Normand Boucher

Factors related to physical activity in adults with cerebral palsy may differ for walkers and nonwalkers.

Maltais DB, Dumas F, Boucher N, Richards CL: Factors related to physical activity in adults with cerebral palsy may differ for walkers and nonwalkers. Objective:To explore what factors besides walking ability, e.g., additional health problems or complications, general health, and sociodemographic status, may be related to physical activity in adults with cerebral palsy. Design:We administered a questionnaire regarding sociodemographic and health-related factors of potential relevance to physical activity to 66 men (20–41 yrs) and 66 women (18–39 yrs) with various types of cerebral palsy. Data were analyzed using logistic regression. Results:Use of walking as the primary means of self-transport (walking ability) was associated with a higher odds of being physically active (odds ratio = 3.75; P = 0.002). Among those who could walk, being younger and having a positive perception of health were also associated with a higher odds of being active (odds ratios of 2.6 and 3.0, respectively). This was not true among nonwalkers. For individuals who walked, inactivity was associated with an increase in the severity (during the past 3 yrs) of several additional health problems or complications. For the nonwalkers, inactivity was most clearly associated with perceived range-of-motion limitations. Conclusions:Among adults with cerebral palsy, the ability to walk, as expected, is associated with being physically active. The factors additionally related to physical activity differ between walkers and nonwalkers.

The influence of selected personal and environmental factors on leisure activities in adults with cerebral palsy.

Purpose. This study examined the influence of selected personal and environmental factors on leisure participation in adults with cerebral palsy (CP). Methods. A group of 145 adults with CP (18–41 years old, 51% male) responded to questionnaires regarding 1) socio-demographic and health factors, 2) life habits (Life-H: short version 3.1) and 3) the environment (Measure of the Quality of the Environment: version 2.0). A χ2 statistic (p < 0.05) estimated the association between 1) socio-demographic and health factors and the environment and 2) the level of leisure activity participation. Results. Most participants (mean age = 28 years) lived with their parents. Leisure activities were their principal occupation. Mobility and participation were positively associated. The environment (e.g. accompanying services, adapted transport, cultural services and computers) facilitated leisure for those with a high or moderate participation level. Individuals with low participation perceived the environment as having no influence. Conclusions. Adults with CP who are more mobile participate more in leisure activities. A positive perception of the environment (facilitating leisure participation) likely reflects the individuals ability to benefit from the environment, whereas a neutral view of the environment may reflect the fact that other factors, such as mobility limitations, are of greater relevance to leisure participation.

Measuring steady-state oxygen uptake during the 6-min walk test in adults with cerebral palsy: feasibility and construct validity.

This study evaluated the feasibility of measuring steady-state oxygen uptake (V[Combining Dot Above]O2) during the 6-min walk test (6MWT) in adults with cerebral palsy (CP) who walk without support and whether there is construct validity for net 6MWT V[Combining Dot Above]O2 as a measure of their walking ability. Cardiorespiratory variables were assessed at rest and during the 6MWT in 15, independently ambulatory adults, 21–41 years old, with CP. The Gross Motor Function Measure dimensions D and E (GMFM-D and GMFM-E) quantified walking-related skills. Steady-state V[Combining Dot Above]O2 was achieved during the 6MWT. After controlling for body mass and speed, the net 6MWT V[Combining Dot Above]O2 was strongly related to GMFM-D (r=−0.58, &rgr;=0.03) and GMFM-E scores (r=−0.66, &rgr;=0.007). We conclude that for young adults with CP who walk without support, it is feasible to measure steady-state V[Combining Dot Above]O2 during the 6MWT and that the net 6MWT V[Combining Dot Above]O2 has construct validity as a measure of walking ability.

Community Needs of People Living With Spinal Cord Injury and Their Family

Returning to the community after intensive functional rehabilitation can be a challenge for people who have sustained a traumatic spinal cord injury (SCI) and for their family members.1-4 They may need different services in order to facilitate their social participation and improve their quality of life.3,5,6 Research was conducted to better understand the role of the environment in community reintegration in the first years post rehabilitation. This article focuses on the needs from the perspective of persons with SCI and their family members. A more complete understanding of unmet needs will help better address them in future intervention and policies.

Life habits performance of individuals with brain injury in different living environments.

Background: Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments. Objective: To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements. Methods: One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined. Results: The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not. Conclusion: Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.

Disability, Rehabilitation Research and Post-Cartesian Embodied Ontologies – Has the Research Paradigm Changed?

Abstract Purpose Since the mid-1990s, the social model of disability has come under scrutiny. Several researchers have examined the role of ontology (philosophical ideas about the nature of what it means to be human) in relation to disability. In this paper, we situate this burgeoning understanding of disability within the set of post-cartesian ontologies, which disrupt the separation of the mind from the body and its attendant dichotomies. Furthermore, we seek to show how such a change can carry through to the research paradigm and therefore affect tangible outcomes of disability research. Design/methodology/approach A commitment to an embodied ontology requires first and foremost that researchers rethink what is being studied by focusing on the diverse characteristics of being and its actualization within the world. This will involve an emphasis on the lived experience of the body, including issues of affect, identity and movement, as well as broader issues of embodied being. Findings Using a research program currently underway at the Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) as a detailed example, we draw on the ontological framework to help articulate the way research can be re-organized. We show how projects at different scales can be brought to work together, and highlight how a focus on embodiment issues facilitates such multi-disciplinary, inter-project collaboration. We note that adopting such an ontology-based framework will accomplish three major outcomes: (1) increase the relevance and effectiveness of new projects with regard to the overall vision; (2) enhance cross-project synergies and ensure stronger ties between research and practice; and (3) contribute to shifting the underlying ontology from a more cartesian approach to a post-cartesian embodied perspective. Originality/value The new ontologies embrace, integrate and extend the earlier social and biomedical perspectives, and offer a critical perspective on technology. The embodied approach recognizes not only the embodiment of research subjects, but also the embodied experience of the researchers themselves. In addition, the approach leads to a more holistic organization of research within a global, interconnected structure of projects rather than simply a collection of separate projects organized into thematic areas, as was done in previous decades. This reorganization of research enhances the ability to engage academic researchers with practitioners not just in the hospital and clinical settings, but also within the wider community.

Mapping review of accessible pedestrian infrastructures for individuals with physical disabilities

Abstract Background: Due to the ageing population and higher prevalence of individuals living with physical disabilities, there is a critical need for inclusive practices when designing accessible pedestrian infrastructures for ensuring social participation and equal opportunities. Purpose: Summarize the physical characteristics of current pedestrian infrastructure design for individuals with physical disabilities (IPD – motor, visual and hearing) found in the scientific literature and assess its quality. Materials and methods: A mapping review of the existing literature on pedestrian infrastructures specifically built for individuals with physical disabilities identifying measurable physical characteristics for their design was done using online databases (Urban Studies Abstracts, Geobase, PubMed, and Cairn and secondary research). Information about accessibility (physical characteristics) of existing pedestrian infrastructures was extracted. The quality of the evidence was assessed using the Guidelines for critical review form – Quantitative studies and Qualitative studies version 2.0 (SAGE Publications, Inc., Thousand Oaks, CA). Results: Of the 1131 articles identified, forty-one articles examined access to bus stops, curb ramps, lighting, pedestrian crossings, ramps, shared spaces, sidewalks and steps. Six articles reported on more than one physical disability. Quality scores were generally low (quantitative: 2–11/15 and qualitative: 1–22/23). Recommended design features differed for the same infrastructure. Conclusions: While there were a fair number of articles (n = 41) documenting accessible design features of pedestrian infrastructures, the quality of the evidence was low. The review identified knowledge gaps. Although specific design solutions exist, they have not yet been tested among individuals with various or multiple types of physical disabilities to ensure access to pedestrian infrastructures by all. Implications for Rehabilitation Pedestrian infrastructures still pose problems to mobility, limiting social participation and quality of life outcomes for individuals with physical disabilities (motor, visual and hearing). The results of this mapping review show that few articles are concerned with the accessibility of pedestrian infrastructures for more than one type physical disability, which might lead to recommendations that are inadequate for individuals with differing disabilities, few recommendations have been compared, most studies have been performed in environments not representative of northern countries and their quality score was generally low. Health professionals and State Parties have a complementary expertise that should be put to use in the determination and implementation of best design solutions to ensure the respect of the needs of individuals with physical disabilities. This review can thus help them have an idea of what has already been done to identify what needs to be achieved to fill the gap of knowledge required to insure access for individuals with motor, visual as well as hearing disabilities. Rehabilitation profesionals should take part in the assessment of the proposed solutions as well as the development of new designs to fill knowledge gaps.

Handicap et loisirs. Vers une meilleure compréhension de la participation sociale par l’expérience de loisir inclusive

The development of dedicated leisure and recreational programs raises questions about their low level of utilization by persons with disabilities. The article aims to identify factors influencing leisure participation among adults with physical disabilities. An exploratory study with a mixed research design was conducted. Two questionnaires were used to identify, on the one hand, the perceived influence of environmental factors on leisure activities, and on the other hand, the individual leisure profile as well as the views of two focus groups on their leisure practices. The results reveal that five environmental factors were perceived as facilitators and four perceived as obstacles to the practice of leisure activities in the community. Some variables measured showed significant differences depending on whether participants were enrolled (22) or not (15) in recreational activities adapted for people with disabilities. The people in the non-enrolled group are not necessarily inactive.