Goal attainment of children with cerebral palsy participating in multi-modal intervention.

AIM: We aimed to determine if there was a significant difference in the functional performance of family requested daily tasks by a heterogeneous group of children with cerebral palsy following a programme of neuro-developmental treatment and in comparison to a randomly control group. BACKGROUND: There are considerable challenges in conducting research into the functional performance of children with cerebral palsy. These include the highly heterogeneous nature of the population group, poor ecological and treatment fidelity, floor and ceiling effects in assessments, and insensitivity to the diverse functional needs and goals of children and families. Therapists and families identified functional goals and specified all aspects of performance details for each goal on five point goal attainment scales. Children with cerebral palsy were assigned randomly to treatment and alternate treatment groups. Children were video recorded attempting to perform targeted functional skills at pre-test, post-pest and follow-up. Videos were recorded and rated by expert clinicians blind to experimental condition. RESULTS: After the first round of target intervention and alternate treatment had been completed, a significant difference in the goal attainment was noted between the control group and the treatment group at the post test, indicating that intervention was associated with a higher level of goal attainment than that attained by the control group (p = 0.0321) with a large effect size. CONCLUSIONS: The study provided evidence of an effective way to investigate and to enhance the available motor capacity of children with moderate to severe cerebral palsy during participation in requested daily task performance, as reflected in goal attainment. Goal attainment scales were a reliable measure that was able to be used to detect changes in functional goals among a highly heterogeneous population group with individualized goals that were meaningful to each child and family.

The Phenomenology of the Body After 85 Years.

The aim of this study was to describe the phenomenology of the body after 85 years, addressing the following question: What is the experience of the body at this age? Within the paradigm of existential phenomenology, this study was philosophically and methodologically underpinned by embodiment theory, positioning the body as the starting point for the exploration of lived experience. In-depth interviews with 20 purposively selected individuals were analyzed using van Manen's context-sensitive phenomenological orientation. Findings indicated that the body was experienced primarily in negative terms, as compromising engagement in meaningful activity, independence, safety, vitality, dignity, and identity. Participants coped with bodily changes through adaptation, humor, and acceptance. In addition, participants viewed their unreliable and at times unfamiliar body, as distinct from their sense of self. This research addresses the current lack of subjective accounts of bodily and embodied experiences in this group, combating assumptive views and contributing insightful understanding.

Life as Experienced Within and Through the Body After the Age of 85 Years: A Metasynthesis of Primary Phenomenological Research.

The body is central to the experience of aging. In this metasynthesis, the authors located, analyzed, and reconceptualized phenomenological research on how life is experienced within and through the body after 85 years. Sandelowski and Barroso's metasynthesis method was employed. Seven databases were searched for primary phenomenological studies. After systematic screening and quality appraisal, 19 studies were included for review. Analysis was guided by Maurice Merleau-Ponty's existential philosophy of embodiment. Findings were organized using Max van Manen's reflective lifeworld existentials. Four ontological dimensions emerged, namely, being in a body (corporeality), being in time (temporality), being in place (spatiality), and being with others (relationality). Each dimension captures a distinct experiential dimension of this stage of the life course. The results suggest vast heterogeneity in the ontological experience of aging, supporting the view that diversity grows with age. The ability to adapt to multidimensional losses was identified as a source of resilience.

Beyond the impasse? Systemic consultation and understanding complex cases.

BACKGROUND: Systemic consultation provides an opportunity for clinicians working with complex cases and behaviours of concern to reflect on interpersonal dynamics that may be inhibiting change. This approach to case review is drawn from systemic family therapy, a model that is gaining some acceptance within the field of intellectual disability. METHOD: Thematic analysis was used to explore the experience of eleven clinicians attending systemic consultation. Clinicians were experienced in behaviour support, had no prior experience in family therapy and presented with complex cases described as 'stuck'. RESULTS: Consultations were seen to have many benefits, including a heightened awareness of the interpersonal needs of both clients and carers and the development of a facilitative position and skills to apply to cases. Less experienced clinicians were more likely to feel overwhelmed by this less structured, more relationally oriented focus. CONCLUSIONS: Systemic consultation has the potential to augment behaviour support, enabling clinicians to understand and negotiate problematic interpersonal dynamics when responding to behavioural difficulties. Less experienced clinicians may require additional training and support in the systemic approach.

Embodied experiences and existential reflections of the oldest old.

The aim of this study was to learn more about the embodied experiences of people over 85 years and to gain a better understanding of how they make sense of the existential issues faced at this unique stage of life. This research is philosophically and methodologically underpinned by existential phenomenology, in particular embodiment theory, which allows exploration of everyday experiences and the personal meanings attributed to them. In-depth interviews with twenty purposively selected individuals were analysed using Interpretive Phenomenological Analysis. Findings indicated that ways of being, relationships with others and one's place in the world continue to evolve into late life. Gerotranscendence theory best encapsulates lived experiences, with salient features including an increased need for deep reflection, positive solitude and meaningful relationships, among other features. This research provides new insights into how identity, meaning and the experience of the broader lifeworld are influenced by corporeal ageing.

Income and employment equity of graduates with and without disabilities.

BACKGROUND: Among Organisation for Economic Co-operation and Development [OECD] countries, Australians with disabilities are most at risk of experiencing poverty. Employment equity is essential for wellbeing, health and social inclusion. Reported differences in income level between people with and without disabilities vary widely between 0 to 47% depending on productivity assumptions. Contradictory to these assumptions, empirical research has demonstrated that people with disabilities often have equivalent skills, superior loyalty and lower absentee rates. OBJECTIVE: To investigate if there is a significant difference in the annual remuneration, hours worked and age-related career trajectory of graduates with and without disabilities. METHODS: Descriptive statistics and regression analysis were used to identify employment equity between graduates with and without disabilities in the 2011 Australian Census. RESULTS: Graduates with disabilities received a mean weekly income that was 53% of the income of graduates without disabilities and 85% of the mean hourly income. Female graduates with disabilities received the lowest mean income of all subgroups at 35% of the mean weekly income of male graduates without disabilitiesCONCLUSION:This corroborates previous research that reports people with disabilities have difficulty obtaining employment, experience insecure employment and have fewer career and promotional opportunities. The income gaps were significantly greater than gaps previously reported.

Employment programs and professionals with a disability.

UNLABELLED: It is unclear whether or not open (competitive) employment programs are meeting the needs of the growing numbers of people with a disability seeking professional employment. OBJECTIVE: To understand and describe the experience of a newly graduated professional (Michael) who was seeking open employment support and to analyze those experiences in relation to principles of effective open employment support. PARTICIPANT: Michael a recently graduated accountant who also has a physical disability. METHODS: A review of the literature was undertaken to identify recommended principles and practices for the conduct of effective open employment and career development programs. A case study was used to describe Michael's experiences as he sought professional employment. Michael's experiences were analysed in relation to recommended principles and practice. RESULTS: The analysis confirmed that the concerns Michael experienced about the supported employment program compromised the effectiveness of the support he received. CONCLUSIONS: Employment services based on models of independent living, disability service standards and remediation are likely to focus on the 'pathology' or performance 'deficits' of the person with a disability. Successful open employment models are more likely to place pre-eminence on the perspective of the person with a disability and effective practices for securing employment.

Medically unexplained chronic pain in Australia: difficulties for rehabilitation providers and workers in pain.

UNLABELLED: In Australia, evidence of an ageing population and a skills shortage are imminent challenges for employers [5,50]. A further concern arises from the work injury and motor accident compensation schemes, where many claims for soft tissue injuries result in permanent impairment depriving the community of otherwise productive workers [85]. In many cases, it is chronic pain that becomes the major barrier to a return to productive work. OBJECTIVE: This study will review the operation of rehabilitation within Australian Workers' and Motor Accidents compensation systems in order to identify values and attitudes underpinning the vocational rehabilitation ethos. The models underlying current practice will also be identified. METHODS: A comprehensive review of published literature and policy documents was undertaken. RESULTS: We identified a variety of contextual factors that influenced progress back into the workforce for people living with persistent pain. The conceptual models underpinning these factors within rehabilitation systems were explored. They were all driven by a strong focus on early return to work and at the same time the sustainability of rehabilitation as a profitable industry. CONCLUSIONS: Implications of these findings on the relationship between the rehabilitation provider and the person in pain are discussed. Rehabilitation professionals are influenced by and in turn influence the context in which chronic pain is experienced. Empirical data about the experiences of vocational rehabilitation professionals in Australian personal injury rehabilitation systems is lacking, yet the implications of the cost of chronic pain to the nation are significant. It is recommended that rehabilitation providers increase their awareness of the perhaps unforeseen traps within the various practice models they might be using on the goal of sustainable return to work for people living with pain.