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This guide is designed to provide teachers in King County, Washington, with a single resource for much of the information needed to help students with disabilities transition from school to adult life and to make informed employment decisions. It begins by providing an overview of federal and state regulations that affect students with disabilities during the transition from school to work. The guide describes two state agencies that help students with disabilities with the transition: the Division of Vocational Rehabilitation and the Division of Developmental Disabilities. The King County Developmental Disabilities Division and its functions are highlighted, including employment services in specialized industries, group supported employment, and individual supported employment. Community access services and special projects are highlighted. The Job Coach Model which provides job development, on the job training, long term follow-up, and replacement services in King County, is discussed. Quality indicators for supported employment vendors are listed and selection criteria for choosing a vendor is provided. The guide closes with a list of King County Developmental Disabilities Division Adult Services Contract Agencies. Attachments include a proposed plan for transition from school to adult life and a sample service delivery outcome plan. (CR)

Background People with disabilities (PwD) have been facing multiple health, social, and economic disparities during the COVID-19 pandemic, stemming from structural disparities experienced for long time. This paper aims to present the PREparedness, RESponse and SySTemic transformation (PRE-RE-SyST): a model for a disability-inclusive pandemic responses and systematic disparities reduction. Methods Scoping review with a thematic analysis was conducted on the literature published up to mid-September 2020, equating to the initial stages of the COVID-19 pandemic. Seven scientific databases and three preprint databases were searched to identify empirical or perspective papers addressing health and socio-economic disparities experienced by PwD as well as reporting actions to address them. Snowballing searches and experts' consultation were also conducted. Two independent reviewers made eligibility decisions and performed data extractions on any action or recommended action to address disparities. A thematic analysis was then used for the model construction, informed by a systems-thinking approach (i.e., the Iceberg Model). Results From 1027 unique references, 84 were included in the final analysis. The PRE-RE-SyST model articulates a four-level strategic action to: 1) Respond to prevent or reduce disability disparities during a pandemic crisis; 2) Prepare ahead for pandemic and other crises responses; 3) Design systems and policies for a structural disability-inclusiveness; and 4) Transform society's cultural assumptions about disability. 'Simple rules' and literature-based examples on how these strategies can be deployed are provided. Conclusion The PRE-RE-SyST model articulates main strategies, 'simple rules' and possible means whereby public health authorities, policy-makers, and other stakeholders can address disability disparities in pandemic crises, and beyond. Beyond immediate pandemic responses, disability-inclusiveness is needed to develop everyday equity-oriented

Background: Due to rises in stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is an increased demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands. Objective: The primary aim of this meta-analysis was to determine the motor outcome effectiveness of self-rehabilitation in comparison to conventional rehabilitation among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours) and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effectiveness. Methods: Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥ 5. Results: Thirty-five trials were selected (2225 participants) and accumulated motor outcome data analysed. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage and intervention design did not appear to have a significant influence on outcomes. Conclusion: This meta-analysis showed low to moderate certainty of evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.

In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with the fundamentals of PRM from a physiological perspective, looking at the human mechanisms both physical and behavioral which are at the base of PRM physicians' work. After a discussion on the development and evolution of PRM that leads to its unique and specific approach, the mechanisms considered include: - repairing processes (and potential of recovery evaluation): repairing processes are mainly related to the quantity and natural history of diseases and impairments, while potential of recovery is also linked to the individual and environmental factors; PRM physicians work on impairments to favor healing or recovery, and propose rehabilitation if there is a potential of recovery: this is related to the prognostic role of PRM physicians; - learning processes: PRM is the specialty of teaching new physical ways and behavioral approaches to make patients participate at best through improvement of impairments and modification of activities; in this perspective, during repair and rehabilitation processes, PRM physicians and the rehabilitation team are teachers of new motor and behavioral strategies; - compensatory processes (adaptation/habilitation/rehabilitation): PRM physicians teach patients how to adapt to the new (acquired) health condition using compensatory mechanisms based on other body structures/functions, behavioral changes and/or assistive devices (or technical aids) (prosthesis and orthosis); during growth PRM physicians aim at allowing a complete (and compensatory) development of the intact function, not to be impaired by the original disease; compensatory processes are related to activities; - management skills: PRM physicians are managers of people and resources; they manage patients and their caregivers, to teach and allow them to reach the best possible participation, also focusing on maintenance; they lead the team, with the aim to make it f

Objectives: To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage. Methods: We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis. Conclusions: This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.

Objectives: To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage. Methods: We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis. Conclusions: This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.

Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.

On 2 December 2020 the World Health Organization (WHO) announced key findings from the newly released “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019” published in The Lancet (1), promoting the upcoming WHO Rehabilitation Need Estimator aligned with these global estimate data. Using data from the 2019 Global Burden of Disease, Injuries, and Risk Factors Study (2), the estimates were based on the prevalence and years of life lived with disability (YLDs) of 25 diseases and impairments selected as amenable to rehabilitation. The Lancet paper presents the headline number that, globally, 2.41 billion individuals live with conditions who could benefit from rehabilitation. Musculoskeletal disorders contributed the most to this total, with a prevalence of 1.71 billion people. The Lancet paper discusses implications for the field of rehabilitation and for country-level rehabilitation priority-setting and decisions on programmes to address rehabilitation needs. The objective of this paper is to put this milestone study of global estimates of rehabilitation need into an historical perspective, and, in particular, to reflect on its implications for the WHO’s broader agenda, “Rehabilitation 2030: A Call for Action”, and for Physical and Rehabilitation Medicine more generally. This paper also briefly elaborates the opportunities for the European Academy of Rehabilitation Medicine (EARM) to contribute to the WHO’s Call for Action., EARM members EARM members collaborating in this paper (in alphabetical order): Jari Arokoski (University of Helsinki, Helsinki, Finland), Mercè Avellanet (Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra), Kristian Borg (Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden), Helena Burger (University Rehabilitation Institute, Ljubljana, Slovenia), Maria Gabriella Ceravolo (“Politecnica delle Marche” University, Ancona, Italy), Joaquim Chaler (EUSES, Universitat de Girona-Universitat de Barcelona, Barcelona, Spain), Anne Chamberlain (University of Leeds Faculty of Medicine, Leeds, UK), Richard Crevenna (Medical University of Vienna, Vienna, Austria), Thierry Deltombe (CHU UCL Namur site Godinne, Yvoir, Belgium), Jean-Pierre Didier (Université de Bourgogne, Dijon, France), Gabor Fazekas (National Institute for Medical Rehabilitation, Budapest, Hungary), Joan García Alsina (Hospital Universitario de Bellvitge. Barcelona, Spain), Christoph Gutenbrunner (Hannover Medical School, Hannover, Germany), Elena Ilieva (Medical University of Plovdiv, Bulgaria), Alvydas Juocevicius (Klaipeda University, Klaipeda, Lithuania), Jaro Karppinen (Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland), Jolanta Ewa Kujawa (Medical University of Lodz, Lodz, Poland), Jorge Lains (Rehabilitation Medicine Center for the Central Region, Rovisco Pais, Tocha, Portugal), Antti Malmivaara (National Institute for Health and Welfare, Helsinki, Finland), Angela McNamara (National Rehabilitation Hospital, Dublin, Ireland), Xanthi Michail (University of West Attica, Athens, Greece), Rory J. O’Connor (University of Leeds, Leeds, UK), Jean Paysant (Regional Rehabilitation Institute, Nancy, France), Brigitte Perrouin-Verbe (University of Nantes, France), E. Diane Playford (University of Warwick, Coventry, UK), Konstantina Petropoulou (National Rehabilitation Center, Athens, Greece), Hans Rietman (University of Twente, Enschede, The

Background Total knee arthroplasty has revolutionized the management of knee osteoarthritis in the world. The "Forgetten Joint Score" was developed to evaluate the patient after total knee arthroplasty. The aim of this study is to validate the FJS-12 questionnaire according to Rasch model. Method Data from 263 subjects regarding the response to the FJS-12, KOOS and KUJALA scales as well as their ages, genders, body mass index, type of knee arthroplasty were collected. Rasch analysis was performed to verify item response categories, overall fit to the Rasch model, differential item functioning, unidimensionality of the scale, and internal consistency. The validity of the construct was also studied according to the Classical Test Theory. Results The item-trait interaction shows a good fit with the Rasch model: chi-squared = 24.34 and p = 0.23. The item difficulty ranges from -0.57 logits to 1.41 logits with residual average of -0.47 +/- 2.26. Comparison of the subgroup estimates in each factor did not reveal a significant difference between the different subgroups. There was a good correlation between the estimates of the different subgroups: for ICC age = 0.97 and p <0.001; for sex, ICC = 0.88 and p <0.001. The reliability index of the scale is 0.87. Conclusion The "Forgetten Joint Score" validated include 10 items with four response categories. It has good internal consistency. It has neither a ceiling effect nor a floor effect. It is one-dimensional and linear. It has excellent correlation with the KOOS and KUJALA scales.

Robotics and upper limb rehabilitation after stroke Thierry Lejeune Collaborator: S. Dehem, M. Gilliaux, G. Stoquart, C. Detrembleur Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab NMSK, Brussels, Belgium Cliniques universitaires Saint-Luc, Service de médecine physique et réadaptation, Brussels, Belgium This talk will be divided in two parts: a general introduction about robotic assisted upper limb rehabilitation after stroke; and, the presentation of the result of a RCT. Introduction/Background Upper limb (UL) robotic assisted therapy (RAT) is promising for stroke rehabilitation. It allows to apply motor relearning principles. Systematic reviews show effectiveness at the at the early and chronic stage. In addition to conventional therapy (CT), RAT has been shown to decrease UL impairment. When RAT is provided as partial substitution of CT, it is supposed to be at least as effective as CT. A few studies demonstrated that RAT might be more effective than CT. Its effectiveness has been less studied in the acute phase than in the chronic one. Assessments have usually been restricted to the two first domains of the International Classification of Functioning framework (ICF). RCT Aim: To perform a pragmatic multicentric single-blind randomized controlled trial to evaluate UL RAT effectiveness, used as partial substitution to CT, in acute stroke patients, following the three ICF domains. Methods: Forty-five acute stroke patients were randomized into two groups (CT group, n=22 and RAT group, n=23). Both interventions were dose-matched about treatment duration and lasted nine weeks. The CT group followed a standard rehabilitation. In the RAT group, four sessions of CT (25%) were substituted by RAT each week. RAT consisted of moving the paretic UL along a reference trajectory while the robot provided an assistance as needed. A blinded assessor evaluated patients before, just after intervention and at 6-month post-stroke according to ICF. Results

Stiff knee gait after stroke: assessment using movement analysis and treatment

Introduction/Background: Telerehabilitation is a promising approach for patients with multiple sclerosis (MS), but uncertainties about patients’ preferences remain. The aim of this study was to investigate the access to technologies of patients with MS and their willingness to use them to receive rehabilitation services. Materials and Methods: 200 consecutive patients with MS filled out a specific questionnaire during a follow-up visit. This 6-page paper questionnaire was built to obtain information about needs, accesses, interests and perspectives of telerehabilitation for patients with MS. Descriptive statistics, Chi-Squared tests and logistic regression analysis were used to characterize the sample and survey answers. Results: The meanage of our sample was 44(±13) years. 71% were women. 49% of the patients were unemployed. The median EDSS score was 2.5, and 77% of the patients had a score of 4 or less on this scale. 91% of the patients regularly used internet, while 73% used apps. A substantial proportion of the sample reported an interest in using telecommunication technologies to receive a program of physical exercises (62%), information and personalized advice about physical activity and MS (69%), as well as to communicate with the caregivers (75%). One third of the patients was not interested in receiving telerehabilitation interventions (32%), especially among patients with moderate or severe disability (EDSS>4) and non-workers. Conclusion: The use of technologies to provide rehabilitation services is desirable by patients with MS, and most of these patients have access to the needed technologies. However, patients with moderate-to-severe disability and non-workers have, in average, less access and ease to use these technologies in a rehabilitation purpose. Given their high needs and strong barriers to benefit from rehabilitation, a special effort should be done to promote the use of telecommunications in this perspective.

Introduction/Background: Shoulder spasticity post-stroke or -traumatic brain injury (TBI) may cause pain and restrict joint range of motion (ROM). Few studies have investigated botulinum toxin injections into shoulder muscles for spasticity treatment. Here we present data for sub-populations of patients receiving shoulder injections of abobotulinumtoxinA (aboBoNT-A) in two international, multicentre clinical studies: phase-4 ULIS-II (Upper Limb International Spasticity Study-II; post-stroke spasticity; NCT01020500), and phase-3 AUL open-label study (Adult Upper Limb; post-stroke or -TBI spasticity; NCT01313299). Materials and Methods: ULIS-II: selection and achievement of patient- centred primary goals. AUL study: Tardieu scale for passive ROM (XV1), angle of catch (XV3) and spasticity angle (X) for shoulder muscles; and Modified Frenchay Scale (MFS) for active function. Results: In ULIS-II, 82 patients receiving aboBoNT-A in shoulder muscles selected pain treatment goal three times more often than those without [Figure 1], with high goal achievement (85.7 and 85.0% respectively). In AUL study, 96 patients received ≥1 injection cycle in shoulder muscles, of which 84 received ≥2 shoulder injections. In patients with 1 shoulder injection, improved shoulder muscle spasticity (Tardieu) at last injection cycle: mean change from baseline at Week 4 was +12.3° and -8.2° for XV3, and X, respectively [Figure 2]. Patients with ≥2 shoulder injections had an improvements of +17.9° in XV3. Concomitant improvements were also observed in active function (Week 4Cycle 4, ≥2 shoulder injections: MFS: +0.71 [0.48]) [Figure 3]. A trend towards lower injection doses in proximal compared with distal muscles was seen. Conclusion: Post-stroke or -TBI patients receiving abobotulinumtoxinA in shoulders, in addition to other proximal muscle groups, reached high levels of goal achievement, particularly relating to pain and showed improvement in active function (MFS).

Introduction/Background: Measured maximal oxygen uptake (VO2peak) is the gold-standard to assess exercise tolerance functions. However, this measure can be very challenging in patients suffering from multiple sclerosis (MS) because of several limiting factors (e.g., fatigue, pain, unfamiliarity with exercise, lack of mobility...). Various submaximal indices have been studied to assess exercise tolerance functions in healthy subjects and in persons with neurological conditions. However, whether they relate to the gold-standard have been barely studied. Our aim was to explore the relations between simplified exercise indices and VO2peak among patients with MS and healthy controls. Materials and Methods: This case-control study included 39 patients with MS (mean age: 45±10 years; median EDSS 2.5 (range 0-4)) and 30 healthy subjects (HS) (mean age: 44±8 years). Participants performed a stepwise maximal exercise testing on a cycle ergometer. VO2peak, oxygen uptake efficiency slope (OUES) derived from different reference periods of the exercise test. Descriptive statistics, Student’s T-tests, Pearson’s correlation coefficients between VO2peak and simplified indices and Fisher Z-tests were computed. Measured VO2peak was also compared to PeakWR-based estimation of VO2max by the Bland-Altman method. Results: VO2peak and all the simplified indices were significantly lower in the MS group compared to the HC group (p<0.001). OUES appeared highly correlated (>0.70, p<0.001) with VO2peak, in both groups, without difference between groups. The relation slightly, but not significantly, increased with the duration period of the test taken into account of the exercise, in both groups. PeakWR-based prediction of VO2peak presented a standard error of the estimate of 315ml/min(10.7%) in HS, and 176 ml/ min(12.5%) in MS. HR-based index appeared lowly-to-moderately correlated to VO2peak in both groups. Conclusion: OUES seem to be valid when comparing with gold standard, in both group, eve

Introduction/Background: After stroke, approximately 80% of patients have upper limb impairment. Upper limb is then a key issue in neurorehabilitation. The objective of this study was to evaluate the efficacy of self-rehabilitation program of upper limb after stroke, in Benin. Materials and Methods: It was a randomised controlled trial concerning 59 patients presenting hemiplegia more than 6 months after stroke. The 28 patients of experimental group have executed a self-rehabilitation program during 8 week at home. The control group had 31 patients who received no treatment related to the study. Patients have been evaluated before the treatment (T0), at the end of the treatment (T1) and 8 weeks after later5T2). Le primary outcome was the manual ability assessed by ABILHAND Stroke for Benin. The secondary outcomes were: neurological impairments (Fugl-Meyer), manual dexterity (Box and Block Test, Wolf Motor Function Test) and quality of life (Whoquol-Brief). Two way repeated measure ANOVA in intention to treat was did for analysis. Results: The experimental group improved significantly their manual ability in comparison to the control group (p < 0.001). Within the experimental group, means difference were 10% between T1 and T0 (IC95%: 1.61 to 18.56), maintained at T2 (IC95%: 1.48 to 18.44). Quality of life also improved in the intervention group. Conclusion: The self-rehabilitation program for upper limb after stroke is feasible and efficient in Benin to enhances the manual ability for chronic stroke patients. The self-rehabilitation program is an intensive program including unimanual and bimanual functional exercises, repeating movements of the daily life of patients.