A Global Environmental Scan of Competencies for Mobility Assistive Product Provision.

Competencies defined in practice standards and frameworks promote safe and effective healthcare by underpinning training curricula and service standards. The provision of mobility assistive products involves a range of professionals, each guided by various standards and frameworks that define various competencies. This environmental scan aimed to identify global resources containing professional competencies applicable to mobility assistive product provision and to compare them against a gold standard. Competencies for mobility assistive products were found in 14 resources of diverse types. While there were similarities between competency standards, such as service steps, there were also significant differences, such as minimum education levels and competency domains. This environmental scan highlights an opportunity for professionals providing mobility assistive products to collaborate and establish unified competencies. Standardizing these competencies could harmonize training, regulation, and service standards, thereby improving coordination and service quality. Additionally, this approach could serve as a model for developing standardized competencies for other assistive products, such as hearing and vision aids, enhancing outcomes across various assistive technology types.

Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial.

BACKGROUND: Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. OBJECTIVES: To determine whether implementation of a self-management program ('My Therapy') improves functional independence relative to routine care in people admitted for physical rehabilitation. METHODS: This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus 'My Therapy', comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. RESULTS: 2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). CONCLUSIONS: My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/.

Biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation: A systematic review of qualitative research.

BACKGROUND: People with disability living in supported accommodation experience ongoing health disparities. Physical activity and dietary quality are factors that may minimise the risk of chronic disease, however this population may experience a range of biopsychosocial barriers to physical activity and healthy eating. OBJECTIVE: The aim of this review was to synthesise the biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation, as reported by existing qualitative research. METHODS: A systematic review of qualitative evidence was conducted according to the JBI's methodological guidance. In September 2023, five academic databases were searched for relevant literature published since database inception. A secondary analysis of the results of included studies was guided by the International Framework for Functioning, Disability, and Health (ICF), using the ICF Linking Rules. RESULTS: A total of 31 articles were included. The analysis identified 154 determinants of physical activity and 112 determinants of healthy eating. Determinants were most prominently representative of environmental factors that captured the health promoting role and attitudes of staff, alongside the influence of the organisational context. CONCLUSION: This review provided evidence for the complex interactions between body functions and structures, activities and participation, personal factors, and the environment that influence physical activity and healthy eating within supported accommodation. Although there is a limited body of evidence to guide practice, the findings highlight the multifactorial nature of interventions that can be utilised by direct care professionals and adapted to the individual needs and interests of people with disability.

'Having the dog as part of our family gives us hope': Experiences of the impact of assistance dogs on the occupational engagement of children with autism and their families.

BACKGROUND: Autism is a developmental disorder characterised by changes in social, communication, and behavioural performance. Assistance dogs can support children with autism to engage in everyday occupations. Despite more children being partnered with assistance dogs, there is limited research regarding the impact of assistance dogs on the occupational engagement of children with autism and their families, and further research is needed to fully understand the impact of this type of support within the Australian context. OBJECTIVES: To explore caregiver-reported experiences of an assistance dog on the occupational engagement of children with autism and their families. METHOD: Using a qualitative approach, semi-structured interviews were undertaken with six caregivers of seven children with autism, who each had an assistance dog. Interviews ranged from 45 to 60 minutes in duration. Data were transcribed verbatim and thematically analysed. Trustworthiness was maximised through independent recruitment, research team discussions, member checking, and a researcher reflective journal. FINDINGS: Three themes were identified: participation in everyday occupations prior to and after partnering with an assistance dog, increased engagement in everyday occupations, and impact of the assistance dog on the family unit. Assistance dogs were reported to progress children from community 'isolation' to 'freedom'. Participants reported the dog increased children's capacities through positively influencing completion of routines, increasing independence, and improving therapy engagement. Assistance dogs were viewed as supporting the whole family's occupational engagement. Some challenges were identified with the introduction of the assistance dog to the family unit, and with animal maintenance costs and time demands, public access rights, and limited government funding. CONCLUSION: This research identifies benefits and challenges for children who partner with autism assistance dogs. It provides insights to inform assistance animal referral, assessment, and support of assistance dogs in Australia for children with autism and occupational therapists working with them.

Occupational therapy scope of practice in the rehabilitation of adults experiencing persistent post-concussion symptoms following traumatic brain injury: a scoping review protocol.

OBJECTIVE: The objective of the review is to identify, categorize, and examine literature describing occupational therapy scope of practice in the rehabilitation of adults experiencing persistent post-concussion symptoms (PPCS). INTRODUCTION: PPCS are symptoms experienced by adults a minimum of 2 to 4 weeks after a traumatic brain injury (TBI), and include vestibular, neuropsychiatric, visual, and cognitive issues. Enduring PPCS may result in disability, affecting a person's independence and/or participation in daily activities. Despite growing recognition of the role occupational therapy can offer in TBI rehabilitation, evidence is limited regarding the scope of practice occupational therapists have in the rehabilitation of adults experiencing PPCS. INCLUSION CRITERIA: Literature that includes adults (aged 18 to 65 years) experiencing PPCS that describes the occupational therapy scope of practice in concussion programs will be considered for inclusion in this review. Sources reporting on participants aged under 18 years, classified with non-persistent symptoms, and receiving care in acute health care settings will be excluded. Non-English publications or gray literature from civil society or disabled persons organizations or other representative bodies in the field of brain injury will also be excluded. METHODS: The scoping review will follow the JBI methodology for scoping reviews. Five electronic databases will be searched for literature published between 2013 and the present: MEDLINE, Embase, Emcare, PsycINFO, and CINAHL. Two reviewers will independently conduct title and abstract screening of the results and, upon consensus, independently screen full texts to confirm final sources for inclusion. Any disagreements will be resolved by discussion with a third reviewer. Data will be extracted from included sources and we will then map occupational therapy scope of practice (inclusive of assessments and interventions) against the World Health Organization's International Classification of Functioning One-Level Classification. Results will be presented in tabular or narrative format. REVIEW REGISTRATION: Open Science Framework osf.io/qxgzj.

Evaluation of the Effectiveness of Assistive Technology for Executive Function Support for People With Acquired Brain Injury: Protocol for Single-Case Experimental Designs.

BACKGROUND: Executive function, including prospective memory, initiating, planning, and sequencing everyday activities, is frequently affected by acquired brain injury (ABI). Executive dysfunction necessitates the use of compensatory cognitive strategies and, in more severe cases, human support over time. To compensate for the executive dysfunction experienced, growing options for electronic mainstream and assistive technologies may be used by people with ABI and their supporters. OBJECTIVE: We outline the study protocol for a series of single-case experimental designs (SCEDs) to evaluate the effectiveness of smart home, mobile, and/or wearable technologies in reducing executive function difficulties following ABI. METHODS: Up to 10 adults with ABI who experience executive dysfunction and have sufficient cognitive capacity to provide informed consent will be recruited across Victoria and New South Wales, Australia. Other key inclusion criteria are that they have substantial support needs for everyday living and reside in community dwellings. On the basis of the participant's identified goal(s) and target behavior(s), a specific electronic assistive technology will be selected for application. Both identification of the target behavior(s) and selection of the assistive technology will be determined via consultation with each participant (and their key support person, if applicable). The choice of SCED will be individualized for each participant based on the type of technology used in the intervention, the difficulty level of the behavior targeted for change, and the anticipated rate of change. For each SCED, repeated measurements of the target behavior(s) during the baseline condition will provide performance data for comparison with the performance data collected during the intervention condition (with technology introduced). Secondary outcome measures will evaluate the impact of the intervention. The protocol includes 2 customizable Microsoft Excel spreadsheets for electronic record keeping. RESULTS: Recruitment period is June 2022 through March 2024. Trial results for the individual participants will be graphed and analyzed separately using structured visual analysis supplemented with statistical analysis. Analysis will focus on important features of the data, including both within- and between-phase comparisons for response level, trend, variability, immediacy, consistency, and overlap. An exploratory economic evaluation will determine the impact on formal and informal support usage, together with quality of life, following the implementation of the new technological intervention. CONCLUSIONS: The study has been designed to test the cause-effect functional relationships between the intervention-in this case, electronic assistive technology-and its effect in changing the target behavior(s). The evaluation evidence gained will offer new insights into the application of various electronic assistive technologies for people who experience executive dysfunction following ABI. Furthermore, the results will help increase the capacity of key stakeholders to harness the potential of technology to build independence and reduce the cost of care for this population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000835741, https://www.anzctr.org.au/ACTRN12622000835741.aspx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48503.

Perspectives of telehealth access and implementation in people recovering from serious transport injury, health care providers and compensation system staff during the COVID-19 pandemic in Australia.

INTRODUCTION: Before the COVID-19 pandemic, few injury compensation schemes supported access to service-delivery via telehealth. The aim of this qualitative study was to explore the perspectives of people recovering from serious transport injury, health care providers, and senior staff of a transport injury compensation scheme, in relation to the uptake and implementation of telehealth during the COVID-19 pandemic, and its ongoing use. METHODS: Semi-structured interviews were undertaken with 35 participants, including 15 seriously injured patients, 16 health care providers and 4 compensation scheme staff. A thematic analysis was performed using a framework approach. RESULTS: Themes identified included the need to provide continuity of care via telehealth during the pandemic for patients recovering from injury, and the associated organisational and technical support needs. It was noted that some types of services worked well via telehealth, including psychology, while others did not, including physical assessments. The convenience of telehealth was highlighted, in relation to reduced travel. However, there were often safety fears relating to falls, and communication issues with injured people. CONCLUSIONS: This research found that the majority of injured patients and health care providers had benefitted from the introduction of service delivery via telehealth during the pandemic for some types of services. Participants saw opportunities for continued benefit post-pandemic, particularly for improving equity of access to health care for people with barriers to mobility and travel.

Barriers and enablers to the implementation of healthy lifestyle interventions for people with disability living in supported accommodation: A systematic review using the consolidated framework for implementation research.

BACKGROUND: People with disability living in supported accommodation often experience significant health disparities, despite the availability of additional support. Healthy lifestyle interventions have been identified as one key health promotion strategy. Implementation science offers an opportunity to explore the factors that influence the efficacy and sustainability of these interventions, yet its application in this context has been underutilized. OBJECTIVE: This systematic review synthesized the barriers and enablers to the implementation of healthy lifestyle interventions delivered to people with disability living in supported accommodation settings. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search for relevant literature published between January 2011 and November 2021 was conducted across six databases. The findings of included studies were coded and analyzed according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) via deductive content analysis. RESULTS: Five studies were included, and their findings were mapped to 21 out of 38 constructs under the CFIR. Interventions from each study delivered health promotion education and training to staff and/or people with disability. The most prominent determinants that influenced implementation success included an intervention's relevance and its flexibility to adapt to the needs of people with disability, alongside organizational resourcing, and stakeholder endorsement in supporting implementation. CONCLUSIONS: The CFIR provided a systematic approach to explore the implementation of healthy lifestyle interventions. However, further research that is grounded in and guided by implementation science theories is warranted. Despite the scarcity of literature, several compelling, yet preliminary recommendations were drawn from the findings.

'Community members aren't aware that assistance animals come in all shapes and sizes, and help people with all kinds of disabilities' - Experiences of using assistance animals within community living in Australia.

PURPOSE: This study aimed to investigate: (1) the characteristics of people using, or had previously used, assistance animals within community living in Australia; (2) positive and/or negative experiences of these users; and (3) educational resources that may aid public awareness. MATERIALS AND METHODS: An online survey was distributed through Australian assistance animal organisations and social media channels. Past/current assistance animal users (n = 112) responded to questions on demographic and types of animal supports used, experience of assistance animal use, community attitudes experienced, and perspectives about the need for public education. Data were analysed with descriptive and inferential statistics. Content analysis provided additional insights of the positive and/or negative experiences assistance animal users had faced. RESULTS: Nearly all participants used an assistance dog (n = 111), and 37 (33%) used the animal for more than one type of support. Seventy percent reported experiencing both positive and negative community attitudes/reactions. Length of time of having an assistance animal was associated with significantly higher prevalence of positive attitudes/reactions, whilst users who received medical support from the animal tended to experience more negative community attitudes/reactions than other users. The majority (90%) agreed that more public education is needed regarding assistance animal public access rights. CONCLUSIONS: This study is the first in Australia to undertake a large-scale survey of assistance animal users with a range of disability types. It highlights the benefits and challenges of assistance animals, which could be useful to consider when determining the most appropriate support for an individual.Implications for RehabilitationThere are a range of possible benefits, but also challenges, in the use of assistance animals that should be considered when a person with disability or health conditions, or people advising them, are determining if an animal is the most appropriate support.Assistance animals can provide multiple types of support to one user, so could offer a potential cost-benefit beyond traditional assistive devices or other types of support.To ensure better inclusion of assistance animal users, public education is needed to promote community awareness of the types of animals that meet the definition of an 'assistance animal', and thus have public access rights.In Australia, a nationally consistent government approach to the regulation, accreditation and funding of assistance animals should be established with the aim to address the current fragmented or unfair investment approach and/or discrimination experienced by some individuals.

Pilot of a dog-walking program to foster and support community inclusion for people with cognitive disabilities.

PURPOSE: To evaluate a dog-walking program (called "Dog Buddies") designed to address the need for evidence-based programs that create opportunities for people with cognitive disabilities to be more socially included in mainstream society. The research question was: Does community dog walking foster social interaction for people with cognitive disabilities? MATERIALS AND METHODS: Single-case experimental design was used with four individuals (three with intellectual disability; one with Acquired Brain Injury (ABI)) recruited via two disability service providers in Victoria. Target behaviours included frequency and nature of encounters between the person with disability and community members. Change was measured from baseline (five community meetings with a handler but no dog) to intervention period (five meetings minimum, with a handler and a dog). Semi-structured interviews, audio-recorded and transcribed verbatim, provided three participants' subjective experiences of the program. RESULTS: Dog Buddies increased the frequency of encounters for all participants. The presence of the dog helped to foster convivial encounters, community members were found to be more welcoming, and some participants were recognised or acknowledged by name over time in the intervention phase. CONCLUSIONS: The dog-walking program offered a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities.IMPLICATIONS FOR REHABILITATIONThe co-presence of people with disabilities in the community with the general population does not ensure social interaction occurs.Both disability policy, and the programs or support that is provided to people with disabilities, needs to have a strong commitment to the inclusion of people with disabilities in mainstream communities.Dog Buddies is a promising example of a program where the presence of a pet dog has been demonstrated to support convivial, bi-directional encounters of people with cognitive disabilities and other community members.Dog-walking offers a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities.

'Yes, I've got the job, but my challenge is keeping the job': an evaluation of a new pathway to open employment to meet the needs of people with acquired brain injury in Australia.

BACKGROUND AND OBJECTIVES: In Australia, people with disability continue to experience low employment rates (48%), compared to the national average (79%), and employment is even lower (30%) for people with acquired brain injury (ABI). This paper evaluates a pilot study of a new mainstream employment pathway following ABI, called Employment CoLab. METHOD: Employment CoLab was piloted across multiple industries using a mix of reasonable employer adjustments, insurance-funded supports and/or access to capacity-building supports. Semi-structured interviews were undertaken with four stakeholders; (1) Employees with ABI (n = 5, age 31-49 years, time since injury M(R) = 11(4-26) years); (2) Employers/co-workers (n = 3); (3) Allied health professionals/vocational providers (n = 4); and (4) Injury insurance funders who hold portfolio responsibility for disability employment (n = 5). An explorative economic evaluation was also conducted to compare the cost to the funder for Employment CoLab compared to traditional employment pathways. RESULTS: Employment CoLab offered a new approach for people with ABI to gain and sustain open employment. Four major themes were identified from participant interviews: valuing employment and diversity; barriers to mainstream employment; reflections on being employed; and being supported over time. The economic evaluation was unable to detect if the pathway was, or was not, less costly when compared to traditional employment pathways. CONCLUSIONS: Employment CoLab is a person-centred collaborative approach which, together with effective social disability insurance approaches, has built new opportunities for inclusive mainstream economic participation following ABI.

Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience.

BACKGROUND: Communication changes following acquired brain injury (ABI) may necessitate use of augmentative and alternative communication (AAC). Speech pathologists regularly assist people with ABI and their families with AAC assessment and recommendations, as well as education and training on AAC use. To date, there has been no Australian research investigating the perspectives of speech pathologists working in the field of ABI and AAC. This research aimed to 1) Explore speech pathologists' insights regarding enablers and barriers to considerations and uptake, and ongoing use, of AAC by people with ABI and 2) Understand their perspectives on AAC acceptance, abandonment and rejection. METHOD: A qualitative research design, with semi-structured interviews, was used with seven speech pathologists working across three Australian states. Interviews were transcribed verbatim, and thematically analysed. To triangulate results, the lived experience reflections of one co-author, who has an ABI and uses AAC, were drawn on. RESULTS: Seven themes were identified, relating to four of the five domains of the World Health Organization's assistive technology model. These included that AAC should be person-centred, with consideration of both products and personnel required, and with effective policy aiding AAC trial, uptake and use. CONCLUSION: This research has highlighted considerations for AAC use by people with ABI, from the perspective of speech pathologists and aided by lived experience reflections. Speech pathologists need to understand the breadth of products, and good practice service steps, to ensure successful AAC use and skill development. Listening to the perspectives of people with ABI is central to that understanding.

Behaviour support for people with acquired brain injury within the National Disability Insurance Scheme: an Australian survey of the provider market.

BACKGROUND AND OBJECTIVES: People with acquired brain injury (ABI) may experience behaviours of concern that require therapy services, including behaviour support. In Australia, the implementation of a National Disability Insurance Scheme (NDIS) and development of the NDIS Quality and Safeguards Commission, has led to significant changes to behaviour support workforce processes, and the way behaviour support is funded, regulated and delivered to people with ABI who are Scheme participants. The aim of this study was to explore the current and future provider market of professionals providing behaviour supports to Scheme participants who experience ABI. METHOD: An anonymous survey was designed and distributed via social media channels, an email listserv and professional association newsletters to professionals working within the NDIS in Australia. Data were analysed using descriptive statistics and content analysis. RESULTS: One hundred and two surveys responses were analysed. A majority of professionals had an average understanding of the NDIS Quality and Safeguard Commission rules and policies on behaviour support. Responses to current and future registration as an NDIS Practitioner indicated the workforce gap could increase by between 17 and 26%. Respondents also raised concerns about the lack of training and experience of allied health professional students and graduates in addressing behaviours of concern. Responses to the open-ended question highlighted additional issues in the provision of behaviour support within the NDIS. CONCLUSIONS: This research highlighted the need for an NDIS behaviour support workforce strategy and supply-side market intervention to ensure a viable and sustainable workforce for people with ABI who need behaviour support.

Australian public health COVID-19 messaging is missing its mark in some vulnerable communities and people who reject COVID-19 safety advice.

Background: There are groups in our community who may be more vulnerable to contracting, transmitting, or experiencing negative health impacts of COVID-19 than the general community. They may also have greater difficulty accessing, accepting, and acting upon COVID-19 public health information. Our aim was to understand if vulnerable communities and those who express "COVID-risk" behavioural intentions seek and respond differently to COVID-19 public health information. Methods: This observational, cross-sectional study recruited adults aged over 18 years from the Australian general community and six community groups (people with disabilities and their caregivers, Aboriginal and Torres Strait Islanders, aged care workers, street-based sex workers, refugees and asylum seekers, and the deaf and hard of hearing). We investigated attitudes and beliefs about COVID-19 public health messages. We identified factors associated with the respondent's perception of the ease of finding information and understanding it, and its relevance to them. We also examined latent classes that were developed based on attitudes to public health measures and vulnerable group categories, along with demographic variables. Results: We received 1444 responses (n = 1121 general community; n ≥50 for each vulnerable group). The vulnerable groups examined found COVID-19 public health messages as easy, if not easier, to find and understand than the general community. Four latent classes were identified: COVID-safe mask wearers (10% of sample), COVID-safe test takers (56%), COVID-risk isolators (19%) and COVID-risk visitors (15%). The COVID-risk classes (34% of sample) were less likely to consider COVID-19 information easy to find, understandable, and relevant. Conclusions: Additional public health messaging strategies may be needed for targeting people with "COVID-risk" beliefs and attitudes who appear across the community (general and vulnerable groups) rather than just targeting specific cultural or other groupings that we think may be vulnerable. COVID-risk classes identified through this study were not defined by demographic characteristics or cultural groupings, but were spread across vulnerable communities and the general community. Different approaches for tailoring and delivery of specific public health information for these groups are needed.

Housing and Support for People with Disability: Perspectives of Motor Accident, Disability and Injury Insurers across Australia and New Zealand.

Housing is a critical enabler of a dignified life, civic participation and the achievement of human rights. Providing appropriate housing for people who experience neurotrauma as a result of road or workplace injury, with both the assistive technology and human support required, continues however to be a policy and practice challenge. Australian and New Zealand motor accident, disability and injury insurers have high and enduring liability in this area, and their under-researched perspectives are needed to strengthen the evidence base for policy and practice development. This qualitative study utilised focus group methodology with representatives from government injury and disability insurers across Australia and New Zealand (n = 8). The study aimed to identify (a) issues and trends; (b) factors for decision making; and (c) service impacts relating to housing and support for people with disability and high daily support needs. Thematic analysis generated results across four key areas: influences on the decision to fund housing and/or support; identifying 'good' housing solutions; evaluating cost-benefit of housing and support investments; and developing future investment in housing and support. Findings such as those regarding decision-making, and investment, attest to the value of capturing the perspectives of this key group of stakeholders to assist to envision better housing and support for people with disability.

Factors influencing care and support for older adults with traumatic injury in Australia: a qualitative study.

PURPOSE: To investigate factors influencing provision of care and support to older adults with traumatic injury in Australia, from a health service and policy perspective. METHODS: Semi-structured interviews were undertaken with 16 clinicians, support providers, researchers, policy makers, and representatives from peak bodies in Australia, who had experience across injury, ageing, and disability sectors. A thematic analysis was performed using a framework approach. RESULTS: Themes identified included prolonged injury recovery in older adults, limited accommodation options, restricted access to preventive care, escalating care needs over time, issues with siloed funding schemes and funding availability, and the need for advocacy to coordinate care across different schemes. Certain themes were specific to people who were older when injured. Others related to people who had acquired an injury at a younger age and were ageing with injury. However, most themes had relevance for both groups. CONCLUSIONS: For older adults, this research has highlighted a range of cross-sector problems which impact upon the potential to recover from injury and to age well with injury. To improve the lives of older adults with injuries, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors, and improved advocacy and case management.Implications for rehabilitationTo address the lack of long-term, multi-disciplinary preventive care for age-related conditions and secondary complications in people with injuries, older adults may need more prolonged, or individualised, care following injury, episodic health checks, and a greater focus on long-term health care.Accessible and well-coordinated specialist housing and support responses, that offer timely access to health care professionals and carers trained in both ageing and disability, and enable greater support for "ageing in place", are required to manage changing care needs of people ageing with injury.There needs to be greater involvement of geriatricians, nurses, and allied health care professionals within the aged care sector in order to care for people with complex needs, including older adults with injury-related disability.To reduce gaps in care and support for injured older adults, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors.

Australian occupational therapists' knowledge of the purpose, scope, and funding of assistance dogs.

BACKGROUND: Assistance dogs, considered a form of assistive technology within Australia's National Disability Insurance Scheme (NDIS), can support scheme participants to achieve greater independence. To receive funding, an allied health assessment report (most often from occupational therapists) is required to justify the animal as a reasonable and necessary support. OBJECTIVES: Examine Australian occupational therapists' knowledge and perceptions of assistance dogs; NDIS funding of animal supports; and resources considered useful to guide occupational therapy assessment and report writing. METHOD: An online anonymous survey was developed and distributed via social media channels, an email listserv, and professional association newsletters to Australian occupational therapists. Data were analysed using descriptive and inferential statistics. Inductive content analysis of open-ended question responses provided additional insights regarding occupational therapists' knowledge, experiences, and information needs in relation to animal supports. RESULTS: One hundred forty-five completed surveys were received. A majority of participants had limited knowledge regarding the purpose, scope, and funding of assistance dogs. Only 14 participants had made a referral for an assistance dog for an NDIS participant. For the 36 participants who self-identified as having good or excellent knowledge of one or more types of assistance dogs, benefits included increasing users' independence, confidence, and quality of life. Although participants agreed they had suitable skills to prescribe assistance dogs, greater clarification regarding their role in the NDIS assessment, advisory, and application process was seen as necessary. CONCLUSION: This research highlighted the need for increased information for occupational therapists regarding the various types of assistance dogs and NDIS funding rules. The provision of NDIS reporting templates, practice guidance, and professional development resources-as well as occupational therapy curriculum for near-graduate therapists-could enhance knowledge, clinical reasoning, and practice when considering the most appropriate support and whether an assistance dog is both reasonable and necessary based on the person's goals and needs.

Access to Assistive Technology during the COVID-19 Global Pandemic: Voices of Users and Families.

The SARS COVID-19 pandemic emerged in 2019 and has impacted people everywhere. Disparities in impact and outcomes are becoming apparent for individuals and communities which go beyond the trajectory of the disease itself, influenced by the strength and weaknesses of systems of universal health care, and the actions of civil society and government. This article is one of a series exploring COVID-19-related experiences of assistive technology (AT) users across the globe and implications for AT systems strengthening. AT such as mobility products, braille devices, and information communication technologies are key enablers of functioning, necessary to the achievement of the UN Sustainable Development Goals and enshrined in the Convention on the Rights of Persons with Disabilities. Reporting on a survey of 73 AT users across six global regions, we demonstrate that minority groups already living with health inequities are unduly impacted. An AT ecosystem analysis was conducted using the WHO GATE 5P framework, that is, people, products, personnel, provision and policy. AT users and families call for inclusive pandemic responses which encompass their needs across the lifespan, from very young to very old. We offer specific recommendations for future action to strengthen access to AT across public policy and civil society in pandemic preparedness and response.