Access to physical activity promotion for people with neurological conditions: Are physical therapists leading the way?

BACKGROUND: People with neurological conditions (NCs) engage in physical activity (PA) at a lower rate than those without disabilities. Physical therapists (PTs) are positioned to provide PA promotion; however, less is known about the consistency of promoting PA for their patients with NC. OBJECTIVE: The objective of this study was to investigate the frequency of PA promotion of PTs who treat patients with NC, the factors associated with PA promotion, and the types of PA promotion used. METHODS: An online survey that assessed the aspects of PA promotion frequency and behaviors was delivered to a sample of licensed PTs recruited in the United States between February and April of 2022. Descriptive statistics and the equality of proportions test were used to analyze the data. RESULTS: Out of 76 participants who reported working with patients with NC, 34 (45%) reported always promoting PA. Of the 38 participants reporting a caseload of over 50% NC, 17 (45%) reported always promoting PA. Seven factors had a significant correlation with the frequency of PA promotion, and participants reported providing education about PA with their patients (99%). CONCLUSIONS: PTs who work with patients with NC are not consistently promoting PA for their patients. There are opportunities for PTs to learn and apply PA promotion in practice for people with disabilities. The lack of PA promotion by PT may be contributing to the health disparities experienced by people with disabilities particularly those with NC.

GamerFit-ASD beta test: adapting an evidence-based exergaming and telehealth coaching intervention for autistic youth.

Background: Health disparities faced by autistic youth are exacerbated by inadequate physical activity (PA) and sleep, whereas healthy PA and sleep may improve mood and function. Adaptive Game Squad (AGS) is an evidence-based telehealth coaching and exergaming intervention to improve PA and sleep for adolescents with diverse neurodevelopmental and psychiatric conditions. This study aimed to adapt AGS for autistic youth ages 10-15 years; beta-test the modified intervention for feasibility, accessibility, and engagement; and further refine the intervention for a larger planned demonstration pilot. Methods: Interdisciplinary experts adapted AGS to create GamerFit-ASD, a 12-week intervention that included a progressive exergame schedule, Fitbit step-tracking, weekly health coaching, and health tip/exercise videos. For beta testing, the intervention was shortened to a 4-week trial with 5 parent/child dyads. Children completed exit surveys and parents and children were interviewed about intervention feasibility, accessibility, and engagement. Exit survey data were summarized with descriptive statistics. Qualitative data were analyzed using a modified grounded-theory approach. Results: All participants (n = 5; ages 10-14 years) attended all 4 planned coaching sessions and completed an average of 9 of 12 planned exergame challenges for a weekly average of 50 min. All participants reported enjoying coaching sessions, 4 of 5 reported enjoying exergames, and 3 of 5 reported enjoying on-demand exercise videos. In interviews, children generally reported finding participation feasible, exergaming challenges active and fun, and coaches friendly and helpful. Parents reported high feasibility of supporting their children's involvement and valued child goal-setting and intervention flexibility; however, some found telehealth sessions overly scripted. Several adaptations to coaching scripts, coach training, and parent materials were made for the larger demonstration pilot, including changes to reduce scriptedness of coaching sessions, to provide parents with more information specific to autism, and to make video content more appropriate to children's needs/preferences. Discussion: A telehealth coaching and exergaming intervention appears feasible, accessible, and engaging for autistic youth aged 10-15. Future studies with larger, more diverse samples, longer study durations and/or follow-up periods, and more rigorous study designs are needed to advance understanding of the appropriateness and effectiveness of this type of intervention for this population.

The Importance of the Cognitive Aspects of Vocational Rehabilitation for Individuals With Multiple Sclerosis.

BACKGROUND: Individuals with multiple sclerosis (MS) face symptoms that affect them physically and cognitively; 80% of individuals diagnosed with MS are out of work within 10 years, and 58% are unemployed. It appears that a diagnosis of MS creates a barrier to individuals obtaining and maintaining work. To combat this, vocational rehabilitation (VR) has been utilized by individuals with MS but with limited success. This may be due to the lack of interventions that address cognitive symptoms that occur. PURPOSE: The purpose of this perspective is to review the interaction between individuals with MS and the components of VR and discuss implications that could potentially increase the success of individuals with MS obtaining work. IMPLICATIONS: Approximately 48.1% of clients with MS receiving services from state VR agencies obtain or retain employment compared to 60% of clients with other diagnoses. This disparity highlights a disconnect in VR services. It has been seen that individuals with MS who were employed at application were more likely to receive services that include cognitive retraining-type services. Including more opportunities for cognitive retraining-type services may decrease this disparity and help more individuals with MS maintain or obtain work.