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Sample records for multiple disabilities improve

  1. Impact of natalizumab on ambulatory improvement in secondary progressive and disabled relapsing-remitting multiple sclerosis.

    Diego Cadavid

    Full Text Available There is an unmet need for disease-modifying therapies to improve ambulatory function in disabled subjects with multiple sclerosis.Assess the effects of natalizumab on ambulatory function in disabled subjects with relapsing-remitting multiple sclerosis (RRMS or secondary progressive multiple sclerosis (SPMS.We retrospectively reviewed ambulatory function as measured by timed 25-foot walk (T25FW in clinical trial subjects with an Expanded Disability Status Scale score ≥3.5, including RRMS subjects from the phase 3 AFFIRM and SENTINEL trials, relapsing SPMS subjects from the phase 2 MS231 study, and nonrelapsing SPMS subjects from the phase 1b DELIVER study. For comparison, SPMS subjects from the intramuscular interferon beta-1a (IM IFNβ-1a IMPACT study were also analyzed. Improvement in ambulation was measured using T25FW responder status; response was defined as faster walking times over shorter (6-9-month or longer (24-30-month treatment periods relative to subjects' best predose walking times.There were two to four times more T25FW responders among disabled MS subjects in the natalizumab arms than in the placebo or IM IFNβ-1a arms. Responders walked 25 feet an average of 24%-45% faster than nonresponders.Natalizumab improves ambulatory function in disabled RRMS subjects and may have efficacy in disabled SPMS subjects. Confirmation of the latter finding in a prospective SPMS study is warranted.

  2. Assisting People with Multiple Disabilities by Improving Their Computer Pointing Efficiency with an Automatic Target Acquisition Program

    Shih, Ching-Hsiang; Shih, Ching-Tien; Peng, Chin-Ling

    2011-01-01

    This study evaluated whether two people with multiple disabilities would be able to improve their pointing performance through an Automatic Target Acquisition Program (ATAP) and a newly developed mouse driver (i.e. a new mouse driver replaces standard mouse driver, and is able to monitor mouse movement and intercept click action). Initially, both…

  3. Disabilities - Multiple Languages

    ... page, please enable JavaScript. Arabic (العربية) Chinese, Traditional (Cantonese ... Iraqi Health Outreach Project: Social Security Disability (SSD) and Supplemental Security Income (SSI) ...

  4. A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort.

    Kalron, Alon; Nitzani, Dalia; Magalashvili, David; Dolev, Mark; Menascu, Shay; Stern, Yael; Rosenblum, Uri; Pasitselsky, Diana; Frid, Lior; Zeilig, Gabi; Barmatz, Caroline; Givon, Uri; Achiron, Anat

    2015-03-04

    People with multiple sclerosis (PwMS) endure walking limitations. To address this restriction, various physical rehabilitation programs have been implemented with no consensus regarding their efficacy. Our objective was to report on the efficacy of an integrated tailored physical rehabilitation program on walking in people with multiple sclerosis categorized according to their level of neurological disability. Retrospective data were examined and analyzed. Specifically, data obtained from all patients who participated in the Multiple Sclerosis Center's 3 week rehabilitation program were extracted for in depth exploration. The personalized rehabilitation program included three major components modified according to the patient's specific impairments and functional needs: (a) goal directed physical therapy (b) moderately intense aerobic exercise training on a bicycle ergometer and (c) aquatic therapy chiefly oriented to body structures appropriate to movement. Gait outcome measurements included the 10 meter, 20 meter, Timed up and go and 2 minute walking tests measured pre and post the rehabilitation program. Three hundred and twelve people with relapsing-remitting multiple sclerosis were included in the final analysis. Patients were categorized into mild (n = 87), moderate (n = 104) and severely (n = 121) disabled groups. All clinical walking outcome measurements demonstrated statistically significant improvements, however, only an increase in the 2 minute walking test was above the minimal clinical difference value. The moderate and severe groups considerably improved compared to the mild gait disability group. Mean change scores (%) of the pre-post intervention period of the 2 minute walking test were 19.0 (S.E. = 3.4) in the moderate group, 16.2 (S.E. = 5.4) in the severe group and 10.9 (S.E. = 2.3) in the mild gait disability group. We presented comprehensive evidence verifying the effects of an intense goal-directed physical

  5. Proximal processes of children with profound multiple disabilities

    Wilder, Jenny

    2008-01-01

    In this thesis four empirical studies dealt with children with profound multiple disabilities and their parents with regard to: (a) how parents perceived interaction with their children (b) how observed child/parent interaction was linked to behavior style of the children as perceived by the parents (c) how parents of children with profound multiple disabilities perceived child/parent interaction and behavior style of their children in comparison to parents to children without disabilities ma...

  6. The Medicaid Medically Improved Group, Losing Disability...

    U.S. Department of Health & Human Services — According to findings reported in, The Medicaid Medically Improved Group, Losing Disability Status and Growing Earnings, published in Volume 4, Issue 1 of the...

  7. Multiple Disabilities and Visual Impairment: An Action Research Project

    Argyropoulos, Vassilios; Thymakis, Paraskevas

    2014-01-01

    Children with visual and motor disabilities constitute a distinct group with a unique set of educational needs. Such children are often grouped with the broader population of children with multiple disabilities and visual impairments (that is, those who are blind or have low vision) (Erin, 2000; McLinden, 1997). The chief characteristic of…

  8. Assessing choice making among children with multiple disabilities.

    Sigafoos, J; Dempsey, R

    1992-01-01

    Some learners with multiple disabilities display idiosyncratic gestures that are interpreted as a means of making choices. In the present study, we assessed the validity of idiosyncratic choice-making behaviors of 3 children with multiple disabilities. Opportunities for each child to choose between food and drink were provided under two conditions. In one condition, the children were given the food or drink item corresponding to their prior choice. In the other condition, the teacher delivere...

  9. Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis.

    Giannini, Margaret J; Bergmark, Brian; Kreshover, Samantha; Elias, Eileen; Plummer, Caitlin; O'Keefe, Eileen

    2010-04-01

    Disability is not a category of disease but rather relates to the physical, sensory, cognitive, and/or mental disorders that substantially limit one or more major life activities. These functional limitations have been found to be predictive of suicide, with psychiatric comorbidities increasing the risk for suicide. Enormous gaps exist in the understanding of the relationship between disability and suicide. We reviewed the current literature addressing the prevalence of and risk factors for suicide among persons with three major disabling conditions and identify priorities for future research. We performed a literature review investigating the relationship between three major disabilities (intellectual disability, spinal cord injury, multiple sclerosis) and suicide. To ensure thorough evaluation of the available literature, we searched PubMed, the Cochrane Library, and Google Scholar with terms including "suicide," "disability," "intellectual disability," "spinal cord injury," "multiple sclerosis," and permutations thereof. By this method we evaluated 110 articles and included 21 in the review. Suicide rates are significantly higher among persons with multiple sclerosis and spinal cord injury than in the general population. A more nuanced picture of suicide rates and risk factors exists for the intellectual disability population, in which it appears that rates of suicide risk factors are higher than among the general population while suicide rates may be lower. The highest rates of suicide are reported among study populations of persons with multiple sclerosis, followed by persons with spinal cord injury, and then individuals with intellectual disability. Suicide among persons with disabilities is a complex and pressing public health concern. Urgent research priorities include (1) valid estimates of suicide rates among persons with disabilities by age cohort; (2) assessment of the predictive importance of suicide risk factors; and (3) determination of best

  10. Teaching Individuals with Profound Multiple Disabilities to Access Preferred Stimuli with Multiple Microswitches

    Tam, Gee May; Phillips, Katrina J.; Mudford, Oliver C.

    2011-01-01

    We replicated and extended previous research on microswitch facilitated choice making by individuals with profound multiple disabilities. Following an assessment of stimulus preferences, we taught 6 adults with profound multiple disabilities to emit 2 different responses to activate highly preferred stimuli. All participants learnt to activate…

  11. Disability impact and coping in mothers of children with intellectual disabilities and multiple disabilities.

    Kishore, M Thomas

    2011-12-01

    Understanding the disability impact on parenting and caregiving is important for intervention. The present study was designed to understand the differences in perceived disability impact and related coping in mothers having children with intellectual disabilities alone compared to those having children with intellectual disabilities and additional disabilities. Accordingly, 30 mothers of children with intellectual disabilities and 30 mothers of children with intellectual and additional disabilities were assessed for disability impact and coping. Group differences for disability impact were present in specific domains but not overall. Despite variations in coping pattern, both positive and negative coping strategies were observed in both groups. The results may imply that the impact of intellectual disability is so pervasive that except in certain domains mothers may not perceive the further impact of additional disabilities. Positive coping does not rule out negative coping strategies. These findings have specific relevance to service delivery in a cultural context.

  12. Disability and Fatigue Can Be Objectively Measured in Multiple Sclerosis.

    Caterina Motta

    Full Text Available The available clinical outcome measures of disability in multiple sclerosis are not adequately responsive or sensitive.To investigate the feasibility of inertial sensor-based gait analysis in multiple sclerosis.A cross-sectional study of 80 multiple sclerosis patients and 50 healthy controls was performed. Lower-limb kinematics was evaluated by using a commercially available magnetic inertial measurement unit system. Mean and standard deviation of range of motion (mROM, sROM for each joint of lower limbs were calculated in one minute walking test. A motor performance index (E defined as the sum of sROMs was proposed.We established two novel observer-independent measures of disability. Hip mROM was extremely sensitive in measuring lower limb motor impairment, being correlated with muscle strength and also altered in patients without clinically detectable disability. On the other hand, E index discriminated patients according to disability, being altered only in patients with moderate and severe disability, regardless of walking speed. It was strongly correlated with fatigue and patient-perceived health status.Inertial sensor-based gait analysis is feasible and can detect clinical and subclinical disability in multiple sclerosis.

  13. Disability outcome measures in multiple sclerosis clinical trials

    Cohen, Jeffrey A; Reingold, Stephen C; Polman, Chris H

    2012-01-01

    Many of the available disability outcome measures used in clinical trials of multiple sclerosis are insensitive to change over time, inadequately validated, or insensitive to patient-perceived health status or quality of life. Increasing focus on therapies that slow or reverse disability...... recommend practical refinements. Conversely, although substantial data support the multiple sclerosis functional composite as an alternative measure, changes to its component tests and scoring method are needed. Novel approaches, including the use of composite endpoints, patient-reported outcomes...... progression makes it essential to refine existing measures or to develop new tools. Major changes to the expanded disability status scale should be avoided to prevent the loss of acceptance by regulators as a measure for primary outcomes in trials that provide substantial evidence of effectiveness. Rather, we...

  14. Plasma lipid peroxidation and progression of disability in multiple sclerosis

    Koch, M.; Mostert, J.; Arutjunyan, A. V.; Stepanov, M.; Teelken, A.; Heersema, D.; De Keyser, J.

    Oxidative stress has been implicated in the pathophysiology of multiple sclerosis (MS), but its relation to disease progression is uncertain. To evaluate the relationship of plasma lipid peroxidation with progression of disability in MS, we measured blood plasma fluorescent lipid peroxidation

  15. Effects of Mindfulness-Based Intervention to Improve Task Performance for Children with Intellectual Disabilities

    Kim, Jeongil; Kwon, Miyoung

    2018-01-01

    Background: Task performance is a critical factor for learning in individuals with intellectual disabilities. This study aimed to examine mindfulness-based intervention (MBI) to improve task performance for children with intellectual disability (ID). Methods: Three elementary school children with ID participated in the study. A multiple baseline…

  16. Multimodal exercise training in multiple sclerosis: A randomized controlled trial in persons with substantial mobility disability.

    Sandroff, Brian M; Bollaert, Rachel E; Pilutti, Lara A; Peterson, Melissa L; Baynard, Tracy; Fernhall, Bo; McAuley, Edward; Motl, Robert W

    2017-10-01

    Mobility disability is a common, debilitating feature of multiple sclerosis (MS). Exercise training has been identified as an approach to improve MS-related mobility disability. However, exercise randomized controlled trials (RCTs) on mobility in MS have generally not selectively targeted those with the onset of irreversible mobility disability. The current multi-site RCT compared the efficacy of 6-months of supervised, multimodal exercise training with an active control condition for improving mobility, gait, physical fitness, and cognitive outcomes in persons with substantial MS-related mobility disability. 83 participants with substantial MS-related mobility disability underwent initial mobility, gait, fitness, and cognitive processing speed assessments and were randomly assigned to 6-months of supervised multimodal (progressive aerobic, resistance, and balance) exercise training (intervention condition) or stretching-and-toning activities (control condition). Participants completed the same outcome assessments halfway through and immediately following the 6-month study period. There were statistically significant improvements in six-minute walk performance (F(2158)=3.12, p=0.05, η p 2 =0.04), peak power output (F(2150)=8.16, pmobility disability. This is critical for informing the development of multi-site exercise rehabilitation programs in larger samples of persons with MS-related mobility disability. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Disability, depression and suicide ideation in people with multiple sclerosis.

    Lewis, V M; Williams, K; KoKo, C; Woolmore, J; Jones, C; Powell, T

    2017-01-15

    Depressive symptoms occur frequently in people with Multiple Sclerosis (MS) and rates of suicide ideation are higher than the general population. There is evidence for a direct association between disability and depression, disability and suicide ideation, and depression and suicide ideation in MS. However, the relationship between all three, i.e. the mediating role of depression between disability and suicidal ideation, has not been investigated. Exploring this relationship could highlight risk factors, alerting clinicians to the need for timely intervention. Seventy five people with progressive MS attending two out-patient clinics took part in this cross-sectional study. Participants completed the Beck Suicide Scale, Beck Depression Inventory, Multiple Sclerosis Impact Scale and Guy's Neurological Disability Scale. Depressive symptoms mediated the relationship between perceived and actual disability and suicide ideation. Different types of disability were associated with suicidality, including: 'tremors' and 'taking longer to do things'. A small sub-group of participants were identified who reported suicide ideation in the presence of only mild levels of depression. There may be a sample bias in this study as all participants were attending out-patient clinics and receiving support which may not be available to everyone with MS. It is important for clinicians to screen regularly for both depression and suicide ideation, to be alert to specific types of disability for which a higher level of suicide ideation might be present and to consider the possibility of suicidal thoughts being present in people who show minimal or no depressive symptoms. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Staffs' documentation of participation for adults with profound intellectual disability or profound intellectual and multiple disabilities.

    Talman, Lena; Gustafsson, Christine; Stier, Jonas; Wilder, Jenny

    2017-06-21

    This study investigated what areas of International Classification of Functioning, Disability and Health were documented in implementation plans for adults with profound intellectual disability or profound intellectual and multiple disabilities with focus on participation. A document analysis of 17 implementation plans was performed and International Classification of Functioning, Disability and Health was used as an analytic tool. One hundred and sixty-three different codes were identified, especially in the components Activities and participation and Environmental factors. Participation was most frequently coded in the chapters Community, social and civic life and Self-care. Overall, the results showed that focus in the implementation plans concerned Self-care and Community, social and civic life. The other life areas in Activities and participation were seldom, or not at all, documented. A deeper focus on participation in the implementation plans and all life areas in the component Activities and participation is needed. It is important that the documentation clearly shows what the adult wants, wishes, and likes in everyday life. It is also important to ensure that the job description for staff contains both life areas and individual preferences so that staff have the possibility to work to fulfill social and individual participation for the target group. Implications for rehabilitation There is a need for functioning working models to increase participation significantly for adults with profound intellectual disability or profound intellectual and multiple disabilities. For these adults, participation is achieved through the assistance of others and support and services carried out must be documented in an implementation plan. The International Classification of Functioning, Disability and Health can be used to support staff and ensure that information about the most important factors in an individual's functioning in their environment is not omitted in

  19. Physical inactivity, neurological disability, and cardiorespiratory fitness in multiple sclerosis.

    Motl, R W; Goldman, M

    2011-02-01

    We examined the associations among physical activity, neurological disability, and cardiorespiratory fitness in two studies of individuals with multiple sclerosis (MS). Study 1 included 25 women with relapsing-remitting MS (RRMS) who undertook an incremental exercise test for measuring peak oxygen (VO₂(peak) ) consumption, wore an accelerometer during a 7-day period, and completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ). Study 2 was a follow-up of Study 1 and included 24 women with RRMS who completed the self-reported Expanded Disability Status Scale (EDSS), undertook an incremental exercise test, wore an accelerometer during a 7-day period, and completed the GLTEQ. Study 1 indicated that VO₂(peak) was significantly correlated with accelerometer counts (pr = 0.69) and GLTEQ scores (pr = 0.63) even after controlling for age and MS duration. Study 2 indicated that VO₂(peak) was significantly correlated with accelerometer counts (pr = 0.50), GLTEQ scores (pr = 0.59), and EDSS scores (pr = -0.43) even after controlling for age and MS duration; there was a moderate partial correlation between accelerometer counts and EDSS scores (pr = -0.43). Multiple linear regression analysis indicated that both accelerometer counts (β = 0.32) and EDSS scores (β = -0.40) had statistically significant associations with VO₂(peak). The findings indicate that physical inactivity and neurological disability might represent independent risk factors for reduced levels of cardiorespiratory fitness in this population. © 2010 John Wiley & Sons A/S.

  20. Multiple Sclerosis Impact Profile (MSIP). An ICF-based outcome measure for Disability and Disability Perception in MS. A manual.

    Wynia, K.; Middel, B.; Reijneveld, S.A.

    2009-01-01

    The aim of this manual is to support working with the Multiple Sclerosis Impact Profile (MSIP), a self-report measure for people with Multiple Sclerosis (MS) to assess disability and disability perception in research and clinical practice. On individual level the MSIP reflects a persons disease

  1. Improving access to screening for people with learning disabilities.

    Marriott, Anna; Turner, Sue; Giraud-Saunders, Alison

    2014-11-04

    People with learning disabilities have poorer health than their non-disabled peers, and are less likely to access screening services than the general population. The National Development Team for Inclusion and the Norah Fry Research Centre developed a toolkit and guidance to improve uptake of five national (English) screening programmes (one of which is delivered through local programmes), based on work to improve access by people with learning disabilities in the south west peninsula of the UK. This article describes the findings in relation to the five English screening programmes and suggests ways to improve uptake of cancer screening by people with learning disabilities.

  2. Multiple intelligences and underachievement: lessons from individuals with learning disabilities.

    Hearne, D; Stone, S

    1995-01-01

    The field of learning disabilities, like education in the main, is undergoing calls for reform and restructuring, an upheaval brought on in great part by the forces of opposing paradigms--reductionism and constructivism. In reexamining our past, we must begin to address the failures of traditional deficit models and their abysmally low "cure" rate. Several new theories have arisen that challenge traditional practices in both general and special education classrooms. Particularly influential has been the work of Howard Gardner, whose theory of multiple intelligences calls for a restructuring of our schools to accommodate modes of learning and inquiry with something other than deficit approaches. At least some current research in the field of learning disabilities has begun to focus on creativity and nontraditional strengths and talents that have not been well understood or highly valued by the schools. In this article, we briefly summarize the findings in our search for the talents of students labeled learning disabled, evidence of their abilities, implications of these for the schools, and a beginning set of practical recommendations.

  3. Brain atrophy at onset and physical disability in multiple sclerosis

    Juan Ignacio Rojas

    2012-10-01

    Full Text Available The aim of this study was to investigate if brain atrophy in multiple sclerosis (MS patients during the disease onset predicts long term disability. METHODS: MS patients with follow-up time of at least 7 years from disease onset and with baseline and second magnetic resonance 12 months later were included to measure brain atrophy. Expanded Disability Status Scale (EDSS was categorized in three groups, EDSS=0, EDSS=1 and 2.5 and EDSS>2.5, and used as disability measure. RESULTS: Twenty-six patients were included. Mean atrophy during the first year in patients that reached an EDSS≥3 was -0.76±0.45 %, in patients with an EDSS between 1 and 2.5 was -0.59±0.56, while in patients with an EDSS of 0 it was -0.38±0.42 (p=0.003. DISCUSSION: Brain atrophy rates during the first year of disease were predictive of disease progression in our population.

  4. Motor network efficiency and disability in multiple sclerosis

    Yaldizli, Özgür; Sethi, Varun; Muhlert, Nils; Liu, Zheng; Samson, Rebecca S.; Altmann, Daniel R.; Ron, Maria A.; Wheeler-Kingshott, Claudia A.M.; Miller, David H.; Chard, Declan T.

    2015-01-01

    Objective: To develop a composite MRI-based measure of motor network integrity, and determine if it explains disability better than conventional MRI measures in patients with multiple sclerosis (MS). Methods: Tract density imaging and constrained spherical deconvolution tractography were used to identify motor network connections in 22 controls. Fractional anisotropy (FA), magnetization transfer ratio (MTR), and normalized volume were computed in each tract in 71 people with relapse onset MS. Principal component analysis was used to distill the FA, MTR, and tract volume data into a single metric for each tract, which in turn was used to compute a composite measure of motor network efficiency (composite NE) using graph theory. Associations were investigated between the Expanded Disability Status Scale (EDSS) and the following MRI measures: composite motor NE, NE calculated using FA alone, FA averaged in the combined motor network tracts, brain T2 lesion volume, brain parenchymal fraction, normal-appearing white matter MTR, and cervical cord cross-sectional area. Results: In univariable analysis, composite motor NE explained 58% of the variation in EDSS in the whole MS group, more than twice that of the other MRI measures investigated. In a multivariable regression model, only composite NE and disease duration were independently associated with EDSS. Conclusions: A composite MRI measure of motor NE was able to predict disability substantially better than conventional non-network-based MRI measures. PMID:26320199

  5. Improving care for people with learning disabilities.

    Turner, Sue

    2014-11-25

    People with learning disabilities have poorer health than the general population and experience health inequalities - partly as a result of problems with accessing health services. Health services have a duty to address health inequalities, by making reasonable adjustments to their services so they are more accessible to people with learning disabilities, but this does not always happen. Failure to make reasonable adjustments can have significant adverse effects for people with learning disabilities and their families. Nurses are well placed to implement reasonable adjustments, many of which are simple to do and can save lives.

  6. Slow walking model for children with multiple disabilities via an application of humanoid robot

    Wang, ZeFeng; Peyrodie, Laurent; Cao, Hua; Agnani, Olivier; Watelain, Eric; Wang, HaoPing

    2016-02-01

    Walk training research with children having multiple disabilities is presented. Orthosis aid in walking for children with multiple disabilities such as Cerebral Palsy continues to be a clinical and technological challenge. In order to reduce pain and improve treatment strategies, an intermediate structure - humanoid robot NAO - is proposed as an assay platform to study walking training models, to be transferred to future special exoskeletons for children. A suitable and stable walking model is proposed for walk training. It would be simulated and tested on NAO. This comparative study of zero moment point (ZMP) supports polygons and energy consumption validates the model as more stable than the conventional NAO. Accordingly direction variation of the center of mass and the slopes of linear regression knee/ankle angles, the Slow Walk model faithfully emulates the gait pattern of children.

  7. Consensus and new improvements of disability glare

    Yu-Wei Zheng

    2014-12-01

    Full Text Available Patients with early cataract may have normal visual acuity(VAbut complain that they have problems in driving at night, like seeing things through a veil. This phenomenon is defined as disability glare which maybe caused by growing stray light. Patients with intraocular lens following cataract surgery may complain about glare, halos and shadows in visual field, which are also resulted from dysphotopia. Disability glare is the VA loss due to disturbing luminance in visual field. In other words, it's the retinal contrast sensitivity reduction because of the straylight. This article contains the consensus and new progress of disability glare. It provides solutions according to its effect factors and offers clues for further study.

  8. Measuring happiness in individuals with profound multiple disabilities.

    Darling, Joseph A; Circo, Deborah K

    2015-12-01

    This quantitative study assessed whether presentation of preferred items and activities during multiple periods of the day (and over multiple days) increased indices of happiness (over time/sustained) in individuals with PMD. A multiple baseline design across participants was utilized to measure changes in indices of happiness of the participants. Participants were recruited from an adult day activity program specializing in providing assistance to individuals with disabilities. For Mary, baseline indices of happiness were 26.67% of intervals, increasing 6.76% during intervention to 33.43%. For Caleb, baseline indices of happiness were 20.84% of intervals, increasing 6.34% during intervention to 27.18%. For Mark, baseline indices of happiness were 40.00% of intervals, increasing 12.75% during intervention to 52.75%. Overall interobserver agreement was 82.8%, with interobserver agreement observations occurring during 63.04% of the observations. The results of the investigation demonstrated that presenting preferred items and activities increased the indices of happiness compared to baseline rates of indices of happiness. Results may have been more robust if the participants were assessed for overall responsiveness patterns prior to the initiation of measurement of indices of happiness. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Improving library services to people with disabilities

    Deines-Jones, Courtney

    2007-01-01

    The book takes account of the key fact that to maximize their potential, people must have lifelong access to the information and services offered through books and libraries. Whether to address concerns of an ageing population or to enable all citizens to contribute fully through meaningful education and work opportunities, more emphasis is being given to promoting library services to people who have disabilities. This book is a compendium of articles focused on serving adults with disabilities in an international setting. From this book, librarians, policy makers and constituents will underst

  10. Two Women with Multiple Disabilities Communicate with Distant Partners via a Special Text Messaging System

    Lancioni, Giulio E.; O'Reilly, Mark F.; Singh, Nirbhay N.; Sigafoos, Jeff; Green, Vanessa A.; Oliva, Doretta; Alberti, Gloria; Carrella, Luigina

    2013-01-01

    This study extended the research on a special text messaging system, which allows persons with multiple disabilities to (a) write and send messages to distant partners and (b) have messages from those partners read out to them. The study involved two women with multiple disabilities (including blindness or minimal residual vision). The system…

  11. Engaging Preschool Children with Severe and Multiple Disabilities Using Books and iPad Apps

    Kemp, Coral; Stephenson, Jennifer; Cooper, Megan; Hodge, Kerry

    2016-01-01

    A single subject multiple treatment design was used to compare the engagement of 3 preschool children with severe and multiple disabilities, using 2 different stimuli: picture books and iPad apps matched for theme and content. Two of the 3 children had diagnoses of autism spectrum disorder in addition to their other disabilities. Sessions for each…

  12. Informal care giving to more disabled people with multiple sclerosis.

    Buchanan, Robert J; Radin, Dagmar; Chakravorty, Bonnie J; Tyry, Tuula

    2009-01-01

    About 30% of the people with multiple sclerosis (MS) require some form of home care assistance and 80% of that assistance is provided by informal or unpaid care givers. This study focusses on the care givers for 530 more disabled people with MS, with the objective of learning more about informal care giving to people with greater dependency and need for assistance. The data presented in this study were collected in a national survey of 530 people who provided informal care to more disabled people with MS. Almost half of these care givers reported that they provided more than 20 h of care per week to the person with MS, with more than 9 in 10 shopping for groceries, doing indoor housework, preparing meals or providing transportation for the person with MS. More than 4 in 10 employed care givers reduced the amount of time worked in the previous 12 months because of their care giving responsibilities. Although more than half of the MS care givers in our study reported that care giving was demanding, time consuming or challenging, about 90% of these MS care givers were happy that they could help. About two in three of these MS care givers found that care giving was rewarding, with more than 8 in 10 proud of the care they provided. More than a quarter of the informal care givers to people with MS thought they would benefit from treatment or counselling provided by mental health professionals. Not only it is necessary to provide access to mental health services for people with MS, but it is also important to assure that their informal care givers also have access to appropriate mental health care, given the scope of their care giving responsibilities.

  13. Supporting Affect Regulation in Children With Multiple Disabilities During Psychotherapy: A Multiple Case Design Study of Therapeutic Attachment. [Miscellaneous Article

    Schuengel, C; Sterkenburg, P S; Jeczynski, P; Janssen, C G C; Jongbloed, G

    2009-01-01

    : In a controlled multiple case design study, the development of a therapeutic relationship and its role in affect regulation were studied in 6 children with visual disabilities, severe intellectual disabilities, severe challenging behavior, and prolonged social deprivation. In the 1st phase,

  14. Improving Work Participation of Young Adults with Physical Disabilities

    Verhoef, J.A.C.

    2015-01-01

    markdownabstract__Abstract__ This thesis addresses the work participation of young adults with physical disabilities caused by a chronic condition. With increasing numbers of young people with a chronic physical condition living into adulthood, knowledge about the development of work participation in these young adults and the support they need to achieve suitable employment is needed. Interventions to improve the work participation of young adults with physical disabilities were lacking. The...

  15. A Replication to Increase Happiness Indices among Some People with Profound Multiple Disabilities.

    Ivancic, Martin T.; And Others

    1997-01-01

    The happiness indices in a Fun Time activity were systematically increased for three of four people with profound multiple disabilities by providing their preferred stimuli. The fourth showed decreased unhappiness. However, three people with profound disabilities and minimal movement failed to show any indices of happiness or unhappiness.…

  16. The pros and cons of inclusive education for children with Profound Intellectual and Multiple Disabilities

    Everaarts, Sanne; de Boer, Anke; van der Putten, Annette; Minnaert, Alexander

    2016-01-01

    Aim: Although children with disabilities have the right to be included into the school system, children with Profound Intellectual and Multiple Disabilities (PIMD) are often not included. The aim of this study is to gather knowledge about inclusive education for children with PIMD by identifying

  17. Implementing Applied Behavior Analysis for Effective Orientation and Mobility Instruction of Students with Multiple Disabilities

    O'Mea, Melanie L.

    2013-01-01

    Working with children who have multiple disabilities that include visual impairments can be especially challenging. Many disabling conditions manifest into behavioral difficulties that may take away from learning. Acting out may be a student's way of expressing a lack of healthy coping mechanisms in relation to his or her environment. Implementing…

  18. First Insights with a Vibrotactile Interface for Children with Multiple Disabilities

    Manresa-Yee, Cristina; Morrison, Ann; Jordi Muntaner, Joan

    2015-01-01

    for users with multiple disabilities. We developed V-Sense, a vibrotactile interface that encourages children with multiple disabilities to move their arms by using vibrations and exploiting the saltation perceptual illusion. In this paper we describe our initial experience evaluating the interface with 5...... children for 7 weeks and we discuss the first insights concerning the use of the interface and the difficulties encountered while conducting the evaluation sessions....

  19. Expanded Disability Status Scale-Based Disability and Dental-Periodontal Conditions in Patients with Multiple Sclerosis.

    Hatipoglu, Hasan; Canbaz Kabay, Sibel; Gungor Hatipoglu, Mujgan; Ozden, Hilmi

    2016-01-01

    The aim of this study was to evaluate the association between different disability states in patients with multiple sclerosis (MS) as determined by the expanded disability status scale (EDSS) and dental-periodontal measures. Eighty patients with MS (64 females and 16 males) were included in this study. Data on MS types, attack frequency, disease duration, EDSS scores and orofacial complaints prior to an MS attack were obtained from medical records. The plaque index (PI), probing depth (PD), clinical attachment level (CAL), gingival index (GI), decayed-missing-filled teeth (DMFT) index and number of present teeth were measured during one dental examination for each subject. The MS patients were divided into the following 2 groups based on their EDSS scores: low physical disability (L-DS) and high physical disability (H-DS). Differences in dental parameters between groups of low and high disability were investigated. p disability in MS patients. In addition, some maxillofacial-oral complaints prior to an MS attack were observed. © 2015 S. Karger AG, Basel.

  20. Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis

    Martinez-Lapiscina, Elena H; Arnow, Sam; Wilson, James A

    2016-01-01

    of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available. METHODS: In this multicentre, cohort study, we collected data about patients (age ≥16 years old) with clinically isolated syndrome, relapsing-remitting multiple sclerosis...... with the risk of subsequent disability worsening by use of proportional hazards models that included OCT metrics and age, disease duration, disability, presence of previous unilateral optic neuritis, and use of disease-modifying therapies as covariates. FINDINGS: 879 patients with clinically isolated syndrome...

  1. Disability Surveillance in multiple sclerosis patients before and after methylprednisolone treatment

    Ghabaae M

    2007-10-01

    Full Text Available Background: Multiple sclerosis (MS is a chronic inflammatory disease of the central nervous system resulting from demyelination and axonal loss. Although treatment of MS has progressed, patients continue to have attacks and treatment for such episodes remains a subject of ongoing study. The object of this study is to determine the effect of intravenous methylprednisolone (IVMP on the degree of disability in MS patients."nMethods: This cross-sectional study involved 63 patients with a definite diagnosis of MS, based on the MacDonald criteria, at the Iranian Center for Neurological Research at Imam Khomeini Hospital, Tehran, Iran, from March 2004 through March 2005. After obtaining informed consent, investigators gathered data including each patient's age, gender, pyramidal activity status, cortical, cerebellar and brain stem activity status, sensory signals in the extremities, including vibration, touch, pain, position, visual status, as well as bladder and intestinal activity, and Expanded Disability Status Scale (EDSS score. SPSS version 11 was used for data analysis."nResults: A five-day regimen of IVMP (5g significantly reduced the immediate post-treatment score from 4.595 to 3.635, which represents a 96% improvement in the EDSS. The greatest change in functional system disability was seen in the pyramidal system with a mean score of 1.13. After treatment, the rate of disability reduction in the sensory system, cerebellum, vision, bladder and intestinal activity was 0.57, 0.49, 0.46, 0.4, and 0.38, respectively. Patients who had experienced fewer relapses responded better to treatment. There was no statistically significant relationship between patient age and the level of response to treatment. However, the rate of disability reduction after treatment was greater in males than females (p=0.05."nConclusion: These results show that IVMP treatment induces an immediate post-treatment effect that could partly account for clinical and

  2. Reducing falls and improving mobility in multiple sclerosis.

    Sosnoff, Jacob J; Sung, JongHun

    2015-06-01

    Falls are common in persons with multiple sclerosis (MS), and are related to physical injury and reduce the quality of life. Mobility impairments are a significant risk factor for falls in persons with MS. Although there is evidence that mobility in persons with MS can be improved with rehabilitation, much less is known about fall prevention. This review focuses on fall prevention in persons with MS. Ten fall prevention interventions consisting of 524 participants with a wide range of disability were systematically identified. Nine of the 10 investigations report a reduction in falls and/or proportion of fallers following treatment. The vast majority observed an improvement in balance that co-occurred with the reduction in falls. Methodological limitations preclude any firm conclusions. Numerous gaps in the understanding of fall prevention in persons with MS are discussed. Well-designed randomized control trials targeting mobility and falls are warranted.

  3. Developing a questionnaire on physical activity support of people with (profound) intellectual (and multiple) disabilities : Experiences from the Netherlands

    Bossink, Leontien; van der Putten, Annette; Vlaskamp, Carla

    2017-01-01

    Introduction: People with intellectual disabilities (ID) undertake extremely low levels of physical activity, which is even more true in people with profound intellectual and multiple disabilities (PIMD). Physical activity approaches, particularly for people with PIMD, are more likely to be

  4. Earnings and Financial Compensation from Social Security Systems Correlate Strongly with Disability for Multiple Sclerosis Patients.

    Kavaliunas, Andrius; Wiberg, Michael; Tinghög, Petter; Glaser, Anna; Gyllensten, Hanna; Alexanderson, Kristina; Hillert, Jan

    2015-01-01

    Multiple sclerosis (MS) patients earn lower incomes and receive higher benefits. However, there is limited knowledge of how this is correlated with their disability. To elucidate sources and levels of income among MS patients with different disability, assessed with the Expanded Disability Status Scale. A total of 7929 MS patients aged 21-64 years and living in Sweden in 2010 were identified for this cross-sectional study. Descriptive statistics, logistic and truncated linear regression models were used to estimate differences between MS patients regarding earnings, disability pension, sickness absence, disability allowance, unemployment compensation, and social assistance. The average level of earnings was ten times lower and the average level of health- related benefits was four times higher when comparing MS patients with severe and mild disability. MS patients with severe disability had on average SEK 166,931 less annual income from earnings and SEK 54,534 more income from benefits compared to those with mild disability. The combined average income for MS patients was 35% lower when comparing patients in the same groups. The adjusted risk ratio for having earnings among MS patients with severe disability compared to the patients with mild disability was 0.33 (95% CI 0.29-0.39), while the risk ratio for having benefits was 1.93 (95% CI 1.90-1.94). Disease progression affects the financial situation of MS patients considerably. Correlations between higher disability and patient income were observed, suggesting that earnings and benefits could be used as measures of MS progression and proxies of disability.

  5. A study on mobility improvement for intellectually disabled student commuters

    Fumihiko Nakamura

    2017-07-01

    Overall, our findings suggested that to actually implement mobility support in school commuting environments in a way that will improve the mobility of intellectually disabled people requires not only the cooperation of schools, but also contributions from transport operators, road administrators, and traffic administrators. Because the contributions of these entities are essential, awareness-raising activities and a system for promoting common understanding among them are vital.

  6. Implementation of Automata Theory to Improve the Learning Disability

    Ali, Syed Asif; Soomro, Safeeullah; Memon, Abdul Ghafoor; Baqi, Abdul

    2013-01-01

    There are various types of disability egress in world like blindness, deafness, and Physical disabilities. It is quite difficult to deal with people with disability. Learning disability (LD) is types of disability totally different from general disability. To deal children with learning disability is difficult for both parents and teacher. As parent deal with only single child so it bit easy. But teacher deals with different students at a time so its more difficult to deal with group of stude...

  7. Quality improvement through multiple response optimization

    Noorossana, R.; Alemzad, H.

    2003-01-01

    The performance of a product is often evaluated by several quality characteristics. Optimizing the manufacturing process with respect to only one quality characteristic will not always lead to the optimum values for other characteristics. Hence, it would be desirable to improve the overall quality of a product by improving quality characteristics, which are considered to be important. The problem consists of optimizing several responses using multiple objective decision making approach and design of experiments. A case study will be discussed to show the application of the proposal method

  8. Substantial adverse association of visual and vascular comorbidities on visual disability in multiple sclerosis.

    Marrie, Ruth Ann; Cutter, Gary; Tyry, Tuula

    2011-12-01

    Visual comorbidities are common in multiple sclerosis (MS) but the impact of visual comorbidities on visual disability is unknown. We assessed the impact of visual and vascular comorbidities on severity of visual disability in MS. In 2006, we queried participants of the North American Research Committee on Multiple Sclerosis (NARCOMS) about cataracts, glaucoma, uveitis, hypertension, hypercholesterolemia, heart disease, diabetes and peripheral vascular disease. We assessed visual disability using the Vision subscale of Performance Scales. Using Cox regression, we investigated whether visual or vascular comorbidities affected the time between MS symptom onset and the development of mild, moderate and severe visual disability. Of 8983 respondents, 1415 (15.9%) reported a visual comorbidity while 4745 (52.8%) reported a vascular comorbidity. The median (interquartile range) visual score was 1 (0-2). In a multivariable Cox model the risk of mild visual disability was higher among participants with vascular (hazard ratio [HR] 1.45; 95% confidence interval [CI]: 1.39-1.51) and visual comorbidities (HR 1.47; 95% CI: 1.37-1.59). Vascular and visual comorbidities were similarly associated with increased risks of moderate and severe visual disability. Visual and vascular comorbidities are associated with progression of visual disability in MS. Clinicians hearing reports of worsening visual symptoms in MS patients should consider visual comorbidities as contributing factors. Further study of these issues using objective, systematic neuro-ophthalmologic evaluations is warranted.

  9. Automatic feedback to promote safe walking and speech loudness control in persons with multiple disabilities: two single-case studies.

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Alberti, Gloria; Boccasini, Adele; Smaldone, Angela; Oliva, Doretta; Bosco, Andrea

    2014-08-01

    Assessing automatic feedback technologies to promote safe travel and speech loudness control in two men with multiple disabilities, respectively. The men were involved in two single-case studies. In Study I, the technology involved a microprocessor, two photocells, and a verbal feedback device. The man received verbal alerting/feedback when the photocells spotted an obstacle in front of him. In Study II, the technology involved a sound-detecting unit connected to a throat and an airborne microphone, and to a vibration device. Vibration occurred when the man's speech loudness exceeded a preset level. The man included in Study I succeeded in using the automatic feedback in substitution of caregivers' alerting/feedback for safe travel. The man of Study II used the automatic feedback to successfully reduce his speech loudness. Automatic feedback can be highly effective in helping persons with multiple disabilities improve their travel and speech performance.

  10. Improving quality of life in multiple sclerosis: an unmet need.

    Zwibel, Howard L; Smrtka, Jennifer

    2011-05-01

    Multiple sclerosis (MS) affects approximately 400,000 people in the United States and 2.1 million people worldwide. It is the most common chronic, non-traumatic neurological disorder afflicting young people during their peak productive ages. MS can diminish quality of life (QOL) by interfering with the ability to work, pursue leisure activities, and carry on usual life roles. Symptoms that affect QOL may include impaired mobility, fatigue, depression, pain, spasticity, cognitive impairment, sexual dysfunction, bowel and bladder dysfunction, vision and hearing problems, seizures, and sDwallowing and breathing difficulties. Direct medical costs of MS in the United States are estimated in excess of $10 billion per year. Indirect costs of MS include costs of reduced employment or unemployment, assistive equipment, disability related home modifications, and paid and unpaid personal care. Although direct medical costs predominate in the earlier stages of MS, indirect costs of productivity loss are responsible for higher costs later. Disease-modifying therapies (DMTs) lessen symptoms, reduce relapses, and delay disability progression. Unfortunately, many DMTs might produce only modest improvements in QOL. Although symptom-specific therapies do not delay disease progression, they may delay unemployment and dependency, thereby reducing indirect costs.

  11. Supporting a child with multiple disabilities to participate in social interaction

    Norén, Niklas; Pilesjö, Maja Sigurd

    2016-01-01

    Asking a question can be a highly challenging task for a person with multiple disabilities, but questions have not received much attention in research on augmentative and alternative communication (AAC). Conversation analysis is employed to examine an instance of multiparty interaction where...... a speech and language therapist supports a child with multiple disabilities to ask a question with a communication board. The question is accomplished through a practice where the action is built as a trajectory of interactional steps. Each step is built using ways of involvement that establish different...

  12. A Technology-Aided Program to Support Basic Occupational Engagement and Mobility in Persons with Multiple Disabilities

    Giulio E. Lancioni

    2017-12-01

    Full Text Available BackgroundPersons with severe/profound intellectual and multiple disabilities tend to be passive and sedentary. Promoting their occupational engagement and mobility (i.e., indoor walking can help to modify their condition and improve their environmental input, health, and social image.AimThis study assessed whether a technology-aided program was suitable to (a support independent occupation and mobility in eight participants with intellectual and sensory disabilities and (b eventually increase the participants’ heart rates to levels considered beneficial for them.MethodThe program, which involved a computer system regulating the presentation of auditory or visual cues and the delivery of preferred stimulation, was introduced according to a non-concurrent multiple baseline design across participants. The auditory or visual cues guided the participants to collect objects from different desks and to transport them to a final destination (i.e., depositing them into a carton. Preferred stimulation was available to the participants for collecting and for depositing the objects.ResultsDuring the program, all participants had an increase in their independent responses of collecting objects and transporting them to the final destination. Their heart rates also increased to levels reflecting moderate-intensity physical exercise, potentially beneficial for their health.ConclusionA program, such as that used in this study, can promote occupational engagement and mobility in persons with multiple disabilities.

  13. Modifiable factors influencing relapses and disability in multiple sclerosis

    D'hooghe, M. B.; Nagels, G.; Bissay, V.; De Keyser, J.

    A growing body of literature indicates that the natural course of multiple sclerosis can be influenced by a number of factors. Strong evidence suggests that relapses can be triggered by infections, the postpartum period and stressful life events. Vaccinations against influenza, hepatitis B and

  14. Resting‐state connectivity of pre‐motor cortex reflects disability in multiple sclerosis

    Dogonowski, Anne-Marie; Siebner, Hartwig Roman; Soelberg Sørensen, P.

    2013-01-01

    Objective To characterize the relationship between motor resting-state connectivity of the dorsal pre-motor cortex (PMd) and clinical disability in patients with multiple sclerosis (MS). Materials and methods A total of 27 patients with relapsing–remitting MS (RR-MS) and 15 patients with secondary...... progressive MS (SP-MS) underwent functional resting-state magnetic resonance imaging. Clinical disability was assessed using the Expanded Disability Status Scale (EDSS). Independent component analysis was used to characterize motor resting-state connectivity. Multiple regression analysis was performed in SPM8...... between the individual expression of motor resting-state connectivity in PMd and EDSS scores including age as covariate. Separate post hoc analyses were performed for patients with RR-MS and SP-MS. Results The EDSS scores ranged from 0 to 7 with a median score of 4.3. Motor resting-state connectivity...

  15. The Role of Sound in Residential Facilities for People With Profound Intellectual and Multiple Disabilities

    van den Bosch, Kirsten A.; Andringa, Tjeerd C.; Baskent, Deniz; Vlaskamp, Carla

    2016-01-01

    Attention to the auditory environment of people with profound intellectual and multiple disabilities (PIMD) is limited, both in research and practice. As there is a dynamic interplay between the quality of the auditory environment and well-being, a study was undertaken to test the validity of the

  16. Language and Play in Students with Multiple Disabilities and Visual Impairments or Deaf-Blindness

    Pizzo, Lianna; Bruce, Susan M.

    2010-01-01

    This article investigates the relationships between play and language development in students with multiple disabilities and visual impairments or deaf-blindness. The findings indicate that students with higher levels of communication demonstrate more advanced play skills and that the use of play-based assessment and exposure to symbolic play are…

  17. Fatigue in multiple sclerosis reciprocal relationships with physical disabilities and depression.

    Schreurs, K.M.G.; Ridder, D.T.D. de; Bensing, J.M.

    2002-01-01

    Objective: To explore relations of fatigue, physical disabilities, and depression in patients with multiple sclerosis (MS) cross-sectionally and over time. Methods: Ninety-eight MS patients were interviewed twice at an interval of a year. Relationships of physical and mental fatigue, and reduced

  18. EARLY PROGNOSTIC FACTORS FOR DISABILITY IN MULTIPLE-SCLEROSIS, A EUROPEAN MULTICENTER STUDY

    RIISE, T; GRONNING, M; FERNANDEZ, O; LAUER, K; MIDGARD, R; MINDERHOUD, JM; NYLAND, H; PALFFY, G; POSER, S; AARLI, JA

    The effects of initial clinical variables on short-term prognosis are analyzed in a cross-sectional study of 574 multiple sclerosis patients from 7 centers in 5 European countries. Patients with a primary progressive course had a 2.3 higher mean disability score (EDSS) than the primary remittent

  19. Operationalizing quality of life for people with profound multiple disabilities : a Delphi study

    Petry, K.; Maes, B.; Vlaskamp, C.

    Background: In a recent study, we constructed an item pool that contains items on the quality of life (QOL) and related aspects of support of people with profound multiple disabilities (PMD). In the present study, a panel of experts assessed the content and the structure of this item pool in order

  20. Sunlight exposure and sun sensitivity associated with disability progression in multiple sclerosis

    D'hooghe, M. B.; Haentjens, P.; Nagels, G.; Garmyn, M.; De Keyser, J.

    Background: Sunlight and vitamin D have been inversely associated with the risk of multiple sclerosis (MS). Objective: We investigated sunlight exposure and sun sensitivity in relation to disability progression in MS. Methods: We conducted a survey among persons with MS, registered by the Flemish MS

  1. Fatigue in multiple sclerosis. Reciprocal relationships with physical disabilities and depression

    Schreurs, K.M.G.; Ridder, D.T.D. de; Bensing, J.

    2002-01-01

    Objective: To explore relations of fatigue, physical disabilities, and depression in patients with multiple sclerosis (MS) cross-sectionally and over time. Methods: Ninety-eight MS patients were interviewed twice at an interval of a year. Relationships of physical and mental fatigue, and reduced

  2. Therapeutic Riding for a Student with Multiple Disabilities and Visual Impairment: A Case Study.

    Lehrman, Jennifer; Ross, David B.

    2001-01-01

    A 9-year-old with multiple disabilities and visual impairments was the focus of a 10-week developmental therapeutic riding program incorporating hippotherapy. The program has led to increased mobility, an increase in visual attention span and fixation time, signs of greater verbal communication, and the acquisition of new functional signs.…

  3. Determining alertness in individuals with profound intellectual and multiple disabilities : the reliability of an observation list

    Munde, V.S.; Vlaskamp, C.; Ruijssenaars, A.J.J.M.; Nakken, H.

    In the support of individuals with profound intellectual and multiple disabilities (PIMD), assessing the level of alertness is a recurring issue for parents and other direct support persons. Although observations show clear advantages above and beyond other assessment methods, there are problems

  4. Social Peer Interactions in Persons with Profound Intellectual and Multiple Disabilities: A Literature Review

    Nijs, Sara; Maes, Bea

    2014-01-01

    Social interactions may positively influence developmental and quality of life outcomes. Research in persons with profound intellectual and multiple disabilities (PIMD) mostly investigated interactions with caregivers. This literature review focuses on peer interactions of persons with PIMD. A computerized literature search of three databases was…

  5. Communication Opportunities via Special Messaging Technology for Two Post-Coma Persons with Multiple Disabilities

    Lancioni, Giulio E.; O'Reilly, Mark F.; Singh, Nirbhay N.; Sigafoos, Jeff; Buonocunto, Francesca; Sacco, Valentina; Colonna, Fabio; Navarro, Jorge; Lanzilotti, Crocifissa; de Pace, Claudia; Megna, Marisa; Oliva, Doretta

    2011-01-01

    This study extended the assessment of a special messaging technology with two additional post-coma adults who had emerged from a minimally conscious state, but showed multiple disabilities including profound motor and communication impairments. For each participant, the study involved an ABAB design, in which the A represented baseline phases and…

  6. Application of Item Response Theory to Modeling of Expanded Disability Status Scale in Multiple Sclerosis.

    Novakovic, A.M.; Krekels, E.H.; Munafo, A.; Ueckert, S.; Karlsson, M.O.

    2016-01-01

    In this study, we report the development of the first item response theory (IRT) model within a pharmacometrics framework to characterize the disease progression in multiple sclerosis (MS), as measured by Expanded Disability Status Score (EDSS). Data were collected quarterly from a 96-week phase III

  7. Two Persons with Multiple Disabilities Use Orientation Technology with Auditory Cues to Manage Simple Indoor Traveling

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Campodonico, Francesca; Oliva, Doretta

    2010-01-01

    This study was an effort to extend the evaluation of orientation technology for promoting independent indoor traveling in persons with multiple disabilities. Two participants (adults) were included, who were to travel to activity destinations within occupational settings. The orientation system involved (a) cueing sources only at the destinations…

  8. Persons with Multiple Disabilities Use Orientation Technology to Find Room Entrances during Indoor Traveling

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Alberti, Gloria; Scigliuzzo, Francesca; Signorino, Mario; Oliva, Doretta; Smaldone, Angela; La Martire, Maria L.

    2010-01-01

    These two studies assessed adapted orientation technology for promoting correct direction and room identification during indoor traveling by persons with multiple (e.g., sensory, motor and intellectual/adaptive) disabilities. In Study I, two adults were included who had severe visual impairment or total blindness and deafness and used a wheelchair…

  9. Visual impairments in people with severe and profound multiple disabilities: An inventory of visual functioning

    van den Broek, E.G.C.; Janssen, C.G.C.; van Ramshorst, T.; Deen, L.

    2006-01-01

    Background: The prevalence of visual impairments in people with severe and profound multiple disabilities (SPMD) is the subject of considerable debate and is difficult to assess. Methods: In a typical Dutch care organization, all clients with SPMD (n = 76) participated in the study and specific

  10. HEART RATE AND PHYSICAL ACTIVITY PATTERNS IN PERSONS WITH PROFOUND INTELLECTUAL AND MULTIPLE DISABILITIES

    Waninge, Aly; van der Putten, Annette A. J.; Stewart, Roy E.; Steenbergen, Bert; van Wijck, Ruud; van der Schans, Cees P.

    2013-01-01

    Because physical fitness and health are related to physical activity, it is important to gain an insight into the physical activity levels of persons with profound intellectual and multiple disabilities (PIMD). The purpose of this study was to examine heart rate patterns to measure the activity

  11. Attentional Processes in Interactions between People with Profound Intellectual and Multiple Disabilities and Direct Support Staff

    Ine, Hostyn; Heleen, Neerinckx; Bea, Maes

    2011-01-01

    Few studies have examined joint attention in interactions with persons with profound intellectual and multiple disabilities (PIMD), despite its important role in high-quality interaction. The purpose of this study is to describe the attention-directing behaviours of persons with PIMD and their direct support staff and the attention episodes…

  12. Interaction between Persons with Profound Intellectual and Multiple Disabilities and Their Partners: A Literature Review

    Hostyn, Ine; Maes, Bea

    2009-01-01

    Background: High quality interactions are of crucial importance for quality of life of persons with profound intellectual and multiple disabilities (PIMD). This literature review describes and synthesises studies addressing the interaction between persons with PIMD and their partners. Method: A computerised literature search using defined…

  13. Effects of Functional Mobility Skills Training for Adults with Severe Multiple Disabilities

    Whinnery, Stacie B.; Whinnery, Keith W.

    2011-01-01

    This study investigated the effects of a functional mobility program on the functional standing and walking skills of five adults with developmental disabilities. The Mobility Opportunities Via Education (MOVE) Curriculum was implemented using a multiple-baseline across subjects design. Repeated measures were taken during baseline, intervention…

  14. Emotional and Behavioural Problems in Children with Visual Impairment, Intellectual and Multiple Disabilities

    Alimovic, S.

    2013-01-01

    Background: Children with multiple impairments have more complex developmental problems than children with a single impairment. Method: We compared children, aged 4 to 11 years, with intellectual disability (ID) and visual impairment to children with single ID, single visual impairment and typical development on "Child Behavior Check…

  15. A Case Study of Tack Tiles[R] Literacy Instruction for a Student with Multiple Disabilities Including Congenital Blindness

    Klenk, Jessicia A.; Pufpaff, Lisa A.

    2011-01-01

    Research on literacy instruction for students with multiple disabilities is limited. Empirical research on braille instruction for students with multiple disabilities that include congenital blindness is virtually nonexistent. This case study offers initial insight into possible methods of early braille literacy instruction for a student with…

  16. The Relevance of Depressive Symptoms and Social Support to Disability in Women with Multiple Sclerosis or Fibromyalgia

    Phillips, Lorraine J.

    2010-01-01

    Multiple sclerosis and fibromyalgia syndrome may spur substantial disability for those affected. Using structural equation modeling, this secondary analysis examined predictors of disability in women with multiple sclerosis (n = 118) and fibromyalgia syndrome (n = 197) recruited for separate wellness studies. Greater functional limitations, lower…

  17. Multiple Improvements of Multiple Imputation Likelihood Ratio Tests

    Chan, Kin Wai; Meng, Xiao-Li

    2017-01-01

    Multiple imputation (MI) inference handles missing data by first properly imputing the missing values $m$ times, and then combining the $m$ analysis results from applying a complete-data procedure to each of the completed datasets. However, the existing method for combining likelihood ratio tests has multiple defects: (i) the combined test statistic can be negative in practice when the reference null distribution is a standard $F$ distribution; (ii) it is not invariant to re-parametrization; ...

  18. Improving parent-child interactions for families of children with developmental disabilities.

    Harrold, M; Lutzker, J R; Campbell, R V; Touchette, P E

    1992-06-01

    Child Management Training (CMT) involves compliance training with a focus on consistent use of antecedents and consequences. Planned Activities Training (PAT) focuses on teaching parents to plan for and engage in activities with their children. A multiple probe design counterbalancing PAT and CMT showed that PAT and CMT were about equally effective in improving mother-child interactions in four families with children with developmental disabilities. Responses to a social validation questionnaire indicated that parents were satisfied with the services received, and that PAT was the slightly preferred treatment. Prior research demonstrated that PAT enhanced the results of CMT. The practical advantages of PAT over CMT are discussed.

  19. Resting-state connectivity of pre-motor cortex reflects disability in multiple sclerosis.

    Dogonowski, A-M; Siebner, H R; Soelberg Sørensen, P; Paulson, O B; Dyrby, T B; Blinkenberg, M; Madsen, K H

    2013-11-01

    To characterize the relationship between motor resting-state connectivity of the dorsal pre-motor cortex (PMd) and clinical disability in patients with multiple sclerosis (MS). A total of 27 patients with relapsing-remitting MS (RR-MS) and 15 patients with secondary progressive MS (SP-MS) underwent functional resting-state magnetic resonance imaging. Clinical disability was assessed using the Expanded Disability Status Scale (EDSS). Independent component analysis was used to characterize motor resting-state connectivity. Multiple regression analysis was performed in SPM8 between the individual expression of motor resting-state connectivity in PMd and EDSS scores including age as covariate. Separate post hoc analyses were performed for patients with RR-MS and SP-MS. The EDSS scores ranged from 0 to 7 with a median score of 4.3. Motor resting-state connectivity of left PMd showed a positive linear relation with clinical disability in patients with MS. This effect was stronger when considering the group of patients with RR-MS alone, whereas patients with SP-MS showed no increase in coupling strength between left PMd and the motor resting-state network with increasing clinical disability. No significant relation between motor resting-state connectivity of the right PMd and clinical disability was detected in MS. The increase in functional coupling between left PMd and the motor resting-state network with increasing clinical disability can be interpreted as adaptive reorganization of the motor system to maintain motor function, which appears to be limited to the relapsing-remitting stage of the disease. © 2013 John Wiley & Sons A/S.

  20. Two adults with multiple disabilities use a computer-aided telephone system to make phone calls independently.

    Lancioni, Giulio E; O'Reilly, Mark F; Singh, Nirbhay N; Sigafoos, Jeff; Oliva, Doretta; Alberti, Gloria; Lang, Russell

    2011-01-01

    This study extended the assessment of a newly developed computer-aided telephone system with two participants (adults) who presented with blindness or severe visual impairment and motor or motor and intellectual disabilities. For each participant, the study was carried out according to an ABAB design, in which the A represented baseline phases and the B represented intervention phases, during which the special telephone system was available. The system involved among others a net-book computer provided with specific software, a global system for mobile communication modem, and a microswitch. Both participants learned to use the system very rapidly and managed to make phone calls independently to a variety of partners such as family members, friends and staff personnel. The results were discussed in terms of the technology under investigation (its advantages, drawbacks, and need of improvement) and the social-communication impact it can make for persons with multiple disabilities. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Smoking and worsening disability in multiple sclerosis: A meta-analysis.

    Heydarpour, P; Manouchehrinia, A; Beiki, O; Mousavi, S E; Abdolalizadeh, A; -Lakeh, M Moradi; Sahraian, M A

    2018-03-15

    Multiple sclerosis (MS) is a chronic demyelinating disorder affecting young adults. Environmental factors and lifestyle behaviors are pivotal in MS pathophysiology. Smoking has been considered as an important risk factor in MS. Various recent studies have been conducted to measure the role of smoking on worsening disability in patients with MS, thus we intended to systematically assess effect of smoking on evolution of disability in this study. We queried MEDLINE, EMBASE and Cochrane Library with following keywords "Multiple Sclerosis, Smoking, Tobacco Use, Disability" on December 1st 2016. Original articles were included when smoking history was mentioned, disability was measured via expanded disability status scale (EDSS) or multiple sclerosis severity score (MSSS). Studies with insufficient outcome data, non-human, or in other languages than English were excluded. Through literature review after duplicate removals, 268 articles were retrieved. A total of 56 articles were screened and 15 articles were assessed for eligibility, finally, eleven articles were included in this systematic review and meta-analysis. Ever smoking was significantly associated with increased EDSS (standardized mean difference (SMD) = 0.15, 95% CI = 0.01-0.28), but had no significant association with risk of reaching EDSS 4 (HR = 1.24, 95% CI = 0.89-1.72) or EDSS 6 (HR = 1.17, 95% CI = 0.88-1.57). Smoking had no effect on MSSS (SMD = 0.14, 95% CI = -0.04-0.32) or T2 lesion volume (SMD = 0.07, 95% CI = -0.08-0.22). This meta-analysis showed smoking increased EDSS, insignificant findings were possibly due to the small number of studies, significant differences in methodologies, and variations in reporting of disability outcomes. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Brain reserve against physical disability progression over 5 years in multiple sclerosis.

    Sumowski, James F; Rocca, Maria A; Leavitt, Victoria M; Meani, Alessandro; Mesaros, Sarlota; Drulovic, Jelena; Preziosa, Paolo; Habeck, Christian G; Filippi, Massimo

    2016-05-24

    The brain reserve hypothesis links larger maximal lifetime brain growth (MLBG, estimated with intracranial volume [ICV]) with lower risk for cognitive decline/dementia. We examined whether larger MLBG is also linked to less physical disability progression over 5 years in a prospective sample of treatment-naive patients with multiple sclerosis (MS). Physical disability was measured with the Expanded Disability Status Scale (EDSS) at baseline and 5-year follow-up in 52 treatment-naive Serbian patients with MS. MRI measured disease burden (cerebral atrophy, T2 lesion volume) and MLBG: a genetically determined, premorbid (established during adolescence, stable thereafter) patient characteristic estimated with ICV (adjusted for sex). Logistic regression tested whether MLBG (smaller vs larger) predicts disability progression (stable vs worsened) independently of disease burden. Disability progression was observed in 29 (55.8%) patients. Larger MLBG predicted lower risk for progression (odds ratio 0.13, 95% confidence interval 0.02-0.78), independently of disease burden. We also calculated absolute change in EDSS scores, and observed that patients with smaller MLBG showed worse EDSS change (0.91 ± 0.71) than patients with larger MLBG (0.42 ± 0.87). Larger MLBG was linked to lower risk for disability progression in patients with MS over 5 years, which is the first extension of the brain reserve hypothesis to physical disability. MLBG (ICV) represents a clinically available metric that may help gauge risk for future disability in patients with MS, which may advance the science and practice of early intervention. Potential avenues for future research are discussed. © 2016 American Academy of Neurology.

  3. Respiratory muscle weakness and respiratory muscle training in severely disabled multiple sclerosis patients.

    Gosselink, R; Kovacs, L; Ketelaer, P; Carton, H; Decramer, M

    2000-06-01

    To evaluate the contribution of respiratory muscle weakness (part 1) and respiratory muscle training (part 2) to pulmonary function, cough efficacy, and functional status in patients with advanced multiple sclerosis (MS). Survey (part 1) and randomized controlled trial (part 2). Rehabilitation center for MS. Twenty-eight bedridden or wheelchair-bound MS patients (part 1); 18 patients were randomly assigned to a training group (n = 9) or a control group (n = 9) (part 2). The training group (part 2) performed three series of 15 contractions against an expiratory resistance (60% maximum expiratory pressure [PEmax]) two times a day, whereas the control group performed breathing exercises to enhance maximal inspirations. Forced vital capacity (FVC), inspiratory, and expiratory muscle strength (PImax and PEmax), neck flexion force (NFF), cough efficacy by means of the Pulmonary Index (PI), and functional status by means of the Extended Disability Status Scale (EDSS). Part 1 revealed a significantly reduced FVC (43% +/- 26% predicted), PEmax (18% +/- 8% predicted), and PImax (27% +/- 11% predicted), whereas NFF was only mildly reduced (93% +/- 26% predicted). The PI (median score, 10) and EDSS (median score, 8.5) were severely reduced. PEmax was significantly correlated to FVC, EDSS, and PI (r = .77, -.79, and -.47, respectively). In stepwise multiple regression analysis. PEmax was the only factor contributing to the explained variance in FVC (R2 = .60), whereas body weight (R2 = .41) was the only factor for the PI. In part 2, changes in PImax and PEmax tended to be higher in the training group (p = .06 and p = .07, respectively). The PI was significantly improved after 3 months of training compared with the control group (p functional status. Expiratory muscle training tended to enhance inspiratory and expiratory muscle strength. In addition, subjectively and objectively rated cough efficacy improved significantly and lasted for 3 months after training cessation.

  4. Basic life support and children with profound and multiple learning disabilities.

    Cash, Stefan; Shinnick-Page, Andrea

    2008-10-01

    Nurses and other carers of people with learning disabilities must be able to manage choking events and perform basic life support effectively. UK guidelines for assessment of airway obstruction and for resuscitation do not take account of the specific needs of people with profound multiple learning disability. For example, they fail to account for inhibited gag and coughing reflexes, limited body movements or chest deformity. There are no national guidelines to assist in clinical decisions and training for nurses and carers. Basic life support training for students of learning disability nursing at Birmingham City University is supplemented to address these issues. The authors ask whether such training should be provided for all nurses including those caring for children and young people. They also invite comment and discussion on questions related to chest compression and training in basic life support for a person in a seated position.

  5. Future disability projections could be improved by connecting to the theory of a dynamic equilibrium.

    Klijs, Bart; Mackenbach, Johan P; Kunst, Anton E

    2011-04-01

    Projections of future trends in the burden of disability could be guided by models linking disability to life expectancy, such as the dynamic equilibrium theory. This article tests the key assumption of this theory that severe disability is associated with proximity to death, whereas mild disability is not. Using data from the GLOBE study (Gezondheid en Levensomstandigheden Bevolking Eindhoven en omstreken), the association of three levels of self-reported disabilities in activities of daily living with age and proximity to death was studied using logistic regression models. Regression estimates were used to estimate the number of life years with disability for life spans of 75 and 85 years. Odds ratios of 0.976 (not significant) for mild disability, 1.137 for moderate disability, and 1.231 for severe disability showed a stronger effect of proximity to death for more severe levels of disability. A 10-year increase of life span was estimated to result in a substantial expansion of mild disability (4.6 years) compared with a small expansion of moderate (0.7 years) and severe (0.9 years) disability. These findings support the theory of a dynamic equilibrium. Projections of the future burden of disability could be substantially improved by connecting to this theory and incorporating information on proximity to death. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Impact of low vision care on reading performance in children with multiple disabilities and visual impairment

    Krishna Kumar Ramani

    2014-01-01

    Full Text Available Background: Lack of evidence in literature to show low vision care enhances the reading performance in children with Multiple Disabilities and Visual Impairment (MDVI. Aim: To evaluate the effectiveness of Low Vision Care intervention on the reading performance of children with MDVI. Materials and Methods: Three subjects who were diagnosed to have cerebral palsy and visual impairment, studying in a special school were recruited for the study. All of them underwent detailed eye examination and low vision care evaluation at a tertiary eye care hospital. A single subject multiple baseline (study design was adopted and the study period was 16 weeks. The reading performance (reading speed, reading accuracy, reading fluency was evaluated during the baseline phase and the intervention phase. The median of all the reading parameters for each week was noted. The trend of the reading performance was graphically represented in both the phases. Results: Reading speed increased by 37 Word per minute, 37 Letters per minute and 5 letters per minute for the subject 1, 2 and 3 respectively after the intervention. Reading accuracy was 84%, 91% and 86.4% at the end of the baseline period and 98.7%, 98.4% and 99% at the end of 16 weeks for subject 1, 2 and 3 respectively. Average reading fluency score was 8.3, 7.1 and 5.5 in the baseline period and 10.2, 10.2 and 8.7 in the intervention period. Conclusion: This study shows evidence of noticeable improvement in reading performance of children with MDVI using a novel study design.

  7. INCLUSION OF CHILDREN WITH INTELLECTUAL AND MULTIPLE DISABILITIES: A COMMUNITY-BASED REHABILITATION APPROACH, INDIA

    Ram LAKHAN

    2013-03-01

    Full Text Available Background: Inclusion of children with intellectual disabilities (ID and multiple disabilities (MD in regular schools in India is extremely poor. One of the key objectives of community-based rehabilitation (CBR is to include ID & MD children in regular schools. This study attempted to find out association with age, ID severity, poverty, gender, parent education, population, and multiple disabilities comprising one or more disorders cerebral palsy, epilepsy and psychiatric disorders with inclusion among 259 children in Barwani Block of Barwani District in the state of Madhya Pradesh, India.Aim: Inclusion of children with intellectual and multiple disabilities in regular schools through CBR approach in India.Method: Chi square test was conducted to investigate association between inclusion and predictor variables ID categories, age, gender, poverty level, parent education, population type and multiple disabilities. Result: Inclusion was possible for borderline 2(66.4%, mild 54(68.3%, moderate 18(18.2%, and age range from 5 to 12 years 63 (43%. Children living in poor families 63 (30.6%, not poor 11(18.9%, parental edu­ca­ti­on none 52 (26%, primary level 11 (65%, midd­le school 10 (48% high school 0 (0% and bachelor degree 1(7%, female 34 (27.9%, male 40 (29.2%, tribal 40 (28.7%, non-tribal 34(28.3% and multiple disabled with cerebral palsy 1(1.2%, epilepsy 3 (4.8% and psychiatry disorders 12 (22.6% were able to receive inclusive education. Sig­ni­ficant difference in inclusion among ID ca­te­gories (c2=99.8, p < 0.001, poverty (c2=3.37, p 0.044, parental education (c2=23.7, p < 0.001, MD CP (c2=43.9, p < 0.001 and epilepsy (c2=22.4, p < 0.001 were seen.Conclusion: Inclusion through CBR is feasible and acceptable in poor rural settings in India. CBR can facilitate inclusion of children with borderline, mild and moderate categories by involving their parents, teachers and community members.

  8. Employment, disability pension and income for children with parental multiple sclerosis.

    Moberg, Julie Yoon; Laursen, Bjarne; Koch-Henriksen, Nils; Thygesen, Lau Caspar; Brødsgaard, Anne; Soelberg Sørensen, Per; Magyari, Melinda

    2017-07-01

    Little is known about the consequences of parental multiple sclerosis (MS) on offspring's socioeconomic circumstances. To investigate employment, disability pension and income in offspring of parents with MS compared with matched reference persons in a nationwide register-based cohort study. All Danish-born persons with onset of MS during 1950-1986 were retrieved from the Danish Multiple Sclerosis Registry. Their offspring were identified using the Civil Registration System. One random offspring from each sibship was matched by sex and year of birth with eight random reference persons. We included 2456 MS offspring and 19,648 reference persons. At age 30, employment was lower among MS offspring than reference children (odds ratio (OR): 0.89; 95% confidence interval (CI): 0.84-0.95; p = 0.0003), and they more often received disability pension (OR: 1.31; 95% CI: 1.15-1.50; p pension and low income in adult life.

  9. Employment, disability pension and income for children with parental multiple sclerosis

    Moberg, Julie Yoon; Laursen, Bjarne; Koch-Henriksen, N.

    2017-01-01

    BACKGROUND: Little is known about the consequences of parental multiple sclerosis (MS) on offspring's socioeconomic circumstances. OBJECTIVE: To investigate employment, disability pension and income in offspring of parents with MS compared with matched reference persons in a nationwide register......-based cohort study. METHODS: All Danish-born persons with onset of MS during 1950-1986 were retrieved from the Danish Multiple Sclerosis Registry. Their offspring were identified using the Civil Registration System. One random offspring from each sibship was matched by sex and year of birth with eight random...... reference persons. RESULTS: We included 2456 MS offspring and 19,648 reference persons. At age 30, employment was lower among MS offspring than reference children (odds ratio (OR): 0.89; 95% confidence interval (CI): 0.84-0.95; p = 0.0003), and they more often received disability pension (OR: 1.31; 95% CI...

  10. Improving Narrative Writing Skills of Secondary Students with Disabilities Using Strategy Instruction

    Foxworth, Lauren L.; Mason, Linda H.; Hughes, Charles A.

    2017-01-01

    Writing standards and objectives outline complex skills for narrative essay writing at the secondary level. Students with disabilities often produce disorganized narratives with fewer narrative elements than their peers without disabilities. A multiple-probe design was used to examine effects of Self-Regulated Strategy Development for the Pick my…

  11. Place of birth,age of immigration,and disability in Hispanics with multiple sclerosis.

    Amezcua, Lilyana; Conti, David V; Liu, Lihua; Ledezma, Karina; Langer-Goulda, Annette M

    2015-01-01

    Hispanics in the US are a diverse community where their knowledge and risk for developing disability in multiple sclerosis (MS) may relate to their level of acculturation. To compare the risk of disability in Hispanics with MS in the US by place of birth and age of immigration. We conducted a cross-sectional study of 304 Hispanics with MS residing in Southern California. Place of birth and age of immigration were used as proxies to acculturation. Individuals were classified as US-born, early and late-immigrant (immigration to the US, respectively). Risk of disability (expanded disability status scale ≥6) was adjusted for age at symptom onset, sex, socioeconomic status, and disease duration, using logistic regression. Late-immigrants were older at symptom onset (34.2±11.9 vs. 31.9±12.9 vs. 28.5±9.7 years, pimmigrant and US-born respectively. There was no difference between groups by female sex, type of MS, ethnicity, chronic medical conditions, and disease duration while differences were noted by socioeconomic status. Being late-immigrant was independently associated with increased disability (adjusted OR 2.3 95% CIs 1.07–4.82; p=0.03) compared to US-born. Later immigration to the US in Hispanics with MS is associated with greater disability. These findings may reflect differences in social, environmental and cultural factors that may act as barriers for accessibility and utilization of health services. An in-depth assessment of the perceptions and attitudes about MS are warranted in this population.

  12. Magnetic resonance spectroscopy of normal appearing white matter in early relapsing-remitting multiple sclerosis: correlations between disability and spectroscopy

    Foronda Jesus

    2004-06-01

    Full Text Available Abstract Background What currently appears to be irreversible axonal loss in normal appearing white matter, measured by proton magnetic resonance spectroscopy is of great interest in the study of Multiple Sclerosis. Our aim is to determine the axonal damage in normal appearing white matter measured by magnetic resonance spectroscopy and to correlate this with the functional disability measured by Multiple Sclerosis Functional Composite scale, Neurological Rating Scale, Ambulation Index scale, and Expanded Disability Scale Score. Methods Thirty one patients (9 male and 22 female with relapsing remitting Multiple Sclerosis and a Kurtzke Expanded Disability Scale Score of 0–5.5 were recruited from four hospitals in Andalusia, Spain and included in the study. Magnetic resonance spectroscopy scans and neurological disability assessments were performed the same day. Results A statistically significant correlation was found (r = -0.38 p Conclusions There is correlation between disability (measured by Expanded Disability Scale Score and the NAA/Cr ratio in normal appearing white matter. The lack of correlation between the NAA/Cr ratio and the Multiple Sclerosis Functional Composite score indicates that the Multiple Sclerosis Functional Composite is not able to measure irreversible disability and would be more useful as a marker in stages where axonal damage is not a predominant factor.

  13. Informal social networks of people with profound intellectual and multiple disabilities : Relationship with age, communicative abilities and current living arrangements

    Kamstra, A.; van der Putten, A.A.J.; Post, W.J.; Vlaskamp, C.

    2015-01-01

    BACKGROUND: People with profound intellectual and multiple disabilities (PIMD) have limited informal social contacts. Research to determine the factors which can positively influence establishing sound informal social contacts is required. MATERIALS AND METHODS: Regression analysis for 200 people

  14. The influence of pregnancy on disability from multiple sclerosis: a population-based study in Middlesex County, Ontario.

    Weinshenker, B G; Hader, W; Carriere, W; Baskerville, J; Ebers, G C

    1989-11-01

    We analyzed the effect of pregnancy on long-term disability resulting from multiple sclerosis in 185 women ascertained through a retrospective population-based survey of MS in Middlesex County, Ontario, Canada. There was no association between disability and total number of term pregnancies, timing of pregnancy relative to onset of MS, or either onset or worsening of MS in relation to a pregnancy. The mean number of pregnancies both before and after onset of MS was no different among groups stratified according to disability. This study addresses some of the difficulties inherent in studying the effect of pregnancy on disability resulting from MS.

  15. Application of Item Response Theory to Modeling of Expanded Disability Status Scale in Multiple Sclerosis.

    Novakovic, A M; Krekels, E H J; Munafo, A; Ueckert, S; Karlsson, M O

    2017-01-01

    In this study, we report the development of the first item response theory (IRT) model within a pharmacometrics framework to characterize the disease progression in multiple sclerosis (MS), as measured by Expanded Disability Status Score (EDSS). Data were collected quarterly from a 96-week phase III clinical study by a blinder rater, involving 104,206 item-level observations from 1319 patients with relapsing-remitting MS (RRMS), treated with placebo or cladribine. Observed scores for each EDSS item were modeled describing the probability of a given score as a function of patients' (unobserved) disability using a logistic model. Longitudinal data from placebo arms were used to describe the disease progression over time, and the model was then extended to cladribine arms to characterize the drug effect. Sensitivity with respect to patient disability was calculated as Fisher information for each EDSS item, which were ranked according to the amount of information they contained. The IRT model was able to describe baseline and longitudinal EDSS data on item and total level. The final model suggested that cladribine treatment significantly slows disease-progression rate, with a 20% decrease in disease-progression rate compared to placebo, irrespective of exposure, and effects an additional exposure-dependent reduction in disability progression. Four out of eight items contained 80% of information for the given range of disabilities. This study has illustrated that IRT modeling is specifically suitable for accurate quantification of disease status and description and prediction of disease progression in phase 3 studies on RRMS, by integrating EDSS item-level data in a meaningful manner.

  16. Improving Work Participation of Young Adults with Physical Disabilities

    J.A.C. Verhoef (Joan)

    2015-01-01

    markdownabstract__Abstract__ This thesis addresses the work participation of young adults with physical disabilities caused by a chronic condition. With increasing numbers of young people with a chronic physical condition living into adulthood, knowledge about the development of work

  17. Detective Questions: A Strategy for Improving Inference-Making in Children With Mild Disabilities

    Jiménez-Fernández, Gracia

    2015-01-01

    One of the most frequent problems in reading comprehension is the difficulty in making inferences from the text, especially for students with mild disabilities (i.e., children with learning disabilities or with high-functioning autism). It is essential, therefore, that educators include the teaching of reading strategies to improve their students'…

  18. [Exome sequencing revealed Allan-Herndon-Dudley syndrome underlying multiple disabilities].

    Arvio, Maria; Philips, Anju K; Ahvenainen, Minna; Somer, Mirja; Kalscheuer, Vera; Järvelä, Irma

    2014-01-01

    Normal function of the thyroid gland is the cornerstone of a child's mental development and physical growth. We describe a Finnish family, in which the diagnosis of three brothers became clear after investigations that lasted for more than 30 years. Two of the sons have already died. DNA analysis of the third one, a 16-year-old boy, revealed in exome sequencing of the complete X chromosome a mutation in the SLC16A2 gene, i.e. MCT8, coding for a thyroid hormone transport protein. Allan-Herndon-Dudley syndrome was thus shown to be the cause of multiple disabilities.

  19. [Neuropsychology of mildly disabled patients with relapsing-remitting multiple sclerosis].

    Santiago Rolanía, Olga; Guàrdia Olmos, Joan; Arbizu Urdiain, Txomin

    2006-02-01

    Previous papers have mainly demonstrated the presence of cognitive impairment in patients with multiple sclerosis (MS), these changes have been traditionally associated with the later stages of the disease. In the current study, a comprehensive neuropsychological battery was administered to 216 relapsing-remitting MS patients with mild clinical disability (EDSSreproduction visual memory; and long term verbal memory of texts, and information processing speed. We also observed greeter incidence of depressive symptoms in patients. And a little relation of the cognitive deficits with the clinical variables in these phase of the disease.

  20. Using tablet assisted Social Stories™ to improve classroom behavior for adolescents with intellectual disabilities.

    Kim, Mi-Seon; Blair, Kwang-Sun Cho; Lim, Kyoung-Won

    2014-09-01

    The present study examined the use of tablet assisted Social Stories™ intervention for three high school students with severe intellectual disabilities whose problem behavior interfered with their learning and caused classroom disruptions. A multiple probe design across participants was employed to test the impact of the tablet assisted SS on the participants' target behaviors. During intervention, the participants read the Social Stories that were created on Prezi and accessed via Quick Response (QR) codes using a Galaxy Tap smart tablet before participating in an academic period. Data indicated that the SS intervention decreased disruptive behavior and increased academic engagement in all three participants. All three demonstrated generalization of behaviors to a nontargeted academic period and maintenance of improved behaviors at the 2-week follow-up. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Combined visual and motor evoked potentials predict multiple sclerosis disability after 20 years.

    Schlaeger, Regina; Schindler, Christian; Grize, Leticia; Dellas, Sophie; Radue, Ernst W; Kappos, Ludwig; Fuhr, Peter

    2014-09-01

    The development of predictors of multiple sclerosis (MS) disability is difficult due to the complex interplay of pathophysiological and adaptive processes. The purpose of this study was to investigate whether combined evoked potential (EP)-measures allow prediction of MS disability after 20 years. We examined 28 patients with clinically definite MS according to Poser's criteria with Expanded Disability Status Scale (EDSS) scores, combined visual and motor EPs at entry (T0), 6 (T1), 12 (T2) and 24 (T3) months, and a cranial magnetic resonance imaging (MRI) scan at T0 and T2. EDSS testing was repeated at year 14 (T4) and year 20 (T5). Spearman rank correlation was used. We performed a multivariable regression analysis to examine predictive relationships of the sum of z-transformed EP latencies (s-EPT0) and other baseline variables with EDSST5. We found that s-EPT0 correlated with EDSST5 (rho=0.72, pdisability in MS. © The Author(s) 2014.

  2. Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability.

    Jasse, Laurence; Vukusic, Sandra; Durand-Dubief, Françoise; Vartin, Cristina; Piras, Carolina; Bernard, Martine; Pélisson, Denis; Confavreux, Christian; Vighetto, Alain; Tilikete, Caroline

    2013-10-01

    The objective of this article is to evaluate in multiple sclerosis (MS) patients the prevalence of persistent complaints of visual disturbances and the mechanisms and resulting functional disability of persistent visual complaints (PVCs). Firstly, the prevalence of PVCs was calculated in 303 MS patients. MS-related data of patients with or without PVCs were compared. Secondly, 70 patients with PVCs performed an extensive neuro-ophthalmologic assessment and a vision-related quality of life questionnaire, the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25). PVCs were reported in 105 MS patients (34.6%). Patients with PVCs had more frequently primary progressive MS (30.5% vs 13.6%) and more neuro-ophthalmologic relapses (1.97 vs 1.36) than patients without PVCs. In the mechanisms/disability study, an afferent visual and an ocular-motor pathways dysfunction were respectively diagnosed in 41 and 59 patients, mostly related to bilateral optic neuropathy and bilateral internuclear ophthalmoplegia. The NEI-VFQ 25 score was poor and significantly correlated with the number of impaired neuro-ophthalmologic tests. Our study emphasizes the high prevalence of PVC in MS patients. Regarding the nature of neuro-ophthalmologic deficit, our results suggest that persistent optic neuropathy, as part of the progressive evolution of the disease, is not rare. We also demonstrate that isolated ocular motor dysfunctions induce visual disability in daily life.

  3. Leptomeningeal Contrast Enhancement Is Associated with Disability Progression and Grey Matter Atrophy in Multiple Sclerosis

    Gleb Makshakov

    2017-01-01

    Full Text Available Leptomeningeal contrast enhancement (LMCE on magnetic resonance imaging (MRI is a newly recognized possible biomarker in multiple sclerosis (MS, associated with MS progression and cortical atrophy. In this study, we aimed to assess the prevalence of LMCE foci and their impact on neurodegeneration and disability. Materials. 54 patients with MS were included in the study. LMCE were detected with a 3 Tesla scanner on postcontrast fluid-attenuated inversion-recovery (FLAIR sequence. Expanded Disability Status Scale (EDSS score, number of relapses during 5 years from MS onset, and number of contrast-enhancing lesions on T1 weighted MRI were counted. Results. LMCE was detected in 41% (22/54 of patients. LMCE-positive patients had longer disease duration (p=0,0098 and higher EDSS score (p=0,039, but not a higher relapse rate (p=0,091. No association of LMCE with higher frequency of contrast-enhancing lesions on T1-weighted images was detected (p=0,3842. Analysis of covariates, adjusted for age, sex, and disease duration, revealed a significant effect of LMCE on the cortex volume (p=0.043, F=2.529, the total grey matter volume (p=0.043, F=2.54, and total ventricular volume (p=0.039, F=2.605. Conclusions. LMCE was shown to be an independent and significant biomarker of grey matter atrophy and disability in MS.

  4. Improved Durand-equation for multiple application

    Weber, M.

    1986-01-01

    The applicability of Durand's equation could be improved for general use by applying suitable parameters representing the grain-size distribution. Thus, the Durand equation cannot only describe polydisperse (pseudo)-homogeneous or heterogeneous transportation, but also solid-fluid mixtures containing a certain amount of fine particles. Even non-Newtonian influences can be taken into account. The applicability of the extended Durand equation for polydisperse mixtures will be demonstrated by measurement data. With respect to this, the transition between pseudohomogeneous and heterogeneous transport has been considered on the basis of measured concentration profiles

  5. The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability.

    Scalfari, Antonio; Neuhaus, Anneke; Degenhardt, Alexandra; Rice, George P; Muraro, Paolo A; Daumer, Martin; Ebers, George C

    2010-07-01

    The relationship of relapses to long-term disability in multiple sclerosis is uncertain. Relapse reduction is a common therapeutic target but clinical trials have shown dissociation between relapse suppression and disability accumulation. We investigated relationships between relapses and disability progression for outcomes of requiring assistance to walk, being bedridden and dying from multiple sclerosis [Disability Status Scale 6, 8, 10] by analysing 28 000 patient-years of evolution in 806-bout onset patients from the London Ontario natural history cohort. Having previously shown no effect of relapse frequency among progressive multiple sclerosis subtypes, here we examined these measures in the pre-progressive or relapsing-remitting phase. Survival was compared among groups stratified by (i) early relapses--number of attacks during the first 2 years of multiple sclerosis; (ii) length of first inter-attack interval; (iii) interval between onset and Disability Status Scale 3 (moderate disability); (iv) number of attacks from the third year of disease up to onset of progression; and (v) during the entire relapsing-remitting phase. Early clinical features can predict hard disability outcomes. Frequent relapses in the first 2 years and shorter first inter-attack intervals predicted shorter times to reach hard disability endpoints. Attack frequencies, in the first 2 years, of 1 versus >or=3, gave differences of 7.6, 12.8 and 20.3 years in times from disease onset to Disability Status Scale 6, 8 and 10, respectively. Time to Disability Status Scale 3 highly and independently predicted time to Disability Status Scale 6, 8 and 10. In contrast, neither total number of relapsing-remitting phase attacks nor of relapses experienced during the relapsing-remitting phase after the second year up to onset of progression showed a deleterious effect on times from disease onset, from progression onset and from Disability Status Scale 3 to these hard endpoints. The failure of a

  6. Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis.

    Shirani, Afsaneh; Zhao, Yinshan; Karim, Mohammad Ehsanul; Evans, Charity; Kingwell, Elaine; van der Kop, Mia L; Oger, Joel; Gustafson, Paul; Petkau, John; Tremlett, Helen

    2012-07-18

    Interferon beta is widely prescribed to treat multiple sclerosis (MS); however, its relationship with disability progression has yet to be established. To investigate the association between interferon beta exposure and disability progression in patients with relapsing-remitting MS. Retrospective cohort study based on prospectively collected data (1985-2008) from British Columbia, Canada. Patients with relapsing-remitting MS treated with interferon beta (n = 868) were compared with untreated contemporary (n = 829) and historical (n = 959) cohorts. The main outcome measure was time from interferon beta treatment eligibility (baseline) to a confirmed and sustained score of 6 (requiring a cane to walk 100 m; confirmed at >150 days with no measurable improvement) on the Expanded Disability Status Scale (EDSS) (range, 0-10, with higher scores indicating higher disability). A multivariable Cox regression model with interferon beta treatment included as a time-varying covariate was used to assess the hazard of disease progression associated with interferon beta treatment. Analyses also included propensity score adjustment to address confounding by indication. The median active follow-up times (first to last EDSS measurement) were as follows: for the interferon beta-treated cohort, 5.1 years (interquartile range [IQR], 3.0-7.0 years); for the contemporary control cohort, 4.0 years (IQR, 2.1-6.4 years); and for the historical control cohort, 10.8 years (IQR, 6.3-14.7 years). The observed outcome rates for reaching a sustained EDSS score of 6 were 10.8%, 5.3%, and 23.1% in the 3 cohorts, respectively. After adjustment for potential baseline confounders (sex, age, disease duration, and EDSS score), exposure to interferon beta was not associated with a statistically significant difference in the hazard of reaching an EDSS score of 6 when either the contemporary control cohort (hazard ratio, 1.30; 95% CI, 0.92-1.83; P = .14) or the historical control cohort (hazard ratio, 0

  7. Improving Work Participation of Young Adults with Physical Disabilities

    Dr. J.A.C. Verhoef

    2015-01-01

    This thesis addresses the work participation of young adults with physical disabilities caused by a chronic condition. With increasing numbers of young people with a chronic physical condition living into adulthood, knowledge about the development of work participation in these young adults and the

  8. Guidelines for Improving Employer Effectiveness in Interviewing Disabled Applicants.

    Cole, Joyce Couch; Bragman, Ruth

    1985-01-01

    This article presents a five-step, structured format to be used in preparing employers for conducting interviews with disabled applicants. Described in this article is a straightforward, convenient tool that can also be used by rehabilitation personnel when providing awareness training and employer education. (Author)

  9. Improving Flash Flood Prediction in Multiple Environments

    Broxton, P. D.; Troch, P. A.; Schaffner, M.; Unkrich, C.; Goodrich, D.; Wagener, T.; Yatheendradas, S.

    2009-12-01

    Flash flooding is a major concern in many fast responding headwater catchments . There are many efforts to model and to predict these flood events, though it is not currently possible to adequately predict the nature of flash flood events with a single model, and furthermore, many of these efforts do not even consider snow, which can, by itself, or in combination with rainfall events, cause destructive floods. The current research is aimed at broadening the applicability of flash flood modeling. Specifically, we will take a state of the art flash flood model that is designed to work with warm season precipitation in arid environments, the KINematic runoff and EROSion model (KINEROS2), and combine it with a continuous subsurface flow model and an energy balance snow model. This should improve its predictive capacity in humid environments where lateral subsurface flow significantly contributes to streamflow, and it will make possible the prediction of flooding events that involve rain-on-snow or rapid snowmelt. By modeling changes in the hydrologic state of a catchment before a flood begins, we can also better understand the factors or combination of factors that are necessary to produce large floods. Broadening the applicability of an already state of the art flash flood model, such as KINEROS2, is logical because flash floods can occur in all types of environments, and it may lead to better predictions, which are necessary to preserve life and property.

  10. Mildly disabled persons with multiple sclerosis use similar net joint power strategies as healthy controls when walking speed increases.

    Brincks, John; Christensen, Lars Ejsing; Rehnquist, Mette Voigt; Petersen, Jesper; Sørensen, Henrik; Dalgas, Ulrik

    2018-01-01

    To improve walking in persons with multiple sclerosis (MS), it is essential to understand the underlying mechanisms of walking. This study examined strategies in net joint power generated or absorbed by hip flexors, hip extensors, hip abductors, knee extensors, and plantar flexors in mildly disabled persons with MS and healthy controls at different walking speeds. Thirteen persons with MS and thirteen healthy controls participated and peak net joint power was calculated using 3D motion analysis. In general, no differences were found between speed-matched healthy controls and persons with MS, but the fastest walking speed was significantly higher in healthy controls (2.42 m/s vs. 1.70 m/s). The net joint power increased in hip flexors, hip extensors, hip abductors, knee extensors and plantar flexors in both groups, when walking speed increased. Significant correlations between changes in walking speed and changes in net joint power of plantar flexors, hip extensors and hip flexors existed in healthy controls and persons with MS, and in net knee extensor absorption power of persons with MS only. In contrast to previous studies, these findings suggest that mildly disabled persons with MS used similar kinetic strategies as healthy controls to increase walking speed.

  11. Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain, according to disability

    Gubieras Laura

    2006-11-01

    Full Text Available Abstract Background Multiple sclerosis (MS is an incurable chronic disease that predominantly affects young adults. It has a high socio-economic impact which increases as disability progresses. An assessment of the real costs of MS may contribute to our knowledge of the disease and to treat it more efficiently. Our objective is to assess the direct and indirect costs of MS from a societal perspective, in patients monitored in our MS Unit (Baix Llobregat, Catalonia and grouped according to their disability (EDSS. Methods We analysed data from 200 MS patients, who answered a questionnaire on resource consumption, employment and economical status. Mean age was 41.6 years, mean EDSS 2.7, 65.5% of patients were female, 79.5% had a relapsing-remitting course, and 67.5% of them were receiving immunomodulatory treatment (IT. Patients were grouped into five EDSS stages. Data from the questionnaires, hospital charts, Catalan Health Service tariffs, and figures from Catalan Institute of Statistics were used to calculate the direct and indirect costs. The cost-of-illness method, and the human capital approach for indirect costs, were applied. Sensitivity analyses were performed to strengthen results. Results The mean total annual cost of MS per patient results 24272 euros. This cost varied according to EDSS: 14327 euros (EDSS = 0, 18837 euros (EDSS = 1–3, 27870 euros (EDSS = 3.5–5.5, 41198 euros (EDSS = 6–7 and 52841 euros (EDSS>7.5. When the mean total annual costs was adjusted by the mean % of patients on IT in our Unit (31% the result was 19589 euros. The key-drivers for direct costs were IT in low EDSS stages, and caregiver costs in high stages. Indirect costs were assessed in terms of the loss of productivity when patients stop working. Direct costs accounted for around 60% of total costs in all EDSS groups. IT accounts from 78% to 11% of direct costs, and decreased as disability progressed. Conclusion The total mean social costs of MS in a

  12. Deep gray matter volume loss drives disability worsening in multiple sclerosis

    Prados, Ferran; Brownlee, Wallace J.; Altmann, Daniel R.; Tur, Carmen; Cardoso, M. Jorge; De Angelis, Floriana; van de Pavert, Steven H.; Cawley, Niamh; De Stefano, Nicola; Stromillo, M. Laura; Battaglini, Marco; Ruggieri, Serena; Gasperini, Claudio; Filippi, Massimo; Rocca, Maria A.; Rovira, Alex; Sastre‐Garriga, Jaume; Vrenken, Hugo; Leurs, Cyra E.; Killestein, Joep; Pirpamer, Lukas; Enzinger, Christian; Ourselin, Sebastien; Wheeler‐Kingshott, Claudia A.M. Gandini; Chard, Declan; Thompson, Alan J.; Alexander, Daniel C.; Barkhof, Frederik; Ciccarelli, Olga

    2018-01-01

    Objective Gray matter (GM) atrophy occurs in all multiple sclerosis (MS) phenotypes. We investigated whether there is a spatiotemporal pattern of GM atrophy that is associated with faster disability accumulation in MS. Methods We analyzed 3,604 brain high‐resolution T1‐weighted magnetic resonance imaging scans from 1,417 participants: 1,214 MS patients (253 clinically isolated syndrome [CIS], 708 relapsing‐remitting [RRMS], 128 secondary‐progressive [SPMS], and 125 primary‐progressive [PPMS]), over an average follow‐up of 2.41 years (standard deviation [SD] = 1.97), and 203 healthy controls (HCs; average follow‐up = 1.83 year; SD = 1.77), attending seven European centers. Disability was assessed with the Expanded Disability Status Scale (EDSS). We obtained volumes of the deep GM (DGM), temporal, frontal, parietal, occipital and cerebellar GM, brainstem, and cerebral white matter. Hierarchical mixed models assessed annual percentage rate of regional tissue loss and identified regional volumes associated with time‐to‐EDSS progression. Results SPMS showed the lowest baseline volumes of cortical GM and DGM. Of all baseline regional volumes, only that of the DGM predicted time‐to‐EDSS progression (hazard ratio = 0.73; 95% confidence interval, 0.65, 0.82; p < 0.001): for every standard deviation decrease in baseline DGM volume, the risk of presenting a shorter time to EDSS worsening during follow‐up increased by 27%. Of all longitudinal measures, DGM showed the fastest annual rate of atrophy, which was faster in SPMS (–1.45%), PPMS (–1.66%), and RRMS (–1.34%) than CIS (–0.88%) and HCs (–0.94%; p < 0.01). The rate of temporal GM atrophy in SPMS (–1.21%) was significantly faster than RRMS (–0.76%), CIS (–0.75%), and HCs (–0.51%). Similarly, the rate of parietal GM atrophy in SPMS (–1.24‐%) was faster than CIS (–0.63%) and HCs (–0.23%; all p values <0.05). Only the atrophy rate in DGM in patients was significantly associated

  13. Mobility disability and the pattern of accelerometer-derived sedentary and physical activity behaviors in people with multiple sclerosis

    Ezeugwu, Victor; Klaren, Rachel E.; A. Hubbard, Elizabeth; Manns, Patricia (Trish); Motl, Robert W.

    2015-01-01

    Objective Low physical activity and high sedentary behavior levels are major concerns in persons with multiple sclerosis (MS) and these differ depending on the level of mobility disability. However, the manner in which daily activity is accumulated is currently unknown in this population. Methods A secondary analysis was performed on a combined data set of persons with MS from two previous investigations of physical activity and symptomatic or quality of life outcomes in the United States over a two year period (2007–2009). Mobility disability status was determined using the Patient Determined Disease Steps (PDDS) while activity behavior was objectively monitored using an ActiGraph accelerometer for 7 days. Results Persons with MS who have mobility disability were involved in sedentary behavior, light and moderate intensity activity for 65%, 34% and 1% of the day, respectively compared to 60%, 37%, and 3%, respectively in those without mobility disability (p mobility disability status. Compared to those without mobility disability, the average number of sedentary bouts longer than 30 min was greater in those with mobility disability (p = 0.016). Conclusion Persons with MS with mobility disability are less active, engage in more sedentary behavior and accumulate prolonged sedentary bouts. PMID:26844077

  14. 76 FR 77238 - Submission for OMB Review; Comment Request; The SSA-NIH Collaboration to Improve the Disability...

    2011-12-12

    ... Collaboration to Improve the Disability Determination Process: Validation of IRT-CAT tools. Type of Information...; Comment Request; The SSA-NIH Collaboration to Improve the Disability Determination Process: Validation of... being developed to assist in the SSA disability determination process. The utilization of CAT technology...

  15. Developing a service improvement initiative for people with learning disabilities in hospice settings.

    Springall, Fiona

    2018-03-21

    People with learning disabilities are often marginalised in healthcare, including in hospice settings, and as a result may not receive effective end of life care. Research in hospice settings has identified that many staff lack confidence, skills and knowledge in caring for people with learning disabilities, which can have a negative effect on the care these individuals receive. To address these issues, the author has proposed a service improvement initiative, which she developed as part of her learning disability nursing degree programme. This proposed initiative aimed to enhance end of life care for people with learning disabilities through the implementation of a community learning disability link nurse in the hospice setting. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  16. Improving Accessibility to Medical Services for Persons with Disabilities in Thailand

    Anpatcha Sakhornkhan

    2012-06-01

    Full Text Available Purpose: This action research aimed at developing an action plan to improve the accessibility to home health care and assistive devices for persons with disabilities in a rural community, and to evaluate changes in the numbers of such persons who received appropriate home health care and assistive devices after a three-month implementation of the action plan.Method: The study was conducted at a sub-district of Maha Sarakham Province, Thailand. The main beneficiaries were 99 persons with disabilities (mean age55.4±18.7 years. Group meetings were organised for persons with disabilities, caregivers, and various community members. An action plan for improving the accessibility of persons with disabilities to home health care and assistive devices was collaboratively formulated and implemented for three months.Results: The main strategy for improving accessibility was to increase the competency of village health volunteers in providing home health care and assistive devices to persons with disabilities. After the three-month action plan implementation, the number of persons with disabilities who received appropriate home health care, i.e. at least once a month, significantly increased from 33.3% to 72.2% (Chi-square test, PConclusions: Under the supervision of physical therapists and/or other allied health professionals, the village health volunteer is likely to be a key person for improving the accessibility to home health care and assistive devices for persons with disabilities in a rural community.Limitations: The study was limited to only one sub-district. No comparable areas were studied. Further, since the study recruited persons with disabilities from a rural community, applicability of the findings to persons with disabilities in an urban community should be considered judiciously.

  17. Predictors of Functional Improvement and Future Work Status After the Disability Benefit Claim: A Prospective Cohort Study

    Cornelius, L.R.; van der Klink, J.J.L.; de Boer, M.R.; Groothoff, J.W.; Brouwer, S.

    2014-01-01

    Objective In most industrialized countries, disability benefit rates have increased substantially in the past decade. Few beneficiaries return into employment once disability benefit is awarded. The present study aims to investigate which factors predict functional improvement and future work status

  18. What parents find important in the support of a child with profound intellectual and multiple disabilities.

    Jansen, S L G; van der Putten, A A J; Vlaskamp, C

    2013-05-01

    The importance of a partnership between parents and professionals in the support of children with disabilities is widely acknowledged and is one of the key elements of 'family-centred care'. To what extent family-centred principles are also applied to the support of persons with profound intellectual and multiple disabilities (PIMD) is not yet known. The purpose of this exploratory study was to examine what parents with a child with PIMD find important in the support of their child. In addition, we examined which child or parent characteristics influence these parental opinions. In total, 100 parents completed an adapted version of the Measure of Processes of Care. Mean unweighted and weighted scale scores were computed. Non-parametric tests were used to examine differences in ratings due to child (gender, age, type and number of additional disabilities, type of services used and duration of service use) and parent characteristics (gender, involvement with support and educational level). Parents rated situations related to 'Respectful and Supportive Care' and 'Enabling and Partnership' with averages of 7.07 and 6.87 respectively on a scale from 1 to 10. They were generally satisfied with the services provided, expressed in a mean score of 6.88 overall. The age of the child significantly affected the scores for 'Providing Specific Information about the Child'. Parents of children in the '6-12 years' age group gave significantly higher scores on this scale than did parents of children in the '≥17 years' age group (U = 288, r = -0.34). This study shows that parents with children with PIMD find family-centred principles in the professional support of their children important. Although the majority of parents are satisfied with the support provided for their children, a substantial minority of the parents indicated that they did not receive the support they find important. © 2012 Blackwell Publishing Ltd.

  19. Extending technology-aided leisure and communication programs to persons with spinal cord injury and post-coma multiple disabilities.

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Ricciuti, Riccardo A; Trignani, Roberto; Oliva, Doretta; Signorino, Mario; D'Amico, Fiora; Sasanelli, Giovanni

    2015-01-01

    These two studies extended technology-aided programs to promote leisure and communication opportunities to a man with cervical spinal cord injury and a post-coma man with multiple disabilities. The studies involved the use of ABAB designs, in which A and B represented baseline and intervention phases, respectively. The programs focused on enabling the participants to activate songs, videos, requests, text messages, and telephone calls. These options were presented on a computer screen and activated through a small pressure microswitch by the man with spinal cord injury and a special touch screen by the post-coma man. To help the latter participant, who had no verbal skills, with requests and telephone calls, series of words and phrases were made available that he could activate in those situations. Data showed that both participants were successful in managing the programs arranged for them. The man with spinal cord injury activated mean frequencies of above five options per 10-min session. The post-coma man activated mean frequencies of about 12 options per 20-min session. Technology-aided programs for promoting leisure and communication opportunities might be successfully tailored to persons with spinal cord injury and persons with post-coma multiple disabilities. Implications for Rehabilitation Technology-aided programs may be critical to enable persons with pervasive motor impairment to engage in leisure activities and communication events independently. Persons with spinal cord injury, post-coma extended brain damage, and forms of neurodegenerative disease, such as amyotrophic lateral sclerosis, may benefit from those programs. The programs could be adapted to the participants' characteristics, both in terms of technology and contents, so as to improve their overall impact on the participants' functioning and general mood.

  20. Reduced gamma-aminobutyric acid concentration is associated with physical disability in progressive multiple sclerosis

    Solanky, Bhavana S.; Muhlert, Nils; Tur, Carmen; Edden, Richard A. E.; Wheeler-Kingshott, Claudia A. M.; Miller, David H.; Thompson, Alan J.; Ciccarelli, Olga

    2015-01-01

    Neurodegeneration is thought to be the major cause of ongoing, irreversible disability in progressive stages of multiple sclerosis. Gamma-aminobutyric acid is the principle inhibitory neurotransmitter in the brain. The aims of this study were to investigate if gamma-aminobutyric acid levels (i) are abnormal in patients with secondary progressive multiple sclerosis compared with healthy controls; and (ii) correlate with physical and cognitive performance in this patient population. Thirty patients with secondary progressive multiple sclerosis and 17 healthy control subjects underwent single-voxel MEGA-PRESS (MEscher-GArwood Point RESolved Spectroscopy) magnetic resonance spectroscopy at 3 T, to quantify gamma-aminobutyric acid levels in the prefrontal cortex, right hippocampus and left sensorimotor cortex. All subjects were assessed clinically and underwent a cognitive assessment. Multiple linear regression models were used to compare differences in gamma-aminobutyric acid concentrations between patients and controls adjusting for age, gender and tissue fractions within each spectroscopic voxel. Regression was used to examine the relationships between the cognitive function and physical disability scores specific for these regions with gamma-aminobuytric acid levels, adjusting for age, gender, and total N-acetyl-aspartate and glutamine-glutamate complex levels. When compared with controls, patients performed significantly worse on all motor and sensory tests, and were cognitively impaired in processing speed and verbal memory. Patients had significantly lower gamma-aminobutyric acid levels in the hippocampus (adjusted difference = −0.403 mM, 95% confidence intervals −0.792, −0.014, P = 0.043) and sensorimotor cortex (adjusted difference = −0.385 mM, 95% confidence intervals −0.667, −0.104, P = 0.009) compared with controls. In patients, reduced motor function in the right upper and lower limb was associated with lower gamma-aminobutyric acid

  1. Sunlight exposure and sun sensitivity associated with disability progression in multiple sclerosis.

    D'hooghe, M B; Haentjens, P; Nagels, G; Garmyn, M; De Keyser, J

    2012-04-01

    Sunlight and vitamin D have been inversely associated with the risk of multiple sclerosis (MS). We investigated sunlight exposure and sun sensitivity in relation to disability progression in MS. We conducted a survey among persons with MS, registered by the Flemish MS society, Belgium, and stratified data according to relapsing-onset and progressive-onset MS. We used Kaplan-Meier survival and Cox proportional hazard regression analyses with time to Expanded Disability Status Scale (EDSS) 6 as outcome measure. Hazard ratios for the time from onset and from birth were calculated for the potentially predictive variables, adjusting for age at onset, gender and immunomodulatory treatment. 704 (51.3%) of the 1372 respondents had reached EDSS 6. In relapsing-onset MS, respondents reporting equal or higher levels of sun exposure than persons of the same age in the last 10 years had a decreased risk of reaching EDSS 6. In progressive-onset MS, increased sun sensitivity was associated with an increased hazard of reaching EDSS 6. The association of higher sun exposure with a better outcome in relapsing-onset MS may be explained by either a protective effect or reverse causality. Mechanisms underlying sun sensitivity might influence progression in progressive-onset MS.

  2. Resilience Processes Supporting Adolescents With Intellectual Disability: A Multiple Case Study.

    Hall, Anna-Marié; Theron, Linda C

    2016-02-01

    Resilience, or the process of adjusting well to risk, relies on constructive collaboration between youths and their social ecologies. Although the literature details the risks of an intellectual disability (ID), there is little explanation of why some young people cope well despite these risks. Accordingly, we report a multiple case study that affords insight into the resilience of 24 adolescents with ID. Using a draw-and-talk methodology, these young people explained their resilience as enabled primarily by supportive social ecologies (which facilitated behavioral and emotional regulation, encouraged mastery, treated them as agentic beings, and offered safe spaces). Adolescents' positive orientation to their life-worlds co-facilitated their resilience. These insights advance effective ways to champion the resilience of young people with ID.

  3. An access technology delivery protocol for children with severe and multiple disabilities: a case demonstration.

    Mumford, Leslie; Lam, Rachel; Wright, Virginia; Chau, Tom

    2014-08-01

    This study applied response efficiency theory to create the Access Technology Delivery Protocol (ATDP), a child and family-centred collaborative approach to the implementation of access technologies. We conducted a descriptive, mixed methods case study to demonstrate the ATDP method with a 12-year-old boy with no reliable means of access to an external device. Evaluations of response efficiency, satisfaction, goal attainment, technology use and participation were made after 8 and 16 weeks of training with a custom smile-based access technology. At the 16 week mark, the new access technology offered better response quality; teacher satisfaction was high; average technology usage was 3-4 times per week for up to 1 h each time; switch sensitivity and specificity reached 78% and 64%, respectively, and participation scores increased by 38%. This case supports further development and testing of the ATDP with additional children with multiple or severe disabilities.

  4. Movement disorders in multiple sclerosis and neuromyelitis optica: A clinical marker of neurological disability.

    Candeias da Silva, Carolina; Bichuetti, Denis Bernardi; Azevedo Silva, Sonia Maria Cesar de; Ferraz, Henrique Ballalai; Oliveira, Enedina Maria Lobato de; Borges, Vanderci

    2018-03-03

    Movement disorders are not rare in demyelinating diseases but there are few studies comparing their frequency between multiple sclerosis and neuromyelitis optica spectrum disorder. Our aim was to determine the frequency and the related features of movement disorders in a cohort of patients with multiple sclerosis and neuromyelitis optica spectrum disorder. It is a cross-sectional study of patients with multiple sclerosis and neuromyelitis optica spectrum disorder. Patients were evaluated by a movement disorder specialist. Data from a personal interview and neurological examination were collected. Fahn-Tolosa-Marin tremor rating scale was used for tremor evaluation. Health-related quality of life was assessed using EuroQol instrument. Two hundred fifty-three patients were included (mean [SD] age, 40 [12] years; 74.3% female; median [IQR] EDSS score 2.5 [1.0-6.0]); 26% presented with movement disorders. Paroxysmal dystonia (n = 32) and tremor (n = 27) were the most common movement disorders. Patients with multiple sclerosis and low Expanded Disability Status Scale score (below 4.0) have fewer movement disorders than patients with neuromyelitis optica spectrum disorder. The diagnosis of neuromyelitis optica spectrum disorder was strongly associated with paroxysmal dystonia (OR = 22.07, 95% CI = 2.56-189.78; p = 0.005). Patients with multiple sclerosis and patients without movement disorders have a slightly better quality of life. Paroxysmal dystonia was the most common movement disorder in demyelinating diseases and strongly associated with neuromyelitis optica spectrum disorder. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. Involving users with learning difficulties in health improvement: lessons from inclusive learning disability research.

    Walmsley, Jan

    2004-03-01

    In this paper the author considers the lessons to be drawn from what is termed "inclusive" learning disability research for user involvement around health improvement. Inclusive learning disability research refers to research where people with learning difficulties (intellectual disability) are involved as active participants, as opposed to passive subjects. There is by now a considerable body of such research, developed over the past 25 years. From the review, the author draws attention to areas which can inform practice in involvement of users in a way that adds value.

  6. [Psychological distress of children with progressive diseases and multiple disabilities: A crossed analysis].

    Perifano, A; Scelles, R

    2015-09-01

    In this paper, we present the results of research conducted on the psychological distress of lysosomal-disease-affected children. Lysosomal diseases are rare genetic diseases most often leading to severe disabilities, both psychological and physiological. As frequently reported by their relatives, affected children experience nervous breakdowns, which are sometimes treated with antidepressant prescriptions. However, mental impairment as well physical disabilities can prevent children from making their pain noticed and identified by their relatives. This raises a new research question: when disabilities are severe, how should the psychological distress of affected children be identified? Recent studies on the care of children with multiple disabilities (San Salavadour 2000; Scelles 2003; Camelio 2006; Pautrel, 2009) have used the children's family and caregivers to access their feelings, considered to be translators of children's feelings because they understand their nonverbal language (Camelio, 2006). Using this methodology, four parents from the French not-for-profit association called "VML" (Vaincre les maladies lysosomales) and four professionals were involved in semi-structured interviews. The goal of these interviews was to identify signs of possible psychological suffering, the context in which those signs were expressed, the meaning and the value attributed to it by the family and caregivers, and the reaction as well as an evaluation of that reaction. Thirteen children were involved, 12 of whom were described as having shown signs of psychological distress. Six lysosomal diseases were represented. Two types of signs were reported: active signs (e.g., agitation, screaming, crying) and passive signs (e.g., no communication, withdrawal, lack of facial expression). Most of the time, passive signs were interpreted by the family and caregivers as evidence of deep psychological distress. The meanings of both types of sign were the following: fear, anxiety

  7. Strategies for improving disability awareness and social inclusion of children and young people with cerebral palsy.

    Lindsay, S; McPherson, A C

    2012-11-01

    Children and youth with disabilities are at a higher risk of being socially excluded or bullied while at school compared with their typically developing peers. This study explored disabled children's suggestions for improving social inclusion. Fifteen children with cerebral palsy were interviewed or took part in a group discussion about social inclusion and bullying. All interviews and focus groups were audio-recorded and transcribed verbatim. The children and youth described several strategies to help improve social inclusion at school including: (1) disclosure of condition and creating awareness of disability; (2) awareness of bullying; (3) developing a peer support network and building self-confidence; and (4) suggestions on what teachers can do. It is recommended that children's suggestions be considered within the classroom context to enhance the social inclusion and participation of children with disabilities. © 2011 Blackwell Publishing Ltd.

  8. Genetic Factors Associated with Risk and Disability Progression of Multiple Sclerosis in Slovak Population

    Hanysova Sandra

    2017-08-01

    Full Text Available Objective: The aim of our study was to determine the relation of particular genetic variants in selected genes (GSTM1, GSTT1 null genotypes; rs1695 GSTP1; rs10735781 EVI5 to the risk of multiple sclerosis (MS development and find out the possible association with disease disability progression rate. Material and methods: Our study included 202 MS patients and 174 healthy control volunteers. MS patients were divided according to disability progression rate to three groups - slowly progressing, mid-rate progressing and rapidly progressing. All DNA samples were isolated from venous blood. Genotyping was performed by PCR-RFLP and multiplex PCR. Results: Our analysis showed that GSTT1 null genotype (OR 0.56; 95%CI 0.33 -0.95; p=0.04 and GSTM1, GSTT1 double null genotype (OR 0.32; 95%CI 0.14 - 0.74; p=0.006 are potentially protective in relation to MS. We observed similar result in GSTT1 null genotype in association with mid-rate progression (OR 0.48; 95%CI 0.24 - 0.97; p=0.05. Frequency of GSTM1 and GSTT1 double null genotype is significantly lower in subgroup of MS patients with progression rate defined as slow (OR 0.22; 95%CI 0.05 - 0.98; p=0.05 and middle (OR 0.33; 95%CI 0.11 - 0.99; p=0.045. We did not show any significant association of genetic changes rs1695 in GSTP1 and rs10735781 in EVI5 with MS or rate of disease progression. Conclusions: Genetic basis of multiple sclerosis is still not fully elucidated. Further research may clarify our results and confirm the value of studied factors for clinical practice.

  9. A fast track path improves access to palliative care for people with learning disabilities.

    Whitington, Jane; Ma, Peng

    People with learning disabilities often experience inequalities in accessing general health services. This group, their families and carers need access to effective palliative care when facing a life limiting illness. This article describes the development and implementation of a fast track referral pathway for people with learning disabilities at St Francis Hospice in Essex. Our aim is to share this pathway so others can replicate the collaborative working to improve access to palliative care services for this group.

  10. Spelling on the fly: investigating a pentop computer to improve the spelling skills of three elementary students with disabilities.

    Doughty, Teresa Taber; Bouck, Emily C; Bassette, Laura; Szwed, Kathryn; Flanagan, Sara

    2013-01-01

    The purpose of this study was to examine the effects of a pentop computer and accompanying spelling software on the spelling accuracy and academic engagement behavior in three elementary students with disabilities who were served in a resource room setting. Using a multiple baseline across students single subject research design, researchers determined student use of the pentop computer--the FLYPen--and its spelling software may serve as an equivalent intervention to traditional spelling instruction. While academic engagement performance increased considerably for students when using the FLYPen, results indicated little to no improvement over traditional instruction in spelling accuracy. Implications and suggestions for future research are presented.

  11. The effect of exercise training in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions.

    Edwards, Thomas; Pilutti, Lara A

    2017-08-01

    There is evidence for the benefits of exercise training in persons with multiple sclerosis (MS). However, these benefits have primarily been established in individuals with mild-to-moderate disability (i.e., Expanded Disability Status Scale [EDSS] scores 1.0-5.5), rather than among those with significant mobility impairment. Further, the approaches to exercise training that have been effective in persons with mild-to-moderate MS disability may not be physically accessible for individuals with mobility limitations. Therefore, there is a demand for an evidence-base on the benefits of physically accessible exercise training approaches for managing disability in people with MS with mobility impairment. To conduct a systematic review of the current literature pertaining to exercise training in individuals with multiple sclerosis (MS) with severe mobility disability. Four electronic databases (PubMed, EMBASE, OvidMEDLINE, and PsychINFO) were searched for relevant articles published up until October 2016. The review focused on English-language studies that examined the effect of exercise training in people with MS with severe mobility disability, characterized as the need for assistance in ambulation or EDSS score ≥ 6.0. The inclusion criteria involved full-text articles that: (i) included participants with a diagnosis of MS; (ii) included primarily participants with a reported EDSS score ≥ 6.0 and/or definitively described disability consistent with this level of neurological impairment; and (iii) implemented a prospective, structured exercise intervention. Data were analyzed using a descriptive approach and summarized by exercise training modality (conventional or adapted exercise training), and by outcome (disability, physical fitness, physical function, and symptoms and participation). Initially, 1164 articles were identified and after removal of duplicates, 530 articles remained. In total, 512 articles did not meet the inclusion criteria. 19 articles were

  12. Use of International Classification of Functioning, Disability and Health (ICF) to describe patient-reported disability in multiple sclerosis and identification of relevant environmental factors.

    Khan, Fary; Pallant, Julie F

    2007-01-01

    To use the International Classification of Functioning, Disability and Health (ICF) to describe patient-reported disability in multiple sclerosis and identify relevant environmental factors. Cross-sectional survey of 101 participants in the community. Their multiple sclerosis-related problems were linked with ICF categories (second level) using a checklist, consensus between health professionals and the "linking rules". The impact of multiple sclerosis on health areas corresponding to 48 ICF categories was also assessed. A total of 170 ICF categories were identified (mean age 49 years, 72 were female). Average number of problems reported was 18. The categories include 48 (42%) for body function, 16 (34%) body structure, 68 (58%) activities and participation and 38 (51%) for environmental factors. Extreme impact in health areas corresponding to ICF categories for activities and participation were reported for mobility, work, everyday home activities, community and social activities. While those for the environmental factors (barriers) included products for mobility, attitudes of extended family, restriction accessing social security and health resources. This study is a first step in the use of the ICF in persons with multiple sclerosis and towards development of the ICF Core set for multiple sclerosis from a broader international perspective.

  13. Organizational Predictors of Staff Stress, Satisfaction, and Intended Turnover in a Service for People with Multiple Disabilities.

    Hatton, Chris; Emerson, Eric

    1993-01-01

    Questionnaire data were collected from 64 direct-care staff members in a residential facility for people with multiple disabilities. Path analyses identified factors predicting levels of perceived stress, overall job satisfaction, overall life satisfaction, and perceived likelihood of leaving the organization. Factors included staff support, job…

  14. Reliability of assessing the sensory perception of children with profound intellectual and multiple disabilities : a case study

    Vlaskamp, C.; Cuppen-Fonteine, H.

    Background This study describes preliminary stages of developing a checklist to enable practitioners to determine the behavioural responses of children with profound intellectual and multiple disabilities to sensory stimuli. Reliability of currently used checklists is low, with a focus on the

  15. Motor activation in people with profound intellectual and multiple disabilities: research in daily practice in residential facilities

    Bossink, Leontien; van der Putten, Annette; Vlaskamp, Carla

    2014-01-01

    Aim: The total study aims at generating knowledge about the best way to motor activate persons with profound intellectual and multiple disabilities (PIMD) in residential facilities. The purpose of the current poster presentation is to present the results of the first step executed in this project

  16. The documentation of health problems in relation to prescribed medication in people with profound intellectual and multiple disabilities

    van der Heide, D. C.; van der Putten, A. A. J.; van den Berg, P. B.; Taxis, K.; Vlaskamp, C.

    Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed.

  17. Domains of quality of life of people with profound multiple disabilities : The perspective of parents and direct support staff

    Petry, K; Maes, B; Vlaskamp, C

    Background This study considered the general validity of the basic domains of quality of life that appear in theoretical models, in relation to people with profound multiple disabilities. The authors examined how parents and direct support staff operationalized these basic domains for people with

  18. Camera-based microswitch technology to monitor mouth, eyebrow, and eyelid responses of children with profound multiple disabilities

    Lancioni, G.E.; Bellini, D.; Oliva, D.; Singh, N.N.; O'Reilly, M.F.; Sigafoos, J.; Lang, R.B.; Didden, H.C.M.

    2011-01-01

    A camera-based microswitch technology was recently used to successfully monitor small eyelid and mouth responses of two adults with profound multiple disabilities (Lancioni et al., Res Dev Disab 31:1509-1514, 2010a). This technology, in contrast with the traditional optic microswitches used for

  19. Informal Social Networks of People with Profound Intellectual and Multiple Disabilities: Relationship with Age, Communicative Abilities and Current Living Arrangements

    Kamstra, A.; van der Putten, A. A. J.; Post, W. J.; Vlaskamp, C.

    2015-01-01

    Background: People with profound intellectual and multiple disabilities (PIMD) have limited informal social contacts. Research to determine the factors which can positively influence establishing sound informal social contacts is required. Materials and Methods: Regression analysis for 200 people with PIMD was used to analyse how age,…

  20. A Field Study of a Standardized Tangible Symbol System for Learners Who Are Visually Impaired and Have Multiple Disabilities

    Trief, Ellen; Cascella, Paul W.; Bruce, Susan M.

    2013-01-01

    Introduction: The study reported in this article tracked the learning rate of 43 children with multiple disabilities and visual impairments who had limited to no verbal language across seven months of classroom-based intervention using a standardized set of tangible symbols. Methods: The participants were introduced to tangible symbols on a daily…

  1. A Girl With Multiple Disabilities Increases Object Manipulation and Reduces Hand Mouthing Through a Microswitch-Based Program

    Lancioni, G.E.; Singh, N.N.; O'Reilly, M.F.; Sigafoos, J.; Didden, H.C.M.; Oliva, D.; Cingolani, E.

    2008-01-01

    The study was an effort to help a girl with multiple disabilities increase object manipulation responses and reduce hand mouthing, carried out according to an ABAB sequence (in which A represented baseline phases; B, treatment phases) and including a 3-month follow-up. During the baseline phases, a

  2. Therapeutic interventions in the Netherlands and Belgium in support of people with profound intellectual and multiple disabilities

    Vlaskamp, Carla; Nakken, Han

    For several reasons, people with profound and multiple disabilities may be offered a variety of therapeutic interventions. Thus far, researchers have shown a limited interest in providing an empirical base for these interventions. Research is needed on the theoretical rationale (if any), the

  3. Exercise, Diet, and Stress Management as Mediators between Functional Disability and Health-Related Quality of Life in Multiple Sclerosis

    Sung, Connie; Chiu, Chung-Yi; Lee, Eun-Jeong; Bezyak, Jill; Chan, Fong; Muller, Veronica

    2013-01-01

    The main objective of this study was to examine the mediational and moderational effect of exercise, diet, and stress management on the relationship between functional disability and health-related quality of life. Quantitative descriptive research design using multiple regression and correlation techniques was used. Participants were 215…

  4. Assisting People with Multiple Disabilities Actively Correct Abnormal Standing Posture with a Nintendo Wii Balance Board through Controlling Environmental Stimulation

    Shih, Ching-Hsiang; Shih, Ching-Tien; Chu, Chiung-Ling

    2010-01-01

    The latest researches adopted software technology turning the Nintendo Wii Balance Board into a high performance change of standing posture (CSP) detector, and assessed whether two persons with multiple disabilities would be able to control environmental stimulation using body swing (changing standing posture). This study extends Wii Balance Board…

  5. The Role of the External Personal Assistants for Children with Profound Intellectual and Multiple Disabilities Working in the Children's Home

    Axelsson, Anna Karin

    2015-01-01

    Background: Children with profound intellectual and multiple disabilities need support to function in an optimal way. However, there is a limited knowledge about the role of external personal assistants working in the children's home. Materials and Methods: A mixed method study was performed including qualitative data from interviews with 11…

  6. Effects of a Voice Output Communication Aid on Interactions between Support Personnel and an Individual with Multiple Disabilities.

    Schepis, Maureen M.; Reid, Dennis H.

    1995-01-01

    A young adult with multiple disabilities (profound mental retardation, spastic quadriplegia, and visual impairment) was provided with a voice output communication aid (VOCA) which allowed communication through synthesized speech. Both educational and residential staff members interacted with the individual more frequently when she had access to…

  7. Catch the wave! Time-window sequential analysis of alertness stimulation in individuals with profound intellectual and multiple disabilities

    Munde, V. S.; Vlaskamp, C.; Maes, B.; Ruijssenaars, A. J. J. M.

    BackgroundWhile optimally activities are provided at those moments when the individual with profound intellectual and multiple disabilities (PIMD) is focused on the environment' or alert', detailed information about the impact that the design and timing of the activity has on alertness is lacking.

  8. Addressing Gender-Based Violence at Schools for Learners with Intellectual Disability in Gauteng, South Africa: A Multiple Case Study

    Phasha, T. N.; Nyokangi, D.

    2012-01-01

    This paper reports part of the findings of the study which investigated sexual violence at two schools catering specifically for learners with mild intellectual disability in Gauteng Province. It looks particularly on participants' suggestions for addressing sexual violence in such school. A multiple case study within the qualitative research…

  9. Quality-Enhancing Interventions for People with Profound Intellectual and Multiple Disabilities: A Review of the Empirical Research Literature

    Maes, Bea; Lambrechts, Greet; Hostyn, Ine; Petry, Katja

    2007-01-01

    Background: This study provides an overview of empirical research on the effectiveness of quality-enhancing interventions for people with profound intellectual and multiple disabilities (PIMD). Method: Through computerised searches of the PsycINFO and ERIC databases, and using several search criteria specifically relating to the target group and…

  10. Performed and perceived walking ability in relation to the Expanded Disability Status Scale in persons with multiple sclerosis

    Langeskov-Christensen, D; Feys, P; Baert, I

    2017-01-01

    BACKGROUND: The severity of walking impairment in persons with multiple sclerosis (pwMS) at different levels on the expanded disability status scale (EDSS) is unclear. Furthermore, it is unclear if the EDSS is differently related to performed- and perceived walking capacity tests. AIMS: To quantify...

  11. Staff attributions of the causes of challenging behaviour in children and adults with profound intellectual and multiple disabilities

    Poppes, P.; van der Putten, A.A.J.; ten Brug, A.; Vlaskamp, C.

    A study has shown that staff do not generally perceive challenging behaviour in people with profound intellectual and multiple disabilities (PIMD) as being of serious consequence. In this study we aimed to gain a better understanding of the causal explanations that direct care and support staff give

  12. iStimulation: Apple iPad Use with Children Who Are Visually Impaired, Including Those with Multiple Disabilities

    Campaña, Laura V.; Ouimet, Donald A.

    2015-01-01

    Since its creation in the early 1980s, Light Box, a product developed by the American Printing House for the Blind (APH) that is designed for working on functional vision tasks with children who have visual impairments or multiple disabilities, has been an effective tool to help teach children with visual impairments to locate and track items…

  13. Health promotion for young people with profound and multiple learning disabilities.

    Davis, Kathy; Carter, Simone; Myers, Elizabeth; Rocca, Nicola

    2018-02-07

    Research confirms that children and young people with severe learning disabilities do not have the same level of access to high-quality care, health education and health promotion activities as children and young people without disabilities. This article discusses a quality improvement, action research project to investigate alternative approaches to health promotion that enhance the health and well-being of children and young people with complex neurodisabilities. The project involved assessment of school records and completion by staff of an eight-question survey. It found that the proactive approach of school nurses in raising awareness and understanding through questioning was positively received, and reinforced how meaningful and relevant information could be delivered to these young people. The project also had unexpected benefits, including more integrated team working, increased knowledge, greater awareness and understanding of the importance of health promotion participation, and student satisfaction. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  14. Improving Test-Taking Performance of Secondary At-Risk Youth and Students with Disabilities

    Banks, Tachelle; Eaton, India

    2014-01-01

    Preparing at-risk youth and students with mild disabilities for state and district tests is important for improving their test performance, and basic instruction in test preparation can significantly improve student test performance. The article defines noncognitive variables that adversely affect test-taker performance. The article also describes…

  15. Career/Vocational Preparation for Students with Disabilities: A Program Improvement Guide.

    Stodden, Robert A.

    This program improvement guide is designed to assist district and school level interdisciplinary planning teams to improve career/vocational programs for students with disabilities. Its focus is on the integration of best practices within the educational program continuum to achieve positive student outcomes. The guide includes three sections.…

  16. Efficient Adoption and Assessment of Multiple Process Improvement Reference Models

    Simona Jeners

    2013-06-01

    Full Text Available A variety of reference models such as CMMI, COBIT or ITIL support IT organizations to improve their processes. These process improvement reference models (IRMs cover different domains such as IT development, IT Services or IT Governance but also share some similarities. As there are organizations that address multiple domains and need to coordinate their processes in their improvement we present MoSaIC, an approach to support organizations to efficiently adopt and conform to multiple IRMs. Our solution realizes a semantic integration of IRMs based on common meta-models. The resulting IRM integration model enables organizations to efficiently implement and asses multiple IRMs and to benefit from synergy effects.

  17. Using Photovoice to Include People with Profound and Multiple Learning Disabilities in Inclusive Research

    Cluley, Victoria

    2017-01-01

    Background: It is now expected that projects addressing the lives of people with learning disabilities include people with learning disabilities in the research process. In the past, such research often excluded people with learning disabilities, favouring the opinions of family members, carers and professionals. The inclusion of the voices of…

  18. Post-Coma Persons with Extensive Multiple Disabilities Use Microswitch Technology to Access Selected Stimulus Events or Operate a Radio Device

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Alberti, Gloria; Oliva, Doretta; Megna, Gianfranco; Iliceto, Carla; Damiani, Sabino; Ricci, Irene; Spica, Antonella

    2011-01-01

    The present two studies extended research evidence on the use of microswitch technology by post-coma persons with multiple disabilities. Specifically, Study I examined whether three adults with a diagnosis of minimally conscious state and multiple disabilities could use microswitches as tools to access brief, selected stimulus events. Study II…

  19. Ganglion cell loss in relation to visual disability in multiple sclerosis.

    Walter, Scott D; Ishikawa, Hiroshi; Galetta, Kristin M; Sakai, Reiko E; Feller, Daniel J; Henderson, Sam B; Wilson, James A; Maguire, Maureen G; Galetta, Steven L; Frohman, Elliot; Calabresi, Peter A; Schuman, Joel S; Balcer, Laura J

    2012-06-01

    We used high-resolution spectral-domain optical coherence tomography (SD-OCT) with retinal segmentation to determine how ganglion cell loss relates to history of acute optic neuritis (ON), retinal nerve fiber layer (RNFL) thinning, visual function, and vision-related quality of life (QOL) in multiple sclerosis (MS). Cross-sectional study. A convenience sample of patients with MS (n = 122; 239 eyes) and disease-free controls (n = 31; 61 eyes). Among MS eyes, 87 had a history of ON before enrollment. The SD-OCT images were captured using Macular Cube (200×200 or 512×128) and ONH Cube 200×200 protocols. Retinal layer segmentation was performed using algorithms established for glaucoma studies. Thicknesses of the ganglion cell layer/inner plexiform layer (GCL+IPL), RNFL, outer plexiform/inner nuclear layers (OPL+INL), and outer nuclear/photoreceptor layers (ONL+PRL) were measured and compared in MS versus control eyes and MS ON versus non-ON eyes. The relation between changes in macular thickness and visual disability was also examined. The OCT measurements of GCL+IPL and RNFL thickness; high contrast visual acuity (VA); low-contrast letter acuity (LCLA) at 2.5% and 1.25% contrast; on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement composite score. Macular RNFL and GCL+IPL were significantly decreased in MS versus control eyes (Pvisual function and vision-specific QOL in MS, and may serve as a useful structural marker of disease. Our findings parallel those of magnetic resonance imaging studies that show gray matter disease is a marker of neurologic disability in MS. Proprietary or commercial disclosure may be found after the references. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  20. Quality of Diagnosis and Treatment Plans After Using the 'Diagnostic Guideline for Anxiety and Challenging Behaviours' in People with Intellectual Disabilities: A Comparative Multiple Case Study Design.

    Pruijssers, Addy; van Meijel, Berno; Maaskant, Marian; Keeman, Noortje; van Achterberg, Theo

    2016-07-01

    People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Working with the 'Diagnostic Guideline for Anxiety and CB' leads to improved diagnoses and treatment plans compared with care as usual. © 2015 John Wiley & Sons Ltd.

  1. New camera-based microswitch technology to monitor small head and mouth responses of children with multiple disabilities.

    Lancioni, Giulio E; Bellini, Domenico; Oliva, Doretta; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Furniss, Fred

    2014-06-01

    Assessing a new camera-based microswitch technology, which did not require the use of color marks on the participants' face. Two children with extensive multiple disabilities participated. The responses selected for them consisted of small, lateral head movements and mouth closing or opening. The intervention was carried out according to a multiple probe design across responses. The technology involved a computer with a CPU using a 2-GHz clock, a USB video camera with a 16-mm lens, a USB cable connecting the camera and the computer, and a special software program written in ISO C++ language. The new technology was satisfactorily used with both children. Large increases in their responding were observed during the intervention periods (i.e. when the responses were followed by preferred stimulation). The new technology may be an important resource for persons with multiple disabilities and minimal motor behavior.

  2. Does Multiple Intelligence Improve Performance? Evidence from a ...

    This study reports the findings of a study that investigated the relationship between multiple intelligence (MI) and academic performance in higher education. It addresses one question: does MI improve academic performance? Taking the case of the finalist cohort of the university's Faculty of Education of the academic year ...

  3. Improving learning with science and social studies text using computer-based concept maps for students with disabilities.

    Ciullo, Stephen; Falcomata, Terry S; Pfannenstiel, Kathleen; Billingsley, Glenna

    2015-01-01

    Concept maps have been used to help students with learning disabilities (LD) improve literacy skills and content learning, predominantly in secondary school. However, despite increased access to classroom technology, no previous studies have examined the efficacy of computer-based concept maps to improve learning from informational text for students with LD in elementary school. In this study, we used a concurrent delayed multiple probe design to evaluate the interactive use of computer-based concept maps on content acquisition with science and social studies texts for Hispanic students with LD in Grades 4 and 5. Findings from this study suggest that students improved content knowledge during intervention relative to a traditional instruction baseline condition. Learning outcomes and social validity information are considered to inform recommendations for future research and the feasibility of classroom implementation. © The Author(s) 2014.

  4. Mothers of young adults with intellectual disability: multiple roles, ethnicity and well-being.

    Eisenhower, A; Blacher, J

    2006-12-01

    Two opposing perspectives--role strain and role enhancement--were considered as predictive of women's psychological and physical health. The authors examined the relation between multiple role occupancy (parenting, employment, marriage) and well-being (depression and health) among mothers of young adults with intellectual disability (ID). Participants were 226 mothers aged 35-70 years old caring for a young adult aged 16-26 years old with moderate to severe/profound ID. Mothers were of either Latino ethnicity (n=117) or Anglo (n=109). Mothers' ethnicity and degree of acculturation and young adults' adaptive behaviour and behaviour problems were examined as potential moderators. Mothers who were employed, married, or both reported better well-being than mothers who were both unemployed and unmarried, especially when their offspring had relatively higher adaptive functioning. This relationship between role occupancy and well-being was fully mediated by socio-economic status (SES) factors. Results did not suggest a role enhancement effect, but instead indicated a role shortage effect; unemployed, unmarried mothers experienced markedly poor well-being, while all other mothers experienced comparable well-being. Well-being scores were higher for Anglo than for Latino mothers; this relationship was entirely accounted for by SES. In Latina mothers, the relation between role occupancy and well-being was moderated by degree of acculturation. Findings suggest that multiple roles benefit mothers of young adults with ID primarily through their impact on socio-economic resources. For more acculturated Latina mothers, occupying more roles predicted better well-being even after controlling for SES. Latina mothers who were unemployed and unmarried had lower SES, and this group emerged as at particular risk. The latter group may benefit most from respite assistance and other interventions aimed at addressing their physical and mental health.

  5. A composite measure to explore visual disability in primary progressive multiple sclerosis.

    Poretto, Valentina; Petracca, Maria; Saiote, Catarina; Mormina, Enricomaria; Howard, Jonathan; Miller, Aaron; Lublin, Fred D; Inglese, Matilde

    2017-01-01

    Optical coherence tomography (OCT) and magnetic resonance imaging (MRI) can provide complementary information on visual system damage in multiple sclerosis (MS). The objective of this paper is to determine whether a composite OCT/MRI score, reflecting cumulative damage along the entire visual pathway, can predict visual deficits in primary progressive multiple sclerosis (PPMS). Twenty-five PPMS patients and 20 age-matched controls underwent neuro-ophthalmologic evaluation, spectral-domain OCT, and 3T brain MRI. Differences between groups were assessed by univariate general linear model and principal component analysis (PCA) grouped instrumental variables into main components. Linear regression analysis was used to assess the relationship between low-contrast visual acuity (LCVA), OCT/MRI-derived metrics and PCA-derived composite scores. PCA identified four main components explaining 80.69% of data variance. Considering each variable independently, LCVA 1.25% was significantly predicted by ganglion cell-inner plexiform layer (GCIPL) thickness, thalamic volume and optic radiation (OR) lesion volume (adjusted R 2 0.328, p  = 0.00004; adjusted R 2 0.187, p  = 0.002 and adjusted R 2 0.180, p  = 0.002). The PCA composite score of global visual pathway damage independently predicted both LCVA 1.25% (adjusted R 2 value 0.361, p  = 0.00001) and LCVA 2.50% (adjusted R 2 value 0.323, p  = 0.00003). A multiparametric score represents a more comprehensive and effective tool to explain visual disability than a single instrumental metric in PPMS.

  6. Endurance training is feasible in severely disabled patients with progressive multiple sclerosis

    Skjerbæk, Ag; Næsby, M; Lützen, Karin

    2014-01-01

    This study tested whether upper-body endurance training (ET) is feasible and can be performed at sufficient intensity to induce cardiovascular adaptations in severely disabled patients with progressive multiple sclerosis (MS). Eleven progressive MS patients (6.5 ≤ EDSS ≤ 8.0) scheduled for a four......-week inpatient rehabilitation program were randomized to a control group (CON, n = 5) that received standard individualized MS rehabilitation or an intervention group (EXE, n = 6) that in addition received 10 sessions of predominantly upper-body ET. One patient dropped out of the EXE group (drop-out rate: 1....../6~17%) and no adverse events were recorded. The EXE group completed on average 9.3±0.8 sessions (~96.0±5%). During the ET sessions an average heart rate of 93.9±9.3beats*min(-1) were sustained corresponding to 91.6±6.8% of the maximal pre-intervention heart rate. In the EXE group a trend toward a time*group interaction...

  7. Attentional processes in interactions between people with profound intellectual and multiple disabilities and direct support staff.

    Hostyn, Ine; Ine, Hostyn; Neerinckx, Heleen; Heleen, Neerinckx; Maes, Bea; Bea, Maes

    2011-01-01

    Few studies have examined joint attention in interactions with persons with profound intellectual and multiple disabilities (PIMD), despite its important role in high-quality interaction. The purpose of this study is to describe the attention-directing behaviours of persons with PIMD and their direct support staff and the attention episodes resulting from their interactions, and to understand how these variables relate to each other. Video observations of 17 staff-client dyads were coded using partial interval recording. The results showed considerable variation across individuals and dyads. In general, persons with PIMD directed the attention of staff members infrequently. The staff members frequently directed their clients' attention towards a topic of interest but did not often use the tactile modality. Within the staff-client dyad, there was not much joint attention; however, shared attention episodes occurred frequently. Shared attention and joint attention are strongly correlated. A negative correlation was found between clients not using attention-directing behaviours and staff members using tactile methods to direct the attention, and joint attention episodes. This study presents both directions for future research and practical implications. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. CSA: An efficient algorithm to improve circular DNA multiple alignment

    Pereira Luísa

    2009-07-01

    Full Text Available Abstract Background The comparison of homologous sequences from different species is an essential approach to reconstruct the evolutionary history of species and of the genes they harbour in their genomes. Several complete mitochondrial and nuclear genomes are now available, increasing the importance of using multiple sequence alignment algorithms in comparative genomics. MtDNA has long been used in phylogenetic analysis and errors in the alignments can lead to errors in the interpretation of evolutionary information. Although a large number of multiple sequence alignment algorithms have been proposed to date, they all deal with linear DNA and cannot handle directly circular DNA. Researchers interested in aligning circular DNA sequences must first rotate them to the "right" place using an essentially manual process, before they can use multiple sequence alignment tools. Results In this paper we propose an efficient algorithm that identifies the most interesting region to cut circular genomes in order to improve phylogenetic analysis when using standard multiple sequence alignment algorithms. This algorithm identifies the largest chain of non-repeated longest subsequences common to a set of circular mitochondrial DNA sequences. All the sequences are then rotated and made linear for multiple alignment purposes. To evaluate the effectiveness of this new tool, three different sets of mitochondrial DNA sequences were considered. Other tests considering randomly rotated sequences were also performed. The software package Arlequin was used to evaluate the standard genetic measures of the alignments obtained with and without the use of the CSA algorithm with two well known multiple alignment algorithms, the CLUSTALW and the MAVID tools, and also the visualization tool SinicView. Conclusion The results show that a circularization and rotation pre-processing step significantly improves the efficiency of public available multiple sequence alignment

  9. Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino

    2013-07-01

    These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Examining Augmented Reality to Improve Navigation Skills in Postsecondary Students with Intellectual Disability

    Smith, Cate C.; Cihak, David F.; Kim, Byungkeon; McMahon, Don D.; Wright, Rachel

    2017-01-01

    The purpose of this study was to examine the effects of using mobile technology to improve navigation skills in three students with intellectual disability (ID) in a postsecondary education program. Navigation skills included using an augmented reality iPhone app to make correct "waypoint" decisions when traveling by foot on a university…

  11. State Data Use Spotlight: North Carolina. Transforming State Systems to Improve Outcomes for Children with Disabilities

    Ruedel, Kristin; Nelson, Gena; Bailey, Tessie; Bradley-Black, Katherine

    2018-01-01

    North Carolina Department of Public Instruction (NCDPI) is focused on improving the 5-year graduation rates for all students with disabilities. To make progress toward the state-identified measurable result (SIMR), the state recognized that a single evidence-based practice (EBP) would not address the diverse needs of all the local entities across…

  12. Building a Culture of Inclusion: Disability as Opportunity for Organizational Growth and Improving Patient Care.

    Ailey, Sarah H; Brown, Paula; Friese, Tanya R; Dugan, Shelia

    2016-01-01

    Administrators at Rush University Medical Center have made a commitment to diversity, including accommodating disabilities in the workplace and for students. This article explains extensive multilevel accommodations instituted by Rush University Medical Center that promote organizational growth and a healthier work environment and improve patient care.

  13. Does Graded Return to Work Improve Disabled Workers’ Labour Market Attachment?

    Høgelund, Jan; Holm, Anders; McIntosh, James

    for the hours off work. When the worker’s health improves, working hours are increased until the sick-listed worker is able to work regular hours. Previous studies either concern specially designed pro-grams with a limited population of disabled workers or they do not take into account the unobserved...

  14. Aerobic Training Improved Low-Grade Inflammation in Obese Women with Intellectual Disability

    Ordonez, F. J.; Rosety, M. A.; Camacho, A.; Rosety, I.; Diaz, A. J.; Fornieles, G.; Garcia, N.; Rosety-Rodriguez, M.

    2014-01-01

    Background: Obesity is a major health problem in people with intellectual disabilities. It is also widely accepted that low-grade systemic inflammation associated to obesity plays a key role in the pathogenic mechanism of several disorders. Fortunately, physical activity has shown to improve inflammation in people with metabolic syndrome and type…

  15. Communication Improvement through Music: The Case of Children with Developmental Disabilities

    Krikeli, Vasiliki; Michailidis, Anastasios; Klavdianou, Niovi-Dionysia

    2010-01-01

    This paper investigates the effect of music on the communication improvement of children with developmental disabilities. Forty subjects (18 boys and 22 girls) 7-12 years old, were divided into an experimental group (n = 20) which participated in music therapy activities and a control group (n = 20) which was discussing and watching television,…

  16. The Graduation Cliff: Improving the Post-School Outcomes of Students with Disabilities. Summary Report

    McFadden, Erica Skogebo; Daugherty, David B.; Lee, Sang Eun; Fisher, Kim W.; Hack, Anthony; Spyra, Ed

    2015-01-01

    There is a federal movement to improve student outcomes targeting some of these predictors in several recently launched initiatives, but where does Arizona stand? What are we currently doing to move the needle, and what do we still need to do? This report prepared for the Arizona Developmental Disabilities Planning Council has two objectives: (1)…

  17. The Graduation Cliff: Improving the Post-School Outcomes of Students with Disabilities

    McFadden, Erica Skogebo; Daugherty, David B.; Lee, Sang Eun; Fisher, Kim W.; Hack, Anthony

    2015-01-01

    There is a federal movement to improve student outcomes targeting some of these predictors in several recently launched initiatives, but where does Arizona stand? What are we currently doing to move the needle, and what do we still need to do? This report prepared for the Arizona Developmental Disabilities Planning Council has two objectives: (1)…

  18. The impact of disability, fatigue and sleep quality on the quality of life in multiple sclerosis

    Ghaem Haleh

    2008-01-01

    Full Text Available Background: Only few papers have investigated the impact of multiple sclerosis (MS, especially MS-related fatigue and the impact of the quality of sleep on the quality of life (QoL in MS patients. Objective: The objective of this study was to measure the quality of life in MS patients and the impact of disability, fatigue and sleep quality, using statistical modeling. Materials and Methods: A cross-sectional study was conducted and data was collected from 141 MS patients, who were referred to the Mottahari Clinic, Shiraz, Iran, in 2005. Data on health-related quality of life (MSQoL-54, fatigue severity scale (FSS, and Pittsburgh sleep quality Index (PSQI were obtained in the case of all the patients. Epidemiology data concerning MS type, MS functional system score, expanded disability status scale (EDSS etc. were also provided by a qualified neurologist. Spearman a coefficient, Mann-Whitney U test, and linear regression model were used to analyze the data. Results : The mean ±SD age of 141 MS patients was 32.6±9.6 year. Thirty five (24.8% of them were male and the others were female. Eighty two (58.1% of the patients had EDSS score of ≤ 2, 36 (25.5% between 2.5 and 4.5, and 23 (16.3% ≥ 5. As per PSQI scores, two (1.4% of the patients had good sleep, 16 (11.3% had moderate sleep and 123 (87.2% had poor sleep. There was a significant high positive correlation between the quality of mental and physical health composite scores (r = 0.791, P < 0.001. There was a significant negative correlation between the quality of physical score and age (r = -0.88, P < 0.001, fatigue score (r = -0.640, P < 0.001, EDSS score (r = -0.476, P < 0.001 and PSQI (sleep quality r = -0.514, P < 0.000. Linear regression analysis showed that PSQI score, EDSS, and fatigue score were predictors in the model between the quality of physical score and covariates ( P < 0.001. Linear regression model showed that fatigue score and PSQI were predictors in the model between the

  19. Factors Influencing Quality of Life for Disabled and Nondisabled Elderly Population: The Results of a Multiple Correspondence Analysis

    M. Avolio

    2013-01-01

    Full Text Available Objectives. The aim of our study is to examine the role of some factors (sociodemographic patterns, social relationship support, and trust in healthcare actors on structure of quality of life among the Italian elderly population, by stratifying according to presence or absence of disability. Methods. Using data of the Italian National Institute of Statistics (ISTAT survey, we obtained a sample of 25,183 Italian people aged 65+ years. Multiple Correspondence Analysis (MCA was used to test such a relationship. Results. By applying the MCA between disabled and nondisabled elderly population, we identified three dimensions: “demographic structure and social contacts,” “social relationships,” “trust in the Italian National Health Services (INHS.” Furthermore, the difference in trust on the INHS and its actors was seen among disabled and non-disabled elderly population. Conclusions. Knowledge on the concept of quality of life and its application to the elderly population either with or without disability should make a difference in both people’s life and policies and practices affecting life. New domains, such as information and trusting relationships both within and towards the care network’s nodes, are likely to play an important role in this relationship.

  20. Debriefing to Improve Student Ability to Assess and Plan for the Care of Persons With Disability.

    Takeda, Mikiko Y; Smith, Mark J; Cone, Catherine J

    2017-12-01

    Although recent literature suggests that students should be trained in the care of persons with disability (PWDs) as a form of cultural sensitivity (CS), healthcare professionals may receive limited experience during their formal training. After pharmacy students in 2 previous years of testing failed to adequately assess and plan for the care of a standardized patient's chief complaint and disability in an Objective Structured Clinical Examination (OSCE), the investigators added debriefing to the OSCE to determine if it would improve student's ability to assess and plan for the care of PWD. Two sequentially enrolled second-year pharmacy school student cohorts participated in this study (control n = 90; intervention n = 82). During the OSCE, students interviewed and examined a standardized patient with a simulated physical disability and other chronic disease states. Students were then instructed to develop a care plan considering the patient's disability and other disease states. The intervention cohort received debriefing; the control did not. Students documented the care plan in a subjective, objective, assessment, and plan (SOAP) note. Investigators assessed SOAP note score (general ability of students to write a SOAP note) and CS score (specific ability to care for PWD) to determine the effectiveness of the debriefing. The intervention group showed a significantly higher percent mean CS score than the control group (93.6% ± 19% and 61.1% ± 30.7%, respectively, P improvement in pass rates (those students scoring ≥70% on the OSCE) of 59.4% with 92.7% of the students passing in the intervention group versus 33.3% of the students passing in the control group (P improved students' performance in developing care plans for disabled patients. Ideally, longitudinal studies should be completed to determine if these skills transfer from debriefings to clinical practice. Development of effective training and assessment methods is essential for students to obtain

  1. Evaluation of the treatment efficacy of patients with multiple sclerosis using Barthel index and Expanded Disability Status Scale

    Edina Tanovic

    2014-09-01

    Full Text Available Introduction: Multiple sclerosis (MS is a chronic, autoimmune and progressive multifocal demyelinating disease of the central nervous system. The aim of this study was to evaluate rehabilitation of patients with multiple sclerosis using BI (Barthel index and EDDS (Expanded Disability Status Scale.Methods: A clinical observational study was made at the clinic for physical medicine and rehabilitation in Sarajevo. We analyzed 49 patients with MS in relation of gender, age and level of disability at admission and discharge, patient disability were estimated using EDDS scale. The ability of patients in their activities of daily living were also analyzed according to the BI at admission and discharge.Results: Of the total number of patients (n=49 there were 15 men and 34 women. The average age of female patient was 42.38±13.48 and male patient 46.06±9.56. EDDS values were significantly different at the beginning and at the end of the therapy (p=0.001 as was the value of BI (p=0.001.Conclusion: MS patients, after the rehabilitation in hospital conditions show significant recovery and a reduced level of disability; they show higher independence in activities but rehabilitation demands individual approach and adjustment with what patients are currently capable of achieving.

  2. Improving IQ measurement in intellectual disabilities using true deviation from population norms.

    Sansone, Stephanie M; Schneider, Andrea; Bickel, Erika; Berry-Kravis, Elizabeth; Prescott, Christina; Hessl, David

    2014-01-01

    Intellectual disability (ID) is characterized by global cognitive deficits, yet the very IQ tests used to assess ID have limited range and precision in this population, especially for more impaired individuals. We describe the development and validation of a method of raw z-score transformation (based on general population norms) that ameliorates floor effects and improves the precision of IQ measurement in ID using the Stanford Binet 5 (SB5) in fragile X syndrome (FXS; n = 106), the leading inherited cause of ID, and in individuals with idiopathic autism spectrum disorder (ASD; n = 205). We compared the distributional characteristics and Q-Q plots from the standardized scores with the deviation z-scores. Additionally, we examined the relationship between both scoring methods and multiple criterion measures. We found evidence that substantial and meaningful variation in cognitive ability on standardized IQ tests among individuals with ID is lost when converting raw scores to standardized scaled, index and IQ scores. Use of the deviation z- score method rectifies this problem, and accounts for significant additional variance in criterion validation measures, above and beyond the usual IQ scores. Additionally, individual and group-level cognitive strengths and weaknesses are recovered using deviation scores. Traditional methods for generating IQ scores in lower functioning individuals with ID are inaccurate and inadequate, leading to erroneously flat profiles. However assessment of cognitive abilities is substantially improved by measuring true deviation in performance from standardization sample norms. This work has important implications for standardized test development, clinical assessment, and research for which IQ is an important measure of interest in individuals with neurodevelopmental disorders and other forms of cognitive impairment.

  3. 76 FR 55690 - Submission for OMB Review; Comment Request; The SSA-NIH Collaboration To Improve the Disability...

    2011-09-08

    ...; Comment Request; The SSA-NIH Collaboration To Improve the Disability Determination Process: Validation of... Collection: Title: The SSA-NIH Collaboration to Improve the Disability Determination Process: Validation of IRT-CAT tools. Type of Information Collection Request: NEW. Need and Use of Information Collection...

  4. Diffusion tensor imaging of the optic tracts in multiple sclerosis: association with retinal thinning and visual disability.

    Dasenbrock, Hormuzdiyar H; Smith, Seth A; Ozturk, Arzu; Farrell, Sheena K; Calabresi, Peter A; Reich, Daniel S

    2011-04-01

    Visual disability is common in multiple sclerosis, but its relationship to abnormalities of the optic tracts remains unknown. Because they are only rarely affected by lesions, the optic tracts may represent a good model for assessing the imaging properties of normal-appearing white matter in multiple sclerosis. Whole-brain diffusion tensor imaging was performed on 34 individuals with multiple sclerosis and 26 healthy volunteers. The optic tracts were reconstructed by tractography, and tract-specific diffusion indices were quantified. In the multiple-sclerosis group, peripapillary retinal nerve-fiber-layer thickness and total macular volume were measured by optical coherence tomography, and visual acuity at 100%, 2.5%, and 1.25% contrast was examined. After adjusting for age and sex, optic-tract mean and perpendicular diffusivity were higher (P=.002) in multiple sclerosis. Lower optic-tract fractional anisotropy was correlated with retinal nerve-fiber-layer thinning (r=.51, P=.003) and total-macular-volume reduction (r=.59, P=.002). However, optic-tract diffusion indices were not specifically correlated with visual acuity or with their counterparts in the optic radiation. Optic-tract diffusion abnormalities are associated with retinal damage, suggesting that both may be related to optic-nerve injury, but do not appear to contribute strongly to visual disability in multiple sclerosis. Copyright © 2010 by the American Society of Neuroimaging.

  5. Two men with multiple disabilities carry out an assembly work activity with the support of a technology system.

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Oliva, Doretta; Campodonico, Francesca

    2013-10-01

    To assess whether two persons with multiple disabilities could learn a work activity (i.e., assembling trolley wheels) with the support of a technology system. After an initial baseline, the study compared the effects of intervention sessions relying on the technology system (which called the participants to the different workstations and provided feedback and final stimulation) with the effects of intervention sessions carried out without technology. The two types of intervention sessions were conducted according to an alternating treatments design. Eventually, only intervention sessions relying on the technology system were used. Both participants managed to assemble wheels independently during intervention sessions relying on the technology system while they failed during sessions without the system. Their performance was strengthened during the final part of the study, in which only sessions with the system occurred. Technology may be critical in helping persons with multiple disabilities manage multi-step work activities.

  6. Leveraging Employer Practices in Global Regulatory Frameworks to Improve Employment Outcomes for People with Disabilities

    Matthew C. Saleh

    2018-03-01

    Full Text Available Work is an important part of life, providing both economic security and a forum to contribute one’s talents and skills to society, thereby anchoring the individual in a social role. However, access to work is not equally available to people with disabilities globally. Regulatory environments that prohibit discrimination and support vocational training and educational opportunities constitute a critical first step toward economic independence. However, they have not proven sufficient in themselves. In this article, we aim to infuse deeper consideration of employer practice and demand-side policy reforms into global policy discussions of the right to work for people with disabilities. We begin by documenting the employment and economic disparities existing for people with disabilities globally, followed by a description of the international, regional, and local regulatory contexts aiming to improve labor market outcomes for people with disabilities. Next, we examine how policies can leverage employer interests to further address inequalities. We discuss employer policies and practices demonstrated in the research to facilitate recruitment, hiring, career development, retention, and meaningful workplace inclusion. The goal of the article is to synthesize existing international literature on employment rights for people with disabilities with the employer perspective.

  7. Profiles of self-concept, goal orientation, and self-regulation in students with physical, intellectual, and multiple disabilities: Implications for instructional support.

    Varsamis, Panagiotis; Agaliotis, Ioannis

    2011-01-01

    The present study explored physical self-concept, goal orientation in sport, and self-regulation in regard to a motor task, in 75 secondary students with physical, intellectual, and multiple disabilities, who were educated in the same special education units. It was found that students with intellectual disabilities generally presented a positive profile in all three psychosocial constructs, whereas students with physical disabilities presented low scores in most measures. Students with multiple disabilities did not differ essentially from students with intellectual disability in regard to physical self-concept and goal orientation; however, they compared unfavorably to them regarding self-regulation. The delineation of a distinct and defendable profile of self-concept, goal orientation, and self-regulation for each disability group allows the formulation of proposals for the implementation of appropriate instructional programs for students belonging to the above mentioned categories. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. The magic stone : a video game to improve communication skills of people with intellectual disabilities

    Corrales Astorgano, Mario

    2016-01-01

    'The Magic Stone' is a video game whose main aim is to help people with Down syndrome to improve communication skills that have been affected due to their disability, especially those related with prosody. The interface of the video game includes a number of elements to motivate the users to practice and train their pronunciation. The usability tests of the system have reported high degrees of satisfaction of users and trainers. Perception tests have permitted to confirm that players improve ...

  9. Cerebellar abnormalities contribute to disability including cognitive impairment in multiple sclerosis.

    Katrin Weier

    Full Text Available The cerebellum is known to be involved not only in motor but also cognitive and affective processes. Structural changes in the cerebellum in relation to cognitive dysfunction are an emerging topic in the field of neuro-psychiatric disorders. In Multiple Sclerosis (MS cerebellar motor and cognitive dysfunction occur in parallel, early in the onset of the disease, and the cerebellum is one of the predilection sites of atrophy. This study is aimed at determining the relationship between cerebellar volumes, clinical cerebellar signs, cognitive functioning and fatigue in MS. Cerebellar volumetry was conducted using T1-weighted MPRAGE magnetic resonance imaging of 172 MS patients. All patients underwent a clinical and brief neuropsychological assessment (information processing speed, working memory, including fatigue testing. Patients with and without cerebellar signs differed significantly regarding normalized cerebellar total volume (nTCV, normalized brain volume (nBV and whole brain T2 lesion volume (LV. Patients with cerebellar dysfunction likewise performed worse in cognitive tests. A regression analysis indicated that age and nTCV explained 26.3% of the variance in SDMT (symbol digit modalities test performance. However, only age, T2 LV and nBV remained predictors in the full model (r(2 = 0.36. The full model for the prediction of PASAT (Paced Auditory Serial Addition Test scores (r(2 = 0.23 included age, cerebellar and T2 LV. In the case of fatigue, only age and nBV (r(2 = 0.17 emerged as significant predictors. These data support the view that cerebellar abnormalities contribute to disability, including cognitive impairment in MS. However, this contribution does not seem to be independent of, and may even be dominated by wider spread MS pathology as reflected by nBV and T2 LV.

  10. Relationship between gait initiation and disability in individuals affected by multiple sclerosis.

    Galli, Manuela; Coghe, Giancarlo; Sanna, Paola; Cocco, Eleonora; Marrosu, Maria Giovanna; Pau, Massimiliano

    2015-11-01

    This study analyzes how multiple sclerosis (MS) does affect one of the most common voluntary activities in life: the gait initiation (GI). The main aim of the work is to characterize the execution of this task by measuring and comparing relevant parameters based on center of pressure (COP) patterns and to study the relationship between these and the level of expanded disability status scale (EDSS). To this aim, 95 MS subjects with an average EDSS score of 2.4 and 35 healthy subjects were tested using a force platform during the transition from standing posture to gait. COP time-series were acquired and processed to extract a number of parameters related to the trajectory followed by the COP. The statistical analysis revealed that only a few measurements were statistically different between the two groups and only these were subsequently correlated with EDSS score. The correlation analysis underlined that a progressive alteration of the task execution can be directly related with the increase of EDSS score. These finding suggest that most of the impairment found in people with MS comes from the first part of the COP pattern, the anticipatory postural adjustments (APAs). The central nervous system performs APAs before every voluntary movement to minimize balance perturbation due to the movement itself. Gait Initiation's APAs consist in some ankle muscles contractions that induce a backward COP shift to the swing limb. The analysis here performed highlighted that MS affected patients have a reduced posterior COP shift that reveals that the anticipatory mechanism is impaired. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Time use of parents raising children with severe or profound intellectual and multiple disabilities.

    Luijkx, J; van der Putten, A A J; Vlaskamp, C

    2017-07-01

    Raising children with severe or profound intellectual and multiple disabilities (PIMD) is expected to put extreme pressure on parental time use patterns. The aim of this study was to examine the total time use of mothers and fathers raising children with PIMD and compare it with the time use of parents of typically developing children. Twenty-seven fathers and 30 mothers raising children with PIMD completed a time use diary on a mobile phone or tablet app, as did 66 fathers and 109 mothers of typically developing children. Independent t-tests and Mann-Whitney tests were performed to compare mean time use. There are no differences in the time use of parents of children with PIMD on contracted time (paid work and educational activities) and necessary time (personal care, eating and drinking and sleeping) when compared with parents of typically developing children. There are significant differences between the parents of children with PIMD and the parents of typically developing children in terms of committed time (time for domestic work and the care and supervision of their children) and free time. The mothers of children with PIMD spend significantly less time on domestic work and more time on care and supervision than mothers of typically developing children. This study shows that the parents of children with PIMD have to spend a significant amount of time on care tasks and have on average 1.5 h less free time per day than parents of typically developing children. This is a striking difference, because leisure time can substantially contribute to well-being. Therefore, it is important not only to consider a child with PIMD's support needs but also to identify what parents need to continue their children's daily care and supervision. © 2017 John Wiley & Sons Ltd.

  12. Pronounced Structural and Functional Damage in Early Adult Pediatric-Onset Multiple Sclerosis with No or Minimal Clinical Disability

    Antonio Giorgio

    2017-11-01

    Full Text Available Pediatric-onset multiple sclerosis (POMS may represent a model of vulnerability to damage occurring during a period of active maturation of the human brain. Whereas adaptive mechanisms seem to take place in the POMS brain in the short-medium term, natural history studies have shown that these patients reach irreversible disability, despite slower progression, at a significantly younger age than adult-onset MS (AOMS patients. We tested for the first time whether significant brain alterations already occurred in POMS patients in their early adulthood and with no or minimal disability (n = 15 in comparison with age- and disability-matched AOMS patients (n = 14 and to normal controls (NC, n = 20. We used a multimodal MRI approach by modeling, using FSL, voxelwise measures of microstructural integrity of white matter tracts and gray matter volumes with those of intra- and internetwork functional connectivity (FC (analysis of variance, p ≤ 0.01, corrected for multiple comparisons across space. POMS patients showed, when compared with both NC and AOMS patients, altered measures of diffusion tensor imaging (reduced fractional anisotropy and/or increased diffusivities and higher probability of lesion occurrence in a clinically eloquent region for physical disability such as the posterior corona radiata. In addition, POMS patients showed, compared with the other two groups, reduced long-range FC, assessed from resting functional MRI, between default mode network and secondary visual network, whose interaction subserves important cognitive functions such as spatial attention and visual learning. Overall, this pattern of structural damage and brain connectivity disruption in early adult POMS patients with no or minimal clinical disability might explain their unfavorable clinical outcome in the long term.

  13. Intensity ratio to improve black hole assessment in multiple sclerosis.

    Adusumilli, Gautam; Trinkaus, Kathryn; Sun, Peng; Lancia, Samantha; Viox, Jeffrey D; Wen, Jie; Naismith, Robert T; Cross, Anne H

    2018-01-01

    Improved imaging methods are critical to assess neurodegeneration and remyelination in multiple sclerosis. Chronic hypointensities observed on T1-weighted brain MRI, "persistent black holes," reflect severe focal tissue damage. Present measures consist of determining persistent black holes numbers and volumes, but do not quantitate severity of individual lesions. Develop a method to differentiate black and gray holes and estimate the severity of individual multiple sclerosis lesions using standard magnetic resonance imaging. 38 multiple sclerosis patients contributed images. Intensities of lesions on T1-weighted scans were assessed relative to cerebrospinal fluid intensity using commercial software. Magnetization transfer imaging, diffusion tensor imaging and clinical testing were performed to assess associations with T1w intensity-based measures. Intensity-based assessments of T1w hypointensities were reproducible and achieved > 90% concordance with expert rater determinations of "black" and "gray" holes. Intensity ratio values correlated with magnetization transfer ratios (R = 0.473) and diffusion tensor imaging metrics (R values ranging from 0.283 to -0.531) that have been associated with demyelination and axon loss. Intensity ratio values incorporated into T1w hypointensity volumes correlated with clinical measures of cognition. This method of determining the degree of hypointensity within multiple sclerosis lesions can add information to conventional imaging. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. The Development of LinguaBytes : An Interactive Tangible Play and Learning System to Stimulate the Language Development of Toddlers with Multiple Disabilities

    Hengeveld, B.; Voort, R.; Hummels, C.; De Moor, J.; Van Balkom, H.; Overbeeke, K.; Van der Helm, A.

    2008-01-01

    Young children with multiple disabilities (e.g., both cognitive and motor disabilities) are confronted with severe limitations in language development from birth and later on. Stimulating the adult-child communication can decrease these limitations. Within LinguaBytes, a three-year research program,

  15. Evaluation of a Multiple Mediator Model of the Relationship between Core Self-Evaluations and Job Satisfaction in Employed Individuals with Disabilities

    Smedema, Susan Miller; Kesselmayer, Rachel Friefeld; Peterson, Lauren

    2018-01-01

    Purpose: To test a meditation model of the relationship between core self-evaluations (CSE) and job satisfaction in employed individuals with disabilities. Method: A quantitative descriptive design using Hayes's (2012) PROCESS macro for SPSS and multiple regression analysis. Two-hundred fifty-nine employed persons with disabilities were recruited…

  16. Improvements in clinical and functional vision and perceived visual disability after first and second eye cataract surgery

    Elliott, D.; Patla, A.; Bullimore, M.

    1997-01-01

    AIMS—To determine the improvements in clinical and functional vision and perceived visual disability after first and second eye cataract surgery.
METHODS—Clinical vision (monocular and binocular high and low contrast visual acuity, contrast sensitivity, and disability glare), functional vision (face identity and expression recognition, reading speed, word acuity, and mobility orientation), and perceived visual disability (Activities of Daily Vision Scale) were measured in 25 subjects before a...

  17. Improved patient-reported health impact of multiple sclerosis

    Macdonell, Richard; Nagels, Guy; Laplaud, David-Axel

    2016-01-01

    BACKGROUND: Multiple sclerosis (MS) is a debilitating disease that negatively impacts patients' lives. OBJECTIVE: ENABLE assessed the effect of long-term prolonged-release (PR) fampridine (dalfampridine extended release in the United States) treatment on patient-perceived health impact in patients...... with MS with walking impairment. METHODS: ENABLE was a 48-week, open-label, Phase 4 study of PR-fampridine 10 mg twice daily. Patients who showed any improvement in Timed 25-Foot Walk walking speed at weeks 2 and 4 and any improvement in 12-item MS Walking Scale score at week 4 remained on treatment....... The primary endpoint was change from baseline in 36-Item Short-Form Health Survey (SF-36) physical component summary (PCS) score. RESULTS: At week 4, 707/901 (78.5%) patients met the criteria to remain on treatment. Patients on treatment demonstrated significant and clinically meaningful improvements in SF-36...

  18. Improved nonparametric inference for multiple correlated periodic sequences

    Sun, Ying

    2013-08-26

    This paper proposes a cross-validation method for estimating the period as well as the values of multiple correlated periodic sequences when data are observed at evenly spaced time points. The period of interest is estimated conditional on the other correlated sequences. An alternative method for period estimation based on Akaike\\'s information criterion is also discussed. The improvement of the period estimation performance is investigated both theoretically and by simulation. We apply the multivariate cross-validation method to the temperature data obtained from multiple ice cores, investigating the periodicity of the El Niño effect. Our methodology is also illustrated by estimating patients\\' cardiac cycle from different physiological signals, including arterial blood pressure, electrocardiography, and fingertip plethysmograph.

  19. Influence of multiple sclerosis, age and degree of disability, in the position of the contrast sensitivity curve peak

    A F Nunes

    2014-01-01

    Full Text Available Context: Contrast sensitivity (CS function is one of the most important tests available for evaluating visual impairment. Multiple sclerosis (MS can produce highly selective losses in visual function and psychophysical studies have demonstrated CS deficits for some spatial frequencies. Aims: This work studies the differences in CS between a group of controls and a group of MS patients, focusing on the location of the maximum sensitivity peak, shape of the curve, and determination of the most affected spatial frequencies. Materials and Methods: Using a sinusoidal stimulus the authors assessed CS function in 28 subjects with definitive relapsing remitting MS, and in 50 controls with acuities of 20/25 or better. The peaks of the CS curves were studied by fitting third degree polynomials to individual sets of data. Results: Compared with the control group, the CS function curve for MS subjects showed more deficits in extreme points (low- and high-spatial frequencies. Our results display significant CS losses, at the high-frequencies band level, in the beginning of the disease. When the disease progresses and the disabilities appear, there are greater losses at the low-frequencies band level. In average, the CS curve peaks for the MS group were shifted in relation to the control group. Conclusions: CS losses in the MS group suggest an association with ageing and disability level in the expanded disability status scale. The position of the CS function peak is influenced by MS, age, and degree of disability.

  20. No relevant impact of ambient temperature on disability measurements in a large cohort of patients with multiple sclerosis.

    Stellmann, J-P; Young, K L; Vettorazzi, E; Pöttgen, J; Heesen, C

    2017-06-01

    Many patients with multiple sclerosis (MS) report a worsening of symptoms due to high ambient temperatures, but objective data about this association are rare and contradictory. The aim of this study was to investigate the influence of ambient temperature on standard clinical tests. We extracted the Symbol Digit Modality Test, Nine Hole Peg Test, Timed 25 Foot Walk (T25FW), Timed Tandem Walk, Expanded Disability Status Scale (EDSS) and quality-of-life items on cognition, fatigue and depression from our clinical database and matched them to historical temperatures. We used linear mixed-effect models to investigate the association between temperature and outcomes. A total of 1254 patients with MS (mean age, 42.7 years; 69.9% females; 52.1% relapsing-remitting MS, mean EDSS, 3.8) had 5751 assessments between 1996 and 2012. We observed a worsening in the T25FW with higher ambient temperatures in moderately disabled patients (EDSS ≥ 4) but not in less disabled patients. However, an increase of 10°C prolonged the T25FW by just 0.4 s. Other outcomes were not associated with ambient temperatures. Higher ambient temperature might compromise walking capabilities in patients with MS with a manifest walking impairment. However, effects are small and not detectable in mildly disabled patients. Hand function, cognition, mood and fatigue do not appear to be correlated with ambient temperature. © 2017 EAN.

  1. An improved multiple flame photometric detector for gas chromatography.

    Clark, Adrian G; Thurbide, Kevin B

    2015-11-20

    An improved multiple flame photometric detector (mFPD) is introduced, based upon interconnecting fluidic channels within a planar stainless steel (SS) plate. Relative to the previous quartz tube mFPD prototype, the SS mFPD provides a 50% reduction in background emission levels, an orthogonal analytical flame, and easier more sensitive operation. As a result, sulfur response in the SS mFPD spans 4 orders of magnitude, yields a minimum detectable limit near 9×10(-12)gS/s, and has a selectivity approaching 10(4) over carbon. The device also exhibits exceptionally large resistance to hydrocarbon response quenching. Additionally, the SS mFPD uniquely allows analyte emission monitoring in the multiple worker flames for the first time. The findings suggest that this mode can potentially further improve upon the analytical flame response of sulfur (both linear HSO, and quadratic S2) and also phosphorus. Of note, the latter is nearly 20-fold stronger in S/N in the collective worker flames response and provides 6 orders of linearity with a detection limit of about 2.0×10(-13)gP/s. Overall, the results indicate that this new SS design notably improves the analytical performance of the mFPD and can provide a versatile and beneficial monitoring tool for gas chromatography. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. IMPROVING FUNCTIONAL INDEPENDENCE OF PATIENTS WITH MULTIPLE SCLEROSIS BY PHYSICAL THERAPY AND OCCUPATIONAL THERAPY

    Ana-Maria Ticărat

    2011-06-01

    Full Text Available Introduction. Patients with multiple sclerosis can have a normal life despite of their real or possible disability and of the progressive nature of it. Scope. Patients who follow physical therapy and occupational therapy will have an increased quality of life and a greater functional independence.Methods. The randomized study was made on 7 patients with multiple sclerosis, from Oradea Day Centre, 3 times/week, ages between 35 – 55 years, functional level between mild and sever. Assessment and rehabilitation methods: inspection, BARTHEL Index. Frenkel method, brething exercises, weights exercises, gait exercises, writind exercises and games were used in the rehabilitation process. Group therapies: sociotherapy, arttherapy, music therapy. Results analysis consisted of the comparison of baseline and final means.Results. By analizing baseline and final means for Barthel Index for each functon separately, it was shown a mild improvement of functional independence for almost assessed functions, with at least 1-1,5 points.Conclusions. Persons with multiple sclerosis who follow physical therapy and occupational therapy presents a better functional independence after the treatment.

  3. Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems.

    Scheifes, Arlette; Egberts, Toine C G; Stolker, Joost Jan; Nijman, Henk L I; Heerdink, Eibert R

    2016-07-01

    Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability. In a treatment facility for people with mild to borderline intellectual disability and severe behavioural problems, a structured medication review was performed. Prevalence and type of drug-related problems (DRPs) and of the recommended and executed actions were calculated. In a total of 55 patients with intellectual disability and behavioural problems, 284 medications were prescribed, in which a DRP was seen in 106 (34%). No indication/unclear indication was the most prevalent DRP (70). Almost 60% of the recommended actions were also executed. This high prevalence of DRPs is worrying. The structured medication review is a valuable instrument to optimize pharmacotherapy and to support psychiatrists in adequate prescribing of both psychotropic and somatic drugs. © 2015 John Wiley & Sons Ltd.

  4. EFFECTIVENESS OF COOPERATIVE LEARNING IN IMPROVING MATHEMATICAL CONCEPTS AMONG STUDENTS WITH MILD INTELLECTUAL DISABILITY

    Ibrahim Rajab Abbas Ibrahim

    2017-01-01

    The purpose of this study was to identify the effectiveness of cooperative learning in improving mathematical concepts among students with mild intellectual disability (SMID). The sample of the study consisted of 8 SMID at Najran in the Kingdom of Saudi Arabia. The sample of the study was divided randomly into two equal groups control and experimental. The students in the experimental group have studied the mathematical concepts by using cooperative learning; however the students in the contr...

  5. Significant Improvement in Sleep in People with Intellectual Disabilities Living in Residential Settings by Non-Pharmaceutical Interventions

    Hylkema, T.; Vlaskamp, C.

    2009-01-01

    Background: Although about 15 to 50 percent of people with intellectual disabilities (ID) living in residential settings suffer from sleep problems, scant attention is paid to these problems. Most available studies focus on pharmaceutical solutions. In this study we focus on improving sleep in people with intellectual disabilities living in…

  6. An ecological method for the sampling of nonverbal signalling behaviours of young children with profound and multiple learning disabilities (PMLD).

    Atkin, Keith; Lorch, Marjorie Perlman

    2016-08-01

    Profound and multiple learning disabilities (PMLD) are a complex range of disabilities that affect the general health and well-being of the individual and their capacity to interact and learn. We developed a new methodology to capture the non-symbolic signalling behaviours of children with PMLD within the context of a face-to-face interaction with a caregiver to provide analysis at a micro-level of descriptive detail incorporating the use of the ELAN digital video software. The signalling behaviours of participants in a natural, everyday interaction can be better understood with the use of this innovation in methodology, which is predicated on the ecology of communication. Recognition of the developmental ability of the participants is an integral factor within that ecology. The method presented establishes an advanced account of the modalities through which a child affected by PMLD is able to communicate.

  7. Phylo: a citizen science approach for improving multiple sequence alignment.

    Alexander Kawrykow

    Full Text Available BACKGROUND: Comparative genomics, or the study of the relationships of genome structure and function across different species, offers a powerful tool for studying evolution, annotating genomes, and understanding the causes of various genetic disorders. However, aligning multiple sequences of DNA, an essential intermediate step for most types of analyses, is a difficult computational task. In parallel, citizen science, an approach that takes advantage of the fact that the human brain is exquisitely tuned to solving specific types of problems, is becoming increasingly popular. There, instances of hard computational problems are dispatched to a crowd of non-expert human game players and solutions are sent back to a central server. METHODOLOGY/PRINCIPAL FINDINGS: We introduce Phylo, a human-based computing framework applying "crowd sourcing" techniques to solve the Multiple Sequence Alignment (MSA problem. The key idea of Phylo is to convert the MSA problem into a casual game that can be played by ordinary web users with a minimal prior knowledge of the biological context. We applied this strategy to improve the alignment of the promoters of disease-related genes from up to 44 vertebrate species. Since the launch in November 2010, we received more than 350,000 solutions submitted from more than 12,000 registered users. Our results show that solutions submitted contributed to improving the accuracy of up to 70% of the alignment blocks considered. CONCLUSIONS/SIGNIFICANCE: We demonstrate that, combined with classical algorithms, crowd computing techniques can be successfully used to help improving the accuracy of MSA. More importantly, we show that an NP-hard computational problem can be embedded in casual game that can be easily played by people without significant scientific training. This suggests that citizen science approaches can be used to exploit the billions of "human-brain peta-flops" of computation that are spent every day playing games

  8. Decreasing health disparities for people with disabilities through improved communication strategies and awareness.

    Sharby, Nancy; Martire, Katharine; Iversen, Maura D

    2015-03-19

    Factors influencing access to health care among people with disabilities (PWD) include: attitudes of health care providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD. Reducing health care disparities in a population with complex needs requires implementation at the primary, secondary and tertiary levels. This review article discusses common barriers to health care access from the patient and provider perspective, particularly focusing on communication barriers and how to address and ameliorate them. Articles utilized in this review were published from 2005 to present in MEDLINE and CINAHL and written in English that focused on people with disabilities. Topics searched for in the literature include: disparities and health outcomes, health care dissatisfaction, patient-provider communication and access issues. Ineffective communication has significant impacts for PWD. They frequently believe that providers are not interested in, or sensitive to their particular needs and are less likely to seek care or to follow up with recommendations. Various strategies for successful improvement of health outcomes for PWD were identified including changing the way health care professionals are educated regarding disabilities, improving access to health care services, and enhancing the capacity for patient centered care.

  9. [Development and Evaluation of a Motivational Interviewing Program for Exercise Improvement in Persons with Physical Disabilities].

    Jeong, Jeong Hee; Jeong, Ihn Sook

    2017-06-01

    The aims of this study were to develop a motivational interviewing program for exercise improvement in persons with physical disabilities and to examine the effect of this motivational interviewing intervention. The study employed a nonequivalent control group pretest and posttest design. A total of 62 persons with physical disabilities (30 in the experimental group, 32 in the control group) were recruited from 2 community rehabilitation centers. The experimental group received 8 sessions of a group motivational interviewing program, scheduled once a week, with each session lasting 60 minutes. Test measures were completed before the intervention, immediately after the end of the intervention, 2 weeks later, and 6 weeks after the end of the intervention. Measures included self-efficacy for exercise, decisional balance for exercise, stage of change for exercise, regularity of exercise, exercise maintenance, and independent living ability. Data were analyzed using the χ²-test, Fisher's exact test, Independent samples t-test, and repeated measures ANOVA, conducted using IBM SPSS Statistics version 18. The experimental group showed a significant increase in self-efficacy for exercise (F=50.98, pmotivational interviewing program has the potential to improve exercise levels in persons with physical disabilities. © 2017 Korean Society of Nursing Science

  10. Parents as experts : the position of parents of children with profound multiple disabilities

    de Geeter, K.I.; Poppes, P.; Vlaskamp, C.

    2002-01-01

    Background Parents of children with disabilities are increasingly considered as experts in the field of care. Their expertise can deliver an important contribution towards planning their child's care and education. The law is increasingly taking this factor into consideration. On the one hand,

  11. Improved multiple displacement amplification (iMDA) and ultraclean reagents.

    Motley, S Timothy; Picuri, John M; Crowder, Chris D; Minich, Jeremiah J; Hofstadler, Steven A; Eshoo, Mark W

    2014-06-06

    Next-generation sequencing sample preparation requires nanogram to microgram quantities of DNA; however, many relevant samples are comprised of only a few cells. Genomic analysis of these samples requires a whole genome amplification method that is unbiased and free of exogenous DNA contamination. To address these challenges we have developed protocols for the production of DNA-free consumables including reagents and have improved upon multiple displacement amplification (iMDA). A specialized ethylene oxide treatment was developed that renders free DNA and DNA present within Gram positive bacterial cells undetectable by qPCR. To reduce DNA contamination in amplification reagents, a combination of ion exchange chromatography, filtration, and lot testing protocols were developed. Our multiple displacement amplification protocol employs a second strand-displacing DNA polymerase, improved buffers, improved reaction conditions and DNA free reagents. The iMDA protocol, when used in combination with DNA-free laboratory consumables and reagents, significantly improved efficiency and accuracy of amplification and sequencing of specimens with moderate to low levels of DNA. The sensitivity and specificity of sequencing of amplified DNA prepared using iMDA was compared to that of DNA obtained with two commercial whole genome amplification kits using 10 fg (~1-2 bacterial cells worth) of bacterial genomic DNA as a template. Analysis showed >99% of the iMDA reads mapped to the template organism whereas only 0.02% of the reads from the commercial kits mapped to the template. To assess the ability of iMDA to achieve balanced genomic coverage, a non-stochastic amount of bacterial genomic DNA (1 pg) was amplified and sequenced, and data obtained were compared to sequencing data obtained directly from genomic DNA. The iMDA DNA and genomic DNA sequencing had comparable coverage 99.98% of the reference genome at ≥1X coverage and 99.9% at ≥5X coverage while maintaining both balance

  12. Do multiple micronutrient interventions improve child health, growth, and development?

    Ramakrishnan, Usha; Goldenberg, Tamar; Allen, Lindsay H

    2011-11-01

    Micronutrient deficiencies are common and often co-occur in many developing countries. Several studies have examined the benefits of providing multiple micronutrient (MMN) interventions during pregnancy and childhood, but the implications for programs remain unclear. The key objective of this review is to summarize what is known about the efficacy of MMN interventions during early childhood on functional outcomes, namely, child health, survival, growth, and development, to guide policy and identify gaps for future research. We identified review articles including meta-analyses and intervention studies that evaluated the benefits of MMN interventions (3 or more micronutrients) in children (growth. Two studies found no effects on child mortality. The findings for respiratory illness and diarrhea are mixed, although suggestive of benefit when provided as fortified foods. There is evidence from several controlled trials (>25) and 2 meta-analyses that MMN interventions improve hemoglobin concentrations and reduce anemia, but the effects were small compared to providing only iron or iron with folic acid. Two recent meta-analyses and several intervention trials also indicated that MMN interventions improve linear growth compared to providing a placebo or single nutrients. Much less is known about the effects on MMN interventions during early childhood on motor and mental development. In summary, MMN interventions may result in improved outcomes for children in settings where micronutrient deficiencies are widespread.

  13. The improvement of movement and speech during rapid eye movement sleep behaviour disorder in multiple system atrophy.

    De Cock, Valérie Cochen; Debs, Rachel; Oudiette, Delphine; Leu, Smaranda; Radji, Fatai; Tiberge, Michel; Yu, Huan; Bayard, Sophie; Roze, Emmanuel; Vidailhet, Marie; Dauvilliers, Yves; Rascol, Olivier; Arnulf, Isabelle

    2011-03-01

    Multiple system atrophy is an atypical parkinsonism characterized by severe motor disabilities that are poorly levodopa responsive. Most patients develop rapid eye movement sleep behaviour disorder. Because parkinsonism is absent during rapid eye movement sleep behaviour disorder in patients with Parkinson's disease, we studied the movements of patients with multiple system atrophy during rapid eye movement sleep. Forty-nine non-demented patients with multiple system atrophy and 49 patients with idiopathic Parkinson's disease were interviewed along with their 98 bed partners using a structured questionnaire. They rated the quality of movements, vocal and facial expressions during rapid eye movement sleep behaviour disorder as better than, equal to or worse than the same activities in an awake state. Sleep and movements were monitored using video-polysomnography in 22/49 patients with multiple system atrophy and in 19/49 patients with Parkinson's disease. These recordings were analysed for the presence of parkinsonism and cerebellar syndrome during rapid eye movement sleep movements. Clinical rapid eye movement sleep behaviour disorder was observed in 43/49 (88%) patients with multiple system atrophy. Reports from the 31/43 bed partners who were able to evaluate movements during sleep indicate that 81% of the patients showed some form of improvement during rapid eye movement sleep behaviour disorder. These included improved movement (73% of patients: faster, 67%; stronger, 52%; and smoother, 26%), improved speech (59% of patients: louder, 55%; more intelligible, 17%; and better articulated, 36%) and normalized facial expression (50% of patients). The rate of improvement was higher in Parkinson's disease than in multiple system atrophy, but no further difference was observed between the two forms of multiple system atrophy (predominant parkinsonism versus cerebellar syndrome). Video-monitored movements during rapid eye movement sleep in patients with multiple system

  14. Association of Expanded Disability Status Scale and Cytokines after Intervention with Co-supplemented Hemp Seed, Evening Primrose Oils and Hot-natured Diet in Multiple Sclerosis Patients

    Behzad Baradaran

    2013-02-01

    Full Text Available Introduction: Multiple sclerosis (MS is an inflammatory demyelinating disease of the central nervous system (CNS. Because of limited efficacy and adverse side effects, identifying novel therapeutic and protective agents is important. The aim of this study is to examine the correlations between expanded disability status scale (EDSS and cytokines after intervention with co-supplemented hemp seed and evening primrose oils and hot-natured diet in patients with relapsing-remitting multiple sclerosis (RRMS. Methods: We studied a group of 23 patients with clinically definite RRMS, with EDSS<6 who received co-supplemented hemp seed and evening primrose oils with advising hot-natured diet. Clinically EDSS and immunological factors (plasma cytokines of IL-4, IFN-γ and IL-17 were assessed at baseline and after 6 months. Results: Mean follow-up was 180±2.9 days (N=23, 7 Male and 16 Females aged 25.0±7.5 years with disease duration 6.26±3.9 years. After 6 months, significant improvements in extended disability status score were found in the patients in agreement with decrease cytokines of IFN-γ and IL-17 and increase cytokines of IL-4. Clinical and immunological parameters showed improvement in the patients after the intervention. Conclusion: Our study shows that co-supplemented hemp seed and evening primrose oils with hot-natured diet can have beneficial effects in improving clinical symptoms in relapsing remitting MS patients and significant correlation was found between EDSS and immunological findings.

  15. Undernutrition in children with profound intellectual and multiple disabilities (PIMD): its prevalence and influence on quality of life.

    Holenweg-Gross, C; Newman, C J; Faouzi, M; Poirot-Hodgkinson, I; Bérard, C; Roulet-Perez, E

    2014-07-01

    To estimate the prevalence of undernutrition among children with profound intellectual and multiple disabilities (PIMD) and to explore its influence on quality of life. Seventy-two children with PIMD (47 male; 25 female; age range 2 to 15 years 4 months; mean age 8.6, SD 3.6) underwent an anthropometric assessment, including body weight, triceps skinfold thickness, segmental measures and recumbent length. Undernutrition was determined using tricipital skinfold percentile and z-scores of weight-for-height and height-for-age. The quality of life of each child was evaluated using the QUALIN questionnaire adapted for profoundly disabled children. Twenty-five children (34.7%) were undernourished and seven (9.7%) were obese. Among undernourished children only eight (32 %) were receiving food supplements and two (8%) had a gastrostomy, of which one was still on a refeeding programme. On multivariate analysis, undernutrition was one of the independent predictors of lower quality of life. Undernutrition remains a matter of concern in children with PIMD. There is a need to better train professionals in systematically assessing the nutritional status of profoundly disabled children in order to start nutritional management when necessary. © 2013 John Wiley & Sons Ltd.

  16. Brain atrophy and lesion load predict long term disability in multiple sclerosis

    Popescu, Veronica; Agosta, Federica; Hulst, Hanneke E

    2013-01-01

    To determine whether brain atrophy and lesion volumes predict subsequent 10 year clinical evolution in multiple sclerosis (MS).......To determine whether brain atrophy and lesion volumes predict subsequent 10 year clinical evolution in multiple sclerosis (MS)....

  17. Multiple sclerosis: Left advantage for auditory laterality in dichotic tests of central auditory processing and relationship of psychoacoustic tests with the Multiple Sclerosis Disability Scale-EDSS.

    Peñaloza López, Yolanda Rebeca; Orozco Peña, Xóchitl Daisy; Pérez Ruiz, Santiago Jesús

    2018-04-03

    To evaluate the central auditory processing disorders in patients with multiple sclerosis, emphasizing auditory laterality by applying psychoacoustic tests and to identify their relationship with the Multiple Sclerosis Disability Scale (EDSS) functions. Depression scales (HADS), EDSS, and 9 psychoacoustic tests to study CAPD were applied to 26 individuals with multiple sclerosis and 26 controls. Correlation tests were performed between the EDSS and psychoacoustic tests. Seven out of 9 psychoacoustic tests were significantly different (P<.05); right or left (14/19 explorations) with respect to control. In dichotic digits there was a left-ear advantage compared to the usual predominance of RDD. There was significant correlation in five psychoacoustic tests and the specific functions of EDSS. The left-ear advantage detected and interpreted as an expression of deficient influences of the corpus callosum and attention in multiple sclerosis should be investigated. There was a correlation between psychoacoustic tests and specific EDSS functions. Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Improving computer usage for students with physical disabilities through a collaborative approach: a pilot study.

    Borgestig, Maria; Falkmer, Torbjörn; Hemmingsson, Helena

    2013-11-01

    The aim of this study was to evaluate the effect of an assistive technology (AT) intervention to improve the use of available computers as assistive technology in educational tasks for students with physical disabilities during an ongoing school year. Fifteen students (aged 12-18) with physical disabilities, included in mainstream classrooms in Sweden, and their teachers took part in the intervention. Pre-, post-, and follow-up data were collected with Goal Attainment Scaling (GAS), a computer usage diary, and with the Psychosocial Impact of Assistive Devices Scale (PIADS). Teachers' opinions of goal setting were collected at follow-up. The intervention improved the goal-related computer usage in educational tasks and teachers reported they would use goal setting again when appropriate. At baseline, students reported a positive impact from computer usage with no differences over time regarding the PIADS subscales independence, adaptability, or self-esteem. The AT intervention showed a positive effect on computer usage as AT in mainstream schools. Some additional support to teachers is recommended as not all students improved in all goal-related computer usage. A clinical implication is that students' computer usage can be improved and collaboratively established computer-based strategies can be carried out by teachers in mainstream schools.

  19. The Effect of Theory of Mind Training on Social Skills Improvement in Intellectually Disabled Students

    mahboub bakhshi-Barzili

    2013-07-01

    Full Text Available Objective: The development of theory of mind is considered as one aspect of social cognition by researchers and have attracted their attention in recent years. The purpose was to determine the effect of theory of mind training on social skills in male students with intellectual disability in Meshkinshahr City. Materials & Methods: In present experimental study, pretest-posttest design with control group were used. All intellectually disabled male students (aged 8-12 years old who educating in Meshkinshahr (43 individuals answered to theory of mind tests. Students who could not pass the tests (39 individuals selected as a sample and their teachers completed Social Skills Rating Scale (SSRS Gresham & Elliot, 1990 for them. They assigned randomly to experimental and control groups. Experimental group participated in 8 training sessions (for 2 weeks, 30 minutes per session. After last session, theory of mind tests and SSRS administered for all subjects again. Data were assesed with analysis of covariance.  Results: Analysis of covariance showed that experimental group performed better than control group in social skills index, cooperation and self-control components significantly (P=0.001. But, two groups were not significantly different in assertion component.  Conclusion: theory of mind training leads to improvement in social skills and its components of intellectually disabled students and will guarantee their success on these areas in adulthood.

  20. Improving Learning Outcomes: The iPad and Preschool Children with Disabilities

    Linda Chmiliar

    2017-05-01

    Full Text Available The digital age has reached early childhood, and the use of touch screens by young children is common place. Research on the use of touch screen tablets with young children is becoming more prevalent; however, less information is available on the use of touch screen tablets to support young children with disabilities. Touch screen tablets may offer possibilities to preschool children with disabilities to participate in learning in a digital way. The iPad provides easy interaction on the touch screen and access to a multitude of engaging early learning applications. This paper summarizes a pilot study with 8 young children with disabilities included in a preschool classroom, who were given iPads to use in class and at home for a period of 21 weeks. Systematic observations, classroom assessments, and teacher and parent interviews documented the improvements in learning outcomes for each child in many areas including, but not limited to: shape and color recognition, letter recognition, and tracing letters throughout six research cycles.

  1. Improving attitudes towards children with disabilities in a school context: a cluster randomized intervention study.

    Godeau, Emmanuelle; Vignes, Céline; Sentenac, Mariane; Ehlinger, Virginie; Navarro, Félix; Grandjean, Hélène; Arnaud, Catherine

    2010-10-01

    although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students' attitudes towards their disabled peers. the participants were students from the 7th grade of twelve paired schools (1509 students from 62 classes; age 12-13y), randomly allocated to an intervention group (205 males, 285 females) or a control group (132 males, 165 females). The intervention consisted of a mandatory comprehensive educational project on disability. The Chedoke-McMaster Attitudes Towards Children with Handicaps Scale (CATCH) was used to assess children's attitudes before (T0) and after (T1) intervention. The hierarchical structure of the data was taken into account by adjusting standard deviations and using linear multilevel models. seven hundred and eighty-four students had at least one score on the three domains (cognitive, affective, behavioural) of the CATCH at T0 and T1. The final scores were higher than baseline scores (total scores, intervention group: baseline score 25.6 (SD=5.4), final score 26.8 (5.9), pattitudes was found in students from schools with special units for their peers with cognitive impairment for total (p=0.013), affective (pattitudes in the intervention and control groups that could be a result of the nature of the scales and questionnaires the students had to complete before the intervention.

  2. Improving Learning Outcomes: The iPad and Preschool Children with Disabilities.

    Chmiliar, Linda

    2017-01-01

    The digital age has reached early childhood, and the use of touch screens by young children is common place. Research on the use of touch screen tablets with young children is becoming more prevalent; however, less information is available on the use of touch screen tablets to support young children with disabilities. Touch screen tablets may offer possibilities to preschool children with disabilities to participate in learning in a digital way. The iPad provides easy interaction on the touch screen and access to a multitude of engaging early learning applications. This paper summarizes a pilot study with 8 young children with disabilities included in a preschool classroom, who were given iPads to use in class and at home for a period of 21 weeks. Systematic observations, classroom assessments, and teacher and parent interviews documented the improvements in learning outcomes for each child in many areas including, but not limited to: shape and color recognition, letter recognition, and tracing letters throughout six research cycles.

  3. Strategies that facilitate participation in family activities of children and adolescents with profound intellectual and multiple disabilities: parents' and personal assistants' experiences.

    Axelsson, Anna Karin; Imms, Christine; Wilder, Jenny

    2014-01-01

    Participation throughout one's life plays a significant role for development and emotional well-being. For this reason, there is a need to identify ways to facilitate participation in family activities for children and adolescents with profound intellectual and multiple disabilities (PIMD). The study design was qualitative and explorative, based on semi structured interviews with 11 parents and 9 personal assistants of children with PIMD. The interviews revealed participation-facilitating strategies relating to the children's/adolescent's proximal environment, such as "Availability and acceptability of the activity", "Good knowledge about the child" and a "A positive attitude of people close to the child", as well as strategies related to the children/adolescents themselves: "Sense of belonging", "Possible for the child/adolescent to understand", "Opportunities to influence" and "Feeling of being needed". Children and adolescents with PIMD are dependent on support obtained through their environment. The identified strategies, individually adapted through awareness and knowledge by the parents and the personal assistants, provide important evidence to assist our understanding in gaining understanding about how to improve participation in family activities of children and adolescents with PIMD. Participation-facilitating strategies related to the child/adolescent and his or her proximal environments are identified to improve participation in children and adolescents with profound intellectual and multiple disabilities (PIMD). Examples of strategies for the child's/adolescents' proximal environment include "good knowledge about the child/adolescent", and, for the child/adolescent, include creating "sense of belonging" and "opportunities to influence". Identifying and making these strategies explicit may assist in enhancing the participation of children and adolescents with PIMD in family activities. People in the child's/adolescent's proximal environment need to set

  4. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures?

    Girsowicz, Elie; Falcoz, Pierre-Emmanuel; Santelmo, Nicola; Massard, Gilbert

    2012-03-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether surgical stabilization is effective in improving the outcomes of patients with isolated multiple distracted and painful non-flail rib fractures. Of the 356 papers found using a report search, nine presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the nine retrieved studies clearly support the use of surgical stabilization in the management of isolated multiple non-flail and painful rib fractures for improving patient outcomes. The interest and benefit was shown not only in terms of pain (McGill pain questionnaire) and respiratory function (forced vital capacity, forced expiratory volume in 1 s and carbon monoxide diffusing capacity), but also in improved quality of life (RAND 36-Item Health Survey) and reduced socio-professional disability. Indeed, most of the authors justified surgical management based on the fact that the results of surgical stabilization showed improvement in short- and long-term patient outcomes, with fast reduction in pain and disability, as well as lower average wait before recommencing normal activities. Hence, the current evidence shows surgical stabilization to be safe and effective in alleviating post-operative pain and in improving patient recovery, thus enhancing the outcome after isolated multiple rib fractures. However, given the little published evidence, prospective trials are necessary to confirm these encouraging results.

  5. Donepezil improved memory in multiple sclerosis in a randomized clinical trial.

    Krupp, L B; Christodoulou, C; Melville, P; Scherl, W F; MacAllister, W S; Elkins, L E

    2004-11-09

    To determine the effect of donepezil in treating memory and cognitive dysfunction in multiple sclerosis (MS). This single-center double-blind placebo-controlled clinical trial evaluated 69 MS patients with cognitive impairment who were randomly assigned to receive a 24-week treatment course of either donepezil (10 mg daily) or placebo. Patients underwent neuropsychological assessment at baseline and after 24 weeks of treatment. The primary outcome was change in verbal learning and memory on the Selective Reminding Test (SRT). Secondary outcomes included other tests of cognitive function, patient-reported change in memory, and clinician-reported impression of cognitive change. Donepezil-treated patients showed significant improvement in memory performance on the SRT compared to placebo (p = 0.043). The benefit of donepezil remained significant after controlling for various covariates including age, Expanded Disability Status Scale, baseline SRT score, reading ability, MS subtype, and sex. Donepezil-treated patients did not show significant improvements on other cognitive tests, but were more than twice as likely to report memory improvement than those in the placebo group (p = 0.006). The clinician also reported cognitive improvement in almost twice as many donepezil vs placebo patients (p = 0.036). No serious adverse events related to study medication occurred, although more donepezil (34.3%) than placebo (8.8%) subjects reported unusual/abnormal dreams (p = 0.010). Donepezil improved memory in MS patients with initial cognitive impairment in a single center clinical trial. A larger multicenter investigation of donepezil in MS is warranted in order to more definitively assess the efficacy of this intervention.

  6. Improving adherence to venous thromoembolism prophylaxis using multiple interventions

    Al-Tawfiq Jaffar

    2011-01-01

    Full Text Available Objective : In hospital, deep vein thrombosis (DVT increases the morbidity and mortality in patients with acute medical illness. DVT prophylaxis is well known to be effective in preventing venous thromoembolism (VTE. However, its use remains suboptimal. The objective of this study was to evaluate the impact of quality improvement project on adherence with VTE prophylaxis guidelines and on the incidence of hospital-acquired VTEs in medical patients. Methods : The study was conducted at Saudi Aramco Medical Services Organization from June 2008 to August 2009. Quality improvement strategies included education of physicians, the development of a protocol, and weekly monitoring of compliance with the recommendations for VTE prophylaxis as included in the multidisciplinary rounds. A feedback was provided whenever a deviation from the protocol occurs. Results : During the study period, a total of 560 general internal medicine patients met the criteria for VTE prophylaxis. Of those, 513 (91% patients actually received the recommended VTE prophylaxis. The weekly compliance rate in the initial stage of the intervention was 63% (14 of 22 and increased to an overall rate of 100% (39 of 39 (P = 0.002. Hospital-acquired DVT rate was 0.8 per 1000 discharges in the preintervention period and 0.5 per 1000 discharges in the postintervention period, P = 0.51. However, there was a significant increase in the time-free period of the VTE and we had 11 months with no single DVT. Conclusion : In this study, the use of multiple interventions increased VTE prophylaxis compliance rate.

  7. Older age, higher perceived disability and depressive symptoms predict the amount and severity of work-related difficulties in persons with multiple sclerosis.

    Raggi, Alberto; Giovannetti, Ambra Mara; Schiavolin, Silvia; Brambilla, Laura; Brenna, Greta; Confalonieri, Paolo Agostino; Cortese, Francesca; Frangiamore, Rita; Leonardi, Matilde; Mantegazza, Renato Emilio; Moscatelli, Marco; Ponzio, Michela; Torri Clerici, Valentina; Zaratin, Paola; De Torres, Laura

    2018-04-16

    This cross-sectional study aims to identify the predictors of work-related difficulties in a sample of employed persons with multiple sclerosis as addressed with the Multiple Sclerosis Questionnaire for Job Difficulties. Hierarchical linear regression analysis was conducted to identify predictors of work difficulties: predictors included demographic variables (age, formal education), disease duration and severity, perceived disability and psychological variables (cognitive dysfunction, depression and anxiety). The targets were the questionnaire's overall score and its six subscales. A total of 177 participants (108 females, aged 21-63) were recruited. Age, perceived disability and depression were direct and significant predictors of the questionnaire total score, and the final model explained 43.7% of its variation. The models built on the questionnaire's subscales show that perceived disability and depression were direct and significant predictors of most of its subscales. Our results show that, among patients with multiple sclerosis, those who were older, with higher perceived disability and higher depression symptoms have more and more severe work-related difficulties. The Multiple Sclerosis Questionnaire for Job Difficulties can be fruitfully exploited to plan tailored actions to limit the likelihood of near-future job loss in persons of working age with multiple sclerosis. Implications for rehabilitation Difficulties with work are common among people with multiple sclerosis and are usually addressed in terms of unemployment or job loss. The Multiple Sclerosis Questionnaire for Job Difficulties is a disease-specific questionnaire developed to address the amount and severity of work-related difficulties. We found that work-related difficulties were associated to older age, higher perceived disability and depressive symptoms. Mental health issues and perceived disability should be consistently included in future research targeting work-related difficulties.

  8. Improved pinning by multiple in-line damage

    Weinstein, Roy [Beam Particle Dynamics Laboratories, University of Houston, Houston, TX 77204-5005 (United States); Sawh, Ravi-Persad [Beam Particle Dynamics Laboratories, University of Houston, Houston, TX 77204-5005 (United States); Gandini, Alberto [Beam Particle Dynamics Laboratories, University of Houston, Houston, TX 77204-5005 (United States); Parks, Drew [Beam Particle Dynamics Laboratories, University of Houston, Houston, TX 77204-5005 (United States)

    2005-02-01

    Columnar pinning centres provide the largest pinning potential, U{sub pin}, but not the greatest J{sub c} or pinnable field, B{sub pin}. Characteristics of ion-generated columnar defects which limit J{sub c} and B{sub pin} are discussed, including reduction of the percolation path, and the need for a larger number of columns of damage, for pinning, than are usually estimated. It is concluded that columnar pinning centres limit B{sub pin} to less than 4 T, and also severely reduce J{sub c}. The goal of maximizing U{sub pin}, via columnar centres, appears to have obscured a more rewarding approach and resulted in neglect of a large regime of ion interactions. Evidence is reviewed that multiple in-line damage (MILD), described herein, can provide orders of magnitude higher J{sub c} and B{sub pin}, despite providing lower U{sub pin}. The MILD pinning centre morphology is discussed, and it is estimated that for present-day large grain high T{sub c} superconductors, a J{sub c} value of {approx}10{sup 6}Acm{sup -2} is obtainable at 77 K, even when crystal plane alignment and weak links are not improved. In addition, the pinned field is increased by over an order of magnitude. An experiment is proposed to confirm these calculations, directly compare MILD pinning to continuous columnar pinning, and determine the optimum MILD structure. Applications of MILD pinning are discussed.

  9. Improving Transition to Employment for Youth With Physical Disabilities: Protocol for a Peer Electronic Mentoring Intervention.

    Lindsay, Sally; Stinson, Jennifer; Stergiou-Kita, Mary; Leck, Joanne

    2017-11-16

    Although youth with disabilities have much to gain from employment readiness programs, they are often excluded from or have limited access to vocational programs. One encouraging approach to address gaps in vocational programming is through peer electronic mentoring (e-mentoring), which may facilitate a smoother transition to adulthood by offering support to enhance coping skills. Despite the increase in online communities, little is known about their impact on vocational mentoring for youth with physical disabilities and their parents. The aim of this paper is to develop, implement, and assess the feasibility of an online peer mentor employment readiness intervention for youth with physical disabilities and their parents to improve their self-determination, career maturity, and social support compared to controls. A mixed-methods feasibility randomized controlled trial (RCT) design will be conducted to develop and assess the feasibility, acceptability, and initial efficacy of the "Empowering Youth Towards Employment" intervention. Youth (aged 15 to 25) with physical disabilities and their parents will be randomly assigned to a control or experimental group (4-week, interactive intervention, moderated by peer mentors). Data collection is in progress. Planned analyses include pre-post measures to determine the impact of the intervention on self-determination, career maturity, and social support. A qualitative thematic analysis of the discussion forums will complement the surveys to better understand why certain outcomes may have occurred. Our intervention includes evidence-informed content and was co-created by a multi-disciplinary group of researchers and knowledge users. It has the potential for widespread implications as a cost-effective resource to supplement educational and vocational programming for youth with disabilities. Clinicaltrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/6uD58

  10. Improvement of driving skills in persons with relapsing-remitting multiple sclerosis: a pilot study.

    Akinwuntan, Abiodun Emmanuel; Devos, Hannes; Baker, Kelly; Phillips, Kendra; Kumar, Vibha; Smith, Suzanne; Williams, Mitzi Joi

    2014-03-01

    To determine the potential to improve driving-related skills using a simulator-based program in persons with relapsing-remitting multiple sclerosis (RRMS). Pre-post intervention. A university driving simulator laboratory. Participants (N=50) with RRMS and Expanded Disability Status Scale (EDSS) scores between 1 and 7 were enrolled. Pre- and posttraining data from 36 participants (mean age ± SD, 46±11y; 30 women) who received training and 6 participants (mean age ± SD, 48±13y; 5 women) who did not receive training (control group) were compared. Five hours of driving training in a simulator. Performance on a road test at pre- and posttraining. Secondary outcome measures were performance on visual, physical, and cognitive tests. Overall, no significant differences were observed between the training and control groups before and after training. However, 4 of the 7 participants in the training group who failed the road test at pretraining passed posttraining, while the only participant in the control group who failed at pretraining still failed at posttraining. The training group also improved on perception of red and colored numbers, the Paced Auditory Serial Addition Test, and the dot cancellation test of the Stroke Driver Screening Assessment battery and reported less fatigue. These improvements were most pronounced among those with an EDSS score between 3 and 7. This pilot study demonstrates the potential of using a simulator to improve driving-related visual, cognitive, and on-road skills in individuals with RRMS, particularly those with an EDSS score >3. Future randomized controlled trials with adequate power are needed to expand this field of study. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Integrating Multiple Data Views for Improved Malware Analysis

    Anderson, Blake H. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2014-01-31

    Exploiting multiple views of a program makes obfuscating the intended behavior of a program more difficult allowing for better performance in classification, clustering, and phylogenetic reconstruction.

  12. Making a difference? A comparison between multi-sensory and regular storytelling for persons with profound intellectual and multiple disabilities.

    Ten Brug, A; Van der Putten, A A J; Penne, A; Maes, B; Vlaskamp, C

    2016-11-01

    Multi-sensory storytelling (MSST) was developed to include persons with profound intellectual and multiple disabilities in storytelling culture. In order to increase the listeners' attention, MSST stories are individualised and use multiple sensory stimuli to support the verbal text. In order to determine the value of MSST, this study compared listeners' attention under two conditions: (1) being read MSST books and (2) being read regular stories. A non-randomised control study was executed in which the intervention group read MSST books (n = 45) and a comparison group (n = 31) read regular books. Books were read 10 times during a 5-week period. The 1st, 5th and 10th storytelling sessions were recorded on video in both groups, and the percentage of attention directed to the book and/or stimuli and to the storyteller was scored by a trained and independent rater. Two repeated measure analyses (with the storytelling condition as a between-subject factor and the three measurements as factor) were performed to determine the difference between the groups in terms of attention directed to the book/stimuli (first analysis) and storyteller (second analysis). A further analysis established whether the level of attention changed between the reading sessions and whether there was an interaction effect between the repetition of the book and the storytelling condition. The attention directed to the book and/or the stimuli was significantly higher in the MSST group than in the comparison group. No significant difference between the two groups was found in the attention directed to the storyteller. For MSST stories, most attention was observed during the fifth reading session, while for regular stories, the fifth session gained least attentiveness from the listener. The persons with profound intellectual and multiple disabilities paid more attention to the book and/or stimuli in the MSST condition compared with the regular story telling group. Being more attentive towards

  13. Abnormal functional connectivity and cortical integrity influence dominant hand motor disability in multiple sclerosis: a multimodal analysis.

    Zhong, Jidan; Nantes, Julia C; Holmes, Scott A; Gallant, Serge; Narayanan, Sridar; Koski, Lisa

    2016-12-01

    Functional reorganization and structural damage occur in the brains of people with multiple sclerosis (MS) throughout the disease course. However, the relationship between resting-state functional connectivity (FC) reorganization in the sensorimotor network and motor disability in MS is not well understood. This study used resting-state fMRI, T1-weighted and T2-weighted, and magnetization transfer (MT) imaging to investigate the relationship between abnormal FC in the sensorimotor network and upper limb motor disability in people with MS, as well as the impact of disease-related structural abnormalities within this network. Specifically, the differences in FC of the left hemisphere hand motor region between MS participants with preserved (n = 17) and impaired (n = 26) right hand function, compared with healthy controls (n = 20) was investigated. Differences in brain atrophy and MT ratio measured at the global and regional levels were also investigated between the three groups. Motor preserved MS participants had stronger FC in structurally intact visual information processing regions relative to motor impaired MS participants. Motor impaired MS participants showed weaker FC in the sensorimotor and somatosensory association cortices and more severe structural damage throughout the brain compared with the other groups. Logistic regression analysis showed that regional MTR predicted motor disability beyond the impact of global atrophy whereas regional grey matter volume did not. More importantly, as the first multimodal analysis combining resting-state fMRI, T1-weighted, T2-weighted and MTR images in MS, we demonstrate how a combination of structural and functional changes may contribute to motor impairment or preservation in MS. Hum Brain Mapp 37:4262-4275, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Electroconvulsive therapy substantially reduces symptom severity and social disability associated with multiple chemical sensitivity: a case report.

    Elberling, Jesper; Gulmann, Nils; Rasmussen, Alice

    2010-09-01

    Multiple chemical sensitivity (MCS) is a chronic nonallergic, multisymptom disorder triggered by common environmental chemicals in concentrations considered nontoxic for most individuals. The condition may lead to loss of occupation and social isolation, and no effective treatment has been reported. Electroconvulsive therapy (ECT) is a safe and effective treatment of severe depression and medical conditions such as chronic pain disorders. We report a case of a 45-year-old man with a 5-year history of MCS who had to quit his job to live a solitary life without his wife and children because of the condition. The patient had no history of psychiatric illness and no signs of clinical depression at treatment start. Over a 3-week period, he underwent a course of 8 ECTs, giving a remarkable effect on symptom severity and social functional level. After a partial symptom relapse, maintenance treatment was started with 1 ECT every second week. No memory impairment or other complications of ECT were reported at the 4-month follow-up. In this case, a substantial, positive effect on symptom severity and social disability related to MCS was obtained by an initial ECT course and maintenance treatment. Electroconvulsive therapy should be considered an option in severe and socially disabling MCS, but more studies are needed to evaluate if ECT can be recommended as a treatment in MCS.

  15. Factor structure of the Disability and Impact Profile in patients with multiple sclerosis

    Cohen, J. L.; Pouwer, F; Pfennings, L E

    1999-01-01

    and their complementary weighted scores share common variance? What is the factor structure of the weighted scores? To what extent do disease-related information and information from psychological questionnaires offer concurrent validity for the factors? Correlations between impairment ratings and the weighted item...... scores were high; for most items the complementary ratings of impact do not supplement information provided by impairment ratings. The DIP weighted scores can be represented to some extent by three independent dimensions: a motor (skeletal movement) or displacement ability factor, a factor relating...... to sensory-cognitive intactness and a psychological well-being factor. A two-factor solution provides a first factor identical to that of the three-factor solution and a second factor representing psychological well-being. The two factors correlate well with instruments measuring disability...

  16. Efforts to increase social contact in persons with profound intellectual and multiple disabilities: Analysing individual support plans in the Netherlands.

    Kamstra, Aafke; van der Putten, Annette Aj; Vlaskamp, Carla

    2017-06-01

    Most people with profound intellectual and multiple disabilities (PIMD) have limited social contact and it is unclear what is done to maintain or increase these contacts. Individual support planning (ISP) can be used in the systematic enhancement of social contacts. This study analyses the content of ISPs with respect to the social contacts of people with PIMD. ISPs for 60 persons with PIMD in the Netherlands were inductively coded and illustrated with quotations. It turned out that every ISP contained information about social contacts. Of all the quotations extracted, 71.2% were about current conditions, 6.2% were about the future and less than 1% concerned actual goals. The social contacts of people with PIMD are mentioned in their ISPs, but this is rarely translated into goals. The results of the current study suggest that attention should be paid to ensuring that professionals understand the importance of social contacts and their application in practice.

  17. The Use of Assistive Technology to Improve Time Management Skills of a Young Adult with an Intellectual Disability

    Green, Julie M.; Hughes, Elizabeth M.; Ryan, Joseph B.

    2011-01-01

    A growing literature base suggests the need for positive interventions to help individuals with intellectual disabilities improve their time management skills. Time management is a crucial area that must be addressed in the effort to equip adults with the skills necessary to achieve independence, success in employment, and improved quality of…

  18. Association of Cortical Lesion Burden on 7-T Magnetic Resonance Imaging With Cognition and Disability in Multiple Sclerosis.

    Harrison, Daniel M; Roy, Snehashis; Oh, Jiwon; Izbudak, Izlem; Pham, Dzung; Courtney, Susan; Caffo, Brian; Jones, Craig K; van Zijl, Peter; Calabresi, Peter A

    2015-09-01

    Cortical lesions (CLs) contribute to physical and cognitive disability in multiple sclerosis (MS). Accurate methods for visualization of CLs are necessary for future clinical studies and therapeutic trials in MS. To evaluate the clinical relevance of measures of CL burden derived from high-field magnetic resonance imaging (MRI) in MS. An observational clinical imaging study was conducted at an academic MS center. Participants included 36 individuals with MS (30 relapsing-remitting, 6 secondary or primary progressive) and 15 healthy individuals serving as controls. The study was conducted from March 10, 2010, to November 23, 2012, and analysis was performed from June 1, 2011, to September 30, 2014. Seven-Tesla MRI of the brain was performed with 0.5-mm isotropic resolution magnetization-prepared rapid acquisition gradient echo (MPRAGE) and whole-brain, 3-dimensional, 1.0-mm isotropic resolution magnetization-prepared, fluid-attenuated inversion recovery (MPFLAIR). Cortical lesions, seen as hypointensities on MPRAGE, were manually segmented. Lesions were classified as leukocortical, intracortical, or subpial. Images were segmented using the Lesion-TOADS (Topology-Preserving Anatomical Segmentation) algorithm, and brain structure volumes and white matter (WM) lesion volume were reported. Volumes were normalized to intracranial volume. Physical disability was measured by the Expanded Disability Status Scale (EDSS). Cognitive disability was measured with the Minimal Assessment of Cognitive Function in MS battery. Cortical lesions were noted in 35 of 36 participants (97%), with a median of 16 lesions per participant (range, 0-99). Leukocortical lesion volume correlated with WM lesion volume (ρ = 0.50; P = .003) but not with cortical volume; subpial lesion volume inversely correlated with cortical volume (ρ = -0.36; P = .04) but not with WM lesion volume. Total CL count and volume, measured as median (range), were significantly increased in participants

  19. Job-Specific Factors and Prevalence of Multiple and Disabling Musculoskeletal Pain Among Office Workers, Nurses, and Caregivers in Estonia

    Merisalu Eda

    2016-10-01

    Full Text Available The aims of this study were to describe job-specific factors and prevalence of musculoskeletal pains (MSPs by the occupation and body regions in the past 12 months and past month, to analyse multisite and disabling pain and sick leave among office workers (OW, nurses and caregivers (CG; and to find relationships between the observed indicators. The study groups were selected by random sample method. Questionnaire responses on demographic parameters, job-specific factors, and MSPs by body parts in the past 12 months (MSP-12 and past month (MSP-1 were analysed. A questionnaire was sent to 1291 participants. The response rate was 54%. Most of the participants were women, with mean age 41.2 (±11.5 years, working on average 42.8 (±6.7 hours per week and had service length more than five years. Repetitive movements of wrist/hands and working under time pressure were more often reported risk factors by the nurses. Lifting weights 25 kg and more, climbing up and down, kneeling more than one hour a day and piecework finished in the work shift were the most often reported job-related risk factors for the CGs. Use of a keyboard was the same frequent work-related risk factor for the OWs. The most prevalent MSP-12 was low back pain for CGs (66.3% and nurses (56.1% and neck pain for OWs (51.5%. The most often reported MSP-1 was shoulder pain for nurses and OWs (84.4% and 65.7%, correspondingly, and elbow pain for CGs (74.9%. In the the entire sampled group, low back pain (53.9% in the past 12 months and shoulder pain (70.9% in the past month were the most often reported pain regions. A higher prevalence of multiple and disabling MSP and sickness absence were reported by CGs, compared to other occupation groups (p < 0.05. Correlation analysis showed positive relationships between job-related risk factors, like repetitive movements, physical load, and time demands, and MSPs and sick leave, especially among CGs (p < 0.05. Job-specific factors need more

  20. Improved nonparametric inference for multiple correlated periodic sequences

    Sun, Ying; Hart, Jeffrey D.; Genton, Marc G.

    2013-01-01

    cross-validation method to the temperature data obtained from multiple ice cores, investigating the periodicity of the El Niño effect. Our methodology is also illustrated by estimating patients' cardiac cycle from different physiological signals

  1. Future disability projections could be improved by connecting to the theory of a dynamic equilibrium

    Klijs, Bart; Mackenbach, Johan P.; Kunst, Anton E.

    2011-01-01

    Objective: Projections of future trends in the burden of disability could be guided by models linking disability to life expectancy, such as the dynamic equilibrium theory. This article tests the key assumption of this theory that severe disability is associated with proximity to death, whereas mild

  2. Future disability projections could be improved by connecting to the theory of a dynamic equilibrium

    B. Klijs (Bart); J.P. Mackenbach (Johan); A.E. Kunst (Anton)

    2009-01-01

    textabstractObjective Projections of future trends in the burden of disability could be guided by models linking disability to life expectancy, such as the dynamic equilibrium theory. This paper tests the key assumption of this theory that severe disability is associated to proximity to death

  3. Self-reported levels of education and disability progression in multiple sclerosis

    D'hooghe, M. B.; Haentjens, P.; Van Remoortel, A.; De Keyser, J.; Nagels, G.

    2016-01-01

    ObjectivesThe purpose of our study is to investigate whether socioeconomic indicators such as education, financial concerns, employment, and living status are associated with disease progression in relapsing-onset and progressive-onset Multiple Sclerosis (MS). Materials and methodsWe performed a

  4. Cerebrospinal fluid oligoclonal bands and progression of disability in multiple sclerosis

    Koch, M.; Heersema, D.; Mostert, J.; Teelken, A.; De Keyser, J.

    Antibody-mediated inflammation is believed to contribute to tissue injury in multiple sclerosis (MS). The majority of patients with MS have oligoclonal bands (OCB), corresponding to antibodies against a variety of antigens, in their cerebrospinal fluid (CSF). The relation of CSF OCB and disease

  5. GABA and glutamate levels correlate with MTR and clinical disability: Insights from multiple sclerosis.

    Nantes, Julia C; Proulx, Sébastien; Zhong, Jidan; Holmes, Scott A; Narayanan, Sridar; Brown, Robert A; Hoge, Richard D; Koski, Lisa

    2017-08-15

    Converging areas of research have implicated glutamate and γ-aminobutyric acid (GABA) as key players in neuronal signalling and other central functions. Further research is needed, however, to identify microstructural and behavioral links to regional variability in levels of these neurometabolites, particularly in the presence of demyelinating disease. Thus, we sought to investigate the extent to which regional glutamate and GABA levels are related to a neuroimaging marker of microstructural damage and to motor and cognitive performance. Twenty-one healthy volunteers and 47 people with multiple sclerosis (all right-handed) participated in this study. Motor and cognitive abilities were assessed with standard tests used in the study of multiple sclerosis. Proton magnetic resonance spectroscopy data were acquired from sensorimotor and parietal regions of the brains' left cerebral hemisphere using a MEGA-PRESS sequence. Our analysis protocol for the spectroscopy data was designed to account for confounding factors that could contaminate the measurement of neurometabolite levels due to disease, such as the macromolecule signal, partial volume effects, and relaxation effects. Glutamate levels in both regions of interest were lower in people with multiple sclerosis. In the sensorimotor (though not the parietal) region, GABA concentration was higher in the multiple sclerosis group compared to controls. Lower magnetization transfer ratio within grey and white matter regions from which spectroscopy data were acquired was linked to neurometabolite levels. When adjusting for age, normalized brain volume, MTR, total N-acetylaspartate level, and glutamate level, significant relationships were found between lower sensorimotor GABA level and worse performance on several tests, including one of upper limb motor function. This work highlights important methodological considerations relevant to analysis of spectroscopy data, particularly in the afflicted human brain. These findings

  6. Improving physiotherapy services to Indigenous children with physical disability: Are client perspectives missed in the continuous quality improvement approach?

    Greenstein, Caroline; Lowell, Anne; Thomas, David Piers

    2016-06-01

    To compare the outcomes of two cycles of continuous quality improvement (CQI) at a paediatric physiotherapy service with findings from interviews with clients and their carers using the service. Case study based at one paediatric physiotherapy service Community-based paediatric allied health service in Northern Australia. Forty-nine clinical records and four staff at physiotherapy service, five Indigenous children with physical disability aged 8-21 years, and nine carers of Indigenous children aged 0-21 years (current or previous clients). The CQI process based on the Audit and Best Practice for Chronic Disease involved a clinical audit; a workshop where clinicians assessed their health care systems, identified weaknesses and strengths, and developed goals and strategies for improvement; and reassessment through a second audit and workshop. Twelve open-ended, in-depth interviews were conducted with previous or current clients selected through purposive and theoretical sampling. CQI and interview results were then compared. Comparison of findings from the two studies Both CQI and interview results highlighted service delivery flexibility and therapists' knowledge, support and advocacy as service strengths, and lack of resources and a child-friendly office environment as weaknesses. However, the CQI results reported better communication and client input into the service than the interview results. The CQI process, while demonstrating improvements in clinical and organisational aspects of the service, did not always reflect or address the primary concerns of Indigenous clients and underlined the importance of including clients in the CQI process. © 2015 National Rural Health Alliance Inc.

  7. Adapting the Unique Minds Program: Exploring the Feasibility of a Multiple Family Intervention for Children with Learning Disabilities in the Context of Spain.

    López-Larrosa, Silvia; González-Seijas, Rosa M; Carpenter, John S W

    2017-06-01

    The Unique Minds Program (Stern, Unique Minds Program, 1999) addresses the socio-emotional needs of children with learning disabilities (LD) and their families. Children and their parents work together in a multiple family group to learn more about LD and themselves as people with the capacity to solve problems in a collaborative way, including problems in family school relationships. This article reports the cultural adaptation of the program for use in Spain and findings from a feasibility study involving three multiple family groups and a total of 15 children and 15 mothers, using a pre-post design. This Spanish adaptation of the program is called "Mentes Únicas". Standardized outcome measures indicated an overall statistically significant decrease in children's self-rated maladjustment and relationship difficulties by the end of the program. Improvements were endorsed by most mothers, although they were not always recognized by the children's teachers. The program had a high level of acceptability: Mothers and children felt safe, understood, and helped throughout the sessions. The efficacy of the adapted intervention for the context of Spain remains to be tested in a more rigorous study. © 2016 Family Process Institute.

  8. The Armeo Spring as training tool to improve upper limb functionality in multiple sclerosis: a pilot study

    Kerkhofs Lore

    2011-01-01

    Full Text Available Abstract Background Few research in multiple sclerosis (MS has focused on physical rehabilitation of upper limb dysfunction, though the latter strongly influences independent performance of activities of daily living. Upper limb rehabilitation technology could hold promise for complementing traditional MS therapy. Consequently, this pilot study aimed to examine the feasibility of an 8-week mechanical-assisted training program for improving upper limb muscle strength and functional capacity in MS patients with evident paresis. Methods A case series was applied, with provision of a training program (3×/week, 30 minutes/session, supplementary on the customary maintaining care, by employing a gravity-supporting exoskeleton apparatus (Armeo Spring. Ten high-level disability MS patients (Expanded Disability Status Scale 7.0-8.5 actively performed task-oriented movements in a virtual real-life-like learning environment with the affected upper limb. Tests were administered before and after training, and at 2-month follow-up. Muscle strength was determined through the Motricity Index and Jamar hand-held dynamometer. Functional capacity was assessed using the TEMPA, Action Research Arm Test (ARAT and 9-Hole Peg Test (9HPT. Results Muscle strength did not change significantly. Significant gains were particularly found in functional capacity tests. After training completion, TEMPA scores improved (p = 0.02, while a trend towards significance was found for the 9HPT (p = 0.05. At follow-up, the TEMPA as well as ARAT showed greater improvement relative to baseline than after the 8-week intervention period (p = 0.01, p = 0.02 respectively. Conclusions The results of present pilot study suggest that upper limb functionality of high-level disability MS patients can be positively influenced by means of a technology-enhanced physical rehabilitation program.

  9. An Improved Wake Vortex Tracking Algorithm for Multiple Aircraft

    Switzer, George F.; Proctor, Fred H.; Ahmad, Nashat N.; LimonDuparcmeur, Fanny M.

    2010-01-01

    The accurate tracking of vortex evolution from Large Eddy Simulation (LES) data is a complex and computationally intensive problem. The vortex tracking requires the analysis of very large three-dimensional and time-varying datasets. The complexity of the problem is further compounded by the fact that these vortices are embedded in a background turbulence field, and they may interact with the ground surface. Another level of complication can arise, if vortices from multiple aircrafts are simulated. This paper presents a new technique for post-processing LES data to obtain wake vortex tracks and wake intensities. The new approach isolates vortices by defining "regions of interest" (ROI) around each vortex and has the ability to identify vortex pairs from multiple aircraft. The paper describes the new methodology for tracking wake vortices and presents application of the technique for single and multiple aircraft.

  10. A systematic review of interventions aiming to improve involvement in physical activity among adults with intellectual disability.

    Brooker, Katie; van Dooren, Kate; McPherson, Lyn; Lennox, Nick; Ware, Robert

    2015-03-01

    Evidence suggests that most adults with intellectual disability do not participate in sufficient amounts of physical activity (PA). A systematic review of peer-reviewed studies that reported an intervention aiming to improve PA levels of adults with intellectual disability was conducted. Keywords related to intellectual disability and physical activity were used to search relevant databases. Studies were excluded if they did not measure PA as an outcome for adults with intellectual disability, were non-English, and were not peer-reviewed. All relevant studies were included in the review regardless of methodological quality and design. Six articles met the inclusion criteria. These included health education or health promotion programs with PA, nutrition, and weight loss components. The quality of studies included in this review was generally poor. Most studies used a prepost design, sample sizes were small, and measurement tools were used that are not valid and reliable for the population assessed. PA interventions have the potential to improve the health and wellbeing of people with intellectual disability, a vulnerable group who require attention from public health practitioners and researchers. Given the health inequities that exist, public health researchers should target efforts to improve PA levels among this group.

  11. Feasibility, Test-Retest Reliability, and Interrater Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in Persons with Profound Intellectual and Multiple Disabilities

    Waninge, A.; Rook, R. A.; Dijkhuizen, A.; Gielen, E.; van der Schans, C. P.

    2011-01-01

    Caregivers of persons with profound intellectual and multiple disabilities (PIMD) often describe the quality of the daily movements of these persons in terms of flexibility or stiffness. Objective outcome measures for flexibility and stiffness are muscle tone or level of spasticity. Two instruments used to grade muscle tone and spasticity are the…

  12. Feasibility, test-retest reliability, and interrater reliability of the Modified Ashworth Scale and Modified Tardieu Scale in persons with profound intellectual and multiple disabilities

    Waninge, A.; Rook, R.A.; Dijkhuizen, A.; Gielen, E.; van der Schans, C.P.

    2011-01-01

    Caregivers of persons with profound intellectual and multiple disabilities (PIMD) often describe the quality of the daily movements of these persons in terms of flexibility or stiffness. Objective outcome measures for flexibility and stiffness are muscle tone or level of spasticity. Two instruments

  13. Eye movement desensitisation and reprocessing therapy for posttraumatic stress disorder in a child and an adolescent with mild to borderline intellectual disability: A multiple baseline across subjects study

    Mevissen, E.H.M.; Didden, H.C.M.; Korzilius, H.P.L.M.; Jongh, A. de

    2017-01-01

    BACKGROUND: This study explored the effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD) in persons with mild to borderline intellectual disability (MBID) using a multiple baseline across subjects design. METHODS: One child and one

  14. Eye Movement Desensitisation and Reprocessing Therapy for Posttraumatic Stress Disorder in a Child and an Adolescent with Mild to Borderline Intellectual Disability: A Multiple Baseline across Subjects Study

    Mevissen, Liesbeth; Didden, Robert; Korzilius, Hubert; de Jongh, Ad

    2017-01-01

    Background: This study explored the effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD) in persons with mild to borderline intellectual disability (MBID) using a multiple baseline across subjects design. Methods: One child and one adolescent with MBID, who met diagnostic criteria…

  15. Eye movement desensitisation and reprocessing therapy for posttraumatic stress disorder in a child and an adolescent with mild to borderline intellectual disability : A multiple baseline across subjects study

    Mevissen, L.; Didden, R.; Korzilius, H.; de Jongh, A.

    2017-01-01

    Background: This study explored the effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD) in persons with mild to borderline intellectual disability (MBID) using a multiple baseline across subjects design. Methods: One child and one

  16. The Effect of Differentiating Instruction Using Multiple Intelligences on Achievement in and Attitudes towards Science in Middle School Students with Learning Disabilities

    Gomaa, Omema Mostafa Kamel

    2014-01-01

    This study investigated the effect of using differentiated instruction using multiple intelligences on achievement in and attitudes towards science in middle school students with learning disabilities. A total of 61 students identified with LD participated. The sample was randomly divided into two groups; experimental (n= 31 boys )and control (n=…

  17. Integrating Multiple Intelligences and Learning Styles on Solving Problems, Achievement in, and Attitudes towards Math in Six Graders with Learning Disabilities in Cooperative Groups

    Eissa, Mourad Ali; Mostafa, Amaal Ahmed

    2013-01-01

    This study investigated the effect of using differentiated instruction by integrating multiple intelligences and learning styles on solving problems, achievement in, and attitudes towards math in six graders with learning disabilities in cooperative groups. A total of 60 students identified with LD were invited to participate. The sample was…

  18. A good read : A study into the use and effects of multi-sensory storytelling; a storytelling method for persons with profound intellectual and multiple disabilities.

    ten Brug, Annet

    2015-01-01

    In order to include persons with profound intellectual and multiple disabilities (PIMD) into our storytelling culture, multi-sensory storytelling (MSST) has been developed. In a multi-sensory book, verbal text is supported by sensory stimuli, the form and content of the book are adjusted to the

  19. Technology-Aided Leisure and Communication Opportunities for Two Post-Coma Persons Emerged from a Minimally Conscious State and Affected by Multiple Disabilities

    Lancioni, Giulio E.; O'Reilly, Mark F.; Singh, Nirbhay N.; Sigafoos, Jeff; Buonocunto, Francesca; Sacco, Valentina; Navarro, Jorge; Lanzilotti, Crocifissa; De Tommaso, Marina; Megna, Marisa; Oliva, Doretta

    2013-01-01

    This study assessed technology-aided programs for helping two post-coma persons, who had emerged from a minimally conscious state and were affected by multiple disabilities, to (a) engage with leisure stimuli and request caregiver's procedures, (b) send out and listen to text messages for communication with distant partners, and (c) combine…

  20. Relabelling behaviour : The effects of psycho-education on the perceived severity and causes of challenging behaviour in people with profound intellectual and multiple disabilities

    Poppes, P.; Putten, van der Annette; Post, W.; Frans, N.; ten Brug, A.; van Es, A.; Vlaskamp, C.

    2016-01-01

    BackgroundPrevalence rates of challenging behaviour are high in children and adults with profound intellectual and multiple disabilities (PIMD). Moreover, many of these behaviours are observed daily. Direct support staff report that most challenging behaviour identified has little impact on the

  1. Increasing Toy Play among Toddlers with Multiple Disabilities in an Inclusive Classroom: A More-to-Less, Child-Directed Intervention Continuum.

    DiCarlo, Cynthia F.; Reid, Dennis H.; Stricklin, Sarintha B.

    2003-01-01

    A study evaluated a more-to-less, child-directed continuum of intervention to increase toy play among six toddlers with multiple disabilities. Toddlers were provided with repeated choices of preferred toys in a child-directed manner. Nonprompted toy play for two toddlers increased. Toy play also increased for another child after staff prompts and…

  2. Relabelling Behaviour. The Effects of Psycho-Education on the Perceived Severity and Causes of Challenging Behaviour in People with Profound Intellectual and Multiple Disabilities

    Poppes, P.; van der Putten, A.; Post, W.; Frans, N.; ten Brug, A.; van Es, A.; Vlaskamp, C.

    2016-01-01

    Background: Prevalence rates of challenging behaviour are high in children and adults with profound intellectual and multiple disabilities (PIMD). Moreover, many of these behaviours are observed daily. Direct support staff report that most challenging behaviour identified has little impact on the person with PIMD and attribute challenging…

  3. A New Standing Posture Detector to Enable People with Multiple Disabilities to Control Environmental Stimulation by Changing Their Standing Posture through a Commercial Wii Balance Board

    Shih, Ching-Hsiang; Shih, Ching-Tien; Chiang, Ming-Shan

    2010-01-01

    This study assessed whether two persons with multiple disabilities would be able to control environmental stimulation using body swing (changing standing posture) and a Wii Balance Board with a newly developed standing posture detection program (i.e. a new software program turns a Wii Balance Board into a precise standing posture detector). The…

  4. Efforts in enhancing social contacts of persons with severe of profound intellectual and multiple disabilities : Analysing individual support plans in the Netherlands

    Kamstra, Aafke; van der Putten, Annette; Vlaskamp, Carla

    2017-01-01

    Most people with profound intellectual and multiple disabilities (PIMD) have limited social contact and it is unclear what is done to maintain or increase these contacts. Individual support planning (ISP) can be used in the systematic enhancement of social contacts. This study analyses the content

  5. A Limb Action Detector Enabling People with Multiple Disabilities to Control Environmental Stimulation through Limb Action with a Nintendo Wii Remote Controller

    Shih, Ching-Hsiang; Chang, Man-Ling; Shih, Ching-Tien

    2010-01-01

    This study assessed whether two persons with multiple disabilities would be able to control environmental stimulation using limb action with a Nintendo Wii Remote Controller and a newly developed limb action detection program (LADP, i.e., a new software program that turns a Wii Remote Controller into a precise limb action detector). This study was…

  6. Look closer : The alertness of people with profound intellectual and multiple disabilities during multi-sensory storytelling, a time sequential analysis

    Ten Brug, Annet; Munde, Vera S.; van der Putten, Annette A. J.; Vlaskamp, Carla

    2015-01-01

    Introduction: Multi-sensory storytelling (MSST) is a storytelling method designed for individuals with profound intellectual and multiple disabilities (PIMD). It is essential that listeners be alert during MSST, so that they become familiar with their personalised stories. Repetition and the

  7. Post-coma persons emerging from a minimally conscious state with multiple disabilities make technology-aided phone contacts with relevant partners

    Lancioni, G.E.; Singh, N.N.; O'Reilly, M.F.; Sigafoos, J.; Oliva, D.; Campodonico, F.; D'Amico, F.; Buonocunto, F.; Sacco, V.; Didden, H.C.M.

    2013-01-01

    Post-coma individuals emerging from a minimally conscious state with multiple disabilities may enjoy contact with relevant partners (e.g., family members and friends), but may not have easy access to them. These two single-case studies assessed whether those individuals could make contact with

  8. Look Closer: The Alertness of People with Profound Intellectual and Multiple Disabilities during Multi-Sensory Storytelling, a Time Sequential Analysis

    Ten Brug, Annet; Munde, Vera S.; van der Putten, Annette A.J.; Vlaskamp, Carla

    2015-01-01

    Introduction: Multi-sensory storytelling (MSST) is a storytelling method designed for individuals with profound intellectual and multiple disabilities (PIMD). It is essential that listeners be alert during MSST, so that they become familiar with their personalised stories. Repetition and the presentation of stimuli are likely to affect the…

  9. Finding suspects in multiple cameras for improved railway protection

    Marck, J.W.; Bouma, H.; Baan, J; Oliveira Filho, J. de; Brink, M. van der

    2014-01-01

    The capability to find individuals using CCTV cameras is important for surveillance applications at large areas such as railway stations, airports and shopping centers. However, it is laborious to track and trace people over multiple cameras post incident. In this paper, we describe the live

  10. The role of helplessness as mediator between neurological disability, emotional instability, experienced fatigue and depression in patients with multiple sclerosis.

    Werf, S.P. van der; Evers, A.W.M.; Jongen, P.J.H.; Bleijenberg, G.

    2003-01-01

    The aim of this study was to test, in patients with multiple sclerosis (MS), whether the concept of helplessness might improve the understanding of the relationship between disease severity (neurological impairment) and personality characteristics (emotional instability) on one hand, and depressive

  11. Serum Compounds of Energy Metabolism Impairment Are Related to Disability, Disease Course and Neuroimaging in Multiple Sclerosis.

    Lazzarino, Giacomo; Amorini, Angela M; Petzold, Axel; Gasperini, Claudio; Ruggieri, Serena; Quartuccio, Maria Esmeralda; Lazzarino, Giuseppe; Di Stasio, Enrico; Tavazzi, Barbara

    2017-11-01

    Multiple sclerosis (MS) is characterized by primary inflammation, demyelination, and progressive neurodegeneration. A biochemical MS feature is neuronal mitochondrial dysfunction, compensated by anaerobic metabolism increase, likely aggravating progression of neurodegeneration. Here, we characterized a pragmatic serum profile of compounds related to mitochondrial energy metabolism of potential clinical use. Blood samples of 518 well characterized (disability, disease course) MS patients and 167 healthy controls were analyzed for serum purines, pyrimidines, creatinine, and lactate. Nine of the 15 compounds assayed, hypoxanthine, xanthine, uric acid, inosine, uracil, β-pseudouridine, uridine, creatinine, and lactate, differed significantly between MS patients and controls (p < 0.0001). Using these nine compounds, a unifying Biomarker Score was calculated. Controls and MS patients had mean Biomarker Scores of 0.4 ± 0.7 and 4.4 ± 1.9, respectively (p < 0.00001). The Biomarker Score was higher in patients with progressive (6.0 ± 1.8 than with relapsing remitting disease course (3.6 ± 1.5, p < 0.00001). High association between the Biomarker Score and increase in disability (EDSS) was also observed. Additionally, in 50 patients who underwent magnetic resonance imaging (MRI), increase in the Biomarker Score correlated to neuroanatomical alterations. These results, obtained in a large cohort of MS patients evaluated for serum metabolic compounds connected to energy metabolism, demonstrated that the Biomarker Score might represent a pragmatic, resource saving, easy to obtain, laboratory tool useful to monitor MS patients and predict at an early stage who will switch from an RR to a progressive disease course. For the first time, it was also clearly shown a link between mitochondrial dysfunction and MRI lesions characteristic of MS.

  12. The role of physical activity in improving physical fitness in children with intellectual and developmental disabilities.

    Collins, Kyla; Staples, Kerri

    2017-10-01

    One in three children in North America are considered overweight or obese. Children with intellectual and developmental disabilities (IDD) are at an increased risk for obesity than their typically developing peers. Decreased physical activity (PA) and low physical fitness may be contributing factors to this rise in obesity. Because children with IDD are at an increased risk of diseases related to inactivity, it is important to improve health-related physical fitness to complete activities of daily living and improve health. The focus of this research is on improving the performance of physical fitness components through physical activity programming among a group of children with IDD, ages 7-12 years. The Brockport Physical Fitness Test was used assess levels of physical fitness of 35 children with IDD (25 boys, 10 girls) before and after participation in a 10-week program. The results of paired sampled t-tests showed participation in 15-h PA program can significantly increase aerobic capacity and muscular strength and endurance in children with IDD. This study is aimed at understanding the role of PA in helping children with IDD to develop the fitness capacities essential to participation in a wide variety of activities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Progranulin genetic polymorphisms influence progression of disability and relapse recovery in multiple sclerosis.

    Vercellino, Marco; Fenoglio, Chiara; Galimberti, Daniela; Mattioda, Alessandra; Chiavazza, Carlotta; Binello, Eleonora; Pinessi, Lorenzo; Giobbe, Dario; Scarpini, Elio; Cavalla, Paola

    2016-07-01

    Progranulin (GRN) is a multifunctional protein involved in inflammation and repair, and also a neurotrophic factor critical for neuronal survival. Progranulin is strongly expressed in multiple sclerosis (MS) brains by macrophages and microglia. In this study we evaluated GRN genetic variability in 400 MS patients, in correlation with clinical variables such as disease severity and relapse recovery. We also evaluated serum progranulin levels in the different groups of GRN variants carriers. We found that incomplete recovery after a relapse is correlated with an increased frequency of the rs9897526 A allele (odds ratio (OR) 4.367, p = 0.005). A more severe disease course (Multiple Sclerosis Severity Score > 5) is correlated with an increased frequency of the rs9897526 A allele (OR 1.886, p = 0.002) and of the rs5848 T allele (OR 1.580, p = 0.019). Carriers of the variants associated with a more severe disease course (rs9897526 A, rs5848 T) have significantly lower levels of circulating progranulin (80.5 ± 9.1 ng/mL vs. 165.7 ng/mL, p = 0.01). GRN genetic polymorphisms likely influence disease course and relapse recovery in MS. © The Author(s), 2015.

  14. Rehabilitation and multiple sclerosis

    Dalgas, Ulrik

    2011-01-01

    In a chronic and disabling disease like multiple sclerosis, rehabilitation becomes of major importance in the preservation of physical, psychological and social functioning. Approximately 80% of patients have multiple sclerosis for more than 35 years and most will develop disability at some point......, a paradigm shift is taking place and it is now increasingly acknowledged that exercise therapy is both safe and beneficial. Robot-assisted training is also attracting attention in multiple sclerosis rehabilitation. Several sophisticated commercial robots exist, but so far the number of scientific studies...... promising. This drug has been shown to improve walking ability in some patients with multiple sclerosis, associated with a reduction of patients' self-reported ambulatory disability. Rehabilitation strategies involving these different approaches, or combinations of them, may be of great use in improving...

  15. Improving Assessment of Work Related Mental Health Function Using the Work Disability Functional Assessment Battery (WD-FAB).

    Marfeo, Elizabeth E; Ni, Pengsheng; McDonough, Christine; Peterik, Kara; Marino, Molly; Meterko, Mark; Rasch, Elizabeth K; Chan, Leighton; Brandt, Diane; Jette, Alan M

    2018-03-01

    Purpose To improve the mental health component of the Work Disability Functional Assessment Battery (WD-FAB), developed for the US Social Security Administration's (SSA) disability determination process. Specifically our goal was to expand the WD-FAB scales of mood & emotions, resilience, social interactions, and behavioral control to improve the depth and breadth of the current scales and expand the content coverage to include aspects of cognition & communication function. Methods Data were collected from a random, stratified sample of 1695 claimants applying for the SSA work disability benefits, and a general population sample of 2025 working age adults. 169 new items were developed to replenish the WD-FAB scales and analyzed using factor analysis and item response theory (IRT) analysis to construct unidimensional scales. We conducted computer adaptive test (CAT) simulations to examine the psychometric properties of the WD-FAB. Results Analyses supported the inclusion of four mental health subdomains: Cognition & Communication (68 items), Self-Regulation (34 items), Resilience & Sociability (29 items) and Mood & Emotions (34 items). All scales yielded acceptable psychometric properties. Conclusions IRT methods were effective in expanding the WD-FAB to assess mental health function. The WD-FAB has the potential to enhance work disability assessment both within the context of the SSA disability programs as well as other clinical and vocational rehabilitation settings.

  16. Improving Social Skills in Adolescents and Adults with Autism and Severe to Profound Intellectual Disability: A Review of the Literature

    Walton, Katherine M.; Ingersoll, Brooke R.

    2013-01-01

    Social skills are important treatment targets for individuals with autism spectrum disorders (ASD) across the lifespan. However, few treatments are available for adolescents and adults with ASD who also have severe to profound intellectual disability (S/PID). Several social skill interventions have been described that may improve social skills in…

  17. Enhancing Writing Self-Efficacy Beliefs of Students with Learning Disabilities Improves Their Writing Processes and Products

    de Caso, Ana Maria; Garcia, Jesus Nicasio; Diez, Carmen; Robledo, Patricia; Alvarez, Maria Lourdes

    2010-01-01

    Introduction: The use of self efficacy has been suggested as an effective classroom intervention procedure. The present research examined the use of self-efficacy training on the writing of Spanish elementary student with learning disabilities. Objectives: We present a research study focused on the improvement of the writing product and the…

  18. Development and Evaluation of a Curriculum to Improve Educational and Career Outcomes for High School Girls with Disabilities

    Doren, Bonnie; Lombardi, Allison; Lindstrom, Lauren; Gau, Jeff

    2012-01-01

    Despite the national focus on improving transition services and post-school outcomes, many young women with disabilities still face significant barriers in obtaining meaningful employment and pursuing postsecondary education or training. Although recent reports indicate that the gender gap in employment rates may be diminishing, in this same…

  19. Technique improvement of thoracoabdominal CT scan for patients with arm-raising disability

    Yuan Zhidong; Liu Yuanjian; Jiang Guoyin; Feng Fei; Wang Chenglin; Liu Pengcheng

    2010-01-01

    Objective: To explore a new scanning technique to reduce and avoid image artifacts of thoracoabdominal CT and improve image quality for patients who cannot raise their arms. Methods: Sixty-one patients with arm-raising disability between March 2004 and May 2009 were enrolled in the study. Thirty-one cases before June 2007 were scanned with their arms beside their body (control group), 30 cases after June 2007 were scanned with their arms shifting to different imaging planes of the spine (study group), and another 30 patients who can raising their arms were taken as routine group. The images artifacts were blindly evaluated by 5-points scale (severe, less severe, moderate, minimum and no artifact) by 2 experienced CT technologists and one radiologist and compared between the three groups (X 2 test). CT values and its noise of the liver with or without artifact of the three groups were measured and analyzed by one-way ANOVA test. Results: In the control group, 11 cases had severe, 15 cases had less severe, 5 cases had moderate. In the study group, 6 cases had moderate, 15 cases had minimum, 9 cases had no artifact. In the routine group, 8 cases minimum and 22 cases had no artifact. Image quality was significantly improved in the study group compared to the conventional group where X 2 =95.32 and P<0.01. CT value and the noise of the liver without artifact were (54.5 ± 3.0) HU and 10.7 ± 2.4 in the control group, (52.0 ± 3.5) HU and 10.7 ± 0.5 in the study group, (53.7 ± 3.1) HU and 9.9 ± 0.5 in the routine group, respectively. CT value and noise of the liver with artifact were (41.7 ± 8.4) HU and 17.9 ± 2.6 in control group, (53.1 ± 6.9) HU and 11.0 ± 0.7 in the study group, (54.1 ± 2.4) HU and 9.9 ± 0.5 in the routine group, respectively. The CT value and its noise variation with artifact were significantly higher in the control group than the study group and the control group, where F=36.352, 235.848, respectively and P<0.01. Conclusion: The image

  20. Techniques for Performance Improvement of Integer Multiplication in Cryptographic Applications

    Robert Brumnik

    2014-01-01

    Full Text Available The problem of arithmetic operations performance in number fields is actively researched by many scientists, as evidenced by significant publications in this field. In this work, we offer some techniques to increase performance of software implementation of finite field multiplication algorithm, for both 32-bit and 64-bit platforms. The developed technique, called “delayed carry mechanism,” allows to preventing necessity to consider a significant bit carry at each iteration of the sum accumulation loop. This mechanism enables reducing the total number of additions and applies the modern parallelization technologies effectively.

  1. Using Primary Care Parenting Interventions to Improve Outcomes in Children with Developmental Disabilities: A Case Report

    Cassandra L. Tellegen

    2012-01-01

    Full Text Available Parenting is central to the health and well-being of children. Children with developmental disabilities have been shown to be at increased risk of developing emotional and behavioral problems. Parent training programs are effective interventions for improving child behavior and family functioning. This paper describes the outcomes of a brief 4-session parenting intervention (Primary Care Stepping Stones Triple P targeting compliance and cooperative play skills in an 8-year-old girl with Asperger’s disorder and ADHD combined type. The intervention was associated with decreases in child behavior problems, increases in parenting confidence, and decreases in dysfunctional parenting styles. This paper demonstrates that low-intensity parenting interventions can lead to significant improvements in child behavior and family functioning. Such brief interventions are cost effective, can be widely disseminated, and have been designed to be delivered within primary health care settings. Pediatricians can play a key role in identifying parents in need of assistance and in helping them access evidence-based parenting interventions.

  2. Achievement for All: improving psychosocial outcomes for students with special educational needs and disabilities.

    Humphrey, Neil; Lendrum, Ann; Barlow, Alexandra; Wigelsworth, Michael; Squires, Garry

    2013-04-01

    Students with special educational needs and disabilities (SEND) are at a greatly increased risk of experiencing poor psychosocial outcomes. Developing effective interventions that address the cause of these outcomes has therefore become a major policy priority in recent years. We report on a national evaluation of the Achievement for All (AfA) programme that was designed to improve outcomes for students with SEND through: (1) academic assessment, tracking and intervention, (2) structured conversations with parents, and (3) developing provision to improve wider outcomes (e.g. positive relationships). Using a quasi-experimental, pre-test-post-test control group design, we assessed the impact of AfA on teacher ratings of the behaviour problems, positive relationships and bullying of students with SEND over an 18-month period. Participants were 4758 students with SEND drawn from 323 schools across England. Our main impact analysis demonstrated that AfA had a significant impact on all three response variables when compared to usual practice. Hierarchical linear modelling of data from the intervention group highlighted a range of school-level contextual factors and implementation activities and student-level individual differences that moderated the impact of AfA on our study outcomes. The implications of our findings are discussed, and study strengths and limitations are noted. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  3. Improved exact method for the double TSP with multiple stacks

    Lusby, Richard Martin; Larsen, Jesper

    2011-01-01

    and delivery problems. The results suggest an impressive improvement, and we report, for the first time, optimal solutions to several unsolved instances from the literature containing 18 customers. Instances with 28 customers are also shown to be solvable within a few percent of optimality. © 2011 Wiley...... the first delivery, and the container cannot be repacked once packed. In this paper we improve the previously proposed exact method of Lusby et al. (Int Trans Oper Res 17 (2010), 637–652) through an additional preprocessing technique that uses the longest common subsequence between the respective pickup...

  4. Improving neutron multiplicity counting for the spatial dependence of multiplication: Results for spherical plutonium samples

    Göttsche, Malte, E-mail: malte.goettsche@physik.uni-hamburg.de; Kirchner, Gerald

    2015-10-21

    The fissile mass deduced from a neutron multiplicity counting measurement of high mass dense items is underestimated if the spatial dependence of the multiplication is not taken into account. It is shown that an appropriate physics-based correction successfully removes the bias. It depends on four correction coefficients which can only be exactly determined if the sample geometry and composition are known. In some cases, for example in warhead authentication, available information on the sample will be very limited. MCNPX-PoliMi simulations have been performed to obtain the correction coefficients for a range of spherical plutonium metal geometries, with and without polyethylene reflection placed around the spheres. For hollow spheres, the analysis shows that the correction coefficients can be approximated with high accuracy as a function of the sphere's thickness depending only slightly on the radius. If the thickness remains unknown, less accurate estimates of the correction coefficients can be obtained from the neutron multiplication. The influence of isotopic composition is limited. The correction coefficients become somewhat smaller when reflection is present.

  5. Epidemiological characteristics and functional disability of multiple sclerosis patients in Kosovo.

    Zeqiraj, Kamber; Kruja, Jera; Kabashi, Serbeze; Muçaj, Sefedin

    2014-01-01

    Multiple Sclerosis (MS) is a chronic recurrent neurological disease that affects the Central Nervous System. This study aims to determine epidemiological factors that affect the appearance of MS, such as: incidence, prevalence, mortality, case appearance in accordance with the disease phase RRMS, SPMS, PPMS, gender, age, age group, and EDSS. Deals with analyzing diagnosed and treated patients in the Clinic of Neurology in Prishtina during the period of 2003-2012. The research was conducted through a questionnaire applied in the diagnosed cases of MS. Information on patients was gathered from: history of illness, discharge reports and other relevant documents on MS illness. Clinical and epidemiological-descriptive study methods were used. The acquired results are shown through tables, graphics. Statistical processing was conducted with Microsoft Office Excel. From the total number of doubtful hospitalized cases of demyelinization (644) in the Clinic of Neurology in Prishtina, 412 cases (64%) were diagnosed with MS. For the period of 2003-2012 the prevalence of MS has been 19.6 of patients in 100,000 inhabitants. MS incidence rate was 0.95 of patients in 100,000 inhabitants. MS mortality rate was 0.14 of deceased in 100,000 inhabitants. The ratio female--male is 2.3:1. A larger number of patients fall within the age group of 30-39 years-old. Clinical form trends: RRSM 72.3%, SPSM 22.6%, PPSM 5.1%. The rate of EDSS 78.3% (0-3.5), 14.9% (4-6.5), 6.8% (7-9).

  6. Sharing Power with Parents: Improving Educational Decision Making for Students with Learning Disabilities

    Connor, David J.; Cavendish, Wendy

    2018-01-01

    In this closing commentary to the special edition of "Learning Disability Quarterly" ("LDQ") on parent voice in educational decision making for students with learning disabilities, we briefly survey main topics from each article, illuminating important findings from the authors, along with several questions they raise, and…

  7. Catalytic activity of autoantibodies toward myelin basic protein correlates with the scores on the multiple sclerosis expanded disability status scale.

    Ponomarenko, Natalia A; Durova, Oxana M; Vorobiev, Ivan I; Belogurov, Alexey A; Telegin, Georgy B; Suchkov, Sergey V; Misikov, Victor K; Morse, Herbert C; Gabibov, Alexander G

    2006-02-28

    Autoantibodies toward myelin basic protein (MBP) evidently emerge in sera and cerebrospinal fluid of the patients with multiple sclerosis (MS), as well as in a MS rodent model, i.e., experimental autoimmune encephalomyelitis (EAE). The studies of the last two decades have unveiled somewhat controversial data on the diagnostic applicability of anti-MBP autoantibodies as a disease' marker. Here, we present the results of new functional analysis of the anti-MBP autoantibodies isolated from MS (in patients) and EAE (in mice) sera, based on their proteolytic activity against the targeted autoantigen. The activity was shown to be the intrinsic property of the IgG molecule. No activity was found in the sera-derived antibody fraction of healthy donors and control mice. Sera of 24 patients with clinically proven MS at different stages of the disease, and 20 healthy controls were screened for the anti-MBP antibody-mediated proteolytic activity. The activity correlated with the scores on the MS expanded disability status scale (EDSS) (r(2)=0.85, P<0.001). Thus, the anti-MBP autoantibody-mediated proteolysis may be regarded as an additional marker of the disease progression.

  8. Quality and quantity of diffuse and focal white matter disease and cognitive disability of patients with multiple sclerosis.

    Bomboi, Giuseppe; Ikonomidou, Vasiliki N; Pellegrini, Stefano; Stern, Susan K; Gallo, Antonio; Auh, Sungyoung; Evangelou, Iordanis E; Agarwal, Jhalak; Pellicano, Clelia; Ohayon, Joan M; Cantor, Fredric K; Ehrmantraut, Mary; McFarland, Henry F; Kane, Robert L; Bagnato, Francesca

    2011-04-01

    Using high-field magnetic resonance imaging (MRI), we investigated the relationships between white matter (WM) lesion volume (LV), normal-appearing WM (NAWM) normalized volume, WM-lesion and NAWM magnetization transfer ratios (MTRs), brain parenchyma fraction (BPF), and cognitive impairment (CI) in multiple sclerosis (MS). Twenty-four patients and 24 healthy volunteers (age, sex, and years of education-matched) underwent a 3.0 Tesla (3T) scan and evaluation of depression, fatigue, and CI using the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery. In this clinically relatively well-preserved cohort of patients (median score on the Expanded Disability Status Scale=1.5), CI was detected on Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT-II), and Controlled Oral Word Association Test. MT data were available in 19 pairs on whom correlation analyses were performed. Associations were seen between SDMT and normalized NAWM volume (P=.034, r=.502), CVLT-II long delay and normalized NAWM volume (P=.012, r=.563), WM-LV (P=.024, r=.514), and BPF (P=.002, r=.666). The use of 3T MRI in a sample of clinically stable MS patients shows the importance of WM disease in hampering processing speed and word retrieval. Copyright © 2010 by the American Society of Neuroimaging.

  9. Guided Imagery Improves Mood, Fatigue, and Quality of Life in Individuals With Multiple Sclerosis: An Exploratory Efficacy Trial of Healing Light Guided Imagery.

    Case, Laura K; Jackson, Paula; Kinkel, Revere; Mills, Paul J

    2018-01-01

    Multiple sclerosis is a disabling and progressive neurological disease that has significant negative effects on health-related quality of life. This exploratory efficacy study examined the effects of Healing Light Guided Imagery (HLGI), a novel variant of guided imagery, compared with a wait-list control in patients with relapsing-remitting multiple sclerosis. Changes in the Beck Depression Inventory, Fatigue Severity Scale, and Multiple Sclerosis Quality of Life instrument (physical and mental components) were compared between groups. Patients who completed HLGI (N = 9) showed significant reductions in depressed mood ( P mental ( P journaling (N = 8). Our results suggest that HLGI can improve self-reported physical and mental well-being in patients with relapsing-remitting multiple sclerosis. Further research is needed to study the effectiveness of this therapy, as well as its mind-body mechanisms of action.

  10. Walking execution is not affected by divided attention in patients with multiple sclerosis with no disability, but there is a motor planning impairment.

    Nogueira, Leandro Alberto Calazans; Santos, Luciano Teixeira Dos; Sabino, Pollyane Galinari; Alvarenga, Regina Maria Papais; Thuler, Luiz Claudio Santos

    2013-08-01

    We analysed the cognitive influence on walking in multiple sclerosis (MS) patients, in the absence of clinical disability. A case-control study was conducted with 12 MS patients with no disability and 12 matched healthy controls. Subjects were referred for completion a timed walk test of 10 m and a 3D-kinematic analysis. Participants were instructed to walk at a comfortable speed in a dual-task (arithmetic task) condition, and motor planning was measured by mental chronometry. Scores of walking speed and cadence showed no statistically significant differences between the groups in the three conditions. The dual-task condition showed an increase in the double support duration in both groups. Motor imagery analysis showed statistically significant differences between real and imagined walking in patients. MS patients with no disability did not show any influence of divided attention on walking execution. However, motor planning was overestimated as compared with real walking.

  11. The Multiple Benefits of Measures to Improve Energy Efficiency

    Puig, Daniel; Farrell, Timothy Clifford

    Understanding the barriers to, and enablers for, energy efficiency requires targeted information and analysis. This report is a summary of four detailed studies providing new insights on how to promote efficiency in selected priority areas. It complements initiatives such as the so-called energy...... efficiency accelerators, which seek to increase the uptake of selected technologies, as well as the work of many other institutions committed to improving energy efficiency. The modelling estimates and the case studies presented in this report illustrate that, while significant progress has already been...... achieved, the case for accelerating energy efficiency action is strong. Key highlights include: • At the global level, energy efficiency improvements would account for between 2.6 and 3.3 Gt CO2e of the reductions in 2030, equivalent to between 23 and 26 percent of the overall reductions achieved...

  12. Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study.

    George A Jelinek

    Full Text Available Emerging evidence links modifiable lifestyle risk factors to disease progression in multiple sclerosis (MS. We sought further evidence around this hypothesis through detailed analysis of the association with disability of lifestyle behaviours of a large international sample of people with MS.A total of 2469 people with MS from 57 countries provided self-reported data via cross-sectional online survey on lifestyle (mostly with validated tools and the primary outcome measure, disability (Patient Determined Disease Steps, categorised from 8 steps into 3 categories, mild, moderate and major disability. Multinomial logistic regression modelling derived relative risk ratios (RRRs for disability categories.RRRs of having moderate vs mild disability were: diet (per 30 points on 100 point scale 0.72 (95%CI 0.52-0.98, ever smoking 1.32 (1.06-1.65, exercise (moderate/high vs low 0.35 (0.28-0.44, latitude (per degree from the equator 1.02 (1.01-1.04, and number of comorbidities (2 vs none 1.43 (1.04-1.95, (3 vs none 1.56 (1.13-2.16. RRRs of having major vs mild disability were: exercise (moderate/high vs low 0.07 (0.04-0.11, alcohol consumption (moderate vs low 0.45 (0.30-0.68, plant-based omega 3 supplementation 0.39 (0.18-0.86, and disease-modifying medication use 0.45 (0.29-0.70.Healthier lifestyle has strong associations with disability in our large international sample of people with MS, supporting further investigation into the role of lifestyle risk factors in MS disease progression.

  13. Multiple barriers to participation for people with psychosocial disability in Dehradun district, North India: a cross-sectional study.

    Mathias, Kaaren; Pant, Hira; Marella, Manjula; Singh, Lawrence; Murthy, Gvs; Grills, Nathan

    2018-02-27

    This study used a population-based cross-sectional survey to describe the prevalence of psychosocial disability and unmet need for access to services in North India. This study was conducted in Dehradun district, Uttarakhand, in 2014. A population-based sample of 2441 people over the age of 18 years. The Rapid Assessment of Disability survey tool identified people with disability and used an adapted version of the Kessler scale to identify those with psychosocial disability. It additionally collected information on socioeconomic variables, access to community services and barriers to participation. Prevalence of psychosocial disability and unmet needs and descriptions of barriers to services were calculated, and multivariable logistic regression was used to assess associations between risk factors and psychosocial disability. Prevalence of psychosocial disability was 4.8% and 75% of participants with psychological distress also reported comorbid functional impairments. Adjusted ORs for depression of more than two were found for people who were unschooled, unemployed and of moderate or poor socioeconomic status. The unmet need for access to services was significantly higher in every domain for people with psychosocial disability and was more than 25% in the areas of employment, health service access and community consultation. People with psychosocial disability encountered greater barriers in each domain compared with controls. People who are poor, uneducated and unemployed are two to four times more likely to have psychosocial disability in Dehradun district. They face unmet needs in accessing community services and perceive negative social attitudes, lack of physical accessibility and lack of information as barriers limiting their participation. Social policy must increase access to education and reduce poverty but additionally ensure action is taken in all community services to increase information, physical accessibility and social inclusion of people with

  14. Improving Psychiatric Hospital Care for Pediatric Patients with Autism Spectrum Disorders and Intellectual Disabilities

    Robin L. Gabriels

    2012-01-01

    Full Text Available Pediatric patients with autism spectrum disorders (ASD and/or intellectual disabilities (ID are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatric hospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children’s hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33% and decreased average lengths of inpatient stay (as short as 26 days versus 45 days. Available data from a subset of patients (=43 in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes.

  15. Changes in the Oswestry Disability Index that predict improvement after lumbar fusion.

    Djurasovic, Mladen; Glassman, Steven D; Dimar, John R; Crawford, Charles H; Bratcher, Kelly R; Carreon, Leah Y

    2012-11-01

    Clinical studies use both disease-specific and generic health outcomes measures. Disease-specific measures focus on health domains most relevant to the clinical population, while generic measures assess overall health-related quality of life. There is little information about which domains of the Oswestry Disability Index (ODI) are most important in determining improvement in overall health-related quality of life, as measured by the 36-Item Short Form Health Survey (SF-36), after lumbar spinal fusion. The objective of the study is to determine which clinical elements assessed by the ODI most influence improvement of overall health-related quality of life. A single tertiary spine center database was used to identify patients undergoing lumbar fusion for standard degenerative indications. Patients with complete preoperative and 2-year outcomes measures were included. Pearson correlation was used to assess the relationship between improvement in each item of the ODI with improvement in the SF-36 physical component summary (PCS) score, as well as achievement of the SF-36 PCS minimum clinically important difference (MCID). Multivariate regression modeling was used to examine which items of the ODI best predicted achievement for the SF-36 PCS MCID. The effect size and standardized response mean were calculated for each of the items of the ODI. A total of 1104 patients met inclusion criteria (674 female and 430 male patients). The mean age at surgery was 57 years. All items of the ODI showed significant correlations with the change in SF-36 PCS score and achievement of MCID for the SF-36 PCS, but only pain intensity, walking, and social life had r values > 0.4 reflecting moderate correlation. These 3 variables were also the dimensions that were independent predictors of the SF-36 PCS, and they were the only dimensions that had effect sizes and standardized response means that were moderate to large. Of the health dimensions measured by the ODI, pain intensity, walking

  16. Constructing and Validating a Multiple-Indicator Construct of Economic Hardship in a National Sample of Adolescents with Disabilities

    Murray, Christopher; Doren, Bonnie; Gau, Jeff M.; Zvoch, Keith; Seeley, John R.

    2015-01-01

    The purpose of the current study was to develop a multi-indicator construct of economic hardship among adolescents with disabilities (N = 9,230) participating in the National Longitudinal Transition Study-2, the largest, most comprehensive investigation of adolescents with disabilities ever conducted. Five theoretically relevant indicators (i.e.,…

  17. Spreading The Net: The Multiple Benefits Of Energy Efficiency Improvements

    NONE

    2012-07-01

    Improving energy efficiency can deliver a range of benefits to the economy and society. However energy efficiency programmes are often evaluated only on the basis of the energy savings they deliver. As a result, the full value of energy efficiency improvements in both national and global economies may be significantly underestimated. This also means that energy efficiency policy may not be optimised to target the potential of the full range of outcomes possible. Moreover, when the merit of energy efficiency programmes is judged solely on reductions in energy demand, programmes are susceptible to criticisms related to the rebound effect when the energy savings are less than expected due to other welfare gains. There are several reasons why the full range of outcomes from energy efficiency policy is not generally evaluated. First, it is due to the non-market, somewhat intangible, nature of the socioeconomic benefits, which makes them difficult to quantify. Second, the effects due to energy efficiency alone can be complex to isolate and to determine causality. Third, evaluators and policy makers working in the energy efficiency sphere are usually energy professionals, working for an energy agency or ministry, with little experience of how energy efficiency might impact other non-energy sectors. The result is an under-appreciation – and related underinvestment – in energy efficiency, and as a consequence, missed opportunities and benefits. These foregone benefits represent the ‘opportunity cost’ of failing to adequately evaluate and prioritize energy efficiency investments. The objective of this report is to fully outline the array of different benefits from improved energy efficiency and investigate their implications for policy design. By better understanding the different benefits arising from energy efficiency it should be easier for policy makers to prioritise the most significant outcomes, in addition to energy savings, in optimising energy efficiency

  18. Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: a randomized controlled trial.

    Kalron, Alon; Rosenblum, Uri; Frid, Lior; Achiron, Anat

    2017-03-01

    Evaluate the effects of a Pilates exercise programme on walking and balance in people with multiple sclerosis and compare this exercise approach to conventional physical therapy sessions. Randomized controlled trial. Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Forty-five people with multiple sclerosis, 29 females, mean age (SD) was 43.2 (11.6) years; mean Expanded Disability Status Scale (S.D) was 4.3 (1.3). Participants received 12 weekly training sessions of either Pilates ( n=22) or standardized physical therapy ( n=23) in an outpatient basis. Spatio-temporal parameters of walking and posturography parameters during static stance. Functional tests included the Time Up and Go Test, 2 and 6-minute walk test, Functional Reach Test, Berg Balance Scale and the Four Square Step Test. In addition, the following self-report forms included the Multiple Sclerosis Walking Scale and Modified Fatigue Impact Scale. At the termination, both groups had significantly increased their walking speed ( P=0.021) and mean step length ( P=0.023). According to the 2-minute and 6-minute walking tests, both groups at the end of the intervention program had increased their walking speed. Mean (SD) increase in the Pilates and physical therapy groups were 39.1 (78.3) and 25.3 (67.2) meters, respectively. There was no effect of group X time in all instrumented and clinical balance and gait measures. Pilates is a possible treatment option for people with multiple sclerosis in order to improve their walking and balance capabilities. However, this approach does not have any significant advantage over standardized physical therapy.

  19. Speech and language therapists' approaches to communication intervention with children and adults with profound and multiple learning disability.

    Goldbart, Juliet; Chadwick, Darren; Buell, Susan

    2014-11-01

    People with profound intellectual and multiple disabilities (PMLD) have communication impairments as one defining characteristic. To explore speech and language therapists' (SLTs) decision making in communication interventions for people with PMLD, in terms of the intervention approaches used, the factors informing the decisions to use specific interventions and the extent to which the rationales underpinning these decisions related to the components of evidence based practice (EBP), namely empirical evidence, clinical experience and client/carer views and values. A questionnaire on communication assessment and intervention for people with PMLD was sent to SLTs in the UK to elicit information on: the communication intervention approaches they used; their rationales for their intervention choices; their use of published evidence to inform decision making. Intensive interaction and objects of reference were the communication interventions most often used with people with PMLD, with some differences between children and adults evident. Rationales provided conformed somewhat to the EBP framework though extension of the existing framework and addition of practical and organizational considerations led to a revised typology of rationale for decision making. Rationales most frequently related to the empowerment, development and behavioural preferences of the person with PMLD. Empirical research evidence was seldom mentioned by SLTs as informing intervention decision making leading to very diverse practice. There is a need for further research on the effectiveness of commonly used but under-evaluated interventions. There is also a need to alert SLTs to the evidence base supporting other approaches, particularly switch-based, cause and effect approaches. © 2014 Royal College of Speech and Language Therapists.

  20. Nurse Educator Attitudes Toward People With Disabilities.

    Lyon, Lori; Houser, Rick

    As educators strongly influence the attitudes of their students, the purpose of this study was to determine nurse educator attitudes toward people with disabilities. Inadequate education of health professionals is a known barrier to care for people with disability. Continuing calls for improved education of health professionals compel an assessment of nurse educator attitudes. This was a cross-sectional, correlational web-based survey of nurse educators (n = 126). Nurse educator attitudes were analyzed using descriptive statistics, analysis of variance, and multiple regression analysis. Nurse educators held discriminatory attitudes toward people with disabilities, though most preferred a biopsychosocial model of disability. Forty-four percent lacked knowledge of disability-related aims, objectives, or outcomes within the curriculum. To advance equity in health care, nurse educators must confront personal bias and teach competent care of people with disabilities.

  1. Disability Overview

    ... About CDC.gov . Disability & Health Home Disability Overview Disability Inclusion Barriers to Inclusion Inclusion Strategies Inclusion in Programs & Activities Resources Healthy Living Disability & Physical Activity Disability & Obesity Disability & Smoking Disability & Breast ...

  2. Symbol labelling improves advantageous decision-making on the Iowa Gambling Task in people with intellectual disabilities.

    Dymond, Simon; Bailey, Rebecca; Willner, Paul; Parry, Rhonwen

    2010-01-01

    Individuals with intellectual and developmental disabilities often have difficulties foregoing short-term loss for long-term gain. The Iowa Gambling Task (IGT) has been extensively adopted as a laboratory measure of this ability. In the present study, we undertook the first investigation with people with intellectual disabilities using a two-choice child version of the IGT, with measures of intellectual and executive functioning. Compared to a group of matched controls, people with intellectual disabilities performed advantageously and showed high levels of subjective awareness about the relative goodness and badness of the decks. A symbol labelling intervention, in which participants were taught to label the good and bad decks at regular intervals significantly improved advantageous decision-making to levels approximating that of controls. Factor analysis of executive functioning scores identified working memory and mental flexibility (response initiation and set shifting), with a near-significant inverse correlation between the extent to which the intervention was required and mental flexibility. These findings show, for the first time, that people with intellectual disabilities are capable of performing advantageously on the IGT and add to the growing clinical literature on decision-making. Copyright 2009 Elsevier Ltd. All rights reserved.

  3. Improving the spatial resolution of the multiple multiwire proportional chamber gamma camera

    Bateman, J.E.; Connolly, J.F.

    1978-03-01

    Results are presented showing how the spatial resolution of the multiple multiwire proportional chamber (MMPC) gamma camera may be improved. Under the best conditions 1.6 mm bars can be resolved. (author)

  4. The Effectiveness of Backward Chaining Methods to Improve Skills in Children with Intellectual Disability

    Arip Apriyadi

    2017-03-01

    Full Text Available A child with intellectual disability has problems in adaptive behavior such as eating skill. The research objective was to describe: 1 the ability of the child with intellectual disability before being given intervention using backward chaining method, 2 the ability of the child with intellectual disability after being given intervention using backward chaining method, and 3 the effectiveness of backward chaining method to increase the eating skills for child with intellectual disability. The method of this study was an experimental method by using the Single Subject Research (SSR with the A-B-A design model. The results showed that the percentage of overlap between the baseline condition-1 and the intervention condition was 0%. The calculation declared that there was increase eating skill for child with intellectual disability with backward chaining. Anak disabilitas intelektual memiliki masalah dalam perilaku adaptif seperti pada keterampilan makan. Tujuan penelitian ini untuk mendeskripsikan: 1 kemampuan anak disabilitas intelektual sebelum diberikan intervensi menggunakan backward chaining, 2 kemampuan anak disabilitas intelektual setelah diberikan intervensi menggunakan backward chaining, dan 3 keefektifan backward chaining untuk meningkatkan keterampilan makan. Metode penelitian yang digunakan dalam penelitian ini adalah metode eksperimen dengan menggunakan Single Subject Reseach (SSR dengan desain A-B-A. Hasil penelitian menunjukan perolehan presentase overlap antara kondisi baseline-1 ke kondisi intervensi sebesar 0%. Perhitungan tersebut menyatakan adanya pengaruh keefektifan backward chaining sebagai intervensi terhadap peningkatan keterampilan makan sebagai target behavior.

  5. Use of the International Classification of Functioning, Disability and Health to describe patient-reported disability: a comparison of Guillain Barré syndrome with multiple sclerosis in a community cohort.

    Khan, Fary; Amatya, Bhasker; Ng, Louisa

    2010-09-01

    To use the International Classification of Functioning, Disability and Health (ICF) to describe and compare patient-reported disability in Guillain-Barré syndrome survivors and persons with multiple sclerosis, and to identify relevant environmental factors. Cross-sectional survey of 77 survivors of Guillain-Barré syndrome in the community. Their Guillain-Barré syndrome-related problems were linked with ICF categories (second level) using an open-ended questionnaire, consensus between health professionals and the "linking rules", and compared with similar data collected previously for 101 persons with multiple sclerosis. Guillain-Barré syndrome survivors were male (59%) and older than persons with multiple sclerosis (mean age 55 vs 49 years). Of 170 ICF categories, 113 were relevant for Guillain-Barré syndrome survivors (mean number 30 vs 18 for persons with multiple sclerosis). The linked categories for Guillain-Barré syndrome included: body function 27 (56%) compared with 48 (42%) for persons with multiple sclerosis; body structure 11 (68%) vs 16 (34%); activities and participation 48 (70%) and 68 (58%); and for environmental factors 27 (71%) compared with 38 (51%) for persons with multiple sclerosis. The main areas linked in the activities and participation domain were mobility, major life areas and interpersonal relationships; and environmental factors included support and relationships, attitudes and products and technology. This is the first study to use ICF in Guillain-Barré syndrome survivors and towards development of the ICF Core Set for Guillain-Barré syndrome from a broader international perspective.

  6. 3T deep gray matter T2 hypointensity correlates with disability over time in stable relapsing-remitting multiple sclerosis: a 3-year pilot study.

    Zhang, Y; Metz, L M; Yong, V W; Mitchell, J R

    2010-10-15

    Abnormally decreased deep gray matter (GM) signal intensity on T2-weighted MRI (T2 hypointensity) is associated with brain atrophy and disability progression in patients with multiple sclerosis (MS) and is believed to represent excessive iron deposition. We investigated the time course of deep GM T2 hypointensity and its relationship with disability at 3T in 8 stable relapsing-remitting (RR) MS patients treated with minocycline over 3years. MRI and disability measurements were compared at baseline, 6, 12, 24, and 36months. Grand mean deep GM T2 hypointensity was negatively correlated with EDSS over time (r=-0.94, P=0.02). This correlation was strongest in the head of caudate (r=-0.95, P=0.01) and putamen (r=-0.89, P=0.04). Additionally, baseline grand mean deep GM T2 hypointensity appears to predict third year EDSS (r=-0.72, P=0.04). These results suggest that iron associated deep GM injury correlates with patient disability in stable RRMS. Measurements of deep GM T2 hypointensity at high field MRI may prove to be useful in monitoring individuals with MS. Further studies are required to confirm these results in a large sample and to determine if T2 hypointensity changes in clinically active MS patients. Copyright 2010 Elsevier B.V. All rights reserved.

  7. Enabled or Disabled: Is the Environment Right for Using Biodiversity to Improve Nutrition?

    Hunter, Danny; Özkan, Isa; Moura de Oliveira Beltrame, Daniela; Samarasinghe, Wellakke Lokuge Gamini; Wasike, Victor Wafula; Charrondière, U Ruth; Borelli, Teresa; Sokolow, Jessica

    2016-01-01

    How can we ensure that 9 billion people will have access to a nutritious and healthy diet that is produced in a sustainable manner by 2050? Despite major advances, our global food system still fails to feed a significant part of humanity adequately. Diversifying food systems and diets to include nutrient-rich species can help reduce malnutrition, while contributing other multiple benefits including healthy ecosystems. While research continues to demonstrate the value of incorporating biodiversity into food systems and diets, perverse subsidies, and barriers often prevent this. Countries like Brazil have shown that, by strategic actions and interventions, it is indeed possible to create better contexts to mainstream biodiversity for improved nutrition into government programs and public policies. Despite some progress, there are few global and national policy mechanisms or processes that effectively join biodiversity with agriculture and nutrition efforts. This perspective paper discusses the benefits of biodiversity for nutrition and explores what an enabling environment for biodiversity to improve nutrition might look like, including examples of steps and actions from a multi-country project that other countries might replicate. Finally, we suggest what it might take to create enabling environments to mainstream biodiversity into global initiatives and national programs and policies on food and nutrition security. With demand for new thinking about how we improve agriculture for nutrition and growing international recognition of the role biodiversity, the 2030 Agenda for Sustainable Development presents an opportunity to move beyond business-as-usual to more holistic approaches to food and nutrition security.

  8. Does walking improve disability status, function, or quality of life in adults with chronic low back pain? A systematic review.

    Lawford, Belinda J; Walters, Julie; Ferrar, Katia

    2016-06-01

    To establish the effectiveness of walking alone and walking compared to other non-pharmacological management methods to improve disability, quality of life, or function in adults with chronic low back pain. A systematic search of the following databases was undertaken: Medline, Embase, CINAHL, Scopus, Pedro, SportDiscus, Cochrane Central Register of Controlled Trials. The following keywords were used: 'back pain' or 'low back pain' or 'chronic low back pain' and 'walk*' or 'ambulation' or 'treadmill*' or 'pedometer*' or 'acceleromet*' or 'recreational' and 'disability' or 'quality of life' or 'function*'. Primary research studies with an intervention focus that investigated walking as the primary intervention compared to no intervention or any other non-pharmacological method in adults with chronic low back pain (duration >3 months). Seven randomised controlled trials involving 869 participants were included in the review. There was no evidence that walking was more effective than other management methods such as usual care, specific strength exercises, medical exercise therapy, or supervised exercise classes. One study found over-ground walking to be superior to treadmill walking, and another found internet-mediated walking to be more beneficial than non-internet-mediated walking in the short term. There is low quality evidence to suggest that walking is as effective as other non-pharmacological management methods at improving disability, function, and quality of life in adults with chronic low back pain. © The Author(s) 2015.

  9. Improving Science Scores of Middle School Students with Learning Disabilities through Engineering Problem Solving Activities

    Starling, A. Leyf Peirce; Lo, Ya-Yu; Rivera, Christopher J.

    2015-01-01

    This study evaluated the differential effects of three different science teaching methods, namely engineering teaching kit (ETK), explicit instruction (EI), and a combination of the two methods (ETK+EI), in two sixth-grade science classrooms. Twelve students with learning disabilities (LD) and/or attention deficit hyperactivity disorder (ADHD)…

  10. Do iPad Applications Help Students with Developmental Disabilities Improve Life-Readiness Skills?

    Dunn, Michael; Barrio, Brenda; Hsiao, Yun-Ju

    2016-01-01

    Students with developmental disabilities often struggle with life-readiness skills (e.g., literacy skills such as reading and writing, task completion, and communication), which also help prepare students for the workplace. Assistive technology tools offer these students a means to do better in these areas. In this action-research study, we…

  11. Practice Brief: Faculty Perspectives on Professional Development to Improve Efficacy when Teaching Students with Disabilities

    Park, Hye Jin; Roberts, Kelly D.; Stodden, Robert

    2012-01-01

    "Innovative and Sustainable Teaching Methods and Strategies" project staff provided professional development to instructional faculty to enhance their attitudes, knowledge, and skills in meeting the diverse needs of students with disabilities. This practice brief describes one of the professional development programs, delivered over the course of…

  12. 75 FR 82428 - VASRD Improvement Forum-Updating Disability Criteria for the Genitourinary System, Digestive...

    2010-12-30

    ... Genitourinary System, Digestive System, Dental Conditions, and Infectious Diseases, Immune Disorders and... Disability Criteria for the Genitourinary System, Digestive System, Dental Conditions, and Infectious... 4.88-4.89), (2) the Digestive System (38 CFR 4.110-4.114), (3) the Genitourinary System (38 CFR 4...

  13. Improving thinking skills in science of learners with (dis)abilities

    Erna Kinsey

    learning areas, are more relevant to learners than transmitting factual content to them, for example ... on the curriculum, inclusive education and disability, mandate that science ... to help learners with special needs to progress in a safe, encouraging .... first step with previous ideas and feelings that the teacher- researcher ...

  14. Intellectual Disability and Developmental Risk: Promoting Intervention to Improve Child and Family Well-Being

    Crnic, Keith A.; Neece, Cameron L.; McIntyre, Laura Lee; Blacher, Jan; Baker, Bruce L.

    2017-01-01

    Initial intervention processes for children with intellectual disabilities (IDs) largely focused on direct efforts to impact core cognitive and academic deficits associated with the diagnosis. Recent research on risk processes in families of children with ID, however, has influenced new developmental system approaches to early intervention. Recent…

  15. Hearing in Athletes with Intellectual Disabilities: The Need for Improved Ear Care

    McCracken, W.; Lumm, J.; Laoide-Kemp, S.

    2011-01-01

    Background: The Special Olympics offer the opportunity for athletes with intellectual disabilities to participate in a range of sports at regional, national and international level. A parallel Healthy Athletes programme was introduced to ensure safety at the games but also to collect data on the health needs of those with intellectual disabilities…

  16. The Development of LinguaBytes: An Interactive Tangible Play and Learning System to Stimulate the Language Development of Toddlers with Multiple Disabilities

    Bart Hengeveld

    2008-01-01

    Full Text Available Young children with multiple disabilities (e.g., both cognitive and motor disabilities are confronted with severe limitations in language development from birth and later on. Stimulating the adult-child communication can decrease these limitations. Within LinguaBytes, a three-year research program, we try to stimulate language development by developing an interactive and adaptive play and learning environment, incorporating tangible objects and multimedia content, based on interactive storytelling and anchored instruction. The development of a product for such a heterogeneous user group presents substantial challenges. We use a Research-through-Design method, that is, an iterative process of developing subsequent experiential prototypes and then testing them in real-life settings, for example, a center for rehabilitation medicine. This article gives an outline of the development of the LinguaBytes play and learning environment from the earliest studies up to the current prototype, CLICK-IT.

  17. Incapacidad laboral en esclerosis múltiple: a propósito de un caso Working disability in multiple sclerosis: a propos of a case

    Gian C. Navarro Chumbes

    2010-12-01

    Full Text Available Enfermera de 34 años de edad que acude a la Unidad Médica de Valoración de Incapacidades del INSS (Instituto Nacional de Seguridad Social para valoración de Incapacidad Temporal (IT; diagnosticada de Esclerosis Múltiple (EM hace 10 años, presentó 6 brotes, por lo que requirió tratamiento con Acetato de Glatirámero y se le adaptó el puesto de trabajo. Actualmente tiene un EDSS (Expanded Disability Status Scale estimado de 1,0, y actualmente no está con tratamiento inmunomodulador. Este caso clínico lo que busca es conocer de qué manera se valora la incapacidad laboral en los casos de trabajadores que padecen de EM, asimismo cómo se determina el grado de menoscabo en función del EDSS y qué aspectos laborales son tomados en consideración.A 34-year old woman, nurse, who arrives to the Medical Assessment Disability Unit of SSNI (Social Security National Institute for to assess Temporary Disability (TD, she was diagnosed of Multiple Sclerosis (MS 10 years ago, she had 6 outbreaks and because of that she was treated with Glatiramer Acetate and also her workstation was adapted. At the moment she has an EDSS (Expanded Disability Status Scale of 1.0, and now she does not receive immunomodulator treatment. With this case report we want to know the way that labour disability is evaluated for workers that complain of MS, also how the damage degree is determined according to EDSS and what labour aspects are taken into consideration.

  18. The Combined Effects of Training on Serum Levels of Interferon Gamma (INF-γ and Expanded Scale Disability Status Scale of Patients with Multiple Sclerosis at Different Levels of Disability

    Z Saberi

    2017-02-01

    Full Text Available Background and aim: Multiple sclerosis is a chronic and debilitating nervous system, leading to demyelination of the central nervous system (brain and spinal cord. Regular exercise and general physical activity is important to maintain health and prevent disease, already well known. Therefore the aim of this study was to evaluate the effect of 12 weeks of combined exercises (strength training, Strengthening Exercises, cardio respiratory endurance, a variety of static and dynamic balance exercises, exercises of the trunk (pilates training and walking on the treadmill training with body weight support on interferon gamma and Expanded Disability Status Scale women with multiple sclerosis. Methods: In the present experimental rsearch, female patients who were admitted to the MS Society of Shahrekord, Iran, were divided into three groups based on physical disability scores. In the first group (physical disability scale less than 4.5, 44 people were randomly selected to one experimental group (22 patients and control group (n = 22. In the second group (scale physical disability between 5 and 5.6, 26 patients were enrolled and randomly assigned to an experimental group (n = 13 and control group (n = 13. The third (Physical Disability Scale-up to 6.5, 26 patients were enrolled and randomly assigned to an experimental group (n = 13 and control group (n = 13. A total of 96 patients were participated in this study. Experimental groups of first, second and third were done its own intervention separately. While the control group received stretching exercises, workout schedule for the experimental group was of 12 weeks, three sessions of lasted one hour. Anthropometric factors and interferon-gamma were measured before and after training with the appropriate tools. Serum levels of INF-γ was determind using a commercial ELISA kit and EDSS scores were measured using the measure of disability in patients with MS. Data analysis was performed using descriptive

  19. Enabled or disabled: Is the environment right for using biodiversity to improve nutrition?

    Danny eHunter

    2016-06-01

    Full Text Available How can we ensure that 9 billion people will have access to a nutritious and healthy diet that is produced in a sustainable manner by 2050? Despite major advances, our global food system still fails to feed a significant part of humanity adequately. Diversifying food systems and diets to include nutrient-rich species can help reduce malnutrition while contributing other multiple benefits including healthy ecosystems. While research continues to demonstrate the value of incorporating biodiversity into food systems and diets, perverse subsidies and barriers often prevent this. Countries like Brazil have shown that by strategic actions and interventions it is indeed possible to create better contexts to mainstream biodiversity for improved nutrition into government programs and public policies. Despite some progress, there are few global and national policy mechanisms or processes that effectively join biodiversity with agriculture and nutrition efforts. This perspective paper discusses the benefits of biodiversity for nutrition and explores what an enabling environment for biodiversity to improve nutrition might look like, including examples of steps and actions from a multi-country project that other countries might replicate. Finally, we suggest what it might take to create enabling environments to mainstream biodiversity into global initiatives and national programs and policies on food and nutrition security. With demand for new thinking about how we improve agriculture for nutrition, and growing international recognition of the role biodiversity, the 2030 Agenda for Sustainable Development presents an opportunity to move beyond business-as-usual, to more holistic approaches to food and nutrition security.

  20. Comparison the Impact of Spark Motor Program and Basketball Techniques on Improving Gross Motor Skills in Educable Intellectually Disabled Boys

    Hashem Faal Moghanlo

    2014-09-01

    Full Text Available Background & objectives : Different types of practises are known for improving motor skills in intellectually disabled boys. The purpose of this study was to compar e the impact of spark motor program and basketball on improving of gross motor skills in this people.   Methods: In this semi-experimental study , from 98 educable intellectually disabled students who studied in special school in Urmia, 30 children ( age range of 9 to 13 years and IQ mean 64.4 were selected objectively and divided in three groups (2 experimental and 1 control based on pre - test. BOTMP was used as a measurement of motor ability. Selected motor program (Spark motor program including strengthening training, games, sports and basketball techniques was performed for 24 sessions. T-tests (dependent and co-variance were used to comparison of results.   Results: In Spark group after 24 sessions, there were significant effects on balance (p= 0.000, bilateral coordination (p=0.000 and strength (p=0.001. There was no significant effect in agility and speed (p= 0.343 in basketball techniques group after 24 sessions, there were significant effects in agility and speed (p= 0.001, balance (p= 0.000, bilateral coordination (p= 0.013 and strength (p= 0.007.   Conclusion: Based on the results of this study, it can be claimed that the Spark program and basketball techniques improve gross motor skills in educable intellectually disabled students. We also found a significant difference between the Spark program and basketball techniques efficacy on the improved skills. Furthermore, the efficacy of Spark program was significantly higher than basketball techniques (p<0.05.

  1. Use of a structured migraine diary improves patient and physician communication about migraine disability and treatment outcomes.

    Baos, V; Ester, F; Castellanos, A; Nocea, G; Caloto, M T; Gerth, W C

    2005-03-01

    Migraine is frequently undertreated, perhaps because impaired communication between patients and physicians underestimate the disability associated with migraine attacks. The purpose of this study was to evaluate the benefits of a structured migraine diary used during a prospective open-label study of triptan-naive patients in Spain for recording information on response to therapy for a pre-study migraine attack and three consecutive migraine attacks, the first and third treated with rizatriptan 10-mg wafer and the second with usual non-triptan therapy. Of 97 patients (83% women; mean age, 39 years) who completed the study, all reported moderate to severe pain, and two-thirds reported severe to total impairment during migraine attacks. At study end, 72% of patients reported that the migraine diary helped communication with their doctor about migraine, and 70% were more or much more satisfied than before the study with level of overall medical care provided by their doctor. Patients who reported the diary to be useful also reported higher overall satisfaction with medical care (p better communicate with their patients about migraine, and all reported that it enabled them to assess differences in pain intensity and disability across patients. We conclude that a structured migraine diary can be a valuable aid for improving communication between physicians and patients regarding migraine disability and treatment outcomes.

  2. The Use of an iPad2 as a Leisure Activity for a Student with Multiple Disabilities

    Helps, Dawn H.; Herzberg, Tina S.

    2013-01-01

    Participation in preferred leisure activities is intrinsically motivating and satisfying. Many individuals with and without disabilities enjoy informal leisure activities, such as watching movies, listening to music, shopping, and going out to eat (Dattilo, Estrella, Light, McNaughton, & Seabury, 2008). Sometimes leisure activities are provided to…

  3. Respecting autonomy in the end-of-life care of people with intellectual disabilities: a qualitative multiple-case study.

    Bekkema, N.; Veer, A.J.E. de; Hertogh, C.M.P.M.; Francke, A.L.

    2014-01-01

    Background: The aim of this article was to describe how caregivers and relatives shape respect for autonomy in the end-of-life care for people with intellectual disabilities (ID) and to discuss to what extent this corresponds with a relational concept of autonomy, such as described in care ethics.

  4. A Case Study Using CRA to Teach Students with Disabilities to Count Using Flexible Numbers: Applying Skip Counting to Multiplication

    Gibbs, Anna S.; Hinton, Vanessa M.; Flores, Margaret M.

    2018-01-01

    Children who struggle in mathematics have a limited understanding of the foundational processes of mathematics. A lack of conceptual understanding causes students to fall behind as they progress through the core curriculum. Children at high risk for developing mathematics disabilities fail to gain numeracy knowledge. The purpose of this case study…

  5. Cognitive rehabilitation: an important tool in disability improvement after brain injuries

    Ioana Stanescu; Gabriela Dogaru

    2016-01-01

    Cognitive rehabilitation is as an important goal of rehabilitation therapy, which aims to help the person with neurological disability to acquire the highest level of cognitive functioning and of functional autonomy. Cognitive impairments in memory, language, judgement, attention, visuo-spatial perception are important blocks in acquiring functional independence. Cognitive rehabilitation therapy is “a systematic, functionally oriented service of therapeutic cognitive activities directed to ...

  6. Helping Students with Cognitive Disabilities Improve Social Writing Skills through Email Modeling and Scaffolding

    Wang, Xiao-lei; Eberhard, Dominique; Voron, Mike; Bernas, Ronan

    2016-01-01

    The purpose of this study is to examine the effects of email modeling and scaffolding on the social writing quality of students with cognitive disabilities. Ten students from a university-affiliated lab school (mean age = 19.3; SD = 1.2) with an average of IQ of 55.30 (SD = 5.98) and 10 teacher candidates in a university teacher education…

  7. VA Disability Benefits: Additional Planning Would Enhance Efforts to Improve the Timeliness of Appeals Decisions

    2017-03-01

    must manually review and correct most incoming cases due to issues with labeling, mismatched dates, and missing files. Via an internal study, VA...individuals acclimate to their jobs —and factored this into the modeling assumptions used to project the number of Board staff needed. More...Needed to Promote Increased User Satisfaction . GAO-15-582 (Washington, D.C.: September 1, 2015). Page 29 GAO-17-234 VA Disability

  8. Use of Chunking and Questioning Aloud to Improve the Reading Comprehension of English Language Learners with Disabilities. ELLs with Disabilities Report 17

    Barrera, Manuel; Liu, Kristi; Thurlow, Martha; Chamberlain, Steve

    2006-01-01

    English language learners (ELLs) with disabilities struggle with reading and the reasons for their struggles are not well understood owing to little knowledge about the impact of disability on language development in either the first or second language (Klingner et al., 2006). Nevertheless, this difficulty in reading achievement historically has…

  9. Challenges and improvements in the rights of persons with disabilities: A global perspective

    María Soledad Cisternas Reyes

    2015-10-01

    Full Text Available The United Nations Convention on the Rights of the Persons with Disabilities is the first human rights treaty of the 21st century, which established the human rights model for this part of the population. The Convention is structured around two main pillars: equality and non discrimination, and diversified rights for this group. This Convention raises a number of legal innovations among which we highlight the accessibility, rehabilitation, the right to independent living, and the right to inclusion in the community, aspects that invite to explore its nature. In addition to these principles, the work of the treaty body, the Committee of Experts of the Convention on the Rights of Persons with Disabilities, will be analyzed. The Committee has competence to examine individual complaints, and has adopted General Comments on critical issues such as equal recognition before the law and accessibility. Finally, this paper studies the link between the human rights of people with disabilities and the Sustainable Development Goals for the Post-2015 Development Agenda, which has predominated the contemporary debate within the United Nations.

  10. Stay in the Box! Embedded Assistive Technology Improves Access for Students with Disabilities

    Katherine Koch

    2017-11-01

    Full Text Available Assistive technology is not only a required component of a student’s IEP; it can be an effective way to help students with (and without disabilities access their education and to provide them with required instructional accommodations. Teachers, however, are often not adequately prepared in their pre-service course work and ongoing professional development to address the technology needs of their special education students and have not had the opportunities to access technology due to limited availability and cost. While assistive technology can be purchased to augment an existing computer, it is often unnecessary to do that. Both Microsoft and Apple operating systems in “off-the-shelf” computers and handheld devices have embedded assistive technology that is easy to access and easy to use. This embedded technology can help teachers become familiar with technology and assist students with sensory, physical, learning, and attention disabilities, and it might have practical applications with Universal Design for Learning. This paper provides a discussion on how embedded technology can support students with disabilities in the school setting and provides examples for access and use.

  11. Functional assessment of the visual pathway with multifocal visual evoked potentials, and their relationship with disability in patients with multiple sclerosis.

    Blanco, Román; Pérez-Rico, Consuelo; Puertas-Muñoz, Inmaculada; Ayuso-Peralta, Lucía; Boquete, Luciano; Arévalo-Serrano, Juan

    2014-02-01

    To objectively evaluate the visual function, and the relationship between disability and optic nerve dysfunction, in patients with multiple sclerosis (MS) and optic neuritis (ON), using multifocal visual evoked potentials (mfVEP). This observational, cross-sectional study assessed 28 consecutive patients with clinically definite MS, according to the McDonald criteria, and 19 age-matched healthy subjects. Disability was recorded using the Expanded Disability Status Scale (EDSS) score. The patients' mfVEP were compared to their clinical, psychophysical (Humphrey perimetry) and structural (optic coherence tomography (OCT)) diagnostic test data. We observed a significant agreement between mfVEP amplitude and Humphrey perimetry/OCT in MS-ON eyes, and between mfVEP amplitude and OCT in MS but non-ON eyes. We found significant differences in EDSS score between patients with abnormal and normal mfVEP amplitudes. Abnormal mfVEP amplitude defects (from interocular and monocular probability analysis) were found in 67.9% and 73.7% of the MS-ON and MS-non-ON group eyes, respectively. Delayed mfVEP latencies (interocular and monocular probability analysis) were seen in 70.3% and 73.7% of the MS-ON and MS-non-ON groups, respectively. We found a significant relationship between mfVEP amplitude and disease severity, as measured by EDSS score, that suggested there is a role for mfVEP amplitude as a functional biomarker of axonal loss in MS.

  12. The Importance of Providing Multiple-Channel Sections in Dredging Activities to Improve Fish Habitat Environments

    Hung-Pin Chiu

    2016-01-01

    Full Text Available After Typhoon Morakot, dredging engineering was conducted while taking the safety of humans and structures into consideration, but partial stream reaches were formed in the multiple-channel sections in Cishan Stream because of anthropogenic and natural influences. This study mainly explores the distribution of each fish species in both the multiple- and single-channel sections in the Cishan Stream. Parts of the environments did not exhibit significant differences according to a one-way ANOVA comparing the multiple- and single-channel sections, but certain areas of the multiple-channel sections had more diverse habitats. Each fish species was widely distributed by non-metric multidimensional scaling in the multiple-channel sections as compared to those in the single-channel sections. In addition, according to the principal component analysis, each fish species has a preferred environment, and all of them have a wide choice of habitat environments in the multiple-channel sections. Finally, the existence of multiple-channel sections could significantly affect the existence of the fish species under consideration in this study. However, no environmental factors were found to have an influence on fish species in the single-channel sections, with the exception of Rhinogobius nantaiensis. The results show that providing multiple-channel sections in dredging activities could improve fish habitat environments.

  13. Design of a Randomised Controlled Trial (RCT on the effectiveness of a Dutch patient advocacy case management intervention among severely disabled Multiple Sclerosis patients

    Annema Coby

    2010-05-01

    Full Text Available Abstract Background Case management has been suggested as an innovative strategy that facilitates the improvement of a patient's quality of life, reduction of hospital length of stay, optimization of self-care and improvement of satisfaction of patients and professionals involved. However, there is little evidence about the effectiveness of the patient advocacy case management model in clinical practice. Therefore, the objective of our study was to examine the effects of the Dutch patient advocacy case management model for severely disabled Multiple Sclerosis (MS patients and their caregivers compared to usual care. Methods/design In this randomized controlled trial the effectiveness of casemanagement on quality of life of patients and their caregivers, quality of care, service use and economic aspects were evaluated. The primary outcomes of this study were quality of life of MS-patients and caregiver burden of caregivers. Furthermore, we examined quality of life of caregivers, quality of care, service use and costs. Discussion This is a unique trial in which we examined the effectiveness of case management from a broad perspective. We meticulously prepared this study and applied important features and created important conditions for both intervention and research protocol to increase the likelihood of finding evidence for the effectiveness of patient advocacy case management. Concerning the intervention we anticipated to five important conditions: 1 the contrast between the case management intervention compared to the usual care seems to be large enough to detect intervention effects; 2 we included patients with complex care situations and/or were at risk for critical situations; 3 the case managers were familiar with disease specific health-problems and a broad spectrum of solutions; 4 case managers were competent and authorized to perform a medical neurological examination and worked closely with neurologists specialized in MS; and 5 the

  14. An intensive social cognitive program (can do treatment) in people with relapsing remitting multiple sclerosis and low disability: a randomized controlled trial protocol.

    Jongen, Peter Joseph; Heerings, Marco; Ruimschotel, Rob; Hussaarts, Astrid; Evers, Silvia; Duyverman, Lotte; Valkenburg-Vissers, Joyce; Cornelissen, Job; Bos, Michel; van Droffelaar, Maarten; Lemmens, Wim A; Donders, Rogier; van der Zande, Anneke; Visser, Leo H

    2016-05-28

    In people with multiple sclerosis (MS) disabilities and limitations may negatively affect self-efficacy. Lowered self-efficacy has been associated with decreases in health-related quality of life, physical activity and cognitive performance. In an explorative observational study we found that a 3-day intensive social cognitive program (Can Do Treatment [CDT]) with the participation of support partners was followed by substantial increases in self-efficacy control and health-related quality of life 6 months after treatment in those people with MS who had relapsing remitting disease and low disability. CDT is a sociologically oriented approach, its goal is to uncover and promote existing capabilities, and the notion "stressor" is the central concept. CDT's components are plenary group sessions, small group sessions, consultations, a theatre evening, and start of the day with a joint activity. The small group sessions form the actual training. Depending on their individual goals the participants join the training groups 'Body', 'Feeling' or 'Life', to work out their aims and to reduce their stressors. The multidisciplinary team includes a psychiatrist, psychiatric nurse, neurologist, specialized MS nurse, physiotherapist, dance therapist, and a person with MS. To evaluate the (cost)effectiveness of CDT in persons with relapsing remitting MS and low disability we perform a single-centre, randomized controlled trial in 140 patients, with or without support partners. The primary outcome is self-efficacy control. The secondary outcomes are self-efficacy function, health-related quality of life, autonomy and participation, anxiety, depression, cost effectiveness and cost utility. The tertiary outcome is care-related strain to support partners. Outcomes are assessed at baseline and at 1, 3 and 6 months after CDT. This randomized controlled trial will adequately evaluate the clinical and cost effectiveness of a 3-day intensive social cognitive program in people with

  15. The Value of Harmonizing Multiple Improvement Technologies: A Process Improvement Professional’s View

    2008-03-01

    maturity models and ISO standards, specifically CMMI, CMMI-ACQ and ISO 12207 . Also, the improvement group supplemented their selection of these...compliant with the technologies and standards that are important to the business. Lockheed Martin IS&GS has integrated CMMI, EIA 632, ISO 12207 , and Six...geographically dispersed organization. [Siviy 07-1] Northrop Grumman Mission Systems has integrated CMMI, ISO 9001, AS9100, and Six Sigma, as well as a

  16. Improving the provision of public transport information for persons with disabilities in the developing world

    Mashiri, M

    2005-04-01

    Full Text Available will be completed in August 2005) aims to design and test appropriate low-cost technologies for information provision in services provided by public transport vehicles in India and South Africa. This project is seeking to address information provision issues... that they use or with a companion if desired. 2.2 Methods of provision Methods of information provision include the following: � Information given directly to the disabled traveller (e.g. from speaking signs, a staffed telephone help-line) � General...

  17. Portable electronic assistive technology to improve vocational task completion in young adults with an intellectual disability.

    Collins, James C; Collet-Klingenberg, Lana

    2017-01-01

    This article summarizes a review of empirical literature from 2000 to 2015 that involved the use of specific portable technology to support persons with an intellectual disability in completing work-related tasks. Nineteen studies were identified for review, with an emphasis on the identification of (a) the characteristics of participants and settings, (b) the types of portable technology and prompting formats used, (c) the research designs utilized, (d) the independent and dependent variables, (e) the measures of reliability and validity, and (f) the overall effectiveness of the interventions. The authors provide an interpretation of the findings as well as the implications of the results and recommended areas for future research.

  18. Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial.

    Heine, Martin; Verschuren, Olaf; Hoogervorst, Erwin Lj; van Munster, Erik; Hacking, Hub Ga; Visser-Meily, Anne; Twisk, Jos Wr; Beckerman, Heleen; de Groot, Vincent; Kwakkel, Gert

    2017-10-01

    Evidence supporting the effectiveness of aerobic training, specific for fatigue, in severely fatigued patients with multiple sclerosis (MS) is lacking. To estimate the effectiveness of aerobic training on MS-related fatigue and societal participation in ambulant patients with severe MS-related fatigue. Patients ( N = 90) with severe MS-related fatigue were allocated to 16-week aerobic training or control intervention. Primary outcomes were perceived fatigue (Checklist Individual Strength (CIS20r) fatigue subscale) and societal participation. An improvement of ⩾8 points on the CIS20r fatigue subscale was considered clinically relevant. Outcomes were assessed by a blinded observer at baseline, 2, 4, 6 and 12 months. Of the 89 patients that started treatment (median Expanded Disability Status Scale (interquartile range), 3.0 (2.0-3.6); mean CIS20r fatigue subscale (standard deviation (SD)), 42.6 (8.0)), 43 received aerobic training and 46 received the control intervention. A significant post-intervention between-group mean difference (MD) on the CIS20r fatigue subscale of 4.708 (95% confidence interval (CI) = 1.003-8.412; p  = 0.014) points was found in favour of aerobic training that, however, was not sustained during follow-up. No effect was found on societal participation. Aerobic training in MS patients with severe fatigue does not lead to a clinically meaningful reduction in fatigue or societal participation when compared to a low-intensity control intervention.

  19. Improving the Comprehension of Students with Significant Developmental Disabilities: Systematic Instruction on the Steps for Completing and Using a Graphic Organizer

    Britt, Alexander P.

    2015-01-01

    A single-subject, multiple-baseline across participants design was used to examine the functional relation between systematic instruction and the ability to complete a graphic organizer and recall facts about informational texts by students with significant development disabilities. Four high school students enrolled in an adapted academic program…

  20. Aerobic exercise increases hippocampal volume and improves memory in multiple sclerosis: preliminary findings.

    Leavitt, V M; Cirnigliaro, C; Cohen, A; Farag, A; Brooks, M; Wecht, J M; Wylie, G R; Chiaravalloti, N D; DeLuca, J; Sumowski, J F

    2014-01-01

    Multiple sclerosis leads to prominent hippocampal atrophy, which is linked to memory deficits. Indeed, 50% of multiple sclerosis patients suffer memory impairment, with negative consequences for quality of life. There are currently no effective memory treatments for multiple sclerosis either pharmacological or behavioral. Aerobic exercise improves memory and promotes hippocampal neurogenesis in nonhuman animals. Here, we investigate the benefits of aerobic exercise in memory-impaired multiple sclerosis patients. Pilot data were collected from two ambulatory, memory-impaired multiple sclerosis participants randomized to non-aerobic (stretching) and aerobic (stationary cycling) conditions. The following baseline/follow-up measurements were taken: high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment. Intervention was 30-minute sessions 3 times per week for 3 months. Aerobic exercise resulted in 16.5% increase in hippocampal volume and 53.7% increase in memory, as well as increased hippocampal resting-state functional connectivity. Improvements were specific, with no comparable changes in overall cerebral gray matter (+2.4%), non-hippocampal deep gray matter structures (thalamus, caudate: -4.0%), or in non-memory cognitive functioning (executive functions, processing speed, working memory: changes ranged from -11% to +4%). Non-aerobic exercise resulted in relatively no change in hippocampal volume (2.8%) or memory (0.0%), and no changes in hippocampal functional connectivity. This is the first evidence for aerobic exercise to increase hippocampal volume and connectivity and improve memory in multiple sclerosis. Aerobic exercise represents a cost-effective, widely available, natural, and self-administered treatment with no adverse side effects that may be the first effective memory treatment for multiple sclerosis patients.

  1. Improving Students' Creative Thinking and Achievement through the Implementation of Multiple Intelligence Approach with Mind Mapping

    Widiana, I. Wayan; Jampel, I. Nyoman

    2016-01-01

    This classroom action research aimed to improve the students' creative thinking and achievement in learning science. It conducted through the implementation of multiple intelligences with mind mapping approach and describing the students' responses. The subjects of this research were the fifth grade students of SD 8 Tianyar Barat, Kubu, and…

  2. Employing mobile technology to improve language skills of young students with language-based disabilities.

    Rodríguez, Cathi Draper; Cumming, Therese M

    2017-01-01

    This exploratory study investigated the effects of a language building iPad application on the language skills (i.e., receptive vocabulary, expressive vocabulary, and sentence formation) of young students with language-based disabilities. The study utilized a pre-test-post-test control group design. Students in the treatment group used the iPad language building application, Language Builder, for 30 minutes a day. Participants were 31 first-grade to third-grade students with identified language-based disabilities. Students were assigned to two groups for the 8-week intervention. Data indicated that students in the treatment group made significantly greater gains in the area of sentence formation than the control group. Results revealed no significant difference between the two groups in the areas of expressive and receptive vocabulary. A short intervention of using Language Builder via the iPad may increase the sentence formation skills of young students with language delays. Additionally, discussion regarding the usefulness of iPad applications in education is presented.

  3. USING POKA-YOKE METHODS TO IMPROVE EMPLOYMENT POTENTIAL OF INTELLECTUALLY DISABLED WORKERS

    N.F. Treurnicht

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: In this project an electronic manufacturing process, namely ribbon cable assembly, was adapted for execution by intellectually disabled individuals. To make the work accessible to them, human error was controlled by a Poka-yoke approach. The design of the work process used industry standard tooling. Mistake-proofing design identified possible errors, and introduced mechanisms and tests that enabled the worker to avoid them. Test results were analysed using learning theory. It is concluded that intellectually disabled individuals can be enabled to perform the task within normal variation compared with a minimum task time, by using the Poka-yoke approach. Selection, however, is desirable.

    AFRIKAANSE OPSOMMING:’n Elektroniese vervaardigingsproses, naamlik platkabelsamestelling, word aangepas vir uitvoering deur intellektueel gestremde persone. Vir toeganklikheid deur hierdie groep, word menslike foute beheer deur die Poka-yoke-benadering. Die ontwerp van die werkproses maak gebruik van standaard nywerheidgereedskap. Die ontwerp fokus daarop om die moontlikheid van foute te identifiseer en kenmerke, meganismes, en toetsapparaat te inkorporeer om die voorkoms daarvan onmoontlik te maak. Toetsresultate word ontleed met leerteorie. Die slotsom is dat intellektueel gestremde persone bemagtig kan word, met die Poka-yoke-benadering, om hierdie taak uit te voer binne normale variasie vergeleke met die minimum taaktyd. Keuring is wel wenslik..

  4. Improving information retrieval with multiple health terminologies in a quality-controlled gateway.

    Soualmia, Lina F; Sakji, Saoussen; Letord, Catherine; Rollin, Laetitia; Massari, Philippe; Darmoni, Stéfan J

    2013-01-01

    The Catalog and Index of French-language Health Internet resources (CISMeF) is a quality-controlled health gateway, primarily for Web resources in French (n=89,751). Recently, we achieved a major improvement in the structure of the catalogue by setting-up multiple terminologies, based on twelve health terminologies available in French, to overcome the potential weakness of the MeSH thesaurus, which is the main and pivotal terminology we use for indexing and retrieval since 1995. The main aim of this study was to estimate the added-value of exploiting several terminologies and their semantic relationships to improve Web resource indexing and retrieval in CISMeF, in order to provide additional health resources which meet the users' expectations. Twelve terminologies were integrated into the CISMeF information system to set up multiple-terminologies indexing and retrieval. The same sets of thirty queries were run: (i) by exploiting the hierarchical structure of the MeSH, and (ii) by exploiting the additional twelve terminologies and their semantic links. The two search modes were evaluated and compared. The overall coverage of the multiple-terminologies search mode was improved by comparison to the coverage of using the MeSH (16,283 vs. 14,159) (+15%). These additional findings were estimated at 56.6% relevant results, 24.7% intermediate results and 18.7% irrelevant. The multiple-terminologies approach improved information retrieval. These results suggest that integrating additional health terminologies was able to improve recall. Since performing the study, 21 other terminologies have been added which should enable us to make broader studies in multiple-terminologies information retrieval.

  5. General Exercise Does Not Improve Long-Term Pain and Disability in Individuals With Whiplash-Associated Disorders: A Systematic Review.

    Griffin, Alexandra; Leaver, Andrew; Moloney, Niamh

    2017-07-01

    Study Design Systematic review of randomized controlled trials. Background General exercise, defined as purposeful physical activity involving repetitive exercises and incorporating multiple muscle groups, is frequently used in the management of whiplash-associated disorders (WADs). Evidence supporting its efficacy is not well established. Objectives To determine whether general exercise is effective in reducing pain and disability in people with WAD. Methods Studies published in English in peer-reviewed journals between January 1990 and May 2015 were eligible if they evaluated a general exercise intervention compared with a different intervention or control. Studies were required to evaluate pain and disability at medium-term (6-14 weeks) and long-term (52 weeks) follow-ups. The mean ± SD and sample size were recorded for follow-up scores and for change scores from baseline to follow-up. Results Of the 3 high-quality studies that were eligible for inclusion, none investigated general exercise alone. There were no clinically meaningful differences between comprehensive exercise programs, which included general exercise, and minimal intervention controls in the medium and long term. No studies directly compared general exercise with a no-treatment control. All included studies used different control interventions, preventing meta-analysis. Conclusion A lack of significant long-term improvements from general exercise interventions in individuals with WAD was identified. This finding differs from the positive benefits of general exercise for other musculoskeletal conditions. This may, in part, relate to the complexity of whiplash conditions. This may also reflect the challenge of exercise prescription in this population, where the need for sufficient intensity is balanced against the impact that exercise has on pain. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2017;47(7):472-480. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7081.

  6. Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities.

    Wachelka, D; Katz, R C

    1999-09-01

    Test anxiety seems like a benign problem to some people, but it can be potentially serious when it leads to high levels of distress and academic failure in otherwise capable students. Because test anxiety is common in older students with learning disabilities (LD), it is surprising that little research has been done on ways to reduce the distress these students experience in test situations. In this study, we used a randomized pretest-posttest control group design to examine the effectiveness of a cognitive-behavioral treatment for reducing test anxiety and improving academic self-esteem in a cohort (N = 27) of high school and college students with learning disabilities (LD). All of the students participated voluntarily. They were enrolled in classes for students with learning problems. Before the study began, they complained of test anxiety and showed an elevated score on the Test Anxiety Inventory (TAI). Eleven students (85%) completed the 8-week long treatment, which consisted of progressive muscle relaxation, guided imagery, self-instruction training, as well as training in study and test-taking skills. Results showed significant improvement in the treated group which was not evident in an untreated control group (N = 16). Compared to the control group, the treated group showed significant reductions in test anxiety on the TAI, as well as improvement in study skills and academic self-esteem as measured by the Survey of Study Habits and Attitudes, and the school scale of the Coopersmith Self-Esteem Inventory. These results extend the generality of similar studies on reducing test anxiety and improving academic self-esteem in younger students. They also suggest that relief from test anxiety can be expected fairly quickly when cognitive-behavioral methods are used. Additional implications and methodological limitations of the study are discussed.

  7. Forefoot running improves pain and disability associated with chronic exertional compartment syndrome.

    Diebal, Angela R; Gregory, Robert; Alitz, Curtis; Gerber, J Parry

    2012-05-01

    Anterior compartment pressures of the leg as well as kinematic and kinetic measures are significantly influenced by running technique. It is unknown whether adopting a forefoot strike technique will decrease the pain and disability associated with chronic exertional compartment syndrome (CECS) in hindfoot strike runners. For people who have CECS, adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition. Case series; Level of evidence, 4. Ten patients with CECS indicated for surgical release were prospectively enrolled. Resting and postrunning compartment pressures, kinematic and kinetic measurements, and self-report questionnaires were taken for all patients at baseline and after 6 weeks of a forefoot strike running intervention. Run distance and reported pain levels were recorded. A 15-point global rating of change (GROC) scale was used to measure perceived change after the intervention. After 6 weeks of forefoot run training, mean postrun anterior compartment pressures significantly decreased from 78.4 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Vertical ground-reaction force and impulse values were significantly reduced. Running distance significantly increased from 1.4 ± 0.6 km before intervention to 4.8 ± 0.5 km 6 weeks after intervention, while reported pain while running significantly decreased. The Single Assessment Numeric Evaluation (SANE) significantly increased from 49.9 ± 21.4 to 90.4 ± 10.3, and the Lower Leg Outcome Survey (LLOS) significantly increased from 67.3 ± 13.7 to 91.5 ± 8.5. The GROC scores at 6 weeks after intervention were between 5 and 7 for all patients. One year after the intervention, the SANE and LLOS scores were greater than reported during the 6-week follow-up. Two-mile run times were also significantly faster than preintervention values. No patient required surgery. In 10 consecutive patients with CECS, a 6-week forefoot strike running intervention led to decreased

  8. Resistance training improves muscle strength and functional capacity in multiple sclerosis

    Dalgas, U; Stenager, E; Jakobsen, J

    2009-01-01

    strength and functional capacity in patients with multiple sclerosis, the effects persisting after 12 weeks of self-guided physical activity. Level of evidence: The present study provides level III evidence supporting the hypothesis that lower extremity progressive resistance training can improve muscle......OBJECTIVE: To test the hypothesis that lower extremity progressive resistance training (PRT) can improve muscle strength and functional capacity in patients with multiple sclerosis (MS) and to evaluate whether the improvements are maintained after the trial. METHODS: The present study was a 2-arm...... and was afterward encouraged to continue training. After the trial, the control group completed the PRT intervention. Both groups were tested before and after 12 weeks of the trial and at 24 weeks (follow-up), where isometric muscle strength of the knee extensors (KE MVC) and functional capacity (FS; combined score...

  9. Improving School Nurse Pain Assessment Practices for Students With Intellectual Disability.

    Quinn, Brenna L; Smolinski, Megan

    2017-01-01

    School nurses are afforded minimal resources related to assessing pain in students with intellectual disability (ID) and have called for continuing education. The purpose of this study was to measure the effectiveness of an education program regarding best practices for assessing pain in students with ID. Educational sessions were presented to 248 school nurses. Pre-, post-, and follow-up surveys measured (1) difficulty school nurses face when assessing pain, (2) knowledge and use of pain assessment methods, and (3) intent to change and actual changes to professional practices. Participants experienced less difficulty assessing pain following the educational program. Almost all participants intended to change pain assessment practices, but large caseloads limited new practice adoption. Policy makers must consider population size and acuity when determining school nurse staffing. Trainings and other resources should be made available to school nurses in order to make pain assessments for students with ID more thorough and efficient.

  10. Evaluation of a complex intervention to improve activities of daily living of disabled cancer patients

    Lindahl-Jacobsen, Line; Hansen, Dorte Gilså; la Cour, Karen

    2014-01-01

    the study and to analyse the feasibility of the recruitment process and the intervention. METHODS: Adult disabled cancer patients at Naestved Hospital in Denmark were enrolled between 1 March 2010 and 30 June 2011 and randomised into an ADL intervention or to a control group. The intervention was performed...... by occupational therapists. The feasibility of the recruitment was analysed with regard to success in achieving the estimated number of participants and identification of barriers, and feasibility of the intervention was based on calculations of patient attendance and patient acceptability. The primary outcome...... on the intervention varied considerably, but for the majority of patients, time consumption was between 1-3 hours. CONCLUSIONS: Despite difficulties with recruitment, participation was considered feasible and the intervention was accepted among patients. Missing data in the follow-up period were mostly due to death...

  11. The Use of the Performance Diagnostic Checklist-Human Services to Assess and Improve the Job Performance of Individuals with Intellectual Disabilities.

    Smith, Madison; Wilder, David A

    2018-06-01

    The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to identify the variables responsible for performance problems. To date, the PDC-HS has not been examined with individuals with intellectual disabilities. In the current study, two supervisors with intellectual disabilities completed the PDC-HS to assess the productivity of two supervisees with disabilities who performed a pricing task in a thrift store. The PDC-HS suggested that performance deficits were due to a lack of training; a PDC-HS-indicated intervention was effective to increase accurate pricing. • The PDC-HS is an informant-based tool designed to identify the variables responsible for employee performance problems in human service settings. • The PDC-HS can be completed by some individuals with intellectual disabilities in a supervisory position to identify the variables responsible for problematic job performance among their supervisees. • A PDC-HS indicated intervention was demonstrated to be effective to improve the job performance of individuals with disabilities. • The PDC-HS may be a useful tool to support performance improvement and job maintenance among individuals with intellectual disabilities.

  12. Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial.

    Monticone, Marco; Ambrosini, Emilia; Cazzaniga, Daniele; Rocca, Barbara; Motta, Lorenzo; Cerri, Cesare; Brayda-Bruno, Marco; Lovi, Alessio

    2016-10-01

    To evaluate the effects of motor and cognitive rehabilitation on disability in adults with idiopathic scoliosis at lower risk of progression. 130 adults with idiopathic scoliosis (main curve rehabilitation programme consisting of active self-correction, task-oriented exercises and cognitive-behavioural therapy (experimental group, 65 subjects, mean age of 51.6, females 48) or general physiotherapy consisting of active and passive mobilizations, stretching, and strengthening exercises of the spinal muscles (control group, 65 subjects, mean age of 51.7, females 46). Before, at the end, and 12 months after treatment, each participant completed the Oswestry disability index (ODI) (primary outcome), the Tampa scale for kinesiophobia, the pain catastrophizing scale, a pain numerical rating scale, and the Scoliosis Research Society-22 Patient Questionnaire. Radiological (Cobb angle) and clinical deformity (angle of trunk rotation) changes were also investigated. A linear mixed model for repeated measures was used for each outcome. Significant effects of time, group, and time by group interaction were found for all outcome measures (P cognitive rehabilitation also led to improvements in dysfunctional thoughts, pain, and quality of life. Changes were maintained for at least 1 year.

  13. The Effectiveness of Storytelling on Improving Auditory Memory of Students with Reading Disabilities in Marivan City, Iran

    Fatemeh Ghaderi

    2017-08-01

    Full Text Available Background: Students with learning disabilities often encounter problems with their lessons due to the disorder in reading and writing and face to some challenging situation such as auditory and visual memory problem, sustaining attention, inhibiting impulses, motor coordination, auditory and visual perception and discrimination. The purpose of this study was to investigate the effectiveness of storytelling on auditory memory of students with reading disabilities of Marivan city, Iran. Materials and Methods: The research method was quasi-experimental with pretest-posttest design with a control group. Sampling method was replaced in this study using an available sampling method on 30 students in two groups (15 experimental and 15 control people. The experimental group test abilities were trained in 12 one-hour session. Inclusion criteria were having a learning disorder (only dyslexic, third grade elementary school and having no other abnormalities and exclusion criteria were students who did not attend the regular sessions. Digit span subtest the Wechsler figures Fourth Edition were used to collect data. Collected data were analyzed by using SPSS version 21.0 software in two levels of descriptive and inferential statistics (ANCOVA. Results: The results showed that 66% of participants were female, also, according to the parents' literacy level, the results showed that the highest level of fathers’ literacy was between high school and diploma (46.7% as well as the highest level of mothers’ literacy was under diploma (50%. The results showed that storytelling had a significant impact on improving dyslexic students’ auditory memory (P

  14. Thinking Ahead: Improving Support for People with Learning Disabilities and Their Families to Plan for the Future

    Towers, Christine

    2013-01-01

    The increasing life expectancy of people with learning disabilities makes it imperative that families plan for the future. The number of people with learning disabilities over the age of 65 is predicted to double over the next two decades. The greatest increase in life expectancy will be amongst people with mild learning disabilities who will have…

  15. A Culturally and Linguistically Responsive Framework for Improving Academic and Postsecondary Outcomes of Students with Moderate or Severe Intellectual Disability

    Rivera, Christopher J.; Jimenez, Bree A.; Baker, Joshua N.; Spies, Tracy; Mims, Pamela J.; Ginevra, Courtade

    2016-01-01

    The needs of culturally and linguistically diverse (CLD) students with moderate or severe intellectual disability (ID) are quite unique and complex. CLD students with moderate or severe ID face many of the same issues as their non-disabled CLD peers; however, due to the nature of their disability this may lead to even less access to the general…

  16. Electroconvulsive therapy substantially reduces symptom severity and social disability associated with multiple chemical sensitivity: a case report

    Elberling, Jesper; Gulmann, Nils; Rasmussen, Alice

    2010-01-01

    Multiple chemical sensitivity (MCS) is a chronic nonallergic, multisymptom disorder triggered by common environmental chemicals in concentrations considered nontoxic for most individuals. The condition may lead to loss of occupation and social isolation, and no effective treatment has been reported...

  17. Current multiple sclerosis treatments have improved our understanding of MS autoimmune pathogenesis.

    Martin, Roland; Sospedra, Mireia; Rosito, Maria; Engelhardt, Britta

    2016-09-01

    Multiple sclerosis (MS) is the most common inflammatory disorder of the central nervous system (CNS) in young adults. When MS is not treated, it leads to irreversible and severe disability. The etiology of MS and its pathogenesis are not fully understood. The recent discovery that MS-associated genetic variants code for molecules related to the function of specific immune cell subsets is consistent with the concept of MS as a prototypic, T-cell-mediated autoimmune disease targeting the CNS. While the therapeutic efficacy of the currently available immunomodulatory therapies further strengthen this concept, differences observed in responses to MS treatment as well as additional clinical and imaging observations have also shown that the autoimmune pathogenesis underlying MS is much more complex than previously thought. There is therefore an unmet need for continued detailed phenotypic and functional analysis of disease-relevant adaptive immune cells and tissues directly derived from MS patients to unravel the immune etiology of MS in its entire complexity. In this review, we will discuss the currently available MS treatment options and approved drugs, including how they have contributed to the understanding of the immune pathology of this autoimmune disease. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. A comparison of two short education programs for improving low back pain-related disability in the elderly: a cluster randomized controlled trial.

    Kovacs, Francisco; Abraira, Víctor; Santos, Severo; Díaz, Elena; Gestoso, Mario; Muriel, Alfonso; Gil del Real, María Teresa; Mufraggi, Nicole; Noguera, Juan; Zamora, Javier

    2007-05-01

    Cluster randomized clinical trial. To assess the effectiveness of 2 minimal education programs for improving low back pain (LBP)-related disability in the elderly. No education program has shown effectiveness on low back pain (LBP)-related disability in the elderly. A total of 129 nursing homes (6389 residents) in northern Spain were invited to participate in the study. The actual participants were 12 nursing homes randomly assigned to 3 groups and 661 subjects. An independent physician gave a 20-minute talk with slide projections summarizing the content of the Back Book (active management group), the Back Guide (postural hygiene group), and a pamphlet on cardiovascular health (controls). Disability was measured with the Roland-Morris questionnaire (RMQ). Blind assessments were performed before the intervention, and 30 and 180 days later. The effect of the intervention on disability was estimated by generalized mixed linear random effects models. Mean age of participants ranged between 79.9 and 81.2 years. Disability improved in all groups, but at the 30-day assessment the postural education group showed an additional improvement of 1.1 (95% confidence interval, 0.2-1.9), RMQ points and at the 180-day assessment the active education group an additional improvement of 2.0 (95% confidence interval, 0.6-3.4). In the subset of subjects with LBP when entering the study, postural education had no advantages over controls, while an additional improvement of 3.0 (95% confidence interval, 1.5- 4.5) RMQ points at the 180-day assessment was observed in the active education group. In institutionalized elderly, the handing out of the Back Book supported by a 20-minute group talk improves disability 6 months later, and is even more effective in those subjects with LBP.

  19. Multiple sclerosis

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    In a cross-sectional investigation of 116 patients with multiple sclerosis, the social and sparetime activities of the patient were assessed by both patient and his/her family. The assessments were correlated to physical disability which showed that particularly those who were moderately disabled...

  20. Dynamic Optimization for IPS2 Resource Allocation Based on Improved Fuzzy Multiple Linear Regression

    Maokuan Zheng

    2017-01-01

    Full Text Available The study mainly focuses on resource allocation optimization for industrial product-service systems (IPS2. The development of IPS2 leads to sustainable economy by introducing cooperative mechanisms apart from commodity transaction. The randomness and fluctuation of service requests from customers lead to the volatility of IPS2 resource utilization ratio. Three basic rules for resource allocation optimization are put forward to improve system operation efficiency and cut unnecessary costs. An approach based on fuzzy multiple linear regression (FMLR is developed, which integrates the strength and concision of multiple linear regression in data fitting and factor analysis and the merit of fuzzy theory in dealing with uncertain or vague problems, which helps reduce those costs caused by unnecessary resource transfer. The iteration mechanism is introduced in the FMLR algorithm to improve forecasting accuracy. A case study of human resource allocation optimization in construction machinery industry is implemented to test and verify the proposed model.

  1. Pharmacometric Analysis of the Relationship Between Absolute Lymphocyte Count and Expanded Disability Status Scale and Relapse Rate, Efficacy End Points, in Multiple Sclerosis Trials.

    Novakovic, A M; Thorsted, A; Schindler, E; Jönsson, S; Munafo, A; Karlsson, M O

    2018-05-10

    The aim of this work was to assess the relationship between the absolute lymphocyte count (ALC), and disability (as measured by the Expanded Disability Status Scale [EDSS]) and occurrence of relapses, 2 efficacy endpoints, respectively, in patients with remitting-relasping multiple sclerosis. Data for ALC, EDSS, and relapse rate were available from 1319 patients receiving placebo and/or cladribine tablets. Pharmacodynamic models were developed to characterize the time course of the endpoints. ALC-related measures were then evaluated as predictors of the efficacy endpoints. EDSS data were best fitted by a model where the logit-linear disease progression is affected by the dynamics of ALC change from baseline. Relapse rate data were best described by the Weibull hazard function, and the ALC change from baseline was also found to be a significant predictor of time to relapse. Presented models have shown that once cladribine exposure driven ALC-derived measures are included in the model, the need for drug effect components is of less importance (EDSS) or disappears (relapse rate). This simplifies the models and theoretically makes them mechanism specific rather than drug specific. Having a reliable mechanism-specific model would allow leveraging historical data across compounds, to support decision making in drug development and possibly shorten the time to market. © 2018, The American College of Clinical Pharmacology.

  2. Modified Truncated Multiplicity Analysis to Improve Verification of Uranium Fuel Cycle Materials

    LaFleur, A.; Miller, K.; Swinhoe, M.; Belian, A.; Croft, S.

    2015-01-01

    Accurate verification of 235U enrichment and mass in UF6 storage cylinders and the UO2F2 holdup contained in the process equipment is needed to improve international safeguards and nuclear material accountancy at uranium enrichment plants. Small UF6 cylinders (1.5'' and 5'' diameter) are used to store the full range of enrichments from depleted to highly-enriched UF6. For independent verification of these materials, it is essential that the 235U mass and enrichment measurements do not rely on facility operator declarations. Furthermore, in order to be deployed by IAEA inspectors to detect undeclared activities (e.g., during complementary access), it is also imperative that the measurement technique is quick, portable, and sensitive to a broad range of 235U masses. Truncated multiplicity analysis is a technique that reduces the variance in the measured count rates by only considering moments 1, 2, and 3 of the multiplicity distribution. This is especially important for reducing the uncertainty in the measured doubles and triples rates in environments with a high cosmic ray background relative to the uranium signal strength. However, we believe that the existing truncated multiplicity analysis throws away too much useful data by truncating the distribution after the third moment. This paper describes a modified truncated multiplicity analysis method that determines the optimal moment to truncate the multiplicity distribution based on the measured data. Experimental measurements of small UF6 cylinders and UO2F2 working reference materials were performed at Los Alamos National Laboratory (LANL). The data were analyzed using traditional and modified truncated multiplicity analysis to determine the optimal moment to truncate the multiplicity distribution to minimize the uncertainty in the measured count rates. The results from this analysis directly support nuclear safeguards at enrichment plants and provide a more accurate verification method for UF6

  3. Mildly disabled persons with multiple sclerosis use similar net joint power strategies as healthy controls when walking speed increases

    Brincks, John; Sørensen, Henrik; Dalgas, Ulrik

    2018-01-01

    flexors in mildly disabled persons with MS and healthy controls at different walking speeds. METHODS:Thirteen persons with MS and thirteen healthy controls participated and peak net joint power was calculated using 3D motion analysis. RESULTS:In general, no differences were found between speed......-matched healthy controls and persons with MS, but the fastest walking speed was significantly higher in healthy controls (2.42 m/s vs. 1.70 m/s). The net joint power increased in hip flexors, hip extensors, hip abductors, knee extensors and plantar flexors in both groups, when walking speed increased. Significant...... correlations between changes in walking speed and changes in net joint power of plantar flexors, hip extensors and hip flexors existed in healthy controls and persons with MS, and in net knee extensor absorption power of persons with MS only. CONCLUSION:In contrast to previous studies, these findings suggest...

  4. Cognitive strategy interventions improve word problem solving and working memory in children with math disabilities.

    Swanson, H Lee

    2015-01-01

    This study investigated the role of strategy instruction and working memory capacity (WMC) on problem solving solution accuracy in children with and without math disabilities (MD). Children in grade 3 (N = 204) with and without MD subdivided into high and low WMC were randomly assigned to 1 of 4 conditions: verbal strategies (e.g., underlining question sentence), visual strategies (e.g., correctly placing numbers in diagrams), verbal + visual strategies, and an untreated control. The dependent measures for training were problem solving accuracy and two working memory transfer measures (operation span and visual-spatial span). Three major findings emerged: (1) strategy instruction facilitated solution accuracy but the effects of strategy instruction were moderated by WMC, (2) some strategies yielded higher post-test scores than others, but these findings were qualified as to whether children were at risk for MD, and (3) strategy training on problem solving measures facilitated transfer to working memory measures. The main findings were that children with MD, but high WM spans, were more likely to benefit from strategy conditions on target and transfer measures than children with lower WMC. The results suggest that WMC moderates the influence of cognitive strategies on both the targeted and non-targeted measures.

  5. An improved multiple linear regression and data analysis computer program package

    Sidik, S. M.

    1972-01-01

    NEWRAP, an improved version of a previous multiple linear regression program called RAPIER, CREDUC, and CRSPLT, allows for a complete regression analysis including cross plots of the independent and dependent variables, correlation coefficients, regression coefficients, analysis of variance tables, t-statistics and their probability levels, rejection of independent variables, plots of residuals against the independent and dependent variables, and a canonical reduction of quadratic response functions useful in optimum seeking experimentation. A major improvement over RAPIER is that all regression calculations are done in double precision arithmetic.

  6. No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South

    Yara Dadalti Fragoso

    Full Text Available ABSTRACT Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS. The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

  7. Learn and apply: using multi-sensory storytelling to gather knowledge about preferences and abilities of children with profound intellectual and multiple disabilities--three case studies.

    Brug, Annet Ten; Van der Putten, Annette A J; Vlaskamp, Carla

    2013-12-01

    Knowledge about the preferences and abilities of children with profound intellectual and multiple disabilities (PIMDs) is crucial for providing appropriate activities. Multi-sensory storytelling (MSST) can be an ideal activity for gathering such knowledge about children with PIMDs. The aim of this study was to analyse whether using MSST did lead to changes in teachers' knowledge about preferences and abilities and whether this knowledge was then applied in practice. Three dyads of children with PIMDs and their teachers read an MSST book 20 times during a 10-week period. A questionnaire designed to identify the teachers' current knowledge was filled in before the 1st and again after the 10th and 20th reading sessions. Also, the teachers were asked for their opinion about their newly gathered knowledge. In all three cases, changes in the teachers' knowledge were observed. However, teachers are insufficiently aware of their new knowledge and do not apply it in practice.

  8. Defining Disability: Understandings of and Attitudes Towards Ableism and Disability

    Carli Friedman

    2017-03-01

    Full Text Available Disabled people, amidst political and social gains, continue to experience discrimination in multiple areas. Understanding how such discrimination, named here as ableism, operates is important and may require studying perspectives of people who do not claim a disability identity.  Ableism may be expressed in a number of ways, and examining how a particular group, in this case siblings of disabled people, understand and value disability may contribute to overall understandings about how ableism works. Thus, the purpose of this study is to explore relationships between siblings of disabled people's broad societal understandings of disability and their attitudes towards it. In order to tease out this relationship further we have also examined factors that impact how people define disability. Using both social psychological and sociological approaches, we have contextualized individual attitudes as providing additional new information about social meanings of disability, and set this study's results against the larger backdrops of debates over meanings of disability within Disability Studies. In our research, participants revealed complex understandings of disability, but most often defined disability as preventing or slowing action, as an atypical function, a lack of independence, and as a socially constructed obstacle. Participants' unconscious (implicit disability attitudes significantly related to their understandings of disability as lacking independence, impairment, and/or in relation to the norm, and their conscious (explicit disability attitudes. Moreover, longer employment in a disability-related industry was correlated with defining disability as a general difference, rather than as slowing or limiting of tasks.

  9. Examination of the communication interface between students with severe to profound and multiple intellectual disability and educational staff during structured teaching sessions.

    Bunning, K; Smith, C; Kennedy, P; Greenham, C

    2013-01-01

    Individuals with severe to profound and multiple intellectual disability (S-PMID) tend to function at the earlier stages of communication development. Variable and highly individual means of communicating may present challenges to the adults providing support in everyday life. The current study aimed to examine the communication interface between students with S-PMID and educational staff. An in-depth, observational study of dyadic interaction in a class within the secondary part of a special school was conducted. The designated educational level was Key Stage 3 under the National Curriculum of England, which is typically for children from age 11 to 14 years attending a state school. There were four student-teacher dyads in the class. The students had multiple impairments with severely limited communication skills. Video capture of dyadic interaction was conducted during five English lessons and sampled to 2.5 min per dyad per lesson. The video footage was transcribed into standard orthography, detailing the vocal and non-vocal aspects. A coding framework guided by the principles of structural-functional linguistics was used to determine the nature of dyadic interaction, comprising linguistic moves, functions and communicative modalities. The relative contributions of student and teacher to the interaction were examined. Significant differences were found between the students and educational staff on the majority of the measures. The teachers dominated the interaction, occupying significantly more turns than the students. Teacher turns contained significantly more initiations and follow-up moves than the students, who used more response moves. Teacher communication mainly served the functions of requesting and information giving. Feedback and scripted functions were also significantly greater among teacher turns, with only limited occurrence among the students. Self- or shared-expression was greatest among the students. The modalities of speech, touch, singing and

  10. Interventions to Improve the Labour Market Situation of Adults with Physical and/or Sensory Disabilities in Low- and Middle-Income Countries: A Systematic Review

    Tripney, J

    2015-11-01

    participants, the sample size was between 251 and 500 in three studies, and the remaining ten studies had a sample size of less than 250. Different methodologies were employed to construct the counterfactual and evaluate the impacts of the interventions. The majority were uncontrolled before-and-after studies. One quasi-experiment (ex-post utilised propensity score matching techniques and one study applied logistic regression to pre-test/post-test data. The remaining studies used a non-equivalent groups design. All 14 studies were assessed as high risk of bias. The 14 studies examined 15 different interventions grouped as follows: treatment & therapy (four interventions; assistive devices and accommodations (two interventions; occupational rehabilitation services (four interventions; financial services (one intervention; and community-based rehabilitation (four interventions. Thirteen were multi-component programmes. All 15 interventions were targeted at people with disabilities, with some designed for people with a specific impairment or diagnosis. Six interventions targeted persons with specific types of physical impairment, and a further two interventions were available to adults with any type of physical impairment. Three interventions were targeted at persons with visual impairments. Finally, four interventions were available to persons with any/multiple impairments. Non-governmental organisations (NGOs were the most common source of funding. The main aim of eight interventions was to improve employment prospects for persons with disabilities. The other interventions sought improvements in a wider range of outcomes. The interventions were designed and implemented on different scales, with the majority available over a large geographical area, such as one or more districts, provinces or regions. Information about duration of the interventions was often not reported, but typically they were available for periods of less than six months. All 14 studies measured relevant

  11. Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: a population study.

    Hannon, Niamh

    2011-09-01

    Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic).

  12. Cortical N-acetyl aspartate is a predictor of long-term clinical disability in multiple sclerosis

    Wu, Xingchen; Hanson, Lars G.; Skimminge, Arnold Jesper Møller

    2014-01-01

    Objective: To evaluate the prognostic value of the cortical N-acetyl aspartate to creatine ratio (NAA/Cr) in early relapsing-remitting multiple sclerosis (RRMS). Methods: Sixteen patients with newly diagnosed RRMS were studied by serial MRI and MR spectroscopic imaging (MRSI) once every 6 months ...

  13. Enabling Access and Enhancing Comprehension of Video Content for Postsecondary Students with Intellectual Disability

    Evmenova, Anya S.; Behrmann, Michael M.

    2014-01-01

    There is a great need for new innovative tools to integrate individuals with intellectual disability into educational experiences. This multiple baseline study examined the effects of various adaptations for improving factual and inferential comprehension of non-fiction videos by six postsecondary students with intellectual disability. Video…

  14. Improving the surface metrology accuracy of optical profilers by using multiple measurements

    Xu, Xudong; Huang, Qiushi; Shen, Zhengxiang; Wang, Zhanshan

    2016-10-01

    The performance of high-resolution optical systems is affected by small angle scattering at the mid-spatial-frequency irregularities of the optical surface. Characterizing these irregularities is, therefore, important. However, surface measurements obtained with optical profilers are influenced by additive white noise, as indicated by the heavy-tail effect observable on their power spectral density (PSD). A multiple-measurement method is used to reduce the effects of white noise by averaging individual measurements. The intensity of white noise is determined using a model based on the theoretical PSD of fractal surface measurements with additive white noise. The intensity of white noise decreases as the number of times of multiple measurements increases. Using multiple measurements also increases the highest observed spatial frequency; this increase is derived and calculated. Additionally, the accuracy obtained using multiple measurements is carefully studied, with the analysis of both the residual reference error after calibration, and the random errors appearing in the range of measured spatial frequencies. The resulting insights on the effects of white noise in optical profiler measurements and the methods to mitigate them may prove invaluable to improve the quality of surface metrology with optical profilers.

  15. Corrected multiple upsets and bit reversals for improved 1-s resolution measurements

    Brucker, G.J.; Stassinopoulos, E.G.; Stauffer, C.A.

    1994-01-01

    Previous work has studied the generation of single and multiple errors in control and irradiated static RAM samples (Harris 6504RH) which were exposed to heavy ions for relatively long intervals of time (minute), and read out only after the beam was shut off. The present investigation involved storing 4k x 1 bit maps every second during 1 min ion exposures at low flux rates of 10 3 ions/cm 2 -s in order to reduce the chance of two sequential ions upsetting adjacent bits. The data were analyzed for the presence of adjacent upset bit locations in the physical memory plane, which were previously defined to constitute multiple upsets. Improvement in the time resolution of these measurements has provided more accurate estimates of multiple upsets. The results indicate that the percentage of multiples decreased from a high of 17% in the previous experiment to less than 1% for this new experimental technique. Consecutive double and triple upsets (reversals of bits) were detected. These were caused by sequential ions hitting the same bit, with one or two reversals of state occurring in a 1-min run. In addition to these results, a status review for these same parts covering 3.5 years of imprint damage recovery is also presented

  16. A Telerehabilitation Program Improves Postural Control in Multiple Sclerosis Patients: A Spanish Preliminary Study

    Rosa Ortiz-Gutiérrez

    2013-10-01

    Full Text Available Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. Fifty patients were recruited. Control group (n = 25 received physiotherapy treatment twice a week (40 min per session. Experimental group (n = 25 received monitored telerehabilitation treatment via videoconference using the Xbox 360® and Kinect console. Experimental group attended 40 sessions, four sessions per week (20 min per session.The treatment schedule lasted 10 weeks for both groups. A computerized dynamic posturography (Sensory Organization Test was used to evaluate all patients at baseline and at the end of the treatment protocol. Results showed an improvement over general balance in both groups. Visual preference and the contribution of vestibular information yielded significant differences in the experimental group. Our results demonstrated that a telerehabilitation program based on a virtual reality system allows one to optimize the sensory information processing and integration systems necessary to maintain the balance and postural control of people with multiple sclerosis. We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available.

  17. A Telerehabilitation Program Improves Postural Control in Multiple Sclerosis Patients: A Spanish Preliminary Study

    Ortiz-Gutiérrez, Rosa; Cano-de-la-Cuerda, Roberto; Galán-del-Río, Fernando; Alguacil-Diego, Isabel María; Palacios-Ceña, Domingo; Miangolarra-Page, Juan Carlos

    2013-01-01

    Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. Fifty patients were recruited. Control group (n = 25) received physiotherapy treatment twice a week (40 min per session). Experimental group (n = 25) received monitored telerehabilitation treatment via videoconference using the Xbox 360® and Kinect console. Experimental group attended 40 sessions, four sessions per week (20 min per session).The treatment schedule lasted 10 weeks for both groups. A computerized dynamic posturography (Sensory Organization Test) was used to evaluate all patients at baseline and at the end of the treatment protocol. Results showed an improvement over general balance in both groups. Visual preference and the contribution of vestibular information yielded significant differences in the experimental group. Our results demonstrated that a telerehabilitation program based on a virtual reality system allows one to optimize the sensory information processing and integration systems necessary to maintain the balance and postural control of people with multiple sclerosis. We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available. PMID:24185843

  18. Placing people in the same room is not enough: An interprofessional education intervention to improve collaborative knowledge of people with disabilities.

    Ståhl, Christian

    2016-05-01

    This study evaluates a continuing interprofessional education (CIPE) intervention designed to improve the skills and knowledge related to managing people with disabilities (PWD) in the educational, healthcare, and social insurance systems, and to improve shared knowledge and promote inter-organisational collaboration. The intervention comprised both on-site and online courses where participants could design their own curriculum based on their perceived needs. A longitudinal survey study was conducted with questions about knowledge of other organisations' work with PWD, knowledge concerning disability policies, competence in meeting PWD, shared values across organisations, and inter-organisational collaboration. Participants' knowledge about disability, disability policy, and how other organisations work with PWD significantly increased after the intervention. Changes in shared values, attitude towards inter-organisational collaboration, or effects on actual collaboration could not be determined. The results suggest that CIPE interventions where participants are allowed to form customised curriculums may increase general knowledge about disability among professionals. Results on knowledge of and collaboration with other organisations were less conclusive, where this may be explained by an educational setting that included little interaction between course participants. To promote professional exchange and experiential learning activities, contextualized educational settings that place more focus on interaction between participants may be advised.

  19. Utilizing multiple scale models to improve predictions of extra-axial hemorrhage in the immature piglet.

    Scott, Gregory G; Margulies, Susan S; Coats, Brittany

    2016-10-01

    Traumatic brain injury (TBI) is a leading cause of death and disability in the USA. To help understand and better predict TBI, researchers have developed complex finite element (FE) models of the head which incorporate many biological structures such as scalp, skull, meninges, brain (with gray/white matter differentiation), and vasculature. However, most models drastically simplify the membranes and substructures between the pia and arachnoid membranes. We hypothesize that substructures in the pia-arachnoid complex (PAC) contribute substantially to brain deformation following head rotation, and that when included in FE models accuracy of extra-axial hemorrhage prediction improves. To test these hypotheses, microscale FE models of the PAC were developed to span the variability of PAC substructure anatomy and regional density. The constitutive response of these models were then integrated into an existing macroscale FE model of the immature piglet brain to identify changes in cortical stress distribution and predictions of extra-axial hemorrhage (EAH). Incorporating regional variability of PAC substructures substantially altered the distribution of principal stress on the cortical surface of the brain compared to a uniform representation of the PAC. Simulations of 24 non-impact rapid head rotations in an immature piglet animal model resulted in improved accuracy of EAH prediction (to 94 % sensitivity, 100 % specificity), as well as a high accuracy in regional hemorrhage prediction (to 82-100 % sensitivity, 100 % specificity). We conclude that including a biofidelic PAC substructure variability in FE models of the head is essential for improved predictions of hemorrhage at the brain/skull interface.

  20. Quality of Diagnosis and Treatment Plans After Using the 'Diagnostic Guideline for Anxiety and Challenging Behaviours' in People with Intellectual Disabilities: A Comparative Multiple Case Study Design

    Pruijssers, A.; Meijel, B. van; Maaskant, M.; Keeman, N.; Achterberg, T. van

    2016-01-01

    BACKGROUND: People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This

  1. The Effectiveness of a Multi Sensory Approach in Improving Letter-Sound Correspondence among Mild Intellectual Disabled Students in State of Kuwait

    Moustafa, Amr; Ghani, Mohd Zuri

    2016-01-01

    This research examines the effectiveness of multi sensory approach for the purpose of improving the knowledge on English Letter sound correspondence among mild disabled students in the state of Kuwait. The discussion in this study is based on the multisensory approach that could be applied in the teaching of reading skills as well as phonemic…

  2. Wheelchairmanship Project. A Program to Educate Personnel in the Transportation, Hotel and Restaurant, and Entertainment Industries in Improved Techniques for Serving Disabled People. Final Report.

    Smith, Anita P.; And Others

    In a project designed to train customer service personnel in improved methods of assisting the physically disabled, audio-visual training materials were developed and presented during 2-week courses involving 1,058 employees at transportation, hotel/restaurant, and entertainment centers in 25 cities. The participants judged the training program…

  3. The Effects of a Story-Mapping Procedure to Improve the Comprehension Skills of Expository Text Passages for Elementary Students with Learning Disabilities

    Stagliano, Christina; Boon, Richard T.

    2009-01-01

    The purpose of this study was to examine the effects of using a story-mapping procedure to improve and enhance the reading comprehension skills using expository text passages for 3 fourth-grade students with learning disabilities (LD). The study was conducted in the resource classroom in which the participants regularly received reading…

  4. Alemtuzumab improves preexisting disability in active relapsing-remitting MS patients

    Giovannoni, Gavin; Cohen, Jeffrey A; Coles, Alasdair J

    2016-01-01

    .0300); improvement in MSFC scores with alemtuzumab was primarily driven by the upper limb coordination and dexterity domain. Alemtuzumab-treated patients had more favorable changes from baseline in SLCLA (2.5% contrast) scores (p = 0.0014) and MSFC + SLCLA composite scores (p = 0.0097) than SC IFN-β-1a...

  5. There are multiple contributors to the verbal short-term memory deficit in children with developmental reading disabilities.

    Kibby, Michelle Y

    2009-09-01

    Prior research has put forth at least four possible contributors to the verbal short-term memory (VSTM) deficit in children with developmental reading disabilities (RD): poor phonological awareness that affects phonological coding into VSTM, a less effective phonological store, slow articulation rate, and fewer/poorer quality long-term memory (LTM) representations. This project is among the first to test the four suppositions in one study. Participants included 18 children with RD and 18 controls. VSTM was assessed using Baddeley's model of the phonological loop. Findings suggest all four suppositions are correct, depending upon the type of material utilized. Children with RD performed comparably to controls in VSTM for common words but worse for less frequent words and nonwords. Furthermore, only articulation rate predicted VSTM for common words, whereas Verbal IQ and articulation rate predicted VSTM for less frequent words, and phonological awareness and articulation rate predicted VSTM for nonwords. Overall, findings suggest that the mechanism(s) used to code and store items by their meaning is intact in RD, and the deficit in VSTM for less frequent words may be a result of fewer/poorer quality LTM representations for these words. In contrast, phonological awareness and the phonological store are impaired, affecting VSTM for items that are coded phonetically. Slow articulation rate likely affects VSTM for most material when present. When assessing reading performance, VSTM predicted decoding skill but not word identification after controlling Verbal IQ and phonological awareness. Thus, VSTM likely contributes to reading ability when words are novel and must be decoded.

  6. Evaluating the Quality of the Interaction between Persons with Profound Intellectual and Multiple Disabilities and Direct Support Staff: A Preliminary Application of Three Observation Scales from Parent-Infant Research

    Hostyn, Ine; Petry, Katja; Lambrechts, Greet; Maes, Bea

    2011-01-01

    Background: Affective and reciprocal interactions with others are essential for persons with profound intellectual and multiple disabilities (PIMD), but it is a challenge to assess their quality. This study aimed to investigate the usefulness of instruments from parent-infant research to evaluate these interactions. Method: Eighteen videotaped…

  7. Laboratory model study of newly deposited dredger fills using improved multiple-vacuum preloading technique

    Jingjin Liu

    2017-10-01

    Full Text Available Problems continue to be encountered concerning the traditional vacuum preloading method in field during the treatment of newly deposited dredger fills. In this paper, an improved multiple-vacuum preloading method was developed to consolidate newly dredger fills that are hydraulically placed in seawater for land reclamation in Lingang Industrial Zone of Tianjin City, China. With this multiple-vacuum preloading method, the newly deposited dredger fills could be treated effectively by adopting a novel moisture separator and a rapid improvement technique without sand cushion. A series of model tests was conducted in the laboratory for comparing the results from the multiple-vacuum preloading method and the traditional one. Ten piezometers and settlement plates were installed to measure the variations in excess pore water pressures and moisture content, and vane shear strength was measured at different positions. The testing results indicate that water discharge–time curves obtained by the traditional vacuum preloading method can be divided into three phases: rapid growth phase, slow growth phase, and steady phase. According to the process of fluid flow concentrated along tiny ripples and building of larger channels inside soils during the whole vacuum loading process, the fluctuations of pore water pressure during each loading step are divided into three phases: steady phase, rapid dissipation phase, and slow dissipation phase. An optimal loading pattern which could have a best treatment effect was proposed for calculating the water discharge and pore water pressure of soil using the improved multiple-vacuum preloading method. For the newly deposited dredger fills at Lingang Industrial Zone of Tianjin City, the best loading step was 20 kPa and the loading of 40–50 kPa produced the highest drainage consolidation. The measured moisture content and vane shear strength were discussed in terms of the effect of reinforcement, both of which indicate

  8. Muscle reaction function of individuals with intellectual disabilities may be improved through therapeutic use of a horse.

    Giagazoglou, Paraskevi; Arabatzi, Fotini; Kellis, Eleftherios; Liga, Maria; Karra, Chrisanthi; Amiridis, Ioannis

    2013-09-01

    Reaction time and muscle activation deficits might limit the individual's autonomy in activities of daily living and in participating in recreational activities. The aim of the present study was to assess the effects of a 14-week hippotherapy exercise program on movement reaction time and muscle activation in adolescents with intellectual disability (ID). Nineteen adolescents with moderate ID were assigned either to an experimental group (n=10) or a control group (n=9). The experimental group attended a hippotherapy exercise program, consisting of two 30-min sessions per week for 14 weeks. Reaction time, time of maximum muscle activity and electromyographic activity (EMG) of rectus femoris and biceps femoris when standing up from a chair under three conditions: in response to audio, visual and audio with closed eyes stimuli were measured. Analysis of variance designs showed that hippotherapy intervention program resulted in significant improvements in reaction time and a reduction in time to maximum muscle activity of the intervention group comparing to the control group in all 3 three conditions that were examined (phippotherapy training. Hippotherapy probably creates a changing environment with a variety of stimuli that enhance deep proprioception as well as other sensory inputs. In conclusion, this study provides evidence that hippotherapy can improve functional task performance by enhancing reaction time. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. A community-based aquatic exercise program to improve endurance and mobility in adults with mild to moderate intellectual disability

    Hakim, Renée M.; Ross, Michael D.; Runco, Wendy; Kane, Michael T.

    2017-01-01

    The purpose of this study was to investigate the impact of a community-based aquatic exercise program on physical performance among adults with mild to moderate intellectual disability (ID). Twenty-two community-dwelling adults with mild to moderate ID volunteered to participate in this study. Participants completed an 8-week aquatic exercise program (2 days/wk, 1 hr/session). Measures of physical performance, which were assessed prior to and following the completion of the aquatic exercise program, included the timed-up-and-go test, 6-min walk test, 30-sec chair stand test, 10-m timed walk test, hand grip strength, and the static plank test. When comparing participants’ measures of physical performance prior to and following the 8-week aquatic exercise program, improvements were seen in all measures, but the change in scores for the 6-min walk test, 30-sec chair stand test, and the static plank test achieved statistical significance (P<0.05). An 8-week group aquatic exercise program for adults with ID may promote improvements in endurance and balance/mobility. PMID:28349039

  10. Engagement in family activities: a quantitative, comparative study of children with profound intellectual and multiple disabilities and children with typical development.

    Axelsson, A K; Granlund, M; Wilder, J

    2013-07-01

    Participation is known to be of great importance for children's development and emotional well-being as well as for their families. In the International Classification of Functioning, Disability and Health - Children and Youth version participation is defined as a person's 'involvement in a life situation'. Engagement is closely related to involvement and can be seen as expressions of involvement or degree of involvement within a situation. This study focuses on children's engagement in family activities; one group of families with a child with profound intellectual and multiple disabilities (PIMD) and one group of families with children with typical development (TD) were compared. A descriptive study using questionnaires. Analyses were mainly performed by using Mann-Whitney U-test and Spearman's rank correlation test. Engagement in family activities differed in the two groups of children. The children with PIMD had a lower level of engagement in most family activities even though the activities that engaged the children to a higher or lesser extent were the same in both groups. Child engagement was found to correlate with family characteristics mostly in the children with TD and in the children with PIMD only negative correlations occurred. In the children with PIMD child engagement correlated with cognition in a high number of listed family activities and the children had a low engagement in routines in spite of these being frequently occurring activities. Level of engagement in family activities in the group of children with PIMD was lower compared with that in the group of children with TD. Families with a child with PIMD spend much time and effort to adapt family living patterns to the child's functioning. © 2013 John Wiley & Sons Ltd.

  11. Improving the Occupational Skills of Students with Intellectual Disability by Applying Video Prompting Combined with Dance Pads

    Lin, Mei-Lan; Chiang, Ming-Shan; Shih, Ching-Hsiang; Li, Meng-Fang

    2018-01-01

    Background: Individuals with intellectual disability (ID) are prone to inattention, are slow in learning and reaction, and have deficits in memory skills. Providing proper vocational education and training for individuals with intellectual disability is able to enhance their occupational skills. Materials and Methods: This study applied video…

  12. Symbol Labelling Improves Advantageous Decision-Making on the Iowa Gambling Task in People with Intellectual Disabilities

    Dymond, Simon; Bailey, Rebecca; Willner, Paul; Parry, Rhonwen

    2010-01-01

    Individuals with intellectual and developmental disabilities often have difficulties foregoing short-term loss for long-term gain. The Iowa Gambling Task (IGT) has been extensively adopted as a laboratory measure of this ability. In the present study, we undertook the first investigation with people with intellectual disabilities using a…

  13. Assessment and monitoring of patients receiving chemotherapy for multiple myeloma: strategies to improve outcomes

    Faiman B

    2016-05-01

    Full Text Available Beth Faiman, Jason Valent Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA Abstract: Improved understanding as to the biology of multiple myeloma (MM and the bone marrow microenvironment has led to the development of new drugs to treat MM. This explosion of new and highly effective drugs has led to dramatic advances in the management of MM and underscores the need for supportive care. Impressive and deep response rates to chemotherapy, monoclonal antibodies, and small molecule drugs provide hope of a cure or prolonged remission for the majority of individuals. For most patients, long-term, continuous therapy is often required to suppress the malignant plasma cell clone, thus requiring clinicians to become more astute in assessment, monitoring, and intervention of side effects as well as monitoring response to therapy. Appropriate diagnosis and monitoring strategies are essential to ensure that patients receive the appropriate chemotherapy and supportive therapy at relapse, and that side effects are appropriately managed to allow for continued therapy and adherence to the regimen. Multiple drugs with complex regimens are currently available with varying side effect profiles. Knowledge of the drugs used to treat MM and the common adverse events will allow for preventative strategies to mitigate adverse events and prompt intervention. The purpose of this paper is to review updates in the diagnosis and management of MM, and to provide strategies for assessment and monitoring of patients receiving chemotherapy for MM. Keywords: multiple myeloma, treatment, symptoms, assessment, monitoring, symptom management, targeted therapies

  14. Multi-sensor fusion with interacting multiple model filter for improved aircraft position accuracy.

    Cho, Taehwan; Lee, Changho; Choi, Sangbang

    2013-03-27

    The International Civil Aviation Organization (ICAO) has decided to adopt Communications, Navigation, and Surveillance/Air Traffic Management (CNS/ATM) as the 21st century standard for navigation. Accordingly, ICAO members have provided an impetus to develop related technology and build sufficient infrastructure. For aviation surveillance with CNS/ATM, Ground-Based Augmentation System (GBAS), Automatic Dependent Surveillance-Broadcast (ADS-B), multilateration (MLAT) and wide-area multilateration (WAM) systems are being established. These sensors can track aircraft positions more accurately than existing radar and can compensate for the blind spots in aircraft surveillance. In this paper, we applied a novel sensor fusion method with Interacting Multiple Model (IMM) filter to GBAS, ADS-B, MLAT, and WAM data in order to improve the reliability of the aircraft position. Results of performance analysis show that the position accuracy is improved by the proposed sensor fusion method with the IMM filter.

  15. Improved Harmony Search Algorithm for Truck Scheduling Problem in Multiple-Door Cross-Docking Systems

    Zhanzhong Wang

    2018-01-01

    Full Text Available The key of realizing the cross docking is to design the joint of inbound trucks and outbound trucks, so a proper sequence of trucks will make the cross-docking system much more efficient and need less makespan. A cross-docking system is proposed with multiple receiving and shipping dock doors. The objective is to find the best door assignments and the sequences of trucks in the principle of products distribution to minimize the total makespan of cross docking. To solve the problem that is regarded as a mixed integer linear programming (MILP model, three metaheuristics, namely, harmony search (HS, improved harmony search (IHS, and genetic algorithm (GA, are proposed. Furthermore, the fixed parameters are optimized by Taguchi experiments to improve the accuracy of solutions further. Finally, several numerical examples are put forward to evaluate the performances of proposed algorithms.

  16. Multiple R&D projects scheduling optimization with improved particle swarm algorithm.

    Liu, Mengqi; Shan, Miyuan; Wu, Juan

    2014-01-01

    For most enterprises, in order to win the initiative in the fierce competition of market, a key step is to improve their R&D ability to meet the various demands of customers more timely and less costly. This paper discusses the features of multiple R&D environments in large make-to-order enterprises under constrained human resource and budget, and puts forward a multi-project scheduling model during a certain period. Furthermore, we make some improvements to existed particle swarm algorithm and apply the one developed here to the resource-constrained multi-project scheduling model for a simulation experiment. Simultaneously, the feasibility of model and the validity of algorithm are proved in the experiment.

  17. Positioning performance improvements with European multiple-frequency satellite navigation - Galileo

    Ji, Shengyue

    2008-10-01

    The rapid development of Global Positioning System has demonstrated the advantages of satellite based navigation systems. In near future, there will be a number of Global Navigation Satellite System (GNSS) available, i.e. modernized GPS, Galileo, restored GLONASS, BeiDou and many other regional GNSS augmentation systems. Undoubtedly, the new GNSS systems will significantly improve navigation performance over current GPS, with a better satellite coverage and multiple satellite signal bands. In this dissertation, the positioning performance improvement of new GNSS has been investigated based on both theoretical analysis and numerical study. First of all, the navigation performance of new GNSS systems has been analyzed, particularly for urban applications. The study has demonstrated that Receiver Autonomous Integrity Monitoring (RAIM) performance can be significantly improved with multiple satellite constellations, although the position accuracy improvement is limited. Based on a three-dimensional urban building model in Hong Kong streets, it is found that positioning availability is still very low in high-rising urban areas, even with three GNSS systems. On the other hand, the discontinuity of navigation solutions is significantly reduced with the combined constellations. Therefore, it is possible to use cheap DR systems to bridge the gaps of GNSS positioning, with high accuracy. Secondly, the ambiguity resolution performance has been investigated with Galileo multiple frequency band signals. The ambiguity resolution performance of three different algorithms is compared, including CAR, ILS and improved CAR methods (a new method proposed in this study). For short baselines, with four frequency Galileo data, it is highly possible to achieve reliable single epoch ambiguity resolution, when the carrier phase noise level is reasonably low (i.e. less than 6mm). For long baselines (up to 800 km), the integer ambiguity can be determined within 1 min on average. Ambiguity

  18. An improved early detection method of type-2 diabetes mellitus using multiple classifier system

    Zhu, Jia

    2015-01-01

    The specific causes of complex diseases such as Type-2 Diabetes Mellitus (T2DM) have not yet been identified. Nevertheless, many medical science researchers believe that complex diseases are caused by a combination of genetic, environmental, and lifestyle factors. Detection of such diseases becomes an issue because it is not free from false presumptions and is accompanied by unpredictable effects. Given the greatly increased amount of data gathered in medical databases, data mining has been used widely in recent years to detect and improve the diagnosis of complex diseases. However, past research showed that no single classifier can be considered optimal for all problems. Therefore, in this paper, we focus on employing multiple classifier systems to improve the accuracy of detection for complex diseases, such as T2DM. We proposed a dynamic weighted voting scheme called multiple factors weighted combination for classifiers\\' decision combination. This method considers not only the local and global accuracy but also the diversity among classifiers and localized generalization error of each classifier. We evaluated our method on two real T2DM data sets and other medical data sets. The favorable results indicated that our proposed method significantly outperforms individual classifiers and other fusion methods.

  19. Problem solving based learning model with multiple representations to improve student's mental modelling ability on physics

    Haili, Hasnawati; Maknun, Johar; Siahaan, Parsaoran

    2017-08-01

    Physics is a lessons that related to students' daily experience. Therefore, before the students studying in class formally, actually they have already have a visualization and prior knowledge about natural phenomenon and could wide it themselves. The learning process in class should be aimed to detect, process, construct, and use students' mental model. So, students' mental model agree with and builds in the right concept. The previous study held in MAN 1 Muna informs that in learning process the teacher did not pay attention students' mental model. As a consequence, the learning process has not tried to build students' mental modelling ability (MMA). The purpose of this study is to describe the improvement of students' MMA as a effect of problem solving based learning model with multiple representations approach. This study is pre experimental design with one group pre post. It is conducted in XI IPA MAN 1 Muna 2016/2017. Data collection uses problem solving test concept the kinetic theory of gasses and interview to get students' MMA. The result of this study is clarification students' MMA which is categorized in 3 category; High Mental Modelling Ability (H-MMA) for 7Mental Modelling Ability (M-MMA) for 3Mental Modelling Ability (L-MMA) for 0 ≤ x ≤ 3 score. The result shows that problem solving based learning model with multiple representations approach can be an alternative to be applied in improving students' MMA.

  20. An improved null model for assessing the net effects of multiple stressors on communities.

    Thompson, Patrick L; MacLennan, Megan M; Vinebrooke, Rolf D

    2018-01-01

    Ecological stressors (i.e., environmental factors outside their normal range of variation) can mediate each other through their interactions, leading to unexpected combined effects on communities. Determining whether the net effect of stressors is ecologically surprising requires comparing their cumulative impact to a null model that represents the linear combination of their individual effects (i.e., an additive expectation). However, we show that standard additive and multiplicative null models that base their predictions on the effects of single stressors on community properties (e.g., species richness or biomass) do not provide this linear expectation, leading to incorrect interpretations of antagonistic and synergistic responses by communities. We present an alternative, the compositional null model, which instead bases its predictions on the effects of stressors on individual species, and then aggregates them to the community level. Simulations demonstrate the improved ability of the compositional null model to accurately provide a linear expectation of the net effect of stressors. We simulate the response of communities to paired stressors that affect species in a purely additive fashion and compare the relative abilities of the compositional null model and two standard community property null models (additive and multiplicative) to predict these linear changes in species richness and community biomass across different combinations (both positive, negative, or opposite) and intensities of stressors. The compositional model predicts the linear effects of multiple stressors under almost all scenarios, allowing for proper classification of net effects, whereas the standard null models do not. Our findings suggest that current estimates of the prevalence of ecological surprises on communities based on community property null models are unreliable, and should be improved by integrating the responses of individual species to the community level as does our

  1. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life

    Rasmussen, Rune Skovgaard; Østergaard, Ann; Kjær, Pia

    2016-01-01

    part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients. MAIN MEASURES: Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome...... score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D™ quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training...... and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective....

  2. Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression: An appraisal of prospectively collected patient outcomes.

    Khan, Muhammad Babar; Bashir, Muhammad Umair; Kumar, Rajesh; Enam, Syed Ather

    2015-01-01

    Our present study aims to assess the short and long-term postoperative outcome of microscopic interlaminar decompression from a neurosurgical center in a developing country and also aims to further determine any predictors of functional outcome. All patients with moderate to severe symptomatic stenosis undergoing elective posterior lumbar spinal decompression were prospectively enrolled in a database. Preoperative, 2 weeks and 2 years postoperative Oswestry Disability Index (ODI) scores were determined for all patients. These scores were retrospectively compared using repeated measures analysis of variance. Further, linear regression modelling was applied to determine the effect of preoperative ODI, body mass index, age, prior physiotherapy, duration of symptoms, and single or multiple level decompression on the change in ODI at 2 weeks and 2 years follow-up respectively. A total of 60 consecutive patients (40 males, 20 females) were included for statistical analysis. The percentage of patients with a minimum clinically important difference (MCID), using an ODI threshold value of 10, was 86.7% (n = 52) at the 2 weeks postoperative follow-up. At the 2 years follow-up assessment, 3.3% (n = 2) patients who had earlier not achieved MCID did so, 78.3% (n = 47) of patients were found to have a change in ODI score of <10 or no change, while 18.3% (n = 11) reported a deterioration in their ODI scores. The preoperative ODI score was an independent predictor of change in ODI score at 2 weeks and 2 years respectively (P < 0.0005). The duration of symptoms prior to surgery was found to predict the change in ODI at 2 years follow-up (P = 0.04). The evidence regarding the long-term and short-term efficacy of microscopic interlaminar decompression in symptomatic lumbar stenosis is overwhelming. Preoperative ODI scores and duration of symptoms prior to surgery can predict postoperative outcomes.

  3. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.

    Lee, Jennifer E; Bisht, Babita; Hall, Michael J; Rubenstein, Linda M; Louison, Rebecca; Klein, Danielle T; Wahls, Terry L

    2017-01-01

    The objective of this study was to examine whether participation in a 12-month multimodal intervention would improve mood and cognitive function in adults with progressive multiple sclerosis (MS). In this one-arm, open-label feasibility trial, participants were prescribed a home-based multimodal intervention, including (1) a modified Paleolithic diet; (2) an exercise program (stretching and strengthening of the trunk and lower limb muscles); (3) neuromuscular electrical stimulation (EStim) of trunk and lower limb muscles; and (4) stress management (meditation and self-massage). Individuals completed measures of mood (Beck Anxiety and Depression Inventories) and cognitive (Cognitive Stability Index, Cognitive Screening Test, Delis-Kaplan Executive Function System) and executive function (Wechsler Adult Intelligence Scale) at baseline and 3, 6, 9, and 12 months after the start of the intervention. Dosage of the multimodal intervention was assessed at 3, 6, 9, and 12 months. The more individuals participated in the intervention activities, the greater improvements they had from baseline to 12 months on self-report measures of anxiety (Beck Anxiety Inventory [BAI]; ps = 0.001 to 0.02), depression (Beck Depression Inventory [BDI]; ps = Mood and cognitive improvements were more closely related to a higher intake of the modified Paleolithic diet than to exercise and stress management dosage. Anxiety and depression changes were evident after just a few months, whereas changes in cognitive function were generally not observed until later in the intervention period. Mood and cognitive function changes from baseline to 12 months were significantly associated with fatigue improvements (ps = exercise, EStim, and stress management intervention like this one has the potential to improve the mood and cognitive symptoms that can lead to considerable suffering in people with MS, potentially improving quality of life and function for people with progressive MS.

  4. [10 theses of the disabled persons' organizations - why participation research with a social perspective is needed].

    Hinz, T

    2012-12-01

    The 5 professional associations for the disabled and the self-help organisations of disabled people state that in Germany a general concept for "participation research" is needed. This concept should address expectations and processes in developing aid services and improve self-determined participation of people with disabilities according to the human rights postulated in the UN Convention on the Rights of People with Disabilities (2006). A concept of "participation research" will go beyond the objectives and methods of i. e., disability studies - it is a focus in the context of which the social and equal participation of the disabled (especially those with multiple and/or intellectual handicaps) has to be addressed. In this context the 5 professional associations for the disabled have drafted 10 theses which are presented in the following article. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Effectiveness of the IMPACT:Ability program to improve safety and self-advocacy skills in high school students with disabilities.

    Dryden, Eileen M; Desmarais, Jeffery; Arsenault, Lisa

    2014-12-01

    Individuals with disabilities experience higher rates of abuse than the nondisabled. Few evidence-based prevention interventions have been published despite a need for such work. This study evaluated Ability, a safety and self-advocacy training for individuals with cognitive and/or physical disabilities. A quasi-experimental design was used to assess change in safety and self-advocacy knowledge, confidence, and behaviors among special education high school students in Boston, MA. Instruments were interviewer-administered at 3 time points. Analysis of covariance (ANCOVA) was used to compare change between the intervention (N = 21) and wait-list (N = 36) groups. Repeated measures analysis was used to test change in the complete sample (N = 57). Students were diverse (58% males, 82% nonwhite) with a range of disabilities. Significantly greater improvement in key outcomes, including safety and self-advocacy knowledge, confidence, and behavior, were observed in intervention students compared to the wait-list group. Results in the complete sample showed evidence of further improvements in students' sense of safety and general self-efficacy. These findings are encouraging given the effects were demonstrated in a heterogeneous urban population. Ability may be an effective safety and self-advocacy training for students with disabilities. Further research will be required to determine effectiveness within particular subpopulations of students. © 2014, American School Health Association.

  6. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial.

    Rasmussen, Rune Skovgaard; Østergaard, Ann; Kjær, Pia; Skerris, Anja; Skou, Christina; Christoffersen, Jane; Seest, Line Skou; Poulsen, Mai Bang; Rønholt, Finn; Overgaard, Karsten

    2016-03-01

    To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care. Interventional, randomised, safety/efficacy open-label trial. University hospital stroke unit in collaboration with three municipalities. Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation. Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients. Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D, Body Mass Index and treatment-associated economy. Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging from Prehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective. © The Author(s) 2015.

  7. Confirmatory Factor Analysis and Multiple Linear Regression of the Neck Disability Index: Assessment If Subscales Are Equally Relevant in Whiplash and Nonspecific Neck Pain.

    Croft, Arthur C; Milam, Bryce; Meylor, Jade; Manning, Richard

    2016-06-01

    Because of previously published recommendations to modify the Neck Disability Index (NDI), we evaluated the responsiveness and dimensionality of the NDI within a population of adult whiplash-injured subjects. The purpose of the present study was to evaluate the responsiveness and dimensionality of the NDI within a population of adult whiplash-injured subjects. Subjects who had sustained whiplash injuries of grade 2 or higher completed an NDI questionnaire. There were 123 subjects (55% female, of which 36% had recovered and 64% had chronic symptoms. NDI subscales were analyzed using confirmatory factor analysis, considering only the subscales and, secondly, using sex as an 11th variable. The subscales were also tested with multiple linear regression modeling using the total score as a target variable. When considering only the 10 NDI subscales, only a single factor emerged, with an eigenvalue of 5.4, explaining 53.7% of the total variance. Strong correlation (> .55) (P factor model of the NDI is not justified based on our results, and in this population of whiplash subjects, the NDI was unidimensional, demonstrating high internal consistency and supporting the original validation study of Vernon and Mior.

  8. The Sound Access Parent Outcomes Instrument (SAPOI): Construction of a new instrument for children with severe multiple disabilities who use cochlear implants or hearing aids.

    Hayward, Denyse V; Ritter, Kathryn; Mousavi, Amin; Vatanapour, Shabnam

    2016-01-01

    To report on the Phase 2 development of the Sound Access Parent Outcomes Instrument (SAPOI), a new instrument focused on formalizing outcomes that parents of children with severe multiple disabilities (SMD) who use amplification prioritize as important. Phase 2 of this project involved item selection and refinement of the SAPOI based on (a) Phase 1 study participant input, (b) clinical specialist feedback, and (c) test-retest instrument reliability. Phase 1 participant responses were utilized to construct a draft version of the SAPOI. Next, clinical specialists examined the instrument for content validity and utility and instrument reliability was examined through a test-retest process with parents of children with SMD. The draft SAPOI was constructed based on Phase 1 participant input. Clinical specialists supported content validity and utility of the instrument and the inclusion of 19 additional items across four categories, namely Child Affect, Child Interaction, Parent Well-being, and Child's Device Use. The SAPOI was completed twice at one-month intervals by parents of children with SMD to examine instrument reliability across the four categories (Child Affect, Child Interaction, Parent Well-being, and Child's Device Use). Instrument reliability was strong-to-excellent across all four sections. The SAPOI shows promise as a much-needed addition to the assessment battery currently used for children with SMD who use cochlear implants and hearing aids. It provides valuable information regarding outcomes resulting from access to sound in this population that currently used assessments do not identify.

  9. Vexatious Litigants and the ADA: Strategies to Fairly Address the Need to Improve Access for Individuals with Disabilities

    Hull, Helia

    2018-01-01

    Cornell Journal of Law and Public Policy: Vol. 26 : Iss. 1 , Article 2. The Americans with Disabilities Act (“ADA”) is recognized as one of the most significant pieces of civil rights legislation in American history and is aimed at protecting the rights of individuals with disabilities. Unfortunately, as the ADA has developed, some attorneys have exposed methods of exploiting the provisions of the ADA for personal, pecuniary benefits—fee-driven lawsuits for violations of plaintiff-friendly pr...

  10. An Improved Clutter Suppression Method for Weather Radars Using Multiple Pulse Repetition Time Technique

    Yingjie Yu

    2017-01-01

    Full Text Available This paper describes the implementation of an improved clutter suppression method for the multiple pulse repetition time (PRT technique based on simulated radar data. The suppression method is constructed using maximum likelihood methodology in time domain and is called parametric time domain method (PTDM. The procedure relies on the assumption that precipitation and clutter signal spectra follow a Gaussian functional form. The multiple interleaved pulse repetition frequencies (PRFs that are used in this work are set to four PRFs (952, 833, 667, and 513 Hz. Based on radar simulation, it is shown that the new method can provide accurate retrieval of Doppler velocity even in the case of strong clutter contamination. The obtained velocity is nearly unbiased for all the range of Nyquist velocity interval. Also, the performance of the method is illustrated on simulated radar data for plan position indicator (PPI scan. Compared with staggered 2-PRT transmission schemes with PTDM, the proposed method presents better estimation accuracy under certain clutter situations.

  11. Optimized, unequal pulse spacing in multiple echo sequences improves refocusing in magnetic resonance.

    Jenista, Elizabeth R; Stokes, Ashley M; Branca, Rosa Tamara; Warren, Warren S

    2009-11-28

    A recent quantum computing paper (G. S. Uhrig, Phys. Rev. Lett. 98, 100504 (2007)) analytically derived optimal pulse spacings for a multiple spin echo sequence designed to remove decoherence in a two-level system coupled to a bath. The spacings in what has been called a "Uhrig dynamic decoupling (UDD) sequence" differ dramatically from the conventional, equal pulse spacing of a Carr-Purcell-Meiboom-Gill (CPMG) multiple spin echo sequence. The UDD sequence was derived for a model that is unrelated to magnetic resonance, but was recently shown theoretically to be more general. Here we show that the UDD sequence has theoretical advantages for magnetic resonance imaging of structured materials such as tissue, where diffusion in compartmentalized and microstructured environments leads to fluctuating fields on a range of different time scales. We also show experimentally, both in excised tissue and in a live mouse tumor model, that optimal UDD sequences produce different T(2)-weighted contrast than do CPMG sequences with the same number of pulses and total delay, with substantial enhancements in most regions. This permits improved characterization of low-frequency spectral density functions in a wide range of applications.

  12. May Diet and Dietary Supplements Improve the Wellness of Multiple Sclerosis Patients? A Molecular Approach

    Paolo Riccio

    2010-01-01

    Full Text Available Multiple sclerosis is a complex and multifactorial neurological disease, and nutrition is one of the environmental factors possibly involved in its pathogenesis. At present, the role of nutrition is unclear, and MS therapy is not associated to a particular diet. MS clinical trials based on specific diets or dietary supplements are very few and in some cases controversial. To understand how diet can influence the course of MS and improve the wellness of MS patients, it is necessary to identify the dietary molecules, their targets and the molecular mechanisms involved in the control of the disease. The aim of this paper is to provide a molecular basis for the nutritional intervention in MS by evaluating at molecular level the effect of dietary molecules on the inflammatory and autoimmune processes involved in the disease.

  13. High-dose therapy improved the bone remodelling compartment canopy and bone formation in multiple myeloma

    Hinge, Maja; Delaissé, Jean-Marie; Plesner, Torben

    2015-01-01

    transplantation, and from 20 control patients with monoclonal gammopathy of undetermined significance were histomorphometrically investigated. This investigation confirmed that MM patients exhibited uncoupled bone formation to resorption and reduced canopy coverage. More importantly, this study revealed......Bone loss in multiple myeloma (MM) is caused by an uncoupling of bone formation to resorption trigged by malignant plasma cells. Increasing evidence indicates that the bone remodelling compartment (BRC) canopy, which normally covers the remodelling sites, is important for coupled bone remodelling....... Loss of this canopy has been associated with bone loss. This study addresses whether the bone remodelling in MM is improved by high-dose therapy. Bone marrow biopsies obtained from 20 MM patients, before and after first-line treatment with high-dose melphalan followed by autologous stem cell...

  14. Meta-analysis of the efficacy of psychological and educational interventions to improve academic performance of students with learning disabilities in Iran.

    Faramarzi, Salar; Shamsi, Abdolhossein; Samadi, Maryam; Ahmadzade, Maryam

    2015-01-01

    with due attention to the importance of learning disabilities and necessity of presenting interventions for improvement of these disorders in order to prevent future problems, this study used meta-analysis of the research model on the impact of psychological and educational interventions to improve academic performance of students with learning disabilities. with the use of meta-analysis method by integrating the results of various researches, this study specifies the effect of psychological and educational interventions. In this order, 57 studies, which their methodology was accepted, were selected and meta-analysis was performed on them. The research instrument was a meta-analysis checklist. The effect size for the effectiveness of psychological-educational interventions on improving the academic performance of students with mathematics disorder (0.57), impaired writing (0.50) and dyslexia (0.55) were reported. The result of meta-analysis showed that according to Cohen's table, the effect size is above average, and it can be said that educational and psychological interventions improve the academic performance of students with learning disabilities.

  15. Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial

    Giovanni Ferreira

    2016-10-01

    Full Text Available Question: In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms? Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: Sixty participants with nerve-related leg pain recruited from the community. Interventions: The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. Outcome measures: Leg pain and low back pain (0, none, to 10, worst, Oswestry Disability Index (0, none, to 100, worst, Patient-Specific Functional Scale (0, unable to perform, to 30, able to perform, global perceived effect (–5 to 5 and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI. Results: At 2 weeks, the experimental group did not have significantly greater improvement than the control group in leg pain (MD –1.1, 95% CI –2.3 to 0.1 or disability (MD –3.3, 95% CI –9.6 to 2.9. At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD –2.4, 95% CI –3.6 to –1.2 and low back pain (MD –1.5, 95% CI –2.8 to –0.2. The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2 and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8, as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5 and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9. No significant between-group differences occurred in disability at 4 weeks and location of symptoms. Conclusion: Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. Trial registration: NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016 Neurodynamic treatment did not improve

  16. A self-determination multiple risk intervention trial to improve smokers' health.

    Williams, Geoffrey C; McGregor, Holly; Sharp, Daryl; Kouldes, Ruth W; Lévesque, Chantal S; Ryan, Richard M; Deci, Edward L

    2006-12-01

    Little is known about how interventions motivate individuals to change multiple health risk behaviors. Self-determination theory (SDT) proposes that patient autonomy is an essential factor for motivating change. An SDT-based intervention to enhance autonomous motivation for tobacco abstinence and improving cholesterol was tested. The Smokers' Health Study is a randomized multiple risk behavior change intervention trial. Smokers were recruited to a tobacco treatment center. A total of 1.006 adult smokers were recruited between 1999 and 2002 from physician offices and by newspaper advertisements. A 6-month clinical intervention (4 contacts) to facilitate internalization of autonomy and perceived competence for tobacco abstinence and reduced percent calories from fat was compared with community care. Clinicians elicited patient perspectives and life strivings, provided absolute coronary artery disease risk estimates,enumerated effective treatment options, supported patient initiatives,minimized clinician control, assessed motivation for change, and developed a plan for change. Twelve-month prolonged tobacco abstinence, and change in percent calories from fat and low-density lipoprotein-cholesterol (LDL-C) from baseline to 18 months. RESULTS- Intention to treat analyses revealed that the intervention significantly increased 12-month prolonged tobacco abstinence (6.2% vs 2.4%; odds ratio [OR]=2.7, P=.01, number needed to treat [NNT] =26), and reduced LDL-C (-8.9 vs -4.1 mg/dL; P=.05). There was no effect on percent calories from fat. An intervention focused on supporting smokers'autonomy was effective in increasing prolonged tobacco abstinence and lowering LDL-C. Clinical interventions for behavior change may be improved by increasing patient autonomy and perceived competence.

  17. Carfilzomib significantly improves the progression-free survival of high-risk patients in multiple myeloma.

    Avet-Loiseau, Hervé; Fonseca, Rafael; Siegel, David; Dimopoulos, Meletios A; Špička, Ivan; Masszi, Tamás; Hájek, Roman; Rosiñol, Laura; Goranova-Marinova, Vesselina; Mihaylov, Georgi; Maisnar, Vladimír; Mateos, Maria-Victoria; Wang, Michael; Niesvizky, Ruben; Oriol, Albert; Jakubowiak, Andrzej; Minarik, Jiri; Palumbo, Antonio; Bensinger, William; Kukreti, Vishal; Ben-Yehuda, Dina; Stewart, A Keith; Obreja, Mihaela; Moreau, Philippe

    2016-09-01

    The presence of certain high-risk cytogenetic abnormalities, such as translocations (4;14) and (14;16) and deletion (17p), are known to have a negative impact on survival in multiple myeloma (MM). The phase 3 study ASPIRE (N = 792) demonstrated that progression-free survival (PFS) was significantly improved with carfilzomib, lenalidomide, and dexamethasone (KRd), compared with lenalidomide and dexamethasone (Rd) in relapsed MM. This preplanned subgroup analysis of ASPIRE was conducted to evaluate KRd vs Rd by baseline cytogenetics according to fluorescence in situ hybridization. Of 417 patients with known cytogenetic risk status, 100 patients (24%) were categorized with high-risk cytogenetics (KRd, n = 48; Rd, n = 52) and 317 (76%) were categorized with standard-risk cytogenetics (KRd, n = 147; Rd, n = 170). For patients with high-risk cytogenetics, treatment with KRd resulted in a median PFS of 23.1 months, a 9-month improvement relative to treatment with Rd. For patients with standard-risk cytogenetics, treatment with KRd led to a 10-month improvement in median PFS vs Rd. The overall response rates for KRd vs Rd were 79.2% vs 59.6% (high-risk cytogenetics) and 91.2% vs 73.5% (standard-risk cytogenetics); approximately fivefold as many patients with high- or standard-risk cytogenetics achieved a complete response or better with KRd vs Rd (29.2% vs 5.8% and 38.1% vs 6.5%, respectively). KRd improved but did not abrogate the poor prognosis associated with high-risk cytogenetics. This regimen had a favorable benefit-risk profile in patients with relapsed MM, irrespective of cytogenetic risk status, and should be considered a standard of care in these patients. This trial was registered at www.clinicaltrials.gov as #NCT01080391. © 2016 by The American Society of Hematology.

  18. Improved environmental and forensics measurements using multiple ion counters in isotope ratio mass spectrometry

    Goldberg, S.A.; Richter, S.; Schwieters, H.

    2002-01-01

    Full text: A new detector system designed for isotope ratio mass spectrometers provides improved precision on measurements of samples with very low amounts ( -11 grams) of analyte. An array of continuous dynode electron multipliers has been installed on a new ThermoFinnigan MAT Triton thermal ionization mass spectrometer acquired by the New Brunswick Laboratory. These ion counters are modifications of miniaturized, commercially-available continuous dynode electron multipliers. They can be readily installed to replace individual Faraday cups in a multi-detector mass spectrometer or bundled together and located along the detector plane with a set of Faraday cups. On the New Brunswick Laboratory mass spectrometer, nine Faraday cups, one conventional discrete dynode electron multiplier, and seven miniaturized ion counters were installed. Six of the small ion counters were bundled together and positioned on the high mass side of the Low 4 Faraday cup. One additional ion counter was positioned on the low mass side of the Low 4 Faraday cup. This arrangement allows for the simultaneous measurement of all uranium (including 233 U) or plutonium (including 244 Pu) isotopes, and allows for the measurement of larger 238 U intensities on the Faraday cup if needed. Unit mass spacing of U, Pu, or other actinides is readily achieved by the use of a mass dispersion zoom lens. The advantage of multiple ion counting is the simultaneous collection of isotopes. It overcomes many of the problems such as transient signal variation in sample emission and ionization. For a given sample, multiple ion counting generates a greater number of counts for each isotope relative to single detector ion counting and provides improved counting statistics by a factor of two or more. Initial tests indicate that the multiple ion counters exhibit high counting efficiency, a dark noise of less than 10 counts per minute and typically less than 1 count per minute, and show linear response characteristics over

  19. Impairment in explicit visuomotor sequence learning is related to loss of microstructural integrity of the corpus callosum in multiple sclerosis patients with minimal disability.

    Bonzano, L; Tacchino, A; Roccatagliata, L; Sormani, M P; Mancardi, G L; Bove, M

    2011-07-15

    Sequence learning can be investigated by serial reaction-time (SRT) paradigms. Explicit learning occurs when subjects have to recognize a test sequence and has been shown to activate the frontoparietal network in both contralateral and ipsilateral hemispheres. Thus, the left and right superior longitudinal fasciculi (SLF), connecting the intra-hemispheric frontoparietal circuits, could have a role in explicit unimanual visuomotor learning. Also, as both hemispheres are involved, we could hypothesize that the corpus callosum (CC) has a role in this process. Pathological damage in both SLF and CC has been detected in patients with Multiple Sclerosis (PwMS), and microstructural alterations can be quantified by Diffusion Tensor Imaging (DTI). In light of these findings, we inquired whether PwMS with minimal disability showed impairments in explicit visuomotor sequence learning and whether this could be due to loss of white matter integrity in these intra- and inter-hemispheric white matter pathways. Thus, we combined DTI analysis with a modified version of SRT task based on finger opposition movements in a group of PwMS with minimal disability. We found that the performance in explicit sequence learning was significantly reduced in these patients with respect to healthy subjects; the amount of sequence-specific learning was found to be more strongly correlated with fractional anisotropy (FA) in the CC (r=0.93) than in the left (r=0.28) and right SLF (r=0.27) (p for interaction=0.005 and 0.04 respectively). This finding suggests that an inter-hemispheric information exchange between the homologous areas is required to successfully accomplish the task and indirectly supports the role of the right (ipsilateral) hemisphere in explicit visuomotor learning. On the other hand, we found no significant correlation of the FA in the CC and in the SLFs with nonspecific learning (assessed when stimuli are randomly presented), supporting the hypothesis that inter

  20. Effectiveness of IMPACT:Ability to Improve Safety and Self-Advocacy Skills in Students With Disabilities-Follow-Up Study.

    Dryden, Eileen M; Desmarais, Jeffrey; Arsenault, Lisa

    2017-02-01

    Research shows that individuals with disabilities are more likely to experience abuse than their peers without disabilities. Yet, few evidenced-based abuse prevention interventions exist. This study examines whether positive outcomes identified previously in an evaluation of IMPACT:Ability were maintained 1 year later. A survey measuring safety and self-advocacy knowledge, confidence, and behaviors among special education high-school students was administered 12 months post-training. Paired samples t-tests were used to compare baseline to follow up and postsurvey to follow up and repeated measures analyses were conducted to test the effect of time across the 3 time points (baseline, post, and 1-year follow up) (N = 47). Follow-up study participants had a range of disabilities, just over half were boys, and most were either black or Latino/Hispanic. Difference between scores at baseline and follow-up for all the measures of interest represented gains from baseline. Statistically significant post-training improvements in participants' safety and self-advocacy knowledge and confidence were maintained 1-year later. These results provide additional support for the case that IMPACT:Ability is a promising safety and self-advocacy training program for diverse groups of students with disabilities. © 2017, American School Health Association.

  1. Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability.

    Lindley, Lisa C; Cozad, Melanie J

    2017-09-01

    Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. Does hippotherapy improve balance in persons with multiple sclerosis: a systematic review.

    Bronson, C; Brewerton, K; Ong, J; Palanca, C; Sullivan, S John

    2010-09-01

    Multiple sclerosis (MS) leads to changes in balance due to the breakdown of a number of neurological processes. Hippotherapy utilizes the movement of the horse to provide sensory feedback and has been used as a therapeutic intervention for different neurological conditions. Little is known about the effects of hippotherapy in MS. The purpose of this study is to systematically review and examine the evidence for hippotherapy as an intervention to improve balance in persons with MS. Major electronic databases were searched for articles relating to hippotherapy, MS and balance. Only full length articles published in peer reviewed journals that were written in English or translated into English were included. Articles were assessed using a modified quality index that was used for descriptive purposes only and did not exclude any study from the review. All studies examined in this review were either case-control or case-series. Collectively all three studies reported improvements in balance. Pre-test and post-test Berg Balance Scale scores in two studies revealed that primary progressive MS demonstrated the greatest amount of change after hippotherapy compared to other subtypes of MS. Hippotherapy has a positive effect on balance in persons with MS and has an added benefit of enhancing quality of life. The data is limited and further research will lead to a greater knowledge base and has the potential to increase accessibility for hippotherapy to be used as a rehabilitation modality.

  3. Oral Dalfampridine Improves Standing Balance Detected at Static Posturography in Multiple Sclerosis

    Luca Prosperini

    2014-01-01

    Full Text Available We report a 14-week post-marketing experience on 20 patients with multiple sclerosis (MS who started prolonged-release (PR oral dalfampridine 10 mg twice daily according to European Medicine Agency criteria. They underwent serial static posturography assessments and the dizziness handicap inventory (DHI to investigate whether PR dalfampridine could impact standing balance and self-reported perception of balance. The incidence of accidental falls per person per month was also recorded throughout the study. Eight (40% patients, who had a relevant improvement in walking speed, were defined as treatment responders. They showed a significant improvement of standing balance (with respect to pretreatment assessment when contrasted with 12 (60% nonresponders (F[4,15] = 3.959, P=0.027. No significant changes in DHI score, as well as in its functional, physical, and emotional subscales, were found in both responders and nonresponders at the end of study (all P values are ≥0.2. Treatment response did not affect the incidence of accidental falls. Future studies based on larger sample sizes, and with longer followup, are required to confirm the beneficial effect of PR dalfampridine on standing balance.

  4. Joint estimation over multiple individuals improves behavioural state inference from animal movement data.

    Jonsen, Ian

    2016-02-08

    State-space models provide a powerful way to scale up inference of movement behaviours from individuals to populations when the inference is made across multiple individuals. Here, I show how a joint estimation approach that assumes individuals share identical movement parameters can lead to improved inference of behavioural states associated with different movement processes. I use simulated movement paths with known behavioural states to compare estimation error between nonhierarchical and joint estimation formulations of an otherwise identical state-space model. Behavioural state estimation error was strongly affected by the degree of similarity between movement patterns characterising the behavioural states, with less error when movements were strongly dissimilar between states. The joint estimation model improved behavioural state estimation relative to the nonhierarchical model for simulated data with heavy-tailed Argos location errors. When applied to Argos telemetry datasets from 10 Weddell seals, the nonhierarchical model estimated highly uncertain behavioural state switching probabilities for most individuals whereas the joint estimation model yielded substantially less uncertainty. The joint estimation model better resolved the behavioural state sequences across all seals. Hierarchical or joint estimation models should be the preferred choice for estimating behavioural states from animal movement data, especially when location data are error-prone.

  5. Learning from Multiple Classifier Systems: Perspectives for Improving Decision Making of QSAR Models in Medicinal Chemistry.

    Pham-The, Hai; Nam, Nguyen-Hai; Nga, Doan-Viet; Hai, Dang Thanh; Dieguez-Santana, Karel; Marrero-Poncee, Yovani; Castillo-Garit, Juan A; Casanola-Martin, Gerardo M; Le-Thi-Thu, Huong

    2018-02-09

    Quantitative Structure - Activity Relationship (QSAR) modeling has been widely used in medicinal chemistry and computational toxicology for many years. Today, as the amount of chemicals is increasing dramatically, QSAR methods have become pivotal for the purpose of handling the data, identifying a decision, and gathering useful information from data processing. The advances in this field have paved a way for numerous alternative approaches that require deep mathematics in order to enhance the learning capability of QSAR models. One of these directions is the use of Multiple Classifier Systems (MCSs) that potentially provide a means to exploit the advantages of manifold learning through decomposition frameworks, while improving generalization and predictive performance. In this paper, we presented MCS as a next generation of QSAR modeling techniques and discuss the chance to mining the vast number of models already published in the literature. We systematically revisited the theoretical frameworks of MCS as well as current advances in MCS application for QSAR practice. Furthermore, we illustrated our idea by describing ensemble approaches on modeling histone deacetylase (HDACs) inhibitors. We expect that our analysis would contribute to a better understanding about MCS application and its future perspectives for improving the decision making of QSAR models. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  6. Multiple breath washout analysis in infants: quality assessment and recommendations for improvement.

    Anagnostopoulou, Pinelopi; Egger, Barbara; Lurà, Marco; Usemann, Jakob; Schmidt, Anne; Gorlanova, Olga; Korten, Insa; Roos, Markus; Frey, Urs; Latzin, Philipp

    2016-03-01

    Infant multiple breath washout (MBW) testing serves as a primary outcome in clinical studies. However, it is still unknown whether current software algorithms allow between-centre comparisons. In this study of healthy infants, we quantified MBW measurement errors and tried to improve data quality by simply changing software settings. We analyzed best quality MBW measurements performed with an ultrasonic flowmeter in 24 infants from two centres in Switzerland with the current software settings. To challenge the robustness of these settings, we also used alternative analysis approaches. Using the current analysis software, the coefficient of variation (CV) for functional residual capacity (FRC) differed significantly between centres (mean  ±  SD (%): 9.8  ±  5.6 and 5.8  ±  2.9, respectively, p  =  0.039). In addition, FRC values calculated during the washout differed between  -25 and  +30% from those of the washin of the same tracing. Results were mainly influenced by analysis settings and temperature recordings. Changing few algorithms resulted in significantly more robust analysis. Non-systematic inter-centre differences can be reduced by using correctly recorded environmental data and simple changes in the software algorithms. We provide implications that greatly improve infant MBW outcomes' quality and can be applied when multicentre trials are conducted.

  7. Improved self-efficacy in persons with relapsing remitting multiple sclerosis after an intensive social cognitive wellness program with participation of support partners: a 6-months observational study

    Jongen, P.J.H.; Ruimschotel, R.; Heerings, M.; Hussaarts, A.; Duyverman, L.; Zande, A. van der; Valkenburg-Vissers, J.; Wolper, H.; Droffelaar, M. van; Lemmens, W.A.J.G.; Donders, R.; Visser, L.H.

    2014-01-01

    BACKGROUND: For persons with multiple sclerosis (MS) it is important to preserve their autonomy, in spite of increasing disability. A major factor mediating autonomy is self-efficacy. According to the social cognitive theory stressors are crucial determinants of self-efficacy, as well as the

  8. Effectiveness of a workplace training programme in improving social, communication and emotional skills for adults with autism and intellectual disability in Hong Kong--a pilot study.

    Liu, Karen P Y; Wong, Denys; Chung, Anthony C Y; Kwok, Natalie; Lam, Madeleine K Y; Yuen, Cheri M C; Arblaster, Karen; Kwan, Aldous C S

    2013-12-01

    This pilot study explored the effectiveness of workplace training programme that aimed to enhance the work-related behaviours in individuals with autism and intellectual disabilities. Fourteen participants with autism and mild to moderate intellectual disability (mean age = 24.6 years) were recruited. The workplace training programme included practices in work context and group educational sessions. A pre-test-post-test design was used with the Work Personality Profile, the Scale of Independent Behaviour Revised and the Observational Emotional Inventory Revised to evaluate the targeted behaviours. Improvement in social and communication skills specific to the workplace was achieved. For emotional control, participants became less confused and had a better self-concept. However, improvement in other general emotional behaviours, such as impulse control, was limited. The results indicated that a structured workplace training programme aimed at improving social, communication and emotional behaviours can be helpful for people with autism and intellectual disability. Further study with a larger sample size and a control group is recommended. The development of specific programme to cater for the emotional control needs at workplace for people with autism is also suggested. Copyright © 2013 John Wiley & Sons, Ltd.

  9. The e-MSWS-12: improving the multiple sclerosis walking scale using item response theory.

    Engelhard, Matthew M; Schmidt, Karen M; Engel, Casey E; Brenton, J Nicholas; Patek, Stephen D; Goldman, Myla D

    2016-12-01

    The Multiple Sclerosis Walking Scale (MSWS-12) is the predominant patient-reported measure of multiple sclerosis (MS) -elated walking ability, yet it had not been analyzed using item response theory (IRT), the emerging standard for patient-reported outcome (PRO) validation. This study aims to reduce MSWS-12 measurement error and facilitate computerized adaptive testing by creating an IRT model of the MSWS-12 and distributing it online. MSWS-12 responses from 284 subjects with MS were collected by mail and used to fit and compare several IRT models. Following model selection and assessment, subpopulations based on age and sex were tested for differential item functioning (DIF). Model comparison favored a one-dimensional graded response model (GRM). This model met fit criteria and explained 87 % of response variance. The performance of each MSWS-12 item was characterized using category response curves (CRCs) and item information. IRT-based MSWS-12 scores correlated with traditional MSWS-12 scores (r = 0.99) and timed 25-foot walk (T25FW) speed (r =  -0.70). Item 2 showed DIF based on age (χ 2  = 19.02, df = 5, p Item 11 showed DIF based on sex (χ 2  = 13.76, df = 5, p = 0.02). MSWS-12 measurement error depends on walking ability, but could be lowered by improving or replacing items with low information or DIF. The e-MSWS-12 includes IRT-based scoring, error checking, and an estimated T25FW derived from MSWS-12 responses. It is available at https://ms-irt.shinyapps.io/e-MSWS-12 .

  10. Clinical Language Intervention Programme (KLISA PROGRAMME to Improve Reading Skill of Students with Learning Disability with Potential in Education

    Bungawali Abduh

    2017-03-01

    Full Text Available Reading is one of the fundamental skills across all subjects. A student with low competency in reading will experience difficulties in teaching and learning. The purpose of this research is to improve reading skills among student with learning disability in one secondary school in Bangi, Selangor. This action research had employed Reading Assessment Approach and descriptive analysis in data collection. Seven students with reading problem participated in this research. However, these students were having potential to be included in either Inclusive Program or Job Transition Program. Therefore, one reading program known as KLISA Program (Language Clinic Program was created and it has been implemented in classroom for 30 minutes during the first period every day. This 9-month program had employed phonics method and used a set of ‘Bacalah Anakku’ books and ABM Velcro in three phases. The reading assessment was conducted at the end of each phase to evaluate the students’ achievement in reading. The findings of this research proved that KLISA Program was effective for students’ improvement in reading. Hence, it is recommended that this program can be consistently implemented to overcome illiterate and reading disorder among primary and secondary school students. Kemahiran membaca adalah merentas semua matapelajaran. Kelemahan dalam kemahiran membaca akan menyebabkan kesulitan mengikuti pengajaran dan pembelajaran. Tujuan penelitian ini adalah untuk meningkatkan kemahiran membaca di kalangan murid-murid bermasalah pembelajaran di sebuah sekolah menengah di Bangi, Selangor. Penelitian tindakan ini menggunakan pendekatan penilaian penaksiran bacaan dan analisis deskriptif untuk mengumpul data, Seramai 7 orang murid dalam sebuah kelas terlibat dalam kajian ini. Mereka terdiri dari murid bermasalah pembelajaran yang berpotensi untuk diserapkan di dalam Program Inklusif atau Transisi pekerjaan tetapi masih tidak boleh membaca. Satu program pemulihan

  11. Recommendations to improve imaging and analysis of brain lesion load and atrophy in longitudinal studies of multiple sclerosis

    Vrenken, H; Jenkinson, M; Horsfield, M A

    2013-01-01

    resonance image analysis methods for assessing brain lesion load and atrophy, this paper makes recommendations to improve these measures for longitudinal studies of MS. Briefly, they are (1) images should be acquired using 3D pulse sequences, with near-isotropic spatial resolution and multiple image......Focal lesions and brain atrophy are the most extensively studied aspects of multiple sclerosis (MS), but the image acquisition and analysis techniques used can be further improved, especially those for studying within-patient changes of lesion load and atrophy longitudinally. Improved accuracy...

  12. Natalizumab Significantly Improves Cognitive Impairment over Three Years in MS: Pattern of Disability Progression and Preliminary MRI Findings.

    Flavia Mattioli

    Full Text Available Previous studies reported that Multiple Sclerosis (MS patients treated with natalizumab for one or two years exhibit a significant reduction in relapse rate and in cognitive impairment, but the long term effects on cognitive performance are unknown. This study aimed to evaluate the effects of natalizumab on cognitive impairment in a cohort of 24 consecutive patients with relapsing remitting MS treated for 3 years. The neuropsychological tests, as well as relapse number and EDSS, were assessed at baseline and yearly for three years. The impact on cortical atrophy was also considered in a subgroup of them, and are thus to be considered as preliminary. Results showed a significant reduction in the number of impaired neuropsychological tests after three years, a significant decrease in annualized relapse rate at each time points compared to baseline and a stable EDSS. In the neuropsychological assessment, a significant improvement in memory, attention and executive function test scores was detected. Preliminary MRI data show that, while GM volume did not change at 3 years, a significantly greater parahippocampal and prefrontal gray matter density was noticed, the former correlating with neuropsychological improvement in a memory test. This study showed that therapy with Natalizumab is helpful in improving cognitive performance, and is likely to have a protective role on grey matter, over a three years follow-up.

  13. Vexatious Litigants and the ADA: Strategies to Fairly Address the Need to Improve Access for Individuals with Disabilities.

    Hull, Helia Garrido

    2016-01-01

    This Article addresses the need to reform the ADA to prevent vexatious litigation and to promote the underlying goals of the Act. Part I of this Article introduces the topic of vexatious litigation and the importance of remedying the effects of exploitation of the ADA. Part II provides an overview of the ADA and its efforts to increase accessibility to individuals with disabilities, emphasizing the provisions of the Act that create incentives to engage in vexatious litigation. Part III examines and analyzes the judiciary's response to vexatious litigation under the ADA, and sanctions that have been issued to limit exploitation. Finally, Part IV provides recommendations to reform the ADA and state disability law counterparts, suggests corrective actions to address vexatious litigation, and identifies methods to promote equality for individuals with disabilities.

  14. 77 FR 8234 - National Institute on Disability and Rehabilitation Research-Disability and Rehabilitation...

    2012-02-14

    ... seeks to: (1) Improve the quality and utility of disability and rehabilitation research; (2) determine...; (3) identify research gaps; (4) identify mechanisms of integrating research and practice; and (5... DEPARTMENT OF EDUCATION National Institute on Disability and Rehabilitation Research-- Disability...

  15. CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study.

    Carling, Anna; Forsberg, Anette; Gunnarsson, Martin; Nilsagård, Ylva

    2017-09-01

    Imbalance leading to falls is common in people with multiple sclerosis (PwMS). To evaluate the effects of a balance group exercise programme (CoDuSe) on balance and walking in PwMS (Expanded Disability Status Scale, 4.0-7.5). A multi-centre, randomized, controlled single-blinded pilot study with random allocation to early or late start of exercise, with the latter group serving as control group for the physical function measures. In total, 14 supervised 60-minute exercise sessions were delivered over 7 weeks. Pretest-posttest analyses were conducted for self-reported near falls and falls in the group starting late. Primary outcome was Berg Balance Scale (BBS). A total of 51 participants were initially enrolled; three were lost to follow-up. Post-intervention, the exercise group showed statistically significant improvement ( p = 0.015) in BBS and borderline significant improvement in MS Walking Scale ( p = 0.051), both with large effect sizes (3.66; -2.89). No other significant differences were found between groups. In the group starting late, numbers of falls and near falls were statistically significantly reduced after exercise compared to before ( p balance and reduced perceived walking limitations, compared to no exercise. The intervention reduced falls and near falls frequency.

  16. How reliable are gray matter disruptions in specific reading disability across multiple countries and languages? Insights from a large-scale voxel-based morphometry study.

    Jednoróg, Katarzyna; Marchewka, Artur; Altarelli, Irene; Monzalvo Lopez, Ana Karla; van Ermingen-Marbach, Muna; Grande, Marion; Grabowska, Anna; Heim, Stefan; Ramus, Franck

    2015-05-01

    The neural basis of specific reading disability (SRD) remains only partly understood. A dozen studies have used voxel-based morphometry (VBM) to investigate gray matter volume (GMV) differences between SRD and control children, however, recent meta-analyses suggest that few regions are consistent across studies. We used data collected across three countries (France, Poland, and Germany) with the aim of both increasing sample size (236 SRD and controls) to obtain a clearer picture of group differences, and of further assessing the consistency of the findings across languages. VBM analysis reveals a significant group difference in a single cluster in the left thalamus. Furthermore, we observe correlations between reading accuracy and GMV in the left supramarginal gyrus and in the left cerebellum, in controls only. Most strikingly, we fail to replicate all the group differences in GMV reported in previous studies, despite the superior statistical power. The main limitation of this study is the heterogeneity of the sample drawn from different countries (i.e., speaking languages with varying orthographic transparencies) and selected based on different assessment batteries. Nevertheless, analyses within each country support the conclusions of the cross-linguistic analysis. Explanations for the discrepancy between the present and previous studies may include: (1) the limited suitability of VBM to reveal the subtle brain disruptions underlying SRD; (2) insufficient correction for multiple statistical tests and flexibility in data analysis, and (3) publication bias in favor of positive results. Thus the study echoes widespread concerns about the risk of false-positive results inherent to small-scale VBM studies. © 2015 Wiley Periodicals, Inc.

  17. Prevalence of disability in Tamil Nadu, India.

    Velayutham, Banurekha; Kangusamy, Boopathi; Mehendale, Sanjay

    2017-01-01

    Information on disability is essential for the government to formulate policies, allocate adequate resources and implement appropriate programmes. We aimed to estimate the prevalence of disability and describe the types of disability by gender, age and geographical regions in Tamil Nadu, India. We analysed the 2011 Census cross-sectional survey data of Tamil Nadu. Age-adjusted disability rates and disability rates per 100 000 population were calculated. There were 1 179 963 disabled individuals in Tamil Nadu in 2011, a disability rate of 1635 per 100 000 population. Disability in movement, hearing and sight individually accounted for 24%, 19% and 11% of the total disability, respectively. Sixteen districts had disability rates above the state average. As age advanced, disability rates increased; the highest disability rate of 2533 per 100 000 was among people aged 60 years and above. The disability rates were higher in males compared to females (1819 v. 1451 per 100 000). Rural areas had higher disability areas compared to urban (1670 v. 1599 per 100 000). Currently married, working populations and literate populations had lower disability rates. Disability rate in the Scheduled Castes was higher at 1763 per 100 000 compared to the Scheduled Tribes and other social groups. Multiple disability was high in the age groups 0-19 years and 60 years and above. Physical or mental disability was observed in 1.6% of the population of Tamil Nadu. Research is warranted to identify underlying causes and interventions to reduce the burden of disability in the state.

  18. Combination of robot-assisted and conventional body-weight-supported treadmill training improves gait in persons with multiple sclerosis: a pilot study.

    Ruiz, Jennifer; Labas, Michele P; Triche, Elizabeth W; Lo, Albert C

    2013-12-01

    The majority of persons with multiple sclerosis (MS) experience problems with gait, which they characterize as highly disabling impairments that adversely impact their quality of life. Thus, it is crucial to develop effective therapies to improve mobility for these individuals. The purpose of this study was to determine whether combination gait training, using robot-assisted treadmill training followed by conventional body-weight-supported treadmill training within the same session, improved gait and balance in individuals with MS. This study tested combination gait training in 7 persons with MS. The participants were randomized into the immediate therapy group (IT group) or the delayed therapy group (DT group). In phase I of the trial, the IT group received treatment while the DT group served as a concurrent comparison group. In phase II of the trial, the DT group received treatment identical to the treatment received by the IT group in phase I. Outcome measures included the 6-Minute Walk Test (6MWT), the Timed 25-Foot Walk Test, velocity, cadence, and the Functional Reach Test (FRT). Nonparametric statistical techniques were used for analysis. Combination gait training resulted in significantly greater improvements in the 6MWT for the IT group (median change = +59 m) compared with Phase I DT group (median change = -8 m) (P = 0.08) and FRT (median change = +3.3 cm in IT vs -0.8 cm in the DT group phase I; P = 0.03). Significant overall pre-post improvements following combination gait training were found in 6MWT (+32 m; P = 0.02) and FRT (+3.3 cm; P = 0.06) for IT and Phase II DT groups combined. Combination of robot with body-weight-supported treadmill training gait training is feasible and improved 6MWT and FRT distances in persons with MS.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A62) for more insights from the authors.

  19. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-03-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

  20. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial.

    Leigh E Charvet

    Full Text Available Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS. We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74 vs. active control (n = 61 training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02-0·30, despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006. This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction.Clinicaltrials.gov NCT02141386.

  1. A diet based on multiple functional concepts improves cardiometabolic risk parameters in healthy subjects

    Tovar Juscelino

    2012-04-01

    Full Text Available Abstract Background Different foods can modulate cardiometabolic risk factors in persons already affected by metabolic alterations. The objective of this study was to assess, in healthy overweight individuals, the impact of a diet combining multiple functional concepts on risk markers associated with cardiometabolic diseases (CMD. Methods Fourty-four healthy women and men (50-73 y.o, BMI 25-33, fasting glycemia ≤ 6.1 mmol/L participated in a randomized crossover intervention comparing a multifunctional (active diet (AD with a control diet (CD devoid of the "active" components. Each diet was consumed during 4 wk with a 4 wk washout period. AD included the following functional concepts: low glycemic impact meals, antioxidant-rich foods, oily fish as source of long-chain omega-3 fatty acids, viscous dietary fibers, soybean and whole barley kernel products, almonds, stanols and a probiotic strain (Lactobacillus plantarum Heal19/DSM15313. Results Although the aim was to improve metabolic markers without promoting body weight loss, minor weight reductions were observed with both diets (0.9-1.8 ± 0.2%; P P P P = 0.0056, LDL/HDL (-27 ± 2%; P P 1c (-2 ± 0.4%; P = 0.0013, hs-CRP (-29 ± 9%; P = 0.0497 and systolic blood pressure (-8 ± 1%¸ P = 0.0123. The differences remained significant after adjustment for weight change. After AD, the Framingham cardiovascular risk estimate was 30 ± 4% (P P Conclusion The improved biomarker levels recorded in healthy individuals following the multifunctional regime suggest preventive potential of this dietary approach against CMD.

  2. Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study.

    McCullagh, Ruth; Fitzgerald, Anthony P; Murphy, Raymond P; Cooke, Grace

    2008-03-01

    To determine if exercise benefits patients with multiple sclerosis. Randomized controlled trial. Participants exercised at home and also attended exercise classes held in a hospital physiotherapy gym. Thirty patients, diagnosed and independently mobile, were recruited in the Dublin area. For three months, classes were held twice-weekly and participants exercised independently once-weekly. The control group was monitored monthly and management remained unchanged. Measurements were taken at baseline, three and six months. The Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Impact Scale-29 (MSIS-29) and Functional Assessment of Multiple Sclerosis (FAMS) were used to measure fatigue and quality of life (QOL). Heart rate (HR) and the Borg's Rating of Perceived Exertion (RPE) were recorded during an incremental exercise test. The change from baseline scores between groups was compared using the Mann-Whitney U-test. Twenty-four participants completed the programme (n = 12 in each group). Based on the change in scores at three months, the exercise group had significantly greater improvements in exercise capacity (HR: -14 [-18.5, -2.5] versus 0.5 [-4, 5.5], P= 0.009), QOL (FAMS: 23 [9.5, 42.5] versus -3.5 [-16, 5], P=0.006) and fatigue (MFIS: -13 [-20, -3] versus 1 [-4, 4.5], P=0.02). At six months, the difference in change scores remained significant for FAMS (19 [14, 31] versus -4.5 [-25, 8], P=0.002) and MFIS (-8.5 [-19.5, -1] versus 0.5 [-2.5, 6.5], P=0.02) only. A three-month exercise programme improved participants' exercise capacity, QOL and fatigue, with the improvements in QOL and fatigue lasting beyond the programme.

  3. Research on improving image recognition robustness by combining multiple features with associative memory

    Guo, Dongwei; Wang, Zhe

    2018-05-01

    Convolutional neural networks (CNN) achieve great success in computer vision, it can learn hierarchical representation from raw pixels and has outstanding performance in various image recognition tasks [1]. However, CNN is easy to be fraudulent in terms of it is possible to produce images totally unrecognizable to human eyes that CNNs believe with near certainty are familiar objects. [2]. In this paper, an associative memory model based on multiple features is proposed. Within this model, feature extraction and classification are carried out by CNN, T-SNE and exponential bidirectional associative memory neural network (EBAM). The geometric features extracted from CNN and the digital features extracted from T-SNE are associated by EBAM. Thus we ensure the recognition of robustness by a comprehensive assessment of the two features. In our model, we can get only 8% error rate with fraudulent data. In systems that require a high safety factor or some key areas, strong robustness is extremely important, if we can ensure the image recognition robustness, network security will be greatly improved and the social production efficiency will be extremely enhanced.

  4. Improving the clinical correlation of multiple sclerosis black hole volume change by paired-scan analysis.

    Tam, Roger C; Traboulsee, Anthony; Riddehough, Andrew; Li, David K B

    2012-01-01

    The change in T 1-hypointense lesion ("black hole") volume is an important marker of pathological progression in multiple sclerosis (MS). Black hole boundaries often have low contrast and are difficult to determine accurately and most (semi-)automated segmentation methods first compute the T 2-hyperintense lesions, which are a superset of the black holes and are typically more distinct, to form a search space for the T 1w lesions. Two main potential sources of measurement noise in longitudinal black hole volume computation are partial volume and variability in the T 2w lesion segmentation. A paired analysis approach is proposed herein that uses registration to equalize partial volume and lesion mask processing to combine T 2w lesion segmentations across time. The scans of 247 MS patients are used to compare a selected black hole computation method with an enhanced version incorporating paired analysis, using rank correlation to a clinical variable (MS functional composite) as the primary outcome measure. The comparison is done at nine different levels of intensity as a previous study suggests that darker black holes may yield stronger correlations. The results demonstrate that paired analysis can strongly improve longitudinal correlation (from -0.148 to -0.303 in this sample) and may produce segmentations that are more sensitive to clinically relevant changes.

  5. Idiopathic Supraglottic Stenosis Refractory to Multiple Interventions Improved With Serial Office-based Steroid Injections.

    Hoffman, Matthew R; Mai, Johnny P; Dailey, Seth H

    2017-10-30

    The objective of this study was to describe a patient with idiopathic supraglottic stenosis who experienced persistent disease despite multiple office-based and operative interventions, whose disease is now better controlled with scheduled serial office-based steroid injections. This is a case report and literature review. A 42-year-old female was referred for worsening supraglottic stenosis despite systemic steroids. She underwent awake tracheotomy. A thorough historical, histologic, and laboratory workup did not reveal an etiology to her stenosis. She later underwent endoscopic partial laryngectomy and was able to be decannulated. She underwent a second endoscopic partial laryngectomy two years later for worsening disease and then was managed over the next seven years with intermittent systemic steroids. Over the last year, she has undergone eight office-based steroid injections with improvement in her degree of stenosis and symptom burden. There are only four prior reported cases of idiopathic supraglottic stenosis, none of which has been managed with serial office-based steroid injections. This case report adds to the small body of literature on the management of this rare disease and proposes a new office-based treatment pathway that may help induce regression of stenosis. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  6. EMUDRA: Ensemble of Multiple Drug Repositioning Approaches to Improve Prediction Accuracy.

    Zhou, Xianxiao; Wang, Minghui; Katsyv, Igor; Irie, Hanna; Zhang, Bin

    2018-04-24

    Availability of large-scale genomic, epigenetic and proteomic data in complex diseases makes it possible to objectively and comprehensively identify therapeutic targets that can lead to new therapies. The Connectivity Map has been widely used to explore novel indications of existing drugs. However, the prediction accuracy of the existing methods, such as Kolmogorov-Smirnov statistic remains low. Here we present a novel high-performance drug repositioning approach that improves over the state-of-the-art methods. We first designed an expression weighted cosine method (EWCos) to minimize the influence of the uninformative expression changes and then developed an ensemble approach termed EMUDRA (Ensemble of Multiple Drug Repositioning Approaches) to integrate EWCos and three existing state-of-the-art methods. EMUDRA significantly outperformed individual drug repositioning methods when applied to simulated and independent evaluation datasets. We predicted using EMUDRA and experimentally validated an antibiotic rifabutin as an inhibitor of cell growth in triple negative breast cancer. EMUDRA can identify drugs that more effectively target disease gene signatures and will thus be a useful tool for identifying novel therapies for complex diseases and predicting new indications for existing drugs. The EMUDRA R package is available at doi:10.7303/syn11510888. bin.zhang@mssm.edu or zhangb@hotmail.com. Supplementary data are available at Bioinformatics online.

  7. Improved assessment of multiple sclerosis lesion segmentation agreement via detection and outline error estimates

    Wack David S

    2012-07-01

    Full Text Available Abstract Background Presented is the method “Detection and Outline Error Estimates” (DOEE for assessing rater agreement in the delineation of multiple sclerosis (MS lesions. The DOEE method divides operator or rater assessment into two parts: 1 Detection Error (DE -- rater agreement in detecting the same regions to mark, and 2 Outline Error (OE -- agreement of the raters in outlining of the same lesion. Methods DE, OE and Similarity Index (SI values were calculated for two raters tested on a set of 17 fluid-attenuated inversion-recovery (FLAIR images of patients with MS. DE, OE, and SI values were tested for dependence with mean total area (MTA of the raters' Region of Interests (ROIs. Results When correlated with MTA, neither DE (ρ = .056, p=.83 nor the ratio of OE to MTA (ρ = .23, p=.37, referred to as Outline Error Rate (OER, exhibited significant correlation. In contrast, SI is found to be strongly correlated with MTA (ρ = .75, p  Conclusions The DE and OER indices are proposed as a better method than SI for comparing rater agreement of ROIs, which also provide specific information for raters to improve their agreement.

  8. Collaboration in Transition Assessment: School Psychologists and Special Educators Working Together to Improve Outcomes for Students with Disabilities

    Kellems, Ryan O.; Springer, Ben; Wilkins, Melinda K.; Anderson, Caroline

    2016-01-01

    The ultimate goal for school psychologists, special education practitioners, and other professionals who work with adolescents with disabilities is to help students plan and prepare to transition from school to adult life with the skills and knowledge to live happy, productive, and fulfilling lives. This article describes how school psychologists…

  9. A School-Based Intervention Associated with Improvements in Cardiometabolic Risk Profiles in Young People with Intellectual Disabilities

    Wallén, Eva Flygare; Müllersdorf, Maria; Christensson, Kyllike; Marcus, Claude

    2013-01-01

    This study evaluates a multifactorial school-based intervention with the aim of decreasing cardiometabolic risk factors by means of a healthy lifestyle, primarily with daily physical activity and healthy food during school hours, at an upper secondary school for students with intellectual disabilities. The outcome is measured in terms of…

  10. Work Integration of People with Disabilities in the Regular Labour Market: What Can We Do to Improve These Processes?

    Vila, Montserrat; Pallisera, Maria; Fullana, Judit

    2007-01-01

    Background: It is important to ensure that regular processes of labour market integration are available for all citizens. Method: Thematic content analysis techniques, using semi-structured group interviews, were used to identify the principal elements contributing to the processes of integrating people with disabilities into the regular labour…

  11. Improving Service Responses for People with Learning Disabilities Who Have Been Sexually Assaulted: An Audit of Forensic Services

    Olsen, Angela; Majeed-Ariss, Rabiya; Teniola, Simonette; White, Catherine

    2017-01-01

    Background: People with learning disabilities are more likely to experience sexual abuse and less likely to access support than the general population, this is due to a range of variables at the individual, societal and service-delivery level. This study presents a service evaluation of St Mary's Sexual Assault Referral Centre, Manchester to…

  12. Effects of Improvement on Selective Attention: Developing Appropriate Somatosensory Video Game Interventions for Institutional-Dwelling Elderly with Disabilities

    Chen, Shang-Ti; Chiang, I-Tsun; Liu, Eric Zhi-Feng; Chang, Maiga

    2012-01-01

    The purpose of this study was to develop appropriate somatosensory video game interventions on enhancing selective attention of institutional-dwelling elderly with disabilities. Fifty-eight participants aged 65[approximately]92 were recruited and divided into four groups, 4-week and 8-week experimental and two control groups, for evaluating the…

  13. Assisting People with Disabilities to Actively Improve Their Collaborative Physical Activities with Nintendo Wii Balance Boards by Controlling Environmental Stimulation

    Shih, Ching-Hsiang; Chen, Ling-Che; Shih, Ching-Tien

    2012-01-01

    The latest researches have adopted software technology to modify the Nintendo Wii Balance Board functionality and used it to enable two people with developmental disabilities to actively perform physical activities. This study extended the latest research of the Wii Balance Board application to assess whether four people (two groups) with…

  14. The Multimedia-Based Learning System Improved Cognitive Skills and Motivation of Disabled Children with a Very High Rate

    Saad, Sawsan; Dandashi, Amal; Aljaam, Jihad M.; Saleh, Moataz

    2015-01-01

    A multimedia-based learning system to teach children with intellectual disabilities (ID) the basic living and science concepts is proposed. The tutorials' development is pedagogically based on Mayer's Cognitive Theory of Multimedia Learning combined with Skinner's Operant Conditioning Model. Two types of tutorials are proposed. In the first type;…

  15. An IEP for Me: Program Improvement for Rural Teachers of Students with Moderate to Severe Disability and Autism Spectrum Disorder

    Pennington, Robert C.

    2017-01-01

    Developing high-quality programming for students with moderate to severe disability (MSD) and/or autism spectrum disorder (ASD) can be challenging for teachers across the range of experience and training including those in rural contexts. This article outlines a process for the iterative refinement of teaching programs comprised of an evaluation…

  16. Using Argument-Based Science Inquiry to Improve Science Achievement for Students with Disabilities in Inclusive Classrooms

    Taylor, Jonte C.; Tseng, Ching-mei; Murillo, Angelique; Therrien, William; Hand, Brian

    2018-01-01

    The increased emphasis on STEM related careers and the use of science in everyday life makes learning science content and concepts critical for all students especially for those with disabilities. As suggested by the National Resource Council (2012), more emphasis is being placed on being able to critically think about science concepts in and…

  17. The Role of Training in Improving Community Care Staff Awareness of Mental Health Problems in People with Intellectual Disabilities

    Costello, Helen; Bouras, Nick; Davis, Hilton

    2007-01-01

    Background: Care staff play a key role in identifying individuals with intellectual disabilities and additional mental health problems. Yet, few receive training in mental health, and evidence about the effectiveness of training is scant. Materials and Methods: A pre-post study is reported, using a mental health screen and a self-report…

  18. Test of an Intervention to Improve Knowledge of Women with Intellectual Disabilities about Cervical and Breast Cancer Screening

    Swaine, J. G.; Parish, S. L.; Luken, K.; Son, E.; Dickens, P.

    2014-01-01

    Background: There is a critical need for evidence-based health education interventions for women with intellectual disabilities (IDs) to promote receipt of preventive health screenings. Previous research has established "Women Be Healthy," an 8-week classroom-style intervention designed to teach women with IDs about breast and cervical…

  19. Evidence-Based Strategies for Improving the Reading Comprehension of Secondary Students: Implications for Students with Learning Disabilities

    Watson, Silvana M. R.; Gable, Robert A.; Gear, Sabra B.; Hughes, Kimberly C.

    2012-01-01

    Reading comprehension is a complex skill that places significant demands on students, beginning with elementary school and continuing through the secondary grades. In this article, we provide an overview of possible factors associated with problems in reading comprehension among secondary students with learning disabilities. Discussion underscores…

  20. Increased cortical and deep grey matter sodium concentration is associated with physical and cognitive disability in relapse-onset multiple sclerosis

    Brownlee, WJ; Alves Da Mota, Patricia; Prados, Ferran

    digit modalities test (SDMT) and tests of verbal and visual memory. Linear regression was used to compare differences in tissue TSC between groups. Multivariable linear regression was used to identify independent associations between TSC and disability with adjustment for age, sex, disease duration......=0.40) and visual memory (β=-0.06, 95%CI -0.11, -.0.02, R2=0.19). Conclusion: Sodium accumulation in cortical and deep grey matter may reflect underlying neurodegeneration that is relevant to the development of long-term disability and cognitive impairment in relapse-onset MS. 23Na-MRI may become a secondary......-appearing white matter (NAWM), T1-isointense and T1-hypointense lesions was calculated. Physical disability was assessed using the Expanded Disability Status Scale (EDSS), timed 25-foot walk test (TWT) and 9-hole peg test (9HPT). Cognition was assessed using the paced auditory serial addition test (PASAT), symbol...

  1. Multiple Agencies Provide Assistance to Service-disabled Veterans or Entrepreneurs, but Specific Needs Are Difficult to Identify and Coordination Is Weak

    2008-01-01

    .... In the Veterans Entrepreneurship and Small Business Development Act of 1999 (P.L. 106-50), Congress stated that too little had been done to help veterans particularly service-disabled veterans, in starting small businesses...

  2. Disability and global development.

    Durocher, Joan; Lord, Janet; Defranco, Allison

    2012-07-01

    The United States invests billions of taxpayer dollars each year into foreign assistance programs that foster international diplomacy and development directed toward improving the quality of life for people around the world. These programs develop economies and combat poverty, promote democracy and governance, build new infrastructure, advance and protect human rights, among other development goals. The United States cannot effectively accomplish the goals of foreign assistance programs unless it undertakes measures to ensure that the programs are accessible to and inclusive of people with disabilities. The United States has been a leader in advancing the rights of people with disabilities and must continue to promote disability rights through its international development work. Overseas economic development will not be successful unless people with disabilities are included. Because of the significant number of people with disabilities in developing countries, if they are not included, the very economic growth the United States is trying to foster will be hindered. The goals of democracy and governance programs cannot be achieved without the inclusion of people with disabilities. In many countries, domestic law contains blatant discriminatory provisions for people with disabilities that undermine access to justice and full participation in society. The provisions that discriminate against people with disabilities include arbitrary exclusions in electoral codes, sweeping plenary guardianship laws with no due-process protections, discriminatory banking practices, and inaccessible court proceedings. National disability legal frameworks remain underdeveloped throughout the world. Copyright © 2012. Published by Elsevier Inc.

  3. Disability and Obesity

    ... About CDC.gov . Disability & Health Home Disability Overview Disability Inclusion Barriers to Inclusion Inclusion Strategies Inclusion in Programs & Activities Resources Healthy Living Disability & Physical Activity Disability & Obesity Disability & Smoking Disability & Breast ...

  4. Learning Disabilities and ADHD

    ... of illnesses and disabilities Learning disabilities and ADHD Learning disabilities and ADHD Learning disabilities affect how you ... ADHD. Learning disabilities Attention deficit hyperactivity disorder (ADHD) Learning disabilities top Having a learning disability does not ...

  5. Multiple data sources improve DNA-based mark-recapture population estimates of grizzly bears.

    Boulanger, John; Kendall, Katherine C; Stetz, Jeffrey B; Roon, David A; Waits, Lisette P; Paetkau, David

    2008-04-01

    A fundamental challenge to estimating population size with mark-recapture methods is heterogeneous capture probabilities and subsequent bias of population estimates. Confronting this problem usually requires substantial sampling effort that can be difficult to achieve for some species, such as carnivores. We developed a methodology that uses two data sources to deal with heterogeneity and applied this to DNA mark-recapture data from grizzly bears (Ursus arctos). We improved population estimates by incorporating additional DNA "captures" of grizzly bears obtained by collecting hair from unbaited bear rub trees concurrently with baited, grid-based, hair snag sampling. We consider a Lincoln-Petersen estimator with hair snag captures as the initial session and rub tree captures as the recapture session and develop an estimator in program MARK that treats hair snag and rub tree samples as successive sessions. Using empirical data from a large-scale project in the greater Glacier National Park, Montana, USA, area and simulation modeling we evaluate these methods and compare the results to hair-snag-only estimates. Empirical results indicate that, compared with hair-snag-only data, the joint hair-snag-rub-tree methods produce similar but more precise estimates if capture and recapture rates are reasonably high for both methods. Simulation results suggest that estimators are potentially affected by correlation of capture probabilities between sample types in the presence of heterogeneity. Overall, closed population Huggins-Pledger estimators showed the highest precision and were most robust to sparse data, heterogeneity, and capture probability correlation among sampling types. Results also indicate that these estimators can be used when a segment of the population has zero capture probability for one of the methods. We propose that this general methodology may be useful for other species in which mark-recapture data are available from multiple sources.

  6. Improving the characterization of radiologically isolated syndrome suggestive of multiple sclerosis.

    Nicola De Stefano

    Full Text Available OBJECTIVE: To improve the characterization of asymptomatic subjects with brain magnetic resonance imaging (MRI abnormalities highly suggestive of multiple sclerosis (MS, a condition named as "radiologically isolated syndrome" (RIS. METHODS: Quantitative MRI metrics such as brain volumes and magnetization transfer (MT were assessed in 19 subjects previously classified as RIS, 20 demographically-matched relapsing-remitting MS (RRMS patients and 20 healthy controls (HC. Specific measures were: white matter (WM lesion volumes (LV, total and regional brain volumes, and MT ratio (MTr in lesions, normal-appearing WM (NAWM and cortex. RESULTS: LV was similar in RIS and RRMS, without differences in distribution and frequency at lesion mapping. Brain volumes were similarly lower in RRMS and RIS than in HC (p<0.001. Lesional-MTr was lower in RRMS than in RIS (p = 0.048; NAWM-MTr and cortical-MTr were similar in RIS and HC and lower (p<0.01 in RRMS. These values were particularly lower in RRMS than in RIS in the sensorimotor and memory networks. A multivariate logistic regression analysis showed that 13/19 RIS had ≥70% probability of being classified as RRMS on the basis of their brain volume and lesional-MTr values. CONCLUSIONS: Macroscopic brain damage was similar in RIS and RRMS. However, the subtle tissue damage detected by MTr was milder in RIS than in RRMS in clinically relevant brain regions, suggesting an explanation for the lack of clinical manifestations of subjects with RIS. This new approach could be useful for narrowing down the RIS individuals with a high risk of progression to MS.

  7. Improving seasonal forecasts of hydroclimatic variables through the state of multiple large-scale climate signals

    Castelletti, A.; Giuliani, M.; Block, P. J.

    2017-12-01

    Increasingly uncertain hydrologic regimes combined with more frequent and intense extreme events are challenging water systems management worldwide, emphasizing the need of accurate medium- to long-term predictions to timely prompt anticipatory operations. Despite modern forecasts are skillful over short lead time (from hours to days), predictability generally tends to decrease on longer lead times. Global climate teleconnection, such as El Niño Southern Oscillation (ENSO), may contribute in extending forecast lead times. However, ENSO teleconnection is well defined in some locations, such as Western USA and Australia, while there is no consensus on how it can be detected and used in other regions, particularly in Europe, Africa, and Asia. In this work, we generalize the Niño Index Phase Analysis (NIPA) framework by contributing the Multi Variate Niño Index Phase Analysis (MV-NIPA), which allows capturing the state of multiple large-scale climate signals (i.e. ENSO, North Atlantic Oscillation, Pacific Decadal Oscillation, Atlantic Multi-decadal Oscillation, Indian Ocean Dipole) to forecast hydroclimatic variables on a seasonal time scale. Specifically, our approach distinguishes the different phases of the considered climate signals and, for each phase, identifies relevant anomalies in Sea Surface Temperature (SST) that influence the local hydrologic conditions. The potential of the MV-NIPA framework is demonstrated through an application to the Lake Como system, a regulated lake in northern Italy which is mainly operated for flood control and irrigation supply. Numerical results show high correlations between seasonal SST values and one season-ahead precipitation in the Lake Como basin. The skill of the resulting MV-NIPA forecast outperforms the one of ECMWF products. This information represents a valuable contribution to partially anticipate the summer water availability, especially during drought events, ultimately supporting the improvement of the Lake Como

  8. Model training across multiple breeding cycles significantly improves genomic prediction accuracy in rye (Secale cereale L.).

    Auinger, Hans-Jürgen; Schönleben, Manfred; Lehermeier, Christina; Schmidt, Malthe; Korzun, Viktor; Geiger, Hartwig H; Piepho, Hans-Peter; Gordillo, Andres; Wilde, Peer; Bauer, Eva; Schön, Chris-Carolin

    2016-11-01

    Genomic prediction accuracy can be significantly increased by model calibration across multiple breeding cycles as long as selection cycles are connected by common ancestors. In hybrid rye breeding, application of genome-based prediction is expected to increase selection gain because of long selection cycles in population improvement and development of hybrid components. Essentially two prediction scenarios arise: (1) prediction of the genetic value of lines from the same breeding cycle in which model training is performed and (2) prediction of lines from subsequent cycles. It is the latter from which a reduction in cycle length and consequently the strongest impact on selection gain is expected. We empirically investigated genome-based prediction of grain yield, plant height and thousand kernel weight within and across four selection cycles of a hybrid rye breeding program. Prediction performance was assessed using genomic and pedigree-based best linear unbiased prediction (GBLUP and PBLUP). A total of 1040 S 2 lines were genotyped with 16 k SNPs and each year testcrosses of 260 S 2 lines were phenotyped in seven or eight locations. The performance gap between GBLUP and PBLUP increased significantly for all traits when model calibration was performed on aggregated data from several cycles. Prediction accuracies obtained from cross-validation were in the order of 0.70 for all traits when data from all cycles (N CS  = 832) were used for model training and exceeded within-cycle accuracies in all cases. As long as selection cycles are connected by a sufficient number of common ancestors and prediction accuracy has not reached a plateau when increasing sample size, aggregating data from several preceding cycles is recommended for predicting genetic values in subsequent cycles despite decreasing relatedness over time.

  9. Using a Classroom Response System to Improve Multiple-Choice Performance in AP[R] Physics

    Bertrand, Peggy

    2009-01-01

    Participation in rigorous high school courses such as Advanced Placement (AP[R]) Physics increases the likelihood of college success, especially for students who are traditionally underserved. Tackling difficult multiple-choice exams should be part of any AP program because well-constructed multiple-choice questions, such as those on AP exams and…

  10. Improving Graduate Students' Graphing Skills of Multiple Baseline Designs with Microsoft[R] Excel 2007

    Lo, Ya-yu; Starling, A. Leyf Peirce

    2009-01-01

    This study examined the effects of a graphing task analysis using the Microsoft[R] Office Excel 2007 program on the single-subject multiple baseline graphing skills of three university graduate students. Using a multiple probe across participants design, the study demonstrated a functional relationship between the number of correct graphing…

  11. Internet-based home training is capable to improve balance in multiple sclerosis: a randomized controlled trial.

    Frevel, D; Mäurer, M

    2015-02-01

    Balance disorders are common in multiple sclerosis. Aim of the study is to investigate the effectiveness of an Internet-based home training program (e-Training) to improve balance in patients with multiple sclerosis. A randomized, controlled study. Academic teaching hospital in cooperation with the therapeutic riding center Gut Üttingshof, Bad Mergentheim. Eighteen multiple sclerosis patients (mean EDSS 3,5) took part in the trial. Outcome of patients using e-Training (N.=9) was compared to the outcome of patients receiving hippotherapy (N.=9), which can be considered as an advanced concept for the improvement of balance and postural control in multiple sclerosis. After simple random allocation patients received hippotherapy or Internet-based home training (balance, postural control and strength training) twice a week for 12 weeks. Assessments were done before and after the intervention and included static and dynamic balance (primary outcome). Isometric muscle strength of the knee and trunk extension/flexion (dynamometer), walking capacity, fatigue and quality of life served as secondary outcome parameters. Both intervention groups showed comparable and highly significant improvement in static and dynamic balance capacity, no difference was seen between the both intervention groups. However looking at fatigue and quality of life only the group receiving hippotherapy improved significantly. Since e-Training shows even comparable effects to hippotherapy to improve balance, we believe that the established Internet-based home training program, specialized on balance and postural control training, is feasible for a balance and strength training in persons with multiple sclerosis. We demonstrated that Internet-based home training is possible in patients with multiple sclerosis.

  12. Improving fatigue in multiple sclerosis by smartphone-supported energy management: The MS TeleCoach feasibility study.

    D'hooghe, Marie; Van Gassen, Geert; Kos, Daphne; Bouquiaux, Olivier; Cambron, Melissa; Decoo, Danny; Lysandropoulos, Andreas; Van Wijmeersch, Bart; Willekens, Barbara; Penner, Iris-Katharina; Nagels, Guy

    2018-03-27

    Fatigue is a frequently occurring, often disabling symptom in MS with no single effective treatment. In current fatigue management interventions, personalized, real-time follow-up is often lacking. The objective of the study is to assess the feasibility of the MS TeleCoach, a novel intervention offering telemonitoring of fatigue and telecoaching of physical activity and energy management in persons with MS (pwMS) over a 12-week period. The goal of the MS TeleCoach, conceived as a combination of monitoring, self-management and motivational messages, is to enhance levels of physical activity thereby improving fatigue in pwMS in an accessible and interactive way, reinforcing self-management of patients. We conducted a prospective, open-label feasibility study of the MS TeleCoach in pwMS with Expanded Disability Status Scale ≤ 4 and moderate to severe fatigue as measured by the Fatigue Scale for Motor and Cognitive Functions (FSMC). Following a 2-week run-in period to assess the baseline activity level per patient, the target number of activity counts was gradually increased over the 12-week period through telecoaching. The primary efficacy outcome was change in FSMC total score from baseline to study end. A subset of patients was asked to fill in D-QUEST 2.0, a usability questionnaire, to evaluate the satisfaction with the MS TeleCoach device and the experienced service. Seventy-five patients were recruited from 16 centres in Belgium, of which 57 patients (76%) completed the study. FSMC total score (p = 0.009) and motor and cognitive subscores (p = 0.007 and p = 0.02 respectively) decreased from baseline to week 12, indicating an improvement in fatigue. One third of participants with severe fatigue changed to a lower FSMC category for both FSMC total score and subscores. The post-study evaluation of patient satisfaction showed that the intervention was well accepted and that patients were very satisfied with the quality of the professional services

  13. Processing Disability.

    Harris, Jasmine

    2015-01-01

    This Article argues that the practice of holding so many adjudicative proceedings related to disability in private settings (e.g., guardianship, special education due process, civil commitment, and social security) relative to our strong normative presumption of public access to adjudication may cultivate and perpetuate stigma in contravention of the goals of inclusion and enhanced agency set forth in antidiscrimination laws. Descriptively, the law has a complicated history with disability--initially rendering disability invisible; later, underwriting particular narratives of disability synonymous with incapacity; and, in recent history, promoting the full socio-economic visibility of people with disabilities. The Americans with Disabilities Act (ADA), the marquee civil rights legislation for people with disabilities (about to enter its twenty-fifth year), expresses a national approach to disability that recognizes the role of society in its construction, maintenance, and potential remedy. However, the ADA’s mission is incomplete. It has not generated the types of interactions between people with disabilities and nondisabled people empirically shown to deconstruct deeply entrenched social stigma. Prescriptively, procedural design can act as an "ntistigma agent"to resist and mitigate disability stigma. This Article focuses on one element of institutional design--public access to adjudication--as a potential tool to construct and disseminate counter-narratives of disability. The unique substantive focus in disability adjudication on questions of agency provides a potential public space for the negotiation of nuanced definitions of disability and capacity more reflective of the human condition.

  14. Use of Multiple Imputation Method to Improve Estimation of Missing Baseline Serum Creatinine in Acute Kidney Injury Research

    Peterson, Josh F.; Eden, Svetlana K.; Moons, Karel G.; Ikizler, T. Alp; Matheny, Michael E.

    2013-01-01

    Summary Background and objectives Baseline creatinine (BCr) is frequently missing in AKI studies. Common surrogate estimates can misclassify AKI and adversely affect the study of related outcomes. This study examined whether multiple imputation improved accuracy of estimating missing BCr beyond current recommendations to apply assumed estimated GFR (eGFR) of 75 ml/min per 1.73 m2 (eGFR 75). Design, setting, participants, & measurements From 41,114 unique adult admissions (13,003 with and 28,111 without BCr data) at Vanderbilt University Hospital between 2006 and 2008, a propensity score model was developed to predict likelihood of missing BCr. Propensity scoring identified 6502 patients with highest likelihood of missing BCr among 13,003 patients with known BCr to simulate a “missing” data scenario while preserving actual reference BCr. Within this cohort (n=6502), the ability of various multiple-imputation approaches to estimate BCr and classify AKI were compared with that of eGFR 75. Results All multiple-imputation methods except the basic one more closely approximated actual BCr than did eGFR 75. Total AKI misclassification was lower with multiple imputation (full multiple imputation + serum creatinine) (9.0%) than with eGFR 75 (12.3%; Pcreatinine) (15.3%) versus eGFR 75 (40.5%; P<0.001). Multiple imputation improved specificity and positive predictive value for detecting AKI at the expense of modestly decreasing sensitivity relative to eGFR 75. Conclusions Multiple imputation can improve accuracy in estimating missing BCr and reduce misclassification of AKI beyond currently proposed methods. PMID:23037980

  15. The implementation of multiple intelligences based teaching model to improve mathematical problem solving ability for student of junior high school

    Fasni, Nurli; Fatimah, Siti; Yulanda, Syerli

    2017-05-01

    This research aims to achieve some purposes such as: to know whether mathematical problem solving ability of students who have learned mathematics using Multiple Intelligences based teaching model is higher than the student who have learned mathematics using cooperative learning; to know the improvement of the mathematical problem solving ability of the student who have learned mathematics using Multiple Intelligences based teaching model., to know the improvement of the mathematical problem solving ability of the student who have learned mathematics using cooperative learning; to know the attitude of the students to Multiple Intelligences based teaching model. The method employed here is quasi-experiment which is controlled by pre-test and post-test. The population of this research is all of VII grade in SMP Negeri 14 Bandung even-term 2013/2014, later on two classes of it were taken for the samples of this research. A class was taught using Multiple Intelligences based teaching model and the other one was taught using cooperative learning. The data of this research were gotten from the test in mathematical problem solving, scale questionnaire of the student attitudes, and observation. The results show the mathematical problem solving of the students who have learned mathematics using Multiple Intelligences based teaching model learning is higher than the student who have learned mathematics using cooperative learning, the mathematical problem solving ability of the student who have learned mathematics using cooperative learning and Multiple Intelligences based teaching model are in intermediate level, and the students showed the positive attitude in learning mathematics using Multiple Intelligences based teaching model. As for the recommendation for next author, Multiple Intelligences based teaching model can be tested on other subject and other ability.

  16. Priorities and strategies for improving disabled women's access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps.

    Bradbury-Jones, Caroline; Breckenridge, Jenna P; Devaney, John; Duncan, Fiona; Kroll, Thilo; Lazenbatt, Anne; Taylor, Julie

    2015-12-28

    Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies. This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen's model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women's access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach. The three most highly ranked barriers to women's access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women's fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were

  17. Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings.

    Crowe, Sonya; Brown, Katherine; Tregay, Jenifer; Wray, Jo; Knowles, Rachel; Ridout, Deborah A; Bull, Catherine; Utley, Martin

    2017-08-01

    Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. A 'Rich Picture' was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration. Published by the BMJ Publishing Group

  18. Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings

    Crowe, Sonya; Brown, Katherine; Tregay, Jenifer; Wray, Jo; Knowles, Rachel; Ridout, Deborah A; Bull, Catherine; Utley, Martin

    2017-01-01

    Background Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. Methods Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. Results A ‘Rich Picture’ was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. Conclusions When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further

  19. Increased cortical and deep grey matter sodium concentration is associated with physical and cognitive disability in relapse-onset multiple sclerosis

    Brownlee, WJ; Alves Da Mota, Patricia; Prados, Ferran

    digit modalities test (SDMT) and tests of verbal and visual memory. Linear regression was used to compare differences in tissue TSC between groups. Multivariable linear regression was used to identify independent associations between TSC and disability with adjustment for age, sex, disease duration......=0.40) and visual memory (β=-0.06, 95%CI -0.11, -.0.02, R2=0.19). Conclusion: Sodium accumulation in cortical and deep grey matter may reflect underlying neurodegeneration that is relevant to the development of long-term disability and cognitive impairment in relapse-onset MS. 23Na-MRI may become a secondary...

  20. Multiple Sessions for Information Literacy Instruction are Associated with Improvement in Students’ Research Abilities and Confidence

    Kelley Wadson

    2017-06-01

    -searching, research, and website analysis skills, and three Likert-type 1-5 rating scale questions measuring comfort levels. ENGL 112 students completed their post-test survey in the spring 2015 semester, which consisted of the same three 1-5 rating scale questions measuring comfort levels, to further test the effectiveness of multiple sessions. Main Results – The ENG 111 pre-test survey had 244 (66.67% female and 33.33% male respondents and the post-test had 150 (72.37% female and 28.69% male respondents. When comparing results, scores increased for pre-searching, specifically understanding of methods for brainstorming search terms (9%, and for all measures of website analysis and research, namely understanding of library databases (7.63%, choosing correct evaluative criteria (4.49%, recognizing reliable top-level domains (TLDs .edu (1.15% and .gov (11.21%, and Google’s advanced search (10.43%. Post-test scores decreased on the measures of understanding of a thesis statement (7% and narrowing a topic if there’s too much information (6%. For comfort levels, neutral responses did not vary much, but there was a shift in responses from “not comfortable” to “somewhat comfortable” and “very comfortable.” Across three measures, namely getting started with a research paper, library research skills, and writing an academic research paper, participants’ “not comfortable” responses decreased and their “comfortable” responses increased. The ENG 112 post-test survey had 29 (60.71% female and 39.29% male respondents and measured the same comfort levels. In addition, responses showed further improvement for all three questions. Within-subject analysis of both surveys showed slight gender variations. On several pre-test and post-test measures, females scored lower than males in understanding of databases, Google’s advanced search, and website analysis. Conclusion – The researchers conclude that expanding IL instruction from a single “one-shot” to four sessions

  1. Improving communication between staff and disabled children in hospital wards: testing the feasibility of a training intervention developed through intervention mapping.

    Gumm, Rebecca; Thomas, Eleanor; Lloyd, Claire; Hambly, Helen; Tomlinson, Richard; Logan, Stuart; Morris, Christopher

    2017-01-01

    To develop and test the feasibility of a novel parent-inspired training intervention for hospital ward staff to improve communication with disabled children when inpatients. Training content and delivery strategies were informed by the iterative process of Intervention Mapping and developed in collaboration with parents of disabled children. UK University Hospital children's ward. 80 medical, nursing, allied health professionals, clerical and housekeeping staff on a children's ward. Themes identified in previous qualitative research formed the basis of the training. Learning objectives included prioritising communication, cultivating empathy, improving knowledge and developing confidence. Participant feedback was used to refine content and delivery. Intervention documentation adheres to the Template for Intervention Description and Replication checklist. Highlighting mandated National Health Service policies and involving the hospital Patient and Carer Experience Group facilitated management support for the training. Eighty staff participated in one of four 1-hour sessions. A paediatric registrar and nurse delivered sessions to mixed groups of staff. General feedback was very positive. The intervention, fully documented in a manual, includes videos of parent carers discussing hospital experiences, interactive tasks, small group discussion, personal reflection and intention planning. Generic and local resources were provided. It was feasible to deliver this new communication training to hospital ward staff and it was positively received. Early feedback was encouraging and indicates a commitment to behaviour change. Further piloting is required to establish the transferability of the intervention to other hospitals, followed by consideration of downstream markers to evaluate the effects on disabled children's inpatient experience. Organisational and cultural change is required to support individual behaviour change.

  2. Machine Learning to Improve Energy Expenditure Estimation in Children With Disabilities: A Pilot Study in Duchenne Muscular Dystrophy.

    Pande, Amit; Mohapatra, Prasant; Nicorici, Alina; Han, Jay J

    2016-07-19

    Children with physical impairments are at a greater risk for obesity and decreased physical activity. A better understanding of physical activity pattern and energy expenditure (EE) would lead to a more targeted approach to intervention. This study focuses on studying the use of machine-learning algorithms for EE estimation in children with disabilities. A pilot study was conducted on children with Duchenne muscular dystrophy (DMD) to identify important factors for determining EE and develop a novel algorithm to accurately estimate EE from wearable sensor-collected data. There were 7 boys with DMD, 6 healthy control boys, and 22 control adults recruited. Data were collected using smartphone accelerometer and chest-worn heart rate sensors. The gold standard EE values were obtained from the COSMED K4b2 portable cardiopulmonary metabolic unit worn by boys (aged 6-10 years) with DMD and controls. Data from this sensor setup were collected simultaneously during a series of concurrent activities. Linear regression and nonlinear machine-learning-based approaches were used to analyze the relationship between accelerometer and heart rate readings and COSMED values. Existing calorimetry equations using linear regression and nonlinear machine-learning-based models, developed for healthy adults and young children, give low correlation to actual EE values in children with disabilities (14%-40%). The proposed model for boys with DMD uses ensemble machine learning techniques and gives a 91% correlation with actual measured EE values (root mean square error of 0.017). Our results confirm that the methods developed to determine EE using accelerometer and heart rate sensor values in normal adults are not appropriate for children with disabilities and should not be used. A much more accurate model is obtained using machine-learning-based nonlinear regression specifically developed for this target population. ©Amit Pande, Prasant Mohapatra, Alina Nicorici, Jay J Han. Originally

  3. How teams use indicators for quality improvement - a multiple-case study on the use of multiple indicators in multidisciplinary breast cancer teams.

    Gort, Marjan; Broekhuis, Manda; Regts, Gerdien

    2013-11-01

    A crucial issue in healthcare is how multidisciplinary teams can use indicators for quality improvement. Such teams have increasingly become the core component in both care delivery and in many quality improvement methods. This study aims to investigate the relationships between (1) team factors and the way multidisciplinary teams use indicators for quality improvement, and (2) both team and process factors and the intended results. An in-depth, multiple-case study was conducted in the Netherlands in 2008 involving four breast cancer teams using six structure, process and outcome indicators. The results indicated that the process of using indicators involves several stages and activities. Two teams applied a more intensive, active and interactive approach as they passed through these stages. These teams were perceived to have achieved good results through indicator use compared to the other two teams who applied a simple control approach. All teams experienced some difficulty in integrating the new formal control structure, i.e. measuring and managing performance, in their operational task, and in using their 'new' managerial task to decide as a team what and how to improve. Our findings indicate the presence of a network of relationships between team factors, the controllability and actionability of indicators, the indicator-use process, and the intended results. Copyright © 2013. Published by Elsevier Ltd.

  4. Volta-Based Cells Materials Chemical Multiple Representation to Improve Ability of Student Representation

    Helsy, I.; Maryamah; Farida, I.; Ramdhani, M. A.

    2017-09-01

    This study aimed to describe the application of teaching materials, analyze the increase in the ability of students to connect the three levels of representation and student responses after application of multiple representations based teaching materials chemistry. The method used quasi one-group pretest-posttest design to 71 students. The results showed the application of teaching materials carried 88% with very good category. A significant increase ability to connect the three levels of representation of students after the application of multiple representations based teaching materials chemistry with t-value > t-crit (11.402 > 1.991). Recapitulation N-gain pretest and posttest showed relatively similar for all groups is 0.6 criterion being achievement. Students gave a positive response to the application of multiple representations based teaching materials chemistry. Students agree teaching materials used in teaching chemistry (88%), and agrees teaching materials to provide convenience in connecting the three levels of representation (95%).

  5. Improving the Pattern Reproducibility of Multiple-Point-Based Prior Models Using Frequency Matching

    Cordua, Knud Skou; Hansen, Thomas Mejer; Mosegaard, Klaus

    2014-01-01

    Some multiple-point-based sampling algorithms, such as the snesim algorithm, rely on sequential simulation. The conditional probability distributions that are used for the simulation are based on statistics of multiple-point data events obtained from a training image. During the simulation, data...... events with zero probability in the training image statistics may occur. This is handled by pruning the set of conditioning data until an event with non-zero probability is found. The resulting probability distribution sampled by such algorithms is a pruned mixture model. The pruning strategy leads...... to a probability distribution that lacks some of the information provided by the multiple-point statistics from the training image, which reduces the reproducibility of the training image patterns in the outcome realizations. When pruned mixture models are used as prior models for inverse problems, local re...

  6. Research about citizenship and disability: a scoping review.

    Sépulchre, Marie

    2017-05-01

    To identify the characteristics of peer-reviewed literature on citizenship and disability published in English from 1985 to 2015. A scoping review was conducted using the Arksey and O'Malley framework. Several databases were searched for peer-reviewed journal articles including the terms citizenship and disability, impairment or handicap in their abstract or title; published between 1985 and 2015; in English. A total of 295 articles were included. Key findings are (1) the number of articles about disability and citizenship increased dramatically over the past three decades, (2) the meaning of citizenship is often left undiscussed, (3) citizenship is more often discussed in terms of access to social rights and less so in regards to contributions to society and participation in family life, technology and culture, (4) disabled people tend to be represented as a homogeneous category, (5) most studies are qualitative and non-participatory. To broaden knowledge about the situation, membership and participation of persons with disabilities in society, further research should develop the conceptual use of citizenship in relation to disability, explore different research designs, investigate various citizenship sectors and take into account the complexity of personal and social situations of persons with disabilities. Implications for Rehabilitation The notion of citizenship is closely related to the goals of rehabilitation as it touches upon issues of membership and participation in society; Understanding the multiple dimensions of citizenship will help practitioners to design and improve rehabilitation treatments and connect these not only to social citizenship rights but also to the various social roles and contributions of persons with disabilities; A better understanding of the complex relationship between citizenship and disability on the part of practitioners is crucial since strategies and policy documents about persons with disabilities often mention citizenship.

  7. Post-Coma Persons Emerged from a Minimally Conscious State and Showing Multiple Disabilities Learn to Manage a Radio-Listening Activity

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Colonna, Fabio; Buonocunto, Francesca; Sacco, Valentina; Megna, Marisa; Oliva, Doretta

    2012-01-01

    This study assessed microswitch-based technology to enable three post-coma adults, who had emerged from a minimally conscious state but presented motor and communication disabilities, to operate a radio device. The material involved a modified radio device, a microprocessor-based electronic control unit, a personal microswitch, and an amplified…

  8. The Effectiveness of Combining Tangible Symbols with the Picture Exchange Communication System to Teach Requesting Skills to Children with Multiple Disabilities Including Visual Impairment

    Ali, Emad

    2009-01-01

    The Picture Exchange Communication System (PECS) is an augmentative and alternative communication program (Frost & Bondy, 2002). Although PECS has been effectively used to teach functional requesting skills for children with autism, mental retardation, visual impairment, and physical disabilities (e.g., Anderson, Moore, & Bourne, 2007; Chambers &…

  9. Effectiveness of Combining Tangible Symbols with the Picture Exchange Communication System to Teach Requesting Skills to Children with Multiple Disabilities Including Visual Impairment

    Ali, Emad; MacFarland, Stephanie Z.; Umbreit, John

    2011-01-01

    The Picture Exchange Communication System (PECS) is an augmentative and alternative communication (AAC) program used to teach functional requesting and commenting skills to people with disabilities (Bondy & Frost, 1993; Frost & Bondy, 2002). In this study, tangible symbols were added to PECS in teaching requesting to four students (ages 7-14) with…

  10. Geriatic Disability Related Factors

    Mohsen Adib Hajbagheri

    2008-07-01

    Full Text Available Objectives: Reports are indicating of increasing trend of aging and disability in the developing countries while such disabilities are decreasing within the developed countries. This study designed to evaluate the disability and some of its related factors among the elderly population (65 and older in Kashan, Iran. Methods & Materials: A cross-sectional analytical study was conducted on a multi-stage random sample of 350 elderly people (65 year and older in Kashan. The WHO-DAS-II was used as the generic disability measure. The questionnair had 48 questions. The range of score could be between 0-144. Chi-square, t-test analysis and ANOVA were utilized to check significant differences between subgroups. Results: 61% were men and 12% were living lonely. One fourth had some type of addiction, the majority were ilitrate and two thired had not regular phisycal activity.Twenty percent of the old people had a modereate disability and 4.3% were extremely disabled. A significant relationship was found between the disability and variables such as sex, age, living style, needing help, marriage status, living location, addiction, job, level of physical activity, education, and having multiple diseases. Conclusion: In conclusion, geriatric population in Iran, has a lower levels of disability in compare to those of other developed countries. Need of geriatric cares must be be increasing, since the populationpattern of elderly people is increasing in Iran. Female and ilitrate elders were sufering of more disability. These findings indicated the nessesity to more attention to these voulnarable subgroups of population.

  11. Multiple endmember spectral-angle-mapper (SAM) analysis improves discrimination of Savanna tree species

    Cho, Moses A

    2009-08-01

    Full Text Available of this paper was to evaluate the classification performance of a multiple-endmember spectral angle mapper (SAM) classification approach in discriminating seven common African savanna tree species and to compare the results with the traditional SAM classifier...

  12. Improving the Reading Ability of Science Students through Study Groups and Multiple Intelligences

    Owolabi, Tunde; Okebukola, Foluso

    2009-01-01

    This study explored the effects of appropriate pedagogical skills (study groups and multiple intelligences) on students' efficiencies in reading skills. It employed a factorial design using three variables. A sample of 90 science students choosing from three intact classes were involved in the study. Data analyses were carried out using mean,…

  13. Multiple Imputation of a Randomly Censored Covariate Improves Logistic Regression Analysis.

    Atem, Folefac D; Qian, Jing; Maye, Jacqueline E; Johnson, Keith A; Betensky, Rebecca A

    2016-01-01

    Randomly censored covariates arise frequently in epidemiologic studies. The most commonly used methods, including complete case and single imputation or substitution, suffer from inefficiency and bias. They make strong parametric assumptions or they consider limit of detection censoring only. We employ multiple imputation, in conjunction with semi-parametric modeling of the censored covariate, to overcome these shortcomings and to facilitate robust estimation. We develop a multiple imputation approach for randomly censored covariates within the framework of a logistic regression model. We use the non-parametric estimate of the covariate distribution or the semiparametric Cox model estimate in the presence of additional covariates in the model. We evaluate this procedure in simulations, and compare its operating characteristics to those from the complete case analysis and a survival regression approach. We apply the procedures to an Alzheimer's study of the association between amyloid positivity and maternal age of onset of dementia. Multiple imputation achieves lower standard errors and higher power than the complete case approach under heavy and moderate censoring and is comparable under light censoring. The survival regression approach achieves the highest power among all procedures, but does not produce interpretable estimates of association. Multiple imputation offers a favorable alternative to complete case analysis and ad hoc substitution methods in the presence of randomly censored covariates within the framework of logistic regression.

  14. Using Combinatorial Approach to Improve Students' Learning of the Distributive Law and Multiplicative Identities

    Tsai, Yu-Ling; Chang, Ching-Kuch

    2009-01-01

    This article reports an alternative approach, called the combinatorial model, to learning multiplicative identities, and investigates the effects of implementing results for this alternative approach. Based on realistic mathematics education theory, the new instructional materials or modules of the new approach were developed by the authors. From…

  15. Using Multiple Intelligences To Improve Retention in Foreign Language Vocabulary Study.

    Anderson, Virginia B.

    The report describes an experiment for increasing retention of foreign language vocabulary by using multiple intelligence approaches and memory enhancement tools. The targeted population was approximately 100 seventh- and eighth-grade Latin students. Student difficulty with vocabulary retention had been ascribed to the teacher's emphasis on…

  16. Understanding balance differences in individuals with multiple sclerosis with mild disability: An investigation of differences in sensory feedback on postural and dynamic balance control

    Denomme, Luke T.

    Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS) and causes a broad range of neurological symptoms. One of the most common symptoms experienced by individuals with MS is poor balance control during standing and walking. The main mechanism underlying impaired balance control in MS appears to result from slowed somatosensory conduction and impaired central integration. The current thesis assessed postural and dynamic control of balance of 'individuals with MS with mild disability' (IwMS). IwMS were compared to 'healthy age-matched individuals' (HAMI) and community-dwelling 'older adults' (OA). The purpose of this thesis was to quantify differences in postural and dynamic control of balance in IwMS to the two populations who display balance control differences across the lifespan and represent two extreme ends of the balance control continuum due to natural aging. IwMS (n = 12, x¯age: 44 +/- 9.4 years), HAMI (n = 12, x¯age: 45 +/- 9.9 years) and community-dwelling OA (n = 12, x¯ age: 68.1 +/- 4.5 years) postural and dynamic balance control were evaluated during a Romberg task as well as a dynamic steering task. The Romberg task required participants to stand with their feet together and hands by their sides for 45 seconds with either their eyes open or closed. The dynamic steering task required participants to walk and change direction along the M-L plane towards a visual goal. Results from these two tasks reveal that IwMS display differences in postural control when compared to HAMI when vision was removed as well as differences in dynamic stability margin during steering situations. During the postural control task IwMS displayed faster A-P and M-L COP velocities when vision was removed and their COP position was closer to their self-selected maximum stability limits compared to HAMI. Assessment of dynamic stability during the steering task revealed that IwMS displayed reduced walking speed and cadence during the

  17. Improved fatigue in individuals with multiple sclerosis after participating in a short-term self-care programme.

    Navipour, Hassan; Madani, Hossein; Mohebbi, Mohammad R; Navipour, Reza; Roozbayani, Parviz; Paydar, Afshin

    2006-01-01

    Fatigue is among the most common, yet least understood symptoms of Multiple Sclerosis (MS). The debilitating symptoms of MS can have adverse effects on the sufferer's self-esteem. We report the effect of a short-term self-managed graded exercise programme on fatigue and self-esteem of patients with MS. Thirty-four (age range: 20-50, mean: 29.7 years; M:F 0.7:1.0) patients with MS who lived in Tehran and were not physically disabled entered the study. Self-esteem score was measured with the Persian translation of the Coopersmith Self-Esteem Inventory. Fatigue was evaluated with a visual analogue scale. The patients performed the self-managed techniques for 6 weeks. Self-esteem and fatigue were evaluated once more after the self-managed graded exercise programme. On paired sample test, the self-esteem score of the patients was significantly different before (53.9) and after (68.1) the self-managed graded exercise programme (Pself-care training as an alternative in rehabilitation of the patients with MS. Self-managed graded exercise programme may be considered as an alternative to direct nursing services for patients with MS.

  18. A bi-level intervention to improve oral hygiene of older and disabled adults in low-income housing: results of a pilot study.

    Reisine, S; Schensul, J J; Goldblatt, R; Radda, K; Foster-Bey, C; Acosta-Glynn, C; Miron-Carcamo, L; Ioannidou, E

    2016-06-01

    This paper describes the results of a bi-level intervention, using a cognitive-behavioral theoretical approach, to improve the oral hygiene of older adults and the disabled in community-based low income senior housing. The bi-level pilot intervention consisted of an on-site tailored adapted motivational interviewing (AMI) session and two oral health fairs, supported by a resident campaign committee, to change community norms. All materials were available in English and Spanish. Participants completed a survey consisting of 12 domains that provided the basis for tailoring the AMI and shaping the campaigns. The domains were activities of daily living (ADLs), access to oral health information, oral hygiene status, dental knowledge, hygiene behaviors, importance of oral hygiene, self-efficacy/locus of control, diet, intentions, self-management worries/fears, perceived risk and dry mouth. Each participant received clinical assessments consisting of full-mouth plaque score (PS) and gingival index (GI) before the intervention and at three months. Twenty-seven residents with at least one tooth completed all phases of the study. The mean number of domains requiring attention was 4.5 (SD 1.6) with a range of one to seven. Mean baseline PS was 83% (SD 16%) which improved significantly to 58% (SD 31%); mean baseline GI was 1.15 (SD 0.61) and improved significantly to 0.49 (SD 0.46). This pilot study supports the feasibility and acceptability of a tailored oral hygiene intervention among older and disabled adults living in low income senior housing. Although a small sample, the study demonstrated significant improvements in both plaque and gingival scores three months after the bi-level intervention.

  19. Improving combustion characteristics and NO(x) emissions of a down-fired 350 MW(e) utility boiler with multiple injection and multiple staging.

    Kuang, Min; Li, Zhengqi; Xu, Shantian; Zhu, Qunyi

    2011-04-15

    Within a Mitsui Babcock Energy Limited down-fired pulverized-coal 350 MW(e) utility boiler, in situ experiments were performed, with measurements taken of gas temperatures in the burner and near the right-wall regions, and of gas concentrations (O(2) and NO) from the near-wall region. Large combustion differences between zones near the front and rear walls and particularly high NO(x) emissions were found in the boiler. With focus on minimizing these problems, a new technology based on multiple-injection and multiple-staging has been developed. Combustion improvements and NO(x) reductions were validated by investigating three aspects. First, numerical simulations of the pulverized-coal combustion process and NO(x) emissions were compared in both the original and new technologies. Good agreement was found between simulations and in situ measurements with the original technology. Second, with the new technology, gas temperature and concentration distributions were found to be symmetric near the front and rear walls. A relatively low-temperature and high-oxygen-concentration zone formed in the near-wall region that helps mitigate slagging in the lower furnace. Third, NO(x) emissions were found to have decreased by as much as 50%, yielding a slight decrease in the levels of unburnt carbon in the fly ash.

  20. Industrial Application of an Improved Multiple Injection and Multiple Staging Combustion Technology in a 600 MWe Supercritical Down-Fired Boiler.

    Song, Minhang; Zeng, Lingyan; Chen, Zhichao; Li, Zhengqi; Zhu, Qunyi; Kuang, Min

    2016-02-02

    To solve the water wall overheating in lower furnace, and further reduce NOx emissions and carbon in fly ash, continuous improvement of the previously proposed multiple injection and multiple staging combustion (MIMSC) technology lies on three aspects: (1) along the furnace arch breadth, changing the previously centralized 12 burner groups into a more uniform pattern with 24 burners; (2) increasing the mass ratio of pulverized coal in fuel-rich flow to that in fuel-lean flow from 6:4 to 9:1; (3) reducing the arch-air momentum by 23% and increasing the tertiary-air momentum by 24%. Industrial-size measurements (i.e., adjusting overfire air (OFA) damper opening of 20-70%) uncovered that, compared with the prior MIMSC technology, the ignition distance of fuel-rich coal/air flow shortened by around 1 m. The gas temperature in the lower furnace was symmetric and higher, the flame kernel moved upward and therefore made the temperature in near-wall region of furnace hopper decrease by about 400 °C, the water wall overheating disappeared completely. Under the optimal OFA damper opening (i.e, 55%), NOx emissions and carbon in fly ash attained levels of 589 mg/m(3) at 6% O2 and 6.18%, respectively, achieving NOx and carbon in fly ash significant reduction by 33% and 37%, respectively.