The majority of people with severe traumatic brain injury (TBI) experience long-term disability and are unable to return to their usual activities. Services that offer community social and leisure participation programs are likely to reduce the social burden associated with severe TBI. The aim of this study was to gain an understanding of the personal effects of becoming engaged in community leisure activities. It was hypothesised that adults with severe TBI who participated regularly in leisure activities over a 6-month period would show measurable positive change in the domains of community integration, social support, mental health and quality of life (QOL). Participants numbered 25 adults (mean age 36.95 years) who had been referred to community leisure programs participated in the study. All participants had sustained severe injuries (post-traumatic amnesia > 1 month). A repeated measures design over 6 months was used. Assessment involved a semistructured interview, global subjective QOL rating and administration of standardised measures: SF-12v2, Neurobehavioral Functioning Inventory, Instrumental-Expressive Social Support-Scale, and Community Integration Questionnaire. Adults who participated regularly over 6 months reported positive and statistically significant changes in social integration and mental health. These findings support the use of assisted community participation programs for adults with severe TBI.

International trends towards people-centred, integrative care and support require any measurement of functioning and disability to meet multiple aims. The information requirements of two major Australian programs for disability and rehabilitation are outlined, and the findings of two searches for suitable measures of functioning and disability are analysed. Over 30 current measures of functioning were evaluated in each search. Neither search found a generic measure of functioning suitable for these multibillion dollar programs, relevant to a wide range of people with a variety of health conditions and functioning experiences, and capable of indicating support needs, associated costs, progress and outcomes. This unsuccessful outcome has implications internationally for policy-relevant information for disability, rehabilitation and related programs. The paper outlines the features of an Integrative Measure of Functioning (IMF) based on the concepts of functioning and environmental factors in the International Classification of Functioning, Disability and Health (ICF). An IMF would be applicable across a variety of health conditions, settings and purposes, ranging from individual assessment to public health. An IMF could deliver person-centred, policy-relevant information for a range of programs, promoting harmonised language and measurement and supporting international trends in human services and public health.

The MMDT, which aims to measure manual speed and manual skill, was tested on 15 subjects with normal function and 10 subjects known to have disabilities affecting the hands. The scores obtained were compared with results from two other commonly used hand function tests (Purdue Peg Board and Minnesota Rate of Manipulation Test). Subtests of all three tests were appropriately matched so that comparisons were meaningful. The scores from 11 subtests were related to normative data and a percentile score was established. The data were statistically analysed using Pearson correlation coefficients to examine the relationship between performance on the M M D T and the comparison tests. The scores of subjects with normal hand function and subjects with known impairment of hand function were compared on all variables. Construct validity was assessed by using the t-test to determine whether the M M D T discriminates between the two groups. To ascertain test reliability, test-retest scores of the M M D T manual speed and manual skill tests were compared. The findings suggest that the M M D T is a reliable but not a valid test instrument and is of questionable value in predicting hand function performance, particularly in relation to manual skill. K E Y W 0 R D S hand assessment, hand function, manual dexterity, test instrument.

Social insurance schemes in Australasia have a long‐standing involvement in leading systemic change as well as funding services for eligible scheme participants. Establishing a long‐term disability care and support scheme for Australia provides opportunities to remove barriers to community access and improve the employment participation of all Australians with a disability, and to increase the use of evidence in policy development and in the delivery of disability supports. Using the examples of successful models in Australia and New Zealand, the authors will propose a model for the development and management of a long‐term disability care and support scheme that enables sector reform in employment participation, barriers to access and participation in all aspects of community life, and funding of disability research to benefit all Australians with a disability.