A framework to support early team-based provision of vocational rehabilitation for adults with acquired brain injury.

PURPOSE: Specialised vocational rehabilitation (VR) following acquired brain injury (ABI) positively impacts return to work, however access to this is limited globally. Providing VR as a component of standard ABI rehabilitation may improve access to VR and influence vocational outcomes. This study aimed to develop an evidence-based framework for the delivery of ABI VR during early transitional community rehabilitation. MATERIALS AND METHODS: The development of the ABI VR framework utilised an emergent multi-phase design and was informed by models of evidence-based practice, national rehabilitation standards, guidelines for complex intervention development, model of care and framework development, and the knowledge-to-action framework. Four study phases were undertaken to identify and generate the evidence base, with findings synthesised to develop the ABI VR framework in phase five. RESULTS: The framework provides a structure for the systematic delivery of VR as a component of team-based ABI rehabilitation, through five phases of rehabilitation: assessment; goal setting and rehabilitation planning; intervention; monitoring and evaluation; and discharge. It details the activities to be undertaken across the phases using a hybrid model of ABI VR (involving program-based VR and case coordination) and contains service delivery features. CONCLUSION: The framework has the potential to translate to other similar service contexts.Implications for rehabilitation:An evidence-based framework has been developed to support the provision of vocational rehabilitation as a component of team-based rehabilitation for adults with acquired brain injury, within the context of early, community rehabilitation.Providing vocational rehabilitation as a component of team-based rehabilitation should improve access to vocational rehabilitation and may positively influence client return to work outcomes.The vocational framework may assist clinicians to identify components of vocational rehabilitation that they can deliver in practice in their own service context.

Occupational therapists' understanding of supporting physical activity participation when working with children and adolescents: A national survey.

INTRODUCTION: Physical inactivity is a leading risk factor to disease and mortality. Despite the recognised benefits of physical activity, over half of the Australian population are not sufficiently active. For individuals with a disability, inactivity rates are further increased placing them at a higher risk of the negative effects of physical inactivity. Developing healthy lifestyle habits such as physical activity participation in early childhood has been found to be supportive of health behaviours being maintained into adulthood. Physical activity is an occupation said to involve the complex interaction between psychological, social, environmental, and physical factors placing it within the scope of occupation therapy. However, limited research is available exploring what this role looks like in practice. METHOD: An online, anonymous survey was developed to better understand how Australian occupational therapists understood physical activity participation, as well as their current and potential role in facilitating regular physical activity participation with their clients. All registered Australian occupational therapists were eligible to participate in this survey, which consisted of both closed and open answered questions. RESULTS: A total of 43 occupational therapists registered to practice within Australia completed the survey. All participants viewed physical activity as an important occupation for maintaining the health and well-being of their clients. Participants described the holistic role occupational therapists could play supporting physical activity participation outside of motor skill development. Therapists identified several ways in which a family-centred, occupation-based approach could be used to support sustained engagement in physical activity. CONCLUSION: The findings from this study contribute to our understanding of the role occupational therapy can play supporting physical activity participation for children and adolescents. This sparsely researched area requires more evaluation to ensure intervention is delivered in a way that is most effective.

Clinician perspectives of ABI vocational rehabilitation in Queensland.

INTRODUCTION: Services to support adults with acquired brain injury (ABI) and return to work goals are varied. In Queensland, Australia, return to work goals may be addressed through private or publicly funded rehabilitation services or through publicly funded employment programs. No set frameworks or processes are in place to guide clinicians in providing vocational rehabilitation to adults with ABI, and the extent to which services address clients' vocational goals and/or provide vocational rehabilitation is unknown. METHOD: This qualitative study investigated the clinical practice and experiences of allied health rehabilitation clinicians (n = 34) to identify current practice in providing vocational rehabilitation to adults with ABI, including pathways and services; models, frameworks and tools; and recommendations for ideal services. Focus groups and online surveys were conducted, with data analysed via content analysis. RESULTS: ABI vocational rehabilitation was inconsistently delivered within and across services in Queensland, with differences in access to services, aspects of vocational rehabilitation provided and timeframes for rehabilitation. Five key themes were identified regarding ABI vocational rehabilitation and service delivery in Queensland: Factors influencing ABI and return to work; Service provision; ABI vocational rehabilitation processes (including assessment tools and interventions); Service gaps; and Ideal ABI vocational rehabilitation services. DISCUSSION: These findings can inform clinical practice and development, and current and future service delivery models for ABI vocational rehabilitation.

Identifying models, processes, and components of vocational rehabilitation following acquired brain injury: a systematic scoping review.

PURPOSE: Acquired brain injury (ABI) is a complex injury which impacts engagement with worker roles. Return to work (RTW) rates for individuals with brain injury are low and those who do RTW often report job instability. Vocational rehabilitation (VR) can improve RTW rates and job stability; however, service provision is varied, and no gold standard has been identified. METHODS: A systematic scoping review of the literature was completed to explore research activity in VR for individuals with ABI to address the following three questions: what models have been identified to underpin VR in ABI? What clinical processes have been identified to guide provision of VR in ABI? What components of VR have been described and/or recommended in the ABI literature? RESULTS: The number of included articles was 57. From these articles, 16 models, nine process steps, eight components, and four service delivery components were identified that were utilised in provision of ABI VR. Implications for practice are discussed. CONCLUSIONS: Key processes and components of ABI VR have been identified across a range of models and apply to clients at all phases post-injury. Findings may be used to inform service provision across a range of time points and support clinicians in their delivery of VR to adults with brain injury.Implications for RehabilitationPeople with acquired brain injury (ABI), even severe injury, can be successful with return to work (RTW) when provided appropriate supports.A wide range of models, interventions, and service components have been identified in the literature which can be used to guide clinical and policy development in ABI vocational rehabilitation.Vocational rehabilitation for individuals with brain injury involves a complex interaction of factors, and consideration should be paid to not only the person and their abilities but also job demands and the environment (physical, social, cultural).Vocational rehabilitation services should be accessible and timed to maximise chances of a successful RTW, provided by a coordinated interdisciplinary team and should involve active stakeholder engagement.

Cross-modal conflicts in object recognition: determining the influence of object category.

Previous research examining cross-modal conflicts in object recognition has often made use of animal vocalizations and images, which may be considered natural and ecologically valid, thus strengthening the association in the congruent condition. The current research tested whether the same cross-modal conflict would exist for man-made object sounds as well as comparing the speed and accuracy of auditory processing across the two object categories. Participants were required to attend to a sound paired with a visual stimulus and then respond to a verification item (e.g., "Dog?"). Sounds were congruent (same object), neutral (unidentifiable image), or incongruent (different object) with the images presented. In the congruent and neutral condition, animals were recognized significantly faster and with greater accuracy than man-made objects. It was hypothesized that in the incongruent condition, no difference in reaction time or error rate would be found between animals and man-made objects. This prediction was not supported, indicating that the association between an object's sound and image may not be that disparate when comparing animals to man-made objects. The findings further support cross-modal conflict research for both the animal and man-made object category. The most important finding, however, was that auditory processing is enhanced for living compared to nonliving objects, a difference only previously found in visual processing. Implications relevant to both the neuropsychological literature and sound research are discussed.