Enabling exercise participation among adolescents and young adults with disability

Professor Nora Shields

Professor of Physiotherapy at La Trobe University

Abstract:

Adolescents and young adults with disability have much to gain from participating in exercise. Being physically active can help people maintain a healthy body weight, prevent physical decline and increase social connectedness. Many young people with disability, however, have sedentary lifestyles despite the known benefits of exercise. The reasons for their lack of participation in exercise are complex and multifactorial, and include many socio-ecological in addition to personal factors.

This presentation will provide an overview of available evidence for the benefits of exercise for young people with disability; it will highlight emerging implementation research on inclusive community-based exercise and physical activity options for young people with disability; and it will consider future research that would help facilitate the participation of youth with disability, particularly those with complex disability, in exercise and physical activity in everyday community settings.

Biography:

Nora Shields is Professor of Physiotherapy at La Trobe University. Her research aims to improve the health and wellbeing of people with disability through participation in physical activity and exercise. She established the innovative, evidence-based FitSkills program to facilitate youth with disability to exercise with a student mentor at their local gym and currently leads a National Health and Medical Research Council research translation partnership project to develop this concept further.

Enhancing healthcare access and support for people with a disability and their carers: Working together to improve hospital experiences

Ms Caitlin Wright1

1Bendigo Health

Abstract:

Aim:
To develop resources and processes which support hospital presentations for people with a disability who have complex needs and behaviours

Method:
This service improvement project has utilised co-design principles with a focus on improving consumer experiences of the service. Two carer representatives participate in the project Advisory Group to monitor, guide and support the development of resources to support hospital access for people with a disability and complex behaviours, particularly those with Autism and/or Intellectual Disability.

Results:
The experiences and advice of carers has informed resource development and staff education regarding caring for patients with a disability and complex needs and behaviours. Key developments have included:
-The Hospital Passport, which details a person’s support needs so that hospital staff know more about the person’s background, abilities and how to approach care;
-Guidelines for assisting patients with a disability who present with complex needs and behaviours, including strategies for communication, environmental modification and managing distress;
-Photo libraries of hospital and dental services to assist with planning and preparation for admissions and appointments; and
-An educational video with carers detailing their perspectives and experiences in accessing healthcare services, which is used in staff training.

Significance of the findings to allied health:
The resources developed emphasise communication access and health equity, which is relevant to all Allied Health clinicians providing care to patients with disability. They also demonstrate the value in co-design and consumer participation for service improvement.

Biography:

Caitlin has worked as a Speech Pathologist with Bendigo Health since 2011. She has worked in a range of clinical areas including acute services, inpatient rehabilitation, outpatient rehabilitation,
transitional care, community services, paediatric outpatient services and residential care. Caitlin has a keen interest in quality improvement and started her role as a Project Officer with Research
and Innovation in 2016 with ‘Enhancing health services access a support for people with a disability and their carers’ project.

Allied health in the National Disability Insurance Scheme (NDIS): Do you have the ability?

Ms Annette Davis1,2, Dr Sarah  Milne1,2, Mr Mitchell Sarkies1,2

1Monash Health, Cheltenham, Australia, 2Department of Health and Human Services, Melbourne, Australia

Abstract:

Aim:
Allied health professionals and the health sector could benefit from the learnings and reforms of the disability sector. The primary aims of this project were to (1) identify key differences between health and disability practices for allied health professionals, and (2) explore learnings and experiences from allied health professionals currently working in disability.

Method:
A qualitative study was nested within a current Victorian Department of Health and Human Services (DHHS) NDIS project. Two 60 minute interviews were conducted with allied health professionals working in the disability sector to identify examples that illustrate key differences, learnings and experiences from professional practice in the disability sector.

Results:
Key areas of difference were explored between the health and disability sectors, including: models of care, considerations when working in the supported persons environment, dignity of risk, goal oriented work, informed choice and informed consent, use of language, reactive and flexible plans, training and education role, and communication styles. Experiences and de-identified case studies from allied health professionals currently working in the disability sector were presented as a mechanism for thematic curation.

Significance of the findings to allied health:
Exploring key differences, learnings, and experiences from allied health professionals who have made the journey from the health to disability sectors could provide a valuable resource for those contemplating or experiencing their own journeys from health to disability service provision.

Biography:

Annette is the project manager for the DHHS NDIS commonwealth and state funded project for greater utilisation of the assistant workforce in disability.  Annette is the Workforce Innovation Strategy Education and Research Manager at Monash Health and submitted a PhD in October 2018.

What factors influence technology use in clinical rehabilitation? A multi-site international focus group study

Dr Kelly Bower1, Dr  Michele  Verdonck2, Dr Anita Hamilton2, Dr Gavin  Williams1,3, Dr Ross Clark2

1University Of Melbourne, Parkville, Australia, 2University of the Sunshine Coast, Sippy Downs, Australia, 3Epworth HealthCare, Richmond, Australia

Abstract:

Aim:
To investigate factors influencing technology use by occupational therapists and physiotherapists working in neurorehabilitation.

Method:
A qualitative focus group study was undertaken in urban and regional locations in Australia and Singapore. Three 60-minute focus groups were conducted via videoconferencing. Each group comprised three purposively selected physiotherapists and three occupational therapists (n = 18) working across different neurorehabilitation settings. Participants were asked to discuss: technology used in their workplace for physical assessment and treatment, barriers and motivators to use, and future desires. Transcripts were analysed independently by two researchers using an inductive approach to generate codes and themes and confirmed by a third researcher.

Results:
Data analysis resulted in the identification of five major themes: 1) value, 2) complexity, 3) access, 4) user attributes; and 5) organisational factors. The findings highlighted the need for technology to be reliable, accessible, effective and able to be used without direct supervision. Barriers to technology included complexity, convenience and cost. Technology use was influenced by the client and therapist attributes and organisation factors such as resourcing and institutional culture.

Significance of the findings to allied health:
The themes identified multiple and interlinking factors influencing clinicians’ use of technology in neurorehabilitation settings. While value was the key driver of technology use, this needed to take into consideration the characteristics of the technology, individual users and organisational context. These findings have implications for successful technology implementation and future development.

Biography:

Dr Kelly Bower is a physiotherapy clinician, researcher and lecturer. She completed her PhD at the University of Melbourne in 2016. She has extensive clinical experience, primarily working in neurorehabilitation at the Royal Melbourne Hospital. Her research has mainly focused on the use of technologies for physical assessment and treatment following stroke. Kelly is currently working in the Physiotherapy Department at the University of Melbourne.

Daily living transactions. Children with cerebral palsy (CP) who are non-ambulant are likely to require assistance from a carer and a supportive context to complete daily routines

Ms Robyn Heesh1, Dr Susan Greaves2, Dr Loretta Sheppard1, Professor Christine Imms1

1Australian Catholic University, Melbourne, Australia, 2The Royal Children’s Hospital, Melbourne, Australia

Abstract:

Aim:
This research investigated what non-ambulatory children with cerebral palsy (CP) aged 5 to 18 years can do, with support, during daily routines. Our purpose was to inform goal setting and intervention planning that focuses on the abilities of children with significant disability and their carers.

Method:
Purposively sampled child/carer dyads took part in video elicited interviews in their homes in Victoria. Qualitative thematic analysis of the interviews examined what the child and carer contributed to tasks and explored the transactions between child, carer and context that enabled daily routines to be completed.

Results:
Findings from five dyads highlighted that children (2 male; aged 8-16 years) used a range of small but important skills that contributed to the completion of daily routines. Three core themes were derived describing how families negotiate a busy life, and the highly variable child, carer and contextual factors that influenced routines daily. The Child Active Routine (CAR) framework was developed as a synthesis of findings describing how routines were achieved under differing circumstances.

Significance of the finding to allied health:
Children with severe disabilities will always need assistance, but there are small skills and actions, (e.g., lean forward during hygiene routines; close hand for dressing), they can learn and contribute to daily routines. The CAR framework may aid communication among children, carers and clinicians about when and how children can contribute and learn skills. Findings can inform therapy interventions that build the capacity of the child and carer within the context of daily routines.

Biography:

Robyn Heesh is an Occupational Therapist with 20 years clinical experience working with children with disabilities and their families in community, school, early intervention, hospital and rehabilitation settings. Through her Masters of Health Science Research based at Australian Catholic University, she recently competed a mixed methods project focused on children with cerebral palsy and their families.

Post stroke communication disability: a risk factor for falls in inpatient rehabilitation

Mrs Rebecca Sullivan1

1Eastern Health, Burwood, Australia

Abstract:

Aim/s:
To investigate whether there is an association between severe communication disability and falls among patients receiving inpatient rehabilitation after stroke.

Method:
Patients consecutively admitted to Eastern Health rehabilitation wards following a stroke were studied retrospectively. Demographic data, premorbid falls risk factors, communication profile, presence of functional communication to meet basic needs (determined by the patient’s ability to meet their basic needs using any communication method) and new cognitive impairment were studied. Incidence of falls per day and risk ratio was calculated.

Results:
149 patients were included in the study.  The 32 patients in the sample (34%) who did not have functional communication (i.e. were unable to communicate their basic needs) were almost twice as likely to fall in hospital as those with functional communication (RR 1.94, 95% CI 1.15 to 3.24). Several commonly assessed factors were not significant predictors of falls in this population.

Significance of the findings to allied health:
Falls in hospital are a common and serious complication of stroke.  The presence of a communication disability in stroke survivors is not routinely considered when assessing a patients risk for a fall.  The findings of this study suggest that existing factors used to predict falls risk may not be effective in this population and that communication disability may be under recognised as a falls risk factor after stroke.

Biography:

Rebecca is a Senior Speech Pathologist within Eastern Health.  Rebecca has over 12 years experience working with adults in subacute care in both hospital and community settings.  Rebecca is passionate about working to empower patients to be an active participant in their healthcare decisions.  Rebecca has previously published research in the area of Allied Health Assistant training using a traineeship model.

Massively Multiplayer Online Role-Playing Games (MMORPG’s) and the emotional wellbeing of adults living with a physical disability

Mrs Anca Grobbelaar1

1Melbourne University, Wattle Glen, Australia

Abstract:

Aims:
Discuss the results of a Scoping Review aiming to address the research question: “What is known in the evidence about using Massively Multiplayer Online Role-Playing Games (MMORPG’s) to promote the emotional wellbeing of adults living with a physical disability?”.

Methods:
This Scoping Review explored the existing empirical research pertaining to utilising MMORPG’s as an intervention tool to promote the emotional wellbeing of adults living with a physical disability. Suitable papers were located by systematically searching the electronic databases PsychINFO, Medline, CINAHL, WebofScience and SocINDEX) using key search terms derived from internet gaming, physical disability, emotional wellbeing and psychological benefits.  Strict Inclusion and Exclusion criteria; focus being on international, evidence-based literature, peer-reviewed articles reporting original findings (2008 – 2018) and selected grey literature.

Results:
Scoping Review highlighted significant gaps in  using digital gameplay (specifically MMORPG’S) as an engagement tool with physically disabled adults. Pre-existing body of literature regarding the use of internet gaming and digital platforms as intervention tools; however almost exclusively focused on children and adolescents.

Significance of findings:
Future research to be conducted to gain insight into whether MMORPG’s has the potential to enhance the emotional wellbeing of adults living with a physical disability; when applied as a problem-focused coping strategy. Using mixed methodology, investigate whether high engagement of physically disabled adults in MMORPG’s;  could be an effective coping mechanism which allows the physically disabled to feel socially connected.

Biography:

Mrs Anca Grobbelaar is a phd student at the University of Melbourne. She has 15 years experience as a social work in Child Protection; and is keen to explore digital platforms as new intervention tools to enhance the overall quality of life for people living with disabilities.

Sneakers not Slippers – Promoting cross-cultural connections and enhancing the health of multicultural seniors

Dr Myrla Sales1, Mrs. Zeinab Hussein1

1Migrant Resource Centre North West Region Inc., St Albans, Australia

Abstract:

Aim:
This study aims to examine the effect of a 12-week outdoor senior exercise park program on social connectedness, feelings of loneliness, wellness and independence in multicultural seniors.

Method:
Multicultural seniors from the Migrant Resource Centre North West Region Inc. in Melbourne participated in a 12-week outdoor senior exercise park program. Measurements of loneliness, wellness and independence (e.g., balance, muscle strength and physical function) were compared between baseline and at 12 weeks. Participants undertook an interview to explore their perceptions (e.g., acceptability of the program and perceived benefits achieved from participation) of the program.

Results:
Twenty participants (18 females, 63.7 ± 6.9 years) completed the 12-week exercise program. A reduction of 18% ± 31% in loneliness was demonstrated. The largest improvements observed in wellness were: physical (8% ± 23%), social (8% ± 14%) and occupational (6% ± 23%) wellness. Independence has improved via improvements in overall muscle strength (6% ± 22%), functional lower extremity strength (6% ± 16%), dynamic balance (24% ± 38%), static balance (148% ± 269%), walking (10% ± 19%), and agility (4% ± 11%). Participants reported that the exercise program improved their physical and psychological well-being and facilitated new social connections.

Significance of the findings to allied health:
The preliminary results of this initiative demonstrated the positive effect of the outdoor senior exercise park program on seniors’ social connectedness, feelings of loneliness, wellness, and independence among people from multicultural background.

Biography:

Dr. Myrla Sales is an accredited exercise physiologist with extensive clinical experience in the management of chronic/complex health conditions (e.g., psychological, metabolic, cancer, cardiovascular, kidney disease, musculoskeletal, neurological and respiratory conditions), injury prevention and reduction of risk factors for falls on ageing groups.

In the last five years, Dr. Sales has been using the novel and innovative concept of outdoor senior exercise parks to improve seniors’ muscle strength, balance, physical function, quality of life and social connectedness.

After being an academic at Victoria University for four years, she now coordinates a community program run by Migrant Resource Centre North West Region Inc and funded by the Victorian Department of Premier and Cabinet (Office of Multicultural Affairs and Citizenship) which aims to enhance participation of multicultural seniors in exercise and to improve their social connectedness.

Enabling participation in paediatric rehabilitation: challenges and opportunities

Professor Christine Imms1

1 Professor Of Occupational Therapy, Australian Catholic University

The importance of positive participation outcomes for those experiencing childhood-onset disability is well established. The introduction of the National Disability Insurance Scheme in Australia has further endorsed the primacy of participation as a health and human services outcome. However, until recently, lack of clarity about what constitutes participation, as distinct to activity performance, has reduced our capacity to build effective intervention models and practices, and to assess whether what we do changes participation outcomes.

The aim of this presentation is to use the recently published family of Participation Related Constructs (fPRC) as a framework to interpret participation research findings in childhood disability and highlight challenges and opportunities for practice and research.

The fPRC was developed following a series of systematic reviews of participation intervention research, culminating in a conceptual paper describing the framework. In the fPRC, participation is defined as having two central constructs: being there (attendance) and involvement. Using systematic review methods, measures purporting to assess participation in childhood disability were identified and mapped to the fPRC, highlighting the frequent disconnect between what was measured and the construct of participation.

Research focused on enhancing participation outcomes, rather than describing participation patterns, is needed. Opportunities to develop and implement theoretically informed intervention models, and to test them using valid measures, rely on those designing, delivering and funding health and human services having a shared and conceptually clear understanding of the construct of participation. The fPRC offers a mechanism to support this goal.

Cancer survivorship and enablement.

Ms Kathryn Rorke1, Mr  Michael Leach2

1Saint John of God (SJOG) Bendigo Hospital, Bendigo, Australia, 2Loddon Mallee Integrated Cancer Service (LMICS), Bendigo, Australia

Aim:

Saint John of God (SJOG) Bendigo Hospital runs an individualised group outpatient oncology rehabilitation program that combines exercise and education from multiple allied health disciplines to treat patients diagnosed with cancers of various types, during or after treatment. The program was designed to address the short- and long-term side effects of cancer treatments. This study aimed to assess whether cancer survivors’ quality of life and fitness outcomes changed following completion of the SJOG oncology rehabilitation program.

Method:

This study retrospectively reviewed those patients discharged from the SJOG oncology rehabilitation program between May 2014 and June 2016 who completed pre- and post-program assessments (n = 58). Eligible patients’ discharge letters were examined. Changes in outcome measures from before to after the program were assessed using the paired samples t-test or the Wilcoxon signed-rank test.  P-values < 0.05 were considered significant. A descriptive analysis of the program model was conducted to understand its impact and identify if it met the needs of cancer survivors.

Results:

From before to after the program, there were significant improvements in all five outcomes. This included significant improvements in FACT-G (Functional Assessment of Cancer Therapy – General) quality of life score (n = 57, mean improvement = 9 points, p[paired samples t-test] < 0.001) and distance walked in 6 minutes (n = 55, mean improvement = 128 metres, p[paired samples t-test] < 0.001).

Significance of findings for allied health:

Cancer survivors’ physical, functional and psychosocial health outcomes improved significantly following completion of the SJOG oncology rehabilitation program.

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