'Do it afraid': An arts-based reflexive collective case study exploring youth responses to post-concussion communication changes in daily life.

BACKGROUND: Concussion and communication researchers have yet to study how post-concussion communication changes affect youths' daily lives. The lack of attention paid to how young people respond to communication changes during concussion recovery constitutes a significant gap in current concussion management research and practices. AIMS: To explore how youth respond to the effects of post-concussion communication changes in their daily life, including (1) daily routines, (2) relationships with family members, (3) relationships with peers and (4) participation in school/work and community activities. METHODS & PROCEDURES: Five youths (16-25 years) and three family members participated in this arts-based reflexive collective case study. Ecocultural theory provided the theoretical framework for study design, data collection and analysis. Cases consist of (1) pre-interview demographic information, (2) three 60-90-min virtual interviews, (3) optional family member interviews, (4) multi-media arts-based participant-generated materials representing participants' experiences of communication change and concussion, and (5) researcher observations, discussions and reflexive journal entries. Reflexive thematic analysis was used to analyse the data. OUTCOMES & RESULTS: Analysis yielded four themes that illustrate the ways youth navigated and adapted to post-concussion communication changes: (1) navigating changes in communication tasks, daily roles, and identity; (2) re-negotiating relationships and emotional reactions; (3) seeking control and learning to let go during recovery; and (4) helping youth adapt to post-concussion communication changes. CONCLUSIONS & IMPLICATIONS: The study findings deepen our understanding of the impact of post-concussion communication changes on youths' daily lives and underscore considerations critical to the development of communication-focused concussion education programs and interventions tailored specifically for youth. WHAT THIS PAPER ADDS: What is already known on the subject Youth is a critical period of social and emotional development. Communication is integral to identity, relationships, participation in daily activities and well-being. Concussions can affect speech clarity, fluency, understanding and use of language, and social interactions. Re-engaging in routine activities and pre-injury roles can be challenging for youth experiencing communication changes as part of complex concussion recoveries. What this paper adds to the existing knowledge Findings from this research illuminate how youth navigate and adapt to communication changes post-concussion and support the development of youth-focused communication education programs, assessments and interventions. Youth participants actively managed their recoveries by developing innovative strategies to support their communication during daily activities, learning about communication, practicing communication tasks sequentially, and facing fears. Youth also reframed and challenged narrow views of 'normal communication'. What are the potential or actual clinical implications of this work? Findings highlight the need for more youth- and communication-focused education materials and programs within youth concussion management protocols. Information about the specific ecological and sociocultural factors youth encounter during concussion recovery is needed to develop targeted communication-focused education and intervention programs for youth and their families to mitigate risks of isolation, loneliness, and mental health concerns and increase youths' participation in family, community and cultural life. By learning from youth about how communication changes affected their participation in daily activities, identity and relationships, clinicians can provide information and interventions to reduce adverse listener reactions and help young people feel supported and understood.

The (radical) role of belonging in shifting and expanding understandings of social inclusion for people labelled with intellectual and developmental disabilities.

There is a gap between the desired outcomes of social inclusion policy and the everyday experiences of people labelled with intellectual and developmental disabilities. Despite belonging rhetorically named in social inclusion policy and practice, belonging is often absent in the lives of people labelled with intellectual and developmental disabilities and remains undertheorised in its relationship to social inclusion. In this paper, we explore the role belonging might play in narrowing the gap between how social inclusion is theorised and how it is experienced. Drawing on critical disability and feminist relational theories, we outline a relational conceptualisation of belonging and use it to 'crip' the construct of social inclusion. Exploring the synergies and tensions that surface when social inclusion and belonging are held together as discrete but interconnected constructs, we name four conceptual shifts and expansions that allow us to see social inclusion differently. Through the centring of the experiences of people labelled with intellectual and developmental disabilities, we explore the ways belonging can help to reimagine inclusion from assimilationist, static, objective and formal towards inclusion as fluid, negotiated, (inter)subjective, (in)formal and intimate.

Intimate partner violence against women with intellectual disability: A relational framework for inclusive, trauma-informed social services.

Women with intellectual disability experience intimate partner violence at higher rates and tend to remain in abusive relationships longer than non-disabled women. The purpose of this inquiry was to generate a preliminary set of principles and delineate domains of support as a general guide for social service workers supporting women with intellectual disability through the difficult, often stop-start process of ending an abusive relationship and creating a desired future. Taking a pragmatic inquiry approach, guiding principles and domains of support were generated through a triangulated engagement with relational theory, relevant published research, and original data gathered through interviews with five experienced social service workers. The results comprise a relational framework for inclusive, trauma-informed services aimed at fostering the relational autonomy of women with intellectual disability. Enacting relational principles of reflexivity, recognition, solidarity and safety, social service workers can support women with intellectual disability with safety planning, securing basic life needs, strengthening social relationships, acquiring new skills and nurturing self-affective attitudes of self-respect, self-efficacy and self-esteem.

Using a robotic teleoperation system for haptic exploration.

INTRODUCTION: When children with physical impairments cannot perform hand movements for haptic exploration, they miss opportunities to learn about object properties. Robotics systems with haptic feedback may better enable object exploration. METHODS: Twenty-four adults and ten children without physical impairments, and one adult with physical impairments, explored tools to mix substances or transport different sized objects. All participants completed the tasks with both a robotic system and manual exploration. Exploratory procedures used to determine object properties were also observed. RESULTS: Adults and children accurately identified appropriate tools for each task using manual exploration, but they were less accurate using the robotic system. The adult with physical impairment identified appropriate tools for transport in both conditions, however had difficulty identifying tools used for mixing substances. A new exploratory procedure was observed, Tapping, when using the robotic system. CONCLUSIONS: Adults and children could make judgements on tool utility for tasks using both manual exploration and the robotic system, however they experienced limitations in the robotics system that require more study. The adult with disabilities required less assistance to explore tools when using the robotic system. The robotic system may be a feasible way for individuals with physical disabilities to perform haptic exploration.

Player and Parent Experiences with Child and Adolescent Power Soccer Sport Participation.

PURPOSE: To provide insight into the experiences of power soccer players and their parents to inform rehabilitation practice. METHODS: Primary data for this Interpretive Description study were individual interviews with five power soccer athletes, ranging from 11 to 17 years of age, and three parents of power soccer players. Observational field notes were also used. RESULTS: Five inter-related themes were developed: 1) Level playing field, 2) I am an athlete, 3) Important "life lessons" are gained through team sports, 4) The value of belonging to a community, and 5) Role of the rehabilitation community in supporting power mobility sports. CONCLUSIONS: Findings of this study demonstrate the benefits and challenges of power sport participation. The results encourage therapists to share information about sport opportunities with families and to consider a broad range of contexts when assessing for power mobility.

Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education.

Objective: Supporting audiologists to work ethically with industry requires theory-building research. This study sought to answer: How do audiologists view their relationship with industry in terms of ethical implications? What do audiologists do when faced with ethical tensions? How do social and systemic structures influence these views and actions? Design: A constructivist grounded theory study was conducted using semi-structured interviews of clinicians, students and faculty. Study sample: A purposive sample of 19 Canadian and American audiologists was recruited with representation across clinical, academic, educational and industry work settings. Theoretical sampling of grey literature occurred alongside audiologist sampling. Interpretations were informed by the concepts of ethical tensions as ethical uncertainty, dilemmas and distress. Results: Findings identified the audiology-industry relationship as symbiotic but not wholly positive. A range of responses included denying ethical tensions to avoiding any industry interactions altogether. Several of our participants who had experienced ethical distress quit their jobs to resolve the distress. Systemic influences included the economy, professional autonomy and the hidden curriculum. Conclusions: In direct response to our findings, the authors suggest a move to include virtues-based practice, an explicit curriculum for learning ethical industry relations, theoretically-aligned ethics education approaches and systemic and structural change.

Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review.

OBJECTIVES: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature. METHODS: The scoping review process described by Arksey and O'Malley was used to guide article selection and data extraction. RESULTS: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies ( n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families ( n = 49). CONCLUSION: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes.

Thinking critically about client-centred practice and occupational possibilities across the life-span.

BACKGROUND: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are "normal" occupational possibilities. These values and beliefs privilege some occupations and negate others. AIM: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. METHODS: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered "normal" occupations and how these taken-for-granted values structure occupational therapy practice. CONCLUSION: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients' predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of "normal'.

What is it like to walk with the help of a robot? Children's perspectives on robotic gait training technology.

PURPOSE: Robotic gait training is an emerging intervention that holds great therapeutic promise in the rehabilitation of children with neuromotor disorders such as cerebral palsy (CP). Little is known about children and parents' views on this new technology. The purpose of this qualitative study was to investigate the expectations and experiences of children with CP in relation to robotic gait training using the Lokomat®Pro. METHOD: An interpretivist qualitative design was employed in which perspectives of children and parents were elicited through separate semi-structured interviews to examine expectations of and experiences with the Lokomat. RESULTS: Four themes related to children's expectations and experiences using the Lokomat were identified: (1) Not sure what to expect, but okay, I will do it; (2) It's more than just the Lokomat, it's the people that make the difference; (3) Having mixed impressions about the Lokomat; and (4) It's probably helping me, but I don't really know. CONCLUSIONS: Rehabilitation professionals, researchers and parents are encouraged to reflect on why and how one might engage children in gait-related rehabilitation in ways that appeal to children's desires and expectations. This may shape how interventions are presented to children and how goals and outcomes are framed. Implications for Rehabilitation Children in this study did not consistently feel excited about, have a wish to use, or have a sustained interest in the use of a robotic technology, and at times experienced some anxiety in relation to their participation in the intervention. Contrary to assumptions that disabled children value walking "normally", children in this study did not express a desire to walk in typical (non-disabled) gait patterns, and equated so-called "normal" walking with their usual walking styles. Thus, we encourage clinicians, researchers and parents to reflect on why, when and how best to engage children in gait-related rehabilitation in ways that appeal to and align with children's desires and expectations.

An investigation of students' perceptions of ethical practice: engaging a reflective dialogue about ethics education in the health professions.

The ethical climate in which occupational therapists, and other health practitioners, currently practice is increasingly complex. There have been a number of calls for greater attention to ethics education within health science curricula. This study investigated occupational therapy students' perceptions of the meaning of ethical practice as a means of engaging in a dialogue about the aims of ethics education in contemporary health science contexts. A phenomenological methodological approach was adopted for the study. Interviews were conducted over 2 years with 25 student participants. The data were analyzed using phenomenological methods of analysis. Seven themes depict students' views about the meaning of ethical practice and include: being faithful to the tenets of your practice, being communicative, being in tune with your values, understanding the client's needs, weighing the pros and cons, negotiating the grey zones, and taking time to reflect. The findings contribute to understanding students' conceptions of the meaning of ethical practice that include and move beyond traditional codes, principles, and professional standards to encompass a range of dimensions of ethical practice. These additional dimensions raise insights of relevance to those who design and facilitate ethics education with health professionals.

A Case Review: Reframing School-Based Practices Using a Critical Perspective.

It is well established in the literature that school-based practice is fraught with challenges such as acquisition of appropriate and sufficient resources, communication barriers among professionals, parental burden, and redundancies and gaps in services. The purpose of this perspective paper is to reframe potentially problematic school-based practices using a critical social science perspective, suggesting a vision and strategies for therapists working in the context of school-based practice. We illustrate our approach with a case example. To reframe school-based practices, we begin with Jill's case, exploring it through a critical lens to identify potential issues and opportunities for change. We then trace these findings to our larger dataset from an ongoing program of research to ensure relevance to the broader context of school-based practice. Reframing of three school-based practice issues is discussed from: (a) advocacy by proxy to collaborative dialogue, (b) governing texts to guiding texts, and (c) playing the "right" part to having a voice. Although this is a perspective paper based on a case exemplar, we posit how we may reframe and rethink school-based practices in pediatric rehabilitation. We suggest that only with a genuine shift in our professional values will we see the enactment of collaborative practice in school-based settings.

Representations of disability and normality in rehabilitation technology promotional materials.

PURPOSE: To explore the ways in which promotional materials for two rehabilitation technologies reproduce commonly held perspectives about disability and rehabilitation. METHOD: Our analysis was informed by critical disability studies using techniques from discourse analysis to examine texts (words and images) and their relation to social practices and power. Using this approach, promotional materials for (a) hearing aid and (b) robotic gait training technologies were interrogated using three central questions: (1) Who are represented? (2) What is promised? and (3) Who has authority? RESULTS: Messages of normalization pervaded representations of disabled children and their families, and the promises offered by the technologies. The latter included efficiency and effectiveness, progress and improvement, success and inclusion, and opportunities for a normal life. CONCLUSIONS: Normalization discourses construct childhood disability through texts and images. These discourses reinforce pervasive negative messages about disability that are taken up by children and families and have ethical implications for clinical practice. Rehabilitation has largely focused on "fixing" the individual, whereas broadening the clinical gaze to the social dimensions of disablement may lead to a more sensitive and informed approach within family-clinician discussions surrounding these advanced technologies and the use they make of promotional materials. Implications for Rehabilitation Awareness of the potential effects of implicit and explicit messages about disability in promotional materials may lead to a more sensitive and informed approach within family-clinician discussions surrounding rehabilitation technologies. In practice, it is important for rehabilitation professionals to remember that parents' and children's values and beliefs are shaped over time, and parents' and professionals' perspectives on disability strongly influence how disabled children internalize what disability means to them.

Constructions of disability: a call for critical reflexivity in occupational therapy.

BACKGROUND: Within professional and practice knowledge there are many assumptions about disability that underpin occupational therapy philosophy. PURPOSE: The objectives of this paper are to (a) critically examine how disability has been constructed in mainstream society by introducing perspectives from contemporary disability studies theories, and (b) apply a critically reflexive lens informed by disability studies perspectives to occupational therapy practice. KEY ISSUES: Drawing upon critical disability perspectives, notions of "nondisabled" versus "disabled"; metanarratives of disability; built environments and social structures; and social and attitudinal constructions of disability and identity are examined. Key issues pertaining to rehabilitation, norms, client-centred practice, language, and education within occupational therapy are discussed. IMPLICATIONS: This critically reflexive examination has revealed the ways in which occupational therapy and society at large are embedded in discourses that may reinforce negative connotations around disability. A renewed understanding of disability may challenge current practices.