Exploring the Shared Meaning of Social Inclusion to Children with and without Disabilities.

AIMS: Perspectives of children with and without disabilities on social inclusion are seldom sought in the childhood disability literature, impeding the ability to provide inclusive experiences for all children. This qualitative study explored meaningful aspects of social inclusion from the perspectives of children with and without disabilities in an inclusive recreation program. METHODS: Drawing on the interpretive paradigm and subjectivity epistemology, this study adopted a generic qualitative methodological approach. Seventeen children with and without disabilities involved in the same inclusive recreation program participated in two semi-structured interviews. These interviews were analyzed using an inductive thematic analysis. RESULTS: Three key themes emerged and were interpreted as dimensions of social inclusion: contextual, intrapersonal, and interpersonal. The contextual dimension included the freedom to choose activities and receiving equal attention from staff. The intrapersonal dimension was characterized by psychological safety and group fellowship. The interpersonal dimension included having positive authentic interactions and giving/receiving help. CONCLUSIONS: These findings may influence future program development and implementation to promote inclusive experiences for all children.

Cognitive Orientation to daily Occupational Performance (CO-OP): A New Approach for Children with Cerebral Palsy.

AIMS: The results of a small single-case study series suggested that Cognitive Orientation to daily Occupational Performance (CO-OP) may be a successful approach for children with cerebral palsy (CP). Therefore a pilot randomized controlled trial was conducted with the following research questions-is CO-OP a feasible approach to use with children with CP, what are the effects of CO-OP when compared to usual practice, and is a larger study warranted? METHODS: 18 children between age 7 and 12 (nine in CO-OP group and nine in Current Usual Practice Approach (CUPA) group) received ten 1-hour sessions of intervention on average once per week at home. Primary outcome measures were the Canadian Occupational Performance Measure and the Performance Quality Rating Scale (PQRS). PQRS assessors were blind to group allocation and timing of assessment. RESULTS: All children in the CO-OP group were able to learn the strategies and achieve their chosen goals, thus demonstrating the feasibility of the approach. Both approaches equally promoted skill acquisition and skill maintenance at follow-up. Effect sizes suggest that CO-OP may show some advantage for transfer and maintenance. CONCLUSION: Based on these initial findings, further research is warranted.

Effect of cognitive intervention on children with ADHD.

Although not considered a diagnostic criterion in DSM-IV, motor difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD) are commonly reported. Prevalence of co-morbidity of ADHD and Developmental Coordination Disorder is as high as 50%. Cognitive Orientation to daily Occupational Performance (CO-OP) is a problem-solving approach originally developed for children with Developmental Coordination Disorder. In this approach, therapists support children to use cognitive strategies in a process of guided discovery to solve occupational performance problems. A single case experimental design (multiple baselines) was used to examine the influence of a 12-week intervention using CO-OP with six children with ADHD. Outcome measures included the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling and the Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP). The results of this study demonstrated improvements in both goals and motor performance in the participants due to the intervention. These results provide some support for the use of CO-OP with children with ADHD. Further research into the application of CO-OP with children with ADHD is warranted based on these preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties.

Analyzing international clinical education practices for Canadian rehabilitation students.

BACKGROUND: Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university. METHODS: In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research. RESULTS: Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing. CONCLUSIONS: International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

Becoming an occupational therapist: perceived influence of international fieldwork placements on clinical practice.

BACKGROUND: Many occupational therapy programs have augmented curricula to provide students with opportunities to engage in international fieldwork placements (IFPs). However, limited research exists exploring the perceived influence that IFPs may have on future occupational therapy roles and characteristics. PURPOSE: The purpose of this study is to explore how Canadian occupational therapists who participated in IFPs as students perceive the influence of their IFP experience on their subsequent practice. METHOD: Semistructured interviews were conducted with 20 occupational therapists who participated in IFPs as occupational therapy students. The interview guide was developed based on the Profile of Occupational Therapy Practice in Canada and relevant literature. A directed content analysis was used in conjunction with the DEPICT model of data analysis to guide the analysis process and summarize the results. FINDINGS: Participants described how IFPs nurtured the development of six skills, or active ingredients, which supported the development of competence in occupational therapy roles. IFPs were also perceived as providing a competitive edge. IMPLICATIONS: This study suggests that IFPs shape the development of competence in key practice skills and occupational therapy roles.

Expression of ALS-PFN1 impairs vesicular degradation in iPSC-derived microglia.

Microglia play a pivotal role in neurodegenerative disease pathogenesis, but the mechanisms underlying microglia dysfunction and toxicity remain to be elucidated. To investigate the effect of neurodegenerative disease-linked genes on the intrinsic properties of microglia, we studied microglia-like cells derived from human induced pluripotent stem cells (iPSCs), termed iMGs, harboring mutations in profilin-1 (PFN1) that are causative for amyotrophic lateral sclerosis (ALS). ALS-PFN1 iMGs exhibited evidence of lipid dysmetabolism, autophagy dysregulation and deficient phagocytosis, a canonical microglia function. Mutant PFN1 also displayed enhanced binding affinity for PI3P, a critical signaling molecule involved in autophagic and endocytic processing. Our cumulative data implicate a gain-of-toxic function for mutant PFN1 within the autophagic and endo-lysosomal pathways, as administration of rapamycin rescued phagocytic dysfunction in ALS-PFN1 iMGs. These outcomes demonstrate the utility of iMGs for neurodegenerative disease research and implicate microglial vesicular degradation pathways in the pathogenesis of these disorders.

Expression of ALS-PFN1 impairs vesicular degradation in iPSC-derived microglia.

Microglia play a pivotal role in neurodegenerative disease pathogenesis, but the mechanisms underlying microglia dysfunction and toxicity remain to be fully elucidated. To investigate the effect of neurodegenerative disease-linked genes on the intrinsic properties of microglia, we studied microglia-like cells derived from human induced pluripotent stem cells (iPSCs), termed iMGs, harboring mutations in profilin-1 (PFN1) that are causative for amyotrophic lateral sclerosis (ALS). ALS-PFN1 iMGs exhibited lipid dysmetabolism and deficits in phagocytosis, a critical microglia function. Our cumulative data implicate an effect of ALS-linked PFN1 on the autophagy pathway, including enhanced binding of mutant PFN1 to the autophagy signaling molecule PI3P, as an underlying cause of defective phagocytosis in ALS-PFN1 iMGs. Indeed, phagocytic processing was restored in ALS-PFN1 iMGs with Rapamycin, an inducer of autophagic flux. These outcomes demonstrate the utility of iMGs for neurodegenerative disease research and highlight microglia vesicular degradation pathways as potential therapeutic targets for these disorders.

The potential impact of experiencing social inclusion in recreation for children with and without disabilities.

PURPOSE: Inclusive recreation programs can have individual and community impacts for children with and without disabilities. However, studies that explore the impact of such programs on children's attitudes are mixed. The purpose of this study was to explore the perspectives of children with and without disabilities on the individual impact of an inclusive recreation program. MATERIAL AND METHOD: This study adopted a generic qualitative methodology. Interviews were conducted with participants between the ages of eight and 18 enrolled in the same program and each participant was interviewed twice. Inductive thematic analysis was used to analyze results. RESULTS: 17 participants were recruited for this study, which included nine children without disabilities (CWODs) and eight children with disabilities (CWDs). This study revealed five themes: a) CWODs have limited exposure to people with disabilities; b) CWODs and CWDs' hopes of change; c) CWODs learned how to interact with people with disabilities; d) CWODs reported greater perceived similarity in functional ability and hobbies/interests between themselves and CWDs, and; e) CWODs become more comfortable being around people with disabilities. CONCLUSIONS: This study helps broaden understandings of how inclusive experiences in recreation settings impact children with and without disability.IMPLICATIONS FOR REHABILITATIONChildren without disabilities can develop more positive attitudes toward children with disabilities in affective and cognitive domains after participating in an inclusive recreation program.Incorporating inclusive language into program design and implementation may promote positive attitudes toward diversity in recreation settings.Children without disabilities would benefit from more opportunities to interact with children with disabilities in unstructured, inclusive or integrated recreation settings.

Contextual strategies to support social inclusion for children with and without disabilities in recreation.

PURPOSE: Integrating children with and without disabilities in recreation programs is assumed to promote inclusion. How social inclusion is facilitated in recreation settings, however, is not fully known. This study aimed to explore how social inclusion is supported in a recreation program. MATERIALS AND METHODS: A generic qualitative methodology was adopted. Seventeen children with and without disabilities registered for the same program were recruited. This sample included eight children with disabilities and nine typically developing children between the age of eight and 17. Two semi-structured interviews and three, two-hour observation periods were conducted with each participant. Inductive thematic analysis was used to analyze interview and observation data. RESULTS: This study revealed five themes that support meaningful aspects of social inclusion from participants' perspectives: (a) creating opportunities for children to communicate their interests and desires; (b) providing opportunities to choose self-directed activities; (c) strategically selecting and placing objects to support interactions between children with and without disabilities; (d) directly encouraging interactions between children with and without disabilities, and; (e) Having relatively equal numbers of children with and without disabilities. CONCLUSIONS: This study facilitates a better understanding of how meaningful inclusion experiences can be facilitated in recreation settings.Implications for rehabilitationParticipation in recreation programs that implement inclusive strategies could mitigate social isolation and loneliness for children with disabilities.Children with and without disabilities may experience greater sense of inclusion when recreation programs adopt a process-oriented and child-driven approach.Staff play a critical role in implementing inclusive strategies such as establishing group communication competency between children with and without disabilities, which could be supported by staff training.

Reported sensory processing of children with Down syndrome.

Investigators have identified delays and differences in cognitive, language, motor, and sensory development in children with Down syndrome (DS). The purpose of this study was to determine the parent-reported frequency of sensory processing issues in children with DS aged 3­10 years, and the parent-reported functional impact of those sensory issues. Parents completed the short sensory profile (SSP) and a parent questionnaire (PQ). SSP results revealed a total score definite difference rate of 49%. Highest rates of probable and definite difference were in the low energy/weak, underresponsive/seeks sensation, and auditory filtering subsections of the SSP. Themes were generated from responses on the PQ regarding the functional impact of sensory differences on occupational performance in their children with DS, and related strategies currently used by parents. Findings from the study provide information to parents and health care professionals regarding sensory processing patterns in children with DS, and provide foundational data for future research.

Understanding rehabilitation in Ukraine from the perspective of key informants.

Background: The evolution of healthcare in Ukraine has been impacted by a number of factors, including years of communist control followed by the birth of an emerging democracy and most recently, conflict in the eastern part of the country. Rehabilitation is an aspect of Ukraine's healthcare system that is still heavily influenced by the Soviet-era mentality of perfectionism.Methods: This article presents the results of a qualitative research study that undertook 13 key informant interviews to answer the question of what can be learned from the perspectives of individuals in Ukraine or with experience working in Ukraine with respect to developing and implementing appropriate rehabilitation that is inclusive and targets health equity.Results: Key themes that informants determined will affect the future of rehabilitation in Ukraine include the current health care structure, the culture surrounding disability, international and domestic sources of involvement, and a revised curriculum for new and existing rehabilitation professionals.Conclusions: The input from these individuals, supported by evidence from the literature, provides a foundational understanding of the currently fragmented rehabilitation system in Ukraine and the factors that professionals prioritize as integral components of an infrastructure that supports rehabilitation in the twenty-first century.Implications for RehabilitationWhile the recent conflict in Eastern Ukraine has served as a lightning rod to shed light on the lack of resources allocated toward disability and chronic care in the region, rehabilitation is also lacking in the general population, requiring a response that addresses the unique needs of a population of over 44 million individuals.Alongside a curriculum that complies with international accreditation standards, an influx of job and career opportunities developed by the government is needed to encourage individuals to work in the rehabilitation sector.A nation-wide strategy must be developed to disseminate knowledge about disability and rehabilitation in order to begin to address the issues of social exclusion and stigma associated with disability in many post-Soviet countries.

Engagement in community life: perspectives of youths with intellectual and developmental disabilities on families' roles.

Purpose: The main objectives of this study were to learn from youths with intellectual and developmental disabilities about the ways their families were involved in their engagement in community life and to capture how they felt about such involvement.Method: The current study is a secondary analysis of a larger study, the Voices of Youths Research Project, framed by inclusive research methods. Thirty-eight semi-structured interviews that discussed perspectives on friendship, social inclusion, and quality of life from 20 participants (ages 13 to 24 years) were included in this paper. All interviews were video-recorded and coded using NVivo 10. Thematic analysis of the coded segments was guided by a constructivist grounded theory approach.Results: Three major themes emerged from the experiences of youths with intellectual and developmental disabilities on family involvement in their social and community engagement: (1) complex of supports and influences, (2) community engagement with and through family, and (3) points of tension.Conclusions: These thematic findings offer insights into the lived experiences of youths with intellectual and developmental disabilities about engagement in community life. These findings provide an understanding, outside of conventional schemas, of transition into young adulthood for these youths.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals often work with youths with intellectual and developmental disabilities who face barriers to reaching transition goals identified either by themselves or others.Family members' views that may focus on goals of maximizing functional independence and/or decreasing caregiver demands can often overshadow the goals or views of youths with intellectual and developmental disabilities themselves.Rehabilitation professionals should find ways to explore with youth their family's roles in engagement and belonging in community life so that they can link youths to appropriate community resources and plan optimal interventions/programs.Rehabilitation professionals need to be aware of and respond to points of tension that can emerge between youths with intellectual and developmental disabilities and their family during transition.

Therapists' experience of the cognitive orientation to daily occupational performance (CO-OP) approach: Shifting from conventional practice.

Background: The CO-OP ApproachTM has been increasingly used in research and practice, yet its critical elements and implementation challenges are largely undescribed. Obtaining therapists' perspectives on CO-OP may reveal insights into potential critical and mediating factors.Aim/Objective: To explore the experiences of CO-OP therapists by understanding their perceptions on the approach compared with conventional practice, and by identifying mediating factors in its implementation.Material and Method: This exploratory study utilized a qualitative descriptive design. A purposive sample of occupational therapists (n = 3) was interviewed. Data were analyzed using thematic analysis and themes were validated within a focus group.Results/Findings: Three themes were identified: 'CO-OP works,' 'CO-OP delivery is mediated by contextual factors,' and 'CO-OP shifts the therapeutic approach.' Therapists perceived CO-OP to be efficacious for client-centred goal attainment. Guided discovery and the problem-solving strategy were identified as unique and challenging CO-OP elements. Mediating factors such as level of cognitive impairment and quality of family member involvement may affect CO-OP efficacy.Conclusions: Therapists found CO-OP to be efficacious and adopted unique elements into their professional approaches.Significance: This is the first study to investigate CO-OP therapists' experiences. Future research is recommended to enhance training of therapists in key CO-OP features.

Disability in low-income countries: issues and implications.

This article reports on a study conducted for the Canadian International Development Agency by The International Centre for Disability and Rehabilitation at the University of Toronto. We critically examined the broad literature in the area of disability and development and in this article we identify the key issues which emerged. Most of the data were collected from existing literature in the academic and practice settings and from the publications of key NGOs and governments. We first, examine disability in the context of low-income countries, and then discuss key critical issues: disability and poverty, disability and health, disability and education, disability and gender, disability and children/youth, disability and conflict/natural disasters and disability and human rights. In all these areas we find reports of discrimination, stigmatisation and marginalisation. We conclude that, as we address issues of multi-cultural disability services in developed countries, it is important to bear in mind the various issues that many people with disabilities and their families bring with them as the result of immigrating from a developing country. Although we address these issues within our own countries, we must bear in mind the changes that are occurring due to globalisation.

Everyday memory difficulties in children and adolescents with Fetal Alcohol Spectrum Disorder.

Purpose: To investigate whether significant differences exist in everyday memory between youth with Fetal Alcohol Spectrum (FASD) compared with a nonexposed (NE) control group, while controlling for socioeconomic status and other comorbidities. Methods: Caregiver ratings using the Everyday Memory Questionnaire were obtained for 105 youth (9-17 years of age). Scores were compared between youth with a FASD diagnosis (N = 41; 56% male) and the NE group (N = 64; 53% male) using multivariate analysis of variance. Results: Significantly poorer scores were found across all domains of everyday memory in youth with FASD (p<0.01 for all comparisons). Findings maintained significance after controlling for group differences in socioeconomic status, presence of learning, and attention disorders, as well as exposure to other teratogens. Conclusions: This study provides important insights regarding the memory issues that underlie daily functional challenges faced by youth with FASD and the need for future intervention research.

Factors impacting participation in sports for children with limb absence: a qualitative study.

BACKGROUND: Individuals with limb absence benefit from participating in sports. While barriers and facilitators affecting sport participation are well documented for adults, they have not been explored for children with limb absence. PURPOSE: To identify the perceived factors impacting participation in sports according to children with limb absence and their parents. METHODS: This study uses a descriptive qualitative study design. Nineteen participants, consisting of children and their parents, were recruited from an outpatient hospital clinic for semi-structured interviews. The 11 interviews were audio recorded and transcribed. Transcripts were then coded and analyzed using the DEPICT model. The thematic analysis was guided by the International Classification of Functioning, Disability, and Health framework. RESULTS: Analysis of our participant interviews identified six themes as having an influence on sport participation: "functionality of prosthesis", "plan in advance", "know what I can do" (understanding capabilities), "it's like every stroke, 2 million questions" (stigma and the social environment), "love for the game" (love for sport), and "these things are an investment" (the investment involved). CONCLUSIONS: The findings have the potential to inform the development and implementation of strategies to increase levels of participation in sports among children with limb absence. Information from this study may help to deepen the rehabilitation team's understanding of factors that impact engagement in sports among children with limb absence. Implications for Rehabilitation Children with limb absence present with unique barriers and facilitators to participating in sports, thus, what may be a facilitator or barrier for one child may not for another. Strategies to increase a child's participation in sports should consider both person and environmental factors. Rehabilitation professionals can play a crucial role in educating both families and the community on living and coping with a limb difference, services and community supports available, and the use of specialized prosthesis and attachments for sport participation.

Investigating a theatre-based intervention for Indigenous youth with fetal alcohol spectrum disorder: Exploration d'une intervention basée sur le théâtre auprès de jeunes Autochtones atteints du syndrome d'alcoolisme fœtal.

BACKGROUND: Theatre-based interventions use artistic media to facilitate social and emotional awareness and have therapeutic benefits for persons with developmental disabilities and mental health problems. The role of these interventions with Indigenous youth who have emotional, behavioural, and cognitive sequelae related to fetal alcohol spectrum disorder (FASD) has not been explored. PURPOSE: The purpose of this study was to explore the experiences and acceptability of a theatre-based approach for facilitating social communication and engagement in youth with FASD. METHOD: Participants were three Indigenous youth with FASD. A qualitative exploration of the experiences and acceptability of the intervention was conducted via focus groups held 2 weeks post-program participation with the participants, their caregivers, and program facilitators. The transcripts were analyzed using an inductive thematic approach. FINDINGS: Our results identified perceived postintervention improvements in participants' development of self-esteem, social skills, and emotional awareness. IMPLICATIONS: A theatre-based arts intervention has the potential to support improvements in social skills for youth with FASD.

Expert consensus on best evaluative practices in community-based rehabilitation.

PURPOSE: The objective of this study was to generate expert consensus on best evaluative practices for community-based rehabilitation (CBR). This consensus includes key features of the evaluation process and methods, and discussion of whether a shared framework should be used to report findings and, if so, which framework should play this role. METHOD: A Delphi study with two predefined rounds was conducted. Experts in CBR from a wide range of geographical areas and disciplinary backgrounds were recruited to complete the questionnaires. Both quantitative and qualitative analyses were performed to generate the recommendations for best practices in CBR evaluation. RESULTS: A panel of 42 experts reached consensus on 13 recommendations for best evaluative practices in CBR. In regard to the critical qualities of sound CBR evaluation processes, panellists emphasized that these processes should be inclusive, participatory, empowering and respectful of local cultures and languages. The group agreed that evaluators should consider the use of mixed methods and participatory tools, and should combine indicators from a universal list of CBR indicators with locally generated ones. The group also agreed that a common framework should guide CBR evaluations, and that this framework should be a flexible combination between the CBR Matrix and the CBR Principles. CONCLUSIONS: An expert panel reached consensus on key features of best evaluative practices in CBR. Knowledge transfer initiatives are now required to develop guidelines, tools and training opportunities to facilitate CBR program evaluations. IMPLICATIONS FOR REHABILITATION: CBR evaluation processes should strive to be inclusive, participatory, empowering and respectful of local cultures and languages. CBR evaluators should strongly consider using mixed methods, participatory tools, a combination of indicators generated with the local community and with others from a bank of CBR indicators. CBR evaluations should be situated within a shared, but flexible, framework. This shared framework could combine the CBR Matrix and the CBR Principles.

Children with disabilities in low-income countries.

Disability is a major public health concern worldwide and the situation for children with disabilities is even more serious. The present article will focus on the issue of children with disabilities in low-income countries. Approximately one-third of the world's disabled population is children and many of these disabling conditions are preventable. In Africa, one the foremost causes of disability is infectious and communicable disease; the incidence of these diseases have been greatly reduced or eliminated in higher income countries. Other causes include war, trauma, accidents, and congenital and noninfectious diseases. The recent HIV/AIDS epidemic has further contributed to the prevalence of disability because many people living with HIV develop different types of impairments and functional limitations. Community-based rehabilitation is one approach that has been used in many low-income countries and which often focuses on children and their families. The work of one organization providing community-based rehabilitation in Tanzania is highlighted. The experiences of the coauthors in their work in Tanzania provide some field examples. For those readers who would like to become involved in international health, opportunities for engagement are described, including short-and long-term volunteer service or research experiences.

The influence of environmental and personal factors on participation of lower-limb prosthetic users in low-income countries: prosthetists' perspectives.

PURPOSE: To examine the environmental and personal factors in low-income countries (LICs) that influence prosthetic rehabilitation of adults with lower-limb (LL) amputations and their ability to participate in daily activities. METHODS: In this qualitative descriptive study, 11 prosthetists participated in semi-structured interviews by telephone or Skype. Qualitative thematic analysis was guided by the International Classification of Function. RESULTS: Facilitating continuity of care, consideration of physical environments and usage, prosthetic quality including durability and socket fit, and minimizing the visibility of disability, were found to be important factors affecting the provision of prosthetic services in LICs. CONCLUSIONS: Environmental and personal factors must be considered when providing prosthetic rehabilitation for adults with LL amputations in LICs in order to optimize participation in activities. Results from this study provide new insights about some of the factors that influence the ability of individuals with LL amputations to rehabilitate to a level where they are able to participate in meaningful activities within their communities. IMPLICATIONS FOR REHABILITATION: There are unique environmental and personal components that can influence activity and participation of lower-limb (LL) prosthetic users in low-income countries (LICs). These components are often overlooked in the design of prosthetic devices and provision of prosthetic services. Continuity of care, condition of the post-surgical residuum, outdoor environments of common occupations, aesthetics and durability of prostheses, and user comfort should all be considered when providing prosthetic rehabilitation to adults with LL amputations in LICs to promote activity and participation. Results of our study can inform the practice of prosthetists in LICs by highlighting their contributions in enabling participation for LL prosthetic users. Our results can also inform the design of durable and comfortable prostheses and the provision of more appropriate prosthetic rehabilitation to LL prosthetic users in LICs to facilitate and optimize participation.