Participation In Life Activities Research Articles

Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning.

Although a cancer diagnosis and stoma creation leave colorectal cancer (CRC) survivors with significant limitations on participation in life activities that would impair their global quality of life (QoL), the underlying psychological mechanisms are understudied. The aim of this cross-section study was to examine whether psychological distress mediates the association of limitations on participation in life activity with global QoL, and whether family functioning moderated the indirect effects of limitations on participation in life activities on global QoL through psychological distress. CRC survivors with permanent stomas (n = 282) completed questionnaires assessing socio-demographic and clinical characteristics, limitations on participation in life activities, psychological distress, family functioning, and global QoL. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS. Mediation analysis showed that the association of limitations on participation in life activities with global QoL was partially mediated by psychological distress (indirect effect = -0.087, 95% CI = -0.135 to -0.041). Moderated mediation analysis indicated that the indirect effects of limitations on participation in life activities on global QoL through psychological distress were significantly moderated by family functioning. Specifically, the indirect effects decreased were significant as family functioning levels increased. CRC survivors with permanent stomas experienced poor global QoL. The moderated mediation model provides a better understanding of how limitations on participation in life activities, psychological distress, and family functioning work together to affect global QoL. Interventions aiming to improve QoL among CRC survivors with permanent stomas should consider targeting these aspects.

A Parent-Mediated Anxiety Intervention Specifically Tailored for Autistic Preschoolers: A Pilot Study.

Autistic children experience reduced participation in life activities. One factor that may contribute to their reduced levels of participation is anxiety, which is identified at higher rates among young autistic children than among their neurotypical peers. Anxiety is also strongly associated with sensory overresponsivity and has a considerable impact on daily functioning. To determine the feasibility, acceptability, and usefulness of a small-group, parent-mediated intervention to prevent and reduce anxiety. Pre-post. University research center. Three parents of autistic children (ages 4-7 yr). Parents completed a six-session group training program. Parents completed an anxiety scale for their child before and after parent training. At the end of training, parents participated in a focus group and were interviewed 4 mo after training. Positively received aspects of the intervention were the benefits of a small group, composed of parents of autistic children, run by a facilitator with expertise in autism and anxiety. Parents gained knowledge, resulting in "taking a different approach" with their child and "seeing an interplay between anxiety and autism." After the intervention, parents reported a reduction in children's reported anxiety levels. Knowledge of autism and anxiety acquired during a parent-mediated group increased parents' understanding of their child's behaviors and assisted them in supporting their child's participation. Further research, including larger studies, is required to determine the effectiveness of this intervention. What This Article Adds: The findings from this research provide preliminary support for the adaptation of an existing parent intervention (Cool Little Kids) to reduce anxiety among autistic children. Parents reported an increased awareness and understanding of anxiety and of the interplay between anxiety and autistic traits. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel etal., 2021; Kenny etal., 2016).

Insulin resistance and related factors in patients with moderate and severe traumatic brain injury.

Traumatic brain injury (TBI) is associated with atherosclerosis and cardiovascular mortality. However, the causal relationship between TBI and atherosclerosis is unclear. This study aimed to evaluate insulin resistance in patients with TBI and its relationship with clinical and demographic characteristics of the patients. The case-controlled study included 60 patients with moderate and severe TBI in the chronic phase and 60 healthy controls matched for sex, age, and body mass index (BMI). Demographic characteristics, serum insulin, and fasting blood glucose levels of both groups were assessed. Insulin resistance was determined by the Homeostasis Model Assessment insulin resistance. The clinical features of the TBI group were also recorded. Insulin resistance was observed to be higher in the TBI group than in the control group (46.7% vs. 18.33%, P = 0.002). However, no significant difference was determined between TBI patients with and without insulin resistance in terms of all demographic and clinical parameters examined (all P > 0.05). Age, sex, BMI, and trauma severity were not significant predictors of insulin resistance in TBI patients. Moderate-to-severe TBI patients have more prevalent insulin resistance than healthy controls. Evaluation of insulin resistance in these patients, who currently have limited participation in life activities and healthy lifestyles, may be useful to prevent cardiovascular diseases caused by insulin resistance.

Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System.

Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.

Posttraumatic stress disorder service dogs and the wellbeing of veteran families

ABSTRACT Background Benefits and challenges associated with service dogs for veterans with posttraumatic stress disorder (PTSD) may extend beyond veterans to their families. Objective The purpose of the current study is to evaluate the impact of veterans’ PTSD service dogs on spouses and families in a parallel-group, longitudinal design with assessments at baseline and three months follow-up. Method A total of 88 United States military veteran spouses completed a survey composed of multiple standardized measures at baseline and three months later. In the intervention group (n = 48), veterans received service dogs shortly after baseline while the waitlist control group (n = 40) did not. Results Linear regression analyses demonstrated significantly lower caregiver satisfaction, higher caregiver burden and higher participation in life activities among spouses who had service dogs in their homes compared to those on the waitlist. Though not significant, small effect sizes were present among additional measures. Conclusion Results suggest that although previous literature demonstrates service dogs may offer significant improvements for veterans, spouses and children may not experience those same benefits. Clinicians should consider how to prepare veteran spouses and families for integrating service dogs into their home. Future studies should explore family-focused approaches for service dog integration, defining an optimal strategy for the benefit of the entire family. HIGHLIGHTS Though service dogs may improve wellbeing for veterans with posttraumatic disorder, families of veterans may not experience those same benefits. Researchers and clinicians should consider how to best prepare veteran families for integrating service dogs into their homes. Though posttraumatic stress disorder (PTSD) service dogs are trained specifically for veterans, recent studies have demonstrated that their impact may go beyond veterans themselves (McCall, Rodriguez, Wadsworth, Meis, & O’Haire, 2020; Nieforth, Craig, Behmer, MacDermid Wadsworth, & O’Haire, 2021). PTSD service dogs may provide both benefits and challenges for veteran families.

Distribution and relation of two arm function tests, Box and Blocks test and Nine Hole Peg test, across disease severity levels and types of multiple sclerosis

BackgroundRegular upper limb evaluation in persons with multiple sclerosis to detect early alterations and to monitor possible deterioration, both in gross and fine motor dexterity, is important for optimal levels of participation in life activities across the life span. The purpose of the present study was to inquire upon alterations in bilateral gross and fine manual dexterity, measured with the Box and Block test (BBT) and the Nine Hole Peg test (NHPT), in persons with MS (PwMS) across a wide range of disability levels and across MS types. MethodsThis is a secondary cross-sectional analysis of BBT and NHPT administered to 215 PwMS at all disability levels and three MS phenotypes, relapsing-remitting, primary progressive and secondary progressive (RRMS, PPMS, SPMS). To inquire on the prevalence of alterations in upper limb gross and fine dexterity, PwMS test scores were compared to normative healthy subjects' values, Abnormal values were defined as scores equal or exceeding 2 standard deviations from the normative values for NHPT and the BBT. The data of both arms was analyzed by disability level and by the type of MS. For characterization and comparisons based on disability level, the sample was divided in four groups according to the EDSS score: 0–3.5 were categorized as Mild (EDSS-Mi), EDSS>3.5 to 5.5 were categorized as Moderate (EDSS-Mo), EDSS>5.5 to 6.5 were categorized as Severe (EDSS-Se), and disability levels of 7 and beyond were categorized as Severe-non-ambulant (EDSS-SeN). Finally, correlations between UL dexterity measures bilaterally were carried out. ResultsMean (SD) age of the sample was 54.07 (±12.81) years, with a mean (SD) disease duration of 18.91 (±10.95) years and a median EDSS (IQR) of 6.5 (5.5/7). Fifty-three% had RRMS, 19% PPMS and 28% SPMS. Almost the whole sample (96.2%) showed abnormal scores on the BBT; 91.5% had abnormal bilateral scores. Abnormal scores were present on the NHPT in 85.4% of the whole sample, with 68.9% having bilateral abnormal scores. With increase in disability levels the mean number of blocks moved was reduced and time taken to finish the NHPT was increased. The BBT and the NHPT in each arm were highly correlated over all disability levels, with correlation ranging from 0.74 to 0.86.Overall, right and left arm had statistical differences in median scores on the NHPT peg/sec (p = 0.004) but similar scores on the BBT (p = 0.57).Abnormal bilateral scores were recorded in 85% of PwRR, in 96% of PwSP and 100% of PwPP for the BBT and in about 56% of PwRR, increasing up to 80 and 85% in PwPP and PwSP for the NHPT. Progressive forms of MS presented statistically different values on the BBT (p<0.001) and the NHPT (p<0.001) with respect to the RRMS type. ConclusionWe found that both fine and gross manual dexterity were altered with respect to normative values in most persons with MS, but abnormalities in gross manual dexterity were more prevalent and pronounced earlier in the disease course. Similarly, with regard to MS types, bilateral alterations in gross manual dexterity were more prevalent than were fine manual dexterity in all three phenotypes considered.

The association of bowel function, participation in life activities, and quality of life in rectal cancer survivors.

To evaluate whether limited participation in life activities is associated with quality of life (QOL) in rectal cancer survivors, and if so, whether this association is independent of bowel function difficulties. We surveyed rectal cancer survivors from four healthcare systems about their QOL, bowel function, and participation in life activities. Additional demographic and clinical variables were extracted from the electronic health record. We examined independent associations between bowel function, participation in life activities, and QOL, controlling for potential confounders. We also identified factors, including ostomy status, that correlate with participation in life activities. Of the 527 respondents, 52% were male, 80% were non-Hispanic white, and the mean age was 63. In fully adjusted models for all rectal cancer survivors, participation in life activities was positively associated with QOL, while bowel function was not. Bowel function retained an independent association with QOL for those who previously had an ostomy and were therefore more likely to have a low rectal anastomosis. Lower participation in life activities was correlated with lower self-reported physical and cognitive function, younger age, financial difficulty, and being non-Hispanic white. Rectal cancer survivors' participation in life activities was strongly associated with QOL, even when controlling for numerous confounders, including bowel function. Identifying ways to improve participation in life activities may be critical to developing rehabilitative and other supportive interventions that optimize QOL among rectal cancer survivors.

Toward a Competency-based Approach to Co-designing Technologies with People with Intellectual Disability

Ability-based design is a useful framework that centralizes the abilities (all that users can do) of people with disabilities in approaching the design of assistive technologies. However, although this framework aspires to support designing with people with all kinds of disabilities, it is mainly effective in supporting those whose abilities can be clearly defined and measured, in particular, physical and sensory attributes of ability. As a result, the ability-based design framework only provides limited guidance to design with users with intellectual disability, whose cognitive, physical, sensory, and practical abilities vary along a spectrum. In this article, we reflect on a long-term co-design study where we leveraged what we termed “competencies,” i.e., the representative practical skills people develop from their participation in life activities, in particular, mainstream technologies, such as social media and the Internet. Our reflection is based on our experience in designing SkillsTube, a web application we co-designed with young adults with intellectual disability to support them to learn life skills through videos. The app's design, which explored and leveraged their social media participation competencies, supported the fundamental participation of all participants and their peers. Their familiarity with the app's social media-inspired design features fostered confidence in their participation, usability, and engagement. Drawing on the findings and design process of the app, we discuss a Competency-based approach to designing with people with disabilities that extends upon ability-based design, by grounding it in user competencies.

Academic Technologies for College Students With Intellectual Disability.

Institutes of higher education have encountered an increase in enrollment of students with intellectual disability (ID). This increase is due, in part, to societal movements (e.g., inclusive participation in life activities) and federal legislation. There are potential benefits to both individuals with ID and society when students within this population complete college (e.g., earn certificates, a collection of completed courses and experiences, increased future employment opportunities). Nevertheless, there are barriers to college that students with ID need to overcome to have successful experiences, particularly in their academic or functional academic courses. This paper presents numerous instructional technologies grounded in behavior analytic strategies and Universal Design for Learning (UDL) that university faculty might implement in their courses and/or recommend to their students for studying to facilitate the learning of college students with ID and their classmates.

Understanding activity participation 3-months after stroke: a mixed methodology study

Purpose To investigate stroke survivors’ activity participation 3-months after stroke, reasons for activity participation and the change in reason for activity participation. Method Thirty stroke survivors were administered the Activity Card Sort-Australia concurrent with a semi-structured interview about their activity participation. Data were analyzed using descriptive statistics and spiral content analysis. Results Participants had returned, in part, to 96% of their previous leisure, social/educational and household activities 3-months after-stroke; retaining more sedentary and home-based activities but fewer physically demanding and community-based activities. Thirteen participants described a change in their reasons for their activity participation. Personal, environmental and temporal dimensions explained these reasons for activity participation, as well as the changes in reason for activity participation. Full activity participation involved participants’ orchestrating a dynamic mix of fulfilling their personal desires according to their current physical, mental and emotional capacity; their social, organizational and physical environmental demands and obligations; and their routines, available time and future plans. Conclusion Qualitative interviews extend our understanding of the process of returning to participation in life activities and occupations following stroke to reveal that it involves the stroke survivor in a dynamic adaptation process of synchronizing personal, environmental and temporal dimensions in their daily lives. IMPLICATIONS FOR REHABILITATION Rehabilitation professionals need to recognize the unique knowledge and ability stroke survivors have to manage their capacities, activities, occupations and environments. Client-centered practice involving true collaborative partnerships are needed to ensure stroke survivors return more satisfactorily to their activities and occupations. Rehabilitation professionals need to continually consider the ongoing changing relationships that occur between the person, their capacities, social, organizational and physical environments, and the person’s activity/occupational participation during recovery from stroke. Returning to full activity/occupational participation after stroke is a dynamic and continuous process. Rehabilitation needs to be provided in different forms at different stages beyond the immediate post-stroke time so that stroke survivors benefit from the “right rehabilitation” at the “right time” throughout their recovery journey.

Self-Perception of Physical Function Contributes to Participation in Cognitively- and Physically-Demanding Activities After Stroke.

Background: Persons with and without aphasia experience decreased participation in meaningful activities post-stroke that result in reduced autonomy and poorer quality of life. Physical, cognitive, and/or communication deficits are prevalent post-stroke and many activities given up are purported to require high levels of communicative, cognitive, or physical skill. However, the relationship between deficits after stroke and participation in life activities that appear to require high skill levels in these three areas has not been investigated fully.Objectives: The objectives of this study are to: (1) determine differences in reported participation in communicatively-, cognitively-, or physically-demanding activities in persons after stroke with and without aphasia living in the community, and to (2) investigate whether performance on commonly used self-perception assessments of these three areas predicts reported participation in activities requiring higher levels of skill in these domains.Methods: In a cross-sectional design, 82 individuals at least 6 months post-stroke with (N = 34) and without aphasia (N = 48) were administered a battery of neuropsychological and participation-based assessments. Supported communication techniques maximized inclusion of individuals with aphasia. A series of regression analyses investigated the relationship between self-perceived communicative, cognitive, and physical functioning and reported participation in activities post-stroke that required high amounts of skilled function in these areas.Results: People with and without aphasia did not differ in terms of the percentage retained in communicatively-, cognitively-, or physically-demanding activities. All individuals retained higher levels of participation in communicatively- and cognitively-demanding activities (at least 60% retained), compared to participation inphysically-demanding activities (about 50% retained). The strongest predictor for retaining participation in two of the three domains of activities was self-perception of physical function, though much of the variance remained unexplained. Self-perception of communication was not related to participation retention in any of the three domains.Significance of Impact: Rehabilitation professionals should be aware of the impact that a variety of communicative, cognitive, and physical factors may have on participation post-stroke. Self-perceptions of impairments in communication and cognition may not directly predict participation in activities requiring high levels of communicative and/or cognitive skill, at least for those with mild impairment, even though activities requiring those skills are given up or done less after stroke.

Assessments used to measure participation in life activities in individuals with cancer: a scoping review.

Individuals with cancer are at high risk for restricted participation in meaningful life activities such as work, school, and social activities. Evaluating participation in life activities is identified as a critical component of rehabilitation referral and triage systems. This scoping review investigates what assessments are used to measure participation in life activities in individuals with cancer. Six databases were systematically searched using keywords and controlled vocabulary through February 2020. Eligible studies used the term participation in the context of life situations and had an assessment with at least 5 participation-specific questions. A total of 4604 unique articles were identified and screened for eligibility. Thirty-two studies were included; 20 unique assessments of participation were identified. Assessments were developed with the primary purpose of measuring participation (n = 8); global or physical function (n = 9); community integration (n = 1); social activity (n = 1); or occupational gaps (n = 1). Most assessments (12/20) were not developed with the purpose of measuring participation and only 4 assessments measured key components of participation other than frequency. Measuring participation in life activities is a developing area in oncology research. Most studies do not accurately or comprehensively measure this construct. The heterogeneity in assessments used indicates no clear consensus on a gold-standard participation measure for use among cancer survivors. Comprehensively measuring participation will help identify individuals in need of rehabilitation services and is an essential first step to inform the development of targeted interventions to enhance participation.

Abstract WP424: Challenges of Participation in Life Activities Post-Stroke: A Qualitative Study

Background and Purpose: Our previous study of 265 stroke survivors recruited immediately before discharge from two regional rehabilitation hospitals found state self-esteem, social support satisfaction, discharge location (home, residential care facility), and gender significantly accounted for 49% of the variance in depressive symptoms. The purpose of this study is to explore the challenges of promoting participation in life activities for stroke survivors. Methods: A qualitative study with individual face-to-face semi-structured interviews were conducted. Adult managerial persons who were responsible for the development of community, rehabilitation or residential care services for stroke survivors were recruited. All participants were asked to share the mission of their institutions, types of care services for stroke survivors, perceived importance of, barriers to and facilitators of promoting participation in life activities, and opportunities for enhancing stroke care services. All interviews were audio recorded and transcribed verbatim for thematic analysis. Results: A total of 11 participants were interviewed. Five were in-charge persons of stroke support groups, two were legislators, two from residential care facilities, and two from community-based organisations. Four key themes were generated: (1) Being institutionalized was found associated with lower levels of psychosocial health, (2) Stroke survivors’ physical and cognitive limitations were perceived as key challenges in promoting participation in life activities, (3) Healthcare providers placed more emphasis on promoting physical rehabilitation than social participation, and (4) Physical environment particularly in residential care facilities posed greater challenges to promoting participation in real life activities. Conclusions: This highlights major challenges for healthcare professionals who care for stroke survivors in residential care facilities. Further studies that investigate the associations between environmental barriers, psychological morbidity and participation restriction is needed.

ICON 2019—International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients

BackgroundThe absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a...

Exploring the Experiences of People Treated With Immunotherapies for Advanced Melanoma and Those Caring for Them: "Real-World" Data.

Recent advances in the development of immunotherapy drugs have resulted in durable responses and improved overall survival for a proportion of patients with advanced melanoma; however, toxicities can be potentially life-threatening. The patients' family and friends (carers) are relied upon to support patients at home post treatment; however, we know little about their experiences. This study aimed to understand the experiences of patients with advanced melanoma who received immunotherapy and their carers; and to explore the impact of immunotherapy treatment on patients' and carers' quality of life (QoL). A cross-sectional, exploratory design was employed. Semi-structured interviews were conducted with patients: diagnosed with stage IV melanoma, attending an Australian public cancer hospital, had completed or were receiving treatment with immunotherapies; and the people caring for them at home. Patients (n = 22) described how immunotherapy impacted emotional health, functional ability; and had damaging economic consequences. Fatigue was reported consistently as having a considerable negative influence across all domains of QoL. Carers (n = 9) were anxious about their ability to correctly identify, report and manage side effects at home. Results demonstrate how immunotherapy can impact the QoL of both patients and carers, either directly through toxicities or indirectly through mechanisms such as stress, financial toxicity, or fatigue that limits participation in life activities. Supportive care resources and interventions are needed for those receiving immunotherapy to minimise negative impacts on QoL. Carers likewise require better preparation and information to assist in identifying potential treatment toxicities and ensure patient safety.

A systematic review and narrative synthesis of occupational therapy-led interventions for individuals with anxiety and stress-related disorders

Anxiety and stress-related disorders are highly prevalent and impede participation in life activities. Occupational therapists work extensively with people diagnosed with these disorders but the effectiveness of their interventions is unclear. A systematic search strategy identified 19 papers describing 13 studies. Studies varied in methodology, intervention type, and theory base. The results show the potential for lifestyle approaches, occupational science-based programs, and skill-building to improve mental health. The variety of interventions and methodologies of many studies means that the effectiveness of occupational therapy interventions for this population is not yet determined. High-quality research is required to replicate interventions with emerging potential for effectiveness.

Information and communication technology use in daily life among young adults with mild-to-moderate intellectual disability.

Information and communication technology (ICT) increases participation in life activities, and young adults are frequent users. Young adults with intellectual disability (ID) do not use ICT as much as their peers, and little is known about how ICT is used by young adults with ID. This study describes the use of ICT from the perspective of young adults with mild to moderate ID in a municipal social care context. Semi-structured interviews were used to collect information from 11 young adults with mild-to-moderate ID living in residential care and analysed using a content analysis. ICT was used for family relationships, daily support, interactions based on interests and amusement, and as support for offline activities. Family members were important providers of support for ICT use. Young adults with mild-to-moderate ID use ICT in their daily life. The social care context needs to be further investigated due to its influence on the young adults' access to ICT and need of support.

Participation changes in various activities for school children with cerebral palsy of different motor severities

Cerebral palsy (CP) not only affects movement and posture, but also is accompanied with cognition, speech, or social problems. These problems further cause limitation in participation in life activities in children with CP. This study aims to investigate the changes in participation outcomes in various activities for children with CP of different motor severities. Sixty-five parents of schoolchildren with CP (6–18 years) were enrolled and classified into two groups based on the Gross Motor Function Classification System (GMFCS) levels: mild (GMFCS levels I–III, n = 41) and severe group (GMFCS level IV–V, n = 24). Participation outcome was assessed by the Children's Assessment of Participation and Enjoyment (CAPE) at baseline and 6-month follow-up. CAPE measures participation diversity and intensity in five activities (recreational, active physical, social, skill-based, and self-improvement), ANCOVA was used to compare the participation changes in various domains between two groups. At baseline and follow-up, mild groups had better participation diversity and intensity in all activities except the intensity in social activities at follow-up than severe groups ( P < 0.05). ANCOVA results showed mild groups had better changes in the participation diversities for total and all activities except the social and skill-based activities than severe groups ( P < 0.05). Furthermore, mild groups had better changes in the participation intensities for total, active physical, and self-improvement activities, than severe groups ( P < 0.05). The GMFCS levels were associated with participation changes in the diversities and intensities for various activities in children with CP. Mild groups had better changes in the participation diversities and intensities for some activities than severe groups. These findings may allow clinicians early predict the changes in the participation outcomes for these children based on simple GMFCS levels.

Participation changes in various activities for school children with cerebral palsy of different motor severities

Cerebral palsy (CP) not only affects movement and posture, but also is accompanied with cognition, speech, or social problems. These problems further cause limitation in participation in life activities in children with CP. This study aims to investigate the changes in participation outcomes in various activities for children with CP of different motor severities. Sixty-five parents of schoolchildren with CP (6–18 years) were enrolled and classified into two groups based on the Gross Motor Function Classification System (GMFCS) levels: mild (GMFCS levels I-III, n = 41) and severe group (GMFCS level IV-V, n = 24). Participation outcome was assessed by the children's assessment of participation and enjoyment (CAPE) at baseline and 6-month follow-up. CAPE measures participation diversity and intensity in five activities (recreational, active physical, social, skill-based, and self-improvement), ANCOVA was used to compare the participation changes in various domains between two groups. At baseline and follow-up, mild groups had better participation diversity and intensity in all activities except the intensity in social activities at follow-up than severe groups ( P < 0.05). ANCOVA results showed mild groups had better changes in the participation diversities for total and all activities except the social and skill-based activities than severe groups ( P < 0.05). Furthermore, mild groups had better changes in the participation intensities for total, active physical, and self-improvement activities, than severe groups ( P < 0.05). The GMFCS levels were associated with participation changes in the diversities and intensities for various activities in children with CP. Mild groups had better changes in the participation diversities and intensities for some activities than severe groups. These findings may allow clinicians early predict the changes in the participation outcomes for these children based on simple GMFCS levels.

Perceived Activities and Participation Outcomes of a Yoga Intervention for Individuals with Parkinson's Disease: A Mixed Methods Study.

Parkinson's disease (PD) often leads to poor balance, increased falls, and fear of falling, all of which can reduce participation in life activities. Yoga, which usually includes physical exercise, can improve functioning and life participation; however, limited research has been conducted on the effects of yoga on life participation of individuals with PD. This study had two purposes: (1) to identify and understand the perceived activities and participation outcomes associated a therapeutic yoga intervention for individuals with PD; and (2) to compare the perceived activities and participation outcomes with the outcomes measured in the clinical trial. A single-blind, randomized, waitlist-controlled, phase II exploratory pilot study using an after-trial embedded mixed methods design (clinical trial Pro00041068) evaluated the effect of an 8-week Hatha Yoga intervention on individuals with PD. Directed content analysis was used to analyze focus group interviews with participants who completed the yoga intervention. Quantitative and qualitative data were merged and compared using a data comparison matrix. Qualitative analysis indicated many activities and participation outcomes. Comparison of qualitative and quantitative data indicated the yoga intervention led to improved balance, mobility, and functional gait, and fewer falls. These outcomes reached beyond the intervention and into participants' daily lives. Results support the use of Hatha Yoga as a community-based rehabilitation intervention for individuals with PD. Yoga, as part of an interdisciplinary approach to treatment, can improve many types of activities and participation outcomes (e.g., mobility, social relationships, self-care, handling stress, recreation).