Domestic Dogs and Horses as Sentinels of Per- and Polyfluoroalkyl Substance Exposure and Associated Health Biomarkers in Gray's Creek North Carolina.

Central North Carolina (NC) is highly contaminated with per- and polyfluoroalkyl substances (PFAS), in part due to local fluorochemical production. Little is known about the exposure profiles and long-term health impacts for humans and animals that live in nearby communities. In this study, serum PFAS concentrations were determined using liquid chromatography high-resolution mass spectrometry and diagnostic clinical chemistry endpoints were assessed for 31 dogs and 32 horses that reside in Gray's Creek NC at households with documented PFAS contamination in their drinking water. PFAS were detected in every sample, with 12 of the 20 PFAS detected in ≥50% of samples from each species. The average total PFAS concentrations in horses were lower compared to dogs who had higher concentrations of PFOS (dogs 2.9 ng/mL; horses 1.8 ng/mL), PFHxS (dogs 1.43 ng/mL, horses < LOD), and PFOA (dogs 0.37 ng/mL; horses 0.10 ng/mL). Regression analysis highlighted alkaline phosphatase, glucose, and globulin proteins in dogs and gamma glutamyl transferase in horses as potential biomarkers associated with PFAS exposure. Overall, the results of this study support the utility of companion animal and livestock species as sentinels of PFAS exposure differences inside and outside of the home. As in humans, renal and hepatic health in domestic animals may be sensitive to long-term PFAS exposures.

Promoting capacities for future adult roles and healthy living using a lifecourse health development approach.

Purposes: First, to describe how young adults with cerebral palsy (CP) experience lifecourse health development, and second, to create key messages for pediatric health service providers to promote children's capacities for future adult roles and healthy adult living.Methods: Interpretive description qualitative design. Participants were a purposive sample of 23 young adults with CP, 25-33 years of age, who varied in functional abilities, education, living, and work situations. Three experienced interviewers conducted 50-60 min interviews. Transcripts were analyzed to identify themes. Subsequently, a one-day meeting was held with an advisory group to inform our interpretive description of key messages.Results: Four themes emerged from the interviews: personal lifecourse, contexts for healthy living, health development through everyday experiences, and healthy living as an adaptive process. Key messages for service providers are: (a) address healthy living across the lifecourse, (b) focus on contexts of healthy living, (c) focus on everyday experiences and experiential learning, and (d) pay attention to the timing of opportunities and experiences.Conclusion: The findings provide first steps toward adoption of an approach to lifecourse health development for individuals with CP that emphasizes physical, mental, and emotional wellbeing and goals for desired social participation over the lifecourse.Implications for rehabilitationYoung adults with cerebral palsy experience lifecourse health development as a personal ongoing and dynamic process occurring in many contexts.Individuals with cerebral palsy continually adjust to changing contexts (adaptive process).Everyday experiences and experiential learning enable individuals with cerebral palsy to develop capacities for current and future healthy living including social participation."Timing" of opportunities and experiences is important for health development.

Using the ICF in transition research and practice? Lessons from a scoping review.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) and subsequent ICF-CY (child and youth version) recognize the importance of personal and environmental factors in facilitating holistic transition planning and service delivery for youth with chronic health conditions (YCHC). AIMS: The objective of this scoping review is to investigate the degree to which the ICF and ICF-CY have been used in transition research and practice since its initial publication. METHODS: Arksey and O'Malley's five-stage methodological framework guided the scoping review using the following databases: AMED, CINAHL, EMBASE, HealthSTAR, MEDLINE, and PsycINFO. Keywords included: 'ICF', 'ICF-CY', and 'transition', which were adapted to each database. RESULTS: 25 articles met final inclusion. Two key themes emerged regarding use of the ICF: 1) the ICF enhances transdisciplinary processes to inform transition planning and interventions; and 2) the ICF facilitates comprehensive and developmentally appropriate transition services over a youth's lifecourse. The strengths and limitations of the ICF in guiding the planning and delivery of transition services are discussed. Some limitations include the large number of items inherent within the ICF and a lack of clarity between the components of activity and participation. CONCLUSION: Key recommendations include: i) further explanation and development of items for quality of life and well-being, personal factors, and psychological issues; and ii) additional research to advance knowledge towards developing empirically- based evidence for the application of the ICF in clinical practice to facilitate transition.

A transactional framework for pediatric rehabilitation: shifting the focus to situated contexts, transactional processes, and adaptive developmental outcomes.

PURPOSE: A paradigm shift is taking place in pediatric rehabilitation research, practice, and policy - a shift towards the real-life contexts of clients rather than requiring clients to navigate the world of pediatric rehabilitation. This article proposes a conceptual framework to bring about a broader awareness of clients' lives and transactional processes of change over the life course. METHOD: The framework draws attention to transactional processes by which individuals, situated in life contexts, change and adapt over the life course and, in turn, influence their contextual settings and broader environments. This framework is based on (a) basic tenets derived from foundational theories taking a life course perspective to change, and (b) transactional processes identified from relevant pediatric rehabilitation models that bring these foundational theories into the pediatric rehabilitation sphere. RESULTS: The framework identifies three types of transactional processes relevant to pediatric rehabilitation: facilitative, resiliency, and socialization processes. These processes describe how contexts and people mutually influence each other via opportunities and situated experiences, thus facilitating capacity, adaptation to adversity, and socialization to new roles and life transitions. CONCLUSIONS: The utility of the framework is considered for research, practice, service organizations, and policy. Implications for Rehabilitation The framework supports practitioners going beyond person and environment as separate entities, to provide services to the "situated person" in real-life contexts The framework shifts the focus from "body structures/functions" and "person in activity" to "person in changing and challenging life contexts" Working from a transactional perspective, practitioner-client conversations will change; practitioners will view client situations through a lens of opportunities and experiences, assess client experiences in real-life contexts, and strive to create context-based therapy opportunities The framework suggests the benefit of greater focus on resiliency processes to support client self-efficacy, self-determination, and autonomy, and socialization processes to enhance ability to enact new life roles at times of transition.

Life course health development of individuals with neurodevelopmental conditions.

The life course health development (LCHD) model by Halfon et al. conceptualizes health development occurring through person-environment transactions that enable well-being and participation in desired social roles throughout life, areas that have not received adequate attention in healthcare. The aim of this 'perspectives' paper is to apply the six core tenets of the LCHD model and the concept of health development trajectories to individuals with lifelong neurodevelopmental conditions. We share the perspective that modifiable aspects of the environment often restrict health development; we then advocate that children, beginning at a young age, should engage in 'real-world' experiences that prepare them for current and future social roles. LCHD encourages future planning from the outset, continuity of care between pediatric and adult systems, and coordination of services and supports. We believe LCHD can be transformative in enabling healthy living of individuals with neurodevelopmental conditions.

Residential immersive life skills programs for youth with disabilities: service providers' perceptions of change processes.

BACKGROUND: Residential immersive life skills (RILS) programs are designed to equip youth with physical disabilities with the foundational life skills required to assume adult roles. The objective was to determine RILS service providers' perceptions of the active ingredients of the intervention change process. METHODS: Thirty-seven service providers from various disciplines completed measures to assess expertise status and participated in qualitative interviews. Qualitative themes were derived, and similarities and differences in themes were identified for blinded groups of novices, intermediates, and experts. RESULTS: The three main themes, reflecting change processes, were: (a) creating a supportive program atmosphere with multiple opportunities for learning, (b) using strategies to support, encourage, and engage youth, and (c) intentionally fostering youth experiences of skill development, social interaction, and pride in accomplishment. In contrast to the novices, experts displayed a more holistic perspective and paid attention to higher-order issues such as providing opportunities and enabling youth. CONCLUSION: The findings indicate how RILS service providers work to create a program atmosphere and employ strategies to intentionally foster particular youth experiences. The findings explicate service providers' theories of practice, the intentional design of RILS program environments to bring about client change, and the value of service provider expertise. Implications for Rehabilitation Service providers of youth independence-oriented life skills programs can intentionally create a learning-oriented and supportive program atmosphere by using non-directive, coaching/guiding, and engagement strategies Youth experiences of skill development, shared experience with others, and pride in accomplishment can be cultivated by providing a range of learning opportunities, including choice making, problem-solving, and skill mastery Compared to more novice service providers, experts discussed managing the program conditions and context, creating opportunities for choice and new experiences, and adopting a facilitating and enabling role (coaching and capitalizing on teachable moments).

Residential immersive life skills programs for youth with disabilities: service providers' perceptions of experiential benefits and key program features.

PURPOSE: The objective was to determine service providers' perceptions of the experiential benefits of residential immersive life skills (RILS) programs for youth with disabilities, along with important program features. METHODS: Thirty-seven service providers from three RILS programs took part in qualitative interviews. Themes were derived using a phenomenological approach. RESULTS: There were perceived benefits for youth, and also for parents and service providers. Study themes concerned the process of youth empowerment, life-changing experiences for youth and parents, and changed service provider views affecting practice. Youth changes were attributed to the residential group format and afforded opportunities, which included being away from home, navigating public transportation, directing attendant services, and sharing intense learning and social experiences with peers. Youth were seen to experience important personal changes in life skills, self-confidence, self-understandings, and self-advocacy. Perceived benefits for parents included realizations concerning their child's abilities and new hope for the future. Service providers indicated changes in their knowledge, perspectives, and approach to practice. CONCLUSIONS: The findings suggest that life skills programs should be intentionally designed to provide challenging experiential opportunities that motivate youth to engage in new life directions by providing new insights, self-realizations, and positive yet realistic views of the future. IMPLICATIONS FOR REHABILITATION: Service providers indicated the importance of challenging, real-world experiential opportunities that provide youth with disabilities with new insights, self-realizations, and positive yet realistic views of the future. Important experiential opportunities for youth included being away from home, navigating public transportation, directing attendant care, and sharing intense learning and social experiences with peers. The findings provide preliminary qualitative evidence that life skills programs should be intentionally designed to provide experiential opportunities that equip youth with knowledge, skills, and confidence, and motivate them to engage in new life directions. Service providers indicated important changes to their practice as a result of their involvement in a RILS program, including adopting a more holistic and facilitative approach to practice.

Complexities during transitions to adulthood for youth with disabilities: person-environment interactions.

PURPOSE: The purpose of this qualitative study was to explore the experiences of youth with different disabilities from across Canada during their transitions from adolescence to adulthood. METHODS: Qualitative methods, using a phenomenological tradition, explored the meaning of the lived experiences of youth with disabilities in transition to adulthood. Purposeful sampling was used to select people with a range of experiences, background, location and demographic characteristics. Individual interviews with key informants and a focus group with an "expert panel" of participants were the methods of data collection. Data analysis was iterative and followed established practices of phenomenology. RESULTS: Over 50 people, including youth with different disabilities, parents/caregivers and service providers from different organizations and systems across Canada participated in individual and/or focus group interviews. An overarching theme of "complexities" emerged from the data analysis. Complexities were related to the interactions between person and environment during transition experiences. Six subthemes about complexities were explored in depth to describe the primary person-environment interactions that were identified by study participants. CONCLUSIONS: The complexities involved in the interactions between person and environment during transitions to adulthood appear to be similar for youth with different types of disabilities. Recommendations are provided to address these complexities using holistic and collaborative approaches in service delivery and future research. Implications for Rehabilitation The complexities involved in transitions to adulthood appear to be similar for youth with different types of disabilities. Rehabilitation service providers can address these complexities using holistic, strengths-based and collaborative approaches. Service providers and researchers in rehabilitation need to acknowledge the interactions between person and environment rather than addressing each component separately. Future research should include youth, families and community members on research teams to ensure that complexities are adequately addressed.

Perspectives on the International Classification of Functioning, Disability, and Health: Child and Youth version (ICF-CY) and occupational therapy practice.

UNLABELLED: Classifying disability for children and youth has typically meant describing a diagnosis or developmental lag. The publication of the International Classification of Functioning, Disability and Health: Child & Youth version (ICF-CY) marks a global paradigm shift in the conceptualization and classification of childhood disability. Knowledge and awareness of the ICF-CY has been slow to diffuse within occupational therapy. PURPOSE: The purpose of this paper is to foster the integration of the ICF-CY into occupational therapy practice with children and youth. KEY ISSUES: Research describes positive trends in using the ICF-CY for cross-disciplinary communication; further clarity and development is warranted around activity and participation categories and functional profiles. IMPLICATIONS: Occupational therapy can contribute to the evolution of the ICF-CY, but must clarify its complementary perspective and knowledge base. If the ICF-CY can be further integrated into occupational therapy systems, it holds promise for shifting practice patterns and creating professional opportunities.

Social participation of adolescents with cerebral palsy: trade-offs and choices.

This article reports on the findings of a qualitative study about the experiences and perceptions of adolescents with cerebral palsy (CP) in relation to social participation. A phenomenological approach was used to interview 10 adolescents with CP, 17 to 20 years of age, selected using purposeful sampling. An iterative process of data collection and analysis resulted in four themes about social participation. The themes of experience, barriers, and supports, and tradeoffs supported the current view of participation as a dynamic interaction between person and environment. The fourth theme of making choices described the unique challenges facing adolescents with CP in terms of deciding what was most important and meaningful to them now and in their future. Health care professionals can support adolescents as they develop the capacity to make their own decisions during the transition to adult living by ensuring that assessments and interventions address social participation.

Exploring issues of participation among adolescents with cerebral palsy: what's important to them?

The purpose of this cross-sectional study was to determine what participation issues are important to adolescents with cerebral palsy (CP). Two hundred and three adolescents with CP (mean age 16.0 ± 1.8 years) were assessed using the Canadian Occupational Performance Measure (COPM). This was done through semistructured interviews by trained physical and occupational therapists. Adolescents responded either directly (n = 144) or through a parent or a caregiver (n = 59) if they were unable to communicate. Issues were extracted from completed questionnaires and coded under three COPM categories (self-care, productivity, and leisure) and 16 subcategories. There was no association between the total number of issues identified and gender (p = .99), age (p = .88), type of respondent (adolescents versus parent) (p = .27), Gross Motor Function Classification System (GMFCS) level (p = .93), or 66-item Gross Motor Function Measure (GMFM-66) score (p = .45). The issues identified most frequently were related to active leisure (identified by 57% of participants), mobility (55%), school (48%), and socialization (44%). Interventions aimed at improving participation among adolescents with physical disabilities, such as CP, should be directed towards these four key areas. Health care professionals should also recognize and consider the interaction of person and environment when addressing issues related to participation.

Becoming and staying physically active in adolescents with cerebral palsy: protocol of a qualitative study of facilitators and barriers to physical activity.

BACKGROUND: Adolescents with cerebral palsy (CP) show a reduced physical activity (PA). Currently there are no interventions for adolescents with CP in this critical life phase that optimise and maintain the individuals' physical activity in the long term. To develop such a program it is important to fully understand the factors that influence physical activity behaviours in adolescents with CP. The aim of this study is to explore what makes it easy or hard for adolescents with CP to be and to become physically active. METHODS/DESIGN: A qualitative research method is chosen to allow adolescents to voice their own opinion. Because we will investigate the lived experiences this study has a phenomenological approach. Thirty ambulatory and non-ambulatory adolescents (aged 10-18 years) with CP, classified as level I to IV on the Gross Motor Function Classification System and 30 parents of adolescents with CP will be invited to participate in one of the 6 focus groups or an individual interview. Therapists from all Children's Treatment Centres in Ontario, Canada, will be asked to fill in a survey. Focus groups will be audio- and videotaped and will approximately take 1.5 hours. The focus groups will be conducted by a facilitator and an assistant. In preparation of the focus groups, participants will fill in a demographic form with additional questions on physical activity. The information gathered from these questions and recent research on barriers and facilitators to physical activity will be used as a starting point for the content of the focus groups. Recordings of the focus groups will be transcribed and a content analysis approach will be used to code the transcripts. A preliminary summary of the coded data will be shared with the participants before themes will be refined. DISCUSSION: This study will help us gain insight and understanding of the participants' experiences and perspectives in PA, which can be of great importance when planning programs aimed at helping them to stay or to become physically active.

Advocacy in occupational therapy: exploring clinicians' reasons and experiences of advocacy.

BACKGROUND: Occupational therapy literature encourages therapists to advocate, yet any member of the team could advocate with/for people with disabilities. There is a need to determine why occupational therapists provide these services and how they learn to advocate. PURPOSE: The objective of this article is to understand the meaning of advocacy for occupational therapists by exploring their reasons for advocating. METHODS: Interpretive phenomenology and the social model of disability were used to interview 13 occupational therapists about their advocacy experiences. Data analysis was completed using a Gadamerian-based approach. FINDINGS: Occupational therapists advocate for a number of reasons; some relate to themselves, some relate to clients, and others relate to both. Learning about advocacy may be understood as taking place on a continuum of time. IMPLICATIONS: The occupational therapist's unique reason for advocating is to facilitate the client's occupational performance. A new definition of advocacy is presented based on study findings.

Transition to adult services for young people with disabilities: current evidence to guide future research.

This article outlines the evidence upon which best practice guidelines for transition to adulthood for young people with physical and developmental disabilities were developed in Ontario, Canada, through consensus activities. Evidence was gathered from published and unpublished literature and focus groups with young people, parents, community members, service providers and policy makers across the province. The evidence was then synthesized and analyzed by an expert panel. Guidelines were developed in the areas of collaboration, capacity-building, information, education, and research. This article focuses on the findings of this project as they relate to transition services and care. These best practice guidelines for the transition to adulthood for young people with disabilities offer a starting point to encourage service providers to work collaboratively with young people, parents, communities, governments, and researchers. The evidence from this project supports a move away from purely service-driven models of transition to holistic, lifecourse/lifespan approaches. Recommendations for future study and collaborative knowledge dissemination are provided.

Mobility experiences of adolescents with cerebral palsy.

The purpose of this study was to describe how youth with cerebral palsy experience mobility in their daily lives using a phenomenological approach. The participants were 10 youth with cerebral palsy, 17 to 20 years of age, selected using purposeful sampling with maximum variation strategies. A total of 14 interviews were completed. Transcripts were analyzed for key concepts and themes. Credibility was established through triangulation of researchers and member checking. Participants viewed mobility as important for self-sufficiency. Youth who walked and also used wheeled mobility spoke of making choices. Safety and efficiency were important considerations when making choices. Some participants had mobility preferences at home that may not be safe, practical, or socially appropriate at school or in the community. Youth spoke of constantly adapting to situations that often reflected a lack of control over the environment. Youth indicated the need for constantly planning ahead to go places and do things. Most participants were dependent on others for transportation and expressed dissatisfaction with public transportation. Safe and efficient mobility to enable participation in daily activities appears to be the primary concern of youth with cerebral palsy.

Life experiences of young adults who have coordination difficulties.

BACKGROUND: Little is known about the impact of developmental coordination disorder (DCD) during adolescence and young adulthood. PURPOSE: This study explored the lived experiences of a nonclinical sample of nine university students who reported having significant coordination difficulties. METHODS: A phenomenological approach was used that included two in-depth interviews asking participants to recall retrospectively their experiences throughout adolescence. Transcripts were coded to identify themes, and member-checking supported the credibility of findings. FINDINGS: Strong pathways of resilience were found with participants who employed cognitive and behavioural strategies to manage their motor differences. Key themes emerged related to managing coordination differences including avoidance/withdrawal/adaptation, seeking compatible activities, using humour, and persevering. As adolescents matured, changing social contexts affected their self-efficacy and others' perceptions of them. IMPLICATIONS: The findings of this study challenge occupational therapists to move beyond impairment-based interventions to ecological interventions that facilitate social and community participation.