Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey.

BACKGROUND.: The existing literature on the effectiveness of interventions targeting vision, visual-perceptual impairments following acquired brain injury (ABI) is scarce and unlinked to occupational performance. PURPOSE.: To explore current occupational therapy practice in vision-rehabilitation among adults with ABI in Canada, and to determine the evidence-practice gaps. METHODS.: An online survey was made available through the Canadian Association of Occupational Therapists (CAOT) website, and disseminated to seven public healthcare institutions in Quebec. The survey collected respondent demographic information, and the types and frequency of treatments delivered. Descriptive statistics were conducted to determine interventions' frequency. Participant comments were collected and grouped into recurring themes. FINDINGS.: Over half (55%) of respondents regularly use evidence-based interventions when addressing visual acuity (VA) and visual field (VF) deficits, but only very few (3%) use it when dealing with oculomotor function and visual stress impairments. IMPLICATIONS.: Results gave a glimpse of interventions used and suggested the need for further research in vision rehabilitation.

Rehabilitation strategies enhancing participation in shopping malls for persons living with a disability.

PURPOSE: After rehabilitation, it is not clear the extent to which persons living with a disability return to their former activities in the community, such as going to shopping malls. Rehabilitation professionals are faced with the challenge to adequately prepare their clients to resume community participation. The purpose of this study was to identify rehabilitation strategies aimed at preparing clients to engage in activities in shopping malls. METHOD: Twenty-two participants including 16 rehabilitation clinicians and 6 persons living with a disability participated in four nominal group sessions. Participants were questioned on current or potential rehabilitation strategies carried out to enhance participation in shopping malls for persons living with a disability. Discussions were audio-recorded and qualitative content analysis was conducted. RESULTS: Participants mentioned strategies that were either carried out by the clinician, or in collaboration with other parties. The latter type of strategies was either carried out with the collaboration of the client, the interdisciplinary team, the relatives, or community organizations. CONCLUSIONS: Rehabilitation clinicians have a role to play in preparing persons living with a disability to resume activities in a shopping mall. Additionally, therapeutic interventions in community settings may enhance the participation of rehabilitation clients in their everyday activities. Implications for rehabilitation Many strategies are currently used in rehabilitation to prepare persons living with a disability to resume shopping activities. Clinicians could implement shopping-oriented rehabilitation strategies with the client and/or with other rehabilitation partners. Involving clients in activities related to shopping might enhance their participation in shopping malls after rehabilitation. Rehabilitation clinicians can be facilitators for people living with a disability to reach optimal participation.

Accompanying citizen of persons with traumatic brain injury in a community integration project: An exploration of the role.

BACKGROUND: The APIC (Citizen Accompaniment Project for Community Integration) is an innovative program that seeks to increase the community integration of people with a traumatic brain injury (TBI) by offering the support of an accompanying citizen (AC) in the accomplishment of significant life activities. OBJECTIVE: This article aims to better define the AC's role in this process, by underlining the mental health risks they face, the strategies they use, and the impacts the role has on their own lives. METHODS: This qualitative study is based on the analysis of interviews conducted with the AC following the first year of implementation. The data is part of a larger project aimed at the implementation and evaluation of APIC program. The data were analysed according to the rules of thematic content analysis, which encourages grouping main ideas into categories. This is an iterative process allowing for the constant emergence of new categories during the analysis. RESULTS: Accompaniment is full of joys and positive moments for the AC and participants. However, some difficult situations are encountered and the AC are constantly faced with challenges and constraints. The emerging study themes are as follows: the environment, the characteristics of the person accompanied, the AC's personal limits, and the ambiguities in the accompanier-accompanied relationship. CONCLUSIONS: Five principles drawn from the results will help oversee this practice more efficiently and limit the mental health risks of accompaniers. These findings may permit further development of this type of program for people living with disabilities.

Rehabilitation living lab in the mall community of practice: learning together to improve rehabilitation, participation and social inclusion for people living with disabilities.

Communities of practice (CoP) can facilitate collaboration between people who share a common interest, but do not usually work together. A CoP was initiated and developed including stakeholders from clinical, research, community and governmental backgrounds involved in a large multidisciplinary and multi-sectorial project: the Rehabilitation Living Lab in a Mall (RehabMaLL). This study aimed to evaluate the structure, process and outcomes of this CoP. A single case-study, using mixed-methods, evaluated the RehabMaLL CoP initiative after one year, based on Donabedian's conceptual evaluation model. Forty-three participants took part in the RehabMaLL CoP with 60.5% (n = 26) participating at least once on the online platform where 234 comments were posted. Four in-person meetings were held. Members expressed satisfaction regarding the opportunity to share knowledge with people from diverse backgrounds and the usefulness of the CoP for the RehabMaLL project. Collaboration led to concrete outcomes, such as a sensitization activity and a research project. Common challenges included lack of time and difficulty finding common objectives. A CoP can be a useful strategy to facilitate knowledge sharing on disability issues. Future research is necessary to determine strategies of increasing knowledge creation between members.

Phenomenological study of neurogenic bowel from the perspective of individuals living with spinal cord injury.

OBJECTIVE: To gain greater insight into the lived experience of individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction (NBD). DESIGN: Qualitative (phenomenologic) interviews and analysis. SETTING: Community. PARTICIPANTS: Individuals with SCI and NBD (N=19) residing in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Concerns related to living with NBD after SCI. RESULTS: Challenges related to living with SCI and NBD included costs and requirements, emotional impact, diet, education and employment, intimacy and interpersonal relations, social participation, spontaneity and daily schedule, travel, lack of appropriate and consistent assistance, loss of autonomy (independence, privacy), lack of predictability and fear of incontinence, medical complications, pain or discomfort, physical effort of the bowel routine, physical experience, and time requirements. CONCLUSIONS: Living with NBD presents many challenges. When categorized according to the International Classification of Functioning, Disability and Health, identified domains include body functions and structures, activity, participation, environmental factors, and personal factors. Identified issues have implications for improving clinical management and should be assessed when determining the impact and efficacy of interventions.

Neurogenic bowel after spinal cord injury from the perspective of support providers: a phenomenological study.

OBJECTIVE: To gain greater insight into the experience of support providers who assist and support individuals with spinal cord injury (SCI) for the performance of bowel care. DESIGN: Qualitative (phenomenological) interviews and analysis. SETTING: Community. PARTICIPANTS: Ten support providers of individuals with SCI. MAIN OUTCOME MEASUREMENTS: Themes related to supporting bowel care for individuals with SCI. RESULTS: Support providers identified concerns and challenges as well as sources of satisfaction related to the provision of bowel care to individuals with SCI. Traits and characteristics of effective support providers also emerged. CONCLUSIONS: Individuals with SCI often require emotional, logistical, and/or physical assistance to complete bowel care. Exploration of neurogenic bowel care from the perspective of support providers identified concerns and challenges, sources of satisfaction, and important traits and characteristics of support providers. This information can facilitate the identification of effective support providers and the provision of enhanced training and support. Interventions of this nature can improve the experience for individuals with SCI and their supports.

[Citizen accompaniment for community integration : a challenge for mental health ?]. / Accompagnement citoyen personnalisé en intégration communautaire : un défi pour la santé mentale ?

APIC (Citizen Accompaniment Project for Community Integration) offers support for the social integration of people living with traumatic brain injury. The accompanying citizen meets the person three hours a week for a period of a year in order to offer assistance in the accomplishment of his/her projects and activities. This role confronts the accompanying citizen with many challenges that may put their mental health at risk. This article offers a reflection on this practice from the accompanying citizen's perspective. Five principles that can help better delimit and define citizen accompaniment are drawn from the results: 1) finding a "good distance" in the relationship to the accompanied person, 2) considering all of the actors in the process, 3) putting the accompanied person and their desires at the heart of the practice, 4) accepting not knowing everything, 5) being committed to the project and accepting it may transform you.