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Introduction: Persistent fatigue after acquired brain injury (ABI) needs long-term self-management. Self-monitoring supports self-management and informs the use of fatigue management strategies. Using ecological momentary assessment to monitor fatigue offers a data-driven approach to managing fatigue. Aims: To explore the usefulness of self-monitoring fatigue in real-time, using ecological momentary assessment to support self-management, from the perspective of people with ABI and occupational therapists. Methods: People with ABI monitoried their fatigue by wearing a Fitbit and completing six surveys a day on their phone for 6 days. Think aloud and semi-structured interviews elicited views on self-monitoring and the data generated. Transcripts were analysed using reflexive thematic analysis. Results: Four themes were developed from people with ABI (n = 9): (1) Attending to experience, (2) making sense of data, (3) the relationship between fatigue and activity, (4) implications for daily life. Three themes from occupational therapists (n = 5): (1) Challenges of using of data, (2) perceived benefits of self-monitoring, (3) viewing data in relation to their understanding of fatigue. Conclusion: Data generated in real-time challenged perspectives on fatigue and fatigue management. These insights may help people with ABI and their clinicians to plan personalised strategies for fatigue management and evaluate its impact on daily living. [ABSTRACT FROM AUTHOR]

Purpose: This review synthesised the evidence for the effect of prehabilitation interventions on biopsychosocial and service outcomes. Materials and Methods: A systematic review was conducted. 10 databases were searched to December 2023. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were included. Prehabilitation was any preoperative intervention to improve physical or psychological outcomes. Included studies required a comparator group or alternative preoperative intervention as well as baseline, presurgical and postoperative assessment points. Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). Results: 6028 studies were screened, with 25 studies included. Prehabilitation interventions were: inspiratory muscle training (five studies n = 450); exercise (nine studies n = 683); psychological (one study n = 400); and nutritional (ten studies n = 487). High quality studies showed preoperative improvements in impairments directly targeted by the interventions. Generally, these did not translate into functional or postoperative improvements, but multimodal interventions were more promising. Conclusion: Current evidence supports prehabilitation as safe to preserve or improve preoperative function. Heterogeneity in outcomes and variable study quality means definitive conclusions regarding interventions are not yet possible, limiting implementation. Agreement of clinical outcomes and cost effectiveness evaluation is required. IMPLICATIONS FOR REHABILITATION: Prehabilitation interventions are safe and when combined optimally may preserve or improve preoperative function in patients undergoing upper gastrointestinal surgery. Multimodal interventions (including exercise, nutritional, and psychological components) showed promise which supports the delivery of prehabilitation by multidisciplinary teams. Development of a core outcome set and agreed time points for both preoperative and postoperative outcomes is needed for effective evidence synthesis. Focus on long term outcomes is necessary to determine cost effectiveness and commissioning of resources. [ABSTRACT FROM AUTHOR]

Introduction: People with Parkinson's disease (PwPD) present motor alterations which can impact daily life tasks that require speed and/or accuracy of movement. Objective: A sub analysis of NCT01439022, aiming to estimate the extent to which two different exercise training protocols (global and handwriting upper limb exercise training) impact reaction time, travel speed, and accuracy in PwPD. Methods: Seventy PwPD, right-side dominant were randomised 1:1 into two six-month training protocol groups; 35 PwPD performed global exercise training and 35 performed specific training (handwriting upper limb exercise movements). Assessments of speed-accuracy and trade-off were carried out at baseline, after 3 and 6 months of training, and at a 12-month follow-up. The current study used data from a previous publication of a randomised controlled trial that included a 6-month self-managed community exercise programme for PwPD. For the present study we included only the participants who completed the Fitts' task during the baseline assessment. Results: In the upper limb assessments, no main effects were found for the number of touches, but the exercise group showed a marginal increase over time on the left side. Error averages on the left side decreased significantly for the exercise group from baseline to 6 and 12 months. The exercise group also presented a lower Error CoV and the Reaction Time CoV increased on the right side. Significant findings for Fitts r on the left side indicated lower values for the exercise group, with improvements continuing at 12 months. Conclusion: We report the potential of global exercise interventions to facilitate improvements in reaction time and travel speed, as well as other motor control metrics, with lasting effects at 12 months, particularly on the non-dominant side. [ABSTRACT FROM AUTHOR]

Introduction: Despite practice guidelines, professionals do not feel confident in implementing positive risk-taking. This may be due to the guidance provided. Method: A scoping review of current organisational guidance for the professional practice of positive risk-taking within Adult Social Care services for people with a physical disability. Guidelines were obtained from Local Authorities in England in October 2020. The data were extracted using TIDieR to describe positive risk-taking as an intervention. The quality of the guidelines was assessed using AGREE II. Findings: In all, 36 Local Authorities responded out of 106 contacted. A total of 21 documents were included for review. Substantial variability was found in terminology, definitions and risk grading between documents. The greatest consistency was found in how to implement a positive risk-taking intervention. Consistency was also found in the policy that documents cited. There was little reference to evidence to support intervention components. Overall, AGREE II quality scores were low and stakeholder involvement, specifically with regard to the views and preferences of service users, was largely absent. Conclusion: There is a need for a greater consensus to guide the professional practice of positive risk-taking. Determining the extent of current evidence and establishing an evidence base may facilitate more consistent guidelines and support professionals' confidence in implementing positive risk-taking. [ABSTRACT FROM AUTHOR]

Despite a growing societal commitment to include students with intellectual disabilities (ID) on college and university campuses, including a robust proliferation of programs in recent years, postsecondary outcomes for these students lag far behind those of non-disabled students and students with other types of disabilities. This article establishes the need for inclusive higher education programming for students with ID, examines current best practices among colleges and universities in preparing students with ID for adult life roles such as independent living and employment, and describes an innovative statewide support model that is currently being implemented in Kentucky. Implications for delivering inclusive higher education programs in the wake of the COVID-19 pandemic are emphasized throughout the article. Keywords: poverty, race, disability, vocational rehabilitation, Increasing emphasis on higher education reflects a shift in the future occupational outlook in the United States. Advances in technology will result in fewer jobs in manufacturing and other customer [...]

Developmental coordination disorder (DCD) is characterized by motor learning deficits that are poorly understood within whole-body activities context. Here we present results of one of the largest non-randomized interventional trials combining brain imaging and motion capture techniques to examine motor skill acquisition and its underpinning mechanisms in adolescents with and without DCD. A total of 86 adolescents with low fitness levels (including 48 with DCD) were trained on a novel stepping task for a duration of 7 weeks. Motor performance during the stepping task was assessed under single and dualtask conditions. Concurrent cortical activation in the prefrontal cortex (PFC) was measured using functional near-infrared spectroscopy (fNIRS). Additionally, structural and functional magnetic resonance imaging (MRI) was conducted during a similar stepping task at the beginning of the trial. The results indicate that adolescents with DCD performed similarly to their peers with lower levels of fitness in the novel stepping task and demonstrated the ability to learn and improve motor performance. Both groups showed significant improvements in both tasks and under single- and dual-task conditions at post-intervention and follow-up compared to baseline. While both groups initially made more errors in the Stroop task under dual-task conditions, at follow-up, a significant difference between single- and dual-task conditions was observed only in the DCD group. Notably, differences in prefrontal activation patterns between the groups emerged at different time points and task conditions. Adolescents with DCD exhibited distinct prefrontal activation responses during the learning and performance of a motor task, particularly when complexity was increased by concurrent cognitive tasks. Furthermore, a relationship was observed between MRI brain structure and function measures and initial performance in the novel stepping task. Overall, these findings suggest that strategies that address task and environmental complexities, while simultaneously enhancing brain activity through a range of tasks, offer opportunities to increase the participation of adolescents with low fitness in physical activity and sports. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResults and conclusions\nIMPLICATIONS FOR REHABILITATIONThis research aims to identify information that is important to provide on supply of custom-contoured seating. The way this information would be best communicated is also of interest. A two-round e-Delphi study was utilised to explore consensus. A panel of stakeholders from Ireland including experts in positioning clients in custom-contoured seating and caregivers were recruited. The first round consisted of open-ended questions and was analysed using thematic analysis. The second round employed a rating technique and 7-point Likert scale. Consensus was set a priori at 70% agreement. The way information should be communicated and by whom was rated in order of preference.Fifteen participants were recruited, nine clinicians and four caregivers. Fifty-two statements under six themes (transfers = 10, positioning = 22, pressure care = 4, general use = 4, post-supply follow-up = 8, functional activity = 4) were generated in round 1 by 13/15 participants. Round 2 was completed by 10/15. 49/52 statements reached consensus and were deemed important. The ways information should be communicated and by whom was identified. Caregivers want individualised information whereas clinicians preferred a more generic approach.There was a high degree of consensus on what information is required to support caregivers. The topics demonstrate the extensive information that should be provided. The preferred delivery method for primary caregivers was hands-on training with the opportunity to practice and take videos. Stakeholders differed in how they would prefer information delivered. Further research should evaluate the method of delivering training and its effectiveness.Caregivers report a lack of guidance on postural management, which exacerbates their own health problems and results in underutilization of positioning equipment.Caregivers should be provided with information on transfers, positioning, pressure care, general chair use, post-supply follow-up, and the impact on functional activities when a new custom contoured seat is supplied.The preferred method of providing information to primary caregivers is to use hands-on training with the opportunity to practice and take videos during the supply appointment. Personalised information booklets or group training sessions may be most appropriate for additional caregivers. [ABSTRACT FROM AUTHOR]

Purpose: This study set out to identify the extent of the relationships between subsections of the Movement Assessment Battery for Children 2nd Edition - MABC2 (manual dexterity, aiming and catching, and balance) to PA, CRF and BMI in adolescents. Methods: Height, BMI, the MABC2, a 20m shuttle run test and wrist-worn accelerometery PA levels (mins) were measured. Multivariable linear regression models, adjusting for sex, height and BMI were used to assess the relationship of the three subsections of the MABC2 with PA, CRF and BMI. Results: A total of 155 adolescents, aged 13-14 years, took part in this study (77 girls, 78 boys). Balance reported significant relationships with moderate to vigorous PA (unstandardised Beta B=0.15, 95%CI 0.02-0.28), vigorous PA (B=0.06, 95%CI 0.02-0.09) and BMI (B=-0.01, 95%CI -0.02-0.005). Balance in addition to aiming and catching skills were both significantly related to adolescent CRF (B=0.30, 95%CI 0.17-0.42 and B=0.29, 95%CI 0.14-0.45, respectively). Conclusion: This study suggests that balance is the strongest correlate skill to achieving the highest intensities of PA and healthier BMI status in adolescents. [ABSTRACT FROM AUTHOR]

Background: Few studies have measured physical activity (PA) levels of adults with intellectual disabilities using both objective and subjective methods, but none included individuals with profound intellectual disabilities. To inform effective measurement of PA across the disability spectrum, this study explored: the feasibility of measuring PA levels using the International Physical Activity Questionnaire-short version (IPAQ-s) and a wrist-worn 7-day accelerometer; examined the level of agreement between instruments/raters; and established the recruitment rate. From the literature reviewed, no study has investigated these issues. Materials and Methods: Two-hundred adults with intellectual disabilities from a local authority lists in UK were invited to participate. Participants were administered an accelerometer for seven days and the IPAQ-s (self and carer-reported). Results: Twenty participants with mild to profound intellectual disabilities (20-70 years) were recruited. The response rate was significantly different between home (16%) and residential homes (4%): ?[superscript 2](1) = 7.7, p < 0.05. All participants completed the IPAQ-s but only 15 completed 7-day accelerometer. Self and carer-reported PA had perfect agreement on IPAQ-s, and agreements between instruments using PA guidelines was substantial (k = 0.6, p < 0.05). However, mean moderate-vigorous PA min/week differed between measures at 145 and 207 from IPAQ-s and accelerometer respectively. Conclusions: Recruitment demonstrated a need for better engagement with residential homes. While both the IPAQ-s and accelerometers can be used to evaluate PA levels, the IPAQ-s was more acceptable and carer report was accurate, but it underestimated absolute moderate-vigorous PA levels. These findings indicate that IPAQ-s can be used to measure PA levels, including in those with profound intellectual disabilities.

Objective: A diagnosis of Parkinson's often leads to uncertainty about the future and loss of perceived control. Peer support may offer a means to address these concerns and promote self-management. Design: A programme evaluation of the feasibility and potential effects of 'First Steps', utilising a pragmatic step wedge approach. Comparing First Steps (intervention) to (control) conditions. Setting: In the community at four sites in southern England. Participants: Newly diagnosed (≤ 12months) people with Parkinson's. Intervention: First Steps was a 2-day peer-conceived, developed and led intervention to support self-management. Main measures: At 0, 12 and 24 weeks anxiety and depression (Hospital, Anxiety and Depression Scale, HADS), daily functioning (World Health Organisation Disability Assessment Schedule, WHODAS), physical activity, quality of life (EQ5D), carer strain and service utilisation were assessed. Results: Between February 2018 and July 2019, 36 participants were enrolled into intervention and 21 to control conditions, all were included in statistical analysis. Lost to follow up was n = 1 (intervention) and n = 1 adverse event was reported (control, unrelated). Of the 36 allocated to the intervention n = 22 participants completed both days of First Steps during the study period. Completion of outcome measures was >95% at 24 weeks. Small effects favouring the intervention were found for HADS (odds ratio (OR) = 2.06, 95% confidence interval (CI) 0.24:17.84), Carer Strain Index (OR = 2.22, 95% CI 0.5:9.76) and vigorous (d = 0.42, 95% CI −0.12:0.97) and total physical activity (d = 0.41, 95% CI −0.13:0.95). EQ5D, WHOSDAS and service utilisation, was similar between groups. Conclusions: First Steps was feasible and safe and we found potential to benefit physical activity, mental health and carer strain. Further research with longer-term follow up is warranted. [ABSTRACT FROM AUTHOR]

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Background: Volunteering may have therapeutic benefits, but little is known about its requirements and potential for people with neurological conditions (pwNC). Design: Two separate focus groups were conducted in Darmstadt, Germany: one group consisting of six pwNC and another group consisting of four health care professionals and three volunteering service providers. The focus groups were audio‐recorded, transcribed and data were managed using NVivo12. The thematic analysis was applied. Results: Four main themes were identified: (1) Impact of volunteering, (2) Individualisation, (3) Developmental space and (4) Funded supported volunteering. Conclusion: According to the findings, volunteering can be used as a strategy to enhance physical, mental and social well‐being in disease management for people with long‐term neurological conditions. Patients or Public Contribution: Facilitators for accessibility of therapeutic volunteering; involvement of pwNC. [ABSTRACT FROM AUTHOR]