Jacquie Ripat

The intersection of culture, disability and assistive technology

Purpose. Although the use of assistive technology (AT) is by an individual, it occurs within a much larger socio-cultural environment. The purpose of this article is to describe and analyse current knowledge about the intersection of culture and disability in the context of the AT user. Methods. Literature review of theoretical and empirical study papers that discuss cultural aspects related to AT use or provision. Results. Understanding how an individuals culturally defined identity is shaped as an AT user, and the meaning the AT holds to that person and family, is essential to providing culturally appropriate AT services. AT providers also belong to a culture framed by their professional experiences; needed are ways of addressing ethnocentricity within culturally diverse practice settings. Some AT users may identify with a disability culture, a culture formed by a shared set of beliefs, values and behaviours around the construct of disability. Conclusion. This review reveals there is a paucity of knowledge about the intersection of AT and culture, and that this intersection requires further research. Embarking on this investigation is mandatory if we seek to meet the needs of the culturally diverse individuals who use AT.

A framework of strategies for client-centred practice.

Background. Implementing strategies to overcome barriers to client-centred practice is a challenge encountered by many occupational therapists in their daily practice. The Client-centred Strategies Framework is proposed as a tool to assist occupational therapists to consider barriers and implement strategies from a variety of perspectives. Description. The framework consists of five categories: personal reflection, client-centred processes, practice settings, community organizing, and coalition advocacy and political action. Within each category are a number of actions that can be taken to facilitate client-centred practice. This paper describes the framework with elaboration of each of the five categories. A case example is used to illustrate how a therapist can use the framework to address client-centred practice issues. Practice Implications. This framework will assist therapists and students to problem-solve ways to enhance the use of client-centred processes within their own practice environments.

Characteristics of assistive technology service delivery models: stakeholder perspectives and preferences

Purpose. The purpose of this study was to identify the key characteristics of an assistive technology service delivery model preferred by the various stakeholders in Manitoba, Canada. Methods. A descriptive, exploratory approach consistent with qualitative research design was used to explore this issue. Three focus groups were held using a semi-structured interview guide and a hypothetical case study to guide the discussion. Eighteen adults participated in the study, each representing one of three groups of stakeholders (assistive technology service providers, funders and users). Interviews were audiotaped, transcribed and analysed using an inductive process to develop categories and themes. Results. Three primary themes emerged from the data: the user of assistive technology is a unique individual; a decision-making process exists; and, assistive technology devices and services are complex. Based on the study results, recommendations for the delivery of assistive technology services are outlined. Conclusions. The results of this study may be useful for developing funding guidelines, supporting the importance of assistive technology in enabling meaningful activities, and examining current delivery of services in different contexts.

Self-perceived participation among adults with spinal cord injury: a grounded theory study

Study design:A grounded theory study of 19 adults with spinal cord injury was conducted. Participants engaged in individual in-depth interviews, and took photographs of aspects of their environment that promoted and restricted participation. Analysis consisted of an inductive process of constant comparison. A focus group with participants was held to discuss and contribute to the credibility of findings.Objectives:To develop a theoretical understanding of the influences on self-perceived participation for individuals with SCI.Setting:Manitoba, Canada.Results:The constructed grounded theory model is summarized as follows: negotiating the body–environment interface is a continuous process for those living with a SCI. Despite the relative stability of their changed body, they live in a changed world, one that is perceived differently after SCI. People use various strategies to interact within their environment, to engage in a process of participation. Intervening conditions are the environmental aspects that serve as barriers or facilitators to this process of participation.Conclusions:Study findings lend support to the need for a self-perceived definition of participation. The theory constructed in this study can be used to target interventions intended to improve the participation experiences of individuals with SCI.

Intense parenting: a qualitative study detailing the experiences of parenting children with complex care needs.

BackgroundIncreased numbers of children with chronic illnesses and/or disabilities who have complex care needs are living at home. Along with the transfer of care to the home setting, parents assume the primary responsibility of their child’s complex care needs. Accordingly, it becomes even more important to understand the evolving roles and challenges faced by parents of children with complex care needs in order to better support them. The aim of this paper is to present research findings that add to our understanding of the roles parents assume in parenting their children with complex care needs.MethodsTo arrive at a detailed and accurate understanding of families’ perspectives and experiences, the qualitative research design of ethnography was used. In total, 68 parents from 40 families were recruited. Data collection strategies included ethnographic methods of interviewing and photovoice. Several levels of analysis generated a sociocultural theme with subthemes representing how parents experienced raising children with complex care needs within the context of their life situations.ResultsIntense parenting as the overarching theme refers to the extra efforts parents had to commit to in raising their children with complex care needs. Parenting was described as labour-intensive, requiring a readiness to provide care at any time. This left parents with minimal time for addressing any needs and tasks not associated with caring for their child. The main theme is supported by four sub-themes: 1) the good parent; 2) more than a nurse; 3) there’s just not enough; 4) it takes a toll on the health of parents.ConclusionsOverall, parents of children with complex care needs take on more roles as well as work more intensely at these roles than parents of healthy children. This, in turn, has led to the need for additional supports and resources for parents. However, to date, parents of children with complex care needs are still lacking adequate services and supports necessary to help them in their role of intense parenting. The findings sensitize professionals to the issues confronted by parents caring for children with complex care needs. Implications for further research and clinical practice are discussed.

Playground Usability: What Do Playground Users Say?

Play, specifically outdoor play, is crucial for a childs development. However, not all playgrounds are designed to provide usable space for children with disabilities. The aim of the study was to gain an understanding of the experiences of playground use for children with disabilities and their caregivers. Using a qualitative descriptive design, interviews were conducted with children with disabilities and their caregivers. Interview transcripts were reviewed and coded. The analysis process resulted in three overarching themes. Playground Experiences addressed the sensory experiences that children seek at playgrounds, the importance of creating environments that promote imaginative play and the need to provide an appropriate level of challenge. In the second theme, Playground Usability, participants described barriers that prevent access and features that promote use. The third theme, Inclusivity, focused on equal access and the importance of providing options in design. The Person-Environment-Occupation model was used to frame the findings and to identify practice and research recommendations. Outdoor play is a key occupation of children, and occupational therapists have a role in promoting usable environments for all children.

The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders

There is evidence that performing job tasks involving repetition, vibration, sustained posture or forceful movement may contribute to symptoms of work related upper extremity disorders. Typing is one such activity; symptoms that develop as a result of this activity can affect performance of work, self-care and leisure occupations. Studies investigating the impact of ergonomic keyboards on symptom reduction are limited, and little research exists regarding the reduction of key activation force as an intervention. Methods: This randomized, prospective study used a sample of 68 symptomatic workers employed by a single company. One group received a commercially available ergonomic keyboard, a second group used a modified version of the same keyboard designed to reduce activation force, vibration and key travel. We measured symptoms and clinical signs, functional status, and device satisfaction in both groups over a six-month study period. Results: Between-groups analyses indicated that the groups performed similarly on the outcomes of interest. Repeated-measure analysis identified a reduction of symptoms, an improvement in functional status, preference for and increased satisfaction with the intervention keyboards, and maintenance of typing speed and accuracy for both groups. Conclusions:

The Winter Walkability Project: Occupational Therapists' Role in Promoting Citizen Engagement

Background. Walkability is one feature of a person-friendly community that citizen engagement can influence. Purpose. Describe a winter walkability project and how an occupational therapist supported citizen engagement and participation in local policy decision making. Methods. Seven stakeholder representatives undertook a participatory research project to address winter walkability. Through focus groups and walking logs, 10 citizens provided feedback on barriers to winter walking and a new sidewalk snow-clearing method. Analysis ascertained factors contributing to winter sidewalk walkability and factors promoting citizen engagement. Findings. Results identified reasons for and barriers to walking, perceived reasons for sidewalk conditions, and perceived effectiveness of the snow-clearing intervention. Citizens recommended against using the new snow-clearing method. Factors promoting citizen engagement included individual actions producing nominal results, individual and community-level interest, and development as citizen-experts. Implications. This project provides one example of how occupational therapists can take a sociopolitical role and facilitate citizen and occupational engagement.

Experiences with using a pushrim-activated power-assisted wheelchair for community-based occupations: : A qualitative exploration

Background. Occupational therapists strive to engage individuals in occupation and enhance community access through wheelchair prescription. Previous research with pushrim-activated, power-assisted wheelchairs identifies a reduction in the physical demands of manual wheelchair propulsion but limited evidence exists regarding user evaluation in context. Purpose. This study explored the experience of using a power-assisted wheelchair in the community. Methods. Eight individuals who used both a power and manual device participated in focus groups after trialing a power-assist wheelchair for three weeks. Data were analyzed using a qualitative description approach. Findings. Three themes emerged from our analysis: relative advantages and disadvantages; environmental factors that affect accessibility; and evaluation of mobility device. Implications. Participants perceived the power-assist as improving performance and accessibility compared with the manual wheelchair, increasing the potential scope of occupations and environments, but not replacing their power mobility device. Sufficient time for adjustment of both user and device was important.

Factors describing community ambulation after stroke: a mixed-methods study

Objective: To develop a model of community ambulation after stroke based on: Canadian data from community-dwelling individuals post-stroke; the experiences and opportunities for community ambulation expressed by individuals with stroke; and current literature. The model presents a visual depiction of the relationships between the different factors of community ambulation after stroke. Design: A quantitative/qualitative explanatory sequential mixed-methods design was utilized. Secondary data analysis with structural equation modeling resulted in a community ambulation model. Two focus groups of individuals with stroke were conducted to verify and explain the model. Setting: Community. Subjects: Quantitative data from 227 participants: 142 (63%) male; 63.4 (12.0) years of age and 2.6 (2.5) years post stroke. Eleven individuals participated in the focus groups: 6 (55%) male; 61.4 (6.9) years of age and 5.8 (3.3) years since stroke. Main measures: Model variables: items from the EuroQol, Preference Based Stroke Index, gait speed, Reintegration to Normal Living Index, the Community Health Activities Model Program for Seniors, and the Geriatric Depression Scale. Results: The model had reasonable fit with three latent variables: ambulation, gait speed, and health perceptions (normed χ2 = 1.8, root mean square error of approximation = 0.060 (0.043; 0.075)). Depression was also a component of community ambulation. Participants verified the model and added endurance and the environment as additional components. Participants used self-awareness and knowledge of the environment to engage in cognitive strategies related to community ambulation. Conclusions A model of community ambulation after stroke was developed and verified. Recognizing important components of community ambulation may assist physiotherapists in determining community ambulation goals, needs, and opportunities in partnership with clients.