions: The complexities involved in the interactions between person and environment during transitions to adulthood appear to be similar for youth with different types of disabilities. Recommendations are provided to address these complexities using holistic and collaborative approaches in service delivery and future research.

• Implications for Rehabilitation

• The complexities involved in transitions to adulthood appear to be similar for youth with different types of disabilities.

• Rehabilitation service providers can address these complexities using holistic, strengths-based and collaborative approaches.

• Service providers and researchers in rehabilitation need to acknowledge the interactions between person and environment rather than addressing each component separately.

• Future research should include youth, families and community members on research teams to ensure that complexities are adequately addressed.

     

Quality of life of patients with Duchenne muscular dystrophy: from adolescence to young men

Purpose: This study investigated quality of life (QOL) in adolescent and young men with Duchenne muscular dystrophy (DMD).

Methods: Health-related QOL and global QOL were assessed with the Short Form 36 (SF-36) and World Health Organization Quality of Life-BREF (WHOQOL-BREF). Associations between functional status and QOL were assessed.

Results: All domains of the SF-36 were below Taiwan norms (effect size: ?14.2 to ?0.5), especially Physical Function, Role Physical, and Social Function. Three of the four domains of the WHOQOL-BREF were below Taiwan norms (effect size: ?2.0 to ?0.7). The Physical Function of the SF-36 was moderately correlated with functional status (mobility, basic activities of daily living, and arm function). The Social Function of the SF-36 and Social Relationships of the WHOQOL-BREF were also moderately correlated with functional status (impairment, basic activities of daily living, and arm function).

Conclusion: The adolescent and young men with DMD had poor health-related and global QOL. Poor QOL was related to both physical condition and social health. We suggest that rehabilitation programs focus on using assistive devices to facilitate arm function and encouraging participation in social activities to improve the QOL of patients with DMD.

• Implications for rehabilitation

• Duchenne muscular dystrophy (DMD) is a progressive muscle weakness disease that not only impacts physical health but also leads to poor quality of life in many domains.

• A valuable rehabilitation goal for patients with DMD is to encourage participation in social activities. Medical care and educational programs should plan a formal transition processes for patients with DMD from pediatric to adult care to maximum their quality of life.

• Arm function is associated with many domains of global quality of life, so a key element in improving quality of life may be to improve arm function.

     

Perspectives of school-work transitions among youth with spina bifida,their parents and health care providers

Purpose Youth with disabilities encounter many challenges in finding employment and transitioning to post-secondary education. In this article, we explore the nature of school-work transitions for youth with spina bifida, which few studies have previously addressed. Method We conducted in-depth interviews with 44 participants (nine youth and 12 young adults with spina bifida, 11 parents and 12 clinicians). We analyzed our data using a qualitative content analysis approach. Results We identified several enablers to school-work transitions, including professional support, social support and school accommodations. Lacking such support created several challenges for youth with spina bifida. We also identified several barriers to school-work transitions, including lack of education and information on finances, housing and transportation; discrimination and stigma; and challenges coping with spina bifida at school and work. Conclusions Although some supports are available, youth with spina bifida encounter many challenges in transitioning to post-secondary education and employment. With clinicians at the helm, efforts should be put in place within the health and social services system to better prepare youth, as they transition to adulthood, to become connected to appropriate information and resources to help them to succeed in their school and employment goals.

• Implications for Rehabilitation

• Youth with spina bifida encounter many challenges in transitioning to post-secondary education or work. Clinicians, educators and parents should continue to support youth with spina bifida in choosing their vocations, setting career goals and developing career plans.

• Starting from a young age, parents, clinicians and educators should help youth with spina bifida prepare for school work transitions by fostering their independence, life skills and self-management of spina bifida-related symptoms.

• Clinicians and educators should help connect youth with spina bifida to appropriate information and resources to support their school-work transitions, including information on finances, housing, transportation, school accommodations and employment supports.

     

Disclosure,accommodations and self-care at work among adolescents with disabilities

Abstract

Purpose: The purpose of this study is to explore whether adolescents with disabilities disclose their condition and what types of accommodations are requested at work. Method: In-depth, qualitative semi-structured interviews were conducted with 18 adolescents with a physical and/or mobility-related disability. We also reviewed their self- and staff assessments completed throughout an employment training program in which they took part. Results: The findings show that most youth were able to disclose their conditions and recognize some of their limitations in performing tasks at work. Youth requested physical accommodations, more time to complete tasks and cognitive accommodations. Youth also performed several self-care tasks to manage their disability at work including personal care, pain management and fatigue. Conclusions: Within the context of this employment training program, youth were able to disclose their condition to their employer, ask for accommodations and manage their disability in the workplace.

• Implications for Rehabilitation

• Educators and clinicians should:

• Assist youth in understanding whether, when and how to disclose their disability to their potential employer.

• Help youth to understand what accommodations are available to them in the workplace and how to access them, to help them to perform their job effectively.

• Coach youth on how to manage their disability in a work context, especially with regard to personal care, pain management and fatigue.

• Encourage and facilitate participation in experience-based opportunities to practice disclosure, requesting accommodations and self-management.

     

Both youth and long-term vitamin D status is associated with risk of type 2 diabetes mellitus in adulthood: a cohort study

Objectives: To determine whether vitamin D status in childhood and adolescence (herein collectively referred to as youth) and the long-term status from youth to adulthood is associated with risk of developing type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) in adulthood.

Materials and methods: This was a 31-year follow-up study of 2300 participants aged 3–18 years. Multinomial logistic regression was used to assess the association of both (a) baseline 25-hydroxyvitamin D (25OHD) levels and (b) the mean of baseline and the latest follow-up 25OHD levels (continuous variable and quartiles) with incident T2DM and IFG (cut-off?=?5.6?mmol/L) in adult life.

Results: High serum 25OHD levels in youth and also mean values from youth to adulthood were associated with reduced risk of developing T2DM in adulthood (odds ratio, 95% confidence interval=?0.73, 0.57–0.95 and 0.65, 0.51–0.84, respectively, for each SD increment in 25OHD). Compared to Q1, a dose-dependent negative association was observed across other quartiles of youth 25OHD, while the strongest association was found in the Q3 for the mean 25OHD levels. Neither youth nor the mean 25OHD was associated with IFG.

Conclusions: High serum 25OHD levels in youth, and from child to adult life, were associated with a reduced risk of developing T2DM in adulthood.

• Key Messages

• High serum 25OHD levels in youth, and between youth and adulthood, were associated with a lower risk of T2DM in adulthood.

• Each SD (15.2?nmol/L) increment in youth serum 25OHD levels was associated with a 26% reduction in odds for T2DM, which was independent of a number of confounding variables and other risk factors for T2DM. A similar magnitude of association was observed for the long-term 25OHD levels between youth and adulthood.

• These findings suggest a potentially simple and cost-effective strategy for reducing adulthood risk of T2DM starting in an earlier stage of life – improving and maintaining vitamin D status throughout youth and early adulthood.

     

A systematic review of mentorship programs to facilitate transition to post-secondary education and employment for youth and young adults with disabilities

Purpose: Youth with disabilities experience barriers in transitioning to Post-Secondary Education (PSE) and employment. Mentorship programs provide a promising approach to supporting youth through those transitions. This paper aims to identify the effective components of mentorship programs and describe participants’ experiences. Method: We undertook a systematic review of mentorship interventions for youth and young adults with disabilities. We searched seven electronic databases for peer-reviewed articles published in English between 1980 and 2014. We included articles that examined mentorship interventions focused on PSE or employment outcomes among youth, aged thirty or younger, with physical, developmental, or cognitive disabilities. Results: Of the 5068 articles identified, 22 met the inclusion criteria. For seven mentorship interventions, at least one significant improvement was reported in school- or work-related outcomes. Mentorship programs with significant outcomes were often structured, delivered in group-based or mixed formats, and longer in duration (>6 months). Mentors acted as role models, offered advice, and provided mentees with social and emotional support. Conclusions: Evidence suggests that mentorship programs may be effective for helping youth with disabilities transition to PSE or employment. More rigorously designed studies are needed to document the impact of mentorship programs on school and vocational outcomes for youth with disabilities.

• Implications for Rehabilitation

• Mentorship interventions have the potential to effectively support youth with disabilities as they transition to post-secondary education and employment.

• Youth should consider participating in formal mentorship interventions, and clinicians and educators should encourage them to do so, to enhance social, educational, and vocational outcomes.

• When developing interventions, clinicians should consider incorporating the effective components (i.e. duration, content, format) of mentorship interventions identified in this paper. Future mentorship programs should also contain a rigorous evaluation component.

• Clinicians can help to create (build content, consult on accessibility), connect (youth to program, program to community agencies), and contribute to mentorship interventions.

     

Conceptualizing participation in context for children and youth with disabilities: an activity setting perspective

Abstract

This article considers the conceptualization, operationalization and implications of “activity settings” for research on the recreation and leisure participation of children and youth with disabilities. Activity settings are contextualized settings that situate child and youth activities and their participation experiences. We discuss activity settings as an important construct for considering environmental qualities that provide opportunities for beneficial participation experiences for children and youth with disabilities. The article considers existing research using the concept of activity settings, the conceptualization of environment and contemporary issues in the measurement of participation and environment, indicating how these are addressed by an activity settings approach. We then describe the development of two quantitative measures of recreation and leisure activity settings – one assessing environmental qualities and the other assessing youth experiences – that have the potential to inform researchers, managers and clinicians about relationships between environmental qualities and participation experiences. Finally, we consider the implications of an activity settings approach for research, theory building and clinical practice.

• Implications for Rehabilitation

• An activity setting perspective can enhance understanding of the recreation and leisure participation of children and youth with disabilities.

• The Measure of Environmental Qualities of Activity Settings (MEQAS) and Self-reported Experiences of Activity Settings (SEAS) provide unique assessments of environmental qualities and experiences from an activity setting perspective.

• Clinicians might use the SEAS alone to understand particular youth experiences in certain types of settings, which may be limiting or facilitating development.

• The combined use of the SEAS and MEQAS can provide experiential profiles linked to activity setting qualities such as structure, type of activity and social partners, providing a valuable source of information about youth programs.

     

Incontinentia pigmenti: a rare pathology with complex rehabilitative aspects

Abstract

Purpose: Incontinentia pigmenti (IP), or Bloch-Sulzberger syndrome, is a rare X-linked dominant genetic disorder with multisystem involvement. To our knowledge, there are no previous reports about rehabilitation in IP adult with intact cognitive development. We report a 20-year-old lady with IP managed and followed into adulthood. Method: Patient management and rehabilitation programs from birth to the last follow-up. Results: There was normal cognitive development despite magnetic resonance imaging (MRI) evidence of white matter, corpus callosum and brainstem hypoplasia. Extensor spasticity was present on both lower limbs for which she underwent rehabilitation from the age of one. Botulinum toxin injections were performed and when she was 15 years old she underwent functional surgery. Conclusion: The absence of mental retardation in our patient enabled us to carry out an active rehabilitation program and provide her with maximum independence in locomotion and in activities of daily living.

• Implications for Rehabiliation

• Incontinentia pigmenti (Bloch-Sulzberger syndrome).

• Incontinentia pigmenti is a rare X-linked dominant genetic disorder with multisystemic involvement.

• Skin lesions, neurological impairments, motormental retardation, skeletal congenital defects and ophthalmologic involvement are IP most frequent manifestations.

• Due to the complex multisystem involvement resulting in severe long-term disability, patients with IP require a multidisciplinary team approach for rehabilitation.

• In IP patients, rehabilitation interventions should always take into consideration the individual phenotype expression, child’s physical development and personal needs.

     

Exploring employment readiness through mock job interview and workplace role-play exercises: comparing youth with physical disabilities to their typically developing peers

Abstract

Purpose: To assess performance differences in a mock job interview and workplace role-play exercise for youth with disabilities compared to their typically developing peers. Methods: We evaluated a purposive sample of 31 youth (15 with a physical disability and 16 typically developing) on their performance (content and delivery) in employment readiness role-play exercises. Results: Our findings show significant differences between youth with disabilities compared to typically developing peers in several areas of the mock interview content (i.e. responses to the questions: “tell me about yourself”, “how would you provide feedback to someone not doing their share” and a problem-solving scenario question) and delivery (i.e. voice clarity and mean latency). We found no significant differences in the workplace role-play performances of youth with and without disabilities. Conclusions: Youth with physical disabilities performed poorer in some areas of a job interview compared to their typically developing peers. They could benefit from further targeted employment readiness training.

• Implications for Rehabilitation

• Clinicians should:

• Coach youth with physical disability on how to “sell” their abilities to potential employers and encourage youth to get involved in volunteer activities and employment readiness training programs.

• Consider using mock job interviews and other employment role-play exercises as assessment and training tools for youth with physical disabilities.

• Involve speech pathologists in the development of employment readiness programs that address voice clarity as a potential delivery issue.

     

Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth

Abstract

Purpose: To explore how women experience living with long-term pregnancy-related pelvic girdle pain.

Materials and methods: Nine women with persistent pregnancy-related pelvic girdle pain of 2–13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28–42 years of age and had given birth to 2–3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis.

Results: The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance.

Conclusion: The participants’ narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

• IMPLICATIONS FOR REHABILITATION

• Chronic pregnancy-related pelvic girdle pain

• ??Pregnancy-related pelvic girdle pain impairs women’s capacity to perform meaningful activities of daily life for many years after pregnancy.

• ??The participants’ narratives highlighted that the pain interfered with their sense of identity.

• ??It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

     

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.

     

Pedestrian navigation and public transit training interventions for youth with disabilities: a systematic review

Abstract

Purpose: Being able to travel independently, whether as a pedestrian or by taking public transportation, is a critical element to maintaining quality of life and participation in the community. The objective of this systematic review is to understand the best practices and effective components of pedestrian and public transit training interventions for youth with disabilities.

Method: Systematic searches of seven international databases identified 29 studies meeting our inclusion criteria. We analyzed these studies based on participant characteristics, methods, results, and quality of evidence.

Results: Among the 29 studies, 857 participants (aged 5–39, mean 18.3 years) were represented across 10 countries. Although the intervention outcomes varied across the studies, 24 of them reported an improvement in at least one of the following: pedestrian and general navigation skills, pedestrian safety, landmark recognition, route knowledge, and public transportation skills.

Conclusions: Our findings highlight that pedestrian and public transit interventions have the potential to improve the participation and quality of life of children and youth with disabilities. More rigorous, theoretically informed interventions, using standardized measures are needed to enhance pedestrian and transit training skills among youth with disabilities.

• Implications for rehabilitation

• Travel training interventions have the potential to effectively support youth with disabilities in learning pedestrian and public transportation navigation skills.

• Clinicians and educators should encourage youth with disabilities to participate in travel training programs enhance their independence skills and participation in the community.

• Clinicians, educators, and program managers can help to build relevant content for travel training programs and connect youth to programs.

     

Rehabilitation of activities of daily living in virtual environments with intuitive user interface and force feedback

Purpose: To investigate the feasibility of using a virtual rehabilitation system with intuitive user interface and force feedback to improve the skills in activities of daily living (ADL).

Method: A virtual training system equipped with haptic devices was developed for the rehabilitation of three ADL tasks – door unlocking, water pouring and meat cutting. Twenty subjects with upper limb disabilities, supervised by two occupational therapists, received a four-session training using the system. The task completion time and the amount of water poured into a virtual glass were recorded. The performance of the three tasks in reality was assessed before and after the virtual training. Feedback of the participants was collected with questionnaires after the study.

Results: The completion time of the virtual tasks decreased during the training (p?<?0.01) while the percentage of water successfully poured increased (p?=?0.051). The score of the Borg scale of perceived exertion was 1.05 (SD?=?1.85; 95% CI?= 0.18–1.92) and that of the task specific feedback questionnaire was 31 (SD?= 4.85; 95% CI?= 28.66–33.34). The feedback of the therapists suggested a positive rehabilitation effect. The participants had positive perception towards the system.

Conclusions: The system can potentially be used as a tool to complement conventional rehabilitation approaches of ADL.

• Implications for rehabilitation

• Rehabilitation of activities of daily living can be facilitated using computer-assisted approaches.

• The existing approaches focus on cognitive training rather than the manual skills.

• A virtual training system with intuitive user interface and force feedback was designed to improve the learning of the manual skills.

• The study shows that system could be used as a training tool to complement conventional rehabilitation approaches.

     

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists’ practice of stroke rehabilitation. Method The frame of reference is Fairclough’s critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012–2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient’s independence than to enabling the regaining of meaningful activities and participation.

• Implications for Rehabilitation

• Individualized rehabilitation must be organized with flexibility as it is a complex process

• Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality

• A broader range of stake holders, including patient organizations, are in demand within health policy making

• The discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient

     

“This is my way”: reimagining disability,in/dependence and interconnectedness of persons and assistive technologies

Purpose: Postmodernism provides a radical alternative to the dominant discourses of Western societies that emphasize autonomy and independence. It suggests a reimagining of the relationship between the self and the body and the increasingly blurred boundaries between biology and machine. The purpose of this article is to explore in/dependence through a discussion of interconnectedness of persons and assistive technologies. Key messages: Drawing on postmodern theories, we discuss the interconnections inherent in disability experiences through the case example of Mimi, an adolescent girl with severe physical disabilities. We consider how Mimi, her assistive technologies and her parents can be viewed as assemblages of bodies/technologies/subjectivities that together achieve a set of practices. An examination of these various couplings suggests different understandings of disability that open up possibilities for multiple connections and reimagines dependencies as connectivities. Conclusions: Connectivity can be embraced to explore multiple ways of being-in-the-world for all persons and problematizes the goals of independence inherent in rehabilitation practices.

Implications for Rehabilitation

• “Dependency” has a negative social connotation that is challenged by postmodern ideas of dynamic connectivity.

• Connectivity offers an alternative lens for conceptualizing relationships between disabled people, their technologies and caregivers.

• Connectivity suggests a rethinking the goals of independence inherent in rehabilitation practices.

     

Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision

Abstract

Purpose: To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. Methods: Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n?=?299?262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. Results: Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. Conclusions: Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population.

• Implications for Rehabilitation

• For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community.

• Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it.

• This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis.

• Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.

     

Skill development in an employment-training program for adolescents with disabilities

Purpose: Relatively little is known about the first employment experiences and skill development of youth with disabilities. The purpose of this study is to explore the skills gained by adolescents with disabilities who have completed an employment-training program. Methods: In-depth, qualitative semi-structured interviews were conducted with 18 adolescents with a physical and/or mobility-related disability. The youth and their parents also completed a brief questionnaire about their experience in the program and we reviewed their self- and staff-assessments that were completed throughout the program. Results: The findings highlight how adolescents with disabilities developed several practical, social and communication skills, and self-confidence over the course of an employment-training program. Despite personal gains, youth reported challenges in their post-program search for employment. Conclusions: Youth valued involvement in the workforce and perceived that through their participation they developed important life skills.

Implications for Rehabilitation

• Educators and health care providers should be awar that teens with disabilities as young as 15 years old are thinking about their future and looking for employment experience.

• Educators and clinicians can assist youth and their families by talking about the benefits of involvement in volunteering and providing practical suggestions for how to get involved, including discussing the strengths and areas for skill development.

• At a community level, advocacy can raise awareness of the importance of early work experience and the potential contributions of youth with disabilities. Advocacy should target community employers, but also increased government funding for employmenttraining programs and employment transition supports for this age group.

     

Applying an ecological framework to understand transition pathways to post-secondary education for youth with physical disabilities

Purpose: The purpose of this study was to explore the experiences of youth with physical disabilities and clinicians who support them in their transition to post-secondary education (PSE). Most research on transition to PSE has focused on youth with intellectual disabilities while there is a lack of research on youth with physical disabilities.

Methods: This study drew on 30 interviews with 20 youth with disabilities and 10 clinicians. We used Bronfrenbrenner’s ecological framework to inform our analysis.

Results: Our results showed that there are several important individual skills that youth need to be successful in transitioning to PSE. Youth with disabilities experienced supports from peers and family that influence their transition to PSE. Several disability-specific issues (e.g., coping, self-care, disclosure, and accommodations) were often a barrier to transitioning to PSE. Clinicians and youth both reported that improved inter-professional collaboration and inter-agency partnerships were needed to enhance the transition experience. Societal attitudes (stigma and discrimination), policies, and the timing of transitions also influence youth’s transition.

Conclusion: Applying an ecological approach helped to provide a more holistic perspective of the PSE transitions and emphasizes the need to consider more than just preparing individuals but also where they are transitioned.

• Implications for rehabilitation

• Clinicians and educators should continue to promote the development of relevant life skills (e.g., self-advocacy, disclosure, and navigating public transportation) that youth need to succeed in post-secondary education.

• Clinicians should continue to educate and support youth regarding the process for disclosing their condition and how to request and set up accommodations in PSE.

• Clinicians should connect youth with disabilities to appropriate resources that can support them and continue to help them to set career goals and develop career plans.

• There is a critical need for improved inter-professional collaboration among clinicians providing transition services and inter-agency partnerships among high schools, disability organizations, and PSEs to enhance transition experiences for youth with disabilities.

     

A systematic review of post-secondary transition interventions for youth with disabilities

Abstract

Purpose: Youth with disabilities have lower rates of enrollment and completion of post-secondary education compared with youth without disabilities. The objective of this systematic review is to understand the best practices and components of post-secondary transition programs for youth with disabilities.

Method: Systematic searches of six international databases identified 18 studies meeting our inclusion criteria (youth with a disability, aged 15–30; focusing on post-secondary education program or intervention, published from 1997 to 2017). These studies were analyzed with respect to the characteristics of the participants, methodology, results, and quality of the evidence.

Results: Among the 18 studies, 2385 participants (aged 13–28, mean 17.7?years) were represented across three countries (US, Canada, and Australia). Although the outcomes of the post-secondary transition programs varied across the studies, all of them reported an improvement in at least one of the following: college enrollment, self-determination, self-confidence, social and vocational self-efficacy, autonomy, social support, career exploration, and transition skills. The post-secondary transition programs varied in duration, length, number of sessions, and delivery format which included curriculum-based, online, immersive residential experience, mentoring, simulation, self-directed, technology-based, and multi-component.

Conclusions: Our findings highlight that post-secondary transition programs have the potential to improve self-determination, transition skills, and post-secondary outcomes among youth with disabilities.

• Implications for rehabilitation

• Post-secondary education interventions have a beneficial influence on post-secondary and related transition outcomes in youth with disabilities.

• Clinicians and educators should consider having multiple components, involving several sessions that include a curriculum, immersive college residential experience, mentoring, and/or simulations in their interventions for optimum program outcomes.

• More research is needed to explore the types of interventions that work best for whom and the optimal age (including exploring the socio-demographic characteristics), setting, and delivery format.

     

Challenges of user-centred assistive technology provision in Australia: shopping without a prescription

Purpose: People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision. Methods: User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia. Results: There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices. Conclusions: Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision.

• Implications for Rehabilitation

• Variations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers.

• An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services.

• Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice.