Jeannine Millsteed

Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review.

Purpose: To systematically review the literature on the effects of assistive technology (AT) on family caregivers of children with physical disabilities. Method: Electronic searches of Medline, CINAHL Plus, PubMed, and PsychInfo were conducted. The main search terms were AT, caregiver, physical disability, cerebral palsy and quality of life. Studies were included if they related to the impact of AT on the family caregiver of children with physical impairment. Data extraction and quality assessments were conducted by three reviewers. Results: Five articles were eligible for inclusion. Two studies rated weak quality of evidence (level 5), two studies rated moderate quality of evidence (level 3), and one article was a systematic review, rating high level of quality (level 1). A paucity of literature, small sample sizes, descriptive study designs and weak methodological quality meant a narrative review was possible. Three articles reported that AT lightened caregiver assistance in the areas of mobility, self- care and social function. Conclusions: Evidence suggests that AT has a positive impact on children with physical impairments and their caregivers. Future studies in this area could include valid and reliable outcome measures of AT use and the psychological impacts of AT on caring for a child with physical impairments. Implications for Rehabilitation Assistive technology can decrease effort and energy expenditure for family caregivers of children with disabilities. Assistive technology can increase child independence, therefore decrease family caregiver burden. Therapists need to educate and guide family caregivers on the use of assistive technology for their child in order to enhance adoption and competence.

The experience of being a motorised mobility scooter user

Abstract Purpose: To explore the individual experience of being a scooter user and the ways in which scooters impact the individual’s community and social engagement, daily activities and enhances mobility. Methods: A qualitative, constructive framework utilising purposive sampling and a semi structured interview was used with 14 individuals. Questions were categorised according to the International Classification of Functioning, Disability and Health framework into the three areas of activities, participation and environmental factors. Results: The three main themes identified through the research were knowledge, engagement and environments. Knowledge included a lack of concise information, and adequate trialling and training prior to purchase. Engagement consisted of participation and interaction demonstrating scooter use resulted in increased participation, role maintenance, choice, freedom and social interaction. Environments highlighted discrimination from the wider population and building design and barriers. Conclusions: The research demonstrated a strong positive impact on individual’s engagement from using a scooter, while highlighting a lack of adequate knowledge about scooters, batteries, skill ability and design along with environmental challenges of discriminatory attitudes and physical barriers. The research indicates the need for pre-purchase assessments and trials along with improvements in community attitudes and environments. Implications for Rehabilitation Development of a pre-purchase assessment including specific core skills for scooter use is of great importance to minimise accidents and death as a consequence of scooter driving. Education and training of prescribers and suppliers of scooters is important to match needs and skills to enable a better fit of scooter to user. Incorporation of adjustability of features within the standard design of scooters, including type of driving controls, seat height, and adjustment of distance to controls, will enable greater fit of scooter to the user s needs.

A Systematic Review of the Impact of Powered Mobility Devices on Older Adults’ Activity Engagement

ABSTRACT Purpose: To systematically review the impact powered mobility devices have on engagement in independent occupations for adults with acquired mobility limitations. Method: Electronic search of CINAHL Plus, Medline, PsychInfo, OT Seeker, Joanna Briggs Institute, and Physiotherapy Evidence Database. Search terms included combinations of words to encompass all terms most likely used for powered mobility. Results: Eleven studies were eligible for inclusion. One study was a true experimental design; four studies were pre-experimental, and six were nonexperimental. Studies indicated positive improvements to occupational engagement and independence while environmental barriers were identified as negatively impacting occupation and increasing risk of injury or accident. Conclusions: Drawing conclusions from this research are problematic due to varying methodological quality. This review suggested two distinct themes: environmental barriers generate difficulties and challenges, which can subsequently result in accident or injury, and access to powered mobility impacts positively on areas of independence, quality of life, mobility and engagement.

In search of wellness: Allied health professionals' understandings of wellness in childhood disability services

Purpose. Wellness approaches are not routine in childhood disability services, despite theoretical and empirical support and an increasing demand for them from health consumers and disability activists. We aimed to investigate how health professionals define or understand wellness and its practice in the context of childhood disability. Method. A qualitative, interpretive approach was taken. Semi-structured interviews were conducted with 23 health professionals (allied health therapists and managers) providing early intervention and ongoing therapy within four Australian childhood health and disability services. Years of experience providing services to children with disabilities and their families ranged from 6 months to 30 years (M = 9.41, SD = 9.04). Results. The data revealed a noteworthy impediment to incorporating wellness into practice – the difficulties in the allied health professionals reaching consensus in defining wellness. There appeared to be distinct differences between the four services, while there appeared to be no appreciable difference based on the individual professionals years of experience or allied health discipline. Conclusions. The effect of organisational culture should be considered in efforts to embed wellness in childhood health and disability services in order to address client well-being, empowerment, choice, independence and rights to meaningful and productive lives.

The impact of switching on family caregivers of children with cerebral palsy

Purpose: This study aimed to enhance our knowledge and understanding of switching, as assistive technology, and how it impacts on family caregivers of children with cerebral palsy with GMFCS levels four or five. Methods: A qualitative method using a constructivist approach was adopted. Purposive sampling was used to recruit five caregivers to participants in this study. Framework analysis was applied to the data collection of semistructured interviews conducted with each caregiver. Findings: The three main themes identified were an investment in the future, resulting in joy and hope. The learning process of switching is resource intensive, time consuming and effortful for caregivers. If caregivers do not perceive this as an investment, then they may not experience the joy switching can bring to their child, and in turn the joy, hope, and caregiver satisfaction it can offer for the future. Conclusion: This research indicates that caregivers often have the greatest impact on whether switching will be adopted in the home. The greatest impact on caregivers is related to their perception on the competence of therapists and coordination of services provided. Implications for Rehabilitation Switching has the potential to increase caregiver satisfaction, decrease burden and provide hope for the future. Therapists need to guide family caregivers through the time consuming and resource intensive learning phase of switching. The greatest impact of assistive technology on caregivers is related to the competence of therapists and coordination of services provided.

Working Sandwich Generation Women Utilize Strategies within and between Roles to Achieve Role Balance

Increasingly, women simultaneously balance the roles of mother, parental carer and worker. However, individual role balance strategies among these working ‘sandwich’ generation women have not been thoroughly explored. Eighteen women combining these three roles were interviewed about their individual role balance strategies. Findings were identified through the framework analysis technique, underpinned by the Model of Juggling Occupations. Achieving and maintaining role balance was explained as a complex process accomplished through a range of strategies. Findings revealed the women used six within-role balance strategies: living with integrity, being the best you can, doing what you love, loving what you do, remembering why and searching for signs of success. The women also described six between-role balance strategies: maintaining health and wellbeing, repressing perfectionism, managing time and energy, releasing responsibility, nurturing social connection and reciprocating. These findings provide a basis for health care providers to understand and potentially support working ‘sandwich’ generation women.

Small business ownership for occupational therapists: key factors for success

The value of small business to all economies is well-known. They have traditionally clustered in certain industry sectors, i.e., manufacturing, retail and trades, but not allied health related fields. With global changes to how health services are funded and with some governments moving the burden of cost from the public to the private sector, there are opportunities for occupational therapists to expand out of the public into the private sector. This paper is an overview of the literature regarding certain factors that could affect the chances of an occupational therapist going into private practice being successful or not. These mainly include their initial motivation, their current management skills and their propensity to learn new competencies, the human capital they possess and their ability to increase their social ties and networks.

Understanding retirement for ageing adults with a disability in supported employment

Introduction Employees with disabilities in supported employment are ageing and, as their retirement from work approaches, it is critical to consider how they perceive their occupational roles might change. They need to consider what activities they choose to engage in, and what service or supports might be necessary to make a successful transition to retirement. The aim of this study was to understand how ageing employees with disabilities perceive retirement, and how their occupational roles might change. Method A qualitative study was conducted with 10 participants working in a supported employment service, for whom transitioning from work to retirement was imminent. Findings Participants perceived retirement to be boring, full of meaningless activities and lonely. It also meant a reduced income that would result in hardship, and a loss of self-esteem at losing their employee role. They had limited knowledge about alternative activities in retirement. Conclusion Participants perceived significant barriers to making the transition from employee to retiree. Occupational therapy can provide support with pre-retirement planning and evidence-based strategies such as a client-centred approach, mapping new routines, and training staff and mentors. They could also advocate for changes in service delivery to improve practices that will encourage active ageing for people with disabilities in retirement.

The impact of within and between role experiences on role balance outcomes for working Sandwich Generation Women

Abstract Women combining paid employment with dual caring responsibilities for children and aging parents, otherwise known as the sandwich generation, experience both benefits and costs related to role participation and quality of life. However, previous literature is inconclusive regarding the impact of this role combination on role balance. In the context of these mixed findings on role balance for working sandwich generation women, this study aimed to explore how within role characteristics and between role interactions are related to role balance for these women. This aim was achieved through the use of a questionnaire administered to 18 Australian working sandwich generation women. Data were analyzed using descriptive statistics and correlation coefficients, with findings suggesting the women studied tended to experience neither role balance or role imbalance. Within-role characteristics, particularly within the mother and family member roles, were related to role balance. In addition, between-role conflict and role interactions involving either the home maintainer or family member roles had the greatest impact on role balance.

The Role of Adult Day Services in Supporting the Occupational Participation of People with Dementia and Their Carers: An Integrative Review

The increasing numbers of people with dementia places considerable stress on health and aged care services and has resulted in the development of community adult day services. Aim: The aim of this integrative review is to determine the extent to which these services support the occupational participation of people with dementia, and how they impact their primary carers. Method: The mixed-methods appraisal tool (MMAT) was used to identify relevant studies in the period 2011–2016. Results: Nine databases were searched and yielded 16 articles with a variety of research designs for inclusion in the review. Conclusions: Findings indicate that adult day services use a range of approaches to support attendees and their carers. In spite of these efforts, there appears to be a lack of interest in utilizing these services while a person is in the early stages of dementia. This suggests that policies in aged care, such as aging-in-place, need to consider the pressure and stress they exert on carer’s quality of life. Another consideration is to better promote the benefits of participating in adult day services in the early stages of dementia for both the attendees and their carers, thereby delaying the tendency towards early institutionalization.