A Co-creation Centre for Accessible Rehabilitation Technology

Background: The prevalence of disabling conditions is increasing globally. Rehabilitation improves function and quality of life across many conditions, particularly when applied intensively. The limited workforce, however, cannot deliver evidence-based intensive rehabilitation. By providing individuals with the tools for self- rehabilitation, technology helps bridge the gap between evidence and practise. Few people, however, can access rehabilitation technology. Barriers such as cost, training, education, portability and poor design stand in the way of equitable access. Our group of engineers and researchers have established a centre dedicated to developing accessible technology through close, frequent engagement with users and industry.Methods: The centre employs a co-creation model, coupling engineering and science with user experience and industrial partnerships to develop accessible technology and associated processes. Due to the complexity and size of the challenge the initial focus is stroke. Recruited through a medical charity, participants, with a wide range of disabilities, use prototype and commercial technology during an 8-week rehabilitation programme with supervision from health professionals. The centre includes de-weighting systems, neurostimulation, virtual reality, treadmills, bespoke rehab games, communication apps, powered exercise equipment and gamified resistance equipment. Standard outcome measures (International Classification of Functioning, Disability and Health) are recorded before, during, immediately after, and 3 months after the intervention and used in combination with an interview to design the initial rehabilitation programme, which is reviewed fortnightly. Qualitative methods (surveys and interviews) are used to capture personal experiences of the programme and individual technology and an advisory group of stroke survivors help interpret outcomes to feed into the technology design process. Ethical approval has been granted for a pilot cohort study with stroke survivors, which is currently underway (01/09/2021–31/12/2021) investigating acceptability and feasibility, due to report findings in 2022.Discussion: Through partnerships, research collaborations and a co-creation model a new centre dedicated to the development of accessible rehabilitation technology has been launched and currently undergoing acceptability and feasibility testing with stroke survivors. The centre, through its close engagement with users and industry, has the potential to transform the way rehabilitation technology is developed and help revolutionise the way rehabilitation is delivered.

It takes two to tango: The therapeutic alliance in community brain injury rehabilitation

Objective: A positive therapeutic (or working) alliance has been associated with better outcomes for clients in the psychotherapeutic and traumatic brain injury (TBI) rehabilitation literature. The aim of this pilot study was to gain an understanding of the therapeutic alliance in community rehabilitation from the perspectives of adults with TBI and their close others who have completed a community rehabilitation programme. Method: This study used a constructivist, qualitative methodology which applied grounded theory analysis techniques. Using purposeful sampling, three pairs of participants (adults with TBI and close others) who had finished a community rehabilitation programme completed separate in-depth interviews which were transcribed verbatim and progressively analysed using a process of constant comparison. Results: A preliminary framework illustrating participants’ experience of a therapeutic alliance was generated, comprising three interconnected themes: being recognised as an individual, working together and feeling personally connected. All participants viewed being able to work together as important in their experience of community rehabilitation and described features that helped and hindered the alliance. Conclusion: These pilot study results demonstrate the importance of the therapeutic alliance to the rehabilitation experience of individuals with TBI and those close to them.

Experiences in a rehabilitation programme: Case studies of male juvenile offenders in a correctional school in Vietnam

<p>While the challenge of rehabilitating juvenile offenders has attracted international research interest, the rehabilitation of juvenile offenders in Vietnam has received little research attention. This study employed a qualitative collective case study approach to gain insights into how eight juvenile offenders perceived and experienced a rehabilitation programme in a correctional school in Vietnam. It drew on the perspectives of juvenile offenders, teachers and one manager. Deprivation, importation and Aker’s social learning theories provided a theoretical framework to explore the juvenile offenders’ experiences. Data were collected through observations, interviews and document analysis supplemented by field notes and a research journal. Data were then analysed thematically. The findings suggest that individual characteristics, family and peers played roles in the development of juvenile offenders’ antisocial behaviours and in their engagement with the rehabilitation programme. These roles could be positive and negative. The case studies illustrate the ways in which the programme was perceived to influence the young people’s thinking and behaviour in positive and negative ways. For instance, the eight young participants all recounted examples of modifying their behaviour in a deliberate attempt to ‘game’ the staff. This was done in order to gain preferential treatment, and as a means to coping with the ‘pains’ of incarceration. The case studies illustrated short coming in the current provision of educational and vocational training programmes intended to support reintegration into the community. A lack of alignment between the school programmes and future educational and labour market opportunities is likely to potentially undermine the policy goal of successful reintegration into the community. Based on the findings of this study, it is proposed that rehabilitation policy and practice in Vietnam should be reviewed and reformed. This study highlights the need to better meet the social, emotional and educational needs of young people in the Vietnamese juvenile justice system. Future research and policy initiatives should be focused on minimising recidivism and supporting reintegration into society on release. There should be guidelines to ensure there is active cooperation between families, the correctional schools and local authorities. It is recommended that the family should be involved in youth rehabilitation processes in the correctional school.</p>

Experiences in a rehabilitation programme: Case studies of male juvenile offenders in a correctional school in Vietnam

<p>While the challenge of rehabilitating juvenile offenders has attracted international research interest, the rehabilitation of juvenile offenders in Vietnam has received little research attention. This study employed a qualitative collective case study approach to gain insights into how eight juvenile offenders perceived and experienced a rehabilitation programme in a correctional school in Vietnam. It drew on the perspectives of juvenile offenders, teachers and one manager. Deprivation, importation and Aker’s social learning theories provided a theoretical framework to explore the juvenile offenders’ experiences. Data were collected through observations, interviews and document analysis supplemented by field notes and a research journal. Data were then analysed thematically. The findings suggest that individual characteristics, family and peers played roles in the development of juvenile offenders’ antisocial behaviours and in their engagement with the rehabilitation programme. These roles could be positive and negative. The case studies illustrate the ways in which the programme was perceived to influence the young people’s thinking and behaviour in positive and negative ways. For instance, the eight young participants all recounted examples of modifying their behaviour in a deliberate attempt to ‘game’ the staff. This was done in order to gain preferential treatment, and as a means to coping with the ‘pains’ of incarceration. The case studies illustrated short coming in the current provision of educational and vocational training programmes intended to support reintegration into the community. A lack of alignment between the school programmes and future educational and labour market opportunities is likely to potentially undermine the policy goal of successful reintegration into the community. Based on the findings of this study, it is proposed that rehabilitation policy and practice in Vietnam should be reviewed and reformed. This study highlights the need to better meet the social, emotional and educational needs of young people in the Vietnamese juvenile justice system. Future research and policy initiatives should be focused on minimising recidivism and supporting reintegration into society on release. There should be guidelines to ensure there is active cooperation between families, the correctional schools and local authorities. It is recommended that the family should be involved in youth rehabilitation processes in the correctional school.</p>

Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study

ObjectivesTo test the feasibility of using a new activity pacing framework to standardise healthcare professionals’ instructions of pacing, and explore whether measures of activity pacing/symptoms detected changes following treatment.DesignSingle-arm, repeated measures study.SettingOne National Health Service (NHS) Pain Service in Northern England, UK.ParticipantsAdult patients with chronic pain/fatigue, including chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis.InterventionsSix-week rehabilitation programme, standardised using the activity pacing framework.Outcome measuresFeasibility was explored via patients’ recruitment/attrition rates, adherence and satisfaction, and healthcare professionals’ fidelity. Questionnaire data were collected from patients at the start and end of the programme (T1 and T2, respectively) and 3 months’ follow-up (T3). Questionnaires included measures of activity pacing, current/usual pain, physical/mental fatigue, depression, anxiety, self-efficacy, avoidance, physical/mental function and quality of life. Mean changes in activity pacing and symptoms between T1-T2, T2-T3 and T1-T3 were estimated.ResultsOf the 139 eligible patients, 107 patients consented (recruitment rate=77%); 65 patients completed T2 (T1-T2 attrition rate=39%), and 52 patients completed T3 (T1-T3 attrition rate=51%). At T2, patients’ satisfaction ratings averaged 9/10, and 89% attended ≥5 rehabilitation programme sessions. Activity pacing and all symptoms improved between T1 and T2, with smaller improvements maintained at T3.ConclusionThe activity pacing framework was feasible to implement and patients’ ability to pace and manage their symptoms improved. Future work will employ a suitable comparison group and test the framework across wider settings to explore the effects of activity pacing in a randomised controlled trial.Trial registration numberNCT03497585.