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Quiñones-Uriostegui I, Alessi-Montero A, Bueyes-Roiz V, Nuñez-Carrera L, Moreno-Hernández A, Quinzaños-Fresnedo J, Rodríguez-Reyes G. Wheelchair users' satisfaction after provision using the WHO 8-step guidelines: A pilot study. J Spinal Cord Med 2024; 47:640-648. [PMID: 37036293 PMCID: PMC11378656 DOI: 10.1080/10790268.2023.2171627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Wheelchairs are vital for the successful rehabilitation and inclusion of people with mobility disabilities; 10% of the population with disabilities needs a wheelchair, but only 15% have access to an adequate one. Not user-configured wheelchairs may lead to postural deformities and pressure ulcers, thus negatively impact user satisfaction, wheelchair skills, and quality of life. OBJECTIVE To assess the impact of the 8-step "Guidelines on the provision of manual wheelchairs in less-resourced settings" from the World Health Organization (WHO) on user satisfaction, wheelchair skills, and quality of life of Mexican manual wheelchair users. METHODS 12 wheelchair users with spinal cord injury that received rehabilitation were recruited. Volunteers were provided a wheelchair and cushion following the WHO 8-step guidelines. Assessment of QUEST, WHOQOL-Bref, and WST-Q was performed at the beginning of the study and 12 months later. RESULTS Significant improvement was observed in terms of satisfaction (QUEST; P = 0.009) after receiving the wheelchair and the foam cushion (QUEST; P = 0.004). WHOQol-Bref did not denote significant differences. For the dimensions assessed by the WST-Q scores, a significant 10.9% improvement was observed in both, capacity (P = 0.022) and performance (P = 0.009). CONCLUSIONS The application of the WHO 8-step guidelines for wheelchair provision may contribute to increase user satisfaction regarding the wheelchair and cushion devices as well as the prescription process as determined by the QUEST. According to the WST-Q, functional capacity and mobility may also be improved by following the 8-step guidelines.
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Affiliation(s)
- Ivett Quiñones-Uriostegui
- Rehabilitation Engineering and Human Motion Analysis Laboratory, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Aldo Alessi-Montero
- Rehabilitation Engineering and Human Motion Analysis Laboratory, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Virginia Bueyes-Roiz
- Rehabilitation Engineering and Human Motion Analysis Laboratory, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Lidia Nuñez-Carrera
- Rehabilitation Engineering and Human Motion Analysis Laboratory, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Ana Moreno-Hernández
- Rehabilitation Engineering and Human Motion Analysis Laboratory, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Jimena Quinzaños-Fresnedo
- Neurologic Rehabilitation Division, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Gerardo Rodríguez-Reyes
- Orthotics and Prosthetics Laboratory, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Pituch E, Rushton PW, Culley K, Houde M, Lahoud A, Lettre J, Routhier F. Exploration of pediatric manual wheelchair confidence among children, parents, and occupational therapists: a qualitative study. Disabil Rehabil Assist Technol 2023; 18:1229-1236. [PMID: 34806519 DOI: 10.1080/17483107.2021.2001059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Manual wheelchair (MWC) confidence is a predictor of adult life-space mobility and social participation. To date, scientific literature specific to pediatric MWC confidence is scarce which prevents in-depth understanding. The objective of this study was to explore the perceptions of pediatric MWC users (PMWU), parents, and occupational therapists regarding pediatric MWC confidence. METHODS Five focus groups were conducted with PMWUs (n = 12) and occupational therapists (n = 9), and semi-structured interviews were conducted with parents of PMWUs (n = 2). Inductive thematic analysis was performed following verbatim transcription of audio recorded material. RESULTS Three overarching themes were identified across PMWUs, parents, and occupational therapists: (1) "MWC confidence is not a clinical priority" depicted the construct's varying level of clinical priority and perceived abstractness; (2) "MWC confidence is both a child and parent consideration" revealed nuances between the PMWU's MWC confidence and the parents' perception of the PMWU's MWC confidence; and (3) "Opportunities to develop MWC confidence are context-specific" contrasted afforded and unafforded opportunities to experience independent MWC mobility. CONCLUSIONS Pediatric MWC confidence is an important aspect of wheelchair use that is shaped by a multitude of factors in PMWU's lives. This new area of pediatric study provides support for the need to measure this important construct.IMPLICATIONS FOR REHABILITATIONThis study is the first to explore children's, parents', and occupational therapists' perceptions of pediatric MWC confidence.Pediatric MWC confidence impacts MWC use in a multifaceted fashion.Future studies should consider the development and validation of a self-report measure to assess pediatric MWC confidence.
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Affiliation(s)
- Evelina Pituch
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada
| | - Paula W Rushton
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre Hospitalier Universitaire Sainte-Justine Research Centre, Montréal, Canada
| | - Kim Culley
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre Hospitalier Universitaire Sainte-Justine Research Centre, Montréal, Canada
| | - Martine Houde
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre Hospitalier Universitaire Sainte-Justine Research Centre, Montréal, Canada
| | - Alexandra Lahoud
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre Hospitalier Universitaire Sainte-Justine Research Centre, Montréal, Canada
| | - Josiane Lettre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
- Department of Rehabilitation, Université Laval, Quebec City, Canada
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Rushton PW, Kawish-Arbelaez D, Levac-Marquis A, Fung K, Daoust G, Ishack M, Goldberg M, Pearlman J. French-Canadian translation, cultural adaptation, and preliminary evaluation of the wheelchair service provision - basic test validity among occupational therapy students. Disabil Rehabil Assist Technol 2023; 18:59-66. [PMID: 35867645 DOI: 10.1080/17483107.2022.2103188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The objectives were: (1) to translate and adapt the International Society of Wheelchair Professional (ISWP) basic Wheelchair Service Provision Test (bWSPT) into French-Canadian and (2) to conduct a preliminary evaluation of the French-Canadian version of the ISWP bWSPT internal consistency and relations with other variables among French-Canadian occupational therapy students. METHODS For Phase 1, based on the International Test Commission Guidelines for Translating and Adapting Tests, a forward translation and adaptation from English to French-Canadian was conducted by a translation team. For Phase 2, the validity evidence of the French-Canadian bWSPT was evaluated through internal consistency and comparison of bWSPT scores and final grades of a wheelchair-specific course with a sample of occupational therapy students (positive, moderate correlation hypothesized). Internal consistency was measured with Cronbach's α. The correlation was calculated using the Spearman's Rank Correlation Coefficient. RESULTS For phase 1, 61 of 167 items of the forward adaptation were revised and modified. All revisions were a consensus by the translation team. For phase 2, we found a Cronbach's α of 0.50 and a correlation of ⍴ = 0.27 (p = 0.43) between the bWSPT French-Canadian version and the wheelchair-specific course final grade. The low variability of the data may explain the lower-than-expected correlation. Other possible data-driven reasons have been explored using post-hoc analysis. CONCLUSION The ISWP bWSPT, French-Canadian version, is not internally consistent and demonstrates a non-statistically significant, positive, weak correlation with the final grade of a wheelchair service provision-specific course among a cohort of 35 occupational therapy students.IMPLICATIONS FOR REHABILITATIONThe lack of adequately educated wheelchair service providers is a contributing factor to inappropriate wheelchair provision worldwide.The ISWP Wheelchair Service Provision Basic Test (ISWP bWSPT) has been created to evaluate competency among wheelchair service providers and provides a standardized test recognized internationally.A French-Canadian version of the ISWP bWSPT allows competency testing of French-speaking wheelchair service providers across Canada.This study shows that the French-Canadian version of the test is not internally consistent and has a low correlation with a wheelchair provision-specific course among a cohort of 35 occupational therapy students at a French-Canadian university suggesting further refinement is required to improve its measurement properties in this population of test-takers.
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Affiliation(s)
- Paula W Rushton
- School of Rehabilitation, University of Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada
| | | | | | - Karen Fung
- School of Rehabilitation, University of Montréal, Montréal, Canada
| | - Geneviève Daoust
- School of Rehabilitation, University of Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada
| | | | - Mary Goldberg
- Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon Pearlman
- Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Ouellet B, Best KL, Wilson D, Miller WC. Exploring the Influence of a Community-Based Peer-Led Wheelchair Skills Training on Satisfaction with Participation in Children and Adolescents with Cerebral Palsy and Spina Bifida: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11908. [PMID: 36231211 PMCID: PMC9564843 DOI: 10.3390/ijerph191911908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Peer-led approaches improve satisfaction with participation, wheelchair skills and wheelchair use self-efficacy in adults, but the evidence is limited in children. This pilot study aimed to explore the influence of community-based, peer-led, group wheelchair training program (i.e., Seating To Go) on satisfaction with participation (primary outcome), wheelchair skills, and wheelchair use self-efficacy in children and adolescents with cerebral palsy and spina bifida. METHODS A single group pre-post design was used. Invitations were shared online and diffused by clinicians and advocacy and provider groups to recruit a convenience sample of eight pediatric wheelchair users. Participants completed the Seating To Go program in groups that were facilitated by adult wheelchair users. Satisfaction with participation (Wheelchair Outcome Measure-Young People), wheelchair skills (Wheelchair Skills Test), wheelchair use self-efficacy (Wheelchair Use Confidence Scale), and perceived wheelchair skills capacity (Wheelchair Skills Test Questionnaire; proxy rating: parents) were evaluated before and after the Seating To Go program. Descriptive statistics and nonparametric longitudinal data analysis were conducted to explore changes in all outcomes from baseline to post-intervention. RESULTS Pediatric wheelchair users (ranging in age from 5 to 15 years) and their parents reported statistically significant improvements in satisfaction with participation. The improvements in wheelchair skills and wheelchair confidence were also statistically significant, but not the parents' perception of their children's wheelchair skills. CONCLUSIONS A community-based peer-led approach to wheelchair skills training seems promising for improving wheelchair outcomes in pediatric wheelchair users. Further controlled studies with larger samples are warranted.
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Affiliation(s)
- Béatrice Ouellet
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et en Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M 2S8, Canada
| | - Krista L. Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et en Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M 2S8, Canada
| | - Deb Wilson
- Seating To Go—Geneva Healthcare, Hamilton 3204, New Zealand
| | - William C. Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- G.F. Strong Rehabilitation Centre—Rehabilitation Research Lab, Vancouver, BC V5Z 2G9, Canada
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Mortenson WB, Routhier F, Mahmood A, Prescott M, Labbé D, Martin Ginis KA, Miller WC. Predictors of Psychological Distress and Confidence Negotiating Physical and Social Environments Among Mobility Device Users. Am J Phys Med Rehabil 2022; 101:324-330. [PMID: 34050064 DOI: 10.1097/phm.0000000000001816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments. DESIGN Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale, and self-reported functional independence scale. PARTICIPANTS The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 yrs, 53% were female, and 52% lived alone and were functionally independent with the use of assistive technology. RESULTS We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments. CONCLUSIONS Age is associated with psychosocial outcomes for assistive device users, and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.
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Affiliation(s)
- W Ben Mortenson
- From the Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (WBM, MP, DL, WCM); International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada (WBM); Rehabilitation Research Program, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada (WBM, MP, DL, WCM); Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Québec, Canada (FR); Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Québec, Canada (FR); Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (AM); Disability and Human Development Department, University of Illinois at Chicago, Chicago, Illinois (DL); Reichwald Family UBC Southern Medical Program Chair in Preventive Medicine, Vancouver, British Columbia, Canada (KAM); and Department of Medicine, Faculty of Medicine, School of Health and Exercise Sciences, Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada (KAM)
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Mortenson WB, Battalova A, Hurd L, Hobson S, Emery R, Kirby RL. Correlates of self-reported Wheelchair Skills Test Questionnaire scores of new users of mobility scooters: a cross-sectional study. Disabil Rehabil Assist Technol 2021:1-8. [PMID: 33503387 DOI: 10.1080/17483107.2021.1874065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe the subjective reported scooter-skill scores of new mobility scooter users and to identify significant correlations with other characteristics and measures. MATERIALS AND METHODS This was a single-centre study using a cross-sectional design. Participants (N = 22) completed the Wheelchair Skills Test-Questionnaire (WST-Q) Version 4.3 for scooter users. It measures the users' perceived capacity (what the user can do), performance (what the user actually does), and confidence (or self-efficacy). Their scooter skills were also rated objectively with the Wheelchair Skills Test (WST). They completed standardised measures of cognition, hearing, vision, life space mobility, visual attention and task switching, and confidence negotiating the social environment using their scooters. RESULTS Mean total WST-Q capacity scores were 83% and performance scores were 25%. WST-Q capacity scores had significant positive correlations with WST-Q performance (r = 0.321) and confidence scores (r = 0.787), WST capacity scores (r = 0.488), and confidence negotiating the social environment (WheelCon) (r = 0.463). WST-Q capacity scores were significantly negatively correlated with Trail Making B scores (r = -0.591) and age (r = -0.531). CONCLUSIONS The correlations between WST-Q scores and other variables are similar to those found in other studies among users of scooters and other mobility devices. The gap between capacity and performance scores highlights the needs for additional skills training in this population of novice scooter users.IMPLICATIONS FOR REHABILITATIONIn implementing scooter training for new scooter users, attention should be paid to building community-based skills for navigating both the physical and the social environment.Scooter users' age and their driving capabilities need to be taken into account when developing and delivering the training.
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Affiliation(s)
- W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Alfiya Battalova
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Laura Hurd
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Sandra Hobson
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Richelle Emery
- Vancouver Coastal Health - Community Care, Vancouver, Canada
| | - R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Canada
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Bourassa J, Best KL, Gagnon C, Hébert LJ, Brais B, Routhier F. Measurement properties of wheelchair use assessment tools in adults with autosomal recessive spastic ataxia of Charlevoix-Saguenay. Disabil Rehabil Assist Technol 2020; 17:907-915. [DOI: 10.1080/17483107.2020.1821104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julie Bourassa
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Krista L. Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
- Interdisciplinary Research Group on Neuromuscular Disorders, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada
| | - Luc J. Hébert
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
- Department of Radiology-Nuclear Medicine, Université Laval, Quebec City, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
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Sakakibara BM, Miller WC, Rushton PW, Polgar JM. Rasch Analyses of the Wheelchair Use Confidence Scale for Power Wheelchair Users. Arch Phys Med Rehabil 2017; 99:17-25. [PMID: 28964794 DOI: 10.1016/j.apmr.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the dimensionality of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P), to identify items that do not fit the Rasch rating scale model as well as redundant items for elimination, and to determine the SEMs and reliability estimates for the entire range of measurements. DESIGN Secondary analysis of cross-sectional data. SETTING Community. PARTICIPANTS Volunteer participants (N=189) using wheelchairs (mean age of the sample, 56.7±13.0y; mean years of wheelchair use experience, 20.4±16.4). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES 59-Item WheelCon-P. RESULTS Principal component analyses confirmed the presence of 2 self-efficacy dimensions: mobility and social situation. Eleven mobility items and 5 social situation items fit the Rasch rating scale model. Three items misfit the model using all 16 items (ie, WheelCon-P short form). In each of the mobility, social situation, and WheelCon-P short form range of measurements, the 2 lowest and 2 highest measures had internal consistency reliability estimates below .70; all other measures had reliability estimates above .70. CONCLUSIONS The WheelCon-P is composed of 2 self-efficacy dimensions related to mobility and social situations. The scores from the WheelCon-P short form and the 11-item mobility and 5-item social situation dimensions using a 0 to 10 response scale have good reliability.
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Affiliation(s)
- Brodie M Sakakibara
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - William C Miller
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Department of Occupational Therapy and Occupational Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paula W Rushton
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Marie Enfant Rehabilitation Center, CHU Sainte-Justine, Montreal, Quebec, Canada.
| | - Jan Miller Polgar
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
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