Perceived barriers and facilitators to physical activity in childhood cancer survivors and their parents: A large-scale interview study from the International PACCS Study.

BACKGROUND: Physical activity (PA) may reduce risks of late effects in childhood cancer survivors, yet many have low activity levels. Using the WHO's International Classification of Functioning, Disability, and Health for Children and Youths (ICF-CY) as a conceptual framework, we aimed to identify perceived barriers and facilitators to PA in young survivors and their parents. DESIGN/METHODS: We conducted individual, semi-structured interviews with 63 survivors, aged 9-18 years, ≥1-year off treatment, and 68 parents, recruited from three pediatric oncology departments in Norway and Denmark. Interviews were analyzed inductively using thematic analysis to identify barriers and facilitators to PA, which were mapped onto the ICF-CY model components; body function/structures, activities, participation, and environmental and personal factors. RESULTS: Two-thirds of the survivors described how treatment-related impairments of bodily functions (e.g., fatigue, physical weakness, reduced lung capacity) caused physical limitations, reducing opportunities to participate in PA, especially team sports and school physical education. This resulted in a perceived ability gap between survivors and peers, reducing motivation for PA. These PA barriers were moderated by environmental factors that facilitated or further hindered PA participation (family, peer, and school support). Similarily, personal factors also facilitated (acceptance, motivation, goal setting) or hindered (anxiety, low motivation, and lack of trust) PA participation. CONCLUSION: Treatment-related long-term or late effects represented significant barriers to PA as their functional consequences reduced survivors' capacities and capabilities to be active. Environmental and personal factors acting as facilitators or further barriers to PA were identified. Applying the ICF-CY framework in clinical practice could help to enable PA participation.

Modernizing Daily Function Assessment in Parkinson's Disease Using Capacity, Perception, and Performance Measures.

Many disease symptoms restrict the quality of life of the affected. This usually occurs indirectly, at least in most neurological diseases. Here, impaired daily function is interposed between the symptoms and the reduced quality of life. This is reflected in the International Classification of Function, Disability and Health model published by the World Health Organization in 2001. This correlation between symptom, daily function, and quality of life makes it clear that to evaluate the success of a therapy and develop new therapies, daily function must also be evaluated as accurately as possible. However, daily function is a complex construct and therefore difficult to quantify. To date, daily function has been measured primarily by capacity (clinical assessments) and perception (surveys and patient-reported outcomes) assessment approaches. Now, daily function can be captured in a new dimension, that is, performance, through new digital technologies that can be used in the home environment of patients. This viewpoint discusses the differences and interdependencies of capacity, perception, and performance assessment types using the example of Parkinson's disease. Options regarding how future study protocols should be designed to get the most comprehensive and validated picture of daily function in patients are presented. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review.

[Purpose] Cervical radiculopathy is a clinical condition associated with pain, numbness and/or muscle weaknesses of the upper extremities due to a compression or irritation of the cervical nerve roots. It is usually managed conservatively but surgical intervention is sometimes required for those who fail to respond adequately. This study performed a literature review to determine the effects of exercise on non-operative and post-operative cervical radiculopathy patients. [Methods] The PubMed, MEDLINE, CINAHL and Scopus databases were searched to identify relevant articles published from January 1997 to May 2014, which explicitly stated that an exercise program was employed as an intervention for cervical radiculopathy. The therapeutic effectiveness and outcomes were then classified based on the International Classification of Functioning, Disability and Health (ICF) model. [Results] Eleven studies were identified and included in the final analysis. In these studies, the main forms of exercise training were specific strengthening and general stretching exercises. Levels of evidence were graded as either I or II for all studies according to the Oxford Centre for Evidence-based Medicine. The PEDro Scale score of these studies ranged from 5 to 8. [Conclusion] A review of eleven high-level evidence and high-quality studies revealed that, based on the ICF model, exercise training is beneficial for improving the body function as well as activity participation of cervical radiculopathy patients.

The effects of hamstring stretching exercises on pain intensity and function in low back pain patients: A systematic review with meta-analysis of randomized controlled trials.

Objectives: This meta-analysis aims to synthesize the available data on the effectiveness of hamstring stretching exercises in relieving pain intensity and improving function for patients with low back pain. Methods: Google Scholars, PubMed, Embase, Cochrane, MEDLINE, CNKI, Wanfang, and VIP were searched from inception to August 2023. We included randomized controlled trials that investigated the effectiveness of hamstring stretching exercises in patients with low back pain. The primary outcomes assessed were pain intensity, hamstring muscle flexibility, and function. Study selection, data extraction, and assessment of risk of bias were performed independently by two reviewers. Results: Our searches retrieved 344 trials, of which 14 met the inclusion criteria for this review (n = 735 participants). The combined meta-analysis showed hamstring stretching resulted in lower pain scores (standardized mean difference = -0.72, 95% confidence interval: -1.35 to -0.09; I 2 = 89%, p = 0.03) in different categories of low back pain. Subgroup analysis showed that hamstring stretching led to a larger range of motion for cases of back pain with radiating pain (standardized mean difference = 2.39, 95% confidence interval: 1.76 to 3.02; I 2 = 0%, p < 0.001). The combined meta-analysis revealed that hamstring stretching resulted in lower Oswestry Disability Index scores in comparison to regular treatment, particularly in individuals suffering from low back pain across all subtypes (mean difference = -6.97, 95% confidence interval: -13.34 to -0.60; I 2 = 95%, p = 0.03). Conclusions: This meta-analysis demonstrates the effectiveness of hamstring stretching exercises in reducing pain intensity in various categories of low back pain and improving the straight leg raise in patients experiencing back pain with radiating pain. Additionally, it highlights the improvement in function for patients with back pain across all subtypes.

Quality-of-life among women with breast cancer: application of the international classification of functioning, disability and health model.

Background: This study aimed to identify the factors that influence Breast Cancer (BC) women's quality of life (QoL) based on the International Classification of Functioning, Disability and Health (ICF) framework. Method: A cross-sectional study was conducted among 188 women with BC. The dependent variable, QoL, was measured using the Quality of Life Index (QLI-c). The independent variables were measured using the following Arabic-validated questionnaires: Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ). Results: There was a significant positive correlation between monthly income (r = 0.17, p = 0.016) and QoL, and significant negative correlation between the stage of disease (r = -0.221, p = 0.002) and duration of first diagnosis (r = -0.280, p = 0.004) with QoL. Poor sleep quality, sexual dysfunction, fatigue, depression, and anxiety had significant negative correlations with QoL (p < 0.01). Multiple regression analysis revealed that among the various factors that might affect QoL, sexual dysfunction, poor sleep quality, depression, and anxiety were significant predictors of QoL (p ≤ 0.05). Conclusion: The ICF provided an excellent framework to explore the factors influencing QoL among women with BC. This study has given evidence for the relationship of demographic, clinical, and body functional factors with QoL among women with BC. Interestingly, sexual dysfunction, poor sleep quality, depression, and anxiety factors are predictors of QoL. Awareness of these factors that predict QoL will guide healthcare professionals to improve the health and QoL of BC women.

Clinical-functional features of individuals with Osteogenesis Imperfecta and Ehlers-Danlos syndromes: A scoping review of assessment tools and ICF model.

BACKGROUND: Clinical-functional assessment of patients affected by Osteogenesis Imperfecta and Ehlers-Danlos Syndromes is essential for clinical management. However, there is no clear information on disease-specific tools of assessment for clinical practice, thus limiting quantification and management of the diseases-related impairments. OBJECTIVE: The present scoping review was aimed at investigating the most common clinical-functional features and assessment tools in individuals with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes, and to provide an updated International Classification of Functioning (ICF) model related to functional impairments for each disease. METHODS: The literature revision was conducted on PubMed, Scopus and Embase databases. Articles reporting an ICF model of clinical-functional features and assessment tools for Osteogenesis Imperfecta and Ehlers-Danlos Syndromes individuals were included. RESULTS: A total of 27 articles were included, 7 reporting an ICF model, and 20 reporting clinical-functional assessment tools. It was reported that patients with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes show impairments in both Body Function and Structure, and Activities and Participation domains of the ICF. A heterogeneous number of assessment tools was found for both diseases regarding proprioception, pain, endurance to exercise, fatigue, balance and motor coordination, and mobility. CONCLUSION: Patients with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes show several impairments and limitations in Body Function and Structure, and Activities and Participation domains of the ICF. Thus, an appropriate and ongoing assessment of the disease-related impairments is necessary to improve clinical practice. Several functional tests and clinical scales can be used to assess the patients despite the heterogeneity of assessment tools found in previous literature.

Applying the ICF model in adult spinal deformity: disability in terms of participation should be incorporated in the care pathway.

PURPOSE: To investigate the participation restriction of adult spinal deformity (ASD) patients, and its relation with the impairments in body structure and function, and activity limitation, as this important information regarding the individual's perspective on the social impact of the disease on their life is presently not captured. METHODS: Forty-three ASD patients participated in the study and completed the impact on participation and autonomy (IPA) questionnaire to assess the level of participation. Activity limitations and impairments were measured with the Balance Evaluation Systems Test (BESTest) and Scoliosis Research Society-22r (SRS-22). Also, age, body height, body weight, BMI, Mini-mental state examination and Cumulative Illness Rating Scale were assessed. A univariate linear regression analysis was conducted to investigate the relationship between the IPA and the independent variables, whereas a multivariate analysis identified the significant predictive variables for the IPA questionnaire. RESULTS: The univariate analysis identified performance on the BESTest and SRS-22 as significantly (p < 0.001) related to the IPA questionnaire. The multiple regression analysis revealed that the performance on BESTest (p = 0.073) and SRS-22 (p < 0.001) independently predicted the IPA questionnaire, explaining 73.5% of its variance. CONCLUSION: To fully understand the impact of ASD on the individual's functioning, disability and health-status, it is suggested that questionnaires on participation to society should be considered, together with clinical postural tests (e.g. the BESTest) and questionnaires related to HRQOL (e.g. the SRS-22), in the ASD care path. This additional information should allow the surgeon to make a more informed selection of surgical patients.

Recommendations for studies on dynamic arm support devices in people with neuromuscular disorders: a scoping review with expert-based discussion.

PURPOSE: Neuromuscular disorders are characterised by muscle weakness that limits upper extremity mobility, but can be alleviated with dynamic arm support devices. Current research highlights the importance and difficulties of evidence-based recommendations for device development. We aim to provide research recommendations primarily concerning upper extremity body functions, and secondarily activity and participation, environmental and personal factors. METHODS: Evidence was synthesised from literature, ongoing studies, and expert opinions and tabulated within a framework based on a combination of the International Classification of Functioning, Disability and Health (ICF) model and contextual constructs. RESULTS: Current literature mostly investigated the motor capacity of muscle function, joint mobility, and upper body functionality, and a few studies also addressed the impact on activity and participation. In addition, experts considered knowledge on device utilisation in the daily environment and characterising the beneficiaries better as important. Knowledge gaps showed that ICF model components and contextual constructs should be better integrated and more actively included in future research. CONCLUSIONS: It is recommended to, first, integrate multiple ICF model components and contextual constructs within one study design. Second, include the influence of environmental and personal factors when developing and deploying a device. Third, include short-term and long-term measurements to monitor adaptations over time. Finally, include user satisfaction as guidance to evaluate the device effectiveness.IMPLICATIONS ON REHABILITATIONSynthesized evidence will support future research and development of dynamic arm supports.Tabulated evidence stresses the importance of integrating ICF model components and contextual constructs to fill the knowledge gaps.Presented knowledge gaps and proposed steps guide the set up of future studies on dynamic arm supports.

Effects of Integrative Autism Therapy on Multiple Physical, Sensory, Cognitive, and Social Integration Domains in Children and Adolescents with Autism Spectrum Disorder: A 4-Week Follow-Up Study.

This study aimed to compare the effects of conventional autism therapy (CAT) and integrative autism therapy (IAT) in children and adolescents with autism spectrum disorder (ASD). A convenience sample of 24 children with ASD was recruited and underwent either CAT or IAT for 60 min/day, twice a week, for 20 sessions over 10 weeks. Outcome measures included the following: (1) physical domain (pediatric balance scale, PBS), (2) sensory domain (short sensory profile), (3) cognitive domains (functional independence measure, FIM; and childhood autism rating scale), and (4) social integration domain (Canadian occupational performance measure, COPM; short falls efficacy scale; and pediatrics quality of life questionnaire). Two-way repeated analysis of variance (ANOVA) was used to determine the intervention-related changes in the four domains across the pre-test, post-test, and follow-up test at p < 0.05. ANOVA showed significant interaction effects on the PBS, FIM, and COPM (p < 0.05) variables. Moreover, time main effects (p < 0.05) were observed in all four domain variables, but no group main effect was noted. This study provides promising evidence that IAT is more effective than CAT for managing children and adolescents with ASD.

Work participation, sensory processing and sleep quality in adults with attention-deficit hyperactive disorder.

BACKGROUND: Although studies have indicated significant effects of attention-deficit hyperactive disorder (ADHD) on work participation, the mechanism underlying work participation of adults with ADHD is still unclear. OBJECTIVE: Following the World Health Organization's international classification of functioning, disability, and health concepts, this study compares sensory processing and sleep quality (body functions) with work participation among adults with and without ADHD and examines predictive relationships among adults with ADHD. METHODS: Sixty-nine adults with ADHD and 52 matched controls completed a sociodemographic questionnaire, the Adult/Adolescent Sensory Profile, the Mini Sleep Questionnaire, and the Occupational Questionnaire. RESULTS: The ADHD group had significantly poorer body functions, sensory processing (i.e., low registration, sensory-sensitivity, and sensation-avoiding patterns), sleep quality, and work performance compared to the control group (p < .001). For adults with ADHD, sensory sensitivity accounted for 10.9%, and sleep quality accounted for 22.0%, of the variance in their work performance. CONCLUSIONS: The deficient body functions of adults with ADHD may affect their work performance and therefore should be considered in further research, as well as in clinical applications.

Effectiveness and Success Factors of Bilateral Arm Training After Stroke: A Systematic Review and Meta-Analysis.

Bilateral arm training (BAT) presents as a promising approach in upper extremity (UE) rehabilitation after a stroke as it may facilitate neuroplasticity. However, the effectiveness of BAT is inconclusive, and no systematic reviews and meta-analyses have investigated the impact of different factors on the outcomes of BAT. This systematic review and meta-analysis aimed to (1) compare the effects of bilateral arm training (BAT) with unilateral arm training (UAT) and conventional therapy (CT) on the upper limb (UL) motor impairments and functional performance post-stroke, and (2) investigate the different contributing factors that may influence the success of BAT. A comprehensive literature search was performed in five databases. Randomized control trials (RCTs) that met inclusion criteria were selected and assessed for methodological qualities. Data relating to outcome measures, characteristics of participants (stroke chronicity and severity), and features of intervention (type of BAT and dose) were extracted for meta-analysis. With 25 RCTs meeting the inclusion criteria, BAT demonstrated significantly greater improvements in motor impairments as measured by Fugl-Meyer Assessment of Upper Extremity (FMA-UE) than CT (MD = 3.94, p = < 0.001), but not in functional performance as measured by the pooled outcomes of Action Research Arm Test (ARAT), Box and Block Test (BBT), and the time component of Motor Function Test (WMFT-time) (SMD = 0.28, p = 0.313). The superior motor impairment effects of BAT were associated with recruiting mildly impaired individuals in the chronic phase of stroke (MD = 6.71, p < 0.001), and applying a higher dose of intervention (MD = 6.52, p < 0.001). Subgroup analysis showed that bilateral functional task training (BFTT) improves both motor impairments (MD = 7.84, p < 0.001) and functional performance (SMD = 1.02, p = 0.049). No significant differences were detected between BAT and UAT for motor impairment (MD = -0.90, p = 0.681) or functional performance (SMD = -0.09, p = 0.457). Thus, our meta-analysis indicates that BAT may be more beneficial than CT in addressing post-stroke UL motor impairment, particularly in the chronic phase with mild UL paresis. The success of BAT may be dose-dependent, and higher doses of intervention may be required. BFTT appears to be a valuable form of BAT that could be integrated into stroke rehabilitation programs. BAT and UAT are generally equivalent in improving UL motor impairments and functional performance.

Home modifications and disability outcomes: A longitudinal study of older adults living in England.

Background: There is limited evidence on the protective effect of housing modifications on disability outcomes among older adults. We examined whether external and internal housing modifications reduce the risk of a range of disability outcomes among older adults living in England. Methods: We analysed adults aged 60 and over from the English Longitudinal Study of Ageing, initially recruited in 2002/03. The longitudinal sample consisted of 32,126 repeated observations from 10,459 individuals across 6 waves with an average follow-up of 11·3 years. Participants were asked if their homes had external (widened doorways, ramps, automatic doors, parking and lift) and internal (rails, bathroom/kitchen modifications, chair lift) housing modifications. Mobility impairment was measured through reported difficulties in 10 activities including walking, climbing, getting up, reaching and lifting. Five disability outcomes were analysed (falls in the previous two years, pain, poor self-rated health, no social activities, and moving home within next two years) using two-way fixed effect models, controlling for key risk factors for disability. Findings: Greater mobility impairments increased the probability of falls, pain and poor self-rated health although this effect was significantly moderated by external housing modifications. Among older adults with severe mobility impairments, external housing modifications reduced the probability of falls by 3% (1%-6%), pain by 6% (4%-8%), and poor health by 4% (2%-5%). Moreover, external housing modifications reduced the probability of no social activities by 6% (5%-7%) and moving home by 4% (2%-5%) even among those without any mobility impairments. Internal housing modifications had similar, but less consistent effects on the disability outcomes. Interpretation: There was strong evidence that external housing modifications protected against a range of disability outcomes. Studies on reducing disability in ageing populations need to consider the role of housing modifications as key interventions to promote healthy ageing in place. Funding: Economic and Social Research Council ES/R008930/1 and ES/S012567/1.

The role of workplace accommodations in explaining the disability employment gap in the UK.

There has been limited theoretical and empirical research into the role of workplace accommodations in enabling workers with and without impairments to remain in work. This study used the International Classification of Functioning, Disability and Health (ICF) model to examine (a) whether workplace accommodations enable workers, particularly those with different impairments, to remain economically active; and (b) the predictors of the onset of work accommodations. Data from two waves of a large-scale longitudinal survey of disability in Great Britain, the Life Opportunities Survey (2009-2012) were analysed. 2307 workers with an impairment and 4308 workers without an impairment were followed up for a year. Work accommodations appear to enable workers with impairments to remain economically active, especially those with mental impairments. There was no difference in the employment rates of workers with and without mental impairments who had two or more work accommodations, in contrast to the 10% employment gap between workers with and without mental impairments who did not have any work accommodations. While there was no gender difference in the disability employment gap, barriers to employment related to caregiving were much greater for women compared to men. Moreover, only workers with incident pain impairments were associated with an increase in their work accommodations, not workers with incident mental impairments. Despite the evidence that workers with mental impairments could benefit considerably from workplace accommodations, they are less likely to have their workplace adjusted. The ICF model is particularly useful in analysing the role of work accommodations because it considers a much wider range of factors that are relevant not just to workers with different types of impairments, but are also relevant to the wider group of workers who use workplace accommodations.

Comparative effects of community-based family-child-centered care and conventional pediatric rehabilitation for cerebral palsy.

BACKGROUND: While the transdisciplinary-based rehabilitation provided ample evidence on improving impairment (body structure and functions) levels, the therapeutic effects on the international classification of functioning, disability, and health (ICF) domains are unknown in cerebral palsy (CP). OBJECTIVE: To compare the effects of the community-based family-child-centered care (CFC) and conventional pediatric rehabilitation (CPR) on the physical, cognitive, sensory, and social integration domains in children and adolescents with CP. METHODS: Twenty-six participants with CP (mean age = 9.37±5.24, 14 females) were assigned into either CPR or CFC groups. Clinical outcomes included gross motor function measure (GMFM-66), Pediatric Balance Scale (PBS), fine motor area of Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Functional Independence Measure (FIM) cognition area, Short Sensory Profile (sSP), COPM, Pediatrics Quality of Life (PedsQL) questionnaire, Short Falls Efficacy Scale (sFES), and Dynamic Postural Instability (DPI). An analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) was conducted at P < 0.05. RESULTS: ANOVA revealed the superior effects of CFC in GMFM-66, PBS, BOT-2, FIM, and PedsQL compared to CPR (P < 0.05). ANCOVA showed the superior effects of CFC in Z-axis of DPI than CPR (P < 0.05). CONCLUSIONS: Our results provide novel, promising clinical evidence that CFC was more effective than CPR at improving impairment, activity, as well as participation levels in participants with CP.

Patterns of Social Engagement Among Older Adults With Mild Cognitive Impairment.

OBJECTIVES: Promoting engagement in social activities may be an intervention that prevents or delays cognitive impairment. Nevertheless, little is known about social engagement among people with mild cognitive impairment (MCI). We aim to examine patterns of social engagement among people with MCI and to assess whether factors under 4 domains of the WHO's ICF model (personal factors, environmental factors, body functions and structure, and health condition) associate with different patterns of social engagement. METHOD: Data were drawn from the 2010 Health and Retirement Study. The final sample comprised 1,227 people with cognitive impairment no dementia (CIND). Latent class analysis and multinomial logistic regression were utilized. RESULTS: Three patterns of social engagement were identified: informal social engagement only, formal and informal social engagement, and low social engagement. Factors in each of the 4 ICF model domains were associated with the probability of class membership. DISCUSSION: Our findings suggest that social engagement is heterogeneous among people with CIND and that some groups of people with CIND have possibilities of engaging in more social activities, especially in formal social activities. Results also indicate that providing informal social resources may be essential for social programs designed specifically for people with CIND to promote their formal social engagement. Future study is needed to examine possible differences in outcomes across groups with similar patterns of social engagement.

Late adolescent & young adult functioning and participation outcomes after prematurity.

There has been an increased emphasis on optimizing health, developmental, and behavioral outcomes over the life course after prematurity. An important framework for examining adolescent and young adult outcomes is the International Classification of Functioning Disability and Health Children (ICF) developed by the World Health Organization (WHO) in 2001 and expanded to children and youth (ICF-CY) under age 19 years in 2007. The ICF and the ICF-CY can be used as a statistical tool in population studies, a research tool to measure outcomes, quality of life, and environmental factors, a clinical tool for outcomes of rehabilitation and vocation training, and as a social policy-educational tool to raise awareness and promote social action for equity. In this review we describe how functioning and participation can help inform transitional outcomes at age 17 years and emerging adult independence at 23 years. We highlight outcomes in adolescence and adulthood of former preterm infants using the ICF domains of functioning and participation. We include current standardized adaptive assessments (Vineland Adaptive Behavior Scales-3rd Edition; VABS3) and Adaptive Behavior Assessment Scale-3; ABAS3) that measure self-care daily living skills, applied learning, and social functioning. We also emphasize that participation involves life activities of higher education attainment, completing vocational training, experiencing employment, living independently, and relationship experiences with partners as well as family formation.

A global health training model for teaching pediatric clinical decision making skills to Rwandan physical therapists: A case report.

Background and Purpose: There is increasing interest among physical therapists from high-income countries to participate in education development projects in low-income countries. However, there are few examples in the literature of effective developmental models or projects. This case report describes a model for improving pediatric clinical decision making skills among Rwandan physical therapists using best practices in clinical decision making, evidence-based practice where possible, and use of the International Classification of Functioning and Disability (ICF) model. Case Description: A 48-hour continuing professional development course based on the pediatric section of the Advancement of Rwandan Rehabilitation Services Project (ARRSP) was presented to 66 Rwandan physical therapists in the form of classroom lectures, laboratory and case study practice, and clinical visits to the course participant's work place. Interactive teaching and learning was emphasized. Outcomes: Course participants completed a pre- and post-course assessment addressing course content. There was a 53% improvement in post-course assessment scores. A post-course evaluation eliciting participants' confidence in eight clinical decision making skills emphasized in course material was also administered. Comments were strongly positive (92%) for the value of clinical visits in reinforcing the participant's new clinical skills. Discussion: This case report documents a global health continuing professional development project that improved pediatric rehabilitation knowledge and clinical skill confidence. The project incorporated sustainability by soliciting both input and involvement of the target audience from start to finish; from the needs assessment to classroom teaching. Building on these two aspects promotes a sense of ownership and longevity.

Progressive intervention strategy for the gait of sub-acute stroke patient using the International Classification of Functioning, Disability, and Health tool.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) provides models for functions and disabilities. The ICF is presented as a frame that enables organizing physical therapists' clinical practice for application. OBJECTIVE: The purpose of the present study was to describe processes through which stroke patients are assessed and treated based on the ICF model. METHODS: The patient was a 65-year-old female diagnosed with right cerebral artery infarction with left hemiparesis. Progressive interventions were applied, such as those aiming at sitting and standing for the first two weeks, gait intervention for the third and fourth weeks, and those aiming at sitting from a standing position for the fifth and sixth weeks. RESULTS: The ICF model provides rehabilitation experts with a frame that enables them to accurately identify and understand their patients' problems. The ICF model helps the experts understand not only their patients' body structure, function, activity, and participation, but also their problems related to personal and environmental factors. CONCLUSIONS: The experts could efficiently make decisions and provide optimum treatment at clinics using the ICF model.

Optimal management of complications associated with achondroplasia.

Achondroplasia is the most common form of skeletal dysplasia, resulting in disproportionate short stature, and affects over 250,000 people worldwide. Individuals with achondroplasia demonstrate a number of well-recognized anatomical features that impact on growth and development, with a complex array of medical issues that are best managed through a multidisciplinary team approach. The complexity of this presentation, whereby individual impairments may impact upon multiple activity and participation areas, requires consideration and discussion under a broad framework to gain a more thorough understanding of the experience of this condition for individuals with achondroplasia. This paper examines the general literature and research evidence on the medical and health aspects of individuals with achondroplasia and presents a pictorial model of achondroplasia based on The International Classification of Functioning, Disability, and Health (ICF). An expanded model of the ICF will be used to review and present the current literature pertaining to the musculoskeletal, neurological, cardiorespiratory, and ear, nose, and throat impairments and complications across the lifespan, with discussion on the impact of these impairments upon activity and participation performance. Further research is required to fully identify factors influencing participation and to help develop strategies to address these factors.

Health-related quality of life and its relation to disease severity in boys with Duchenne muscular dystrophy: satisfied boys, worrying parents--a case-control study.

The progression of Duchenne muscular dystrophy is expected to negatively influence the patients' health-related quality of life, but knowledge of the relationship with disease severity is limited. We investigated the relationship between health-related quality of life (KIDSCREEN-52 questionnaire) and disease severity (clinical assessments of body functions and activities) in 40 boys with Duchenne muscular dystrophy (19 ambulant, 21 wheelchair dependent) who were in different phases of the disease and underwent life-limiting events such as the loss of the ability to ambulate and the ability to lift the arms. In addition, we compared boys' health-related quality of life perceptions with that of their parents. The participants' health-related quality of life was similar to healthy peers' and not influenced by disease severity, except for the physical domain. Parents scored much lower than the boys on the KIDSCREEN-52 domains Self Perception, Moods and Emotions, and Bullying. The latter finding needs attention in the management of Duchenne muscular dystrophy.