Mobility Lifestyle Research Articles

Program Factors Affecting Weight Loss and Mobility in Older Adults: Evidence From the Mobility and Vitality Lifestyle Program (MOVE UP).

Background. The Mobility and Vitality Lifestyle Program (MOVE UP) is a behavioral weight-management intervention for improving mobility among community-dwelling older adults. We examined program factors that affect implementation outcomes and participant-level health outcomes. Methods. The MOVE UP program was implemented in the greater Pittsburgh area from January 2015 to June 2019 to improve lower extremity performance in community-dwelling older adults who were overweight or obese. Thirty-two sessions were delivered over 13 months. All sessions were designed to be 1-hour in length, on-site, group-based, and led by trained and supported community health workers (CHWs). Participants completed weekly Lifestyle Logs for self-monitoring of body weight, diet, and physical activity. We evaluated the MOVE UP program using the RE-AIM framework, and collected quantitative data at baseline, 5-, 9-, and 13-months. Multilevel linear regression models assessed the impacts of program factors (site, CHW, and participant characteristics) on implementation outcomes and participant-level health outcomes. Results. Twenty-two CHWs delivered MOVE UP program to 303 participants in 26 cohorts. Participants were similar to the target source population in weight but differed in some demographic characteristics. The program was effective for weight loss and lower extremity function in both intervention and maintenance periods (ps < .01), with an independent effect for Lifestyle Logs submission but not session attendance. Discussion. CHWs were able to deliver a multi-component weight loss intervention effectively in community settings. CHW and site characteristics had independent impacts on participants' adherence. Lifestyle Log submission may be a more potent measure of adherence in weight loss interventions than attendance.

Potret Perempuan Urban dalam Novel Divortiare Karya Ika Natassa: Kajian Sosiologi Sastra

This study aims to: (1) describe the portrait of urban women in the Divortiare about the prestige of recreation, (2) describe the portrait of urban women in the Divortiare about the culture of instant living, (3) describe the portrait of urban women in the Divortiare about the mobility lifestyle, (4) describe the portrait of urban women in Divortiare about the individualist lifestyle. The object of this research is the novel Divortiare by Ika Natassa which was published in 2008. This research is literary research using descriptive methods. The data of this research are in the form of words, phrases, clauses, and sentences that show the prestige of recreation, instant living culture, mobility lifestyle, and individualist lifestyle in Ika Natassa's Divortiare. The research instrument is the author himself with the help of another instrument in the form of a recording sheet. Data collection techniques are reading and understanding novels, conducting library research, determining the main character, and finding and recording data related to research problems contained in the novel. The Data validation technique is using triangulation technique. The data analysis technique is identifying and classifying the data. Then interpret the data, and conclude the data analysis. The results of the study stated that (1) the recreational prestige of urban female characters in Ika Natassa's novel Divortiare can be seen through education, work, shopping, restaurants visited, and places of entertainment visited, (2) the instant lifestyle of urban women depicted in the novel Divortiare by Ika Natassa. Ika Natassa can be seen from people in their daily lives such as eating at fast food restaurants and online shopping, (3) the mobility lifestyle of urban women in Ika Natassa's Divortiare novel is seen from people who move around due to work demands, (4) portrait style The individualist life of an urban woman in the novel Divortiare by Ika Natassa is someone who does everything independently and chooses to live alone without the help of others.

IMPROVING THE PERFORMANCE OF COMMUNITY HEALTH WORKERS IN A BEHAVIORAL LIFESTYLE INTERVENTION FOR OLDER ADULTS

Abstract Community health workers (CHWs) play essential roles in implementing community-based behavioral lifestyle interventions. This qualitative analysis aimed to explore what program factors and CHW characteristics would help improve CHW performance in the Mobility and Vitality Lifestyle Program (MOVE UP), a community-based behavioral weight-management intervention for improving mobility among overweight or obese older adults. The MOVE UP program was implemented from January 2015 to June 2019 at 23 community-based sites in Pittsburgh, Pennsylvania. Trained and supported CHWs delivered 32 group sessions over 13 months. We collected data from semi-structured interviews with 21 CHWs and 14 community key informants (community site directors or coordinators); seven focus group discussions with participants from 9 sites, and 124 pieces of graduation advice provided by MOVE UP graduates for future participants; onsite CHW performance observation at 18 sites, and 124 meeting memos of support phone calls with CHWs. Interviews and focus groups were audio-recorded and transcribed verbatim. All data were thematically analyzed in a deductive approach, using the CHW generic logic model. Emerging themes were: Trained CHWs still require onsite support by experienced CHWs or training staff to deliver the first session; Participants need a Q&amp;A session by specialists to address their questions beyond CHWs’ knowledge; Desirable CHW characteristics could increase CHWs’ relation and accessibility to participants, such as the same age group, similar weight loss experience, and living or working in the same community. These findings provide important insight as to recruiting and supporting CHWs in a community-based behavioral lifestyle intervention for older adults.

Effectiveness of a behavioral lifestyle intervention on weight management and mobility improvement in older informal caregivers: a secondary data analysis

BackgroundOlder informal caregivers are prone to sedentary behavior and obesity. With great caregiving burdens and frequent physical and mental distress, older informal caregivers may have low adherence and poor results in behavioral intervention for weight management. This study examined whether overweight or obese older informal caregivers could benefit from a behavioral weight management program as much as non-caregivers.MethodsThe Mobility and Vitality Lifestyle Program (MOVE UP) was a pre-post, community-based, 13-month lifestyle intervention study to help older adults improve physical function performance and lose weight. We identified a subset of informal caregivers (n = 29) and non-caregivers (n = 65) from the MOVE UP participants retrospectively. Changes in lower extremity function, weight, depressive symptoms, and self-efficacy from baseline were compared between caregivers and non-caregivers using paired t-tests and ANCOVA.ResultsOlder informal caregivers had significantly lower session attendance rates than non-caregivers (67.7% vs 76.8%, P < 0.05), however, both informal caregivers and non-caregivers improved significantly in lower extremity function, weight loss, and self-efficacy in diet (Ps < 0.05). For each outcome, changes from baseline to the 13-month endpoint were the same among informal caregivers and non-caregivers.ConclusionThis study provides evidence that older informal caregivers can benefit from behavioral weight management interventions despite the challenge caregiving poses for effective self-care. Future behavioral intervention studies for older informal caregivers should adopt self-monitoring tools and extend the on-site delivery to home-based settings for higher adherence and greater flexibility.Trial registrationRegistered at clinicaltrials.gov (NCT02657239).

Diet Improvements in Community-Dwelling Older Adults in the Mobility and Vitality Lifestyle Program.

This analysis examined whether a community-based intervention produced measurable improvements in dietary habits. MOVE UP combined translational, evidence-based weight management and healthy aging interventions using a non-randomized design. This 13-month intervention included 32 group sessions, explicit calorie and physical activity goals, self-monitoring, and nutrition education. Participants were (N = 297) older adults (mean = 68.0years) with overweight and obesity. Diet was measured using Rate Your Plate (RYP)-Heart. Changes in scores from baseline to 5, 9, and 13months were assessed using mixed models. MOVE UP successfully shifted eating patterns from baseline (mean = 50.9) to 5months (mean = 55.1) (p < .0001) adjusted for age, sex, and race. Improvements persisted through 9 (mean = 54.7) and 13months (mean = 55.0) (p < .0001). Although participants were not prescribed a specific diet, RYP-Heart indicated positive dietary shifts. Community-implemented behavioral weight loss interventions may assess the modifiability of dietary habits with a simple, easy-to-administer tool.

Weight Loss through Lifestyle Intervention Improves Mobility in Older Adults.

The high prevalence of overweight or obesity in older adults is a public health concern because obesity affects health, including the risk of mobility disability. The Mobility and Vitality Lifestyle Program, delivered by community health workers (CHWs), enrolled 303 community-dwelling adults to assess the impact of a 32-session behavioral weight management intervention. Participants completed the program at 26 sites led by 22 CHWs. Participation was limited to people aged 60-75 who had a body mass index (BMI) of 27-45 kg/m2. The primary outcome was the performance on the Short Physical Performance Battery (SPPB) over 12 months. Participants were aged 67.7 (SD 4.1) and mostly female (87%); 22.7% were racial minorities. The mean (SD) BMI at baseline was 34.7 (4.7). Participants attended a median of 24 of 32 sessions; 240 (80.3%) completed the 9- or 13-month outcome assessment. Median weight loss in the sample was 5% of baseline body weight. SPPB total scores improved by +0.31 units (p < .006), gait speed by +0.04 m/s (p < .0001), and time to complete chair stands by -0.95 s (p < .0001). Weight loss of at least 5% was associated with a gain of +0.73 in SPPB scores. Increases in activity (by self-report or device) were not independently associated with SPPB outcomes but did reduce the effect of weight loss. Promoting weight management in a community group setting may be an effective strategy for reducing the risk of disability in older adults.

Changing Mobility Lifestyle

The article is focused on a detailed micro-study describing changes in the behaviour of the authors in three months before and during the COVID-19 pandemic. The study is based on data from Google Location Service. Despite the fact it evaluates only three people and the study cannot be sufficiently representative, it is a unique example of possible data processing at such a level of accuracy. The most significant changes in the behaviour of authors before and during the COVID-19 quarantine are described and interpreted in detail. Another purpose of the article is to point out the possibilities of analytical processing of Google Location while being aware of personal data protection issues. The authors recognize that by visualizing the real motion data, one partially discloses their privacy, but one considers it very valuable to show how detailed data Google collects about the population and how such data can be used effectively.

PHILEOS (haemoPHILia and ostEoporOSis) Study: protocol of a multicentre prospective case–control study

IntroductionTwo meta-analyses showed lower bone mineral density (BMD) in patients with haemophilia (haemophilia type and severity were often not specified) compared with healthy controls. This finding could be related to...

Multidimensional Benefits of Weight Management in Old Age: The Mobility and Vitality Lifestyle Program

The high prevalence of overweight or obesity in older adults is a public health concern because obesity is associated with risk of mobility disability. The benefits of brief community-based lifestyle interventions that promote modest weight loss and increased physical activity are unclear. We assessed the impact of a 13-month lifestyle intervention, the Mobility and Vitality Lifestyle Program (MOVE UP), delivered by community health workers (CHW), on a variety of outcomes, including weight loss, performance-based lower extremity function (Short Physical Performance Battery, SPPB), activity, diet, and health-related quality of life (CDC U48 DP005001). The 32-session behavioral weight management intervention enrolled 303 community-dwelling adults (90.4% of those eligible), who were followed for 12 months (2015-19). Participants completed the program at 26 sites led by 22 CHWs. Participants were age (sd) 67.7 (4.1) and were mostly female (87%). 22.7% were racial minorities. The mean (sd) BMI at baseline was 34.7 (4.7). Median weight loss in the sample was 5% of baseline body weight. SPPB total scores improved by +0.31 units (p < .006), gait speed by +0.04 m/sec (p < .0001), and time to complete chair stands by -0.95 sec (p < .0001). Presenters will assess the effect of MOVE UP on activity, diet, fatigue, and health-related quality of life. A final paper examines implementation of MOVE UP and how site and CHW factors affected outcomes. Findings suggest that promoting healthier eating, weight loss, and physical activity in a community setting is an effective strategy for reducing risk of disability in older adults.

Quality of Diet Among Community-Dwelling Elders Participating in the Mobility and Vitality Lifestyle Program

Dietary choices play an important role in disease prevention both through its effect on weight and independent of it. Improving diet can be an effective means of disease prevention among older adults. Participants (n=303) were recruited from the Allegheny County, PA area and received nutritional education in group sessions led by trained community health workers over one year. Diet quality was captured at baseline and final endpoint (either 9 or 13 months) using the Rate Your Plate (RYP) instrument for assessing healthfulness of diet and includes 24 items that can be summed to generate a total quality score. The mean RYP diet quality score improved from baseline (RYP=50.87) to endpoint (RYP=54.85) (p<.001). Over the course of the intervention, 30.9% of participants made enough improvement in diet to move to a better RYP category. A community-based group intervention for older adults was effective in inducing improvements in diet quality.

Perceived Physical Fatigability Improves After a Weight Management Intervention

The effects of a weight loss and physical activity (PA) intervention on improving perceived physical fatigability are unknown. We examined this question in a subset (n=79) of older adults who are obese enrolled in the 13-month Mobility and Vitality Lifestyle Program (mean□SD age 68.8±4.2 years, 83.5% female, 26.6% African American, body mass index 34.6±4.3 kg/m2). Accelerometer-assessed PA (mean/day vector magnitude) was measured with a wrist-worn triaxial GT3X+ ActiGraph for 7 full days. Perceived physical fatigability was measured using the 10-item self-administered Pittsburgh Fatigability Scale (PFS, 0-50; lower score= less fatigability). Baseline PFS was 18.7±8.5 with 69.6% having higher fatigability (PFS ≥15). At 13-months, PFS decreased by 15% (2.8 points) to 15.9±8.4 (p<0.01) and prevalence of higher fatigability declined to 60.8%. Concurrently, participants lost 6.2% of their body weight and PA increased by 2.4%. A lifestyle intervention may be effective at reducing fatigability, an important component in the age-related disablement pathway.

P49. Physical activity measures in lumbar laminectomy patients: a prospective comparison of fitness tracker measures versus patient-reported outcome measures

BACKGROUND CONTEXT Assessing spine surgery patients' disability and mobility levels allows clinicians to evaluate the efficacy of surgical procedures and track postoperative recovery. While the current standard, patient-reported outcome measures (PROMs), provides a cross-sectional subjective assessment of functional levels, wearable fitness trackers can continuously and objectively track physical activity even outside of the clinic. PURPOSE The present study aims to assess how a wearable fitness tracker and two PROMs compare in tracking patients' recoveries from lumbar laminectomy. STUDY DESIGN/SETTING This is a prospective observational clinical study conducted within an urban academic health system. PATIENT SAMPLE The sample is composed of patients with lumbar stenosis who have undergone non-revision lumbar laminectomy with or without single level fusion. Patients who have had spine surgery within the past 5 years or have medical conditions that significantly inhibit mobility (including cardiovascular conditions and other orthopedic conditions) were excluded. OUTCOME MEASURES Patient median steps taken per day were continuously collected using the Fitbit Flex 2 fitness tracker. The Oswestry Disability Index (ODI) and Physical and Mental Components of the 12-Item Short Form Health Survey (SF-12 PCS/MCS) PROMs were assessed using standardized questionnaires throughout the study period. METHODS Each patient was provided with a fitness tracker at least 2 weeks prior to surgery until 6 months postoperatively to record median steps taken per day during the preoperative (baseline) and 2 week, 1, 3, and 6 month postoperative intervals. ODI and SF-12 PCS/MCS scores were calculated at enrollment and at the end of each interval. Two-tailed Student's t-tests were used to evaluate changes from baseline. Associations between the change in median steps per day and PROMs throughout the study were evaluated using Pearson's correlation coefficient. RESULTS Twelve of 18 enrolled subjects have thus far completed the study. Average compliance for wearing the fitness tracker, which was defined as the percentage of days the device was worn relative to the number of days the subject was enrolled in the study, was 91%. Average median steps per day and PROM scores normalized to preoperative levels decline immediately after surgery but recover after 1-3 months. Median steps per day were not significantly different from baseline at 6 months postoperatively (2.45% increase; p = 0.60). Average SF-12 PCS and ODI scores surpassed baseline scores by 1 month postoperatively and improved from baseline by 38% and 45% respectively at 6 months postoperatively (p = 0.004 and 0.05). No significant correlations were found between the change in median steps per day and corresponding change in PROM scores at any study time points. CONCLUSIONS Though enrollment is still ongoing, we can conclude that lumbar laminectomy patients had significantly improved SF-12 PCS and ODI scores by 6 months postoperatively while median steps per day only returned to baseline. Patients therefore perceive that their conditions have improved after lumbar laminectomy more quickly than their mobilities objectively increase. The lack of significant correlations between the change in median steps per day and corresponding change in PROM scores throughout the study also suggests that these outcome measurements describe distinct patient experiences. Though patients' self-reported pain-free mobility increases, lifestyle and other factors may be important in explaining the lack of difference between preoperative and 6-month postoperative median steps taken per day. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Examining human attitudes toward shared mobility options and autonomous vehicles

This paper presents a comprehensive analysis of people’s attitudes toward shared mobility options and autonomous vehicles (AVs), with a focus on the underlying patterns and potential determinants. A stated preference (SP) survey was designed and implemented in the U.S. Four sets of questions were included in the questionnaire, each focused on one unique aspect of user attitudes, including a) preferences for mobility options and lifestyle (such as overall view of driving, factors in mode choice decisions and technology engagement), b) perceived benefits and concerns of shared mobility option, c) reasons toward or against private vehicle ownership, and d) motivations for and desired features of AVs. A structural equations model was developed to identify latent attitudinal factors and examine the correlations between the latent attitudes (as the endogenous variables) and the observed covariates (including the socio-economic and demographic characteristics, and users’ current mobility profile, such as mode use frequency, travel distance, and trip fare). The model identified eleven latent factors that represent various aspects of attitudes toward AVs and shared mobility options. The findings could be used by policymakers and Transportation Network Companies (TNCs) to a) recognize the users’ latent attitudes, b) understand the underlying patterns of attitudes, c) implement plans and policies more efficiently, d) guide or influence users’ perceptions, and e) enhance travel behavior models. This study lays the foundation for further analysis on understanding user acceptance and adoption of these emerging mobility options, which is essential to estimate the likelihood and magnitude of behavior shifts in the era of automated, connected and shared mobility.

MOVE UP STUDY RESULTS: WEIGHT LOSS POSITIVELY AFFECTS HEALTH-RELATED QUALITY OF LIFE BUT NOT DEPRESSIVE SYMPTOMS

Obesity is prevalent among older adults as are increases in depressive symptoms and declines in health-related quality of life (HRQOL). Healthy weight loss and mitigating mild depressive symptoms (MDS) and HRQOL could have critical public health significance. The Mobility and Vitality Lifestyle Program (MOVE UP) led by Community Health Workers delivered 32 healthy aging/weight management group sessions over 13 months. Data from 240 participants were evaluated to assess program impact on CES-D (20-item) depressive symptom and SF-36 HRQOL scores. Participants were 88% female, 28% black/other race, 42% ≥ college-educated. Mean (SD) age was 67.6 (4.1) and BMI was 34.7 (4.7). At baseline, average CES-D score was 7.9 (7.2) and 27.9 % (N = 67) had MDS, scoring 17.1 (6.2). Results show significant mean (SD) weight change of -12.7 (13.3) lb from baseline (p<0.0001). Overall, CES-D mean (SD) score change was -0.4 (6.7) (p=0.33); participants with MDS had an average CES-D decrease of -4.4 (7.8) points (p<0.0001). Further, HRQOL improved significantly in all realms, particularly the physical component score (p<0.0001). SF-36 (SD) total score improved +1.1 (7.6), mental + 2.1 (11.7), and physical + 5.0 (16.7). Regression analyses (age/sex adjusted) demonstrate that for each 5 lb of weight loss there was an average (SEM) 3.35 (1.49) point increase in SF-36 total score (p=0.03). The mitigation of depressive symptoms in the MDS subgroup was not significantly associated with weight loss but may reflect other positive effects of the intervention experience. Conversely, positive HRQOL changes appear to be driven strongly by weight loss.

Coping with uncertainties of sustainability transitions using exploratory modelling: The case of the MATISSE model and the UK's mobility sector

Modelling is an important approach for analysing the behaviour of sustainability transitions. However, the presence of uncertainty challenges the usefulness of models and our inference from model results. We use the example of the MATISSE agent-based model to examine conditions for a transition to a public transport mobility regime under uncertainty in the UK. We use ‘exploratory modellingö to investigate the regions of model uncertainty in a structured way. Model results are generated from a wider range of input values compared to that applied normally in transitions modelling. A stochastic description of the pathways of adoption of different mobility lifestyles is developed. Our approach identifies possible transition pathways under an uncertain future in response to ranges of behavioural changes of households. A sensitivity analysis over the critical behavioural parameters also shows how the interactions between households and mobility lifestyle niches are determined by the dynamics of household behaviours.

Low carbon transitions pathways in mobility: Applying the MLP in a combined case study and simulation bridging analysis of passenger transport in the Netherlands

The analysis addresses two critical gaps in the literature on low-carbon mobility transitions: 1) scenarios of low-carbon mobility concentrate on technological substitution and have only a limited representation of niche-regime interactions and behavioural change, and 2) detailed qualitative analysis of socio-technical transitions dynamics have limited utility in developing future projections. It applies the Multi-Level Perspective on transitions, combining case studies of mobility niches in the Netherlands with simulations of transitions pathways using the MATISSE model, by applying the bridging approach proposed by Turnheim et al. (2015a). The iterative, combined qualitative case study and quantitative simulation approach develops transition pathways including both behavioural and technological change.The results show that both technological substitution to low carbon cars or a reconfiguration pathway away from car ownership to mobility lifestyles based on new public transport or cycling and walking for local trips are possible. However, while there is empirical evidence for the initial stage of a technological substitution to battery electric vehicles, transitions away from car ownership as the dominant mobility lifestyle have to overcome an established regime and will require major changes in culture and behaviour as well as support for new priorities in the institutions of transport planning.

Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function.

Background and ObjectivesObesity rates in adults ≥65 years have increased more than other age groups in the last decade, elevating risk for chronic disease and poor physical function, particularly in underserved racial and ethnic minorities. Effective, sustainable lifestyle interventions are needed to help community-based older adults prevent or delay mobility disability. Design, baseline recruitment, and implementation features of the Mobility and Vitality Lifestyle Program (MOVE UP) study are reported.Research Design and MethodsMOVE UP aimed to recruit 26 intervention sites in underserved areas around Allegheny County, Pennsylvania and train a similar number of community health workers to deliver a manualized intervention to groups of approximately 12 participants in each location. We adapted a 13-month healthy aging/weight management intervention aligned with several evidence-based lifestyle modification programs. A nonrandomized, pre–post design was used to measure intervention impact on physical function performance, the primary study endpoint. Secondary outcomes included weight, self-reported physical activity and dietary changes, exercise self-efficacy, health status, health-related quality of life, and accelerometry in a subsample.ResultsOf 58 community-based organizations approached, nearly half engaged with MOVE UP. Facilities included neighborhood community centers (25%), YMCAs (25%), senior service centers (20%), libraries (18%), senior living residences (6%), and churches (6%). Of 24 site-based cohorts with baseline data completed through November 2017, 21 community health workers were recruited and trained to implement the standardized intervention, and 287 participants were enrolled (mean age 68 years, 89% female, 33% African American, other, or more than one race).Discussion and ImplicationsThe MOVE UP translational recruitment, training, and intervention approach is feasible and could be generalizable to diverse aging individuals with obesity and a variety of baseline medical conditions. Additional data regarding strategies for program sustainability considering program cost, organizational capacity, and other adaptations will inform public health dissemination efforts.

MUSIC THERAPY IN RETT SYNDROME CASES

Rett syndrome is a rare (0,01%) genetic disorder affecting girls' development. Individuals with Rett syndrome experience a full range of health problems that severely influence and complicate their mobility, intellect, communication, learning, and entire lifestyle. The treatment of Rett's syndrome is still aimed at investigating new pathways to ensure the best possible patient’s development and quality of life. The distinctive feature of Rett syndrome is the two main sensations with little damage: hearing and vision. Therefore, music therapy plays an exceptional role in the treatment and special education of children with Rett syndrome. The goal of this study is to find the most effective music therapy techniques and their specific indications whilst working with individuals with Rett syndrome. Research method used: music therapists’ online survey conducted internationally. The research suggests that the most effective methods in Rett syndrome cases are structured musical games that promote targeted hands-on movements, as well as listening to the songs and choice of favourite songs using pictures or other symbols. Music therapy can be applied for various health needs of individuals with Rett syndrome, especially to enhance hand functions as well as to improve non-verbal communication and to help individuals experience togetherness and joy.

MUSIC THERAPY IN RETT SYNDROME CASES

Rett syndrome is a rare (0,01%) genetic disorder affecting girls' development. Individuals with Rett syndrome experience a full range of health problems that severely influence and complicate their mobility, intellect, communication, learning, and entire lifestyle. The treatment of Rett's syndrome is still aimed at investigating new pathways to ensure the best possible patient’s development and quality of life. The distinctive feature of Rett syndrome is the two main sensations with little damage: hearing and vision. Therefore, music therapy plays an exceptional role in the treatment and special education of children with Rett syndrome. The goal of this study is to find the most effective music therapy techniques and their specific indications whilst working with individuals with Rett syndrome. Research method used: music therapists’ online survey conducted internationally. The research suggests that the most effective methods in Rett syndrome cases are structured musical games that promote targeted hands-on movements, as well as listening to the songs and choice of favourite songs using pictures or other symbols. Music therapy can be applied for various health needs of individuals with Rett syndrome, especially to enhance hand functions as well as to improve non-verbal communication and to help individuals experience togetherness and joy.

Place identity construction of Third Culture Kids: Eliciting voices of children with high mobility lifestyle

•High mobility lifestyles has spread people around the globe making long-term relationships (friendships) more difficult.•Lacking quality of long term relationships or failed to make an attempt to connect and maintain connection with others make Third Culture Kids feel isolated and lonely.•Enabling modalities for place identity construction for Third Culture Kids include: sense of stability, sense of belongingness and sense of direction.