A kinematic and electromyographic study of grip in extension in a clinical setting

Aim: Grip, including grip in extension, is an essential element in human beings. The functional evaluation scales of the hand require a greater number of objective variables in order to offer an overall perspective. Devices such as surface electromyography and inertial sensors can be used in evaluation and tasks. Such equipment can lead to new variables for analysis and offer different approaches for treatment. Methods: Six participants were selected randomly from a sample of healthy population. Each participant made the grip in extension, which was parameterized in real time. This movement was analyzed and recorded in a synchronized manner with surface electromyography and accelerometer-type inertial sensors in the hand. Results: After analyzing and processing the data, it was possible to detect five phases within the movement thanks to in-depth analysis of the module vector of the index finger along with electromyography of the musculature of the first dorsal interosseous. Conclusions: Parameterization is possible in real time for the grip in extension based on surface electromyography and accelerometer, offering new analysis variables on hand operation while providing a suitable complement to standardized assessments.

• Implications for Rehabilitation

• The use of surface electromyography and accelerometry in the arm synchronously, allows clinicians to identify new intervention and treatment variables.

• The protocol developed can be used in clinical practice because it is non-invasive, the enabled devices do not cause damage on the subject.

• According to the results, the muscles of the hypothenar region and the first dorsal interosseous have greater activation in the hand during grip extension.

• The wrist extensor muscles and flexor carpi ulnaris have more activation during the approach phase to grip. These are the muscles that should be prioritized for rehabilitation.

• The variation of the acceleration allows you to differentiate between the phases of rest and movement of the hand. If the variation of the acceleration at rest is higher than 0.3g, this could indicate the presence of abnormal movements or tremor.

     

Evaluation of hand orthoses in Duchenne muscular dystrophy

Abstract

Purpose: The purpose of this study was to evaluate whether treatment of boys with Duchenne muscular dystrophy using hand orthoses could benefit joint mobility, grip strength, or fine motor function.

Method: Eight boys with Duchenne muscular dystrophy were provided with individually customised rest orthoses. The results were analysed using single-subject design. The study included a baseline and an intervention phase. A follow-up examination was also performed.

Results: Boys with less than 50° passive wrist extension mobility were included. Wrist extension of the dominant hand increased in four and was maintained in four. Wrist extension in the non-dominant hand increased in five, was maintained in two and decreased in one. Thumb abduction in the dominant hand increased in six and two remained stable. In the non-dominant hand five increased and three remained stable. Grip strength and fine motor function showed also positive results.

Conclusions: This study indicates that the use of hand orthoses in Duchenne muscular dystrophy can delay development of contractures and improve passive wrist extension and thumb abduction. Hand orthoses can therefore be recommended for boys who start to develop contractures in the long finger flexors. Due to small sample size further studies are needed to confirm this result.

• Implications for rehabilitation

• Evaluation of hand orthoses in Duchenne muscular dystrophy.

• Preserved hand function is of uttermost importance for performance of activities in the late stages of Duchenne muscular dystrophy.

• Contractures of long finger flexors affect hand function and limit performance of daily activities.

• Hand orthoses can delay development of contractures and preserve hand function and give prerequisites for independence.

• The occupational therapists should measure wrist joint mobility regularly to be able to find the right time for intervention with hand orthoses in this progressive disorder.

     

The applicability of four clinical methods to evaluate arm and hand function in all stages of spinal muscular atrophy type II

Abstract

Aim: To evaluate the ability of four clinical methods to reflect arm and hand function at impairment and activity level and to determine their ability to discriminate among SMA II patients of all ages and in all stages of the disease. Methods: Fifty-two patients with SMA II (age range: 8–73 years) were assessed by means of the Egen Klassifikation 2 (EK2 scale), the Motor Function Measure Scale (MFM D3), the Manual Muscle Test (MMT) and Hand-Held Dynamometry (HHD) in full fist grip and lateral pinch grip. Patients were classified into six levels of upper limb function by means of the Brooke Upper Limb Scale, and the four methods’ ability to differentiate among patients within these levels was calculated. Modified versions of the EK2 scale (EK Upper Limb) and the MFM D3 (MFM D3 Upper Limb) were assessed in the same manner. Results: The patients’ physical abilities were best described by the MMT and EK2 while the “EK Upper Limb”, MFM D3 and MMT were best at discriminating among patients across the range of upper limb function. Quantitative muscle tests as measured by Citec? HHD were less applicable to weak patients; full fist grip could discriminate among patients at Brooke levels 3–5, and lateral pinch grip among the strongest patients. Conclusion: At the impairment level, MMT is the superior measure of muscle function in very weak patients in whom HHD cannot reflect capacity. At the activity level, the EK 2 represents daily activities whereas the MFM D3 measures motor functions. In differentiating among SMA II patients of all ages and in all stages of the disease, the ability of abbreviated versions of scales targeting upper limb function is superior to unabridged versions of these scales.

• Implications for Rehabilitation

• Evaluation of upper limb function in spinal muscular atrophy II

• Even very weak patients with SMA II have some residual upper limb function that is measurable if the right method is chosen.

• The Manual muscle test is applicable to all patients with SMA II and is useful to determine possible interventions – such as methods to drive a wheelchair or operate a computer.

• Abbreviated versions of the EK2 scale and the MFM are useful as methods to evaluate subtle changes in upper limb function resulting from disease progression or interventions.

     

Patients’ view on health-related aspects of functioning and disability of joint contractures: a qualitative interview study based on the International Classification of Functioning,Disability and Health (ICF)

Abstract

Purpose: The aim of this study was to identify health-relevant aspects of functioning and disability of persons aged 65 years or older with joint contractures, to link the findings to corresponding ICF categories and to describe the patients’ perspective. Methods: We conducted 43 qualitative, semi-structured, face-to-face interviews with affected persons in two different locations (Witten, Munich) and in three different settings. Data were analyzed using the “meaning condensation procedure” and then linked to ICF categories. Results: From all interviews a total of 2499 single meaning-concepts were extracted which were linked to 324 different ICF categories. The participants in all settings mainly reported problems related to “Mobility of a single joint (b710)”, “Sensation of pain (b280)” and problems related to “Walking (d450)”. Almost all participants reported “Products and technology for personal indoor and outdoor mobility and transportation (e120)” as a relevant environmental factor. Conclusions: From the patients’ perspective, joint contractures have an impact on multifaceted aspects of functioning and disability, mainly body functions, environmental factors and activities and participation. The results of this study will contribute to the development of a standard instrument for measuring functioning, disability and health-relevant aspects for patients with joint contractures.

• Implications for Rehabilitation

• Joint contractures are a major cause for the development of disability in older people.

• Patients’ perspectives and their personal experiences have to be considered when assessing the impact of joint contractures.

• The International Classification of Functioning, Disability and Health (ICF) is an appropriate framework for describing the patients’ multifaceted experience of joint contractures.

     

The Jacket Test for assessing people with chronic stroke

Purpose: (1) To examine the intra-rater, inter-rater and test–retest reliability of Jacket Test times with 28 people with chronic stroke. (2) To determine the correlation of Jacket Test time with stroke-specific impairments. (3) To construct the optimal cutoff time for the Jacket Test that best discriminated 28 people with stroke from 30 healthy older adults.

Methods: The Jacket Test completion times were measured along with the Fugl–Meyer Upper Extremity Assessment, hand grip strength, 5-times Sit-to-stand test, Berg Balance Scale and timed “up and go” test, and Community Integration Measure using the cross-sectional design.

Results: The Jacket Test completion times showed excellent intra-rater, inter-rater and test–retest reliability (Intra-class Correlation Coefficient = 0.781–1.000). The unaffected-side Jacket Test times were significantly correlated with FMA-UE score, affected hand grip strength, Berg Balance Scale score, timed “up and go” test times and Community Integration Measure score. The affected-side Jacket Test times significantly correlated with affected hand grip strength. The cutoff time of 18.33s in affected side and 18.38s for unaffected side (sensitivity 96.7%; specificity 85.7–96.4%) was used to best discriminate the subjects with stroke and healthy older adults.

Conclusion: The Jacket Test is a reliable and valid measure tool in clinic to evaluate the upper extremity function in people with chronic stroke.

• Implication for rehabilitation

• The Jacket Test completion times has excellent intra-rater, inter-rater and test–retest reliabilities in patients with chronic stroke.

• The Jacket Test completion times significantly correlated with motor functions of the upper limbs.

• The Jacket Test completion times of 18.33s in affected side and 18.38s for unaffected side (sensitivity 96.7%; specificity 85.7%-96.4%) was found to be the most representative for discriminating chronic stroke survivors and healthy older adults.

• The Jacket Test is a reliable and valid measuring tool to evaluate the upper extremity function of people with chronic stroke.

     

Long-term functional outcome of patients with longitudinal radial deficiency: cross-sectional evaluation of function,activity and participation

Purpose: To evaluate all functional aspects of patients with longitudinal radial dysplasia and to clarify the relationship between body functions on the one hand and limitations in activity and participation on the other hand. Methods: Thirty-one arms of seventeen adult patients with longitudinal radial dysplasia were analysed. Body function was assessed by measuring grip and pinch strength and active range of motion (ROM) of the hand. Activities were measured using the “Sequential Occupational Dexterity Assessment “, to measure perceived restrictions in participation the “Impact on Participation and Autonomy questionnaire” was used. Relationships between severity of dysplasia, body function, participation and activity were determined. Results: Patients with a severe type scored significantly lower in body function scores than patients with a mild form. Patients with limited active finger joint motion performed worse on activities. We found no significant differences in activity and participation between mild or severe types and found no correlation in participation scores. Conclusion: Although considerable restrictions in joint mobility and strength were revealed, little or no limitations on the activity and participation level were found. Limitations in body functions hardly influenced capacity on activity level and did not influence participation in societal roles.

Implications for Rehabilitation

• People with LRD learn to accomplish many of the everyday tasks without great difficulty and do not report a low quality of participation in major life activities.

• Professionals working in rehabilitation medicine should focus on activity and participation rather than on body structure or functions. Therapy focused solely on increasing joint motion or strength does not lead to further improvement.

• For parents it will be reassuring to know that children with severe radial deficiencies can satisfactory fulfill social roles in later life.

     

Parents’ experiences of participation in physical activities for children with cerebral palsy – protecting and pushing towards independence

Purpose: To explore how parents of children with cerebral palsy (CP) experience their child’s participation in physical activities and to identify facilitators and barriers for being physically active and reducing sedentary behaviour. Methods: Twenty-five parents of sixteen children, aged 8–11 years old with CP, with varying gross motor, cognitive and communicative functions and with different cultural backgrounds, participated in focus group or individual interviews. Content analysis was used for analysis. Results: Five subcategories addressing children’s participation in physical activity were found: “Belonging and taking space in the family”, “Important persons facilitating and hindering”, “Friends important but hard to get”, “Good for the body but challenging” and “Availability and opting out possibilities”. The subcategories built the main category “Protecting and pushing towards independence”, expressing the challenges parents experienced when their child wanted to be physically active. Conclusions: Parents desire competent persons to be available for support in participation in physical activities. They want support in finding friends for their child to be physically active with. Family culture and attitudes affect their child’s motivation for being physically active and should be taken into account when designing interventions for increased participation in physical activities and for reduced sedentary behaviour in children with disabilities.

• Implications for Rehabilitation

• Friends and competent adults facilitate participation in physical activities and reduce sedentary behaviour.

• Information on accessible and tailored physical activities is an important facilitator for participation in physical activities.

• Service planning and design of interventions may be facilitated by taking the individual family culture into account.

     

“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.

     

Strategies that facilitate participation in family activities of children and adolescents with profound intellectual and multiple disabilities: parents’ and personal assistants’ experiences

Abstract

Purpose: Participation throughout one’s life plays a significant role for development and emotional well-being. For this reason, there is a need to identify ways to facilitate participation in family activities for children and adolescents with profound intellectual and multiple disabilities (PIMD). Methods: The study design was qualitative and explorative, based on semi structured interviews with 11 parents and 9 personal assistants of children with PIMD. Results: The interviews revealed participation-facilitating strategies relating to the children’s/adolescent’s proximal environment, such as “Availability and acceptability of the activity”, “Good knowledge about the child” and a “A positive attitude of people close to the child”, as well as strategies related to the children/adolescents themselves: “Sense of belonging”, “Possible for the child/adolescent to understand”, “Opportunities to influence” and “Feeling of being needed”. Conclusions: Children and adolescents with PIMD are dependent on support obtained through their environment. The identified strategies, individually adapted through awareness and knowledge by the parents and the personal assistants, provide important evidence to assist our understanding in gaining understanding about how to improve participation in family activities of children and adolescents with PIMD.

• Implications for Rehabilitation

• Participation-facilitating strategies related to the child/adolescent and his or her proximal environments are identified to improve participation in children and adolescents with profound intellectual and multiple disabilities (PIMD).

• Examples of strategies for the child’s/adolescents’ proximal environment include “good knowledge about the child/adolescent”, and, for the child/adolescent, include creating “sense of belonging” and “opportunities to influence”.

• Identifying and making these strategies explicit may assist in enhancing the participation of children and adolescents with PIMD in family activities.

• People in the child’s/adolescent’s proximal environment need to set the scene for participation.

     

A pragmatic implementation of a 6-day physiotherapy service in a mixed inpatient rehabilitation unit

Purpose: This study determined the impact of a pragmatic 6-day physiotherapy service on length of stay, functional independence, gait and balance in people undergoing inpatient rehabilitation, compared to a 5-day service.

Method: A prospective cohort study with historical comparison was undertaken in a mixed inpatient rehabilitation unit. Intervention period participants (2011) meeting inclusion criteria were eligible for a 6-day physiotherapy service. All other participants, including the historical cohort (2010) received usual care (5-day physiotherapy). Length of stay, functional independence, gait and balance performance were measured.

Results: A total of 536 individuals participated in this study; 270 in 2011 (60% received 6-day physiotherapy) and 266 in 2010. Participants in 2011 showed a trend for reduced length of stay (1.7 days, 95%CI ?0.53 to 3.92) compared to 2010. Other measures showed no significant differences between cohorts. In 2011, those receiving 6-day physiotherapy were more dependent, but showed significantly improved functional independence and balance compared to those receiving 5-day physiotherapy (p?Conclusion: Implementing a 6-day physiotherapy service in a “real-world” rehabilitation setting demonstrated a trend towards reduced length of stay, and improved functional gains. This service could lead to cost-savings for hospitals and improved patient flow.

• Implications for Rehabilitation

• “Real-world” implementation of a 6-day physiotherapy service in rehabilitation shows a trend for reducing length of stay.

• This reduction in length of stay may lead to cost-savings for the hospital system, and improve patient flow into rehabilitation.

• Patients receiving 6-day physiotherapy made significant gains in balance and functional independence compared to patients receiving 5-day physiotherapy services in the rehabilitation setting.

     

Technology,design and dementia: an exploratory survey of developers

Purpose: Despite worldwide surges in dementia, we still know relatively little about the design of home technologies that support this population. The purpose of this study was to investigate design considerations from the perspective of developers.

Method: Participants, including technical and clinical specialists, were recruited internationally and answered web-based survey questions comprising Likert-type responses with text entry options. Developers were queried on 23 technology acceptance characteristics and 24 design practices.

Results: In all, forty developers completed the survey. Concerning “technology acceptance”, cost, learnability, self-confidence (during use) and usability were deemed very important. Concerning “design practice”, developers overwhelmingly valued user-centred design (UCD). In terms of general assistive technology (AT) models, these were largely unknown by technical specialists compared to clinical specialists.

Conclusions: Recommendations based on this study include incorporating “self-confidence” into design protocols; examining the implications of “usability” and UCD in this context; and considering empathy-based design approaches to suit a diverse user population. Moreover, clinical specialists have much to offer development teams, particularly concerning the use of conceptual AT models.

• Implications of rehabilitation

• Stipulate precise usability criteria.

• Consider “learnability” and “self-confidence” as technology adoption criteria.

• Recognize the important theoretical role that clinical specialists can fulfil concerning the use of design schemas.

• Acknowledge the diversity amongst users with dementia, potentially adopting techniques, such as designing for “extraordinary users”.

     

Experiences of using an Environmental Control System (ECS) for persons with high cervical spinal cord injury: the interplay between hassle and engagement

Abstract

Purpose: Environmental Control Systems (ECS) have many benefits; however studies of personal experience of ECS use are scarce. This qualitative study explored the insiders’ experience of using an ECS. Method: An ECS starter-pack was compiled and trialled for an eight-week period with six persons with high spinal cord injuries (SCI) living in Ireland. Semi-structured interviews were subsequently completed with each person and analysed using Interpretative Phenomenological Analysis (IPA). Findings: Two major themes emerged: “Taking back a little of what has been lost”, and “Getting used to ECS” which is the focus of the current paper. This theme captured a dynamic interplay between the experience of “hassle” and “engagement” for new users of ECS. “Hassle” resulted from technological frustrations and the challenge of breaking familiar habits, while “Engagement” resulted from feeling good, having fun and being surprised. Conclusions: The complex interweaving of hassle and engagement experienced by new ECS users reflects the clinical experience of rehabilitation providers. The importance of overcoming initial hassle needs to be understood by clinicians and users in order to maximise the potential benefit of ECS. Non-use must be considered one reasonable outcome if based on realistic ECS trials.

• Implications for Rehabilitation

• People with high cervical SCI find ECS use to be engaging, enjoyable, and fun.

• Successful engagement with ECS involves overcoming “hassle”.

• For some, ECS may be too much hassle resulting in non-use. However, it is important that non-use is not necessarily considered a failure, provided it is based on real experience and well-informed choice.

• Realistic trials need to be made available early in rehabilitation in order to facilitate the establishment of ECS use as a habit.

     

Coding of meaningful concepts in lymphedema-specific questionnaires with the ICF

Abstract

Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005–2010) were conducted. The concepts in the questionnaires were retrieved from the included studies and linked to the ICF. Results: Of the 2381 abstracts retrieved, 136 studies were included. The study population suffered from lymphedema in the upper limb (65%), in the lower limb (25%), in the midline (3%) and in combinations of these areas (7%). In total, 12 lymphedema-specific questionnaires were found (nine for the upper limb, two for the lower limb and one for lymphedema in general). A total of 301 concepts were extracted from the questionnaires, of which 271 (90%) could be linked to the ICF. There were 45 two-level ICF categories linked to concepts in ≥2 questionnaires; 13 in Body Functions, 6 in Body Structures, 16 in Activities and Participation and 10 in Environmental Factors. The most frequently measured categories were “Structure of upper extremity”, “Immunological system functions”, “Looking after one’s health”, “Sensation of pain”, “Touch functions”, “Dressing” and “Health services, systems and policies”. Conclusion: The ICF provides a valuable reference to identify concepts in questionnaires focusing on individuals with lymphedema.

• Implications for Rehabilitation

• Lymphedema is a chronic condition and the problems in physical functioning related to lymphedema can result in distress and loss of quality of life.

• ICF Core Sets for lymphedema consist of a lymphedema-specific selection of ICF categories, which makes it easier to implement the use of the ICF in medical and allied health care.

• ICF Core Sets for lymphedema can act as a framework for more unity in questionnaires concerning consequences of lymphedema.

• Part of the development process of ICF Core Sets for lymphedema is the linking of items from lymphedema-specific clinical questionnaires to ICF codes. The ICF codes most frequently used to link the items in the reviewed questionnaires were “Structure of upper extremity”, “Immunological system functions”, “Looking after one’s health”, “Sensation of pain”, “Touch functions”, “Dressing” and “Health services, systems and policies”.

     

Validity of the Wisconsin Card Sorting Test in patients with stroke

Background: The Wisconsin Card Sorting Test (WCST) is the most widely used measure for assessing executive functions in patients with stroke. However, no study has examined the ecological, discriminative and convergent validities of the WCST in patients with stroke. This study aimed to examine the above validities of the WCST in patients with stroke.

Methods: Ninety-eight patients were administered the WCST, two measures of activities of daily living and one cognitive measure. Seven indexes of the WCST were used in this study.

Results: Two WCST indexes (“total number correct” and “number of categories completed”) had moderate correlations with two measures of activities of daily living (Pearson’s r?=?0.39–0.49). The other indexes showed low or moderate correlations with two measures of activities of daily living (r?=?0.26–0.53). The results of independent t-test showed statistically significant difference between patients with and without disability for the seven WCST indexes (p?=?0.001–0.013) and nonsignificant differences between patients with different affected regions of the brain (p?>?0.05). Moderate correlations (r?=?0.35–0.54) were found among the seven WCST indexes and one cognitive measure.

Conclusions: The WCST has poor to adequate ecological validity, acceptable discriminative validity and acceptable convergent validity in patients with stroke. The two WCST indexes (“total number correct” and “number of categories completed”) are recommended for use to reflect the degree of living independence in patients with stroke.

• Implications for rehabilitation

• The Wisconsin Card Sorting Test showed poor to adequate ecological validity, acceptable discriminative validity, and acceptable convergent validity in patients with stroke.

• Two indexes of the Wisconsin Card Sorting Test (i.e., “total number correct” and “number of categories completed”) can adequately reveal the degrees of living independence in patients with stroke.

     

Independence in self-care activities in children with myelomeningocele: exploring factors based on the International Classification of Function model

Purpose: To investigate the relationship between disease factors, body functions and structures, activities, personal and environmental factors with independence in self-care activities in children with myelomeningocele (MMC), utilizing the International Classification of Function model.

Method: 113 children with MMC, aged 3–18 years were assessed during an annual MMC-clinic visit. Data on the personal and environmental factors, disease factors, hand function, mobility, visual perception, cognition, and communication were assessed in relation to the Pediatric Evaluation of Disability Inventory (PEDI) self-care domain.

Results: The mean PEDI caregiver assistance score was 22.1 (ranged between <10 and 62) well below the norms. The most significant determinant of dependence in self-care activities was the presence of hydrocephalus, a child with hydrocephalus scored a mean of 9.2 points less on the PEDI caregiver scale (p?=?0.02). By using a linear regression, the most significant factors associated with the PEDI scores among children with hydrocephalus were the age of the child, function of the non-dominant hand, ambulation, and cognitive function.

Conclusion: In children with MMC the presence of hydrocephalus appears to be more significantly associated with functional independence than the neurological level. The International Classification of Function model provides an in-depth multidisciplinary model that facilitates in investigating independence in self-care activities in children with MMC. It is important to take personal factors and various functional impairments into account when working with these children to promote independence.

• Implications for Rehabilitation

• When working with children with myelomeningocele on independence in daily living activities, it is necessary that health professionals demonstrate a holistic view of the child and his/her disability.

• Health professionals should take into account information on all factors of the International Classification of Function, in order to help the children, achieve maximal independence.

• It is important for health professionals to consider presence or lack of hydrocephalus when working with children with myelomeningocele to achieve functional gains.

• Improving upper extremity function and cognitive ability in children with myelomeningocele may help promote independence in activities of daily living.

• It is necessary for health professionals to continue to work with children with myelomeningocele on maximizing independence as they get older, for it is possible for them to achieve independence at a later age.

• While this study did not explore participation, this is an essential part of the International Classification of Function and is generally related to function. Participation allows a child to be involved in life situations, contributes to life satisfaction and prepares children for critical adult roles. It is therefore important to assess and monitor this measure. Further studies should examine associations between independence in self-care activities and participation.

     

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.

     

“I think I became a swimmer rather than just someone with a disability swimming up and down:” paralympic athletes perceptions of self and identity development

Purpose: The purpose of this study was to explore the role of swimming on Paralympic athletes’ perceptions of self and identity development.

Method: A hermeneutic phenomenological approach was taken. During semi-structured interviews, five Paralympic swimmers (aged 20–24 years) were asked questions about their swimming career, perceptions of self, integration, and impairment. Interviews were audio-recorded and transcribed verbatim.

Results: An Interpretative Phenomenological Analysis yielded three superordinate themes: (a) “One of the crowd”; none of the participants viewed themselves as disabled, nor as supercrips; these perceptions stemmed from family-, school-, and swimming-related experiences, (b) “Becoming me”; participation in swimming facilitated self- and social-acceptance, and identity development, and c) “A badge of honor”; swimming presented opportunity to present and reinforce a positive identity.

Conclusions: Swimming experiences enabled the participants to enhance personal and social identities, integrate through pro-social mechanisms, and to develop a career path following retirement from competition.

• Implications for rehabilitation

• Offering equal sporting opportunities for people with/without physical disability can help facilitate social integration and act as a buffer against stigmatization.

• Our research suggests that participation in sport had afforded the participants a heightened sense of self-concept, independence, ability and corresponding pride.

• When working with individuals with physical disabilities, rehabilitation professionals could utilize sport as a means of increasing an individual’s feelings of independence, confidence and normalization.

• As such, part of rehabilitation should be to ensure opportunities for sport participation for people with physical disability are available for people of all ages.

     

Social participation of children age 8–12 with SLI

Purpose: Two objectives are being pursued: (1) to describe the level of social participation of children aged 8–12 presenting a specific language impairment (SLI) and (2) to identify personal and family factors associated with their level of social participation. Method: This cross-sectional study was conducted among 29 children with SLI and one of their parents. Parental stress and family adversity were measured as risk factors. The measure of life habits (LIFE-H) adapted to children aged 5-3 was used to measure social participation. Results: The assumption that social participation of these children is impaired in relation to the communication dimension was generally confirmed. The statements referring to the “communication in the community” and “written communication” are those for which the results are weaker. “Communication at home” is made easier albeit with some difficulties, while “telecommunication” is totally preserved. A high level of parental stress is also confirmed, affecting the willingness of parents to support their child’s autonomy. Conclusions: The achievement of a normal lifestyle of children with SLI is upset in many spheres of life. Methods of intervention must better reflect the needs and realities experienced by these children in their various living environments, in order to optimize social participation, and consequently, to improve their well-being and that of their families. The need to develop strategies to develop children's independence and to reduce parental stress must be recognized and all stakeholders need to be engaged in the resolution of this challenge.

• Implications for Rehabilitation

• The realization of life habits of SLI children is compromised at various levels, especially in the domain related to “communication in the community” and “written communication”.

• Speech-language pathologists must consider providing ongoing support throughout the primary years of these children and during adolescence, to promote and facilitate the continued realization of life habits of SLI persons.

• Providing ongoing support throughout the primary years and thereafter is needed to facilitate the continuing realization of life habits of SLI persons.

• Parents of children with SLI experience considerable stress in relation to the exercise of their parental roles.

• It is important to intervene and to support parents to promote autonomy for their SLI children.