Re/producing the Pediatric Concussion Discourse in clinical rehabilitation practice.

PURPOSE: In the field of pediatric concussion, little to no scholarship has examined how clinical practice is shaped by patterned ways of thinking, talking about, and coming to understand concussion and young people (or "discourses of concussion in young people"). In this paper, we examine the ways in which one such discourse, the Pediatric Concussion Discourse (PCD), shapes how young people with concussion, their parents, and clinicians can think about, act in relation to, and experience concussion. MATERIALS AND METHODS: This critical rehabilitation research is informed by the post-structuralist theory of Michel Foucault (1926-1984), and the key concepts of power/knowledge, discourse, and the subject. RESULTS: Circulating through clinical guidelines for the management of pediatric concussion, the PCD re/produces the expectation that young people with concussion and their parents will behave as "responsible" subjects who follow the recommendations of so-called experts without question. If recommendations are not implemented, the PCD has the potential to constitute these same groups as "nonadherent", re/producing problematic discourses of medical compliance. CONCLUSIONS: By examining the effects of the PCD, it becomes possible to imagine how clinical practice and research might evolve in new ways that respect the knowledges and experiences of young people with concussion and their parents.Implications for RehabilitationEngaging in critical examination of clinical rehabilitative practice creates opportunity to imagine how we might approach commonly adopted clinical approaches, including the delivery of health education, differently.Implications for clinical rehabilitation practice include delivering health education in the context of supportive therapeutic relationships that respect the knowledges and experience of young people with concussion and their parents.Implications for rehabilitation research include engaging with critical scholarship within and beyond field and disciplinary boundaries, engaging in formal educational opportunities, and connecting with less formal but invaluable communities of practice.

Living in autistic bodies: bloggers discuss movement control and arousal regulation.

AIM: We sought to deepen understanding of embodied experiences of autism by examining how autistic bloggers describe and discuss autism. METHODS: Working within a qualitative description approach, we sampled 40 blogs written by people who identify as autistic. We conducted a directed content analysis, applying a codebook that was generated using themes from a previous study, while remaining open to additional theme generation and elimination. RESULTS: The rich description in the blog posts support our previous finding that autism is a highly embodied experience including challenges with movement control. Additionally, we found arousal regulation (ability to maintain a calm yet alert state) to be an important embodied experience for the bloggers. CONCLUSIONS: Our findings support a conceptualization of autism that sees embodiment, movement and arousal regulation as important elements of autism. Rehabilitation researchers and professionals should note that autistic insider perspectives can and must be accessed for optimal outcomes.IMPLICATIONS FOR REHABILITATIONClinicians should consider movement control (starting and stopping movement at will) difficulties as possible barriers to function for some autistic people.Clinicians should consider arousal regulation (ability to govern physiological and psychological activation level) difficulties as a possible barrier to function for some autistic people.Clinicians should be cautious when interpreting observed behaviours of autistic people and should make every effort to get explanations for behaviour directly from the perspective of individual clients.

From the day they are born: a qualitative study exploring violence against children with disabilities in West Africa.

BACKGROUND: Despite the building evidence on violence against children globally, almost nothing is known about the violence children with disabilities in low and middle-income countries (LMICs) experience. The prevalence of violence against children with disabilities can be expected to be higher in LMICs where there are greater stigmas associated with having a child with a disability, less resources for families who have children with disabilities, and wider acceptance of the use of corporal punishment to discipline children. This study explores violence experienced by children with disabilities based on data collected from four countries in West Africa- Guinea, Niger, Sierra Leone, and Togo. METHODS: A qualitative study design guided data generation with a total of 419 children, community members, and disability stakeholders. Participants were selected using purposive sampling. Stakeholders shared their observations of or experiences of violence against children with disabilities in their community in interviews and focus groups. Thematic analysis guided data analysis and identified patterns of meaning among participants' experiences. RESULTS: Results illuminate that children with disabilities experience violence more than non-disabled children, episodes of violence start at birth, and that how children with disabilities participate in their communities contributes to their different experiences of violence. CONCLUSIONS: The study recommends policy-oriented actions and prevention programs that include children and their families in strategizing ways to address violence.

Exploring the use of tablets (iPads) with children and young adults with disabilities in Trinidad.

PURPOSE: This study was conducted to review data gathered during a pilot project which trialed the use of a tablet computer, the iPad. METHODS: Students from a segregated special education school and pre-vocational centre, with a wide range of intellectual and physical disabilities, were previously observed participating in 5-10-min introductory learning sessions with the iPad. This study reviewed quantitative and qualitative data collected during these sessions which included data regarding students' level of engagement and overall ability to learn how to operate the iPad and its applications. RESULTS: Results were positive for level of engagement and ease of use with cause and effect applications. For lower functioning students or students not previously exposed to tablet technology, scores were lower but overall remained high based on the 5-point scaling used in this study. CONCLUSION: Regular use of tablet technology in the classroom with applications appropriate to the level of ability of the student has the potential to enhance engagement in learning as well as maximise independence in the classroom. Implications for Rehabilitation The iPad has the capacity to be used with learners of all different ability levels if applications are selected appropriately and learners are given equal opportunity to access this type of technology. Enjoyment when using the iPad was high overall and this type of technology has the potential to promote more engagement in the learning process. Many applications are easy to use and progress students through step by step increasing the potential for independent learning in the classroom.

Experiences of work among people with disabilities who are HIV-positive in Zambia.

This paper focuses on accounts of how having a disability and being HIV-positive influences experiences of work among 21 people (12 women, 9 men) in Lusaka, Zambia. In-depth semi-structured interviews were conducted in English, Bemba, Nyanja, or Zambian sign language. Descriptive and thematic analyses were conducted. Three major themes were generated. The first, a triple burden, describes the burden of having a disability, being HIV-positive, and being unemployed. The second theme, disability and HIV is not inability, describes participants' desire for work and their resistance to being regarded as objects of charity. Finally, how work influences HIV management, describes the practicalities of working and living with HIV. Together these themes highlight the limited options available to persons with disabilities with HIV in Lusaka, not only secondary to the effects of HIV influencing their physical capacity to work, but also because of the attendant social stigma of being a person with a disability and HIV-positive.

Parental perceptions of barriers to physical activity in children with developmental disabilities living in Trinidad and Tobago.

BACKGROUND: Parents have a strong influence on their child's engagement in physical activities, especially for children with developmental disabilities, as these children are less likely to initiate physical activity. Knowledge is limited regarding parents' perceptions of this phenomenon in low- and middle-income countries (LMICs); yet many rehabilitation providers work with children with developmental disabilities and their parents in these contexts. PURPOSE: The aim of this study was to explore the barriers perceived by parents of children with developmental disabilities to their children's engagement in physical activity. METHODS: An occupational perspective was used to explore how parents speak about barriers to their child's engagement in physical activity. Interviews were conducted with nine parents in Port-of-Spain, Trinidad and Tobago. FINDINGS: Parent's perceived barriers were categorized into four themes: family priorities, not an option in our environment, need to match the activity to the child's ability, and need for specialized supports. CONCLUSIONS: FINDINGS provide opportunities for future rehabilitation and community programming in LMICs. Implications for Rehabilitation Children living with a developmental disability may engage more in solitary and sedentary pursuits as a result of parents choosing activities that do not present extensive social and physical demands for their child. Therapists can play an important role in providing knowledge to parents of appropriate physical activity and the benefits of physical activity for children with developmental disabilities in order to promote children's participation. In environments where there is limited social support for families, therapists need to consider and be particularly supportive of parental priorities and schedules.

Arts-based social skills interventions for adolescents with acquired brain injuries: five case reports.

OBJECTIVE: Previous research has demonstrated the value of arts-based programs for adolescents with childhood brain disorder to facilitate social skills and participation. The current study extends this work by examining the feasibility and effectiveness of an arts-based intervention for youth with acquired brain injuries (ABI). METHODS: A case study approach was used with four adolescent participants and one case control. A battery of quantitative measures were administered four and one week pre-intervention, one week post-intervention, as well six to eight month post-intervention. RESULTS: Improvements in pragmatic communication skills and social and participation goals were observed across intervention participants. Similar improvements were not seen with the case control participant. CONCLUSION: Results support the use of an arts-based intervention for youth with ABI to facilitate social skills and participation. Findings also highlight the need for more sensitive measures of these skills for these youth. Suggested guidelines for program implementation are provided.

International fieldwork placements and occupational therapy: lived experiences of the major stakeholders.

INTRODUCTION: Occupational therapy students obtain a great deal of their professional preparation and experience through fieldwork placements. Although many occupational therapy students have taken part in international fieldwork placements, there is little research on this topic. As fieldwork placements are an integral part of the education of occupational therapy students, literature on the subject of international fieldwork placements is necessary. Accordingly, the aim of this study was to examine the personal and professional experiences of occupational therapy students, supervisors, and on-site staff who have taken part in an international fieldwork placement. METHODS: Qualitative interviews for this phenomenological study were administered with 14 participants who had taken part in an international fieldwork placement in Trinidad and Tobago. Data were analysed using thematic analysis. FINDINGS: Three themes emerged: collaborative learning, cultural negotiations and thinking on my own. DISCUSSION: Considering fieldwork is a critical component in the occupational therapy curriculum, it is reassuring to uncover that international placements can be of benefit to all stakeholders while achieving its primary goal of preparing students to become competent therapists. All participants developed a greater cultural awareness and appreciation, which is necessary as occupational therapists are increasingly working in diverse settings with diverse client groups. This information can also be used to enhance international fieldwork education as students continue to travel abroad to complete their mandatory fieldwork hours.

Disability and rehabilitation in Tanzania: a review of the literature.

PURPOSE: This scoping review outlines recently published information available about disability prevalence and management, as well as environmental conditions and the rehabilitation context in the country of Tanzania. The information is presented from diverse sources including research articles, government documents and reports from international development agencies. METHOD: Documents for this review were located using four search strategies; a search of electronic databases, contact with key informants, a reference list search of articles selected for review and a search of key websites. The documents were classified based on the format and focus of the material, while the information was organised into qualitative themes based upon the research objectives to present a descriptive overview on this topic. FINDINGS: The findings of this study confirmed the lack of information available about the profile of disabilities, with evidence suggesting that disabilities are not satisfactorily managed in Tanzania; however, environmental conditions were found to be well documented. Several environmental supports and barriers for people with disabilities were described. CONCLUSION: The findings of this review indicate a need to further develop rehabilitation service provisions in Tanzania to improve the management of disabilities.

Revisiting therapy assumptions in children's rehabilitation: clinical and research implications.

PURPOSE: This commentary draws on a recent workshop hosted by the Canadian Children's Rehabilitation Research Network that brought together stakeholders to critically examine assumptions embedded in children's rehabilitation in order to advance current debates and suggest areas for further inquiry. METHOD: Six issues are discussed: (1) the wisdom of dichotomising 'fix' versus 'function'; (2) the ethics of it might help and it won't hurt' therapy approaches; (3) the emphasis on early intervention rather than a lifespan approach; (4) the challenges of providing care for new rehabilitation populations; (5) discrepancies between performance outcomes and patient satisfaction; and (6) innovative partnerships to support care transitions of adolescents and their families. RESULTS: Issues identified include: finding the right balance between therapies that focus on 'fixing' children versus enhancing function, judicious design of therapy programs as to not overburden children and families, adopting lifespan approaches to meet the needs of multiple 'paediatric' populations, cautious interpretation of measures and approaches that link well-being with physical performance, and the benefits of including parent and youth facilitators on children's rehabilitation teams. CONCLUSIONS: Ongoing debate, discussion and research are needed in each of these areas to ensure that rehabilitation services are enhancing the well-being of children and families.

A case study of the changing nature of a non-government organisation: a focus on disability and development.

PURPOSE: The purpose of this article is to describe the changing nature, process and structure of an international non-governmental organisation (NGO) in response to internal and external factors. METHOD: This article is based on the interview data collected for the study which focussed on the experiences and perception of key informants on trends related to official development assistance, local governments' perspective of the NGO as a development partner and the NGO's perception of corporate and foundation support. Qualitative descriptive data analysis was used. RESULTS: Three main themes were developed with the interview data. Our analysis indicated shifts in the: (1) vision/nature (single to cross disability focus), (2) structure (building internal and external relationships) and (3) process (from ad hoc to systemic evaluations). CONCLUSIONS: These broader issues of vision, structure (relationships) and evaluation within and outside of the organisation, needs to be addressed to provide a foundation upon which funding initiatives can be developed. A closer relationship between funders and projects/programmes would do much to enhance the partnership and would ensure that the projects are able to measure and report results in a manner that is conducive to increasing support.