Rehabilitation Through Physical Activity and Sport in Light of the International Classification of Functioning, Disability, and Health-Current Research Perspectives.

The implementation of functioning by the World Health Organization (WHO) as the third global health indicator, along with mortality and morbidity, represents a promising advancement for a comprehensive assessment of international health systems and health strategies. The description of a person's health state operationalized by both biological and lived health via functioning provides a holistic picture of an individual's life situation and proved to be successful in building a framework for formulating therapy goals, achievable activities, and participational aspects against the background of an individual's life situation. Furthermore, improving an individual's functional ability and wellbeing could potentially affect the health indicators of morbidity and mortality and will be codable beyond the ICF in ICD-11. This methodological perspective emphasizes the use of ICF applications on the wider and narrower level of international rehabilitation systems and highlights the incorporation of the term functioning in rehabilitation through physical activity and sport. Current research perspectives in applying the ICF and functioning in clinical and rehabilitation practices are discussed and a current explorative study is presented, which applies the holistic orientation of functioning and the biopsychosocial model to the specific case by an individualized sports coaching intervention in rehabilitation. Subsequently, a unifying ICF- oriented language in rehabilitation is considered as a powerful foundation for a consistent international research strategy concerning increased international collaborations and future research perspectives.

Effect of Indoor Climbing on Occupational Self-Efficacy and Employability: Results of a 10-Month Randomised Controlled Study of Persons with Intellectual Disability.

(1) Background: Indoor climbing has different effects at various levels, including physical, psychological, and social ones. It is of high interest to assess whether social skills developed through climbing can be transferred to another environment, such as the working environment. This study investigates the effects of indoor climbing on employability and occupational self-efficacy of people with intellectual disability, who possess lower levels of social competences in general. (2) Methods: A randomised controlled study (RCT) experimental study design with three groups was formed-one intervention (IG) and two control groups (CGI&II). For 10 months, the IG went climbing (two times per week), whereas the first CG followed a sports programme and the second CG served as controls. (3) Results: IG participants showed significant improvement in mental and somatic health over time. Regarding occupational self-efficacy, females had a significantly lower mean. Nevertheless, only the IG's female participants mean increased significantly over time. (4) Conclusions: Indoor climbing can be effective for improving occupational health and can be beneficial for specific groups; however, additional research is needed to further specify the influence of indoor climbing on a wider variety of aspects of the life of people with intellectual disability.

Measuring Equine-Assisted Therapy: Validation and Confirmatory Factor Analysis of an ICF-Based Standardized Assessment-Tool.

The International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO) was established as an international framework for monitoring rehabilitation outcomes and the impacts of health interventions since, as the term "functioning" implies, it emphasizes a person's "lived health" in addition to their biological health status. Equine-assisted therapy (EAT) represents a holistic intervention approach that aims to improve both biomedical functioning and the patient's lived health in relation to performing activities and participating in social situations. In this study, the psychometric properties of an ICF-based digital assessment tool for the measurement of the rehabilitation impacts of EAT were analyzed via simultaneous confirmatory factor analyses (CFA) and reliability and sensitivity tests. In total, 265 patients from equine-assisted therapy centers in Germany were included for CFA. Change sensitivity was assessed via multi-level analyses based on 876 repeated assessments by 30 therapists. Results show satisfactory model-fit statistics; McDonald's omega (ML) showed excellent scores for the total scale (ω = 0.96) and three subscales (ω = 0.95; ω = 0.95, ω = 0.93). The tool proved itself to be change sensitive and reliable (change sensitivity p ≤ 0.001), retest r = 0.745 **, p ≤ 0.001). Overall, the developed assessment tool satisfactorily fulfills psychometric requirements and can be applied in therapeutic practice.

Development of an ICF-based assessment tool for equine-assisted therapy: model structure and reliability.

BACKGROUND: Scientific investigation and documentation of equine-assisted therapy has increased over the past several years. Yet there are no standardized and validated tools for evidence-based measurement of processes and outcomes to assess equine-assisted interventions. AIM: The objective of this cross-sectional survey study was to develop a standardized assessment tool for the effective measurement of equine-assisted therapy based on the common language of the International Classification of Functioning, Disability and Health (ICF) framework of the World Health Organization (WHO). DESIGN: Cross-sectional study. SETTING: Six equine-assisted therapy rehabilitation centers in Germany. POPULATION: Persons with indications for equine-assisted therapy. METHODS: In a qualitative conceptual portion of the study, four semi-structured focus group interviews were conducted and analyzed with a total of 17 experts and therapists according to the aims, content, and sphere of influence of equine-assisted therapy via structured content analysis. Based on these findings and a linkage to the classification system of ICF, a standardized assessment tool (a general module and three specialized submodules) for equine-assisted therapy was developed. It was field-tested with 116 participants at six locations in a multicenter practical field approach and statistically analyzed via explorative factor analyses and reliability tests. RESULTS: Explorative factor analysis provided support for a three-factor structure for the general module, including psychosocial, motor, and mental functioning scales. For both submodules, i.e., the individual and group settings, a two-factor structure was indicated. Reliability was in the good to excellent range for all modules. CONCLUSIONS: A global 80-item assessment tool, divided into a general and three submodules, provides a first step toward a standardized ICF-based assessment of the effects of equine-assisted therapy. A common language in measuring therapy outcomes could increase synchronization and integration of equine-assisted therapy interventions into the international healthcare system. By applying the ICF in multidisciplinary services in rehabilitation management, improved coordination and networking of all necessary services can be provided. CLINICAL REHABILITATION IMPACT: The developed assessment tool contributes to evidence-based outcome-measurement and therapy monitoring of equine-assisted interventions. Prospectively, it could enable cost-effectiveness analyses and comparability with other health system interventions.

Health-related quality of life in working-age adults with visual impairments in Germany.

Purpose The purpose of this study was to gather data about physical activity and quality of life (QoL) for people of working age with visual impairments to optimize upcoming physical activity-based interventions in vocational rehabilitation. Methods Two hundred and seventy-seven former participants of four vocational rehabilitation centres in Germany answered an online questionnaire. The health-related QOL has been assessed by means of the WHOQOL-BREF questionnaire. The data were analysed via multivariate analysis of covariances (MANCOVAs), univariate analysis of covariances (ANCOVAs) and discriminant function analysis. Results Compared to a normative group of adults aged 36-45, the study group showed lower values in all domains of QOL. The MANCOVA (visual acuity) produced no multivariate significant effect. Also, the ANCOVA showed no significant effect for the global dimension of the WHOQOL-BREF. The MANCOVA (leisure time activity) produced a multivariate significant effect. Post-hoc ANCOVAS revealed significant effects for all four domains of QoL. The ANCOVA analysing the global domain showed a similar significant effect as well. The active persons had higher values in all domains of QoL compared to the more passive participants. Conclusion Interventions in vocational rehabilitation should focus on leisure time activity to enhance QoL. At this stage, the role of physical activity is still unclear and further studies are needed. Implications for rehabilitation People with visual impairments often show a worse quality of life than normal-sighted people. The degree of severity of the visual impairment does not affect quality of life. Sport and physical activity are effective means of improving quality of life. An active leisure time activity supports the improvement of the quality of life of visual-impaired people that participated in a vocational rehabilitation.

Energy Expenditure in Adolescents With Cerebral Palsy: Comparison of the SenseWear Armband and Indirect Calorimetry.

BACKGROUND: Inactivity and overweight are major health concerns in children and adolescents with disabilities. Methods for the assessment of activity and energy expenditure may be affected negatively by the underlying disability, especially when motor function is impaired. The purpose of this study was to assess the validity of the SenseWear Armband in adolescents with cerebral palsy and hemiparesis. METHODS: Ten volunteers (age: 13.4 ± 1.6 years) were equipped with SenseWear Armbands on the hemiparetic and nonhemiparetic side of the body. Energy expenditure was measured at rest and during treadmill exercise (speed range: 0.85 to 2.35 m/s). Indirect calorimetry served as independent reference method. RESULTS: The mean error was between -0.6 and 0.8 kcal/min and there were no significant differences between SenseWear and indirect calorimetry at any speed. Differences between body sides in expenditure (mean: -0.2 to 0.0 kcal/min) and step count (mean: -3.4 to 9.7 steps/min) were not significant. CONCLUSIONS: The validity of the SenseWear Armband does not appear to be negatively affected by cerebral palsy during laboratory treadmill exercise. Future field studies are necessary to assess the validity and practicability energy expenditure and physical activity in children and adolescents with physical disabilities.

Moderate cycling exercise enhances neurocognitive processing in adolescents with intellectual and developmental disabilities.

Research has shown that physical exercise enhances cognitive performance in individuals with intact cognition as well as in individuals diagnosed with intellectual and developmental disabilities. Although well identified in the field of health (for example, the transient hypofrontality theory), the underlying neurocognitive processes in intellectual and developmental disabilities remain widely unclear and thus characterize the primary aim of this research. Eleven adolescents with intellectual and developmental disabilities performed moderate cycling exercise and common relaxation. Cross-over designed, both 10-min meetings were randomly allocated at the same time of day with 24-h time lags in between. Conditions were embedded in ability-modified cognitive performance (decision-making processes). Participants' reaction times and their equivalent neurophysiological parameters were recorded using standard EEG and analyzed (spatial activity, N2). Exercise revealed a decrease in frontal electrocortical activity, most pronounced in the medial frontal gyrus (10%). To that effect, reaction time (p<0.01) was decreased and mirrored in decreased N2 latency (p<0.01) after exercise. In contrast, relaxation revealed no significant changes. Results of this research suggest exercise temporarily enhances neuronal activity in relation to cognitive performance for adolescents with intellectual and developmental disabilities; further research is needed to explore possible future effects on enhancing neurocognitive development.

Exercise, mood and cognitive performance in intellectual disability - a neurophysiological approach.

While numerous researches addressed the connection between physical exercise, changes in brain cortical activity and its relationship to psycho-physiological processes, most of these neuro-scientific studies were set up for healthy individuals. However, the benefits of exercise, such as well being, physical and cognitive health enhancements are also becoming increasingly important for intellectually disabled individuals. This study aimed to localize electroencephalographic activity changes in intellectually disabled individuals following a moderate running exercise for 30 min. An increase in cognitive performance and in mood was hypothesized to correlate with a decrease in fronto-temporal brain areas following exercise. Significant changes in cortical current density in frontal brain areas as well as decreases in perceived physical energy could be shown. Overall motivational states (including self-confidence and social acceptance) as well as positive mood increased significantly. However, no changes could be observed for the cognitive tasks following exercise. With respect to the data provided here there is reason to believe, that a self-selected pace running exercise, enhances self-esteem, coincided with cortical activity changes in fronto-temporal brain areas.