Dogonowski, A-M; Siebner, H R; Soelberg Sørensen, P; Paulson, O B; Dyrby, T B; Blinkenberg, M; Madsen, K H
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.
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
Dogonowski, Anne-Marie; Siebner, Hartwig Roman; Soelberg Sørensen, P.
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...
Darling, Joseph A; Circo, Deborah K
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.
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...
Argyropoulos, Vassilios; Thymakis, Paraskevas
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…
Sigafoos, J; Dempsey, R
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...
Giannini, Margaret J; Bergmark, Brian; Kreshover, Samantha; Elias, Eileen; Plummer, Caitlin; O'Keefe, Eileen
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
Tam, Gee May; Phillips, Katrina J.; Mudford, Oliver C.
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…
Kishore, M Thomas
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.
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.
Cohen, Jeffrey A; Reingold, Stephen C; Polman, Chris H
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...
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
Lewis, V M; Williams, K; KoKo, C; Woolmore, J; Jones, C; Powell, T
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.
Talman, Lena; Gustafsson, Christine; Stier, Jonas; Wilder, Jenny
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
Photon Multiplicity Detector (PMD) measures the multiplicity and spatial distribution of photons in the forward region of ALICE on a event-by-event basis. PMD is a pre-shower detector having fine granularity and full azimuthal coverage in the pseudo-rapidity region 2.3 < η < 3.9.
Motl, R W; Goldman, M
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.
Wynia, K.; Middel, B.; Reijneveld, S.A.
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
Results: Age >60 years, female sex, presence of diabetic retinopathy (DR), proliferative DR, shorter DM duration, glaucoma, macular ... visual disability was significantly associated with female sex and diabetic retinopathy. .... Only older age,.
Hearne, D; Stone, S
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.
Juan Ignacio Rojas
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.
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.
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
Lancioni, Giulio E.; O'Reilly, Mark F.; Singh, Nirbhay N.; Sigafoos, Jeff; Green, Vanessa A.; Oliva, Doretta; Alberti, Gloria; Carrella, Luigina
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…
Kemp, Coral; Stephenson, Jennifer; Cooper, Megan; Hodge, Kerry
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…
Buchanan, Robert J; Radin, Dagmar; Chakravorty, Bonnie J; Tyry, Tuula
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.
Aggarwal, M.M.; Badyal, S.K.; Bhaskar, P.; Bhatia, V.S.; Chattopadhyay, S. E-mail: email@example.com; Das, S.; Datta, R.; Dubey, A.K.; Dutta Majumdar, M.R.; Ganti, M.S.; Ghosh, P.; Gupta, A.; Gupta, M.; Gupta, R.; Kaur, I.; Kumar, A.; Mahajan, S.; Mahapatra, D.P.; Mangotra, L.K.; Mishra, D.; Mohanty, B.; Nayak, S.K.; Nayak, T.K.; Pal, S.K.; Phatak, S.C.; Potukuchi, B.V.K.S.; Raniwala, R.; Raniwala, S.; Sahoo, R.; Sharma, A.; Singaraju, R.N.; Sood, G.; Trivedi, M.D.; Varma, R.; Viyogi, Y.P
Details concerning the design, fabrication and performance of STAR Photon Multiplicity Detector (PMD) are presented. The PMD will cover the forward region, within the pseudorapidity range 2.3-3.5, behind the forward time projection chamber. It will measure the spatial distribution of photons in order to study collective flow, fluctuation and chiral symmetry restoration.
Schuengel, C; Sterkenburg, P S; Jeczynski, P; Janssen, C G C; Jongbloed, G
: 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,
cord and nerve root compression14,15 of uncertain cause was made. Cervical antero-posterior, lateral and oblique view x-rays were taken revealing anterior ankylosis and narrowing between C2 and C3 plus reduced intervertebral spaces at C4/5,C5/6, C6/7 and C7/T1 indicating multiple prolapsed intervertebral discs and ...
Ivancic, Martin T.; And Others
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.…
Everaarts, Sanne; de Boer, Anke; van der Putten, Annette; Minnaert, Alexander
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
O'Mea, Melanie L.
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…
Manresa-Yee, Cristina; Morrison, Ann; Jordi Muntaner, Joan
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....
Hatipoglu, Hasan; Canbaz Kabay, Sibel; Gungor Hatipoglu, Mujgan; Ozden, Hilmi
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.
Martinez-Lapiscina, Elena H; Arnow, Sam; Wilson, James A
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...
Bossink, Leontien; van der Putten, Annette; Vlaskamp, Carla
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
Kavaliunas, Andrius; Wiberg, Michael; Tinghög, Petter; Glaser, Anna; Gyllensten, Hanna; Alexanderson, Kristina; Hillert, Jan
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.
Marrie, Ruth Ann; Cutter, Gary; Tyry, Tuula
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.
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.
Buxbaum, Bernd; Schwarte, Rudolf; Ringbeck, Thorsten; Luan, Xuming; Zhang, Zhigang; Xu, Zhanping; Hess, H.
.g., heterodyne techniques), in this contribution only so called quasi-heterodyne techniques - - also known as phase shifting methods -- are discussed and used for the implementation. The light modulation schemes described in this contribution are square-wave as well as pseudo-noise modulation. The latter approach, inspired by the wide spread use in communication as well as in position detection (e.g., IS-95 and GPS), offers essential advantages and is the most promising modulation method for the ranging approach. So called CDMA (code division multiple access) systems form a major task in communication technology investigations since the third generation mobile phone standard is also partly based on this principle. Fast and reliable synchronization in direct sequence spread spectrum communication systems (DSSS) differs hardly from the already mentioned ranging approach and will also be discussed. The possibility to integrate all components in a monolithic PMD based DLL design is also presented and discussed. This method might offer the feature to integrate complete lines or matrixes of PMD based DLLs for highly parallel, multidimensional ranging. Finally, an outlook is given with regard to further optimized PMD front ends. An estimation of the expected characteristics concerning accuracy and speed of the distance measurement is given in conclusion.
Ning, G.; Shum, P.; Aditya, S.; Gong, Yandong
We use the expression relating the output state of polarization and PMD vector. Based on this expression we get the power fading including first-order PMD and chromatic dispersion, which is dependent on the angle of precession of output state of polarization around the PMD vector. From the expression for power fading, we get the average power penalty for chromatic dispersion and PMD. We propose a novel and fast PMD and chromatic dispersion monitoring technology. Measured results agree well with theoretical analysis.
Norén, Niklas; Pilesjö, Maja Sigurd
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...
Sandroff, Brian M; Bollaert, Rachel E; Pilutti, Lara A; Peterson, Melissa L; Baynard, Tracy; Fernhall, Bo; McAuley, Edward; Motl, Robert W
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.
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
van den Bosch, Kirsten A.; Andringa, Tjeerd C.; Baskent, Deniz; Vlaskamp, Carla
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
Pizzo, Lianna; Bruce, Susan M.
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…
Schreurs, K.M.G.; Ridder, D.T.D. de; Bensing, J.M.
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
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
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
Schreurs, K.M.G.; Ridder, D.T.D. de; Bensing, J.
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
Lehrman, Jennifer; Ross, David B.
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.…
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
Nijs, Sara; Maes, Bea
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…
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
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…
Novakovic, A.M.; Krekels, E.H.; Munafo, A.; Ueckert, S.; Karlsson, M.O.
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
Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Campodonico, Francesca; Oliva, Doretta
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…
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.
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…
van den Broek, E.G.C.; Janssen, C.G.C.; van Ramshorst, T.; Deen, L.
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
Waninge, Aly; van der Putten, Annette A. J.; Stewart, Roy E.; Steenbergen, Bert; van Wijck, Ruud; van der Schans, Cees P.
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
Ine, Hostyn; Heleen, Neerinckx; Bea, Maes
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…
Hostyn, Ine; Maes, Bea
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…
Whinnery, Stacie B.; Whinnery, Keith W.
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…
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…
Klenk, Jessicia A.; Pufpaff, Lisa A.
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…
Phillips, Lorraine J.
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…
Zhao, Wenyu; Zhang, Haiyi; Ji, Yuefeng; Xu, Daxiong
Based on the proposed polarization mode dispersion (PMD) compensation simulation model and statistical analysis method (Monte-Carlo), the critical parameters initialization of two typical optical domain PMD compensators, which include optical PMD method with fixed compensation differential group delay (DGD) and that with variable compensation DGD, are detailedly investigated by numerical method. In the simulation, the line PMD values are chosen as 3ps, 4ps and 5ps and run samples are set to 1000 in order to achieve statistical evaluation for PMD compensated systems, respectively. The simulation results show that for the PMD value pre-known systems, the value of the fixed DGD compensator should be set to 1.5~1.6 times of line PMD value in order to reach the optimum performance, but for the second kind of PMD compensator, the DGD range of lower limit should be 1.5~1.6 times of line PMD provided that of upper limit is set to 3 times of line PMD, if no effective ways are chosen to resolve the problem of local minimum in optimum process. Another conclusion can be drawn from the simulation is that, although the second PMD compensator holds higher PMD compensation performance, it will spend more feedback loops to look up the optimum DGD value in the real PMD compensation realization, and this will bring more requirements on adjustable DGD device, not only wider adjustable range, but rapid adjusting speed for real time PMD equalization.
Heydarpour, P; Manouchehrinia, A; Beiki, O; Mousavi, S E; Abdolalizadeh, A; -Lakeh, M Moradi; Sahraian, M A
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.
Sumowski, James F; Rocca, Maria A; Leavitt, Victoria M; Meani, Alessandro; Mesaros, Sarlota; Drulovic, Jelena; Preziosa, Paolo; Habeck, Christian G; Filippi, Massimo
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.
Cash, Stefan; Shinnick-Page, Andrea
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.
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.
Wang, ZeFeng; Peyrodie, Laurent; Cao, Hua; Agnani, Olivier; Watelain, Eric; Wang, HaoPing
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.
Moberg, Julie Yoon; Laursen, Bjarne; Koch-Henriksen, Nils; Thygesen, Lau Caspar; Brødsgaard, Anne; Soelberg Sørensen, Per; Magyari, Melinda
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.
Moberg, Julie Yoon; Laursen, Bjarne; Koch-Henriksen, N.
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...
investigations, she had both medical and surgical intervention. RESULTS: Two ... a diagnosis of nephrotic syndrome. There was ... nephrotic syndrome,; gangrene of digits ; multiple digit. RÉSUMÉ .... drew attention away from the background.
Amezcua, Lilyana; Conti, David V; Liu, Lihua; Ledezma, Karina; Langer-Goulda, Annette M
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.
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.
Kamstra, A.; van der Putten, A.A.J.; Post, W.J.; Vlaskamp, C.
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
Weinshenker, B G; Hader, W; Carriere, W; Baskerville, J; Ebers, G C
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.
Novakovic, A M; Krekels, E H J; Munafo, A; Ueckert, S; Karlsson, M O
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.
Arvio, Maria; Philips, Anju K; Ahvenainen, Minna; Somer, Mirja; Kalscheuer, Vera; Järvelä, Irma
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.
Santiago Rolanía, Olga; Guàrdia Olmos, Joan; Arbizu Urdiain, Txomin
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.
Schlaeger, Regina; Schindler, Christian; Grize, Leticia; Dellas, Sophie; Radue, Ernst W; Kappos, Ludwig; Fuhr, Peter
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.
Jasse, Laurence; Vukusic, Sandra; Durand-Dubief, Françoise; Vartin, Cristina; Piras, Carolina; Bernard, Martine; Pélisson, Denis; Confavreux, Christian; Vighetto, Alain; Tilikete, Caroline
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.
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.
Chattopadhayay, Subhasis; Ghosh, Premomoy; Gupta, R.; Mishra, D.; Phatak, S.C.; Sood, G.
High granularity photon multiplicity detector (PMD) is scheduled to take data in Relativistic Heavy Ion Collision(RHIC) this year. A detailed scheme has been designed and implemented in object oriented programming framework using C++ for the monitoring and reconstruction job of PMD data
Scalfari, Antonio; Neuhaus, Anneke; Degenhardt, Alexandra; Rice, George P; Muraro, Paolo A; Daumer, Martin; Ebers, George C
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
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
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
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
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
Ezeugwu, Victor; Klaren, Rachel E.; A. Hubbard, Elizabeth; Manns, Patricia (Trish); Motl, Robert W.
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
Jansen, S L G; van der Putten, A A J; Vlaskamp, C
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.
Solanky, Bhavana S.; Muhlert, Nils; Tur, Carmen; Edden, Richard A. E.; Wheeler-Kingshott, Claudia A. M.; Miller, David H.; Thompson, Alan J.; Ciccarelli, Olga
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
D'hooghe, M B; Haentjens, P; Nagels, G; Garmyn, M; De Keyser, J
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.
Hall, Anna-Marié; Theron, Linda C
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.
Mumford, Leslie; Lam, Rachel; Wright, Virginia; Chau, Tom
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.
Candeias da Silva, Carolina; Bichuetti, Denis Bernardi; Azevedo Silva, Sonia Maria Cesar de; Ferraz, Henrique Ballalai; Oliveira, Enedina Maria Lobato de; Borges, Vanderci
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  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.
Perifano, A; Scelles, R
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
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.
Khan, Fary; Pallant, Julie F
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.
Hatton, Chris; Emerson, Eric
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…
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
Bossink, Leontien; van der Putten, Annette; Vlaskamp, Carla
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
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.
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
Lancioni, G.E.; Bellini, D.; Oliva, D.; Singh, N.N.; O'Reilly, M.F.; Sigafoos, J.; Lang, R.B.; Didden, H.C.M.
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
Kamstra, A.; van der Putten, A. A. J.; Post, W. J.; Vlaskamp, C.
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,…
Shih, Ching-Hsiang; Shih, Ching-Tien; Peng, Chin-Ling
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…
Trief, Ellen; Cascella, Paul W.; Bruce, Susan M.
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…
Lancioni, G.E.; Singh, N.N.; O'Reilly, M.F.; Sigafoos, J.; Didden, H.C.M.; Oliva, D.; Cingolani, E.
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
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
Sung, Connie; Chiu, Chung-Yi; Lee, Eun-Jeong; Bezyak, Jill; Chan, Fong; Muller, Veronica
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…
Shih, Ching-Hsiang; Shih, Ching-Tien; Chu, Chiung-Ling
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…
Axelsson, Anna Karin
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…
Schepis, Maureen M.; Reid, Dennis H.
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…
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.
Phasha, T. N.; Nyokangi, D.
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…
Maes, Bea; Lambrechts, Greet; Hostyn, Ine; Petry, Katja
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…
Langeskov-Christensen, D; Feys, P; Baert, I
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...
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
Campaña, Laura V.; Ouimet, Donald A.
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…
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…
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
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…
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
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.
Lancioni, Giulio E; Bellini, Domenico; Oliva, Doretta; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Furniss, Fred
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.
Gosselink, R; Kovacs, L; Ketelaer, P; Carton, H; Decramer, M
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.
Eisenhower, A; Blacher, J
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.
Poretto, Valentina; Petracca, Maria; Saiote, Catarina; Mormina, Enricomaria; Howard, Jonathan; Miller, Aaron; Lublin, Fred D; Inglese, Matilde
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.
Krishna Kumar Ramani
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.
Skjerbæk, Ag; Næsby, M; Lützen, Karin
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...
Hostyn, Ine; Ine, Hostyn; Neerinckx, Heleen; Heleen, Neerinckx; Maes, Bea; Bea, Maes
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.
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
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.
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.
Weislogel, M. M.; Sala, M. A.; Collicott, S. H.; Rame, Enrique (Technical Monitor)
Recent investigations have successfully demonstrated closed-form analytical solutions of spontaneous capillary flows in idealized cylindrical containers with interior corners. In this report, the theory is extended and applied to complex containers modeling spacecraft fuel tanks employing propellant management devices (PMDs). The specific problem investigated is one of spontaneous rewetting of a typical partially filled liquid fuel/cryogen tank with PMD after thrust resettling. The transients of this flow impact the logistics of orbital maneuvers and potentially tank thermal control. The general procedure to compute the initial condition (mean radius of curvature for the interface) for the closed-form transient flows is first outlined then solved for several 'complex' cylindrical tanks exhibiting symmetry. The utility and limitations of the technique as a design tool are discussed in a summary, which also highlights comparisons with NASA flight data of a model propellant tank with PMD.
Dasenbrock, Hormuzdiyar H; Smith, Seth A; Ozturk, Arzu; Farrell, Sheena K; Calabresi, Peter A; Reich, Daniel S
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.
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Oliva, Doretta; Campodonico, Francesca
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.
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Alberti, Gloria; Boccasini, Adele; Smaldone, Angela; Oliva, Doretta; Bosco, Andrea
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.
Gumpp, T.; Schamm, T.; Bergmann, S.; Zöllner, J. M.; Dillmann, R.
In diesem Artikel wird ein System zur Verfolgung von Fahrspuren unter Verwendung von PMD-Kameras vorgestellt. Er gibt einen überblick über die Auswertung der Intensitäts- und Tiefenbilder dieses Sensors in einem System zur fremdlichtunabhängigen Fahrspurverfolgung. Ein Kaiman-Filter wird verwendet, um neben den Fahrspurparametern auch die Position und Orientierung des Fahrzeugs relativ zur Fahrspur zu schätzten.
Varsamis, Panagiotis; Agaliotis, Ioannis
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.
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.
Galli, Manuela; Coghe, Giancarlo; Sanna, Paola; Cocco, Eleonora; Marrosu, Maria Giovanna; Pau, Massimiliano
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.
Luijkx, J; van der Putten, A A J; Vlaskamp, C
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.
Giulio E. Lancioni
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.
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.
Hengeveld, B.; Voort, R.; Hummels, C.; De Moor, J.; Van Balkom, H.; Overbeeke, K.; Van der Helm, A.
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,
Smedema, Susan Miller; Kesselmayer, Rachel Friefeld; Peterson, Lauren
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…
A F Nunes
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.
Stellmann, J-P; Young, K L; Vettorazzi, E; Pöttgen, J; Heesen, C
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.
Atkin, Keith; Lorch, Marjorie Perlman
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.
Lancioni, Giulio E; O'Reilly, Mark F; Singh, Nirbhay N; Sigafoos, Jeff; Oliva, Doretta; Alberti, Gloria; Lang, Russell
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.
Djordjevic, Ivan B
The possibility of polarization-mode dispersion (PMD) compensation in fiber-optic communication systems with direct detection using a simple channel estimation technique and low-density parity-check (LDPC)-coded orthogonal frequency division multiplexing (OFDM) is demonstrated. It is shown that even for differential group delay (DGD) of 4/BW (BW is the OFDM signal bandwidth), the degradation due to the first-order PMD can be completely compensated for. Two classes of LDPC codes designed based on two different combinatorial objects (difference systems and product of combinatorial designs) suitable for use in PMD compensation are introduced.
de Geeter, K.I.; Poppes, P.; Vlaskamp, C.
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,
Full Text Available Optical Time-of-Flight measurement gives the possibility to enhance 2-D sensors by adding a third dimension using the PMD principle. Various applications in the automotive (e.g. pedestrian safety, industrial, robotics and multimedia fields require robust three-dimensional data (Schwarte et al., 2000. These applications, however, all have different requirements in terms of resolution, speed, distance and target characteristics. PMDTechnologies has developed 3-D sensors based on standard CMOS processes that can provide an optimized solution for a wide field of applications combined with high integration and cost-effective production. These sensors are realized in various layout formats from single pixel solutions for basic applications to low, middle and high resolution matrices for applications requiring more detailed data. Pixel pitches ranging from 10 micrometer up to a 300 micrometer or larger can be realized and give the opportunity to optimize the sensor chip depending on the application.
One aspect of all optical sensors based on a time-of-flight principle is the necessity of handling background illumination. This can be achieved by various techniques, such as optical filters and active circuits on chip. The sensors' usage of the in-pixel so-called SBI-circuitry (suppression of background illumination makes it even possible to overcome the effects of bright ambient light. This paper focuses on this technical requirement. In Sect. 2 we will roughly describe the basic operation principle of PMD sensors. The technical challenges related to the system characteristics of an active optical ranging technique are described in Sect. 3, technical solutions and measurement results are then presented in Sect. 4. We finish this work with an overview of actual PMD sensors and their key parameters (Sect. 5 and some concluding remarks in Sect. 6.
Schamm, Thomas; Vacek, Stefan; Natroshvilli, Koba; Marius Zöllner, J.; Dillmann, Rüdiger
Die Detektion von Hindernissen vor dem Automobil ist eine Hauptanforderung an moderne Fahrerassistenzsysteme (FAS). In dieser Arbeit wird ein System vorgestellt, das mit Hilfe einer PMDKamera (Photomischdetektor) Hindernisse auf der Fahrspur erkennt und deren relevante Parameter bestimmt. Durch die PMD-Kamera werden zunächst 3D-Tiefenbilder der Fahrzeugumwelt generiert. Nach einem initialen Filterprozess werden im Tiefenbild mit Hilfe eines Bereichswachstumsverfahrens Hindernisse gesucht. Zur Stabilisierung des Verfahrens und zur Parameterberechnung wird ein Kaiman Filter eingesetzt. Das Ergebnis ist eine Liste aller Hindernisse im Fahrbereich des Automobils.
Holenweg-Gross, C; Newman, C J; Faouzi, M; Poirot-Hodgkinson, I; Bérard, C; Roulet-Perez, E
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.
Popescu, Veronica; Agosta, Federica; Hulst, Hanneke E
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)....
Peñaloza López, Yolanda Rebeca; Orozco Peña, Xóchitl Daisy; Pérez Ruiz, Santiago Jesús
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.
Ning, G.; Shum, P.
We derive the expressions for the power fading including first-order polarization mode dispersion (PMD), chromatic dispersion, chirp parameter as well as polarization-dependent chromatic dispersion (PCD), which is dependent on the angle of precession of output state of polarization around the PMD vector. From the expression for radio frequency (RF) signals power fading, we get the average power fading for chromatic dispersion, chirp parameter, first-order PMD and PCD for both double sideband (DSB) modulation and single sideband (SSB) modulation. We also demonstrate a fast PMD and chromatic dispersion monitoring technology with reduced polarization-dependent gain. The measured results agree well with theoretical analysis.
Shirani, Afsaneh; Zhao, Yinshan; Karim, Mohammad Ehsanul; Evans, Charity; Kingwell, Elaine; van der Kop, Mia L; Oger, Joel; Gustafson, Paul; Petkau, John; Tremlett, Helen
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
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
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.
along the possible axes of oppression. The main emphasis of the author's reading is, as the title suggests, the notion of motherhood in the broadest sense of the .... migratory movements are also taken into account, as well as the multiplicity of feminisms one has to consider for such an undertaking. Ksenia Robbe, probably ...
Davis, Kathy; Carter, Simone; Myers, Elizabeth; Rocca, Nicola
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.
Ten Brug, A; Van der Putten, A A J; Penne, A; Maes, B; Vlaskamp, C
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
Zhong, Jidan; Nantes, Julia C; Holmes, Scott A; Gallant, Serge; Narayanan, Sridar; Koski, Lisa
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.
Brincks, John; Christensen, Lars Ejsing; Rehnquist, Mette Voigt; Petersen, Jesper; Sørensen, Henrik; Dalgas, Ulrik
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.
Elberling, Jesper; Gulmann, Nils; Rasmussen, Alice
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.
Cohen, J. L.; Pouwer, F; Pfennings, L E
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...
Kamstra, Aafke; van der Putten, Annette Aj; Vlaskamp, Carla
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.
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
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.
Harrison, Daniel M; Roy, Snehashis; Oh, Jiwon; Izbudak, Izlem; Pham, Dzung; Courtney, Susan; Caffo, Brian; Jones, Craig K; van Zijl, Peter; Calabresi, Peter A
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
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
D'hooghe, M. B.; Haentjens, P.; Van Remoortel, A.; De Keyser, J.; Nagels, G.
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
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
Nantes, Julia C; Proulx, Sébastien; Zhong, Jidan; Holmes, Scott A; Narayanan, Sridar; Brown, Robert A; Hoge, Richard D; Koski, Lisa
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
Waninge, A.; Rook, R. A.; Dijkhuizen, A.; Gielen, E.; van der Schans, C. P.
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…
Waninge, A.; Rook, R.A.; Dijkhuizen, A.; Gielen, E.; van der Schans, C.P.
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
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
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
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
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…
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.
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
Gomaa, Omema Mostafa Kamel
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=…
Eissa, Mourad Ali; Mostafa, Amaal Ahmed
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…
ten Brug, Annet
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
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
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…
Poppes, P.; Putten, van der Annette; Post, W.; Frans, N.; ten Brug, A.; van Es, A.; Vlaskamp, C.
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
DiCarlo, Cynthia F.; Reid, Dennis H.; Stricklin, Sarintha B.
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…
Poppes, P.; van der Putten, A.; Post, W.; Frans, N.; ten Brug, A.; van Es, A.; Vlaskamp, C.
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…
Shih, Ching-Hsiang; Shih, Ching-Tien; Chiang, Ming-Shan
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…
Kamstra, Aafke; van der Putten, Annette; Vlaskamp, Carla
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
Shih, Ching-Hsiang; Chang, Man-Ling; Shih, Ching-Tien
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…
Ten Brug, Annet; Munde, Vera S.; van der Putten, Annette A. J.; Vlaskamp, Carla
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
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.
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
Ten Brug, Annet; Munde, Vera S.; van der Putten, Annette A.J.; Vlaskamp, Carla
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…
Lazzarino, Giacomo; Amorini, Angela M; Petzold, Axel; Gasperini, Claudio; Ruggieri, Serena; Quartuccio, Maria Esmeralda; Lazzarino, Giuseppe; Di Stasio, Enrico; Tavazzi, Barbara
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.
Vercellino, Marco; Fenoglio, Chiara; Galimberti, Daniela; Mattioda, Alessandra; Chiavazza, Carlotta; Binello, Eleonora; Pinessi, Lorenzo; Giobbe, Dario; Scarpini, Elio; Cavalla, Paola
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.
Sambo, Nicola; Secondini, Marco; Andriolli, Nicola
stochastic characteristics. Moreover, PMD depends on time-variant factors, such as the temperature and the fiber stress. When implementing a dynamic GMPLS-controlled transparent optical network, the GMPLS protocol suite must take into account physical impairment information in order to establish lightpaths......In transparent optical networks, the signal transmission is degraded by optical layer physical impairments. Therefore, lightpaths may be blocked due to unacceptable quality of transmission (QoT). Among physical impairments, polarization mode dispersion (PMD) is a detrimental effect which has...... that PTC scheme significantly reduces the lightpath blocking probability with respect to the classical scheme. Moreover, PTC demonstrates that, by considering PMD temporal correlation, the transparency domain size can be increased, since paths that would be rejected by a classical model can be actually...
Zeqiraj, Kamber; Kruja, Jera; Kabashi, Serbeze; Muçaj, Sefedin
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).
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino
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.
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
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.
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
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.
Nogueira, Leandro Alberto Calazans; Santos, Luciano Teixeira Dos; Sabino, Pollyane Galinari; Alvarenga, Regina Maria Papais; Thuler, Luiz Claudio Santos
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.
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.
Mathias, Kaaren; Pant, Hira; Marella, Manjula; Singh, Lawrence; Murthy, Gvs; Grills, Nathan
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
Murray, Christopher; Doren, Bonnie; Gau, Jeff M.; Zvoch, Keith; Seeley, John R.
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.,…
Chen, Chen; Zhuge, Qunbi; Plant, David V
This paper presents a new channel estimation/equalization algorithm for coherent OFDM (CO-OFDM) digital receivers, which enables the elimination of the cyclic prefix (CP) for OFDM transmission. We term this new system as the zero-guard-interval (ZGI)-CO-OFDM. ZGI-CO-OFDM employs an overlapped frequency-domain equalizer (OFDE) to compensate both chromatic dispersion (CD) and polarization mode dispersion (PMD) before the OFDM demodulation. Despite the zero CP overhead, ZGI-CO-OFDM demonstrates a superior PMD tolerance than the previous reduced-GI (RGI)-CO-OFDM, which is verified under several different PMD conditions. Additionally, ZGI-CO-OFDM can improve the channel estimation accuracy under high PMD conditions by using a larger intra-symbol frequency-averaging (ISFA) length as compared to RGI-CO-OFDM. ZGI-CO-OFDM also enables the use of ever smaller fast Fourier transform (FFT) sizes (i.e. OFDM. We show that ZGI-CO-OFDM requires reasonably small additional computation effort (~13.6%) compared to RGI-CO-OFDM for 112-Gb/s transmission over a 1600-km dispersion-uncompensated optical link. © 2011 Optical Society of America
Goldbart, Juliet; Chadwick, Darren; Buell, Susan
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.
Edwards, Thomas; Pilutti, Lara A
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
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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
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.
Zhang, Y; Metz, L M; Yong, V W; Mitchell, J R
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.
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.
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
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.
Gian C. Navarro Chumbes
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.
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
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
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
Helps, Dawn H.; Herzberg, Tina S.
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…
Bekkema, N.; Veer, A.J.E. de; Hertogh, C.M.P.M.; Francke, A.L.
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.
Gibbs, Anna S.; Hinton, Vanessa M.; Flores, Margaret M.
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…
Blanco, Román; Pérez-Rico, Consuelo; Puertas-Muñoz, Inmaculada; Ayuso-Peralta, Lucía; Boquete, Luciano; Arévalo-Serrano, Juan
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.
Li, Xiang; Alphones, Arokiaswami; Zhong, Wen-De; Yu, Changyuan
We investigate the polarization-mode dispersion (PMD) effect of zero padding OFDM (ZP-OFDM) in direct-detection optical orthogonal frequency division multiplexing (DDO-OFDM) systems. We first study the conventional equalization method for ZP-OFDM. Then an equalization method based on sorted QR decomposition is proposed to further improve the performance. It is found that the performance improvement of ZP-OFDM is due to the frequency domain oversampling (FDO) induced inter-carrier interference (ICI). Numerical simulation results show that compared with cyclic prefix OFDM (CP-OFDM), ZP-OFDM has a significantly higher tolerance to PMD in DDO-OFDM systems when the channel spectral nulls occur at certain differential group delay (DGD) values.
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
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
Full text: The team of Indian scientists from Calcutta's Variable Energy Cyclotron Centre, Bhubaneswar Institute of Physics, Panjab (Chandigarh), Rajasthan (Jaipur) and Jammu in collaboration with GSI Darmstadt have contributed a large and highly granular preshower photon multiplicity detector (PMD) for the WA98 experiment at the CERN SPS proton synchrotron. This experiment studies high energy collisions of lead ions and will measure both charged particle and photon multiplicity in a large overlap region. The motivation for measuring photon multiplicity in ultra-relativistic heavy ion collisions stems from theoretical predictions of changes in the relative production of photons and charged particles in the phase transition of hadronic matter to quarkgluon plasma and its subsequent hadronization. The photon multiplicity detector consists of a matrix of scintillator pads placed in light-tight boxes and mounted behind the lead converter plates. The light from the scintillator pads is transported to the readout system using wavelength shifting (WLS) fibres. Developing on the team's earlier experience with a smaller version for the WA93 experiment (September 1991, page 16), several modifications were incorporated to improve light collection and transport. Use of improved WLS fibres, short WLS pieces to minimize self-absorption, and thermal splicing with long clear fibres were some of the important changes incorporated. Tests showed signficantly improved light collection. The scintillator pads were fabricated at all the five collaborating centres in India and the complicated assembly in the detector box modules carried out at the Variable Energy Cyclotron Centre, Calcutta. More than 400 lead converter plates were machined in Calcutta to rigorous tolerances of 0.2 mm. The assembled detector box modules and lead plates were shipped to CERN in spring 1994 for tests and installation. The WA98 PMD consists of over 50,000 scintillator pads of sizes varying from 15 to
Full text: The team of Indian scientists from Calcutta's Variable Energy Cyclotron Centre, Bhubaneswar Institute of Physics, Panjab (Chandigarh), Rajasthan (Jaipur) and Jammu in collaboration with GSI Darmstadt have contributed a large and highly granular preshower photon multiplicity detector (PMD) for the WA98 experiment at the CERN SPS proton synchrotron. This experiment studies high energy collisions of lead ions and will measure both charged particle and photon multiplicity in a large overlap region. The motivation for measuring photon multiplicity in ultra-relativistic heavy ion collisions stems from theoretical predictions of changes in the relative production of photons and charged particles in the phase transition of hadronic matter to quarkgluon plasma and its subsequent hadronization. The photon multiplicity detector consists of a matrix of scintillator pads placed in light-tight boxes and mounted behind the lead converter plates. The light from the scintillator pads is transported to the readout system using wavelength shifting (WLS) fibres. Developing on the team's earlier experience with a smaller version for the WA93 experiment (September 1991, page 16), several modifications were incorporated to improve light collection and transport. Use of improved WLS fibres, short WLS pieces to minimize self-absorption, and thermal splicing with long clear fibres were some of the important changes incorporated. Tests showed signficantly improved light collection. The scintillator pads were fabricated at all the five collaborating centres in India and the complicated assembly in the detector box modules carried out at the Variable Energy Cyclotron Centre, Calcutta. More than 400 lead converter plates were machined in Calcutta to rigorous tolerances of 0.2 mm. The assembled detector box modules and lead plates were shipped to CERN in spring 1994 for tests and installation. The WA98 PMD consists of over 50,000 scintillator pads of sizes varying from 15 to 25 mm
Kulaeva, Olga A; Zhernakov, Aleksandr I; Afonin, Alexey M; Boikov, Sergei S; Sulima, Anton S; Tikhonovich, Igor A; Zhukov, Vladimir A
Pea (Pisum sativum L.) is the oldest model object of plant genetics and one of the most agriculturally important legumes in the world. Since the pea genome has not been sequenced yet, identification of genes responsible for mutant phenotypes or desirable agricultural traits is usually performed via genetic mapping followed by candidate gene search. Such mapping is best carried out using gene-based molecular markers, as it opens the possibility for exploiting genome synteny between pea and its close relative Medicago truncatula Gaertn., possessing sequenced and annotated genome. In the last 5 years, a large number of pea gene-based molecular markers have been designed and mapped owing to the rapid evolution of "next-generation sequencing" technologies. However, the access to the complete set of markers designed worldwide is limited because the data are not uniformed and therefore hard to use. The Pea Marker Database was designed to combine the information about pea markers in a form of user-friendly and practical online tool. Version 1 (PMD1) comprises information about 2484 genic markers, including their locations in linkage groups, the sequences of corresponding pea transcripts and the names of related genes in M. truncatula. Version 2 (PMD2) is an updated version comprising 15944 pea markers in the same format with several advanced features. To test the performance of the PMD, fine mapping of pea symbiotic genes Sym13 and Sym27 in linkage groups VII and V, respectively, was carried out. The results of mapping allowed us to propose the Sen1 gene (a homologue of SEN1 gene of Lotus japonicus (Regel) K. Larsen) as the best candidate gene for Sym13, and to narrow the list of possible candidate genes for Sym27 to ten, thus proving PMD to be useful for pea gene mapping and cloning. All information contained in PMD1 and PMD2 is available at www.peamarker.arriam.ru.
Elberling, Jesper; Gulmann, Nils; Rasmussen, Alice
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...
Stenager, E; Knudsen, L; Jensen, K
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...
Novakovic, A M; Thorsted, A; Schindler, E; Jönsson, S; Munafo, A; Karlsson, M O
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.
Brincks, John; Sørensen, Henrik; Dalgas, Ulrik
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...
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.
Brug, Annet Ten; Van der Putten, Annette A J; Vlaskamp, Carla
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.
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.
Axelsson, Anna Karin; Imms, Christine; Wilder, Jenny
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
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.
Bunning, K; Smith, C; Kennedy, P; Greenham, C
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
Wu, Xingchen; Hanson, Lars G.; Skimminge, Arnold Jesper Møller
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 ...
Werf, S.P. van der; Evers, A.W.M.; Jongen, P.J.H.; Bleijenberg, G.
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
Djordjevic, Ivan B; Xu, Lei; Wang, Ting
Low-density parity-check (LDPC)-coded orthogonal frequency division multiplexing (OFDM) is studied as an efficient coded modulation scheme suitable for simultaneous chromatic dispersion and polarization mode dispersion (PMD) compensation. We show that, for aggregate rate of 10 Gb/s, accumulated dispersion over 6500 km of SMF and differential group delay of 100 ps can be simultaneously compensated with penalty within 1.5 dB (with respect to the back-to-back configuration) when training sequence based channel estimation and girth-10 LDPC codes of rate 0.8 are employed.
West African Journal of Medicine Vol. ... Empyema thoracis and death occurred .... The three hospitals chosen had high admission rates and were situated in three ... negative radiological survey and .... cancer (prostrate and breast), multiple .... for multiple health outcomes. American. Journal Clinical Nutrition 2006; 84:.
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
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
Kibby, Michelle Y
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.
López-Larrosa, Silvia; González-Seijas, Rosa M; Carpenter, John S W
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.
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
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…
Axelsson, A K; Granlund, M; Wilder, J
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.
Sharif, S.; Rival; Noordin, M.Y.
Titanium alloys which are categorized as lightweight materials, poses greater strength and toughness are usually known to create major challenges during machining. Electrical discharge machining (EDM) which is very prominent amongst the non-conventional machining methods is expected to be used quite extensively in machining titanium alloys. EDM process is known to cause surface damaged layers which consists of three types of surfaces; spattered, recast and heat affected zone. This project was undertaken to study the machining performance of EDM and powder mixed dielectric-electrical discharge machining (PMD E DM) in machining Ti-6246 with respect to the surface integrity of machined surface by using copper tungsten (CuW) electrode. The machining parameters considered are voltage (V), current (I), pulse on time(T on ), interval time (T off ) and concentration of the SiC powder (C) in dielectric fluid. The respected responses investigated include surface alteration and overcut. It was found that PMD-EDM process produced less damaging effect on the surface layer of the machined surface and widened the overcut. (author)
Croft, Arthur C; Milam, Bryce; Meylor, Jade; Manning, Richard
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.
Hayward, Denyse V; Ritter, Kathryn; Mousavi, Amin; Vatanapour, Shabnam
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.
Aggarwal, M M; Baba, P V K S; Badyal, S K; Bharti, A; Bhasin, A; Bhati, A K; Bhatia, V S; Chattopadhyay, S; Dubey, A K; Dutta-Majumdar, M R; Mazumdar, K; Ganti, M S; Ghosh, P; Sen-Gupta, A; Gupta, V K; Mahapatra, D P; Mangotra, L K; Mohanty, B; Nayak, T K; Phatak, S C; Raniwala, R; Raniwala, S; Rao, N K; Sambyal, S S; Singaraju, R N; Sinha, B; Trivedi, M D; Viyogi, Y P
A preshower Photon Multiplicity Detector (PMD) is proposed to be implemented in the ALICE experiment to study event shapes and isospin fluctuations. The PMD, to be mounted on the magnet door at 6m from the vertex, has fine granularity and full azimuthal coverage in the pseudo-rapidity region 1.8
Bonzano, L; Tacchino, A; Roccatagliata, L; Sormani, M P; Mancardi, G L; Bove, M
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
Minkov, Lyubomir L; Djordjevic, Ivan B; Xu, Lei; Wang, Ting; Kueppers, Franko
Large-girth quasi-cyclic LDPC codes have been experimentally evaluated for use in PMD compensation by turbo equalization for a 10 Gb/s NRZ optical transmission system, and observing one sample per bit. Net effective coding gain improvement for girth-10, rate 0.906 code of length 11936 over maximum a posteriori probability (MAP) detector for differential group delay of 125 ps is 6.25 dB at BER of 10(-6). Girth-10 LDPC code of rate 0.8 outperforms the girth-10 code of rate 0.906 by 2.75 dB, and provides the net effective coding gain improvement of 9 dB at the same BER. It is experimentally determined that girth-10 LDPC codes of length around 15000 approach channel capacity limit within 1.25 dB.
Djordjevic, Ivan B; Xu, Lei; Wang, Ting
We present two PMD compensation schemes suitable for use in multilevel (M>or=2) block-coded modulation schemes with coherent detection. The first scheme is based on a BLAST-type polarization-interference cancellation scheme, and the second scheme is based on iterative polarization cancellation. Both schemes use the LDPC codes as channel codes. The proposed PMD compensations schemes are evaluated by employing coded-OFDM and coherent detection. When used in combination with girth-10 LDPC codes those schemes outperform polarization-time coding based OFDM by 1 dB at BER of 10(-9), and provide two times higher spectral efficiency. The proposed schemes perform comparable and are able to compensate even 1200 ps of differential group delay with negligible penalty.
Jednoróg, Katarzyna; Marchewka, Artur; Altarelli, Irene; Monzalvo Lopez, Ana Karla; van Ermingen-Marbach, Muna; Grande, Marion; Grabowska, Anna; Heim, Stefan; Ramus, Franck
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.
Velayutham, Banurekha; Kangusamy, Boopathi; Mehendale, Sanjay
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.
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...
.... 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...
... 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 ...
... 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 ...
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
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.
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...
Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Colonna, Fabio; Buonocunto, Francesca; Sacco, Valentina; Megna, Marisa; Oliva, Doretta
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…
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 &…
Ali, Emad; MacFarland, Stephanie Z.; Umbreit, John
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…
Mohsen Adib Hajbagheri
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.
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
Swanson, H L
Three theoretical models (additive, independence, maximum rule) that characterize and predict the influence of independent hemispheric resources on learning-disabled and skilled readers' simultaneous processing were tested. Predictions related to word recall performance during simultaneous encoding conditions (dichotic listening task) were made from unilateral (dichotic listening task) presentations. The maximum rule model best characterized both ability groups in that simultaneous encoding produced no better recall than unilateral presentations. While the results support the hypothesis that both ability groups use similar processes in the combining of hemispheric resources (i.e., weak/dominant processing), ability group differences do occur in the coordination of such resources.
Aleksiūnienė, Beata; Preiksaitiene, Egle; Morkūnienė, Aušra; Ambrozaitytė, Laima; Utkus, Algirdas
Many studies have shown that molecular karyotyping is an effective diagnostic tool in individuals with developmental delay/intellectual disability. We report on a de novo interstitial 1q22q23.1 microdeletion, 1.6 Mb in size, detected in a patient with short stature, microcephaly, hypoplastic corpus callosum, cleft palate, minor facial anomalies, congenital heart defect, camptodactyly of the 4-5th fingers, and intellectual disability. Chromosomal microarray analysis revealed a 1.6-Mb deletion in the 1q22q23.1 region, arr[GRCh37] 1q22q23.1(155630752_157193893)×1. Real-time PCR analysis confirmed its de novo origin. The deleted region encompasses 50 protein-coding genes, including the morbid genes APOA1BP, ARHGEF2, LAMTOR2, LMNA, NTRK1, PRCC, RIT1, SEMA4A, and YY1AP1. Although the unique phenotype observed in our patient can arise from the haploinsufficiency of the dosage-sensitive LMNA gene, the dosage imbalance of other genes implicated in the rearrangement could also contribute to the phenotype. Further studies are required for the delineation of the phenotype associated with this rare chromosomal alteration and elucidation of the critical genes for manifestation of the specific clinical features. © 2018 S. Karger AG, Basel.
Z Saberi; E Banitalebi; M Faramarzi
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 exer...
Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction.
Desideri, Lorenzo; Bizzarri, Martina; Bitelli, Claudio; Roentgen, Uta; Gelderblom, Gert-Jan; de Witte, Luc
There is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3-17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.
... below average Development way below that of peers Intelligence quotient (IQ) score below 70 on a standardized ... Social. Nutrition programs can reduce disability associated with malnutrition. Early intervention in situations involving abuse and poverty ...
... NICHD) See all related organizations Publications Problemas de aprendizaje Order NINDS Publications Patient Organizations CHADD - Children and ... NICHD) See all related organizations Publications Problemas de aprendizaje Order NINDS Publications Definition Learning disabilities are disorders ...
... books. While his friends were meeting for pickup soccer games after school, he was back home in ... sometimes thought to contribute to learning disabilities. Poor nutrition early in life also may lead to learning ...
Rask, Mette T; Rosendal, Marianne; Fenger-Grøn, Morten
Denne artikel undersøger karakteristika, sygefravær og førtidspension for patienter med multiple medicinsk uforklarede symptomer (MUS) og somatoforme lidelser og sammenligner disse med en gruppe af patienter med veldefineret fysisk sygdom. Resultaterne viser, at patienter med somatoforme lidelser...
..., postsecondary education or training, braille literacy, inclusive corporate cultures, and some characteristics of... vision loss or who have multiple disabilities (National Longitudinal Transition Study-2, 2005; Shaw, Gold... (e.g., individuals with more severe vision loss or individuals with multiple disabilities). The RRTC...
McFerran, Katrina S.; Shoemark, Helen
Students with profound intellectual disabilities disorders (IDDs) have the right to participate in educational opportunities that recognize their unique resources and needs, as do all children. Because of their specific communication challenges, positive relationships with attentive communication partners are critical for success. In fact, the power of positive relationships in schools is recognized to be connected to student well-being more broadly. This article examines the case of one young man with profound IDD and his relationship with his music therapist using a duo-ethnographic informed paradigmatic case study. Video analysis based on multi-voice perspectives is used to generate hermeneutic phenomenological findings to closely examine the relationship between a young man with profound IDD and a music therapist. The voices of four allied health researchers were also gathered to inform the authors’ construction of an informed commentary on the phenomenon. The results suggest that the essence lay in a combination of attentive, responsive and creative being with the other person over time. Four principles of musical engagement were identified in the video footage as critical to the meaningful relationships through music: the music therapist listens; the music therapist takes responsibility for structure; spontaneous initiation is sought from the young person; and the relationship is built over time. These concepts are contextualized within a discussion of student well-being that is underpinned by positive relationships and leads to students achieving their full potential within diverse school contexts. PMID:23930986
McFerran, Katrina S; Shoemark, Helen
Students with profound intellectual disabilities disorders (IDDs) have the right to participate in educational opportunities that recognize their unique resources and needs, as do all children. Because of their specific communication challenges, positive relationships with attentive communication partners are critical for success. In fact, the power of positive relationships in schools is recognized to be connected to student well-being more broadly. This article examines the case of one young man with profound IDD and his relationship with his music therapist using a duo-ethnographic informed paradigmatic case study. Video analysis based on multi-voice perspectives is used to generate hermeneutic phenomenological findings to closely examine the relationship between a young man with profound IDD and a music therapist. The voices of four allied health researchers were also gathered to inform the authors' construction of an informed commentary on the phenomenon. The results suggest that the essence lay in a combination of attentive, responsive and creative being with the other person over time. Four principles of musical engagement were identified in the video footage as critical to the meaningful relationships through music: the music therapist listens; the music therapist takes responsibility for structure; spontaneous initiation is sought from the young person; and the relationship is built over time. These concepts are contextualized within a discussion of student well-being that is underpinned by positive relationships and leads to students achieving their full potential within diverse school contexts.
Ion, D.B.; Ion, M.L.
In this paper we define a new kind of quantum entropy, namely, the nonextensivity conjugated entropy S Jθ (p,q) bar.Then we prove the optimal nonextensivity conjugated entropic uncertainty relations (ONC-EUR) as well as optimal nonextensivity conjugated entropic uncertainty bands (ONC E UB). The results of the first experimental test of ONC-EUB in the pion-nucleus scattering, obtained by using 49-sets of experimental phase shift analysis, are presented. So, strong evidences for the saturation of the PMD-SQS-optimum limit are obtained with high accuracy (confidence level > 99%) for the nonextensivities: 1/2 ≤ p ≤ 2/3 and q = p/(2p-1). (authors)
... 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 ...
Spiroergometric and Spirometric Parameters in Patients with Multiple Sclerosis: Are there any Links between these Parameters and Fatigue, Depression, Neurological Impairment, Disability, Handicap and Quality of Life in Multiple Sclerosis?
Řasová, K.; Brandejský, P.; Havrdová, E.; Zálišová, M.; Rexová, Patrícia
Roč. 11, - (2005), s. 213-221 ISSN 1352-4585 Grant - others:GA UK(CZ) 1641/2002-IV-GA UK Institutional research plan: CEZ:AV0Z10300504 Keywords : fatigue * multiple sclerosis * spirometric and spiroergometric parameters Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 2.832, year: 2005
McCullagh, Ruth; Fitzgerald, Anthony P; Murphy, Raymond P; Cooke, Grace
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.
Family-centredness of professionals who support people with profound intellectual and multiple disabilities: validation of the Dutch 'Measure of Processes of Care for Service Providers' (MPOC-SP-PIMD).
Jansen, Suzanne L G; van der Putten, Annette A J; Post, Wendy J; Vlaskamp, Carla
A Dutch version of the 'Measure of Processes of Care for Service Providers' (MPOC-SP) was developed to determine the extent to which professionals apply the principles of family-centred care in the rehabilitation of children with physical disabilities. However, no data were available on the reliability and construct validity of this instrument when it comes to supporting people with profound intellectual and multiple disabilities (PIMD). This study aimed to validate an adapted version of the Dutch MPOC-SP for assessing the family-centred behaviours of professionals who support this group (MPOC-SP-PIMD). A total of 105 professionals took part in the study. A Mokken scale analysis was conducted to determine whether the instrument satisfied the assumptions of both monotone homogeneity and double monotonicity. Loevinger's scalability coefficient (H) was used for the scalability of the entire scale and of each item separately. Rho was calculated as a measure of the internal consistency of the scales. The analyses resulted in two scales: a nine-item scale interpreted as 'Showing Interpersonal Sensitivity', with H=.39 and rho=.76, and a seven-item scale interpreted as 'Treating People Respectfully', with H=.49 and rho=.78. A validated version of the MPOC-SP-PIMD, suitable for supporting people with PIMD, consists of a subset of two scales from the original Dutch MPOC-SP. This instrument can be used to compare the family-centredness of professionals with parent's expectations and views. This information can be used in practice to match the support to the needs of the parents and family of the child with PIMD. Copyright © 2014 Elsevier Ltd. All rights reserved.
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...
This booklet uses hypothetical case examples to illustrate the definition, causal theories, and specific types of learning disabilities (LD). The cognitive and language performance of students with LD is compared to standard developmental milestones, and common approaches to the identification and education of children with LD are outlined.…
Four case studies concerning long-term psychodynamic treatment of German individuals with intellectual disabilities are presented: an aggressive young man with a mild intellectual disability; a young man with multiple disabilities with destructive behavior; a withdrawn young woman with self-destructive behavior; and a young man with autism with…
When children with profound multiple disabilities are hospitalized: A cross-sectional survey of parental burden of care, quality of life of parents and their hospitalized children, and satisfaction with family-centered care.
Seliner, Brigitte; Latal, Bea; Spirig, Rebecca
We aimed to assess parental burden of care, satisfaction with family-centered care, and quality of life (HRQoL) of parents and their hospitalized children with profound intellectual and multiple disabilities (PIMD), and determine the relationship among these factors. A cross-sectional study using printed questionnaires and qualitative questions was undertaken at a Swiss University Children's Hospital. The 117 parents (98 mothers, 19 fathers) studied indicated a substantial impact on burden of care and parental health-related quality of life. Significant correlations with the hospitalized children's well-being were rs = .408 for burden of care and rs -.368 for quality of life. Qualitative results showed parents struggling to safeguard their children and worrying most about the children's well-being. Health professionals need to be aware of parental burden and that the perception of the children's well-being and the parents' efforts determine their support needs. Easing parents' burden and fostering confidence in the hospitalized children's well-being requires coordination of care provided by advanced nurse specialists, with an institutional framework that clarifies parental collaboration. © 2016, Wiley Periodicals, Inc.
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.
Bohne-Lang, Andreas; Lang, Elke; Taube, Anke
Web-based searching is the accepted contemporary mode of retrieving relevant literature, and retrieving as many full text articles as possible is a typical prerequisite for research success. In most cases only a proportion of references will be directly accessible as digital reprints through displayed links. A large number of references, however, have to be verified in library catalogues and, depending on their availability, are accessible as print holdings or by interlibrary loan request. The problem of verifying local print holdings from an initial retrieval set of citations can be solved using Z39.50, an ANSI protocol for interactively querying library information systems. Numerous systems include Z39.50 interfaces and therefore can process Z39.50 interactive requests. However, the programmed query interaction command structure is non-intuitive and inaccessible to the average biomedical researcher. For the typical user, it is necessary to implement the protocol within a tool that hides and handles Z39.50 syntax, presenting a comfortable user interface. PMD2HD is a web tool implementing Z39.50 to provide an appropriately functional and usable interface to integrate into the typical workflow that follows an initial PubMed literature search, providing users with an immediate asset to assist in the most tedious step in literature retrieval, checking for subscription holdings against a local online catalogue. PMD2HD can facilitate literature access considerably with respect to the time and cost of manual comparisons of search results with local catalogue holdings. The example presented in this article is related to the library system and collections of the German Cancer Research Centre. However, the PMD2HD software architecture and use of common Z39.50 protocol commands allow for transfer to a broad range of scientific libraries using Z39.50-compatible library information systems.
Tung, Esther S; Flessner, Christopher A; Grant, Jon E; Keuthen, Nancy J
Limited research has investigated disability and functional impairment in trichotillomania (TTM) subjects. This study examined the relationships between hair pulling (HP) style and severity and disability while controlling for mood severity. Disability was measured in individual life areas (work, social, and family/home life) instead of as a total disability score as in previous studies. One hundred fifty three adult hair pullers completed several structured interviews and self-report instruments. HP style and severity, as well as depression, anxiety, and stress were correlated with work, social, and family/home life impairment on the Sheehan Disability Scale (SDS). Multiple regression analyses were performed to determine significant predictors of life impairment. Depressive severity was a significant predictor for all SDS life areas. In addition, interference/avoidance associated with HP was a predictor for work and social life disability. Distress from HP was a significant predictor of social and family/home life disability. Focused HP score and anxiety were significant predictors of family/home life disability. As expected, depression in hair pullers predicted disability across life domains. Avoiding work and social situations can seriously impair functioning in those life domains. Severity of distress and worry about HP may be most elevated in social situations with friends and family and thus predict impairment in those areas. Finally, since HP often occurs at home, time spent in focused hair pulling would have a greater negative impact on family and home responsibilities than social and work life. Copyright © 2014 Elsevier Inc. All rights reserved.
Experimental Autoimmune Encephalomyelitis (EAE-Induced Elevated Expression of the E1 Isoform of Methyl CpG Binding Protein 2 (MeCP2E1: Implications in Multiple Sclerosis (MS-Induced Neurological Disability and Associated Myelin Damage
Tina Khorshid Ahmad
Full Text Available Multiple sclerosis (MS is a chronic neurological disease characterized by the destruction of central nervous system (CNS myelin. At present, there is no cure for MS due to the inability to repair damaged myelin. Although the neurotrophin brain derived neurotrophic factor (BDNF has a beneficial role in myelin repair, these effects may be hampered by the over-expression of a transcriptional repressor isoform of methyl CpG binding protein 2 (MeCP2 called MeCP2E1. We hypothesize that following experimental autoimmune encephalomyelitis (EAE-induced myelin damage, the immune system induction of the pathogenic MeCP2E1 isoform hampers the myelin repair process by repressing BDNF expression. Using an EAE model of MS, we identify the temporal gene and protein expression changes of MeCP2E1, MeCP2E2 and BDNF. The expression changes of these key biological targets were then correlated with the temporal changes in neurological disability scores (NDS over the entire disease course. Our results indicate that MeCP2E1 mRNA levels are elevated in EAE animals relative to naïve control (NC and active control (AC animals during all time points of disease progression. Our results suggest that the EAE-induced elevations in MeCP2E1 expression contribute to the repressed BDNF production in the spinal cord (SC. The sub-optimal levels of BDNF result in sustained NDS and associated myelin damage throughout the entire disease course. Conversely, we observed no significant differences in the expression patterns displayed for the MeCP2E2 isoform amongst our experimental groups. However, our results demonstrate that baseline protein expression ratios between the MeCP2E1 versus MeCP2E2 isoforms in the SC are higher than those identified within the dorsal root ganglia (DRG. Thus, the DRG represents a more conducive environment than that of the SC for BDNF production and transport to the CNS to assist in myelin repair. Henceforth, the sub-optimal BDNF levels we report in the SC
Experimental Autoimmune Encephalomyelitis (EAE)-Induced Elevated Expression of the E1 Isoform of Methyl CpG Binding Protein 2 (MeCP2E1): Implications in Multiple Sclerosis (MS)-Induced Neurological Disability and Associated Myelin Damage.
Khorshid Ahmad, Tina; Zhou, Ting; AlTaweel, Khaled; Cortes, Claudia; Lillico, Ryan; Lakowski, Ted Martin; Gozda, Kiana; Namaka, Michael Peter
Multiple sclerosis (MS) is a chronic neurological disease characterized by the destruction of central nervous system (CNS) myelin. At present, there is no cure for MS due to the inability to repair damaged myelin. Although the neurotrophin brain derived neurotrophic factor (BDNF) has a beneficial role in myelin repair, these effects may be hampered by the over-expression of a transcriptional repressor isoform of methyl CpG binding protein 2 (MeCP2) called MeCP2E1. We hypothesize that following experimental autoimmune encephalomyelitis (EAE)-induced myelin damage, the immune system induction of the pathogenic MeCP2E1 isoform hampers the myelin repair process by repressing BDNF expression. Using an EAE model of MS, we identify the temporal gene and protein expression changes of MeCP2E1, MeCP2E2 and BDNF. The expression changes of these key biological targets were then correlated with the temporal changes in neurological disability scores (NDS) over the entire disease course. Our results indicate that MeCP2E1 mRNA levels are elevated in EAE animals relative to naïve control (NC) and active control (AC) animals during all time points of disease progression. Our results suggest that the EAE-induced elevations in MeCP2E1 expression contribute to the repressed BDNF production in the spinal cord (SC). The sub-optimal levels of BDNF result in sustained NDS and associated myelin damage throughout the entire disease course. Conversely, we observed no significant differences in the expression patterns displayed for the MeCP2E2 isoform amongst our experimental groups. However, our results demonstrate that baseline protein expression ratios between the MeCP2E1 versus MeCP2E2 isoforms in the SC are higher than those identified within the dorsal root ganglia (DRG). Thus, the DRG represents a more conducive environment than that of the SC for BDNF production and transport to the CNS to assist in myelin repair. Henceforth, the sub-optimal BDNF levels we report in the SC may arise
Full Text Available Developmental disabilities consist of conditions that delay or impair the physical, cognitive, and/or psychological development of children. If not intervened at the earliest, these disabilities will cause significant negative impact on multiple domains of functioning such as learning, language, self-care and capacity for independent living. Common developmental disabilities include autism spectrum disorders, intellectual disabilities, developmental delay and cerebral palsy. About one fourth of young children in developing countries are at risk for or have developmental delay or disabilities. Inadequate stimulation has significant negative impact on physical, socioemotional and cognitive development of children. Hence early scientific intervention programs are necessary in the management of children at risk for developmental delay.
Full Text Available Measuring red blood cell (RBC deformability has become important for clinical disease diagnostics. Various methods for measuring RBC deformability have been developed; however, they require costly and large instruments, long measuring time, and skilled personnel. In this study, we present a three-dimensional-printed mini-disk (3D-PMD for measuring RBC deformability to overcome the previous limitations. For a miniaturized and low-cost setup, the 3D-PMD was fabricated by a 3D printing technique, which had not yet been used for fabricating a lab-on-a-compact disk (LOCD. Using a 3D printing technique, a multi-layered fluidic channel on the mini CD could be fabricated easily. During rotation by a spinning motor, the difference of the length of compressed RBCs in the fluidic channel was measured and analysed as compressibility indices (CIs of normal and glutaraldehyde-treated hardened RBCs. The rotation speed and time were decided as 3000 rpm and 30 min, respectively, at which the difference of CI values between normal and hardened RBCs was largest (CInormal-CIhardened = 0.195.
Ways of thinking about and responding to disability have radically changed in recent decades. Traditionally, disability was regarded in terms of sin, karma, or divine punishment. More recently, disability was made a medical issue and defined in terms of shortcomings of body or mind, which had to be prevented or cured at all costs. In the late 20th century, people with disabilities worldwide became more organised and created national and international disabled people’s organisations. They succ...
Antonelli, Cristian; Mecozzi, Antonio; Shtaif, Mark; Winzer, Peter J
Modal dispersion (MD) in a multimode fiber may be considered as a generalized form of polarization mode dispersion (PMD) in single mode fibers. Using this analogy, we extend the formalism developed for PMD to characterize MD in fibers with multiple spatial modes. We introduce a MD vector defined in a D-dimensional extended Stokes space whose square length is the sum of the square group delays of the generalized principal states. For strong mode coupling, the MD vector undertakes a D-dimensional isotropic random walk, so that the distribution of its length is a chi distribution with D degrees of freedom. We also characterize the largest differential group delay, that is the difference between the delays of the fastest and the slowest principal states, and show that it too is very well approximated by a chi distribution, although in general with a smaller number of degrees of freedom. Finally, we study the spectral properties of MD in terms of the frequency autocorrelation functions of the MD vector, of the square modulus of the MD vector, and of the largest differential group delay. The analytical results are supported by extensive numerical simulations.
Full Text Available Women have suffered from drug abuse for conturies, although formal Treatment assistance for women has been recognized as important only during the past few decades. The nature and underlying reasons for women's drug abuse differ from men’s behavior in many ways. It is finally understood that research on men will not simply translate into effective solutions for women as well. Here deal with the many issues that can arise in working with disabled women suffered from drug abuse because biologically, Culturally, and socially, their experience is different from that of men and other women and key theme For this discourse is that a woman who suffered from drug abuse is first and foremost a woman. Disabled women also have specific issues that must acknowledge and incorporate into the counseling, social work and other experince, so, here review is based on more than 25 years of the collective experience and firsthand knowledge of Monique Cohen and their Counselors at The CASPAR outpatient Clinic in Cambridge, Massachusett (2000 about women with drug abuse and alcoholism. The clinic Provides omprehensive substance abuse treatment to Individuals and Families struggling with either one or multiple addictions.
Wolfe, C V
These cases represent individuals who feel they have a severe impairment and are "disabled." They have been labeled with fibromyalgia. They are truly distressed. Their symptoms, their courses, are more chronic and refractory than those of medically ill patients, and they are high users of medical services, laboratory investigations, and surgical procedures. These patients see multiple providers simultaneously and frequently switch physicians. They are difficult to care for, and they reject psychosocial factors as an influence on their symptoms. Such persons "see themselves as victims worthy of a star appearance on the Oprah Winfrey show. A sense of bitterness emerges...." Shorter, a historian, believes that fibromyalgia is "heaven-sent to doctors as a diagnostic label for pain patients who display an important neurotic component in their illness. Our culture increasingly encourages patients to conceive vague and nonspecific symptoms as evidence of real disease and to seek specialist help for them; and the rising ascendancy of the media and the breakdown of the family encourage patients to acquire the fixed belief that they have a given illness...." Regarding the finding of "disability," this is a social construct, and many authors believe it is society and the judicial system who must decide who can work. To remain objective, the physician should report the objective clinical information. Physicians need not and should not sit in judgment of the veracity of another human being.
Irene Hierro Zorrilla
Full Text Available The San Martín Scale is an instrument used to measure the quality of life of people with significant disabilities with adequate levels reliability and validity. In 2012, the San Martín Scale was administered to 85 adults with intellectual disabilities who were provided supports at Obra San Martin Foundation (Santander. In this article, we describe the results obtained at the mesosystem level, an example at the microsystem level, and future areas of work identified from the results.
Social Security Administration — The dataset includes fiscal year data for initial claims for SSA disability benefits that were referred to a state agency for a disability determination. Specific...
Hayhoe, Celia Ray; Smith, Mike, CPF
The purpose of disability income insurance is to partially replace your income if you are unable to work because of sickness or an accident. This guide reviews the types of disability insurance, important terms and concepts and employer provided benefits.
... Over a billion people, about 15% of the world's population, have some form of disability. Between 110 million ... disability. This corresponds to about 15% of the world's population. Between 110 million (2.2%) and 190 million ( ...
Shandra, Carrie L
People with disabilities in the United States experience lower levels of social integration than people without disabilities. However, less is known about the association between disability and volunteer participation-despite an extensive literature on other disparities in volunteerism. This study uses data from the 2009-2015 Volunteer Supplement of the Current Population Survey to evaluate how working-aged adults with sensory disabilities, cognitive disabilities, physical disabilities, or multiple disabilities access, participate in, and maintain volunteer roles. Net of sociodemographic characteristics, adults with disabilities are no less likely than those without disabilities to report informal volunteering, although the presence of physical and multiple disabilities negatively associates with formal volunteering. Adults with disabilities report no fewer annual hours or weeks than those without disabilities if they are formal volunteers, but the mechanism through which they initially become involved in volunteer organizations varies. People with different types of disability experience different patterns of volunteering, and the sociodemographic characteristics associated with having a disability exacerbate many of these differences. Results suggest that adults with disabilities can-and do-participate in voluntary work, but may face barriers to accessing formal volunteer roles. Copyright © 2017 Elsevier Inc. All rights reserved.
The Effect of 12 Weeks Individualized Combined Exercise Rehabilitation Training on Physiological Cost Index (PCI and Walking Speed in Patients with Multiple Sclerosis at all Levels of Physical Disability
Full Text Available Background & aim: Most research on the effects of exercise on people with MS rehabilitation exercises sclerosis (MS have been carried out on patients with low to moderate disability, but research on patients with different severity of disability (physical disability scale of zero to 10 still has to be carefully considered. The aim of this study was to investigate the effects of twelve weeks of rehabilitation exercises personalized compound exercise on physiological cost index (PCI and average speed walking in patients with MS at various levels of disability. Methods: The present research was a semi-experimental practical study. Thus among female patients admitted to the MS Association of Shahrekord city, 96 people were chosen on the basis of physical disability scores and divided into three groups. The first group consisted of less than 5/4 a total of 44 people, the second group between 5/65 and 5/6 up third of each 26 patients were then randomly assigned to an experimental group and a control group. Afterwards each group was divided randomly into an experimental group and a control group. The first group (the scale of disability less than 4.5, N= 44. The second group (the scale of disability 5 - 6.5, N=26. Also 26 patients were in the third group (the scale of disability 6.5 and above. In addition, they were divided into 6 experimental and control groups. Training programs for experimental groups were 12 weeks, three sessions per week and one hour for each session. Factors such as physiological cost index and walking speed were measured with the appropriate tools before and after training. The experimental groups of 1, 2 and 3 each did their own intervention, while the control groups received only stretching exercises. Analysis of data obtained from 96 patients studied was done using descriptive statistics and the analysis of covariance and paired comparing of the adjusted means (P<0.05. Results: A significant difference in walking
Dodiuk-Gad, R; Lerner, M; Breznitz, Z; Cohen-Barak, E; Ziv, M; Shani-Adir, A; Amichai, B; Zlotogorski, A; Shalev, S; Rozenman, D
Neuropsychiatric features and intellectual difficulties have been reported in studies of Darier's disease. Learning disabilities have never been reported or evaluated systematically in these patients. To assess the prevalence of learning disabilities in 76 patients with Darier's disease, and cognitive functioning in 19 of them. The data were collected by two methods: a questionnaire, as part of a larger study on the clinical characteristics of 76 patients; and neuropsychological measures for the assessment of learning disabilities in 19 of them. Thirty-one of the 76 patients reported learning disabilities (41%) and 56 (74%) reported a family history of learning disabilities. Significant differences were found between the 19 patients evaluated on cognitive tasks and a control group of 42 skilled learners on subtraction and multiplication tasks. Six (32%) of the 19 were identified as having reading difficulties and five (26%) exhibited low performance on the Concentration Performance Test. All patients had general cognitive ability in the average range. Findings suggest an association between Darier's disease and learning disabilities, a heretofore unreported association, pointing to the need to obtain personal and family history of such disabilities in order to refer cases of clinical concern for further study. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.
Grumstrup, Brianna; Demchak, MaryAnn
This review of literature focuses on health issues for individuals with Intellectual Disabilities (ID), Intellectual and Developmental Disabilities (IDD), and Multiple Impairments (MI). This population has two to three times higher overweight and obesity prevalence than typically developing individuals. Furthermore, they have higher risk for…
Music therapists regard music therapy as a valuable intervention for students with moderate to severe intellectual disability or multiple disabilities, but many special educators would regard it as a controversial practice, unsupported by empirical research. This paper reviews the goals and strategies used by music therapists working with students…
A person-oriented approach was used to examine the role of parenting in the associations between single learning disabilities and multiple learning disabilities and the adjustment difficulties in 8-11-year-olds. The results revealed that multiple, but not single, learning disabilities were associated with greater difficulties in emotional and…
Full Text Available This article sets out to increase awareness regarding the wide and universal significance of disability, as well as the important benefits of an Integrated Disability Management (IDM approach. The scientific basis for IDM is explored in the first place through an analysis of its relationship to the International Classification of Functioning, Disability and Health (ICF. The conceptual paradigm of the ICF shares an ideological position with the IDM approach in that they are both underpinned by dynamic and multidimensional constructions of disability, which imply equally holistic and interdisciplinary responses. The IDM approach can be applied across a diversity of human situations to provide solutions that reflect the multifaceted and widespread nature of disability. The IDM approach is intended as a strategy capable of handling: inclusion of people with disabilities, active aging of human resources, health and safety in the workplace, prevention of disabilities and various diseases, return-to-work, absenteeism, and presenteeism.
Full Text Available Ways of thinking about and responding to disability have radically changed in recent decades. Traditionally, disability was regarded in terms of sin, karma, or divine punishment. More recently, disability was made a medical issue and defined in terms of shortcomings of body or mind, which had to be prevented or cured at all costs. In the late 20th century, people with disabilities worldwide became more organised and created national and international disabled people’s organisations. They successfully demanded that disability be seen as a matter of equal opportunities and human rights, a shift which has now been described in the United Nations Convention on the Rights of Persons with Disabilities. This is a global treaty which has so far been signed by 155 states and passed into law by 127.
... Collection (Disability Benefits Questionnaires--Group 3) Activity Under OMB Review AGENCY: Veterans Benefits... Questionnaire, VA Form 21-0960C-5. b. Headaches (Including Migraine Headaches), Disability Benefits Questionnaire, VA Form 21-0960C-8. c. Multiple Sclerosis (MS), Disability Benefits Questionnaire, VA Form 21...
Research has generally amalgamated minority ethnic (all called "Asian" or "black") disabled young people's experiences and failed to acknowledge the multiple aspects of Asian and black disabled identities, for example how the combined attributes of race, ethnicity, religion, gender, culture, class and disability shape their…
Banks, Martha E.
This article is an application of the "Guidelines for Psychological Practice with Girls and Women" to psychological issues faced by Women with Disabilities. It includes culture-specific issues faced by Women with Disabilities, the multiple roles of Women with Disabilities, the importance of informal support systems, and the intersection between…
Morningstar, Mary E.; Kurth, Jennifer A.; Johnson, Paul E.
Using the least restrictive environments (LRE) data from annual "Reports to Congress," this study examined national trends in placement between 2000 and 2014 for school-aged students considered to have significant disabilities from among the categories of autism (ASD), intellectual disability (ID), multiple disabilities (MD), and…
 Oral findings in patients with NS include a high arched palate ... the atypical dental anomalies such as multiple unerupted permanent ... clinical features in a child with NS. .... Disabilities, Centers for Disease Control and Prevention (CDC).
Platt, Jennifer M.; Janeczko, Donna
This article presents adaptations for teaching art to students with disabilities. Various techniques, methods, and materials are described by category of disability, including students with mental disabilities, visual impairments, hearing impairments, learning disabilities, emotional disabilities, and physical disabilities. (JDD)
Feb 14, 2015 ... This article presents an exemplary case study of an Independent Business Owner (IBO) from multiple case studies on narratives of differently abled persons. The aim of this article is to illustrate mainstreaming disability through an exemplary case of the IBO. The article is informed by the imperatives of ...
Brooks, Tony; Petersson, Eva; Hasselblad, Stefan
This paper reflects upon a case study where exploration, play and empowerment in interactive therapy sessions with audio and visual stimuli resulted in achievement, self-esteem and a shared pride between a young adult with profound and multiple learning disabilities (PMLD), his mother...... and the special teacher that conducted the sessions. Following the gift to the mother of a video recording that depicted the young adult’s progress as a result of the sessions it was found that upon viewing he was able to recognize himself and associate to his activities. Further, when watching alongside his...
Laditka, James N.; Laditka, Sarah B.
The United States workforce is aging. At the same time more people have chronic conditions, for longer periods. Given these trends the importance of work disability, physical or nervous problems that limit a person’s type or amount of work, is increasing. No research has examined transitions among multiple levels of work disability, recovery from work disability, or trends. Limited research has focused on work disability among African Americans and Hispanics, or separately for women and men. ...
This study examines the relative risk for suicide attempts (SA) among high-school students self-identifying with one or more disability classifications (nine); assesses the extent to which youth with disabilities are disproportionately vulnerable to risk factors that predict suicidal behavior among all adolescents; and explores whether disability status adds to risk for SA after accounting for a comprehensive set of known risk and protective factors for SA. Analyses using Wisconsin's 2012 Dane County Youth Assessment Survey data found that youth in each disability category were 3-9 times more likely to report suicide attempt(s) relative to peers, and the endorsement of multiple disabilities tripled the risk SA relative to youth reporting a single disability. Some disability sub-groups, including youth reporting autism spectrum disorder, hearing, and vision impairments reported surprisingly high rates of SA. While youth with disabilities reported disproportionate exposure to adversity in every life domain examined, similar to youth reporting SA, disability status added unique risk for suicidal behavior. This suggests that disability may be a 'fundamental cause' of suicidal behavior, a question that requires further investigation.
Kandasamy, Niro; Soldatic, Karen; Samararatne, Dinesha
This article draws on grounded qualitative research with rural Tamil women who acquired a disability during the civil war in Sri Lanka and conceptualizes an intersectionality-peace framework. Three main themes were developed from the interviews: narratives of conflict, survival outcomes of social assistance and mobilization of cross-ethnic relationships. With the support of a local women's disability advocacy organization, Tamil women with disabilities were enabled to overcome social stigma and claim a positive identity as women with disabilities. The organization's focus on realizing disability rights created new opportunities for these highly marginalized rural women. The women were also supported to form cross-ethnic relationships with women who similarly faced multiple oppressions. These relationships transformed the women into 'agents of peace', using their newfound disability identity to foster cross-ethnic dialogue and create safe spaces in the post-conflict context.
Dai, Jin-fang; Wang, Sheng-yong; Wang, Chang; Zhao, Guo-xiang; Dong, Xiao-mei
To describe and analyze the prevalence and epidemiological features of people with disability caused by injury in the Chinese population, and to provide scientific basis for developing the prevention and control programs on injuries. Statistics and intervention measures were used to analyze the data from the Second China National Sample Survey on injury-caused Disability. Cluster analysis was used to analyze the differences in regions. The overall prevalence of disability caused by injury was 99.68/10 000 which occupied 15.59% of all the disability, with multiple disability excluded. Physical disability and hearing disability accounted for 65.59% and 23.35% of all the injury-caused disability respectively, while those ranked Grade IV and III making up the majority (55.14% and 25.83%) of the disability, respectively. There were significant differences in the distribution of injury-caused disability among different age groups (χ(2) = 23 106.14, P Problems discovered by injury-caused disability in the Chinese population should not be ignored. Both physical and hearing disabilities appeared to be the two main types of disability while age, gender and region were related to injury-caused disability. Targeted strategies should be developed to decrease the injury-caused disability in China.
Kjeldsen, Lena; Amby, Finn
Danish governments have continuously proclaimed goals of raising the employment rate for people with disabilities, most recently in the publication “10 goal for social mobility” (Government 2016). In spite of this, the employment rate for people with disabilities has been more than 30 percent less...... than that of people without disabilities for more than a decade (Larsen & Høgelund 2015). An explanation of this difference could be the limited connection between these general goals, the employment laws and the actual implementation of the goals in the job centers (Amby 2015). Earlier Danish studies...... have by large focused on employment and disability at the stage where the client already has been categorized as having a disability (e.g. Møller & Stone 2013). This study offers new insight to the field in a Danish context by exploring the process in which people with disabilities are categorized...
Cremer, Helmuth; Lozachmeur, Jean-Marie; Pestieau, Pierre
This Paper studies the design of retirement and disability policies. It illustrates the often observed exit from the labour force of healthy workers through disability insurance schemes. Two types of individuals, disabled and leisure-prone ones, have the same disutility for labour and cannot be distinguished. They are not, however, counted in the same way in social welfare. Benefits depend on retirement age and on the (reported) health status. We determine first- and second-best optimal benef...
For the theoretical part of this master's thesis foreign literature and finished foreign researches were studied. In this part of the thesis the characteristics of mothers with intellectual disabilities; factors, which influence the success of carrying out their mother role; and the rights of people with intellectual disabilities as parents, all based on Slovene legislation are included. We listed reasons for limiting reproduction for women with intellectual disabilities and issues concerning...
Krause, N; Lynch, J; Kaplan, G A; Cohen, R D; Goldberg, D E; Salonen, J T
Disability retirement may increase as the work force ages, but there is little information on factors associated with retirement because of disability. This is the first prospective population-based study of predictors of disability retirement including information on workplace, socioeconomic, behavioral, and health-related factors. The subjects were 1038 Finnish men who were enrolled in the Kuopio Ischemic Heart Disease Risk Factor Study, who were 42, 48, 54, or 60 years of age at the beginning of the study, and who participated in a 4-year follow-up medical examination. Various job characteristics predicted disability retirement. Heavy work, work in uncomfortable positions, long workhours, noise at work, physical job strain, musculoskeletal strain, repetitive or continuous muscle strain, mental job strain, and job dissatisfaction were all significantly associated with the incidence of disability retirement. The ability to communicate with fellow workers and social support from supervisors tended to reduce the risk of disability retirement. The relationships persisted after control for socioeconomic factors, prevalent disease, and health behavior, which were also associated with disability retirement. The strong associations found between workplace factors and the incidence of disability retirement link the problem of disability retirement to the problem of poor work conditions.
Durocher, Joan; Lord, Janet; Defranco, Allison
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.
Lykke Hindhede, Anette
Using disability theory as a framework and social science theories of identity to strengthen the arguments, this paper explores empirically how working-age adults confront the medical diagnosis of hearing impairment. For most participants hearing impairment threatens the stability of social...... interaction and the construction of hearing disabled identities is seen as shaped in the interaction with the hearing impaired person‟s surroundings. In order to overcome the potential stigmatisation the „passing‟ as normal becomes predominant. For many the diagnosis provokes radical redefinitions of the self....... The discursively produced categorisation and subjectivity of senescence mean that rehabilitation technologies such as hearing aids identify a particular life-style (disabled) which determines their social significance. Thus wearing a hearing aid works against the contemporary attempt to create socially ideal...
Horner-Johnson, Willi; Dobbertin, Konrad
People with disabilities experience barriers to dental care, which may vary depending on type of disability and disability complexity (e.g., impact on activities of daily living). The purpose of this study was to examine differences in dental insurance, receipt of dental checkups, and delayed and unmet needs for dental care by type and complexity of disability. We conducted cross-sectional analysis of 2002-2011 data from the Medical Expenditure Panel Survey. Multivariable logistic regression analyses compared adults ages 18-64 in five disability type groups (physical, cognitive, vision, hearing, or multiple disabilities) to those with no disabilities, and compared people with complex activity limitations to those without complex limitations. All disability types except hearing had significantly higher adjusted odds of being without dental insurance, as did people with complex activity limitations. All disability groups except those with cognitive disabilities had increased odds of receiving dental checkups less than once a year. Similarly, all disability groups were at increased risk of both delayed and unmet needs for dental care. Odds ratios were generally highest for people with multiple types of disabilities. There are significant disparities in having dental insurance and receiving dental care for adults with disabilities, especially those with multiple types of disabilities, after controlling for socioeconomic and demographic differences. Further, disparities in care were apparent even when controlling for presence of dental insurance. © 2016 American Association of Public Health Dentistry.
US Department of Education, 2007
Business is about productivity and maintaining a competitive advantage. To do this, business needs qualified workers. Hiring people with disabilities adds value to a business and will attract new customers. Disability is not inability. Employers can make sound business decisions and gain a competitive advantage by using this guide to increase the…
Salter, Erica K
From growth attenuation therapy for severely developmentally disabled children to the post-natal management of infants with trisomy 13 and 18, pediatric treatment decisions regularly involve assessments of the probability and severity of a child's disability. Because these decisions are almost always made by surrogate decision-makers (parents and caregivers) and because these decision-makers must often make decisions based on both prognostic guesses and potentially biased quality of life judgments, they are among the most ethically complex in pediatric care. As the introduction to HEC Forum's special thematic issue on Childhood and Disability, this article orients the reader to the history of bioethics' relationship to both pediatric ethics and disability studies and introduces the issue's five manuscripts. As clinicians, disability scholars, philosophers and clinical ethicists writing on various aspects of pediatric disability, the articles' authors all invite readers to dig beneath an overly-simplified version of what disability might mean to children and families and instead embrace a posture of genuine humility, recognizing both the limits and harms of traditional medical and bioethical responses (or indifferences) to the disabled child.
Dwyer, Kevin P.
This report discusses disciplining children with disabilities in schools, in the context of the legal requirements of the Individuals with Disabilities Education Act. Practical concepts are explained in terms of the school's responsibility to: (1) maintain a safe environment; (2) teach a code of discipline to all students; (3) use the…
Bogdan, Robert; And Others
From the early nineteenth century to the present, horror, gangster, and adventure films, television, the comics, and newspapers have shown physical and mental disabilities to connote murder, violence, and danger. Such false portrayals have promoted negative public attitudes toward people with disabilities. (Author/MJL)
Brown, S E
People with disabilities have, for the most part, failed to identify with each other as a group. This has been detrimental because it has built a sense of isolation when a camaraderie based upon existing commonalities could have been developed. During the past ten to twenty years, there has been a great deal of discussion about appropriate language to use when discussing disability issues. This discussion has been a part of a larger debate concerning the existence of a disability culture. I believe that there is indeed a disability culture and I am a proponent of identifying and passing on stories which contribute to that culture. I have chosen to use mythology to convey this message and have begun with a focus on heroes - people who do something out of the ordinary. It is contended that almost all people with disabilities have performed heroic activities because of the pervasive discrimination encountered by each individual with a disability. Creating a disability mythology is an attempt to recognize and promote heroes within the disabled community and to advocate the importance of telling other people how positive change has occurred through instances of individual heroism.
State Employees Division of Senior and Disabilities Services DHSS State of Alaska Home Divisions and ; Assistance Senior Benefits Program Medicare Substance Abuse Treatment Alaska Tribal Child Welfare Compact ; Senior and Disabilities Services Page Content Director Duane Mayes photo image. Duane Mayes Director
Anderson, David W.
People often hold stereotypical notions about disability, assuming people with significant disabilities offer little in terms of friendship or contribution. Some are even repulsed by that person's physical appearance. Such responses, evident within the Christian community as well, fail to acknowledge the inherent worth of the person as created in…
Aug 20, 2011 ... Africa Vision 525 Initiative, Abuja, Nigeria. ... various historical continua anchored on social engineering by colonial officials who sought to .... translated into the kind of struggle for independence that the American colonies ... detained, while their opposition party, the Kenya Peoples Union (KPU), was.
Oct 15, 2013 ... what Mamdani (1996: 9) calls 'history by analogy'. .... people into positions of power, and allowed less room for the .... establishment of an enduring set of political institutions that ... Writing in the state-owned Saturday Vision newspaper, senior ...... billion shillings (500 million US dollars) as of 2008.
the MPV decrease into consideration along with the White Blood Cell Count elevation would be beneficial in patients with ... children is still problematic. ... complete blood count was studied using horiba ABX. Pentra DX 120 automatic blood count device in two ... was analyzed, there was a linear relationship between.
1, diet-2, diet-3) fed to wild caught lungfish fingerlings reared in indoor tanks for ... gradually accepted sinking pellets, and marginal increases in average body .... under 6 hr of light with an 18 hr dark photo ..... Asian sea bass, Latescalcarifer.
.1. In arguing that the poet .... sion by appealing to his memory of the homeland in his exploration. The simultane- .... a good deal of all the colours of Nigeria when you come to Lagos (…) Let me concede the point straight ...
Jul 10, 2007 ... He writes: '[t]he discovery that mythical thinking has a different func- .... thoughts accumulate and grow if they are constantly undone by the lack of .... I have found Africa's Quest for a Philosophy of Decolonization a rich.
14 oct. 2013 ... positively linked to labour (payroll costs) or assets variables vary in .... en termes de compétitivité financière est manifestement plus large et ...... Nagle, T.T. et Holden, R. K., 1995, « The strategy and tactics of pricing », Prentice.
Mar 2, 2009 ... communal objectives, and the optimization of another web of social interactions. ... instance the authors Michael Crichton, V. S. Naipaul and John le Carré, ... Yet, if the interior was not empty, practice lagged behind theory.
The microbial quality of drinking water in Manonyane community: Maseru District ... Total coliform and Escherichia coli were above the permissible limits of the World Health Organization drinking water ... household drinking water where disinfection is not available. ..... sources elsewhere show that surface drinking water.
Jun 18, 2008 ... Currently at the Department of Economics, University of Botswana. .... export oriented strategy which requires production of quality goods for ex- port at low prices. .... Regarding the impact of globalisation on industrial development, Bot- .... Zambia', MA Dissertation, University of Botswana, Gaborone.
2 Metodología. Iniciaremos nuestro estudio con un breve repaso histórico para establecer cómo y ... lenguas nacionales de la península, que aumentaban rápidamente en importancia, habladas y .... matemáticas en la cual las operaciones ...
Islamic Studies,” was among a handful of scholars who devoted much of his ... transformed by Willemse with the assistance of Dangor into this book under review, ..... the Harvard referencing system, the one that Davids used for the thesis, not ...
approvisionnement des aliments des ovins présents sur les marchés à bétail dans la ville d'Abidjan. Elle a été réalisée à partir d'enquêtes et d'inventaires floristiques effectués sur les marchés à bétail. Il ressort de cette étude que les fourrages ...
and guardians to access loans for fees in good time; parents and guardians ... Having said this though, we realize that often communication breakdowns occur .... Most learners feel that finding out information for themselves is time consuming ... themselves and the cross cultural challenges they are bound to face in and.
Aug 10, 2011 ... Though public investment in education may be gender-neutral, parental ... the concept of social capital has a long intellectual history in the social ... retention of students within the primary sector in Côte d'Ivoire and Gambia,.
Jun 2, 2007 ... la Culture (National Week of Culture), the Pan-African Film Festival of Ouagadougou .... This Academy offered courses in fine art, music, ..... their customers, initially exclusively made up of expatriates and tourists, tend to.
dehydrogenase, creatinine, urea and alanine aminotransferase were observed in untreated diabetic rats. Also, untreated diabetic rats had significantly (p<0.05) elevated urinary glucose and protein and, lowered .... 12-h light–dark cycle.
Oct 15, 2013 ... change in the culture of migration if, over time, the benefits of education ... Mais de retour chez eux, ils ont eu du mal à trouver un emploi du fait ..... were not renewed while in others the response to the gold crisis was closing.
Oct 19, 2011 ... Abstract. This article reviews select principal literature on traditional religion and ... Shoko: Shona Traditional Religion and Medical Practices ..... the subject of African traditional religion and healing has attracted little attention.
May 16, 2017 ... services in some African sub-regions, which affect the benefits that ... defining the concept, scholars usually differentiate between regional .... Although regional integration is imperative for Africa, it is not at any cost. ...... appropriate police and service delivery ... tion for all, combating of HIV/AIDS and other.
odds ratio 1.69, 95% CI 1.31-2.20, p<0.001) and be faithful in marriage (odds ratio 1.69, 95% CI 1.11-2.57, p=0.012). Respondents without Sujda were more likely to have ever taken alcohol before ..... program managers and decision makers.
Department of Physiotherapy, Bayero University, Kano, Nigeria. Abstract. Background: Data on ... responsible for those movements that we take for granted such as smiling, .... people are right handed 17, making use of the body which could ...
1Université des Sciences et Techniques de Masuku (USTM) ; Unité de Recherche Agrobiologie, Laboratoire de Phytopathologie, B.P. 901 ; Franceville, ... comme médicament en pharmacopée (anti- scorbut, antiseptique, digestif, purgatif, ... déterminée par la mesure du diamètre moyen. (dans 2 directions perpendiculaires) ...
সীমিত হােৱাত ই পূব-পশ্চিম দিশৰ ফালে বিস্তৃত হৈছে আৰু ফলত মাটি দাম বৃদ্ধি হৈছে। মাটিৰ এনে মূল্য বৃদ্ধিৰ. ফলত খেতিয়কসকলে মধ্যভােগীসকলক মাটি বিক্ৰী কৰি দিছে আৰু ...
belief forming. Thus certain beliefs ... A defective form of anger is to take one's anger out on the ..... Since David Goleman's Emotional Intelligence, a “ground breaking. New York ... he could establish sound habits from childhood. South Africa is ...
23 Jul 2008 ... In this novel memory and the importance of remembering is contemplated. ... process, often brings a sense of loss, but also contributes finding a way ... gemoeid met herinnering, met die wal gooi teen die verbygaan van tyd.
29 Jul 2010 ... geboorteplaas, moet die roman gelees word teen die agtergrond van die ontwikkeling van die plaasroman. ..... traumatic memory into narrative memory”. Die gevangenskap ..... Journal of Loss and Trauma,. 11: 321–35. Wylde ...
Jun 23, 2009 ... I would like to start by moving into one of the deeper layers of A .... In the pages you refer to I think the implosion came about in the ..... Art Spiegelman, the cartoon artist of Mouse, once said to me that, when concentrat-.
Karne ya ishirini na moja kwa kweli ni muhimu katika historia ya ulimwengu mzima. Hii ni karne ambayo imeshuhudia kuingia kwa utandawazi kwa kiwango cha juu sana ikilinganishwa na karne zingine zilizopita. Kwa hakika, utandawazi si tukio jipya ulimwenguni bali umekuwepo kwa karne nyingi japo kwa viwango vya ...
sex relations go through difficult phases in their lives as they struggle to find acceptance and fulfilment. They have to challenge, explicitly or implicitly, the sexual hegemonies within the wider society, breaking away from either a heterosexual ...
Department of Paediatrics and Child Health Makerere University, Kampala, Uganda. 2. Department of ... several times each day, often during meals, and in ..... Figure 2: The smaller patient has Nodding syndrome and is the same age as the taller adolescent who is of the ... Onchocerca volvulus in the CSF confirms our lack.
Apr 2, 2009 ... journalist, but also to focus on the creation of an African discourse in communist ... they had a large impact on people in communist Central Europe and also contributed to the creation of a particular image of the Congo. These books, together with ..... his articles and on the posters for his lectures. Parízek's ...
Oct 14, 2013 ... a form of political relationship, encouraging political conflicts and corruption in colonial and ... in the process of nation-building in Africa (Lemarchand 1972). More recent ..... as maintaining a godfather-godson relation.
Prof. Adipala Ekwamu
The saponification value of the oil was 186.28 mg KOH g-1; while the acid value was generally low (1.33 -1.95 mg KOH g-1). Iodine value ranged from 98.20 to 103.32 I2 g 100 g-1. Four major fatty acids; linoleic (39.85%), (oleic 25.74%), stearic (19.01%) and palmitic (15.40%) were found in Balanites oil. This gives a high ...
Feb 26, 2009 ... lion people, to be trapped in conflict zones according to the African. Development Bank ..... intensity conflicts since the Cold War safety valves provided by the United. States and the Soviet Union are no longer in place. These new ...... visibility on the global geo-strategic map of the United States which has.
23 juli 2008 ... Maar als het een zaak van leven of dood is, dan moeten we onze tradities laten vallen.” (Weaver 2000: 23–4). Na deze aanhaling zou de lezer kunnen denken dat er een zeker evenwicht in dit etnografische relaas werd bereikt, dat de auteur uiteindelijk het bestaansrecht van hybride vormen heeft erkend.
behaviour, community, family, and school variables5-. 8. Little information is .... computer games, talking with friends, or doing other sitting activities. ..... with the relative economic development of the countries .... Addiction Res Theory 2007;.
May 19, 2017 ... Africanism. The existence of an African identity thus provides a fitting basis .... superpowers - proved to be an effective emotive tool for rallying 'Africans' .... Africa has the largest global youthful population, a reality which makes.
Oct 15, 2013 ... is the only remaining superpower and the American president the world's most influential leader. ... The American people finally endorsed his message of change when they ..... The reality is that UN agencies such as UNESCO ... Senator Obama referred to the existence of the Guantanamo prison where.
Jul 29, 2010 ... have a tree growing in their heads, but the brain itself is much more a grass than a tree. .... point for further research or learning since Mesopotamian times. ..... frozen in its incomplete form – via the Wayback machine. .... wiki was a decision to consider a broader range of possible ways for participants to.
I gave out the questionnaires to the students of the two different Japanese language .... Thompson (1981) argues that teachers' attitude and classroom management style contribute to learners' character building that would have impact on.
May 3, 2013 ... statistics and the logistic model. The results obtained ... addition to the reduction in the cost of production. (Diamini, 1976 ... development and growth may be studied either through the ... Considering a case of only one input flow in which a current ... firm's demand curve of an input shows the quantity which it ...
19 oct. 2011 ... connaître la part des ressources qui seraient nécessaires pour extraire tous les pauvres de leur situation par le biais des transferts de liquidités parfaitement ciblés. Concrètement, la profondeur de la pauvreté permet d'évaluer les ressources nécessaires pour éradiquer la pauvreté, dans le cas d'un ciblage.
12 Jun 2006 ... benadering definieer. Maria Edgeworth (1767-1849) het byvoorbeeld na 'n realistiese uitbeelding van haar samelewing gestreef en word as 'n belangrike invloed op beide Sir Walter Scott se historiese werke en Jane Austen se sosiale romans beskou. (Albei skrywers het haar bewonder en. 03 Wessels 03.
introverted or extroverted, competitive or cooperative, independent or dependent and finally, cautious or impulsive. The best results from group exercises tend to be the result of consensus, cooperation and mutual agreement. Certain speech acts are likely to be particularly pertinent as they immediately correspond to the ...
Oct 31, 2004 ... This is what constitutes ethics and entails a sense of basic honesty in .... when they do it can be excused as ignorantes who have no business in a serious ... the tradition of William Randolph Hearst, Joseph Pulitzer, and Henry ...
Apr 7, 2007 ... businesses and industries and departed, the government bought some .... those like Maina and Meja who try to live by the moral expectations of the society .... Most importantly, though, they touch on the issue of the alienated ...
avec le moteur étant la cause la plus commune des blessures. La .... Number. Motor vehicle accident. 9. Motor bike accident. 6. Pedestrian hit by car. 3 ... seven received ICU admission (Table 3). .... injury where futile efforts at magical bullet.
Oct 10, 2003 ... Although the creation of the ECOWAS Community Court of Justice (ECJ) was approved in 1991 in pursuant to the ... to extensive personal interviews with the President of the Court, this study describes the emergence, composition, ...... national commercial disputes. In their reaction to the ECOWAS Court ...
Abstract. Background: HIV related renal disease is a common occurrence in patients with HIV infection. It is the third leading cause of end stage renal disease among African-American males between the ages of 20 and 64 years in USA. Renal function impairment has been reported at all stages of HIV infection. The aim of ...
After 12 days of incubation at 30 ± 1oC, the mycelial mats were filtered through Whatman filter paper No 42, washed with sterile distilled water thrice and churned separately in a blender/ mixer with 100 ml sterilised distilled water. The blended material of each flask, containing the mycelial bits and spores, was resuspended ...
23 Jun 2009 ... Londen: W.W. Norton & Company, 514–22,. Goodwin, Sarah Webster. 1993. Romanticism and the ghost of prostitution: Freud, Maria, and “Alice. Fell”, in Goodwin, Sarah Webster & Bronfen, Elisabeth (reds.) Death and Representation. Baltimore en Londen: The John Hopkins University Press, 152–73.
Mar 2, 2009 ... Belgian colonisers introduced the Congo to modernity as they ... years of the twentieth century, images of genocides and ruthless capitalist exploita- ..... ed to express all that, the effect that the traveler has on the living milieu rather ..... Cent ans de culture francophone en Afrique centrale (Zaïre, Rwanda et.
Saharan Africa, breast milk HIV transmission will be a rare event and the health benefits of breastfeeding for the infant and mother will be ... and in breast milk as an independent risk factor ... to all women and those who can practice exclusive.
The effect of bleeding on the quality of farmed African catfish in Uganda. M. Masette1 ... however, been done to show the effect of bleeding and ... asked to assess the quality of fish samples subjected to .... The Fish Quality Assurance rules of.
Jul 20, 2017 ... also imported hospital equipment and set up bureaucratic structures for the .... In doing so however, an effective organizational structure needs ..... taking out life insurance cover based on the belief that insuring one's life.
Jun 2, 2007 ... tions of New York”), included in the collection Poèmes pour l'Angola, there is a con- .... Barthes 1972) in his “zero space” (Manéga and/or Burkina Faso), the ... land of Uncle” (62); “Holywood (sic) stars are sitting on the ground, ...
23 juil. 2008 ... Une lecture attentive de l'œuvre d'Henri Lopes conduirait maints lecteurs .... kou qui estime que « les femmes ne doivent jamais faire des .... d'ordinaire personne ne s'attarde parce qu'ils semblent « naturels » et aller de soi ».
5 sept. 2007 ... sexuels. Il définit les valeurs et attitudes qu'une communauté ou une société ..... Hobbes estime qu'à l'état de nature, les femmes sont égales aux ..... qu'est richesse ce qui satisfait un besoin, cette fonction de satisfaction défi-.
24 Jul 2008 ... Gertie as Little Red Riding Hood is metaphorically swallowed by the fox of Christian values about women and sex. Key words: Afrikaans literature, child identity, Jeanne Goosen, Mark Behr, race, sexuality. However, Goldhagen's explanation (the tradition of eliminationist anti-Semitism which was already ...
Gene action and heritability of blast resistance in GULU-E was determined from crosses between. GULU-E as .... estimation of components of generation ... ANOVA for F1S, F2S, backcrosses & parents based on period from inoculation to.
is associated with variable degrees of liver and pancreatic damage, ... but is most severe in patients with advanced disease. Early reports .... potential haematological toxicity of ARVs and ... lipid, carbohydrate and bone metabolism need to.
impact on the clinicians' counseling for HCV positive females seeking ICSI. Key words: intracytoplasmic sperm injection, hepatitis C virus. African Health Sciences 2012; 12(1): 58 - 62. *Correspondence author: Fathi Nesrine. Faculty of Medicine. Medical Microbiology and Immunology. Khartoum square Azarita Alexandria ...
Oct 15, 2013 ... Council for the Development of Social Science Research in Africa, 2013 ... the activities of the tobacco industry network in the African region. .... result, smoking is prevalent mostly in cities and urban areas in many African ...... the ATSA has expanded to include the use of country specific case studies.
Objective: To compare the ANGPTL3 mRNA and protein expression, exon mutation and promoter district CpG island methylation state ... tissue samples (the liver, muscle (lean meat, lean) and ... ice-cold Trizol reagent (Changsha Axybio bio-tech ... To synthesize single- .... normalized, temperature-shifted, difference curves.
Prof. Adipala Ekwamu
Dry matter content of the leaves, flowers and fruit pulp ranged from. 95% in fruit pulp, to 98% in .... collected from 10 randomly selected healthy trees after natural fruit fall. ..... and physico-chemical characteristics of shea butter in Uganda.
Jun 2, 2007 ... observations, that is, to order and organize them to draw some ... Generally speaking, an institution implies recognition of a social sub-system by the .... camouflage, that is, the disappearance, imaginary loss of one's individuality, .... chological dimensions: the child is made to fight and floor the mask, follow-.
and improving N, P, Ca and Mg contentin sandy soils, and consequently support crop growth and yield, and ... management, soil moisture conservation ... improves the productivity of degraded, ... sampling corresponded to the time when.
Apr 12, 2005 ... in such accountable systems, as is the case in most developing ... interest rather than serving public interest in terms of decisions which were .... this management process lies in making water and other resources affordably ..... methods or tactics involved in managing a state or government or its organs.
Sep 15, 2016 ... paradigm shift in the processing system for the Fellowship nominations. ..... decision-making, classification, clustering and prediction methodologies are necessary. ...... nanoparticle capping agents for the preparation of water-.
2 Department of Population Studies, University of Botswana, Private Bag 00705, Gaborone, Botswana ... Methods: The study used cross-sectional data from the Botswana AIDS Impact Survey III on 1,257 men aged 15 years ... is unknown and are having sex with circumcised men. ...... Global HIV prevention working group.
Jul 10, 2007 ... and management problems listed in Table 3, like embezzlement of funds; ..... scene like a colossus, Kibaki has adopted a laissez-faire form of administra- tion. As much as this style has seen the president criticised for being ...
cholesterol (TC), high-density lipoprotein-cholesterol ... were used for TG, HDL-C and TC analysis. The .... ratio, TC: Total cholesterol, HDL-C: High density lipoprotein-cholesterol, LDL-C: Low density lipoprotein- cholesterol, TG: Triglyceride.
palm wine, a popular traditional alcoholic beverage, seriously increases in Gabon. This sweet beverage seems to be ... limits for alcoholic beverages with less than 2 µg.L-1 for cadmium, less than 10 µg.L-1 for arsenic and for .... then put in a larger plastic tube for safety transport at room temperature. It took about ten days to ...
Jun 12, 2006 ... and culture should manifest in a manner that is “compatible with our common be ... The concept of identity necessarily invokes similarity and difference. ... particular groups as this may lead to “an absolutely paralyzing cultural relativism ...... points to the importance of moral and ethical behaviour in the quest ...
Aug 20, 2011 ... current problems/opportunities and the possible solutions. .... are wheat, lucerne, tomatoes, spinach, watermelons, cabbages, groundnuts, ..... following activities: hydroponics, greenhouses, high-value crops, specialised.
The acoustic analysis includes the Pitch F0 (Hz), Formants, intensity, Jitter (%), Shimmer (dB), harmonic to noise ratio .... known that any change in the anatomical structure of the vocal tract, .... of phonation in his new mechanism of speech.
liberal globalisation, and considers why problems of African development can- not be solved ...... it served their pur- pose to define it thus, economic nationalism was good, but, once that logic ... Discourses and debates about the future of.
propaganda from the print and electronic media, propaganda that subliminally promote Western ... Innovation can also be crucial in both mercantile and social entrepreneurship to ... 3 Mary Crookston, Elementary school teacher, Arizona, USA.
Dec 17, 2012 ... The study investigated the Latchkey experiences of school-age children (5-13 years) from the ... Council for the Development of Social Science Research in Africa, 2012 ... school, but that currently, the term self care is used to refer to elementary and middle school .... attention in previous research or media.
12 Jun 2006 ... nie dwingende rede is om daarvan af wyk nie, is sekerlik nie te veel gevra nie. Myns insiens is die vernaamste rede waarom Visagie die onderhawige roman as minder vlot as Van Heerden se vorige roman ervaar en Hugo die hebbelikheid van mooiskrywery vermoed, direk in verband te bring met 'n sterk ...
7 Apr 2007 ... Verskillende mense skryf om verskillende redes en op verskillende maniere. Een rede waarom ek skryf, is om dinge vir myself te probeer interpreteer, om te besin daaroor, om dinge vas te lê. Die stroom van die lewe gaan so sterk en so vinnig verby. Deur woorde probeer ek 'n klein stroompie afkeer, ...
23 Jun 2009 ... Die gedigtitel funk- sioneer by uitnemendheid samevattend en aanvullend by die lees van die gedig. Die woord “nekra” suggereer ook nekrofilia (seks met die dode). Die koppeling en teen- oormekaarstel van die poësie en die seksuele figureer in baie van die gedigte in hierdie bundel. Die rigor mortis van ...
Dec 1, 2011 ... Council for the Development of Social Science Research in Africa, 2011 .... tapes and Video CDs, but also through live performances, movies and the .... man, now I need a gorgeous woman to live with me, to have children with .... interested in Bongo Flavour music while conducting my Ph.D. field research.
skills and experience acquired as part of an ancestral heritage 1,3,5. However, there are no scientific inquisitions and there is no peer review of the results obtained. The training is ... Use of splints and bamboo stick 4 or rattan cane or palm leaf axis3 with ... of the lack of structured training for TBS in Nigeria, it is therefore not ...
TGFâR1 or TGFâR2.2 This abnormality of the protein leads to variable clinical problems particularly affecting the skeletal, ocular, and cardiovascular systems. Nearly 50 percent of patients have to undergo aortic surgery in their lifetime resulting in reconstruction or replacement of the aortic root or total of this vessel's parts.3.
antimicrobial agents available for infections caused by these bacteria3-7. .... Folate pathway inhibitors. SXT. 92.6 .... from urinary tract infections in the year 2000. In this study, the .... infections and antibiotics sensitivity among pregnant women.
Objective: To evaluate the febrile neutropenia episodes of hematological patients and their outcomes with respect to fungal pathogens ... and undergo allogeneic hematopoietic stem cell transplantation with prior conditioning ... fungal infection, amphotericin B (conventional or liposomal, AM-B) ... Mantle-cell lymphoma. 2 (3).
in 26 (61.9%) of the trauma related cases followed by 8 (19.0%) pedestrians involved in road traffic accidents, while 30 (71.4%) .... with flaps completely covering the stump. Outcome was measured by the healing of the stumps. .... with musculoskeletal injury in our society. This may be due to their easy availability, purported ...
Departments of *Surgery, †Pathology, School of Medical Sciences, Kwame Nkrumah Univ. of Science and Technology, Private Mail. Bag, University Post Office, Kumasi, Ghana, E-Mail: firstname.lastname@example.org. Correspondence: Dr Michael Ohene-Yeboah, Department of Surgery, School of Medical Sciences, ...
tourists returning from high impact sites that may have left-over money that ... segment is able to maximize its utility by choosing the most for a given budget, while each service provider is able to maximize its revenues by capturing a marginal.
Aug 9, 2011 ... biographical trajectory and towards a reconsideration of contemporary and ... education: public spheres (the university), personal papers (the archive), and .... Ruth First, who at the time was teaching in the Department of Sociology .... and the challenges of the experiment in higher education launched in the.
Kaduna, Nigeria. Email: email@example.com. Introduction. Bleeding from the nose and nasopharynx is a common feature of diverse conditions. It may present as mild recurrent bleeds or severe life threatening emergency and posing a challenge to even a skilled otolaryngologist1. The true incidence remains unknown.
Dec 17, 2012 ... Communication and trust building in adolescent-parent interaction occurs ... of building and sustaining adolescent-parent trust is a continuum and multi- ..... and in some cases they had asked us to touch their breasts without ...
and small seed plot technologies in the Mt. Elgon zone ... of seasons and the small seed plot technology in enhancing seed potato production in the Mt. ..... De Temmerman, L., Hacour, A. and Guns, ... Kidenamariam, H.M. and Adipala, E. 2003 ...
2 maart 2009 ... The première of Claus' play Het leven en de werken van Leopold II (The Life and Works of Leopold II), .... beeld waarin de Uilenspiegelfiguur Jan van der Molen voor politieke misdaden te- ...... Nijmegen: Vantilt, 195–214.
propose research questions to generate evidence to mitigate future epidemics. Methods: A case definition for a VHF was developed. A frequency distribution of symptoms of confirmed and probable cases was done. Descriptive analyses of reported cases using simple percentages, percent distributions and computation of.
Mar 2, 2009 ... This article analyzes the “adoption plot” in colonial children's literature from the 1950s, which narrates how ... lonial criticism.1 This is unfortunate, for children's literature strongly impacts upon ..... stocking and Harry Potter.
Feb 25, 2008 ... The article concludes by exploring more successful attempts at gender transformative ..... development strategies adopted by post-colonial states that were inspired by both dependency theory and ...... Corporate Services.
Jul 10, 2007 ... mies forward on condition that poverty reduction and not accounting records is their point of ..... Since the 1980s and sequel to the financial and economic crises which ..... principal economic institutions located in Washington.
personal growth and of the knowledge of the world around him, and this will in turn ... United States International University (USIU) is a pioneer, since Spanish was ... When a Kenyan student embarks on the study of a foreign language at the ... The first major implication of studies in intercultural communication is the ...
24 Jul 2008 ... Tog is dit opvallend dat die dood in die romans sedert Karolina Ferreiratelkens in 'n persoonlike gedaante uitgebeeld word – as. Jama in Karolina Ferreira, Moira in Landskap met vroue en slang, Jan de Dood in Buller se plan, die rooikopvrou en die vrou in swart/swart vrou in Niggie en Theo Verwey in Die.
as well as the attitude they adapt influences their coping strategies with the trauma. .... event, they will get affected more severely than those on the periphery. .... emotions, memory, judgment, and social functioning suggests that negative.
Mar 6, 2012 ... Foucault objected to the idea of power as a system of total domination. He ... was the result of an anti-state struggle, and the consequence was the .... knowledge and action, and the creation of citizenship' (Bignell 2000:155).
Peltier CA, Omes C, Ndimubanzi PC et al. Validation of 2006 WHO Prediction Scores for. True HIV Infection in Children less than 18 months with a positive serological HIV test. PLoS ONE I www.plosone.org April 2009; 4. (4): I e5312. 28. Mayaux MJ, Burgard M, Teglas JP,et al. Neonatal characteristics in rapidly progressive ...
CEDRES) de ... est d'analyser la richesse des nations à la lumière de l'outil mathématique. Ainsi, dans cet ouvrage, il traite de ... Le présent papier ne revient pas sur la définition de la socioéconométrie faite lors du Colloque de ...
Dec 4, 2009 ... Basile Ndjio teaches Social and Political Anthropology at the University of Douala in. Cameroon. ..... their aptitude at building up clientelistic and patrimonial networks from the local to the national ..... 'bio-power.' As he has ...
beliefs on death and cadavers. *Charlier P, Brun L, de la Grandmaison GL, Hervé C. 1. Department of Forensic Medicine and Pathology, University Hospital R. Poincaré, Paris, France. 2. Department of Pathology, University Hospital, Parakou, Benin. 3. Department of Forensic Medicine and Pathology, University Hospital R.
Dec 17, 2012 ... Impact of Absentee Fathers on the Lives of ... et élevés dans des familles avec des parents mariés. ... especially children from divorced families and the never married. ... more time than men in work and as a result, men have increased ... groups held which lasted for two hours each and were conducted ...
It also examines the role of indigenous languages in instruction in promoting and .... differs from the country's two official languages (English and Setswana). ... The view above is tenable because it is proven that the use of the child's first .... disadvantage a Motswana whose mother tongue differs from the country's national.
ask for fax line). Cell: +2772 40 59 561. E-mail: firstname.lastname@example.org. Comments on: “Gold tailings as a source of waterborne uranium contamination of streams – The Koekemoerspruit as a case study” published in Water SA 30 (2) 219-240.
Sep 5, 2010 ... phyla, provide puzzling examples of myriad sex- determining primary signals. ..... proved that this course will become a very good motivation for the students ..... Service for National Agricultural Research (ISNAR),. Netherlands ...
9.0%) and history of polio vaccination (75.0% vs. 0.0%). No wild-type ... serious threat to polio eradication program in Nigeria. ... (GPEI) is widespread use of oral polio vaccine at ..... concerted effort should be made by the government.
Jun 12, 2006 ... Brink's representation of firstly, the ways Afrikaner men relate to ... the opinion that in the new South Africa, Afrikaner masculinity has moved “from a ... tion of white males tended to feel threatened by affirmative action and gender equal- ..... strategic responses to their perceived loss of gendered power ”.
May 2, 2011 ... Kangan since the white man left because those who make plans make plans for .... with Papa's reaction that results in the breaking of Mama's figurines. ... The action moves to the past in section two which is entitled, “Speaking ...
Dec 1, 2011 ... and mutilation and confinement of men in inhuman prisons are not lawful. Sentences of .... radicalisation may find expression in the form of violent actions or reactions. According to ... Development and technology transfer that.
at a scale never imagined and domestic rice production programmes have been largely ... The overall objective is to provide .... deserved attention on food production with the ... productivity in the region. .... maintenance of irrigation works and.
7 Apr 2007 ... Literatura afrikaans XVII–XIX wiek. Die uitgewer is Akademiese. Uitgewery Dialoog (Wydawnictwo Akademickie “Dialog”), wat in vakliteratuur oor. Asië en Afrika spesialiseer. Die eerste oplaag was 'n duisend eksemplare. Besonder aan hierdie publikasie is dat dit oorsee ontstaan het en dat die skrywer nie ...
29 Jul 2010 ... The underlying theoretical impulse provides a reading influenced by Bakhtinian notions of dialogism and the reconstruction of the circumstances in which the initial ...... Die stem van die bruinman in die Afrikaanse poësie. Ongepubliseerde M.A. verhandeling. Universiteit van Potchefstroom vir CHO.
Methods: Convenience sampling method was used to recruit 69 pregnant women aged 21-41 years with gestational age of. 0-20 weeks in ... Keywords: progesterone, oxidative stress, recurrent spontaneous abortion, trace metals, antioxidants. African Health ... spontaneous abortion in women might be related to selenium ...
12 Jun 2006 ... Ek is egter ook oer-nuuskierig en wil weet hoe dinge inmekaar steek. Ek is baie geïnteresseerd in mitologie en die misterieuse, in die universele ver- bande tussen (dikwels oënskynlik onverwante) dinge – die universal interconnect- edness of things – en Jungiaanse idees en simboliek in alle vorme ...
10 août 2011 ... Résumé. Depuis 2007, la RDC dispose d'un Parlement issu des élections libres, pluralistes .... Pour y arriver, nous avons subdivisée ce travail en deux points. .... même, les deux chambres législatives belges, le Ministère des Colonies et le .... formation de l'opinion publique nationale, élaborer des lois non.
6):101-105. 12. Culei I. Methodology for the analysis of vegetable drugs: Practical Manual on the industrial. Utilisation of Medicinal and Aromatic Plants. 1st ed. Romania: Center Building, 1982. 13. Nayak SB, Sandiford S, Maxwell A. Evaluation.
Prof. Adipala Ekwamu
greenhouse, indicating that the QTL linked to this marker is important in order to obtain high levels of resistance. Progenies from backcrosses with ... 28 plants gave a resistant phenotypic reaction. (rating<2.0), indicating an accuracy of .... 500 ml isopropanol, mixed by gentle inversion and incubated at room temperature for.
Mar 12, 2012 ... political into "rational" authority'(Habermas 2006:76). Through this principle .... public, is transmitted through aesthetic and emotional modes of communication. ..... www.parliament.gov.za/live/content.php?Item_ID=297. Poster ...
Mar 4, 2008 ... in Mauritius by first surveying the main economic challenges of Mauritius, particularly the .... local textile industry is facing fiercer competition from China. In fact China ... External events can affect the local tourism industry too.
Apr 7, 2007 ... works to the advantage of Europe and the West but to the disadvantage of Africa. .... Africans are elites produced by the colonial educational and political machinery .... of inferiority but also use the very paradigms that globalism use to construct us in ... the content of the global ICT infrastructure is in English.
Methods: This case-control study was conducted at Mulago Hospital from 1st May 2008 to 1st May 2009; 207 women were the cases and .... entered into Epi-Data 3.1 statistical software ..... Rumbold AR, Crowther CA, Haslam RR, Dekker GA,.
The peripheral blood findings and the morphological abnormalities in the bone marrow can simulate myelodysplastic syndrome, myeloproliferative disorders .... presented in table 2 of results. Table1: Distribution of participants by level of age group (N=107). Age group (years) Number of Relative frequency participants (%).
2 Jan 2009 ... bach was vanjaar die wenner van dié Prote- aprys, naamlik vir sy reeds herhaaldelik be- kroonde bundel uit 2007, Die windvanger. Die resep is nou al 'n beproefde een. Sowel gevestigde as “opkomende” digters word be- trek. Die genooide gevestigdes is hoofsaak- lik digters van wie in daardie of die ...
Dec 17, 2012 ... adult learners and 20 volunteer teachers from ten different adult literacy classes across Togo. ... in literacy classes, particularly adult women (Amenyah 2005; 2011). ... have tried to determine their outcomes or benefits and performance to ... This intentionality can vary from the very simple (one single goal).
Mar 2, 2009 ... a complete breakdown of interest in his successful career, he leaves his old life and ... things British, he has never been regarded by them as “one of us” (Le .... woman who has “a baby every year by a different man,” the .... the scheming of the Belgian companies and Hammad, trying to obtain a face of re-.
Uganda Journal of Agricultural Sciences, 2013, 14 (2): 27 - 36. ISSN 1026-0919 ... Fifty four (54) small East African goats (female = 36, male = 18), of 4-6 months and from 18 flocks, ..... management in Northern Rift Valley,. Kenya. Livestock ...
A United Nations report has pointed out that tourism in Kenya dates back to pre- ... impact sites). Secondly, given that the tourist industry is strongly influenced by transportation (access), areas without systematic and organized transport ... stages of tourism, the natural physical attributes tend to dominate the structure of.
The index case was a 33-year old male ... county. The district health office notified the Ministry of. Health of the strange illness/cluster of deaths on the 18th October 2012. Three blood samples collected from the initial cases tested positive for. Marburg at ... Parents Clinic, Ibanda Town Council where he was treated for ...
Mar 2, 2009 ... Dongala's novel Le feu des origines(The fire of origins, 1987). ..... being confronted with an extraordinary creature: a huge monster that is half-reptile, .... guity here and clearly echoes the effects of colonial violence: “the sun ...
The logistic regression model to predict neonatal mortality had a good fit (AUC: 0.8507, misclassification rate: 13.6%) ... intensive care units, principal component analysis, logistic regression, ... between cost of neonatal care and length of stay.
Department of Pediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State,. Nigeria ... Key words: microalbuminuria, obesity, hypertension, children, Nigeria ... renal disease, female students who were menstruating.
these countries, food security is precarious and hundreds of thousands in the region ... Although food insecurity in the region is often attributed to natural disasters such as recurrent droughts ..... Report of the Committee on Fast Tracking East.
examines these issues by drawing experiences from several countries across West Africa. The overall objective is to provide appropriate policy .... society, promoting security and general well- being of the people through alleviation of .... cooperatives, outlawed private commerce and established a group of state monopolies.
: Nigerians should ... puis a commencé une chimiothérapie. Dans l'évaluation clinique et neurologique du patient a été décrite avec les analyses de laboratoire de son CCA. Résultat de la manière dont il a été géré a également été rapportés.
9 nov. 2012 ... détérioration du tissu social, alors qu'apparaissent des inégalités économiques, ... Nigeria's Niger Delta and on the corporate social responsibility ...... Welfare Association (EWWA), Port-Harcourt: Uklint Media Publishers.
23 Jul 2008 ... hulle fisiese en kollektiewe identiteit en ruimte (ook deur dit self as skrywer te beleef); en die literêre ruimte waarbinne ... 'n ontleding van tekste wat deur die teikengroep self geskryf is.2 Die navorser se deel- nemende ...... Conceptualizing space: mapping schemas as meaningful representations – Indige-.
Mar 2, 2009 ... ... treatment inflicted on the natives by employees of the monopolistic ..... the concessionary company, accompanied by the Administrator, to the market once a ... came to that hotel were gamblers and they had more money that ...
Oct 19, 2011 ... Council for the Development of Social Science Research in Africa, 2011 ... masculinities within a racialized South African public sphere are played out in the ... against immigrants in South Africa caused a stir in the media, both ...
0919. Printed in ... losses in excess of 50% have been reported on ..... The variations in colour/shades over the map are used to typify disease severity .... Grey leaf spot: A disease of global importance in maize production. Plant. Disease 83: 884 ...
Toucher rectal pour les tumeurs de la prostate et du rectum: Connaissance et ... PSA, Prostate Specific Antigen; RTA, Rectal Teaching Associate; SPETA, ... ability to diagnose prostatic and rectal ..... have felt benign prostate between one.
Prof. Adipala Ekwamu
Plant biomass is a major source of energy for households in eastern Africa. Unfortunately, the heavy reliance on this form of energy is a threat to forest ecosystems and a recipe for accelerated land resource degradation. Due to the increasing scarcity of traditional fuel wood resources, rural communities have shifted to ...
and health. Key words: computers, technology, toxic wastes, conventions, environment ... has caused a dangerous explosion in electronic scrap (e-waste) containing toxic chemicals .... dollars — four times its Gross National Product, the minister of Trade and Tourism explained ..... affects the mouth, gums, and teeth. Mercury ...
rainfall less than 1800 mm year-1 and water deficits higher ... Côte d'Ivoire. Keywords : Palm-oil, extraction rate, marginal climatic zone, manual press, rainfall, bunch yield. .... Barima, 2007). Geomorphology of the study area (Barima, 2007).
Oct 17, 2005 ... The information generated by the research will assist us develop ... They responded to this threat to self or others with feelings of “intense ... what is happening” and “There are other things to watch on TV e.g. movies etc”.
Oct 17, 2005 ... and thoughts. This expression of ideas, feelings and thoughts is coded in words, .... History is full of examples of kingdoms and empires rising and .... These included marketing managers, small and medium business owners,.
Prof. Adipala Ekwamu
At about 150,000 tons of fish recorded from Lake Albert and. Albert Nile, the .... positions for fish landing sites on the Lake were plotted on ..... investment in regular monitoring to provide adequate ... Uganda Bureau of Statistics (UBOS),. 2002.
The fish stocks of Lake Albert face immense exploitation pressure which has led to “fishing- down” of their fisheries, with ... fishery monitoring and regulatory mechanism .... number of landing sites and their GPS locations ..... and effort statistics.
Jun 2, 2007 ... Pierre Guingané, a Burkinabè playwright and theatre director, and .... immunity; he can be an iconoclast without any consequences. ..... tales, it would occur to none to seek to censor the war veteran – a madman – unless,.
particularly, the Otolaryngologists worldwide1-4. Although this disease is associated with few complications nowadays, the complicated ones are still considered potentially fatal5,6. Computed Tomography (CT scan) is currently reputed to be the radiographic gold standard for the diagnosis of patients with this disease7-11.
Dec 1, 2011 ... Most Mayi-Mayi fighters are very young, often children. From ..... These changes, due to the new laws, produced inter-generational effects. In fact, the new ..... war; but this alternative seems to be moulded largely by fantasy.
Apr 7, 2007 ... I can't help giggling to myself at the thought of the final showdown in heaven between the two ... After I placed my order I decided to walk to the .... Miriam Tlali's Amandla (1980) and Mongane Serote's To Every Birth its Blood (1979). Ride on the ... hatred, low self-esteem, and inferiority complexes. Sepamla ...
Key words: Antimicrobial resistance, urinary tract infection, bacteria, nosocomial. African Health Sciences ... These UTIs are the most common bacterial infections encountered ..... trend in antimicrobial resistance of pediatric uropathogens in ...
9 août 2011 ... L'interaction entre l'économie solidaire et l'espace public suscite de plus en ..... essentiellement de l'agro-industrie, de la chimie et de la parachimie. .... Nous remarquons également l'absence de coordination entre les ...
resource constrained farmers (Omondi et al., 2001; Gichuruet ... strong influence by human activity as a result of ... management strategies before disease progress .... package (13th Edition) and Statistical. Package ..... Proceedings of the 7th.
Colletotrichum sublineolum, the causal agent of sorghum anthracnose, presents high variability, genetic instability and host specialisation, hence rapidly breaking ... revealed the presence of a population structure, (*FST = 0.08 P = 0.05) leading to acceptance of null hypothesis stating a presence of population differentiation ...
Apr 7, 2007 ... In his commitment as a visionary, BB's personality as the artist-dictator overwhelmed that ... juntas Cameroon has nurtured in the name of political leadership. Besong qualifies ... His style is considered “wild and fragmentary (a ...
Reciprocal effects were observed for all traits, except for the 50 % flowering day. The best .... analysis shows that GCA effects were highly significant ..... inheritance. CONCLUSION. Results of the study show that, combining ability and heterosis were important. Genetic variation for the characters appeared to be influenced.
ABSTRACT. BACKGROUND: Children are dependent on parents/care givers for the quality of health care services received and in developing countries, where they are not protected against child abuse; many die as a result of denial of appropriate treatment. OBJECTIVE: The objective of this study was to determine the.
Aug 9, 2011 ... Tanganyika African National Union (TANU)'s policy on 'socialism and self- ... Shortly afterwards, First wrote back to Rosenberg regarding monetary, cost- benefit ... Tanzania under the principles of socialism and self-reliance'. .... must have a market which is ready to absorb a continuously increasing.
Jul 20, 2017 ... Council for the Development of Social Science Research in Africa, 2017 ... Many organizations (WHO, World Bank, Help Age International) advocate for and ...... Reduced charges or free treatments for older people such as dental .... Apt, N., 1996, 'Coping With Old Age in a Changing Africa', Journal of Cross.