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

DEFF Research Database (Denmark)

Skjerbæk, Ag; Næsby, M; Lützen, Karin

2014-01-01

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

Growth retardation and functional disability in patients with juvenile idiopathic arthritis

International Nuclear Information System (INIS)

Saeed, S.; Zammurrad, S.; Rasheed, U.

2017-01-01

To determine the frequency of growth retardation and functional disability in patients with juvenile idiopathic arthritis (JIA). Methods: This descriptive cross sectional study was carried out at the Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad from March 2016 to December 2016. 92 patients with JIA were included in the study. Height and weight of each patient was recorded and BMI calculated. Functional Disability was determined by calculating the CHAQ Score, while disease activity was estimated through JADAS 27 score. Growth Retardation was defined as height, weight and/or BMI below the 3rd centile according to the CDC growth charts. A cut off of ?1 for CHAQ Score was used to define severe functional disability. Results: Out of 92 patients, there were 47 male (51.1%) and 45 (48.9%) females. Height, weight and BMI below 3rd centile was observed in 30(32.6%), 49(53.3%) and 41(44.6%) patients, respectively. The overall frequency of growth retardation was 64.1% (n=59) and severe functional disability (CHAQ Score ?1) was seen in 32.6% (n=30) of patients. Conclusions: Growth retardation was seen in more than half of patients with JIA and a significant proportion had severe functional disability. Severe functional disability was seen only in patients with active disease. (author)

Workshop for disabled survivors of severe head injury.

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London, P S

1973-08-18

Existing services for the disabled do not cater for the needs of lame-brain survivors of severe head injury who may be capable of productive work though they may never become employable. A grant from the Nuffield Provincial Hospitals Trust made it possible to set up in 1967 a special workshop in premises provided by the regional hospital board. The hospital management committee assumed financial responsibility for the centre after three years, and after five years the Department of Health and Social Security purchased adjoining premises, which will double the present accommodation for about 35 persons. Though 45% of the 101 patients attending the workshop have returned to work, no financial support has yet been received from the Department of Employment. A suitably staffed hostel is needed for patients who live too far away to travel daily to and from the workshop. This undertaking has shown a need for special facilities for some of the victims of severe head injury, who differ in many important ways from other disabled persons.

[Impairment and disability in patients with a severe ischemic cerebral infarction at admission to the rehabilitation center and six months after stroke].

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Prevo, A J; Dijkman, M M; Le Fèvre, F A

1998-03-21

Evaluation of impairment and disability in stroke patients with a severe cortical infarction at admission as well as six months after the stroke. Prospective and descriptive study. Rehabilitation Centre Heliomare, Wijk aan Zee, the Netherlands. Between 1 January 1987 en 31 May 1992 stroke patients were admitted to the rehabilitation centre with a severe, first ever, cortical infarction without any comorbidity. The patients were dependent in activities of daily living and wheel-chair-bound. Motor and neuropsychological impairment and disability were evaluated at admission to the rehabilitation centre as well as six months after the stroke. Return to home and length of stay were evaluated. 43 patients were included. Recovery of arm and hand function was very poor (there was complete paresis at admission in 33 patients (77%) and six months after the CVA in 25 patients (58%)); recovery of the affected leg was reasonable (complete paresis in 10 (23%) and 0 patients, respectively). Cognitive deficits diminished in severity, but remained noticeable in three-quarters of the patients. Independent walking was achieved by 30 patients (70%), independence in personal activities of daily living by 32 patients (74%) and returning home by 36 patients (84%). The mean hospital stay was 26 weeks (SD: 9.26; range: 11-30). Prognosis of personal independence and returning home after a severe cortical infarction was rather good despite poor recovery of motor and cognitive impairment.

Augmentative and alternative communication in adolescents with severe intellectual disability: a clinical experience.

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Uliano, D; Falciglia, G; Del Viscio, C; Picelli, A; Gandolfi, M; Passarella, A

2010-06-01

Augmentative and alternative communication devices proved to be effective in patients with severe intellectual disability to overcome their communication impairments. In order to give a contribution for design of augmentative and alternative communication systems that better meet the needs of beginning communicators we decided to report our clinical experience about using augmentative and alternative communication in adolescents with severe intellectual disability. Five patients who underwent a long time traditional speech rehabilitation program (at least 5 years) with scant improvements in linguistic function were recruited and evaluated by means of the Vineland Adaptive Behaviour Scale before and after a three years augmentative and alternative communication intervention carried out by a multidisciplinary team. After the rehabilitative intervention patients showed an improvement in communication, daily living skills and socialization as measured by the Vineland Adaptive Behaviour Scale. Augmentative and alternative communication is an effective rehabilitation approach to people with severe intellectual disability and impairments in linguistic expression. Moreover augmentative and alternative communication is a useful tool allowing these patients to increase their social participation also enhancing their self-esteem. Our clinical experience confirmed these topics also in adolescents who underwent a long time traditional speech rehabilitation program with scant improvements, providing practical information to clinicians.

UBE2A deficiency syndrome: Mild to severe intellectual disability accompanied by seizures, absent speech, urogenital, and skin anomalies in male patients.

NARCIS (Netherlands)

Leeuw, N. de; Bulk, S.; Green, A.; Jaeckle-Santos, L.; Baker, L.A.; Zinn, A.R.; Kleefstra, T.; Smagt, J.J. van der; Vianne Morgante, A.M.; Vries, L.B.A. de; Bokhoven, J.H.L.M. van; Brouwer, A.P.M. de

2010-01-01

We describe three patients with a comparable deletion encompassing SLC25A43, SLC25A5, CXorf56, UBE2A, NKRF, and two non-coding RNA genes, U1 and LOC100303728. Moderate to severe intellectual disability (ID), psychomotor retardation, severely impaired/absent speech, seizures, and urogenital anomalies

[Usefullness of bronchofiberscopy for difficult intubation in patients with severe motor and intellectual disabilities].

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Mizuno, Yuji; Ukaji, Koutarou

2005-11-01

In 21 patients with severe motor and intellectual disabilities, bronchofiberoptic intubation was performed because of difficulty in tracheal intubation by direct laryngoscopy. The patients ranged from 3 to 35 years old (mean age: 20.2 years). Twenty patients (95.2%) were bedridden. Among the 21 patients, 15 had cerebral palsy and 20 had hypertonia. The reason for intubation were acute respiratory failure due to pneumonia in 17 cases, suffocation after aspiration of food in 2 cases, hypovolemic shock in 1 case, and laryngotracheomalacia in 1 case. Intubation was done pernasally in 15 patients and perorally in 10. It was successful in 20 cases without any significant complications. The Cormack score ranged from 3rd degree in 4 cases to 4th in 17 cases. The 20 cases of successful fiberoptic intubation were divided into 7 patients with and 13 without tracheostomy. The mortality rate was 14.3% in patients with tracheostomy and 30.8% in those without tracheostomy. When more than 4 intubation trials were needed, there was a significantly higher mortality rate. In neurologically handicapped patients with deformity or hypertonia of the oral, cervical, or airway structures, a bronchofiberoptic procedure may be recommended when there is difficulty with intubation.

The characteristics of salivary pepsin in patients with severe motor and intellectual disabilities.

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Hashizume, Naoki; Fukahori, Suguru; Asagiri, Kimio; Ishii, Shinji; Saikusa, Nobuyuki; Higashidate, Naruki; Yoshida, Motomu; Masui, Daisuke; Sakamoto, Saki; Tanaka, Yoshiaki; Yagi, Minoru; Yamashita, Yushiro

2017-09-01

The aim of the present study was to determine the utility of measuring the salivary pepsin level (SPL) as an objective assessment of gastroesophageal reflux disease (GERD) in severe motor and intellectual disabilities (SMID) patients. This prospective study included 26 SMID patients who underwent simultaneous 24-h multichannel intraluminal impedance pH measurement (pH/MII) and SPL evaluation. The enrolled patients were divided into GERD (+) or GERD (-) groups according to the pH/MII findings. The age, gender and pH/MII parameters were compared between the two groups. A correlation analysis was also conducted for the SPL following early-morning fasting and post-enteral feeding and the age, gender, presence of gastrostomy and tracheostomy and pH/MII parameters. The SPL was compared between the two sampling groups. Fifteen patients were classified as GERD (+), and 11 patients were classified as GERD (-). The mean SPL following early-morning fasting and post-enteral feeding among all patients were 104.3 (median: 38, 25th and 75th percentile: 12, 361) ng/ml and 222.2 (median: 152:0, 500) ng/ml, respectively. Regarding positivity, 76.9% and 73.1% of SPL values in early-morning fasting and post-enteral feeding SMID patients, respectively, were positive (≧16ng/ml). The SPL following early-morning fasting demonstrated a weak but significant positive correlation with age. In contrast, we noted no correlation between the pH/MII parameters and the SPL for either the early-morning fasting or post-enteral feeding patients, and no significant difference in the SPL was observed between the GERD (+) and (-) patients. The present study showed that a high proportion of SMID patients had a relatively high SPL, regardless of the presence of GERD. The SPL in SMID patients might be affected by several distinctive factors in addition to gastroesophageal reflux. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Ancestry and Severity of Disability: A National Study.

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Wheaton, Joe E.; Hertzfeld, Jennifer

2002-01-01

Examines effects of ancestry and severity of disability of vocational rehabilitation consumers. European Americans, individuals with higher costs, and persons who received assistive technology were more likely to be closed rehabilitated. Individuals from other ancestry groups, who were coded severely disabled, or who had been in the system for…

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

Science.gov (United States)

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

2015-01-01

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

Long term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin

NARCIS (Netherlands)

Zahavi, A; Geertzen, JHB; Middel, B; Staal, M; Rietman, JS

2004-01-01

Objectives: To evaluate long term change in impairment, disability, and health related functional status in patients with severe spasticity who received intrathecal baclofen. Methods: A long term ( more than five years) observational longitudinal follow up study assessing 21 patients who received

PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES

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Sylvio Mistro Neto

2015-12-01

Full Text Available Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index, which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.

Unintentional injuries among Chinese children with different types and severity of disability.

Science.gov (United States)

Zhu, Huiping; Xiang, Huiyun; Xia, Xin; Yang, Xia; Li, Dan; Stallones, Lorann; Du, Yukai

2014-01-01

Little research has been done in China to study injury in individuals with disability. We investigated the impact of type and severity of disability on injury among children with disability in Hubei Province of China. A sample of 1201 children with disability were matched with 1201 healthy children on gender, age, and neighborhood. Disability type and severity were determined using the Chinese national standards. Caregivers were interviewed face-to-face about nonfatal unintentional injuries suffered by the child in the past 12 months before the interview. Univariate χ(2) test and logistic regression models were used to investigate association between disability type/severity and nonfatal unintentional injuries. Injury rate among children with disability was significantly higher than that among children without disability (10.2% vs. 4.4%; P disability and injury varied by type and severity of disability. The magnitude of the association between the presence or absence of disability in children and their risk of injury was large and significant, regardless of the type or severity of the children's disabilities. Copyright © 2014 Elsevier Inc. All rights reserved.

Visual Disability Among Juvenile Open-angle Glaucoma Patients.

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Gupta, Viney; Ganesan, Vaitheeswaran L; Kumar, Sandip; Chaurasia, Abadh K; Malhotra, Sumit; Gupta, Shikha

2018-04-01

Juvenile onset primary open-angle glaucoma (JOAG) unlike adult onset primary open-angle glaucoma presents with high intraocular pressure and diffuse visual field loss, which if left untreated leads to severe visual disability. The study aimed to evaluate the extent of visual disability among JOAG patients presenting to a tertiary eye care facility. Visual acuity and perimetry records of unrelated JOAG patients presenting to our Glaucoma facility were analyzed. Low vision and blindness was categorized by the WHO criteria and percentage impairment was calculated as per the guidelines provided by the American Medical Association (AMA). Fifty-two (15%) of the 348 JOAG patients were bilaterally blind at presentation and 32 (9%) had low vision according to WHO criteria. Ninety JOAG patients (26%) had a visual impairment of 75% or more. Visual disability at presentation among JOAG patients is high. This entails a huge economic burden, given their young age and associated social responsibilities.

Needs of Persons with Severe Intellectual Disabilities: A Q-Methodological Study of Clients with Severe Behavioural Disorders and Severe Intellectual Disabilities

Science.gov (United States)

Kreuger, Linda; van Exel, Job; Nieboer, Anna

2008-01-01

Background: A demand-oriented approach is becoming increasingly important in care provision. The purpose of this study was to identify the primary needs of clients with Severe Behavioural Disorders and Severe Intellectual Disabilities. Materials and Methods: We used the theory of Social Production Function and Maslow's hierarchy of needs to…

Case-control cohort study of patients' perceptions of disability in mastocytosis.

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Olivier Hermine

Full Text Available BACKGROUND: Indolent forms of mastocytosis account for more than 90% of all cases, but the types and type and severity of symptoms and their impact on the quality of life have not been well studied. We therefore performed a case-control cohort study to examine self-reported disability and impact of symptoms on the quality of life in patients with mastocytosis. METHODOLOGY/PRINCIPAL FINDINGS: In 2004, 363 mastocytosis patients and 90 controls in France were asked to rate to their overall disability (OPA score and the severity of 38 individual symptoms. The latter was used to calculate a composite score (AFIRMM score. Of the 363 respondents, 262 were part of an ongoing pathophysiological study so that the following data were available: World Health Organization classification, standard measures of physical and psychological disability, existence of the D816V KIT mutation, and serum tryptase level. The mean OPA and AFIRMM scores and the standard measures of disability indicated that most mastocytosis patients suffer from disabilities due to the disease. Surprisingly, the patient's measurable and perceived disabilities did not differ according to disease classification or presence or absence of the D816V KIT mutation or an elevated (> or = 20 ng/mL serum tryptase level. Also, 32 of the 38 AFIRMM symptoms were more common in patients than controls, but there were not substantial differences according to disease classification, presence of the D816V mutation, or the serum tryptase level. CONCLUSIONS: On the basis of these results and for the purposes of treatment, we propose that mastocytosis be first classified as aggressive or indolent and that indolent mastocytosis then be categorized according to the severity of patients' perceived symptoms and their impact on the quality of life. In addition, it appears that mastocytosis patients suffer from more symptoms and greater disability than previously thought, that mastocytosis may therefore be under

Clinical characteristics of disabling attacks at onset in patients with neuromyelitis optica spectrum disorder.

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Seok, Jin Myoung; Cho, Eun Bin; Lee, Hye Lim; Cho, Hye-Jin; Min, Ju-Hong; Lee, Kwang Ho; Kim, Byoung Joon

2016-09-15

Individual attacks of neuromyelitis optica (NMO) are generally severe enough to cause disability even after the onset attack. We aimed to elucidate the clinical characteristics of disabling attacks at the onset of NMO. We investigated the clinical characteristics at onset and at first relapse in patients with NMO or NMO spectrum disorder with seropositive for the anti-aquaporin-4 antibody. A disabling attack at onset (DAO) was defined as an onset attack in which, at best recovery (allowing up to one year), patients were unable to walk without assistance or were left functionally blind in at least one affected eye. Fifty-seven patients were enrolled (53 females; onset age, 41.9±14.8years). Ten patients (17.5%) had a DAO; four had become unable to walk without assistance following myelitis, and six had severe visual impairment following optic neuritis despite rescue treatments. Attack severity at nadir was the only clinical factor predicting a DAO (odds ratio, 2.120; 95% CI, 1.162-3.869; P=0.014). The use of immunosuppressants delayed the interval to the first relapse (P=0.003). Our study showed characteristics of NMO onset attacks that caused severe disability. However, no clinically modifiable factors predicted disabling attacks, except attack severity. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of single low-temperature sauna bathing in patients with severe motor and intellectual disabilities.

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Iiyama, Junichi; Matsushita, Kensuke; Tanaka, Nobuyuki; Kawahira, Kazumi

2008-07-01

We have previously reported that thermal vasodilation following warm-water bathing and low-temperature sauna bathing (LTSB) at 60 degrees C for 15 min improves the cardiac function in patients with congestive heart failure. Through a comparative before-and-after study, we studied the hemodynamic and clinical effects of single exposure to LTSB in cerebral palsy (CP) patients who usually suffer from chilled extremities and low cardiac output. The study population comprised 16 patients ranging between 19 and 53 years with severe motor and intellectual disabilities. Noninvasive methods were used to estimate the systemic and peripheral circulatory changes before and after LTSB. Using blood flow velocity analysis, the pulsatile and resistive indexes of the peripheral arteries of the patients' lower limbs were calculated. Following LTSB, the patients' deep body temperature increased significantly by 1 degrees C. Their heart rates increased and blood pressure decreased slightly. The total peripheral resistance decreased by 11%, and the cardiac output increased by 14%. There was significant improvement in the parameters that are indicative of the peripheral circulatory status, including the skin blood flow, blood flow velocity, pulsatile index, and resistive index. Numbness and chronic myalgia of the extremities decreased. There were no adverse side effects. Thus, it can be concluded that LTSB improves the peripheral circulation in CP patients.

Development and validation of an ICD-10-based disability predictive index for patients admitted to hospitals with trauma.

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Wada, Tomoki; Yasunaga, Hideo; Yamana, Hayato; Matsui, Hiroki; Fushimi, Kiyohide; Morimura, Naoto

2018-03-01

There was no established disability predictive measurement for patients with trauma that could be used in administrative claims databases. The aim of the present study was to develop and validate a diagnosis-based disability predictive index for severe physical disability at discharge using the International Classification of Diseases, 10th revision (ICD-10) coding. This retrospective observational study used the Diagnosis Procedure Combination database in Japan. Patients who were admitted to hospitals with trauma and discharged alive from 01 April 2010 to 31 March 2015 were included. Pediatric patients under 15 years old were excluded. Data for patients admitted to hospitals from 01 April 2010 to 31 March 2013 was used for development of a disability predictive index (derivation cohort), while data for patients admitted to hospitals from 01 April 2013 to 31 March 2015 was used for the internal validation (validation cohort). The outcome of interest was severe physical disability defined as the Barthel Index score of predictive index for each patient was defined as the sum of the scores. The predictive performance of the index was validated using the receiver operating characteristic curve analysis in the validation cohort. The derivation cohort included 1,475,158 patients, while the validation cohort included 939,659 patients. Of the 939,659 patients, 235,382 (25.0%) were discharged with severe physical disability. The c-statistics of the disability predictive index was 0.795 (95% confidence interval [CI] 0.794-0.795), while that of a model using the disability predictive index and patient baseline characteristics was 0.856 (95% CI 0.855-0.857). Severe physical disability at discharge may be well predicted with patient age, sex, CCI score, and the diagnosis-based disability predictive index in patients admitted to hospitals with trauma. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Nature of Interactions between Students with Severe Disabilities and Their Friends and Acquaintances without Disabilities.

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Grenot-Scheyer, Marquita

1994-01-01

This study of 20 elementary-school children with severe disabilities examined differences in their interactions with friends without disabilities compared with interactions with acquaintances without disabilities. Friends and acquaintances did not differ in developmental level, language age, functional movement, or social competence. Group…

Patient clusters in acute, work-related back pain based on patterns of disability risk factors.

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Shaw, William S; Pransky, Glenn; Patterson, William; Linton, Steven J; Winters, Thomas

2007-02-01

To identify subgroups of patients with work-related back pain based on disability risk factors. Patients with work-related back pain (N = 528) completed a 16-item questionnaire of potential disability risk factors before their initial medical evaluation. Outcomes of pain, functional limitation, and work disability were assessed 1 and 3 months later. A K-Means cluster analysis of 5 disability risk factors (pain, depressed mood, fear avoidant beliefs, work inflexibility, and poor expectations for recovery) resulted in 4 sub-groups: low risk (n = 182); emotional distress (n = 103); severe pain/fear avoidant (n = 102); and concerns about job accommodation (n = 141). Pain and disability outcomes at follow-up were superior in the low-risk group and poorest in the severe pain/fear avoidant group. Patients with acute back pain can be discriminated into subgroups depending on whether disability is related to pain beliefs, emotional distress, or workplace concerns.

Patient Health Questionnaire 15 as a generic measure of severity in fibromyalgia syndrome: surveys with patients of three different settings.

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Häuser, Winfried; Brähler, Elmar; Wolfe, Frederick; Henningsen, Peter

2014-04-01

Graduated treatment of patients with functional somatic syndromes (FSS) and fibromyalgia syndrome (FMS) depending on their severity has been recommended by recent guidelines. The Patient Health Questionnaire 15 (PHQ 15) is a validated measure of somatic symptom severity in FSS. We tested the discriminant and transcultural validity of the PHQ 15 as a generic measure of severity in persons with FMS. Persons meeting recognized FMS-criteria of the general German population (N=98), of the US National Data Bank of Rheumatic Diseases (N=440), and of a single German pain medicine center (N=167) completed validated self-report questionnaires on somatic and psychological distress (Polysymptomatic Distress Scale, Patient Health Questionnaire 4), health-related quality of life (HRQOL) (Short Form Health Survey 12 or 36) and disability (Pain Disability Index). In addition, self-reports of working status were assessed in the clinical setting. Overall severity of FMS was defined by PHQ 15 scores: mild (0-9), moderate (10-14) and severe (15-30). Persons with mild, moderate and severe FMS did not differ in age and gender. Irrespective of the setting, persons with severe FMS reported more pain sites, fatigue, depressed mood, impaired HRQOL and disability than persons with moderate or mild FMS. Patients with severe FMS in the NDB and in the German clinical center reported more work-related disability than patients with mild FMS. The PHQ 15 is a valid generic measure of overall severity in FMS. Copyright © 2014 Elsevier Inc. All rights reserved.

Hyponatremia And Disability, Prevalence And Prognosis In Babol Stroke Patients.

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Alijan Ahmadi Ahangar

2017-02-01

Full Text Available Background: Stroke is the leading cause of serious long-term disability. In recent studies hyponatremia as a risk factor for stroke. Methods: This cross-sectional descriptive study was to evaluate serum zinc level in serum sodium over the first 24 hours after the onset of stroke. Different intensities were determined on Stroke Scale NIH (National Institute of Health (mild 4-1 and (average moderate 15-5 and (moderate to severe 20-16 and (extreme severe 42- 21. Determination intensity of stroke after admission and discharge with Modified Rankin Scale and Barthel index. Blood serum concentrations of sodium 0.5 mL of venous blood were taken and sodium serum level was performed with Latex particle agglutination test in Ayatollah Rouhani Hospital. That normal range was defined 136-146 meq / L Findings: 125 patients were entered into this study; the prevalence of hyponatremia in female was 70% vs 60% in male. Of stroke patients included in this study 66% of them had hyponatremia and the frequency of hyponatremia in ischemic and hemorrhagic was 82% and 63%, respectively. Increase in hyponatremia with disability period of admission had statistically significant (10(12 mild vs 40(32 moderate, 32(25.6 severe, p=0.01 also with disability before discharge (24(19.2 mild, 26(20.8 moderate, 32(25.6 severe, p=0.03. Conclusions: Hyponatremia can effect on severity of the stroke and can be considered as a predictor of increased stroke severity and disability at admission and discharge.

Learning disabilities in Darier's disease patients.

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Dodiuk-Gad, R; Lerner, M; Breznitz, Z; Cohen-Barak, E; Ziv, M; Shani-Adir, A; Amichai, B; Zlotogorski, A; Shalev, S; Rozenman, D

2014-03-01

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.

Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study.

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Jui-An Lin

Full Text Available BACKGROUND: Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. METHODS: A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. RESULTS: Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37, pneumonia (odds ratio 2.01, 1.61 to 2.49, postoperative bleeding (odds ratio 1.35, 1.09 to 1.68 and septicemia (odds ratio 2.43, 1.85 to 3.21 without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. CONCLUSION: Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

Diagnostic accuracy of audio-based seizure detection in patients with severe epilepsy and an intellectual disability

NARCIS (Netherlands)

Arends, Johan B.; van Dorp, Jasper; van Hoek, Dennis; Kramer, Niels; van Mierlo, Petra; van der Vorst, Derek; Tan, Francis I.Y.

2016-01-01

We evaluated the performance of audio-based detection of major seizures (tonic–clonic and long generalized tonic) in adult patients with intellectual disability living in an institute for residential care. Methods First, we checked in a random sample (n = 17, 102 major seizures) how many patients

Predictive validity of disability rating scale in determining functional outcome in patients with severe traumatic brain injury.

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Deepika, Akhil; Devi, B Indira; Shukla, Dhaval

2017-01-01

Most patients with severe traumatic brain injury (TBI) are discharged when they have still not recovered completely. Many such patients are not available for follow up. We conducted this study to determine whether the condition at discharge from acute care setting, as assessed with disability rating scale (DRS), correlates with functional outcome at follow up. This study was conducted at a Neurosurgical intensive care unit (ICU) of a tertiary care referral center. This was a prospective observational study. Patients admitted to ICU with a diagnosis of severe TBI were enrolled for the study. On the day of discharge, all patients underwent DRS assessment. A final assessment was performed using Glasgow outcome scale extended (GOSE) at 6 months after discharge from the hospital. The correlation between the DRS scores at the time of discharge with DRS scores and GOSE categories at 6 months after discharge was determined using Spearman's rho correlation coefficient. A total of 88 patients were recruited for the study. The correlation coefficient of DRS at discharge for DRS at 6 months was 0.536 and for GOSE was -0.553. The area under the curve of DRS score at discharge for predicting unfavorable outcome and mortality at 6 months was 0.770 and 0.820, respectively. The predictive validity of DRS is fair to good in determining GOSE at follow-up. Pending availability of a more accurate outcome assessment tool, DRS at discharge can be used as a surrogate outcome for GOSE at follow up.

The extremity function index (EFI), a disability severity measure for neuromuscular diseases : psychometric evaluation

NARCIS (Netherlands)

Bos, Isaac; Wynia, Klaske; Drost, Gea; Almansa, Josué; Kuks, Joannes

2017-01-01

OBJECTIVE: To adapt and to combine the self-report Upper Extremity Functional Index and Lower Extremity Function Scale, for the assessment of disability severity in patients with a neuromuscular disease and to examine its psychometric properties in order to make it suitable for indicating disease

The identification of job opportunities for severely disabled sick-listed employees

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Broersen Jake PJ

2012-03-01

Full Text Available Abstract Background Work disability is a major problem for both the worker and society. To explore the work opportunities in regular jobs of persons low in functional abilities, we tried to identify occupations low in task demands. Because of the variety of functional abilities and of the corresponding work demands, the disabled persons need to be classified by type of disability in a limited number of subgroups. Within each subgroup, occupations judged suitable for the most seriously disabled will be selected as having a very low level of the corresponding task demands. These occupations can be applied as reference occupations to assess the presence or absence of work capacity of sick-listed employees in regular jobs, and as job opportunities for people with a specific type of functional disability. Methods Registered data from 50,931 disability assessments within the Dutch social security system were used in a second order factor analysis to identify types of disabilities in claimants for a disability pension. Threshold values were chosen to classify claimants according to the severity of the disability. In the disability assessment procedure, a labour expert needs to select jobs with task demands not exceeding the functional abilities of the claimant. For each type of disability, the accessible jobs for the subgroup of the most severely disabled claimants were identified as lowest in the corresponding demand. Results The factor analysis resulted in four types of disabilities: general physical ability; autonomy; psychological ability; and manual skills. For each of these types of disablement, a set of four to six occupations low in task demands were selected for the subgroup of most severely disabled claimants. Because of an overlap of the sets of occupations, 13 occupations were selected in total. The percentage of claimants with at least one of the occupations of the corresponding set (the coverage, ranged from 84% to 93%. An alternative

Emotion Regulation in Patients with Psoriasis: Correlates of Disability, Clinical Dimensions, and Psychopathology Symptoms.

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Almeida, Vera; Taveira, Sofia; Teixeira, Maribel; Almeida, Isabel; Rocha, José; Teixeira, Ana

2017-08-01

There are known connections between emotions and psoriasis; however, we have not established a clear pathway for this association. This study aimed to explore correlates of difficulties in emotional regulation in patients with psoriasis and predict the influence of emotional regulation in psoriasis disability. Two hundred and twenty eight participants completed the Difficulties in Emotion Regulation Scale, Self-administered Psoriasis Area and Severity Index, Psoriasis Disability Index, and Brief Symptom Inventory. Spearman's correlation and a hierarchical stepwise multiple regression were carried out to analyse associations. Results indicated that patients with the most recent diagnoses experienced greater difficulty in acting in accordance with goals (r = .16, p psoriasis severity (r = .15, p psoriasis disability (β = .34). The results highlighted the relationship between emotional regulation difficulty, disease characteristics, and psychological variables in psoriasis disability emphasizing the importance of including a broader approach in clinical management of psoriatic patients.

Disability among patients with opioid use disorders and its relationship with stigma toward substance use

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Saurabh Kumar

2018-01-01

Full Text Available Background: From a medical model perspective of substance use disorders (SUDs, opioid use disorders are associated with some degree of disability. This study aimed to assess the disability among patients with opioid use disorders (OUDs and its relationship with internalized stigma. Methodology: This cross-sectional study assessed patients with SUDs at a tertiary care center. Disability among patients with OUDs was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS while stigma was measured using Internalized Stigma of Mental Illness Scale (ISMIS. Results: Among 168 patients with OUD, the disability was greatest in the domain of work followed by interpersonal activities. About 48.2% and 3.0% of the participants had moderate and severe disability according to IDEAS. Disability (IDEAS scores had a robust correlation with the stigma (ISMIS scores (r = 0.453, P < 0.01. Multiple regression analysis found that internalized stigma (ISMIS score was an independent predictor of disability among patients with OUDs (β =0.42, P < 0.01. Conclusions: From a medical perspective, OUDs are associated with considerable disability which has significant correlation with internalized stigma. Designing interventions which can target internalized stigma among patients with OUD may help in reducing the disability associated with it.

Psychological Factors Associated with Chronic Migraine and Severe Migraine-Related Disability: an Observational Study in a Tertiary Headache Center

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Seng, Elizabeth K.; Buse, Dawn C.; Klepper, Jaclyn E.; Mayson, Sarah Jo; Grinberg, Amy S.; Grosberg, Brian M.; Pavlovic, Jelena M.; Robbins, Matthew S.; Vollbracht, Sarah E.; Lipton, Richard B.

2016-01-01

Objective To evaluate relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. Background Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. Methods Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors [depressive symptoms (Patient Health Questionnaire-9), anxious symptoms (Generalized Anxiety Disorder-7), Pain Catastrophizing Scale and Headache Specific Locus of Control]. Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. Results Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1,11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. Conclusions Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate relationships among naturalistic

Visual disability and quality of life in glaucoma patients.

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Cesareo, Massimo; Ciuffoletti, Elena; Ricci, Federico; Missiroli, Filippo; Giuliano, Mario Alberto; Mancino, Raffaele; Nucci, Carlo

2015-01-01

Glaucoma is an optic neuropathy that can result in progressive and irreversible vision loss, thereby affecting quality of life (QoL) of patients. Several studies have shown a strong correlation between visual field damage and visual disability in patients with glaucoma, even in the early stages of the disease. Visual impairment due to glaucoma affects normal daily activities required for independent living, such as driving, walking, and reading. There is no generally accepted instrument for assessing quality of life in glaucoma patients; different factors involved in visual disability from the disease are difficult to quantify and not easily standardized. This chapter summarizes recent works from clinical and epidemiological studies, which describe how glaucoma affects the performance of important vision-related activities and QoL. © 2015 Elsevier B.V. All rights reserved.

Communication Services and Supports for Individuals with Severe Disabilities: Guidance for Assessment and Intervention

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Brady, Nancy C.; Bruce, Susan; Goldman, Amy; Erickson, Karen; Mineo, Beth; Ogletree, Bill T.; Paul, Diane; Romski, Mary Ann; Sevcik, Rose; Siegel, Ellin; Schoonover, Judith; Snell, Marti; Sylvester, Lorraine; Wilkinson, Krista

2015-01-01

The National Joint Committee for the Communication Needs of People with Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons with severe disabilities are presented, along with guidance regarding assessment and intervention practices. A revised version of the Communication Bill of Rights, a powerful document that describes the communication rights of all individuals, including those with severe disabilities is included in this article. The information contained within this article is intended to be used by professionals, family members, and individuals with severe disabilities to inform and advocate for effective communication services and opportunities. PMID:26914467

Leisure Education Programs for the Severely Disabled.

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Schleien, Stuart J.; And Others

1985-01-01

The importance of leisure education for severely disabled students is emphasized as a means of enabling them to purposefully use leisure time and to expand social and motor skills that facilitate independent daily living. Sample activities for inclusion in physical education programs are included. (DG)

[Relationship between quality of life and disability level in patients with occupational disease].

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Li, Hongmei; Lin, Mingjing; Zhang, Wenwen; Li, Jing; Zou, Jianfang

2015-10-01

To investigate the relationship between the quality of life (QOL) and disability level in patients with occupational disease and to investigate the influencing factors for QOL. A total of 255 patients with occupational disease were selected from three specialized hospitals dedicated to occupational disease and the department of occupational medicine of one comprehensive hospital using cluster sampling from December 2013 to May 2014. A survey was carried out using WHOQOL-BREF and general questionnaire (including disability level), and statistical analysis was also performed using t test, F test, analysis of variance, and multivariate stepwise regression analysis. The QOL scores of patients with occupational diseases, from high to low, were social domain (11.48 ± 2.86), psychological domain (10.60 ± 2.28), physiological domain (10.54 ± 1.65), and environmental domain (10.50 ± 2.55), scores of which were significantly lower than the normal levels (Poccupational diseases of different disability levels (P>0.05). Also, QOL showed no significant differences between stage I, II and III patients with pneumoconiosis (P>0.05). The patients with pneumoconiosis were divided into mild, moderate, and severe groups, and the QOL scores of patients with mild pneumoconiosis in psychological and environmental domains were significantly higher than those of the patients with moderate or severe pneumoconiosis (Poccupational poisoning was divided into mild, moderate and severe groups, and the three groups showed no significant differences in QOL score (P>0.05). Multivariate regression analysis showed that the QOL score of each domain was mainly influenced by the degree of lung injury, complications, course of disease, age of onset, income, and employment status. The QOL of patients with occupational disease is significantly reduced, and disability level cannot accurately reflect their QOL. The treatment of patients with occupational disease should focus on their complications, and at

Visuospatial Orientation Learning through Virtual Reality for People with Severe Disability

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de la Torre-Luque, Alejandro; Valero-Aguayo, Luis; de la Rubia-Cuestas, Ernesto J.

2017-01-01

This study aims to test how an intervention based on virtual reality (VR) may enhance visuospatial skills amongst people with disability. A quasi-experimental intra-group study was therefore conducted. Participants were 20 people with severe disability (65% males; 34.35 years, on average, and 84.95% of disability rate according to the Andalusian…

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

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

2000-06-01

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

Music Therapy and the Education of Students with Severe Disabilities

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Stephenson, Jennifer

2006-01-01

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…

Nuclear cardiological investigations in patients classified as physically disabled following myocardial infarction

International Nuclear Information System (INIS)

Mester, Janos; Zolnay, Imre; Csernay, Laszlo

1988-01-01

110 patients classified as physically disabled as a consequence of myocardial infarction were reinvestigated by means of nuclear cardiological methods. Resting 201 Tl perfusion scintigraphy showed a normal distribution of radioactivity, while radionuclide ventriculography revealed a normal left ventricular ejection fraction and a normokinetic left ventricle in 20 patients. The investigation of a further 19 patients demonstrated only minimal pathological changes. The results in 34 patients revealed severe myocardial damage, and in a further 19 cases the development of left ventricular aneurysm. The results clearly show the value of 201 Tl scintigraphy and radionuclide ventriculography in assessments of the degree of physical disability after myocardial infarction. (author) 15 refs.; 3 tabs

Exploring assistive technology and post-school outcomes for students with severe disabilities.

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Bouck, Emily C; Flanagan, Sara M

2016-11-01

This study sought to understand the extent to which students with severe disabilities receive assistive technology in school and out-of-school, and the relationship between receipt of assistive technology in school and post-school outcomes for these students. This study was a secondary analysis of the National Longitudinal Transition Study-2 (NLTS2) from the USA. To analyze the data in this correlational study, researchers conducted frequency distributions, Chi Square Tests of Associations, significance tests and logistic regressions. The main results suggest (a) receipt of assistive technology in school varied greatly by disability identification; (b) receipt of assistive technology post-school also varied by disability identification, but receipt was generally lower; and (c) few statistically significant post-school outcome differences existed between students who received assistive technology and those who did not. An under-utilization of assistive technology exists in practice in the USA for students with severe disabilities. Implications for Rehabilitation An under-utilization of assistive technology for secondary students and adults with severe disabilities likely exists. A need exists for improved collaboration between professionals in rehabilitation and professionals in schools to ensure continuation of needed services or aids, such as assistive technology. Additional research is needed to better understand the adult life (or post-school) outcomes of individuals with severe disabilities, factors from PK-12 schooling or post-school services that positively and negative impact those outcomes.

Gender differences in patients with dizziness and unsteadiness regarding self-perceived disability, anxiety, depression, and its associations

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Kurre Annette

2012-03-01

Full Text Available Abstract Background It is known that anxiety and depression influence the level of disability experienced by persons with vertigo, dizziness or unsteadiness. Because higher prevalence rates of disabling dizziness have been found in women and some studies reported a higher level of psychiatric distress in female patients our primary aim was to explore whether women and men with vertigo, dizziness or unsteadiness differ regarding self-perceived disability, anxiety and depression. Secondly we planned to investigate the associations between disabling dizziness and anxiety and depression. Method Patients were recruited from a tertiary centre for vertigo and balance disorders. Participants rated their global disability as mild, moderate or severe. They filled out the Dizziness Handicap Inventory and the two subscales of the Hospital Anxiety Depression Scale (HADS. The HADS was analysed 1 by calculating the median values, 2 by estimating the prevalence rates of abnormal anxiety/depression based on recommended cut-off criteria. Mann-Whitney U-tests, Chi-square statistics and odds ratios (OR were calculated to compare the observations in both genders. Significance values were adjusted with respect to multiple comparisons. Results Two-hundred and two patients (124 women mean age (standard deviation of 49.7 (13.5 years participated. Both genders did not differ significantly in the mean level of self-perceived disability, anxiety, depression and symptom severity. There was a tendency of a higher prevalence of abnormal anxiety and depression in men (23.7%; 28.9% compared to women (14.5%; 15.3%. Patients with abnormal depression felt themselves 2.75 (95% CI: 1.31-5.78 times more severely disabled by dizziness and unsteadiness than patients without depression. In men the OR was 8.2 (2.35-28.4. In women chi-square statistic was not significant. The ORs (95% CI of abnormal anxiety and severe disability were 4.2 (1.9-8.9 in the whole sample, 8.7 (2.5-30.3 in men

Adult Sibling Relationships with Brothers and Sisters with Severe Disabilities

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Rossetti, Zach; Hall, Sarah

2015-01-01

The purpose of this qualitative study was to examine perceptions of adult sibling relationships with a brother or sister with severe disabilities and the contexts affecting the relationships. Adult siblings without disabilities (N = 79) from 19 to 72 years of age completed an online survey with four open-ended questions about their relationship…

High self-assessment of disability and the surgeon's recommendation against surgical intervention may negatively impact satisfaction scores in patients with spinal disorders.

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Mazur, Marcus D; McEvoy, Sara; Schmidt, Meic H; Bisson, Erica F

2015-06-01

OBJECT Patient satisfaction scores have become a common metric for health care quality. Because satisfaction scores are right-skewed, even small differences in mean scores can have a large impact. Little information, however, is available on the specific factors that play a role in satisfaction in patients with spinal disorders. The authors investigated whether disability severity and the surgeon's recommendation for or against surgical intervention were associated with patient satisfaction scores. METHODS The authors conducted a retrospective cohort study involving adult patients who were referred to a spine surgeon for an outpatient evaluation of back pain. Patients completed the Oswestry Disability Index (ODI) before their clinic appointment and a Press Ganey patient satisfaction survey after their visit. Patients were grouped by self-assessed disability severity: mild to moderate (ODI Satisfaction scores were graded from 0 (very poor) to 100 (very good). Nonparametric tests were used to evaluate the association between patient satisfaction and current disability self-assessment. The authors also investigated whether the surgeon's recommendation against surgery negatively affected patient satisfaction. RESULTS One hundred thirty patients completed the ODI questionnaire before and satisfaction surveys after seeing a spine surgeon for a new outpatient back pain consultation. Of these, 68 patients had severe disability, 62 had mild to moderate disability, 67 received a recommendation for surgery, and 63 received a recommendation against surgery. Composite satisfaction scores were lower among patients who had severe disability than among those with mild to moderate disability (median [interquartile range]: 91.7 [83.7-96.4] vs 95.8 [91.0-99.3], respectively; p = 0.0040). Patients who received a recommendation against surgery reported lower satisfaction scores than those who received a recommendation for surgery (91.7 [83.5-95.8] vs 95.8 [88.5-99.8]; p = 0

Effect of Posttraumatic Serum Thyroid Hormone Levels on Severity and Mortality of Patients with Severe Traumatic Brain Injury

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Forough Saki

2012-02-01

Full Text Available Traumatic brain injury (TBI is an important cause of death and disability in young adults ,and may lead to physical disabilities and long-term cognitive, behavioral psychological and social defects. There is a lack of definite result about the effect of thyroid hormones after traumatic brain injury in the severity and no data about their effect on mortality of the injury. The aim of this study is to evaluate the effect of thyroid hormones after traumatic brain injury in the severity and mortality and gain a clue in brain injury prognosis. In a longitudinal prospective study from February 2010 until February 2011, we checked serum levels of T3, T4, TSH and TBG of severely brain injured patients and compared the relationship of them with primary Glasgow Coma Scale (GCS score and mortality of patients. Statistical analysis used SPSS 11.5 software with using chi-square and Fisher exact test. Serum levels of T3 and T4 were decreased after brain trauma but not TSH and TBG. Mortality rates were higher in patients with lower T4 serum levels. The head injury was more severe in whom with low T3 and T4. Follow a severe brain injury a secondary hypothyroidism is happened due to pituitary dysfunction. Also, serum level of T3 and T4 on the first day admission affect on primary GCS score of patients which is an indicator of severity of brain injury. In addition, mortality rates of severely brain injured patients have a high correlation with the serum level of T4 in the first day admission.

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

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

2016-01-01

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

Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients.

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Byrne, Shannon A; Cherniack, Martin G; Petry, Nancy M

2013-09-01

Opioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. Using data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n=22) and those not receiving (n=93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. Both an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps<.05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio=5.66; 95% confidence interval=1.58-20.28). These results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients.

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Diab, Mahmoud; Guenther, Albrecht; Sponholz, Christoph; Lehmann, Thomas; Faerber, Gloria; Matz, Anna; Franz, Marcus; Witte, Otto W; Pletz, Mathias W; Doenst, Torsten

2016-10-01

Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome. We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses. Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2 %) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1 ± 2.6 vs. 6.6 ± 3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17 %) and septic shock (37 vs. 19 %). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1 % vs. 45 %, p = 0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58 %, p = 0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis. Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.

The cross-sectional association between severity of non-cognitive disability and self-reported worsening memory.

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Cannell, M Brad; Bouldin, Erin D; Teigen, Kari; Akhtar, Wajiha Z; Andresen, Elena M

2016-04-01

Research has demonstrated a clear association between cognitive decline and non-cognitive disability; however, all of these studies focus on disability as a correlate or result of some level of cognitive impairment or dysfunction. The relationship between disability and cognition is likely a complex one, that is currently incompletely described in the literature. Our objective was to estimate the prevalence of long-term, non-cognitive disability using a population-representative sample of adults aged 18 and older, and then estimate the association between long-term, non-cognitive disability and self-reported worsening memory. Using the 2009 Florida Behavioral Risk Factor Surveillance System (BRFSS), we measured the relationship between non-cognitive disability and worsening memory using multivariable logistic regression analysis weighted to account for the complex sampling design of the BRFSS. We also estimated the adjusted odds of worsening memory by disability severity, classified according to the types of assistance needed. Approximately 18% (95% confidence interval = (16%, 19%)) of Floridians were living with a long-term, non-cognitive disability in 2009. Among adults with no disability during or prior to the last year, only 5% reported worsening memory. The proportion of Floridians reporting worsening memory increases with increasing severity of disability-related limitations. In a multivariable logistic regression model, odds of worsening memory increased significantly with severity of disability-related limitations. These results highlight the association between non-cognitive disability and subsequent increased odds of worsening memory, independent of several other known risk factors, and a dose-response association with disability-related limitations. Copyright © 2016 Elsevier Inc. All rights reserved.

Disability and quality of life in patients with fibromyalgia

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Verbunt Jeanine A

2008-01-01

Full Text Available Abstract Background Patients with fibromyalgia often feel disabled in the performance of daily activities. Psychological factors seem to play a pronounced disabling role in fibromyalgia. The objectives of the study are: Firstly, to investigate contributing factors for disability in fibromyalgia. Secondly, to study psychological distress in patients with fibromyalgia as compared to other nonspecific pain syndromes. And finally, to explore the impact of fibromyalgia on a patient's quality of life. Methods In this cross sectional study, explaining factors for disability were studied based on a regression analysis with gender, mental health, physical and social functioning as independent variables. For the assessment of disability in fibromyalgia the FIQ was used. The levels of psychological distress in patients with fibromyalgia, Complex Regional Pain Syndrome (CRPS and chronic low back pain (CLBP were compared based on scores on the Symptom Checklist (SCL90. Quality of life of patients with fibromyalgia was compared with scores (SF36 of both patients with fibromyalgia and other health conditions as derived from the literature. Results Disability in fibromyalgia seemed best explained by a patients mental health condition (β = -0.360 p = 0.02. The level of psychological distress was higher in patients with fibromyalgia as compared to patients with CRPS or CLBP (p Conclusion Patients with fibromyalgia report a considerable impact on their quality of life and their perceived disability level seems influenced by their mental health condition. In comparison with patients with other pain conditions psychological distress is higher.

The National and Regional Prevalence Rates of Disability, Type, of Disability and Severity in Saudi Arabia-Analysis of 2016 Demographic Survey Data.

Science.gov (United States)

Bindawas, Saad M; Vennu, Vishal

2018-02-28

The prevalence of disability varies between countries ranging from less than 1% to up to 30% in some countries, thus, the estimated global disability prevalence is about 15%. However, it is unknown what the current estimate of disability and its types and severity are in Saudi Arabia. Thus, the objective of this study is to estimate national and regional prevalence rates of any disability, types of disability, and their severity among Saudi populations. Data on disability status were extracted from the national demographic survey conducted in 2016 as reported by the General Authority for Statistics, Saudi Arabia (N = 20,064,970). Prevalence rates per a population of 100,000 of any disability, type of disability, and its severity were calculated at the national level and in all 13 regions. Out of 20,064,970 Saudi citizens surveyed, 667,280 citizens reported disabilities, accounting for a prevalence rate of 3326 per a population of 100,000 (3.3%). Individuals aged 60 years and above (11,014) and males (3818) had a higher prevalence rate of disability compared with females (2813). The Tabuk region has the highest rate of reported disability, at 4.3%. The prevalence rates of extreme disabilities in mobility and sight were higher in Madinah (57,343) and Northern border (41,236) regions, respectively. In Saudi Arabia, more than half a million Saudi citizens (1 out of every 30 individuals) reported the presence of disability during the year 2016. A higher prevalence rate of disability was seen among those aged 60 years and above, and males. Targeted efforts are required at the national and regional levels to expand and improve rehabilitation and social services for all people with disabilities.

Communication-based services for persons with severe disabilities in schools: a survey of speech-language pathologists.

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Siegel, Ellin B; Maddox, Laura L; Ogletree, Billy T; Westling, David L

2010-01-01

Speech-language pathologists in school settings were surveyed with an instrument created from the National Joint Committee for the Communication Needs of Persons with Severe Disabilities' quality indicators self-assessment tool. Participants valued practice indicators of quality communication assessment and intervention to a higher degree than their actual practice. These findings appear to suggest that SLPs may not provide best practice services to individuals with severe disabilities. Suggestions for enhancing inservice training and intervention practices of SLPs and team members who work with individuals with severe disabilities are provided. The reader will be able to; (1) understand the value of using the NJC quality indicators to guide SLP practices with individuals with severe disabilities in schools; (2) recognize that research indicates that SLPs working with individuals with severe disabilities in schools may not provide best practice services to the extent that they value these practices; (3) discuss possible strategies to increase the quality of services provided to individuals with severe disabilities in schools.

The Diagnostic Yield of Array Comparative Genomic Hybridization Is High Regardless of Severity of Intellectual Disability/Developmental Delay in Children.

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D'Arrigo, Stefano; Gavazzi, Francesco; Alfei, Enrico; Zuffardi, Orsetta; Montomoli, Cristina; Corso, Barbara; Buzzi, Erika; Sciacca, Francesca L; Bulgheroni, Sara; Riva, Daria; Pantaleoni, Chiara

2016-05-01

Microarray-based comparative genomic hybridization is a method of molecular analysis that identifies chromosomal anomalies (or copy number variants) that correlate with clinical phenotypes. The aim of the present study was to apply a clinical score previously designated by de Vries to 329 patients with intellectual disability/developmental disorder (intellectual disability/developmental delay) referred to our tertiary center and to see whether the clinical factors are associated with a positive outcome of aCGH analyses. Another goal was to test the association between a positive microarray-based comparative genomic hybridization result and the severity of intellectual disability/developmental delay. Microarray-based comparative genomic hybridization identified structural chromosomal alterations responsible for the intellectual disability/developmental delay phenotype in 16% of our sample. Our study showed that causative copy number variants are frequently found even in cases of mild intellectual disability (30.77%). We want to emphasize the need to conduct microarray-based comparative genomic hybridization on all individuals with intellectual disability/developmental delay, regardless of the severity, because the degree of intellectual disability/developmental delay does not predict the diagnostic yield of microarray-based comparative genomic hybridization. © The Author(s) 2015.

Comparison between neck pain disability and cervical range of motion in patients with episodic and chronic migraine: a cross-sectional study.

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Carvalho, Gabriela F; Chaves, Thais C; Gonçalves, Maria C; Florencio, Lidiane L; Braz, Carolina A; Dach, Fabíola; Fernández de Las Peñas, Cesar; Bevilaqua-Grossi, Débora

2014-01-01

The purpose of this study was to evaluate neck pain-related disability and cervical range of motion (CROM) in patients with episodic migraine (EM) and chronic migraine (CM) and to examine the correlation of both outcomes. This cross-sectional study consisted of 91 patients with EM and 34 with CM. Cervical range of motion was measured with the CROM device, and pain during the cervical movement was recorded. Self-reported disability related to neck pain was assessed with the Neck Disability Index. Patients with CM showed higher Neck Disability Index scores and more moderate and severe disability (P = .01). Severe disability as a result of neck pain was associated with 7.6-fold risk of developing CM (P = .003). No significant differences in CROM were identified between groups. Moderate negative correlations between CROM and disability were found for 4 motions within the CM group (-0.60 pain evoked during CROM in both groups (0.34 pain was highly prevalent in patients with migraine. Neck pain-related disability increased with increased frequency of the migraine attacks and was associated with the risk of migraine chronicity. The correlation between CROM and neck pain disability was more evident in patients with CM and in patients with pain during cervical movement. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Atrophy of reward-related striatal structures in fatigued MS patients is independent of physical disability.

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Damasceno, Alfredo; Damasceno, Benito Pereira; Cendes, Fernando

2016-05-01

MRI studies have shown gray-matter abnormalities in fatigued multiple sclerosis (MS) patients. However, given that physical disability is highly correlated to MS fatigue, it is often difficult to disentangle its effect in these MRI findings. The objective of this research paper is to investigate gray-matter damage in mildly disabled MS patients, addressing which variables were better related to fatigue while controlling for physical disability and depression. Forty-nine relapsing-remitting MS (RRMS) patients and 30 controls underwent MRI (3T). Fatigue was assessed using the Fatigue Severity Scale (FSS). Multivariate logistic regression was performed to assess the contribution of clinical and MRI metrics to fatigue. Statistical analyses were performed controlling for disability and depression. Fatigue was present in 22 (44.9%) patients. FSS score was highly correlated with EDSS (p = 0.00001). Patients with fatigue had lower brain cortical and subcortical gray-matter volumes. However, after controlling for EDSS, only the caudate and the accumbens volumes remained statistically significant. Fatigued MS patients have a global cortical and subcortical gray-matter atrophy that seems largely related to higher physical disability. However, striatal structures involved in effort-reward functions exhibited smaller volumes in fatigued patients, independently of physical disability and depressive symptoms, supporting the theory of cortico-striatal network impairment in MS fatigue. © The Author(s), 2015.

Analyzing the History of Falls in Patients with Severe Knee Osteoarthritis.

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Tsonga, Theano; Michalopoulou, Maria; Malliou, Paraskevi; Godolias, George; Kapetanakis, Stylianos; Gkasdaris, Grigorios; Soucacos, Panagiotis

2015-12-01

One out of three adults over the age of 65 years and one out of two over the age of 80 falls annually. Fall risk increases for older adults with severe knee osteoarthritis, a matter that should be further researched. The main purpose of this study was to investigate the history of falls including frequency, mechanism and location of falls, activity during falling and injuries sustained from falls examining at the same time their physical status. The secondary purpose was to determine the effect of age, gender, chronic diseases, social environment, pain elsewhere in the body and components of health related quality of life such as pain, stiffness, physical function, and dynamic stability on falls frequency in older adults aged 65 years and older with severe knee osteoarthritis. An observational longitudinal study was conducted on 68 patients (11 males and 57 females) scheduled for total knee replacement due to severe knee osteoarthritis (grade 3 or 4) and knee pain lasting at least one year or more. Patients were personally interviewed for fall history and asked to complete self-administered questionnaires, such as the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and physical performance test was performed. The frequency of falls was 63.2% for the past year. The majority of falls took place during walking (89.23%). The main cause of falling was stumbling (41.54%). There was a high rate of injurious falling (29.3%). The time patients needed to complete the physical performance test implied the presence of disability and frailty. The high rates of fall risk, the high disability levels, and the low quality of life were confirmed by questionnaires and the mobility test. Patients with severe knee osteoarthritis were at greater risk of falling, as compared to healthy older adults. Pain, stiffness, limited physical ability, reduced muscle strength, all consequences of severe knee osteoarthritis

78 FR 12219 - Excepted Service-Appointment of Persons With Intellectual Disabilities, Severe Physical...

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2013-02-22

...;Prices of new books are listed in the first FEDERAL REGISTER issue of each #0;week. #0; #0; #0; #0;#0... appointment of people with mental retardation, severe physical disabilities, and psychiatric disabilities. As... a particular work environment. Persons with disabilities today, however, often have work...

Disability and quality of life in patients with fibromyalgia

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Verbunt, Jeanine A; Pernot, Dia HFM; Smeets, Rob JEM

2008-01-01

Background Patients with fibromyalgia often feel disabled in the performance of daily activities. Psychological factors seem to play a pronounced disabling role in fibromyalgia. The objectives of the study are: Firstly, to investigate contributing factors for disability in fibromyalgia. Secondly, to study psychological distress in patients with fibromyalgia as compared to other nonspecific pain syndromes. And finally, to explore the impact of fibromyalgia on a patient's quality of life. Methods In this cross sectional study, explaining factors for disability were studied based on a regression analysis with gender, mental health, physical and social functioning as independent variables. For the assessment of disability in fibromyalgia the FIQ was used. The levels of psychological distress in patients with fibromyalgia, Complex Regional Pain Syndrome (CRPS) and chronic low back pain (CLBP) were compared based on scores on the Symptom Checklist (SCL90). Quality of life of patients with fibromyalgia was compared with scores (SF36) of both patients with fibromyalgia and other health conditions as derived from the literature. Results Disability in fibromyalgia seemed best explained by a patients mental health condition (β = -0.360 p = 0.02). The level of psychological distress was higher in patients with fibromyalgia as compared to patients with CRPS or CLBP (p fibromyalgia on quality of life appeared to be high as compared to the impact of other health conditions. Conclusion Patients with fibromyalgia report a considerable impact on their quality of life and their perceived disability level seems influenced by their mental health condition. In comparison with patients with other pain conditions psychological distress is higher. PMID:18211701

Quality of Life and Migraine Disability among Female Migraine Patients in a Tertiary Hospital in Malaysia

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Shaik, Munvar Miya; Hassan, Norul Badriah; Gan, Siew Hua

2015-01-01

Background. Disability caused by migraine may be one of the main causes of burden contributing to poor quality of life (QOL) among migraine patients. Thus, this study aimed to measure QOL among migraine sufferers in comparison with healthy controls. Methods. Female diagnosed migraine patients (n= 100) and healthy controls (n=100) completed the Malay version of the World Health Organization QOL Brief (WHOQOL-BREF) questionnaire. Only migraine patients completed the Malay version of the Migraine Disability Assessment questionnaire. Results. Females with migraines had significantly lower total WHOQOL-BREF scores (84.3) than did healthy controls (91.9, Pmigraine patients with lower total QOL scores had 1.2 times higher odds of having disability than patients with higher total QOL scores. Conclusions. The present study showed that migraine sufferers experienced significantly lower QOL than the control group from a similar population. Disability was severe and frequent and was associated with lower QOL among the migraine patients. PMID:25632394

[Clinical analysis of acute encephalocele during operation in 21 patients with severe craniocerebral injury].

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Zhuang, Qiang; Qu, Chun-cheng; Liang, Wen-zhi; Qin, Hao; Yu, Rui

2011-03-08

To analyze the clinical features of acute intra-operative encephalocele and the proper prophylactic-therapeutic measures for severe craniocerebral injury. The clinical data were collected and analyzed for 21 patients with severe head injuries who suffered acute intra-operative encephalocele from June 2008 to May 2010. There were 12 males and 9 females with an age range of 18 - 69 years old. Among these patients, 6 died with a mortality rate of 28.5%. It was lower than that reported in literatures. One patient died post-operatively of severe brain swelling and intracranial infection secondary to leakage of cerebrospinal fluid. Four patients died of severe craniocerebral injury, brain swelling and brain stem failure. And 1 patient died after his guardian abandoned the treatment. The follow-up period for the remaining 15 surviving patients was 3 - 6 months. According to the Glasgow outcome score (GOS), there were a favorable prognosis (n = 9), moderate disabilities (n = 5) and severe disability (n = 1). The probability of acute intra-operative encephalocele may be predicted in advance with a combination of clinical features and computed tomographic scans. The therapeutic success rate of acute encephalocele will be boosted by taking protective and therapeutic measures pre- and intra-operatively.

Injury severity assessment for car occupants in frontal impacts, using disability scaling.

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Norin, H; Krafft, M; Korner, J; Nygren, A; Tingvall, C

1997-01-01

Injury classification and assessment is one of the most important fields of injury prevention. At present, injury assessment focuses primarily on the risk of fatalities, in spite of the fact that most people who are injured survive the trauma. The net result of a fatality-based approach is that safety and vehicle engineers must make decisions with an incomplete, and sometimes misleading, picture of the traffic safety problem. By applying disability scaling reflecting long-term consequences to injury data, the most significant disabling injuries can be identified. The priorities change with the level of disability used in the scaling. In this study, the risk of permanent medical disability due to different injuries was derived and linked to abbreviated injury scale (AIS) values for 24,087 different injured body regions. This material is based on insurance data. To study how the importance of different bodily injuries changes with different severity assessments in a realistic real-world injury distribution, Swedish insurance industry disability scaling was applied to 3066 cases of belted Volvo drivers involved in frontal collisions. Crash severity was included in the study by using equivalent barrier speed (EBS). When lower levels of disability are included, injuries to the neck and the extremities become the most important, while brain and skull injuries become the most prominent at higher levels of disability. The results presented in this article should be regarded as a contribution to the development of a suitable disability scaling method. The results can also be utilized to further injury research and vehicle design aimed at reducing injuries which have the most important long-term disability consequences.

Disability and quality of life in patients with fibromyalgia

OpenAIRE

Verbunt, Jeanine A; Pernot, Dia HFM; Smeets, Rob JEM

2008-01-01

Abstract Background Patients with fibromyalgia often feel disabled in the performance of daily activities. Psychological factors seem to play a pronounced disabling role in fibromyalgia. The objectives of the study are: Firstly, to investigate contributing factors for disability in fibromyalgia. Secondly, to study psychological distress in patients with fibromyalgia as compared to other nonspecific pain syndromes. And finally, to explore the impact of fibromyalgia on a patient's quality of li...

A Functional Analysis of Gestural Behaviors Emitted by Young Children with Severe Developmental Disabilities

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Ferreri, Summer J.; Plavnick, Joshua B.

2011-01-01

Many children with severe developmental disabilities emit idiosyncratic gestures that may function as verbal operants (Sigafoos et al., 2000). This study examined the effectiveness of a functional analysis methodology to identify the variables responsible for gestures emitted by 2 young children with severe developmental disabilities. Potential…

Postsurgical outcome in pediatric patients with epilepsy: a comparison of patients with intellectual disabilities, subaverage intelligence, and average-range intelligence.

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Gleissner, Ulrike; Clusmann, Hans; Sassen, Robert; Elger, Christian E; Helmstaedter, Christoph

2006-02-01

Intellectual disabilities are often associated with bilateral or diffuse morphologic brain damage. The chances of becoming seizure free after focal surgery are therefore considered to be worse in patients with intellectual disabilities. The risk of postoperative cognitive deficits could increase because diffuse brain damage lowers the patient's ability to compensate for surgically induced deficits. Several studies in adult patients have indicated that IQ alone is not a good predictor of postoperative cognitive and seizure outcome. Our study evaluated this subject in children and adolescents. Pediatric patients with intellectual disabilities (IQ intelligence (IQ between 71 and 85), or average-range intelligence (IQ > 85) were matched according to several clinical and etiologic criteria to determine the influence of IQ (N = 66). No dependency of seizure outcome, postoperative cognitive development, and behavioral outcome on the IQ level was found. All groups slightly improved in attention while memory functions tended to decrease and executive functions were stable. School placement remained unchanged for the majority of patients. Between 67 and 78% were seizure free 1 year after surgery (Engel outcome class I). IQ alone is not a good predictor of postoperative outcome in pediatric patients with epilepsy. As with patients of average-range intelligence, the decision to operate on patients with a low level of intelligence should depend on the results of the presurgical diagnostics. If the results of the neuropsychological examination indicate diffuse functional impairment, this should not hinder further steps, if all other findings are consistent.

Language barriers in Hispanic patients: relation to upper-extremity disability.

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Menendez, Mariano E; Eberlin, Kyle R; Mudgal, Chaitanya S; Ring, David

2015-06-01

Although upper-extremity disability has been shown to correlate highly with various psychosocial aspects of illness (e.g., self-efficacy, depression, kinesiophobia, and pain catastrophizing), the role of language in musculoskeletal health status is less certain. In an English-speaking outpatient hand surgery office setting, we sought to determine (1) whether a patient's primary native language (English or Spanish) is an independent predictor of upper-extremity disability and (2) whether there are any differences in the contribution of measures of psychological distress to disability between native English- and Spanish-speaking patients. A total of 122 patients (61 native English speakers and 61 Spanish speakers) presenting to an orthopaedic hand clinic completed sociodemographic information and three Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS Pain Interference, PROMIS Depression, and PROMIS Upper-Extremity Physical Function. Bivariate and multivariable linear regression modeling were performed. Spanish-speaking patients reported greater upper-extremity disability, pain interference, and symptoms of depression than English-speaking patients. After adjusting for sociodemographic covariates and measures of psychological distress using multivariable regression modeling, the patient's primary language was not retained as an independent predictor of disability. PROMIS Depression showed a medium correlation (r = -0.35; p Spanish-speaking patients. PROMIS Pain Interference had a large correlation with disability in both patient cohorts (Spanish-speaking: r = -0.66; p immigration to the USA did not correlate with disability among Spanish speakers. Primary language has less influence on symptom intensity and magnitude of disability than psychological distress and ineffective coping strategies. Interventions to optimize mood and to reduce pain interference should be considered in

Intracerebral hemorrhage with intraventricular extension and no hydrocephalus may not increase mortality or severe disability.

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Mahta, Ali; Katz, Paul M; Kamel, Hooman; Azizi, S Ausim

2016-08-01

This paper aimed to test the hypothesis that intraventricular extension of spontaneous intracerebral hemorrhage (ICH) in the absence of hydrocephalus is not associated with increased mortality or severe disability. We performed a retrospective consecutive cohort study of patients with primary spontaneous ICH who were admitted to a single institution. Multivariate logistic regression analysis was used to assess the association of each variable with functional outcome as measured by the modified Rankin Scale (mRS). A total of 164 patients met our inclusion criteria and were included in the study. Only hydrocephalus (p=0.002) and hematoma volume (p=0.006) were significantly associated with mortality or poor functional outcome (mRS of 3 to 6). In contrast, the presence of intraventricular hematoma was not independently associated with poor functional outcome. The presence of intraventricular extension of ICH in the absence of hydrocephalus may not increase mortality or disability. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of corrective surgery on social phobia, psychological distress, disease-related disability and quality of life in adult strabismus patients.

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Alpak, Gokay; Coskun, Erol; Erbagci, Ibrahim; Bez, Yasin; Okumus, Seydi; Oren, Burak; Gurler, Bulent

2014-07-01

Corrective surgery is done for ocular alignment and disrupted facial expression in some cases of adult strabismus patients. The effects of corrective surgery on the presence of social phobia (SP) diagnosis, the severity of social anxiety symptoms, the disease-related disability and the quality of life (QoL) among strabismus patients have not been thoroughly studied yet. The study sample was composed of patients who had undergone corrective surgery for strabismus. Preoperative and postoperative evaluations made by using standardised measures of social phobia diagnosis (DSM-IV-TR) and severity (Liebowitz Social Anxiety Scale (LSAS)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), disability (Sheehan Disability Scale) and quality of life (short form-36). Preoperatively, SP diagnosis was detected in 17 of 31 (54.8%) patients, whereas postoperatively 6 of 31 (19.4%) patients had SP (p=0.001). Participants showed a significant decrease in all subscale scores and total score of both LSAS and HADS compared with their preoperative scores. Significant improvements were observed in QoL and disability scores as well. Adult strabismus patients seem to gain benefits from corrective surgery not only for their ocular misalignment but also for social anxiety levels that may be associated with improvements in their QoL and disability levels.

Phenotypic heterogeneity of intellectual disability in patients with congenital insensitivity to pain with anhidrosis: A case report and literature review.

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Liu, Zhenlei; Liu, Jiaqi; Liu, Gang; Cao, Wenjian; Liu, Sen; Chen, Yixin; Zuo, Yuzhi; Chen, Weisheng; Chen, Jun; Zhang, Yu; Huang, Shishu; Qiu, Guixing; Giampietro, Philip F; Zhang, Feng; Wu, Zhihong; Wu, Nan

2018-01-01

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive heterogeneous disorder mainly caused by mutations in the neurotrophic tyrosine receptor kinase 1 gene ( NTRK1) and characterized by insensitivity to noxious stimuli, anhidrosis, and intellectual disability. We herein report the first north Han Chinese patient with CIPA who exhibited classic phenotypic features and severe intellectual disability caused by a homozygous c.851-33T>A mutation of NTRK1, resulting in aberrant splicing and an open reading frame shift. We reviewed the literature and performed in silico analysis to determine the association between mutations and intellectual disability in patients with CIPA. We found that intellectual disability was correlated with the specific Ntrk1 protein domain that a mutation jeopardized. Mutations located peripheral to the Ntrk1 protein do not influence important functional domains and tend to cause milder symptoms without intellectual disability. Mutations that involve critical amino acids in the protein are prone to cause severe symptoms, including intellectual disability.

Including Students with Severe Disabilities in General Education Settings.

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Wisniewski, Lech; Alper, Sandra

1994-01-01

This paper presents five systematic phases for bringing about successful regular education inclusion of students with severe disabilities. Phases include develop networks within the community, assess school and community resources, review strategies for integration, install strategies that lead to integration, and develop a system of feedback and…

Effects of ozone on the pain and disability in patients with failed back surgery syndrome

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Danilo Costa Barbosa

Full Text Available Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS, which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS, Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI, Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.

Operationalisation of quality of life for adults with severe disabilities.

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Gómez, L E; Arias, B; Verdugo, M Á; Tassé, M J; Brown, I

2015-10-01

The operationalisation of quality of life for people with more severe disabilities has been acknowledged in the published research for more than two decades. This study aims to contribute to our knowledge and understanding of the quality of life of adults with severe disabilities by developing a set of quality of life indicators appropriate to this population using a Delphi method and the eight-domain conceptual model proposed by Schalock & Verdugo (2002). The participating panel in the Delphi method included 12 experts who evaluated each proposed item according to four criteria: suitability, importance, observability and sensitivity. Descriptive analyses were used to select the best items in each of the four rounds of this Delphi study, as well as examining the coefficients of concordance that were calculated for the final pool of items. The four rounds of the Delphi study resulted in a final pool of 118 items (91 that were considered valid in the first round plus 27 items proposed, reformulated or discussed in the following rounds). Importance and sensitivity were the criteria that received the highest and lowest ratings, respectively, but also the ones that had the highest and lowest mean coefficients of concordance. Experts showed the strongest agreement for items related to material well-being, while the weakest was found for items related to personal development. This study further contributes to our understanding of how to operationalise and measure quality of life in adults with severe disabilities. The item pool generated may prove helpful in the development of instruments for the measurement of quality of life-related outcomes in this population. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Subjective Cognitive Complaints and Functional Disability in Patients With Borderline Personality Disorder and Their Nonaffected First-Degree Relatives

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Ruocco, Anthony C; Lam, Jaeger; McMain, Shelley F

2014-01-01

Objective: To examine the contributions of subjective cognitive complaints to functional disability in patients with borderline personality disorder (BPD) and their nonaffected relatives. Method: Patients with BPD (n = 26), their first-degree biological relatives (n = 17), and nonpsychiatric control subjects (n = 31) completed a self-report measure of cognitive difficulties and rated the severity of their functional disability on the World Health Organization Disability Assessment Schedule 2.0. Results: After accounting for group differences in age and severity of depressive symptoms, patients and relatives endorsed more inattention and memory problems than control subjects. Whereas probands reported greater disability than relatives and control subjects across all functional domains, relatives described more difficulties than control subjects in managing multiple life activities, including domestic activities and occupational and academic functioning, and participating in society. For both probands and relatives, inattention and memory problems were linked primarily to difficulties with life activities, independent of depression and other comorbid psychiatric disorders. Conclusions: Problems with inattention and forgetfulness may lead to difficulties carrying out activities of daily living and occupational or academic problems in patients with BPD, as well as their nonaffected first-degree relatives. PMID:25007408

Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia.

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Huang, Shih-Wei; Chang, Kwang-Hwa; Escorpizo, Reuben; Chi, Wen-Chou; Yen, Chia-Feng; Liao, Hua-Fang; Chang, Feng-Hang; Chiu, Wen-Ta; Lin, Jia-Wei; Liou, Tsan-Hon

2016-08-01

To analyse the disability status of elderly Taiwanese dementia patients by using the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). We enrolled 12 126 disabled elderly (>65 years) patients with dementia during July 2012-January 2014 from the Taiwan Data Bank of Persons with Disability. Trained interviewers evaluated the standardised scores in the six WHODAS 2.0 domains. Student's t test was used for comparing WHODAS 2.0 scores of male and female dementia patients with different age groups. The study population comprised 12 126 patients; 7612 were women and 4514 were men. The WHODAS 2.0 scores showed that the dementia patients had global activity limitation and participation restriction in all domains. Dementia-induced disability was prominent in male patients in all of the domains of the WHODAS 2.0. The domains of life activities, getting along with people and cognition were more strongly affected than the other domains. However, women experienced more rapid functional decline than men did as they aged. The data analysed in this large-scale, population-based study revealed crucial information on dementia-induced disability in elderly patients on the basis of the WHODAS 2.0 framework. Implications for rehabilitation Dementia patients have global functional disability in all domains of WHODAS 2.0 and multidisciplinary team is needed for rehabilitation programme intervention for these patients. When considering the rehabilitation resource and strategy, the domains of cognition, activities of daily living and life activities should be focussed. When dementia patients aged 65-75 years old, male patients got more restriction of function than female and more medical resource allocation for disabled male patients is recommended. With ageing, female dementia patients exhibited more rapid functional decline than male patients did and more budget about rehabilitation for maintain functional and dementia progression is crucial for female patients.

Communication impairment and activity limitation in stroke patients with severe aphasia.

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Darrigrand, Benedicte; Dutheil, Sabine; Michelet, Valerie; Rereau, Stephanie; Rousseaux, Marc; Mazaux, Jean-Michel

2011-01-01

This study investigated how patients with severe aphasia communicated in daily living, which verbal and non-verbal communication skills were spared and which were impaired, and whether activity limitations in communication are related to verbal impairments. Twenty-seven patients with severe aphasia and 9 with moderate aphasia originating from a sample of 102 aphasic persons followed up in a French regional survey were assessed with a communication test and a communication activity limitation questionnaire 12-18 months after a first stroke. Patients with severe aphasia suffered severe activity limitations in communication, with performance 3-fold lower than that of patients with moderate aphasia, and 4-fold lower than scores attained by normals. Both aphasia severity and communication disability at follow-up were related to the initial severity of aphasia. Using a phone, credit card and a chequebook, reading and filling in administrative documents, and communication behaviours involved in social life were the most severely impaired. Non-verbal communication performance was not related to aphasia severity. We conclude that there is a great need for speech therapy research to develop new compensatory or alternative strategies for patients with severe aphasia.

A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry.

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Molina-Ruiz, Rosa M; Martín-Carballeda, Julia; Asensio-Moreno, Inmaculada; Montañés-Rada, Francisco

2017-03-01

Background Subjects with intellectual disability are at increased risk of having comorbid psychiatric disorders and worse response to psychotherapeutic and psychopharmacological treatment interventions. On the other hand, available data on best treatment approach in this population are scarce and lack scientific evidence due to methodological limitations. The present study aims to perform a systematic review of the literature to facilitate the use of psychotropic drugs in clinical practice and better establish future research targets in this field. Objectives To review the available psychopharmacological strategies for patients with intellectual disabilities, psychiatric disorders, and behavioural disturbances. Serve as a quick guide for clinicians working in the field of intellectual disability. Methods We conducted a selective evidence-based review of the literature using Pubmed and EMBASE databases and selected most recent and relevant papers for this review. Results There are several available psychotropic drugs for the treatment of patients with intellectual disability and comorbid psychiatric disorders, although scientific evidence is limited. Treatment should be individualized according to risk-benefit balance. Discussion Further studies are needed and new available drugs should be considered to gain knowledge in effectiveness of different therapeutic approaches available in this population.

Epidemiology of fractures in people with severe and profound developmental disabilities

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Glick, N.R.; Fischer, M.H.; Heisey, D.M.; Leverson, G.E.; Mann, D.C.

2005-01-01

Fractures are more prevalent among people with severe and profound developmental disabilities than in the general population. In order to characterize the tendency of these people to fracture, and to identify features that may guide the development of preventive strategies, we analyzed fracture epidemiology in people with severe and profound developmental disabilities who lived in a stable environment. Data from a 23-year longitudinal cohort registry of 1434 people with severe and profound developmental disabilities were analyzed to determine the effects of age, gender, mobility, bone fractured, month of fracture, and fracture history upon fracture rates. Eighty-five percent of all fractures involved the extremities. The overall fracture rate increased as mobility increased. In contrast, femoral shaft fracture risk was substantially higher in the least mobile [relative risk (RR), 10.36; 95% confidence interval (CI), 3.29-32.66] compared with the most mobile group. Although the overall fracture rate was not associated with age, the femoral shaft fractures decreased but hand/foot fractures increased with age. Overall fracture risk declined in August and September (RR, 0.70; 95% CI, 0.55-0.89), being especially prominent for tibial/fibular fractures (RR, 0.31; 95% CI, 0.13-0.70). Gender was not a factor in fracture risk. Two primary fracture mechanisms are apparent: one, largely associated with lack of weight-bearing in people with the least mobility, is exemplified by femoral fractures during non-traumatic events as simple as diapering or transfers; the other, probably due to movement- or fall-related trauma, is exemplified by hand/foot fractures in people who ambulate. The fracture experience of people with severe and profound developmental disabilities is unique and, because it differs qualitatively from postmenopausal osteoporosis, may require population-specific methods for assessing risk, for improving bone integrity, and for reduction of falls and accidents

Physical Disability and Diabetes Mellitus; Qualitative Exploration of Patients' Perception and Behavior.

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Gillani, Syed Wasif; Syed Sulaiman, Syed Azhar; Abdul, Mohi Iqbal Mohammad; Saad, Sherif Yahya

2017-07-10

Disability is a key indicator implicating both overall morbidity and success of public health efforts to compress the period of morbidity among geriatrics for the overall population. Disabilities are more prevalent among diabetics than among those without diabetes. This study aimed to determine self-monitoring practices, awareness to dietary modifications and barriers to medication adherence among physically disabled type 2 diabetes mellitus patients. Interview sessions were conducted at diabetes clinic - Penang general hospital. The invited participants represented three major ethnic groups of Malaysia (Malay, Chinese & Indians). An open-ended approach was used to elicit answers from participants. Interview questions were related to participant's perception towards self-monitoring blood glucose practices, Awareness towards diet management, behaviour to diabetes medication and cues of action. A total of twenty-one diabetes patients between the ages 35 - 67 years with physical disability (P1-P21) were interviewed. The cohort of participants was dominated by Males (n=12) and also distribution pattern showed majority of participants were Malay (n=10), followed by Chinese (n=7) and rest Indians (n=4). When the participants were asked in their opinion what was the preferred method of recording blood glucose tests, several participants from low socioeconomic status and either divorced or widowed denied to adapt telemontoring instead preferred to record manually. There were mixed responses about the barriers to control diet/calories. Even patients with high economic status, middle age 35-50 and diabetes history of 5-10 years were influenced towards alternative treatments. Study concluded that patients with physical disability required extensive care and effective strategies to control glucose metabolism. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Do Panic Symptoms Affect the Quality of Life and Add to the Disability in Patients with Bronchial Asthma?

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A. D. Faye

2015-01-01

Full Text Available Background. Anxiety and panic are known to be associated with bronchial asthma with variety of impact on clinical presentation, treatment outcome, comorbidities, quality of life, and functional disability in patients with asthma. This study aims to explore the pattern of panic symptoms, prevalence and severity of panic disorder (PD, quality of life, and disability in them. Methods. Sixty consecutive patients of bronchial asthma were interviewed using semistructured proforma, Panic and Agoraphobia scale, WHO Quality of life (QOL BREF scale, and WHO disability schedule II (WHODAS II. Results. Though 60% of the participants had panic symptoms, only 46.7% had diagnosable panic attacks according to DSM IV TR diagnostic criteria and 33.3% had PD. Most common symptoms were “sensations of shortness of breath or smothering,” “feeling of choking,” and “fear of dying” found in 83.3% of the participants. 73.3% of the participants had poor quality of life which was most impaired in physical and environmental domains. 55% of the participants had disability score more than a mean (18.1. Conclusion. One-third of the participants had panic disorder with significant effect on physical and environmental domains of quality of life. Patients with more severe PD and bronchial asthma had more disability.

Playable One-Switch Video Games for Children with Severe Motor Disabilities Based on GNomon

Directory of Open Access Journals (Sweden)

Sebastián Aced López

2015-12-01

Full Text Available Being able to play games in early years is very important for the development of children. Even though, children with physical disabilities encounter several obstacles that exclude them from engaging in many popular games. In particular, children with severe motor disabilities that rely on one-switch interfaces for accessing electronic devices find dynamic video games completely unplayable. In this paper we present the development and evaluation of GNomon: a framework, based on the NOMON interaction modality, that enables the creation of dynamic one-switch games for children with severe motor disabilities. The framework was designed following a series of guidelines elicited in close collaboration with a team of speech therapists, physiotherapists and psychologists from one of the Local Health Agencies in Turin, Italy. Likewise, three mini games were developed for testing the playability of GNomon-based games. Finally, we conducted a series of trials with 8 children with severe motor disabilities assisted by the health agency, in which we found that all of them enjoyed playing the GNomon- based mini games and that 7 of them were able to interact and play autonomously.

Social Interaction with Adults with Severe Intellectual Disability: Having Fun and Hanging Out

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Johnson, Hilary; Douglas, Jacinta; Bigby, Christine; Iacono, Teresa

2012-01-01

Background: Social interaction is integral to social inclusion. Little is known about the nature of social interaction between adults with severe intellectual disability and those with whom they engage. Method: Participants were six adults with intellectual disability and people identified as those with whom they shared demonstrable pleasurable…

Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study.

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Acciarresi, Monica; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Morotti, Andrea; Costa, Paolo; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; D'Amore, Cataldo; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrissoula; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D'Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario Maimone; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria Giulia; Lees, Kennedy R

2017-06-01

The aim of this study was to investigate for a possible association between both prestroke CHA 2 DS 2 -VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA 2 DS 2 -VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA 2 DS 2 -VASc and severity of stroke, as well as disability and mortality at 90 days. Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA 2 DS 2 -VASc score and severity of stroke (P = .001). On multivariate analysis, CHA 2 DS 2 -VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the receiver operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA 2 DS 2 -VASc score and lesion size. In patients with AF, in addition to the risk of stroke, a high CHA 2 DS 2 -VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Learning from Physicians with Disabilities and Their Patients.

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DeLisa, Joel A; Lindenthal, Jacob Jay

2016-10-01

Although progress has been made in diversifying medical school admissions and faculty, this has not extended to physicians with physical disabilities. To improve our understanding of medical students and physicians with physical and sensory disabilities, the authors propose systematically gathering information on the needs and experiences of four groups: physicians who had disabilities before beginning practice, physicians whose disabilities were incurred during their medical careers, physicians drawn from those two groups, and patients of physicians with disabilities. It is hoped these data would be used by counselors, administrators, and admissions committees in advising medical school applicants with disabilities and in revising institutional policies with a view to increasing matriculation and graduation rates of medical students with disabilities. © 2016 American Medical Association. All Rights Reserved.

Impairment and disability rating in low back pain.

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Katz, R T

2001-08-01

LBP is one of the two most common forms of disability in Western society (mental illness is the other), and remains a thorny problem in the arena of disability evaluation. Disability evaluation after LBP differs whether the pain is work-related or not. If work-related, guidelines for disability evaluation differ by jurisdiction and type of employment (e.g., private vs. federal employee). When outside of the workplace, thresholds for disability differ between entitlement programs (Social Security Disability) and private insurance programs (long-term disability insurance). In the patient without obvious findings, the disability evaluating physician needs to be caring and compassionate and yet maintain an objective stance with the understanding that there may be significant psychosocial overlay in patients with nonobjective pain complaints. Although some would argue that objective independent medical evaluation is an oxymoron, psychiatrists have excellent training and perspective with which to do so. The patient suffering from catastrophic brain injury or spinal cord injury offers a useful contrast--on the most severe end of the disability spectrum--to the patient with persisting low back complaints but normal physical examination. As a society, we have to wisely manage the funds that comprise our social "safety net" in order to provide for persons with severe disability who cannot provide for themselves. It would then follow that patients with minor impairments/disabilities should receive minor (i.e., noninflated) ratings. Psychiatrists need to enable rather than disable their patients.

Migraine disability and its recognition and assessment

NARCIS (Netherlands)

A. Dowson

2005-01-01

textabstractThe main aim of this thesis is to investigate the clinical significance of headache-related disability; the clinical importance of assessing disability, the means of recognising the patients with severe disability and the development of new ways to assess headache-related disability

Effective Literacy Instruction for Students with Moderate or Severe Disabilities

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Copeland, Susan R.; Keefe, Elizabeth B.

2007-01-01

For students with moderate or severe disabilities, developing literacy skills is a critical component of successful communication, employment, and community participation. Finally, educators have a practical, concise guidebook for helping these students meet NCLB's academic standards for literacy. Appropriate for use in all settings, including…

Use of a structured migraine diary improves patient and physician communication about migraine disability and treatment outcomes.

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Baos, V; Ester, F; Castellanos, A; Nocea, G; Caloto, M T; Gerth, W C

2005-03-01

Migraine is frequently undertreated, perhaps because impaired communication between patients and physicians underestimate the disability associated with migraine attacks. The purpose of this study was to evaluate the benefits of a structured migraine diary used during a prospective open-label study of triptan-naive patients in Spain for recording information on response to therapy for a pre-study migraine attack and three consecutive migraine attacks, the first and third treated with rizatriptan 10-mg wafer and the second with usual non-triptan therapy. Of 97 patients (83% women; mean age, 39 years) who completed the study, all reported moderate to severe pain, and two-thirds reported severe to total impairment during migraine attacks. At study end, 72% of patients reported that the migraine diary helped communication with their doctor about migraine, and 70% were more or much more satisfied than before the study with level of overall medical care provided by their doctor. Patients who reported the diary to be useful also reported higher overall satisfaction with medical care (p better communicate with their patients about migraine, and all reported that it enabled them to assess differences in pain intensity and disability across patients. We conclude that a structured migraine diary can be a valuable aid for improving communication between physicians and patients regarding migraine disability and treatment outcomes.

A novel ALDH5A1 mutation is associated with succinic semialdehyde dehydrogenase deficiency and severe intellectual disability in an Iranian family.

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Püttmann, Lucia; Stehr, Henning; Garshasbi, Masoud; Hu, Hao; Kahrizi, Kimia; Lipkowitz, Bettina; Jamali, Payman; Tzschach, Andreas; Najmabadi, Hossein; Ropers, Hans-Hilger; Musante, Luciana; Kuss, Andreas W

2013-08-01

Succinic semialdehyde dehydrogenase (SSADH) deficiency is a disorder of the catabolism of the neurotransmitter gamma-aminobutyric acid (GABA) with a very variable clinical phenotype ranging from mild intellectual disability to severe neurological defects. We report here on a large Iranian family with four affected patients presenting with severe intellectual disability, developmental delay and generalized tonic-clonic seizures. Molecular genetic analysis revealed a missense mutation c.901A>G (p.K301E, RefSeq number NM_001080) in ALDH5A1 co-segregating with the disease in the family. The missense mutation affects an amino acid residue that is highly conserved across the animal kingdom. Protein modeling showed that p.K301E most likely leads to a loss of NAD(+) binding and a predicted decrease in the free energy by 6.67 kcal/mol furthermore suggests a severe destabilization of the protein. In line with these in silico observations, no SSADH enzyme activity could be detected in patient lymphoblasts. Copyright © 2013 Wiley Periodicals, Inc.

ICT based technology to support play for children with severe physical disabilities.

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van den Heuvel, Renée; Lexis, Monique; de Witte, Luc

2015-01-01

Play is important for a child's development. Children with severe physical disabilities experience difficulties engaging in play. With the progress of technology the possibilities to support play are increasing. The purpose of this review was to gain insight into the possibilities and availability of ICT based technology to support play in children with severe physical disabilities. A systematic literature search within the databases PubMed, CINAHL, IEEE and ERIC was carried out. Three reviewers assessed titles and abstracts independently. Additionally, Google Scholar, conference proceedings and reference lists were used. The included publications reported on 27 different technologies, which can be classified into three main groups; robots, virtual reality systems and computer systems. There are several options that may have great potential in supporting play for this target group.

Playable One-Switch Video Games for Children with Severe Motor Disabilities Based on GNomon

OpenAIRE

ACED LOPEZ, Sebastian; Corno, Fulvio; DE RUSSIS, Luigi

2015-01-01

Being able to play games in early years is very important for the development of children. Even though, children with physical disabilities encounter several obstacles that exclude them from engaging in many popular games. In particular, children with severe motor disabilities that rely on one-switch interfaces for accessing electronic devices find dynamic video games completely unplayable. In this paper we present the development and evaluation of GNomon: a framework, based on the NOMON inte...

Predicting the Grade of Disability 1 Year After Stroke Following Rehabilitation

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Jau-Hong Lin

2005-05-01

Full Text Available The purpose of this study was to identify predictors of grades of disability at least 1 year after stroke rehabilitation therapy. We recruited stroke patients from the inpatient rehabilitation department of a university hospital. The degree of disability was graded using the disability evaluation at least 1 year after stroke onset. Functional ability was evaluated using the Functional Independence Measure instrument on admission, on discharge from the inpatient rehabilitation program, and at the 6-month follow-up visit after discharge. Major sociodemographic, medical, and rehabilitative factors were also collected during the hospitalization period. Of the 109 patients surveyed, 64 (58.7% had severe or very severe grades of disability. The correlates of severe or very severe disability in logistic regression analyses were bilaterally affected (odds ratio, OR, 10.8, impaired orientation (OR, 3.6, and poorer functional ability at discharge (OR, 7.6. Based on the significant predictors identified, the logistic regression model correctly classified severe or very severe disability in 68.0% of subjects. The higher frequency of severe or very severe disability in this study may have been due to the relatively more severely affected stroke patient population in the inpatient rehabilitation service and the use of unique disability evaluation criteria. These results may provide information useful in planning continuous rehabilitation care and setting relevant socio-welfare policies for stroke victims.

Disability in adults with arthrogryposis is severe, partly invisible, and varies by genotype.

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Dai, Shenhao; Dieterich, Klaus; Jaeger, Marie; Wuyam, Bernard; Jouk, Pierre-Simon; Pérennou, Dominic

2018-04-06

To understand the disability of adults with arthrogryposis multiplex congenita (AMC), a rare disease spectrum characterized by at least 2 joint contractures at birth in different body areas. This is a retrospective analysis of data for unselected persons with AMC referred to the French center for adults with AMC from 2010 to 2016. All underwent a pluriprofessional systematic and comprehensive investigation of deficits, activity limitation, and participation restriction according to the International Classification of Functioning, Disability and Health and genetic analysis when indicated. Participants were divided by amyoplasia and other AMC types. Mean (SD) age of the 43 participants (27 female) was 33.2 (13.4) years; 28 had amyoplasia and 15 other types of AMC. Beyond joint stiffness, deformities, and muscle weakness, the well-known core symptoms that we quantified and for which first-line treatment involved technical aids, other less visible disorders that could contribute to severe participation restriction were particularly pain and psychological problems including anxiety, fatigue, difficulty in sexual life, altered self-esteem, and feelings of solitude. Severe respiratory disorders were infrequent and were linked to PIEZO2 mutations. Gait disorders were not due to respiratory impairment but to skeletal problems and were always associated with amyoplasia when severe. Functional independence was worse but respiratory and swallowing capacities were better with amyoplasia than other AMC types. This study describes disability patterns of a cohort of adults with AMC by genotype. The disability of adults with AMC is influenced by genotype, with important invisible disability. © 2018 American Academy of Neurology.

A newly recognized syndrome of severe growth deficiency, microcephaly, intellectual disability, and characteristic facial features.

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Vinkler, Chana; Leshinsky-Silver, Esther; Michelson, Marina; Haas, Dorothea; Lerman-Sagie, Tally; Lev, Dorit

2014-01-01

Genetic syndromes with proportionate severe short stature are rare. We describe two sisters born to nonconsanguineous parents with severe linear growth retardation, poor weight gain, microcephaly, characteristic facial features, cutaneous syndactyly of the toes, high myopia, and severe intellectual disability. During infancy and early childhood, the girls had transient hepatosplenomegaly and low blood cholesterol levels that normalized later. A thorough evaluation including metabolic studies, radiological, and genetic investigations were all normal. Cholesterol metabolism and transport were studied and no definitive abnormality was found. No clinical deterioration was observed and no metabolic crises were reported. After due consideration of other known hereditary causes of post-natal severe linear growth retardation, microcephaly, and intellectual disability, we propose that this condition represents a newly recognized autosomal recessive multiple congenital anomaly-intellectual disability syndrome. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging.

Science.gov (United States)

Sirvanci, Mustafa; Bhatia, Mona; Ganiyusufoglu, Kursat Ali; Duran, Cihan; Tezer, Mehmet; Ozturk, Cagatay; Aydogan, Mehmet; Hamzaoglu, Azmi

2008-05-01

Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate

Delineation of the KIAA2022 mutation phenotype: two patients with X-linked intellectual disability and distinctive features.

Science.gov (United States)

Kuroda, Yukiko; Ohashi, Ikuko; Naruto, Takuya; Ida, Kazumi; Enomoto, Yumi; Saito, Toshiyuki; Nagai, Jun-Ichi; Wada, Takahito; Kurosawa, Kenji

2015-06-01

Next-generation sequencing has enabled the screening for a causative mutation in X-linked intellectual disability (XLID). We identified KIAA2022 mutations in two unrelated male patients by targeted sequencing. We selected 13 Japanese male patients with severe intellectual disability (ID), including four sibling patients and nine sporadic patients. Two of thirteen had a KIAA2022 mutation. Patient 1 was a 3-year-old boy. He had severe ID with autistic behavior and hypotonia. Patient 2 was a 5-year-old boy. He also had severe ID with autistic behavior, hypotonia, central hypothyroidism, and steroid-dependent nephrotic syndrome. Both patients revealed consistent distinctive features, including upswept hair, narrow forehead, downslanting eyebrows, wide palpebral fissures, long nose, hypoplastic alae nasi, open mouth, and large ears. De novo KIAA2022 mutations (p.Q705X in Patient 1, p.R322X in Patient 2) were detected by targeted sequencing and confirmed by Sanger sequencing. KIAA2022 mutations and alterations have been reported in only four families with nonsyndromic ID and epilepsy. KIAA2022 is highly expressed in the fetal and adult brain and plays a crucial role in neuronal development. These additional patients support the evidence that KIAA2022 is a causative gene for XLID. © 2015 Wiley Periodicals, Inc.

A model for the development of virtual communities for people with long-term, severe physical disabilities

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C.M. Tilley

2006-01-01

Full Text Available Introduction. This paper reports results of an investigation into the needs of persons with disabilities wanting to participate in the use of virtual communities. The aim was to investigate 'how virtual communities for persons with long-term, severe physical disabilities can best be facilitated'? Method. A Grounded Theory approach was adopted to inform the investigation. In- depth interviews were conducted with twelve persons with paraplegia, quadriplegia or other severe, long-term physical or mobility disabilities and six health care professionals, service providers, information personnel and policy advisers who were involved in their well-being. Analysis. Rich explanations were derived about the information and communication technology (ICT usage and the technologies' contributions towards restoration of sense of control over their lives. Results. The primary outcome of the investigation is a theory regarding the character of virtual communities for the disabled. The theory is represented as a Virtual Community Model. The model identifies: the need for 'a sense of control' as the foundation element of virtual communities for the disabled; the key domains in which disabled people participate in virtual communities; and the barriers and enablers to their participation. Conclusion. The model provides a framework which can be used by interest groups and other organizations to facilitate the development of virtual communities for persons with severe physical disabilities. The six key types of community need to be represented in such virtual communities if a full 'sense of control' is to be achieved by disabled persons.

Effect of joint traction on functional improvement and quality of life in patients with severe knee osteoarthritis

OpenAIRE

Sedigheh Sadat Naeimee; Abbas Rahimi; Mehdi Rezaee; Alireza Akbarzadeh Baghban; Khosro Khademi Kalantari; ُSomayeh Mahmoudi Aghdam

2012-01-01

Background and aim: Osteoarthritis (OA) is the most prevalent joint disease in adults around the world and its incidence rises with age. Patients with severe knee osteoarthritis often complain of pain and severe functional disability. Most of conservative treatments used in this group of patients induce poor improvements. This study evaluated the effect of joint traction on quality of life of patients with severe knee osteoarthritis.Materials and Methods: In this clinical trial study, forty f...

Are different soil metals near the homes of pregnant women associated with mild and severe intellectual disability in children?

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MCDERMOTT, SUZANNE; BAO, WEICHAO; TONG, XIN; CAI, BO; LAWSON, ANDREW; AELION, CMARJORIE

2014-01-01

AIM We explored the association of relatively low concentrations of metals in the soil proximal to maternal residence during pregnancy, with intellectual disability. We hypothesized different metals would be associated with mild versus severe intellectual disability. METHOD We used a mixed methods design, starting with a retrospective cohort from 1996–2002, of 10 051 pregnant mothers, soil sampling in the areas where these mothers resided during pregnancy, and follow-up of their children to determine if there was an intellectual disability outcome. We tested the soil and then predicted the soil concentration at the maternal homes, and modeled the association with the severity of the child’s intellectual disability. RESULTS We found a significant positive association between mild intellectual disability and soil mercury (p=0.007). For severe intellectual disability, there was a significant positive association with the soil arsenic and lead (p=0.025). INTERPRETATION This is the first report of the differential impact of metals in soil and severity of intellectual disability in children. Soil mercury concentration in the area the mother lived during pregnancy is associated with significantly increased odds of mild intellectual disability; a combination of arsenic and lead is associated with significantly increased odds of severe intellectual disability. These associations are present when controlling for maternal, child, and neighborhood characteristics. PMID:24750016

Personal impact of disability in osteoarthritis: patient, professional and public values.

Science.gov (United States)

Wylde, Vikki; Hewlett, Sarah; Learmonth, Ian D; Cavendish, Victoria J

2006-09-01

Osteoarthritis (OA) is a leading cause of disability. Numerous tools are available to assess this, but they fail to place a patient value upon disability. In rheumatoid arthritis, research has shown patients have different importance values for similar disabilities, and these individual values can be used to weight disability levels, creating a measure of personal impact. Firstly, to determine if the Health Assessment Questionnaire (HAQ) can be used as the basis for an importance value scale by assessing if it includes activities considered important by OA patients. Secondly, to determine if the weights used for the value scale should be based on population, healthcare professional or patient values. Twenty-five OA patients, 25 healthy controls and 25 healthcare professionals rated the importance of the items on the HAQ and shortened Modified HAQ (MHAQ). Prior to completing the HAQ, patients generated a list of activities that were important to them. The HAQ contained 69% of items that patients considered important. No items were consistently deemed unimportant by patients. There was low agreement within and between groups about the importance of the items on the HAQ and MHAQ. The HAQ is a suitable basis for a value scale for an OA disability impact score. Importance values for function differed for patients, healthcare professionals and the general population; therefore individual patient weightings need to be used. Further work is under way to validate a measure of the personal impact of disability in patients with lower limb OA. Copyright (c) 2006 John Wiley & Sons, Ltd.

Correlates of Prevalent Disability Among HIV-Infected Elderly Patients.

Science.gov (United States)

Ávila-Funes, José Alberto; Belaunzarán-Zamudio, Pablo Francisco; Tamez-Rivera, Oscar; Crabtree-Ramírez, Brenda; Navarrete-Reyes, Ana Patricia; Cuellar-Rodríguez, Jennifer; Sierra-Madero, Juan; Amieva, Hélène

2016-02-01

The growing elderly population of HIV-infected patients is leading to a significant epidemiological transition and HIV infection has been proposed as a premature and accelerated aging model rending the individual more susceptible to premature disability. However, the determinants of disability among this emergent population are still lacking. Therefore, the aim of this study is to determine the correlates of prevalent disability in adults ≥50 years with HIV infection. A cross-sectional study of 184 HIV-infected adults receiving ambulatory care in an HIV clinic of a tertiary care, university-affiliated hospital in Mexico City was conducted. Disability for instrumental (IADL) and basic activities of daily living (ADL) was established. Sociodemographic factors, clinical variables, current CD4(+) cell count, and HIV viral load (VL) were tested as potential determinants of disability. Multivariate logistic regression analyses were used to identify the correlates of both types of disability. The mean age was 59.3 years. All participants were receiving highly active antiretroviral therapy. Of participants 17.9% had disability for IADL and 26.1% for ADL. Multivariate logistic regression analyses indicated that being older; having a lower CD4(+) cell count, and having a detectable HIV VL were independently associated with both types of disability. In addition, educational level was also independently associated with ADL disability. Age, educational level, low CD4(+) cell count, and detectable HIV VL were independently associated with disability. Whether effective and timely antiretroviral therapy will reduce the risk of disability in HIV-infected elderly patients needs to be evaluated.

Coraco- or Costoclavicular Paraosteoarthropathies in Patients with Severe Central Neurological Disorders

International Nuclear Information System (INIS)

Lacout, A.; Mompoint, D.; Perrier, Y.; Vallee, C.A.; Carlier, R.Y.

2008-01-01

Background: Paraosteoarthropathy (POA) is a frequent disabling orthopedic complication after severe central neurological impairment. The hip is the most frequently affected joint (32.1%) followed by the elbow and the shoulder (25%). Purpose: To evaluate coraco- and costoclavicular paraosteoarthropathy in patients with severe central neurological disorders. Material and Methods: We report a series of five consecutive patients with severe central neurological disorders who developed a POA of the clavicular region (coracoclavicular or costoclavicular POA). Every patient underwent a clinical, radiological, and computed tomographic (CT) examination of the shoulder region. Results: Four patients had a history of traumatic brain injury (TBI), and one an acute disseminated encephalomyelitis (ADEM). They developed POA of the clavicular region, although not around the glenohumeral joint. The patients complained of shoulder pain and of moderate limitation of movements. Radiological and CT examinations showed the presence of a bony formation in the coracoclavicular space in four cases and extending from the clavicle to the first rib around the costoclavicular joint in one case. Conclusion: In patients with severe brain lesions suffering from shoulder pain and moderate limitation of joint movements, POAs of the clavicular region are rare but should be considered

Child labor and severe functioning difficulties and disability in Mexican children and adolescents 5-17 years of age

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Aremis Villalobos

2017-07-01

Full Text Available Objective. To describe the characteristics of Mexican children and adolescents 5-17 years with severe functioning difficulties and disability and explore their participation in child labor. Materials and methods. Using data from the National Survey of Boys, Girls and Women in Mexico 2015 we estimated prevalence of functioning difficulties and disability and used logistic regression to explore the association between this condition and child labor. Results. While 11.2% of Mexicans 5-17 years-old has severe functioning difficulties or disability, 13.4% work. The functioning difficulty and disability domains with the highest prevalence are experiencing anxiety (5.4% and depression (1.5% daily. Children and adolescents with severe functioning difficulties and disability are 70% more likely to do child labor [OR=1.7, 95%CI:1.2,2.4]. Educational lag doubles the likelihood of doing child labor [OR=2.2, 95%CI:1.5,3.3]. Conclusions. Guaranteeing educational opportunities and respect for the rights of children with severe functioning difficulties and disability is essential to achieve development of their full potential.

Prevalence of- and risk factors for work disability in Dutch patients with inflammatory bowel disease.

Science.gov (United States)

Spekhorst, Lieke M; Oldenburg, Bas; van Bodegraven, Ad A; de Jong, Dirk J; Imhann, Floris; van der Meulen-de Jong, Andrea E; Pierik, Marieke J; van der Woude, Janneke C; Dijkstra, Gerard; D'Haens, Geert; Löwenberg, Mark; Weersma, Rinse K; Festen, Eleonora A M

2017-12-14

To determine the prevalence of work disability in inflammatory bowel disease (IBD), and to assess risk factors associated with work disability. For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability (sick leave, partial and full disability) and long-term full work disability (> 80% work disability for > 2 years). Prevalence of work disability was higher in Crohn's disease (CD) (29%) and ulcerative colitis (UC) (19%) patients compared to the general Dutch population (7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years, smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level (OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications (OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work disability. The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.

Specialized Placement of Quadriplegics and Other Severely Disabled. Final Report.

Science.gov (United States)

Rusk, Howard A.; And Others

To help quadriplegics and other severely disabled achieve vocational placement and confront the catastrophic impact of quadriplegia on bodily function (as detailed in the report), a rehabilitation team provided medical, various special, and vocational rehabilitation services. The 100 clients (59% men, 79% less than 45 years and 62% between 20 and…

Supporting Students with Severe Disabilities in Inclusive Schools: A Descriptive Account From Schools Implementing Inclusive Practices

Science.gov (United States)

Kurth, Jennifer A.; Lyon, Kristin J.; Shogren, Karrie A.

2015-01-01

The purpose of the present study was to investigate practices that support the inclusion of students with severe disabilities in the learning and social activities of inclusive K-8 schools to inform inclusive school reform research and practice. Eighteen K-8 students with severe disabilities in six schools recognized for their implementation of…

Patients with severe head trauma who talk and then deteriorate

Energy Technology Data Exchange (ETDEWEB)

Isayama, Kazuo; Nakazawa, Shozo; Kobayashi, Shiro; Yokota, Hiroyuki; Ikeda, Yukio; Yajima, Kouzo; Yano, Masami; Otsuka, Toshibumi

1987-08-01

Patients with severe head trauma who talk and then deteriorate (or die) are analyzed by means of clinical signs, computerized tomography (CT), and outcome. The twelve severely head-injured patients had an initial verbal score on the Glasgow coma scale (GCS) of 3 or more and a GCS score of 9 or more. There were 8 male and 4 female patients. The ages of these patients ranged from 23 to 85 years (average age 60.9 years); nine of the patients were older than 60 years of age. An initial CT revealed subdural hematoma in 7 cases and traumatic subarachnoid hemorrhage in 8 cases. Serial CT could be used for 9 cases; delayed intracerebral hematoma was found in 5 patients, and acute cerebral swelling, in 3 patients. The elderly tended to have the hematoma, while the young tended to have acute cerebral swelling. Concerning the Glasgow outcome scale of cases of head trauma who talk and then deteriorate three months after trauma, there was moderate disability in 2 cases and a persistent vegetative state in one, while 9 had died.

Patient-centered medical homes for patients with disabilities.

Science.gov (United States)

Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael

2015-01-01

The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

Feasibility and reliability of the modified berg balance scale in persons with severe intellectual and visual disabilities

NARCIS (Netherlands)

Waninge, Aly; van Wijck, R.; Steenbergen, B.; van der Schans, Cees

2011-01-01

Background: The purpose of this study was to determine the feasibility and reliability of the modified Berg Balance Scale (mBBS) in persons with severe intellectual and visual disabilities (severe multiple disabilities, SMD) assigned Gross Motor Function Classification System (GMFCS) grades I and

Do psychological states associate with pain and disability in chronic neck pain patients?

Science.gov (United States)

Dimitriadis, Zacharias; Kapreli, Eleni; Strimpakos, Nikolaos; Oldham, Jacqueline

2015-01-01

Chronic neck pain is one of the most usual neuromusculoskeletal pain conditions which can lead patients to chronic disability. Similarly to other pain conditions, the changed psychological status of these patients is believed to be associated with their pain condition and disability. However, the association between the psychological status of patients with idiopathic neck pain and their pain intensity and disability is minimally explored. This study was aimed at investigating the association between psychological states (anxiety, depression, kinesiophobia, catastrophizing) of patients with chronic idiopathic neck pain and self-reported pain and disability. Forty five patients with idiopathic chronic neck pain (more than 6 months, at least once a week) participated. Their psychological states were assessed by using the Hospital Anxiety and Depression scale, Pain Catastrophizing scale and Tampa Scale for Kinesiophobia. Self-reported disability was recorded with the Neck Disability Index. Pain intensity was recorded by using a visual analog scale. Neck pain intensity was significantly correlated with anxiety (pneck pain is associated with their self-reported disability, whereas anxiety is also associated with their pain intensity. Anxiety and catastrophizing may be important predicting markers of patients' self-reported disability.

The Gait Deviation Index Is Associated with Hip Muscle Strength and Patient-Reported Outcome in Patients with Severe Hip Osteoarthritis

DEFF Research Database (Denmark)

Rosenlund, Signe; Holsgaard-Larsen, Anders; Overgaard, Søren

2016-01-01

) and with severe primary hip osteoarthritis underwent 3-dimensional gait analysis. Mean Gait Deviation Index, pain after walking and maximal isometric hip muscle strength (flexor, extensor, and abductor) were recorded. All patients completed the 'Physical Function Short-form of the Hip disability...... was to investigate associations between Gait Deviation Index as a measure of gait 'quality' and hip muscle strength and between Gait Deviation Index and patient-reported outcomes in patients with primary hip osteoarthritis. METHOD: Forty-seven patients (34 males), aged 61.1 ± 6.7 years, with BMI 27.3 ± 3.4 (kg/m2...... and Osteoarthritis Outcome Score (HOOS-Physical Function) and the Hip disability and Osteoarthritis Outcome Score subscales for pain (HOOS-Pain) and quality-of-life (HOOS-QOL). RESULTS: Mean Gait Deviation Index was positively associated with hip abduction strength (pstrength (p = 0...

Feasibility and reliability of the modified Berg Balance Scale in persons with severe intellectual and visual disabilities

NARCIS (Netherlands)

Waninge, A.; van Wijck, R.; Steenbergen, B.; van der Schans, C. P.

Background The purpose of this study was to determine the feasibility and reliability of the modified Berg Balance Scale (mBBS) in persons with severe intellectual and visual disabilities (severe multiple disabilities, SMD) assigned Gross Motor Function Classification System (GMFCS) grades I and II.

The Quality of Life of Children with Severe Developmental Disabilities

Science.gov (United States)

Ncube, B. L.; Perry, A.; Weiss, J. A.

2018-01-01

Background: Research examining the quality of life (QoL) of children with severe developmental disabilities (SDD) is limited. The present study examines parent perceptions of child QoL in children with SDD compared with typically developing (TD) children and then examines predictors of QoL for the SDD group. Method: Parents of 246 children with…

Relationship between personality and disability in patients with major depressive disorder.

Science.gov (United States)

Güleç, Medine Yazici; Hocaoğlu, Ciçek

2011-01-01

The co-morbidity of major depressive disorder (MDD ) with personality disorders (PDs) in patients with long-standing work disability at a psychiatry clinic was investigated. The purpose of our study was to evaluate personality for contributing to disability in patients with MDD and to investigate the relationship with these two psychometric characters in patients with MDD. Seventy-two patients with a MDD and 72 healthy controls were assessed by means of both clinician and self-rating scales for depression, anxiety, disability, and the SCID-II personality inventory. There was no difference between the personality parameters of the groups regarding schizotypal and antisocial PDs. Avoidant personality was found to be less common in the patient group (p=0.030). Dependent (p less than 0.001), obsessive (p=0.003), passive-aggressive (p=0.025), self-defeating (p less than 0.001), paranoid (p less than 0.001), schizoid (p=0.012), histrionic (p=0.001), narcissistic (p less than 0.001), and borderline (p less than 0.001) PDs in patients were more common than in controls. On the disability sub-scales, physical role limitation, vitality, social functioning, emotional role limitation, and mental health were significantly lower in patient group than normal control group. While Cluster A was not related to any disability subscale, Cluster B had a positive correlation with vitality and mental health, whereas Cluster C and Cluster NOS had a negative correlation with emotional role limitation. Only the emotional role limitation predicts the presence of depression, whereas only self-defeating, obsessive, paranoid, and passive aggressive personality predict the emotional role limitation. Patients with MDD have personality and disability problems. PDs in depression contribute to disability. Our results demonstrated that the emotional role limitation is the unique sub-scale that predicts the MDD group.

[The severely disabled: a new way of driving a car (author's transl)].

Science.gov (United States)

Raschke, G

1979-11-01

In many cases, the provision of an automobile equipped with a special control system is a necessary part of the rehabilitation of the severely disabled. The car is so important to the disabled as it enables him to overcome daily the distance between home and place of work, hence increasing his mobility and life quality. The presented care control system was developed to meet the individual needs of a particular disability. It is, however, possible to use this system for, or adapt it to, similar types of disabilities. This problem complex has been overcome by following innovations: 1. The electronically controlled accelerator which can be operated with minimal finger pressure. 2. The LIDA shoulder device for tetraplegics, a connecting piece between the shoulder and the manually operated brake lever. 3. The removable armrest on the right hand side of the driver's seat to improve the sitting stability. The car can be easily be converted for "normal driving". The author received financial assistance.

The trajectories of overall disability in the first 5 years after moderate and severe traumatic brain injury.

Science.gov (United States)

Forslund, Marit V; Roe, Cecilie; Perrin, Paul B; Sigurdardottir, Solrun; Lu, Juan; Berntsen, Svein; Andelic, Nada

2017-01-01

To assess longitudinal trajectories of overall disability after moderate-to-severe traumatic brain injury (TBI) and to examine whether those trajectories could be predicted by socio-demographic and injury characteristics. Demographics and injury characteristics of 105 individuals with moderate-to-severe TBI were extracted from medical records. At the 1-, 2-, and 5-year follow-ups, TBI-related disability was assessed by the GOSE. A hierarchical linear model (HLM) was used to examine functional outcomes up to 5 years following injury and whether those outcomes could be predicted by: time, gender, age, relationship, education, employment pre-injury, occupation, GCS, cause of injury, length of post-traumatic amnesia (PTA), CT findings and injury severity score, as well as the interactions between each of these predictors and time. Higher GOSE trajectories (lower disability) were predicted by younger age at injury and shorter PTA, as well as by the interaction terms of time*PTA and time*employment. Those who had been employed at injury decreased in disability over time, while those who had been unemployed increased in disability. The study results support the view that individual factors generally outweigh injury-related factors as predictors of disability after TBI, except for PTA.

A Population Survey in Italy Based on the ICF Classification: Recognizing Persons with Severe Disability

Directory of Open Access Journals (Sweden)

Matilde Leonardi

2012-01-01

Full Text Available Aim of this paper is to describe functioning of subjects with “severe disability” collected with a protocol based on the International Classification of Functioning, Disability, and Health. It included sections on body functions and structures (BF and BS, activities and participation (A&P, and environmental factors (EF. In A&P, performance without personal support (WPS was added to standard capacity and performance. Persons with severe disability were those reporting a number of very severe/complete problems in BF or in A&P-capacity superior to mean + 1SD. Correlations between BF and A&P and differences between capacity, performance-WPS, and performance were assessed with Spearman's coefficient. Out of 1051, 200 subjects were considered as severely disabled. Mild to moderate correlations between BF and A&P were reported (between 0.148 and 0.394 when the full range of impairments/limitations was taken into account; between 0.198 and 0.285 when only the severe impairments/limitations were taken into account; performance-WPS was less similar to performance than to capacity. Our approach enabled identifying subjects with “severe disability” and separating the effect of personal support from that of devices, policies, and service provision.

Delineation of the anatomical relationship of innominate artery and trachea by respiratory-gated MR imaging with true FISP sequence in patients with severe motor and intellectual disabilities

International Nuclear Information System (INIS)

Fujikawa, Yoshinao; Sato, Noriko; Sugai, Kenji; Endo, Yusaku; Matsufuji, Hiroki; Oomi, Tsuyoshi; Honzawa, Shiho; Sasaki, Masayuki

2008-01-01

Tracheoinnominate artery fistula is a well-known complication that arises on using a cannula. Therefore, routine examination of the anatomical relationship of the innominate artery and trachea should be carried out. We evaluated the usefulness of magnetic resonance imaging in 5 patients with severe motor and intellectual disabilities (SMID) using a combination of true-fast imaging of steady-state precession (true-FISP) sequences and two-dimensional prospective acquisition correction (2D-PACE). For all patients, the trachea and the innominate artery were identified without sedation and contrast media. In one patient, the innominate artery was observed to be pressing on the trachea. In three patients, the trachea and innominate artery were brought very close each other, and in the other patient the anatomical relationship of the trachea and surrounding structure was delineated before tracheotomy. The validity of true-FISP sequences combined with the respiratory-gated technique was confirmed useful for the patients who are difficult to lie quietly and to hold their breath voluntarily. (author)

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

Science.gov (United States)

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

2016-01-01

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

An Interstitial Deletion at 7q33-36.1 in a Patient with Intellectual Disability, Significant Language Delay, and Severe Microcephaly

Directory of Open Access Journals (Sweden)

Trupti Kale

2016-01-01

Full Text Available Interstitial deletions of the distal 7q region are considered a rare entity. In this report, we describe a seven-year-old male with a heterozygous interstitial deletion at 7q33-36.1 with characteristic dysmorphic facial features, intellectual disability, severe microcephaly, and significant language delay. The primary focus of our report is to compare our case with the few others in the literature describing interstitial deletions at the long arm of chromosome 7. Based on the various breakpoints in prior studies, a number of phenotypic variations have been identified that are unique to each of the reports. However, there are also a number of similarities among these cases as well. We hope to provide a concise review of the literature and genes involved within our deletion sequence in the hope that it will contribute to creating a phenotypic profile for this patient population.

Navigation-synchronized multimodal control wheelchair from brain to alternative assistive technologies for persons with severe disabilities.

Science.gov (United States)

Puanhvuan, Dilok; Khemmachotikun, Sarawin; Wechakarn, Pongsakorn; Wijarn, Boonyanuch; Wongsawat, Yodchanan

2017-04-01

Currently, electric wheelchairs are commonly used to improve mobility in disabled people. In severe cases, the user is unable to control the wheelchair by themselves because his/her motor functions are disabled. To restore mobility function, a brain-controlled wheelchair (BCW) would be a promising system that would allow the patient to control the wheelchair by their thoughts. P300 is a reliable brain electrical signal, a component of visual event-related potentials (ERPs), that could be used for interpreting user commands. This research aimed to propose a prototype BCW to allowed severe motor disabled patients to practically control a wheelchair for use in their home environment. The users were able to select from 9 possible destination commands in the automatic mode and from 4 directional commands (forward, backward, turn left and right) in the shared-control mode. These commands were selected via the designed P300 processing system. The wheelchair was steered to the desired location by the implemented navigation system. Safety of the user was ensured during wheelchair navigation due to the included obstacle detection and avoidance features. A combination of P300 and EOG was used as a hybrid BCW system. The user could fully operate the system such as enabling P300 detection system, mode shifting and stop/cancelation command by performing a different consecutive blinks to generate eye blinking patterns. The results revealed that the prototype BCW could be operated in either of the proposed modes. With the new design of the LED-based P300 stimulator, the average accuracies of the P300 detection algorithm in the shared-control and automatic modes were 95.31 and 83.42% with 3.09 and 3.79 bits/min, respectively. The P300 classification error was acceptable, as the user could cancel an incorrect command by blinking 2 times. Moreover, the proposed navigation system had a flexible design that could be interfaced with other assistive technologies. This research developed

Disability in patients with trapeziometacarpal joint arthrosis: incidental versus presenting diagnosis.

Science.gov (United States)

Becker, Stéphanie J E; Makarawung, Dennis J S; Spit, Silke A; King, John D; Ring, David

2014-10-01

To test the hypothesis that there is no difference in trapeziometacarpal (TMC) joint arthrosis-related symptoms and disability between patients seeking treatment for symptoms of TMC arthrosis and those with incidental TMC joint arthrosis. We compared 64 patients presenting for care of TMC joint arthrosis with 64 with incidental TMC joint arthrosis. For both groups, the diagnosis was based on crepitation on examination. Bivariate and multivariate analyses assessed factors associated with symptoms and disability related to TMC joint arthrosis. In bivariate analysis, patients presenting for care of TMC joint arthrosis had significantly more symptoms and disability from TMC joint arthrosis than those with incidental TMC joint arthrosis. The best multivariate linear regression model for fewer TMC joint arthrosis-related symptoms and disability included patients with incidental TMC joint arthrosis, male sex, no other painful conditions, less catastrophic thinking, and fewer depressive symptoms and explained 74% of the variability. Having incidental TMC joint arthrosis (25%) and more adaptive coping strategies (less catastrophic thinking; 5%) were the most important contributors to fewer symptoms and less disability. Future studies are merited to determine whether training in better coping strategies (eg, less catastrophic thinking and fewer depressive symptoms) can decrease symptoms and disability in patients with TMC joint arthrosis. Prognostic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Efficacy and Social Validity of Peer Network Interventions for High School Students with Severe Disabilities

Science.gov (United States)

Asmus, Jennifer M.; Carter, Erik W.; Moss, Colleen K.; Biggs, Elizabeth E.; Bolt, Daniel M.; Born, Tiffany L.; Bottema-Beutel, Kristen; Brock, Matthew E.; Cattey, Gillian N.; Cooney, Molly; Fesperman, Ethan S.; Hochman, Julia M.; Huber, Heartley B.; Lequia, Jenna L.; Lyons, Gregory L.; Vincent, Lori B.; Weir, Katie

2017-01-01

This randomized controlled trial examined the efficacy of peer network interventions to improve the social connections of 47 high school students with severe disabilities. School staff invited, trained, and supported 192 peers without disabilities to participate in individualized social groups that met throughout one semester. Compared to…

Diversity, Severe Disability, and Family: A Systematic Review of the Literature

Science.gov (United States)

Shurr, Jordan; Hollingshead, Aleksandra

2017-01-01

Understanding family challenges and perspectives are critical to effective programming and services for individuals with severe disabilities. Equally central, yet often overlooked, is the relationship between family challenges and diversity. This systematic review examined a set of peer reviewed literature published between 2002-2015 at the…

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

Science.gov (United States)

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

2018-04-16

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

Severe cold lower limbs in patients with Parkinson’s disease during the summer

Directory of Open Access Journals (Sweden)

Hiroshi Kataoka

2016-11-01

Full Text Available Parkinson’s disease (PD is frequently associated with vasomotor symptoms such as distal cold limbs or sensitivity to cold. Coldness of the lower limbs (COL usually occurs in winter and is often accompanied by pain, potentially causing difficulty in walking or standing. A standard dopaminergic treatment for such symptoms is yet to be established. We describe two patients with PD, who had severe COL during summer. For example, the patients wore many pairs of socks or used heating appliances in the summer. Severe COL can occur in summertime and can be intolerable or unpleasant, since it can worsen disability. The treatment with a dopamine agonist did not sufficiently decrease the severity of COL.

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

Science.gov (United States)

Elberling, Jesper; Gulmann, Nils; Rasmussen, Alice

2010-09-01

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

Medical Management of the Severe Traumatic Brain Injury Patient.

Science.gov (United States)

Marehbian, Jonathan; Muehlschlegel, Susanne; Edlow, Brian L; Hinson, Holly E; Hwang, David Y

2017-12-01

Severe traumatic brain injury (sTBI) is a major contributor to long-term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with prehospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of sTBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care. Where appropriate, differences between the third and fourth editions of the Brain Trauma Foundation guidelines for the management of severe traumatic brain injury are highlighted.

Is age a determinant for nausea and vomiting in disabled patients ...

African Journals Online (AJOL)

Background and Aim: Postoperative nausea and vomiting (PONV) is one of most frequently encountered problems after dental treatment of mentally and/or motor disabled patients under sedation or general anesthesia. In this study, we aimed to investigate whether PONV incidence in disabled patients differs between adults ...

Use of consumer wireless devices by South Africans with severe communication disability.

Science.gov (United States)

Bornman, Juan; Bryen, Diane Nelson; Moolman, Enid; Morris, John

2016-01-01

Advancements in wireless technology (e.g. cell phones and tablets) have opened new communication opportunities and environments for individuals with severe communication disabilities. The advancement of these technologies poses challenges to ensuring that these individuals enjoy equal access to this increasingly essential technology. However, a paucity of research exists. To describe the nature and frequency with which South African adults with severe communication disabilities have access to and use wireless devices, as well as the types of activities for which wireless devices are used. Survey research was conducted with 30 individuals who use augmentative and alternative communication (AAC) technology using the Survey of User Needs Questionnaire developed in the United States, and localized to the South African context. All participants, despite their limited education, unemployment and low economic status, owned and/or used mainstream wireless devices. Slightly more than half of the participants (53.3%) needed adaptations to their wireless devices. Advantages of using wireless devices were highlighted, including connecting with others (through using text messaging, social networking, making plans with others, sharing photos and videos with friends), for leisure activities (e.g. listening to music, watching videos, playing games), and for safety purposes (e.g. to navigate when lost, using the device when in trouble and needing immediate assistance). These wireless devices offer substantial benefits and opportunities to individuals with disabilities who rely on AAC in terms of independence, social participation, education and safety/security. However, they still do not enjoy equal opportunity to access and use wireless devices relative to the non-disabled population.

Does Intellectual Disability Affect the Development of Dental Caries in Patients with Cerebral Palsy?

Science.gov (United States)

Moreira, Rafaela Nogueira; Alcantara, Carlos Eduardo Pinto; Mota-Veloso, Isabella; Marinho, Sandra Aparecida; Ramos-Jorge, Maria L.; Oliveira-Ferreira, Fernanda

2012-01-01

The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of…

Use of consumer wireless devices by South Africans with severe communication disability

OpenAIRE

Juan Bornman; Diane Nelson Bryen; Enid Moolman; John Morris

2016-01-01

Background: Advancements in wireless technology (e.g. cell phones and tablets) have opened new communication opportunities and environments for individuals with severe communication disabilities. The advancement of these technologies poses challenges to ensuring that these individuals enjoy equal access to this increasingly essential technology. However, a paucity of research exists. Objectives: To describe the nature and frequency with which South African adults with severe communicatio...

Relationships between craniocervical posture and pain-related disability in patients with cervico-craniofacial pain

Science.gov (United States)

López-de-Uralde-Villanueva, Ibai; Beltran-Alacreu, Hector; Paris-Alemany, Alba; Angulo-Díaz-Parreño, Santiago; La Touche, Roy

2015-01-01

Objectives This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP). Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP) and the sternomental distance (SMD). Methods Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively). Results We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]). A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52). Neck disability was strongly positively correlated with craniofacial disability (r=0.79; Pposture, but these differences were very small (mean difference =1.44 cm for HP; 6.24 mm for SMD). The effect sizes reached by these values were estimated to be small for SMD (d=0.38) and medium for HP (d=0.76). Conclusion The results showed no statistically significant correlations between craniocervical posture and variables of pain-related disability, but a strong correlation between the two variables of disability was found. Our findings suggest that small differences between CCFP patients and asymptomatic subjects exist with respect to the two measurements used to assess craniocervical posture (HP and SMD), and these measures demonstrated high test–retest intrarater reliability for

Severe depressive symptoms as predictor of disability pension : a 10-year follow-up study in Denmark

NARCIS (Netherlands)

Bultmann, Ute; Christensen, Karl B.; Burr, Hermann; Lund, Thomas; Rugulies, Reiner

Are severe depressive symptoms prospectively associated with disability pension? To answer that question, we linked data from a representative sample of the Danish workforce with disability pension (DP) award data from the National Registry on Public Transfer Payments. Of the 5106 study

Correlation between subtalar varus angle and disability in patients with patellofemoral arthritis

Directory of Open Access Journals (Sweden)

Patel Birenkumar Jagdishbhai

2009-11-01

Full Text Available Aim: To find the correlation between subtalar varus angle & disability in patients with patellofemoral arthritis. Methods: A total of 30 subjects aged (48.86±5.74 referred to the department of physiotherapy, with patellofemoral arthritis and fulfilling the criteria of inclusion were recruited for the study, sampling method being convenient sampling. Disability score was measured of each patient by WOMAC index (Western Ontario and McMaster Universities Index of Osteoarthritis disability questionnaire and subtalar varus angle was measured in non weight bearing position in prone lying. Results: Pearson’s correlation coefficient test showed a highly significant (p=0.000 positive correlation (r=0.821 between disability scores and subtalar varus angle. Conclusion: There is a highly significant relation between disabilities due to patellofemoral pain in patellofemoral arthritis patients and sub talar varus angle

Impact of Nonmotor Symptoms on Disability in Patients with Parkinson's Disease

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Raggi, Alberto; Leonardi, Matilde; Carella, Francesco; Soliveri, Paola; Albanese, Alberto; Romito, Luigi M.

2011-01-01

Patients with Parkinson's disease have nonmotor symptoms (NMS) that, although poorly considered, have an impact on their quality of life. In contrast, the effect on disability is not systematically evaluated. Adult patients were consecutively enrolled and administered the Non-Motor Symptoms Questionnaire and the WHO Disability Assessment Schedule.…

Associated factors with functional disability and health-related quality of life in Chinese patients with gout: a case-control study.

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Fu, Ting; Cao, Haixia; Yin, Rulan; Zhang, Lijuan; Zhang, Qiuxiang; Li, Liren; Gu, Zhifeng

2017-11-03

Gout is a painful, inflammatory disease that may cause decreased function and health-related quality of life (HRQoL). Limited study did not take the influence of gout characteristics and anxiety on HRQoL into consideration and there are no studies associated with functional disability in individuals with gout from China. This study aims to investigate the related factors of functional disability and HRQoL in gout patients recruited from China. A total of 226 consecutive gout patients and 232 age- and gender-matched healthy individuals were involved in the study. A series of questionnaires (the Short Form 36 health survey, the Patient Health Questionnaire, the Generalized Anxiety Disorder questionnaire, the 10 cm Visual Analog Scale, and the Health Assessment Questionnaire-Disability Index) were applied. Blood samples were taken to examine the level of serum uric acid. Independent samples t-tests, Chi square tests, U test, Spearman rank correlation, logistic regression modeling, and linear regression were used to analyze the data. After adjusted demographic variables, individuals with gout have poorer HRQoL compared to healthy controls. Univariate tests presented that patients with functional disability had longer disease duration, more frequent flares/last year, more severe total pain, more number of tophi, higher degree of depression and anxiety, with a trend toward diabetes, the treatment of colchicine and corticosteroids use, compared to patients without functional disability. Meanwhile, place of residence, hypertension, DM, disease duration, cardiovascular disease, number of flares/last year, total pain, more number of tophi, presence of tender joints, depression, anxiety, currently using colchicine and corticosteroids were correlated significantly with HRQoL. Additionally, multiple regression analysis identified severe pain, depression, and colchicine use as predictors of functional disability. Cardiovascular disease, total pain, number of flares/last year

A Culturally and Linguistically Responsive Framework for Improving Academic and Postsecondary Outcomes of Students with Moderate or Severe Intellectual Disability

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Rivera, Christopher J.; Jimenez, Bree A.; Baker, Joshua N.; Spies, Tracy; Mims, Pamela J.; Ginevra, Courtade

2016-01-01

The needs of culturally and linguistically diverse (CLD) students with moderate or severe intellectual disability (ID) are quite unique and complex. CLD students with moderate or severe ID face many of the same issues as their non-disabled CLD peers; however, due to the nature of their disability this may lead to even less access to the general…

Comparison of Functional Disability with Physical Activity in Patients ...

African Journals Online (AJOL)

The objectives of this study were to evaluate the effects of functional disabilities and physical activity in patients with low back pain (LBP) and apparently healthy individuals (AHI).Oswestry Low back Pain disability questionnaire was administered to thirty five (35) subjects drawn from 3 various health facilities in Lagos State.

Does the severity of disability matter? : The opinion of parents about professional support in residential facilities

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Luijkx, J.; Ten Brug, A.; Vlaskamp, C.

BACKGROUND: Researchers have shown that the characteristics of a person with an intellectual disability (ID), in particular the severity of the disability, are related to the outcomes of professional support. Hardly any studies have asked parents and/or legal guardians for their own opinion about

Behavioural treatment of severe food refusal in five toddlers with developmental disabilities

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Moor, J.M.H. de; Didden, H.C.M.; Korzilius, H.P.L.M.

2007-01-01

BACKGROUND: Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. METHODS: A behavioural treatment package was

Behavioral treatment of severe food refusal in five toddlers with developmental disabilities

NARCIS (Netherlands)

Moor, J.M.H. de; Didden, H.C.M.; Korzilius, H.P.L.M.

2007-01-01

Background Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. Methods A behavioural treatment package was

Behavioural treatment of severe food refusal in five toddlers with developmental disabilities.

NARCIS (Netherlands)

Moor, J.M.H. de; Didden, R.; Korzilius, H.P.L.M.

2007-01-01

BACKGROUND: Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. METHODS: A behavioural treatment package was

Monitoring the autonomic nervous activity as the objective evaluation of music therapy for severely and multiply disabled children.

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Orita, Makiko; Hayashida, Naomi; Shinkawa, Tetsuko; Kudo, Takashi; Koga, Mikitoshi; Togo, Michita; Katayama, Sotetsu; Hiramatsu, Kozaburo; Mori, Shunsuke; Takamura, Noboru

2012-07-01

Severely and multiply disabled children (SMDC) are frequently affected in more than one area of development, resulting in multiple disabilities. The aim of the study was to evaluate the efficacy of music therapy in SMDC using monitoring changes in the autonomic nervous system, by the frequency domain analysis of heart rate variability. We studied six patients with SMDC (3 patients with cerebral palsy, 1 patient with posttraumatic syndrome after head injury, 1 patient with herpes encephalitis sequelae, and 1 patient with Lennox-Gastaut syndrome characterized by frequent seizures, developmental delay and psychological and behavioral problems), aged 18-26 (mean 22.5 ± 3.5). By frequency domain method using electrocardiography, we measured the high frequency (HF; with a frequency ranging from 0.15 to 0.4 Hz), which represents parasympathetic activity, the low frequency/high frequency ratio, which represents sympathetic activity between the sympathetic and parasympathetic activities, and heart rate. A music therapist performed therapy to all patients through the piano playing for 50 min. We monitored each study participant for 150 min before therapy, 50 min during therapy, and 10 min after therapy. Interestingly, four of 6 patients showed significantly lower HF components during music therapy than before therapy, suggesting that these four patients might react to music therapy through the suppression of parasympathetic nervous activities. Thus, music therapy can suppress parasympathetic nervous activities in some patients with SMDC. The monitoring changes in the autonomic nervous activities could be a powerful tool for the objective evaluation of music therapy in patients with SMDC.

Validation of the "World Health Organization Disability Assessment Schedule, WHODAS-2" in patients with chronic diseases

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Burger Helena

2010-05-01

Full Text Available Abstract Background The WHODAS-2 is a disability assessment instrument based on the conceptual framework of the International Classification of Functioning, Disability, and Health (ICF. It provides a global measure of disability and 7 domain-specific scores. The aim of this study was to assess WHODAS-2 conceptual model and metric properties in a set of chronic and prevalent clinical conditions accounting for a wide scope of disability in Europe. Methods 1,119 patients with one of 13 chronic conditions were recruited in 7 European centres. Participants were clinically evaluated and administered the WHODAS-2 and the SF-36 at baseline, 6 weeks and 3 months of follow-up. The latent structure was explored and confirmed by factor analysis (FA. Reliability was assessed in terms of internal consistency (Cronbach's alpha and reproducibility (intra-class correlation coefficients, ICC. Construct validity was evaluated by correlating the WHODAS-2 and SF-36 domains, and comparing known groups based on the clinical-severity and work status. Effect size (ES coefficient was used to assess responsiveness. To assess reproducibility and responsiveness, subsamples of stable (at 6 weeks and improved (after 3 moths patients were defined, respectively, according to changes in their clinical-severity. Results The satisfactory FA goodness of fit indexes confirmed a second order factor structure with 7 dimensions, and a global score for the WHODAS-2. Cronbach's alpha ranged from 0.77 (self care to 0.98 (life activities: work or school, and the ICC was lower, but achieved the recommended standard of 0.7 for four domains. Correlations between global WHODAS-2 score and the different domains of the SF-36 ranged from -0.29 to -0.65. Most of the WHODAS-2 scores showed statistically significant differences among clinical-severity groups for all pathologies, and between working patients and those not working due to ill health (p Conclusions The latent structure originally

Long-lasting functional disabilities in patients who recover from coma after cardiac operations.

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Rodriguez, Rosendo A; Nair, Shona; Bussière, Miguel; Nathan, Howard J

2013-03-01

Uncertainty regarding the long-term functional outcome of patients who awaken from coma after cardiac operations is difficult for families and physicians and may delay rehabilitation. We studied the long-term functional status of these patients to determine if duration of coma predicted outcome. We followed 71 patients who underwent cardiac operations; recovered their ability to respond to verbal commands after coma associated with postoperative stroke, encephalopathy, and/or seizures; and were discharged from the hospital. The Glasgow Outcome Scale Extended (GOSE) was used to assess functional disability 2 to 4 years after discharge. Outcomes were classified as favorable (GOSE scores 7 and 8) and unfavorable (GOSE scores 1-6). Of 71 patients identified, 39 were interviewed, 15 died, 1 refused to be interviewed, and 16 were lost to follow-up. Of the 54 patients with completed GOSE evaluations, only 15 (28%) had favorable outcomes. Among patients with unfavorable outcomes, 15 (28%) died, 14 (26%) survived with moderate disabilities, and 10 (18%) had severe disabilities. Factors associated with unfavorable outcomes were increases in duration of coma (p = 0.007), time in intensive care (p = 0.006), length of hospitalization (p = 0.004), and postoperative serum creatine kinase levels (p = 0.006). Only duration of coma was an independent predictor of unfavorable outcome (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.008-1.537; p = 0.042). Patients with durations of coma greater than 4 days were more likely to have unfavorable outcomes (OR, 5.1; 95% CI, 1.3-21.3; p = 0.02). Two thirds of comatose patients who survived to discharge after cardiac operations had unfavorable long-term functional outcomes. A longer duration of unconsciousness is a predictor of unfavorable outcome. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Career transitions for persons with severe physical disabilities: integrating technological and psychosocial skills and accommodations.

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Lash, M; Licenziato, V

1995-01-01

This article describes a vocational training program entitled, 'Careers in Automation for Persons with Severe Physical Disabilities', that was developed by the Department of Physical Medicine and Rehabilitation at Tufts University School of Medicine in collaboration with the Massachusetts Rehabilitation Commission. Its goal is to secure employment for individuals with severe physical impairments by using computers and technology as job related accommodations. Psychosocial, educational, and vocational profiles are presented for 24 clients over 4 years. Three case studies involving persons with traumatic, chronic and developmental disabilities illustrate the importance of matching technological accommodations with employer needs and personal preferences. Discussion of employment outcomes illustrates that the effective use of computers and technology by persons with disabilities is best measured not by the degree of sophistication and engineering of systems and devices, but by employer and employee satisfaction with job performance and productivity.

Design of a Randomised Controlled Trial (RCT on the effectiveness of a Dutch patient advocacy case management intervention among severely disabled Multiple Sclerosis patients

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Annema Coby

2010-05-01

Full Text Available Abstract Background Case management has been suggested as an innovative strategy that facilitates the improvement of a patient's quality of life, reduction of hospital length of stay, optimization of self-care and improvement of satisfaction of patients and professionals involved. However, there is little evidence about the effectiveness of the patient advocacy case management model in clinical practice. Therefore, the objective of our study was to examine the effects of the Dutch patient advocacy case management model for severely disabled Multiple Sclerosis (MS patients and their caregivers compared to usual care. Methods/design In this randomized controlled trial the effectiveness of casemanagement on quality of life of patients and their caregivers, quality of care, service use and economic aspects were evaluated. The primary outcomes of this study were quality of life of MS-patients and caregiver burden of caregivers. Furthermore, we examined quality of life of caregivers, quality of care, service use and costs. Discussion This is a unique trial in which we examined the effectiveness of case management from a broad perspective. We meticulously prepared this study and applied important features and created important conditions for both intervention and research protocol to increase the likelihood of finding evidence for the effectiveness of patient advocacy case management. Concerning the intervention we anticipated to five important conditions: 1 the contrast between the case management intervention compared to the usual care seems to be large enough to detect intervention effects; 2 we included patients with complex care situations and/or were at risk for critical situations; 3 the case managers were familiar with disease specific health-problems and a broad spectrum of solutions; 4 case managers were competent and authorized to perform a medical neurological examination and worked closely with neurologists specialized in MS; and 5 the

Patients living with disabilities: The need for high-quality primary care.

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Lofters, Aisha; Guilcher, Sara; Maulkhan, Niraj; Milligan, James; Lee, Joseph

2016-08-01

To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. A waiting room survey using a convenience sample. A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. Patients from the Mobility Clinic were more than twice as likely to be receiving benefits or social assistance (75.0% vs 32.1%, P data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P = .004). In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can help to increase quality of care. Copyright© the College of Family Physicians of Canada.

Natural course and predictors of severe disability and death in Thai patients with dementia.

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Dharmasaroja, Pornpatr A; Lolekha, Praween; Kulkantrakorn, Kongkiat; Charernboon, Thammanard; Watcharakorn, Arvemas; Piyabhan, Pritsana

2017-12-01

More than half of patients with dementia lived in countries with low and middle incomes. However, there have been few studies on the natural course of disease in these countries. The purpose of this study was to study the natural course and the predictive factors of advanced stage and death in Thai patients with dementia. Patients with dementia who were treated in neurologic and psychiatric clinic from September 2004 to February 2016, were included. Data about natural course of diseases, behavioral and psychological symptoms in dementia (BPSD) and complications were studied. 207 patients were included. Mean age was 77years old. Mean Thai Mental State Examination (TMSE) was 17.5. Alzheimer's disease was the most common cause of dementia (55%). With the mean follow-up of 39months (range from 2 to 126months), 64% of the patients had BPSD. Sixty-two patients (30%) had complications required admission. Seven patients died. Fifty-four patients (29%) ended in the advanced stage of dementia. Mean duration from diagnosis to the advanced stage was 49months. Complications that required admission usually occurred in moderate to severe dementia and were strongly associated with the advanced stage or death (OR 6.1, 95%CI 2.57-14.49, p-valuedementia in the study. Most demented patients presented in moderate severity of dementia. Mean duration from diagnosis to the advanced stage of dementia was approximate 4-5years. Complications required admissions related to the progression to advanced stage or death. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perceptions Matter: Administrators' Vision of Instruction for Students with Severe Disabilities

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Roberts, Carly A.; Ruppar, Andrea L.; Olson, Amy J.

2018-01-01

School administrators play an important role in shaping teaching and learning. However, very little is known regarding how school administrators perceive instruction for students with severe disabilities and how those perceptions shape expectations and visions for instruction. Semistructured interviews were used to interview 12 administrators…

A description of the severity of equestrian-related injuries (ERIs) using clinical parameters and patient-reported outcomes.

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Papachristos, Alexander; Edwards, Elton; Dowrick, Adam; Gosling, Cameron

2014-09-01

Despite a number of injury prevention campaigns and interventions, horse riding continues to be a dangerous activity, resulting in more accidents per hour than motorcycling, skiing and football. Injuries are often serious, with one in four patients requiring admission to hospital. This study aims to describe the severity of equestrian-related injuries (ERIs) using both clinical parameters and patient-reported outcomes. A retrospective study of all patients aged ≥18 years admitted to The Alfred Hospital between January 2003 and January 2008 with an ERI was performed. Specific clinical data were extracted from the medical record. In addition, a questionnaire was conducted identifying the details of the accident, the required recovery time and levels of ongoing pain and physical disability. During the study period 172 patients met the inclusion criteria. There were three deaths (2%). Eighty-two patients (48%) suffered head injuries. Forty-one patients (24%) were admitted to the ICU and 31 patients (18%) required mechanical ventilation. On discharge, 41 patients (24%) required transfer to a sub-acute rehabilitation facility. One-hundred-and-twenty-four patients (72%) completed the questionnaire. Thirty-nine respondents (31%) were not wearing a helmet. Among patients injured for more than 6 months, 38 (35%) still experienced moderate or severe pain or disability. Ninety-five patients had returned to work at the time of review, among which 47(50%) required longer than 6 months to recover, and 40 (42%) returned at a reduced capacity. The clinical and patient-reported outcomes of ERIs requiring hospital admission are poor. Persistent pain and disability are common, even up to 5 years post-injury. A large proportion of patients required longer than 6 months to return to work and many return at a reduced capacity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Disability in subacute whiplash patients: usefulness of the neck disability index.

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Nieto, Rubén; Miró, Jordi; Huguet, Anna

2008-08-15

Cross-sectional study. To analyze the psychometric properties of the neck disability index (NDI), with a special emphasis in its factor structure, and its usefulness, in a sample of patients suffering from a subacute whiplash problem. A valid and reliable instrument to assess pain-related disability would be of great help to clinicians and researchers interested in whiplash associated disorders. First, to better understand the impact of whiplash on the patient's life, and his or her progress over time. Second, to formulate comprehensive treatment plans, and evaluate the results from therapeutic actions. Finally, to follow-up patients' changes and improvement. The NDI could be an appropriate instrument for these purposes. A convenience sample of 150 subacute whiplash patients participated. They were requested to complete the Catalan version of the NDI, and report about their pain intensity, pain interference and depression. RESULTS.: An exploratory factor analysis showed that the NDI can be viewed as a 2-factor instrument. The items and the instrument's total score were normally distributed. Internal consistency was also appropriate both for the total score (Cronbach's alpha: 0.87) and the 2 subscales (0.7 for the pain and interference with cognitive functioning scale, and 0.83 for the physical functioning scale). Total NDI and subscales scores significantly correlated with pain intensity, pain interference, and depression. The NDI showed excellent psychometric properties in a sample of subacute whiplash patients. Additional research is needed to replicate the NDIs factor structure.

Use of consumer wireless devices by South Africans with severe communication disability

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Juan Bornman

2016-02-01

Full Text Available Background: Advancements in wireless technology (e.g. cell phones and tablets have opened new communication opportunities and environments for individuals with severe communication disabilities. The advancement of these technologies poses challenges to ensuring that these individuals enjoy equal access to this increasingly essential technology. However, a paucity of research exists. Objectives: To describe the nature and frequency with which South African adults with severe communication disabilities have access to and use wireless devices, as well as the types of activities for which wireless devices are used. Method: Survey research was conducted with 30 individuals who use augmentative and alternative communication (AAC technology using the Survey of User Needs Questionnaire developed in the United States, and localized to the South African context. Results: All participants, despite their limited education, unemployment and low economic status, owned and/or used mainstream wireless devices. Slightly more than half of the participants (53.3% needed adaptations to their wireless devices. Advantages of using wireless devices were highlighted, including connecting with others (through using text messaging, social networking, making plans with others, sharing photos and videos with friends, for leisure activities (e.g. listening to music, watching videos, playing games, and for safety purposes (e.g. to navigate when lost, using the device when in trouble and needing immediate assistance. Conclusion: These wireless devices offer substantial benefits and opportunities to individuals with disabilities who rely on AAC in terms of independence, social participation, education and safety/security. However, they still do not enjoy equal opportunity to access and use wireless devices relative to the non-disabled population.

Self-Determination for Individuals with the Most Severe Disabilities: Moving beyond Chimera.

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Brown, Fredda; Gothelf, Carole R.; Guess, Doug; Lehr, Donna H.

1998-01-01

This article explores implications of people's interpretations of communicative efforts by people with severe disabilities. Recent initiatives to support and promote self-determination are critically assessed as possibly functioning to limit self-determination. Use of preference assessments and behavior supports is discussed as a key to…

Attuning: A Communication Process between People with Severe and Profound Intellectual Disability and Their Interaction Partners.

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Griffiths, Colin; Smith, Martine

2016-03-01

People with severe and profound intellectual disability typically demonstrate a limited ability to communicate effectively. Most of their communications are non-verbal, often idiosyncratic and ambiguous. This article aims to identify the process that regulates communications of this group of people with others and to describe the methodological approach that was used to achieve this. In this qualitative study, two dyads consisting of a person with severe or profound intellectual and multiple disability and a teacher or carer were filmed as they engaged in school-based activities. Two 1-hour videotapes were transcribed and analysed using grounded theory. Attuning was identified within the theory proposed here as a central process that calibrates and regulates communication. Attuning is conceptualized as a bidirectional, dyadic communication process. Understanding this process may support more effective communication between people with severe or profound intellectual and multiple disability and their interaction partners. © 2015 John Wiley & Sons Ltd.

Severely disabling chronic pain in young adults: prevalence from a population-based postal survey in North Staffordshire

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Thomas Elaine

2005-07-01

Full Text Available Abstract Background Severely disabling chronic pain in the adult population is strongly associated with a range of negative health consequences for individuals and high health care costs, yet its prevalence in young adults is less clear. Methods All adults aged 18–25 years old registered with three general practices in North Staffordshire were invited to complete a postal questionnaire containing questions on pain within the last 6 months, pain location and duration. Severity of chronic pain was assessed by the Chronic Pain Grade. Severely disabling chronic pain was defined as pain within the last six months that had lasted for three months or more and was highly disabling-severely limiting (Grade IV. Results 858 responses from 2,389 were received (adjusted response = 37.0%. The prevalence of any pain within the previous six months was 66.9% (95%CI: 63.7%, 70.1%. Chronic pain was reported by 14.3% (95%CI: 12.0%, 16.8% of respondents with severely disabling chronic pain affecting 3.0% (95%CI: 2.0%, 4.4% of this population. Late responders were very similar to early responders in their prevalence of pain. Cross-checking the practice register against the electoral roll suggested register inaccuracies contributed to non-response. Conclusion Pain is a common phenomenon encountered by young adults, affecting 66.9% of this study population. Previously observed age-related trends in severely disabling chronic pain in older adults extend to younger adults. Although a small minority of younger adults are affected, they are likely to represent a group with particularly high health care needs. High levels of non-response in the present study means that these estimates should be interpreted cautiously although there was no evidence of non-response bias.

Broadening the Definition of Engagement for Students with Severe Disabilities: A Phenomenological Study of the Experts in the Field

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Hollingshead, Aleksandra K.

2013-01-01

While a great deal has been written about the complexities of engagement for learners without severe disabilities, there is less for students with severe disabilities. Engagement as a complex construct, consisting of behavioral, cognitive, and emotional components (Finn & Zimmer, 2012; Fredricks, Blumenfeld, & Paris, 2004; Skinner &…

Intellectual disability and patient activation after release from prison: a prospective cohort study.

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Young, J T; Cumming, C; van Dooren, K; Lennox, N G; Alati, R; Spittal, M J; Brophy, L; Preen, D B; Kinner, S A

2017-10-01

Intellectual disability and patient activation may be important drivers of inequities in health service access and health outcomes for people with intellectual disability transitioning from prison to the community. We assessed the association between intellectual disability and patient activation after prison release and examined whether this association varied, depending on whether intellectual disability was identified prior to prison release. Overall, 936 prisoners were screened for intellectual disability by using the Hayes Ability Screening Index and completed the Patient Activation Measure (PAM) within 6 weeks of prison release and again at 1, 3 and 6 months post-release. We estimated the association between intellectual disability status and PAM scores by using a multilevel linear model, adjusting for sociodemographic, behavioural, health and criminogenic factors. We used propensity score matching to estimate the impact of being identified with intellectual disability prior to release from prison on the change in mean PAM score after prison release. Compared with those who screened negative for intellectual disability, ex-prisoners who screened positive, both with and without prior identification of intellectual disability, had significantly decreased mean PAM scores [(B = -4.3; 95% CI: -6.3, -2.4) and (B = -4.5; 95% CI: -6.8, -2.3), respectively] over 6 months of follow-up. Among those who reported being identified with intellectual disability prior to release from prison, a significant increase in PAM score at the 6-month follow-up interview (B = 5.89; 95% CI: 2.35, 9.42; P = 0.001) was attributable to being identified with intellectual disability prior to release. Ex-prisoners screening positive for possible intellectual disability have decreased patient activation for at least 6 months after release from prison. However, individuals whose possible intellectual disability is unidentified appear to be particularly vulnerable. Incarceration is a

Disproportionately severe calcinosis cutis in an 88-year-old patient with CREST syndrome

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Buchowski, J.M.; Ahn, N.U.; Ahn, U.M. [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore, MD (United States); McCarthy, E.F. [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore, MD (United States); Dept. of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Mehta, M.B. [Clinical Associates, Good Samaritan Hospital, Baltimore, MD (United States)

2001-08-01

An 88-year-old woman with CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias) presented with hyperglycemia, intravascular depletion, and atrial fibrillation. The patient was found to have unusually severe calcinosis cutis in both legs extending from the knees to the ankles bilaterally, as well as Raynaud's phenomenon, sclerodactyly, and telangiectasias. The patient was normocalcemic and normophosphatemic. Although subcutaneous calcification is often seen with CREST syndrome, this case is unusual in that the area of involvement was much larger than previously described. Furthermore, the amount of calcinosis was disproportionately severe and was the major cause of symptoms and disability compared with the other components of the syndrome. (orig.)

Correlation of PROMIS Physical Function and Pain CAT Instruments With Oswestry Disability Index and Neck Disability Index in Spine Patients.

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Papuga, Mark O; Mesfin, Addisu; Molinari, Robert; Rubery, Paul T

2016-07-15

A prospective and retrospective cross-sectional cohort analysis. The aim of this study was to show that Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) assessments for physical function and pain interference can be efficiently collected in a standard office visit and to evaluate these scores with scores from previously validated Oswestry Disability Index (ODI) and Neck Disability Index (NDI) providing evidence of convergent validity for use in patients with spine pathology. Spinal surgery outcomes are highly variable, and substantial debate continues regarding the role and value of spine surgery. The routine collection of patient-based outcomes instruments in spine surgery patients may inform this debate. Traditionally, the inefficiency associated with collecting standard validated instruments has been a barrier to routine use in outpatient clinics. We utilized several CAT instruments available through PROMIS and correlated these with the results obtained using "gold standard" legacy outcomes measurement instruments. All measurements were collected at a routine clinical visit. The ODI and the NDI assessments were used as "gold standard" comparisons for patient-reported outcomes. PROMIS CAT instruments required 4.5 ± 1.8 questions and took 35 ± 16 seconds to complete, compared with ODI/NDI requiring 10 questions and taking 188 ± 85 seconds when administered electronically. Linear regression analysis of retrospective scores involving a primary back complaint revealed moderate to strong correlations between ODI and PROMIS physical function with r values ranging from 0.5846 to 0.8907 depending on the specific assessment and patient subsets examined. Routine collection of physical function outcome measures in clinical practice offers the ability to inform and improve patient care. We have shown that several PROMIS CAT instruments can be efficiently administered during routine clinical visits. The

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability.

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Slawski, Diana E; Salahuddin, Hisham; Shawver, Julie; Kenmuir, Cynthia L; Tietjen, Gretchen E; Korsnack, Andrea; Zaidi, Syed F; Jumaa, Mouhammad A

2018-04-01

The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0-2 or return to baseline. Of the 96 patients, 50 had mild baseline disability (mRS score 0-1) and 46 had moderate disability (mRS score 2-4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, p = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, p = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, p = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability ( p baseline disability, and delayed treatment are associated with sub-optimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment.

Assessing the Social Skills and Problem Behaviors of Adolescents With Severe Disabilities Enrolled in General Education Classes.

Science.gov (United States)

Lyons, Gregory L; Huber, Heartley B; Carter, Erik W; Chen, Rui; Asmus, Jennifer M

2016-07-01

Although enhancing the social competence of students with severe disabilities has long remained a prominent focus of school-based intervention efforts, relatively little attention has focused on identifying the most critical social and behavioral needs of students during high school. We examined the social skills and problem behaviors of 137 adolescents with severe disabilities from the vantage point of both special educators and parents. We sought to identify areas of potential intervention need, explore factors associated with social skill and problem behavior ratings, and examine the extent to which teachers and parents converged in their assessments of these needs. Our findings indicate teachers and parents of high school students with severe disabilities rated social skills as considerably below average and problem behaviors as above average. In addition, lower social skills ratings were evident for students with greater support needs, lower levels of overall adaptive behavior, and a special education label of autism. We found moderate consistency in the degree to which teachers and parents aligned in their assessments of both social skills and problem behavior. We offer recommendations for assessment and intervention focused on strengthening the social competence of adolescents with severe disabilities within secondary school classrooms, as well as promising avenues for future research.

Feasibility of bioelectrical impedance analysis in persons with severe intellectual and visual disabilities

NARCIS (Netherlands)

Havinga-Top, Thamar; Waninge, Aly; van der Schans, Cees; Jager, Harriët

2015-01-01

Background: Body composition measurements provide importanti nformation about physical fitness and nutritional status. People with severe intellectual and visual disabilities (SIVD) have an increased risk for altered body composition. Bioelectrical impedance analysis (BIA) has been evidenced as a

Feasibility of bioelectrical impedance analysis in persons with severe intellectual and visual disabilities

NARCIS (Netherlands)

Havinga-Top, A. M.; Waninge, A.; van der Schans, C. P.; Jager-Wittenaar, H.

2015-01-01

Background: Body composition measurements provide important information about physical fitness and nutritional status. People with severe intellectual and visual disabilities (SIVD) have an increased risk for altered body composition. Bioelectrical impedance analysis (BIA) has been evidenced as a

Design of a Code-Maker Translator Assistive Input Device with a Contest Fuzzy Recognition Algorithm for the Severely Disabled

Directory of Open Access Journals (Sweden)

Chung-Min Wu

2015-01-01

Full Text Available This study developed an assistive system for the severe physical disabilities, named “code-maker translator assistive input device” which utilizes a contest fuzzy recognition algorithm and Morse codes encoding to provide the keyboard and mouse functions for users to access a standard personal computer, smartphone, and tablet PC. This assistive input device has seven features that are small size, easy installing, modular design, simple maintenance, functionality, very flexible input interface selection, and scalability of system functions, when this device combined with the computer applications software or APP programs. The users with severe physical disabilities can use this device to operate the various functions of computer, smartphone, and tablet PCs, such as sending e-mail, Internet browsing, playing games, and controlling home appliances. A patient with a brain artery malformation participated in this study. The analysis result showed that the subject could make himself familiar with operating of the long/short tone of Morse code in one month. In the future, we hope this system can help more people in need.

Body Concept, Disability, and Depression in Patients with Spasmodic Torticollis

Directory of Open Access Journals (Sweden)

M. Jahanshahi

1990-01-01

Full Text Available Eighty-five patients with idiopathic spasmodic torticollis were compared with an equally chronic group of 49 cervical spondylosis sufferers in terms of body concept, depression, and disability. The torticollis patients were significantly more depressed and disabled and had a more negative body concept. Depression had different determinants in the two groups. Extent of disfigurement was a major predictor of depression in torticollis. Neuroticism accounted for the greatest proportion of the variance of depression in cervical spondylosis.

The dischargeable cut-off score of Oswestry Disability Index (ODI) in the inpatient care for low back pain with disability.

Science.gov (United States)

Park, Sang-Won; Shin, Ye-Sle; Kim, Hye-Jin; Lee, Jin-Ho; Shin, Joon-Shik; Ha, In-Hyuk

2014-10-01

The admission due to low back pain (LBP) became prevalent cause of international economic losses. Since LBP patients with disability are often subject to inpatient care, it is important to determine the appropriate time of discharge. The purpose of this study is to set the cut-off value of appropriate Oswestry Disability Index (ODI) at the time of discharge. Of 1,394 LBP patients admitted in hospital specialized in spinal disease, 774 eligible patients with disability were included in this study. And several clinical variables including numerical rating score, ODI, satisfaction level were observed during the hospital stay. We considered satisfaction level as an important factor for discharge, categorized patients into satisfied group and dissatisfied group. Through the statistical analysis, appropriate factor for determining dischargeable patients satisfied with their current condition and its cut-off value of ODI were found. And proper predictors for the cut-off value were extracted statistically and logically from a pool of several clinical indexes. The ODI at the time of discharge was most accurate in determining dischargeable patients. The cut-off value of ODI was 30. Predictors were ODI questions 4 and 6. We set the cut-off value of dischargeable ODI for LBP inpatient with disability and found its predictor.

Meaningful Collaboration in the Inclusive Music Classroom: Students with Severe Intellectual Disabilities

Science.gov (United States)

Darrow, Alice-Ann

2017-01-01

Most music educators have little experience or preparation in teaching students with severe intellectual disabilities. Increasing diversity in our schools will require music educators to teach students whose needs exceed those typically found in the music class or ensemble. Facilitating their inclusion in a music program can be immensely rewarding…

Acquired Severe Disabilities and Complex Health Care Needs: Access to Inclusive Education

Science.gov (United States)

Ballard, Sarah L.; Dymond, Stacy K.

2016-01-01

This case study examined one high school student's access to inclusive education and experiences in an inclusive English class after he acquired severe disabilities and complex health care needs from a nontraumatic brain injury. Multiple sources of data (i.e., interviews, field notes, and documents) were collected and analyzed to formulate…

Reimagining Childhood: Responding to the Challenge Presented by Severe Developmental Disability.

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Salter, Erica K

2017-09-01

Through an exploration of the experience of severe and profound intellectual disability, this essay will attempt to expose the predominant, yet usually obscured, medical anthropology of the child and examine its effects on pediatric bioethics. I will argue that both modern western society and modern western medicine do, actually, have a robust notion of the child, a notion which can find its roots in three influential thinkers: Aristotle, Immanuel Kant and Jean Piaget. Together, these philosophers offer us a compelling vision: the child is primarily a future rational, autonomous adult. While this tacit understanding has arguably widespread effects on such things as our concept of good parenting, of proper schooling, and so on, I will focus on the effect is has on the treatment of children with severe developmental disabilities. When examined in light of this population, the dominant medical anthropology of the child will be shown to be deficient. Instead, I argue for an expansion-indeed, a full reimagining-of our notions of childhood, not only to re-infuse dignity into the lives of children with SDD, but to better represent the goods of childhood, generally.

Effects of biomarkers of oxidative stress damage on prevalence and severity of visual disability among black Central Africans.

Science.gov (United States)

Longo-Mbenza, B; Muaka, M Mvitu; Yokobo, E Cibanda; Phemba, I Longo; Mokondjimobe, E; Gombet, T; Ndembe, D Kibokela; Mona, D Tulomba; Masamba, S Wayiza

2012-01-01

Because of the demographic transition, lifestyle changes, urbanization, and nutrition transition, Central Africans are at higher risk of ocular diseases associated with oxidative stress and visual disability. This study aimed to estimate the normal values of oxidant status defined by oxidized low-density lipoprotein (Ox-LDL), 8-Isoprostane and 8-hydroxy-deoxyguanosine (8-OHdG) and to determine their pathogenic role in the prevalence and the severity of visual disability among these black Africans. This was a cross-sectional study, run in a case-control study randomly selected from Kinshasa province, DR Congo. The study included 150 type 2 diabetes mellitus (T2DM) patients (cases) matched for sex and age to 50 healthy non diabetic controls. Logistic regression models were used to identify independent determinants of visual disability. The presence rates were 8.5% for blindness, 20.5% for visual impairment and 29% for visual disability including blindness and visual impairment. After adjusted for taro leaves intake, red beans intake, T2DM, aging, waist circumference, and systolic blood pressure, we identified low education level (OR=3.3 95%CI 1.5-7.2; p=0.003), rural-urban migration (OR=2.6 95% CI 1.2-5.6; p=0.017), and high Ox-LDL (OR=2.3 95% CI 1.1-4.7; p=0.029) as the important independent determinants of visual disability. After adjusted for education, intake of red beans, intake of taro leaves, triglycerides, and T2DM, we identified no intake of safou fruit (OR=50.7 95% CI 15.2-168.5; pvisual disability. After adjusted for education level, no intake of red beans, no intake of Taro leaves, triglycerides, and T2DM, we identified no intake of Safou fruit (OR=43.1 95% CI 13.7-135.4; pvisual disability. Visual disability remains a public health problem in Central Africa. Antioxidant supplement, fruit intake, nutrition education, control of migration, and blocking of oxidative stress are crucial steps for delayed development of vision loss.

Mood disorders in intellectual disability.

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Hurley, Anne D

2006-09-01

This article examines reviews and research on the diagnosis and treatment of mood disorders in people with intellectual disability published from September 2004 to December 2005. Patients with intellectual disability have limitations in verbal ability, and with increasing levels of disability may have an atypical clinical presentation. Thus, methods to diagnose mood disorders were a major research focus. Informant-rating scales and two self-report instruments provided data on thought patterns, aberrant behavior, appetite, and suicidality. Behavioral symptoms such as aggression were frequently associated with mood disorders. Pharmacotherapy and electroconvulsive therapy were found to be effective treatments. Mood disorders were frequently identified in people with intellectual disability, although suicide was still quite rare. Patients with milder levels of disability can use self-report measures and can be diagnosed using standard criteria with little modification. For those with more severe disability, diagnosis is challenging and often requires the use of residual categories. Atypical clinical presentation, including maladaptive behaviors, lent support for 'behavioral equivalent' substitutes of standard criteria. Typical pharmacological agents were effective for depression and electroconvulsive therapy for treatment-resistant bipolar disorder.

Robots and ICT to support play in children with severe physical disabilities: a systematic review.

Science.gov (United States)

van den Heuvel, Renée J F; Lexis, Monique A S; Gelderblom, Gert Jan; Jansens, Rianne M L; de Witte, Luc P

2015-09-02

Play is an essential part of children's lives. Children with physical disabilities experience difficulties in play, especially those with severe physical disabilities. With the progress of innovative technology, the possibilities to support play are increasing. The purpose of this literature study is to gain insight into the aims, control options and commercial availability of information and communication technology (ICT) and robots to support play (especially play for the sake of play) in children with severe physical disabilities. A systematic literature search in the databases PubMed, CINAHL, IEEE and ERIC was carried out. Titles and abstracts were assessed independently by three reviewers. In addition, studies were selected using Google Scholar, conference proceedings and reference lists. Three main groups of technology for play could be distinguished: robots (n = 8), virtual reality systems (n = 15) and computer systems (n = 4). Besides, ICT and robots developed for specific therapy or educational goals using play-like activities, five of the in total 27 technologies in this study described the aim of "play for play's sake". Many ICT systems and robots to support play in children with physical disabilities were found. Numerous technologies use play-like activities to achieve therapeutic or educational goals. Robots especially are used for "play for play's sake". Implications for Rehabilitation This study gives insight into the aims, control options and commercial availability for application of robots and ICT to support play in children with severe physical disabilities. This overview can be used in both the fields of rehabilitation and special education to search for new innovative intervention options and it can stimulate them to use these innovative play materials. Especially robots may have great potential in supporting "play for play's sake".

Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with 'nociceptive', 'peripheral neuropathic' and 'central sensitisation' pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain.

LENUS (Irish Health Repository)

Smart, Keith M

2012-04-01

Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of \\'nociceptive\\' (NP), \\'peripheral neuropathic\\' (PNP) and \\'central sensitisation\\' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient\\'s pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance. There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai\\'s Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

An integrative review of patient safety in studies on the care and safety of patients with communication disabilities in hospital.

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Hemsley, Bronwyn; Georgiou, Andrew; Hill, Sophie; Rollo, Megan; Steel, Joanne; Balandin, Susan

2016-04-01

To review the research literature on the experiences of patients with communication disabilities in hospital according to the Generic Model of patient safety. In 2014 and 2015, we searched four scientific databases for studies with an aim or result relevant to safety of hospital patients with communication disabilities. The review included 27 studies. A range of adverse event types were outlined in qualitative research. Little detail was provided about contributing or protective factors for safety incidents in hospital for these patients or the impact of the incidents on the patient or organisations involved. Further research addressing the safety of patients with communication disabilities is needed. Sufficient detail is required to identify the nature, timing, and detection of incidents; factors that contribute to or prevent adverse events; and detail the impact of the adverse events. In order to provide safe and effective care to people with communication disabilities in hospital, a priority for health and disability services must be the design and evaluation of ecologically appropriate and evidence-based interventions to improve patient care, communication, and reduce the risk of costly and harmful patient safety incidents. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A comparison between patients with epiphora and cataract of the activity limitations they experience in daily life due to their visual disability.

Science.gov (United States)

Bohman, Elin; Wyon, Maria; Lundström, Mats; Dafgård Kopp, Eva

2018-02-01

The objective of this study was to compare patients with epiphora and cataract in terms of the activity limitations they experience in daily life due to their visual disability and to validate the use of the Catquest-9SF questionnaire for epiphora patients. Seventy-two consecutively encountered adult patients with confirmed lacrimal obstruction and listed for dacryocystorhinostomy (DCR) or lacrimal intubation at the St. Erik Eye Hospital, Stockholm, Sweden, completed the Catquest-9SF questionnaire, which measures activity limitations in daily life due to visual disability. The psychometric qualities of the Catquest-9SF results obtained from this group of patients were evaluated by Rasch analysis. Rasch analysis was further employed to convert the ordinal raw data to a Rasch score for comparison with the preoperative scores of patients registered in the Swedish National Cataract Register (NCR) during March 2013. The Catquest-9SF exhibited good psychometric qualities when investigating epiphora patients, with the exception of a misfit for Item 4, the item regarding facial recognition. On the Rasch scale (-5.43 = no activity limitations to +5.01 = severe activity limitations), the mean score for epiphora patients was -0.82 while for patients listed for 1st eye and 2nd eye cataract surgery it was -0.17 and -0.76, respectively. An equivalence test confirmed that the reported visual disability of epiphora patients was not significantly different from visual disability reported by patients waiting for 2nd eye cataract surgery. The Catquest-9SF is a valid measure of visual disability in patients with epiphora. Epiphora patients experience visual disability to the same degree as patients awaiting 2nd eye cataract surgery. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Pattern of Disabilities among Leprosy Patients in Abia State, Nigeria - a Retrospective Review.

Science.gov (United States)

Onyeonoro, U U; Aguocha, G U; Madukwe, S O; Nwokeukwu, H I; Nwamoh, U N; Aguocha, B U

2016-01-01

Early case detection and prompt treatment have been identified as key strategies for effective control and elimination of leprosy disease. Hence, control efforts should include among others treatment of the disease and disability prevention. This study is aimed at determining prevalence and pattern of disability among leprosy patients treated in a Leprosy Center in Abia State, Nigeria. Records of 287 leprosy patients treated in Uzoakoli Leprosy Center, Abia State between 2002 and 2006 were reviewed and analysed. Findings showed 23 (9.9%) with childhood leprosy, 206 (83.7%) multi-bacillary type and 64 (28.4%) with grade 2 disability among the leprosy cases.Four children (15.4%) presented with grade 2 disability at diagnosis. Prior to treatment 80 (27.9%) had grade 2 disability, while 11 (6.6%) at the end of the treatment.,Based on EHF score 85 patients (50.9%) out 167 patients who completed treatment had impairment before treatment; on completion of treatment 133 (89.9%) of them improved, while 5 (3.4%) deteriorated. The lower limb (92.6%) was the most affected site in the leprosy patients,, while the eye (3.4%) was the leastaffected. The current leprosy control efforts should be intensified to ensure early case detection and prompt treatment in order to reduce the leprosy burden, including disabilities in individuals and community at large.

Relationship between neural rhythm generation disorders and physical disabilities in Parkinson's disease patients' walking.

Science.gov (United States)

Ota, Leo; Uchitomi, Hirotaka; Ogawa, Ken-ichiro; Orimo, Satoshi; Miyake, Yoshihiro

2014-01-01

Walking is generated by the interaction between neural rhythmic and physical activities. In fact, Parkinson's disease (PD), which is an example of disease, causes not only neural rhythm generation disorders but also physical disabilities. However, the relationship between neural rhythm generation disorders and physical disabilities has not been determined. The aim of this study was to identify the mechanism of gait rhythm generation. In former research, neural rhythm generation disorders in PD patients' walking were characterized by stride intervals, which are more variable and fluctuate randomly. The variability and fluctuation property were quantified using the coefficient of variation (CV) and scaling exponent α. Conversely, because walking is a dynamic process, postural reflex disorder (PRD) is considered the best way to estimate physical disabilities in walking. Therefore, we classified the severity of PRD using CV and α. Specifically, PD patients and healthy elderly were classified into three groups: no-PRD, mild-PRD, and obvious-PRD. We compared the contributions of CV and α to the accuracy of this classification. In this study, 45 PD patients and 17 healthy elderly people walked 200 m. The severity of PRD was determined using the modified Hoehn-Yahr scale (mH-Y). People with mH-Y scores of 2.5 and 3 had mild-PRD and obvious-PRD, respectively. As a result, CV differentiated no-PRD from PRD, indicating the correlation between CV and PRD. Considering that PRD is independent of neural rhythm generation, this result suggests the existence of feedback process from physical activities to neural rhythmic activities. Moreover, α differentiated obvious-PRD from mild-PRD. Considering α reflects the intensity of interaction between factors, this result suggests the change of the interaction. Therefore, the interaction between neural rhythmic and physical activities is thought to plays an important role for gait rhythm generation. These characteristics have

De novo mutations of KIAA2022 in females cause intellectual disability and intractable epilepsy

Science.gov (United States)

de Lange, Iris M; Helbig, Katherine L; Weckhuysen, Sarah; Møller, Rikke S; Velinov, Milen; Dolzhanskaya, Natalia; Marsh, Eric; Helbig, Ingo; Devinsky, Orrin; Tang, Sha; Mefford, Heather C; Myers, Candace T; van Paesschen, Wim; Striano, Pasquale; van Gassen, Koen; van Kempen, Marjan; de Kovel, Carolien G F; Piard, Juliette; Minassian, Berge A; Nezarati, Marjan M; Pessoa, André; Jacquette, Aurelia; Maher, Bridget; Balestrini, Simona; Sisodiya, Sanjay; Warde, Marie Therese Abi; De St Martin, Anne; Chelly, Jamel; van ‘t Slot, Ruben; Van Maldergem, Lionel; Brilstra, Eva H; Koeleman, Bobby P C

2016-01-01

Background Mutations in the KIAA2022 gene have been reported in male patients with X-linked intellectual disability, and related female carriers were unaffected. Here, we report 14 female patients who carry a heterozygous de novo KIAA2022 mutation and share a phenotype characterised by intellectual disability and epilepsy. Methods Reported females were selected for genetic testing because of substantial developmental problems and/or epilepsy. X-inactivation and expression studies were performed when possible. Results All mutations were predicted to result in a frameshift or premature stop. 12 out of 14 patients had intractable epilepsy with myoclonic and/or absence seizures, and generalised in 11. Thirteen patients had mild to severe intellectual disability. This female phenotype partially overlaps with the reported male phenotype which consists of more severe intellectual disability, microcephaly, growth retardation, facial dysmorphisms and, less frequently, epilepsy. One female patient showed completely skewed X-inactivation, complete absence of RNA expression in blood and a phenotype similar to male patients. In the six other tested patients, X-inactivation was random, confirmed by a non-significant twofold to threefold decrease of RNA expression in blood, consistent with the expected mosaicism between cells expressing mutant or normal KIAA2022 alleles. Conclusions Heterozygous loss of KIAA2022 expression is a cause of intellectual disability in females. Compared with its hemizygous male counterpart, the heterozygous female disease has less severe intellectual disability, but is more often associated with a severe and intractable myoclonic epilepsy. PMID:27358180

Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb: The WOLLF Randomized Clinical Trial.

Science.gov (United States)

Costa, Matthew L; Achten, Juul; Bruce, Julie; Tutton, Elizabeth; Petrou, Stavros; Lamb, Sarah E; Parsons, Nick R

2018-06-12

Open fractures of the lower limb occur when a broken bone penetrates the skin. There can be major complications from these fractures, which can be life-changing. To assess the disability, rate of deep infection, and quality of life in patients with severe open fracture of the lower limb treated with negative pressure wound therapy (NPWT) vs standard wound management after the first surgical debridement of the wound. Multicenter randomized trial performed in the UK Major Trauma Network, recruiting 460 patients aged 16 years or older with a severe open fracture of the lower limb from July 2012 through December 2015. Final outcome data were collected through November 2016. Exclusions were presentation more than 72 hours after injury and inability to complete questionnaires. NPWT (n = 226) in which an open-cell solid foam or gauze was placed over the surface of the wound and connected to a suction pump, creating a partial vacuum over the dressing, vs standard dressings not involving application of negative pressure (n = 234). Disability Rating Index score (range, 0 [no disability] to 100 [completely disabled]) at 12 months was the primary outcome measure, with a minimal clinically important difference of 8 points. Secondary outcomes were complications including deep infection and quality of life (score ranged from 1 [best possible] to -0.59 [worst possible]; minimal clinically important difference, 0.08) collected at 3, 6, 9, and 12 months. Among 460 patients who were randomized (mean age, 45.3 years; 74% men), 88% (374/427) of available study participants completed the trial. There were no statistically significant differences in the patients' Disability Rating Index score at 12 months (mean score, 45.5 in the NPWT group vs 42.4 in the standard dressing group; mean difference, -3.9 [95% CI, -8.9 to 1.2]; P = .13), in the number of deep surgical site infections (16 [7.1%] in the NPWT group vs 19 [8.1%] in the standard dressing group; difference, 1.0% [95

Raising end of life care issues for patients with learning disabilities.

Science.gov (United States)

Sander, Ruth

2012-11-30

This qualitative study explored the views of three learning disability nurses, and three district nurses, caring for people with learning disabilities at the end of their lives. Although they saw some good practice, the nurses identified several difficulties associated with end of life care.

Chinese Families of Children with Severe Disabilities: Family Needs and Available Support

Science.gov (United States)

Wang, Peishi; Michaels, Craig A.

2009-01-01

This descriptive study gathered quantitative and qualitative data about 368 families in the People's Republic of China who had children with severe disabilities to better understand (a) the perceived needs that families have, (b) the supports available to them, (c) any differences in perceived needs and support between mothers and fathers, and (d)…

A clinical study on seizure disorder in intellectually disabled patients in Barak Valley, North-Eastern India

Directory of Open Access Journals (Sweden)

Kamal Nath

2016-01-01

Full Text Available Background: Intellectual disability (ID is a state of developmental deficit, beginning in childhood which results in significant limitation of intellect or cognition and poor adaption to the demands of everyday life. The relationship between seizure disorders and ID, and their socio-demographic correlations is a current topic of research to implement proper psychosocial interventions and to eliminate the preventable causes of ID as well as seizure disorder. Aims: To find out the prevalence of seizure disorders and their types in the intellectually disabled patients, and find out their socio-demographic correlations. Materials and methods: A cross-sectional study sample comprising of 100 intellectually disabled patients of Silchar Medical College and Hospital was taken, and the study was conducted after obtaining institutional ethical committee approval and permission from the college. Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5 criteria were used for diagnosing ID. A standardised proforma describing socio-demographic variables, Malin’s Intelligence Scale for Indian Children (MISIC for children in age group six to 17 years, Wechsler Adult Intelligence Scale, third edition for subjects above 18 years, and the Vineland Social Maturity Scale were applied to diagnose and classify ID. International League Against Epilepsy guidelines were used to classify seizure disorder. Results: Prevalence of seizure disorder was found to be 22% among the intellectually disabled population in our sample. A significant association was found between the severity of ID and increased incidence of seizure disorder (p=0.0045. Seizure disorder was more prevalent in the low intelligence quotient (IQ group (p=0.0067. Generalised tonic clonic seizure (GTCS was the commonest among the types of seizure disorder (n=11, 50%. Among the GTCS cases, eight out of 11 (72.7% were from severe/profound ID group and from an IQ range of one to 35

A Functional Genomic Analysis of NF1-Associated Learning Disabilities

National Research Council Canada - National Science Library

Tang, Shao-Jun

2006-01-01

Learning disabilities severely deteriorate the life of many NFI patients. However, the pathogenic process for NFI-associated learning disabilities has not been fully understood and an effective therapy is not available...

Patient Satisfaction, Empowerment, and Health and Disability Status Effects of a Disease Management-Health Promotion Nurse Intervention among Medicare Beneficiaries with Disabilities

Science.gov (United States)

Friedman, Bruce; Wamsley, Brenda R.; Liebel, Dianne V.; Saad, Zabedah B.; Eggert, Gerald M.

2009-01-01

Purpose: To report the impact on patient and informal caregiver satisfaction, patient empowerment, and health and disability status of a primary care-affiliated disease self-management-health promotion nurse intervention for Medicare beneficiaries with disabilities and recent significant health services use. Design and Methods: The Medicare…

Postural Care for People with Intellectual Disabilities and Severely Impaired Motor Function: A Scoping Review

Science.gov (United States)

Robertson, Janet; Baines, Susannah; Emerson, Eric; Hatton, Chris

2018-01-01

Background: Poor postural care can have severe and life-threatening complications. This scoping review aims to map and summarize existing evidence regarding postural care for people with intellectual disabilities and severely impaired motor function. Method: Studies were identified via electronic database searches (MEDLINE, CINAHL, PsycINFO and…

Severe Intellectual Disability: Systematic Review of the Prevalence and Nature of Presentation of Unipolar Depression

Science.gov (United States)

Walton, Catherine; Kerr, Mike

2016-01-01

Background: The diagnosis of depression in severe and profound intellectual disability is challenging. Without adequate skills in verbal self-expression, standardized diagnostic criteria cannot be used with confidence. The purpose of this systematic review was to investigate the assessment and diagnosis of unipolar depression in severe and…

Disability Compensation and Patient Expenditures: FY2000 to FY2013

Data.gov (United States)

Department of Veterans Affairs — This report contains FY2000 through FY2013 data on disability compensation expenditures and recipients and on VA healthcare system patients and patient expenditures.

What Symptoms Predict the Diagnosis of Mania in Persons with Severe/Profound Intellectual Disability In Clinical Practice?

Science.gov (United States)

Matson, J. L.; Gonzalez, M. L.; Terlonge, C.; Thorson, R. T.; Laud, R. B.

2007-01-01

Background: While researchers have attempted to address the difficulties of diagnosing affective disorders in the intellectually disabled population, diagnosing bipolar disorder in an individual with severe intellectual disability (ID) remains a challenge. The aim of this study was to identify what symptoms can predict a diagnosis of mania in the…

The impact of disability in survivors of critical illness.

Science.gov (United States)

Hodgson, Carol L; Udy, Andrew A; Bailey, Michael; Barrett, Jonathan; Bellomo, Rinaldo; Bucknall, Tracey; Gabbe, Belinda J; Higgins, Alisa M; Iwashyna, Theodore J; Hunt-Smith, Julian; Murray, Lynne J; Myles, Paul S; Ponsford, Jennie; Pilcher, David; Walker, Craig; Young, Meredith; Cooper, D J

2017-07-01

To use the World Health Organisation's International Classification of Functioning to measure disability following critical illness using patient-reported outcomes. A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge. The primary outcome was measurement of disability using the World Health Organisation's Disability Assessment Schedule 2.0. The secondary outcomes included the limitation of activities and changes to health-related quality of life comparing survivors with and without disability at 6 months after ICU. We followed 262 patients to 6 months, with a mean age of 59 ± 16 years, and of whom 175 (67%) were men. Moderate or severe disability was reported in 65 of 262 (25%). Predictors of disability included a history of anxiety/depression [odds ratio (OR) 1.65 (95% confidence interval (CI) 1.22, 2.23), P = 0.001]; being separated or divorced [OR 2.87 (CI 1.35, 6.08), P = 0.006]; increased duration of mechanical ventilation [OR 1.04 (CI 1.01, 1.08), P = 0.03 per day]; and not being discharged to home from the acute hospital [OR 1.96 (CI 1.01, 3.70) P = 0.04]. Moderate or severe disability at 6 months was associated with limitation in activities, e.g. not returning to work or studies due to health (P Disability measured using patient-reported outcomes was prevalent at 6 months after critical illness in survivors and was associated with reduced health-related quality of life. Predictors of moderate or severe disability included a prior history of anxiety or depression, separation or divorce and a longer duration of mechanical ventilation. NCT02225938.

Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): results from the PariS-TBI study.

Science.gov (United States)

Jourdan, C; Bosserelle, V; Azerad, S; Ghout, I; Bayen, E; Aegerter, P; Weiss, J J; Mateo, J; Lescot, T; Vigué, B; Tazarourte, K; Pradat-Diehl, P; Azouvi, P

2013-01-01

To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI). Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale-Extended (GOSE) and employment. Univariate and multivariate tests were computed. Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age. Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI.

Modeling of Recovery Profiles in Mentally Disabled and Intact Patients after Sevoflurane Anesthesia; A Pharmacodynamic Analysis

Science.gov (United States)

Shin, Teo Jeon; Noh, Gyu-Jeong; Koo, Yong-Seo

2014-01-01

Purpose Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. Materials and Methods Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). Results End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and γ value were lower in the mentally disabled patients (C50=0.37 vol %, γ=16.5 in mentally intact patients, C50=0.19 vol %, γ=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and γ value to pharmacodynamic model. Conclusion A sigmoid Emanx model explains the pharmacodynamic relationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentration at ROC an compared to normal patients. PMID:25323901

Disability and Survival in Duchenne Muscular Dystrophy

OpenAIRE

Kohler, M; Clarenbach, C F; Bahler, C; Brack, T; Russi, E W; Bloch, K E

2009-01-01

BACKGROUND: Duchenne muscular dystrophy (DMD) leads to progressive impairment of muscle function, respiratory failure and premature death. Longitudinal data on the course of physical disability and respiratory function are sparse. OBJECTIVES: To prospectively assess physical impairment and disability, respiratory function and survival in DMD patients over several years in order to describe the course of the disease with current care. METHODS: In 43 patients with DMD, aged 5-35 years, yearly a...

Clinical manifestation of late sequelae and patient disability after breast cancer treatment

Energy Technology Data Exchange (ETDEWEB)

Radenkov, K [Okryzhen Onkologichen Djspanser, Shumen (Bulgaria)

1976-01-01

Based on medical records from 453 breast cancer patients undergoing complex treatment with follow-up periods of 1 to 12 years at the Shumen Area Oncologic Dispensary, evidence of late effects of therapy was studied in terms of resulting disability. Pre- and post-operative radiotherapy was found to enhance, in a dose-dependent fashion, upper extremity lymphatic stasis following mastectomy. The impact of radiotherapy was further manifested in bone changes, painfulness of shoulder-joint mitions, leukopenia, pneumosclerosis, and a number of neurologic and mental signs. The following invalidity groups were delineated: first group, any III or IV stage patient within the 5-year post-treatment period irrespective of how radical the treatment; second group, any II or I stage patient experiencing severe complication(s); and third group, any I stage patient with only slight physical defects and no concomitant conditions or other complications.

Dr. Tulp attends the soft machine: patient simulators, user involvement and intellectual disability.

Science.gov (United States)

McClimens, Alex; Lewis, Robin; Brewster, Jacqui

2012-09-01

Simulation as a way to teach clinical skills attracts much critical attention. Its benefits, however, might be significantly reduced when the simulation model used relies exclusively on patient simulators. This is particularly true if the intended patient population for students taught is characterized by intellectual disability. Learning to care for people with intellectual disability might be better supplemented when the simulation model used incorporates input from 'real' people. If these people themselves have intellectual disabilities then the verisimilitude of the simulation will be higher and the outcomes for learners and potential patients will also be improved.

Social disability of Brazilian mood disorder patients

Directory of Open Access Journals (Sweden)

Tucci A.M.

2004-01-01

Full Text Available Mood disorders cause many social problems, often involving family relationships. Few studies are available in the literature comparing patients with bipolar, unipolar, dysthymic, and double depressive disorders concerning these aspects. In the present study, demographic and disease data were collected using a specifically prepared questionnaire. Social adjustment was assessed using the Disability Adjustment Scale and family relationships were evaluated using the Global Assessment of Relational Functioning Scale. One hundred patients under treatment for at least 6 months were evaluated at the Psychiatric Outpatient Clinic of the Botucatu School of Medicine, UNESP. Most patients were women (82% more than 50 (49% years old with at least two years of follow-up, with little schooling (62% had less than 4 years, and of low socioeconomic level. Logistic regression analysis showed that a diagnosis of unipolar disorder (P = 0.003, OR = 0.075, CI = 0.014-0.403 and dysthymia (P = 0.001, OR = 0.040, CI = 0.006-0.275 as well as family relationships (P = 0.002, OR = 0.953, CI = 0914-0.992 played a significant role in social adjustment. Unipolar and dysthymic patients presented better social adjustment than bipolar and double depressive patients (P < 0.001, results that were not due to social class. These patients, treated at a teaching hospital, may represent the severest mood disorder cases. Evaluations were made knowing the diagnosis of the patients, which might also have influenced some of the results. Social disabilities among mood disorder patients are very frequent and intensive.

A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil.

Science.gov (United States)

Sousa, Kelienny de Meneses; Oliveira, Wagner Ivan Fonsêca de; Melo, Laiza Oliveira Mendes de; Alves, Emanuel Augusto; Piuvezam, Grasiela; Gama, Zenewton André da Silva

2017-03-01

Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the

The Psychological Impact of Abuse on Men and Women with Severe Intellectual Disabilities

Science.gov (United States)

Rowsell, A. C.; Clare, I. C. H.; Murphy, G. H.

2013-01-01

Background: In other populations, the psychological impact of abuse has been conceptualized as Post Traumatic Stress Disorder (PTSD, DSM-IV, American Psychiatric Association (APA), 1994), but little is known about whether this is appropriate for adults with severe intellectual disabilities and very limited communication skills. Methods: An…

Compliance of Children with Moderate to Severe Intellectual Disability to Treadmill Walking: A Pilot Study

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Vashdi, E.; Hutzler, Y.; Roth, D.

2008-01-01

Background: Individuals with Intellectual Disability (ID) exhibit reduced levels of compliance to exercise, including treadmill walking. The purpose of this study was to measure the effects of several training conditions on compliance to participation in treadmill walking of children with moderate to severe ID. Method: Criteria for compliance were…

A Functional Genomic Analysis of NF1-Associated Learning Disabilities

National Research Council Canada - National Science Library

Tang, Shao-Jun

2008-01-01

Learning disabilities severely deteriorate the life of many NF1 patients. However, the pathogenic process for NF1-associated learning disabilities has not been fully understood and an effective therapy is not available...

A Functional Genomic Analysis of NF1-Associated Learning Disabilities

National Research Council Canada - National Science Library

Tang, Shao-Jun

2007-01-01

Learning disabilities severely deteriorate the life of many NF1 patients. However, the pathogenic process for NF1-associated learning disabilities has not been fully understood and an effective therapy is not available...

Disability from posttraumatic headache is compounded by coexisting posttraumatic stress disorder.

Science.gov (United States)

Roper, Louise S; Nightingale, Peter; Su, Zhangjie; Mitchell, James L; Belli, Antonio; Sinclair, Alexandra J

2017-01-01

Posttraumatic headache (PTH) occurs in up to 82% of patients with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD) occurs in 39% of those with PTH. This study evaluates whether PTSD affects PTH disability. Eighty-six patients with TBI were prospectively evaluated in a secondary care trauma center. Headache disability was assessed using the Headache Impact Test version 6 and signs indicative of PTSD using the PTSD Check List Civilian version. Increased PTSD-type symptoms were significantly associated with increased headache disability ( p headache disability (Spearman's correlation rho=0.361, p =0.001). Increased severity of PTSD-type symptoms is significantly associated with increased headache disability in patients with chronic PTH. Managing PTSD symptoms in patients with chronic PTH may facilitate headache management.

Visual functions and disability in diabetic retinopathy patients.

Science.gov (United States)

Shrestha, Gauri Shankar; Kaiti, Raju

2014-01-01

This study was undertaken to find correlations between visual functions and visual disabilities in patients with diabetic retinopathy. A cross-sectional study was carried out among 38 visually impaired diabetic retinopathy subjects at the Low Vision Clinic of B.P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu. The subjects underwent assessment of distance and near visual acuity, objective and subjective refraction, contrast sensitivity, color vision, and central and peripheral visual fields. The visual disabilities of each subject in their daily lives were evaluated using a standard questionnaire. Multiple regression analysis between visual functions and visual disabilities index was assessed. The majority of subjects (42.1%) were of the age group 60-70 years. Best corrected visual acuity was found to be 0.73±0.2 in the better eye and 0.93±0.27 in the worse eye, which was significantly different at p=0.002. Visual disability scores were significantly higher for legibility of letters (1.2±0.3) and sentences (1.4±0.4), and least for clothing (0.7±0.3). Visual disability index for legibility of letters and sentences was significantly correlated with near visual acuity and peripheral visual field. Contrast sensitivity was also significantly correlated with the visual disability index, and total scores. Impairment of near visual acuity, contrast sensitivity, and peripheral visual field correlated significantly with different types of visual disability. Hence, these clinical tests should be an integral part of the visual assessment of diabetic eyes. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Comparison of patients with and without intellectual disability under general anesthesia: A retrospective study.

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Sitilci, T; Demirgan, S; Akcay, C; Kahraman, N; Koseoglu, B G; Erdem, M A; Cankaya, A B

2017-04-01

We analyzed and retrospectively compared patients with and without intellectual disability (ID) who underwent oral surgery under general anesthesia at Istanbul University, Faculty of Dentistry, Department of General Anesthesia, between October 2012 and June 2013 with regard to the following categories: Demographic features, American Society of Anesthesiologists (ASA) classification, Mallampati score, type of anesthetic drug used during the operation, type of intubation used, any difficulties with tracheal intubation, presence of systemic diseases, and recovery times after ending general anesthesia. A total of 348 patients were selected from the Department of Maxillofacial Surgery and the Department of Pedodontics who underwent surgery with general anesthesia. Medical histories of all patients were taken, and their electrocardiography, chest X-rays, complete blood count, and blood clotting tests were checked during a preoperative assessment. Mallampati evaluations were also performed. Patients were grouped into ASA I, II, or III according to the ASA classification and were treated under general anesthesia. There was no significant difference between normal and intellectually disabled patients in terms of gender, Mallampati scores, intubation difficulties, mean anesthetic period, time to discharge, or postoperative nausea and vomiting. Epilepsy and genetic diseases in intellectually disabled patients were significantly more common than in non-ID (NID) patients. However, the frequency of diabetes and chronic obstructive pulmonary disease in NID patients was significantly higher than in the intellectually disabled patients. Dental treatment of intellectually disabled patients under general anesthesia can be performed just as safely as that with NID patients.

Functional Limitations in Severe Haemophilia

NARCIS (Netherlands)

Genderen, F.R. van

2006-01-01

This thesis aims to describe the Disablement Process (DP) in Dutch adult patients with severe haemophilia, with specific focus on the domain of “Functional Limitations”. Four main questions underlie this thesis: How can Functional Limitations in severe haemophilia be investigated? Can the

Work ability as a determinant of old age disability severity: evidence from the 28-year Finnish Longitudinal Study on Municipal Employees.

Science.gov (United States)

von Bonsdorff, Mikaela B; Seitsamo, Jorma; Ilmarinen, Juhani; Nygård, Clas-Håkan; von Bonsdorff, Monika E; Rantanen, Taina

2012-08-01

Lower occupational class correlates with a higher disability risk later in life. However, it is not clear whether the demands made by mental and physical work relative to individual resources in midlife predict well-being in old age. This study investigated prospectively whether work ability in midlife predicts disability severity in activities of everyday living in old age. Data come from the population-based 28-year follow-up called Finnish Longitudinal Study of Municipal Employees. A total of 2879 occupationally active persons aged 44-58 years answered a questionnaire on work ability at baseline in 1981 and activities of daily living in 2009. At baseline, perceived work ability relative to lifetime best was categorized into excellent, moderate, and poor work ability. At follow-up, disability scales were constructed based on the severity and frequency of difficulties reported in self-care activities of daily living (ADL) and instrumental activities of daily living (IADL). There was a graded prevalence of ADL and IADL disability severity, according to excellent, moderate and poor midlife work ability (pwork ability had an 11 to 20% higher mean ADL or IADL disability severity score, compared with those with excellent midlife work ability (reference), incidence rate ratios (IRR) ranging from 1.11 (95% CI 1.01-1.22) to 1.20 (95% CI 1.10-1.30). Those with poor midlife work ability had a mean ADL or IADL disability severity score 27 to 38% higher than the referent, IRRs ranging from 1.27 (95% CI 1.09-1.47) to 1.38 (95% CI 1.25-1.53). Adjusting for socio-economics, lifestyle factors and chronic diseases only slightly attenuated the associations. Work ability, an indicator of the de- mands made by mental and physical work relative to individuals' mental and physical resources, predicted disability severity 28 years later among middle-aged municipal employees.

Family Stress Associated with Transition to Adulthood of Young People with Severe Disabilities.

Science.gov (United States)

Thorin, Elizabeth J.; Irvin, Larry K.

1992-01-01

Analysis of concerns expressed by 42 members of 19 families of young adults with severe developmental disabilities indicated concerns in such areas as self-care capabilities, sexuality, and quality of residential services. Concerns in the residential domain were most predictive of overall individual and family stress. Effects of questioning…

Disability Surveillance in multiple sclerosis patients before and after methylprednisolone treatment

Directory of Open Access Journals (Sweden)

Ghabaae M

2007-10-01

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

What is different about workers' compensation patients? Socioeconomic predictors of baseline disability status among patients with lumbar radiculopathy.

Science.gov (United States)

Atlas, Steven J; Tosteson, Tor D; Hanscom, Brett; Blood, Emily A; Pransky, Glenn S; Abdu, William A; Andersson, Gunnar B; Weinstein, James N

2007-08-15

Combined analysis of 2 prospective clinical studies. To identify socioeconomic characteristics associated with workers' compensation in patients with an intervertebral disc herniation (IDH) or spinal stenosis (SpS). Few studies have compared socioeconomic differences between those receiving or not receiving workers' compensation with the same underlying clinical conditions. Patients were identified from the Spine Patient Outcomes Research Trial (SPORT) and the National Spine Network (NSN) practice-based outcomes study. Patients with IDH and SpS within NSN were identified satisfying SPORT eligibility criteria. Information on disability and work status at baseline evaluation was used to categorize patients into 3 groups: workers' compensation, other disability compensation, or work-eligible controls. Enrollment rates of patients with disability in a clinical efficacy trial (SPORT) and practice-based network (NSN) were compared. Independent socioeconomic predictors of baseline workers' compensation status were identified in multivariate logistic regression models controlling for clinical condition, study cohort, and initial treatment designation. Among 3759 eligible patients (1480 in SPORT and 2279 in NSN), 564 (15%) were receiving workers' compensation, 317 (8%) were receiving other disability compensation, and 2878 (77%) were controls. Patients receiving workers' compensation were less common in SPORT than NSN (9.2% vs. 18.8%, P socioeconomic characteristics significantly differed according to baseline workers' compensation status. In multiple logistic regression analyses, gender, educational level, work characteristics, legal action, and expectations about ability to work without surgery were independently associated with receiving workers' compensation. Clinical trials involving conditions commonly seen in patients with workers' compensation may need special efforts to ensure adequate representation. Socioeconomic characteristics markedly differed between patients

Social security work disability and its predictors in patients with fibromyalgia.

Science.gov (United States)

Wolfe, Frederick; Walitt, Brian T; Katz, Robert S; Häuser, Winfried

2014-09-01

To determine prevalence and incidence of US Social Security Disability and Supplemental Security Income (SSD) in patients with fibromyalgia and to investigate prediction of SSD. Over a mean of 4 years (range 1-13 years), we studied 2,321 patients with physician-diagnosed fibromyalgia (prevalent cases) and applied modified American College of Rheumatology (ACR) 2010 research criteria to identify criteria-positive patients. During the study, 34.8% (95% confidence interval [95% CI] 32.9-36.8%) of fibromyalgia patients received SSD. The annual incidence of SSD among patients not receiving SSD at study enrollment was 3.4% (95% CI 3.0-3.9%), and 25% were estimated to be work disabled at 9.0 years of followup. By comparison, the prevalence of SSD in rheumatoid arthritis (RA) patients with concomitant fibromyalgia was 55.6% (95% CI 54.3-57.0%) and was 42.4% in osteoarthritis (OA). By study conclusion, 31.4% of SSD awardees were no longer receiving SSD. In univariate models, incident SSD in patients with fibromyalgia was predicted by sociodemographic measures and by symptom burden; but the strongest predictor was functional status (Health Assessment Questionnaire disability index [HAQ DI]). In multivariable models, the HAQ DI and the Short Form 36-item health survey physical and mental component summary scores, but no other variables, predicted SSD. Fibromyalgia criteria-positive patients had more SSD, but the continuous scale, polysymptomatic distress index derived from the ACR criteria was a substantially better predictor of SSD than a criteria-positive diagnosis. The prevalence of SSD is high in fibromyalgia, but not higher than in RA and OA patients who satisfy fibromyalgia criteria. The best predictors of work disability are functional status variables. Copyright © 2014 by the American College of Rheumatology.

Copy Number Variations Found in Patients with a Corpus Callosum Abnormality and Intellectual Disability.

Science.gov (United States)

Heide, Solveig; Keren, Boris; Billette de Villemeur, Thierry; Chantot-Bastaraud, Sandra; Depienne, Christel; Nava, Caroline; Mignot, Cyril; Jacquette, Aurélia; Fonteneau, Eric; Lejeune, Elodie; Mach, Corinne; Marey, Isabelle; Whalen, Sandra; Lacombe, Didier; Naudion, Sophie; Rooryck, Caroline; Toutain, Annick; Caignec, Cédric Le; Haye, Damien; Olivier-Faivre, Laurence; Masurel-Paulet, Alice; Thauvin-Robinet, Christel; Lesne, Fabien; Faudet, Anne; Ville, Dorothée; des Portes, Vincent; Sanlaville, Damien; Siffroi, Jean-Pierre; Moutard, Marie-Laure; Héron, Delphine

2017-06-01

To evaluate the role that chromosomal micro-rearrangements play in patients with both corpus callosum abnormality and intellectual disability, we analyzed copy number variations (CNVs) in patients with corpus callosum abnormality/intellectual disability STUDY DESIGN: We screened 149 patients with corpus callosum abnormality/intellectual disability using Illumina SNP arrays. In 20 patients (13%), we have identified at least 1 CNV that likely contributes to corpus callosum abnormality/intellectual disability phenotype. We confirmed that the most common rearrangement in corpus callosum abnormality/intellectual disability is inverted duplication with terminal deletion of the 8p chromosome (3.2%). In addition to the identification of known recurrent CNVs, such as deletions 6qter, 18q21 (including TCF4), 1q43q44, 17p13.3, 14q12, 3q13, 3p26, and 3q26 (including SOX2), our analysis allowed us to refine the 2 known critical regions associated with 8q21.1 deletion and 19p13.1 duplication relevant for corpus callosum abnormality; report a novel 10p12 deletion including ZEB1 recently implicated in corpus callosum abnormality with corneal dystrophy; and) report a novel pathogenic 7q36 duplication encompassing SHH. In addition, 66 variants of unknown significance were identified in 57 patients encompassed candidate genes. Our results confirm the relevance of using microarray analysis as first line test in patients with corpus callosum abnormality/intellectual disability. Copyright © 2017 Elsevier Inc. All rights reserved.

Predictive value of specific radiographic findings of disability in patients with rheumatoid arthritis

International Nuclear Information System (INIS)

Kaye, J.J.; Nance, E.P. Jr.; Callahan, L.F.; Pincus, T.

1986-01-01

This study was carried out to determine whether and to what extend radiographic erosion, joint space narrowing, and malalignment are predictive of clinical disability in patients with rheumatoid arthristis (RA). Radiographs of the hands and wrists of 224 patients with RA were scored for these radiographic parameters. To determine which of these findings best explained variation in clinical measures of disability, a series of regression analyses was performed. Malalignment scores were the best predictor of joint deformity and limitation of motion. Erosion scores were most predictive of variation in functional tests. The author concludes that specific radiographic findings of malalignment and erosion are significantly predictive of disability in patients with RA

Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression.

Science.gov (United States)

Shim, Eun-Jung; Hahm, Bong-Jin; Go, Dong Jin; Lee, Kwang-Min; Noh, Hae Lim; Park, Seung-Hee; Song, Yeong Wook

2018-06-01

To examine factors in the fear-avoidance model, such as pain, pain catastrophizing, fear-avoidance beliefs, physical disability, and depression and their relationships with physical and psychological quality of life in patients with rheumatic diseases. The data were obtained from 360 patients with rheumatic diseases who completed self-report measures assessing study variables. Structural equation modeling was used to examine the hypothesized relationships among factors specified in the fear-avoidance model predicting physical and psychological quality of life. Final models fit the data well, explaining 96% and 82% of the variance in physical and psychological quality of life, respectively. Higher pain catastrophizing was related to stronger fear-avoidance beliefs that had a direct negative association with physical disability and depression, which, in turn, negatively affected physical quality of life. Pain severity was also directly related to physical disability. Physical disability also affected physical quality of life indirectly through depression. The hypothesized relationships specified in the model were also confirmed for psychological quality of life. However, physical disability had an indirect association with psychological quality of life via depression. The current results underscore the significant role of cognitive, affective, and behavioral factors in perceived physical disability and their mediated detrimental effect on physical and psychological quality of life in patients with rheumatic diseases. Implications for rehabilitation The fear-avoidance model is applicable to the prediction of quality of life in patients with rheumatic diseases. As pain-catastrophizing and fear-avoidance beliefs are important factors linked to physical disability and depression, intervening these cognitive factors is necessary to improve physical function and depression in patients with rheumatic diseases. Considering the strong association between depression and

Assessment of Leisure Preferences for Students with Severe Developmental Disabilities and Communication Difficulties

Science.gov (United States)

Kreiner, Janice; Flexer, Robert

2009-01-01

The purpose of this study was to develop and to evaluate the Preferences for Leisure Attributes (PLA) Assessment, a forced-choice computer software program for students with severe disabilities and communication difficulties. In order to determine content validity of the PLA Assessment, four experts in related fields assigned critical attributes…

Differential Predictors of Pain and Disability in Patients with Whiplash Injuries

Directory of Open Access Journals (Sweden)

Michael JL Sullivan

2002-01-01

Full Text Available The psychological predictors of pain and disability were examined in a sample of people who sustained whiplash injuries during rear-end motor vehicle accidents. Sixty-five patients referred to a specialty pain clinic with a diagnosis of whiplash injury completed measures of depression, anxiety, catastrophizing, pain and perceived disability. Regression analysis revealed that psychological variables accounted for 18% of the variance in pain ratings. The magnification subscale of the Pain Catastrophizing Scale was the only variable that contributed significant, unique variance to the prediction of pain. Psychological variables accounted for 37% of the variance in perceived disability scores. In the latter analysis, however, none of the independent variables contributed significant, unique variance to the prediction of perceived disability. Psychological variables accounted for significant variance in disability ratings, even when controlling for pain intensity. Discussion focuses on the need to draw clearer distinctions between determinants of pain and disability, and directions for interventions aimed at minimizing disability following whiplash injury are suggested.

The role of Tc-99m HMPAO brain perfusion SPECT in the psychiatric disability evaluation of patients with chronic traumatic brain injury

Energy Technology Data Exchange (ETDEWEB)

So, Young [Nuclear Medicne, Seoul National Univ., Seoul (Korea, Republic of); Lee, Kang Wook; Lee, Sun Woo; Ghi, Lek Sung; Song, Chang June [College of Medicine, Chungnam National Univ., Taejon (Korea, Republic of)

2002-08-01

We studied whether brain perfusion SPECT is useful in the psychiatric disability evaluation of patients with chronic traumatic brain injury (TBI). Sixty-nine patients (M:F=58:11, age 39 {+-} 14 years) who underwent Tc-99m HMPAO brain SPECT, brain MRI and neuropsychological (NP) tests during hospitalization in psychiatric wards for the psychiatric disability evaluation were included; the severity of injury was mild in 31, moderate in 17 and severe in 21. SPECT, MRI, NP tests were performed 6 {approx} 61 months (mean 23 months) post-injury. Diagnostic accuracy of SPECT and MRI to show hypoperfusion or abnormal signal intensity in patients with cognitive impairment represented by NP test results were compared. Forty-two patients were considered to have cognitive impairment on NP tests and 27 not. Brain SPECT showed 71% sensitivity and 85% specificity, while brain MRI showed 62% sensitivity and 93% specificity (p>0.05, McNemar test). SPECT found more cortical lesions and MRI was superior in detecting white matter lesions. sensitivity and specificity of 31 mild TBI patients were 45%, 90% for SPECT and 27%, 100% for MRI (p>0.05, McNemar test). Among 41 patients with normal brain MRI, SEPCT showed 63% sensitivity (50% for mild TBI) and 88% specificity (85% for malingerers). Brain SPECT has a supplementary role to neuropsychological tests in the psychiatric disability evaluation of chronic TBI patients by detecting more cortical lesions than MRI.

The role of Tc-99m HMPAO brain perfusion SPECT in the psychiatric disability evaluation of patients with chronic traumatic brain injury

International Nuclear Information System (INIS)

So, Young; Lee, Kang Wook; Lee, Sun Woo; Ghi, Lek Sung; Song, Chang June

2002-01-01

We studied whether brain perfusion SPECT is useful in the psychiatric disability evaluation of patients with chronic traumatic brain injury (TBI). Sixty-nine patients (M:F=58:11, age 39 ± 14 years) who underwent Tc-99m HMPAO brain SPECT, brain MRI and neuropsychological (NP) tests during hospitalization in psychiatric wards for the psychiatric disability evaluation were included; the severity of injury was mild in 31, moderate in 17 and severe in 21. SPECT, MRI, NP tests were performed 6 ∼ 61 months (mean 23 months) post-injury. Diagnostic accuracy of SPECT and MRI to show hypoperfusion or abnormal signal intensity in patients with cognitive impairment represented by NP test results were compared. Forty-two patients were considered to have cognitive impairment on NP tests and 27 not. Brain SPECT showed 71% sensitivity and 85% specificity, while brain MRI showed 62% sensitivity and 93% specificity (p>0.05, McNemar test). SPECT found more cortical lesions and MRI was superior in detecting white matter lesions. sensitivity and specificity of 31 mild TBI patients were 45%, 90% for SPECT and 27%, 100% for MRI (p>0.05, McNemar test). Among 41 patients with normal brain MRI, SEPCT showed 63% sensitivity (50% for mild TBI) and 88% specificity (85% for malingerers). Brain SPECT has a supplementary role to neuropsychological tests in the psychiatric disability evaluation of chronic TBI patients by detecting more cortical lesions than MRI

The effect of color on the recognition and use of line drawings by children with severe intellectual disabilities.

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Stephenson, Jennifer

2007-03-01

Line drawings are commonly used as communication symbols for individuals with severe intellectual disabilities. This study investigated the effect of color on the recognition and use of line drawings by young children with severe intellectual disabilities and poor verbal comprehension who were beginning picture users. Drawings where the color of the picture matched the object and where the color of the drawing did not match the object were used, as well as black and white line drawings. Tentative findings suggest that some students with intellectual disabilities may find it more difficult to recognize and line drawings where the color does not match the object compared to line drawings where the color of the drawing does match the color of the object.

Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial.

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Espí-López, G V; Rodríguez-Blanco, C; Oliva-Pascual-Vaca, A; Benítez-Martínez, J C; Lluch, E; Falla, D

2014-12-01

Tension-type headache (TTH) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments. To assess the effectiveness of manual therapy techniques, applied to the suboccipital region, on aspects of disability in a sample of patients with tension-type headache. Randomized Controlled Trial. Specialized centre for headache treatment. Seventy-six (62 women) patients (age: 39.9 ± 10.9 years) with episodic chronic TTH. Patients were randomly divided into four treatment groups: 1) suboccipital soft tissue inhibition; 2) occiput-atlas-axis manipulation; 3) combined treatment of both techniques; 4) control. Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory (HDI). Headache frequency, severity and the functional and emotional subscales of the questionnaire were assessed. Photophobia, phonophobia and pericranial tenderness were also monitored. Headache frequency was significantly reduced with the manipulative and combined treatment (Ptreatment groups (Ptreatment also reduced the score on the emotional subscale of the HDI (Ptreatments were combined, effectiveness was noted for all aspects of disability and other symptoms including photophobia, phonophobia and pericranial tenderness. Although individual manual therapy treatments showed a positive change in headache features, measures of photophobia, photophobia and pericranial tenderness only improved in the group that received the combined treatment suggesting that combined treatment is the most appropriate for symptomatic relief of TTH.

Clinical manifestation of late sequelae and patient disability after breast cancer treatment

International Nuclear Information System (INIS)

Radenkov, Kh.

1976-01-01

Based on medical records from 453 breast cancer patients undergoing complex treatment with follow-up periods of 1 to 12 years at the Shumen Area Oncologic Dispensary, evidence of late effects of therapy was studied in terms of resulting disability. Pre- and post-operative radiotherapy was found to enhance, in a dose-dependent fashion, upper extremity lymphatic stasis following mastectomy. The impact of radiotherapy was further manifested in bone changes, painfulness of shoulder-joint mitions, leukopenia, pneumosclerosis, and a number of neurologic and mental signs. The following invalidity groups were delineated: first group, any III or IV stage patient within the 5-year post-treatment period irrespective of how radical the treatment; second group, any II or I stage patient experiencing severe complication(s); and third group, any I stage patient with only slight physical defects and no concomitant conditions or other complications. (A.B.)

The Effect of an Attachment-Based Behaviour Therapy for Children with Visual and Severe Intellectual Disabilities

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Sterkenburg, P. S.; Janssen, C. G. C.; Schuengel, C.

2008-01-01

Background: A combination of an attachment-based therapy and behaviour modification was investigated for children with persistent challenging behaviour. Method: Six clients with visual and severe intellectual disabilities, severe challenging behaviour and with a background of pathogenic care were treated. Challenging behaviour was recorded…

The Contribution of High Levels of Somatic Symptom Severity to Sickness Absence Duration, Disability and Discharge

NARCIS (Netherlands)

Hoedeman, Rob; Blankenstein, Annette H.; Krol, Boudien; Koopmans, Petra C.; Groothoff, Johan W.

Introduction: The primary objectives were to compare the duration of sickness absence in employees with high levels of somatic symptom severity (HLSSS) with employees with lower levels of somatic symptom severity, and to establish the long-term outcomes concerning return to work (RTW), disability

Disability, Activities of Daily Living and Self Efficacy in Dialysis Patients

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Mukadder Mollaoglu

2011-04-01

Full Text Available Purpose: The purpose of this study is to assess patients’ disability, activities of daily living and self-efficacy patients undergoing hemodialysis (HD and continuos ambulatory peritoneal dialysis (CAPD, to examine the relationship between them. Material and Methods: This study was carried with 152 patients as sample group. In this study, three instruments were used: Personal Information Form, Brief Disability Questionnaire, Katz\\'s Activity\\'s of Daily Living Index and Lawton and Brody\\'s Instrumental Activities of Daily Living Index and Self-efficacy Assessment Form. Data collected from the study was analyzed using percent, mean, Tukey test, significance test of two means, One-way variant analysis and Kruskal-Wallis test. Results: The study results demonstrate that while there is a correlation between self-care ability and age, education level, marital status and additional health problems, factors such as age, gender, education level, work status, income level, social insurance status and frequency of hemodialysis application determine self-efficacy. Furthermore, a negative correlation was found between patients’ disability and activities of daily living , self-efficacy. It was determined that as the level of disability increases self-efficiacy level decreases. Conclusions: Dialysis application affects patients’ disability, activities of daily living and self-efficacy levels. In view of this study’s results, it is recommended to organize education programs to increase self-efficacy levels of dialysis patients and prepare comprehensive plans including patients’ families. [TAF Prev Med Bull 2011; 10(2.000: 181-186

Cardiff acne disability index in Sarawak, Malaysia.

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Yap, Felix Boon-Bin

2012-05-01

Acne is considered a cosmetic nuisance in Malaysia since no insurance coverage is provided for its treatment. Its psychological impact is unknown. The aim of this study is to determine the impact of acne on quality of life and its relationship with severity. A cross-sectional study using the Cardiff acne disability index (CADI) and Global Acne Grading System for acne severity grading was done in three government-run dermatology clinics in Sarawak, Malaysia. The study cohort of 200 patients had a mean CADI score of 5.1. Most of the patients (59.5%) had mild CADI impairment, with the domain of feelings most affected. Patients with a family income 0.05). The correlation between CADI and mild acne severity was low (Pearson correlation coefficient=0.35; pSarawak was moderate and must be addressed. It should be viewed as a psychologically disabling disease requiring optimal management and resource allocation.

Teachers' Beliefs about the Participation of Students with Severe Disabilities in School Clubs

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Pence, Alicia R.; Dymond, Stacy K.

2016-01-01

The purpose of this study was to investigate teachers' beliefs about the participation of students with severe disabilities (SD) in school clubs. Participants were special education teachers (N = 60) of middle and junior high school students with SD from one state. Data were collected using a survey. Results indicate that teachers value including…

De novo mutations of KIAA2022 in females cause intellectual disability and intractable epilepsy.

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de Lange, Iris M; Helbig, Katherine L; Weckhuysen, Sarah; Møller, Rikke S; Velinov, Milen; Dolzhanskaya, Natalia; Marsh, Eric; Helbig, Ingo; Devinsky, Orrin; Tang, Sha; Mefford, Heather C; Myers, Candace T; van Paesschen, Wim; Striano, Pasquale; van Gassen, Koen; van Kempen, Marjan; de Kovel, Carolien G F; Piard, Juliette; Minassian, Berge A; Nezarati, Marjan M; Pessoa, André; Jacquette, Aurelia; Maher, Bridget; Balestrini, Simona; Sisodiya, Sanjay; Warde, Marie Therese Abi; De St Martin, Anne; Chelly, Jamel; van 't Slot, Ruben; Van Maldergem, Lionel; Brilstra, Eva H; Koeleman, Bobby P C

2016-12-01

Mutations in the KIAA2022 gene have been reported in male patients with X-linked intellectual disability, and related female carriers were unaffected. Here, we report 14 female patients who carry a heterozygous de novo KIAA2022 mutation and share a phenotype characterised by intellectual disability and epilepsy. Reported females were selected for genetic testing because of substantial developmental problems and/or epilepsy. X-inactivation and expression studies were performed when possible. All mutations were predicted to result in a frameshift or premature stop. 12 out of 14 patients had intractable epilepsy with myoclonic and/or absence seizures, and generalised in 11. Thirteen patients had mild to severe intellectual disability. This female phenotype partially overlaps with the reported male phenotype which consists of more severe intellectual disability, microcephaly, growth retardation, facial dysmorphisms and, less frequently, epilepsy. One female patient showed completely skewed X-inactivation, complete absence of RNA expression in blood and a phenotype similar to male patients. In the six other tested patients, X-inactivation was random, confirmed by a non-significant twofold to threefold decrease of RNA expression in blood, consistent with the expected mosaicism between cells expressing mutant or normal KIAA2022 alleles. Heterozygous loss of KIAA2022 expression is a cause of intellectual disability in females. Compared with its hemizygous male counterpart, the heterozygous female disease has less severe intellectual disability, but is more often associated with a severe and intractable myoclonic epilepsy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A Program Evaluation of a Literacy Initiative for Students with Moderate to Severe Disabilities

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De La Cruz, Carrie F.

2009-01-01

Recently the National Reading Panel concluded that systematic and direct instruction in phonological awareness, phonics, fluency, vocabulary, and comprehension that is informed by ongoing assessments of student progress results in positive student achievement (NICHHD, 2002). For students with moderate to severe disabilities and students with…

Multimodal Chiropractic Care for Pain and Disability in a Patient Diagnosed With Ehlers-Danlos Syndrome-Hypermobility Type: A Case Report.

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Strunk, Richard G

2017-06-01

The purpose of this article is to describe the clinical response to multimodal chiropractic treatment of a patient diagnosed with Ehlers-Danlos syndrome, hypermobility type (EDS-HT), and chronic pain. A 22-year-old woman presented with severe chronic neck and low back pain, headaches, and bilateral hand pain and stiffness. In addition to these pain complaints, the patient had a family history of EDS, weekly or daily recurring joint dislocations, and upper and lower extremity joint hypermobility. As a result of her significant history and examination findings, which met the Brighton and Villefranche criteria, she was diagnosed with EDS-HT. Treatment primarily consisted of low force joint manipulative therapy and soft tissue therapy intermittently over 21 months concurrently with conventional and complementary medical care. Multiple outcome questionnaires were administered pragmatically at follow-up intervals of 3, 5½, 8½, 19, and 21 months, including but not limited to the Headache and Neck Disability Indices and the Oswestry Low Back Questionnaire. The patient had clinically meaningful improvements on the Neck Disability Index, the Headache Disability Index, and the Revised Oswestry after 3, 5½, 8½, and 21 months from baseline. This patient with EDS-HT had clinically meaningful decreases in disability, headache, and spine pain after a course of multimodal chiropractic care combined with conventional and complementary medical care.

The Neuropsychology of Cluster Headache: Cognition, Mood, Disability, and Quality of Life of Patients With Chronic and Episodic Cluster Headache

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Torkamani, Mariam; Ernst, Lea; Cheung, Lok Sze; Lambru, Giorgio; Matharu, Manjit; Jahanshahi, Marjan

2015-01-01

Background Cluster headache (CH) is commonly regarded as one of the most disabling headache conditions, and referred to as one of the most painful conditions known to humankind. Although there has been some research indicating the severe impact of CH, there is little comprehensive evidence of its impact on quality of life, disability, mood, and cognitive function in both its episodic (ECH) and chronic (CCH) variants. Methods This cross-sectional study investigates various aspects of cognitive function including intelligence, executive function, and memory, and mood, disability, and quality of life in 22 patients with ECH and CCH compared with age-matched healthy controls. Results The results showed that intelligence and executive functions are intact in patients with CH, but that patients with CH perform significantly worse than healthy controls on tests of working memory and (all P  .05). The patients with CH reported poor quality of life compared with healthy controls; however, this difference was not statistically significant. Conclusion Patients with CH show worse working memory, disturbance of mood, and poorer quality of life compared with healthy controls. The differences between patients with ECH and CCH, and the implications of these findings for the management of CH are discussed. PMID:25688646

Taping reduces pain and disability in patients with knee osteoarthritis.

NARCIS (Netherlands)

Ende, E. van den

2004-01-01

Question: Is taping of the knee effective in improving pain and disability in patients with osteoarthritis of the knee? Design Randomised controlled trial. Setting University and private practices in Melbourne, Australia. Patients: Volunteers who responded to advertisements in local newspapers.

Attitudes of Fortune 500 corporate executives toward the employability of persons with severe disabilities: a national study.

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Levy, J M; Jessop, D J; Rimmerman, A; Levy, P H

1992-04-01

Executives (N = 341) responsible for hiring decisions in Fortune 500 industrial and service corporations returned a mail questionnaire measuring their attitudes toward persons with severe disabilities and their employability. Responses indicated that attitudes were favorable to persons with disabilities and to their employability, both in terms of advantages for the individual and lack of disadvantages for others in the work setting. Significant differences in attitudes existed among subgroups of executives. Executives who had contact with persons with disabilities in the corporate work world had more positive attitudes than did executives who did not have such experiences.

The joint association of depression and cognitive function with severe disability among community-dwelling older adults in Finland, Poland and Spain.

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Olaya, Beatriz; Moneta, Maria Victoria; Koyanagi, Ai; Lara, Elvira; Miret, Marta; Ayuso-Mateos, José Luis; Chatterji, Somnath; Leonardi, Matilde; Koskinen, Seppo; Tobiasz-Adamczyk, Beata; Lobo, Antonio; Haro, Josep Maria

2016-04-01

To explore the joint association of depression and cognitive function with severe disability in nationally-representative samples of community-dwelling adults aged 50 years and older from Finland, Poland and Spain. Cross-sectional. Community-based. Population-based sample of 7987 non-institutionalized adults aged 50 and older. The outcome was severe disability, defined as ≥ 90th percentile of the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Past 12-month DSM-IV major depressive disorder was assessed with the depression module of the WHO Composite International Diagnostic Interview (CIDI). A global cognitive function score was obtained through neuropsychological tests. Product terms between depression and cognition were introduced in multivariable logistic regression models to test for interaction. Lower cognitive function and depression were both significantly associated with severe disability in all countries. A significant interaction was only found in Finland where the ORs (95% CIs) of depression for severe disability at the 25th (worse), 50th, and 75th (better) percentiles of cognitive function were 7.26 (4.28-12.32), 11.1 (6.7-18.38), and 17.56 (9.29-33.2), respectively. People with depression and cognitive decline are likely to benefit from the usual evidence-based treatments to reduce the burden of disability. However, in Finland, those with better cognitive function may benefit from more aggressive depression treatment. Future research is warranted to assess whether our results may be replicated.

The Effect of an Attachment-Based Behaviour Therapy for Children with Visual and Severe Intellectual Disabilities. [Article

NARCIS (Netherlands)

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

2008-01-01

Background: A combination of an attachment-based therapy and behaviour modification was investigated for children with persistent challenging behaviour., Method: Six clients with visual and severe intellectual disabilities, severe challenging behaviour and with a background of pathogenic care were

Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain.

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Boonstra, Anne M; Schiphorst Preuper, Henrica R; Reneman, Michiel F; Posthumus, Jitze B; Stewart, Roy E

2008-06-01

To determine the reliability and concurrent validity of a visual analogue scale (VAS) for disability as a single-item instrument measuring disability in chronic pain patients was the objective of the study. For the reliability study a test-retest design and for the validity study a cross-sectional design was used. A general rehabilitation centre and a university rehabilitation centre was the setting for the study. The study population consisted of patients over 18 years of age, suffering from chronic musculoskeletal pain; 52 patients in the reliability study, 344 patients in the validity study. Main outcome measures were as follows. Reliability study: Spearman's correlation coefficients (rho values) of the test and retest data of the VAS for disability; validity study: rho values of the VAS disability scores with the scores on four domains of the Short-Form Health Survey (SF-36) and VAS pain scores, and with Roland-Morris Disability Questionnaire scores in chronic low back pain patients. Results were as follows: in the reliability study rho values varied from 0.60 to 0.77; and in the validity study rho values of VAS disability scores with SF-36 domain scores varied from 0.16 to 0.51, with Roland-Morris Disability Questionnaire scores from 0.38 to 0.43 and with VAS pain scores from 0.76 to 0.84. The conclusion of the study was that the reliability of the VAS for disability is moderate to good. Because of a weak correlation with other disability instruments and a strong correlation with the VAS for pain, however, its validity is questionable.

Relationships between craniocervical posture and pain-related disability in patients with cervico-craniofacial pain

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López-de-Uralde-Villanueva I

2015-07-01

Full Text Available Ibai López-de-Uralde-Villanueva,1–4 Hector Beltran-Alacreu,1–3 Alba Paris-Alemany,1–4 Santiago Angulo-Díaz-Parreño,2,3,5 Roy La Touche1–4 1Department of Physiotherapy, Faculty of Health Science, 2Research Group on Movement and Behavioral Science and Study of Pain, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain; 3Institute of Neuroscience and Craniofacial Pain (INDCRAN, Madrid, Spain; 4Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain; 5Faculty of Medicine, Universidad San Pablo CEU, Madrid, Spain Objectives: This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP. Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP and the sternomental distance (SMD. Methods: Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively. Results: We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]. A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52. Neck disability was strongly positively correlated with craniofacial disability (r=0.79; P>0.001. The test–retest intrarater reliability of the HP measurement was high for

The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis

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Rojas-Villarraga, Adriana; Bayona, Javier; Zuluaga, Natalia; Mejia, Santiago; Hincapie, Maria-Eugenia; Anaya, Juan-Manuel

2009-01-01

Background Alterations in the feet of patients with rheumatoid arthritis (RA) are a cause of disability in this population. The purpose of this research was to evaluate the impact that foot impairment has on the patients' global quality of life (QOL) based on validated scales and its relationship to disease activity. Methods This was a cross-sectional study in which 95 patients with RA were enrolled. A complete physical examination, including a full foot assessment, was done. The Spanish versions of the Health Assessment Questionnaire (HAQ) Disability Index and of the Disease Activity Score (DAS 28) were administered. A logistic regression model was used to analyze data and obtain adjusted odds ratios (AORs). Results Foot deformities were observed in 78 (82%) of the patients; hallux valgus (65%), medial longitudinal arch flattening (42%), claw toe (lesser toes) (39%), dorsiflexion restriction (tibiotalar) (34%), cock-up toe (lesser toes) (25%), and transverse arch flattening (25%) were the most frequent. In the logistic regression analysis (adjusted for age, gender and duration of disease), forefoot movement pain, subtalar movement pain, tibiotalar movement pain and plantarflexion restriction (tibiotalar) were strongly associated with disease activity and disability. The positive squeeze test was significantly associated with disability risk (AOR = 6,3; 95% CI, 1.28–30.96; P = 0,02); hallux valgus, and dorsiflexion restriction (tibiotalar) were associated with disease activity. Conclusion Foot abnormalities are associated with active joint disease and disability in RA. Foot examinations provide complementary information related to the disability as an indirect measurement of quality of life and activity of disease in daily practice. PMID:19527518

Addressing the General Education Curriculum in General Education Settings with Students with Severe Disabilities

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Ballard, Sarah L.; Dymond, Stacy K.

2017-01-01

This systematic literature review examined research on stakeholders' beliefs about addressing the general education curriculum in general education classrooms with students with severe disabilities (SD). The investigation was limited to studies published in peer-reviewed journals between 1997 and 2015. Ten articles were identified and then…

Mediator Variables in Headache Research: Methodological Critique and Exemplar Using Self-Efficacy as a Mediator of the Relationship Between Headache Severity and Disability.

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Peck, Kelly R; Smitherman, Todd A

2015-09-01

Despite advances in headache medicine, there remains little research on process-related variables that mediate relations between headache and outcomes, as well as limited dissemination of optimal statistical methodology for conducting mediation analyses. The present paper thus aims to promote and demonstrate a contemporary approach to mediation analysis as applied to headache. An overview of a contemporary path-analytic approach to mediation analysis is presented, with an empirical exemplar for illustrative purposes. In the exemplar, headache management self-efficacy (HMSE) was proposed as a mediator between headache severity and disability. The sample included 907 young adults (M age = 19.03 [SD = 2.26]; 70.8% female) with primary headache. Direct and indirect effects of headache severity on headache disability through HMSE were assessed using the espoused methods. Pain severity was positively associated with headache disability (β = 2.91, 95% confidence interval [CI; 2.62, 3.19]) and negatively associated with HMSE (β = -3.50, 95% CI [-4.24, -2.76]); HMSE was negatively associated with headache disability (β = 0.07, 95% CI [-0.09, -0.04]). A positive indirect effect of pain severity on disability through HMSE was identified (point estimate = 0.24, 95% CI [0.14, 0.34]); thus, self-efficacy mediated the association between pain severity and disability. The proposed mediation model accounted for 38% of total variance in disability (P headache literature. In one exemplar application, self-efficacy partially accounted for the disability resulting from headache. We advocate for increased attention to intervening variables in headache via dissemination of contemporary mediation analyses. © 2015 American Headache Society.

Challenges and successes in the treatment of hemophilia: the story of a patient with severe hemophilia A and high-titer inhibitors

Directory of Open Access Journals (Sweden)

Saba HI

2012-05-01

Full Text Available Hussain I Saba, Duc Quang Tran, JrDepartment of Medicine, University of South Florida Medical Center, Tampa, FL, USAAbstract: In the past, patients with severe hemophilia have suffered a substantially reduced quality of life with frequent bleeding episodes, disabling arthropathy, and shorter life expectancy. In addition, methods of treatment and management have been costly and time-consuming, and have placed a considerable burden on patients' physical and psychological well-being. With the advent of the on-demand therapy and prophylactic treatment paradigm, patients have been able to receive care with less interruption of daily activities. Treatments may be more challenging for hemophiliacs with inhibitors to replacement factor; however, recent advances in the use of bypassing agents and immune tolerance therapy have enabled them to aggressively manage their disease while maintaining their independence. This review focuses on the challenges of treating such a severe hemophiliac through examination of the lifetime experience of a young adult male with a severe form of congenital hemophilia A. At this stage of his life, the patient has minimal disabilities and is inhibitor-free through optimal care and strong family support. His aspiration to pursue a productive life has led him to a career in medicine. After receiving his medical degree, he pursued a specialty in the treatment of hemophilia. By assisting other hemophilia patients, he exemplifies both the rewards of persevering through episodes of bleeding and other complications and the fact that disabilities can be minimized when managed meticulously and in a timely fashion to enable a productive and dignified life.Keywords: hemophilia, quality of life, factor VIII inhibitors, hemophilia treatment center, early treatment, bypassing agent

Measuring disability in patients with chronic low back pain : the usefulness of different instruments

NARCIS (Netherlands)

Kuijer, Wietske

2006-01-01

Measuring disability is an important topic in rehabilitation research in patients with chronic low back pain (CLBP). Due to the major impact of CLBP on functioning in both daily living and work, measuring disability in patients with CLBP is best described in terms of limitations in activities and

Impact of a new simplified disability scoring system for adult patients with localized scleroderma.

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Okiyama, Naoko; Asano, Yoshihide; Hamaguchi, Yasuhito; Jinnin, Masatoshi; Motegi, Sei-Ichiro; Koizumi, Haruka; Hasegawa, Minoru; Ishikawa, Osamu; Sato, Shinichi; Takehara, Kazuhiko; Yamamoto, Toshiyuki; Fujimoto, Manabu; Ihn, Hironobu

2018-04-01

Localized scleroderma (LoS) involves dermal but not internal inflammation and fibrosis. Cosmetic changes often impact quality of life (QOL), however, impairment of activities of daily living (ADL) in LoS patients has not been investigated. To determine what factor(s) are associated with ADL in adult patients with LoS, we performed a retrospective observational study in 177 Japanese adult LoS patients using a novel LoS disability score based on Barthel's indices of ADL: feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers, mobility and stairs. LoS disability scores increased in proportion to the number of affected body parts but were not correlated to age and duration of illness. The presence of leg lesions significantly impaired ADL of LoS patients compared with lesions on other body parts. Patients treated with systemic medications, who tended to have multiple lesions, presented higher LoS disability scores than those without systemic treatments. Our study proposes that physicians evaluate ADL, not only QOL, in LoS patients. Our findings using LoS disability scoring indicate that multiple affected body parts and leg lesions are risk factors for ADL impairment. © 2018 Japanese Dermatological Association.

Severe Intellectual Disability: Systematic Review of the Prevalence and Nature of Presentation of Unipolar Depression.

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Walton, Catherine; Kerr, Mike

2016-09-01

The diagnosis of depression in severe and profound intellectual disability is challenging. Without adequate skills in verbal self-expression, standardized diagnostic criteria cannot be used with confidence. The purpose of this systematic review was to investigate the assessment and diagnosis of unipolar depression in severe and profound intellectual disability. The review aimed to examine the methods used to assess for depression. The secondary aim was to explore the frequency and symptoms of depression. The PRISMA (2009) Checklist for systematic review was followed, and a search of electronic databases was undertaken. Nine studies were included in the qualitative synthesis from over 2000 records identified. The quality of the studies was assessed and scored, with a wide range of results. Individual studies scored between 2 and 7 of a maximum possible score of 8. The diagnostic tools utilized by each of the studies were assessed and compared. In terms of the methods used to assess for depression, results were varied. This was due to the heterogeneous nature of the individual study designs. The Aberrant Behaviour Checklist consistently showed promise, in particular when combined with other instruments or clinical examination. Qualitative analysis of the selected studies has shown a wide variation in the quality of primary research in this field, with more required to make firm conclusions regarding the diagnosis, frequency and presentation of depression in severe and profound intellectual disability. © 2015 John Wiley & Sons Ltd.

Predicting Vision-Related Disability in Glaucoma.

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Abe, Ricardo Y; Diniz-Filho, Alberto; Costa, Vital P; Wu, Zhichao; Medeiros, Felipe A

2018-01-01

To present a new methodology for investigating predictive factors associated with development of vision-related disability in glaucoma. Prospective, observational cohort study. Two hundred thirty-six patients with glaucoma followed up for an average of 4.3±1.5 years. Vision-related disability was assessed by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at baseline and at the end of follow-up. A latent transition analysis model was used to categorize NEI VFQ-25 results and to estimate the probability of developing vision-related disability during follow-up. Patients were tested with standard automated perimetry (SAP) at 6-month intervals, and evaluation of rates of visual field change was performed using mean sensitivity (MS) of the integrated binocular visual field. Baseline disease severity, rate of visual field loss, and duration of follow-up were investigated as predictive factors for development of disability during follow-up. The relationship between baseline and rates of visual field deterioration and the probability of vision-related disability developing during follow-up. At baseline, 67 of 236 (28%) glaucoma patients were classified as disabled based on NEI VFQ-25 results, whereas 169 (72%) were classified as nondisabled. Patients classified as nondisabled at baseline had 14.2% probability of disability developing during follow-up. Rates of visual field loss as estimated by integrated binocular MS were almost 4 times faster for those in whom disability developed versus those in whom it did not (-0.78±1.00 dB/year vs. -0.20±0.47 dB/year, respectively; P disability developing over time (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.70; P = 0.013). In addition, each 0.5-dB/year faster rate of loss of binocular MS during follow-up was associated with a more than 3.5 times increase in the risk of disability developing (OR, 3.58; 95% CI, 1.56-8.23; P = 0.003). A new methodology for classification and analysis

Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability

NARCIS (Netherlands)

Rieken, Rob; van Goudoever, Johannes B.; Schierbeek, Henk; Willemsen, Sten P.; Calis, Elsbeth A. C.; Tibboel, Dick; Evenhuis, Heleen M.; Penning, Corine

2011-01-01

Accurate prediction equations for estimating body composition and total energy expenditure (TEE) in children with severe neurologic impairment and intellectual disability are currently lacking. The objective was to develop group-specific equations to predict body composition by using

Epidemiology of severe trauma.

Science.gov (United States)

Alberdi, F; García, I; Atutxa, L; Zabarte, M

2014-12-01

Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Iconicity in the development of picture skills: typical development and implications for individuals with severe intellectual disabilities.

Science.gov (United States)

Stephenson, Jennifer

2009-01-01

The iconicity of graphic symbols and the iconicity hypothesis are theoretical concepts that have had an impact on the use of augmentative and alternative communication strategies for people with severe intellectual disabilities. This article reviews some of the recent literature on the impact of iconicity on symbol recognition and use by typically developing children and relates those findings to people with severe disability. It seems that although iconicity may have some impact on symbol learning, there are other variables that are likely to be much more important. It is likely that iconicity is not helpful to those learning graphic symbols who have little or no comprehension of spoken language.

Association between visual impairment and patient-reported visual disability at different stages of cataract surgery.

Science.gov (United States)

Acosta-Rojas, E Ruthy; Comas, Mercè; Sala, Maria; Castells, Xavier

2006-10-01

To evaluate the association between visual impairment (visual acuity, contrast sensitivity, stereopsis) and patient-reported visual disability at different stages of cataract surgery. A cohort of 104 patients aged 60 years and over with bilateral cataract was assessed preoperatively, after first-eye surgery (monocular pseudophakia) and after second-eye surgery (binocular pseudophakia). Partial correlation coefficients (PCC) and linear regression models were calculated. In patients with bilateral cataracts, visual disability was associated with visual acuity (PCC = -0.30) and, to a lesser extent, with contrast sensitivity (PCC = 0.16) and stereopsis (PCC = -0.09). In monocular and binocular pseudophakia, visual disability was more strongly associated with stereopsis (PCC = -0.26 monocular and -0.51 binocular) and contrast sensitivity (PCC = 0.18 monocular and 0.34 binocular) than with visual acuity (PCC = -0.18 monocular and -0.18 binocular). Visual acuity, contrast sensitivity and stereopsis accounted for between 17% and 42% of variance in visual disability. The association of visual impairment with patient-reported visual disability differed at each stage of cataract surgery. Measuring other forms of visual impairment independently from visual acuity, such as contrast sensitivity or stereopsis, could be important in evaluating both needs and outcomes in cataract surgery. More comprehensive assessment of the impact of cataract on patients should include measurement of both visual impairment and visual disability.

HIT-6 and MIDAS as measures of headache disability in a headache referral population.

Science.gov (United States)

Sauro, Khara M; Rose, Marianne S; Becker, Werner J; Christie, Suzanne N; Giammarco, Rose; Mackie, Gordon F; Eloff, Arnoldas G; Gawel, Marek J

2010-03-01

The objective of this study was to compare the headache impact test (HIT-6) and the migraine disability assessment scale (MIDAS) as clinical measures of headache-related disability. The degree of headache-related disability is an important factor in treatment planning. Many quality of life and headache disability measures exist but it is unclear which of the available disability measures is the most helpful in planning and measuring headache management. We compared HIT-6 and MIDAS scores from 798 patients from the Canadian Headache Outpatient Registry and Database (CHORD). Correlation and regression analyses were used to examine the relationships between the HIT-6 and MIDAS total scores, headache frequency and intensity, and Beck Depression Inventory (BDI-II) scores. A positive correlation was found between HIT-6 and MIDAS scores (r = 0.52). The BDI-II scores correlated equally with the HIT-6 and the MIDAS (r = 0.42). There was a non-monotonic relationship between headache frequency and the MIDAS, and a non-linear monotonic relationship between headache frequency and the HIT-6 (r = 0.24). The correlation was higher between the intensity and the HIT-6 scores (r = 0.46), than MIDAS (r = 0.26) scores. Seventy-nine percent of patients fell into the most severe HIT-6 disability category, compared with the 57% of patients that fell into the most severe MIDAS disability category. Significantly more patients were placed in a more severe category with the HIT-6 than with the MIDAS (McNemar chi-square = 191 on 6 d.f., P MIDAS appear to measure headache-related disability in a similar fashion. However, some important differences may exist. Headache intensity appears to influence HIT-6 score more than the MIDAS, whereas the MIDAS was influenced more by headache frequency. Using the HIT-6 and MIDAS together may give a more accurate assessment of a patient's headache-related disability.

Efficacy of nursing interventions in reducing social and occupational disabilities among patients with neurosis.

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Nagarajaiah; Jothimani, G; Parthasarathi, R; Reddemma, K; Giri, A T S

2012-01-01

Individuals suffering from neurosis suffer from social and occupational disabilities similar to that of psychoses. Though understanding of disabilities in neurosis is essential in management of the clients, the relevant interventional studies are very limited. The present study attempted to evaluate the effect of nursing interventions in reducing social and occupational disabilities in neurotic patients. Sixty neurotic patients diagnosed as per ICD 9 criteria were randomly assigned to experimental and control groups followed by pre-assessment by Groningen social disability schedule. Of the 10 sessions of nursing intervention, 3 were individual sessions with clients, 5 with clients and family members and 2 with small group of clients with similar problems; nursing intervention group and non-nursing intervention group received the routine drug treatment at rural community mental health centre, NIMHANS, Bengaluru. The post-assessment was carried out first, second, and the third month followed by the nursing intervention. The findings revealed statistically significant reduction in social and occupational disabilities. A community-based psychosocial intervention led by community health nurses catering to the needs of neurotic patients is indicated by the results.

A qualitative study of Functioning, Disability, and Rehabilitation of patients after hip fracture surgery

DEFF Research Database (Denmark)

Ehlers, Monica Milter

2013-01-01

A qualitative study of functioning, disability, and rehabilitation of patients after hip fracture surgery Monica Milter Ehlers PhD student, MSc in Nursing Merete Bender Bjerrum* PhD, MA, Associate Professor Claus Vinther Nielsen* Professor, PhD, MD, Specialist in Clinical Social Medicine...... *Department of Public Health, Aarhus University Introduction Hip fractures cause the greatest consumption of bed days in Danish hospitals. The need for rehabilitation of hip fracture patients older than 65 years is increasing because of a growing number of elderly people in Denmark. Rehabilitation of hip...... fracture patients consists primarily of muscle training and daily mobilisation. Patients' functioning, disability, and involvement in their rehabilitation process have not been investigated in scientific studies. Aims To establish a specific research-based knowledge for functioning, disability...

Is Age a Determinant for Nausea and Vomiting in Disabled Patients ...

African Journals Online (AJOL)

2016-06-24

Jun 24, 2016 ... disabled patients under sedation or general anesthesia. In this study, we aimed ... dental procedures in patients with anxiety and fear, cognitive ... of Paediatric Dentistry, ..... management of postoperative nausea and vomiting.

Disability and Fatigue Can Be Objectively Measured in Multiple Sclerosis.

Directory of Open Access Journals (Sweden)

Caterina Motta

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

Assessment with Oswestry disability index in surgically treated patients with lumbar spondylolisthesis: experience in 96 patients.

Science.gov (United States)

Pasha, Ibrahim Farooq; Qureshi, Muhammad Asad; Farooq, Maheen; Talha, Muhammed; Ahmed, Naveed; Ismail, Junaid

2015-11-01

To assess the outcome of surgical treatment in spondylolisthesis of lumbosacral region using Oswestry disability Index. The quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi from 2006 to 2013 and comprised surgically treated patients with spondylolisthesis. The patients with degenerative and isthmic types with follow-up of at least two years were included. A performa was designed for each patient and records were kept in a custom-built database. Oswestry disability index was used as the assessment tool and assessment was done pre-operatively, at 1, 3 and 6 months and then at 1 year and 2 years. There were 96 patients with mean pre-op Oswestry disability index score of 81.06% (range 42.22-100, SD ±11.99). L5-S1 was affected in 44 (45.83%) patients, L4-L5 in 30 (31.25%), L4-5-S1 in 7 (7.29%) and multi or high level was found in the rest of the cases. One level was involved in 77 (80.2%), 2 in 11 (11.45%), 3 in 7 (7.29%) and 4 in 1 (1.04%). The slip grade as per Meyerding grades was 1 in 31 (32.29%), II in 39 (40.62%), III in 19 (19.79%), IV in 5 (5.2%) and 2 (2.08%) had spondyloptosis. Mean follow-up was 42 months (range 24-63). Mean Oswestry disability score at 1 month was 38.51% (range 11- 62.22%, SD ±11.75); at 6 months 10.02% (range 0-40%, SD ±6.99); at 1 year 4.62% (range 0-24%, SD ±5.36) and at 2 years 4.21% (range 0-15%, SD ±4.2). Surgical treatment of spondylolisthesis gives excellent long-term result in most patients.

Evolution of disability in traffic accident victims in rehabilitation, characterized by the International Classification of Functioning, Disability and Health (ICF

Directory of Open Access Journals (Sweden)

Ligia Regina de Oliveira

Full Text Available Abstract Introduction: The International Classification of Functioning, Disability and Health (ICF enables monitoring of the clinical evolution of a patient. Objective: This study aimed to characterize the evolution of disabilities in patients undergoing physical therapy following traffic accidents, using the ICF. Methods: A longitudinal study of 53 accident victims was conducted between April and October 2010, in a rehabilitation unit in the capital of Mato Grosso State, Brazil. Data from physical therapy evaluation were collected in 2 stages and coded by the ICF. Results: The average time between evaluation and reevaluation was 73.4 days. The evolution of functional impairment demonstrated a reduction in the number of patients with deficits, except for muscle tone functions. On initial evaluation, 90.6% had difficulty with sensory functions and pain, varying from mild to complete, decreasing to 67.9% on reevaluation, with pain still mostly present. Almost all patients (96.2% had a disability of neuromusculoskeletal and movement related functions on initial assessment, with a decrease to 15.7% of patients on reevaluation. The greatest improvements were observed in the categories of muscle strength (36.7% and gait pattern (30.6%. On reevaluation, improvement was also observed regarding perceived impairment of body structures, especially for those with severe and complete disability. Conclusion: The study confirmed a reduction in the percentage of patients with some form of disability, and positive development in functional capacity. The use of ICF enabled evaluation of physical disabilities and monitoring of the evolution of patients undergoing physical therapy.

The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis

Directory of Open Access Journals (Sweden)

Rojas-Villarraga Adriana

2009-06-01

Full Text Available Abstract Background Alterations in the feet of patients with rheumatoid arthritis (RA are a cause of disability in this population. The purpose of this research was to evaluate the impact that foot impairment has on the patients' global quality of life (QOL based on validated scales and its relationship to disease activity. Methods This was a cross-sectional study in which 95 patients with RA were enrolled. A complete physical examination, including a full foot assessment, was done. The Spanish versions of the Health Assessment Questionnaire (HAQ Disability Index and of the Disease Activity Score (DAS 28 were administered. A logistic regression model was used to analyze data and obtain adjusted odds ratios (AORs. Results Foot deformities were observed in 78 (82% of the patients; hallux valgus (65%, medial longitudinal arch flattening (42%, claw toe (lesser toes (39%, dorsiflexion restriction (tibiotalar (34%, cock-up toe (lesser toes (25%, and transverse arch flattening (25% were the most frequent. In the logistic regression analysis (adjusted for age, gender and duration of disease, forefoot movement pain, subtalar movement pain, tibiotalar movement pain and plantarflexion restriction (tibiotalar were strongly associated with disease activity and disability. The positive squeeze test was significantly associated with disability risk (AOR = 6,3; 95% CI, 1.28–30.96; P = 0,02; hallux valgus, and dorsiflexion restriction (tibiotalar were associated with disease activity. Conclusion Foot abnormalities are associated with active joint disease and disability in RA. Foot examinations provide complementary information related to the disability as an indirect measurement of quality of life and activity of disease in daily practice.

The AMC Linear Disability Score (ALDS): a cross-sectional study with a new generic instrument to measure disability applied to patients with peripheral arterial disease

NARCIS (Netherlands)

Met, R.; Reekers, J.A.; Koelemay, M.J.W.; Legemate, D.A.; de Haan, R.J.

2009-01-01

Background: The AMC Linear Disability Score (ALDS) is a calibrated generic itembank to measure the level of physical disability in patients with chronic diseases. The ALDS has already been validated in different patient populations suffering from chronic diseases. The aim of this study was to assess

Monitoring the prevalence of severe intellectual disability in children across Europe

DEFF Research Database (Denmark)

van Bakel, Marit; Einarsson, Ingolfur; Arnaud, Catherine

2014-01-01

Our aim was to study the feasibility of creating a framework for monitoring and undertaking collaborative research on intellectual disability at the European level, based on existing databases of children with such disability.......Our aim was to study the feasibility of creating a framework for monitoring and undertaking collaborative research on intellectual disability at the European level, based on existing databases of children with such disability....

Insomnia in a chronic musculoskeletal pain with disability population is independent of pain and depression.

Science.gov (United States)

Asih, Sali; Neblett, Randy; Mayer, Tom G; Brede, Emily; Gatchel, Robert J

2014-09-01

Insomnia is frequently experienced by patients suffering from chronic musculoskeletal disorders but is often seen as simply a symptom of pain or depression and not as an independent disorder. Compared with those who experience only chronic pain, patients with both chronic pain and insomnia report higher pain intensity, more depressive symptoms, and greater distress. However, insomnia has not yet been systematically studied in a chronic musculoskeletal pain with disability population. This study assessed the prevalence and severity of patient-reported insomnia, as well as the relationship among insomnia, pain intensity, and depressive symptoms, in a chronic musculoskeletal pain with disability population. This was a retrospective study of prospectively captured data. A consecutive cohort of 326 chronic musculoskeletal pain with disability patients (85% with spinal injuries) entered a functional restoration treatment program. All patients signed a consent form to participate in this protocol. Insomnia was assessed with the Insomnia Severity Index, a validated patient-report measure of insomnia symptoms. Four patient groups were formed: no clinically significant insomnia (score, 0-7); subthreshold insomnia (score, 8-14); moderate clinical insomnia (score, 15-21); and severe clinical insomnia (score, 22-28). Three patterns of sleep disturbance were also evaluated: early, middle, and late insomnia. Additional validated psychosocial patient-reported data were collected, including the Pain Visual Analog Scale, the Beck Depression Inventory, the Oswestry Disability Index, and the Pain Disability Questionnaire. Patients completed a standard psychosocial assessment battery on admission to the functional restoration program. The program included a quantitatively directed exercise process in conjunction with a multimodal disability management approach. The four insomnia groups were compared on demographic and psychosocial variables. The shared variances among insomnia

Reductions in Perceived Injustice are Associated With Reductions in Disability and Depressive Symptoms After Total Knee Arthroplasty.

Science.gov (United States)

Yakobov, Esther; Scott, Whitney; Stanish, William D; Tanzer, Michael; Dunbar, Michael; Richardson, Glen; Sullivan, Michael J L

2018-05-01

Perceptions of injustice have been associated with problematic recovery outcomes in individuals with a wide range of debilitating pain conditions. It has been suggested that, in patients with chronic pain, perceptions of injustice might arise in response to experiences characterized by illness-related pain severity, depressive symptoms, and disability. If symptoms severity and disability are important contributors to perceived injustice (PI), it follows that interventions that yield reductions in symptom severity and disability should also contribute to reductions in perceptions of injustice. The present study examined the relative contributions of postsurgical reductions in pain severity, depressive symptoms, and disability to the prediction of reductions in perceptions of injustice. The study sample consisted of 110 individuals (69 women and 41 men) with osteoarthritis of the knee scheduled for total knee arthroplasty (TKA). Patients completed measures of perceived injustice, depressive symptoms, pain, and disability at their presurgical evaluation, and at 1-year follow-up. The results revealed that reductions in depressive symptoms and disability, but not pain severity, were correlated with reductions in perceived injustice. Regression analyses revealed that reductions in disability and reductions in depressive symptoms contributed modest but significant unique variance to the prediction of postsurgical reductions in perceived injustice. The present findings are consistent with current conceptualizations of injustice appraisals that propose a central role for symptom severity and disability as determinants of perceptions of injustice in patients with persistent pain. The results suggest that the inclusion of psychosocial interventions that target depressive symptoms and perceived injustice might augment the impact of rehabilitation programs made available for individuals recovering from TKA.

Prospective memory, level of disability, and return to work in severe mental illness.

Science.gov (United States)

Burton, Cynthia Z; Vella, Lea; Twamley, Elizabeth W

2018-02-25

Prospective memory (the ability to remember to do things) has clear implications for everyday functioning, including employment, in people with severe mental illnesses (SMI). This study aimed to evaluate prospective memory performance and its relationship to real-world functional variables in an employment-seeking sample of people with SMI (Clinical Trial registration number NCT00895258). 153 individuals with DSM-IV diagnosis of depression (n = 58), bipolar disorder (n = 37), or schizophrenia (n = 58) who were receiving outpatient psychiatric care at a university clinic enrolled in a trial of supported employment and completed a baseline assessment. Prospective memory was measured with the Memory for Intentions Test (MIST); real-world functional status included work history variables, clinical history variables, baseline functional capacity (UCSD Performance-based Skills Assessment-Brief), and work outcomes (weeks worked and wages earned during two years of supported employment). Participants with schizophrenia performed worse on the MIST than did those with affective disorders. Independent of diagnosis, education, and estimated intellectual functioning, prospective memory significantly predicted variance in measures of disability and illness burden (disability benefits, hospitalization history, current functional capacity), and work outcomes over two years of supported employment (weeks worked). Worse prospective memory appears to be associated with greater illness burden and functional disability in SMI. Mental health clinicians and employment specialists may counsel clients to use compensatory prospective memory strategies to improve work performance and decrease functional disability associated with SMI.

Variation at local government level in the support for families of severely disabled children and the factors that affect it.

Science.gov (United States)

Forsyth, Rob; McNally, Richard; James, Peter; Crossland, Kevin; Woolley, Mark; Colver, Allan

2010-11-01

The aim of this study was to examine geographical variability in the support for families caring for children with severe disabilities as well as the relationships between this variability and local government social and educational performance indicators. Data were collected from a cross-sectional, self-completed postal survey of the families of 5862 children and young people (aged 0-24 y, mean 10 y 7 mo; 68% male) with severe disabilities resulting in a variety of impairments (21% with autism spectrum disorders, 16% with learning disabilities,* 13% with emotional and behavioural difficulties, and 13% with cerebral palsy [CP]). Data on the severity of intrinsic impairment were assessed using the Health Utilities Index, and the need for support was assessed from the results of a novel parent-completed questionnaire, the European Child Environment Questionnaire (ECEQ). These responses were related to data published by local authorities on educational and social policy. Higher levels of unmet need and lack of support, as reported by parents of children and young people with severe disabilities, are associated with greater impairment but not with socioeconomic deprivation. After controlling for impairment and diagnosis, variation at local government level is of the order of 1 to 1.5 ECEQ standard deviation scores. The best- and the worst-performing local authorities--in terms of the averages of the 'support' scores reported by their surveyed residents--cluster in urban areas. For children with CP, a positive correlation was found between the reported unmet educational support requirements in each local authority area and rates of mainstream school placement for children with special educational needs. This indicates that the placement of children with disabilities into mainstream schools is associated with reported unmet need (r=0.60; p=0.01). In the case of children with autism spectrum diagnoses, the provision of additional basic educational support in mainstream

Cognitive and behavioural therapy of voices for with patients intellectual disability: Two case reports

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Pernier Sophie

2007-08-01

Full Text Available Abstract Background Two case studies are presented to examine how cognitive behavioural therapy (CBT of auditory hallucinations can be fitted to mild and moderate intellectual disability. Methods A 38-year-old female patient with mild intellectual disability and a 44-year-old male patient with moderate intellectual disability, both suffering from persistent auditory hallucinations, were treated with CBT. Patients were assessed on beliefs about their voices and their inappropriate coping behaviour to them. The traditional CBT techniques were modified to reduce the emphasis placed on cognitive abilities. Verbal strategies were replaced by more concrete tasks using roleplaying, figurines and touch and feel experimentation. Results Both patients improved on selected variables. They both gradually managed to reduce the power they attributed to the voice after the introduction of the therapy, and maintained their progress at follow-up. Their inappropriate behaviour consecutive to the belief about voices diminished in both cases. Conclusion These two case studies illustrate the feasibility of CBT for psychotic symptoms with intellectually disabled people, but need to be confirmed by more stringent studies.

Effect of joint traction on functional improvement and quality of life in patients with severe knee osteoarthritis

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Sedigheh Sadat Naeimee

2012-07-01

Full Text Available Background and aim: Osteoarthritis (OA is the most prevalent joint disease in adults around the world and its incidence rises with age. Patients with severe knee osteoarthritis often complain of pain and severe functional disability. Most of conservative treatments used in this group of patients induce poor improvements. This study evaluated the effect of joint traction on quality of life of patients with severe knee osteoarthritis.Materials and Methods: In this clinical trial study, forty female patients with severe knee OA were randomly assigned to two following groups; common physiotherapy treatment and common physiotherapy treatment accompanied by knee distraction. Quality of life was evaluated pre- and post-treatment and also one month follow-up using the Knee injury and Osteoarthritis Outcome Score (KOOS questionnaire.Results: Common physiotherapy treatment accompanied by knee distraction resulted in significantly better quality of life post-treatment and at 1month follow-up, compared to common physiotherapy treatment alone (P<0.01.Conclusion: Common physiotherapy treatment accompanied by knee distraction induces significant improvement in quality of life in patients with severe knee osteoarthritis compared to common physiotherapy treatment alone.

Prevalence of Disability in Patients With Musculoskeletal Pain and Rheumatic Diseases in a Population From Cuenca, Ecuador.

Science.gov (United States)

Guevara-Pacheco, Sergio Vicente; Feican-Alvarado, Astrid; Delgado-Pauta, Jorge; Lliguisaca-Segarra, Angelita; Pelaez-Ballestas, Ingris

2017-09-01

The aim of this study was to determine the prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in Cuenca, Ecuador. We performed a cross-sectional analytical study with randomized sampling in 4877 subjects, from urban and rural areas. COPCORD (Community Oriented Program for Control of Rheumatic Diseases)-validated questionnaire was administered house-to-house to identify subjects with nontraumatic musculoskeletal pain and rheumatic diseases. The subjects were assessed by rheumatologists for diagnostic accuracy, and the Health Assessment Questionnaire Disability Index was administered to assess functional capacity. A logistic regression analysis was conducted to determine the association of rheumatic diseases with functional disability. Functional disability was found in 221 subjects (73.1% women), with mean age 62 (SD, 18.2) years, residing in rural areas (201 [66.5%]), with education of 6.9 (SD, 5.3) years, and of low income (77 [47.2%]). The value of HAQ-DI was a mean of 0.2 (0-2.9). The real prevalence of physical disability was 9.5%. Moderate and severe disability predominated in activities such as kneeling (4.9% and 3.3%), squatting (4.8% and 2.7%), and leaning to pick up objects (3.7% and 0.9%), respectively. Rheumatic diseases associated with physical disabilities were knee osteoarthritis (95 [31.4%]) and hand osteoarthritis (69 [22.8%]), mechanical low-back pain (43 [14.2%]), fibromyalgia (27 [9.5%]), and rheumatoid arthritis (11 [3.6%]; P Rheumatic diseases associated with disability were hand and knee osteoarthritis, back pain, fibromyalgia, and rheumatoid arthritis.

Communication intervention in children with severe disabilities and multilingual backgrounds: perceptions of pedagogues and parents.

Science.gov (United States)

Pickl, Gonda

2011-12-01

Increasing global population movement has resulted in a corresponding increase of children with severe and multiple disabilities and complex communication needs who at home are exposed to languages different from the language used at school. The aim of this study was to highlight facilitating as well as limiting factors for effective communication intervention for these children both in school and within the family. Based on observations, qualitative research interviews and analysis in the tradition of grounded theory the results indicate that the quality of parent-teacher-interaction is central to effective communication intervention and culturally sensitive use of communication aids. Challenges for teachers as well as parents to achieve a mutually satisfying interaction are addressed, and issues regarding the language use with children with severe disabilities and a multilingual and multicultural background and the inclusion of their parents in school based activities are discussed.

Comparison of measures of functional disability in patients with gout

NARCIS (Netherlands)

ten Klooster, Peter M.; Oude Voshaar, Antonius H.; Taal, Erik; van de Laar, Mart A F J

2011-01-01

Objective. To compare the measurement properties of the HAQ disability index (HAQ-DI), HAQ-II and short form 36 physical functioning scale (PF-10) in patients with gout. Methods. A cross-sectional sample of 97 patients with gout completed all three measures. Reliability was assessed by examining the

An Enduring Health Risk of Childhood Adversity: Earlier, More Severe, and Longer Lasting Work Disability in Adult Life.

Science.gov (United States)

Laditka, Sarah B; Laditka, James N

2018-02-08

Childhood adversity has been linked with adult health problems. We hypothesized that childhood adversity would also be associated with work limitations due to physical or nervous health problems, known as work disability. With data from the Panel Study of Income Dynamics (PSID) (1968-2013; n=6,045; 82,374 transitions; 129,107 person-years) and the 2014 PSID Childhood Retrospective Circumstances Study, we estimated work disability transition probabilities with multinomial logistic Markov models. Four or more adversities defined a high level. Microsimulations quantified adult work disability patterns for African American and non-Hispanic white women and men, accounting for age, education, race, sex, diabetes, heart disease, obesity, and sedentary behavior. Childhood adversity was significantly associated with work disability. Of African American women with high adversity, 10.2% had moderate work disability at age 30 versus 4.1% with no reported adversities; comparable results for severe work disability were 5.6% versus 1.9% (both pwork disability remained significant after adjusting for diabetes, heart disease, obesity, and sedentary behavior (pwork disability throughout adult life. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Experiment on a novel user input for computer interface utilizing tongue input for the severely disabled.

Science.gov (United States)

Kencana, Andy Prima; Heng, John

2008-11-01

This paper introduces a novel passive tongue control and tracking device. The device is intended to be used by the severely disabled or quadriplegic person. The main focus of this device when compared to the other existing tongue tracking devices is that the sensor employed is passive which means it requires no powered electrical sensor to be inserted into the user's mouth and hence no trailing wires. This haptic interface device employs the use of inductive sensors to track the position of the user's tongue. The device is able perform two main PC functions that of the keyboard and mouse function. The results show that this device allows the severely disabled person to have some control in his environment, such as to turn on and off or control daily electrical devices or appliances; or to be used as a viable PC Human Computer Interface (HCI) by tongue control. The operating principle and set-up of such a novel passive tongue HCI has been established with successful laboratory trials and experiments. Further clinical trials will be required to test out the device on disabled persons before it is ready for future commercial development.

Population Characteristics and Progressive Disability in Neurofibromatosis Type 2.

Science.gov (United States)

Iwatate, Kensho; Yokoo, Takeshi; Iwatate, Eriko; Ichikawa, Masahiro; Sato, Taku; Fujii, Masazumi; Sakuma, Jun; Saito, Kiyoshi

2017-10-01

To characterize the clinical features of patients with neurofibromatosis type 2 (NF2) and determine prognostic risk factors for progressive disabilities. In this retrospective cohort study of the Japanese national NF2 registry between 2009 and 2013, clinical data (demographic, history, oncologic, and neurologic) of 807 patients with a diagnosis of NF2 were analyzed. The overall severity of neurologic disability was assessed using a comprehensive 25-point scoring system encompassing a wide variety of neurologic deficits. In 587 patients in whom longitudinal disability data were available, multivariate logistic regression was performed to identify risk factors for significant progression of disability. The clinical characteristics of the Japanese NF2 population were heterogeneous. The median age of onset was 24 years (range, 1-80 years), the male:female ratio was 1:1.29, and the initial severity score was 4 (range, 0-22) out of 25 points. A family history of NF2 was present in 33% of the patients. Most frequent clinical features were bilateral cranial nerve VIII nerve sheath tumor (NST) in 87%, spinal NST in 80%, hearing loss in 65%, spinal dysfunction in 50%, intracranial meningioma in 49%, and facial paresis in 36%. The disability score progressed by ≥5 points in 6.1% of patients over the study period. Based on multivariate logistic regression analyses, the significant independent risk factors of progression (P value) included age of onset history (P = 0.007), positive treatment history (P = 0.026), hearing loss (P = 0.014), facial paresis (P = 0.015), blindness (P = 0.011), and hemiparesis (P = 0.025). The Japanese NF2 population has heterogeneous clinical features. Risk factors for progressive disability include younger age of onset, positive family history, positive treatment history, and specific neurologic deficits. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

The Disability Rate of 5-Year Post-Stroke and Its Correlation Factors: A National Survey in China.

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Yang, Yang; Shi, Yu-Zhi; Zhang, Ning; Wang, Shuo; Ungvari, Gabor S; Ng, Chee H; Wang, Yi-Long; Zhao, Xing-Quan; Wang, Yong-Jun; Wang, Chun-Xue; Xiang, Yu-Tao

2016-01-01

Few studies on long-term functional outcome have been conducted in post-stroke patients in China. The objective of this study was to conduct a nationwide survey in China to investigate the 5-year prevalence of post-stroke disability and its correlation factors. A total of 893 patients with ischemic stroke were included. Demographic, clinical and neuro-imaging information were collected with standardized instruments that assessed stroke severity, depression, cognitive impairment, stroke recurrence and physical disability. Disability was assessed with the modified Ranking Score (mRS), of which a cutoff score ≥2 indicates disability. Statistical analysis included chi-square tests, two independent samples t-tests, Mann-Whitney U test and multiple logistic regression analysis. The frequency of disability in this study population was 45%. Multivariate analyses revealed that older age, lower education level, previous history of stroke, stroke severity at admission, depression, cognitive impairment at 3 months, and stroke recurrence within 5 years follow up were all significantly associated with post-stroke disability. The disability rate in 5-year post-stroke was high in Chinese patients. Treatment of depression, secondary prevention of stroke and rehabilitation may benefit disabled patients with stroke in China.

Patient agency and contested notions of disability in social assistance applications in South Africa.

Science.gov (United States)

Kelly, Gabrielle

2017-02-01

Problems in fairly allocating welfare and health resources are very often located in the spaces where citizens interact directly with state workers. This study draws on observations of doctor-patient encounters in disability assessments for the South African disability grant (DG) to examine how doctor-patient interactions and patient agency shape social welfare allocation in a context of high poverty and inequality. Data were gathered via interviews with healthcare workers and observations of doctor-patient interactions in twelve clinics and three hospitals in the Western Cape province between October 2013 and August 2014. Twenty-four doctors were interviewed, of whom seventeen were observed conducting a total of 216 consultations with patients. Two training sessions of DG assessors were also observed. Findings show that interactions between doctors and patients are sites of negotiation and contestation over rights to social assistance. Claimants' understanding of disability differed from biomedical and bureaucratic definitions. Patients attempted to influence doctors' decisions through narratives of suffering and performances of disability. Others used verbal or physical abuse as a form of protest against perceived unfair treatment. To defend themselves from these pressures and maintain authority in these interactions, doctors employed coping strategies that distanced and objectified claimants. This resulted in strained doctor-patient relationships and made the DG system confusing to the public. This demonstrates the importance of considering trust, power dynamics and the exercise of agency by both patients and providers in understanding policy implementation. Copyright © 2017 Elsevier Ltd. All rights reserved.

The use of observation on patients who self-harm: Lessons from a learning disability service

Directory of Open Access Journals (Sweden)

Peter Thomas Sandy

2016-12-01

Conclusion: Observation is a useful practice in in-patient learning disability services, which can be used to prevent or reduce the incidence of self-harm in these settings. This approach should therefore be an integral part of nurses' daily therapeutic activities in in-patient learning disability services.

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

NARCIS (Netherlands)

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

2006-01-01

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

Assumptions of Decision-Making Capacity: The Role Supporter Attitudes Play in the Realisation of Article 12 for People with Severe or Profound Intellectual Disability

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Joanne Watson

2016-02-01

Full Text Available The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD was the first legally binding instrument explicitly focused on how human rights apply to people with disability. Amongst their obligations, consistent with the social model of disability, the Convention requires signatory nations to recognise that “…persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and mandates signatory nations to develop “…appropriate measures to provide access by persons with disability to the support they may require in exercising their legal capacity”. The Convention promotes supported decision-making as one such measure. Although Australia ratified the UNCRPD in 2008, it retains an interpretative declaration in relation to Article 12 (2, 3, 4, allowing for the use of substituted decision-making in situations where a person is assessed as having no or limited decision-making capacity. Such an outcome is common for people with severe or profound intellectual disability because the assessments they are subjected to are focused on their cognition and generally fail to take into account the interdependent nature of human decision-making. This paper argues that Australia’s interpretative declaration is not in the spirit of the Convention nor the social model of disability on which it is based. It starts from the premise that the intention of Article 12 is to be inclusive of all signatory nations’ citizens, including those with severe or profound cognitive disability. From this premise, arises a practical need to understand how supported decision-making can be used with this group. Drawing from evidence from an empirical study with five people with severe or profound intellectual disability, this paper provides a rare glimpse on what supported decision-making can look like for people with severe or profound intellectual disability. Additionally, it describes the importance of

Comparison of pain intensity, emotional status and disability level in patients with chronic neck and low back pain.

Science.gov (United States)

Altuğ, Filiz; Kavlak, Erdoğan; Kurtca, Mine Pekesen; Ünal, Ayşe; Cavlak, Uğur

2015-01-01

This study was planned to compare of pain, emotional status and disability level in patients with chronic neck pain and low back pain. In this study, fifty patients with chronic low back pain (Group I) and fifty patients with chronic neck pain (Group II) at least 6 months were evaluated. A Visual Analog Scale was used to describe pain intensity. To determine emotional status of the subjects, the Beck Depression Scale was used The Oswestry Disability Index and the Neck Disability Index were used to evaluate disability level. The mean age of the patients with low back pain and neck pain were 39.70 ± 9.71 years, 45.44 ± 10.39 years, respectively. It was not found a significant difference between in low back pain (Group I) and neck pain (Group II) in results of pain intensity (p= 0.286) and pain duration (p= 0.382). It was found a significant difference between group I and group II in results of emotional status (p= 0.000) and disability level (p= 0.000). The emotional status and disability level scores were found highest in patient's with low back pain. Chronic low back pain is affect in patients than chronic neck pain as a emotional status and disability level.

The contribution of rib fractures to chronic pain and disability.

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Gordy, Stephanie; Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John

2014-05-01

The contribution of rib fractures to chronic pain and disability is not well described. Two hundred three patients with rib fractures were followed for 6 months. Chronic pain was assessed using the McGill Pain Questionnaire Pain Rating Index and Present Pain Intensity (PPI) scales. Disability was defined as a decrease in work or functional status. The prevalence of chronic pain was 22% and disability was 53%. Acute PPI predicted chronic pain. Associated injuries, bilateral rib fractures, injury severity score, and number of rib fractures were not predictive of chronic pain. No acute injury characteristics were predictive of disability. Among 89 patients with isolated rib fractures, the prevalence of chronic pain was 28% and of disability was 40%. No injury characteristics predicted chronic pain. Bilateral rib fractures and acute PPI predicted disability. The contribution of rib fractures to chronic pain and disability is significant but unpredictable with conventional injury descriptors. Copyright © 2014 Elsevier Inc. All rights reserved.

[Preliminary study on civil capacity rating scale for mental disabled patients].

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Zhang, Qin-Ting; Pang, Yan-Xia; Cai, Wei-Xiong; Tang, Tao; Huang, Fu-Yin

2010-10-01

To create civil capacity rating scale for mentally disabled patients, and explore its feasibility during the forensic psychiatric expertise. The civil capacity-related items were determined after discussion and consultation. The civil capacity rating scale for mentally disabled patients was established and the manual was created according to the logistic sequence of the assessment. The rating scale was used during the civil assessment in four institutes. There were 14 items in civil capacity rating scale for mentally disabled patients. Two hundred and two subjects were recruited and divided into three groups according to the experts' opinion on their civil capacities: full civil capacity, partial civil capacity and no civil capacity. The mean score of the three groups were 2.32 +/- 2.45, 11.62 +/- 4.01 and 25.02 +/- 3.90, respectively, and there was statistical differences among the groups. The Cronbach alpha of the rating scale was 0.9724, and during the split-reliability test, the two-splited part of the rating scale were highly correlated (r = 0.9729, P = 0.000). The Spearman correlative coefficient between each item and the score of the rating scale was from 0.643 to 0.882 (P = 0.000). There was good correlation between the conclusion according to the rating scale and the experts' opinion (kappa = 0.841, P = 0.000). When the discriminate analysis was used, 7 items were included into the discrimination equation, and 92.6% subjects were identified as the correct groups using the equation. There is satisfied reliability and validity on civil capacity rating scale for mentally disabled patients. The rating scale can be used as effective tools to grade their civil capacity during the forensic expertise.

Symptom severity and life satisfaction in brain injury: The mediating role of disability acceptance and social self-efficacy.

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Ditchman, Nicole; Sung, Connie; Easton, Amanda B; Johnson, Kristina S; Batchos, Elisabeth

2017-01-01

Although the negative impact of symptom severity on subjective well-being outcomes has been established among individuals with brain injury, the mediating and protective role that positive human traits might have on this relationship has not been adequately explored. The purpose of this study was to examine the impact of social self-efficacy and disability acceptance on the relationship between symptom severity and life satisfaction among individuals with brain injury. Hierarchical regression analysis and correlation techniques were used to test a hypothesized dual-mediation model of life satisfaction in a sample of 105 adults with acquired brain injury. Results indicated that social self-efficacy and disability acceptance fully mediated the relationship between symptom severity and life satisfaction, lending support for a dual-mediation model with disability acceptance being the strongest contributor. These findings suggest there may be considerable value for rehabilitation providers to develop strengths-based service strategies and/or specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with brain injury. Implications for clinical practice and future research direction are also discussed.

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

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M Narimani

2016-11-01

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

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

International Nuclear Information System (INIS)

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

2010-01-01

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

Parent and Teacher Ratings of Communication among Children with Severe Disabilities and Visual Impairment/Blindness

Science.gov (United States)

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

2012-01-01

Three trends emerged from independent parent and teacher ratings of receptive communication and expressive forms and functions among students with severe disabilities and visual impairment/blindness. Parents had higher ratings than teachers, receptive communication was rated the highest, and no skills occurred often. Implications are discussed for…

Home Care for Children with Chronic Illnesses and Severe Disabilities: A Bibliography and Resource Guide.

Science.gov (United States)

Wells, Alice; And Others

The bibliography and resource guide summarizes relevant research and information on home care for children with disabilities and chronic illnesses, including those with such diagnoses as spina bifida, cerebral palsy, severe mental retardation, acquired immune deficiency syndrome (AIDS), hemophilia, sickle cell anemia, autism, or failure-to-thrive…

Prolonged pain and disability are common after rib fractures.

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Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John

2013-05-01

The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis. One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29). Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

Robot ZORA in rehabilitation and special education for children with severe physical disabilities: a pilot study.

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van den Heuvel, Renée J F; Lexis, Monique A S; de Witte, Luc P

2017-12-01

The aim of this study was to explore the potential of ZORA robot-based interventions in rehabilitation and special education for children with severe physical disabilities. A two-centre explorative pilot study was carried out over a 2.5-month period involving children with severe physical disabilities with a developmental age ranging from 2 to 8 years. Children participated in six sessions with the ZORA robot in individual or in group sessions. Qualitative and quantitative methods were used to collect data on aspects of feasibility, usability, barriers and facilitators for the child as well as for the therapist and to obtain an indication of the effects on playfulness and the achievement of goals. In total, 17 children and seven professionals participated in the study. The results of this study show a positive contribution of ZORA in achieving therapy and educational goals. Moreover, sessions with ZORA were indicated as playful. Three main domains were indicated to be the most promising for the application of ZORA: movement skills, communication skills and cognitive skills. Furthermore, ZORA can contribute towards eliciting motivation, concentration, taking initiative and improving attention span of the children. On the basis of the results of the study, it can be concluded that ZORA has potential in therapy and education for children with severe physical disabilities. More research is needed to gain insight into how ZORA can be applied best in rehabilitation and special education.

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

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Edwards, Thomas; Pilutti, Lara A

2017-08-01

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

Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: findings from RAF Study

OpenAIRE

Acciarresi, Monica; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Morotti, Andrea; Costa, Paolo; Padovani, Alessandro; Csiba, László; Szabó, Lilla; Sohn, Sung-Il

2017-01-01

Background and Purpose:\\ud \\ud The aim of this study was to investigate for a possible association between both prestroke CHA2DS2-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF).\\ud Methods:\\ud \\ud This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using t...

Disability in Patients With Trapeziometacarpal Joint Arthrosis: Incidental Versus Presenting Diagnosis

NARCIS (Netherlands)

Becker, Stéphanie J. E.; Makarawung, Dennis J. S.; Spit, Silke A.; King, John D.; Ring, David

2014-01-01

Purpose To test the hypothesis that there is no difference in trapeziometacarpal (TMC) joint arthrosis-related symptoms and disability between patients seeking treatment for symptoms of TMC arthrosis and those with incidental TMC joint arthrosis. Methods We compared 64 patients presenting for care

Making Music, Making Friends: Long-Term Music Therapy with Young Adults with Severe Learning Disabilities

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Pavlicevic, Mercédès; O'Neil, Nicky; Powell, Harriet; Jones, Oonagh; Sampathianaki, Ergina

2014-01-01

This collaborative practitioner research study emerged from music therapists' concerns about the value of improvisational, music-centred music therapy for young adults with severe learning disabilities (SLDs), given the long-term nature of such work. Concerns included the relevance, in this context, of formulating, and reporting on, therapeutic…

Comparison of patients with and without intellectual disability under ...

African Journals Online (AJOL)

Background and Purpose: We analyzed and retrospectively compared patients with and without intellectual disability (ID) who underwent oral surgery under general anesthesia at Istanbul University, Faculty of Dentistry, Department of General Anesthesia, between October 2012 and June 2013 with regard to the following ...

Factors contributing to disability in rheumatoid arthritis patients: An Egyptian multicenter study.

Science.gov (United States)

Hammad, Marwa; Eissa, Mervat; Dawa, Ghada A

2018-04-30

Minimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA. This is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients' disability was done using Modified HAQ (MHAQ). A significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000). Aging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle. Copyright © 2018 Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. Publicado por Elsevier España, S.L.U. All rights reserved.

Incontinentia pigmenti: learning disabilities are a fundamental hallmark of the disease.

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Maria Rosa Pizzamiglio

Full Text Available Studies suggest that genetic factors are associated with the etiology of learning disabilities. Incontinentia Pigmenti (IP, OMIM#308300, which is caused by mutations of the IKBKG/NEMO gene, is a rare X-linked genomic disorder (1:10000/20:000 that affects the neuroectodermal tissues. It always affects the skin and sometimes the hair, teeth, nails, eyes and central nervous system (CNS. Data from IP patients demonstrate the heterogeneity of the clinical phenotype; about 30% have CNS manifestations. This extreme variability suggests that IP patients might also have learning disabilities. However, no studies in the literature have evaluated the cognitive profile of IP patients. In fact, the learning disability may go unnoticed in general neurological analyses, which focus on major disabling manifestations of the CNS. Here, we investigated the neuropsychological outcomes of a selected group of IP-patients by focusing on learning disabilities. We enrolled 10 women with IP (7 without mental retardation and 3 with mild to severe mental retardation whose clinical diagnosis had been confirmed by the presence of a recurrent deletion in the IKBKG/NEMO gene. The participants were recruited from the Italian patients' association (I.P.A.SS.I. Onlus. They were submitted to a cognitive assessment that included the Wechsler Adult Intelligence scale and a battery of tests examining reading, arithmetic and writing skills. We found that 7 patients had deficits in calculation/arithmetic reasoning and reading but not writing skills; the remaining 3 had severe to mild intellectual disabilities. Results of this comprehensive evaluation of the molecular and psychoneurological aspects of IP make it possible to place "learning disabilities" among the CNS manifestations of the disease and suggest that the IKBKG/NEMO gene is a genetic determinant of this CNS defect. Our findings indicate the importance of an appropriate psychoneurological evaluation of IP patients, which

Incontinentia pigmenti: learning disabilities are a fundamental hallmark of the disease.

Science.gov (United States)

Pizzamiglio, Maria Rosa; Piccardi, Laura; Bianchini, Filippo; Canzano, Loredana; Palermo, Liana; Fusco, Francesca; D'Antuono, Giovanni; Gelmini, Chiara; Garavelli, Livia; Ursini, Matilde Valeria

2014-01-01

Studies suggest that genetic factors are associated with the etiology of learning disabilities. Incontinentia Pigmenti (IP, OMIM#308300), which is caused by mutations of the IKBKG/NEMO gene, is a rare X-linked genomic disorder (1:10000/20:000) that affects the neuroectodermal tissues. It always affects the skin and sometimes the hair, teeth, nails, eyes and central nervous system (CNS). Data from IP patients demonstrate the heterogeneity of the clinical phenotype; about 30% have CNS manifestations. This extreme variability suggests that IP patients might also have learning disabilities. However, no studies in the literature have evaluated the cognitive profile of IP patients. In fact, the learning disability may go unnoticed in general neurological analyses, which focus on major disabling manifestations of the CNS. Here, we investigated the neuropsychological outcomes of a selected group of IP-patients by focusing on learning disabilities. We enrolled 10 women with IP (7 without mental retardation and 3 with mild to severe mental retardation) whose clinical diagnosis had been confirmed by the presence of a recurrent deletion in the IKBKG/NEMO gene. The participants were recruited from the Italian patients' association (I.P.A.SS.I. Onlus). They were submitted to a cognitive assessment that included the Wechsler Adult Intelligence scale and a battery of tests examining reading, arithmetic and writing skills. We found that 7 patients had deficits in calculation/arithmetic reasoning and reading but not writing skills; the remaining 3 had severe to mild intellectual disabilities. Results of this comprehensive evaluation of the molecular and psychoneurological aspects of IP make it possible to place "learning disabilities" among the CNS manifestations of the disease and suggest that the IKBKG/NEMO gene is a genetic determinant of this CNS defect. Our findings indicate the importance of an appropriate psychoneurological evaluation of IP patients, which includes early

Care for patients with severe mental illness: the general practitioner's role perspective

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Groenier Klaas H

2009-05-01

Full Text Available Abstract Background Patients with severe mental illness (SMI experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. Methods A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. Results 186 general practitioners distributed over urban areas (49%, urbanised rural areas (38% and rural areas (15% of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices. GPs also saw their role as giving support and information to the patient's family. However, they felt a need for recognition of their competencies when working with mental health care specialists. Conclusion GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients.

Care for patients with severe mental illness: the general practitioner's role perspective.

Science.gov (United States)

Oud, Marian J T; Schuling, Jan; Slooff, Cees J; Groenier, Klaas H; Dekker, Janny H; Meyboom-de Jong, Betty

2009-05-06

Patients with severe mental illness (SMI) experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. 186 general practitioners distributed over urban areas (49%), urbanised rural areas (38%) and rural areas (15%) of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices.GPs also saw their role as giving support and information to the patient's family.However, they felt a need for recognition of their competencies when working with mental health care specialists. GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients.

An Evaluation of Social and Adaptive Skills in Adults with Bipolar Disorder and Severe/Profound Intellectual Disability

Science.gov (United States)

Matson, Johnny L.; Terlonge, Cindy; Gonzalez, Melissa L.; Rivet, Tessa

2006-01-01

The purpose of this study was to explore the interrelationship of social and adaptive skills in adults with bipolar disorder and severe or profound intellectual disability. A bipolar group (N=14), a severe psychopathology group without bipolar disorder (N=14), and a control group with no DSM-IV Axis I diagnosis (N=14) were compared on the…

Functional disability in patients with low back pain: the mediator role of suffering and beliefs about pain control in patients receiving physical and chiropractic treatment.

Science.gov (United States)

Pereira, M Graça; Roios, Edite; Pereira, Marta

Low back pain is the leading cause of disability worldwide. There is evidence that depression, anxiety, and external locus of control are negative predictors of functional disability in low back patients. This study focused on the mediator role of suffering and beliefs about pain control in the relationship between psychological morbidity and functional disability in patients receiving physical therapy and chiropractic treatment for chronic low back pain. The sample included 213 patients receiving chiropractic treatment and 125 receiving physical therapy, who answered the following instruments: Beliefs about Pain Control Questionnaire; Inventory of Subjective Experiences of Suffering in Illness; Oswestry Low Back Pain Disability Questionnaire; and the Hospital Anxiety and Depression Scales. Suffering was a mediator in the relationship between depression and functional disability in both treatment groups. Only beliefs related to external chance events mediated the relationship between depression and functional disability in the physical therapy group, but not in the chiropratic teratment group. Intervention should focus on suffering regardless of the type of treatment and target beliefs about pain control, in patients receiving physical therapy treatment since they seem to play a key role in functional disability in patients with low back pain. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Community nurses’ perceptions of and exposure to children with severe disabilities and their primary caregivers

Directory of Open Access Journals (Sweden)

Juan Bornman

2002-11-01

Full Text Available In primary health care clinics nurses are faced with individuals of different ages with different problems, ranging from minor ailments to severe disabilities. ABSTRAK In primêre gesondheidsorgklinieke kom verpleegkundiges in aanraking met individue van verskillende ouderdomme met ‘n verskeidenheid probleme, wat strek vanaf geringe kwale tot erge gestremdhede.

Transition Satisfaction and Family Well Being among Parents of Young Adults with Severe Intellectual Disability

Science.gov (United States)

Neece, Cameron L.; Kraemer, Bonnie R.; Blacher, Jan

2009-01-01

The transition from high school to adulthood is a critical life stage that entails many changes, especially for youth with severe intellectual disability. The transition period may be especially stressful for the families of these young adults, who often experience a sudden change, or decrease, in services. However, little research has examined…

Alex in the Middle: Inclusion of a Child with Severe Disabilities and Complex Health Needs.

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Bruns, Deborah A.

This case study describes the 2-year process of moving a young child with severe disabilities and complex medical needs from a special school setting to a special class in a regular education setting. The child had Marshall-Smith Syndrome, characterized by respiratory, pulmonary, and skeletal abnormalities, and developmental delays due to the…

Visual disability rates in a ten-year cohort of patients with anterior visual pathway meningiomas.

Science.gov (United States)

Bor-Shavit, Elite; Hammel, Naama; Nahum, Yoav; Rappaport, Zvi Harry; Stiebel-Kalish, Hadas

2015-01-01

To examine the visual outcome of anterior visual pathway meningioma (AVPM) patients followed for at least one year. Data were collected on demographics, clinical course and management. Visual disability was classified at the first and last examination as follows: I--no visual disability; II--mild visual defect in one eye; III--mild visual defect in both eyes; IV--loss of driver's license; V--legally blind. Eight-one AVPM patients had their tumor originate in the clinoid process in 23 (28%), sphenoid-wing area in 18 (22%), cavernous sinus in 15 (19%), tuberculum sellae in 8 (10%), and mixed in 17 (21%). On last examination, 46 patients (57%) had good visual acuity in one or both eyes (Class I or II) and 17 (21%) were mildly affected in both eyes. The rate of Class IV disability was 16%, and Class V disability was 6%. Attention needs to be addressed to the considerable proportion of patients with AVPM (22% in this study) who may lose their driver's license or become legally blind. Occupational therapists should play an important role in the multidisciplinary management of those patients to help them adapt to their new physical and social situation. Anterior visual pathway meningiomas (AVPMs) are commonly not life-threatening but they can lead to profound visual disability, especially when the tumor originates in the tuberculum sellae and cavernous sinus. Particular attention should be paid to visual acuity and visual field deficits, as these can profoundly affect the patient's quality of life including ability to drive and activities of daily living. The interdisciplinary management of patients with AVPM should include the neurosurgeon, neuro-ophthalmologist and occupational therapist. Also, early intervention by the occupational therapist can help patients adapt to their current physical and social situation and return to everyday tasks more rapidly.

Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study.

Science.gov (United States)

Seng, Elizabeth K; Robbins, Matthew S; Nicholson, Robert A

2017-09-01

Objective To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p migraine disability and highest acute medication satisfaction.

Teaching Socially Valid Social Interaction Responses to Students with Severe Disabilities in an Integrated School Setting.

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Nientimp, Edward G.; Cole, Christine L.

1992-01-01

Evaluated effects of procedure to teach appropriate social responses to adolescents with severe disabilities by employing ABA withdrawal design, replicated twice with two students, and AB design with third student. Results showed increases in correct responding and decreases in echolalia following intervention. Generalization of appropriate…

Fruit flies and intellectual disability

OpenAIRE

Bolduc, François V.; Tully, Tim

2009-01-01

Mental retardation—known more commonly nowadays as intellectual disability—is a severe neurological condition affecting up to 3% of the general population. As a result of the analysis of familial cases and recent advances in clinical genetic testing, great strides have been made in our understanding of the genetic etiologies of mental retardation. Nonetheless, no treatment is currently clinically available to patients suffering from intellectual disability. Several animal models have been use...

End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives.

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Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G

2013-09-01

Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.

Assessment of disabilities in stroke patients with apraxia : Internal consistency and inter-observer reliability

NARCIS (Netherlands)

van Heugten, CM; Dekker, J; Deelman, BG; Stehmann-Saris, JC; Kinebanian, A

1999-01-01

In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

Assessment of disabilities in stroke patients with apraxia: internal consistency and inter-observer reliability.

NARCIS (Netherlands)

Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Stehmann-Saris, J.C.; Kinebanian, A.

1999-01-01

In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

Feasibility and Reliability of Two Different Walking Tests in People With Severe Intellectual and Sensory Disabilities

NARCIS (Netherlands)

Waninge, Aly; Evenhuis, I.E.; Van Wijck, R.; van der Schans, Cees

2011-01-01

Background  The purpose of this study is to describe feasibility and test–retest reliability of the six-minute walking distance test (6MWD) and an adapted shuttle run test (aSRT) in persons with severe intellectual and sensory (multiple) disabilities. Materials and Methods  Forty-seven persons with

Working with the disabled patient: exploring student nurses views for curriculum development using a SWOT analysis.

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Willis, Diane S; Thurston, Mhairi

2015-02-01

Increased longevity will mean an increase in people presenting with cognitive and physical disabilities, such as sight loss or dementia. The Patient Rights (Scotland) Act 2011 states that health care should be patient-focussed, taking into account patient needs. This will necessitate nursing curricula to reflect the needs of people who have disabilities and equip the future workforce with knowledge and skills to provide appropriate care. This study explores student nurses' strengths and weakness when working with people with disabilities and identifies opportunities and threats to developing their knowledge and skills to meet the needs of this population. As part of a study day, students from the year one Nursing programme were asked to take part in a SWOT analysis and post comments under the categories: strengths, weakness, opportunity and threats on a central wall about working with people with disabilities. Students acknowledged some of the challenges of being disabled especially in a health setting but also believed they were developing their skills to provide holistic care that ensured autonomy. Communication was viewed as both a strength and weakness and was identified as an essential skill to working effectively with people who had a disability. Students acknowledged that clinical staff were not always experts in working with people who were disabled and welcomed the opportunity to work with experts and clients as well as being directed to resources to increase their knowledge. Integration of disability into the nursing curriculum is needed to ensure students have awareness of and the confidence to work effectively with people who have a range of cognitive and physical disabilities alongside other medical problems. Copyright © 2014 Elsevier Ltd. All rights reserved.

Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support.

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Hesse, S; Uhlenbrock, D; Sarkodie-Gyan, T

1999-10-01

To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer. Open study comparing the movement on the gait trainer with assisted walking on the treadmill. Motion analysis laboratory of a rehabilitation centre. Fourteen chronic, nonambulatory hemiparetic patients. Complex gait analysis while training on the gait trainer and while walking on the treadmill. Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance. Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking (p gait trainer (p gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.

Quality of Life, Disability, and Body Mass Index Are Related in Obese Patients

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Sirtori, Anna; Brunani, Amelia; Liuzzi, Antonio; Pasqualinotto, Lucia; Villa, Valentina; Leonardi, Matilde; Raggi, Alberto

2011-01-01

The aim of this study is to analyze the relationship between health-related quality of life (QoL), disability, and degree of obesity. Adult obese patients (BMI greater than 30) were consecutively enrolled in this cross-sectional observational study. The WHO Disability Assessment Schedule (WHO-DAS II) and the short version of the impact of weight…

Work Disability in Early Systemic Sclerosis

DEFF Research Database (Denmark)

Sandqvist, Gunnel; Hesselstrand, Roger; Petersson, Ingemar F

2015-01-01

OBJECTIVE: To study work disability (WD) with reference to levels of sick leave and disability pension in early systemic sclerosis (SSc). METHODS: Patients with SSc living in the southern part of Sweden with onset of their first non-Raynaud symptom between 2003 and 2009 and with a followup of 36...... months were included in a longitudinal study. Thirty-two patients (26 women, 24 with limited SSc) with a median age of 47.5 years (interquartile range 43-53) were identified. WD was calculated in 30-day intervals from 12 months prior to disease onset until 36 months after, presented as the prevalence...... of WD per year (0-3) and as the period prevalence of mean net days per month (± SD). Comparisons were made between patients with different disease severity and sociodemographic characteristics, and between patients and a reference group (RG) from the general population. RESULTS: Seventy-eight percent...

Neuro-ophthalmologic evaluation, quality of life, and functional disability in patients with MS.

Science.gov (United States)

Garcia-Martin, Elena; Rodriguez-Mena, Diego; Herrero, Raquel; Almarcegui, Carmen; Dolz, Isabel; Martin, Jesus; Ara, Jose R; Larrosa, Jose M; Polo, Vicente; Fernández, Javier; Pablo, Luis E

2013-07-02

To evaluate correlations between longitudinal changes in neuro-ophthalmologic measures and quality of life (QOL) and disability in patients with multiple sclerosis (MS), using optical coherence tomography (OCT), visual evoked potentials (VEP), and visual field examination. Fifty-four patients with relapsing-remitting MS were enrolled in this study and underwent Multiple Sclerosis Quality of Life questionnaire (54 items) (MSQOL-54) and Expanded Disability Status Scale (EDSS) evaluation, as well as complete neuro-ophthalmologic examination including visual field testing and retinal nerve fiber layer (RNFL) measurements using Cirrus and Spectralis OCT and VEP. All patients were re-evaluated at 12, 24, and 36 months. Logistical regression was performed to analyze which measures, if any, could predict QOL. Overall, RNFL thickness results at the baseline evaluation were significantly different from those at 3 years (p ≤ 0.05), but there were no differences in functional measures (visual acuity, contrast sensitivity, color vision, visual field, and VEP). A reduced MSQOL-54 score was associated with an increase in EDSS score and a decrease in both functional and structural parameters. Patients with longer MS duration presented with a lower MSQOL-54 score (reduction in QOL). Patients with progressive axonal loss as seen in RNFL results had a lower QOL and more functional disability.

Factors Associated with Pain, Disability and Quality of Life in Patients Suffering from Frozen Shoulder

Directory of Open Access Journals (Sweden)

Farshid Bagheri

2016-07-01

Full Text Available Background: Frozen shoulder is resulting in limb disability and reduction of quality of life but the factors associated with patients’ disability and quality of life is not clear. To assess pain, disability, the quality of life and factors associated with them in patients suffering from frozen shoulder.  Methods: We enrolled 120 patients (37 men and 83 women with phase-II idiopathic frozen shoulder in our cross-sectional study. Demographic data were collected and shoulder range of motion was measured in four different directions (elevation, abduction, external and internal rotation in both upper limbs. Patients were asked to fill out Visual Analog Scale for pain (VAS and, Short-Form Health Survey questionnaire (SF-36 as well as Disabilities of the Arm, Shoulder and Hand (DASH questionnaires. We asked the patients to fill out the Hamilton anxiety and depression questionnaires. Results: The mean of VAS pain, DASH, PCS, and MCS scores were 69(18, 53(17, 35(8.0, and 42(10 respectively. All the domains of SF36 questionnaires where below the normal population except physical function. VAS pain score was correlated to Hamilton depression scores in both bivariate and mulivarilable analysis. DASH score were correlated to sex, age, ROM, and both Hamilton anxiety and depression scores; However, DASH score only impact with Hamilton anxiety and ROM independently. PCS is correlated to age and MCS to Hamilton depression. Conclusion: Patient with frozen shoulder are more suffering from pain and disability secondary to psychiatric parameters such as depression and anxiety than demographic features or even restriction of range of motion.

Teaching adolescents with severe disabilities to use the public telephone.

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Test, D W; Spooner, F; Keul, P K; Grossi, T

1990-04-01

Two adolescents with severe disabilities served as participants in a study conducted to train in the use of the public telephone to call home. Participants were trained to complete a 17-step task analysis using a training package which consisted of total task presentation in conjunction with a four-level prompting procedure (i.e., independent, verbal, verbal + gesture, verbal + guidance). All instruction took place in a public setting (e.g., a shopping mall) with generalization probes taken in two alternative settings (e.g., a movie theater and a convenience store). A multiple probe across individuals design demonstrated the training package was successful in teaching participants to use the telephone to call home. In addition, newly acquired skills generalized to the two untrained settings. Implications for community-based training are discussed.

Communication training for centre-based carers of children with severe or profound disabilities in the Western Cape, South Africa

Directory of Open Access Journals (Sweden)

Martha Geiger

2012-09-01

Full Text Available The purpose of this paper is to provide a preliminary, qualitative review of an approach to training centre-based carers in supporting basic communication development and providing communication opportunities for the children with severe and profound disabilities in their care. In South Africa, these children are often the most neglected in terms of planning and providing appropriate interventions. For those with severe communication disabilities, an additional lack is in the area of the basic human right to meaningful interactions and communication. Sustainable strategies to provide opportunities for basic communication development of these children are urgently sought. Several effective international and local parent training programmes have been developed, but the urgent need remains to train centre-based carers who are taking care of groups of diversely disabled children in severely under-resourced settings. Non-profit organisations (NPOs have been exploring practical centre-based approaches to skills sharing in physical rehabilitation, activities for daily living, feeding and support for basic communication development. As a freelance speech therapist contracted by four NPOs to implement hands-on training in basic communication for centre-based carers of non-verbal children, the author describes a training approach that evolved over three years, in collaboration with the carers and centre managements. Implications for training (for speech therapists and for community-based rehabilitation workers and for further research are identified.

Withholding nutrition on the conscious mentally disabled patient: a review and commentary.

Science.gov (United States)

Veatch, Robert M

2002-01-01

A recent important and poorly publicized legal case in California raised the question of whether the wife of a severely mentally disabled man could intentionally withhold medically supplied nutrition from him on the grounds that it was no longer providing benefits. Rita L. Marker has published a detailed case report and analysis. The readers of the Newsletter on Ethics and Intellectual Disability should know about her analysis. A summary is presented here together with some observations about the issues the case raises. Readers are encouraged to consult the original article: Rita L. Marker, "Mental Disability and Death by Dehydration." National Catholic Bioethics Quarterly 2 (Spring 2002): 125-36. All quotations are from the Marker analysis.

Is Celiac Disease an Etiological Factor in Children with Nonsyndromic Intellectual Disability?

Science.gov (United States)

Sezer, Taner; Balcı, Oya; Özçay, Figen; Bayraktar, Nilufer; Alehan, Füsun

2016-03-01

To determine the prevalence of celiac disease in children and adolescents with nonsyndromic intellectual disability, we investigated serum levels of tissue transglutaminase antibody and total IgA from 232 children with nonsyndromic intellectual disability and in a healthy control group of 239 children. Study participants who were positive for tissue transglutaminase antibody underwent a duodenal biopsy. A total of 3 patients in the nonsyndromic intellectual disability group (5.45%) and 1 in the control group (0.41%) had positive serum tissue transglutaminase antibody (P > .05). Duodenal biopsy confirmed celiac disease in only 1 patient who had nonsyndromic intellectual disability. In this present study, children with nonsyndromic intellectual disability did not exhibit a higher celiac disease prevalence rate compared with healthy controls. Therefore, we suggest that screening test for celiac disease should not be necessary as a part of the management of mild and moderate nonsyndromic intellectual disability. However, cases of severe nonsyndromic intellectual disability could be examined for celiac disease. © The Author(s) 2015.

[Validating the Oswestry Disability Index in patients with low back pain in Sichuan].

Science.gov (United States)

Tan, Ke; Zheng, Min; Yang, Bang-xiang; Ernest, Volinn; Liu, Hui; He, Jing; Jiang, Min; Li, Xiao-song

2009-05-01

To test the reliability and validity of the Oswestry Disability Index (ODI) in patients with low back pain in China. Eighty six patients (female 51, male 35, average age 39.5 +/- 10.1) with chronic low back pain were assessed with the ODI. The assessment was repeated 48 hours after the first test. The Cronbach' Alpha coefficient for the ODI was 0.891. The intraclass correlation coefficient (ICC) for the repeated tests was 0.854 (95% CI = 0.775-0.905). The exploratory factor analysis extracted two factors, which accounted for 61.91% of the total variance. Significant correlations were found between the ODI and the 6 domains of the SF-36. The Chinese version of Oswestry Disability Index has satisfactory reliability and validity. It can be used as an instrument for assessing chronic low back pain-related disability.

Parental Adaptation to Out-of-Home Placement of a Child with Severe or Profound Developmental Disabilities

Science.gov (United States)

Jackson, Jeffrey B.; Roper, Susanne Olsen

2014-01-01

Utilizing grounded theory qualitative research methods, a model was developed for describing parental adaptation after voluntary placement of a child with severe or profound developmental disabilities in out-of-home care. Interviews of parents from 20 families were analyzed. Parents' cognitive appraisals of placement outcomes were classified…

Attuning: A Communication Process between People with Severe and Profound Intellectual Disability and Their Interaction Partners

Science.gov (United States)

Griffiths, Colin; Smith, Martine

2016-01-01

Background: People with severe and profound intellectual disability typically demonstrate a limited ability to communicate effectively. Most of their communications are non-verbal, often idiosyncratic and ambiguous. This article aims to identify the process that regulates communications of this group of people with others and to describe the…

Follow-up of 13 patients with surgical treatment of cerebral cavernous malformations: effect on epilepsy and patient disability

NARCIS (Netherlands)

Folkersma, H.; Mooij, J. J.

2001-01-01

We report a series of 13 patients with surgical treatment of cerebral cavernous malformation (CM). The aim of this study was to investigate postoperative patient disability and seizure control in patients with CM in order to clarify indications for neurosurgical removal. In our series we emphasize

Follow-up of 13 patients with surgical treatment of cerebral cavernous malformations : effect on epilepsy and patient disability

NARCIS (Netherlands)

Folkersma, H; Mooij, JJA

Objective: We report a series of 13 patients with surgical treatment of cerebral cavernous malformation (CM). The aim of this study was to investigate postoperative patient disability and seizure control in patients with CM in order to clarify indications for neurosurgical removal. In our series we

Olfactory identification and its relationship to executive functions, memory, and disability one year after severe traumatic brain injury.

Science.gov (United States)

Sigurdardottir, Solrun; Andelic, Nada; Skandsen, Toril; Anke, Audny; Roe, Cecilie; Holthe, Oyvor Oistensen; Wehling, Eike

2016-01-01

To explore the frequency of posttraumatic olfactory (dys)function 1 year after severe traumatic brain injury (TBI) and determine whether there is a relationship between olfactory identification and neuropsychological test performance, injury severity and TBI-related disability. A population-based multicenter study including 129 individuals with severe TBI (99 males; 16 to 85 years of age) that could accomplish neuropsychological examinations. Olfactory (dys)function (anosmia, hyposmia, normosmia) was assessed by the University of Pennsylvania Smell Identification Test (UPSIT) or the Brief Smell Identification Test (B-SIT). Three tests of the Delis-Kaplan Executive Function System (D-KEFS) were used to assess processing speed, verbal fluency, inhibition and set-shifting, and the California Verbal Learning Test-II was used to examine verbal memory. The Glasgow Outcome Scale-Extended (GOSE) was used to measure disability level. Employing 2 different smell tests in 2 equal-sized subsamples, the UPSIT sample (n = 65) classified 34% with anosmia and 52% with hyposmia, while the B-SIT sample (n = 64) classified 20% with anosmia and 9% with hyposmia. Individuals classified with anosmia by the B-SIT showed significantly lower scores for set-shifting, category switching fluency and delayed verbal memory compared to hyposmia and normosmia groups. Only the B-SIT scores were significantly correlated with neuropsychological performance and GOSE scores. Brain injury severity (Rotterdam CT score) and subarachnoid hemorrhage were related to anosmia. Individuals classified with anosmia demonstrated similar disability as those with hyposmia/normosmia. Different measures of olfaction may yield different estimates of anosmia. Nevertheless, around 1 third of individuals with severe TBI suffered from anosmia, which may also indicate poorer cognitive outcome. (c) 2015 APA, all rights reserved).

Measuring disabilities in stroke patients with apraxia : A validation study of an observational method

NARCIS (Netherlands)

van Heugten, CM; Dekker, J; Deelman, BG; van Dijk, AJ; Stehmann-Saris, FC; Kinebanian, A

The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a

Measuring disabilities in stroke patients with apraxia: a validation study of an observational method.

NARCIS (Netherlands)

Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, F.C.; Kinebanian, A.

2000-01-01

The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a

The ability of preoperative factors to predict patient-reported disability following surgery for rotator cuff pathology.

Science.gov (United States)

Woollard, Jason D; Bost, James E; Piva, Sara R; Kelley Fitzgerald, G; Rodosky, Mark W; Irrgang, James J

2017-10-01

Minimal research has examined the prognostic ability of shoulder examination data or psychosocial factors in predicting patient-reported disability following surgery for rotator cuff pathology. The purpose of this study was to examine these factors for prognostic value in order to help clinicians and patients understand preoperative factors that impact disability following surgery. Sixty-two patients scheduled for subacromial decompression with or without supraspinatus repair were recruited. Six-month follow-up data were available for 46 patients. Patient characteristics, history of the condition, shoulder impairments, psychosocial factors, and patient-reported disability questionnaires were collected preoperatively. Six months following surgery, the Western Ontario Rotator Cuff Index (WORC) and global rating of change dichotomized subjects into responders versus nonresponders. Logistic regression quantified prognostic ability and created the most parsimonious model to predict outcome. Being on modified job duty (OR = .17, 95%CI: 0.03-0.94), and having a worker's compensation claim (OR = 0.08, 95%CI: 0.01-0.74) decreased probability of a positive outcome, while surgery on the dominant shoulder (OR = 11.96, 95%CI: 2.91-49.18) increased probability. From the examination, only impaired internal rotation strength was a significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ) score (OR = 0.95, 95%CI: 0.91-0.98) and the FABQ_work subscale (OR = 0.92, 95%CI: 0.87-0.97) were univariate predictors. In the final model, surgery on the dominant shoulder (OR = 8.9, 95%CI 1.75-45.7) and FABQ_work subscale score ≤25 (OR = 15.3, 95%CI 2.3-101.9) remained significant. Surgery on the dominant arm resulted in greater improvement in patient-reported disability, thereby increasing the odds of a successful surgery. The predictive ability of the FABQ_work subscale highlights the potential impact of psychosocial factors on patient

Functional assessment of the visual pathway with multifocal visual evoked potentials, and their relationship with disability in patients with multiple sclerosis.

Science.gov (United States)

Blanco, Román; Pérez-Rico, Consuelo; Puertas-Muñoz, Inmaculada; Ayuso-Peralta, Lucía; Boquete, Luciano; Arévalo-Serrano, Juan

2014-02-01

To objectively evaluate the visual function, and the relationship between disability and optic nerve dysfunction, in patients with multiple sclerosis (MS) and optic neuritis (ON), using multifocal visual evoked potentials (mfVEP). This observational, cross-sectional study assessed 28 consecutive patients with clinically definite MS, according to the McDonald criteria, and 19 age-matched healthy subjects. Disability was recorded using the Expanded Disability Status Scale (EDSS) score. The patients' mfVEP were compared to their clinical, psychophysical (Humphrey perimetry) and structural (optic coherence tomography (OCT)) diagnostic test data. We observed a significant agreement between mfVEP amplitude and Humphrey perimetry/OCT in MS-ON eyes, and between mfVEP amplitude and OCT in MS but non-ON eyes. We found significant differences in EDSS score between patients with abnormal and normal mfVEP amplitudes. Abnormal mfVEP amplitude defects (from interocular and monocular probability analysis) were found in 67.9% and 73.7% of the MS-ON and MS-non-ON group eyes, respectively. Delayed mfVEP latencies (interocular and monocular probability analysis) were seen in 70.3% and 73.7% of the MS-ON and MS-non-ON groups, respectively. We found a significant relationship between mfVEP amplitude and disease severity, as measured by EDSS score, that suggested there is a role for mfVEP amplitude as a functional biomarker of axonal loss in MS.

Measuring disabilities in stroke patients with apraxia: a validation study of an observational method.

OpenAIRE

Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, F.C.; Kinebanian, A.

2000-01-01

The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a blouse or shirt. The study was carried out at occupational therapy departments in general hospitals, rehabilitation centres, and nursing homes. Patients diagnosed to have had a stroke in the left h...

Visual functions and disability in diabetic retinopathy patients

OpenAIRE

Shrestha, Gauri Shankar; Kaiti, Raju

2013-01-01

Purpose: This study was undertaken to find correlations between visual functions and visual disabilities in patients with diabetic retinopathy. Method: A cross-sectional study was carried out among 38 visually impaired diabetic retinopathy subjects at the Low Vision Clinic of B.P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu. The subjects underwent assessment of distance and near visual acuity, objective and subjective refraction, contrast sensitivity, color vision, and central a...

Effectiveness of cognitive behavioral therapy for depression in patients receiving disability benefits: a systematic review and individual patient data meta-analysis.

Directory of Open Access Journals (Sweden)

Shanil Ebrahim

Full Text Available To systematically summarize the randomized trial evidence regarding the relative effectiveness of cognitive behavioural therapy (CBT in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits.All relevant RCTs from a database of randomized controlled and comparative studies examining the effects of psychotherapy for adult depression (http://www.evidencebasedpsychotherapies.org, electronic databases (MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL to June 2011, and bibliographies of all relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION: Adult patients with major depression, randomly assigned to CBT versus minimal/no treatment or care-as-usual.Three teams of reviewers, independently and in duplicate, completed title and abstract screening, full text review and data extraction. We performed an individual patient data meta-analysis to summarize data.Of 92 eligible trials, 70 provided author contact information; of these 56 (80% were successfully contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of benefits, of which 2 provided individual patient data. Including both patients receiving and not receiving disability benefits, 2 trials (227 patients suggested a possible reduction in depression with CBT, as measured by the Beck Depression Inventory, mean difference [MD] (95% confidence interval [CI] = -2.61 (-5.28, 0.07, p = 0.06; minimally important difference of 5. The effect appeared larger, though not significantly, in those in receipt of benefits (34 patients versus not receiving benefits (193 patients; MD (95% CI = -4.46 (-12.21, 3.30, p = 0.26.Our data does not support the hypothesis that CBT has smaller effects in depressed patients receiving disability benefits versus other patients. Given that the confidence interval is wide, a

Using Lego robots to estimate cognitive ability in children who have severe physical disabilities.

Science.gov (United States)

Cook, Albert M; Adams, Kim; Volden, Joanne; Harbottle, Norma; Harbottle, Cheryl

2011-01-01

To determine whether low-cost robots provide a means by which children with severe disabilities can demonstrate understanding of cognitive concepts. Ten children, ages 4 to 10, diagnosed with cerebral palsy and related motor conditions, participated. Participants had widely variable motor, cognitive and receptive language skills, but all were non-speaking. A Lego Invention 'roverbot' was used to carry out a range of functional tasks from single-switch replay of pre-stored movements to total control of the movement in two dimensions. The level of sophistication achieved on hierarchically arranged play tasks was used to estimate cognitive skills. The 10 children performed at one of the six hierarchically arranged levels from 'no interaction' through 'simple cause and effect' to 'development and execution of a plan'. Teacher interviews revealed that children were interested in the robot, enjoyed interacting with it and demonstrated changes in behaviour and social and language skills following interaction. Children with severe physical disabilities can control a Lego robot to perform un-structured play tasks. In some cases, they were able to display more sophisticated cognitive skills through manipulating the robot than in traditional standardised tests. Success with the robot could be a proxy measure for children who have cognitive abilities but cannot demonstrate them in standard testing.

Raising the Bar: Significant Advances and Future Needs for Promoting Learning for Students with Severe Disabilities

Science.gov (United States)

Spooner, Fred; Browder, Diane M.

2015-01-01

This essay describes major advances in educating students with severe disabilities. The authors propose that applied behavior analysis, the focus on functional life skills, and the promotion of academic content have been the major advances in the "how" and "what" of learning for this population. An increased focus on literacy,…

A Preliminary Investigation of the Suitability of Aquatics for People with Severe and Profound Intellectual Disabilities

Science.gov (United States)

Aherne, Cian; Coughlan, Barry

2017-01-01

Background: Aquatics is an under-researched but possibly appropriate form of activity for people with severe to profound intellectual disabilities (SPIDs). Aim: The current pilot study investigates the suitability of an aquatics programme for service users with SPIDs. Method: Four service users with SPID completed an 8-12-session aquatics…

A Review of EEG-Based Brain-Computer Interfaces as Access Pathways for Individuals with Severe Disabilities

Science.gov (United States)

Moghimi, Saba; Kushki, Azadeh; Guerguerian, Anne Marie; Chau, Tom

2013-01-01

Electroencephalography (EEG) is a non-invasive method for measuring brain activity and is a strong candidate for brain-computer interface (BCI) development. While BCIs can be used as a means of communication for individuals with severe disabilities, the majority of existing studies have reported BCI evaluations by able-bodied individuals.…

The effects of neural mobilization on cervical radiculopathy patients' pain, disability, ROM, and deep flexor endurance.

Science.gov (United States)

Kim, Dong-Gyu; Chung, Sin Ho; Jung, Ho Bal

2017-09-22

Cervical radiculopathy (CR) is a disease of the cervical spine and a space-occupying lesion that occurs because of pathological problems with cervical nerve roots. Nerve root injury to produce functional disability. The purpose of this study was to examine the effects of neural mobilization with manual cervical traction (NMCT) compared with manual cervical traction (MCT) on pain, functional disability, muscle endurance, and range of motion (ROM) in individuals with CR patients. A blinded randomized clinical trial was conducted. Thirty CR patients were divided into two groups - those who received NMCT and those who received MCT. The intervention was applied three times per week for eight weeks. It was measured in order to determine the pain and functional disability in patients with CR. The numeric pain rating scale (NPRS), neck disability index (NDI), ROM, and deep flexor endurance of patients were measured prior to the experiment, four weeks, and eight weeks after the experiment to compare the time points. A repeated-measures analysis of variance was used to compare differences within each group prior to the experiment. And Bonferroni test was performed to examine the significance of each time point. There were significant differences within each group prior to the intervention, four weeks after the intervention, and eight weeks after the intervention in NPRS, NDI, ROM, and deep flexor endurance (Ppain relief, recovery from neck disability, ROM, and deep flexor endurance for patients with CR.

Automated radiogrammetry is a feasible method for measuring bone quality and bone maturation in severely disabled children

NARCIS (Netherlands)

Mergler, Sandra; de Man, Stella A.; Boot, Annemieke M; Bindels-de Heus, Karen G. C. B.; Huijbers, Wim A. R.; van Rijn, Rick R.; Penning, Corine; Evenhuis, Heleen M.

Children with severe neurological impairment and intellectual disability are prone to low bone quality and fractures. We studied the feasibility of automated radiogrammetry in assessing bone quality in this specific group of children. We measured outcome of bone quality and, because these children

A longitudinal study of cerebral glucose metabolism, MRI, and disability in patients with MS

DEFF Research Database (Denmark)

Blinkenberg, M; Jensen, C.V.; Holm, S

1999-01-01

OBJECTIVE: To study the time-related changes in cerebral metabolic rate of glucose (CMRglc) in MS patients and to correlate these with changes in MRI lesion load and disability. BACKGROUND: Measurements of MRI lesion load and neurologic disability are used widely to monitor disease progression...... and parietal cortical areas. There was a statistically significant increase of disability (pmetabolism in MS is decreased significantly during a 2......-year observation period, suggesting a deterioration of cortical activity with disease progression. The time-related changes of cortical CMRglc are statistically stronger than changes in TLA measurements and neurologic disability, and might be a useful secondary measure of treatment efficacy...

The impact of visual impairment on the ability to perform activities of daily living for persons with severe/profound intellectual disability.

Science.gov (United States)

Dijkhuizen, Annemarie; Hilgenkamp, Thessa I M; Krijnen, Wim P; van der Schans, Cees P; Waninge, Aly

2016-01-01

The ability to perform activities of daily living (ADL) as a component of participation is one of the factors that contribute to quality of life. The ability to perform ADL for persons experiencing severe/profound intellectual disability (ID) may be reduced due to their cognitive and physical capacities. However, until recently, the impact of the significantly prevalent visual impairments on the performance of activities of daily living has not yet been revealed within this group. The purpose of this prospective cross-sectional study was to investigate the impact of visual impairment on the performance of activities of daily living for persons with a severe/profound intellectual disability. The Barthel Index (BI) and Comfortable Walking Speed (CWS) were used to measure the ability of performing activities of daily living (ADL) in 240 persons with severe/profound ID and having Gross Motor Functioning Classification System (GMFCS) levels I, II or III; this included 120 persons with visual impairment. The impact of visual impairment on ADL was analyzed with linear regression. The results of the study demonstrated that visual impairment slightly affects the ability of performing activities of daily living (BI) for persons experiencing a severe/profound intellectual disability. GMFCS Levels II or III, profound ID level, and visual impairment each have the effect of lowering BI scores. GMFCS Levels II or III, and profound ID level each have the effect of increasing CWS scores, which indicates a lower walking speed. A main effect of visual impairment is present on CWS, but our results do show a substantive interaction effect between GMFCS level III and visual impairment on Comfortable Walking Speed in persons with a severe/profound intellectual disability. Visual impairment has a slight effect on ability to perform ADL in persons experiencing severe/profound ID. Copyright © 2015 Elsevier Ltd. All rights reserved.

Relationship Between Voice and Motor Disabilities of Parkinson's Disease.

Science.gov (United States)

Majdinasab, Fatemeh; Karkheiran, Siamak; Soltani, Majid; Moradi, Negin; Shahidi, Gholamali

2016-11-01

To evaluate voice of Iranian patients with Parkinson's disease (PD) and find any relationship between motor disabilities and acoustic voice parameters as speech motor components. We evaluated 27 Farsi-speaking PD patients and 21 age- and sex-matched healthy persons as control. Motor performance was assessed by the Unified Parkinson's Disease Rating Scale part III and Hoehn and Yahr rating scale in the "on" state. Acoustic voice evaluation, including fundamental frequency (f0), standard deviation of f0, minimum of f0, maximum of f0, shimmer, jitter, and harmonic to noise ratio, was done using the Praat software via /a/ prolongation. No difference was seen between the voice of the patients and the voice of the controls. f0 and its variation had a significant correlation with the duration of the disease, but did not have any relationships with the Unified Parkinson's Disease Rating Scale part III. Only limited relationship was observed between voice and motor disabilities. Tremor is an important main feature of PD that affects motor and phonation systems. Females had an older age at onset, more prolonged disease, and more severe motor disabilities (not statistically significant), but phonation disorders were more frequent in males and showed more relationship with severity of motor disabilities. Voice is affected by PD earlier than many other motor components and is more sensitive to disease progression. Tremor is the most effective part of PD that impacts voice. PD has more effect on voice of male versus female patients. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Quality of Life and Quality of Support for People with Severe Intellectual Disability and Complex Needs

Science.gov (United States)

Beadle-Brown, J.; Leigh, J.; Whelton, B.; Richardson, L.; Beecham, J.; Baumker, T.; Bradshaw, J.

2016-01-01

Background: People with severe and profound intellectual disabilities often spend substantial time isolated and disengaged. The nature and quality of the support appears to be important in determining quality of life. Methods: Structured observations and staff questionnaires were used to explore the quality of life and quality of support for 110…

Telepsychiatry and Virtual Reality an the Teatment of Patients with Intellectual and Developmental Disabilities.

Science.gov (United States)

Krysta, Krzysztof; Krzystanek, Marek; Cubała, Wiesław J; Wiglusz, Mariusz S; Jakuszkowiak-Wojten, Katarzyna; Gałuszko-Węgielnik, Maria; Czarnowska-Cubała, Monika; Szarmach, Joanna; Włodarczyk, Adam; Janas-Kozik, Małgorzata

2017-09-01

Treatment and rehabilitation of people with intellectual and developmental disabilities is a multidisciplinary challenge, which require implementing new attitudes. The use of modern technology solutions like telepsychiatry or virtual reality may be a valuable addition to the traditional methods. The objective of this review was to explore the usability of new technological solutions in this special population of patients. The search in the PubMed was conducted using the following terms: (intellectual disability (Title/Abstract) OR developmental disability OR learning disorder (Title/Abstract)) AND virtual reality (Title/Abstract) OR telepsychiatry OR telemedicine OR e-mental health AND English (lang) AND (1995/01/01(PDAT): 2017/07/31(PDAT)). Telepsychiatry may be a useful tool in situations, when the direct access to professional assistance is limited, in solving particular problems like e.g. managing challenging behavior, also to support patients' parents and for diagnostic and educational purposes. Virtual reality can be a safe and effective method of improving different skills, developing physical fitness, and enriching the ways of spending the leisure time. Using modern technology is a relatively new and promising field in which new ideas may develop to support the already existing services for patients with intellectual and developmental disabilities.

Neck motion, motor control, pain and disability: A longitudinal study of associations in neck pain patients in physiotherapy treatment.

Science.gov (United States)

Meisingset, Ingebrigt; Stensdotter, Ann-Katrin; Woodhouse, Astrid; Vasseljen, Ottar

2016-04-01

Neck pain is associated with several alterations in neck motion and motor control, but most of the findings are based on cross-sectional studies. The aim of this study was to investigate associations between changes in neck motion and motor control, and changes in neck pain and disability in physiotherapy patients during a course of treatment. Prospective cohort study. Subjects with non-specific neck pain (n = 71) participated in this study. Neck flexibility, joint position error (JPE), head steadiness, trajectory movement control and postural sway were recorded before commencement of physiotherapy (baseline), at 2 weeks, and at 2 months. Numerical Rating Scale and Neck Disability Index were used to measure neck pain and disability at the day of testing. To analyze within subjects effects in neck motion and motor control, neck pain, and disability over time we used fixed effects linear regression analysis. Changes in neck motion and motor control occurred primarily within 2 weeks. Reduction in neck pain was associated with increased cervical range of motion in flexion-/extension and increased postural sway when standing with eyes open. Decreased neck disability was associated with some variables for neck flexibility and trajectory movement control. Cervical range of motion in flexion-/extension was the only variable associated with changes in both neck pain and neck disability. This study shows that few of the variables for neck motion and motor control were associated with changes neck pain and disability over a course of 2 months with physiotherapy treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Five Essential Features of Quality Educational Programs for Students with Moderate and Severe Intellectual Disability: A Guide for Administrators

Science.gov (United States)

Pennington, Robert; Courtade, Ginevra; Jones Ault, Melinda; Delano, Monica

2016-01-01

Despite encouraging changes in the expectations of programming for persons with moderate to severe intellectual disability (MSD), data suggest that programs for these individuals are still lacking in several critical areas. Building administrators play a key role in promoting high quality programs for students with MSD within local schools but may…

Impact of community-based lymphedema management on perceived disability among patients with lymphatic filariasis in Orissa State, India.

Directory of Open Access Journals (Sweden)

Philip J Budge

Full Text Available Lymphatic filariasis (LF infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients' perceived disability.For this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009, and then at regular intervals through 24 months (July, 2011, to assess patients' perceived disability. Disability scores decreased significantly (p<0.0001 from baseline to 24 months. Multivariable analysis using mixed effects modeling found that employment and time in the program were significantly associated with lower disability scores after two years of program involvement. Older age, female gender, the presence of other chronic health conditions, moderate (Stage 3 or advanced (Stage 4-7 lymphedema, reporting an adenolymphangitis (ADL episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (p<0.001 due to their lymphedema, compared to baseline.These results indicate that community-based lymphedema management programs

Patient-Reported Outcome (PRO) questionnaires for young-aged to middle-aged adults with hip and groin disability

DEFF Research Database (Denmark)

Thorborg, K.; Tijssen, M.; Habets, B.

2015-01-01

BACKGROUND/AIM: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults. METHODS: A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus......-based Standards for the selection of health Measurement INstruments list (COSMIN) together with standardised evaluations of measurement properties of each PRO. RESULTS: Twenty studies were included. Nine different questionnaires for patients with hip disability, and one for hip and groin disability, were...

The rational patient and beyond: implications for treatment adherence in people with psychiatric disabilities.