Psychostimulant Medications for Physical Function and Spasticity in Children With Cerebral Palsy: Protocol for a Randomized Controlled Trial.

BACKGROUND: Cerebral palsy (CP) is a prevalent nonprogressive disorder that leads to impaired movement (ie, spasticity), posture, and balance, which affects functions such as walking and upper extremity tasks. Current medical treatments show efficacy in improving motor performance but have considerable side effects. Emerging off-label use of central nervous system (CNS) medications for improving motor performance has shown promising results in children with CP and other populations. OBJECTIVE: The aim of this study is to describe a protocol for a pilot randomized controlled trial (RCT) to examine the safety, tolerability, and efficacy of methylphenidate (MPH) and modafinil on spasticity and motor performance in children with CP. METHODS: This will be a protocol study for a pilot, triple-masked, placebo-controlled RCT (a class I trial following the American Academy of Neurology criteria) with blinded patients, outcome assessors, and intervention delivery team. Eligible children should be diagnosed with CP levels I or II based on the Gross Motor Function Classification System and be aged between 7 and 12 years. Thirty-six children with CP will be randomized into 3 groups to receive (1) MPH (2.5 mg of MPH + 100 mg placebo), (2) modafinil (100 mg modafinil + 2.5 mg placebo), or (3) a placebo (2.5 mg placebo + 100 mg placebo), in addition to physical therapy for 12 weeks. Primary outcomes include the Gross Motor Function Measure-66 and the Modified Ashworth Scale. Secondary outcomes include the Timed Up and Go test, 5 Time Sit to Stand test, Modified Clinical Test for Sensory Interaction of Balance, and 10-Meter Walk Test. RESULTS: The protocol has been accepted by Kuwait University (VDR/EC-225) and the Ministry of Health of Kuwait (2022/2157). The inclusion of participants will start in June 2024. CONCLUSIONS: The combination of CNS stimulant medications and controlling for rehabilitation has not been studied yet. The findings of this study may determine if using CNS stimulant medications is beneficial for the reduction of spasticity and improvement of physical function in children with spastic CP. TRIAL REGISTRATION: ClinicalTrials.gov NCT05675098; https://clinicaltrials.gov/study/NCT05675098. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/53728.

Effect of psychostimulant medications on physical function in children with cerebral palsy: scoping review.

The aim of this scoping review is to examine the extent and depth of the literature on effects of central nervous system (CNS) stimulant medications on physical function in children with cerebral palsy (CP). A systematic search for relevant peer-reviewed studies was conducted of PubMed, CINAHL, Cochrane, SPORTDiscus, Embase, & Scopus (January 2002 & August 2022). We included studies that examined the effects of CNS stimulants on physical function in children with CP. Four studies met our selection criteria. All studies explored the effect of Modafinil on physical function outcomes. Three studies of the four included studies reported positive effects of Modafinil on spasticity, motor performance, and gait, whereas one study reported no significant effects of Modafinil. Our findings suggest that there is very low-quality evidence that suggests that Modafinil may enhance physical improvements in body structure and function, including reduction in spasticity and improvements in gait parameters. IMPACT: Central nervous system stimulants were examined for efficacy on physical function and spasticity in children with cerebral palsy. The evidence on the effects of central nervous system stimulants on physical function in children with CP is limited and inconsistent.

Development and implementation of a virtual "collaboratory" to foster interprofessional team-based learning using a novel faculty-student partnership.

BACKGROUND: Safe and efficient healthcare demands interprofessional collaboration. To prepare a practice-ready workforce, students of health professions require opportunities to develop interprofessional competencies. Designing and delivering effective interprofessional learning experiences across multiple professions is often hampered by demanding course loads, scheduling conflicts, and geographical distance. To overcome traditional barriers, a case-based online interprofessional collaboratory course was designed for professions of dentistry, nursing, occupational therapy, social work and public health using a faculty-student partnership model. AIM: To build a flexible, web-based, collaborative learning environment for students to actively engage in interprofessional teamwork. METHODS: Learning objectives addressed Interprofessional Education Collaborative (IPEC) core competency domains of Teamwork, Communications, Roles/Responsibilities, and Values/Ethics. Four learning modules were aligned with developmental stages across the case patient's lifespan. Learners were tasked with producing a comprehensive care plan for each developmental life stage using interprofessional teamwork. Learning resources included patient and clinician interviews, discussion board forums, elevator pitch videos, and interprofessional role modelling. A mixed methods quality improvement approach integrated the pre and post IPEC Competency Self-Assessment Tool with qualitative student feedback. RESULTS: In total, 37 learners participated in the pilot. IPEC Competency Assessment Interaction domain mean scores increased from 4.17/5 to 4.33 (p = 0.19). The Values domain remained high (4.57/5 versus 4.56). Thematic analysis highlighted five core themes for success: active team engagement, case reality, clear expectations, shared team commitment, and enjoyment. CONCLUSIONS: A faculty-student partnership model was feasible and acceptable for designing and implementing a virtual, interprofessional team-based course. Using a quality improvement cycle fast-tracked improvements to course workflow, and highlighted strategies for engaging students in online team-learning.

Physical Activity Self-Efficacy in Older Adults with Vision Loss: A Grounded Theory Study.

The purpose of this study was to develop a model describing the process of how older adults with age-related macular degeneration develop physical activity self-efficacy. The primary aim of this research was to determine how adults with age-related macular degeneration living in a southeastern metropolitan area develop physical activity self-efficacy. Sixteen older adults with age-related macular degeneration participated in face-to-face interviews and observations of their regular physical activity. Grounded theory approach was used to identify emerging themes and a model describing the development of physical activity self-efficacy in this cohort. Five themes related to the development of physical activity self-efficacy emerged: 1) physical activity engagement, 2) self-management behaviors, 3) physical activity determinants, 4) strategies, and 5) self-perceived benefits. These themes were analyzed to produce a preliminary model describing the development of physical activity self-efficacy in older adults with age-related macular degeneration. Findings provide a preliminary model, which practitioners can use to facilitate self-efficacy and participation in physical activity in older adults with age-related macular degeneration.

An Evaluation of a Clinic-Based Low Vision Device Lending Library.

As the efficacy of low vision service provision is facilitated by clients' access to and proper use of low vision devices, the objective of this study was to evaluate an outpatient clinic-based low vision device lending library program and the functional and psychosocial impact that device use had upon clients. Twenty individuals borrowed portable video magnifiers during the study period. Line items from the Revised-Self-Report Assessment of Functional Visual Performance and the Reading Behavior Inventory were analyzed before and after device loan at two months. The Psychosocial Impact of Assistive Devices Scale-10 and a semi-structured interview were also completed at two months. Reported improvements in reading performance and satisfaction levels on the Reading Behavior Inventory were significant (p<.001). The Revised-Self-Report Assessment of Functional Visual Performance indicated improved independence in reading medications, bills and labels. Higher scores in happiness, independence, sense of control and adaptability on the Psychosocial Impact of Assistive Devices Scale-10 indicated device retention at two months. Qualitative themes included improved independence, time needed to acclimate to the device, personal appraisal impacting motivation and challenges specific to low vision. This article provides occupational therapists a model to facilitate access, person-device fit and successful use of low vision devices to promote therapy outcomes.

Impact of Virtual Yoga on Management of Sleep and Anxiety in Persons with Vision Impairment.

The goal of this research was to assess the effects of virtual yoga on sleep and anxiety in persons with vision impairment. This study was a quasi-experimental single group design. Thirteen participants engaged in a six-week Hatha yoga experience with weekly sessions presented on a zoom platform with the recorded sessions provided to the participants after each session. Participants completed self-report assessments for sleep quality and anxiety, pre and post intervention. Wilcoxon Signed Ranks tests revealed significant improvements in both outcomes. Participants reported other positive outcomes from this experience, including opportunities for peer support, socialization, and the ability to exercise within the safety of their home environment.

Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial.

BACKGROUND: Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). OBJECTIVE: The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. METHODS: This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children's Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. RESULTS: A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children's Assessment of Participation and Enjoyment Active Physical Recreation-Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants' adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. CONCLUSIONS: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. TRIAL REGISTRATION: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390.

The 'magic' of magic camp from the perspective of children with hemiparesis.

Previous studies have examined the quantitative results of using an organized approach of teaching and learning magic tricks-a therapeutic magic camp-but set aside the qualitative aspect. The purpose of this qualitative study is to explore the interpretation of the lived experience of children with hemiparesis after they have participated in a therapeutic magic camp. Six children, aged between 11 and 14 years old, with hemiparesis who completed the magic camp program 3 months prior were invited to participate in an in-person individual semistructured interview. The interviews were audio-recorded and transcribed verbatim for content analysis. Results from the initial qualitative analysis yielded categories of enjoyment, positive social and learning experience from participation in the camp, increased confidence, and self-motivation to use the affected upper limb. These categories were grouped into two themes: "having fun with others while learning" and "helping my arm perform." Having fun with others while learning was an amalgamation of fun, and positive social and learning experience. Helping my arm perform reflected a sense of increased competence and self-belief, and a willingness and motivation of the children to attempt challenging daily activities. The lived experiences of children with hemiplegia who participated in an organized delivery of learning to perform magic tricks yield-ed positive outcomes. These themes are consistent with the limited literature that is available suggesting that further research is needed to confirm the efficacy of the therapeutic magic camp intervention.

Perspectives of diabetes educators and dental hygienists regarding strategies to improve oral health for people with diabetes.

Aims: This study aims to explore the opinions of dental hygienists and diabetes educators on improving oral health for people with diabetes. Methods: Registered dental hygienists (RDHs) and certified diabetes educators (CDEs) who provided written responses to the same open-ended question from two state-wide mailing surveys (one for RDHs and the other for CDEs) "what more can you tell us to help improve oral health for people with diabetes?" were included in this study. The surveys were sent to all RDHs (n=2237) and CDEs (n=250) in the state of South Carolina, United States. Results: Of the 1125 valid returned questionnaires from both surveys, 474 provided written responses to this question. Qualitative analysis revealed three main themes from participants' written responses which were: Education (3 subthemes: resources for patients, educate the public, and professional practice resources), interprofessional collaborative care (3 subthemes: role of medical and dental professionals in oral health promotion for people with diabetes, and role of dental and diabetes professional organizations, and companies in the oral healthcare industry), and dental insurance. Conclusions: The three themes that emerged are interrelated indicating that strategies to improve oral health for people with diabetes are multi-faceted.

Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data.

BACKGROUND: There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population. OBJECTIVES: This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference. METHODS: Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted. RESULTS: In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62-78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22-3.12) and IV (OR 1.77, 95% CI 1.03-4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66-84), and mean pain severity was 3.7/10 (95% CI 2.7-4.7) and pain interference 3.5/10 (95% CI 2.5-4.5). CONCLUSIONS: This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.

Leisure-time physical activity interventions for children and adults with cerebral palsy: a scoping review.

AIM: To summarize current evidence on the effects and reach of leisure-time physical activity (LTPA) interventions among children and adults with cerebral palsy (CP). METHOD: Systematic searches were conducted in PubMed, CINAHL, and Google Scholar to identify randomized controlled trials (RCTs) of LTPA interventions in CP. Data from eligible studies were extracted for qualitative synthesis. RESULTS: Forty-nine studies enrolled a total of 1513 participants (mean [SD] age 13y [7y], range 5-43y; 818 males, 655 females, 40 not reported) and primarily included ambulatory children. RCTs underrepresented adults and people in Gross Motor Function Classification System (GMFCS) levels IV and V. Forty-one studies reported at least one favorable benefit from LTPA. Benefits included improvements to musculoskeletal strength, cardiorespiratory fitness, quality of life, spasticity, participation, and core aspects of physical function. Regarding reach, only 34% of people that were contacted to participate enrolled within a study. A smaller percentage of participants dropped out from intervention (8%) and follow-up periods (3%). INTERPRETATION: Study findings highlight effective interventions to improve health, fitness, and function. To enhance the reach and generalizability of LTPA trials for CP, future studies should examine how to increase study sample sizes and aim to include a better representation of adults and people in GMFCS levels IV and V. WHAT THIS PAPER ADDS: People with cerebral palsy (CP) may experience improvements in health, fitness, and physical function from leisure-time physical activity (LTPA) interventions. Effective interventions include exercise training, active video games, recreation activities, behavioral coaching, and motor skills training. Interventions that incorporate telehealth technology, behavioral coaching, and community resources may enhance LTPA. Interventions primarily include children in Gross Motor Functional Classification System (GMFCS) levels I to III. Adults, wheelchair users, and those in GMFCS levels IV and V are underrepresented.

Psychometric Properties of Clinical Tests of Balance and Vestibular-Related Function in Children With Cerebral Palsy.

PURPOSE: The purpose of this study was to establish the psychometric properties of clinical tests of balance and vestibular-related function in children with cerebral palsy (CP), aged 7 to 12 years, Gross Motor Function Classification System levels I to III. METHODS: Forty-two children with CP and 33 children with typical development were examined using Clinical Dynamic Visual Acuity Test, Modified Clinical Test of Sensory Interaction on Balance, Head Impulse Test, Bucket Test, and Northeastern State University College of Optometry oculomotor test. A subgroup was tested twice for reliability. Reference tests included rotary chair and sensory organization test. RESULTS: Most children with CP had central rather than peripheral vestibular dysfunction. Clinical tests except Northeastern State University College of Optometry oculomotor test had moderate to good reliability, good sensitivity but poor specificity to identify central vestibular-related impairments. CONCLUSIONS: Tests of balance and vestibular-related function may help guide clinical management of children with CP.

Evaluation of a Magic Camp for Children with Hemiparesis: A Pilot Study.

This single-group open trial was designed to evaluate the effectiveness of a two-week magic camp as a means of hand-arm motor skills training to improve upper limb motor function (unilateral and bilateral) in children with hemiparesis. Seven children with hemiparesis participated in a magic camp program which met 3 days a week, 4 hours each day, for two consecutive weeks for a total of 24 hours. Participants completed three assessments at the beginning of the camp, post-camp, and at a three-month follow-up: the Jebsen Hand Function Test (JHFT), Children's Hand Experience Questionnaire (CHEQ), and a box opening task that required coordination of both upper limbs. A Wilcoxon signed-rank test revealed significant improvement in JHFT composite scores of the affected limb at post-camp (p = .04) and three-month follow-up (p = .04). In addition, a significant improvement in the number of activities performed using two hands from baseline to three-month follow-up was observed (p = .03). This pattern of improvement was also observed in the speed of completion for the box opening task. The improvement in motor function seems related to the participants' continuing performing daily activities with the affected hand and two hands after the magic camp.

Methodological quality of service learning studies in rehabilitation professions: A systematic review.

BACKGROUND: Service-learning (SL) has been widely implemented and grown as a pedagogy in the rehabilitation professions. However, assessment on the quality of evidence for the effectiveness of SL related to student learning outcomes and the scope of SL activities related to the occupation of work in the rehabilitation professions is not available. OBJECTIVE: This systematic review was to evaluate the rigor of the methodological quality of SL studies and the scope of SL activities related to the occupation of work in the rehabilitation professions. METHODS: We performed a systematic on-line electronic literature search of nine bibliographic databases available through the university library system to identify peer-reviewed journal articles on SL provided by the tri-alliance of rehabilitation professional students, with the primary or secondary outcome on the evaluation of student SL experiences. Twenty-two SL articles using experimental design between 1995 and 2016 were extracted as they qualified for the methodological appraisal. Appraisal of each article was performed independently by four investigators using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS: In six of the 22 SL studies (27%), service provided by the rehabilitation professional students was related to the occupation of work (i.e., assessment, prevention of illness, injury, and disability, and intervention). There was a significant increase in the number (and percent) of SL studies related to the occupation of work compared to that of a previous systematic review (0%, P = 0.03, Fisher's exact test). Results from the evaluation of the methodological quality of these 22 reviewed articles revealed that all received a global rating score of weak. The low methodological quality rating of the reviewed articles was mainly attributed to not controlling for confounders (22 articles), non-blinding (21), and using outcome measures which did not have evidence to support their validity (14). Inability to control for confounders was related to weak research design as more than 77% of the reviewed articles used quasi-experimental designs without a control group. Non-blinding was related to the self-report nature of the outcome measures. CONCLUSIONS: A significant increase in the number of SL studies related to the occupation of work was found, which may provide an indirect indication on an increase in the capacity to provide (work) rehabilitation services. However, selected studies demonstrated high risk of bias which limited firm conclusions to be drawn on reported findings from SL in the tri-alliance of rehabilitation professions curricula.

Vestibular and Oculomotor Function in Children with Cerebral Palsy: A Scoping Review.

Cerebral palsy (CP) is a nonprogressive permanent brain injury that causes an impairment of movement and posture. This scoping review aimed to answer the following questions: (1) "What is the status of oculomotor function in children with CP?" (2) "What is the status of vestibular function (i.e., gaze stability, perception of vertical, vestibular-related balance abilities) in children with CP?" Using Arksey's and O'Malley's five-stage framework, we searched six online databases for relevant articles. The inclusion criteria were: (1) participants of the studies included individuals with CP; (2) a primary outcome in the studies was measurement of oculomotor, vestibular, and/or balance; (3) studies were published within the past 20 years; and (4) the participants in the studies were between 0 and 21 years of age. Twenty-one articles were found that described impairments in oculomotor function ( n = 9), vestibular function ( n = 1), and oculomotor and vestibular integration ( n = 11) in children with CP. The evidence suggests that children with CP may have altered saccadic and smooth pursuit eye movements, abnormal saccular function, poor eye-hand coordination, and abnormal use of vestibular information for balance. Future studies should explore peripheral and central vestibular function using reliable and valid methods for this population. This scoping review demonstrated a paucity of rigorous and objective research to describe the status of oculomotor and vestibular function in children with CP. However, preliminary studies suggest that more research is warranted.

A common data language for clinical research studies: the National Institute of Neurological Disorders and Stroke and American Academy for Cerebral Palsy and Developmental Medicine Cerebral Palsy Common Data Elements Version 1.0 recommendations.

To increase the efficiency and effectiveness of clinical research studies, cerebral palsy (CP) specific Common Data Elements (CDEs) were developed through a partnership between the National Institute of Neurological Disorders and Stroke (NINDS) and the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). International experts reviewed existing NINDS CDEs and tools used in studies of children and young people with CP. CDEs were compiled, subjected to internal review, and posted online for external public comment in September 2016. Guided by the International Classification of Functioning, Disability and Health framework, CDEs were categorized into six domains: (1) participant characteristics; (2) health, growth, and genetics; (3) neuroimaging; (4) neuromotor skills and functional assessments; (5) neurocognitive, social, and emotional assessments; and (6) engagement and quality of life. Version 1.0 of the NINDS/AACPDM CDEs for CP is publicly available on the NINDS CDE and AACPDM websites. Global use of CDEs for CP will standardize data collection, improve data quality, and facilitate comparisons across studies. Ongoing collaboration with international colleagues, industry, and people with CP and their families will provide meaningful feedback and updates as additional evidence is obtained. These CDEs are recommended for NINDS-funded research for CP. WHAT THIS PAPER ADDS: This is the first comprehensive Common Data Elements (CDEs) for children and young people with CP for clinical research. The CDEs for children and young people with CP include common definitions, the standardization of case report forms, and measures. The CDE guides the standardization for data collection and outcome evaluation in all types of studies with children and young people with CP. The CDE ultimately improves data quality and data sharing.

Lighting as a Compensatory Strategy for Acquired Visual Deficits After Stroke: Two Case Reports.

OBJECTIVE: The objective of this article was to explore the effects of enhanced lighting on the function of people with an acquired visual deficit resulting from cerebrovascular accident (CVA) in an inpatient rehabilitation facility (IRF). METHOD: An ABAB design was used with two cases to assess how a short-term intervention involving lighting changes affected clients' grooming performance in an IRF. Analysis consisted of scores on the grooming section of the FIM®, times for each grooming task, and light meter readings. RESULTS: Both participants demonstrated improvements in function as measured by the FIM and in time to complete grooming tasks with enhanced lighting. CONCLUSION: These results suggest that individualized lighting can lead to improved grooming function in clients with CVA.

Using an Education Intervention to Increase Preparedness Among Pet Owners: Results of a Pilot Study.

OBJECTIVES: Households with pets are considered a high-risk population, presenting many challenges to response and recovery efforts. Research indicates that households with pets are less likely to evacuate during disasters, and pets left behind pose a health risk to relief workers and the general public. This pilot study explores a brief education intervention targeting households with pets as a method of increasing general household preparedness, with the purpose of facilitating evacuation and protective behaviors in this population. METHODS: A convenience sample of households with pets was recruited to participate in a one-group pre- and post-survey design evaluating the impact of a brief education intervention on increasing pet-specific and general household preparedness levels. RESULTS: Results suggest that the sample population was below national estimates in basic household preparedness before the intervention. Post-survey results indicate an increase in completion of some preparedness tasks after the intervention. There was a statistically significant increase in overall pet preparedness at the P=0.10 level; however, that difference did not translate into general household preparedness. CONCLUSION: The findings from this study are consistent with those from previous literature suggesting that persons often place the needs of their pets above their own; however, the use of a brief education intervention may be successful in increasing pet-specific preparedness levels, which may be useful in successful evacuation and pet well-being. (Disaster Med Public Health Preparedness. 2018;12:441-445).

Falls prevention interventions for older adults with low vision: A scoping review: Étude de portée sur les interventions visant à prévenir les chutes chez les aînés ayant une basse vision.

BACKGROUND: Older adults with low vision are especially vulnerable to falls. There are no comprehensive reviews of fall prevention interventions for older adults with vision loss who live in the community. PURPOSE: The aim of this study was to review the evidence regarding community-based falls prevention interventions that appear inclusive of and/or accessible to individuals with low vision. METHOD: A scoping review was completed using the framework developed by Arksey and O'Malley, and the charted data were analyzed using sums and percentages and qualitative content analysis. FINDINGS: Seventeen publications were selected for this review. The analysis allowed for a thorough description of the types of falls prevention interventions (multiple components, home safety/modification, tai chi, the Alexander Technique, improvement of vision through vision assessment and referral, vision/agility training, and yoga), how each intervention addresses vision impairment, and the relation of results to falls risk. IMPLICATIONS: Falls prevention research targeting individuals with visual impairment is limited, and the intervention approaches available may not be effective for older adults with permanent vision loss.

Multi-morbidity, disability and adaptation strategies among community-dwelling adults aged 75 years and older.

BACKGROUND: The impact of multi-morbidity and disability on the use of adaptation strategies in older adults has not been well researched. OBJECTIVE: This study investigated categories of adaptation strategies that community-dwelling older adults use to complete their daily activities, identified factors that are associated with the use of behavioral adaptations, and examined the relationship among multi-morbidity, disability and adaptation strategies in this population. METHODS: A mixed methods research design was used. 105 community-dwelling older adults with ages ranging from 75 to 94 years completed a questionnaire and semi-structured interview on types of chronic illnesses (multi-morbidity), amount of difficulty in completing daily activities (degree of disability), and types of behavioral efforts made to complete daily activities that are challenging (adaptation strategies). The model of selective optimization with compensation (SOC) was used to categorize these strategies. RESULTS: The findings revealed that older adults use a wide range of adaptations with compensation and selection the most (40.4%) and least (16.5%) frequently reported respectively. Degree of disability was uniquely associated with the frequency of using SOC strategies while controlling for other factors. Furthermore, degree of disability was a mediator for multi-morbidity in predicting frequency of using SOC strategies. CONCLUSIONS: The findings support that older adults using behavioral adaptations to cope with functional decline is prevalent. Knowing the types of adaptation that older adults employed and the indirect relationship between multi-morbidity and frequency of using SOC strategies, with degree of disability as the mediator will be helpful in planning interventions and prevention programs for educating older adults.