Strategy training is a promising stroke rehabilitation intervention commonly delivered in Western countries. We examined the perspectives of rehabilitation therapists who have delivered strategy ...training in Taiwan and the United States to understand the influence of culture on strategy training implementation.
In this rapid ethnographic study, the maximum variation sampling approach was used to recruit seven therapists in Taiwan and seven therapists in the United States with experience delivering strategy training. Data was collected from multiple sources, including interviews, study documents, therapist notes, and reflective memos. Interviews with the recruited therapists in Taiwan and the United States were conducted in Mandarin and English, respectively. Data were analyzed using a constant comparative approach.
The following two themes were generated: (1) differences between conventional rehabilitation and strategy training, namely that conventional rehabilitation is therapist-directed and emphasizes impairment reduction, whereas strategy training empowers clients and focuses on real-life generalization, and (2) challenges in implementing strategy training in practice, including difficulty in achieving client buy-in and disengagement.
Therapists from both countries shared similar perspectives on the perceived advantages of strategy training, such as enhancing client empowerment and engagement, and the generalization of strategies. Family involvement was more prominently discussed by therapists in Taiwan than by those in the United States.
IMPLICATIONS FOR REHABILITATION
Strategy training differs from conventional rehabilitation in its emphasis on clients' life participation and empowerment, generalization of strategies, and enhancement of their engagement, confidence, and problem-solving skills.
Therapists may face challenges related to client buy-in and disengagement as well as difficulties in establishing a therapeutic rapport at the beginning of strategy training because clients have different expectations from those of conventional rehabilitation.
Cultural differences in norms and expectations and the clinical experiences of therapists may influence the delivery of strategy training to clients.
Family support may influence the success of strategy training.
Thoughtful conversations to reach a mutual understanding regarding the expectations of strategy training among clients, family, and rehabilitation practitioners are necessary prior to implementing strategy training.
We aim to build a system incorporating electroencephalography (EEG) and augmented reality (AR) that is capable of identifying the presence of visual spatial neglect (SN) and mapping the estimated ...neglected visual field. An EEG-based brain-computer interface (BCI) was used to identify those spatiospectral features that best detect participants with SN among stroke survivors using their EEG responses to ipsilesional and contralesional visual stimuli. Frontal-central delta and alpha, frontal-parietal theta, Fp1 beta, and left frontal gamma were found to be important features for neglect detection. Additionally, temporal analysis of the responses shows that the proposed model is accurate in detecting potentially neglected targets. These targets were predicted using common spatial patterns as the feature extraction algorithm and regularized discriminant analysis combined with kernel density estimation for classification. With our preliminary results, our system shows promise for reliably detecting the presence of SN and predicting visual target responses in stroke patients with SN.
Accelerating the rate of renewable energy deployment in Small Island Developing States is critical to reduce dependence on expensive fossil fuel imports and meet emissions reductions goals. Though ...many islands have now introduced policy measures to encourage RE development, the existing literature focuses on qualitative recommendations and has not sought to quantitatively evaluate and compare the impacts of policy interventions in the Caribbean. After compiling the first systematic database of RE policies implemented in 31 Caribbean islands from 2000 to 2018, we conduct an econometric analysis of the effectiveness of the following five policy interventions in promoting the deployment of RE: investment incentives, tax incentives, feed-in tariffs, net-metering and net-billing programs, and regulatory restructuring to allow market entry by independent power producers. Using a fixed effects model to control for unit heterogeneities between islands, we find evidence that net-metering/net-billing programs are strongly and positively correlated with increases in installed capacity of renewable energy - particularly solar PV. These findings suggest that the RE transition in the Caribbean can be advanced through policies targeting the adoption of small-scale, distributed photovoltaics.
•This is the first econometric study of renewable energy policy in Caribbean islands.•We provide a database of renewable energy policies in 31 islands from 2000 to 2018.•We use a fixed effects model to test five policy instruments on renewable capacity.•Net-metering programs are the most implemented policy instruments.•Net-metering programs and feed-in tariffs are strongly correlated with increases in RE.
To examine patterns of community participation, as well as the relationship among community participation outcomes and time since injury, impairments, environmental factors, and enfranchisement in ...adults with traumatic brain injury (TBI).
Cross-sectional study of a sample of 61 adults with TBI.
We administered the Participation Measure- 3 Domains 4 Dimensions to examine community participation in the three domains (productivity, community activities, and social participation) using four dimensions (diversity of activities, frequency, difficulty, and desire for change).
All dimensions of community participation seem to be impaired following TBI, as evidenced by scores in the lower half of the available range. Most impaired was social participation (frequency: M = 10.0, SD = 3.4, possible range 0-24; difficulty: M= 11.3, SD = 3.2, possible range 4-16). Correlational analyses revealed that depression (r = 0.51), environmental factors (r = 0.51), and enfranchisement (r = 0.42), seem to play an important role in community participation outcomes, and may be potential targets for intervention. Results did not vary based on time since injury.
Our results suggest that depression, environmental factors, and enfranchisement may be important considerations for future interventions aiming to promote management of identified barriers.
Little is known about the severity of participation restrictions among people living in the community with chronic stroke. Even less is known about the association between participation and health in ...this population.
To describe participation among people with chronic stroke and examine the association between participation and physical and mental health.
Secondary analysis of baseline data from an intervention study.
The parent multisite intervention study was conducted in the community, and assessments were administered in participants' homes.
Thirty-one community-dwelling adults with chronic stroke.
Participation was measured with the Activity Card Sort (percentage of prestroke activities retained) and the Enfranchisement Scale of the Community Participation Indicators. Health was measured with the PROMIS®-29 Physical Health and Mental Health subscales. We calculated descriptive statistics for participation measures and Spearman's ρ correlations between participation and health outcomes.
Participation scores were poor on all measures of participation. Most striking, 94.9% of participants retained less than 80% of their prestroke activities. All measures of participation were modestly correlated with physical health (ρ = .28-.46) and were moderately correlated with mental health (ρ = .42-.63).
Participation restrictions are prevalent among adults with chronic stroke, with potential implications for mental health. Stronger community-based rehabilitation and support services to enhance participation of this high-risk population are warranted. What This Article Adds: This report highlights the severity of participation restrictions among people with chronic stroke. Moreover, this report shows that people with stroke feel a lack of inclusion in the community and that participation is associated with mental and physical health.
To describe disparities in community participation during the COVID-19 pandemic among people with disabilities.PURPOSETo describe disparities in community participation during the COVID-19 pandemic ...among people with disabilities.Respondents to Phase 3.3 of the COVID Household Pulse Survey (US Census Bureau) were classified by disability status. Risk ratios and risk differences were computed to compare the risk of poor outcomes on economic participation, community service use, and community activities by disability status - both overall (compared to the nondisabled reference) and by race/ethnicity (each subgroup compared to the White nondisabled reference).METHODSRespondents to Phase 3.3 of the COVID Household Pulse Survey (US Census Bureau) were classified by disability status. Risk ratios and risk differences were computed to compare the risk of poor outcomes on economic participation, community service use, and community activities by disability status - both overall (compared to the nondisabled reference) and by race/ethnicity (each subgroup compared to the White nondisabled reference).At least one type of disability was reported by 59.6% of respondents. People with disabilities were more likely to report in-person medical appointments but were at greater risk of poor outcomes across all other outcomes risk ratio range = 1.01(1.01-1.02) to 1.91(1.80-2.01), risk difference range = 1.0(0.5-1.5) to 13.4(12.6-14.2). The disabled Black and disabled Hispanic/Latino groups experienced disproportionately high risk of poor outcomes across all indicators risk ratio range = 1.0 (1.0-1.1) to 6.1 (5.0-7.1), risk difference range = 3.2 (1.9-4.4) to 33.1 (30.1-35.4).RESULTSAt least one type of disability was reported by 59.6% of respondents. People with disabilities were more likely to report in-person medical appointments but were at greater risk of poor outcomes across all other outcomes risk ratio range = 1.01(1.01-1.02) to 1.91(1.80-2.01), risk difference range = 1.0(0.5-1.5) to 13.4(12.6-14.2). The disabled Black and disabled Hispanic/Latino groups experienced disproportionately high risk of poor outcomes across all indicators risk ratio range = 1.0 (1.0-1.1) to 6.1 (5.0-7.1), risk difference range = 3.2 (1.9-4.4) to 33.1 (30.1-35.4).The high number of people reporting disability, along with the notable disparities in community participation outcomes among those reporting disability, suggest the need for expanded rehabilitation services and community supports to enhance participation.CONCLUSIONSThe high number of people reporting disability, along with the notable disparities in community participation outcomes among those reporting disability, suggest the need for expanded rehabilitation services and community supports to enhance participation.
