'Do it afraid': An arts-based reflexive collective case study exploring youth responses to post-concussion communication changes in daily life.

BACKGROUND: Concussion and communication researchers have yet to study how post-concussion communication changes affect youths' daily lives. The lack of attention paid to how young people respond to communication changes during concussion recovery constitutes a significant gap in current concussion management research and practices. AIMS: To explore how youth respond to the effects of post-concussion communication changes in their daily life, including (1) daily routines, (2) relationships with family members, (3) relationships with peers and (4) participation in school/work and community activities. METHODS & PROCEDURES: Five youths (16-25 years) and three family members participated in this arts-based reflexive collective case study. Ecocultural theory provided the theoretical framework for study design, data collection and analysis. Cases consist of (1) pre-interview demographic information, (2) three 60-90-min virtual interviews, (3) optional family member interviews, (4) multi-media arts-based participant-generated materials representing participants' experiences of communication change and concussion, and (5) researcher observations, discussions and reflexive journal entries. Reflexive thematic analysis was used to analyse the data. OUTCOMES & RESULTS: Analysis yielded four themes that illustrate the ways youth navigated and adapted to post-concussion communication changes: (1) navigating changes in communication tasks, daily roles, and identity; (2) re-negotiating relationships and emotional reactions; (3) seeking control and learning to let go during recovery; and (4) helping youth adapt to post-concussion communication changes. CONCLUSIONS & IMPLICATIONS: The study findings deepen our understanding of the impact of post-concussion communication changes on youths' daily lives and underscore considerations critical to the development of communication-focused concussion education programs and interventions tailored specifically for youth. WHAT THIS PAPER ADDS: What is already known on the subject Youth is a critical period of social and emotional development. Communication is integral to identity, relationships, participation in daily activities and well-being. Concussions can affect speech clarity, fluency, understanding and use of language, and social interactions. Re-engaging in routine activities and pre-injury roles can be challenging for youth experiencing communication changes as part of complex concussion recoveries. What this paper adds to the existing knowledge Findings from this research illuminate how youth navigate and adapt to communication changes post-concussion and support the development of youth-focused communication education programs, assessments and interventions. Youth participants actively managed their recoveries by developing innovative strategies to support their communication during daily activities, learning about communication, practicing communication tasks sequentially, and facing fears. Youth also reframed and challenged narrow views of 'normal communication'. What are the potential or actual clinical implications of this work? Findings highlight the need for more youth- and communication-focused education materials and programs within youth concussion management protocols. Information about the specific ecological and sociocultural factors youth encounter during concussion recovery is needed to develop targeted communication-focused education and intervention programs for youth and their families to mitigate risks of isolation, loneliness, and mental health concerns and increase youths' participation in family, community and cultural life. By learning from youth about how communication changes affected their participation in daily activities, identity and relationships, clinicians can provide information and interventions to reduce adverse listener reactions and help young people feel supported and understood.

The (radical) role of belonging in shifting and expanding understandings of social inclusion for people labelled with intellectual and developmental disabilities.

There is a gap between the desired outcomes of social inclusion policy and the everyday experiences of people labelled with intellectual and developmental disabilities. Despite belonging rhetorically named in social inclusion policy and practice, belonging is often absent in the lives of people labelled with intellectual and developmental disabilities and remains undertheorised in its relationship to social inclusion. In this paper, we explore the role belonging might play in narrowing the gap between how social inclusion is theorised and how it is experienced. Drawing on critical disability and feminist relational theories, we outline a relational conceptualisation of belonging and use it to 'crip' the construct of social inclusion. Exploring the synergies and tensions that surface when social inclusion and belonging are held together as discrete but interconnected constructs, we name four conceptual shifts and expansions that allow us to see social inclusion differently. Through the centring of the experiences of people labelled with intellectual and developmental disabilities, we explore the ways belonging can help to reimagine inclusion from assimilationist, static, objective and formal towards inclusion as fluid, negotiated, (inter)subjective, (in)formal and intimate.

Re-envisioning paradigms of education: towards awareness, alignment, and pluralism.

In this article we introduce a synthesis of education "paradigms," adapted from a multi-disciplinary body of literature and tailored to health professions education (HPE). Each paradigm involves a particular perspective on the purpose of education, the nature of knowledge, what knowledge is valued and included in the curriculum, what it means to learn and how learning is assessed, and the roles of teachers and learners in the learning process. We aim to foster awareness of how these different paradigms look in practice and to illustrate the importance of alignment between teaching, learning and assessment practices with paradigmatic values and assumptions. Finally, we advocate for a pluralistic approach that purposefully and meaningfully integrates paradigms of education, enhancing our ability to drive quality in HPE.

Critically reflective practice and its sources: A qualitative exploration.

CONTEXT: Critical reflection may improve health professionals' performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value-conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored what critical reflection consisted of in a context known for indeterminacy, and to what sources participants attributed their critically reflective insights and approaches. METHODS: The study context was the interface between health care and education for children with chronic conditions or disabilities necessitating health-related recommendations and supports (eg accommodations or equipment) at school. We conducted a secondary analysis of 42 interview transcripts from an institutional ethnographic study involving health professionals, school-based educators and parents of children with chronic conditions or disabilities. We coded all transcripts for instances of critical reflection, moments that seemed to lack but could benefit from critical reflection, and participant-attributed sources of critically reflective insights. RESULTS: Critically reflective practice involved getting to know the other, valuing and leveraging different forms and sources of knowledge, identifying and communicating workarounds (ie strategies to circumvent imperfect systems), seeing inequities, and advocating as collaborators, not adversaries. Participants invariably attributed critically reflective insights to personal experiences such as former careers or close personal relationships. CONCLUSIONS: This study shows that personal experiences and connections inspire critically reflective views, and that being critically reflective is not a binary trait possessed (or not) by individuals. It is learnable through personally meaningful experiences. Health professions education could aim to preserve philosophical space for personal experience as a source of learning and integrate evidence-informed approaches to foster critically reflective practice.

Player and Parent Experiences with Child and Adolescent Power Soccer Sport Participation.

PURPOSE: To provide insight into the experiences of power soccer players and their parents to inform rehabilitation practice. METHODS: Primary data for this Interpretive Description study were individual interviews with five power soccer athletes, ranging from 11 to 17 years of age, and three parents of power soccer players. Observational field notes were also used. RESULTS: Five inter-related themes were developed: 1) Level playing field, 2) I am an athlete, 3) Important "life lessons" are gained through team sports, 4) The value of belonging to a community, and 5) Role of the rehabilitation community in supporting power mobility sports. CONCLUSIONS: Findings of this study demonstrate the benefits and challenges of power sport participation. The results encourage therapists to share information about sport opportunities with families and to consider a broad range of contexts when assessing for power mobility.

Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education.

Objective: Supporting audiologists to work ethically with industry requires theory-building research. This study sought to answer: How do audiologists view their relationship with industry in terms of ethical implications? What do audiologists do when faced with ethical tensions? How do social and systemic structures influence these views and actions? Design: A constructivist grounded theory study was conducted using semi-structured interviews of clinicians, students and faculty. Study sample: A purposive sample of 19 Canadian and American audiologists was recruited with representation across clinical, academic, educational and industry work settings. Theoretical sampling of grey literature occurred alongside audiologist sampling. Interpretations were informed by the concepts of ethical tensions as ethical uncertainty, dilemmas and distress. Results: Findings identified the audiology-industry relationship as symbiotic but not wholly positive. A range of responses included denying ethical tensions to avoiding any industry interactions altogether. Several of our participants who had experienced ethical distress quit their jobs to resolve the distress. Systemic influences included the economy, professional autonomy and the hidden curriculum. Conclusions: In direct response to our findings, the authors suggest a move to include virtues-based practice, an explicit curriculum for learning ethical industry relations, theoretically-aligned ethics education approaches and systemic and structural change.

Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review.

OBJECTIVES: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature. METHODS: The scoping review process described by Arksey and O'Malley was used to guide article selection and data extraction. RESULTS: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies ( n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families ( n = 49). CONCLUSION: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes.

An investigation of students' perceptions of ethical practice: engaging a reflective dialogue about ethics education in the health professions.

The ethical climate in which occupational therapists, and other health practitioners, currently practice is increasingly complex. There have been a number of calls for greater attention to ethics education within health science curricula. This study investigated occupational therapy students' perceptions of the meaning of ethical practice as a means of engaging in a dialogue about the aims of ethics education in contemporary health science contexts. A phenomenological methodological approach was adopted for the study. Interviews were conducted over 2 years with 25 student participants. The data were analyzed using phenomenological methods of analysis. Seven themes depict students' views about the meaning of ethical practice and include: being faithful to the tenets of your practice, being communicative, being in tune with your values, understanding the client's needs, weighing the pros and cons, negotiating the grey zones, and taking time to reflect. The findings contribute to understanding students' conceptions of the meaning of ethical practice that include and move beyond traditional codes, principles, and professional standards to encompass a range of dimensions of ethical practice. These additional dimensions raise insights of relevance to those who design and facilitate ethics education with health professionals.

A Case Review: Reframing School-Based Practices Using a Critical Perspective.

It is well established in the literature that school-based practice is fraught with challenges such as acquisition of appropriate and sufficient resources, communication barriers among professionals, parental burden, and redundancies and gaps in services. The purpose of this perspective paper is to reframe potentially problematic school-based practices using a critical social science perspective, suggesting a vision and strategies for therapists working in the context of school-based practice. We illustrate our approach with a case example. To reframe school-based practices, we begin with Jill's case, exploring it through a critical lens to identify potential issues and opportunities for change. We then trace these findings to our larger dataset from an ongoing program of research to ensure relevance to the broader context of school-based practice. Reframing of three school-based practice issues is discussed from: (a) advocacy by proxy to collaborative dialogue, (b) governing texts to guiding texts, and (c) playing the "right" part to having a voice. Although this is a perspective paper based on a case exemplar, we posit how we may reframe and rethink school-based practices in pediatric rehabilitation. We suggest that only with a genuine shift in our professional values will we see the enactment of collaborative practice in school-based settings.

"You gotta try it all": Parents' Experiences with Robotic Gait Training for their Children with Cerebral Palsy.

AIMS: Innovative robotic technologies hold strong promise for improving walking abilities of children with cerebral palsy (CP), but may create expectations for parents pursuing the "newest thing" in treatment. The aim of this qualitative study was to explore parents' values about walking in relation to their experiences with robotic gait training for their children. METHODS: Semi-structured interviews were conducted with parents of five ambulatory children with CP participating in a randomized trial investigating robotic gait training effectiveness. RESULTS: Parents valued walking, especially "correct" walking, as a key component of their children's present and future well-being. They continually sought the "next best thing" in therapy and viewed the robotic gait trainer as a potentially revolutionary technology despite mixed experiences. CONCLUSIONS: The results can help inform rehabilitation therapists' knowledge of parents' values and perspectives, and guide effective collaborations toward meeting the therapeutic needs of children with CP.

The devolution of eugenic practices: Sexual and reproductive health and oppression of people with intellectual disability.

Early 20th century eugenicists propagated a system of ideas, values and dispositions that constituted adults with intellectual disability as the antithesis of the paradigmatic citizen, and a biological threat to society. The eugenic schema was encoded in sex-segregated institutionalization and, in many places, forced sterilization. These eugenic practices are no longer sanctioned. However, eugenic practices did not disappear. In this paper we argue that the eugenic schema is now encoded and purveyed through a multiplicity of social arrangements and practices that deny adults with intellectual disability the respect, opportunity and means necessary to participate on a par with others in social life. Such practices include, for example, covert or coerced contraception, and discriminatory child welfare interventions leading to high rates of custody deprivation. Drawing on relational theory, we problematize normative assumptions of embodiment and citizenship, which give rise to attributions of incapacity, and argue that adults with intellectual disability need what all other adults need to make and effect choices concerning their sexuality, relationships and parenthood, i.e., recognition, opportunity and support.

Intimate partner violence against women with intellectual disability: A relational framework for inclusive, trauma-informed social services.

Women with intellectual disability experience intimate partner violence at higher rates and tend to remain in abusive relationships longer than non-disabled women. The purpose of this inquiry was to generate a preliminary set of principles and delineate domains of support as a general guide for social service workers supporting women with intellectual disability through the difficult, often stop-start process of ending an abusive relationship and creating a desired future. Taking a pragmatic inquiry approach, guiding principles and domains of support were generated through a triangulated engagement with relational theory, relevant published research, and original data gathered through interviews with five experienced social service workers. The results comprise a relational framework for inclusive, trauma-informed services aimed at fostering the relational autonomy of women with intellectual disability. Enacting relational principles of reflexivity, recognition, solidarity and safety, social service workers can support women with intellectual disability with safety planning, securing basic life needs, strengthening social relationships, acquiring new skills and nurturing self-affective attitudes of self-respect, self-efficacy and self-esteem.

Exploring environmental factors affecting assistive technology strategies in mathematics learning for students with physical disabilities.

PURPOSE: To explore the environmental facilitators and barriers affecting K-12 students with physical disabilities when using two assistive technology (AT) strategies, LEGO Mindstorms robots and a computer, in mathematics lessons. MATERIALS AND METHODS: A qualitative multiple case study with three students with physical disabilities was conducted. The participants did five lessons in concepts they were studying in school with each AT strategy in a controlled environment. Observations of the lessons, and parent and teacher interviews after the last session were collected. RESULTS: The AT strategies acted as facilitators because they were easy to use, participants could participate actively, and parents and school staff wanted to implement them. However, the strategies presented some barriers since the students required more time to complete the lessons with the robot, and some computer programs were not compatible with the students' skills. Also, barriers such as lack of technical knowledge on the part of parents and teachers, distractions in the environment, and funding issues were reported. CONCLUSION: This study may be useful for rehabilitation staff and teachers who are considering implementing AT to support the participation of students with disabilities. Personnel needs to be trained to use the AT strategies, and several modifications may be necessary for the satisfactory use of the devices.IMPLICATIONS FOR REHABILITATIONHands-on manipulation promotes the active learning of early mathematical concepts. Students with disabilities may have the opportunity to participate in active learning through assistive technology (AT).Knowledge about environmental factors that may facilitate or limit the use of AT in the classroom will help teaching staff make decisions when implementing these strategies with students with disabilities.The use of an AT strategy may depend on the objectives the rehabilitation staff and teachers want to achieve during a task. For instance, the robot could be used for tailoring a task according to the student's needs and abilities. On the other hand, computer programs could be considered if time and ease of use are important factors.

Child, parent, and clinician experiences with a child-driven goal setting approach in paediatric rehabilitation.

PURPOSE: To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting. METHODS: Nine children receiving inpatient and outpatient rehabilitation aged 5.0-12.3 years (x¯ = 8.3, SD = 2.3; 5 females) and their parents (n = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children (n = 7), their parents (n = 9), occupational therapists (n = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting. RESULTS: Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process. CONCLUSIONS: Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting.IMPLICATIONS FOR REHABILITATIONChildren are often not optimally involved in setting their own rehabilitation goals.In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy.Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input.Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.

Constructions of disability: a call for critical reflexivity in occupational therapy.

BACKGROUND: Within professional and practice knowledge there are many assumptions about disability that underpin occupational therapy philosophy. PURPOSE: The objectives of this paper are to (a) critically examine how disability has been constructed in mainstream society by introducing perspectives from contemporary disability studies theories, and (b) apply a critically reflexive lens informed by disability studies perspectives to occupational therapy practice. KEY ISSUES: Drawing upon critical disability perspectives, notions of "nondisabled" versus "disabled"; metanarratives of disability; built environments and social structures; and social and attitudinal constructions of disability and identity are examined. Key issues pertaining to rehabilitation, norms, client-centred practice, language, and education within occupational therapy are discussed. IMPLICATIONS: This critically reflexive examination has revealed the ways in which occupational therapy and society at large are embedded in discourses that may reinforce negative connotations around disability. A renewed understanding of disability may challenge current practices.

Using a robotic teleoperation system for haptic exploration.

INTRODUCTION: When children with physical impairments cannot perform hand movements for haptic exploration, they miss opportunities to learn about object properties. Robotics systems with haptic feedback may better enable object exploration. METHODS: Twenty-four adults and ten children without physical impairments, and one adult with physical impairments, explored tools to mix substances or transport different sized objects. All participants completed the tasks with both a robotic system and manual exploration. Exploratory procedures used to determine object properties were also observed. RESULTS: Adults and children accurately identified appropriate tools for each task using manual exploration, but they were less accurate using the robotic system. The adult with physical impairment identified appropriate tools for transport in both conditions, however had difficulty identifying tools used for mixing substances. A new exploratory procedure was observed, Tapping, when using the robotic system. CONCLUSIONS: Adults and children could make judgements on tool utility for tasks using both manual exploration and the robotic system, however they experienced limitations in the robotics system that require more study. The adult with disabilities required less assistance to explore tools when using the robotic system. The robotic system may be a feasible way for individuals with physical disabilities to perform haptic exploration.

Exploring a cognitive intervention for children with pervasive developmental disorder.

BACKGROUND: Pervasive developmental disorders (PDD) affect approximately 3-4% of the childhood population. PDD pervades every aspect of a child's life, having significant adverse effects on occupational performance. PURPOSE: This study investigates a new treatment approach to treating children with PDD, the Cognitive Orientation to Occupational Performance (CO-OP). CO-OP emphasizes problem-solving strategies and guided discovery of child- and task-specific strategies. METHOD: Three goals were established in collaboration with the parents and the child. Pre- and post-measures of parents'perceptions of child performance were identified using the Canadian Occupational Performance Measure (COPM). Repeated measures were taken using clinical observations, video analysis, and the Performance Quality Rating Scale (PORS). FINDINGS: Improved COPM ratings of performance and satisfaction were observed, and these results were paralleled by improved PQRS scores. PRACTICE IMPLICATIONS: Self-report and observer report together provide preliminary evidence of the effectiveness of the CO-OP approach with children who have PDD supporting the use of CO-OP and suggesting further investigation.

Utility of science, technology and innovation governance for occupational discourses from the perspective of occupational therapy students.

BACKGROUND: Science, technology and innovation (STI) governance concerns itself with the societal impact of STI. Occupation, whether used with the meaning of paid, unpaid work or any activity that is considered meaningful to the individual on an everyday basis, is one area of societal impact of STI. Fields such as occupational therapy, occupational science and occupational health and safety concern themselves with the relationship between occupation and the health and well-being of human beings albeit all with different foci. OBJECTIVE: To ascertain the knowledge of students from two Occupational Therapy programs on STI governance, specific STI products and their views on the impact of STI governance and STI products on occupational therapy and its clients. METHODS: Online survey employing Yes/No' questions with comment boxes and open-ended textbox questions. Descriptive quantitative and thematic qualitative data was generated. RESULTS: Students were unfamiliar with STI governance discourses but felt that they should be aware of them. Students stated that how one governs STI impacts occupational therapy on all levels and that the occupational therapy community has expertise that would enrich STI governance discourses around occupation. CONCLUSION: Education actions seem to be warranted on the level of students and practitioners by the occupational therapy and STI governance communities.