Disability, CBR and Inclusive Development aims to enhance knowledge in the field of disability and inclusive development, addressing the needs of practitioners, policy makers, DPOs and the scientific community.
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Introduction to the Special Issue of the DCID Journal on Systems of Support to Enable Community Inclusion of Persons with Disabilities and their Families
Copyright (c) 2026 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0
A response to the editorial of March 2026 "Bridging the Research–Practice Gap: A Crisis of Values in Rehabilitation” by Zelalem Dessalegn Demeke
Physical Activity, Sedentary Behaviour and Physical Fitness among Male Adolescents with and without Intellectual Disability in Kinshasa, Democratic Republic of Congo
Background: Physical activity, sedentary behaviour, and physical fitness are key health indicators, yet they remain under-documented in the Democratic Republic of Congo, particularly among adolescents with intellectual disability (ID). Objective This study aimed to (i) compare levels of physical activity, sedentary behavior, body composition, and physical fitness between adolescents with and without intellectual disability, and (ii) examine the associations between body composition and physical fitness variables. Method: A cross-sectional analytical study was conducted over a three-month period (November 2022 to February 2023) among 322 male adolescents aged 12-17 years attending school in Kinshasa, Democratic Republic of Congo. A stratified convenience sampling strategy was used, whereby schools were first stratified by type (specialized vs. mainstream), and participants were then recruited based on availability within each stratum. The sample included 180 adolescents with clinically diagnosed moderate intellectual disability and 142 without ID. Physical fitness (balance, flexibility, and upper limb strength) was assessed using standardized EUROFIT tests. Body composition (waist circumference, fat mass, and muscle mass) was measured using anthropometry and bioelectrical impedance. Physical activity and sedentary behavior were assessed using the validated CAPAS-Q questionnaire. Group comparisons were conducted using Student’s t-test or Mann–Whitney U test, and χ² tests for categorical variables. Effect sizes (Cohen’s d, Cramér’s V) and regression analyses were computed. Results: Adolescents with ID showed higher waist circumference (66.2±1.5 vs 65.6±1.3, d = -0.42, p < 0.001) and body fat percentage (21.0±1.9 vs 20.6±1.6, d = -0.26, p = 0.017), and lower muscle mass (20.9±2.6 vs 25.5±2.9, d = 0.69, p < 0.001) compared to peers without ID. They also demonstrated lower flexibility (8.3±2.1 vs 12.8±1.8, d = 2.26, p < 0.001) and balance (6.8±3.4 vs 10.0±2.2, d = 1.09, p < 0.001). Sedentary behavior was significantly higher (Cramér’s V = 0.73–0.88, p < 0.001), while physical activity levels were lower (Cramér’s V = 0.50–0.84, p < 0.001). Regression analyses indicated that muscle mass positively predicted flexibility (β = 0.57, p < 0.001) and balance (β = 0.81, p < 0.001), whereas waist circumference negatively predicted both outcomes. Conclusion: Adolescents with intellectual disability exhibit lower physical activity, higher sedentary behavior, poorer body composition, and reduced physical fitness compared to their peers. Body composition, particularly muscle mass and abdominal adiposity, is strongly associated with physical fitness outcomes. These findings highlight the need for targeted, inclusive physical activity interventions in the Congolese context.
Playing for wellbeing: A scoping review of students with disabilities and tertiary sport
Aim: Students with disabilities at tertiary institutions do not have guaranteed opportunities for recreational sport and physical activity (RS&PA). This scoping review synthesized evidence on the contribution of RS&PA towards improving the social inclusion and wellbeing of these students to inform implementation of policy into practice. Methods: EBSCOhost, PubMed, Scopus, Web of Science and ProQuest were searched before two reviewers screened studies based on the following inclusion criteria: social inclusion and/or wellbeing; recreational sport and physical activity; students with disabilities; tertiary institutions. Studies published in English from between 1995 and 2025 were included. Results: From 349 studies from the search, 10 were included. An additional 10 studies were included from screening the reference lists of the selected studies. Most studies were qualitative and from the Global North. Evidence supports RS&PA facilitating students with disabilities’ social inclusion and wellbeing through enabling health outcomes, physical accomplishment, academic persistence, empowerment and a sense of belonging. Conclusions: More evidence from the Global South is needed. Equitable policies that facilitate implementation of inclusive sport and physical activity practices can be achieved through engaged research about students’ experiences. Implications: Addressing the gap in research from the Global South will provide evidence to influence disability inclusion on policy and practice. Institutional leadership needs to be intentional about increasing the participation of students with disabilities in RS&PA.
Bridging the Research–Practice Gap: A Crisis of Values in Rehabilitation
Experiences of People with Disabilities and Chronic Illnesses Accessing Healthcare in Rural and Remote Communities: A Scoping Review
Background: Rural and remote communities face well-documented challenges in healthcare access, including workforce shortages and long travel distances. For disabled people and people living with chronic illness, these challenges are compounded by accessibility barriers, fragmented services, and heightened dependence on accommodations, supports, and continuity of care. Objective: This scoping review aimed to map the literature on how disabled people and people with chronic illness experience accessing healthcare in rural and remote settings, with attention to barriers, facilitators, care pathways, and patient-identified priorities for improvement. Methods: Following the PRISMA-ScR framework, we systematically searched MEDLINE, Embase, CINAHL, PsycINFO, and Scopus from inception to July 2025. Eligible studies included qualitative, quantitative, and mixed-methods research describing healthcare access experiences among disabled people and/or individuals with chronic illness living in rural or remote regions. Data were charted on population, geography, care setting, access dimensions, and reported outcomes, and were synthesized using descriptive and thematic analysis. Results: Twenty-five studies were included, spanning primary care, specialty care, rehabilitation, home care, and emergency services across rural and remote regions in high-, middle-, and select low-income settings. Four themes emerged: (1) distance, transportation, and the “time tax” of care; (2) service scarcity and discontinuity across the care journey; (3) accessibility and accommodation gaps within rural health systems; and (4) relational, cultural, and privacy dynamics shaping care-seeking and trust. Across studies, telehealth and local “wraparound” relationships were frequently described as partial mitigations, but often limited by broadband access, disability-related communication needs, and reduced opportunities for hands-on assessment. Conclusion: Disabled and chronically ill people in rural and remote communities face layered access barriers that extend beyond geography to include accessibility, continuity, and the social realities of rural life. Future research should evaluate interventions that combine accessible transportation supports, strengthened local interdisciplinary capacity, disability-competent telehealth, and coordinated pathways for specialty and rehabilitation care.
Enhancing Rehabilitation Access: A Program Evaluation of Embrace a Child Program for Children with Disabilities
Aim: This study evaluates the potential of the Embrace A Child Program, an initiative of the Open Arms Organization delivering telehealth-based occupational therapy, as a model for inclusive development and service delivery in the Philippines. The program responds to gaps in access to rehabilitation services for children with disabilities (CWD) in developing countries, where high costs, geographic isolation, and social exclusion remain persistent barriers. Method: Using a concurrent mixed-methods design guided by the PACE Framework (Population and Health Outcomes, Access, Cost-Effectiveness, and Stakeholder Experiences), the study purposively sampled twenty-five caregivers and five volunteers for surveys and semi-structured interviews. Data were analyzed through descriptive statistics and thematic analysis, with triangulation employed to enhance rigor and trustworthiness. Results: Findings indicate that the program contributed to notable improvements in children’s functional participation, communication, and emotional and behavioral regulation. Telehealth delivery effectively extended services to underserved and geographically isolated communities while significantly reducing the financial burden on families. Stakeholders reported high satisfaction, citing strong therapeutic relationships and sustained caregiver engagement Conclusions: The study demonstrates how Embrace A Child Program expands access to rehabilitation services through a cost-effective, stakeholder-endorsed, and community-based approach, albeit limited by a small sample size and the inherent risk of unconscious bias. The findings hold significant implications for the future practice of occupational therapists and related professionals, who may benefit from incorporating telehealth into community-based rehabilitation (CBR) models to enhance service delivery and inclusivity in underserved settings. Stakeholders are urged to explore telehealth-driven CBR models as viable approaches.
We Support Each Other: Lived Experiences of Natural Support among Persons with Disabilities in Ethiopia
Aim: Evidence suggests that natural support plays a crucial role in promoting the inclusion of persons with disabilities. Despite its significance, the community’s role in providing natural support remains underexplored in Ethiopia. This lack of exploration may obscure the importance of such support, resulting in it being undervalued and underutilized in a context where formal support systems are already limited. This study sought to understand the breadth, impact, and value of natural support for persons with disabilities, and to identify factors that could enhance it. Method: We employed an exploratory-descriptive qualitative design, semi-structured interviews for data collection, and a reflexive thematic analysis. The study utilized Ethics of Care, Dependency, and Disability, and Appreciative Inquiry as theoretical lenses. Purposive sampling was used to recruit 21 participants. Persons with disabilities were recruited through the University of Gondar’s community-based rehabilitation program, while neighbours were recommended by those persons with disabilities and/or their caregivers. Results: Persons with disabilities receive food, clothing, school supplies, transportation, emotional support, information, and advocacy support from family, friends, and neighbours. They reciprocate by offering emotional support, helping with household tasks, and financial and material support. Improving community awareness, expanding social networks for persons with disabilities, and providing livelihood support for caregivers can strengthen natural support. Conclusion: In the Ethiopian context, where formal support is limited, the government and its partners must recognize the importance and value of natural supports within communities for persons with disabilities and design community-based programs that effectively enhance these supports.
Editorial: An end of the year message in turbulent times
Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0
Pattern of Sedentary Activity among Persons with Neurodevelopmental Disabilities: A Scoping Review
Aim: The global prevalence of Neuro-developmental Disorders (NDDs) is alarming, with approximately 316.8 million cases identified. Individuals with NDDs are reportedly less physically active compared to their peers. However, reviews are limited, focusing on sedentary patterns of individuals with NDDs alongside disorder-specific data. This study aims to identify disorder-specific patterns and factors influencing sedentary lifestyles in this population. Method: The review followed PRISMA-ScR guidelines and Arksey and O’Malley’s framework, with study selection guided by the JBI Population–Concept–Context (PCC) approach. Searches were conducted in PubMed, Scopus, Web of Science, and Google Scholar using keywords such as “sedentary activity,” “screen time,” “sitting time,” “neurodevelopmental disorders,” “ASD,” “ADHD,” and “intellectual disability,” combined with Boolean operators “AND” and “OR.” Eligible studies were peer-reviewed articles examining sedentary patterns in individuals with NDDs. Review articles, studies on typically developing populations, and studies addressing only physical activity were excluded. Results: A total of 19 articles were entitled for this study, involving 27,180 samples. Screen media usage was the most common form of sedentary activity among individuals with NDDs. Other sedentary activities were reading, imaginative play, playing with toys, crafting, indoor games, and playing musical instruments. Screen time was higher among individuals with Autism Spectrum Disorder (ASD) (2 to 7 hours/day) and Intellectual Disability (2 to 10 hours/day) compared to other groups. Moreover, sedentary time was higher on weekends compared to weekdays. Conclusion: The findings indicate that individuals across all age groups with NDDs exceed the ideal screen time limits. Disorder traits, physical and socio-economic barriers, and quality of life influence sedentary behaviors. The limited exploration of disorders, aside from a few observational studies in this context, highlights the need for broader, more comprehensive research. Limitation: The absence of a preregistered protocol may reduce methodological transparency and increase the potential for bias.
CBR: A Lifeline for People Living in Poverty and Poverty-Stricken Areas
Cell Phone Addiction and Its Association with Socio-Environmental Factors among Children with Neurodevelopmental Disorders
Cell phone addiction has emerged as a critical behavioral concern, especially among children with neurodevelopmental disorders. However, exposure to smartphone addiction in this group remains scarce, especially in the context of Bangladesh. This study aims to explore the cell phone addiction level among children with NDDs and associated factors in Dhaka, Bangladesh. In this study, an analytical cross-sectional design and a criteria-based purposive sampling technique were implemented. Socio-demographic questions and the Digital Addiction Scale for Children (DASC) were used to collect necessary data. A descriptive statistic, the Pearson Chi-square test, and Regression analysis were applied to achieve the study objective. Among 182 samples, 66.8 were boys and 33.2% girls with a mean age of 6.83 years. The findings revealed that 43.5% exhibited moderate levels of addiction and 37% showed severe levels, while fewer than 20% were categorized as mildly addicted. The study found parenting time [OR = 2.34], mother's occupation [OR = 2.24], family income [OR = 2.55], and disorder type [OR = 2.18] as risk factors for cell phone addiction (p <.05). Cell phone addiction was prevalent among children with NDDs, particularly children with autism spectrum disorder and attention disorder/ hyperactivity disorder are at higher risk. Several socio-demographic factors are significantly associated with addiction severity, aligned with the Social Cognitive Theory, which emphasizes the role of environmental influences and behavioral characteristics in shaping individual perspectives. In addition to parents' monitoring, the development of public health policies could be a crucial initiative to combat the issue.
Parenting Paradox: Exploring the Lived Experiences of Raising Young Adult and Twins with Down Syndrome in Mauritius
Aim: There is a paradox of challenges and development while raising a child with Down syndrome (DS). This research explores the lived experiences of Mauritian parents raising identical twins with Down syndrome and other youngsters in this condition. This research aims to examine the positive and negative affect, resilience, cultural dynamics and interaction of relationships between child, parent, family and community. Method: The study employed a qualitative interpretive design which is guided by Family System Theory, by looking at relationships and structures in the family dynamics and how the family environment supported their coping efforts. Sixteen (16) parents of young adults with Down syndrome, recruited from U-Link and Down Syndrome Mauritius, participated in semi-structured interviews with purposeful sampling. Thematic analysis is employed to examine positive and negative parental experiences from essentially different layers of relationships. Results: Initially, parents described shock, at a loss, stigma and grief at diagnosis but gradually turned into resilience with community support, peer social networks, spiritual beliefs and adaptive parenting strategies. While raising twins with DS, parent claimed an intensified caregiving demands with a resilient paradox of grief and growth but eventually their presence brought profound joy in spite of the financial strain, minimal access to inclusive services and other challenges. In a nutshell, families raising young adults with Down syndrome in Mauritius epitomize vulnerability, instability and positive resistance. Conclusion: Parents reported enhanced family cohesion, strengthened social networks, and a growing sense of purpose, despite ongoing challenges related to stigma, access to services, and emotional fatigue. These findings call for sustained, multidimensional support systems and inclusive policies that recognize both the burdens and the transformative potential of parenting young adult with DS in resource-constrained and culturally diverse settings like Mauritius .
Actions, Potentialities, and Limitations of the Brazilian Network of Care for People with Disabilities: A Qualitative Study
Introduction: The Care Network for Persons with Disabilities aims to provide comprehensive and continuous care to this population, structured through components of primary care, specialized rehabilitation care, and hospital care, including urgent and emergency care. In this context, the Care Network should be anchored in the guidelines of decentralization and regionalization of health to promote equal access. Objective: To understand the actions aimed at people with disabilities, and the strengths and limitations of the Care Network for Persons with Disabilities in the IX Health Region of Pernambuco, Brazil. Materials and Methods: This is a qualitative narrative study, guided by Critical Disability Theory, conducted with five regional health managers and five primary care coordinators working in the IX Health Region of Pernambuco. Data were collected through semi-structured interviews and subjected to thematic content analysis. Results: Three thematic categories emerged, condensing the main topics addressed by the participants: (1) "We don't stop to think about this; it's rare and difficult": actions aimed at people with disabilities; (2) "Specialized Rehabilitation Centers need to be opened": potential of the Care Network for People with Disabilities; and (3) "Recife is a long way away, isn't it?": limitations of the Care Network for People with Disabilities. Conclusion: the health system in the IX Health Region perpetuates a fragmented and unequal care model, which reinforces the marginalization of people with disabilities.
Investigation of Spoon-feeding Skills in Children with Cerebral Palsy and Typically Developing Children: A Comparative Study
Aim: Mastering spoon feeding is a key developmental milestone typically achieved by age two, yet evidence comparing these skills between children with CP and typically developing (TD) peers is scarce, particularly in socio-culturally diverse contexts like India. This study aimed to compare spoon-feeding skills, including utensil use, in children with CP and TD children. Methods: A validated questionnaire was developed to assess positioning, spoon characteristics (handle length, bowl depth), placement, normal/abnormal oral motor patterns, reflexes, and mealtime behaviours. Video recordings of naturalistic spoon-feeding sessions from 17 children with CP and 22 age-matched TD children (2-10 years) were analysed. The data were subjected to statistical analysis using chi-square tests. Results: Significant inter-group differences were found in positioning, spoon characteristics, and spoon placement. All normal patterns except for maintained lip closure during swallowing differed significantly. Significant abnormal patterns included suckle-swallow, anterior spillage, head extension, tongue protrusion, and clearing with teeth. Mealtime problem behaviours did not differ significantly. Conclusions: This study profiles distinct spoon-feeding patterns in children with CP versus TD children. These findings underscore the need to target these specific skills during feeding therapy for the CP population. Limitations: The generalizability of findings is limited by the small sample size. Future research should explore regional variations within India and investigate how food consistency influences spoon placement.
A Decade Without Audiologists: Persistent Non-Recruitment in Indian Public Health
The National Programme for Prevention and Control of Deafness (NPPCD) was introduced in India to provide early hearing detection and intervention services at district and tertiary healthcare levels. While the programme outlines the post of a qualified Audiologist at each district facility, our research — based on Right to Information (RTI) queries and policy records from 2014–2024 — finds that most public hospitals across India have failed to appoint Audiologists. Instead, Audiometric Assistants and Technicians are routinely substituted, despite lacking statutory recognition or registration. Under the Rehabilitation Council of India (RCI) Act, 1992, only RCI-registered professionals may practice as Audiologists. In 2021, RCI issued Model Recruitment Rules (MRRs) to standardize qualifications, pay scales, and designation. Yet, no central or state institution has adopted them to date. This paper analyzes a decade of non-compliance and institutional neglect using legal provisions, budget allocations, and government admissions obtained through RTIs. It concludes that continued misclassification of roles and the failure to recruit qualified Audiologists represent violations of statutory, ethical, and programmatic obligations, undermining the rights of persons with hearing disabilities and misusing public funds. We call for mandatory implementation of RCI’s MRRs, audit of NPPCD-compliant staffing, and legal accountability for healthcare providers violating rehabilitation laws. The findings have implications for inclusive health policy and disability justice in India
Caregivers’ Beliefs, Practices, and Experiences about Spoon Feeding Children with Cerebral Palsy from Rural North Karnataka
Aim: Spoon feeding is a foundational skill supporting the transition from breastfeeding to independent eating. In India, however, traditional hand-feeding practices dominate, and limited research exists on spoon-feeding practices, especially in children with cerebral palsy (CP). Gaining caregivers' perspectives will benefit researchers in developing culturally relevant treatment protocols. This study aimed to explore the beliefs, practices and experiences of caregivers of children with CP from rural North Karnataka regarding spoon feeding. Methods: Eight caregivers of children aged 2 to 17 years diagnosed with oral dysphagia secondary to CP participated in a focus group discussion. The discussion was video-recorded, transcribed, and thematically analysed. Results: Eight key themes emerged: Spoon-feeding practice in families, Early experience with spoon feeding, Child’s preference towards spoon feeding, Present status of spoon feeding, Communication by the child during feeding, Caregiver preference for spoon feeding, Managing spoon feeding difficulties and Impact of spoon feeding difficulties on the caregiver. Findings revealed a strong cultural preference for hand-feeding, with spoon use limited to semi-solid or hot foods, particularly in contexts such as school or travel. Early spoon-feeding attempts were inconsistent and often involved unsafe techniques, such as scraping food against the child’s teeth or feeding in a supine position. Post-therapy, caregivers reported improved oral motor skills and greater acceptance of spoon-feeding. Non-verbal cues were commonly used by children to communicate hunger and fullness. Conclusion: These insights underscore the importance of incorporating caregiver experiences into feeding interventions, emphasising the need to develop culturally sensitive training modules for rural Indian contexts. Implications: Speech-language pathologists must consider these insights when designing caregiver education and feeding therapy protocols. Future research should involve larger and more diverse caregiver populations across different cultural and socioeconomic settings.
Experiences Caregiving Together: Optimising the Involvement of Fathers of Children with Disabilities in India
Background While mothers are often the default caregivers of children with disabilities in India, emerging evidence highlights the importance of fathers’ engagement in caregiving, which may enhance child development and family wellbeing. However, paternal caregiving remains underexplored in low-resource settings. Aim To explore the caregiving roles, perspectives, and barriers experienced by Indian fathers of children with disabilities, using a large qualitative dataset from diverse geographic and cultural contexts. Methods This exploratory qualitative study involved 54 semi-structured interviews and 9 focus group discussions with fathers and other caregivers, conducted across eight sites in five Indian states. Participants were purposively sampled to capture a range of disability types (physical, sensory, intellectual, developmental, and mental health conditions) and caregiving experiences. Interviews were transcribed, translated, and analysed using inductive thematic analysis in NVivo 14. The large sample size allowed for thematic saturation across diverse subgroups and regions. Results Thematic analysis revealed three key themes: fathers’ caregiving roles, the impact of caregiving, and support needs. Fathers’ involvement ranged from providers and decision makers to occasional primary caregivers, influenced by cultural beliefs, availability, skills, and emotional bonds. Caregiving shaped fathers’ self-perception, mental health, and family dynamics. Acceptance was higher when caregiving was viewed as purposeful. Barriers included stigma, rigid gender norms, limited inclusive infrastructure, and lack of tailored services. Fathers expressed the need for greater public awareness, emotional encouragement, and consistent, accessible disability services to support their roles and enhance outcomes for children and families. Implications Fathers are active but under-recognised caregivers in families of children with disabilities. Interventions must address regional, systemic, and emotional barriers to support father-inclusive care in India.
Challenges and Opportunities in Disability-Inclusive Development
Parent-Child Play And Playfulness Among Children With Disabilities: A Systematic Review
Aim: This systematic review examines the role of parent–child play and playfulness among children with disabilities, and their impact on child development and parent–child relationships. Method: A comprehensive literature search was conducted across multiple electronic databases, supplemented by reference list screening and hand-searching of relevant journals. Studies examining parent–child play and playfulness in children with disabilities were included based on predefined inclusion criteria. A total of 16 studies were identified and analysed. Results: Findings indicate that symptoms associated with medical, developmental, or psychological conditions may negatively influence playfulness in children. However, active parental involvement and responsive interaction were consistently associated with increased playfulness. Parent–child play was also linked to improved parental self-efficacy, stronger parent–child relationships, enhanced emotional regulation, and positive developmental outcomes in children. Conclusion: Parent–child play plays a significant role in supporting the emotional, social, and developmental wellbeing of children with disabilities, while also strengthening parental confidence and relationships.
Return-To-Work Status And Quality Of Life Of Persons With Lower Limb Amputation In South India
Aim: The constraints brought forth by amputation cause immense impairments in the realms of physical, social, and psychological functioning of individuals. The exact estimates of the number of persons with amputation in India are unknown. Past studies report that the incidence of amputation is 0.62/1000 individuals in India, which is nearly 1 million of its population. Lower limb amputation impacts Return-to-Work status. Prosthetic training offered to individuals with lower limb amputation could empower them to get back to work, thus refining their Quality of Life. The aim of this study is to determine the Return-to-Work status and Quality of Life of persons with lower limb amputation after prosthetic training. Method: This cross-sectional observational study recruited eighty-four participants who underwent prosthetic training after lower limb amputation from a tertiary care hospital in South India. Demographic and clinical characteristics were obtained using a self-designed data form through a telephone survey. Quality of Life was measured using WHOQOL-BREF. Data analysis was done using chi square tests and t-tests. Results: In our study, we found that 60.7% of our participants returned to work. Prosthetic use (p value = 0.016) and independence with transfers (p value = 0.007) are significant factors that facilitated positive Return-to-Work. Psychosocial characteristics such as self-motivation (p value = 0.001), social support (p value= 0.001) and family support (p value = 0.017) have enabled individuals to get back to work. Quality of Life among individuals who returned to work was found to be significantly higher than the persons who have not returned to work in all domains (p value < 0.01). Conclusion : Prosthetic training has enabled persons with lower limb amputation to get back to their work. Daily use of prosthesis coupled with socket comfort, has facilitated positive Return-to-Work, thereby improving their Quality of Life.
The Perceptions of State-Owned Enterprises on the Employment of People with Disabilities and Special Needs in Namibia: A qualitative study
Introduction: Previous research has shown that employers' attitudes can affect the hiring of People with Disabilities and Special Needs (PWDSN), however there is insufficient research on the perceptions of Namibian state-owned enterprises (SOEs), their recruitment practices, and their compliance with national legislation and guidelines. Aim: This study examined the views and experiences of SOE managers and HR personnel regarding the employment of PWDSN in Namibia. Methods: A phenomenological qualitative research design was used for this study. Semi-structured interviews were conducted with fifteen participants who were recruited using purposive sampling. The interview recordings were transcribed verbatim before thematic analysis. Adherence to the four ethics principles, comprising autonomy, beneficence, non-maleficence, and justice, was maintained throughout the process. Results: Five main themes were generated from the study; these relate to employee welfare; perceptions of impairments on performance abilities; employee experiences and exposure; work environment and employment procedures. Findings show that there are insufficient dedicated recruitment strategies for PWDSN and limited adherence to national policies and legislation. Recommendations include strategies for development and implementation of employment practices that are inclusive of people with disabilities and special needs within the SOEs. Conclusion: Despite some progress to ensure sustainable employment of PWDSN, there remains significant gaps and inequality in the development, understanding and implementation of inclusive employment practices within the SOEs included in this study. These findings are significant for various stakeholders, including management, HR personnel, health and safety officers, wellness coordinators, training and development teams, planners, and those involved in recruitment processes. Contribution: This research has generated evidence that could be helpful in informing improvements in ensuring inclusive recruitment for PWDSN in SOEs in Namibia. The findings could also be applicable in other organizations where similar employment policies and legislation apply. Furthermore, this study provides recommendations for implementation and adherence to inclusive employment policies and legislature.
Disability Prevention initiatives in Rural India
Primary healthcare is a central feature of all national health care systems delivering high quality care at affordable cost. The state in India has focused on establishing an elaborate, efficient and effective system of primary healthcare which would aid to the creation of a healthy and productive nation state vital for the future development of the country. The National Rural Health Mission 2005 aimed to provide accessible and affordable Universal Health Care keeping in mind both quality and equity of care by ensuring health care delivery, and synergy between health and determinants of good health. Yet the National Rural Health Mission, which has been revamped several times over the last few years, has little to offer to persons with disabilities in terms of access to health facilities. The Primary Health Care system in India remains unresponsive to the requirements of disabled people, whether it is general health needs or impairment specific issues. The World Programme of Action for Disabled Persons (United Nations, 1982) stressed three things necessary for the state to provide in order to safeguard the rights of disabled persons and ensure their wellbeing. These fall under the broad headings - prevention, rehabilitation, and equalization of opportunities. This paper attempts to explore the ways in which the primary health system in rural areas addresses prevention of disability both during pregnancy and after the birth of a new born baby and in early childhood in 2 states of India, West Bengal and Odisha. West Bengal is at 13th position at the border of low-middle level of the Human Development Index 2007-08 and Odisha is at 22nd position with very poor status of human development. Data analysis based on secondary data compiled from Census reports 2011, District Census Handbooks and National Rural Health Mission allowed for drawing up a picture of availability of services that help reduce or mitigate the incidence of disability.
The Role of Interdisciplinary Teams in Preventing ICU-Acquired Weakness: A Systematic Review
Background: ICU-Acquired Weakness (ICUAW) is a frequent complication among critically ill patients and is associated with prolonged mechanical ventilation, extended hospitalization, functional decline, reduced quality of life, and long-term disability. Various nursing and rehabilitation interventions have been implemented to prevent ICUAW; however, evidence regarding their effectiveness remains variable. Objectives: To synthesize current evidence on nursing and interdisciplinary interventions for preventing ICU-Acquired Weakness in critically ill adult patients and to identify interventions associated with improved functional outcomes. Method: A systematic review was conducted using PubMed, ProQuest, MEDLINE, ScienceDirect, and Google Scholar. Studies published between January 2014 and May 2024 were screened according to predefined inclusion and exclusion criteria. Eligible studies included adult ICU patients receiving nursing or interdisciplinary interventions aimed at preventing ICUAW. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Results: Of 693 records identified, seven studies met the inclusion criteria. The findings indicated that early mobilization consistently improved muscle strength, mobility, and functional recovery while reducing the incidence of ICUAW. Nutritional optimization, range-of-motion exercises, massage therapy, neuromuscular electrical stimulation, blood flow restriction-assisted mobilization, and structured rehabilitation programs demonstrated beneficial effects on muscle preservation and recovery. Multidisciplinary collaboration involving nurses, physiotherapists, nutritionists, rehabilitation specialists, and psychologists was associated with improved rehabilitation outcomes and functional independence. Conclusion: Nursing and interdisciplinary interventions, particularly early mobilization and comprehensive rehabilitation strategies, may effectively reduce the risk of ICUAW and improve recovery among critically ill adults. Nurses play a central role in coordinating rehabilitation, monitoring patient safety, providing education, and facilitating patient engagement throughout the recovery process.
Towards More Inclusive Elections: State of the Art and Challenges of Electronic Voting for People with Disabilities in Developing Countries
Aim: This study examines the current state of electronic voting (e-voting) technologies and their implications for accessibility among people with disabilities, particularly in developing countries. It identifies key technological solutions, existing barriers, and potential improvements to ensure a more inclusive electoral process. Methods: A systematic review was conducted using the PRISMA methodology, analyzing publications from 2018 to 2023 in databases such as Scopus, Web of Science, ScienceDirect, Wiley, and IEEE. The selection criteria included studies that focus on e-voting technologies and their application to accessibility. Articles related to general electronic voting, without specific reference to disabilities, were excluded. Results: The findings highlight blockchain technology as a promising solution due to its security and transparency features. However, major barriers remain, including the digital divide, lack of inclusive design, and absence of legal frameworks supporting electronic voting for people with disabilities. While some countries, such as Estonia, have successfully implemented remote voting, there are still no widespread solutions tailored specifically to people with disabilities in developing regions. Conclusions: The study underscores the need for e-voting solutions that are designed with accessibility in mind from inception, ensuring usability without stigmatization. Future research should explore pilot implementations of accessible voting systems in developing countries, integrating biometrics and assistive technologies. Limitations: The study is based on a literature review and does not include empirical testing of proposed solutions. Further validation through real-world implementation is required.
Special Education in Ghana: Current Challenges and Opportunities
This study explores the challenges and opportunities in implementing inclusive education for persons with disabilities (PWDs) in Ghana. A systematic review approach was employed, analyzing a range of peer-reviewed articles, policy documents, and reports published between 2019 and 2025. Crossref, EBSCO, PubMed, Cochrane, and ProQuest were among the databases searched to obtain data on challenges and opportunities. Thirteen mixed studies (qualitative and quantitative), 10 qualitative studies, and 2 policy documents were eventually found to meet the inclusion criteria. The study identifies significant barriers such as inadequate infrastructure, insufficient teacher training, and weak enforcement of the Persons with Disabilities Act (Act 715), which hinder access to quality education. Socio-cultural stigma and negative societal attitudes further marginalize PWDs, especially in rural areas. However, the study also highlights opportunities like policy support for inclusive education, the integration of assistive technologies, and community-based initiatives. The study recommends increased funding, stronger policy enforcement, expanded teacher training, and greater community-driven advocacy to improve educational and employment outcomes for PWDs.
Inclusivity In Social Spacies: A Lens On Deaf Muslims Religious Participation
A socially inclusive society is one in which all people feel valued, and their inherent differences and diversity are respected while their basic needs are met, guaranteeing a life of dignity. While efforts are being made to promote a socially inclusive society for all, existing evidence suggests that Deaf people remain excluded in key social spaces particularly, places of worship. This study sought to explore the extent to which the Deaf access spaces of worship, the barriers, and the mechanisms for their inclusion in such spaces in Ghana. Framed by Social Inclusion Theory and case study design, the study employed semi-structured interviews, focus group discussions and key informant interviews in obtaining data from 31 respondents, including Deaf Muslims, religious leaders and parents. Descriptive statistics and thematic analysis were employed in the data analysis. The study revealed that there are Deaf Muslims who desire to participate in worship but are often excluded due to the absence of sign language interpretation, limited awareness of Deaf needs among Imams, gendered religious rules, and negative societal attitudes. It is recommended that sign language interpreters be prioritised and engaged in places of worship while awareness-raising through educative programs on the communication needs of the deaf and elimination of discriminatory tendencies be stepped up in order to attain meaningful inclusion of Deaf Muslims in social spaces.
The Current State of Ghana's Disability Policy
This article contributes significantly to the practices in Ghana that aim to alleviate the systemic challenges and opportunities for improving the lives of persons with disabilities (PWDs). This is a survey review paper culled from peer-reviewed articles. After an extensive online search (on Google Scholar, ProQuest, etc.) for articles on current disability programmes and policy, more than 76 articles were downloaded. These included 52 journal articles, 6 book chapters, 7 reports, 1 conference paper, 6 web-based papers, and 2 policy documents. After a careful review, some of them were discarded. The criteria used were that the article must be about disability policy, programmes, and activities in Ghana, either by the central government, non-governmental organisation agencies, or civil society groups. During the analyses, the papers were grouped under the headings presented in this paper. Most of the reviewed articles talked positively about activities, programmes and policy interventions provided in Ghana to the disabled. Some policies in place for PDWs are Persons with Disability Act, 2006 (Act 715), the National Health Insurance Scheme, the District Assembly Common Fund, Livelihood Empowerment Against Poverty, free public transportation, disability-friendly public structures, and other support systems from the community. Some recommendations for future studies are the evaluation of the socio-cultural beliefs about PDWs, an assessment of the economic implications of PWD policy interventions and how technology influences the daily life and activities of PWDs.
Functional Independence, Quality of Life and Participation of Stroke Survivors in the Rural Community- A Cross-Sectional Survey
Background: In Low and Middle Income countries (LMICs) like India, the majority of stroke survivors are residing in rural community deprived of comprehensive rehabilitation resulting in long-term disabilities. The objective of our study was to identify the level of functional independence, quality of life and Community Integration of stroke survivors and to find the burden and quality of life of their primary caregivers. Study design: A cross-sectional survey. Study setting: A rural community setting served by a tertiary care hospital in South India. Method: We included 30 stroke survivors and their primary caregivers. Demographic characteristics and stroke related information were gathered from our database and clinical characteristics were obtained using self-designed data form. Modified Barthel Index (MBI), Fugl-Meyer Assessment Upper Extremity (FMA-UE), World Health Organization Quality of Life Instrument (WHOQOL-BREF), National Institute of Health Stroke Scale (NIHSS), Community Integration Questionnaire (CIQ) and Caregiver Burden Scale (CBS) were used as outcome measures. Results: Participants showed moderate level of impairment (mean ± SD 34±24);and independence(mean ± SD 67±28); with low level of community reintegration (mean ± SD 4±6) and quality of life. The caregivers of stroke survivors showed moderate to severe burden (41±19). The quality of life of stroke survivors correlates well with quality of life of caregivers in all the quality of life domains(p-<0.01). The caregiver burden moderately correlates with all their quality of life domains except for physical health (psychological domain (r = -0. 507; p=0.004), social relationship domain (r = -0. 506; p=0.004), environment domain (r = -0. 663; p=0.000) physical health domain(r = -0. 218; p=0.247). Conclusion: Stroke survivors residing in rural South Indian community have shown moderate level of independence in their functional status despite majority of them have experienced moderate level stroke. However, the caregivers of stroke survivors showed moderate to severe burden.
Rising Above Stigma: Exploring the Coping Strategies of Adolescents with Albinism in Tanzania Through a Group Coping Intervention
Aim: Adolescents with albinism in Tanzania regularly experience stigmatisation, yet little is known about their coping strategies or related interventions. This qualitative brief report aims to explore the stigma-coping strategies employed by adolescents with albinism, and to gain insight into the influence of peer support on those strategies through a group coping intervention. Methods: Data were collected from ten Tanzanian adolescent girls with albinism who participated in four sessions of a group coping intervention, followed by individual interviews. One universal and one stigma-specific coping framework were used in the analysis. Results: Data suggest that adolescents with albinism employed, prior to the intervention, mostly strategies related to disconfirming stereotypes, such as becoming educated. Through participation in the intervention, the participants mostly learned about coping strategies linked to primary and secondary control engagement, such as building self-acceptance and help-seeking, indicating some form of empowerment. All but one participant expressed a desire to continue meeting with the peers in their intervention group to discuss stigma and coping. Conclusion and Implications: Adolescents with albinism in Tanzania possess a diverse range of strategies to cope with stigma. Group coping interventions can be beneficial for the development of complementary and potentially healthier stigma-coping strategies. Peer support could be a positive factor. More research into the careful implementation and interpretation of a group coping intervention for stigmatised youth is warranted.
Towards Comprehensive Cardiovascular Care: The Part of Community-Based Rehabilitation in Controlling Cardiovascular Risk Factors in Indonesia
Aim: Alternative models of cardiac rehabilitation (CR) have emerged globally to address the underutilization of hospital-based programs. Community-based cardiac rehabilitation emphasizes patient assessment, risk stratification, education, counseling, and program evaluation. This review aims to understand the forms of community-based rehabilitation that can be implemented to enhance cardiovascular health and specifically explores their roles and applications in Indonesia. Methods: A comprehensive literature search was conducted in PubMed and Google Scholar using the keywords “cardiac rehabilitation”, “community-based cardiac rehabilitation”, and “cardiac rehabilitation in Indonesia”. We also identified relevant guidelines and textbook resources. The search was limited to articles written in English and Indonesian, and published over the past twenty years. Results: Out of 644 retrieved articles, only 50 met the inclusion criteria and were used for the review. Conclusion: Community-based CR is effective for patients with heart failure and acute coronary syndrome post-intervention. In Indonesia, initiatives like the chronic disease management program or program pengendalian penyakit kronis (Prolanis) and the integrated non-communicable disease service post or pos pembinaan terpadu penyakit tidak menular (Posbindu PTM) target hypertension and diabetes, key risk factors for cardiovascular diseases. However, significant disparities in awareness and treatment persist, highlighting the need for robust strategies to enhance prevention and control within community-based CR frameworks. This narrative review underscores the potential of community-based approaches to improve cardiovascular health outcomes in Indonesia and beyond.
Knowledge, Attitude, and Utilization of Sexual and Reproductive Health Services among People with Disabilities
Introduction and Purpose: Knowledge and attitude toward sexual and reproductive health play a crucial role in services utilization among people with disabilities. The purpose of this study was to assess the knowledge, attitude, and utilization of sexual and reproductive health services among people with disabilities in Kathmandu Valley. Methods: The study was a quantitative, descriptive, and cross-sectional study. The total sample was 217, and a census was conducted to collect data from people with disabilities. The data were entered in EPI data 3.1 and exported to SPSS version 22 for further analysis. Descriptive and inferential statistics were used for data analysis. Results: Of the 217 respondents, over half (54.8%) did not utilize sexual and reproductive health services (SRH), while 45.2% did. Among those SRH service users, more than two-thirds (66.3%) used family planning, and more than four-fifths (87.8%) sought those services from government health facilities. Conclusion: This study revealed that slightly more than half did not utilize any sexual and reproductive health services, and the reason for not utilizing SRHS was the distance to facilities, as said by almost two-fifths of the respondents, while just over a third of the respondents mentioned no-disability-inclusive services.
The Impact Evaluation of Community Based Inclusive Development (CBID) Training: Outcomes of CBM India Trust Training
Aim: This study aims to evaluate the effectiveness of a pilot Community-Based Inclusive Development (CBID) competency-based certificate course in India. Launched in 2021, the course was designed to equip grassroots workers with the necessary skills to improve quality of life outcomes and promote the integration and inclusion of people with disabilities within their communities. Method: A qualitative case study methodology, using Brinkerhoff's Success Case Method (SCM), was employed to assess the outcomes of the training program. The study identified both successful and less successful applications of the acquired competencies in real-world settings. Results: The findings indicate significant improvements in workplace competencies among trained fieldworkers, resulting in positive impacts on the lives of individuals with disabilities and their families in their communities. Additionally, the study offers recommendations to adapt And improve the CBID training program. Conclusion and Implications: The results underscore the importance of competency-based training for grassroots workers, emphasizing its potential to drive inclusive development and advocating for increased investment by policymakers and training providers. Keywords: Competency-Based Training, Success Case Method, Disability Inclusion, Training Evaluation
The Indonesian Inclusive Schools: Unravelling Parents' Hopes and Concerns for The Future of Children with Disabilities
Objective: Inclusive education is a miniature society that prepares children with disabilities to live in society after their education. This study aimed to explore parents' experiences of hope and concern for the future of children with disabilities attending inclusive or mainstream schools. Methods: In-depth interviews using a semi-structured interview guide were conducted face-to-face. The participants were 7 parents representing primary school, middle school, and secondary school education levels with varying disabilities. Results: Three primary themes were examined: parents' strategies for addressing their concerns and expectations regarding education, and their hopes and concerns regarding the future. Sub-themes presented some parents' perspectives on children's development, third-party support, and parents' resilience efforts to overcome worries and concerns, subsequently building hope. Conclusion: Inclusive education can demonstrate positive relationships between children, parents, teachers, school authorities, and policymakers. Long-term support gives parents optimism and the ability to seek other resources for their child's future. Meanwhile, low support and severe levels of disability create more anxiety and frustration for parents about their child's development and future. Keywords: inclusive education; parents’ hopes and concerns; parents of children with disabilities; parents’ strategies
Using nominal group technique to develop a training model for community health workers in physical rehabilitation services: in-sights and perspectives from stakeholders
Aim: This study aimed to identify the training needs of community health workers in physical rehabilitation and propose a suitable training model. Methods: Key stakeholders in community physical rehabilitation were invited to participate in a workshop using purposive sampling. The study employed the nominal group technique for data collection, which consisted of two phases. Phase 1 focused on identifying training needs for community health workers delivering physical rehabilitation services, while Phase 2 aimed to ascertain the appropriate training model for community health workers in physical rehabilitation services. Participants used a Likert scale of 1–4 to rank the training needs and the training model, and an overall ranking score was calculated for each. The participants were provided with the results of the ranking exercise for their feedback. The qualitative data was analysed thematically. Results: The participants emphasised the importance of detailed patient assessment and case management for community health workers rendering physical rehabilitation services. In addition, the participants suggested that a decentralised approach to training be adopted, with the ability to read and write suggested as the entry requirement. The training could take three months and use a combination of physical and online instruction. A theoretical and practical summative evaluation and certificate will be issued at the end of training. Conclusion: Standardising training for community health workers who deliver physical rehabilitation services could be implemented in Zambia, which would enhance access to and the quality of physical rehabilitation services at the community level. Implications: Community health workers offer a solution to the ongoing human resources for health crisis in resource-constrained settings and can support physical rehabilitation services. Training Community health workers in physical rehabilitation could help fill the human resource gap and improve service distribution, especially in resource-constrained settings.
Support and Services for Adolescents with Mental Health Issues in Ghana: A Narrative Review
Aim: This narrative review explores and critically examines the current landscape of support systems for adolescents with mental health disorders and challenges (AMHCD) in Ghana, an area that has been unexplored and in need of extensive research. Method: The study synthesised findings from literature accessed through computerized databases, manual searches, and grey literature. Results: The review identified that the support system for AMHCD spans micro (family and individuals), mezzo (school and community), and macro (policy and healthcare systems) levels, offering both direct and indirect services. However, the themes identified reveal a significant disconnect between the levels of care, driven by limited resources, stigma, lack of trained professionals, and gaps between policies and practical implementation. Conclusion: Unlike previous studies, this review underscored the need for more holistic services and offered valuable insights into Ghanaian adolescents' current mental health support systems. Doing so fills the gap in the literature by providing insight into the fragmented landscape of the support systems for AMHCD in Ghana to shine light on the issues, thereby promoting the need for further research to enhance support for this vulnerable population. Implication: This review has important implications for policy implementation and key adolescent mental health support stakeholders. Policymakers can use these insights to improve services and make them more accessible to adolescents. Families and other actors in the ADMH support system will better understand available support, helping them seek appropriate care.
Stigma in Disability, Rock-hard Beliefs and Disability
Copyright (c) 2024 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0
Strategies for Fostering Inclusive Early Childhood Education for Children with Communication Disorders
Purpose: Education fundamentally involves acquiring valuable knowledge, capacities, values, and dispositions. With over 85% of brain development occurring by age six, appropriate care and stimulation during these years are essential. Inclusive early childhood education provides equitable learning opportunities for all children, including those with communication disorders. Special educators, rehabilitation professionals, and parents are crucial in empowering and supporting these children. Hence, the researcher planned to study the strategies for fostering inclusive early childhood education for children with communication disorders. Method: A descriptive survey method was followed, using the ‘Inclusive Education Strategies Test’ developed by the researcher to assess these strategies. One seventy-thirty rehab professionals working in the special education field were selected using snowball sampling techniques, and data was collected via Google Forms: percentage, mean scores, and one–way ANOVA were used for analyzing the data. Result: The study revealed that early intervention, professional training, and effective inclusive teaching practices are essential for supporting children with communication disorders. The significant impact of multidisciplinary collaboration and field expertise emphasizes the need for targeted professional development and resource allocation to enhance educational outcomes. Conclusion: The study underscores the necessity of continuous professional development for educators and therapists to ensure they be updated with the most current knowledge and skills to effectively support children with communication disorders. It also highlights the need for increased funding and resources to address the challenges identified, such as inadequate assistive technology and insufficient training opportunities. Keywords: Strategies, Fostering, Inclusive Early Childhood Education, Children with Communication Disorder.
Child Rights and Cerebral Palsy Rehabilitation in India
Stakeholders’ perspectives on a pilot project focusing on improving access to primary healthcare for adults with disability in Santiago Atitlán, Guatemala
Background: Primary healthcare has been identified as a key strategy in not only achieving Universal Health Coverage but also in Goal 3, Health, of the United Nation’s Sustainable Development Goals. Unfortunately, however, an estimated 4.5 billion people, more than half of the global population, lack access to essential health services, including primary healthcare. Research shows that despite their greater need for healthcare, people with disabilities experience greater barriers to access due to discrimination, stigma, and social disadvantages. People with disabilities make up the largest minority group in the world at 16% of the world population. Community Based Rehabilitation (CBR), a strategy developed to meet the needs of people with disabilities in low- and middle-income countries, is a multisectoral approach based on implementing services through the combined efforts and engagement of different governmental and non-governmental sectors, people with disabilities and their families, and the broader community. Health is one of the five key components of CBR. Aim: This paper aims to explore the perspectives of the various stakeholders on a CBR pilot program developed to improve access to health services, specifically primary healthcare for people with disabilities in Santiago Atitlan, Guatemala. Method: A qualitative approach was used to explore the perspectives of the CBR program’s stakeholders. A total of 27 participants were interviewed. Results: Four themes were identified: program challenges, program facilitators, program impact and sustainability of the program. The results indicate that despite challenges faced by the program, there was a positive impact on the community and improved access to primary healthcare for people with disabilities. Conclusion: CBR has the potential to increase the inclusion of people with disabilities in mainstream health services. Implications: There remains a need for ongoing research on the impact of CBR in improving access to and use of mainstream healthcare services by people with disabilities.
Experiences of Dwarfism in Higher Education Learning Environment in South Africa
Abstract Purpose: Students with short body stature, such as dwarfism, not only find it difficult to access higher education institutions but also experience physical and psycho-emotional trauma. The experiences of accessibility and inclusivity in learning environments for students with dwarfism at a university of technology in South Africa premise this study. Method: The theoretical framework of this study is supported by Rawl's distributive justice, which promotes equitable distribution of social resources, and universal design, which emphasizes equal access to and use of goods and facilities. Two participants with dwarfism were identified through purposive sampling. The phenomenological research design was used to collect data on experiences of accessibility and inclusivity in the participant’s learning environment. Finding: The findings revealed that the learning environment for students with dwarfism is in contradiction with universal design and social justice principles. Such an environment is detrimental to their health, quality of epistemic access, self-esteem, and academic performance. Conclusion: Failing to provide learning environments that adhere to universal design and social justice principles is tantamount to discrimination and the violation of the basic human rights of minority groups.
Challenges, Promoting Factors of Disparity and Coping Strategies for Women Employees with Disabilities: Evidence from Malawi
Background: Persons with disabilities often face discrimination and marginalization, particularly women. This undermines the achievement of the Sustainable Development Goals (SDGs) that promote equality and equity. Therefore, identifying the underlying factors and ways of ameliorating such challenges is imperative for equality and inclusiveness. Objectives: The study's main objectives were to identify the challenges faced by women with disabilities in their workplaces in Malawi, promoting factors that cause such challenges and the coping strategies adopted in overcoming such challenges. Method: The present study adopted a qualitative research design. The participants for the study were forty-five working women with disabilities, identified through purposive sampling. The data was collected through interviews and analyzed thematically. Results: The results revealed that women employees with disabilities face diverse challenges, such as stigma and prejudice. The factors that were promoting such challenges included gender, marital status, and minority status of these women. The study also revealed self-confidence and withdrawal as the different coping strategies adopted by these women. Conclusion: The current study demonstrated the need to increase awareness and support/intervention services for women with disabilities in the workplace, especially women in a volatile society such as Malawi, to enhance social and cultural inclusiveness. Contribution: The study created more awareness of the need to provide an enabling environment and social security for women with disabilities in the workplace.
Community-Based Rehabilitation Enhances the Functioning of General Disability Service Centers in Khon Kaen Province, Thailand
Purpose: To identify factors that promote the functioning of general disability service centers in utilizing local resources and community participation. Method: This study selected representatives from 13 general disability service centers in Khon Kaen province, Thailand. These representatives were sourced from local governmental organization, disability organizations, and hospitals, totalling 63 participants. They included local government, community representatives, persons with disabilities, and caregivers. Data collection was conducted through document analysis, in-depth interviews, and focus group discussions. Results: The study found that there are 7 factors related to the operation of general disability service centers that incorporate the concepts and practices of CBR. These factors are: 1) Project manager or person in charge of the general disability service centers. 2) The proportion of community representatives in the management committee. 3) Networking within and outside the community. 4) Effective utilization of local resources. 5) Development of vocational knowledge and skills. 6) Efficient database management. 7) Public relations and communication with society. Conclusions: General disability service centers can emerge and operate based on the community's efforts to rehabilitate the abilities of persons with disabilities. Community engagement is crucial in utilizing local resources to enhance the effectiveness of these centers. Therefore, policies and guidelines supporting factors related to this should be established to improve the operational efficiency of general disability service centers.
Exploring Educational Needs of Young Adults with Hearing Disability in Kabul, Afghanistan Before the Taliban Regime: Insights and Limitations from a Phenomenological Study
ABSTRACT Purpose: The primary aim of the study is to explore the educational needs of young adults with hearing disability in Kabul, Afghanistan Method: The research utilized a qualitative approach, specifically employing the phenomenological method. In-depth semi-structured interviews were conducted with ten participants, allowing them to articulate their experiences and perspectives in detail. The data analysis involved a thematic analysis, comprising six key steps. Findings: In examining the educational needs of young hearing-disabled individuals, the findings underscore the vital importance of good quality of the educational system, qualified teachers, and ensuring the right to access better education. Addressing these fundamental components is crucial to, facilitating a good quality education system, providing a motivating, and conducive learning environment, and enhancing educational opportunities, in order to meet the unique educational needs of hearing-disabled individuals. Conclusion: In conclusion, the study underscores the pressing challenges faced by hearing-disabled individuals in Afghanistan's education system. Despite commendable initiatives, the government's neglect and financial constraints hinder optimal development. Two proposed approaches—special education and inclusive education—highlight potential solutions, emphasizing the need for teacher training and a supportive learning environment. The study also advocates for the universal right to quality education for hearing-disabled individuals, calling for improved services and special classes tailored to their unique needs. Limitations: The study acknowledges several limitations, such as the absence of data on hearing-disabled individuals in Afghanistan, security concerns during data collection, and the unavailability of sign-language interpreters.
Co-Design of Collaboration Monitoring Apps for Teacher-Children to support Autism in Religious Skills
Purpose: This study introduces a collaborative model involving teachers and children to enhance the religious learning progress of students with Autism Spectrum Disorder (ASD) in educational settings. The proposed collaborative model utilises assistive technology to monitor and support the learning journey of these children. The primary objective is to design a mobile-based assistive technology application, MyQuranic, tailored to support the development of religious skills in children with ASD. Method: Qualitative methods, including interviews and focus group discussions with UI designers, subject matter experts, and mobile app specialists, were employed to identify the needs and requirements in developing the MyQuranic application. Thematic analysis was applied to interpret the data, resulting in the emergence of findings based on key themes. Co-design principles were incorporated in the design process to ensure the active involvement of end-users, including individuals with autism. This collaborative approach aimed to create a user-friendly, contextually relevant, and effective technology solution, emphasising the unique perspectives and needs of individuals with ASD. Results: The study outcomes include the potential of design principles for teachers to monitor the learning engagement and interest of children with autism in religious studies using the MyQuranic application. The findings are expected to contribute valuable insights to the broader community, particularly researchers focused on autism-related studies. Conclusion: This study underscores the significant role of assistive technology in the education of children with autism, specifically within the religious education context. By employing co-design principles, the MyQuranic application strives to enhance social interaction skills, address individual needs, and contribute to the overall advancement of educational support for individuals with ASD.
Challenges faced and Strategies used by Teachers to enhance Academic Performance among Learners with Autism Spectrum Disorder (ASD) at a School in Zimbabwe: A Quantitative Descriptive Study
Aim: The study aimed to investigate the challenges that are encountered by teachers when teaching learners with autism at a high school in Zimbabwe and to identify strategies that can be used to enhance academic performance of the learners. Methods: A cross sectional survey study design was used in this study. A questionnaire was used to collect data from the teachers. A sample size of 20 teachers participated in the study. Ethical principles of autonomy, beneficence, non-maleficence, and justice were adhered to throughout the research process. Descriptive statistics were used to analyse all quantitative data. Responses to open ended questions were analysed thematically. Results: Key challenges reported by the teachers among leaners with autism were time management, meltdowns, difficulties in coping with routine changes, obsessive compulsive tendencies and being easily distracted. The teachers reported the following confidence levels with teaching learners with autism: 5% not confident at all; 15% slightly confident; 65% fairly confident; 10% more confident and 5% extremely confident. Most of the strategies currently being used at the school relate to visual teaching materials such as use of colour coding, objects, videos, and worksheets. Participants recommended the adoption of new strategies such as provision of therapies at the school, advocacy to raise awareness, use of modern technology and some changes to curriculum delivery. Conclusions and implications: Findings show that teachers at the school are using a range of strategies to support learners with autism despite some feeling less confident and having moderate knowledge about autism. Results imply a significant need for the teachers to be trained on autism and how the learners with autism can be better supported in order to enhance their academic performance. Findings may not be generalisable to other schools in Zimbabwe.
The Role of Communication and Information Access for Persons with Disabilities during the COVID-19 Pandemic in Thailand: A Qualitative Research
This study aims to explore the role of communication and information access of Thai persons with disabilities during the COVID-19 pandemic. Qualitative research with an in-depth interview as well as on-site and online focus groups was conducted. Criterion and snowball sampling were used to select participants. A total of 71 participants were recruited from different regions of Thailand. Based on the findings, This research identified the role of communication in helping persons with disabilities and their caregivers during crisis time separated into different levels of communication as first the self-reflection, the particular context cultivated them to play different active and passive roles in surviving the COVID-19 crisis. Second, group communication was beneficial in various aspects such as gaining social capital, empowering family cohesion, and these contradict some recent studies that reported sibling conflict during the lockdown. Finally, there was inequality access reflected from the mass communication level, there is no critical timely information, and insufficient accessibility support for PWDs in mainstream media.
Burden on Families of Children with Hearing Impairment and Intellectual Disabilities
Aim: The immediate families and/or caregivers of persons with disabilities often experience lifestyle changes that may manifest in the form of financial burden, restricted or dysfunctional family interactions, altered physical and mental health, etc. Similar problems are also faced by parents who have a child with disability. Though there are reports of changes in the lifestyle of parents of a child with an impairment/s, it is important to quantify and characterize the burden. This would, in turn, help in counseling. Objective: To quantify third party burden in parents of children with intellectual disabilities and parents of children with hearing impairments, and to compare the groups. Methods: Sixty-five parents were interviewed using the Family Burden Scale developed by Pai and Kapur (1982). Twenty-one parents had typically developed children, twenty-three parents had children with intellectual disabilities, and twenty-one parents had children with hearing impairments. The mean age of the children was 4.7, 6, and 4.8 years, respectively. Statistical analysis involved MANOVA to compare group data across subcategories and total scores, with Bonferroni-corrected post hoc tests applied as needed. Results: Parents of children with disabilities suffer significantly more burden than parents of typically developing children. Parents of children with intellectual disabilities face more burden than parents with hearing impairment. Among the various contributors to the burden, the financial burden was found to be the highest. Conclusion and implications: Parents of children with disabilities have to be made aware of the possible impact of having a child with disability in their family and how to handle such an impact. It is of utmost importance for any professional to look for the possibility of referring the parents to a psychologist.
Accessible public environment in Mysore: a case study of malls
Abstract Aim In India, attitudes towards people with disabilities have undergone a drastic change. Nowadays, they are also in the mainstream of social empowerment. It is always essential to study accessibility and how we can improve it, especially in public gathering places such as malls. Implications The findings from this study will help identify the accessible facilities provided by theses malls, so that people with disabilities can use them at their optimum. In addition, the recommendations from this audit will help the authorities of these malls to enhance their facilities to accommodate the accessibility needs of people with disabilities. Keywords: access audit, people with disability, malls, disability, disability act, the built environment
Barriers to Social Participation of Persons with Mobility Disabilities in the City of Accra, Ghana
Background: In most parts of Africa including Ghana, disability is shrouded in discrimination and marginalization. This may be due to the etiological belief that disability is based on witchcraft or curses. It has been observed that in these countries, there is the lack of focus on ensuring that systems and structures are designed to accommodate individuals with disabilities, particularly those with mobility disabilities. Aim: This paper explores the impact of physical and transportation access barriers on the social participation of individuals with mobility disabilities in Accra. Method: Using the photo voice methodology, the researchers engaged 10 participants with mobility disabilities. The participants were trained in photography, provided with cameras, and encouraged to capture scenes about the built environment and transportation access challenges they faced regularly. Results: The data (pictures) were analyzed with the participants’ involvement and shed light on accessibility challenges faced by individuals with mobility disabilities and the impact on movement, security, safety, and social interactions at the mezzo and macro levels. Conclusion and Implication: The policy of inclusivity is emphasized in ensuring that the needs of PWDs are taken into consideration to foster their rights as outlined in the Convention on the Rights of Persons with Disabilities and the achievement of the Sustainable Development Goals.
Editorial issue 3, 2023 - Women in the forefront of Support
Conceptual Analysis on Inclusive Education for Students Labelled with Severe Disabilities: A Critical Disability Studies Approach
The literature on inclusive education commonly focuses on students labelled with less severe disabilities and rarely focuses on students labelled with severe disabilities. Severe disabilities consist of a range of impairments requiring extensive daily support. This analysis examines the three pillars or impacts of inclusive education for students labelled with severe disabilities: proximity; social; and academic. The critical disability studies (CDS) perspective in education is described to examine the root of inclusive education and the historical, cultural, and social factors that impact educational settings and outcomes for students with disabilities more generally. The analysis applies on the critical disability studies framework in an educational context to promote systemic change and anti-ableist pedagogy in education. As systemic ablism is built into educational pedagogy and curriculum, this analysis applies the established CDS framework to students labelled with severe disabilities in inclusive education. Future research should examine the root of systemic ablism and work towards deconstructing ableist systems that oppress students labelled with severe disabilities.
Social Determinants of Health in the Lives of People with Disability
Purpose: Health is socially produced through the acquisition of socioeconomic, cultural and environmental domains, known as Social Determinants of Health (SDH). It is noted that people with disability experience social inequalities in health, as they are denied rights involved in the production of health. Therefore, this study aimed to review the existing literature on the SDH of people with disability and to identify the gaps in knowledge and challenges in this field. Method: An integrative review study was carried out in the Eric, PubMed and Science Direct databases. From 2013 to 2022, 1,252 articles were identified and 29 were selected for analysis. All the articles were in English and only one was based in Brazil. The studies were analyzed by categorization according to the layers of Dahlgren and Whitehead's SDH theoretical model. Results: The results indicated a greater number of studies carried out with guardians of people with disabilities. People with disability tend to experience depression and engage in less physical activity. Their social participation is hampered, mainly by the lack of accessibility to transport and voting. Their friendships are limited due to negative disability stereotypes. Working contributed to a feeling of well-being and social belonging, although access to employment was negatively impacted by their disability. It was pointed out that access to education reinforces the possibilities of access to formal work. Conclusion: People with disability face multiple and interrelated challenges to their health, which are influenced by the social determinants of health (SDH). Each sector involved in the provision of health services and social support has a role to play in addressing these challenges. Thus, public policies that promote the social and collective participation of people with disability, especially in the labour market, are essential.
Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0
Factors influencing Nutritional Needs of Children with Disabilities in United Arab Emirates: Special Education Teachers vs Parents
Aims: Children with disabilities are likely to have poor eating habits, resulting in being underweight or overweight. The United Nations in the Sustainable Development Goals, has strongly encouraged countries to promote good eating habits among children. However, studies on ways to effectively promote the nutritional needs of children with disabilities are quite limited. Using a health literacy model by Nutbeam as a framework, this study attempted to develop insights into the factors which may impact the understanding and practice of stakeholders about the nutritional needs of children with disabilities in the United Arab Emirates (UAE). Methods: The revised Food and Nutritional Literacy Scale was used to collect data from 149 parents and special education teachers. The survey data collected from parents and special education teachers were analysed by computing the mean and subjecting them to t-test and one- and two-way analysis of variances. Results: The results showed ambivalence of parents and teachers on knowledge and practical skills to promote good eating habits among children with disabilities. Moreover, variables such as age, participant type, nationality, gender, and awareness of nutritional policy were found to influence awareness about nutritional needs of children with disabilities. Conclusion and implications: The study concludes with a recommendation to policymakers in the UAE to expedite public education and the importance of professional development in the area of safe and good nutrition for children with disabilities by key stakeholders.
Higher Education of Persons with Disabilities in India: Past, Present and Future
Purpose: The article aimed at providing glimpses of the status of higher education for persons with disabilities in India, starting with the distant past and moving on to present day developments. It describes the impact of legislations and policies on the educational support systems through the years. Method: Desk review of relevant documents was undertaken and data was presented in the conventional narrative review style. Research questions address the status of higher education of persons with disabilities in India, the impact of Acts and policies and the support systems in place in the past and in the current educational systems. The main focus is on factors that lead to successful completion of higher education and challenges in accessing higher education by persons with disabilities in the country. Results: In ancient India, during the Vedic period, there were no special arrangements for higher education of persons with disabilities. During the Mughal and British periods as well the education of persons with disabilities was not addressed. After Independence, although the provisions mandated by the Acts have increased the support systems in universities and colleges, higher education requires more streamlining to meet the needs of persons with disabilities. Universities that have made innovative arrangements for the education of persons with disabilities have been mentioned. Conclusion: India has made giant strides in facilitating higher education for all, yet there are gaps in the educational system. The article puts forward some recommendations for achieving equitable higher education for persons with disabilities. Key words: models in higher education, Acts and policies on education, Indian education, educational administration, university education, students with disabilities
Features of Telerehabilitation and Considerations for Resource-Limited Settings: A Scoping Review
Aim: The global need for rehabilitation is extensive yet remains significantly unmet. Health systems, especially in low- and middle-income countries (LMICs), lack structures and resources to address the rapidly growing need for rehabilitation services. Telerehabilitation offers an innovative approach to narrow health systems gaps and facilitate rehabilitation services. Few studies have investigated features and functionalities used in telerehabilitation, especially regarding implications for resource-limited settings and LMICs. This scoping review aims to identify technological features and functionalities used to deliver telerehabilitation, map them onto clinical care processes, and outline gaps and directions for future research. Methods: This study utilized the PRISMA- checklist. Six databases were searched (PubMed, Embase, Scopus, CINAHL, Compendex, NARIC) to identify articles that described the remote delivery of rehabilitation services. Three reviewers screened and selected relevant publications. Descriptive statistics and qualitative content analysis were used to analyze full-text articles. Results: 135 articles were included in the full-text review. The publication year ranged from 1997 to 2021. The most frequently identified telerehabilitation feature was “data collection,” followed by “videoconferencing,” and “messaging.” Features mapped onto six clinical categories, with “implementation” accounting for 41% of all features, Only 18% of articles focused on LMICs. Few papers included a comprehensive platform of features, discussed integration into health systems, or included financial analyses. Conclusions: Diverse technological features exist for the remote delivery of rehabilitation services, but few cohesive platforms offer features across multiple clinical categories. Additionally, high income countries are overwhelmingly represented in the literature. Future directions for research include expanded focus on resource-limited settings and LMICS, discussion about financial considerations, and attention to health systems integration. Limitations: The generalizability of our findings are limited given the rapid growth of literature on telerehabilitation and continued development of apps and platforms since the time of review.
According to The Rights of Persons with Disabilities Act, 2016, ‘Person with disability’ means a person with long term physical, mental, intellectual or sensory impairment which, in interaction with barriers, hinders his/her full and effective participation in society equally with others. The persons with disabilities have equal rights to live a purposeful life of dignity. One means of achieving that is to have well qualified professionals engaged in educational rehabilitation of children with disabilities.
It is with great joy that I am introducing this new issue of the DCID journal. It has taken a while to publish this first issue of the DCID journal and before saying more about this I would like to thank all people who made it possible to publish the journal.
Memories that linger… my journey in the world of disability by Padmani Mendis: an autobiography
Thanks for the submission of your letter to the editor, which I have been hesitant in accepting. The fact is, most our readers are from low- and middle-income countries, and I would say that your letter is not in the interest of promoting rehabilitation services in these countries given the already usual lack of interest and political will to invest in the field of disability and rehabilitation there.
New Horizons in Addressing Fear of Falling among Elderly: A Narrative Review
Abstract Aim: The elderly segment of the population is increasing in most of the countries across the world. Fear of falling is experienced by a sizeable percentage of the elderly. Hence the authors, reviewed the current literature on fear of falling, evaluation and management of it. Methods: Extensive literature search was conducted in PubMed, Science Direct, Ovid databases with keywords, Fear of Falling, Fall Fear, Fall Efficacy, Elderly, Senior, Older, and Elders in various combinations. The search was restricted to articles published between 2016 to 2021 in English language. Results Out of 478 articles retrieved only 46 met the inclusion criteria and were included in the current review. The abstracts were reviewed initially and the full text of the studies which met the inclusion criteria were used for the preparation of the review. Conclusions: Fear of falling is reported up to 65% among non-fallers and 92% fallers among elderly. Fear of falling arises due to various bio-psycho-social factors. Tools measuring fear of falling are classified into those measuring fear of falling and those measuring fall efficacy. The 2 main management strategies are physical interventions and psychological interventions. Combination of physical and psychological interventions are more effective in fear of falling management. Limitations: Only articles published in English were considered.
Technology-Assisted Early Disability Identification and Monitoring in Children: A Model for Middle- and Low Income Countries
The initial 1000 days after birth is the period of major brain development. It is found that children with various neurological, musculoskeletal and developmental disorders and those “at high risk of disability” show early identifiable signs and symptoms. If an appropriate level of intervention is initiated at an early age, when neuroplasticity is at the maximum, a great extent of positive changes could be brought in their overall development. Recent advances in the technology could be used for early screening and monitoring of children. The authors discuss a technology-assisted early disability identification and monitoring system ideal for middle- and low-income countries.
‘Manasadhara’: a Day-Care Rehabilitation Programme for Persons with Mental Disorders in South India
Introduction: Health and Family Welfare Services (H&FWS) of Karnataka, a southern state in India having about 65 million population is funding the “Manasadhara Programme”, under which community-based psychiatric rehabilitation services (PRS) are offered through day-care centres, since 2014. Little research is carried out in this regard, despite significant money spent by the Exchequer. Objectives: To understand the PRS delivery-related challenges and beneficial effects from the experiential accounts of staff. Methodology: Authors reviewed various government documents concerning the funding and the number of service users available to the public. The authors also relied on their personal experience of supervising the PRS delivery at one such day-care centre for 18 months in collaboration with the HDK Results: H&FWS spends Indian Rupees (INR) 16,14,000 (USA $ 19,834) per annum per centre. Implementing this programme across the State costs INR 48,420,000 (USA $ 595,022) per annum. Data suggest that INR 73.1 (USA $ nine million) was spent between 2014-20. A range of beneficial effects to persons with mental disorders availing day-care services, and to their family caregivers are observed by the authors, and discussed in this article. Conclusion: Manasadhara programme appears to offer structured engagement and rehabilitation services for people who were able to access this. More research is needed to conclude this observation.
An Assessment of Community Health Workers’ Knowledge, Attitude and Practice of Rehabilitation Services in a Dhaka District Sub-Unit
Background: About 2.4 billion people live with various degrees of rehabilitation need in today's world, with a sizable proportion of this population coming from the community. Community health workers are one method of disseminating rehabilitative services among these individuals. Thus, it is critical to ascertain CHWs' knowledge, attitudes, and practises regarding rehabilitation to ensure success in primary health care. Objective: This study aimed to determine the knowledge, attitude, and practise of community health workers towards rehabilitation service in a selected sub-unit of Dhaka district. Method: A cross-sectional design was conducted through a self-administered questionnaire. Bloom’s cut-off ≥80%, ≥90%, ≥75% was used to determine adequate knowledge, a positive attitude, and good practise, respectively. The data were analysed using SPSS version 25.0. Result: The results of the study showed that a significant proportion of CHWs, specifically 105 (98.1%) and 89 (83.2%), exhibited inadequate knowledge and poor practise. However, it is noteworthy that 87 (81.3%) of the CHWs showed a positive attitude towards rehabilitation services. A significant statistical association was observed between socio-demographic factors such as age, education, designation, and experience and the level of knowledge, attitudes, and practises (KAP). Conclusion: The community health worker lacked adequate knowledge and was unaware of the need for rehabilitation services. Overall, they demonstrated a positive attitude towards rehabilitation services but were poor in practise. These findings indicate that CHWs must broaden their knowledge and practise to provide effective rehabilitation services. Limitation: The primary constraint is the lack of a standardised questionnaire to assess CHW knowledge, attitude, and practise. Another limitation is the findings' generalizability, as this study was conducted in a particular upazila. The findings may not apply to all Upazilas. There is insufficient literature to discuss from a national perspective due to Bangladesh's dearth of research in this field. Keywords: Rehabilitation service, Community health worker, Knowledge, Attitude, Practise.
Activity Limitations and Life Satisfaction: A Cross-sectional Study among Amputees in an Orthopaedic Rehabilitation Centre in Ghana
Aim To examine the limitations encountered by amputees in the performance of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) and its impact on their life satisfaction. Methods A quantitative cross-sectional study was conducted among 200 amputees at the Nsawam Orthopaedic Training Centre (OTC). The Groningen Activity Restriction Scale (GARS) and the Life Satisfaction Questionnaire-11 (LISAT-11) were used to collect data from the respondents. All statistical analyses were made using IBM Statistical Package for the Social Sciences (SPSS) software 23.0 and summarized in tables. A multivariate analysis was used to establish the relationship between activity limitation and life satisfaction. Results The respondents experienced some limitations in executing ADLs and IADLS with an overall mean activity limitation score of (36.57±10.93). There was a moderate life satisfaction of respondents with a mean score of (3.86±1.15). A multivariate analysis revealed that, there was a strong negative statistically significant relationship between activity limitations and life satisfaction [ß =--0.13, p=0.000] Conclusion and Implication The government of Ghana through the Ministry of Health and its agencies who are involved in the management and rehabilitation of amputees must explore these limitations to inform decision making during the planning and preparation of rehabilitation programs, resource allocation, and policy formulation for amputees to improve their overall satisfaction and well-being.
Caregiver Perceptions about Factors Impacting their Ability to Carry out Home-Based Therapy Programmes in Central Botswana: A Qualitative Study
Aim. Home-based programs, as an aspect of Community Based Rehabilitation (CBR), are provided as an integral part of remedial programming for children with disabilities in central Botswana. Observed difficulties with integration of these activities into daily living were deemed worthy of further investigation. The authors’ aim was to gain an in-depth picture of caregiver and therapist perceptions about the factors that impacted ability to carry out prescribed therapy. Methods. Purposive sampling was used. Therapists and caregivers were recruited for semi-structured qualitative interviews through active occupational therapy and physiotherapy contacts in central Botswana. Caregivers lived in different villages served by CBR and had been referred for therapy at the NGO branch office. Twelve questions for caregivers and 9 for therapists were presented during in-person meetings. Results. Interviews with 5 caregiver family members and 4 therapists were audio recorded and transcribed by the first author. Thematic analysis combined manual coding and NVivo software. Participant response themes described both direct and indirect influences on adherence to the home program. Direct influence themes were child characteristics, therapy competence and frequency, competing demands, and other issues. Indirect influence themes, which represented major impediments for carrying out a home program, were insufficient preparedness of healthcare providers, mismatched social welfare services, support system inadequacies, and language barriers. Conclusions. The findings of this study underscore the need for understanding the lived experiences of parents and other caregivers who are charged with carrying out home-based therapy programs for children with disabilities. Given this knowledge, workers in the CBR system can implement solutions in the community designed to educate policymakers and workers in the social welfare system while assisting clients to overcome barriers and advocate for their needs.
Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0
Linkage between International Classification of Functioning, Disability and Health Qualifiers to levels of the Functional Independence Measure: A proposal for applicability in clinical practice in a Developing Country
Aim: To propose a link between Functional Independence Measure (FIM) levels and International Classification of Functioning, Disability and Health (ICF) qualifiers for use in a developing country (Brazil). Methods: A multidisciplinary committee was formed that discussed the need for standardization of the classification so that different professionals could accurately record the functioning and, at the same time, be meaningful for the individual and his support group, allowing observation and participation in the rehabilitation process. They proposed steps to adapt linking ICF qualifiers with FIM scores and functional levels: 1. Transposition, 2. Parity, 3. Inversion and 4. Adaptation. Results: FIM’s seven levels of functioning have been linked to the five ICF qualifiers. FIM levels "7" (independent) and "6" (modified independence) have been linked to qualifiers ("0 = no problem" and "1 = mild problem)", respectively. FIM levels "4" and "5" have been grouped and linked to ICF qualifier "2 = moderate". FIM levels "3" and "2" have been related to qualifier "3 = severe". FIM level 1 which indicates complete dependence has been linked to qualifier "4 = complete". Conclusion: This methodology allows us to create a link between the FIM and ICF preserving clinically important information and having a description and clear relationship, thus being able to facilitate clinical use of the ICF.
School Readiness For Inclusive Education In Tripura, India
The changing educational scenario in India is seeing a huge emphasis on inclusive education. Efforts are seen in the direction of bringing the children from varied marginalised sections into the fold of inclusive classrooms. Inclusion of children with disability is of crucial importance too. The present study attempted to understand whether the schools in the state of Tripura are ready for inclusive education in its true sense. Data collected from the headmasters/headmistresses of the schools, the school teachers, and the observation of the physical infrastructure were analysed. Results suggest that the schools are far from being ready for inclusion, but are attempting to inch forward gradually.
Perceived Family and Organizational Support among People with Dwarfism in Tamil Nadu, India: A Qualitative Inquiry
Aims Despite the fact that society has become tolerant and inclusive, people of short stature still experience stigma and discrimination in every aspect of life. The study focuses on the peculiar challenges which extend from household to environmental infrastructure and also aims to understand the significance of family and organizational support to lead an integrated life. Methods The inclusion criterion to purposively select twelve adult participants in the study is that they must be an associate to the organization exclusively functioning for the empowerment of short statured. Data was gathered using semi structured interview guide and thereafter thematic analysis was done. Results Results revealed the existence of wide range of peculiar difficulties encountered daily which extend from household to public spaces, like difficulty in finding cloths which fit them appropriately, strain to cook with their body size, loss of breath in a crowd amongst average sized people, higher chances of heavy vehicle hitting them accidentally etc,. Dwarfs receive support from parents, siblings, partner and children through acceptance, care and emotional assistance to combat their inability and to accomplish their tasks. Organizational support assists them in the aspect of partner selection, career guidance and to voice out for their rights thereby increasing the chances of social integration. Conclusion The combined support of family members and organization is necessary to a dwarf person in order to overcome and cope with the peculiar challenges encountered every day to attain a living with utmost wellness. Limitations The data on the number of dwarfs in India is not available which makes it tough for the future researchers to give equal representations to study their issues and to give an overall generalization.
Copyright (c) 2024 The Author(s) https://creativecommons.org/licenses/by/4.0
Predictors of quality of life of persons with physical disabilities in Indonesia
Purpose: Indonesia lacks policies and programs to implement laws aimed at reducing the barriers that hinder the improvement of quality of life (QOL) in persons with disabilities. This study analyzed people’s attitude barriers, levels of disability, and QOL and its predictors in persons with physical disabilities. Methods: In this cross-sectional study, 202 participants with physical disabilities completed the attitude subscale of Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the World Health Organisation Quality of Life (WHOQOL-BREF). The Rasch model converted the ordinal data to the interval logits scale. Multiple linear regression was used to analyze QOL predictors. Results: Participants reported a mean WHOQOL-BREF score of 0.12+0.98 (poor QOL). Participants with poor QOL perceived people’s attitudes as impactful barriers (-1.68 ± 1.44). There was a significant difference in participants’ mean WHODAS 2.0 score with poor (-0.38 ± 1.06) and good QOL (-1.79 ± 0.77). The regression revealed the following significant QOL predictors: employment (B = 0.512), disability levels (B = −0.409), attitude barrier (B = −0.090), and age (B = −0.014). Conclusions: Persons with physical disabilities reported poor QOL. Higher disability levels, unemployment, perceived impactful attitude barrier, and older age are predictors of lower QOL of persons with physical disabilities.
Core Concepts of Human Rights and Inclusion of Vulnerable Groups in the National Mental Health Policies of Ireland, Kenya, South Africa, India, and Liberia
Background: Policy analysis is a powerful tool to ensure that policies are rights-based and socially inclusive. The primary aim of this study was to assess the level of commitment to core concepts of human rights and the inclusion of vulnerable groups in five national mental health policies across low-, middle- and high-income countries. Methods: Policy documents were evaluated using EquiFrame, a systematic policy content analysis framework. Policies were examined with regards to their coverage of 21 core concepts of human rights (Core Concept Coverage), their quality of commitment to these core concepts (Core Concept Quality), and their inclusion of 12 vulnerable groups (Vulnerable Group Coverage). An Overall Summary Ranking was also assigned to each policy with regards to it being of High, Moderate, or Low quality. Results: Each of the polices scored high on Vulnerable Group Coverage and Core Concept Coverage, although there were notable omissions. All policies, with the exception of Ireland, scored below EquiFrame’s criteria for Core Concept Quality. The Irish policy produced a High Overall Summary Ranking; while the Liberian, Kenyan, South African, and Indian policies each received a Moderate Overall Summary Ranking. Conclusion: All policies received their lowest scores for Core Concept Quality, signifying a need for policy-makers to ensure specific policy actions and monitoring mechanisms to address human rights in mental health policies. EquiFrame offers a constructive tool for mental health policy analysis in relation to core concepts of human rights and inclusion of vulnerable groups, which are considered key in successfully realising the Sustainable Development Goals.
Have Thailand’s Personal Assistance Services for Persons with Disabilities Evolved?
Aim: To consider the critical disability theory perspective and the Independent Living (IL) philosophy to not only identify how personal assistants (PAs) and persons with disabilities in Thailand have worked together during the COVID-19 pandemic, but also analyze the power relationships among stakeholders in the Thai personal assistance service system. Methods: This research applied a qualitative research methodology with three groups: PAs, persons with disabilities working with PAs, and administrators of PA service delivery agencies in four provinces in Thailand. Fifty-eight respondents participated in in-depth interviews and three focus group discussions. A matrix involving case and coding analyses was used to analyze the data. Results: PA services under the IL philosophy, which introduced by the Thai IL movement, were incorporated in a law to be implemented. However, this implementation was mostly managed and delivered by governmental offices responsible for charitable modes of care, with an emphasis on a volunteering spirit. The PA services were perceived as caregivers for older persons. During the COVID-19 pandemic PA services provided support to persons with disabilities and filled gaps in family care. Conclusion and Implications: The group leaders among persons with disabilities are active agents to strive for more participation at all levels in the PA system structure. It is important to train PA service users and have organizations of persons with disabilities to manage and monitor PA services. Hence, developing a PA career path with proper working benefits will be significant in creating sustainable PA services.
Streamlining the process to support higher education: a case for technological adoption
Understanding Barriers and Facilitators to Inclusive Education for Grade 7-9 Students with Disabilities in Ethiopia and Ghana: A Qualitative study
Background: Youth with disabilities in Africa continue to face significant challenges in accessing and participating in general education settings. This study aimed to explore the barriers and facilitators to inclusive education among youth with disabilities in Ethiopia and Ghana in Grades 7-9. Method: This study adopted a qualitative descriptive approach to explore the lived experiences of Grades 7 to 9 students with disabilities in Ethiopian and Ghanaian schools. We conducted five focus group discussions, with an average of six students in each focus group. We used thematic analysis to explore and analyze study participants’ schooling experiences. Results: The findings show commonalities and differences in the barriers and facilitators to inclusive education among students with disabilities in Ethiopia and Ghana. Participants reported that psychosocial, physical, systemic, and resource-related barriers hinder their access to education and school participation. They also identified facilitators including emotional and material support from various sources and personal coping strategies and perseverance in overcoming barriers to their schooling. Conclusion: A complex system of structural, institutional, and individual factors affect school enrolment and participation among grade 7-9 students with disabilities in Ethiopia and Ghana that require concerted and multisectoral inclusive education programming and supports.
Epistemic access for students using assistive technology in the introduction of online teaching
Purpose: The epistemic access and success for students with disabilities remain a topical issue in higher education, more so during the transition to online teaching and learning that was ignited by Covid19. This study aims to examine how the epistemic access of students using assistive technology was imperilled during Covid19 lockdown restrictions. Methodology: This qualitative study is based at this university of technology in KwaZulu Natal Province in South Africa. A total of 25 students with disabilities who use different assistive technologies were identified through purposive sampling, amongst 57 registered students with disabilities. The data was collected through semi-structured interviews and as a means of triangulation, a focus group was also held with thirteen students. The data was thereafter thematically analysed. Findings: Students reported extraordinary difficulties in accessing and utilising assistive devices, due to lack of appropriate assistive technology, technical skills, poor network, and support. This perpetuated discrimination, social exclusion, and injustices in higher education for students with disabiliites. Some had to double their efforts to access their lessons and assessments. Even though their epistemic access was disrupted; they displayed a resilient character. Conclusion: Online or blended teaching and learning appear to be the future trend in higher education, thus; effective plans and systems alignment are required to avoid exclusion of students with disabilities in the learning digital space. To continue to promote social inclusion and inclusive education in higher education institutions, the provision and procurement of assistive technologies must be prioritised. Students with disabilities should be amongst other key stakeholders in the planning of future teaching and learning.
An inclusive education for students with visual impairments in Lao People's Democratic Republic: Qualitative study
Aim: This study aims to explore teachers’, students’ and parents’ perspectives on practices used in inclusive education (IE) settings for students with visual impairments (SWVIs). The perspectives were then used to create a proposed suitable IE model for those students in the Lao People's Democratic Republic (Lao PDR). Methods: Qualitative study was designed. Data were collected through focus groups, in-depth interviews, and non-participatory observations among 20 participants including teachers, parents and SWVIs. Results: The results showed that inclusive education has been prioritized, special schools or centers have been still needed but for teaching Braille and completing grades 1 and 2 before entering the neighboring inclusive primary schools. IE policy exists but guidelines for implementation are missing and coordination and cooperation among stakeholders’ is poor. Conclusion and implementation: The proposed IE model should be consisted of clear policy and implementation guidelines as well as cooperation and support among stakeholders.
“I will die before God wants me to.” Factors that affect older adults’ attendance, of public healthcare rehabilitation services in Gauteng, South Africa
Aim: Healthcare facilities are valued out-of-home places older adults’ visit and a key constituent of Healthy Ageing. The study explored factors that affected older adults’ rehabilitation attendance in Gauteng’s public healthcare services, strategies to mitigate the barriers they confronted, and suggestions for improving their experiences. Methods: An exploratory concurrent mixed methods design saw 84 multi-professional rehabilitation clinicians, working in public healthcare facilities, and interview with 393 community dwelling older adults in their rehabilitation practices. A semi-structured interview guide was used. Clinicians kept field notes and participated in discussion groups. Qualitative data were predominant and analysed through inductive content analysis. Quantitative data ware analysed using descriptive statistics. Results: Transport and fiscal poverty were predominant factors affecting older adult attendance of rehabilitation services in urban low-income communities. These affected compliance with attendance and effort exertion during rehabilitation. The perceptions and personal experiences of older adults when attending rehabilitation, along with their preference to attend out-of-home places that have multiple purposes and where they can be of use to their communities, were also factors that should be taken into consideration. Conclusion: Older adults’ living in South African urban areas, access to public healthcare is intrinsically tied to the communities that they live in. Factors outside of and inside healthcare affected their rehabilitation attendance. Cognisance of and insight into the complex and multifactorial nature of these factors is necessary for rehabilitation service providers to become part of strategies that address older adults’ access to public healthcare rehabilitation. Actuating and strengthening resources within families and communities, fortifying the dignity of older service users, and incorporating the principles of community-oriented rehabilitation services are suggested as starting points. Implications for rehabilitation: This article provides evidence towards understanding, insight, and knowledge of the realities that South African urban older adults, from low-resourced communities, face to get to rehabilitation. Attending rehabilitation appointments is affected by multiple factors such as transport poverty, limited funds, crime, public humiliation, personal health, and experiences at medical facilities. These findings contribute to the WHO’s Decade of Healthy Ageing agenda and could be taken into consideration by national and local rehabilitation service providers and related stakeholders. Limitations: Due to the uniqueness of South African settings and the use of a convenience sample, external validity is limited. The authors suggest that the results be seen as transferable only to other urbanised areas within South Africa. Interviews were held with older adults who arrived at healthcare facilities. The views and realities of those that cannot make it to healthcare facilities might add additional evidence to the problem investigated. Within South Africa (Ramafikeng & Marshall, 2023), and in other African countries (Kori-Siakpere et al., 2024), differences in age, language, education, and ethnicity affect communication and interaction. In this study, there were differences in age, language, education, and ethnicity between clinicians and the older adults they were interviewing. During discussion groups after the interviews, clinicians reported experiencing these differences as a barrier when conducting the interviews. This could have affected the quality and content of the interviews.
Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Communication Disorders and Artificial Intelligence: A Short Bibliometric Review
Aim - Due to the quadrupling in publications since 2022, a bibliometric study is a need of an hour. This study offers a thorough analysis of communication disorders across an appropriate time period. Methodology - Based on the Pubmed database, a total of 8713 papers about communication disorders were examined during the time period 1963-2022. At the end, 6233 publications and 7012 key terms were retained specially related to communication disorders. Result - This study systematically reviews research articles on numerous parameters such as (i) cumulative frequency of keywords (ii) analysis of common key terms, (iii) top 10 research scientists, (iv) research article production of top 10 researchers, (v) co-occurrence of key terms Conclusion - The paper examines the literature using meta-perspectives to analyses the quantitative traits of communication disorders. The proposed analytical study will be a vital resource for substantive discussion about potential future research plans.
COP27 Climate Change Conference: Urgent Action needed for Africa and the World
Copyright (c) 2022 The Author(s) https://creativecommons.org/licenses/by/4.0
Representation of Acquired Disabilities in Australian Research, Policy, and Practice: a Scoping Review
Purpose: Emerging data shows that Australia has a significantly higher number of persons who acquired a disability after birth than persons with congenital disabilities. Little is known about the impact of acquired disabilities on employment outcomes to guide employers, disability service providers and policymakers. This scoping review outlines the gaps in knowledge about the impact of acquired disabilities on employment participation and discusses the conflicting positions of disability models. Method: A review was conducted of academic and grey literature on disability employment research and policy, published between 1990 and 2021. These were synthesised to analyse the representation of acquired disabilities in research and policy. Results: It was found that the term “acquired disabilities” is not clearly identified and defined in the literature and the application of terms of reference for disability vary between disability peak bodies and service delivery organisations. Conclusion: Future research on disability studies needs to capture the definition and identification of acquired disabilities and how they impact on employment outcomes, to foster a unified definition of disability and to devise a refined model of disability that would guide research, policy and practice.
Analysis of Health, Disability, Gender and Disaster Risk Reduction Policies in Nepal using a Human Rights-based Approach
Background: People with disabilities (PwDs) and women often face difficulties in accessing healthcare and life-saving procedures and are at greater risk of death, injury, and long-term negative impact on their health and well-being at the time of disaster. The public policies in low-resourced countries are rarely analyzed to understand whether those policies include adequately the issues of vulnerable populations to support them during disasters in line with human rights principles. Aim of the study: This study assessed the extent to which the issues of PwDs, women, and girls are incorporated in line with human rights principles in the key policies related to health, disability, gender, and disaster risk reduction in Nepal. Method: A content analysis of selected policies was carried out using EquiFrame, which analyses policies for the inclusion of vulnerable groups based on the Core Concepts of Human Rights. Fifteen policies were analyzed regarding the frequency and quality that included PwDs, women, and girls in the documents. Results: Nepal’s health policy (n=4) covered 52% of the Human Rights Core Concepts, while disability (n=3), gender (n=2), and DRR policy (n=6) covered 46%. The overall qualities of those policies were ranked significantly low, ranging in the quality index from 8 - 28. Conclusion: The policies inadequately incorporated human rights principles for the inclusion of disability and gender and ranked low in terms of quality to address their health needs and rights. To enhance social inclusion and promote equity in health, it is suggested that the human rights approach be followed as guided by the EquiFrame while developing policies.
Incorporating Music Therapy-Informed Techniques into CBR: Experiences from Practice with two Children and their Families in Rural India
Purpose: This experiential account describes the process and observed impact of including music therapy-informed techniques into community-based rehabilitation for two boys with disabilities in rural India. The aim is to inform other CBR facilitators and grassroots organisations of the potential of including music in CBR. Method: This is reported from the perspective of two experienced CBR programme leaders. While their experiences of integrating music into CBR are narrated, the methods used are reported elsewhere in an accessible format (see in-text for link). The individual cases are part of an international research collaboration between Australian music therapists and Indian CBR facilitators. Results: In the two cases described, music in CBR supported existing physical development goals, and increased motivation and engagement in CBR for the children and their supporting communities. Conclusion and Implications: Online peer-mentoring between music therapists and CBR facilitators can support CBR facilitators to use music in ways that supplement their existing skills. It also offers novel and engaging new ways for them to motivate participation and support development for children with disabilities and their families. CBR facilitators found that they were able to effectively embed music into their CBR work and that doing so enhanced their enjoyment and engagement in CBR.
Exploring Employer’s Practices for Persons Living with Disabilities and Employers' Implementation of the Persons with Disability Act in Zambia: A Qualitative Study
Purpose: The study aimed to explore the employers’ practices for persons living with disabilities and employer’s implementation post-enactment of the Persons with Disability Act No. 6 of 2012 in the public sector. Material and method: A qualitative phenomenological study design was used, and data was gathered through in-depth interviews with human resource directors, managers, and commissioners. A total of eight participants took part in the in-depth interviews. The analysis was performed using Atlas.ti version 7 software. To allow the themes to emerge from the data, thematic analysis using an inductive approach was used. Results: Only a few persons living with disabilities were employed at the headquarters of the three government organizations. The study found that employers mainly use the Employment Act and do not take the Persons with Disability Act no. 6 of 2012 into account when recruiting. Furthermore, the majority demonstrated a lack of knowledge of the provisions enabling disability inclusion in workplaces as well as awareness of the Persons with Disability Act no. 6 of 2012. Conclusions: The study emphasizes the gap between developing and implementing Disability Act policies. Raising awareness of the Persons with Disability Act No.6 of 2012 and its provisions supporting the inclusion of persons with disabilities in the workforce, as well as strengthening employers’ knowledge of these policies is essential for its successful implementation.
Enhancing Inclusive Education for Children with Dysgraphia: Assessing the Knowledge of Basic School Teachers in the Nkwanta South Municipality in Ghana
Introduction: Children with learning disabilities experience difficulty in acquiring basic academic competencies compared to those without disability, and dysgraphia is not excluded. Aim: This study assesses the knowledge of teachers on children with dysgraphia in Ghana. Methods: The study adopted a cross-sectional study design with quantitative approach. A stratified probability sampling technique was used to select 98 teachers. The study employed a structured questionnaire to interview respondents in eight (8) communities. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 17. Results: The study found that 94% of basic schoolteachers possess moderate knowledge of dysgraphia. Again, of the 98 respondents, the majority gave ‘cannot tell /neutral' responses on knowledge of characteristics of dysgraphia: awkward pen or pencil grip (65/98 respondents), spelling errors (74/98), difficulty getting thoughts on paper (53/98), and taking longer to complete a written sentence (68/98). However, respondents have good knowledge of dysgraphia children producing bad writing (89/98), unfinished words (86/98), a mixture of upper- and lower-case letters (79/98), irregular spacing of words or letters (82/98), and writing that is either too small or too large (56/98). Conclusion: Few Teachers have adequate knowledge of the characteristics of children with dysgraphia. Limitations: The study would have been interesting if children with dysgraphia were directly involved, where they would be asked to write sentences, and a video version was taken and published with this manuscript.
Disability and Quality of Life in Persons with Locomotor Disability: Determining Factors
ABSTRACT Purpose: The lives of individuals with locomotor disabilities are often filled with challenges and obstacles. Disability has become a more observable societal reality; social fencing practices limit the lives of people with disabilities, and those who lack social agency structurally are unable to enjoy a life course. According to studies on locomotive impairment with inclusion and Quality-of-Life, they encounter social issues as a result of an unbalanced social institutions. In this context, this study throws light on the issues that people with locomotive impairment confront, particularly in terms of their perceived quality of life. Method: Descriptive research design were employed by using semi-structured interview schedule. The simple random sampling technique was useful to reach 98 persons with locomotor disability in Tamil Nadu specifically in Dharmapuri district. Further, the inclusion and exclusion criteria of the study sample are discussed in detail. Results: The consequences of disability vary depending on a person's gender, age, marital status, family size, and social support network. They are frequently judged solely on their flaws and are denied social participation, lowering their quality of life. Findings from the study indicate that persons with locomotor impairments are financially disadvantaged; they are mostly low-income and jobless. Further, Health-related quality of life includes domains such as physical, mental, emotional, and social well-being that have an impact on attaining a good standard of living. Conclusion and Implications: The construction plays a vital role in a disadvantaged environment that leads to impairment to the disability with the maximum inconvenience. At the outset, financial dependency on the pension scheme of the government seems high in the study area. Hence, awareness for persons with locomotor disabilities, on accessible and affordable opportunities can be given to them based on their physical or mental abilities.
Power at your Fingertips to Empower Others!
Community-Based Rehabilitation in Settings of Armed Conflict, Natural Disaster, or Mass Displacement: A Scoping Review
Purpose: Since its inception in 1978, CBR approaches have been implemented in many countries and settings. This study aimed to synthesise knowledge available in the scientific literature about health-related CBR programmes in settings affected by armed conflict, natural disaster or mass displacement. Method: Databases searched in this scoping review were MEDLINE, CINAHL, EMBASE, PsycInfo and Google Scholar. Articles were included if they focused on health-related CBR undertaken in communities affected by armed conflict, natural disaster or mass displacement. Descriptive statistics and qualitative content analysis were used to analyse the selected articles. Results: Of the 5537 articles screened, 31 met the eligibility criteria. Collectively, they address diverse CBR programmes across crisis settings. Factors that promoted successful CBR implementation were strong community and family support, and the development of CBR activities tailored to local cultural and social contexts. Barriers included human resource limitations and insufficient collaboration. Authors of the selected articles made recommendations for CBR implementation in crisis settings, including prioritising efforts to enhance community involvement, investment in crisis preparedness, initiatives to increase disability awareness, and the adoption of long-term management strategies. Conclusion: CBR programmes can make important contributions in crisis settings. Community involvement and access to resources are crucial for programmes to effectively respond to the needs of the individuals and communities they aim to serve and for the sustainability of these initiatives. The findings of this review can help to inform CBR stakeholders regarding opportunities and challenges for developing and carrying out CBR programmes in crisis settings, including initiatives to establish guidance or policy.
Perceptions of Youth with Disabilities in Bhutan on Family Support, Attitudes, and Encouragement towards Meaningful Community Engagement: Implications for Parental Self-Efficacy
Purpose: Awareness and attention towards disability-inclusion in Bhutan has steadily increased over the last few years. However, there are still many challenges that remain to support meaningful employment and community engagement for youth with disabilities such as inequity, discrimination, stigma, inaccessible physical environments, and bullying that seems to impact the self-efficacy of the youth with disabilities themselves. In this article, we explore how youth with disabilities in Bhutan perceive their family’s level of support, attitudes, and encouragement in order to explore the implications of parental self-efficacy. Method: This article reports the perceptions of youth with disabilities (n = 216; Male = 127 & Female = 87) about family attitudes, support systems, and family encouragement towards their employment and the role of parental self-efficacy beliefs. The participants for the national level survey were recruited through purposeful and snowball sampling procedures. Data were analysed using descriptive and inferential statistics. Results: Findings from this study suggest that youth with disabilities were supported and encouraged to contribute to the family livelihood within the home, but less so out in the community, indicating lower parental self-efficacy beliefs about their child with a disability’s capabilities to contribute in the community and their own ability to facilitate and ensure that contribution. Conclusion: Negative family attitude and lower self-efficacy – and, equally, the youth with a disability’s perception of their negative family attitudes and low self-efficacy – can be detrimental as it limits the ability of persons with disabilities to fulfil and achieve their life goals. This article recommends further research into the self-efficacy beliefs of the parents themselves, as well as further engagement, awareness, and training for parents to support their efforts to support their child with a disability to engage in meaningful employment and community activities.
Access to Public Healthcare Rehabilitation Services by Persons with Disabilities in South Africa: a Scoping Review
Purpose: The South African National Health System, funded by National Health Insurance, aims to ensure universal access to quality healthcare for all South Africans. The aim of this scoping review was to explore barriers and facilitators experienced by persons with disabilities when accessing rehabilitation services in public healthcare facilities in South Africa. For this scoping review, disability was seen as defined in the International Classification of Functioning, Disability and Health (ICF), and access was understood to include availability, accessibility, acceptability, and affordability of rehabilitation. Method: Sources were included if they were published between 2012 and 2021, in English, and contained primary research undertaken in South Africa pertaining to accessibility to public healthcare facilities for rehabilitation by persons with disabilities. Following Joanna Briggs Institute guidelines, the search included CINAHL, EBSCOhost, Scopus, Web of Science, PubMed, Science Direct, SciELO, and Google Scholar. Rayyan was used to screen sources for eligibility. Ineligible sources were removed, based on titles and abstracts, and the eligibility of remaining sources was confirmed in the full texts review. Although 70 sources were identified and screened, only 19 were found to be eligible for inclusion. Data was extracted on Microsoft Excel and Word templates. Analysis and synthesis were done using Microsoft Excel and Taguette. Results: The findings showed that the most prominent barrier restricting the access of persons with disability to rehabilitation was affordability. Other barriers were availability and acceptability of services. Physical access to rehabilitation was affected by inaccessible transport and community mobility, social and community barriers. The facilitators that were most prevalent were personal attitudes, family and friends - societal and community - and governmental support. Conclusion and Implications: This scoping review confirmed that access to rehabilitation services in public healthcare facilities in South Africa is a multifaceted issue, which requires a multisectoral approach to achieve sustainable and effective solutions. Intersectoral and interprofessional approaches by public healthcare rehabilitation service providers and stakeholders are necessary to improve access to services. Better reliance on facilitators that are already in place should improve access to rehabilitation services. This includes improved collaboration with community leaders, family members and users of disability services.
Pushing Down the Walls: Advocating for “Rehabilitation for All” in South Africa
This article aims to advocate for providing rehabilitation to all South Africans in the context of achieving universal health coverage. The potential benefits of accessible rehabilitation for South Africans with chronic disease and disability are described and supported by a description of national and international policies that promote the delivery of primary healthcare services (including rehabilitation) into or near people’s homes. A discussion follows on why the ‘walls’ separating professional silos need to be broken down to ensure that rehabilitation can be provided in a cost-effective and sustainable manner. The authors also suggest ways in which advocacy efforts can be strengthened to assist in this call for “rehabilitation for all”.
School-aged Children with Down Syndrome in Galle, Sri Lanka: Relationship between Level of Disability, Resource Use and Caregiver Burden
Aim: We assessed the relationship between the level of disability amongst school-aged children with Downs Syndrome and overall caregiver burden, and the potential moderating effects of social support and external service access on the caregiver/child relationship. Methods: Caregivers were recruited to complete the Caregiver Priorities and Child Health Index of Life with Disabilities (CP-CHILD) assessment and the Caregiver Difficulties Scale (CDS) and answered questions regarding resource use. A subset of 15 surveyed caregivers were also invited to participate in semi-structured interviews. Regression analyses were used to investigate the impact of resource usage on the association between level of disability and caregiver burden. Results: Lower perceived levels of child disability were related to less caregiver burden. Thirty-seven percent of caregivers reported receiving assistance from external supports. The relationship between the child’s level of disability and caregiver burden was attenuated by family support for caregiving and school attendance in a general class in a general school. Conclusions and Implications: External supports reduce caregiver burden but may not be available to many caregivers.
Outcomes of Cognitive-Communication Intervention in Traumatic Brain Injury: a Case Study
Purpose: Traumatic brain injury (TBI) is an acquired non-progressive condition, resulting in distinct deficits of cognitive communication abilities such as naming, word-finding, self-monitoring, auditory recognition, attention, perception and memory. Cognitive-communication intervention in TBI is individualised, in order to enhance the person’s ability to process and interpret information for better functioning in family and community life. The present case study illustrates the cognitive-communicative disturbances secondary to TBI and its intervention outcomes in a female adult in India. Method: The 43-year-old subject attended 20 sessions of cognitive-communication intervention which followed a domain-general adaptive training paradigm, with tasks relevant to everyday cognitive-communication skills. Results: Improvements were found in perception, short-term and working memory, with reduction in perseverations and naming difficulties. Conclusion: Rehabilitation of clients with moderate to severe head injury can be done effectively through the appropriate selection of goals and activities relevant to the functional needs of each individual.
The Experiences of Public Transport Drivers with People with Disability in the City of Tshwane, South Africa
Purpose: Public transport drivers are an intermediary between transport infrastructure and passengers with disability. The purpose of this study was to understand the perspectives of public transport drivers on their encounters with passengers with disability, and the impact this has on public transport inaccessibility. Method: A qualitative research approach was applied. A semi-structured interview guide was utilised to collect data from public transport drivers. Thematic analysis was used to analyse data and an inductive approach was followed to allow data to determine themes. Results: The study found that public transport drivers operate under challenging conditions. The drivers' main issues and challenges are lack of training and knowledge on disability, negative attitudes displayed by passengers, and having to satisfy conflicting demands from both employers and passengers with disability. The conflicting demands are intensified by the lack of universally designed vehicles and infrastructure. Conclusion: The actions of transport providers contribute to transport inaccessibility. Transport issues and drivers’ concerns established in this study could help to enhance driver training, improve transport services and enrich inputs into public transport policies.
What do COVID-19, Conflict and Climate Change have in common?
Implications of a Holistic Rehabilitation Approach following Spinal Cord Injury: a Case Study from India
Purpose: Spinal cord injury causes temporary or permanent changes in spinal cord function. This case report highlights the significance of multidisciplinary rehabilitation team interventions after surgery for spinal cord injury. Method: The paper examines the case of a 16-year-old girl, diagnosed with spinal cord injury after a traumatic incident four months earlier. The adolescent (client), a 9th grade student from a lower socioeconomic background, presented with weakness in the lower limbs, pressure ulcer, and neuropathic pain. Along with dependency for lower limb activities of daily living, there was severe biopsychosocial impairment. The client’s mother had no respite during the entire process of caregiving. On the basis of psychosocial findings, specific customised interventions were administered to the client and her mother, on a daily basis, for one and a half months. Results: Different scales were used to assess the quality of life (BREF-QoL), illness perception (Brief IPQ) and depression and anxiety (HADS) of the client, both pre and post interventions. A comprehensive tailor made psycho-social interventions were provided during and after the rehabilitation and significant improvement was found. Scales to assess the social and occupational functioning (SOFAS) of the family and perceived family burden also noted positive changes. Conclusion: Psychiatric social work interventions play a vital role in rehabilitating persons with neurological conditions. Adopting holistic rehabilitation approaches enhances the well-being and quality of life of persons with spinal cord injury and their families.
Integrating Traditional Bone-Setting and Orthopaedic Medicine Practices in the Management of Fractures in Nigeria: Community-Based Rehabilitation Model in Perspective
Despite the documented advancements in orthodox medicine, traditional bonesetters (TBS) continue to be well patronised for the management of musculoskeletal injuries in low- and middle-income countries such as Nigeria. However, the practice of traditional bone-setting is often marred by the lack of trust and belief among orthodox healthcare practitioners on the one hand, and the serious post-fracture complications associated with this practice, on the other. The identified downsides have resulted in the stakeholders’ call for the integration of TBS into the national orthodox healthcare services in Nigeria. Despite efforts toward the integration, implementation and realisation remain unfulfilled. One identified potential missing link is the lack of a community-oriented pathway such as the community-based rehabilitation (CBR) model in the previous efforts. This brief review aims to elucidate the concept of CBR in relation to the proposed integration process. It highlights the need for integration, the notions of the CBR model as well as the conceptual framework for CBR. CBR has been showcased as a globally accepted model which encompasses pragmatic strategies or policies for community managers and stakeholders in a wide range of areas for people in need of essential services. It can be a suitable model for integrative management of fracture cases.
Developing an Assessment Tool for Post-Surgical Paediatric Rehabilitative Care in Tanzania: an Interprofessional Approach
Purpose: Located in Arusha, Tanzania, The Plaster House provides rehabilitative services to children receiving surgical care for treatable disabilities. This article describes a set of outcome measurements developed in a collaborative relationship between an evaluation team from The Plaster House staff and St. Catherine University faculty, focused on effectively and efficiently collecting post-operative evaluation and outcome data from a rehabilitative care facility for children with treatable disabilities. Method: From seven care pathways utilised for surgically treatable disabilities (cleft lip and palate, spina bifida, skeletal fluorosis, osteomyelitis, burns, clubfoot and hydrocephalus), an interactive process led to the development of a medical assessment tool for monitoring and evaluation with limited electronic health record and staffing capacity. Results: The medical assessment tool serves multiple purposes for the rehabilitation programme, including monitoring participants’ progress, evaluating the effectiveness of current practices, and sharing data with stakeholders. The tool includes collection of demographic and background information, one to three diagnosis-specific indicators to measure progress, and three questions related to typical development (activities of daily living, play, and social interaction). Conclusion and Implications: Due to the delayed ability to conduct a site visit, the evaluation team relied heavily on effective communication to sufficiently relay challenges and successes in developing and implementing the tool. The proposed medical assessment tool developed by an interprofessional team has the potential to feasibly capture post-operative outcome measurements during rehabilitative care.
Universal design: An embedded case study on the approach towards the inclusion of students with physical disabilities in higher education in India
Aim: Research on students with physical disabilities (SWPDs) in higher educational institutions (HEIs) often focuses on students’ abilities rather than environmental barriers. Architectural barriers are notably the major roadblock for SWPDs in higher education. Although Indian HEIs are doing architectural modifications (e.g., accessible ramps, washrooms) creating a conducive built environment that supports SWPDs’ meaningful participation seems a distant dream. This study aimed to explore the architectural barriers faced by the SWPDs and the environmental requirements for social participation and inclusion. Methods: Using a qualitative approach, the study employed an instrumental embedded case study to explore the need for the Universal design to promote the inclusion of SWPDs in HEIs. Six students with physical disabilities, aged between 22 and 30 years, and their teachers (n=5) participated in the study. Data were collected using semi-structured interviews and participatory observational accessibility assessment. The data was analysed using categorical aggregation followed by cross-case analysis through constant comparisons on similarities and differences of themes. Results: Findings showed that two‐thirds of the participants experienced barriers to participation in the built and the social environment. Most barriers originated from the institute’s-built environment design and activities conducted on the premises. Students using a wheelchair or walking frame experienced significantly more participation barriers than students using crutches or walking sticks. The results suggested the area in need of most improvements to promote SWPD’s participation are the indoor spaces (for example, corridor, classrooms) and opportunities for vertical movements at the institute. Conclusion: Failure to provide adequate built environmental modifications results in SWPDs’ restricted participation or exclusion from the participation opportunities in and out of the classroom. Implications: Our study findings can have implications across future research, practices of architectural design, HEIs, and the policies to promote inclusion, optimal participation, and social interaction of SWPDs within HEIs.
Searching for Jobs: The Experiences of Persons with Disabilities in the Komenda, Edina, Eguafo, Abirem Municipality of Ghana
Purpose: The study investigated the job search experiences of persons with disabilities in the Komenda, Edina, Eguafo, Abirem Municipality in the central region of Ghana. It examined how attitude of employers influence the kinds of jobs persons with disabilities do and how these attitudes influence their future job search. It also examined major barriers to successful job search and placement and recommended measures to improve employability of persons with disabilities. Methods: The study adopted descriptive and qualitative study design. Purposive sampling was used to select twenty participants who had ever searched for jobs. They included visually impaired, hearing impaired and people with physical disabilities. Data were collected through face-to-face interviews. Interviews were conducted in the local language, fante and recorded. The raw data was transcribed and translated from Fante to English, using the notes taken during interview and compared with information captured by the audio recorders. The transcribed data were grouped under various subthemes based on study objectives and analyzed thematically. Data were analyzed through thematic approach. Results: Findings from the study revealed that attitudes of employers towards persons with disabilities who search for jobs were pitiful rather than considering them based on their professional qualification. This resulted in meager wages leading to them not being satisfied with their jobs. This attitude of employers according to participants deter them from searching for future jobs but will prefer self-established jobs. Inaccessible workplaces and access to information were also major barriers reported by participants. Conclusion and Implications: It is recommended that stakeholders promote and intensify public education on disability and the need to respect all persons regardless of background. The working environment should also be made accessible to all people regardless of their disabilities to ensure an improved economic status and inclusive society.
Measuring Access to Assistive Technology using the WHO rapid Assistive Technology Assessment (rATA) questionnaire in Guatemala: Results from a Population-based Survey
Purpose: Using the World Health Organisation (WHO) rapid Assistive Technology Assessment (rATA) tool, this study aimed to estimate the population level self-reported Assistive Technology use and unmet need in the province of Sololá in Western Guatemala. Method: Sixty-one clusters of 50 people, 2+ years of age, were selected using probability proportional to size sampling. Households within clusters were selected using adapted compact segment sampling. Participants were interviewed using the standardised WHO rATA questionnaire. Results: A total of 2874 persons were interviewed (response rate 94%). The prevalence of self-reported unmet need for at least one assistive product (AP) was 17.1% (95% CI 14.7-19.8), use was 7.4% (95% CI 5.9-9.3) and overall need was 20.3% (95% CI 17.6-23.2). These indicators all increased significantly with increasing age and level of functional difficulty. The three most common APs used in Guatemala were spectacles (5.8%), canes/sticks/tripods/quadripods (0.8%) and pill organisers (0.3%).The most common APs reported as unmet need were spectacles (13.4%), canes/sticks/tripods/quadripods (3.1%) and hearing aids (2.6%). Among assistive product users, most of them (53%) sourced their APs from private providers and paid out of pocket (58%) and the majority (93%) were quite satisfied/very satisfied with their APs. Cost was the most commonly reported barrier to AP use. Conclusion and Implications: There was a high total need and unmet need for assistive products in the province of Sololá in Guatemala, and lower use of APs. These findings highlight an urgent need to strengthen Assistive Technology provision to improve access in this setting, particularly for older people, and to address cost-related barriers and increase public provision. The findings can be used to raise awareness of the AT needs in the population in Guatemala, including for older people and people with functional difficulties, and to advocate and plan at local and national levels to make assistive products more accessible.
Assessment of demographic variables affecting teacher attitudes towards inclusive education in Ghana.
Objective: This study examined teachers' attitudes toward the inclusion of learners with special educational needs (LWSEN) in three schools in the Central region of Ghana. Methods: The study adopted a cross-sectional survey involving 142 teachers, [68 (48%) female teachers and 74 (52%) male teachers], selected from two special schools and one inclusive school in the Central Region of Ghana. Independent T-test and one-way ANOVA measures were used for data analysis. Results: Differences exist in male and female teacher attitudes, with age found to be the most influential in determining teacher attitudes toward inclusion. Female teachers were more positive in overall attitudes than male teachers. Younger teachers aged between 20-30 years and being classroom teachers were associated with positive attitudes towards LWSEN. However, the level of education and length of professional service did not affect teacher attitudes toward LWSEN. The study recommends that in-service training be organized for teachers of LWSEN Conclusion: The study concluded that generally, educators in special schools and inclusive schools in the Central Region of Ghana have a positive attitude towards LWSEN and recommends further training as a means of improving teacher attitudes towards inclusion in Ghana.
Content and Effectiveness of Community-Based Rehabilitation on Quality of Life in People Post Stroke: a Systematic Review with Meta-Analysis
Purpose: The study aimed to review the content and evaluate the effects of CBR on quality of life (QoL), balance, and walking capacity for people post stroke, compared to other rehabilitation protocols or no care. Methods: A systematic search and meta-analysis of clinical trials of CBR interventions for stroke survivors was conducted. Five online electronic databases (MEDLINE/PubMed, Web of sciences, Scopus, Hinari, and Pedro) were searched for articles published in English and French languages, from inception up to December 2021. Sixteen studies were included that reported on QoL outcomes from CBR interventions involving 1755 adults post stroke. Results: The different CBR interventions that were selected were grouped into three clusters: a) exercise programmes, b) task-oriented training, and c) educational and taking-charge programmes. CBR interventions were more effective than other rehabilitation protocols (SMD=0.16[0.02, 0.30], P=0.03, I2 =40%) on QoL for people with chronic stroke. The effects of interventions on walking capacity and balance demonstrated non-significant difference (SMD=0.31[-0.02, 0.64], P=0.06, I2 =88%, and SMD= 0.20[-0.12, 0.53], P=0.22, I2 =68%, respectively). Conclusion: Current data indicates that CBR can be used in many forms or in combinations to benefit people with chronic stroke. Also, CBR is as effective as other rehabilitative protocols on walking capacity and balance, while being more effective than institution-based rehabilitation or no care, in improving quality of life which is a well-recognised goal in the rehabilitation of people with chronic stroke.
(Neo) Colonialist Attitudes in International Cooperation: imposed, self-imposed or an easy excuse? Plus some suggestions to overcome them
HELP: Help Educate Low-Income Countries to Set their Own Priorities
“HIV is a Story, not Life”: Resilience among South Asian Women living with HIV in Canada
Purpose: This study aimed to understand how immigrant South Asian women living with HIV in Canada develop resilience and to identify their self-management strategies. These strategies could be used by marginalised women and can be supported by health providers. Method: The study participants were eight South Asian women with HIV, living in Ontario, Canada. The women belonged to an urban HIV community organisation. Qualitative methods were used to investigate their experiences. In-depth face-to-face interviews were conducted, utilising a photo/object elicitation technique, to identify the strategies used to develop resilience. Results: The women were primarily in mid-adulthood (age range 39-60 years) and had lived for many years with HIV (range 8-25 years). Thematic analysis of the interview transcripts revealed three themes characterising strategies for resilience: identifying the need for self-care, maintaining social connectivity, and remaining optimistic. Conclusion and Implications: With these strategies, the women had cultivated strength and perseverance in adjusting to adversity. Viewing the resilience of South Asian immigrant women living with HIV through a cultural lens could help to understand and facilitate the development of culturally acceptable self-management strategies.
The Dynamics of Social Inclusion of People with Spinal Cord Injury
Purpose: Social inclusion of people with disability is critical for maintaining social equity. The goal of this paper was to examine the dynamics of social inclusion of persons with spinal cord injury. Method: A cross-sectional research design was adopted to study the impact of individual, interpersonal, organisational, community and socio-political conditions on interpersonal relationships and community participation. Confirmatory factor analysis was used to validate the measurement models. Structural equation modelling (SEM) in AMOS was used to derive results. Results:The individual, interpersonal, organisational, community and socio-political conditions strongly influence social inclusion of persons with spinal cord injury. The strongest influencer of community participation is socio-political conditions (ꞵ=0.692 and p=0.001) and the strongest influencer of interpersonal relationships is organisational conditions (ꞵ=0.677 and p=0.001). Conclusion: Social inclusion, measured by interpersonal relationships and community participation, can be enhanced by improving the individual, interpersonal, organisational, community and socio-political conditions, thereby contributing to social equity and sustainable performance.
Role of Young Carers of Parents with a Disability in Sierra Leone and Cameroon: an Explorative Study
Purpose: This study aimed to get insights into the role of children who are caring for their parents with a disability in Sierra Leone and Cameroon. Method: Quantitative and qualitative data were collected using two different questionnaires that were distributed among parents with a disability and community fieldworkers. The parents were asked to answer questions about their personal life and the roles that their children, other family members and aid organisations play in their lives. The fieldworkers were asked about their experiences and opinions regarding children’s roles as caregivers for their parents. Results: It was found that children supported their parents in performing domestic chores, childcare, and intimate and general caregiving. They also gave emotional support, mostly by showing compassion. Most parents wanted more help in raising their children, as well as financial support. Fieldworkers judged the caring roles of children as a responsibility, a blessing, or a burden. Conclusion: This study indicates that children play diverse roles in caring for their parents with a disability. Future research could map cultural norms and expectations about a child’s caregiving responsibilities, and focus on the possible consequences for a young carer, like dealing with poverty or being unable to attend school.
Inclusive Education in Pakistan: Role of Teachers’ Sense of Self-Efficacy
A Rapid Review of the Roles of Community Rehabilitation Workers in Community-based Mental Health Services in Low- and Middle-Income Countries
Purpose: The term Community Rehabilitation Worker (CRW) encompasses a group of mid-level health workers introduced within healthcare systems to increase accessibility to health- care services for individuals within the community sphere. This study aimed to summarise the current knowledge on the role of community rehabilitation workers in community-based mental health services in low- and middle- income countries. Method: Between the 10th and 17th of July, 2020, searches were conducted on the following databases: Cochrane, EbscoHost, Primo, and Pubmed. The search strategy identified 521 individual records, 4 of which were included in this review: 2 qualitative descriptive studies, 1 quantitative descriptive study and 1 conceptual study. Results: Across the 4 studies, eight roles of community rehabilitation workers were identified in relation to mental health services: home visits, client illness management, referral, documentation and administration, client and family education, community education, intersectoral collaboration and mediation. There was no data found on the role of community rehabilitation workers in mental health services in low- and middle- income countries specifically, indicating a gap in research. Conclusion: There is a need to improve knowledge and understanding of the roles and responsibilities of community rehabilitation workers where mental health service provision is concerned. The data summarised in this review could be utilised to educate health professionals regarding the role of community rehabilitation workers.
How Neo-colonial Are We in What we are Doing?
Copyright (c) 2021 The Author(s) https://creativecommons.org/licenses/by/4.0
Implementation of the United Nations Convention on the Rights of Persons with Disabilities in Africa: a Scoping Review
Aim: The UNCRPD is an international treaty that promotes the advancement of the rights of persons with disabilities. This scoping review aimed to map the evidence on strategies employed by countries in implementing the UNCRPD in Africa and the implementation challenges faced. Method: The PRISMA extension for scoping reviews (PRISMA-Scr) was used in this study. Key terms pertinent to the implementation of the UNCRPD in Africa were used to search for literature. Strict eligibility criteria were set and a qualitative data extraction template developed. Two reviewers worked independently to extract and chart data into data extraction forms. An analysis of country reports was also conducted to identify relationships between the African country reports and findings from the studies included in the scoping review. Inductive reasoning enabled the generation of themes. A total of 107 sources were initially retrieved and after a process of screening and exclusion, 31 sources (11 research papers and 20 country reports) were included for inductive analysis. Results: The study revealed evidence of implementation of UNCRPD in Africa, albeit limited, especially to the area of education, and employment. However, there are unique contextual limitations in implementation of UNCRPD in Africa. The country reports reflected similar implementation issues to those identified in studies selected for this paper. Conclusion and Implications: This calls for African governments to broaden focus on implementation of other articles of the UNCRPD in order to create inclusive societies.
Emotions, Relationships and Behaviour: a Qualitative Study on Experiences of Stigma among Persons Affected by Leprosy in Northern Nigeria
Purpose: Leprosy is a highly stigmatised disease with far-reaching psychosocial and economic consequences. This study explored the social consequences of leprosy and the factors that drive stigma among persons affected by leprosy in northern Nigeria. Method: The study used a cross-sectional design with a qualitative approach. Semi-structured in-depth interviews were conducted with 20 persons affected by leprosy. Data were collected from September to November 2020. ILEP’s four stigma domains (emotions, thoughts, behaviour and relationships) were used to develop the interview guide and to analyse the data. The framework approach to thematic analysis was performed. Results: The study identified: (1) negative societal attitudes and behaviour towards persons affected by leprosy, (2) restrictions in social participation among affected persons, such as in communal eating, job opportunities and education, (3) negative impact of leprosy on marital life and marriage prospects, also experienced by family members, and (4) negative emotions such as sadness and despair. Some of the problems seemed to be caused by negative perceptions and a lack of knowledge of leprosy. The main coping strategies included adjustments in behaviour (e.g., marrying other persons affected by leprosy and communal eating amongst persons affected), and religion (by seeking consolation through faith in God/Allah). Conclusion: High levels of stigma were experienced by the participants. This underscores the importance of sustained information, education and communication interventions via traditional and modern media, to fill knowledge gaps and address misconceptions and myths about leprosy.
Lessons from a Women-led Livelihood Pilot in a Neglected Tropical Diseases endemic area in Southern India
Purpose: This study was conducted in a Neglected Tropical Diseases (NTD) endemic location in South India. It aimed to determine whether income-generating opportunities for members of low-income households would help in reducing their vulnerability to NTDs. Method: Eleven women participated in the ‘Jagruti’ livelihood project. A baseline survey captured their demographic details, economic situation, and perspectives of the future. An end-of-project survey recorded the impact. The marketing strategy used Behaviour Change Communication through product and menstrual hygiene awareness among Self-Help Group (SHG) women, one-on-one peer education for women at home, and counselling for adolescent schoolgirls. Results: All participating women had changed their own and their daughters’ menstrual hygiene behaviour. They felt that their entrepreneurial and communication skills had improved. The maximum and minimum individual earnings from sanitary napkin sales had been USD 54 and USD 8 per month respectively. This additional income had met pressing household needs, toilet repairs, and medical treatment of family members with COVID-19. In May 2021 the COVID-19 second wave and lockdown, as well as the state government initiative to sell sanitary napkins at subsidised rates to rural women, and free of cost to adolescent school-going girls, led to the termination of the livelihood project earlier than scheduled. Conclusion and Implications: Sustainable livelihoods for women from low-income households can bring in additional income to be utilised for medical treatment, improving household sanitation and nutrition, etc. This may would reduce household members’ risk of contracting or transmitting NTDs. The government initiative will be routed through selected SHGs with proven efficiency. Four of the trained women entrepreneurs are confident that their SHGs will be selected and look forward to using the knowledge and experience they have gained from the livelihood project. Investment in empowering and developing the business skills of enterprising women is a worthy cause.
Creating an Inclusive Ecosystem through Healthcare in Disability Management: Malaysians’ Experience
Purpose: MyRehabMaker is a community initiative project utilising technology as an innovative platform to solve the challenges of people with disabilities specifically, and of society as a whole. Method: Providing an Assistive and Adaptive Device (AAD) is one of the interventions to assist people with disabilities in improving their functional level. The AAD prescription work process was enhanced by forming an expert multidisciplinary team and introducing 3D printing technology into practice. Results: This project has been recognised and has won a few awards in innovation exhibitions and competitions. The project later expanded into the community to encourage community involvement and contribution. Conclusion: The project framework aims to address the needs and interests of participating bodies and promotes inclusivity by adopting community-based rehabilitation and social innovation principles on the IR 4.0 healthcare platform.
Resilience and Coping by Parents of Children with Intellectual Disability in Kerala, South India
Purpose: This study examined the relationship between the resilience and coping mechanisms of the parents of children with intellectual disability. Method: Study participants were recruited from special schools and neighbourhood groups of parents of children with special needs in Kerala, a southern state of India. Around 121 parents completed the Connor-Davidson Resilience Scale and Coping Strategies Screen. The correlational analysis revealed a significant relationship between their coping strategies and resilience. Results: Problem focussed coping strategies such as problem-solving skills, taking professional assistance, seeking information about managing the condition, taking time to discuss the ways of handling child’s condition with the family members/significant others and having recreational activities improved parental resilience. Whereas, emotion focused coping strategies for example, reliance on religious leaders for emotional support, weeping, blaming fate and doing nothing decreased their resilience. Rehabilitation professionals may plan interventions to expand problem focused coping skills so as to improve their resilience Conclusion: The findings have specific applications in developing interventions for parents of children with intellectual disability.
The Impact of Leprosy and Physical Disability on Marital and Sexual Relationships of Married Nepali Men
Purpose: Both leprosy and disability can have a negative impact on a person’s relationships. This study aimed to gain insight into the impact of leprosy and disability on marital and sexual relationships of married Nepali men. Method: The study used a cross-sectional design with a qualitative approach. Thirty participants were selected using purposive sampling and put in 3 groups (10 to a group): (1) men with impairments due to leprosy, (2) men without leprosy but with physical disabilities, and (3) men without leprosy or disabilities (control group). Data was collected during semi-structured interviews and two focus group discussions, and analysed with the software programme NVivo using structured coding. Results: The majority of the men indicated they were satisfied with their marital and sexual relationships. However, some leprosy-affected men and some men with disabilities experienced friction in their marital relationships. Fighting between husband and wife was reported by half of the men affected by leprosy. Leprosy and disability had a negative influence on the sexual relationships of some of the men, because of physical limitations, pain, or decreased sex drive. Furthermore, many participants appeared to lack knowledge about the cause of leprosy and about sexual health. Conclusion and Implications: Men affected by leprosy or disabilities seemed to face more problems in their marital relationships than men from the control group. This was primarily related to physical limitations which resulted in the inability to work; this threatened their personal and social identity. Findings show that there may be a problem in accessibility or availability of sex education. In addition, some marital problems could be related to lack of knowledge of leprosy. These point to the importance of providing education on leprosy and sexual health at the time of diagnosis.
Appropriate Screen Time Use to Prevent Speech and Language Delay in Toddlers during the Covid-19 Pandemic: a Brief Report
With the COVID-19 lockdown and other limitations, screen time has increased for everyone, even young children. Children's screen use has a deleterious influence on a variety of cognitive functions, including language delay. Various Paediatrics organizations have noticed these harmful impacts, and suggestions for parents were released to limit screen usage. These agencies have provided suggestions on the duration of screen usage for specific age groups. This study tries to address screen time from a qualitative standpoint. Suggestions for successful ways to participate in screen time are presented. Interactive screen time, including co-viewing and enough language engagement, may assist to mitigate the negative effects of screen time on language development. The screen has its own restrictions and several severe repercussions if they are exceeded. As a result, wherever feasible, screen time should be avoided, and language-rich quality time with children should be prioritized.
CBR Practice and Inclusion: Persons with Disabilities in North East India
In third world countries, Community-based rehabilitation (CBR) was advocated as a core strategy in the 1970s-80s for improvement of the quality of life of persons with disabilities by providing facilities for rehabilitation to persons with disabilities at the community level. This paper explores the long-term impact of CBR programmes undertaken in the North East region of India, in order understand the ways in which targeted interventions led to changes in the lives of persons with disabilities and their families, to discern the extent of their inclusion within communities and any systemic changes brought about towards accessing their human rights. The paper will attempt to reveal how, as a result of CBR initiatives, persons with disabilities, their families and the communities that they live in, experience a quality change in their everyday lives, enjoy better access to an entire range of rights and entitlements and the ways in which such initiatives sustain, even after the exit of a structured CBR programme.
Extra-Institutional Factors Limiting Access to Rehabilitation Services for Children with Cerebral Palsy: Perspectives of Caregivers in Marsabit County, Kenya
Purpose: This paper explored the factors limiting access to and use of hospital-based rehabilitation services for children with cerebral palsy in Marsabit County, Kenya. The factors were unrelated to healthcare institutions providing the services and the focus was on the perspectives of caregivers of children with cerebral palsy. Method: A qualitative study was conducted with a total of 18 participants who were selected by purposive sampling. Semi-structured interviews were used to collect data from the participants. Data was analysed using Erlingsson and Brysiewicz’s approach to content analysis. Results: The major barriers for the caregivers were belief systems, lack of awareness of rehabilitation services, no support at home, transport problems, and cost of transport. Conclusion and Implications: Access to rehabilitation services for caregivers of children with cerebral palsy appear to be limited. Health policymakers, service providers and other stakeholders should ramp up their efforts to improve access to these services and make them affordable as well. Efforts at improving access could be supported by information and awareness-creation among caregivers about the importance of rehabilitation services for children with cerebral palsy.
Fostering Social Communication for Children with Autism Through Augmented Reality Toy
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder disease, which hinders communication and socialisation. This paper examines an augmented reality toy application, AR Toys supporting social communication of children with Autism Spectrum Disorder. This paper reports on how the application was used in school classroom. AR Toys was evaluated 7 children in an Autism Centre in Melaka, Malaysia. This analysis focuses entirely on interactions between children and teachers at school. Three finding were revealed (1) AR Toys is able to motivate children with ASD on adaptive language; (2) AR Toys is able to model expressive language identify child’s emotion; (3) AR Toys is able to promote pretend play on learning emotion in classroom activities. This gives children with ASD more opportunities to communicate among peers and interact with teachers at schools.
Lived Experiences of Women with Disabilities in Accessing Sexual and Reproductive Health Services in Lira District, Northern Uganda
Purpose: The study aimed at exploring the lived experiences of women with disabilities in accessing sexual and reproductive health services in Lira district, Northern Uganda. Method: This study utilised a phenomenological study design. Ten women, aged 15 - 49 years, were purposively selected from Lira District Union of Persons with Disabilities. They were accessing sexual and reproductive health services across the district. Data was collected using an in-depth interview guide, and thereafter thematic analysis was done. Results: More than half (60%) of the participants were 40-50 years old and had more than 2 children. Half of them (50%) were married; the majority (70%) resided in the rural area and had a physical disability. They related their positive and negative experiences. On the positive side, they indicated the existence of supportive stakeholders, availability of services, and being served with no discrimination in some health facilities. Negatively, they experienced difficulty in navigating the physical environment in health facilities, lack of transport, negative healthcare provider attitudes, long waiting time, side effects of family planning methods, lack of privacy and unhygienic sanitary environments in health facilities. Conclusion and Recommendations: Women with disability in Lira district had both positive and negative experiences in accessing sexual and reproductive health services. Recommendations of this study include counselling women with disabilities about side effects of hormonal family planning methods, incorporating disability studies in curricula for health workers, on-the-job training for health workers on care for persons with disabilities, and enforcing policies that favour access to sexual and reproductive health services for women with disability. The government should empower the local leadership to supervise every new health facility that is being constructed, and ensure that accessibility standards for women with disabilities are met.
The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review
Purpose: Despite the growth of literature regarding community-based interventions (CBI) in low- to middle-income and high-income countries, its effectiveness in improving outcomes related to activities of daily living (ADL) and quality of life (QOL) in people with stroke is inconclusive. This systematic review compared the effectiveness of community-based interventions with the usual or hospital-based treatments in improving ADL and QOL outcomes in this population. Method: Four databases were systematically searched from inception until December 31, 2020, for relevant experimental studies from high-income and low- to middle-income countries that compared CBI with the usual/hospital rehabilitation on outcomes related to ADLs and QOL in clients with stroke. Results: All the 10 experimental studies that were included came from high-income countries (Italy, United Kingdom, South Korea, Canada, and Australia), involving 1575 participants (806 males, 656 females, 113 not classified) with age range from 22-103 years. Seven articles measured ADL performance, and 10 measured QOL. Results indicated that CBI generally demonstrates improvement in ADL and QOL values similar to usual or hospital-based care. There was wide variability in the interventions described and the outcome measures used for both groups. Risk of bias assessment revealed issues with randomisation, blinding and follow-up. Stroke-specific baseline characteristics such as length of time since diagnosis and laterality varied considerably in all of the studies. Conclusion and Limitations: CBI did not demonstrate significant difference in improving ADL and QOL outcomes for people with stroke compared to usual care, possibly due to the high quality of rehabilitation services existing in the countries where the studies took place. There is a need to use standardised outcome measures and interventions to ascertain these outcomes.
Time to Refocus: Rehabilitation Perspective on Meeting the Needs of the Indian Population
COVID-19 Prevention and Difficulties experienced by Blind Persons in Low- and Middle-Income Countries
Improving Well-Being, Academic Self-Concept and Academic Achievement of Indian Children with Specific Learning Disability by utilising Positive Psychology Intervention
Purpose: It is widely recognised that children’s well-being involves not only the absence of psychological distress, but also the presence of positive indicators of optimal functioning to be mentally healthy. The aim of this study was to investigate whether a Positive Psychology Intervention (PPI) implemented in school going children with specific learning disability (SLD) would lead to increased subjective well-being (SWB), improved academic self-concept (ASC) and academic achievement (AA). Method: The study followed a one group pre-test post-test design. Purposive sampling was used to select 75 children with SLD (61 boys and 14 girls) from 3 schools in Telangana State, India. Children who were between 8 – 12 years of age (in classes 3 – 7) were selected on the basis of the inclusion criteria. The main outcome measures used were Brief Multidimensional Students’ Life Satisfaction Scale (BMSLSS), Positive and Negative Affect Schedule for Children (PANAS-C) and Academic Self-Concept Scale. Academic achievement was recorded through total marks scored by the student in all the core subjects (language/s, math, science, social studies) of the semester examination. The Positive Psychology Intervention consisted of activities integrating gratitude, mindfulness and attributional style. Each class group received weekly sessions of group intervention for 12 weeks. Results were analysed using Statistical Package for the Social Sciences (SPSS Version 20.0). Wilcoxon signed-rank test was calculated to find the difference between pre-, post- and follow-up scores. Results: The findings showed significant increase in the levels of subjective well-being, academic self-concept and academic achievement of children with SLD after PPI. The follow-up after 6 months found the effect was maintained on all the studied variables except academic achievement. Conclusion and Implication: Positive Psychology Intervention has the potential to sustain significant improvements in happiness and academic self-concept of children with SLD. It also aided improvement in their academic achievement. There is a need to further investigate the applicability of these interventions to boost positive emotions and alleviate negative emotions in all children, with and without specific needs. In addition, these PPIs may be used to empower parents and teachers with positive attributes to face their challenges in dealing with other disabilities in children.
Hearing, Speech and Language Outcomes in Children with Cochlear Implants: a Comparison between ADIP Scheme and Self-Financed Scheme
Purpose: Cochlear implants (CIs) are of immense benefit to children with severe to profound hearing impairment. While cochlear implants under the ADIP scheme cost a lot to the public exchequer, parents spend considerable amounts on CI surgery under the self-financed scheme. This study aimed to find and compare outcomes of cochlear implants in children who availed of the ADIP scheme and those who were implanted under a self-financed scheme. The secondary aim was to elicit the views of parents on the challenges their wards faced under the ADIP scheme for cochlear implants. Method: The study focused on twelve children who received cochlear implants under the ADIP scheme and twelve children who received implants under a self-financed scheme at a tertiary care health centre. The baseline for measurement of various outcomes was a minimum of six months post implantation. Cochlear implant outcomes were compared using MAIS/IT-MAIS, SIR, CAP, and ISD tests. Interviews were also conducted with the parents of children who received cochlear implants under the ADIP scheme, for information regarding the challenges they faced. Results: There was a significant difference (p<.05) between the two groups in the scores of CAP and reception, speech, and cognition subsections of the ISD scale. The scores of the ADIP group were significantly lower in these domains. The possible reasons might be a lack of funds, not visiting the therapy centre regularly, loss of wages during a visit to the therapy centre, lack of family support, and insufficient time to repeat therapy activities at home. There was no significant difference in age, CI age, and CI usage duration between the two groups. Conclusion and Implications: Compared to children implanted under the self-financed scheme, children implanted under the ADIP scheme are significantly lacking in a few domains of communication skills. The efficacy of the ADIP scheme for cochlear implantation can be evaluated and policy change can be advocated based on this study. The study has outlined some modifications to this welfare scheme in order to fill the observed lacunae and widen the scope of its reach.
Does Residing in Environments of Different Metropolises in a Developing Country exert an Impact on Disability after Stroke?
Purpose: The study aimed to analyse the association between the environment in two different Brazilian metropolises (São Paulo and Belo Horizonte) and disability after a stroke. Method: A cross-sectional study was conducted involving individuals with chronic hemiparesis resulting from a stroke and residing in either São Paulo or Belo Horizonte. The environment (city of residence) was considered an independent variable and disability (modified Rankin scale) was the dependent variable. The following clinical and demographic covariates were considered: age, number of comorbidities, socio-economic class, motor impairment (Fugl-Meyer scale), emotional functioning (Geriatric Depression Scale) and walking ability (10-metre walk test). Results: A total of 114 individuals were analysed - 51 from São Paulo (SP) and 63 from Belo Horizonte (BH). No association was found between the environment in which the individual resides and the degree of disability (OR = 1.436; 95%CI: 0.547 - 3.770; p = 0.46). However, the following variables were predictors of post-stroke disability: motor impairment (OR = 0.216; 95% CI: 0.090 - 0.520; p <0.001) and walking ability (OR = 0.066; 95% CI: 0.005 - 0.912; p = 0.04). The overall correctness of the model was 77.9%. Conclusion: Living in different Brazilian cities had no impact on post-stroke disability. In contrast, motor impairment and walking ability were responsible for 77.9% of the disability found in the sample. The study findings identify possible causes of disabilities after stroke; these could facilitate the most appropriate actions to be taken during rehabilitation.
Christina Danielli Coelho de Morais Faria
Disability Inclusive Education in Bangladesh
Aim: This account is based on a strategic Design Note developed for the inclusion of Children with Disabilities (CwDs) into the public-school system under Primary Education Development Program (PEDP4) in Bangladesh. It aims at analyzing the right to inclusive education from the perspective of the Convention on the Rights of Persons with Disabilities (CRPD), notably article 24 on inclusive education and Sustainable Development Goals (SDG4). Method: Extensive consultations were carried out within the course of developing the Design Note with stakeholders, notably civil society and organizations of persons with disabilities (DPOs). Results: In order to improve the capacity of the primary education system to identify, enroll, maintain and retain Learners with Disabilities (LwDs) throughout the primary cycle, a reform in the system is required starting by creating an enabling environment and focusing on overcoming attitudinal barriers in the local community and school authority; improving school infrastructure; strengthening inclusion practices, notably adapted pedagogy, as well as consolidating policy framework, coordination and governance in addition to empowering users and enhancing their voice. Conclusion and Implication: Such key actions can greatly enhance targeting, screening and reaching out for a full range of children with disabilities in schools as well as out of school and contribute to improving learning outcomes, fulfilling the right to education (art. 24 of CRPD) and achieving SDG4.
Reporting Behaviour of People with Disabilities in relation to the Lack of Accessibility on Government Websites: Analysis in the light of the Theory of Planned Behaviour
Purpose: The observance of inclusive practices in e-government has been overlooked in several countries, and surveillance and action taken by official bodies is often inefficient especially in low-and middle-income countries. This article investigated factors that influence the behaviour of people with disabilities concerning filing formal complaints about accessibility barriers of government portals in Brazil. Method: Five people with disabilities and three prosecutors were interviewed. A content analysis by category, using the Theory of Planned Behaviour, was performed. Results: Interviewees emphasised aspects such as government websites being accessed with low frequency; lack of a combative culture; disbelief in the effectiveness of filing a complaint; ignorance or superficial knowledge about the laws; the technical ignorance of the user; lack of awareness of the severity of communication barriers; unfamiliarity with the role of the Public Prosecutor's Office; excessive formalism; and, the influence of close people. Conclusion: There is a need to promote cultural change so as to value and respect people with disabilities as equal citizens.
Emoticons as Self-Disclosure in Social Media and Its Meaning for People Who are Deaf
Purpose: The limitations in communication for people who are deaf or unable to speak are evident. Like other people with disabilities, they too seek to acquire knowledge, search for information and understand its content, but there are barriers to self-expression and self-disclosure. This study provides insights into opportunities for people who are deaf, yet are able to access digital communication technology. It analyses their use of social media and emoticons for messages and communication. Online interaction enables self-disclosure to other people with deafness, as well as to people without disabilities. Method: The study used a qualitative approach with a phenomenological design. The interpretation of data was carried out with informants from the deaf community in Indonesia, who use social media applications and various types of emoticons for self-disclosure on WhatsApp and Facebook. Selection of various emoticons took place through in-depth interviews, observations, and analysis of the conversations among themselves as well as people without disabilities. Results: The findings show that the motives for using social media, emoticons, and communication technology are to build online interactions and enable self-disclosure among people who are deaf. The use of emoticons in social media helps people who are deaf to express their feelings towards others, to communicate with their families and build intimate interpersonal relationships, making it easier to get along in their community. The ability to interact and understand social media content and communication technology, in general, depends on their experience and ability to master and give meaning to signs, words, emoticons, and language. Conclusion: People with hearing impairment have had significant benefits from using social media and communication technology. Access to information and knowledge about the personal lives of individuals and their communities, through social media, has added cohesiveness within the community of people who are deaf. By using various emoticons, people with hearing impairment can apply signs, words, and symbols to express emotions and feelings. This makes the meaning of a sentence or interaction between individuals more robust and precise, creates stronger messages, and at the same time can be a medium for self-disclosure. However, due to difficulty in distinguishing between messages on social media that may be true or false, people who are deaf tend to feel at times uncertain and confused.
Efficacy of the Smartphone App for sending Text Reminders to reduce ‘No Shows’ in Speech Therapy Sessions at a Tertiary Care Centre in India
Purpose: There is a need for intensive therapy following cochlear implantation, but many clients fail to show up for their scheduled appointments at the therapy centres. This study aimed to establish the efficacy of a Smartphone app in reducing the ‘no shows’ among the population with cochlear implants (CI). A secondary aim was to find the level of satisfaction with automated reminder SMS messages among parents of children with CI. Method: The study participants were 24 children with CI who were attending the Auditory Verbal Therapy sessions at a tertiary care centre. Half of them formed the study group and the other half the control group. Parents in the study group, with access to working mobile phones, received SMS text reminders about therapy and mapping sessions; parents in the control group did not receive any reminders. Data was analysed after 3 months, using a z test for proportions to find the difference in the mean percentage of ‘shows’ in the study and control groups. A questionnaire was administered to the parents in order to evaluate their satisfaction with the SMS reminders. Results: The number of 'shows' in the study group was 209 out of the scheduled 233 appointments, while the number of 'shows' in the control gorup was 173 out of the scheduled 232 appointments. The reminder system was effective for parents of children with cochlear implants to maintain appointment schedules with greater regularity as compared to the parents who did not receive the reminders. Conclusion: SMS text reminders via a Smartphone app are a low-cost and effective method of reducing the ‘no shows’ in the Auditory Verbal Therapy and mapping sessions for children with cochlear implants. Parents of the children in the study expressed a high level of satisfaction with the SMS text reminders. Future studies with a larger number of subjects could consider controlling the variables like income, education level, distance from the therapy centres and motivation of the parents. Results: The number of 'shows' in the study group was 209 out of the scheduled 233 appointments, while the number of 'shows' in the control group was 173 out of the scheduled 232 appointments. The reminder system was effective for parents of children with cochlear implants to maintain appointment schedules with greater regularity as compared to the parents who did not receive the reminders.
Parents, Teachers and Rehabilitation Professionals: Are all needed in enabling children with disabilities?
The Functions of Vocational Rehabilitation Using Agriculture in Japan
Purpose: Vocational horticultural therapy seems effective in the recovery of individuals with psychiatric disabilities; however, few studies have explored the factors underlying the effectiveness of such therapeutic intervention in the context of psychosocial vocational rehabilitation. While many jobs are available in metropolitan areas such as Tokyo, agricultural jobs are often limited, especially at sheltered workshops for individuals with disabilities (Type B Support Centres) in Japan. Methods: A mail survey was conducted with 119 administrators of Type B Support Centres in Akita Prefecture, a northern area of Japan. Respondents were asked to complete the “Efficacy of Agricultural Vocational Rehabilitation” (EAVR) questionnaire which was developed by the authors of this article. Results: The results of exploratory factor analysis revealed two factors: “Assurance” and “Place of Exchange.” There was no significant difference between the perceived effectiveness of vocational horticultural therapy in farming and non-farming job categories. Support Centres that offered farming opportunities seemed to provide more direct job opportunities, preferences, and possibilities. On the other hand, Centres that did not offer farming seemed to focus more on central administration, operational management, independent handling of matters, and collaboration with other support institutions. Conclusion: While Type B Support Centres in Japan offer support in farming jobs, they do not provide enough support for horticultural therapy for people with psychiatric conditions. To promote collaboration between Type B Support Centres that offer farming jobs and social welfare centres that have expertise in horticultural therapy, it is necessary to disseminate knowledge about the benefits of horticultural therapy. Limitation:As this study was an analysis of a survey within a limited range of the Type B Support Centres in Akita Prefecture, future studies should investigate whether the results are generalisable to other metropolitan areas and local regions nationwide.
Perspectives of Caregivers on Pubertal Changes among Young Adolescent Girls with Cerebral Palsy: a Qualitative Analysis
Purpose: Girls with cerebral palsy have limited capacity to cope with pubertal issues. It results in their parents being burdened with additional caregiving during this period. A qualitative study was undertaken among parents of girls with cerebral palsy to understand the caregivers’ challenges and concerns. Method: Twenty-one interviews were conducted among purposively selected parents and caregivers of young adolescent girls with cerebral palsy in a tertiary care referral hospital in South India. The interview questions were related to menstrual hygiene, behavioural changes around puberty, fear of sexual abuse, and perceptions about contraception. Transcripts were coded and, after data anonymisation, manual thematic analysis was done using an inductive approach. Results: A total of 6 themes emerged, related to identification of problems, treatment-seeking patterns of the caregivers, social support and perspectives on contraception, pubertal challenges and concerns of parents for the future of their girls. Caregivers reported that puberty in girls with cerebral palsy places an additional burden on the caregivers. They were also worried about the safety of their girl children. Contraception and menstrual suppression were not considered as options. Caregivers wanted education and financial independence for their children. Conclusion: Awareness of methods of managing pubertal issues, shared caregiving responsibility by the family, and customised approach for healthcare interventions are of paramount importance in helping caregivers deal with the transition to puberty by girls with cerebral palsy. Family counselling and therapy can help to allay the parents’ fears, worries and tensions.
Feasibility Assessment of the ICF Minimal Generic Set as a Disability Screening Tool in Rural Nepal
Purpose: Nepal’s 2017 Disability Rights law provided a new national definition of disability consistent with the UN Convention on the Rights of Persons with Disabilities (CRPD). Updated measurement methods are now indicated to assess disability, suitable for use in populations where self-report tools may be sub-optimal. This study describes the development and field testing of a screening methodology using a clinical assessment conducted by trained non-professionals to score the ICF Minimal Generic Set (MGS). Method: A prospective, 2-stage assessment of disability was conducted over an eight-month period among a convenience sample of individuals aged ≥ 18, admitted to a rural District Hospital in Northeastern Nepal. After 30 hours of training, non-professional assessors completed Stage 1 screening during hospital admission, with positive screening thresholds set on the basis of MGS scores. A physiotherapist completed Stage 2 assessments in the homes of participants with long-term disability, after their hospital discharge. Results: Data from 161 participants was analysed, with 159 (98.8%) screening positive for either temporary or long-term disability. Stage 1 screening was completed independently by assessors in 8-12 minutes. Of the 35 participants (21.7%) with positive screening for long-term disability, 13 (37.1%) underwent Stage 2 detailed evaluation. Disability was confirmed in all Stage 2 assessments, indicating feasibility of the screening process. Conclusion: Disability screening conducted by trained non-professional assessors using clinical assessment to score the MGS appears to be a promising methodology, and warrants further investigation. If it is found to be valid, it could provide a powerful tool to increase the visibility of disability among some of the most vulnerable populations.
Methodological Approaches to Researching Organisations of Persons with Disabilities: a Case Study from Uttarakhand, North India
Purpose: Organisations of Persons with Disabilities (OPDs) are promoted to encourage the inclusion of persons with disabilities in development programmes. However, there is little peer-reviewed literature on the effectiveness of OPDs in low and middle-income countries. This Case Study in Uttarakhand State of North India, aimed to explore the methodological approaches used to understand and evaluate the formation and function of OPDs. Method: The Nossal Institute of Global Health, Australia, partnered with the Uttarakhand Cluster (an NGO in India) to facilitate the development of Organisations of Persons with Disabilities. Five research studies were undertaken between 2014 and 2018 to understand their formation and function. The current Case Study has focused on these 5 studies, examined the qualitative and quantitative methodological approaches that were used in each study, summarised their findings, and analysed the advantages and limitations of the methodologies used in the context of the formation and function of OPDs. Results: The methodologies used included: Thematic analysis; Realist Evaluation; Participatory Action Research using Videovoice; Social Network Analysis; and a Cluster Randomised Trial. By examining the 5 selected studies, rather than drawing conclusions from any individual methodology, this Case Study derived a better understanding of OPDs in Uttarakhand. OPDs were seen to have had positive impacts across a variety of domains. Conclusion and Implications: The Case Study showed the value of multiple and mixed methods approaches to study complex phenomena such as the formation and function of OPDs. It helped in understanding the mechanisms for OPD impact.
An Unclear Task? The Perspectives of Swedish Preschool and Special Needs Teachers on their Role in Assessing and Documenting Child Development
Purpose: This study explored how preschool and special needs teachers in Sweden perceive their own role and the role of each other in the preschools’ documentation and assessment practices. It examines the possible consequences of this perception and of the actions based on it for children with special needs. Method: The study took a qualitative approach. Individual semi-structured interviews were conducted with seven special needs teachers and seven preschool teachers from different schools and municipalities. Results: The results show that the preschool and special needs teachers’ roles regarding assessment and documentation, as described and specified in the curriculum, are contradictory and difficult. Assessing an individual child’s knowledge development by observing and documenting the child group was regarded as problematic by both occupational groups, and further training in assessments was sought. Conclusion and Implications: Clear differences were found between the way in which preschool teachers and special needs teachers performed observations and assessments and documented them. Preschool teachers mainly used participant observations at a group level, while special needs teachers were usually tasked with observing a particular child. Preschool teachers’ reluctance to document the performance of individual children might result in children’s special needs remaining hidden. It is important to find methods which endorse assessments that allow for and appreciate diversity, and that are not based on normative notions which often result in differentiating between children and dividing them into different groups of learners based on their perceived level of knowledge. Limitations: From the interview results, it has sometimes been difficult to differentiate between the concepts of observation, documentation and assessment as they are often parts of a whole within the context of preschools. As the survey was of limited scope, the results cannot be generalised to all Swedish preschools, but the data obtained could provide important guidance for further work with inclusive preschools.
/t/ before /ʈ/ or /ʈ/ before /t/: Emerging Trends from a Preliminary Study of Consonant Acquisition in Typically developing Sinhala-speaking Children aged 3 to 6 years
Purpose: Speech and language therapists use developmental norms established for consonant acquisition to determine whether a child has age-appropriate, delayed or disordered speech skills. There are currently no established norms for the acquisition of Sinhala consonants, which have implications for accurate diagnosis. The aim of this study was to document preliminary trends observed in the trajectory of consonant sound development in Sinhala-speaking young children so as to form a set of ‘working norms’. Method: A picture-based articulation assessment was administered to 70 typically developing children who were between 3 years and 6 years 11 months of age. Results: Regarding the rate of acquisition and order of acquisition, the findings displayed trends comparable to general patterns of consonant mastery reported within cross-linguistic studies. In addition, a different rate of acquisition and order of mastery was observed for both uncommon Sinhala language-specific speech sounds showing ambient language effects and for a few common sounds occurring in Sinhala and other languages. Conclusion & Implications: The convergence and divergence in the rate and order of Sinhala consonant acquisition compared to the cross-linguistic literature has important clinical implications for assessment, early identification of speech difficulties and intervention within speech and language therapy practice in Sri Lanka.
International Continuing Education for Rehabilitation Workers in Honduras: a Pre-test Post-test Evaluation
Background: The knowledge of Honduran healthcare workers who deliver rehabilitation services can be enhanced by support from community-engaged academic collaborations outside the country. Objective: This study aimed to evaluate reactions and learning linked to two continuing education workshops for rehabilitation workers in northern Honduras. Method: A pre-test post-test study design was used. In September 2017, faculty from Canada and Colombia, together with health professionals from Honduras, facilitated two neurorehabilitation workshops - one in a rehabilitation centre and the other in a family support organisation located in northern Honduras. The participants were physiotherapists, physicians, nurses and educational professionals, as well as a psychologist, kinesiologist, and non-professionals trained onsite. Seventeen participants attended the ‘Acquired brain injury/spinal cord injury workshop’ (adult workshop), and 15 attended the ‘Rehabilitation for children with impaired neuromotor development workshop’ (paediatric workshop). They completed three questionnaires before the workshops: one on sociodemographic information; one related to knowledge; and, the Modified Stages of Learning Questionnaires (MSLQs). Three questionnaires were completed after the workshops: the Modified Kirkpatrick; a knowledge questionnaire; and, the MSLQ. Results: Most of the participants agreed that the workshops had positive effects in two of the four Kirkpatrick levels that were evaluated: reaction and learning. In the MSLQs of the paediatric workshop, there was a statistically significant change in the percentage of participants who moved from scanning/evaluation stages in the pre-test to learning/gaining experience in the post-test, in three of the six topics. Three of the knowledge questions showed important learning effects. Conclusion and Implications: Workshops offered through an international collaboration resulted in enhancing learning and knowledge of neurological rehabilitation workers in Honduras. This initiative has the potential to improve the quality of care for people with neurological conditions in the region. Participants evaluated the workshops as relevant and held very positive attitudes about the perceived outcomes. The inclusion of local practitioners in planning the workshops and selecting the topics appeared to have aided their relevance. It is recommended that workshop planners take adequate time to ensure relevancy.
Cross-Cultural Adaptation and Validation of the Kannada version Fatigue Severity Scale among Kannada-speaking Individuals with Neurological Disorders: a Cross-Sectional Study done in South India
Purpose: The Fatigue Severity Scale (FSS) has been translated and validated in many languages across the world. Since it is a self-reported scale, it is necessary for clients to understand the components in order to quantify them. However, to date, the version in Kannada, the language spoken locally in the state of Karnataka in South India, has not been validated. This study aimed to perform cross-cultural adaptation and determine concurrent validity and test-retest reliability of the Kannada version among Kannada-speaking individuals with neurological disorders. Method: A cross-sectional study was conducted in the neuro-rehabilitation unit of a tertiary care hospital in southern Karnataka. Cultural adaptation of the scale was targeted at the Kannada-speaking population. It was pilot tested among 30 individuals with neurological conditions. The adapted scale was then evaluated for concurrent validity along with the Visual Analogue Fatigue Scale, by correlating the scores of fatigue assessed by both the scales among 83 participants. Reassessment of fatigue was done on all the participants the following day, to determine the test-retest reliability of the Kannada-version FSS scale among individuals with neurological disorders. Results: The Kannada version of the Fatigue Severity Scale showed an excellent correlation with Visual Analogue Fatigue Scale scores (r = 0.71, p<0.001) and good intra class correlation coefficient (α = 0.92). The fatigue scores also showed a minimal correlation with various neurological conditions. Conclusion and Implications: The culturally-adapted Kannada version of the Fatigue Severity Scale has proved to be a valid and reliable tool to assess severity of fatigue among Kannada- speaking individuals with neurological disorders. It could therefore be used routinely as an efficient tool for the effective assessment and management of fatigue in clients with all types of neurological conditions.
Training in Qualitative Research Methods for Professionals working with Persons with Disabilities
Purpose: The study aimed to investigate the impact of intensive in-service training in qualitative research methods on the research competencies of a cohort of rehabilitation professionals. Method: A series of three-day workshops was held on professional development in the promotion and utilisation of qualitative research in the field of disability and rehabilitation. It was organised at five centres across India for professionals working in that field. Data was collected through a survey of workshop participants, to ascertain the impact and efficacy of the training provided. Results: The results suggest that practitioners working in the area of disability and rehabilitation see considerable value in the application of qualitative research and are enthusiastic about its potential to improve the lives of those with whom they work. They believe that such an approach will provide useful data and increased knowledge in respect of the lives of individuals with disabilities and those interventions that provide them with greatest benefits. The survey revealed that the knowledge of qualitative research methods was limited even among professionals who had studied for research degrees. Conclusion: There is the need for more intensive training in qualitative methods in order to enhance the quality of research in disability and rehabilitation in India, and to assist in improving the lives of individuals with disabilities, their families, carers and those who work with them.
A Qualitative Approach to Study the Identity Development of Deaf Students in India
Purpose: This research aimed to explore the deaf identity development process and to compare the identity status of deaf children in India, based on their exposure to inclusive and segregated educational institutions. The first section of the paper presents the Deaf Identity Development Models proposed by other researchers, while the second section deals with the information acquired from the deaf students in the study sample. Method: Forty pre-lingual deaf students were selected through a purposive sampling technique. The study tool was an adapted version of the Deaf Identity Development scale. The data was analysed qualitatively through content analysis. Identified themes were presented along with the verbatim statements. Results: The findings revealed that the age of onset of hearing loss, degree of hearing impairment, parents' hearing ability, family's socio-economic status, parents' education, family environment, the attitude of parents, social exposure, present and past experiences and social acceptance of the deaf child contribute tremendously to the development of an identity. The study also found that most of the deaf students who had not attended special schools possessed a culturally marginal identity, whereas students with prior special school experience possessed a bicultural identity and were better adjusted in the inclusive schools as compared to their counterparts. Conclusion: Further research is suggested, with a special focus on how people with different degrees of congenital hearing impairment experience and negotiate their identity in context. ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
Healthcare-seeking Behaviour among Working Women with Disability in Karnataka, India
Purpose: In India women constitute 44% of the total population with disabilities, which roughly amounts to around 10 million persons. This study explores healthcare-seeking behaviour among working women with disabilities in the country. Method: A cross-sectional study using a quantitative survey was conducted among 72 working women with disability to explore their patterns of health-seeking behaviour. Women with disability, between 18 and 45 years of age, who were currently working full-time and who had experienced a serious health problem in the past year were included in the study. A pre-structured questionnaire was used for the survey. Results:Body pain (78%) followed by Urinary Tract Infections (9%) were the commonly cited health problems by the study participants. Eighty percent (80%) of women with disability sought care for their health issues. The actions that they took for their health problems depended on the severity of the disability (p-value-0.001), type of the disability (p-value-0.05), marital status (p-value-0.035) and savings (p-value-0.042) they had set aside for themselves. Monthly family income and years of disability showed correlation with the type of care that they opted for. Conclusion: Employed women with disability show a positive healthcare seeking behaviour pattern. The action they take in addressing their health issues and the type of care that they opt for depends on factors associated with their disability, marital status and financial stability or available savings.
Exploring the Use of Communication Supports Inventory- Children and Youth (CSI-CY) - to Identify Barriers and Facilitators in Implementing Augmentative and Alternative Communication in India: Preliminary Evidence from Two Case Reports
Purpose: Augmentative and Alternative Communication (AAC) systems are very often abandoned by the users and caregivers due to potential challenges in implementation. This study aimed at exploring the use of Communication Supports Inventory-Children and Youth (CSI-CY), based on the International Classification of Functioning, Disability, and Health-Children and Youth (ICF-CY), as a potential tool for identifying barriers and facilitators in AAC implementation in the southern part of India. Method: The CSI-CY was administered to the parents of a child with cerebral palsy and a child with autism spectrum disorder, respectively. Environmental facilitators and barriers that affect communication were rated. A semi-structured interview was also conducted to identify additional barriers and facilitators as identified by parents. Results: Barriers related to services and policies, people and assistive technology, were identified for both cases. Additionally, the semi-structured interview identified barriers related to myths, clinicians, child, AAC use, economy and society. Conclusion: CSI-CY is a potential tool for clinicians to systematically identify and document barriers and facilitators to implement AAC. It can further assist them in setting goals and defining the necessary intervention for each child with disability. Early use of AAC contributes to better therapeutic outcomes. Training should be given to professionals, special need educators and school teachers about different AACs and the appropriate techniques to be used. Counselling and evidence from earlier successful AAC interventions can dispel existing myths. Awareness programmes, group discussions and training on AAC can be done to eliminate barriers that may exist among rehabilitation professionals in India.
Employers' Attitudes and Hiring Intentions towards Persons with Disabilities in Hotels
Purpose: The hospitality industry is labour intensive. Currently, in India, hotels have a high employee attrition rate. This study aimed to explore the attitudes of hotel managers towards recruiting persons with disabilities as employees, a move which could benefit all concerned. Method: A structured survey instrument was sent to 31 employers in star category hotels. Results: Employers' attitudes have a significant influence on the recruitment of persons with disabilities. While the intention to hire persons with disabilities is positively associated with quality of work, loyalty, and dependability, it can also be negatively associated with lack of skill, work experience, poor time management and absenteeism. Conclusion: It is concluded that employers hire person with disabilities to work in hotels as they are more reliable and loyal towards the organisation. This attitude from the side of employees with disabilities will also help to overcome the problem of high employee attrition that has a deleterious effect on profitability in the service industry. Limitation: The data is collected from hotels in a single city, which may limit the generalisation of the findings.
The Quality of Life and Associated Factors in Indonesian Meningioma Clients after Surgery: A Cross-Sectional Study
Purpose: The quality of life (QOL) of meningioma clients in Indonesia is poorly understood. This study aimed to investigate and examine the factors associated with the QOL of these meningioma clients after surgery, in order to help create an appropriate post-operative nursing intervention. Method: This was a cross-sectional study. The QOL data was collected from a sample of 118 clients, using a EuroQol-5D-5L (EQ-5D-5L) questionnaire. Functional status, fatigue, illness perception and social support were assessed by the Barthel Index, FACIT-Fatigue Scale, Brief Illness Perception Questionnaire, and Medical Outcome Study Social Support Survey-6, respectively. Statistical analyses were conducted using the Chi-square test, Fisher’s exact test, and logistic regression test. Results: After surgery, more than half of the 118 clients reported “ problems” in the EQ‐5D dimensions of mobility (65%), self‐care (57%), usual activities (70%), pain/discomfort (84%), and anxiety/depression (70%).The average postoperative EQ-5D index value (±SD) was 0.55 ± 0.26 while the median of EQ-VAS was 69.2 (IQR 40–90).Factors related to low QOL were age (p = 0.014), tumour grade (p = 0.0001), functional status (p = 0.0001), fatigue (p= 0.001), illness perception ( p = 0.0001), and social support (p = 0.001). Multivariate analysis showed that the most dominant factor associated with QOL was functional status (OR 6.728; Confidence interval=95%; p=0.008). Conclusion and Implications: There is a correlation between age, tumour grade, functional status, fatigue, illness perception, and social support with the QOL of postoperative meningioma clients. The study recommends that these be included in their nursing assessment and an appropriate nursing rehabilitation programme be planned in order to improve their QOL.
Training of Mid-Level Rehabilitation Workers for Community-Based Rehabilitation Programmes
Purpose: There is a lack of trained rehabilitation professionals, especially in the small towns and rural areas of low- and middle-income countries. In India, a new cadre of mid-level rehabilitation workers, the Rehabilitation Therapy Assistants (RTAs), are being trained by Mobility India, a Non-Governmental Organisation (NGO). This paper explores their training and experience after the training. Method: The paper has collected information from three different initiatives connected with the trained RTAs: An impact assessment of their training; interviews with RTAs during an evaluation; and a survey of 188 RTAs trained between 2002 and 2019. Results: Analysis of the information shows that RTAs have good skills to provide rehabilitation interventions in the field and are appreciated by clients and other stakeholders. Most of the RTAs work for NGOs in CBR programmes, and in private hospitals and clinics. There is no role for them in government services in most countries. The number of trained RTAs remains small in spite of the large needs. This may be due to lack of an accreditation system for RTAs and the low priority given to rehabilitation services in general. Conclusions: The analysis provides useful information to strengthen the RTA training courses. Training RTAs to provide rehabilitation services in smaller towns and rural areas of low- and middle-income countries can have a good impact through CBR programmes. However, this impact remains circumscribed to small areas where NGOs are active. Changes are needed in the health systems for the inclusion of mid-level rehabilitation workers in primary health care services.
Scaling of Organisations of Persons with Disabilities: A Case Study in the People’s Democratic Republic of Lao
Purpose: The ability to have impact at scale is an important concern for Organisations of Persons with Disabilities (OPDs), but little is known about how scaling occurs in practice and the capacity of OPDs to undertake scaling. The aim of this study was to assess perceptions and experiences of scaling and broader organisational practices among a sample of people working for OPDs in Lao PDR. The study also aimed to deductively analyse the qualitative data in relation to a pre-defined socially inclusive scaling framework. Methods: In-depth interviews were conducted with a sample of people working with 10 OPDs operating in Lao PDR (n = 12; 6 female and 6 male). Participants included directors, administration personnel, and advisers of OPDs. Grounded theory was used to analyse the qualitative data. A deductive approach, comprising a multiple cycling coding process, was used to analyse the data in relation to the IPILA socially inclusive scaling framework. Results: Participants reported their perceptions of scaling and broader organisational practices in relation to eight themes: OPDs’ relationship with government; collaboration among OPDs; legal registration; operational challenges; good practices for success; different strategies across OPDs; next steps to improve the work of OPDs; and implementation of policies. Findings from the deductive analyses indicated that OPDs use different strategies to include their members and/or service-users. The OPDs scaled in different directions, despite facing operational challenges such as funding and technical expertise. While OPDs identified scaling practices, they react to rather than plan scaling opportunities. Conclusion: This study addressed the ways in which scaling is understood by OPDs in the context of Lao PDR. The findings show that OPDs recognise their good practices and the steps needed to scale, but lack planning and monitoring processes for scaling.
Balancing between Rehabilitation and Inclusion and not ignoring the most valuable resource in Society
Copyright (c) 2020 The Author(s) https://creativecommons.org/licenses/by/4.0
Barriers to Utilisation of Dental Services among Children with Disabilities in a Coordinated Healthcare Programme in Mangalore, South India: A Mixed Methods Study
Purpose: Unmet oral health needs affect the quality of life of individuals, especially if they are already at a disadvantage like children with special health care needs. Strategies to mitigate these disparities in India’s diverse healthcare settings have hitherto been largely ineffective. This study aimed to assess the utilisation and barriers to the use of dental health services among children with special health care needs, against the background of a coordinated healthcare programme implemented in the A B Shetty Institute of Dental Sciences in Mangalore, India. Method: The study was conducted over a 6-month period, from September 2018 to February 2019. A mixed-methods design was concurrently employed for data collection. Utilisation of dental services was assessed quantitatively, and the barriers to dental services utilisation were assessed qualitatively through caregiver interviews, with a sequential data integration strategy. Results: The quantitative data revealed gross underutilisation of dental resources by children (only 16% availed of some form of dental treatment), and the prevalence of avoidance behaviour (63% showed reluctance and did not turn up for appointments). Restorative needs formed the highest unmet dental component among the children (67% required secondary dental care). In-depth interviews with the children’s caregivers revealed that the presence of cognitive barriers could have a direct effect on the time and quality of dental care delivered to their children. Conclusion: Cognitive barriers among caregivers appear to have a profound impact on the underutilisation of dental services in their children with special healthcare needs. These barriers may be addressed within the integrated healthcare programme and the dental curricula through provisions for continued individual and community dental education, and motivational efforts that simultaneously target the caregivers and their children with special healthcare needs.
Academic Outcomes and Coping Mechanisms of Children using Cochlear Implants in Mainstream Schools in Kerala, India
Purpose: The aim of the present study was to understand the academic outcomes of children using cochlear implants in mainstream schools in Kerala, India and to explore the compensatory strategies used by them to overcome the difficulties faced in classrooms. Method: Thirty-one children using cochlear implants who were attending first and second grades in mainstream schools, and their parents and teachers participated in the study. Teachers were asked to rate a questionnaire, “Teachers’ Perceptions of Academic Outcomes”, which consisted of five sections – oral comprehension, oral expression, reading, writing and mathematics. The performance of the children using cochlear implants was compared with the performance of typically hearing children in the class. The grades obtained in the previous examination were also used for the comparison. Information was collected regarding difficulties faced by the children inside the classroom and their strategies to overcome the challenges. Results: The class teachers rated the performance of 71 % of these children as ‘above average’. Though the academic outcomes were found to be good on the questionnaire and classroom tests, most of the children with cochlear implants faced various difficulties and had used different compensatory strategies to give their optimum performance in the classroom. Conclusion: The study emphasizes the importance of having mid- and long-term follow-ups with children using cochlear implants, even after mainstreaming. It is necessary to orient and train teachers about the needs of these children and to implement support strategies in mainstream schools.
Disability, Sociodemographics, and Discrimination: A Descriptive Analysis of Household Survey Data from Bangladesh
Purpose: Disability affects upwards of one billion people worldwide, the majority of whom live in low- and middle-income countries. Based on survey data from Bangladesh, the aim of the study is to contribute to an improved understanding of the experiences of people with disabilities in terms of discrimination, health, and sociodemographic indicators. Method: A descriptive analysis of data is presented, from a survey implemented in 2016 on a sample of adult persons with disabilities from18 districts in Bangladesh (n=1,900). The summary statistics of main indicators and correlation analysis of key variables are given. Results: Women comprised around 40% of the sample. The mean age was 36 years (minimum 18 years and maximum 55 years). Women had lower socioeconomic status than men (p<0, 01), were less likely to be well-educated or employed, had worse self-assessed health (p<0, 05), and were less likely to be able to read and write. Men were more likely to have a physical disability than women (p<0, 01). Both women and men reported unmet needs in terms of access to assistive products and not receiving a benefit. Around 40 % of the sample reported having experienced discrimination, with no significant differences between women and men. Conclusion and Implications: Many women and men with disability experience some forms of discrimination, including in matters pertaining to healthcare, education, and employment. Such experiences may have a negative impact on their life chances. However, women and men with a disability differ in several important respects, both in terms of socioeconomic status and types of disability. Such differences need to be considered for effective and equitable policy development.
Views and Experiences of People with Intellectual Disabilities to Improve Access to Assistive Technology: Perspectives from India
Purpose: People with intellectual disabilities are deeply affected by health inequity, which is also reflected in their access to and use of assistive technology (AT) which could benefit them. Including the perspectives of adults with intellectual disabilities and their caregivers, together with the views of local health professionals, suppliers of AT and policy-makers, this paper aims to provide an overview of factors influencing access to AT and its use by people with intellectual disabilities in Bangalore, a southern region of India. Method: Face-to-face interviews were conducted with 15 adults with intellectual disabilities (ranging from mild to profound) and their caregivers, and with 16 providers of assistive technology. This helped to gain insight into the current use, needs, knowledge, awareness, access, customisation, funding, follow-up, social inclusion, stigma and policies around assistive technology and intellectual disability. Results: Access to assistive technology was facilitated by community fieldworkers and services to reach out and identify people with intellectual disability. Important barriers were stigma, and lack of knowledge and awareness among parents. Factors related to continued use were the substantial dependence on the care system to use assistive technology, and the importance of AT training and instructions for the user and the care system. Conclusion and Implications: The barriers and facilitators related to assistive technology for people with intellectual disability differ from other populations in need. The findings of this study can be used to inform and adjust country policies and frameworks whose aim is to improve access to AT and enhance the participation of people with intellectual disabilities within their communities.
Socioeconomic Factors Hindering Access to Healthcare by Persons with Disabilities in the Ahanta West Municipality, Ghana
Purpose: An estimated 15% of the world’s population lives with disabilities of various types and 80% of them are in low-income countries, with limited or no access to basic services including healthcare and rehabilitation facilities. The general objective of the study was to determine the socioeconomic factors that hinder access to quality healthcare by persons with disabilities in the Ahanta West Municipality of Ghana. Method: A qualitative study was carried out. Purposive sampling was used to select the participants (persons with disabilities and healthcare workers). Data was collected through 10 in-depth interviews with health workers and 5 focus group discussions with persons with disabilities. Data was analysed based on the themes that emerged during the discussions. Results: The major social factors found to hinder access to quality healthcare were cultural explanations of disability and its causes, stigmatisation, and attitudes of healthcare workers towards persons with disabilities. The economic factors that created barriers include costs of treatment and assistive devices, unemployment, poverty, and transportation problems. Conclusion: A review of national health policy programmes and their implementation to ensure that the needs of persons with disabilities are adequately catered for. This study reveals that the current health policies and subsequent health services are not adequately considering the needs of persons with disabilities. It is recommended also, that there is the need for a change in attitude by the general public towards persons with disabilities. This in particular is a role of influential stakeholders such as government and NGOs engaging on effective public education to bring to the notice of the general public the meaning and cause of disability in order to reduce the way at which disability is explained from a cultural point of view.
Challenges associated with Vocational Rehabilitation for Persons with Disability in the Kumasi Metropolis of Ghana
Purpose: The study examined the challenges associated with vocational rehabilitation for persons with disabilities in the Kumasi metropolis of Ghana. It assessed the support available for vocational rehabilitation delivery centres and suggested measures that could ensure effective delivery of services to persons with disabilities. Method: The study design was descriptive and qualitative. Purposive sampling was used to select 4 heads/managers and 11 tutors from four institutions offering vocational rehabilitation services for persons with disabilities. Interviews were conducted with the aid of semi-structured interview guides. Data was transcribed from audio-recordings and analysed using a thematic approach. The themes and codes are presented as findings and supported by quotes. Results: The study revealed that the vocational rehabilitation centres in the Kumasi metropolis face challenges such as: insufficient finance, infrastructure deficits, inadequate teaching and learning materials, and stigmatisation of staff members. To counter these, participants proposed: prompt payment of government grants, increasing staff motivation, improvement in infrastructure, provision of adequate tools and equipment for teaching, and posting of additional tutors. Conclusion and Implications: The government of Ghana, through the Ministry of Education, must restore the goods and services grants, as well as administrative grants, and minimise delays in the release of funds. Non-governmental organisations that work towards funding disability-related activities should redirect their focus towards vocational rehabilitation for persons with disabilities.
Comprehensive Management of People with Cerebral Palsy: An Indian Perspective
Purpose: Guidelines for the management of people with cerebral palsy are available from many countries. However, these cannot be adopted in their entirety in other countries due to socio-cultural differences and varied health systems. This study set out to develop guidelines for the management of people with cerebral palsy, throughout their lifetime, in India. Methods: A mixed methodology with a multiphasic approach was used. The first phase involved an extensive literature review to compile current evidence about the management of people with cerebral palsy. In the second phase, a questionnaire was given to stakeholders in order to explore current practices. The third phase consisted of consensus-building meetings with stakeholders, to develop resolutions that incorporate global best-practice recommendations for India. Results: Responses from the second phase were compiled and categorised based on discipline. Proceedings of the consensus meetings were transcribed verbatim and best evidence was synthesised to understand current global practice guidelines. Resolutions were formed within the framework of the results of phases I and II. These were ratified by experts and then formalised. Conclusion: Sixty-four resolutions were formed, detailing a framework for multidisciplinary management of persons with cerebral palsy throughout their lifetime. A card with guidelines was developed to document all aspects of rehabilitation, development and care. However, the utilisation and application of these guidelines have not been explored as yet.
Mixed-Methods Programme Evaluation of Disability Equality Training (DET) in Mongolia
Purpose: An evaluation of a disability equality training (DET) programme, based on the social model of disability, was conducted to explore the changes in the participants’ attitudes and behaviours in Ulaanbaatar, Mongolia. Methods: This study is composed of two parts. First, the participants’ attitude changes during DET sessions were examined through a descriptive quantitative and qualitative analysis of questionnaires and related documents. Second, the behavioural changes at the organisational and individual levels, the impact on society, and related factors were explored by quantitative and qualitative analysis of good practice cases: 39 participants were selected through purposive sampling and semi-structured interviews were conducted. Results: It was found that most participants adopted the social model perspective within these sessions. A qualitative content analysis of the good practice cases also found that the majority of participants attempted to change their social environments after the sessions. Thematic analysis identified promotional factors, such as within-organisation dynamics and compatibility and barriers at the individual and organisational levels, which were associated with participants’ behaviours after DET sessions. Conclusion: The implications of these findings are discussed in connection with the strategic implementation of DET to promote disability-inclusive development. Future studies should examine the effectiveness of a strategy by considering the factors identified in this study and by using a reliable sample in various settings where DET sessions are conducted.
Impact of Visual Impairment and Correction on Vision-Related Quality of Life: Comparing People with Different Levels of Visual Acuity in Indonesia
Purpose: This study assessed the extent to which visual impairment impacts on vision-related quality of life in Indonesia, by comparing four groups of people: those with 1) normal vision, 2) corrected visual impairment, 3) uncorrected visual impairment, and 4) blindness. Method: Purposive sampling was used. There were 162 respondents, between 21 and 86 years of age. Participants with normal vision and blindness were community-dwellers in Yogyakarta, Indonesia. Those with corrected and uncorrected visual impairment were recruited from an eye clinic. This cross-sectional study used NEI VFQ-25 to assess vision-related quality of life. The total scores and 11 NEI VFQ-25 subscales scores of four respondent groups were analysed using ANOVA, followed by post-hoc analyses to reveal between group differences. Results: There was a significant difference in the NEI VFQ-25 total scores among the four respondent groups. Respondents with normal vision had the highest score and those with blindness had the lowest. There were also significant differences among the four groups for the 11 subscales. Post-hoc analyses revealed no significant difference between respondents with normal vision and corrected visual impairment in the total and 9 NEI VFQ-25 subscales. Respondents with uncorrected visual impairment and blindness had significantly lower vision-related quality of life compared to those with normal vision or corrected visual impairment in the total and 5 NEI VFQ-25 subscales, indicating that visual impairment decreases vision-related quality of life. Conclusion: Visual impairment has a detrimental impact on a person's vision-related quality of life. The negative impact of visual impairment can be minimised by correction. Failure to correct visual impairment leads to significantly lower vision-related quality of life.
Evolution from Negative Identity to affirmation of ‘Disability Identity’: Life story of a Woman with Spina Bifida in India
Purpose: This paper is part of a research study that explored the lived experiences of adults with physical disability in Delhi, India. It traces the evolution of a positive outlook towards disability in a young woman living with spina bifida. Method: This paper is part of a larger study, and is one of the twelve narrative accounts of adults with physical disability, who had been selected to be part of the study using purposive sampling. The study adopted a life story approach wherein the participant talked about their life events in a chronological order. It is believed that stories constitute the psychological realities, including identity, and identity is expressed in sociocultural relations through talk. This paper is the life story of one woman with spina bifida and it recounts her journey depicting the dynamic nature of identity construction. Her life story gives rich insights in terms of personal and social experiences that enabled the researcher to explore the complexities in identity construction. A pseudonym, Ashima, has been used to maintain confidentiality. Results: By describing her childhood experiences, medical journey, relationships, and marriage, the participant was able to make sense of the events leading up to the emergence of a positive disability identity. The daily lived realties of exclusion had instilled a sense of negativity in her but she began to affirm the disability identity after contact with disability groups. The positive role of the family was an additional factor in the participant’s acceptance of her disability identity. Conclusion: The paper presents the emergence of a positive identity by challenging the traditional approaches and oppressive social constructions of disability. It underscores the importance of voice, agency and the celebration of disability identity, and paves the way for future researchers to listen to the insider’s perspective in order to create a culture of valuing differences.
Experiences of Persons with Disabilities and their Quality of Life in Two Namibian Villages
Purpose: The study aimed to determine the convergence and divergence of the Photovoice method and the WHOQOL-BREF assessment in integrating the experiences of persons with disabilities with Community-Based Rehabilitation and their quality of life respectively. It also aimed to propose a shared framework for Community-Based Rehabilitation (CBR) programme evaluation in Namibia. Method: A qualitative phenomenological design was utilised. Twelve participants were part of this study.The primary data sets used for analysis were photographs taken during a study using the Photovoice method and the results from the WHOQOL-BREF questionnaire. The Photovoice process preceded completion of the WHOQOL-BREF questionnaire. Information about the participants was gathered during the two phases. The CBR Matrix developed by the World Health Organisation was utilised to determine themes for the Photovoice method. Results of the Photovoice study were integrated with those of the WHOQOL-BREF to determine convergence and divergence. Results: Notably, most participants (n=8) in both study sites had low scores regarding their quality of social relationships and environment. Furthermore, the Photovoice method revealed negative experiences of the participants regarding the environment (physical safety and security, home environment, financial resources, health and social care, access to information, recreation and leisure, physical environment, and transport). By and large there was a stronger convergence than divergence of the Photovoice method and WHOQOL-BREF assessment. Conclusion and Implications: Notwithstanding the in-depth investigation, the small sample size limits generalisability of the research findings. A study with a larger sample size is needed to confirm the findings, especially regarding the WHOQOL-BREF assessment. This study proposes a practice framework for CBR programme evaluation in Namibia that integrates the WHO CBR Matrix, Photovoice method, WHOQOL-BREF and highlights from the other frameworks. Further studies are required to validate the framework.
Characteristics of Outpatients receiving Physical Therapy Services at a Provincial Hospital in Papua New Guinea: A Descriptive Case Study
Purpose: Development of Physical Therapy (PT) services for people with disability is one of the urgent challenges in the health sector in Papua New Guinea (PNG). However, information on the current status of PT services in PNG is scarce, as also is the case for the hospital-based outpatient PT services. This study aimed to describe the characteristics of outpatients receiving PT services in a provincial hospital in West New Britain (WNB) Province, PNG and to compare them with the characteristics of inpatients. Method: This was a retrospective case study using outpatient and inpatient records. The records of clients receiving PT services as either outpatients (413 records, outpatient group) or inpatients (350 records, inpatient group) were reviewed in relation to sex, age and diagnosis. Comparisons were made between the two groups on basis of quantitative data of the two patient groups . Results: The final analysis comprised 404 records in the outpatient group and 344 records in the inpatient group. In the outpatient group, injury and musculoskeletal disease were forming the most dominant diagnosis groups with 52.5% and 22.0%, respectively. Injury was most common in the agegroup 20 to 39 years and musculoskeletal diseases was most common in the agegroup 40 to 59 years. These two diagnosis groups and congenital malformations were significantly more represented among outpatients than among inpatients. Conclusions: Young to middle-aged clients with injury or musculoskeletal disease were predominant among outpatient PT services as compared to inpatient services. The study findings serve to provide information on the current situation and potential needs of hospital-based outpatient PT services in one provincial hospital of PNG. These findings could be the base for planning outpatient PT service in WNB Province and PNG.
Self-Advocacy and Ally-Advocacy for Disability Justice: Organisational, Psychosocial, and Political Resources
The world of today sees more persistent, collective work of marginalised people resisting structural oppression rooted in racism and misogyny through newly-organised multinational movements like Black Lives Matter, #IamSpeaking, and Me Too. This has led to a rapid rise in public consciousness and activism about social injustices across many sectors of society. Ableism and other types of discrimination in education, employment and community-living experienced by people with a disability have both similarities to, and differences from, the indignity and impact of racism and misogyny. The activist disability community is working hard to have their advocacy agendas gain more public awareness and support. The common ground among all oppressed groups is their demand to have their human rights honoured. This requires two societal value shifts: (1) listening to voices outside the dominant culture and power structures through the involvement of insiders, based on their lived experience as members of the marginalised groups, and (2) collaborative advocacy to achieve milestones on their journey towards social justice. Applying these principles, this article aims to elevate and amplify the historical and current activities of self-advocates from the disability community to affirm and secure their human rights. The article provides explanations and examples of: (1) the complexities of disability-based discrimination; (2) political activism by the disability rights and independent living movements in the United States; (3) the psychosocial dimensions of embracing disability identity, culture, and pride; and (4) various outstanding consumer-driven artistic and organisational resources that are shaping the evolution of equal opportunity and disability justice.
People with Physical Disabilities playing Light Volleyball: A Qualitative Study in Hong Kong
Purpose: This study aimed at understanding the perceptions of people with physical disabilities regarding playing Light Volleyball (LVB), identifying the possible constraints and risks they might face while playing, and providing their suggestions for fine-tuning the Light Volleyball intervention programmes. Method: Four focus group interviews were conducted with 17 participants who joined the Light Volleyball trial programme. The participants were 11 males and 6 females, with an average age of 53.5 years (SD=11.83 years). People with poliomyelitis (n = 15), spinal cord injury (n = 1), hearing impairment (n = 1) were included. Results: Participants indicated improved reactivity and coordination, happiness, cooperation in team, happiness, and novelty in general as positive outcomes while playing Light Volleyball. They preferred to play in the seated position (i.e., sitting light volleyball - SLVB), and with simpler rules. They believed that their ability to play Light Volleyball was subject to their body constraints. Conclusion: Sitting Light Volleyball can be one of the new physical activity options for future sport promotion among people with physical disabilities in the community. The effectiveness of playing Sitting Light Volleyball in enhancing health among people with physical disabilities needs to be studied in future.
Assistive Devices for Persons with Visual Impairment and Low Vision: Preferences and Expectations of Users in the Southern States of India
Purpose: Persons with visual disabilities use various assistive devices to support, uphold or progress their functional abilities. Under the ADIP scheme of the Government of India, persons with any form of disability are provided with assistive devices to suit their needs. This study focused on finding out the preferences of persons with visual impairment in selecting and using their assistive devices. It also aimed to understand their expectations and measures for assessing the utility of assistive devices. Method: Data was collected by using semi-structured interview schedules from 227 respondents in the Southern States of India and the Union Territory of Puducherry (Pondicherry). The expectations and suggestions made by the study sample are discussed in detail. Results: Assistive devices of any sort are considered in terms of credibility, availability and suitability. The study findings revealed that 90% of the users preferred assistive devices such as Braille Slate-Interpoint A4, Taylor Frame, Daisy Player, JAWS Screen Reading Software, NVDA Screen Reading Software, Chessboard and Audible Cricket Ball, which were extremely helpful for their independent living. They had used most of these assistive devices in the optimal way. Conclusion: Assistive devices distributed to persons with visual impairment under various schemes are beneficial in enhancing their progress in education, employment, social participation and recreational aspects of life. The expectation of the respondents/users was that assistive device services be made easily accessible.
Disability Inclusion and Global Development: A Preliminary Analysis of the United Nations Partnership on the Rights of Persons with Disabilities programme within the context of the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals
Purpose: This paper provides a preliminary snapshot of the proposed priorities approved by the United Nations programme designated to support the progressive realisation of the CRPD, the United Nations Partnership on the Rights of Persons with Disabilities (UNPRPD) outlined by specific Convention Articles and, more broadly, the Sustainable Development Goals (SDGs). Method: A content analysis of project proposal summaries approved for funding by the UNPRPD was conducted against the CRPD and SDGs.A matrix of data was produced to draw links between proposed objectives and established international frameworks guiding global development. Results: This analysis provides two sets of information. First, a look at the distribution of rights identified in the initial project proposals and accepted by the UNPRPD, establishing a baseline of priorities and outstanding need. Second, it identifies issues that need to be addressed to ensure the advancement of all rights outlined in the CRPD and equitable achievement of the SDGs. Conclusion and Implications: Disability inclusion is necessary to achieve the SDGs in an equitable manner by 2030, as well as implement the CRPD. The UNPRPD supports a diverse range of projects spanning many of the Convention Articles and global goals; however, full participation and scope of disability inclusion requires programming in all areas of both instruments, and this has not yet been fully integrated in the UNPRPD funded project proposals. Limitations: This study was limited to the available UNPRPD project proposal summaries that were successful, and did not include all the proposals submitted for consideration. The proposals accepted for funding give insights into the disability inclusive development priorities chosen for project implementation by UN agencies.
Role of the Speech Therapist in the Management of Autism Spectrum Disorder in the COVID-19 pandemic era
Disclosure of Disease among Women affected by Leprosy: A Qualitative Study
Purpose: Although leprosy is completely curable with multidrug therapy, it is unfortunate that the stigma attached to leprosy persists even today. Fear of social exclusion prevents disclosure of the disease to the family and community. This study aimed to evaluate the extent of disclosure of disease among women affected by leprosy in a tertiary referral hospital in Chhattisgarh State, India. Method: A qualitative study was conducted with 57 women affected by leprosy who reported at a tertiary referral hospital in Champa, Chhattisgarh State. The respondents were 18 years of age or older, and had completed multidrug therapy for leprosy. They were asked whether the disclosure of disease had affected their interactions with family, neighbours and community members. Results: Of the 57 women, 48 (84%) had disclosed their disease to their family, 17 (30%) to their neighbours and 13 (23%) to the community members. Thirty women (53%) reported that they experienced problems after revealing the ailment to their family, friends and neighbours. The qualitative analysis found that negative behaviour towards people affected by leprosy still persists in the community. Consequently, women affected by leprosy try to hide their disease due to fear of negative community reactions. Conclusion: This study emphasises the need to spread awareness about the disease and its transmission, by educating the people affected by leprosy, their families and the community. This should be a continuous process in order to reduce or remove the stigma and discrimination against women affected by leprosy, in particular.
Effectiveness of Community-Based Rehabilitation on the lives of Parents of Children with Cerebral Palsy: A Mixed Method Study in Karnataka, India
Purpose: The study aimed to identify the effects of the CBR programme on parents of children with Cerebral Palsy, living in Karnataka State, India. It also tried to find the challenges and improvements needed to make the CBR programme more effective. Method: A cross-sectional, descriptive study design was used to collect a sample of 100 parents of children with Cerebral Palsy, with GMFCS levels IV and V. The sample was drawn from various communities in Bangalore, Davanagere and Bijapur, where the services of The Association of People with Disability are available. Face-to-face interviews were conducted with the study subjects. Data was analysed by SPSS using descriptive and inferential statistics. Results: It was observed that the CBR programme had a positive effect on parents’ health, knowledge, social lives and empowerment. A binary logistic regression was done to find the relationship between health, knowledge, social lives and assistive devices use. A strong association was found between all the areas (p=.001) except GMFCS and assistive devices use (p=.004) at 95% CI. The odds ratios between them were greater than 1 and showed the strong positive effect of the CBR programme on parents. Conclusion: The CBR programme not only has a positive effect on children with Cerebral Palsy, but also plays an important role in parents’ lives. It contributes in a positive way to parents’ overall activity.
Activity Limitation of People Affected by Leprosy in an Endemic District in West Bengal, India
Purpose: This study aimed to assess the level of activity limitation, and the factors associated with it, among people affected by leprosy who were reporting at a leprosy referral centre of Purulia, in West Bengal state, India. Method: A cross-sectional study was conducted among 358 individuals affected by leprosy. Persons recruited for this study were above 18 years of age, married, and had been diagnosed with leprosy for at least 1 year at the time of the interview. A semi-structured questionnaire was used to gather information about the respondents’ socio-economic and disease status. The Screening of Activity Limitation and Safety Awareness (SALSA) Scale was used to measure activity limitation. Results: Of the 358 respondents, 59% were male, 60% were between 18 and 45 years of age, and 42% were illiterate. About 144 or 40% of the respondents had Grade 2 disability and 60% had disease duration of more than 3 years. There were 229 individuals (64%) who had no limitation in activities, 103 (29%) had mild limitation and 26 (7%) had moderate to severe limitation in activities. There is a significant association between gender, age, occupation, physical disability and disease duration with activity limitation. Conclusion: It appears that limitations in activities among persons affected by leprosy are associated with being a woman, a housewife, an aged person, and with longer disease duration. The physical disability was intrinsically associated with limitation in activities.
Employment Needs of Young Adults with Visual Disability need to be recognised in Kabul, Afghanistan
Purpose: The aim of this qualitative paper was to understand the employment needs of young adults with visual disability in Kabul, Afghanistan. Method: The phenomenological approach was employed to obtain rich data based on the participants’ personal experiences. In-depth semi-structured interviews were conducted with 14 adults with visual disability, between 20-40 years of age, using open-ended questions to shed light on the employment needs of this population. The data derived from the interviews was transcribed, translated, and thematic analysis was performed. Results: Findings indicate that people with visual disability need to be equipped with essential skills to be competent workers. Support from employers and society is needed and, importantly, encouragement from family members and those involved in advocacy of the people with visual disabilities. Conclusion: Improving the public's awareness regarding personal and vocational abilities of people with visual disabilities, enhancing the skills necessary for employment, promoting their abilities, family support and maintaining positive attitudes are some of the strategies which could result in better employment prospects for people with visual disabilities in Afghanistan.
Community-Based Rehabilitation in Nigeria: A Scoping Study of Literature
Purpose: Previous reviews of community-based rehabilitation literature provide scant evidence supporting community-based rehabilitation in Nigeria. This study aimed at discovering the extent of the community-based rehabilitation impact in Nigeria by reviewing published literature and making it available to researchers, CBR project coordinators and managers, and policy-makers. Method: A scoping study of community-based rehabilitation literature on people with disabilities, families, and communities in Nigeria was conducted, using the databases of Pubmed, African journal online, Google Scholar, African journal of disability, Asksource.info, and REHABDATA on naric.com, for articles published between the years 1990 – 2018. Fourteen studies met all the inclusion criteria and were classified according to type as descriptive (n = 4), theory (n = 5), impact (n = 2), and case studies (n = 2) or review (n = 1) papers. Results: The results indicated a recent increase in community-based rehabilitation literature publication. Conclusion: However, there is a need for more well-designed literature to better inform community-based rehabilitation practice.
Greek Secondary Education Teachers’ Views on Inclusive Education of People with Intellectual Disabilities
Purpose: This paper aimed to investigate Greek secondary education teachers' views on people with intellectual disabilities, their inclusion in the typical educational system, and the dimensions of social and educational exclusion that may be associated with it. Method: The qualitative research design involved semi-structured interviews with 18 Greek secondary school teachers. Results: It was revealed that people with intellectual disabilities face educational exclusion for two reasons. The first is because the structure of the education system itself cannot meet their increased needs, and the second is due to the fact that a percentage of secondary education teachers feel negative about their inclusion in the typical education system. Conclusion and Implications: The implemented policy for the co-education of people with intellectual disabilities in Greece is not effective due to endogenous difficulties. It is necessary to orient the educational policy towards an education for all without "filters" of social exclusions.
"I Need to Love and to Be Loved": Perspective of Young Adults with Hearing Loss in Kabul-Afghanistan
Purpose: This research aimed to explore love and belonging or social needs, of young adults with hearing loss in Kabul, Afghanistan. Method: A qualitative research method specifically, the phenomenological approach, was adopted to conduct this research. An in-depth semi-structured interview was used to interview ten participants. Conclusion: Overall, two themes and four sub-themes were derived from thematic analysis. The finding indicates that social support from family members and people in the surrounding, and a sense of belonging are fundamental social needs of people with hearing loss. Further research is needed to investigate the reasons behind the unmet social needs of people with hearing loss. Limitation: The major limitations of the study were - lack of official data regarding people with hearing disability in Afghanistan, non-availability of sign language interpreters, and cultural constraints faced by female study participants.
Inclusive Education and Disabilities: Narratives from Ghana
Purpose: Inclusive Education (IE) has been recognised internationally as the ideal model of educational access to all. Despite this, it faces many challenges. The present study explored the narratives of 10 participants with diverse disabilities in Accra, Ghana, keeping the focus on (a) how children with disabilities in an Inclusive Educational facility understand their educational experiences, (b) how they perceive their relationship with peers and teachers in school, and (c) how accessible they find existing school infrastructures. Method: Using a phenomenological approach, data was generated through in-depth interviews with 10 participants from two selected schools. Results: The experiences of participants, in some instances, were found to be two-sided. While participants felt accepted by some of their peers, they also experienced bullying by others. While some of the teachers were supportive, others were not. All the participants agreed that the physical school environment was disability-unfriendly. Conclusion: Despite limited participation of children with special needs, greater stakeholder commitment was observed. This is promising for the future success of Inclusive Education in Ghana.
Ground Realities of Autism Spectrum Disorders in Sri Lanka
Autism spectrum disorders (ASD) are a group of developmental disabilities that impact children and adults globally. The majority of children diagnosed with ASD live in low- and middle-income countries (LMICs). There is, however, inadequate understanding of the prevalence, screening, diagnosis and treatment for these children in LMICs. As most of the current evidence comes from high-income countries, this narrative review will focus specifically on children with ASD living in Sri Lanka, a lower-middle-income country. It will discuss the prevalence of ASD, current screening and diagnostic assessments, and services available for these children, with a focus on speech therapy and augmentative and alternative communication (AAC).
User Satisfaction with Conventional Lower-Limb Orthotic Devices: A Cross-Sectional Survey in Pakistan
Purpose: Persons with disabilities affecting lower-limb function use ankle-foot-orthoses (AFO) and knee-ankle-foot-orthoses (KAFO) on a regular basis. However, the effectiveness of these devices in daily use is seldom evaluated, especially in the developing world. This study aimed to evaluate user satisfaction with lower-limb orthotic devices while performing a broad spectrum of daily life activities in Pakistan, and to document the desired outcomes. Method: A survey was conducted among orthotic device users in the out-patient departments of three hospitals in Lahore, Pakistan. The survey questionnaire was devised by adapting the Prosthetic Evaluation Questionnaire to suit orthotics evaluation. Fifty-four AFO and KAFO users participated in the study. Results: Most users felt comfortable while walking on even surfaces with their orthoses. However, donning/doffing these, climbing stairs and performing certain routine activities were considered problematic for most people. Energy conservation was the most desired AFO feature, while the KAFO users wanted automatic knee-joint function. Conclusion and Implications: Overall satisfaction with the existing lower-limb orthoses is adequate. Yet, significant improvements are needed in terms of energy efficiency and comfort while walking on different terrains. Further research is required in order to improve the functioning of the existing orthotic devices.
Stance Phase Kinematics in Ankle Joint during Ambulation on Uneven Surface: A Comparison between Stroke Survivors and Typical Adults
Purpose: Gait impairment is a common disability among stroke survivors and is a known risk factor of falls. Outdoor ambulation is essential for everyone, even for basic activities of daily living, but routine assessment of stroke survivors concentrates mainly on indoor ambulation and function. This study is an attempt to document gait parameters in stroke survivors and typical adults during outdoor ambulation. Method: For this prospective pilot study, 7 chronic adult stroke survivors and 7 age-matched typical adults were recruited by convenience. Measurements were taken of their ankle and subtalar joint angles during various phases of gait, using video analysing software, Kinovea 0.8.15. Results: Large differences in range of motion in the ankle and subtalar joints were noticed between stroke survivors and typical adults during ambulation on various surfaces. During ambulation on a firm surface, plantar flexion range of motion at the ankle was greater at initial contact and mid-stance, whereas on pebbled surfaces vast differences could be seen on initial contact and mid-stance. Conclusion and Implications: Significant stance phase deviations are evident in stroke survivors during ambulation on uneven terrain. This may be a risk for falls and musculoskeletal degeneration. Although definitive conclusions cannot be drawn due to the small sample size, these findings indicate a need for considering outdoor gait evaluation in routine practice in the community. Mobility correlates highly with quality of life and meaningful strategies to adopt safe ambulation methods can be developed only with proper evaluation methods.
Effectiveness of Caregiver Education for Prevention of Shoulder Pain in Acute Stroke Survivors: A Randomised Controlled Trial
Purpose: This study aimed to determine the effectiveness of caregiver education to prevent or reduce hemiplegic shoulder pain, a complication following stroke that adversely affects functional outcomes and prolongs rehabilitation. Method: The study was a randomised controlled trial involving acute stroke survivors in the hospital and their primary caregivers. The participants were conveniently selected and randomly allocated to the experimental (n = 20) and control groups (n = 20) using block randomisation. The stroke survivors of both the study groups received conventional therapy. In the experimental group, caregivers participated in three individual sessions of the education programme for shoulder care, which comprised provision of information, demonstration and training. The outcome measures at pre-assessment were the Visual Analogue Scale (VAS) for shoulder pain and the Fugyl-Meyer Assessment for Upper Extremity for Motor Recovery. Caregiver feedback scores were obtained following the intervention. The VAS scores were obtained at 30 days following intervention and 30 days following post-assessment (follow-up assessment) through the posted envelopes. Mann-Whitney U test and Chi- square test were used for statistical analysis. Results: There was no significant difference between the groups on VAS at follow-up assessment. The number of stroke survivors reporting “no pain” increased by 29% in the experimental group and decreased by 6% in the control group. Caregiver feedback scores were higher in the experimental group than in the control group (P < 0.001). Conclusion: This study indicates that educating caregivers on shoulder care during acute management at the hospital, improves their confidence in handling and positioning the stroke survivor after discharge and could reduce hemiplegic shoulder pain.
Community Physiotherapy in India: Status Quo?
Implementation of a Remote Control Application for Elderly People in Brazil: Analysis of the Factors Involved in the use of a Technological Innovation related to Telecare
Purpose: The rapid ageing of the Brazilian population highlights the importance of new assistive technologies. The objective of this study was to analyse the positive and negative factors involved in the implementation of a Remote Care App for the elderly in Brazil. Method: A qualitative method as been used, based on discussion groups involving 30 older Brazilian people who participated via a Telecare App. Results: The results obtained highlight positive factors such as security, independence and personal tranquillity, and negative factors such as the privacy of the elderly, the social differences of Brazil, and the design and utility of the App. Conclusion: Discourses on ageing at home using assistive technologies are cultural resources from which older people can make sense of their experience as users of Remote Care. It is also relevant information for the improvement of public policies aimed at caring for the elderly, by considering assistive technologies as factors for independent ageing.
Outcomes of Self-Care in Clients with Heart Failure before and after Treatment, using a Case Management Approach
Purpose: Heart failure (HF) is a clinical syndrome that is the final stage of most types of heart diseases. Thailand - in the Asia-Pacific region - has an unusually high incidence as the risk factors for heart disease increase due to population structure changes. This article aims to compare the self-care of heart failure clients before and after treatment using case management. Methods: A quasi-experimental research design was employed with 30 clients who were treated at the Khon Kaen University Heart Failure Clinic (KKU-HF) between April 2017 and March 2018. The research tool was a 2-part questionnaire that included demographic data and the comparison of scores of self-care before and after treatment using case management. Inferential statistics and paired t-test were used to analyze the data. Results: Most of the clients were males (80%), and most of them (56.67 %) were around 60 years of age and older. A comparison of scores for knowledge and understanding of self-care, before and after the treatment, showed a statistically significant improvement at the level of 0.05. Self-care behavior had also improved. The general quality of life had improved by up to 66.67%. Conclusion and Implications: The goal of this research study was to reduce the rate of re-hospitalization, the cost of medical treatment, and the death rate of heart failure clients. The findings can be used not only to develop self-care systems of the Khon Kaen University Heart Failure Clinic (KKU-HF) but also for other clinics to adopt.
Participation of Persons with Disabilities in Political Activities in Kumasi Metropolis, Ghana
Purpose: The opportunity to participate in political activities is at the heart of life in a just and democratic community. This paper attempts to assess the participation of persons with disabilities in political activities in Kumasi Metropolis, Ghana. Method: A cross-sectional study design with a quantitative approach was followed. A multi-stage sampling technique was adopted to select three disability groups (physically impaired, visually impaired and hearing impaired) from the study area. Using a random sampling method, 415 participants were included in the study. Data was collected with the help of a structured questionnaire, and analysed using SPSS version 20. Results: Most of the respondents did not participate in any political activities other than voting in elections. Other types of non-involvement included: Not contributing money to a political party or a candidate (75%); not having written or spoken to an elected representative/official (52%); not attending political meetings (51%); not writing letters to newspapers on a political issue (53%); not contributing money to an organisation trying to influence government policy/legislation (55%); and, not working with groups or on their own to change government laws or policies (51%). Conclusion: Participation of persons with disabilities in various types of political activities was generally low, apart from voting. The government should actively promote an accessible environment in which persons with disabilities can effectively and fully participate in public affairs, without discrimination and on an equal basis with others. This could encourage greater interest in political participation.
A Bibliometric Review of Executive Function as Cognitive Endophenotypes in Parents of Children with Neurodevelopmental Disorders
Purpose: The main aim of this study was to review whether first-degree relatives (parents) and their children with neurodevelopmental disorders (NDD) are cognitive endophenotypes in executive functioning. Method: A survey design was employed from May 2018 to January 2019, using an online and offline database of national and international ISSN Journals and ISBN books. Results: A bibliometric analysis was conducted on 19 of the 63 reviewed studies. A PRISMA Flow diagram and Harvest Plot have been used to depict the results of the analysis Conclusion and Implications: Delineation of executive functions (EF) as cognitive endophenotypes of NDD is, first of all, useful in exploring the genetic basis of these disorders; secondly, for identifying which cognitive traits may be important to it; and thirdly, to initiate and promote better educational practices and cognitive remediation. With a disclaimer that this analysis is only as inclusive as possible in the field of endophenotypes in NDD, limitations in the various studies have been identified, along with future suggestions for research.
Teachers’ Attitudes towards Inclusion of Blind or Partially-Sighted Students in Secondary Schools in Nigeria
Purpose: This study investigated the attitudes of secondary school teachers towards students with blindness or partial sight in selected states in Nigeria. Method: The authors utilised the modified version of a previous instrument to collect data from 306 secondary school teachers in Nigeria. Six basic questions were established to address: respondents’ attitudes towards inclusion; training acquired related to teaching; knowledge pertaining to policy and legislation; confidence levels; impact of geographical location; and differences in attitudes by the variables of subject(s) taught, school level taught, and years of teaching experience. Results: Attitudes of participants were mixed but generally indicated a positive trend. The level of training was low, with teachers showing limited knowledge of policy and legislation. A little over a quarter (27%) of them lacked confidence in teaching. There were differences in attitudes related to the geographical location of respondents. Those who taught at the senior secondary school level tended to have higher attitude scores on average than their counterparts at the junior secondary school level. Conclusion and Limitations: This study used self-report measures, although observations and interviews could be additional ways to evaluate the attitudes of participants throughout the country. Moreover, in-service programmes should be implemented to increase the knowledge base and expand the experiences of teachers in line with established policies and legislation.
Physical Activity of the Community- Dwelling Elderly Population in Gujarat, India: A Cross-Sectional Study
Purpose: While ageing is an inevitable phenomenon of life, physical activity is important for healthy ageing. Compared to the other age groups, older adults throughout the world have the lowest rate of participation in recommended levels of physical activity. This study aimed to investigate the physical activity status of the community-dwelling elderly population in Gujarat, India. Method: This was a cross-sectional study. A door-to-door survey was conducted among selected communities near Vadodara in Gujarat. Based on the inclusion criteria (age≥60years, MMSE-≥24), 347 elderly persons were included in the study. Data was collected using the Global Physical Activity Questionnaire (GPAQ), and analysed using descriptive statistics. Results: Among the 347 older adults (mean age 67.43±7.46 years) who participated in the study, 159 were male and 188 were female. While 125 participants (36%) were physically active at levels recommended by the World Health Organisation, 222(64%) were physically inactive. Conclusion: Only 36% of the participants were physically active as per WHO recommendations. The men were more physically active than the women in the study sample. This study implies that there is a need to create an awareness regarding the importance of physical activity for healthy aging.
Effects of Biofeedback and Task-Oriented Intervention on Balance Confidence and its Relationship with Social Participation among Stroke Survivors
Purpose: The study aimed to compare the effects of balance training on balance confidence and its relationship with social participation among clients with stroke. Method: A pre- and post- experimental group design was used. Stroke survivors who met the inclusion criteria were consecutively assigned to two groups (task-oriented and biofeedback). Participants in the task-oriented group received task-oriented activities for 20 minutes and the biofeedback group received intervention in correckta (equipment used for balance training) for 20 minutes, along with conventional occupational therapy - 5 sessions per week, for 12 weeks. Balance Confidence Scale was used for measuring balance confidence, and Frenchay Activities Index (FAI) was used to measure social participation. Statistical calculations were performed with SPSS version 16.0 package. Statistical tests were carried out with the level of significance set at p≤ 0.05. Results: The findings suggest that both the biofeedback and task-oriented groups showed significant improvement in balance confidence and there was no statistically significant difference between the groups. There was a moderate to good relationship between balance confidence and social participation. Conclusions and Implications: There is evidence that many stroke survivors have low balance confidence. Therapists should assess the balance confidence of their clients and encourage them to participate in these beneficial interventions.
Editorial: Essential Standards for CBR field workers
Life Accomplishment, Social Functioning and Participation of South-Eastern Nigerians with Lower Limb Amputation
Purpose: For a better understanding of the possible impact of impairments and disabilities on the life of individuals with lower limb amputation,it is important to explore the levels of Life Accomplishment (LA), Social Functioning and Participation (SFP) among them.The present study, set in South-Eastern Nigeria, aimed to study these levels and the influence of selected clinical and demographic variables on these constructs. Method: This cross-sectional survey involved 60 individuals with lower limb amputation (46 unilateral, 14 bilateral) recruited from all the five South-Eastern Nigerian States. The Social Functioning Questionnaire (SFQ), Participation Scale and Life Habit Questionnaire were used for measuring levels of social functioning, social participation and life accomplishment, respectively. Data was analysed using descriptive statistics of frequency count, percentages, mean and standard deviation. Mann-Whitney U and Kruskal-Wallis tests were used to test the hypotheses. Alpha level was set at 0.05. Results: Most of the participants (51.7%-58.3%) had low levels of social functioning across SFQ domains. Most of them (61.7%) had severe participation restrictions, and they all had reduced life accomplishments. Participants with bilateral amputation had poorer levels of social functioning (P<0.0001), participation restriction (P<0.0001), and life habits accomplishment (P<0.0001) than their counterparts with unilateral amputation. Individuals with below-knee amputation had significantly better levels of social functioning (P<0.0001) and participation (P<0.0001) than those with above-knee amputation. Participants with prosthetic mobility aids had significantly better levels of social functioning (P<0.0001) and participation (P<0.0001) than those with no prosthetic mobility aids. There was no significant difference in the levels of social functioning and participation between male and female participants, but female participants had statistically significant (P<0.0001) higher scores in nine out of twelve life habit domains than their male counterparts. Conclusion and Implications: Low social functioning, severe participation restrictions, and reduced life accomplishments were prevalent among individuals with lower limb amputation, particularly amongthose with bilateral and above-knee amputations. There is a need to routinely evaluate the studied constructs among individuals with lower limb amputation. The provision of prosthetic aids may help to improve their levels of life accomplishment, social functioning and participation.
Menstrual Hygiene Management: Challenges and Coping Strategies for Adolescents with Disabilities in the Kumasi Metro of Ghana
Purpose: Effective menstrual hygiene management is vital to the health, well-being, dignity, empowerment, mobility and productivity of girls and women. This study was conducted to ascertain menstrual hygiene management challenges and coping strategies of adolescents with disabilities in the Kumasi Metro of Ghana. Method: An exploratory study design with qualitative approach was employed to select 18 participants. Data was collected through in-depth interviews and focus group discussions, and then transcribed and categorised into specific themes. Results: Females with visual impairment had difficulty in maintaining good menstrual hygiene because of problems in detecting menstrual blood, inability to fix sanitary pads appropriately and wash underwear properly, and anxiety and stress from not knowing whether their period has started. The problems of those with physical impairment were related to inaccessible washrooms, long hours of being seated on the part of wheelchair-users, and difficulty in fixing sanitary pads for those with upper limb impairment. For those with hearing impairment, the main challenge was the communication barrier between them and their significant others whenever they needed help. Conclusion: There are common challenges faced by all girls across the globe with regard to menstrual hygiene management. Adolescent females with disability however face additional challenges with regard to MHM. Those with physical disability encounter accessibility challenges, while the main challenge for the deaf and those with speech problems is communication. The visually impaired live in anxiety due to fear of staining their clothes.
Editorial: Rehabilitation in an uprooted world
Measuring Stigma related to People with Albinism in Tanzania: A Cultural Validation Study of the EMIC-CSS and SDS among Adults
Purpose: People with albinism in Tanzania are severely stigmatised. A measurement tool to assess this stigmatisation among adults is lacking. This research aimed at the cultural validation of two Scales to measure stigma related to albinism: The Albinism Social Distance Scale (A-SDS) and the Albinism Explanatory Model Interview Catalogue Community Stigma Scale (A-EMIC-CSS). Method: Conceptual, item, semantic and operational equivalences were evaluated through focus groups and interviews. A pilot study among adults attending religious institutes, as a representation of Tanzanian society, was conducted to assess the measurement equivalence. There were 101 respondents for the test and 79 respondents for the re-test. Results: Conceptual, item, semantic and operational equivalences of the Scales are sufficient. In terms of measurement equivalence, the internal consistency of the A-SDS and A-EMIC-CSS are adequate. However, social desirability should be taken into account when interpreting the findings. Conclusion and Implications: The insights provided by this article can aid in the development of tools to measure stigma cross-culturally and across stigmatising conditions. The combination of the two Scales for short and long-term effect measurement is recommended.
Community-Based Screening and Early Intervention for Birth Defects and Developmental Disabilities: Lessons from the RBSK Programme in India
Purpose: The Rashtriya Bal Swasthya Karyakram (RBSK) is an ongoing screening and early intervention programme for children in India. Children with birth defects and developmental disabilities from rural and urban communities are referred for treatment and therapies to early intervention centres located in urban areas. This study primarily aimed at determining caregiver uptake and compliance to referral advice of the RBSK, with the larger goal of determining the utility of the community-based screening and district-based intervention service model for caregivers of children with disabilities. Method: Three administrative blocks and one municipal corporation area of Pune district, in Maharashtra, were randomly selected. The sample consisted of 115 caregivers of children with disabilities. They were interviewed using a semi-structured questionnaire that investigated uptake of referral advice, treatment outcome, current health status of the child and reasons for noncompliance, three to nine months after the first referral by the RBSK team. Results: Sixty-four caregivers were aware of their child’s disability, but most children remained untreated. After screening and referral by the RBSK team, compliance was high for treatable conditions like congenital heart defects. Treatment was discontinued for 83% (24 out of 29) of children with developmental disabilities. Reasons for discontinuation included lengthy waiting time, distance to facility, difficulty in transporting the child, loss of wages, and denial of the child’s disability. Conclusion and Implications: The results indicated that the RBSK programme provides treatment opportunities for children who are left undiagnosed and untreated in the community. Providing rehabilitation services at district centres is a barrier for service uptake. Alternative models such as early childhood development screening and integrating rehabilitation services at the primary healthcare level may be more feasible to provide services for children with disabilities in India.
Monitoring the Internal Training Load and Surrogate Measures in a Senior Female Paralympic Athlete with Spinal Cord Injury: A Case Study
Purpose: Paralympic Games were started originally for therapeutic reasons; nowadays they demonstrate the characteristics of high-performance sports. The surrogate measures (e.g., sleeping habits) and the internal training load (ITL) measures are strongly associated and are used to monitor performance in sport. This study aimed to understand whether the relationship between internal training load and surrogate measures, observed over a 16-week period, would be beneficial or otherwise in the case of a senior female Paralympic athlete with spinal cord injury, who was training to compete in table tennis at the Parapan American Games in Lima. Method: This case study evaluated the surrogate measures through the Heart Rate Variability measure, the Wisconsin Upper Respiratory Symptom Survey and the Pittsburgh Sleep Quality Index and assessed their relationship with the internal training load. Results: The data demonstrated that during the monitoring period the athlete presented minimal fluctuations in the Heart Rate Variability measure, the Wisconsin Upper Respiratory Symptom Survey and the Pittsburgh Sleep Index. Significance was considered at p< 0.05. Conclusion and Implication: Contrary to the athlete`s age and physical condition, the data demonstrated some gains towards her success in the sporting competition. A new approach in monitoring internal training load associated with surrogate measures is necessary. It could prove to be a good strategy for implementation in competition training routines for Paralympic athletes to reach their individual goals.
Accessing Healthcare in Ghana: Challenges Encountered and Strategies Adopted by Persons with Disabilities in Accra
Purpose: Access to quality and timely healthcare is essential to the health and wellbeing of all individuals. Unfortunately, the more vulnerable populations, such as persons with disabilities, encounter a number of barriers in accessing healthcare services. This study focusses on barriers that persons with disabilities face in accessing healthcare in the Accra metropolis, and the strategies they adopt when they are ill. Method: A phenomenological approach was employed to achieve a deeper and holistic understanding of the challenges encountered when accessing healthcare. Purposive sampling technique was used to recruit 21 persons with disabilities, between 18 and 64 years of age, from the organisations of persons with disabilities in Accra. Results: The study revealed that physical, financial, communication, transportation, and attitudinal barriers, as well as healthcare professionals’ lack of knowledge about disability issues, limited access of persons with disabilities to healthcare. The majority of persons with disabilities preferred to stay at home and self-medicate or depend on herbal medicine, rather than seek help from healthcare professionals. Conclusion: Healthcare for all is a right that every human being is entitled to, irrespective of disability. The removal of barriers restricting access to healthcare for persons with disabilities is a necessity to achieve Goal 3 of the Sustainable Development Goals (SDG) Agenda 2030.
AUTEMOGAZE – Efficient Emotion and Gaze Change Identification System for Autism Spectrum Disorder
Spinal Postures of Children seated on the floor in Schools in Ahmedabad District, India
Purpose: In some schools in India, children sit on the floor during class time due to non-availability of furniture. The present study was conducted to assess the spinal postures of school-going children when seated in various positions on the floor. Method: The cross-sectional survey included 62 children by random selection. The boys and girls were from classes 1 - 8. Photographs were taken in four positions: A-standing; B-sitting on the floor while looking at teacher or board; C-sitting on the floor and looking down while writing in books; D-sitting on the floor and copying from the blackboard. Markers were placed on anatomical points: tragus, canthus, C7 vertebra, T12 vertebra, greater trochanter and the lateral malleolus. Craniovertebral angle (CVA), gaze angle, trunk angle and sway angle in degrees were measured using Surgimap software. Differences in mean angles in various positions were compared using Kruskal-Wallis test. Post-hoc analysis was performed using Dunn-Sidak correction test. Results: Mean CVA in position A (standing) was 54.11±7.0 degrees; in position B it was 41.7±9.2 degrees; in position C it was 43.60±43.09 degrees; and, in position D it was 8.8±16.85 degrees. Mean gaze angle in position A was 20.01±9.18 degrees; in position B it was 26.99±10.15 degrees; gaze angle could not be measured in position C (when the students looked into their books); and, in position D it was 35.08±9.164 degrees. Mean trunk angle in position A was 147.95±9.6 degrees; in position B it was 132.80±10.11 degrees; in position C it was 132.80±10.69 degrees; and, in position D it was 128.64±10.80 degrees. Mean sway angle was 160.91±7.70 degrees in standing position. Statistics showed significant difference between the angles in all the different positions (p<0.001). Conclusion: In schools without appropriate furniture, sitting on the floor leads to a significant alteration in spinal postures among school-going children. Increased stress on the neck and back may predispose these children to early degenerative changes. Suitable furniture needs to be provided and good posture needs to be taught to children. Limitations: Detailed pain assessment and comparison between higher and lower classes could not be done.
Physical Activity, Enjoyment and Quality of Life among Institutionalised Older Adults in Malaysia: A Cross-Sectional Study
Purpose: In many nations across the world it has become a priority to stimulate increased physical activity (PA) among elderly persons. This study aimed to find the association between physical activity patterns and enjoyment of physical activity and health-related quality of life (HRQoL) among institutionalised older adults in Malaysia. Method: A sample of institutionalised older adults (n=134, mean age = 73.72; SD = 8.59) was recruited from the Klang valley in Malaysia. In cross-sectional analyses, their physical activity, enjoyment of physical activity and quality of life were screened using the Physical Activity Scale for the Elderly, the 8-item Physical Activity Enjoyment Scale and the EuroQuol-5 Dimensions-5 Levels questionnaires, respectively. High levels of physical activity were associated with enjoyment of physical activity and health-related quality of life. Results: In total, 41% of the participants met the guidelines of the Physical Activity Scale for the Elderly and 53% enjoyed physical activity. A positive correlation was found between the level of physical activity and its enjoyment (rs = .355, p <.001). Significant correlations were recorded between the dimensions of health-related quality of life and the level of physical activity (p < 0.001), except for pain/discomfort and anxiety/depression. Conclusion: Providing opportunities for institutionalised older adults to engage in a variety of activities might help them to identify the kind of physical activity they enjoy and facilitate a lifelong physical activity routine.
Management of Undergraduate Community-Based Rehabilitation Programmes in the Philippines: A Cross-Sectional Survey
Purpose: The survey aimed to identify common strengths and weaknesses regarding the characteristics, management and implementation of Community-Based Rehabilitation (CBR) training in the undergraduate curriculum of Schools of Physical Therapy in the Philippines, and make recommendations for improvement. Method: A survey was conducted with the academic heads of CBR departments in 10 Physical Therapy schools. The institutions were selected through cluster sampling according to regional location. Nine of these were private institutions. Data was collected through a 24-item self-assessment survey distributed to the heads of the participating colleges /departments. Results: A number of strengths and weaknesses were identified. The strengths were: all schools had a 1 to 2-month clinical CBR course integrated into their undergraduate curriculum; CBR courses were supported by a course syllabus, learning outcomes, student assessment and clinical training manual; 80% of institutions had implementing policies and guidelines governing management of the CBR programme(s); at least one physiotherapist was involved in the management of the CBR programme(s); and, CBR activities were delivered in coordination with key stakeholders management, with emphasis on delivery of physical therapy services, disability prevention, health education, participation of persons with disabilities and community awareness. The weaknesses were: no head/programme coordinator for 30% of CBR programmes; 40% did not have clinical coordinators as designated management positions in the CBR programme; only 50% of academic staff received formal CBR training, of which 80% was provided through CBR summits and professional interaction with other physical therapists; and, only 50% of schools adopted a multidisciplinary approach to service delivery which was focused on the Health domain of the CBR Matrix. Conclusion: The CBR component of the undergraduate physical therapy curriculum in the Philippines can be improved. A shift in the teaching to transdisciplinary care and inter-professional learning is recommended. Regular review of the CBR indicators should be done by the schools, including the key stakeholders. Challenges for CBR implementation were recruitment of community volunteers as CBR workers, availability of indigenous resources and finances to support CBR activities, and family participation in the rehabilitation of a relative with a disability. Each school should determine whether current human resources and training are adequate. Schools must be encouraged to jointly identify common problems in CBR education and share solutions.
‘Enabling Access’: A Pilot Study on Access and Use of Assistive Products in the Northern Province, Sri Lanka
Purpose: The need for suitable assistive technology is growing all over the world, not only for people with disabilities but also for the ageing population with functional decline and non-communicable diseases. Access to assistive technology promotes access to education, employment and active societal participation. The aim of this study was to assess the self-reported need by persons with disabilities and by people who were 65 years and older without disabilities in the Northern Province of Sri Lanka, for assistive products; and to identify barriers to accessing these assistive products. Method: This mixed-methods pilot study included 76 participants who were either persons with disabilities or their caregiver or persons 65 years and older, from the Northern Province of Sri Lanka, affected by the now-ended 30-year civil war. To ascertain trends in the local need for assistive products, a translated version of the World Health Organisation's Priority Assistive Products List of 50 items was used. In addition, semi-structured interviews with key participants were conducted, to gain some insights into the barriers to accessing assistive products. Results: The most widely used assistive products among persons with disabilities were connected to war-related injuries. In contrast, those used by the older age group of persons without disabilities were connected to non-communicable diseases and age-related frailty. The assistive products requested by both groups were aids to promote independence in daily activities and to support access to education and employment. The emergent themes included affordability, employment, independence in activities of daily living, stigma and psychological impact, and a lack of awareness and guidance in the use of assistive devices. Conclusion: The findings highlight the need for policies and practices to be informed by local socio-cultural, historical and geographical realities.
Happiness and Resilience among Young Physically Disadvantaged Employees in India: A Pilot Study
Purpose: The study aimed to examine and compare the happiness and resilience of disadvantaged employees and non-disadvantaged employees. Method: The study sample included 37 young employees, between 20 and 30 years of age. Among them, 17 were with physical disadvantages of one type or the other, and 20 had no physical disadvantages. Results: Mann-Whitney U test showed that there is no difference in resilience and happiness between disadvantaged and non-disadvantaged employees. Among the non-disadvantaged employees, there is a relationship between happiness and resilience. However, among the disadvantaged employees, this relationship is not there. Conclusions: Disadvantaged employees in the present sample do not differ from the non-disadvantaged in their happiness and resilience. However, it cannot be assumed that happiness is a contributing factor to the resilience of the disadvantaged employees. Also, it is not possible to generalise the results of the study due to the small sample size.
Intersections of Disability and Gender in Sports: Experiences of Indian Female Athletes
Purpose: This qualitative study aimed to compare the experiences of two groups of female athletes - those with and without visual disability- who participate in sports. Method: In-depth interviews were conducted with 16 athletes and thematic analysis of the data was done. Results: Both groups identified various benefits of engaging in sports, including increased fitness and higher self-esteem. Para-athletes felt that sports provided them with opportunities to break stereotypes associated with disability. Both groups also identified certain barriers impeding sports participation, the most pervasive of these being poor infrastructure. In terms of differences, athletes without disability were initiated into sports at a much earlier age, had enjoyed more freedom in choosing their sport, and were given more family support than the para-athletes. Conclusion: An analysis of the findings in terms of the Self-Determination Theory (Deci & Ryan, 2002) indicated that needs for competence, autonomy and relatedness were being more wholly met through sports-related experiences for athletes without disability than for the para-athletes. Implications: Current conditions within para-sport need to be improved by providing more sporting choices to athletes with disability, easier access to sports opportunities at an earlier age, development of self-efficacy with regard to sports, challenging of stereotypes, and generating awareness among parents that sports can be a viable and safe option for their daughters.
Environmental Accessibility Assessment for People with Vision, Hearing and Speech Disabilities in Mongolia
Purpose: The main objective of this paper was to assess environmental accessibility for people with vision, hearing and speech disabilities in Mongolia, with particular focus on public buildings and public transportation. Methods: A standardised internationally-used questionnaire, consisting of 29 questions, was used for the accessibility of public buildings assessment. The questionnaire results were grouped into categories and descriptive statistics were obtained. To determine quality and accessibility to public transportation a standardised sheet, consisting of 51 questions from the internationally accepted SERVQUAL, was used. This model is commonly used for measurement of the discrepancies between actual performance and customer expectations. Result: Assessment of public buildings in Mongolia revealed that they were moderately accessible for people with vision, hearing and speech disabilities. The assessment of public transportation found that the discrepancy between actual performance and customer expectation is the highest across all indicators for people with hearing and speech impairments. Conclusion: The research findings indicated a strong need to pay closer attention to the current environmental unfriendliness and inaccessibility faced by people with vision, hearing and speech disabilities.
Barriers Faced by Persons with Disabilities in Formal Employment in India
Purpose: According to the World Report on Disability, prepared by the World Health Organisation and the World Bank (2011), people with disabilities still face substantive discrimination in the world of work. An ILO report (2014) on “Disability and corporate social responsibility” identified some serious issues why employees with disability throughout the world still face discrimination and human rights violation. This study attempts to examine the severity of the multiple barriers faced by employees with disability in the course of their employment. Method: Descriptive research design was used. By stratified random sampling, 100 persons with disabilities (mainly visual, hearing and physical impairments) were contacted and interviewed. Results: Most of the respondents were between 20-30 years of age and 70% were males. Around 41.2% were graduates, yet most of them had low earnings. A large proportion (87.5%) was employed in the private sector. While most of the respondents (65%) reported facing a high level of physical barriers, a large proportion (52.5%) reported high levels of psychological and information, communication and technological (ICT) barriers. Conclusion: Employees with disability mentioned several barriers and limitations with regard to transport, the attitudes of employers or colleagues, anxiety or lack of confidence, and issues relating to access and support. To ensure inclusive involvement in an organisation, employers must be sensitised on disability issues. A non-discriminative recruitment policy, an accessibility audit to minimise barriers, role-mapping of suitable positions, and adaptation of equipment to suit employees, are recommended.
Impact of Exercise Training on Depression among People with Type 2 Diabetes Mellitus: A Narrative Review
Purpose: The prevalence of clinically relevant depressive symptoms among clients with Type 2 diabetes mellitus is in the range of 30%. Since these conditions are often under-diagnosed and under-treated in clinical practice, they negatively affect functional recovery, adherence to treatment, and the quality of life. Despite the large body of evidence regarding the effects of exercise training on different aspects of diabetes, no updated conclusive article that reviews depression is available. This article aims to review the current literature on exercise training and its effect on depression in people with Type 2 diabetes mellitus. Method: An electronic search of literature from 2010, highlighting the effects of exercise on depression among Type 2 diabetes mellitus clients, was conducted using Google Scholar and PubMed. Relevant articles were utilised for this review. The selected studies are based on relational and rehabilitative exercise training approaches. Results: While most of the studies support the efficacy of exercise training, study settings and described models are not conclusive. No single clearly defined model exists for exercise training for depression among people with diabetes. There is evidence for the efficacy of supervised aerobic exercise in the treatment of depression, when undertaken three times weekly at moderate intensity, for a minimum of eight weeks. Further research is required to develop specific exercise training models that can be tested in experimental studies for this client group. Conclusion: The current review showed that exercise training can be used to alleviate depression among people with diabetes. Future studies should adopt rigorous methodological criteria to back up the present findings.
Health-Related Quality of Life of Wheelchair Fencers, Sedentary People with Disability and Conventional Fencers in Brazil, Assessed by Short Form 36 (SF-36)
Purpose: It is well established that physical exercise, in general, decreases anxiety and depression. Para sport or sport for people with disabilities is used as a rehabilitation strategy to improve their quality of life. This study aimed to investigate people ivith disabilities who practise wheelchair fencing, sedentary people with physical disability and conventional fencers, assessed by Short Form 36 (SF-36), by comparing the groups. Method: Forty-two people from Physical Disability Association of Parana (ADFP) answered SF-36 and were divided into three groups: Conventional Fencers (CF), Wheelchair Fencers (WF), and Sedentary People with Physical Disability (SD). Results: This study was the first to report the Health-Related Quality of Life (HRQOL) of conventional fencers, wheelchair fencers, and sedentary people with physical disability, using SF-36. The data demonstrated high scores in CF and WF, on seven SF-36 scales of the eight-scale profile, including functional and mental health, role physical, bodily pain, general health perception, vitality, social functioning, mental health. Moreover, the sedentary group had lower scores in most of the domains when they were compared to CF. Conclusion: The results might provide supportive evidence that HRQOL of WF has demonstrated a positive effect on people with disability since para sport has been used as a rehabilitation programme. Implication: The implementation of a public campaign is recommended, about sport as a health promoter for disability and rehabilitation. By involving healthcare providers from the area, people with disabilities can be encouraged to participate in para sport.
Quality of Life of Persons with Disabilities in Southern Nations, Nationalities, and Peoples’ Region, Ethiopia
Purpose: There is very little demographic or prevalence data regarding persons with disabilities in Ethiopia, let alone data on more in-depth factors such as access to services or quality of life. This study aimed to find out about the current quality of life of persons with disabilities in Southern Nations, Nationalities, and Peoples’ Region (SNNPR), Ethiopia. Method: The WHO CBR Indicator Survey was used to measure quality of life, and the Washington Group Short Set was included to allow disaggregation of the data by different types of functional limitations. Interviews were conducted with 966 persons with disabilities in 10 towns in SNNPR. The majority of data collectors were persons with disabilities themselves. Results: People with disabilities who were surveyed generally regarded their health as good (65.9%). Very few had significant levels of education (16.5% were completing higher education). Only 6.7% were working for wages and 45.2% were reportedly working on their own account. Hardly any of them (2.9%) stated that their money was sufficient for their needs. Only a small group (38%) felt valued in their community, just over half of the respondents (56.6%) were members of a Disabled Persons’ Organisation (DPO) or any other self-representing group. Conclusion: Persons with disabilities scored relatively or extremely low in all areas of life measured with the CBR Indicator Survey (health, education, livelihood, social and empowerment). The survey will be repeated after a few years in the same communities to measure changes over time, and persons without disabilities will be included in order to draw comparisons. Implications: Public and private organisations in SNNPR need to become more accessible and inclusive of persons with disabilities so as to improve their quality of life.
Assessing the Willingness of Employers to Hire Persons with Disabilities in the Media Industry, in Ashanti Region of Ghana
An Educational Intervention to Promote Access to Rehabilitation for People Living with HIV
This paper describes the design and novel features of an evidence- and theory-informed client activation intervention to increase the capacity of people living with HIV to: 1) self-manage their health-related challenges using rehabilitation strategies, and 2) communicate their rehabilitation needs to their healthcare providers to improve access to rehabilitation. Building on social-cognitive theory and evidence, the intervention is a community-based workshop to develop knowledge and skills of people living with HIV to advocate for rehabilitation services. Novel features include engagement of community-based organisations in a train-the-trainer delivery model, a problem-based learning design to promote problem-solving and application, and a focus on client-centred practice. The intervention is flexible and adaptable. Health providers in other countries and contexts could use the pedagogical features to develop a workshop to meet their local needs. Given that most knowledge transfer interventions aim to change health provider behaviour, the focus on teaching people living with HIV to advocate for referral to rehabilitation is unique. The workshop model may be of interest to those in communities where access to rehabilitation for people living with HIV can be limited due to a lack of knowledge of the potential role of rehabilitation.
Barriers and Facilitators to Community Ambulation in Maharashtra, India: Perception of Individuals with Stroke
Purpose: The study aimed to understand the self-perceived environmental barriers/ facilitators to community ambulation among stroke survivors in Maharashtra State, India. Method: The Facilitators and Barriers Survey /Mobility Questionnaire (FABS/M) was used to collect information from a convenience sample of 50 individuals with stroke. Data was analysed using descriptive statistics in Statistical Package for Social Sciences (SPSS) 22.00. Results: Curbs, gravel surfaces, rain, noise, and crowd were marked as barriers by 56%, 58%, 52%, 36% and 50% of the participants, respectively. Ramps, elevators, and flat surfaces were reported as facilitators by 42%, 70% and 82% of the participants, respectively. Participants also mentioned the absence of automatic doors and escalators in community areas (92% and 88%), specialised exercise equipment, handrails and specialised bathroom equipment at home (92%, 50% and 52%), and inaccessibility to public places (50%), as barriers to easy mobility. Conclusions: To enhance community mobility of individuals with stroke, environmental barriers should be reduced and facilitators should be enhanced. The marked absence of facilitators in the environment should be rectified and appropriate steps should be taken to enhance ambulation. Limitations of the study are the small sample size. Factors like balance, economic status, physical activity of the stroke individuals and severity of stroke were also not considered.
Introduction of Indian Sign Language in Inclusive Education
Purpose: The predominant mode of human communication is speech, and whenever it is hindered, humans resort to the tactile-kinaesthetic mode. Use of sign language by persons with speech-hearing impairments is a classic example of such adaptation. The Demonstration School at the Regional Institute of Education in Mysuru, South India, undertook training of typically-developing students in Indian Sign Language (ISL), so as to facilitate communication and instruction of students with hearing impairment who are in mainstream learning environments. Method: Training in ISL was imparted to 140 typically-developing students in higher primary classes. Twenty-four 40-minute sessions were conducted over a month. After theoretical orientation in logical bases of manual communication, practical training commenced with elementary manual alphabets, progressed through essential daily-life vocabulary necessary to construct simple sentences and carry out general conversations, and culminated in signing the Indian National Anthem. Results: Typically-developing students gained primary benefits such as improved awareness about non-verbal communication modes, mastery of basic skills in ISL, and positive attitudes towards sign languages. Conclusion: The UNCRPD 2006 authorises sign language as the linguistic identity of the Deaf, and encourages the use of sign language in learning environments. Future research should add to the findings on secondary benefits in the form of scholastic and sociometric advantages derived by students with hearing impairments who receive instructions in sign language in mainstream learning environments.
Association of Occupational Stress and Emotional Intelligence among Physiotherapists in Malaysia: A Cross-sectional Study
Purpose: While occupational stress may negatively affect physiotherapists’ work attitudes and behaviour, emotional intelligence has been suggested as a factor that leads to successful performance and provision of quality service in the healthcare profession. This study was designed to investigate the association of occupational stress and emotional intelligence among physiotherapists in Malaysia. Method: The study employed a cross‐sectional self‐report design. Convenience sampling method was used to recruit 171 participants. The sample comprised physiotherapists who work in government and private settings in Malaysia. Questionnaires consisting of socio-demographic data, Genos Emotional Intelligence Inventory and Occupational Stress Index were distributed to the participants. The data was analysed using Pearson Correlation, Independent samples t-test and One-way ANOVA. Results: It was found that 130 physiotherapists (76%) suffered from moderate stress, 21.1% experienced low stress and 2.9% reported high stress. Overall, moderate emotional intelligence level was reported by the participants with mean of 129.36±18.314. A negative correlation was found between occupational stress and emotional intelligence. Males exhibited higher level of occupational stress than female physiotherapists. Demographic variables such as years of clinical experience and monthly salary were statistically significant with emotional intelligence. Conclusion: Emotional self-management and understanding others' emotions appear to play an important role in managing occupational stress.
Psychosocial Functioning in Children with Dyslexia: Perspectives from Parents, Counsellors and Teachers
Purpose: The study aimed to understand the issues and challenges encountered by various stakeholders (teachers, parents and counsellors) working with children with dyslexia in the inclusive school context. Method: Using purposive and snowball sampling, 20 teachers, 20 counsellors and 20 parents (mothers) of children with specific learning disability (dyslexia) were selected from 8 inclusive schools in Delhi. A qualitative approach was adopted, with a semi-structured interview schedule to elicit responses. Qualitative thematic analysis was used as a framework for data analysis. Results: Parents experienced negative feelings due to lack of awareness and acceptance of dyslexia. Counsellers felt parental ignorance led to delay in assessment and remediation. Parents and counsellors perceived lack of support from schools and lack of empathy among teachers. Teachers confessed they lacked training to deal with dyslexic learners, were unaware of policies and concessions for them, and were currently overburdened with their workload. Conclusion: There is a need to hold psycho-educational workshops for parents in order to increase their awareness, and conduct training workshops (pre-service and in-service) for teachers to increase awareness and build empathy. Schools should provide in-house assistive services such as assessment and remediation, and redefine the goals of education to focus on the holistic skills of children.
Increasing Attention and Mood of Post-Stroke Clients using Natural Restorative Environment
Purpose: The objective of this study was to analyse the impact of the natural restorative environment on the attention and mood of post-stroke clients. Methods: A quasi-experimental design was followed, with pre- and post-tests on a control group. Purposive sampling procedure was used to select 76 post-stroke clients – 38 each for the treatment group and the control group. The treatment group received natural restorative environment intervention, twice a day for three days, while the control group was managed in accordance with the medical protocol. Before and after the intervention, clients in both groups were assessed for attention and mood. Results: Increasing level of attention and mood was found in the intervention group, verified by p-value= 0.000. Conclusion: Exposure to the natural restorative environment could increase the attention and improve the mood of post-stroke clients. The natural restorative environment helps in restoring the ability to focus and creates a positive mood.
The Cultural Validation of Two Scales assessing Albinism - related Social Stigma among High School Students in Tanzania
Purpose: Albinism in Tanzania causes fierce stigmatisation. Although various stigma reduction interventions (SRI) are employed, research on their effectiveness is lacking. This research aimed to develop a tool to measure albinism-related social stigma among high school students in Tanzania. Cultural equivalence was tested for the Explanatory Model Interview Catalogue Community Stigma Scale (EMIC-CSS) and Albinism Social Distance Scale for Adolescents (ASDS-A) assessing conceptual, item, semantic, operational and measurement equivalence. Methods: The methods used were workshops, in-depth interviews, translation and re-translation, discussions, a test (n=337) re-test (n=142) of the survey, and follow-up focus group discussions (n=25). Results: The Scales have proven to be adequate on all equivalences other than measurement equivalence. The reproducibility statistics raise questions that can be explained by characteristics of the sample. Conclusion and Implications: The analysis provides insights for further validation of the Scales, contributes to the discussion about a universal stigma measurement tool and demonstrates the importance of validation studies of existing and proven tools used in a different context.
Editorial - A thirty year-long journey of a journal
MAANASI - A Sustained, Innovative, Integrated Mental Healthcare Model in South India
Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas. A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term. Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs. As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered clients is 1930. Empowerment of treated clients is the final outcome, assisting them in self-employment. Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.
Copyright (c) 2019 The Author(s) https://creativecommons.org/licenses/by/4.0
A Preliminary Report of the Audiological Profile of Hearing Impaired Pupils in Inclusive Schools in Lagos State, Nigeria
Purpose: The programme to enrol hearing impaired pupils in inclusive schools in Lagos State, Nigeria, has been endorsed recently and is at a transitional phase. The study assessed the audiological profile of the enrolled pupils with hearing impairment. Methods: After a random selection of 7 designated inclusive primary schools in Lagos State, a two-stage study was conducted. First, a questionnaire documenting audiological history was administered to the pupils with hearing impairment. This was followed by pure tone audiometry. Results: Study participants were between 4 and 26 years of age (mean 12.8±4.1). About 158 (96.9%) of them had bilateral profound hearing loss. Method of communication for 132 (81%) was by sign language, followed by lip reading for 56(34.4%). Conclusion: Severity of hearing impairment was profound among this category of enrolled students. Most of them had probably been transferred from schools for the Deaf to inclusive schools. Less severe degrees of hearing impairment may have been detected if audiological assessment had been mandatory for all the school children.
The GRID Network: A Community of Practice for Disability Inclusive Development
Purpose: This paper aimed to provide an overview of the evaluation of the GRID Network (Groups for Rehabilitation and Inclusive Development) and the impact it had on its members. Method: Information was collected through a compilation of the resources developed during the project, and a summative evaluation process was employed at the end of the project. The paper is a short report on the summative evaluation. Results: GRID Network members reported that the network was effective and beneficial. They developed new information and knowledge that was relevant to their local contexts; shared knowledge from local, national, and international sources; and, increased their skill in using social media for professional purposes. Recommendations include continuing with this kind of community of practice, with greater opportunities for more engagement and training; inclusion of more partner organisations; large group workshops and conferences; increased attention to advocacy for policy change; and, for more research to be carried out locally. Conclusion and Implications: This project demonstrated that it is possible to develop and maintain a community of practice in a low-resource context on a minimal budget, even during times of political crisis. Further programme development, evaluation, and research are warranted to ascertain how this model can be scaled up to include a broader group of rehabilitation and other practitioners involved in disability inclusive development.
Perceived Benefits and Barriers to Exercise among Physically Active and Non-Active Elderly People
Purpose: Adhering to a physically active lifestyle and exercising regularly is a challenge for many elderly people. Identifying the factors that influence such adherence may help in policy-making and in promoting a physically active lifestyle. This study aimed to compare perceived benefits and barriers to exercise among physically active and non-active elderly persons. Method: Around 140 elderly persons with normal cognition and no depression, living in the community, were divided into two groups - the physically active and the non-active - using Rapid Assessment of Physical Activity Scale. Their perception about benefits, barriers and motivators for exercise were studied using Exercise Benefits and Barriers Scale. The scores of both groups were analysed. Results: A significant difference was found in scores of perceived benefits and scores of motivators in both groups (p <0.0003 and <0.0001 respectively), but no difference was found in perceived barriers(p=0.0607). Strongest benefit perceived by the physically active elderly was “Exercise helps me to sleep better”, and the strongest motivator was “I enjoy exercise”. Conclusion: The study shows that although both the physically active and non-active elderly perceive equal barriers for exercise, the benefit perceptions and motivators seem to play a significant role in adhering to a physically active lifestyle and exercising regularly. Spreading awareness about such benefits and the reduction of barriers may help in promoting regular physical activity among the elderly.
Users’ Satisfaction with Assistive Devices in Afghanistan
Purpose: The objective of this study was to assess users’ satisfaction and effectiveness of assistive devices in four regions of Afghanistan, namely Mazar-e-Sharif, Ghazni, Jalalabad and Taloqan. Method: A random sample of 785 users, who were provided with 874 mobility and assistive devices in four regional prosthetic and orthotic workshops of the Swedish Committee for Afghanistan (SCA), participated in the study. Results: The study revealed that the majority of the participants rated the assistive devices as very useful. While 45% of respondents even described them as excellent, 49% expressed a good level of satisfaction with the services they received at treatment centres. Similarly, the majority of respondents (67%) mentioned a maximum level of improvement, while 15% claimed to have witnessed some improvement in their physical condition. Fitting, comfort, and ease of use, along with durability, weight and appearance were rated as the most important factors of assistive devices. On the other hand, slow service and limited access to maintenance and repair facilities were identified as reasons for dissatisfaction. Conclusion: The study provided continuous and valuable information to rehabilitation professionals regarding device effectiveness and satisfaction. The findings also recommended a stronger focus on comfort and usefulness of mobility and assistive devices. Lastly, the study suggested that lack of local device-repair service needs to be addressed by rehabilitation professionals.
Changes in Social Participation of Persons Affected by Leprosy, Before and After Multidrug Therapy, in an Endemic State in Eastern India
Purpose: In general, multidrug therapy (MDT) completion rate and the change in disability levels before and after medical treatment are reported as outcomes in leprosy programmes. Changes in activity and social participation levels are rarely reported, possibly because the parameters are more difficult to measure. The study aimed to assess and evaluate the changes in social participation among leprosy-affected persons after completion of MDT. Method: An observational study was conducted among 108 newly-diagnosed leprosy- affected clients, who were registered at the Leprosy Referral Hospital in Champa, Chhattisgarh. Their disability levels pre- and post- MDT were assessed using the WHO Disability Grading, and their social participation level was assessed using the Participation Scale. Results: Of the 108 clients registered during the study period, 90 completed the full course of MDT and were included in the analysis. The majority of these 90 clients or 83% were multibacillary and 23% had Grade 2 disability at the time of diagnosis. At the end of MDT with steroids therapy for reaction and neuritis, the proportion of clients with no participation restriction increased from 76% to 93%. Clients with visible impairments had more restriction as compared to those with no deformity or no visible deformity, before and after MDT. Among those with visible impairments, 78% had mild to severe restriction before MDT and it declined to 26% on completion of treatment. Conclusion: Presence of Grade 2 disability at the time of diagnosis was significantly associated with participation restriction. MDT and steroid therapy for management of reaction and/or neuritis improves the participation level of leprosy-affected clients, suggesting that early detection and appropriate management would reduce their risk of participation restriction.
Perceptions of Primary Caregivers about Causes and Risk Factors of Cerebral Palsy in Ashanti Region, Ghana
Purpose: Cerebral palsy (CP) is the most common chronic childhood disability, but in most cases the primary causes are largely unknown. The study sought to determine the perceptions about the causes and risk factors of CP among primary caregivers of children with CP in the Ashanti region of Ghana. Method: A descriptive study design with a quantitative approach was used. A simple random sampling technique was adopted to select 100 participants from among the primary caregivers whose children with CP were attending the physiotherapy unit of the Komfo Anokye Teaching Hospital in Ashanti region. A structured questionnaire was administered to the respondents and data were analysed using SPSS version 21.0. Results: CP was perceived as a disease caused by witchcraft (40%), punishment from God or Gods (12%), or by being cursed (10%). More than half (54%) of the respondents did not know of any risk factor for CP. Conclusion and Implications: The perceived negative causes, as well as ignorance about the risk factors for CP, could result in primary caregivers stopping their children with CP from availing of the physiotherapy services. Public education and campaigns should focus on the causes and risk factors for CP, in order to change negative perceptions and improve awareness among the general public.
Stereotypes about Adults with Learning Disabilities: Are Professionals a Cut Above the Rest?
Purpose: The study examined the differing perceptions of professionals and the public (non-professionals) regarding life success for adults with learning disability (LD). Method: The sample (N = 342) consisted of 175 professionals (P) and 167 non-professionals (NP), with a mean age of 30.02 years and S.D. = 12.42 years. Their perceptions about life success of an individual with learning disability were studied with the help of four vignettes that provided hypothetical information about the age, class, and hobbies of a college student. The four vignettes were identical in describing the student and only differed in terms of gender (M and F), and presence and absence of learning disability (LD and NLD). Results: No significant difference was found between attitudes held by professionals and non-professionals. Both the groups showed significantly greater negative attitudes about perceived life success for adults with learning disability than for those without learning disability. The results have been discussed with the help of social psychological theories in the areas of attitude, bias, and stigmatization. Conclusion and Implications: It is clear that a negative bias exists toward individuals with learning disability in the urban Indian milieu. The fact that not only the public but also professionals were biased against individuals with learning disability regarding their life success implies that negative stereotypes are deeply embedded. This research may provide the impetus to address issues like prevalence of stigma against learning disability in society, its effective attenuation as well as equality and inclusion for individuals with learning disability.
Assessing the Knowledge of Persons with Disabilities on Politics, in the Kumasi Metropolis of Ghana
Exploring the Experiences of Students with Visual Impairments at the University of Botswana
Purpose: This paper sought to document the responsiveness of the University of Botswana towards the academic needs of students with visual impairments. The study examined the academic experiences of students with visual impairments enrolled at the University and explored their information-seeking needs. The study was informed by the theory of social justice. Method: This was a qualitative study. Data was collected from students with visual impairments and academic staff from different faculties at the University of Botswana, through document analysis, interviews and observation techniques. Results: The findings revealed that students with visual impairments experience extra challenges compared to students without disabilities. This is mainly because they do not get full support to enable them to excel academically. Furthermore, lecturers use teaching methodologies that do not accommodate these students, and learning materials are not adapted to formats suitable for them. Access to information is another major concern that hinders the participation of students with visual impairments in tertiary institutions. Conclusion: The study recommends that lecturers need to be trained on suitable methods to teach students with visual impairments and how best to deliver academic content to them.
Physical Therapy for Diabetic Peripheral Neuropathy: A Narrative Review
Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus in both developed and developing countries. It is found in about 10% of diabetic clients at diagnosis, and in the majority of clients 25 years down the line. Clients with pre-diabetes may also develop neuropathies that are similar to diabetic neuropathies. Long-term hyperglycemia can cause peripheral nerve damage, resulting in distal-predominant nerve fibre degeneration. Loss of feeling in the lower limbs is a high risk for limb amputation. Despite efforts to make an early diagnosis and to halt the progression of diabetic neuropathy, currently there is no effective treatment available at a global level, except for strict control of blood glucose. Physical therapy can improve the overall quality of life of diabetes mellitus clients with peripheral neuropathy and can alleviate the symptoms of neuropathy. This paper assesses the effectiveness of interventions used by physical therapists to minimise dysfunctions in people with DPN. It reviews the different treatment strategies and presents evidence and conditions for its applications.
The inclusion of children with disabilities in mainstream education has become an important agenda for many developing countries. The Uzbekistan government has also attempted to provide equal educational opportunities to this previously excluded group of children. Despite these efforts, however, many children with disabilities remain segregated. The total number of children with disabilities under 16 years old in the country is 97,000 (Uzbek Society of Disabled People, 2014). The majority of them either study at specialised educational institutions, or receive home-based education. Those who are placed at specialised institutions are often deprived of resources and services necessary to receive adequate education (UNICEF, 2013). While limited by the lack of reliable empirical data and research, this article aims to present the current situation in the development of inclusive education in Uzbekistan. It outlines the major legislative documents intended to support inclusive education and identifies some of the current obstacles to inclusive education practices.
Impact of Parenting a Child with Cerebral Palsy on the Quality of Life of Parents: A Systematic Review of Literature
Purpose: The implications of parenting a child with cerebral palsy (CP) are multifaceted, as parents have to cope with their child’s functional limitations and specific needs, and prepare for the possibility of long-term dependence. There has been significant research on the consequences of managing these parenting tasks. This article reviews the literature on the effects of parenting children with CP, and summarises the related factors. Methods: A systematic search of online databases was conducted and, based on the reference lists of selected articles, further studies were identified. Thirty-six articles that met the inclusion criteria were analysed. Conclusion & Implication: Parents of children with CP were found to have lower quality of life, associated with high levels of stress and depression, due to factors such as child behaviour and cognitive problems, low caregiver self-efficacy and low social support. The implications of these findings in relation to the planning and development of interventions addressing the family as a whole are discussed. The aim is to enhance parents’ competence and resources so that they are better able to cope with the demands of parenting their children.
The Arabic Version of Trinity Amputation and Prosthetic Experience Scale - Revised (TAPES-R) for Lower Limb Amputees: Reliability and Validity
Purpose: Despite the importance of the evaluation process in lower limb prosthetic rehabilitation, prostheses are rarely evaluated properly in the Arab world. This is partly due to the absence of any suitable Arabic evaluative tool. The aim of this study is to translate TAPES-R (a standardised evaluative questionnaire) into Arabic and to investigate its psychometric properties on lower limb amputees. Such a tool would ultimately be of benefit for clinical follow-up and research purposes. Method: International standards were followed for the forward- and back-translation of the TAPES-R questionnaire. A sample of 111 Arabic-speaking volunteers with lower limb amputation completed the translated version of the questionnaire. The responses were then statistically analysed using factor analysis and Cronbach’s α to assess the content and construct validity, and internal consistency (reliability) respectively. Results: Factor analysis showed that the questionnaire’s items (included in the analysis) can be divided into three distinct dimensions as was originally suggested. The distribution of the items within the three dimensions is comparable with the original questionnaire. All three parts of TAPES-R showed high reliability; where Cronbach’s α were .892, .894, and .873 respectively. Conclusion: This study found that the Arabic version of TAPES-R represents a valid and reliable tool. Limitations: The questionnaire is designed to be emailed or posted, but the majority of the amputee population in Jordan did not have these services, so direct contact with each participant was necessary.
Access to Social Organisations, Utilisation of Civil Facilities and Participation in Empowerment Groups by People with Disabilities in Amravati district, Maharashtra
Purpose: This survey aimed to assess the baseline level of access to social institutions, utilisation of civil facilities and participation in empowerment schemes by people with disabilities in Amravati district of Maharashtra State, India. Method: Sixty villages from two blocks in Amravati district were randomly selected for the survey. From these villages, 522 households were sampled and 3056 individuals were surveyed. Interviews were conducted with 590 individuals with disability from among the surveyed population. The structured interview schedule consisted of demographic data, access to social organisations, utilisation of civil services, and participation in empowerment schemes. Results: Locomotor disability was the most prevalent (44.6%) type of disability in the study area. Disabilities were more often present among male adolescents and young adults than among the older population and females. Over 50% of the study participants had no occupation (including children and students) and had not been to school. Only 48% had achieved secondary education and more. The proportion of disability among people belonging to Scheduled Castes and Scheduled Tribes was considerably higher than among the general population. Access to social institutions was less than 50% for most of the items, and was even lower among females. Except for the ration card and Aadhar card, civil services were generally under-utilised by people with disability. Only 3.2% of the participants were members of self-help groups, and not a single person was a member of the Disabled People’s Organisation. Conclusions: In the study area access to social institutions, utilisation of civil services and participation in empowerment schemes was very low. Limitations: Data, including general socio-demographic, access and utility data, was not collected for the general population but was limited to people with disabilities. This restricted the scope for comparison between people with and without disabilities.
Community-Based Rehabilitation Programming for Sex(uality), Sexual Abuse Prevention, and Sexual and Reproductive Health: A Scoping Review
Purpose: The United Nations Convention on the Rights of Persons with Disabilities aims to protect the human rights and dignity of all people with disabilities. In low-and middle-income countries (LMICs), one way this goal is pursued is through Community-Based Rehabilitation (CBR), a strategy to support the full and equal participation of people with disabilities. In spite of policy and community-based interventions, people with disabilities continue to experience inequities in many areas of life - one of these being their sexual and reproductive health (SRH) rights. This scoping review explored the literature to understand how CBR programming has supported sex(uality), sexual abuse prevention, and SRH for people with disabilities. Methods: Arksey and O’Malley’s (2007) framework was used to identify relevant studies in academic and grey literature. This included six databases, the WHO website, and five Regional CBR Network websites. Relevant studies were selected using criteria and data was charted to examine the quantity, variation, and nature of CBR interventions. Results: Fifteen studies were identified. The majority were implemented in Africa; targeted all people with disabilities, regardless of gender, age, or type of disability; and frequently focussed on the topic of HIV/AIDS. The interventions were most commonly designed to educate people with disabilities on issues of sex(uality), sexual abuse prevention, or SRH. Conclusion: A number of studies discussed CBR programmes that aim to support sex(uality), sexual abuse prevention and SRH for people with disabilities, yet gaps were identified that indicate that certain populations and topics are being overlooked by CBR interventions. Implications: CBR practitioners can focus on filling the gaps identified in this review through future programming. Further action must concentrate on implementing a variety of CBR Matrix strategies to address comprehensive issues related to sex(uality), sexual abuse prevention, or SRH.
Assessment of Knowledge about Childhood Autism among IERT/ SSA teachers in the State of Andhra Pradesh, India
Use of Tactile Diagrams in Teaching Science to Visually Impaired Learners at the Upper Primary Level
Inclusive classrooms are a must in today’s education system so that all the students are given equal opportunities, irrespective of their abilities. Understanding science without diagrams and illustrations can be a challenging task for learners. Although Braille books are available for visually impaired students, they lack diagrams and illustrations. To address this issue, the Department of Education in Science and Mathematics (DESM), National Council of Educational Research and Training (NCERT), New Delhi, has brought out a tactile science book for upper primary level students. This paper aims to convey the importance of the tactile science book for students of class VI. The tactile science books were distributed to students from different inclusive schools as well as students in special schools. The students with visual impairments felt that they were able to understand science concepts easily with the aid of the tactile diagrams. The tactile science book can promote comprehensive classrooms in inclusive setups and, through diagrams and illustrations, can help students with visual impairments to increase the efficacy of their learning.
Revenue and Expenses over Five Years in Intellectual Disability Service Providers in Pennsylvania
Purpose: The aim of this study was to ascertain the financial health of intellectual disability provider agencies in Pennsylvania over a five-year period of time. Method: GuideStar was used to access the 990 tax forms of 79 provider agencies belonging to the PAR provider association. Results: Data revealed that approximately 1/3 of the service providers had expenses that exceeded revenue each year. Despite this negative finding, net assets of the provider agencies grew and it was evident that additional money was entering the system. The threats of this sort of situation were discussed. Conclusions: It appears to be a constant that 1/3 of provider agencies have expenses that exceed revenue each year. This data questions the long-term sustainability of Pennsylvania intellectual disability providers.
Accessibility of Public Buildings in Khulna, Bangladesh, for Wheelchair Users
Purpose: Physical accessibility is one of the fundamental rights of wheelchair users in order to ensure their integration into society. After Bangladesh ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) on November 30, 2007, there has been a paradigm shift in the government’s approach to ensure the welfare and rights of persons with disabilities through legislative and policy actions. This study assesses how accommodative the public buildings are for wheelchair users in Khulna, Bangladesh. Method: All the public buildings in Khulna city - including government offices, public schools, colleges and universities, hospitals, libraries, post offices and court buildings - were visited to assess the presence and suitability of facilities for wheelchair users, such as accessible parking, ramps, elevators, doors, and essential interior facilities like water closets and drinking-water fountains. Bangladesh has no specific accessibility guidelines document, but accessibility requirements have been included in the Bangladesh National Building Code (BNBC) 2008. The study made its assessment using an abridged form of the Americans with Disabilities Act Accessibility Guidelines (ADAAG) and BNBC 2008. Results: Only 6.7% (5) of the 75 public buildings were found suitable for wheelchair users. There is scope for modifications to be made in 28% (21) of the buildings which are currently unsuitable for wheelchair users. Conclusion: The study revealed that public buildings are, in general, not very accommodative of wheelchair users. There is a need for modifications in infrastructure to ensure inclusive development of these individuals.
Barriers in Dental Care Delivery for Children with Special Needs in Chennai, India: A Mixed Method Research
Purpose: The study aimed to assess the barriers faced by children with disability, both qualitatively and quantitatively, from the perspectives of caregivers and dental practitioners. Methods: A concurrent mixed method design was used. A sample of 195 dentists and 100 caregivers was selected through convenience sampling. A pre-validated questionnaire was used to assess the barriers faced by the children with disability in their care. Focus group discussions and in-depth interviews were conducted with caregivers. Descriptive statistics were computed using SPSS version 20 and thematic analysis of qualitative data was done using NVivo software. Results: 195 dentists and 100 caregivers responded to the survey. Majority of practising dentists (83.7%) reported inadequate training in handling children with special needs, while caregivers (38%) reported fear of dentist among the children as major barriers experienced in utilising dental services. Conclusion and Implications: This study helps to identify the barriers faced by children with special healthcare needs. The findings highlight the need for hands-on training to be incorporated into the dental curriculum. It also suggests that improvements be made in dental clinics to accommodate these children in comfort. Due to limitations of the study, it is suggested that there is a need for further longitudinal studies that involve other family members of children with disability.
The Impact of Communication Disorders on Discrimination against Deaf Workers
Purpose: The study aimed to determine the impact of communication disorders on discrimination against people who are deaf in the workplace, as well as to find the differences in study participants’ opinions. Method: The study sample consisted of 171 respondents from different industries in Bosnia-Herzegovina- 57 workers who were deaf, 57 workers who could hear, and 57 managers. Both quantitative and qualitative approaches were used in the survey. The opinions of the respondents were elicited through a questionnaire which consisted of 15 statements. The interviews of workers and managers focussed on the presence of discrimination against deaf workers in the workplace. Responses of respondents were converted to quantified values using analysis of discrimination group. The significance of statistical differences among the samples tested is defined at 0.01 level of significance using F-Test. Results: Discriminant analysis tested the null hypothesis that respondents’ answers do not differ regarding discrimination against deaf workers in the workplace. However differences were found between the groups that felt deaf workers did not have equal position at work in comparison to their hearing co-workers. Participants mentioned a number of barriers in workplaces. Workers were of the opinion that there was significant discrimination in the workplace (p>0.01) between groups of participants. Conclusion: There are statistically significant differences in the opinions of respondents regarding statements that workers who are deaf cannot hold positions equal to their co-workers who have regular hearing.
Children with Cerebral Palsy in Bangladesh: Their Contribution to the Development of a Rehabilitation Training Programme
Purpose: Although cerebral palsy is the most prevalent health condition linked to childhood disability in Bangladesh, support and rehabilitation for this group is limited and intervention development is slow. An initiative to address these unmet needs was the development of a parent training programme for the rehabilitation of children with cerebral palsy. The aim of this study was to explore what was important in the everyday lives of children with cerebral palsy in rural Bangladesh and take their views into account in order to inform the parent/caregiver training programme. Methods: Qualitative data was collected from12 children with cerebral palsy, between 5 - 14 years of age. The children were purposively selected from among those who attended the parent training programme. A participatory method called the ‘Feeling Dice’ was used to elicit children’s feelings about their everyday lives. The approach was easy to use, acceptable in the local context, the children enjoyed the activity, and it generated rich information. Results: ‘Inclusion in play’ and ‘being able to attend school’ made the children happy and were their two main priorities, yet were not key issues for parents. The children were frustrated by their dependence on others for day-to-day activities such as feeding, bathing, and transport to school. Children also played an important part in encouraging their parents to attend the training course. Conclusion: This study showed that valuable information can be gathered from children with cerebral palsy by using a simple and adaptable participatory research tool. Children’s views and priorities sometimes differed from those of their parents and carers, and could be useful for developing more relevant and valid interventions. Children need to be recognised as important ‘agents of change’ within their own rehabilitation. This methodology is in harmony with the UNCRPD recommendations, and supports inclusive and rights-based intervention development.
Physical Disability, Rights and Stigma in Ghana: A Review of Literature
Purpose: This is a survey of peer-reviewed articles focussed on the causes and consequences of stigma towards persons with physical disability in Ghana. Method: After a systematic search of the online databases EBSCOhost, ProQuest, PubMEd and Web of Science for peer-reviewed articles on disability in Ghana, 26 articles were chosen for critical review. The three main selection criteria were: the articles had to be peer-reviewed, they had to be based on interviews with Ghanaians in the field, and they had to discuss stigma and human rights. For analysis, the content of the articles was grouped under two sections: major themes (human rights, causes of stigma, consequences of stigma) and policy recommendations (economics, medical services/healthcare, affirmative action, attitudes and awareness-raising, inclusion of cultural beliefs). Results: This review found that most of the studies attribute stigma to negative attitudes towards Ghanaians with disability, and many highlight beliefs among Ghanaians that disability is caused by spiritual and supernatural forces. The consequences, according to most authors, are social, economic and political exclusion. Policy recommendations include improving government policy, increasing funding for disability programmes, changing public attitudes, and paying attention to Ghanaian culture and tradition in designing disability interventions. While these are valid points, the authors of this paper are of the opinion that the literature also suffers from lack of a deep understanding of the historical and socio-cultural roots of supernatural beliefs in Ghana. Conclusion: The 26 studies discussed in this review show that since 2006 very good work has been produced on disability in Ghana, especially by Ghanaian disability scholars. It is hypothesised, however, that a full understanding of disability and stigma in Ghana must be based on deeper research into the roots of the beliefs that drive stigma. Future work therefore should focus on deepening the analysis of cultural beliefs towards disability in Ghana, in order to understand fully the roots of culturally-based disability stigma. More research into the economic causes and consequences of disability is also recommended, without which a full analysis of cultural stigma will not be possible.
Relationship between Poverty and Disability in OIC Countries
Compliance of Zimbabwean Hotels in the Provision of Innovative Facilities for Guests with Disabilities
Purpose: In Zimbabwe, people with disabilities have limited options when looking for hotel accommodation as hotels often lack facilities that cater to their specific needs. This study sought to explore the perceptions of people with disabilities on the compliance of Zimbabwean hotels in the provision of innovative facilities for guests with disabilities. Methods: Data was collected by administering a semi-structured interview guide to 55 respondents. Thematic analysis of the data was carried out. Results: The findings indicate that hotels are not compliant in terms of providing innovative facilities for guests with disabilities. Accessibility of facilities emerged as the most important consideration for guests with disabilities. Conclusion: It is recommended that hotels be more innovative and upgrade their facilities so that they are accessible to people with disabilities. This would not only enhance their guests’ hotel experience, but would also expand the hotels’ customer base to include this clientele.
The Impact of the National Health Insurance Scheme on the Lives of Persons with Disabilities in Kumasi Metropolis, Ghana
Purpose: In Ghana, the National Health Insurance Scheme (NHIS) is one of the government’s social protection measures to provide healthcare for its citizens. Persons with disabilities and their families, though worthy recipients of such services, are more likely to face challenges in accessing healthcare through the NHIS due to social discrimination. The objective of the study was to evaluate the impact of the National Health Insurance Scheme on the lives of persons with disabilities in the Kumasi Metropolis. Method: A qualitative study was carried out. Purposive sampling was used to select persons with disabilities and NHIA staff as participants. Structured interviews and focus group discussions were employed to collect data from them. Results: Unemployment among persons with disabilities was the major economic factor that influenced access to health insurance and healthcare. Most of the mobility impaired and visually impaired persons were inconvenienced by inaccessible routes to NHIA offices. For the hearing impaired, communication was a major problem since the NHIA staff were unable to understand sign language. Conclusion and Implications: NHIS has been instrumental in providing healthcare for persons with disabilities, and stakeholders must encourage persons with disabilities to register for NHIS. Their unemployment issues should be addressed by aiding their economic ventures. Access routes to NHIA offices must also be made disability-friendly.
Efficacy of a Low-cost Multidisciplinary Team-led Experiential Workshop for Public Health Midwives on Dysphagia Management for Children with Cerebral Palsy
Purpose: Over the past decade there has been a growing focus on offering appropriate training to healthcare professionals and caregivers to support safe feeding practices for children with cerebral palsy. Early and consistent multidisciplinary intervention is required to minimise the risks of aspiration pneumonia. The high incidence of complications from aspiration pneumonia among children with cerebral palsy in Sri Lanka has made it necessary to conduct low-cost multidisciplinary team-led dysphagia awareness workshops for healthcare professionals and caregivers. Method: A group of 38 Public Health Midwives (PHMs) was offered an experiential workshop by a small multidisciplinary team (MDT). To determine changes in knowledge, a self-administered questionnaire that included a video-based client scenario was administered pre- and post-workshop. The data were analysed statistically using non-parametric within-participant t-tests. Results: The post-workshop responses to the questionnaire indicated a significant increase in the level of knowledge. This included positive changes in the understanding and knowledge of cerebral palsy (t (37) =-7.44, p=.000), effects of cerebral palsy on eating and drinking skills (t (37) =-3.91, p=.000), positioning (t (37) = -9.85, p=.000), aspiration (t (37) =-3.46, p=.001), food categorisation (t (37), -3.85, p=.000) and client video observation (t (37)-3.91, p=.000) at a p=.05 level of significance. While there was also an increase in the knowledge on general guidelines during mealtimes, this did not reach statistical significance. Conclusion: The low-cost MDT-led experiential workshop was effective in increasing knowledge of feeding and dysphagia-related issues in cerebral palsy among a group of PHMs. This workshop could serve as a model for training PHMs and Community-Health Workers across the country in order to reach the Sustainable Development Goal of ‘good health and well-being’ for children with cerebral palsy and all children experiencing feeding difficulties. Follow-up workshops and continued professional development courses for midwives on dysphagia care are strongly recommended, in addition to collaborative clinical practice.
Effect of an Aerobic Fitness Programme Intervention on the Motor Proficiency of Children with Mild and Moderate Intellectual Disabilities in India
Purpose: The study aimed to assess the effect of an Aerobic Fitness Programme intervention on children with mild and moderate intellectual disabilities in Jammu, India. Method: In a pre-test post-test control group design, 66 children with mild and moderate intellectual disabilities, who fulfilled the inclusion and exclusion criteria, were placed in control and experimental groups. A validated tool, the Test of Motor Proficiency, was used as a pre-test and post-test measure to assess the effect of the intervention. Results: The mean difference between the two groups of children with mild and moderate intellectual disabilities was significant. ANCOVA analysis indicated F (1,28) = 312.13, P =.00 in children with mild intellectual disabilities, and F (1,32) = 22.540, P =.00 in children with moderate intellectual disabilities. The intervention was effective in developing visual motor control, upper limb speed and dexterity, running speed and agility, balance, strength, and upper limb coordination. It was ineffective in improving bilateral coordination in both groups of children with intellectual disabilities. Conclusion: This intervention programme can be introduced into the daily curriculum of children with intellectual disabilities at special schools. It would be helpful in compensating for the lack of physical activity due to classroom-based teaching.
The Effect of Age, Gender and Socioeconomic Status on Self-esteem, Body Image and Quality of Life of Amputees: An Evaluation Seven Years after the 2008 Sichuan Earthquake
Purpose: Psychological well-being is a growing concern in society. It is starting to play a pivotal role in the treatment and care of clients. This study aimed to evaluate the effect of age, sex and socioeconomic status on the self-esteem, body image and quality of life of the 2008 Sichuan earthquake amputees. Many of them are at a significant stage in their lives, especially those who are making the transition from childhood and adolescence into adulthood. Methods: This cross-sectional study was conducted in October 2015. Forty-five participants were recruited from clinic sessions in Sichuan. The main outcome measures were Rosenberg Self-Esteem Scale (RSE), Chinese Amputee Body Image Scale (CABIS), and WHO Quality of Life-Bref Instrument (WHO-QOL-Bref). Results were analysed using Student’s T-test and Chi-square test where appropriate, and ANOVA for multi-group comparisons. Results: Participants under 18 years of age scored higher in RSE (p=0.05), and lower in CABIS (p<0.005). They also scored higher in various QOL domains (D3: p<0.08, D4: p=0.06) and WHOQOL-Bref question 2 (p=0.06). Participants of different SES did not show any significant differences in the outcome measures. Female subjects scored higher in WHOQOL-Bref Question 1 (p=0.03). Conclusion and Implication: Younger amputees have less body image distortion, higher quality of life and self-esteem compared to older amputees. Female amputees also appear to have a higher quality of life compared to male amputees. Socioeconomic status does not affect rehabilitation outcome and psychological well-being of amputees. However, the main factors affecting psychological well-being appear to be predominantly age and, possibly, gender.
Training Needs of Community-based Rehabilitation Workers for the Effective Implementation of CBR Programmes
Purpose: This review investigates the training needs of Community-Based Rehabilitation (CBR) workers that would enable them to effectively facilitate CBR programmes. Emphasis was placed on identifying: (a) the skills that CBR workers require (b) the training currently available for them, and (c) the gaps in current training. Method: A scoping review was conducted using on-line database searches (Medline, Embase, Cinahl, PsycInfo, Global Health) for English articles from 2006 onwards. A combination of keywords related to CBR, personnel, and training were applied. Hand searches of reference lists and the DCID journal were also conducted. Grey literature related to training, from the World Health Organisation (WHO), CBR Regional Networks and organisations affiliated with CBR were included as secondary data. Thirty-three articles and thirty-five sources from the grey literature were included. Data was organised under the three objectives outlined above – i.e., required skills, available training and training gaps. Results: CBR workers represent a diverse group requiring a broad range of skills. A new cadre of mid-level workers is also necessary to effectively implement the CBR guidelines. There is currently no standardised training for CBR workers and training varies widely, depending on context. CBR workers require further training in various clinical, social, management, communication, and cultural competence skills across the spectrum of the CBR Matrix, and specifically in empowering persons with disabilities and facilitating community development. They also need to develop critical reasoning, creativity, and compassion. Conclusion: A standardised approach to training CBR workers would be beneficial to ensure basic standards and quality services, to allow meaningful comparison and evaluation across contexts, to recognise the role of mid-level CBR workers, and to strengthen the workforce. Further research is required to determine minimal competencies, define the roles of various CBR workers, and evaluate the effectiveness of training.
Ujamaa and Universal Design: Developing Sustainable Tactile Curricular Materials in Rural Tanzania
Purpose: This article illustrates the power of collaboration in the spirit of Ujamaa to build curricular materials that can engage and support the learning of a diverse group of students in under-resourced environments. The authors reflect on their personal experience overseeing collaborative service learning projects with Tanzanian partners through a study abroad programme. Method: The service learning project took place in a rural primary school in northern Tanzania, characterised by large class sizes and the unavailability of teaching and learning materials. Tactile curricular materials were collaboratively developed by Tanzanian student teachers, practising teachers, and American undergraduate students. Locally available and recyclable materials were used, such as plastic water bottles, tubing, plastic bags and cardboard boxes. Results: Examples of curricular materials that were developed are presented, and lessons learned through the experience are shared. Conclusion: The use of locally available, recyclable materials enhanced sustainability. Having sustainable curricular materials that are accessible to a diverse range of students in under-resourced educational settings has the potential to foster learning for all. The underlying cultural concept of interconnectedness or Ujamaa strengthened the collaborative relationship between participating teachers and students, and can be drawn upon to enhance future service learning and international development efforts in education.
Copyright (c) 2018 The Author(s) https://creativecommons.org/licenses/by/4.0
Zero Rejection Policy in Admission of Children with Special Needs - Myth or Reality
Purpose: To study the difficulties (if any) faced in the admission process of Children With Special Needs (CWSN) and the reason for these difficulties (if any) and also to suggest possible solutions for overcoming the difficulties. Methods: The data was collected from 16 resource teachers working in Delhi. The anecdotal narratives provided by resource teachers were qualitatively analyzed via content shifting. Results: Majority (more than 80 %) of the resource teachers faced lot of difficulties while acting as facilitator for admission of CWSN. Conclusion: Existing lack of awareness about the zero rejection policy by the school authorities (principal/head teacher), fear of accidents in the school, bullying of CWSN by non-CWSN, non-availability of resource teacher and the required support, were found to be the main challenges in implementation of zero rejection policy in admission of CWSN. The possible solution lies in preparing the regular teachers for addressing the needs of CWSN in the inclusive classroom and in turn making them responsible and accountable for teaching learning of CWSN, just like they are for children without special needs.
Developmental Social Work for Promoting the Socioeconomic Participation of Persons with Disabilities: An Application of the Capability Approach
The promotion of the socioeconomic participation of persons with disabilities is an important concept of developmental social work in community-based rehabilitation (CBR). This approach can be used to tackle poverty and inequalities, and to foster inclusion and empowerment. However, since discussions in the literature on common frameworks for developmental social workers in CBR appear inadequate, this review article aims to develop a practical framework that promotes the socioeconomic participation of persons with disabilities by applying the capability approach. First, the concept of socioeconomic participation and some of its dimensions are discussed and analytically framed using the capability approach. Following this, the practical framework for developmental social work is laid out. It is suggested that developmental social workers consider the complex dynamics between capabilities, functionings, resources, conversion factors, and other factors, with an emphasis on the social dimensions of practice. Thereafter, some theoretical and practical challenges and recommendations are identified.
Cross-Cultural Adaptation and Evaluation of Psychometric Properties of Persian Version of Supports Intensity Scale among Adults with Intellectual and Developmental Disabilities
Purpose: This study was designed to translate and assess the psychometric properties of Supports Intensity Scale among adults with intellectual and developmental disability in Ahvaz and Tehran, Iran. Method: The cross-sectional study was carried out in two stages. The first stage consisted of the forward-backward translation of Supports Intensity Scale - Adult Version) SIS-A(. In the second stage, 197 people with intellectual and developmental disabilities were recruited in order to assess the internal consistency and test-retest reliability, concurrent and content validity of SIS-A. The confirmatory factor analysis (CFA) was performed to approve the seven-factor model of the instrument. Results: The intra-class correlation coefficient values varied between 0.85 and 0.99 (very good to excellent). All subscales of the SIS-A showed Cronbach’s alpha above 0.70. Correlation coefficient between SIS-A and Barthel index was about -0.65, which shows excellent concurrent validity of SIS-A. The findings showed SIS-A had high ability to discriminate between groups with different IQ (p<0.05). There was no significant correlation between SIS-A and the age of participants (p>0.05). The result of CFA confirmed that the seven-factor model of SIS-A is the fittest pattern for SIS-A. Conclusion: The results indicated that the Persian version of SIS-A is a valid and reliable instrument to assess function and disability among people with intellectual and developmental disability.
Effect of Abacus Training on Numerical Ability of Students with Hearing Loss
Purpose: The study focussed on the effect of Abacus training on numerical ability (comprising of counting and mathematical operations) of children with hearing loss. Method: 90 students with hearing loss were sampled from 6 special schools in Mumbai, India. A quasi- experimental study was employed using two group pre-test and post-test design. Data were collected using the Numerical Ability Test (NAT) as an instrument. Six null hypotheses based on the objectives were formulated and tested at 0.05 level of significance using t-Test - Assuming Equal Variances. Results: The findings revealed that the experimental group which was instructed through Abacus showed higher proficiency in numerical ability as compared to the control group instructed through the conventional method. Gender as a variable seems to influence the mean achievement of numerical ability of students with hearing loss. While girls and boys did not differ in simple tasks such as counting, boys were found to be better in mathematical operations and overall numerical ability. Conclusions: The Abacus teaching method results in higher mathematical achievements among students with hearing loss. Gender also plays an important role in mathematical learning, as evidenced by boys demonstrating more numerical ability than girls in the study sample.
A Cross-sectional Survey of Rehabilitation Service Provision for Children with Brain Injury in Selangor, Malaysia
Purpose: Rehabilitation services in Malaysia are provided by both governmental and non-governmental agencies but there are challenges, such as the lack of integration between agencies, and accessibility barriers to services especially for the population of urban poor and people in the rural areas. With the help of a survey, this project aimed to gain a better understanding of rehabilitation services provided for children with brain injury within the state of Selangor and Federal Territories of Kuala Lumpur and Putrajaya. Method: A list of 205 organisations that provide rehabilitation services for children with neurological injuries was compiled. The researchers attempted to verify the services by visiting the facilities or via telephone or email communication if visits were not possible. Results: The researchers were able to verify 83% of the organisations identified. There are 40 hospitals and 17 service providers for acute and / or chronic physical rehabilitation services for persons with disabilities of all ages, including children. Conclusion: Findings showed the unequal distribution of rehabilitation service provision by districts. Service providers were concentrated in the urban areas. Setting up new healthcare facilities is one of the solutions but the costs for development, construction, and manpower could be high. An alternative solution is proposed, namely, the use of a home-based virtual rehabilitation programme.
Barriers and Facilitators for Wheelchair Users in Bangladesh: A Participatory Action Research Project
Purpose: People who use wheelchairs face a range of physical, social, and economic barriers to regular participation in their communities. These barriers may be more acute in countries such as Bangladesh which are affected by poverty and often lack the physical infrastructure or resources necessary to create inclusive or accessible environments. This research aimed to identify: (a) the barriers and facilitators to accessibility faced by wheelchair users in Bangladesh; (b) how these barriers affect the inclusion of wheelchair users in Bangladeshi society; and (c) what could be done to improve accessibility and inclusion for wheelchair users in Bangladesh. Methods: This participatory action research (PAR) project used Photovoice and semi-structured interviews to identify barriers and facilitators to accessibility for people who use wheelchairs in Bangladesh. Results: Participants mentioned a number of barriers in public spaces, such as roads, missing or inadequate ramps, inaccessible restrooms, and negative attitudes. There were also participants who had made their home environments more accessible with accommodations such as ramps, arrangement of space, and low countertops/work spaces. Women wheelchair users seemed to face greater barriers to access, as compared to men, in a range of community spaces and activities. Participants’ recommendations for improvement targeted government stakeholders and included greater focus on road infrastructure, particularly during flooding in the rainy season, and modifications to the public transportation system. Conclusion: A key goal of the study was to identify barriers and facilitators, and use the information gathered to promote social change on the ground. Future research and action should encourage more people to get involved in removing barriers for people with disabilities, in Bangladesh as well as globally.
Lived Experience of Psychosocial Disability and Social Inclusion: A Participatory Photovoice Study in Rural India and Nepal
Purpose: This study aimed to investigate the experiences of people living with a psychosocial disability in rural India and Nepal, and to highlight key barriers and enablers for inclusion. Method: Participatory action research approaches and Photovoice methodology were employed to investigate the lived experience of 32 participants in rural India and Nepal. There were 12 participants and 4 caregivers of people with psychosocial disability from each of the two countries. Semi-structured interviews with study participants were transcribed and analysed thematically to answer the study question. Results: The findings revealed themes related to various supports, meaningful engagement in activity, and community awareness. Among these categories were both enabling and impeding factors to inclusion, the presence or absence of which was typically associated with improvements or worsening of symptoms respectively. Conclusions and Implications: This study underscores the need for integrated community-based approaches that are multisectoral, inclusive of family, and strengthen community responses. Photovoice was also shown to be a feasible research methodology for providing insights into the lived experience of people with psychosocial disability and for fostering their empowerment.
Concern about Citation and Misrepresentation of Own Work in Recent Publication
Teacher Trainees’ Perceptions of Inclusion of and its Challenges
Purpose: Teachers’ perceptions of inclusion could differ in relation to their knowledge and understanding of inclusion at different stages of the teacher training programme. This paper explores associate teachers’ perceptions of the concept of inclusive education in 21st century England. Method: A group of participants (n=126) in a teacher education course at Chester University, UK, were asked to represent their understanding of the concept of inclusion within the local context. A self-developed questionnaire was used to collect data. Results: Analysis revealed that many teachers had struggled to understand and operationalise inclusion as: everyone included in education under the same roof (57.89 %); catering to individual needs (22.8 %); and, everyone getting equal rights and opportunities (19.3 %). For 85% of respondents the understanding of inclusion came from their school-based learning, for 70% it was from modules, research and discussion, and for 22% it was through lectures and seminars. Conclusion: A shift in conceptualisation of inclusion was observed at different levels during the training. It is therefore recommended thatorientation training of policy-makers and education department officials, both at the state and block levels, be conducted.
Competencies of Students with Visual Impairment in using the White Cane in their Learning Environment: a Case Study at Wenchi Senior High in Ghana
Purpose: This study investigated the competencies of students with visual impairment at Wenchi Senior High School, Ghana, in familiarising themselves with their learning environment using the cane. Method: A case study design was adopted for the study. A mixed method approach was utilized in this study. A quantitative approach was used to assess students’ competencies in using the cane while qualitative approach was adopted to probe challenges related to using the cane. Results: Students had reached higher stages on the Conscious Competence Matrix and were by and large competent in using the white cane in their learning environment. However, personal and environmental factors were marring their progress. The personal factors included difficulties with fine motor skills and onset of blindness. The external factors were lack of mobility trainers and canes, as well as barriers within the physical environment. There is generally a positive correlation between onset of visual impairment and specific cane skills. Conclusion and Implications: It is recommended that resource persons devote more time to developing the competencies of students in cane techniques, especially in skills related to identification of obstacles. Modifying the physical environment, as well as providing more canes and additional mobility trainers, will be useful in facilitating the movement of visually impaired students within the school. Limitations: A major limitation is the lack of objective assessment of residual vision and motor impairment. Residual vision likely played a crucial role during the competency test.
Negotiating Future Uncertainty: Concerns of Mothers of Children with Down Syndrome in Kashmir, India
Purpose: Down syndrome is developmental disorder that poses unique challenges and implications to families. The present paper is the outcome of a study carried out in Srinagar district of J & K in India, on mothers’ apprehensions about the uncertain future for their children with Down syndrome. Method: A phenomenographic approach was followed. Purposive sampling technique was used at selected special schools in Srinagar. Mothers of 8 children with Down syndrome who were enrolled in school, participated in the study. The mothers were between 31 and 67 years of age; their children were between 2 and 30 years of age. In-depth interviews were conducted in Urdu and Kashmiri, the local languages. The recorded information was subsequently transcribed and classified into themes. Results: The key theme that emerged was the participants’ worry about the unpredictable future of their child. Once a child is diagnosed with Down syndrome, parents - especially mothers - recognise that their child’s future may not include a carefree childhood and, at a later date, higher studies, an independent life and marriage. Conclusion: Mothers of children with Down syndrome experience high levels of stress and often have to make adjustments in their careers, finances and lifestyles. There is a need for training programmes to help parents cope with the problems faced by their children with Down syndrome. Stakeholders in the education sector could help in this regard.
Predictors in the Selection of an AAC system: An Evidence-based Report on Overcoming Challenges
Purpose: Identification of the most suitable Augmentative Alternative Communication (AAC) device for individuals with varying degrees of communication impairments is immensely challenging. This study aimed to understand the effectiveness of analysing the various sensory, cognitive and environmental factors during the selection of an AAC. Methods: Four children with different developmental disabilities were assessed in the domains of sensory ability, cognitive skills and environmental factors. The selection of an AAC was primarily dependent on the positive indicators in these domains and the specific challenges pertaining to each participant. Results: Participants’ progress was assessed. All the children progressed across the levels of the Communication Matrix. Conclusion: Understanding of sensory perceptual capacities and an attempt to overcome environmental barriers lead to the successful use of an AAC system. The study attempts to establish a platform for further research on the efficacy of utilising sensory perceptual learning with AAC to overcome communication barriers in children with severe developmental disabilities.
Utilisation and Satisfaction with Health Services among Persons with Disabilities in Accra, Ghana
Purpose: Healthcare, one of mankind’s basic needs, is generally accessible to persons without disability, but people with disabilities are marginalized and stigmatized in developing countries and as such are unable to utilise the health services they require. The health-related Sustainable Development Goals (SDGs) talk about good health and well-being, and about reducing inequality in societies. In South Africa and Ghana, constitutional provisions and policies have been made for inclusion and for reducing inequality among persons with disabilities, but implementation is still in its infancy. The aim of this study is to determine the level of utilisation and satisfaction with health services among persons with disabilities, and to recommend strategies to improve the current situation in the country. Method: A non-interventional, descriptive cross-sectional study was employed, with a quantitative data collection method. A structured questionnaire comprising of both open- and closed-ended questions was used for the data collection. A total of 363 respondents were involved in the study – 360 were persons with disabilities, and 3 were key informants. Results: While A total of 66.9% of persons with disabilities reported being warmly received by health professionals, 23.1% reported encountering a cold attitude, and 5.6% reported being scorned at health facilities. Only 20.5% of persons with disabilities reported frequent visits to health facilities, 42.8% did not visit health facilities frequently, and 36.4% rarely visited a health facility. Moreover 76.4% reported that they made hospital visits for all their ailments. Conclusion: Although health facilities were utilised by few persons with disabilities, the majority of respondents reported that they were well-received there and as such would visit health facilities for all their medical needs. Implications: Persons with disabilities should be included in all areas of society by spreading awareness about their abilities. Partnerships between persons with disabilities and the government and other non-governmental organization’s should be established, to mainstream health services to meet their general and specific needs. It is increasingly important that persons with disabilities play an active role in managing their healthcare needs.
Parental Perceptions, Attitudes and Involvement in Interventions for Autism Spectrum Disorders in Sarawak, Malaysia
Purpose: This study explores and compares perspectives of educators and parents regarding interventions used in managing Autism Spectrum Disorder (ASD) in Sarawak, Malaysia. Information on parental desires and limitations when selecting and maintaining management will aid in the development of strategies for ASD educators to work effectively with parents and caregivers, and vice versa. Method: This qualitative research employed traditional question and answer interviews with 7 ASD educators and 30 parents. Interviews were semi-structured and questions were open-ended to allow for additional details to be relayed within the scope of the subject matter. Thematic analysis revealed overarching perceptions concerning parental attitudes towards involvement in their children’s interventions, and implications of cultural context. Results: Perspectives were similar regarding the importance of confidentiality from educators and cultural factors playing a major role in content of intervention chosen by parents. Perspectives differed across four themes. Of significance was the way in which both samples viewed parental self-reliance in supplementing interventions and parental attitudes in effort and perseverance. Conclusion: Parental resources and culture influence ability and attitudes towards involvement. While educators may not agree on certain aspects, mutual appreciation of differing perspectives would benefit the children.
Anticipated Barriers to Implementation of Community-Based Rehabilitation in Ribeirão Preto, Brazil
Purpose: Disability is a global health and a global development concern. To address both issues, a community-based rehabilitation (CBR) approach is increasingly recommended to meet a spectrum of needs, especially for people with disabilities. It is first necessary to understand the perceptions of local, frontline providers, in order to design effective measures for implementing CBR programmes. This paper aimed to understand the conceptions of Primary Healthcare Providers (PHPs) - serving a sub-urban, socially-vulnerable territory in Brazil - about: 1) disability, 2) rehabilitation, and 3) the possible local implementation of a CBR strategy, including any anticipated barriers. Method: Cross-sectional, exploratory qualitative research was based on focus groups conducted between 2013 and 2016. It involved a total of 78 PHPs serving the western region of the Ribeirão Preto municipality in São Paulo, Brazil. Data analysis was based on Habermas’ critical hermeneutics approach. Results: PHPs understood disability mostly within the biomedical paradigm. Similarly, the predominant conception of rehabilitation was focussed on enabling individuals’ capacity, more than their environment. For local CBR implementation, the barriers that were anticipated were: 1) difficulties in managing and running action across sectors, and 2) the broader socio-political environment that hardly empowers civil society and is affected by power differentials. Conclusion and Implications: While local PHPs identified important CBR implementation barriers which are contextual in nature, the predominant conceptions of disability and rehabilitation (i.e., biomedical, impairments-based) also act as a barrier. Contextual and cognitive barriers must both be addressed when envisioning a local CBR implementation.
Access to Education and Rehabilitative Resources for Children with Developmental Disabilities in Botswana
Exclusion through Attempted Inclusion: Research Experiences with Disabled Persons’ Organisations (DPOs) in Western Zambia
Partnership with disabled persons’ organisations (DPOs) is often presented as one mechanism to ensure the inclusion of persons with disabilities in research that concerns them. In working with two DPOs in Western Zambia, we learned that one of these groups was organised in a way that differed from our own presumptions and the descriptions of DPOs in literature: the group was fluid in membership and willing to re-formulate itself according to the priorities of visitors. From this we understand that limiting research partnerships to DPOs, as typically described, could lead to the inadvertent exclusion of people involved in many different forms of organising by persons with disabilities.
Effects of Trampoline Exercise on Attentional Control and Daytime Sleepiness among Young Adults with Anxiety Disorders in Malaysia
Purpose: Anxiety disorder has been linked to deficient attentional control and sleep problems in young adults. This study aimed to investigate the possible effects of trampoline exercise on attentional control and daytime sleepiness among young adults with anxiety disorders. Method: This single-blinded randomised controlled trial involved 40 young adults with anxiety disorders. All the participants were initially screened for eligibility using Beck Anxiety Inventory and Physical Activity Readiness Questionnaire, and randomly assigned to either an experimental group (n=20) or a control group (n=20). While the experimental group was subjected to trampoline exercise for 4 weeks, all the participants in both the groups were taught deep breathing exercise. Attentional control and daytime sleepiness of the participants were evaluated using Attentional Control Scale and Epworth Sleepiness Scale respectively. Results: The experimental group showed statistically significant improvement in Attentional Control Scale (p=0.009) and Epworth Sleepiness Scale (p=0.005) compared to the control group. Conclusion: Trampoline training resulted in reduction in daytime sleepiness and improvement in attentional control after 4 weeks of trial. This highlights the potential of trampoline exercise training as an adjunct to established clinical treatment.
Role of Caregivers of Children with Intellectual Disabilities and Support Systems Available to them in Ghana
Purpose: This paper explores the role of parents, teachers and house mothers, and the support services available in promoting effective education for children with intellectual disabilities in Ghana. Methods: Qualitative research approach and exploratory design were adopted. Simple random sampling technique was used to select parents, while purposive sampling technique was used to select the teachers and house mothers. Data was collected at interviews, using an interview guide and making audio recordings and notes. Data transcription from the notes was compared with the audio recordings to ensure consistency. The main themes that were developed and coded using data-led approach have been presented as the major findings. Results: The study revealed that most parents refuse to visit their children with intellectual disability in school. They also shirk their responsibility in providing training materials. It was found that training programmes are not organised for house mothers, teachers and parents of pupils with intellectual disability. Also, no incentives are given to teachers and house mothers of these pupils. Conclusion: The study provides insight into the specific roles of parents, teachers and house mothers, and the appropriate support services available for these caregivers. There is a need to highlight these issues for policy making.
Participation Restriction due to Arm and Leg Motor Impairment after Stroke Rehabilitation in the Tamale Metropolitan Area, Ghana
Purpose: The study was conducted to examine the relationship between arm and leg motor impairment in stroke survivors and participation restriction, post rehabilitation, within the Tamale metropolis. Method: The participants were 102 stroke survivors from the Tamale metropolitan area, who had undergone at least 3 months of rehabilitation. Upper limb motor assessment was followed by lower limb motor assessment based on the Manual Muscle Test. Levels of participation restriction were measured using the London Handicap Scale. Correlation analysis of motor impairment and participation restriction were done using Spearman rank correlation analysis. Results: The mean age of post-stroke participants was 62.08 years (95% CI= 59.77-64.39), with men comprising 67.65% and 32.35% women. The Spearman rank correlation co-efficient between arm motor impairment and participation was 0.8343, depicting a strong positive relationship between the aforementioned variables. The correlation between leg motor impairment and participation yielded 0.8013. Conversely, leg motor impairment was found to have a stronger relationship with participation restriction in comparison to arm motor impairment. Conclusion and Implications: The strong relationship between limb motor impairment and participation restriction suggests that clinicians and disability experts involved in rehabilitation should take cognisance of the social implication of motor impairment in order to make informed decisions. Further to this, arm and leg assistive devices could be useful in reducing the levels of participation restriction among persons with stroke within the Tamale metropolis. Limitations: A major limitation is that motor impairment was assessed solely on the ability to perform voluntary movement (muscle power). Sensory disturbances and motor coordination difficulties also have the potential to influence participation restriction, so the exclusion of stroke survivors who are unable to communicate implies that external validity of the research is limited.
The Family and Disability in Ghana: Highlighting Gaps in Achieving Social Inclusion
Purpose: There are social and environmental barriers faced by persons with disabilities which have been reported in literature. In discussing these barriers, attention is yet to be given to the support from families to members with disabilities. This study aimed to examine family support and its impact on the lives of persons with disabilities in Ghana. Methods: The study participants were 48 persons with disabilities - physical, hearing and visual disabilities - who were members of Disabled Peoples’ Organisations. They were conveniently drawn from 4 districts in the Northern region of Ghana. Results: The study found that the families of the participants did not give them adequate support to access services that would improve their lives. For instance, limited access to education resulted in inability of participants to secure jobs. Conclusion: Without the primary support of the family, persons with disabilities might be unable to break down social barriers due to their inability to access education and other developmentally useful services. The implication of the study for policy-making has been discussed extensively.
Barriers to Healthcare Services for People with Disabilities in Developing Countries: A Literature Review
Purpose: This literature review aimed to identify the main barriers in access to mainstream healthcare services for people with disabilities. Method: Online databases were searched for relevant articles published after 2006. Preference was given to articles pertaining to developing countries. On the basis of pre-determined inclusion and exclusion criteria, 16 articles were selected for the review. Barriers noted in the articles were grouped thematically. Results: There appeared to be 7 main barriers - 4 related to the demand side i.e., pertaining to the individual seeking healthcare services, and 3 barriers on the supply side i.e., pertaining to healthcare provision. These are: 1) Lack of information; 2) Additional costs of healthcare; 3) Limited mobility; and, on the demand side, 4) Stigmatisation; while on the supply side, 5) Staff attitude; 6) Communication barriers; and, 7) Inaccessible facilities. Conclusion: To ensure that people with disabilities can successfully access the necessary health services, the barriers on the demand side (the individuals requiring healthcare) as well as the barriers that are part of the healthcare system, should be attended to.
An Evaluative Study of Services Provided in Community-Based Rehabilitation Centres in Jordan
Purpose: This research study aimed to investigate the effectiveness of the services provided by CBR programmes in Jordan. Method: This was a mixed-methods investigation. A survey was carried out with 47 participants (stakeholders and volunteers) from four CBR centres in Jordan. It comprised 18 questions that collected both qualitative and quantitative data with both closed- and open-ended questions. The quantitative data was analysed using SPSS Version 22.0. Qualitative data was analysed through thematic content analysis and open coding to identify emergent themes. Results: 40.4% of the participants evaluated the effectiveness of CBR services as low. This mainly stemmed from the lack of efforts to increase the local community’s knowledge about CBR, disability and the role of CBR programmes towards people with disabilities. Conclusions: A proposal was offered concerning the priorities of CBR programmes in Jordan. Efforts need to be directed at promoting livelihood and empowerment components in order to actualise the principles of CBR, mainly by promoting multispectral collaboration as a way of operation. Implications: This study was inclusive of all types of disability. Barriers to the effectiveness of services may stem from accessibility issues to the families of persons with disabilities (hard to reach) or from CBR services themselves (hard to access). The culturally specific evaluative tool in this study was of “good” specificity and sensitivity, this evaluative instrument can be transferrable to measure the impact of CBR programmes in other settings.
Academic Challenges of Students with Hearing Impairment (SHIs) in Ghana
Purpose: Several researches have showed that the average academic performances of students with hearing impairment (SHIs) are below that of hearing students. This research sought to elucidate challenges that prevent SHIs from high academic achievements, using the case of students in Tetteh Ocloo State School for the Deaf in the Greater Accra Region of Ghana. Method: A qualitative research design was used for data collection through in-depth interviews, analysis and the interpretation of the responses of thirty participants (12 Students with hearing impairments, 11 parents and 7 special educators). Results: Findings showed that challenges which hinder SHIs academic performance emanate from different systems and actors including SHIs themselves, their parents and other institutional barriers that exist in deaf education. The findings also indicated that parents influenced the academic performance of their children with hearing impairment (CHI) through their responsibilities, expectations and the learning assistance they gave to their wards at home. Results also established that institutional barriers such as effective instructional procedures adopted in deaf education, availability of facilities, teaching, reading learning materials, and curricular contents posed challenges to the academic performance of students with hearing impairment. Conclusion: The identified challenges which prevent SHIs from higher academic performance are from different systems of SHIs’ environment and the interplay between them. The study recommends that interventions must be directed at the different systems within their environment.
Copyright (c) 2017 The Author(s) https://creativecommons.org/licenses/by/4.0
Accessibility to Power: Framing of the Disability Rights Movements in India and Nepal
Purpose: This paper explores the effect of inherent social inequalities on disability rights movements and their political activities in India and Nepal. The situation for persons with disabilities is similar in both countries. Many social and cultural phenomena coincide, and laws and policies are currently being formulated in line with the human rights agenda. In order to understand the current situation and the envisioned future for persons with disabilities, it is important to probe how, and under what circumstances, the disability issue is framed. Method: Purposive sampling was used to access outspoken activists in Kolkata in India and Kathmandu in Nepal. Semi-structured interviews were conducted, coded according to recurring themes, and analysed with Nancy Fraser’s theory on misrepresentation of social movements along with literature on framing. Though only 7 interviews were conducted (a limitation of the paper), together with informal discussions and previous knowledge they provided a sufficient overview of the social movements in the two countries. Results: This paper increases the knowledge on the two social movements, and provides interesting case studies on how persons with disabilities engage in political activities in the Global South. The rights-based approach has a strong influence within both movements, and appears to be the main strategy adopted by them. Conclusions and Implications: The Indian and Nepalese disability rights movements are affected by social inequalities. It seems as though the urban middle-class and their needs colour the movements and its framing. Further research is needed to probe what implications these inequalities have for the situation of persons with disabilities.
Nigerian Teachers’ Understanding of Autism Spectrum Disorder: A Comparative Study of Teachers from Urban and Rural areas of Lagos State
Purpose: Autism Spectrum Disorder (ASD) is a lifelong developmental disability characterised by difficulties in social interaction and social communication, and restricted and repetitive behaviour (American Psychiatric Association, 2013). Despite its prevalence the world over, there is a paucity of research in some areas such as education, particularly in sub-Saharan Africa. This paper attempts to address the gap by exploring teachers’ understanding of ASD in Nigeria. Method: Using an adapted version of the Knowledge About Childhood Autism Among Health Workers (KCAHW) questionnaire (Bakare et al, 2008), a survey was conducted among 177 mainstream primary teachers from Lagos State (112 from eleven urban schools and 65 from four rural schools). Results: The total mean score on the Adapted KCAHW questionnaire among all the participating teachers was 10.81 ± 4.13 out of a possible total of 16. The mean score for urban teachers was 11.21 ± 4.31, while the mean score for rural teachers was 10.11 ± 3.75. In total, 46% of the urban teachers and 31% of the rural teachers demonstrated a generally accurate knowledge of ASD, with 15% (23 urban teachers and 4 rural teachers) of the sample answering all questions correctly. Over 50% of urban teachers and almost 70% of rural teachers surveyed had only a low or moderate understanding of ASD. Conclusions: This research supports previous studies that identified low professional knowledge and understanding of ASD, and a need for improved professional education and training. Limitations: The focus was on only one state within Nigeria, and only on mainstream primary schools. Further research is necessary across the educational age range as well as different geographical areas in the country.
Development and Standardization of a Test of Motor Proficiency in Children with Intellectual Disabilities in India
Purpose: To develop a scale for the assessment of gross and fine motor skills of the children with mild and moderate intellectual disabilities so that their skills could be assessed and accordingly interventions in physical activities could be specifically designed for them. Method: Thirty-eight items for the Test of Motor Proficiency scale was developed after initial try out, pilot study and final try-out by the researchers. Fifty children with mild intellectual disabilities (n = 26), and moderate intellectual disabilities (n = 24) aged between 6 to 17 years fulfilling inclusion and exclusion criteria were selected from special schools in Jammu district, J&K (India).The Test of Motor Proficiency was administered on the selected sample. Results: Internal consistency as calculated through Cronbach's Alpha was .906, indicating very good reliability. There was a highly significant correlation between the two independent assessments in inter-rater reliability r (48) = .95, p< .05 and also within the domains of motor proficiency, Visual-Motor control r (48) =.728, p< .05, Upper limb speed and dexterity r (48) = .98, p< .05 , Running speed and agility r (48) =.99, p< .05, Bilateral coordination r (48) =.96, p< .05, Strength r (48) =.95, p<.05, upper limb coordination r (48) =.62, p< .05. Concurrent validity of Test of Motor Proficiency was established against BASIC- MR; the correlation of BASIC-MR (M = 151.92, SD = 18.08, N = 50) and Test of Motor Proficiency (M = 49.22, SD = 12.23, N = 50) was highly significant r (48) = .76, p< .05. The construct validity assessed through test retest was r (48) =.97, p< .05. Implications: The Scale can be used in the assessment of gross and fine motor skills of children with mild and moderate intellectual disabilities for clinical and research purposes.
Is Adaptive Behaviour too Normal to be Normally Distributed?
Purpose: This study attempts to ascertain if adaptive behaviour complies with the characteristics of a normal distribution. Methods: Adaptive behaviour data collected from two large state samples of 2900 were reviewed to determine the shape of their distributions. A smaller convenience sample of 37 adults without intellectual disability was similarly reviewed. Results: Findings suggest that the shape of the distribution of adaptive behaviour increasingly deviates from normal as cognitive abilities increase. Conclusions/Implications: It does not appear that adaptive behaviour is normally distributed. This will impact the diagnosis of intellectual disability because while IQ scores two standard deviations below the mean reliably cut off about 2% of the population, a similar cut-off cannot be assumed for adaptive behaviour.
Online Parent Training: A Pilot Programme for Children with Autism and Neurodevelopmental Disabilities in Bangladesh
Purpose: This study aimed to assess the implementation of an online parent training programme in Bangladesh, designed to enhance parental knowledge of autism and neurodevelopmental disorders and related interventions. In addition, study participants were expected to become “Master Trainers” with the intention of training other parents in their local communities. Method: This survey study assessed parental knowledge and programme effectiveness, such as potential online learning barriers, cultural sensitivities, and general course content feedback after each unit. Results: The programme had an 81% completion rate (with parents completing all but one unit) with an average programme knowledge score of 86%. Parents felt that the course content was moderately difficult, the length of the units was appropriate, and the units were culturally sensitive. They requested more detailed lessons, specific case studies, and adaptation of the curriculum for older children. Conclusion: The pilot programme merits the next phase of development, which includes local adaptation and translation. However, the findings are limited by the small sample size.
Disability Inclusive Development Good Practices: Level of Commitment to Core Concepts of Human Rights
Aim: Good practices have been documented by International Non-Governmental Organisations (INGOs) to promote disability inclusive development and encourage the replication or scaling up of good practices that use rights based approaches. This study aimed to investigate the extent to which Core Concepts of human rights are illustrated in disability inclusive development good practices related to health. Methods: This study analysed case studies of disability inclusive development good practices focusing on health that are available in the public domain using EquiFrame, an established content analysis framework in benchmarking health and social policies. Results: A total of 42 health related good practices were identified from 3 different INGOs working in the field of disability inclusive development. The highest occurring human rights Core Concepts were; access 55%, individualised services 48%, capacity building 45% and participation 38%. The Core Concepts with the lowest levels of commitment were; autonomy 3%, cultural responsiveness 3%, accountability 3%, and efficiency 3%. Privacy and autonomy were not mentioned at all. The quality of reporting of the core concepts of human rights was low as they did not state specific programme actions or intentions to monitor Core Concepts. Conclusion: Level of commitment to Core Concept coverage and quality of reporting was low. EquiFrame was successfully extended to analyse disability inclusive development good practices focusing on health. Its use in further analysis of inclusive good practice is advised. Implications: These results can be used for advocacy in disability inclusive development and to guide programme staff training and documentation of disability inclusive development good practices.
Cross-sectional Survey to Assess Prevalence of Disability and Access to Services in Albay Province, The Philippines
Aim: A cluster randomized cross-sectional survey to assess the prevalence of disability and access to support services was conducted in Albay Province, the Philippines in April 2016. Method: The population-based survey methodologies developed by the Washington Group of the United Nations Statistical Commission and UNICEF were utilized. A sample of 70 barangays (the 3rd level administrative division in the Philippines) was selected as clusters, with probability proportional to size, and 30 households were selected randomly in each barangay to be surveyed. Results: The estimated prevalence of disability using the standard criteria of the Washington Group and UNICEF among children (2-17 years old) was 2.0% and for adults (≥18 years old) it was 6.5%. The estimated prevalence of disability was higher in rural than in urban areas. Deficiencies in the performance of existing services were identified; access by children with disabilities to support services was lowest in rural highland and rural plain barangays. Conclusions: There was a large unmet demand for support services addressing the needs of persons with disabilities in Albay Province, especially in rural highland areas. Persons with disabilities were disadvantaged in access to education and employment; many had not been educated in their basic rights. Implications: To identify, educate and fully support persons with disabilities, community-based rehabilitation (CBR), health and other rehabilitation services must communicate effectively with each other, their current work should be mapped and analysed, their comparative strengths identified, and their future work coordinated. It is a priority to educate persons with disabilities and their families about their rights, and facilitate their access to support services; this requires increased investment in communication targeting persons with disabilities and the communities, especially rural. Providers caring for persons with disabilities need to work in partnership to identify unreached persons with disabilities. Prevalence surveys, with stronger focus on the profiles and performance of CBR and related services, would add to the evidence-base to improve the quality and coverage of services for persons with disabilities.
The Effects of Age and Gender on the Quality of Life of People with Chronic Back Pain in Bosnia and Herzegovina
Purpose: Quality of life (QOL) is an important area of research in many scientific disciplines, and the findings could help in designing strategies to improve QOL for various clinical conditions. Chronic low back pain is a frequent medical condition that has a detrimental effect on QOL. The goal of this study was to examine the QOL of people with chronic low back pain in Bosnia and Herzegovina (BIH), and to assess the impact of demographic variables such as age and gender on the QOL. Methods: The study sample consisted of 50 people with low back pain, between 19-79 years of age (mean age 51.2, SD- 13.1 years). There were 35 females (70%) and 15 males (30%) in the sample. The instrument used for measuring the QOL was World Health Organisation Quality of Life scale BREF (WHOQOL BREF). Results: The study demonstrated that low back pain has a detrimental effect on QOL. There was a significant effect of age and gender on certain domains of QOL. Conclusions: Older age is a risk factor for lower QOL of people with chronic low back pain. Females are more likely to have lower scores on the psychological domain of QOL,and therefore need effective psychological interventions aimed at improving their QOL.
Stigma, Learning and Inheritance: An Ecocultural Study of Adaptation and Resource use among Families of Children with Down Syndrome in Thailand
Purpose: This study explored family adjustment and access to rehabilitative services for children with Down syndrome, between 0-5 years of age, in the ecoculture of Petchaburi Province, Thailand. Methods: The study used a family systems genogram in focus group sessions at Pra Chom Klao Hospital, and made home visits to the eight participants from five families in Petchaburi Province, Thailand. Qualitative data collection included field notes, pictures and video recordings of the 7 focus group discussions. The analysis used rigorous procedures for constant comparison, analysis of space, content, domains and critical discourse analysis. Results: Participating families had adjusted to emotional ruptures at home by moving out. They were resilient in the face of health, culture, economic and educational stress. Cultural and religious resources, especially from the mother’s side of the family, contributed most during and after health crises in the first 2 years of childhood. Parents were concerned about seriously delayed development of communication skills when their children were in the 2 ½ - 5 years age group. Parent conviction that the children would be lifelong dependants limited the possibilities for fostering independent living and occupations for these children. Conclusion and Implications: This study contributes to family and community-based rehabilitation strategies, stigma reduction and promotion of early childhood intervention for children with Down syndrome in Thailand. It found moderate public stigma, obstacles in educational transitions and resource use, and limited parental understanding of children’s inheritance and future quality of life. The recommendations made are: better development of family support groups and rehabilitation counselling services, language and communication strategies, abuse training for mothers, and discussion on inheritance rights which offer insight into sibling relations and employability. Service provision can consider reducing hospital stigma, advocacy for inclusive public and work-based play areas, increased support and professional development for community-based counsellors and special education centre extension services.
Effect of Multidisciplinary Intervention on Clinical Outcomes of Children with Autism Spectrum Disorder in Mumbai, India
Purpose: To analyse clinical outcomes in terms of functional changes in children with Autism Spectrum Disorder (ASD), before and after receiving a multidisciplinary developmental intervention programme. Methods: Structured goal-oriented multidisciplinary intervention, individualised to each child, was implemented through 5 child development centres in Mumbai, India, in 2014-2015. Secondary data analysis of 38 children diagnosed with ASD, in the age group of 2.1 - 6.1 years, was conducted. All children received occupational therapy and speech therapy, and parental counselling was also done. The average number of intervention sessions were 48-72 for occupational therapy (twice or thrice a week), 24-48 for speech therapy (once or twice a week) and 5-6 for parental counselling (once a month). Childhood Autism Rating Scale (CARS) and Vineland Social Maturity Scale (VSMS) were used for assessment, before and after intervention. Results: Mean positive difference in CARS total scores through paired t-test was 4.18 (p < 0.0001). Significant positive changes in functional ability were observed in most of the sub-scales (relating to people; object use; visual response; verbal and non-verbal communication; taste, smell and touch response and use; level and consistency of intellectual response and general impression). Paired t-test also showed significant positive changes on all VSMS sub-scales, except Socialisation. Conclusions: The model used in this multidisciplinary intervention, and adherence to its protocols, has the potential to improve functional ability (or the child’s adaptation to his/her condition) in children with ASD, in a region with limited awareness of developmental disabilities. Limitations: Separate effects of factors outside the intervention could not be tested due to inadequate sample sizes for sub-analyses. Results also need to be validated by tests that do not depend on parental reporting (e.g., CARS and VSMS) but assess the performance of the child instead.
Positive and Negative Impacts on Caregivers of Children with Intellectual Disability in India
Purpose: The factor integral to the empowerment of children with intellectual disability is the presence and active involvement of support mechanisms such as their family and their caregivers. This study assesses both positive and negative impacts on parents/caregivers of children with intellectual disability in Oddanchatram block of Dindigul District in Tamil Nadu, India. Method: Mixed method techniques (quantitative and qualitative) were used. Results: Although many disturbing realities in the family situation were revealed, there were also positive impacts which were a hopeful sign. Conclusion: Empowering the caregivers of children with intellectual disability is the first step towards inclusion of these special children in society. Various strategies to achieve this goal are discussed in the study.
Analysis of Bibliography on Specific Learning Disability in India
Aim: This study attempts a comprehensive qualitative and quantitative analysis of un-annotated bibliographic listing of books and citations compiled on specific learning disability published by researchers in India. Method: An online and offline survey covering ISSN journals and ISBN marked books available in print or electronic media was compiled, coded, categorized, and classified by title, theme, year, journals, and names of author/s. Results: The bibliographic search yielded 450 research articles drawn from 196 national and international journals of Indian origin and 29 book titles on the topic of learning disability and/or its equivalents covering themes related to their nature-characteristic (N: 184; 40.89%), therapy-intervention (N: 115; 25.56%), causes-correlates (N: 57; 12.67%), screening-assessment-identification (N: 52; 11.56 %), and epidemiology-prevalence (N: 42; 9.33%). A decade wise timeline analysis shows an increasing trend in the quantum of publications on learning disability by almost four times from the base years of <=1990s to the contemporary period, along with corresponding shift in the increased use of the term ‘learning disability’ in preference for other older terms (p:<0.05). Conclusion: On the whole, there seems to be much unused information available about learning disabilities in the country, which now lies widely scattered. Limitations & Recommendation: Although no claim is made that the bibliographic listing is all inclusive, it is recommended that the first step is to have an information gathering mechanism, creation of a dynamic repository, or archival system with retrieval systems in place for prospective researchers on a subject matter of great importance within the country.
Parent Empowerment in Early Intervention Programmes of Children with Hearing Loss in Mumbai, India
Purpose: Since families are perceived to be active agents in the early intervention programmes of young children with disabilities, professionals ought to treat parents as equal partners and keep them informed and involved in various aspects of the intervention. This study aimed to explore the areas in which parent empowerment is currently being facilitated in the early intervention centres for children with hearing loss. Method: A qualitative research with conversational analysis was the approach used. Focus group discussions with the two primary stakeholders, namely parents and special educators, were held separately at five sites in Mumbai, to gather their views on the existing areas of empowerment. It was also decided to explore the felt needs of parents in this regard. Person triangulation was used to ascertain the credibility of the data. Results: Conversational analysis yielded 4 themes with respect to parents: Parental knowledge, involvement, support and needs. Conclusion and Implications: The study highlighted the gaps in parent empowerment in the programmes undertaken by early intervention centres. A recommendation is made to develop a common framework for empowering parents. It is envisaged that such a framework will bridge the gap between what currently exists for parents, their felt needs, and current global practices. This framework could also assist in measuring family empowerment outcomes.
Access to Services and Barriers faced by People with Disabilities: A Quantitative Survey
Purpose: In low- and middle-income countries, reliable and disaggregated disability data on prevalence, participation and barriers is often not available. This study aimed to estimate disability prevalence, determine associated socio-demographic factors and compare access in the community between people with and without disability in Dehradun district of Uttarakhand, India, using the Rapid Assessment of Disability Survey. Methods: A cross-sectional population-based survey was conducted on a sample of 2431 adults, selected using a two-stage cluster randomised sampling technique. The survey comprised an interviewer-administered household survey and an individual survey measuring disability, wellbeing and participation. For each person with disability, an age and sex-matched control (without disability) was selected. In addition to prevalence, the difference in participation and barriers faced by people with and without disability were analysed. Results and Conclusions: The prevalence of disability was 6.8% (95% CI 5.8-7.8) with significant associations with age, sex, economic status, education and employment. Psychosocial distress (4.8%) and mobility impairment (2.7%) were the most common disabilities identified. The study showed that people with disabilities had significantly less access to services than those without disability, and the barriers reported most often were lack of information, transport and physical inaccessibility.
Teachers’ Perceptions of Disabilities on the Island of Roatán, Honduras
Purpose: Roatán, a small island in Honduras, is home to six ethnic groups. Due to financial constraints, many children have limited access to schooling. This article is a study on teachers’ perceptions of disabilities and students with disabilities and inclusive education on the island. Method: Twenty seven teachers working in public and private schools, and schools funded by the World Bank, were interviewed in March-April of 2014 in order to explore cultural and social representations of disabilities on the island. Results: The findings show that many of the teachers’ representations can be analysed under the lens of different models of disability - the medical model, the social model, and a religious-moral model. Inclusive education is perceived less as a means of including children with disabilities in the regular classroom, and more as a method of creating institutions to take care of their needs. Conclusion: There is a strong intersection of poverty, post-colonialism and disability which makes working under an inclusive lens very difficult for teachers. The cultural norms influence ideas of normalcy and disabilities, and the blame is on parents for having children with disabilities.
Physiotherapy Students’ Awareness of Community Health in India
Purpose: The study aimed to provide inputs that would help to promote Community Physiotherapy as a field of future study and work. While the focus was on undergraduate physiotherapy students’ perceptions, attitudes and beliefs regarding this field of specialisation, the study also attempted to find whether there were variations in attitude depending on which year of the programme the students belonged to. Method: In December 2015, 118 students of a private physiotherapy college in Gujarat, India, took part in a self-administered questionnaire-based survey. Of these, 56 students were in the third year of their course, while the rest were in the final year. Written informed consent was taken from each respondent. Results: While it was a positive finding to note that this cohort viewed physiotherapy as a service profession, majority of the students wished to pursue higher education outside India due to their perceptions about lack of adequate training facilities, salaries and scope for the profession within the country. For the majority, musculoskeletal sciences was the preferred area of specialisation, followed by Community Health. However, there was awareness about the importance of Community Physiotherapy. Conclusion: Among undergraduate physiotherapy students in the study sample, musculoskeletal sciences is the preferred specialisation, followed by Community Physiotherapy. The year of the programme in which they were studying did not significantly affect their attitudes towards Community Physiotherapy. Limitations: The sample size was too small to compare the differing attitudes of participants from different batches of the course. First and second-year students could not be included since the specialisation of Community Physiotherapy is introduced only in the third year.
Towards Accessible Built Environments in Universities in Ghana: An Approach to Inclusiveness Assessment
Purpose: The study aimed to objectively assess the level of inclusiveness of buildings in selected Universities on the basis of international protocols and local legislation that require that buildings should be made accessible to persons with disabilities. Method: A building inclusiveness model, the Composite Disability Design Inclusiveness Score (CDDIS), was used to assess the levels of inclusiveness of 110 buildings in 6 purposively selected Universities in Ghana, using maximal variation sampling. Results: It was found that the buildings of the sampled Universities were not inclusive to a large extent. With one exception, there were variations in the levels of inclusiveness of the buildings in each institution. Conclusions: Irrespective of international protocols and local legislation, the built environments in Universities are not as accessible as they ought to be. Limitation: The CDDIS is a simple quantitative means of assessing the inclusiveness of buildings and allows for objective comparisons. However, it is expected that for purposes of comparison, identical buildings should be used. Any intended use of the CDDIS will require the use of a checklist that is appropriately designed to meet the peculiarities of the particular study. Implications: There is the need for expedited effort to ensure inclusiveness in University built environments. This will help greatly towards the achievement of the Sustainable Development Goals.
The Effects of Severe Burns on Levels of Activity
Purpose: With the recent advances in medicine, the survival rate of clients with severe burns has improved. This has resulted in greater demand for rehabilitation services. One of the major goals for rehabilitation programmes is to restore these clients to their pre-trauma activity levels. However, there is not much research on the subject. Methods: Based on their availability, 30 clients with severe burns were selected, who had been discharged from the hospital for periods ranging from 1 month to 1 year. Interviews were conducted and the participants’ perceptions were recorded regarding changes in their self-care, household chores, professional work, hobbies and recreational activities. Based on the results, 2 independent assessors categorised the activity levels as none, minor, intermediate and severe, in terms of negative effect. Results: In the self-care category, 8 participants reported no negative effect, 12 reported minor, 4 reported intermediate and 6 reported severe effects. In the household chores category, only 2 clients reported no effect and 13 indicated severe effects on their activities. Of the 21 participants who were working, only 2 reported no change in pre-trauma activities while 11 reported severe changes in their working activity levels. While 5 participants indicated no change in their recreational and leisure activity levels, 6 reported severe changes. Conclusion: Severe burns reduce clients’ levels of activity in some of the categories. However, they often regain their ability to perform activities at a lower level, depending on the site of burn, burning agent, and having received early rehabilitation pre- and post-discharge. Psycho-social factors, pre- and post- trauma, are also important.
Effect of Music Intervention on the Behaviour Disorders of Children with Intellectual Disability using Strategies from Applied Behaviour Analysis
Purpose: The effect of music intervention on mild and moderate Intellectually disabled children was studied in non-randomized pre-test post-test control group design at an Indian state (Jammu) J&K. Method: The mild and moderate intellectual disabled children fulfilling inclusive and exclusive criteria were placed into control and experimental group. BASIC-MR part-B (pre-test) was administered on both the groups. Intervention in music activities using strategies from Applied Behaviour Analysis was introduced sequentially to the experimental group. Children in the control group were not involved in any additional activity. Both the groups were assessed after 6 months (post-test) to find out the effect of intervention. Results: The mean difference between both the groups of mild and moderate intellectually disabled children was significant. In both mildly disabled children, F (1, 2) = 36.937, p = .026 and moderately disabled children F (1, 13) =71.686, p = .000, the effect of the music intervention was highly significant. Conclusion: Music intervention program produced significant changes in the domains of violent and destructive behaviour and misbehaviours with others domains of children with mild intellectual disability. In children with moderate disability, music intervention produced significant changes in the domains of violent and destructive behaviour, misbehaviours with others, self-injurious behaviours, repetitive behaviours, hyperactivity, rebellious behaviours, and anti-social behaviours. Both mild and moderate intellectually disabled children didn’t show any significant change in temper tantrums, odd behaviours and fears domains of behaviour disorders.
Purpose: This study primarily aimed to find the factors which can facilitate or, alternatively, hinder inclusion efforts. Method: Results from a number of student theses, which dealt with common issues in the area of inclusion of pupils with special needs, were brought together systematically. The method has been called area-delimited meta-study, where increased validity and generalisability are expected to strengthen development at the schools where the thesis work is carried out. A total of 18 thesis projects with a representation of 24 classrooms were included. The results of these projects have been categorised with the help of two models, positive and negative labelling, as well as inner and outer inclusion capital. Results: The respondents in the various studies were quite positive towards inclusion. The teachers stated that inclusion offers a range of possibilities even if problems often occur during implementation. For efforts to succeed, personnel should internalise the values intrinsic to inclusion. Staff knowledge, perception and empathy are examples of the inner inclusion capital necessary to achieve the goal of inclusion. Courage, self-confidence and self-awareness are additional factors that are essential for success. Outer inclusion capital such as clear leadership and effective teamwork are conditions that promote inclusion. Conclusion: Based on the results, it would be logical to invest in the positive labelling factors that are identified and at the same time work towards minimising the negative factors. The work can be further developed with area-delimited meta-studies, and future thesis projects could be initiated with a structure that is more participatory and action-oriented. Limitations: One problem in evaluating the circumstances around inclusion is that the respondents' interpretation of the definition of the word inclusion may vary. Even the experience of how inclusion works can differ between the teachers involved in the study. Despite these difficulties, the overall results provide a robust picture of the problems and opportunities that fit within the area. Differences in teacher interpretation could also be an important element for the research.
Communication Disability in Fiji: Community Cultural Beliefs and Attitudes
Purpose: Beliefs about communication disability vary according to the cultural context, and influence people’s attitudes and help-seeking behaviour. Little is known about Fijians with communication disability or the communities in which they live, and specialist services for people with communication disability are yet to be established in Fiji. An understanding of Fijian beliefs about the causes of communication disability and attitudes towards people with communication disability may inform future service development. Method: An interpretivist qualitative research paradigm and the International Classification of Functioning, Disability and Health (ICF) framework informed this project’s design. Scenarios of adults and children with communication disability were presented to 144 participants, randomly sampled across multiple public spaces in two Fiji cities. Thematic analysis of responses to 15 survey questions revealed participant beliefs about the causes and attitudes towards people with communication disability. Results: Three clusters describing perceived causes emerged from the analysis - internal, external, and supernatural. Major clusters across child and adult scenarios were similar; however, response categories within the scenarios differed. Community attitudes to people with communication disability were predominantly negative. These community attitudes influenced individual participants’ beliefs about educational and employment opportunities for Fijians with communication disability. Conclusion: Determination and acknowledgement of individuals’ belief systems informs development of culturally appropriate intervention programmes and health promotion activities. Implications: Speech-language pathologists and other professionals working with Fijian communities should acknowledge community belief systems and develop culturally-specific health promotion activities, assessments, and interventions.
The Impact of Community-Based Rehabilitation in a Post-Conflict Environment of Sri Lanka
Purpose: Conflict and disability are closely associated; it is therefore significant to examine strategies at the grassroots-level for restoring the human rights of people with disabilities living in post-conflict societies. The aim of this study is to reveal the impact of and issues with community-based rehabilitation (CBR) in the Northern Province of Sri Lanka that was ravaged by civil war from 1983 to 2009. Methods: The research was implemented in October 2016, in collaboration with a local NGO in the Mullaitivu district. A mixed-methods approach was followed, which included quantitative analysis of the NGO’s registration database of people with disabilities in the area (n=964), group interviews with 9 community rehabilitation committees (CRCs) of people with disabilities and their family members (n=118), and semi-structured interviews with clients of the CBR programme (n=5). Thematic analysis was applied to the narrative data. Results: The quantitative analysis on clients of the NGO revealed that 60.9% of disabilities were related to war. Livelihood assistance was the most common type of self-reported need (44.6%). The qualitative analysis revealed that in communities with inadequate local resources, CRCs that had access to livelihood assistance made a positive impact on the socioeconomic conditions of people with disabilities and their family members. Potential issues were observed, such as the expectation of and dependence on the financial aid without self-help. Some people with disabilities would not attend CRCs if there were no financial benefits. As most of the participants had war-related disabilities, it is also possible that participation of people with intellectual and psychiatric disabilities unrelated to war may not have been promoted in some CRCs. Conclusions: The CBR programme has had positive impacts on the living conditions of participants, albeit with some potential issues such as financial expectations and aid dependency. The authors argue that empowerment of people with disabilities and addressing socioeconomic inequality should be considered simultaneously.
Community Action Research in Disability (CARD): An inclusive research programme in Uganda
The ideology of Emancipatory Disability Research (EDR) reflected in the phrase ‘Nothing about us without us’, was first put forward in the 1990s. Although it aimed to place research control in the hands of the ‘researched’, i.e., people with disability, this rarely happens even today, 25 years later. The Community Action Research on Disability (CARD) programme in Uganda embraced and modified the EDR approach, recognising the need for including people with disability in the research process from concept to outcome, and nurturing participation and collaboration between all the stakeholders in achieving action-based research. The research teams always included people with disability and staff from Disability People’s Organisations (DPOs) as well as academics and service providers. It endeavoured to generate and carry out research around issues that mattered to people with disability and their families. Leadership roles were assigned by team members. The objectives of the CARD programme were: (1) to fund teams to carry out action-based research on disability in Uganda; (2) to develop research and administrative capacity to manage the initiative within the academic registrar’s office at Kyambogo University; (3) to incorporate new knowledge generated from the studies into the ongoing local community-based rehabilitation and special education courses; and, (4) to ensure wide dissemination of research findings to all stakeholder groups. CARD ran for 5 years, commissioning 21 action research studies in the field of disability and community-based services. This paper describes the process, presents the 12 completed studies, examines the extent to which the objectives were achieved and evaluates the experiences of the participating research teams, particularly in relation to the inclusion of its members with disability. It concludes with recommendations for future initiatives designed to promote validity, good value and inclusive approaches in disability research.
Demographic Profile of Spinal Cord Injury (SCI): A Hospital-based Prospective study in Bangladesh
Purpose: To provide an overview of demographic characteristics of spinal cord injury (SCI) in Bangladesh. Methods: The study was conducted between 1st January and 31st December 2012 at 5 hospitals: Centre for the Rehabilitation of the Paralysed (CRP) in Savar, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Bangabandhu Sheikh Mujib Medical University (BSMMU), Rangpur Medical College Hospital, and Chittagong Medical College Hospital. 600 SCI cases from these tertiary hospitals were enrolled, and data was collected from those who met the study criteria, using a structured questionnaire developed on the basis of SCI core data set. Data was processed and analysed by SPSS version 16. Results: The male/female ratio was 4.5:1. Mean age at injury was 34.53 years (16–83 years). The cause of SCI was falls for 34.8% and RTA for 25.5% of the clients. 83.5% of SCI was traumatic and 16.5% was non-traumatic in origin. Only 9.5% of the clients were directly admitted to tertiary hospitals while 90.5% had intermediate admission before that. One-third (33.2%) of the clients used ambulance for intra-hospital transfer. 70.5% of the injury resulted in paraplegia and 29.5% in tetraplegia. Thoraco-lumbar junction (T11-L2) was the region most commonly involved, accounting for 38.7% of all cases. Overall 58.7% SCI cases were found with complete injury (ASIA-A) and 41.3% with incomplete injury during admission. 20.8% of the clients were admitted with pressure ulcer. The study found 27.2% of cases were operated on. The in-hospital mortality rate was 3.3%. Limitation: The pre-hospital fatalities were not included in the study. During data collection, extent of SCI was found in only 507 cases instead of all 600 enrolled. Conclusions: This study could contribute to the establishment of an effective prevention programme and comprehensive SCI management in Bangladesh.
Differences in Malaria Prevention between Children with and without a Disability in the Upper East Region of Ghana
Purpose: Malaria is a common cause of death among children with a disability in Ghana. This research aimed to find out whether there are differences in malaria prevention measures given by caretakers to children with and without a disability – under 15 years of age – within one family, in the Upper East Region of Ghana. Methods: Semi-structured interviews were conducted with 19 families who had both a child with and without a disability. Snowball sampling was used to locate the families living in both rural and urban areas. They were interviewed by using a non-validated topic list based on literature. Statements were processed through qualitative data analysis. A malaria professional working at the Bolgatanga Regional Hospital was interviewed for a nurse’s perspective on the subject. Results: Caretakers with some education knew more about malaria and malaria prevention measures than uneducated caretakers. None of the caretakers in rural areas had any education and they had limited knowledge about malaria. All the children in this study received some form of prevention from their caretakers, but it was not very effective. In the rural area there was a difference in the incidence of malaria among children with and without a disability. The malaria professional’s perspective was that children with a disability are more vulnerable despite receiving the same prevention and treatment as other children. Conclusions: Almost all the children within one family received the same malaria prevention measures from their caretakers, but it was not always as effective as required, especially in the rural area where the incidence of malaria was higher among some of the children with a disability. Limitations: Some of the study limitations are the use of translators, the discussion of sensitive subjects and the possibility that socially desirable answers were given.
Disability Data Collection in Community-based Rehabilitation
Today there are Community-based Rehabilitation (CBR) programmes in a large number of countries. In many countries, the CBR approach is a part of the national rehabilitation services. However, there is a lack of reliable data about persons with disabilities who benefit from CBR and the kind of benefits they receive. This article reviews the disability data collection systems and presents some case studies to understand the influence of operational factors on data collection in the CBR programmes. The review shows that most CBR programmes use a variable number of broad functional categories to collect information about persons with disabilities, combined occasionally with more specific diagnostic categories. This categorisation is influenced by local contexts and operational factors, including the limitations of human and material resources available for its implementation, making it difficult to have comparable CBR data. Therefore, any strategies to strengthen the data collection in CBR programmes must take these operational factors into account.
Effectiveness of Role Play and Bibliotherapy in Attitude Change of Primary School Pupils towards Learners with Special Needs in Nigeria
Purpose: The research addressed two major problems, namely, the persistent negative attitude towards learners with special needs; and the effectiveness of role play and bibliotherapy in changing the attitude of primary school pupils towards their differently-abled fellow students. Method: Two null hypotheses guided the conduct of the study. Albert Bandura’s Theory of Social Learning (1977) provided the theoretical framework for the study and the Solomon four-group design was followed in practice. The study population consisted of all the Primary Six school pupils in the 502 primary schools in Owerri educational zone. From a total of 76,481 Primary Six pupils, a sample of 80 students from two schools was selected for the study. One instrument - Attitude Towards the Disabled Rating Scale (ATDRS) - and two programmes - Nwachukwu’s Role Play Exercise Programme (NRPEP) and Nwachukwu’s Bibliotherapy Programme (NBP) - were used for the successful implementation of the study, which was validated by experts. The hypotheses were tested using t-test for correlated and independent samples. Results: The findings indicated that the pupils’ attitudes towards learners with special needs in Owerri educational zone improved significantly after they were exposed to the NRPEP and NBP respectively, indicating the effectiveness of the two programmes. Conclusion: Education policy makers, the Ministry of Education and State Universal Basic Education Boards should recommend the use of inclusion books and encourage the practice of role play in schools for the success of inclusive education in Nigeria.
Advocacy Campaign for the Rights of People with Disabilities: A Participatory Action Research within a Community-based Rehabilitation Project in Vangani, Maharashtra
Purpose: This paper aimed to demonstrate how participatory action research (PAR) within a Community-based Rehabilitation (CBR) project facilitated community participation to advocate for the rights of people with visual impairment. An advocacy campaign, led by the local people with and without disabilities, was launched for the construction of an accessible foot over- bridge (FOB) at Vangani railway station in Maharashtra, India. Methods: The PAR approach was used to explore the issues faced by the local people with visual impairment. It ensured maximum community consultation, engagement and, consequently, meaningful outcomes for the community. Advocacy tools such as video documentary, online petition, media advocacy, and signature campaign were employed to publicise the issue on a larger platform. Sources for this paper included quantitative data from the survey of Vangani community and documents such as CBR project reports, media coverage articles, minutes of the meeting and correspondence with the Central Railways during the advocacy campaign that was conducted from 2012 - 2015. Results: After 12 months of consistent advocacy, the Ministry of Railways sanctioned INR 15 million for the construction of the foot over-bridge. The construction work on the foot overbridge was completed in December 2016 and now it is open for public use.. Conclusion and Implications: This study illustrates how PAR within a CBR project successfully used an advocacy campaign as a tool for community participation, action and change. Although geographically limited to rural pockets of Maharashtra state, the learning experiences brought out some of the elements crucial for the success of an advocacy intervention within CBR programmes for the rights of people with disability in India.
Educational Concerns of Students with Hearing Impairment in Secondary and Higher Secondary Classes in Mumbai, India
Purpose: Although education, and higher education in particular, is considered a vehicle for empowerment, the enrolment of students with hearing impairment in secondary and higher secondary education is almost negligible in comparison to their hearing peers. This study was conducted in the city of Mumbai, India, with the aim of identifying the educational concerns of students with hearing impairment studying in secondary and higher secondary classes. Method: The survey method was followed. A questionnaire, developed and validated by the researchers, was the study tool. The participants were 152 of the randomly selected 160 students with hearing impairment studying in secondary classes, and 42 of the randomly selected 45 students with hearing impairment studying in higher secondary classes. Percentage scores as part of descriptive statistics were calculated to arrive at the results. Results: Various academic, administrative and personal concerns were identified among these students with hearing impairment in special schools. Conclusions: As the focus of all educational programmes is on creating and promoting barrier-free education, the educational concerns identified in the current study cannot be ignored by schools, families and the community.
CBR Workers' Training Needs for People with Communication Disability
Aims: In order for speech-language pathologists to work better together with CBR workers, there is a necessity to understand what they perceive as their training needs for people with communication disability (PWCD). Method: In 2013, a cross-sectional written survey was conducted with 421 Malaysian workers, using convenient sampling and a mixed-method approach. Results: In-depth information on training needs from descriptive analysis of quantitative data and content analysis of qualitative data were obtained and discussed. Conclusion: This study, although not generalizable, builds up the literature on worker training needs in developing countries, and would be of benefit for speech-language pathologists and worker trainers.
Social Inclusion and Mental Health of Children with Physical Disabilities in Gaza, Palestine
Purpose: Social inclusion of children with physical disabilities is essential for their mental health. The long-standing conflict and political instability in Palestine since 1948 has resulted in an unprecedented number of children with disabilities. This study aimed to assess social inclusion and mental health of children with physical disabilities in Palestine. Method: A mixed methods research design was used. The 12-item General Health Questionnaire and a Social Inclusion Questionnaire were administered to 100 children with amputations, 12-18 years of age, in the Gaza Strip. Ten semi-structured interviews were also conducted with personnel working across civil society rehabilitation services in the area, particularly in services that focussed on the physical rehabilitation of children who had lost a limb. Results: Quantitative findings indicated that 88% of children’s disabilities were caused by war-related incidents. While the sample of children showed on average relatively low levels of psychological distress, males reported feeling more socially included and having better mental health than did females. Furthermore, there was a strong positive correlation between mental health and social inclusion, and a moderate positive correlation between psychological distress and social inclusion. The qualitative data identified different factors that hinder social inclusion, mainly: political instability; under-resourced disability organisations; lack of coordinated efforts; and negative societal attitudes towards disability. Conclusion: A new questionnaire for social inclusion was developed, which can now be used as a tool to assess social inclusion in similar contexts; as well as a culturally-adapted form of the General Health Questionnaire-12 to assess mental health. There is a clear need for service-providers to move beyond a medical model of care to one that embraces community-based rehabilitation and the realisation of rights, in order to promote the social inclusion and mental health of children with disabilities in Palestinian society.
Musculoskeletal Physiotherapy in the Community: Some successful strategies for India
Copyright (c) 2016 The Author(s) https://creativecommons.org/licenses/by/4.0
Community-Based Rehabilitation for Children with Intellectual Disability: A Case Study of Endosulfan Affected Areas in India
This article describes a Community-Based Participatory Approach (CBPA) for children with intellectual disability in Endosulfan affected areas of Kasaragod district in Kerala state of India. The CBPA strategy evolved from Community Based Rehabilitation (CBR) and was led by Local Self-Government (LSG) members. It involves a four-pronged approach encompassing family, community, service centres and LSG, with a focus on income generation activities and creation of employment opportunities. The CBPA model considers the cultural uniqueness and limited resources in areas where the unscientific and extensive use of pesticides has had long lasting effects leading to high prevalence of multiple deformities including intellectual disabilities.
Impact of Long-term Use of Adaptive Seating Device among Children with Cerebral Palsy and their Families in Mumbai, India: A feasibility study
Purpose: There is evidence that adaptive seating devices can play a major role in the positioning and support of children with cerebral palsy (CP), and be of great benefit to them and their families. This study aims to provide preliminary information on the impact of long-term use of seating devices on the functional life of children with cerebral palsy. Method: Family Impact of Assistive Technology Scale (FIATS) was used to assess the impact of the chair among children with cerebral palsy. The study participants consisted of 15 parents (9 mothers and 6 fathers) of young children (12 males and 3 females) with cerebral palsy. On the basis of Gross Motor Functional Classification System (GMFCS), 1 child at level III ,7 children at level IV, and 7 children at level V were included in the study. Mean age of the children was 5 years, and the mean duration of use of adaptive seating was 13 months. Results: It was found that the uninterrupted use of adaptive seating devices had an overall positive effect on the lives of families of children with GMFCS levels III, IV and V as measured by FIATS. The greatest benefits were in relation to the children’s social interactions, the acceptance of assistive technology by parents, feeling of contentment among children, and the degree of autonomy over their own activities and in the performance of these activities independently. Conclusions: From the perspective of parents, FIATS is a measurement instrument that focusses on domains that give quantitative descriptions of a wide range of seating devices when used in a child’s home environment. Use of FIATS helps therapists to take a judicious approach regarding long-term use of seating devices. Parents’ perceptions can help in this process.
Quality of Life among Persons with Paraplegic Spinal Cord Injury
Purpose: This article aimed to examine quality of life (QoL) among persons with paraplegic spinal cord injury (SCI), to determine their socio-demographic details, and to measure the different levels of performance in correlation with the International Classification of Functioning, Disability and Health (ICF). Method: A descriptive cross–sectional study was conducted with a structured questionnaire to collect information from 45 persons with paraplegic SCI. Data was collected by purposive sampling technique and face-to-face interviews. Results: Most of the participants (47%, n=21) were in the age group of 20-30 years, with a mean age of 33.53 (± 11.14) years. There were more men (89%, n=40) than women (11%, n=5) and the ratio was 8:1. The most common occupation was farming (27%, n=12), followed by daily labour (22%, n=10). Fall from a height (58%, n=26) was the most common cause of injury. A high percentage of participants (36%, n=16) rated their quality of life (QoL) as poor. Depression was felt very often (44%, n=20), where as happiness lasted for only a little while (38%, n=17).Older participants faced problems at work more often than younger persons. Males and those who worked in public places faced problems in dressing or bathing independently. Married participants were more dissatisfied regarding income and the amount of work they were able to do. Those who had met with road accidents had more emotional problems than others. Association analysis showed that by increasing happiness and decreasing depression participants’ quality of life could improve. Conclusion: The study demonstrated that spinal cord injury greatly affects quality of life (QoL) and gives rise to more problems, especially in the areas of physical and mental health. It is necessary to take steps to improve the physical and emotional status of paraplegic spinal cord injury clients, as this will eventually lead to improvement in their quality of life
Supporting Parents in Caring for Children with Disability in Ghana
Purpose: This study assesses the factors that influence the wellbeing of caregivers and their children with a disability, in a rural and an urban site in Ghana. The wellbeing of parents, not surprisingly, influences the wellbeing of their children. A better understanding of the role and challenges faced by parents in caring for their child with a disability will help to improve existing services and support for children with disability. Methods: Twenty-five parents of children with different disabilities participated in a PhotoVoice study. Photographs taken by parents, to show the challenges they experienced in childcare, were explained and discussed during focus group discussions. The Cantril Ladder was used to discuss subjective wellbeing. Results: The photographs and discussions with parents indicated that the extensive time spent on their child, the child’s poor health status, and lack of educational opportunities had a negative influence on the wellbeing of both parent and child. Parents struggle to earn an income to provide for a child with disability. This often causes them to sink into (even deeper) poverty, and further increases the challenge to provide the (specific) care that a child with disability needs. Conclusions and Implications: If governments, non-governmental organisations and community-based organisations want to contribute to the wellbeing of children with disability, they should be aware of the immediate context of the child, namely the family, and of the specific needs of the parents. Since the wellbeing of parents can affect the wellbeing of the child, and a child with disability may often cause further poverty in the family, relieving parents from some of the demands of childcare could help them to generate income, to the ultimate benefit of the entire family. Organisations working for children with a disability should actively involve parents of these children in designing and implementing interventions.
Physiotherapy Care for Adults with Paraplegia due to Traumatic Cause: A Review
Purpose: This review aimed to identify the practice guidelines/ recommendations for physiotherapy management in acute /post-acute/ chronic/long-term phase of rehabilitation of clients with paraplegia due to traumatic causes. Methods: Of the 120 articles retrieved, 26 met the inclusion criteria. After quality appraisal, 16 articles were included in the study. Data were extracted under the sub-headings: physiotherapy care in acute, chronic and long-term community stage; expected outcomes; effect of physical interventions; morbidities; wheelchair characteristics and standing. Results: There is strong evidence in support of strength and fitness training, and gait training. Parameters of strength training (frequency, duration and intensity) vary. There is lack of evidence on passive movements, stretching, bed mobility, transfers and wheelchair propulsion. Preservation of upper limb functions is an important consideration in caring for clients with paraplegia. Conclusion: Many areas of rehabilitation interventions remain inadequately explored and there is a need for high quality studies on rehabilitation protocols. Client preferences and feasibility are other areas that should be explored. Limitations: The search criteria of articles in the English language or articles translated in English is a reason for this limitation. Articles related to advanced therapeutic interventions such as robot-assisted training, and transcranial electrical and magnetic stimulation were excluded from the study.
The Functions of Disabled People’s Organisations (DPOs) in Low and Middle-income Countries: A Literature Review
Purpose: The aim of this study was to review peer-reviewed literature on the roles and functions of Disabled Peoples’ Organisations (DPOs) in low and middle-income countries, and their outputs and outcomes for people with disabilities. Method: Online databases were searched without date or language limiters (Medline, CINAHL, Scopus, Embase and Cochrane), using a combination of two key word search strategies. Eleven studies were selected for inclusion in this review on the basis of predetermined inclusion and exclusion criteria. Included studies underwent quality assessment using the Critical Appraisal Skills Programme (CASP) and Downs and Black’s criteria for quality assessment. Data for thematic analysis was then grouped under the broad themes of: participation and factors that facilitate participation; development of partnerships and connections; and self-development and self-help. Results: There was some evidence within the included studies to suggest that DPOs can produce significant, positive outcomes for persons with disability in terms of factors such as employment rates, access to microfinance and bank loans, accessibility of housing, acquisition of orthopaedic devices, involvement in civil society, development of friendships and networks, and participation in training programmes. Although the studies under review largely did not investigate the long-term impact of the reported DPO functions and outputs, some of the short-term outputs may be considered proximal indicators of outcomes such as increased empowerment and wellbeing. Conclusion: The 11 studies in this review suggested that DPOs can be effective in achieving their stated aims of promoting wellbeing, participation and rights of people with disabilities in low and middle- income countries.
Users’ Satisfaction with Prosthetic and Orthotic Assistive Devices in the Lao People’s Democratic Republic: A Cross-sectional Study
Purpose: User satisfaction with assistive devices is a predictor of use and an important outcome measure. This study evaluated client satisfaction with prosthetic and orthotic assistive devices and services in three provinces in the Lao People’s Democratic Republic. Method: A cross-sectional study was done, using the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. The sample was drawn from the client register of three of the five Rehabilitation Centres in the country which are under the Ministry of Health’s Centre for Medical Rehabilitation. Clients were eligible if they had received their device in the 12 months prior to the study. Based on the number of registered clients, the sample size was calculated as 274 with a 95% confidence interval, with the final sample N = 266. Qualitative semi-structured interviews were also conducted (N = 34). Results: Most of the assistive devices were in use at the time of the survey and were reported to be in good condition (n = 177, 66.5%). The total mean score for satisfaction (services and device combined) was 3.80 (SD 0.55). Statistically significant differences were observed in satisfaction between gender and location of residence. Effectiveness and comfort were rated as the two most important factors when using a device; at the same time, these were the most common reasons for dissatisfaction and sub-optimal use. Conclusion and Implications: Clients were quite satisfied with the assistive device and services provided, yet many reported barriers to optimal device use and difficulties in accessing follow-up services. There is a need to examine how prosthetic and orthotic devices can be improved further for better comfort and ambulation on uneven ground in low-resource contexts and to address access barriers.
Exploring the Complexities of Leprosy-related Stigma and the Potential of a Socio-economic Intervention in a Public Health Context in Indonesia
Purpose: This article explores the complexities of leprosy-related stigma and the potential effectiveness of a socio-economic intervention in Cirebon District, Indonesia. Methods: A qualitative approach was adopted. 53 people affected by leprosy were interviewed, and 17 focus group discussions were conducted among people affected by leprosy, community and religious leaders, and health providers and other key persons who were all purposively selected. Results: People affected by leprosy face major socio-economic consequences. This was confirmed by key persons. Several opportunities for a possible socio-economic intervention were perceived, as also the barriers. People affected by leprosy are constrained by certain aspects of the health system (e.g., the health providers’ negative attitudes), views in society (e.g., misunderstandings about the condition, stigma), and the physical and social consequences of the disease (impairments, feelings of shame). Study participants identified strategies to deal with these barriers, as well as specific activities for a socio-economic intervention; in particular, the training of staff responsible for implementation. Conclusion and Implications: Socio-economic interventions in the field of leprosy need to anticipate the barriers and develop strategies to deal with them. Cooperation between people working in the health system and those in the welfare / financial system is needed, to improve the quality of life of people affected by leprosy
The Double Burden: Barriers and Facilitators to Socioeconomic Inclusion for Women with Disability in Bangladesh
Purpose: Recent evidence suggests that, globally, women with disability suffer multiple forms of discrimination and exclusion from mainstream society when compared with their female peers and men without disability. In Bangladesh, which is a grossly overpopulated low-income country in South Asia, women with disability have poor health outcomes within a gender-biased cultural context. This study aimed to define the current barriers and facilitators to socioeconomic inclusion for women with physical disability living in the community in Bangladesh and to highlight the impact of these barriers on health. Methods: Semi-structured in-depth interviews were conducted with 15 women who had either a spinal cord injury or amputation, and who had been discharged for at least 3 months after inpatient admission. Mixed purposeful sampling (a mixture of typical case sampling and criterion sampling) was used to recruit the study participants. A thematic analysis was conducted to extract themes from the data. The social determinants of health framework and the International Classification of Functioning (ICF) model were then used to contextualise the data. Results: Five major themes were identified including: exclusion from formal education, exclusion from the work force, exclusion from public facilities, exclusion from marriage and increased risk of violence and exclusion from community activities and social groups. Facilitators to inclusion include: provision of accessible buildings and transport, community- based advocacy services and vocational training services. Conclusions: The combination of physical disability and female gender presents multiple complex barriers to inclusion in the socioeconomic and cultural life of Bangladesh. Practical interventions through both up-scaling and expansion of disability-specific programming and sustained policy implementation are required to facilitate individual empowerment and better health outcomes for women with disability.
Community-Based Rehabilitation Services in Low and Middle-Income Countries in the Asia-Pacific Region: Successes and Challenges in the Implementation of the CBR Matrix
Purpose: This literature review aims to explore the importance of physical therapy services and the increasing awareness of CBR, specifically related to challenges in its implementation in low and middle-income countries in the Asia-Pacific region. Method: A literature review of multiple databases was conducted to locate relevant articles written within the past five years. The databases used for the search were Google Scholar, Cochrane Library, CINAHL, and PubMed. Results: Thirteen articles about CBR were included in the literature review. These consist of studies on the quality of life, access to healthcare services, and barriers to CBR, as well as about the impact of CBR to LMICs and stakeholders. The articles demonstrate the vast potential of CBR, especially in LMICs in the Asia-Pacific region, with a significant positive impact on the lives of people with disabilities. Conclusion: CBR has improved the quality of life, access to medical services, functional independence, autonomy, community inclusion, and empowerment of people with disabilities in LMICs in the Asia-Pacific region. However, challenges in the implementation of CBR remain. These include lack of awareness and understanding of CBR, and physical, environmental, socio-economical and personal barriers.
Sexual Violence against Women with Disabilities in Ghana: Accounts of Women with Disabilities from Ashanti Region
Purpose: Women with disabilities are particularly vulnerable to violence and often at risk of being violated sexually. The study aimed to document the causes and consequences of sexual violence against women with disabilities in Mampong Municipality of Ashanti region in Ghana. Methods: This exploratory study recruited 41 participants, made up of women living with intellectual, visual and hearing disabilities, were interviewed using convenience and snowball sampling techniques. Results: It was found that many participants had suffered sexual violence and factors such as poverty, rejection by families, isolation and unemployment were given as the cause. It was also found that these women suffered consequences such as unwanted pregnancies, divorce, outright rejection and psychological trauma. Conclusion: The current situation of women with disabilities make it impossible for them to escape sexual violence. Therefore, it is essential that national awareness campaigns be fashioned to encourage people to provide support to their family members with disabilities.
Concurrent Validity of Mobility Disability Scale among Community-dwelling Individuals
Purpose: A new Mobility Disability Scale (MDS) has been developed to assess the level of mobility disability among community-dwelling individuals. For it to be used effectively, a systematic evaluation of the psychometric properties is required. This study was conducted to determine the concurrent validity of the MDS among community-dwelling individuals, as compared to the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM). Method: Based on the survey of a semi-urban community, purposive sampling was used to select 52 individuals with mobility disability. All of them were evaluated using MDS and FIM FAM scales at the same time. Spearman’s Rank correlation coefficient was used to analyse the correlation of MDS scores with the FIM FAM scale scores. Results: MDS scores had statistically significant negative correlation with FIM FAM total scale scores (r= -0.711) and the correlation was stronger when analysed with the mobility components of FIM FAM scales (r= -0.724). Conclusion: The MDS possesses moderate concurrent validity with an existing functional scale. This indicates that it may be a suitable tool to quantify the level of mobility disability in persons with disability living in community. Limitation: The psychosocial domain, though important, could not be compared with any gold standard measures due to unavailability of suitable scales.
The Use of the International Classification of Functioning, Disability and Health in Primary Care: Findings of Exploratory Implementation Throughout Life
Purpose: The International Classification of Functioning (ICF) has found widespread acceptance since it was launched in 2001. Yet, little is known about its use in Primary Care. This paper aims to contribute to the dialogue about the practical use of the ICF by exploring how this framework constitutes a supplementary source to inform disability-related decision making in integrated Primary Care. Method: The implementation process of the ICF in a Latin American Primary Care and Community-Based Rehabilitation setting is described and the ICF diagram is applied to a life story as an example of its current use. Participant observation, in-depth study of reports of team meetings and the review of clinical files are the main data collection methods. Data analysis is enabled by the combination of single-case study with theory testing, which facilitates the generation of hypotheses in this exploratory study. Results: A valuable time component of the ICF may support continuity in Primary Care and the universal application of the ICF framework can promote comprehensiveness by integrating individual rehabilitation and collective disability prevention. A way to mitigate the perceived dominance of biomedical disease and deficiency thinking is proposed in order to encourage the biopsychosocial focus of Primary Care. Finally, the implementation of the International Classification of Diseases (ICD-10) in the health condition domain of the ICF highlights the importance of social responsibility towards disability. Conclusion: This study suggests that a creative implementation of the ICF during life course to everyone who uses universally accessible healthcare may strengthen the integrative functions of Primary Care, and may be at the heart of the information system of this essential part of the healthcare system. Further research on the complementary use of ICF and ICD-10 is suggested in order to support community-based multisectoral intervention which may be coordinated by Primary Care.
Work Ability Index: Validation and Model Comparison of the Malaysian Work Ability Index (WAI)
Purpose: The study aimed to (1) measure the Work Ability of employees with disability; (2) assess the factor structure of different potential models of Work Ability Index (WAI) for employees with disability; and (3) identify the best factor structure of Work Ability Index for employees with disability in the Malaysian cultural context. Methods: Data was collected using the Work Ability Index (WAI) translated into Malay language. The study sample consisted of 275 employees with physical disability, from both public and private sectors across Malaysia. Descriptive statistics were calculated using IBM SPSS 20 to evaluate the score of each subscale and the cumulative index of Work Ability among employees with disability. Confirmatory factor analysis (CFA) was conducted using IBM SPSS AMOS 21 to assess the factor structure of WAI and evaluate the validity of the proposed models for employees with disability. Results: The WAI scores were 29.5% poor, 35.3% moderate, 28.7% good and 6.5% excellent. In the validation process, a non-orthogonal two dimensional structure was identified. In this model of WAI, the subscales were attributed to two factors: (1) subjective Work Ability factor that consisted of subscales 1, 2 and 7; and (2) health-related Work Ability factor, comprised of subscales 3, 5, 4 and 6. These two factors were positively correlated, which indicates that employees with disability who exhibit positive subjective Work Ability tend to also report positive health- related Work Ability. Conclusion: This study has provided the first Malay version of WAI and has paved the way for future studies on work ability among employees with disability. The WAI translation has been validated among employees with disability and has shown adequate psychometric properties, thus making it suitable to investigate the associations between aspects of work and their impact on the health of employees with disability.
Identifying Rehabilitation Workforce Strengths, Concerns and Needs: A Case Study from the Pacific Islands
Purpose: This exploratory case study was undertaken to inform capacity development of the rehabilitation workforce in member nations of the Pacific Islands Forum (PIF). Method: Participants at the 1st Pacific CBR Forum in June 2012 were key informants for this study. They comprised the disability focal points from government departments in each of the 14 countries, representatives of DPOs and disability service providers. The study was conducted in 3 phases: a template to gather data on rehabilitation workers; key informant interviews; and, stakeholder workshops to identify strengths and needs of the rehabilitation workforce in the Pacific. Results: The detailed case study findings suggest two critical drivers for rehabilitation health workforce development in the Pacific context. The first is leadership and commitment from government to serve rehabilitation needs in the community. The second is the urgent need to find alternative ways to service the demand for rehabilitation services as it is highly unlikely that the supply of specialist personnel will be adequate. Conclusions: A multi-sectoral view of health and social service systems is a key element for the development of a rehabilitation health workforce. The endorsement of the WHO Global Disability Action Plan by the World Health Assembly in 2014 further enhances the opportunity to work collaboratively across sectors in Pacific countries. Specialist personnel are and will remain in short supply. There is opportunity for the region to lead the development of alternate workforce mechanisms through the training and supply of skilled community-based rehabilitation personnel.
An Online Survey on Identification of Evaluation Capacity, Needs and Current Practice of Programme Evaluation in Community-based Rehabilitation
Purpose: Evaluation of Community-based Rehabilitation (CBR) is important for developing good practice and providing a foundation for evidence of efficacy of practice. Since not much is known about the extent to which monitoring and evaluation (M&E) are carried out within CBR programmes, this study aimed to enhance knowledge by focussing on current M&E activities, the need and capacity of programmes to conduct evaluations and the challenges experienced. Method: An online survey of 15 questions was developed, field-tested and sent out to 236 CBR managers in Africa, Asia and Latin America. Results: The majority (86%) of the respondents indicated that their programmes had been evaluated in the past.While this was mainly done by international donors (87%), only around half of the respondents reported programme participants as the main audience. Just over half of the programmes (54%) included people with disabilities, their families and community members in evaluation processes. Insufficient financial resources were considered the most important challenge to conduct evaluation, particularly in the African region and among smaller programmes. The complexity of CBR was also indicated as an important barrier to evaluation. Conclusions and Recommendations: Although evaluations have been widely implemented in CBR programmes, many of them are not locally owned, and people with disabilities and their families are often not included in evaluation processes. The issues of limited financial resources and CBR complexity reflect current discussions in other areas of mainstream development. It is therefore recommended that models for evaluation in CBR should learn from, and be embedded in, ongoing developments in mainstream evaluation in international development.
Community Physiotherapy in Different Regions
Community physiotherapy is unique to every country. The successful implementation of community physiotherapy depends on various factors, such as the local community settings, the availability of resources, the type of health conditions prevalent at the time of rehabilitation, and the national health laws, to name a few. Certain challenges are common to most countries, especially the developing ones. If major challenges like lack of adequate training and research opportunities and inadequate awareness about the importance of physiotherapy among communities, are addressed, community physiotherapy can prove to be cost-effective tool of rehabilitation. The progressive community physiotherapy models that are being used in developed countries can serve as a guide to countries that are struggling to further community health. In addition, cross-country and/or cross-continent collaborations could help in knowledge dissemination and faster adoption and implementation of effective community physiotherapy models. This brief report discusses certain community rehabilitation practices and strategies that have been put to use in different parts of the globe. In addition, some of the effective examples have been highlighted.
“We are not getting jobs”: Job seeking Problems of People with Disability and Coping Strategies adopted in an Urban Traditional Community in Ghana
Purpose: The study aimed to examine how misconceptions affect the ability of people with disability to find and maintain jobs, and the coping strategies they adopt to manage their economic conditions. Methods: A qualitative study was conducted with special focus on the Kumasi Metro. Purposive sampling enabled the researchers to select participants on the basis of their own set of inclusion criteria. Data was collected through Focus group discussions and interviews that were conducted in the local language, Twi. The raw data was transcribed from Twi to English, using the notes taken during the discussions and comparing it with information recorded on tapes and audio recorders. Corrected and transcribed data was grouped under the various themes of the discussions. Data was analysed through the question-led approach. The most identified themes have been presented as the major findings with related headings. Some responses have been quoted to support the findings. Results: People with disability who participated in the study experienced unemployment, job-seeking problems, the desire to maintain jobs, inability to retain jobs as a result of negative attitudes from co-workers and members of the larger community, and faced difficulty in paying personal bills. To manage their problems, the tendency was to avoid and withdraw from normal societal interaction, and while some begged for alms on the street, others relied on government policies and financial interventions. Conclusion and Implications: It is recommended that stakeholders should intensify public education on disability. Public education should be custom-made to suit the community’s needs and understanding of the condition, taking into account local culture and belief systems. People with disability should be encouraged to form groups for self-help programmes, especially at the community level.
Understanding Hearing Impairment in Individuals from a Perspective of Social and Emotional Functioning
Purpose: Hearing Impairment is one of the most neglected forms of disability. It accounts for the loss of thousands of disability adjusted life years (DALYs) worldwide (WHO, 2005). Developed countries have made some progress in the measuring and management of hearing impairment (HI), but this is still in the initial stages in developing countries such as India. The International Classification of Functioning disability and Health (ICF) has shifted the approach towards a holistic perspective in defining and measuring disability. This paper tries to measure HI from the perspective of social and emotional functioning of individuals. Method: The sample population consisted of 1160 individuals, selected by systematic random sampling from among those who complied with inclusion criteria. 51.7% of the total respondents were females, and 48.3% were males. The participants were administered a questionnaire (Standardised) and their responses were quantified. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: Prevalence of HI was found more among males than females. 84.6% of the total population had no hearing impairment, whereas 13.7% had mild to moderate impairment, and 1.7% had significant hearing impairment. The Total Impairment score obtained by the individuals was divided into Social Impairment score and Emotional Impairment score. Correlation and Multivariate regression analysis were used. Correlation - Age and Social Dimension Score r= 0.609, p≤0.01, n=1160, R2= 0.370; Age and Emotional Dimension score: r= 0.622, p≤0.01, n=1160, R2= 0.386; Regression- Gender and Social Dimension score b= 0.703, t (1160) = 2.988, p<0.05; Age and Total HI score b= 0.787, t (1160) = 27.096, p< 0.01. Conclusion: Measuring HI in terms of social and emotional functioning is more holistic and cost-effective, and could be used in resource-poor settings, and for initial screening in large-scale studies.
Relationships between Sense of Coherence, Coping Strategies and Quality of Life of Parents of Children with Autism in Malaysia: A Case Study among Chinese Parents
Purpose: This study aimed to examine the relationships between Sense of Coherence (SoC), Coping Strategies and Quality of Life (QoL) of parents of children with autism in Malaysia. Method: Purposive sampling was used to recruit parents of children with autism from 3 Autism Centres run by NGOs. The parents were asked to complete a questionnaire. Results: The results of the study show that SoC and cognitive reframing are important factors that are associated with QoL. Conclusions: It is recommended that policy-makers and programmers at the Autism Centres conduct more training workshops for parents of children with Autism Spectrum Disorder (ASD), so that their overall QoL can be improved. Limitations: Future studies could recruit more participants, especially parents at government centres.
Educational Opportunity, Post-School Life and CBR: A Multisectoral Approach in Rural Sri Lanka
Purpose: Inclusive education and post-school life are crossover issues that cut across societal lines and therefore need a multisectoral approach. This study examines the educational opportunities of children with disability and their post-school life in rural Sri Lanka. Methods: The research was implemented with multiple sectors in a rural area of the North Central Province, from January - November 2014. Mixed methods were applied as follows: surveys with children with disability aged 2 to 18 years (n=103); case studies of children with disability who dropped out of or did not attend school (n=3); semi-structured interviews with ex-students with disability who had attended special needs classes (n=13); and, informal interviews with a CBR core group officer. Data was mainly analysed with qualitative procedures. Results: The study consists of 3 parts. The first part revealed that in terms of the current educational opportunities among children with disability aged 2 to 18 years, approximately 31.1% utilised educational resources whereas 38.8% were at home with no special social activities. The case studies in the second part revealed the reasons for limited educational opportunities in the area and the barriers to educational access, which included family members’ attitudes and socio-economic aspects such as poverty. The third part, consisting of semi-structured interviews with ex-students with disability who received education but did not participate in the CBR activities, revealed 3 types of post-school lifestyle: ‘time mostly spent at home’, ‘household chores’ and ‘temporary agricultural work’. The interviews also indicated other barriers to post-school participation, such as a lack of network and information, negative experiences during the schooling period, and families’ priorities. Conclusions: Inadequate educational opportunities among children with disability and barriers to post-school social participation in rural Sri Lanka are revealed. This study argues the importance of the multisectoral approach to find unidentified children as well as to conduct comprehensive programmes.
Assessment of Rehabilitation Capacity in Ghana
Purpose: This study describes a cross-sectional assessment of infrastructure, human resources, and types of rehabilitation interventions provided in a sample of healthcare facilities in Ghana. The objectives were to (a) develop and pilot a questionnaire assessing rehabilitation capacity in LMICs, and (b) provide initial data regarding available rehabilitation care in rural Ghana. Methods: Data was collected from a sample of rehabilitation workers at 9 facilities, comprised of 5 regional and 4 district hospitals, located in seven of the ten geographical regions of Ghana. Participants completed a modified version of the World Health Organisation's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, adapted to reflect core indicators of rehabilitation infrastructure. Participating facilities were mailed questionnaires and agreed to subsequent site visits from the first author. Results: There were several limitations associated with basic rehabilitation infrastructure. Consistent with previous research, significant human resources limitations were observed as hospital-based rehabilitation services were primarily rendered by 20 physiotherapists and 21 physiotherapy assistants across the 9 participating sites. No rehabilitation physicians were identified at any of the surveyed facilities. With regard to therapeutic interventions, management of musculoskeletal impairments was generally consistent with current evidence-based practices, whereas rehabilitative approaches for neurologic conditions were limited to physical rather than sensory-motor modalities. Conclusions: For the first time there is study data which details the rehabilitation infrastructure, human resources, and interventions in Ghana. This study furthers the field through the adaptation and initial piloting of a rehabilitation assessment instrument that can be used in LMIC contexts. Limitations: The questionnaire used for the study was modified from the questionnaire for assessing surgical care in resource poor countries, and has not yet been validated. Since the study was conducted in a convenience sample of rehabilitation/physiotherapy centres in Ghana, generalisability may be limited.
Exploring Conceptualisations of Disability: A Talanoa approach to Understanding Cultural Frameworks of Disability in Samoa
Purpose: The concepts of disability are explored from a Samoan cultural frame. The impact of disability conceptualisations on identity development and cultural inclusion was assessed through the Samoan language. The study also evaluated the extent of endorsement of global policy initiatives at a local level. Methods: Through facilitating a Talanoa approach, which is a rich cultural tradition of sharing knowledge, space emerged for dialogue around the lived experiences of members of the disability community in Samoa. Results: Incongruous conceptualisations of disability were identified as a contributing factor in the persistence of stigmatising attitudes and beliefs. Borrowing concepts and terms from moral, medical, and social disability models, this disparity of conceptualisation is reflected in Samoan disability terminology. It was also found that while global policy initiatives are generally politically embraced, they engage more effectively with the community when they are underpinned by Samoan cultural ontologies. Conclusion: The findings suggest that multiple ideologies regarding rights, capabilities and experiences, challenge the development of identity, self-worth, and inclusion. There is significant value in merging cultural concepts with a social disability model framework. It is important to future development that people with disability can express a sense of cultural identity without risking the right to inclusion and equality.
CBR Indicators: Pick and Choose what fits your Purpose
Community physiotherapy in India- Students’ perspective
Multidisciplinary Management of Knee Osteoarthritis using the International Classification of Functioning, Disability and Health
Purpose: To identify the role of environmental, cultural and accessibility factors in community reintegration and to assess how a healthcare team can provide complete rehabilitation to a client with knee osteoarthritis (OA). Method: A 57-year-old woman with bilateral knee OA was assessed using the ICF core set for OA. The components identified were linked to ICF categorical profile and assessment sheet. ICF allowed the team to identify the global, service programme and cycle goals. The client’s clinical status was followed over a 4 month period. Results: At 16 weeks, the client was able to walk faster and reported an increased ability to sit continuously, climb stairs and carry out her routine activities for a full day without increase in pain. Though she is satisfied with the outcome of the treatment, her engagement with public sphere continues to pose a problem in her attempts to reintegrate in to community. She is also concerned that her pace of doing activities has decreased within the household and outside world. Conclusion: The social construct of disability needs to be emphasized more seriously for complete rehabilitation, failing which there may not be any success at the level of functioning. Implications: This method of depicting the problems from both the client’s and health professionals’ perspective ensured that the process of goal setting is shared between the client and rehabilitation team. Some of the non-modifiable goals identified by the team revolved around environmental factors and social policy development. These factors have to be considered by policy makers to improve functioning of persons with OA at the community and society level.
Access and Challenges of Assistive Technology Application: Experience of Teachers of Students with Visual Impairments in Singapore
Purpose: Assistive Technology (AT) enables persons with visual impairments to lead independent and productive lives. Teachers play an important role in facilitating education for students with visual impairments. This study describes the experiences of AT use by teachers of students with visual impairments in Singapore. Method: 6 teachers were recruited from the only school for the blind in Singapore. In-depth interviews were conducted in order to understand beliefs, practices and needs regarding the use of AT. The teachers were asked: how they learnt AT, where they acquired the knowledge, how they used AT in their teaching, what were the challenges or successes experienced. Qualitative thematic content analysis was used to evaluate the transcriptions. Results: There was unequivocal recognition that AT is a facilitator for accessing information and improving the quality of life for students with visual impairments. At the same time, there were indications of significant gaps and disconnection in AT knowledge and skill among teachers. A noteworthy feature was the use and teaching of AT being driven by a teacher champion. Other focal areas include teaching of Braille and AT, whether AT is to be taught as a curriculum or enrichment subject, and whether the integration of AT is overlooked. The findings also point to limitations in resources, and inadequacies in pre-service training and professional development. Conclusion: Knowledge of AT is inadequate and its use by teachers of students with visual impairments is inconsistent. AT needs to be viewed as a complementary tool to aid teaching; not as something separate and a competitor to Braille. These gaps can be addressed by improving pre-service, in-service and professional development courses for teachers.
China’s Mental Health Law: Analysis of Core Concepts of Human Rights and Inclusion of Vulnerable Groups
Purpose: The aim of this research is to assess China’s first Mental Health Law in terms of Core Concepts of Human Rights and equitable coverage of Vulnerable Groups. Methods: The EquiFrame analytical tool provided the framework for evaluation of the inclusion of Core Concepts of Human Rights as well as Vulnerable Groups in the Law. Results: China’s Mental Health Law scored 83% for Core Concept coverage, with a Core Concept Quality score of 76%. The Law had a 42% score for Vulnerable Groups coverage. This gave the Law an overall score of “Moderate” in terms of Human Rights coverage. Conclusions: China’s Mental Health Law is a landmark document providing the country’s first ever legal framework for mental health. While the Law scores high on level commitment in Core Concepts of Human Rights, the potential for equitable protection would be enhanced by increased inclusion of Vulnerable Groups. Limitations: Further analyses of health and social policies in the People’s Republic of China from a Human Rights perspective would provide a deeper understanding of the Law in context.
“Our children have the right to an education too”: Strategies employed by Orange Farm Caregivers of Children with Disabilities in Pursuit of the Right to a Basic Education
Purpose: This paper aims to understand the agency that caregivers who participated in a CBR empowerment component programme exercised, in order to promote the rights of their children with disabilities to a basic education. Methods: An interdisciplinary theoretical framework and qualitative methodology were used to examine the agency and the opportunity structures within which the caregivers operate. Focus group discussions, case study interviews and secondary Programme data were analysed using manual thematic analysis. Results: Thousands of children with disabilities in South Africa are effectively denied the right to a basic education as a result of discriminatory norms, stigmatising discourses and unjust power relations. Yet, a group of caregivers have successfully advocated for their children with disabilities in the township of Orange Farm, Gauteng. Their lobbying has contributed to the establishment, by the State, of a new school. Conclusion and Implications: The findings suggest that human rights advocacy movements, as well as disability organisations, would do well to recognise and encourage the power and agency possessed by caregivers of children with disabilities. Catalysing civic action and providing opportunities for active citizenry and self-help seem to nurture increased efficacy and competence at navigating systems and accessing rights. While advocacy organisations may act as proxy agents, direct and collective agentic strategies should be nurtured. In implementing inclusive education, policy makers and the Department of Education should recognise the role that caregivers of children with disabilities can play, and the potential contribution that their motivation, resourcefulness, and disability-related knowledge can make.
Translation of Revised Version of Developmental Coordination Disorder Questionnaire (DCDQ’07) into Kannada – Results of Validation
Purpose: The revised version of Developmental Coordination Disorder Questionnaire (DCDQ’07) is a widely used parent-reported screening tool for DCD. The tool is not available in any Indian language. This article reports on the results of the cross-cultural validation of DCDQ’07 into Kannada, a South Indian language. Methods: The questionnaire was first translated into Indian English to overcome differences in phraseology between Canadian and Indian English (DCDQ’07-IE). Following this, forward translation, synthesis, back translation, expert committee review, and pre-testing of the translated version were conducted to obtain the Kannada version of the questionnaire (DCDQ’07-K). Minor examples, in keeping with local usage, were added.160 parents were recruited, among whom 80 were parents of children with motor difficulties and 80 were parents of children without motor difficulties. They rated their children on DCDQ’07-IE. After a washout period of 2 weeks, the same parents once again rated their children on DCDQ’07-K.Statistical analysis for reliability, construct validity, and Rasch diagnostics (person and item reliability, fit statistics, category functioning of scores and person-item map) were conducted. Results: Internal consistency (Cronbach’s Alpha>0.8), parallel form test-retest reliability (ICC=0.95 at 95% CI) and floor and ceiling were acceptable. Principal component analysis (PCA) showed three factors accounting for total variance of 59.29% and 58.80% in DCDQ’07-IE and DCDQ’07-K respectively. Item reliability (<0.8) and separation index (<2) were poor in both versions. Category functioning was effective. Person-item map represented inconsistency in spread of items in difficulty and person’s abilities. Qualitative review of the parents revealed that they were unfamiliar with the performance of their children on sports-related items and hence scored their child on the basis of conjecture. Conclusion: Translation into Kannada was fairly successful. Although traditional tool properties produced satisfactory results, Rasch analysis demonstrated problems with the tool. This could be due to cultural reasons. Hence DCDQ’07-K should be interpreted with caution when rated by parents in the local context.
Teaching Children with Learning Difficulties via Community-Based Rehabilitation Projects in rural Sri Lanka
Teachers in rural Sri Lanka find it challenging to support students with Learning Difficulties (LD) in regular classrooms. As a result, students with LD often quit school early. Community-Based Rehabilitation (CBR) projects located in rural areas sometimes provide learning opportunities for students who are school dropouts. Purpose: The research focussed on identifying an effective teaching approach that Developmental Assistants (DAs) can employ when teaching students with LD. Methods: An action research methodology with two action cycles was selected for this purpose. Each cycle consisted of four stages: analysing, reflecting, planning, and implementing, and monitoring. Data collection involved semi-structured interviews and real-time observations. A combination of qualitative and quantitative methods was adopted for data analysis. Research participants included 11 students aged 8-14 years, their parents and two DAs. Results: Outcomes suggest that students with LD actively engage in learning when an integrated approach that uses thematic units which reflect the students’ world, is in force. They also benefit when some elements of the behavioural approach to teaching-learning: explicit direct instruction, modelling, scheduled practice, reinforcement and feedback, are combined with certain components of the constructivist approach: independent work, group discussions and reflection. Conclusions: The study demonstrates that students with LD can succeed when the teaching-learning process is modified to suit their needs. Hence, CBR project workers ought to be trained to plan and design lessons that meet the needs of students with LD. It further validates the role CBR projects can play in diminishing negative views on disability and in creating inclusive societies. Limitations: The study’s illuminative design was appropriate within a limited sample of students. However, this sample is not wholly representative of the multicultural and multi-religious student population with LD in hard-to-reach areas of Sri Lanka.
Participatory Monitoring of Community-Based Rehabilitation and other Disability- Inclusive Development Programmes: the Development of a Manual and Menu
Purpose: This paper describes a three-year research project leading to the development of the CBR Monitoring Manual and Menu (MM&M). The MM&M is a practical toolkit that meets the needs of CBR managers and stakeholders, and is consistent with the philosophy of CBR and community-based disability-inclusive development. It is designed to produce meaningful and locally useful information and data, based on international data standards where possible, to enable aggregation at regional, national and international levels. Methods: Five complementary workstreams of research were carried out from 2011 to 2014: 1) literature review and analysis; 2) participatory action research with CBR stakeholders; 3) analysis and refinement of validity of concepts and structures; 4) consultation and review; and 5) synthesis of results. This article documents the method and key results of each of the five workstreams, and the lessons learned along the way. Results: The MM&M is now freely available on-line at http://sydney.edu.au/health-sciences/cdrp/projects/cbr-monitoring.shtml. Collaboration among members of the development team continues, chiefly via an on-line group to which new members have been welcomed. Conclusion and Implications: At the time of writing, the MM&M is the only international monitoring product, known to the authors, that consciously sets out to reflect both a ‘bottom- up’ and ‘top-down’ perspective of monitoring information and data. To achieve this for a complex programme such as CBR, and to align with its principles, it was essential to use a multi-component and multi-stage strategy for tool development, involving a diverse multidisciplinary team includingcollaboration with CBR stakeholders.
Cost-effectiveness of a Community-based Rehabilitation Programme in Nepal
Purpose: This study aimed to estimate the cost-effectiveness of a community-based rehabilitation (CBR) programme known as Inspire2Care (I2C), implemented in Nepal by Karuna Foundation Nepal. In the absence of any gold standard methodology to measure cost-effectiveness, the authors developed a new methodology to estimate the programme’s achievements and cost-effectiveness. Methods: Financial records were reviewed to determine total expenditure during the period August 2011 - December 2013. Programme records which documented the physical, mental and social status of children and adults with a disability qualitatively before, during and after the intervention were used to determine a starting disability weight and improvement score, which was then converted into a change in disability weight. The disability weight and expected remaining lifespan of each person were used to estimate disability-adjusted life years (DALYs) averted by the intervention. The cost per DALYaverted was estimated by dividing the total programme expenditure by the sum of DALYs averted over that same period. Results: I2C cost 204,823 Euros to implement over the period August 2011 - December 2013. In total, an estimated 1,065 DALYs were averted from the treatment and rehabilitation components. The cost per DALY averted was 192.34 Euros. Conclusions and Implications: The methodology devised for the study was able to successfully estimate the cost-effectiveness of the I2C programme. Using WHO benchmarks, this programme can be considered highly cost-effective. Other organisations can assess the cost-effectiveness of their programmes by using the assessment improvement score and subsequent conversion to DALYs averted. However, while mental, physical and social gains have been captured, other benefits from I2C cannot be captured in the cost per DALY averted statistic. Further research is needed to develop methods for incorporating these harder-to-measure gains in cost-effectiveness studies with a single outcome measure like the DALY.
Adapted Science Experimental Aids for Students with Visual Impairment
Copyright (c) 2015 The Author(s) https://creativecommons.org/licenses/by/4.0
Community-based Rehabilitation in a post-Soviet environment in Azerbaijan – Where Society meets Ideology
This paper explores UAFA’s experience, since 2002, in working with Azerbaijani stakeholders to move from the medical approach to disability, propagated by the Soviet model of planning and implementation, to a social, community-based approach. The paper highlights the common misconceptions and how these can be overcome, including the policy gaps that challenge effective implementation. The importance of creating and maintaining a core team is discussed, alongside the process that UAFA has developed for building up teams of CBR workers. Finally, the paper raises the issue of introducing outcomes-based evaluation in a society that has no such prior experience, followed by an account of the continual challenge faced by most programmes–namely, how to achieve sustainable funding.
Attitudes of Parents towards the Behavioural Management of their Children with Intellectual Disability
Purpose: The study was designed to understand the attitudes of parents of children with intellectual disabilities, with regard to the management of problematic behaviour of their children, and to identify whether the mothers or the fathers had more positive attitudes. Method: A structured interview schedule was developed. Convenience sampling was used to select 74 parents (30 fathers and 44 mothers) of children with intellectual disability. The data was analysed using descriptive and inferential statistics. For descriptive statistics, the frequency, percentage, mean and standard deviations were calculated. Inferential statistics included t-test and ANOVA. Results: Indications were that parents of children with intellectual disability had positive attitudes towards their children. While mothers had more positive attitudes than fathers, there was no significant difference between the negative attitudes of fathers and mothers towards their children with intellectual disability. Conclusion: It is recommended that further research should be conducted to identify the elements that influence the attitudes of parents of children with intellectual disability.
Accessibility and Participation of Persons with Disabilities in Tourism: Perspective of Tourism Workers in the Ashanti region of Ghana
Purpose: Tourism contributes a great deal to the world’s economy. However, persons with disabilities are underrepresented in the industry, particularly in Ghana, due to inaccessible tourism structures and facilities. Accessibility and participation in tourism will enhance social inclusion of persons with disabilities. This study sought to document the nature of access as well as the participation of persons with disabilities in tourism, from the perspective of tourism workers in the Ashanti region of Ghana. Methods: An exploratory study using qualitative methods was conducted among workers at tourist centres in the Ashanti region of Ghana. A total of 21 participants were involved in the study. A voice-recorded interview was used to collect data from respondents. Results were generated through thematic content analysis to develop themes. Results: Findings revealed that the participation of persons with disabilities in tourism is limited due to factors such as the inaccessible tourism environment, the nature of transport services and the language barrier. Suggested provisions were canopy walks, accessible banquets, vehicles, and sign language interpreters at various tourism destinations. Conclusion: Tourism destinations should be made disability friendly through regulations, monitoring and supervision with regard to accessibility, structures and environment.
Virtual Reality Games as an Intervention for Children: A Pilot Study
Purpose: This pilot study explored the use of virtual reality-based games as an enjoyable yet effective intervention to improve skills in children with developmental disabilities. Although the intervention was primarily targeted at the enhancement of motor skills, the children’s communication, cognitive and social/emotional skills were also monitored and changes, if any, were tracked during this period. Methods: Therapists guided 5 children (4 boys with Autism Spectrum Disorder and 1 girl with Learning Disability) while they played carefully chosen games on the Xbox-Kinect, in individual sessions. Each child attended between 4 and 6 sessions over a span of one month. Therapists used a 4-point rating scale to evaluate specific skills in each of the four domains (motor, communication, cognitive and social/emotional) at the beginning of the intervention, and again at the end. Results: Pre-and post-intervention scores revealed that the children made significant progress, not only in certain motor skills but also in skills from the cognitive and social/emotional domains. None of the children regressed in any of the skills monitored from the different domains. Conclusions: Initial findings indicate that virtual reality games provide a useful platform for building interventions for children with developmental disabilities. There is much scope for future research in this area. The results of the study provide insights into the skills which might require prolonged, consistent inputs during the intervention, and the ones which might be acquired quickly through leaps in learning. The different ways in which children with varied developmental profiles might benefit from virtual reality-based interventions were also highlighted.
Knowledge of Primary School Teachers in Identifying Children with Learning Disabilities
Purpose: This study explores the knowledge of primary school teachers in identifying children with learning disabilities. Method: The study sample consisted of 200 primary school teachers from 16 schools in Bangalore, India. The teachers’ knowledge about learning disabilities was assessed using Knowledge Questionnaire on Learning Disabilities. Results: The results revealed statistically significant differences in overall knowledge and various domains across gender, type of school, education, class being taught and years of experience. Conclusion: The need to improve the knowledge of primary school teachers for the identification of children with learning disabilities was highlighted. Based on the findings of the study, the “Manual for Primary School Teachers on Learning Disabilities” was developed.
Stroke Rehabilitation in the Philippines: An Audit Study
Purpose: Although cerebrovascular accident is a leading cause of mortality in the Philippines, there has never been a national survey of stroke client descriptors and rehabilitation practices. This paper reports on data from the audit of stroke care for inpatients in hospitals serviced by physiatrists. Method: Audit was done of the medical records of stroke clients admitted to hospitals with rehabilitation units. Performance indicators for timely referral to rehabilitation were applied. Results: A total of 1683 records were audited. The majority of clients had cerebral infarct followed by cerebral haemorrhage. The median length of stay was 7 days; stay was lengthier for haemorrhagic strokes. Only 54.1% of the clients were referred to rehabilitation, with a median delay of 3 days between admission and referral to rehabilitation. 25.4% of the clients had early referral to rehabilitation. 39.2% of the 1397 clients were referred to rehabilitation earlier than 2 days before discharge. Conclusion: This Filipino study provides valuable information on stroke types and prevalence, demographics and rehabilitation practices. Despite the prevalence of post-stroke rehabilitation, it has been underutilised in the management of stroke. Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms. Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.
Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries
Purpose: This research aims to identify a core set of clinical skills for working in a Community Based Rehabilitation (CBR) setting, and to discuss whether they are appropriate for task shifting to a new or an alternative cadre of rehabilitation workers. Methods: The study focussed on work activities relating to the health component of the CBR Matrix. 40 health professionals working in CBR in Low and Middle Income Countries (LMIC) were surveyed to discover the clinical skills that were used most frequently during the past 3 months and to determine which of these skills were deemed most important in a CBR setting. Results: A core set of clinical skills for health-related CBR work in LMIC were identified: advocacy and sensitisation; assessment, monitoring and reporting; behavioural and cognitive interventions; collaboration and referral; communication; continuing professional development; education; gait training; group work; home-based rehabilitation; manual therapy; neurofacilitation techniques; positioning; prescription of strengthening exercises; prescription of stretching programmes; provision of aids, assistive devices and technologies; psychosocial support; recreational therapy; self-care; sensory interventions; supervision; upper body rehabilitation; vocational rehabilitation and working with families. Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms. Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.
The Impact of Education on the Lives of Young Persons with Disabilities after University Graduation in Cambodia
Purpose: In 2009, the University Scheme Programme, managed by Cambodia Trust, was initiated with the objective of giving young persons with disabilities access to higher education in order to increase their employment prospects. Of the 40 young persons with disability who received scholarships through this programme, 15 have graduated from university. This study aimed to explore the possible impact of education on this target group, their families and immediate community (defined as people in the neighbourhood and village), and the broader community of potential employers. Methods: Data was collected by conducting in-depth interviews with 14 participants (9 of them female) from the first cohort of graduates from the universities in Cambodia. Results: The study found that education had a very positive, empowering impact on the lives of the graduates due to changes in their self-perceptions and perceptions of them by family members, neighbours, and colleagues. However, their educational accomplishments had less impact within the broader community, as some participants continued to experience discrimination when seeking employment. Conclusion: Although education seemed to positively impact the young persons with disabilities in this sample, within the broader community there remained discrimination related to finding employment. Limitations: The small non-representative sample size limits generalisation from this study.
A 10-Year Literature Review of the Impact of CommunityBased Rehabilitation
A thematic literature review of the impact of CommunityBased Rehabilitation (CBR) in low to middle-income countries was conducted. The review covered the period from 2002 to 2012, and the CBR Matrix was utilised to provide structure for the evidence. Seven studies that investigated the impact of CBR interventions in developing countries were included. A modified harvest plot was used to summarise the strength and nature of evidence provided in relation to the CBR Matrix. Quantitative studies tended to focus on the Health domain, while qualitative studies generally focussed on the Social and Empowerment domains. No evidence of CBR impact was found in the Education domain, and very little evidence was found pertaining to Livelihood. Overall, the evidence base related to the impact of CBR remains limited, both in terms of quantity and robustness of design.
Towards an Inclusive Society in Cameroon: Understanding the Perceptions of Students in University of Yaounde II about Persons with Disabilities
Purpose: Disability cuts across every society and all spheres of life. For an inclusive society, it is important to understand people’s perceptions about persons with disabilities. However, there seems to be limited information, particularly about the perceptions of students who are the generation of future policy-makers. This study examines the perceptions of students in the University of Yaoundé II about persons with disabilities in Cameroon. Methods: A cross sectional design using quantitative methods was employed with a sample of students at the University of Yaoundé II. A questionnaire was used to gather information from 500 students selected by simple random sampling. The data analysis involved descriptive and inferential statistics at 95% CI. Results: Among the participants, 51.8% were males, 89.2% were single and the average age was 24.9 years. Findings showed that 69.8% did not know about the actual population of persons with disabilities in Cameroon, though 14.6% had relatives with disabilities. None of the students perceived disability as a contagious condition, and 79.8% agreed that education had influenced their perceptions about persons with disabilities. Gender and education level had significant relationship with changes in perception (OR=1.8; p=0.01 and OR=1.91; p=0.04). However, 13.5% were unwilling to work with a person with disability in the future. Conclusion: The findings suggest that issues of disability have not been taken into consideration in Cameroon. Therefore, there is the need for education and sensitisation of the general population towards disability. Additionally, policy-makers should factor persons with disabilities into national strategic plans, in order to ensure an inclusive society.
Prevalence of Physical Disability among Urban Community-dwelling Adults in Sri Lanka
Purpose: Assessment of physical disability at the community level is essential for rehabilitation and supply of services. This study aimed to assess the prevalence of physical disability among adults in an urban community in Sri Lanka. Methods: A descriptive cross-sectional study was conducted among 2460 adults (18-59 years of age) who were selected using cluster sampling. Physical disability was measured using a Physical Impairment Examination Tool (PIET) and World Health Organisation Disability Assessment Schedule II (WHODAS II). Results: Prevalence of physical disability was 4.2% (95% CI= 3.5-5.1). Physical disability was higher among people in the age group of 40-59 years (6.5%, n=64) than among those in the age group of 18-39 years (2.6%, n=39) (P<0.05). Physical disability was more prevalent among females (4.4%, 95% CI= 4.2-4.6) than males (2.6%, 95% CI: 2.4-2.8), and among Tamils (7.8%, 95% CI=5.1%- 10.5%) than Sinhalese (3.3%, 95% CI=2.4%- 4.1%). It was higher among those who were divorced/widowed (58.3%, 95% CI=30.4- 86.2) than among married people (3.6%, 95% CI=2.8- 4.4). The prevalence of physical disability was 7.1% (95% CI=4.6- 9.5) among people with primary education, 4.5% (95% CI=3.4- 5.6) among those with secondary education, and 1.8% (95% CI=0.8- 2.8) among those with tertiary education. It was higher among the unemployed (7.2%, 95% CI=5.7-8.7) than the employed (1.8%, 95% CI=1.1-2.5). Age, gender, ethnicity, marital status, education levels and employment status were significantly associated with physical disability. Conclusions: Though the prevalence of physical disability appears to be higher among Sri Lankan adults than among people in developed countries, it is less than among people in other South-East Asian countries. Associations with socio-demographic variables were consistent with other studies.
Financial Access to Healthcare among Persons with Disabilities in the Kumasi Metropolis, Ghana
Purpose: According to the World Health Organisation, 10% to 15% of the population of every developing country lives with disability. This amounts to about 2.4 - 3.6 million Ghanaians with disability. Since their contribution is important for the development of the country, this study aimed to assess the financial access to healthcare among persons with disabilities in the Kumasi Metropolis of Ghana. Methods: A cross-sectional study, involving administration of a semi-structured questionnaire, was conducted among persons with all kinds of disabilities (physically challenged, hearing and visually impaired) in the Kumasi Metropolis. Multi-stage sampling was used to randomly select 255 persons with disabilities from 5 clusters of communities - Oforikrom, Subin, Asewase, Tafo and Asokwa. Data analysis involved descriptive and analytical statistics at 95% CI using SPSS software version 20. Results: There were more male than female participants, nearly one-third of them had no formal education and 28.6% were unemployed. The average monthly expenditure on healthcare was GHC 21.46 (USD 6.0) which constituted 9.8% of the respondents’ income. Factors such as age, gender, disability type, education, employment, and whether or not they stayed with family members had significant bearing on the average monthly expenses on healthcare (p<0.05). Transportation cost, the travel distance to facilities, as well as the regular sources of payment for healthcare, had significant relationship with access to healthcare (p<0.05). Although about 63.5% of the respondents used the National Health Insurance Scheme as the regular source of payment for healthcare, 94.1% reported that sources of payment did not cover all their expenses and equipment. Conclusion: Financial access to healthcare remains a major challenge for persons with disabilities. Measures to finance all healthcare expenses of persons with disabilities are urgently needed to improve their access to healthcare.
Work Ability of Employees with Disabilities in Malaysia
Purpose: Based on a sample of employees with disability, this study aimed to: (1) evaluate the construct validity of work ability index (WAI), core self-evaluation scale (CSES) and job in general index (JIG), in order to make a valid and reliable assessment of their work ability, job satisfaction and core self-evaluation; (2) assess their levels of work ability, job satisfaction, and core self-evaluation; (3) investigate the associations of work ability with job satisfaction and core self-evaluation among them; and (4) determine which demographic characteristics significantly affect the work ability of employees with disability. Methods: The sample consisted of 275 employees with disability. Data was collected using a self-administered survey. The analysis focussed on: (1) CFA- for evidence of the construct validity of the employed scales; (2) Descriptive analysis - for evaluating the variables of the study; (3) Pearson correlation analysis – for understanding the simple correlation between variables of the study; and, (4) One-way ANOVA- for identifying the demographic factors that influence the work ability of employees with disability. Results: The findings indicated that 29.5% of the participants had poor levels of work ability, while 35.3% reported moderate levels of work ability. Also, 49.1% of the participants reported moderate levels of core self-evaluation, and 70.5% exhibited high job satisfaction. In this study, work ability was found to be associated with core self-evaluation and job satisfaction. Significant differences in work ability levels were found in terms of age, level ofeducation and employment status of the respondents. Conclusion: Work ability among employees with disabilities did not seem to be influenced merely by individual health status. Attitudinal and dispositional factors appeared to have a significant impact on their levels of work ability. The potential positive impact of education and employment status on employees’ levels of work ability are highlighted in this study.
Understanding the Lives of Caregivers of Children with Cerebral Palsy in rural Bangladesh: Use of Mixed Methods
Cerebral palsy is the most prevalent health condition linked to childhood disability in Bangladesh, yet support and rehabilitation for this group is limited. Understanding the impact of cerebral palsy at family level is important for the development of appropriate interventions. Purpose: This study aims to explore the impact on the lives of caregivers of children with cerebral palsy. Methods: The study used mixed methods. The PedsQL™ Family Impact Questionnaire Module was administered to the main caregivers in 135 families with a child with cerebral palsy and 150 families that did not have a child with a disability, from the same villages. In-depth interviews and observations were undertaken with 10 families, and 2 focus group discussions were conducted with representatives from 14 parent/caregiver groups. The project was conducted from April 2011-April 2013. Data collection was from September 2011-Dec 2012. Results: The mean overall and sub-scale PedsQL™ scores were significantly poorer (p<0.001) for caregivers of a child with cerebral palsy compared to scores from families that did not have a child with disability. Caregivers reported high levels of stress, anxiety, isolation, stigma, physical tiredness, and lack of time to complete everyday tasks. Knowledge and understanding about cerebral palsy was generally low. Conclusion: This study demonstrates the particular vulnerability of families of children with disabilities in resource-limited settings. It reveals the extent of the impact on the caregivers. Interventions therefore need to be holistic, addressing the well-being and empowerment of caregivers as well as children.
The Role of Community-Based Rehabilitation in Poverty Reduction
Over the last thirty years Community-based Rehabilitation (CBR) has emerged as an effective method of providing rehabilitation services to the population with disabilities in developing countries. Although CBR programmes have been recognised as a strategy for poverty reduction by the World Health Organisation (WHO, 2003), CBR workers and their managers face the challenge of understanding the causes and effects of poverty, and contributing towards poverty alleviation. The purpose of this paper is to describe the role of community-based rehabilitation in poverty reduction. A brief review on Community-Based Rehabilitation and Poverty Reduction is followed by an assessment of different models of disability, to find which one provides the best framework to understand the overall picture of disability and poverty. The Capabilities Approach, developed by Amartya Sen and Martha Nussbaum, seems to offer a sound basis to understand the relationship between poverty and disability. This paper concludes that CBR can play a crucial role in poverty reduction programmes by expanding the capabilities of people with disabilities.
Effects of Motor Imagery on Upper Extremity Functional Task Performance and Quality of Life among Stroke Survivors
Purpose: To assess the effects of Motor Imagery programme on upper extremity functional task performance and quality of life among stroke survivors. Method: Thirty people who were diagnosed with stroke, were selected from the Department of Occupational Therapy, SVNIRTAR, Odisha, India, and consecutively assigned to control (n=15) and experimental (n=15) groups. The control group received conventional occupational therapy only, and the experimental group received conventional occupational therapy combined with Motor Imagery programme. Upper Extremity Motor Activity Log (UE-MAL) and Stroke Specific Quality Of Life Questionnaire (SSQOL) were used for assessment, before and after the intervention. Results: The experimental group showed significant improvement compared to the control group (P<.004 & P<.001). The implication is that there is a good relationship between upper extremity functional task performance and quality of life (r= 0.928). Conclusions: The Motor Imagery programme is a simple and very cost-effective treatment used in Occupational Therapy practice. It can be easily taught and learnt. The study concludes that Motor Imagery programme is effective in improving upper extremity functional task performance and quality of life among stroke survivors.
Variables Influencing Emotional Intelligence of Visually Impaired Students in Higher Education
Purpose: Emotional Intelligence is a set of abilities which enables people to understand emotions more accurately and solve problems in their emotional lives. The present study attempted to identify variables influencing emotional intelligence (EI) of visually impaired students studying in higher educational institutions. Method: A survey method of descriptive research design was adopted. 60 visually impaired students pursuing higher education were selected through purposive sampling. Their emotional intelligence (EI) was measured using ‘Mangal Emotional Intelligence Inventory’ (MEII). The collected data was analysed using differential and descriptive statistics to identify the influence of selected demographic variables on EI. Results: The study results revealed that demographic variables did not have significant impact on the EI of students with visual impairment studying in higher educational institutions, except at the onset of visual impairment. Those who had lost their vision later in life seemed to have more EI than those who were congenitally blind. Conclusion: Suitable training programmes should be planned to promote the emotional intelligence of those who are visually impaired since birth, because most behaviour is learnt through visual clues.
Barriers in Using Assistive Devices among a Group of Community-dwelling Persons with Lower Limb Disabilities in Sri Lanka
Purpose: Rehabilitation with assistive devices is of great benefit to people with limb disabilities, enabling them to lead independent and productive lives. While assistive devices improve the quality of life of persons with lower limb disabilities by facilitating activities of daily living, there are also many barriers to their use. This study aims to describe these barriers among community-dwelling persons with lower limb disabilities in central Sri Lanka. Methods: A community survey was conducted among adults between 18 and 59 years of age, to find persons with lower limb disabilities in Kandy Municipal Council area, in the central province of Sri Lanka. This was followed by purposive sampling to select a sub-sample of 12 individuals with unilateral lower limb disabilities for a qualitative study using in-depth interviews. Unilateral lower limb disabilities were identified using a clinical examination and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). A qualitative thematic content analysis was used to evaluate the interview text. Results: Participants described several barriers in using assistive devices, such as unaffordable assistive technology like wheelchairs and artificial limbs, unavailability of appropriate assistive technology, difficulties associated with repair and maintenance, and problems in accessibility. Limited knowledge of modern technology also restricted their choice of better devices. Psychological barriers and stigma in using assistive devices directly affected their social lives and day-to-day activities as well. Conclusion and Implications: People with lower limb disabilities face multiple barriers in using assistive devices. These barriers need to be addressed by improving local infrastructure and accessibility facilities, public awareness and funding, and ensuring continuous supply and maintenance services.
Inclusive Education at the crossroads in Ashanti and BrongAhafo regions in Ghana: Target not achievable by 2015
Purpose: Inclusive education, widely acknowledged as an alternative method of making education accessible to children with special needs, has been piloted for 10 years in selected districts of Ghana. This article aims to discuss the feasibility of implementing it throughout the country, by assessing the inclusive education programme piloted in Ghana’s Ashanti and BrongAhafo regions. Method: One round of in-depth interviews was conducted with 31 participants, to collect data on the issue under study. Participants were officials of Special Education at the national Head Office, District Special Education Coordinators, Resource Teachers, Headmasters and Classroom Teachers of inclusive education. Results: The study findings indicated that the pilot programme did not live upto expectations when faced with challenges such as inaccessible environments, lack of resources, lack of funds, lack of qualified teachers, poor teaching methods and negative attitudes of teachers towards children with disabilities. Conclusion: It is very unrealistic to commence inclusive education programmes unless practical measures are put in place, such as adequate funding from the government and provision of sufficient resources for inclusive schools.
Nigerian Realities: Can we ignore Traditional Leadership in developing successful CBR?
Purpose: To study the role of traditional leaders (Sarakuna) who provide a form of social welfare for persons with disabilities in the Hausa society of Northern Nigeria. From the results of this study, lessons are derived for cooperation with Sarakuna in (emerging) Community Based Rehabilitation programmes. Methods: A literature study was done using different (non-)electronic sources. In addition, 26 semi-structured interviews were conducted with different stakeholders (e.g., non-governmental organisations, disabled people’s organisations), and 8 focus group discussions were held with (leaders of) persons with a disability. Question-led analysis was utilised by considering 4 dimensions: rehabilitation outcomes, rehabilitation services, involvement of beneficiaries, and social acceptability. Results: Not much literature is available on the role of traditional leadership in rehabilitation programmes and social welfare. Nevertheless, this study found indications that traditional leadership is still present in contemporary Northern Nigeria. Some Sarakuna improve the socio-economic position of persons with disabilities by functioning as mediators and by their ability to provide social insurance. Their cooperation with multiple stakeholders enables them to distribute food and clothes. Also, since they possess essential information, NGOs are helped to access the community of persons with disabilities. Sarakuna are in a position to promote the inclusion and rehabilitation of persons with disabilities, but often lack necessary skills and training; yet, Community Based Rehabilitation programmes often ignore them. Conclusions and Implications: Community Based Rehabilitation programmes should take better note of social contexts and therefore should also work in the specific context of traditional leadership. In this way, rehabilitation programmes are more likely to meet the expectations of persons with disability.
The Development of a New Quality of Life Questionnaire for Children with Hearing Loss - The Impact of Hearing Loss on Children (IHL-C): Field Testing and Psychometric Evaluation
Purpose: To report the development of user-defined, multidimensional, psychometrically sound Quality of Life questionnaires – Impact of Hearing Loss on Children – IHL-C 69 and Brief IHL-C for children with hearing loss, in two languages - Tamil and English. Methods: 421 problem statements from previous qualitative studies were reduced to a 220-item questionnaire with 7 domains (educational implications, social integration, psycho-social well-being, speech, language and communication, family relationships, leisure time activities and general functioning). After field testing, the domain of leisure time activities was dropped, resulting in a 103-item self-administered questionnaire with 6 domains. This 103-item questionnaire was translated from Tamil to English, and self-administered by children with hearing loss (11-18 years of age) in Special schools (n=100) and Integrated schools (n=100), as well as by normal controls in Integrated schools (n=200). Standard methods were used for item reduction and to evaluate psychometric properties. Results: Psychometric item reduction produced the 69-item IHL-C69 (long version) and 48- item Brief IHL-C (brief version) questionnaires. Psychometric evaluation showed that all the domains of both the questionnaires had good acceptability, high internal consistency (alpha >0.80; intrinsic validity >0.80) and test-retest reliability (0.86). The questionnaires significantly discriminated between the children with hearing loss and the normal controls. The domains of both the questionnaires showed moderate evidence of convergent validity, and discriminant validity derived through hypotheses testing showed mixed results. The translation validity was also determined. Conclusion: The IHL-C 69 and Brief IHL-C are reliable and valid user-defined, multidimensional questionnaires, available for the first time in both Tamil and English languagesin Tamil Nadu, India. Designed to analyse the impact of hearing loss and to determine the quality of life of children with hearing loss, the questionnaires could be used to prioritise the goals for rehabilitation intervention for these children.
Twenty-five years of Community Living: Changes in Support Staff Perceptions
Purpose: The attitudes of support staff towards people with intellectual disability can greatly impact upon an individual’s quality of life and level of social inclusion. However, there are few studies that examine how perceptions and beliefs have changed within one organisation over the past few decades; a period during which there have been major social and government policy changes including deinstitutionalisation, inclusive education and the introduction of the United Nations Convention on the Rights of Persons with Disabilities. In conjunction with a 25th anniversary review of a community-living project in rural Australia, the current research replicated a study from 1987 that examined attitudes of staff with respect to people with intellectual disability, and thematically compared the findings of the two questionnaires. Method: In 1987,a purpose-designed questionnaire was developed and completed by 15 direct care staff. This 10-item tool asked for basic demographic information and for the participants’ perceptions of people with intellectual disability and their own work roles in the disability sector. This tool was replicated in 2013 and was again completed by 15 direct care staff from the same organisation. Results: The thematic analysis indicated a number of differences between the 1987 and 2013 cohorts in regard to their attitudes. The wide acceptance of the rights of people with intellectual disability was one key change. There was an age separation found within the 2013 cohort, with older participants (> 50 years of age) more likely to display similar attitudes to the 1987 group than the younger participants (<30 years old). Dealing with the problem of ageing-related issues, something that was not obvious 25 years ago, was now considered of major importance. There was evidence that disability support was increasingly recognised as a valid career choice, with a substantial difference in motivation found between the two age groups. Across both cohorts, direct exposure to the realities of the job was seen to be the best training for new employees. Conclusions: The past 25 years have seen positive developments in both social acceptance and expectations for people with disabilities. Individuals are now viewed in a realistic but more positive light. As an exemplar of this change, concerns about individuals entering a consenting sexual relationship have changed dramatically, and what was once an issue of major concern is now no longer raised. While the training provided to staff has changed significantly over the past 25 years, on-the-job exposure to people with intellectual disability, combined with support from peers, is still perceived as vital for developing a quality support network.
The Application of Focus Group Discussions and Interviews in Community Physiotherapy
Copyright (c) 2014 The Author(s) https://creativecommons.org/licenses/by/4.0
Knowledge and Beliefs about Ear and Hearing Health among Mothers of Young Children in a Rural Community in South India
Purpose: To study the knowledge and beliefs about ear and hearing healthcare among mothers from a rural community. Method: In 1 week, 6 focus group discussions were conducted across 6 villages of a district in Tamil Nadu in southern India. The participants were 60 mothers who had children below 5 years of age. Results: Mothers in this rural community had information about some aspects of ear and hearing healthcare. They were aware that use of hairpins and safety-pins to clean ears was harmful; they were knowledgeable about ways to identify hearing ability (child responds to name call, verbal instructions, and startles at loud sounds); and, conditions like consanguinity and malnutrition of expectant mothers were recognised as risk factors for hearing loss. However, misconceptions also existed. The practice of pouring herbal juices to remove insects in the ear continued; there was the perception that all children with a hearing problem were “deaf”, and a lack of awareness about the possibility of partial/unilateral hearing loss. Regarding the age of identification, mothers believed that a child’s ability to speak and the ability to hear was pertinent to assess hearing. None of the mothers related normal speech development to normal hearing. Conclusion: For the success of a community-based hearing screening programme, it is important to utilise the existing knowledge of the mothers, and simultaneously attempt to fill in gaps in knowledge and clarify misconceptions. These measures will facilitate greater compliance from the community in achieving the goals of early identification and early intervention for problems of hearing loss.
Disability Inclusion in Primary Health Care in Nepal: An Explorative Study of Perceived Barriers to Access Governmental Health Services
Purpose: Persons with disabilities face additional barriers in accessing primary healthcare services, especially in developing countries. Consequently the prevalence of secondary health conditions is higher among this population. This study aims to explore the perceived barriers to access primary healthcare services by persons with disabilities in the Western region of Nepal. Methods: 10 primary healthcare providers and 11 persons with disabilities (physically or visually impaired) were selected by non-governmental organisations from the hilly and lower areas. Based on the International Classification of Functioning and the health accessibility model of Institute of Medicine, semi-structured interviews were conducted and analysed using analytical induction. Results: In general, healthcare providers and persons with disabilities reported similar barriers. Transportation and the attitude of family members and the community were the main environmental barriers. Even with assistive devices, people still depend on their families. Financial barriers were mainly reported, such as lack of funds for health expenses, problems in generating an income by persons with disabilities themselves, and the low socio-economic status of their families. Personal barriers, which affect help-seeking behaviour in a major way, were most often mentioned in relation to financial and socio-environmental barriers. Low self-esteem of the person with disability determines the family’s attitude and the motivation to seek out healthcare. Lastly, poor public awareness about the needs of persons with disabilities was reported. Conclusions: Besides the known physical environmental barriers, this study found several environmental, financial and personal barriers that also affect access to primary healthcare. In particular, the attitudes of families and poor financial conditions seem to be interrelated and greatly influence help-seeking behaviour. Implications: There is a definite need to educate primary healthcare providers who work at the community level about disability-related health conditions, and train them to diminish barriers to access health services. In addition, the government support system for persons with disabilities should be revised and implemented accordingly. Lastly, further research is needed to understand the interaction between the reported barriers that influence the inclusion of persons with disabilities in healthcare.
Assessing Parental Role as Resource Persons in Achieving Goals of Early Detection and Intervention for Children with Hearing Impairment
Early detection and intervention for any degree of hearing loss is critical to the linguistic, social and educational development of children with auditory deficit. Since parents and family members are in a position to identify hearing loss at an early stage, they can play a vital role in achieving the goals of early identification and intervention for their children. Purpose: This study was conducted to determine the age at which parents and significant others begin to suspect hearing impairmentin their children, and to advocate for using them as resource persons in the early detection of hearing loss. Method: Parents of children with hearing impairment were retrospectively surveyed and interviewed to determine the age at which suspicion, diagnosis, fitting of amplification and initiation of interventions occurred. Results: Interviews revealed the average age to be 16.5, 24.3, 31.7 and 33.4 months, for suspicion, diagnosis, fitting of amplification and initiation of early intervention for hearing loss respectively. The obtained age of suspicion is lower than the age of identification of hearing loss reported in Indian literature. The current study found delays in diagnosis and fitting of amplification, both of which are essential to initiate early remedial programmes which facilitate development of speech and language skills in children with hearing impairment. Surprisingly, it was found that these delays were caused by professional failures. Conclusion: It is emphasised that parents are in the best position to detect hearing problems in their children, and can be effectively utilised as manpower/equal partners in achieving the goal of early identification of hearing loss. The study outlines appropriate ways and means to facilitate early identification and provide effective intervention for children with hearing impairment. Implications: In the absence of a universal hearing screening programme for newborn infants, parents can be used as manpower/resource persons to identify children with hearing impairment.
Barriers to Early Diagnosis, Intervention and Social Integration of Children with Developmental Disabilities: A Qualitative Study from Rural Villages and a Poor Urban Settlement of Bangalore, South India.
Purpose: Children with developmental disabilities,if given skilled early intervention, have the potential to lead productive lives and can contribute to the social and economic development of their communities. This study explores the barriers to early diagnosis and intervention for children with developmental disabilities who live in rural and urban areas of Bangalore city, India. Methods: The study was conducted in selected villages of Devanahalli Taluk in Bangalore Rural District, and in DevaraJeevanahalli (DJ Halli), a shanty town in Bangalore city. The qualitative study design consisted of in-depth interviews and focus group discussions (FGDs).Parents of children with developmental disabilities, doctors practising in the area and school teachers were interviewed using a purposive sampling framework. An inductive, data-driven thematic analysis was carried out. Results: The physician-related barriers were identified as lack of skills and understanding of children with developmental disabilities, lack of knowledge and resources, lack of specialist back-up services, and communication difficulties with regard to conveying bad news to clients. Parent-related barriers were financial constraints, delay in accepting the diagnosis, and prevalent myths, beliefs and stigma pertaining to disability. The teachers viewed children with special needs as an additional responsibility, and were also apprehensive about the attitudes and interaction of normal children at school with children with disabilities. Limitations: Although the conditions are more or less similar in the different shanty towns and villages in South India, inclusion of more such settlements and villages using probability sampling would have increased the external validity of the study. Implications: Better understanding on the part of parents, doctors and teachers can influence rehabilitation policy and practice, thereby facilitating early diagnosis and rehabilitation of children with developmental disabilities.
Community Mobilisation in a CBR Programme in a Rural Area of Sri Lanka
Purpose: This article examines community mobilisation in a model administrative division of the national community-based rehabilitation (CBR) programme in Sri Lanka. Method: After comprehensively analysing local human resources related to the CBR programme at the study site, the focus of the study was on volunteers (n = 17), youth club members (n = 7), and local government officers from multiple sectors(n = 33). A semi-structured interview, focus group discussion and case information provided data, which was collected through social work practice in line with a previously developed one-year action plan. Narrative data was analysed using a qualitative procedure. Results: The findings suggest that the local supporters, including people with disability, made a positive contribution to the CBR programme, and felt satisfied with the activities. Although the local resources and opportunities for people with disability are limited, the analysis points to the importance of coordination, attitudes, and mutual support rituals by villagers, in promoting community mobilisation. Conclusions: Although it is an exploratory study with a limited sample of stakeholders at one study site in Sri Lanka, the study contributes to a growing body of literature that suggests the significance of community mobilisation in CBR. Future studies could explore some of the issues identified here, such as promotion of community-based inclusive development (CBID). However, since a limited sample of stakeholders was involved, findings can be generalised only to a similar context and setting.
Exploring a Model of Effectual Learning for a Student Speech Pathology Placement at a Community-Based Rehabilitation (CBR) Centre in Malaysia
Purpose: Speech-language pathologists in Malaysia typically do not work within CBR. Therefore, exploring the use of services through a non-traditional student placement was a crucial first step in understanding how to develop capacity for such services. It was also important to develop an understanding of the ways in which the implementation of this student placement influenced learning in the context of a Malaysian CBR programme. Method: An action research study was designed to implement and evaluate student speech-language pathology (SLP) placement within a Malaysian community-based rehabilitation (CBR) centre for children with communication disabilities. Data collection involved the learning experiences of key adult stakeholders (students, workers, parents, and the principal research investigator (PI) or lead author). Results: Study findings indicated that all adult learners became better empowered by working together. Workers involved in impairment-focussed rehabilitation activities grew in understanding and skills when supported by relevant professionals.The importance of mentoring as a learning-teaching relationship was demonstrated. Conclusion: While the study has indicated that the setting is beneficial as a student placement, the development of a specialisation in CBR for allied health professionals would be a relevant way forward in the Malaysian context.
Narratives Around Concealment and Agency for Stigma-reduction: A study of Women affected by Leprosy in Cirebon District, Indonesia
Purpose: This study analyses the experiences of women affected by leprosy, taking into consideration whether they concealed or disclosed their status, and looks specifically at their ‘agency’. The aim is to provide recommendations for stigma-reduction interventions. Methods: The study population consisted of women affected by leprosy who live in Cirebon District, Indonesia. Study subjects were purposively selected on the basis of characteristics such as age and role in the community. After informed consent was obtained, they were interviewed in their homes. Data was collected through semi-structured in-depth interviews. Analysis was done with six points of focus: who knows, care, social stigma, feelings, self-isolation and agency. Results: In total, 53 women were interviewed. Eight were omitted due to ambiguity over who knew about their leprosy status. Five different categories of ‘disclosure’ were identified, ranging from 1 woman who concealed completely to 19 (42%) who disclosed fully. Disclosure created possibilities for care and support, which 84% mentioned they received. In contrast, disclosure was also found to be linked to negative feelings, isolation and social stigma, which 18 women experienced. The women coped with this through acceptance, comforting themselves, trusting in God, focussing on recovery, friendship or finding inspiration in others. Conclusions: An analysis of these experiences helps to understand how women affected by leprosy are coping, and what they are already doing for and by themselves. This could be a starting point for more appropriate and effective stigma-reduction interventions. It is recommended to consider the following: i) assisting people with their choice, if any, of either concealment or disclosure, ii) the appropriateness of any intervention for people who (want to) conceal their illness, iii) the existing sources of care and support, and iv) the inner strength demonstrated and its three sources (spirituality, relationships and the desire to be cured).
Investing in Community-based Physiotherapy: the Non-economic Benefits
Comparative Effect of Massage Therapy versus Kangaroo Mother Care on Physiological Responses, Chest Expansion and Body Weight in Low Birthweight Preterm Infants
Massage therapy (MT) and Kangaroo Mother Care (KMC) are both effective in increasing the weight of low birthweight preterm infants. However no comparisons have been made until now between the two. Purpose: The aim of this study was to compare the effectiveness of MT and KMC on body weight, physiological responses and chest expansion of low birthweight preterm (LBWPT) infants. Method: Using convenience sampling, 20 LBWPT infants from the Neonatal Intensive Care Unit of VS Hospital were randomly divided into 2 groups of 10 each. Group 1 received MT and Group 2 received KMC for 15 minutes, thrice daily for 5 days. Medically stable babies with gestational age <37 weeks and birth weight <2500g were included. Those on ventilators and with congenital, orthopaedic or genetic abnormality were excluded. Outcome measures including body weight, physiological responses (heart rate, respiratory rate and body temperature) and chest expansion were taken pre-intervention on day 1 and post-intervention on day 5. Level of significance was kept at 5%. Results: Data were analysed using SPSS version 16. Both MT and KMC were found to be effective in improving body weight (p=0.005, p=0.007), decreasing heart rate (p=0.005, p=0.004), respiratory rate (p=0.018, p=0.004) and body temperature (p=0.005, p=0.007), and improving chest expansion (p=0.026, p=0.014). However, while both were found to be equally effective for body weight (p=0.341), heart rate (p=0.22), respiratory rate (p=0.969) and chest expansion (p=0.331), MT was found to be better than KMC in decreasing body temperature (p=0.003). Conclusion: MT and KMC were both found to be equally effective, though MT appeared better at decreasing body temperature. Limitations: Factors that may affect the physiological responses and body weight were not monitored. ­­Implications: Massage Therapy and Kangaroo Mother Care can be used in the community for weight gain, improvement of chest expansion and regularisation of physiological responses among preterm infants.
Profile of Childhood Health Conditions referred to Physiotherapy and Attributing Factors to Disablement
Purpose: This study attempted to profile the prevalence of childhood health conditions and the factors that contribute to the disablement process and thus leading to disability among children who visit a tertiary referral hospital in Mysore, India. Method: A mixed methods approach was adopted. Phase 1 of the study delineated the profile of cases being referred for physiotherapy treatment. Cases of Cerebral Palsy were reported to be the highest (46%). Phase 2 of the study identified 4 major themes based on the mothers’ experiences with their children. Result: The findings revealed the need to create awareness among paediatricians about the importance of early intervention in childhood disorders and optimal referral to physiotherapy. The other themes which emerged included various attitudes of family and society, lack of cooperation from school as well as the presence physical barriers in school and community and frustration experienced by caregivers due to lack of help and facilities. Conclusion: There is a need to educate parents and society at large that disability should not be associated with “abnormal”. It is rather an interrelated phenomenon where the health issues of an individual and the outlook of society both play an important part.
Fatigue and Functional Capacity in Persons with Post-Polio Syndrome: Short-term Effects of Exercise and Lifestyle Modification Compared to Lifestyle Modification Alone
Purpose: Post-polio Syndrome (PPS) affects polio survivors many years after the initial attack, and causes new musculoskeletal symptoms and decline in physical function. This study aims to compare the effect of exercise and lifestyle modification versus lifestyle modification alone, on fatigue and functional capacity in persons with PPS. Method: An experimental study was conducted at the physiotherapy department of VS Hospital in Ahmedabad. As per the criteria of Halstead (1985), 21 PPS subjects who were between 18 and 65 years of age, and able to walk indoors and outdoors, with or without assistive aids, were included. They were randomly allocated into 3 groups using the envelope method. Those with physician-diagnosed respiratory or cardiac insufficiency, disabling co-morbidity which interfered with the intervention programme or influenced the outcome, and those unable to cooperate due to cognitive impairment or use of any psychotropic drugs, were excluded. Fatigue and functional capacity were measured using Fatigue Severity Scale (FSS) and 2-minute walk distance, respectively. Physical and psychological functions were assessed using Patient Reported Outcome Measurement Information System (PROMIS) questionnaire and Patient Health Questionnaire (PHQ-9) respectively. Intervention was given for 5 days a week, over 4 weeks. Group A received exercise and lifestyle modification, group B received lifestyle modification alone and group C continued their usual routine for 1 month. Results: There was a significant difference in fatigue and functional capacity within groups A and B, with group A showing better reduction in fatigue than groups B or C. Physical function improved only within group A, and a significant difference was seen compared to groups B and C. Psychological function showed no difference within or between the groups. Conclusion: There was improvement in fatigue, functional capacity and physical function in PPS subjects after 4 weeks of exercise and lifestyle modification. Lifestyle modifications alone for 4 weeks improved fatigue and functional capacity in PPS subjects. There is significant reduction in fatigue and improvement in functional capacity when lifestyle modification advice is given along with exercise. Limitation: Long-term follow-up of the subjects was not undertaken, blinding was not possible, and confounders such as the number of body sites with residual paresis, duration and number of new neuro-musculoskeletal symptoms, and level of physical activity were not considered.
Characteristics and Quality of Life Among People Living with HIV at Drop-in Centres and Shelter Homes in Malaysia
Purpose: The aim of the study was to examine whether there are any significant differences in demographic characteristics and health-related Quality of Life (QoL) among people living with HIV (PLWH) at shelter homes and drop-in centres in Malaysia. Method: 117 PLWH were recruited by using the purposive sampling method. Data were collected through a questionnaire survey. Results: Significant differences were found between PLWH at shelter homes and drop-in centres, in their demographic characteristics and in the 3 factors in the HIV/AIDS-Targeted Quality of Life Instruments (HAT-QoL) – namely, overall function, health worries, and provider trust. Conclusion: Due to the differences in characteristics and QoL among PLWH in these two settings, different approaches are suggested to assist PLWH from shelter homes and drop-in centres.
A Transect Walk to Establish Opportunities and Challenges for Youth with Disabilities in Winterveldt, South Africa
Winterveldt was one of the 9 sites included in a national study to determine the livelihood strategies of youth with disabilities, undertaken by the Occupational Therapy Departments of 6 Universities in South Africa. Community-based rehabilitation (CBR) programmes were initiated in Winterveldt in the 1990s by non-governmental organisations and the Occupational Therapy Department at the University of Limpopo - Medical University of South Africa (MEDUNSA). Purpose: This paper describes the use of a Transect Walk to identify aspects of context that contribute to the vulnerability of youth with disabilities with regard to their livelihood strategies. Method: Transect Walk was employed as a participatory rapid-appraisal tool to gather data. Convenience sampling was used to identify 11 participants, including three youth with disabilities. Field notes and observations were analysed deductively for themes related to the 5 categories of livelihood assets. Results: The findings describe the natural and built environment, the access to health, educational and financial services, and the social attitudes of people in this community towards youth with disabilities. The discussion uses the 5 CBR components as a framework to explore strategies for enhancing the assets of youth with disabilities, namely, empowerment, social, health, education, and livelihood. Conclusions: There is significant development that could be maximised if youth with disabilities were aware of their rights and were able to access services and resources. The implication for local government is to create an inclusive environment in which youth with disabilities are able to participate in mainstream youth development opportunities.
Perceived Needs Related to Social Participation of People with Leprosy-related Disabilities and other People with Disabilities in Cambodia: A Qualitative Study
Purpose: The objective of this study was to describe the similarities and differences in perceived needs related to social participation of persons with leprosy-related disabilities and other persons with disabilities in Cambodia, and to suggest key interventions to promote participation in the community. Methods: A cross-sectional study was conducted. People with leprosy-related disabilities were selected at home during field visits or at the rehabilitation centre for people with leprosy in Phnom Penh. People with locomotor disabilities were selected at the rehabilitation centre for persons with disabilities in Phnom Penh and Prey Veng. A pilot-tested, face-to-face semi-structured interview, with open and closed questions, and focus group discussions were used to investigate the perceived needs related to social and economic participation in the community. The interview was based on the International Classification of Functioning, Disability and Health (ICF) model of the WHO. Results: Both groups of people with disabilities struggle with social exclusion in society. People with leprosy-related disabilities, in particular, live below the poverty line of US$ 0.5 per day. Most of the participants lived in rural areas. Participants raised the need for enhanced self-esteem and help in finding jobs. To overcome the difficulty in finding employment, they felt vocational training and microcredit to start businesses, were required. Conclusions: The study found that both groups of people with disabilities have similar needs to improve participation in social and economic life. Rehabilitation centres provide vocational training and microcredit. Self-help groups have also proven effective in reaching poor people with disabilities in rural areas and improving social participation. The authors suggest that it is best to form multi-disability self-help groups to empower all the affected people and help fight poverty.
Knowledge Management-based Classification Method for Disability-Inclusive Business
Purpose: This study provides evidence to clarify disability inclusiveness in activities of rural business. As an alternative to the analysis method that deals with disability-inclusiveness as a vague concept, knowledge management principles were applied to propose a classification method for disability-inclusive business as an emerging concept at the community level. Methods: The analysis focuses on: 1) productivity of entrepreneurs with disabilities; 2) knowledge of entrepreneurs with disabilities; and 3) understanding of customers. A total of 50 entrepreneurs with disabilities in micro and small businesses in Southeast Asia were identified in this context. Data was collected and analysed according to a story-based knowledge management approach and value chain analysis. Fuzzy logic analysis which exploited domain ontology was utilised to convert knowledge from tacit to explicit, in line with knowledge management principles. A numeric weight based on linguistic variables became available to describe each disability-inclusive business case, as well as the arrangements of fuzzy sets. Results: Out of 50 cases, 7 were classified as fully disability-inclusive while 14 were classified as not disability-inclusive. Productivity of entrepreneurs with disabilities in 3 elements of the value chain, namely procurement, product/service development and distribution, was observed to be significant. It was proven that disability-related knowledge of entrepreneurs with disabilities could contribute to business performance according to the key success factors to enhance added value. Two elements of the value chain, namely sales/marketing and customer service, are not the decisive factors to clarify disability-inclusiveness. Conclusion: Settings in Southeast Asia are diverse and at varying stages of economic and social development; hence the environment which promotes the disability-inclusive business concept may become inconsistent. Micro and small-scale rural businesses were tackled as a first step to evaluate comparative efforts of each case of disability-inclusive business from the viewpoint of entrepreneurs with disabilities. Therefore, in highlighting the differences, it is recommended that further research should seek to apply weighting factors depending on the individual size, contents and scale of major business areas.
Computer-based Communication Aid using EEG for Paralytic Clients
Evolution of Community Physiotherapy in India
Despite the urgent need for physiotherapy services for underprivileged communities, Community Physiotherapy is not a sought-after specialisation in India. Physiotherapists tend to serve in institutions rather than at community level, as a result of which this field of healthcare has stagnated. This article, based on an interview with one of the country’s eminent community physiotherapists, gives a first person account of the evolution of community physiotherapy in India and provides qualitative inputs to deal with the prevalent issues. While the need for services has increased, there has been no matching growth in the pool of physiotherapists willing to work in the community. Several recommendations have been made, including changes in approach to community physiotherapy by both physiotherapists as well as community organisations in India.
Improving Disability and Rehabilitation Systems in Low and Middle-income Countries: Some Lessons from Health Systems Strengthening
Aim: This report seeks to draw attention to, summarise, and make inferences from the “Good Health at Low Cost” studies for the area of disability and rehabilitation service delivery. Methods: Key findings from this series of important studies are identified. Based on reflection, potential implications for CBR and inclusive development systems in low and middle income countries are identified. Conclusions: These studies underscore the importance of organisational, political and systems thinking to improve service systems in low and middle income countries. They reinforce the importance of sustained and visionary political action and lobbying. They show that substantial improvements can be made to service systems despite limited resources. Implications: The advancement of CBR and disability-inclusive development is dependent on effective systems in low and middle income countries. Participatory research to inform such system strengthening is vital.
Developing the Content of a New Quality of Life Questionnaire for Children with Hearing Loss
Habilitation and rehabilitation call for a paradigm shift from the traditional intervention programmes which focus on physical functioning to programmes that include aspects of physical, psychological and social wellbeing. Purpose: To develop a quality of life instrument, using focus group discussions to assess the outcomes of interventions for school-going children with hearing loss. Methods: Separate focus group discussions were held with children with hearing loss between 8 and 18 years of age, special educators and mothers. Focus group discussions were conducted separately for boys and girls. Each focus group had 8–10 participants. In-depth interviews were conducted with the heads of institutions and rehabilitation professionals. Fathers had to complete self-administered questionnaires. The focus group discussions were guided by topics and probes drawn from literature reviews, and were audio recorded, transcribed and analysed. Results: Around 421 problem statements were classified under 7 themes: Educational implications; Social integration; Psycho-social wellbeing; Family relationships; Speech, language and communication; Leisure and recreation; and General functioning. Education and career aspirations were considered to be most important. The problem statements revealed that the primary focus of training was on improving academics. Integration and feeling comfortable with social situations were cited as limitations; as also, the preference for friendship with people of similar abilities. For the majority of children, leisure and recreation was limited to watching television. Parents and siblings were considered vital to their progress and achievements. Conclusions: Multidimensional and varied perspectives of different stakeholders, especially family members, are necessary for a comprehensive analysis of the impact of hearing loss on the quality of life of school-going children.
What has worked for Bringing Out-of-school Children with Disabilities into Regular Schools? A Literature Review
Purpose: A literature review was undertaken to determine (a) what is currently being done to bring out-of-school children into schools and retain them there; (b) what has succeeded in bringing out-of-school children into schools and retaining them; and (c) what is being done to bring out-of-school children with disabilities into schools? Methods: Various databases were searched to identify relevant articles for the review. Only articles published after the year 2000 were included in the analysis. Results: A total of 23 articles were reviewed. The review identified economical, socio-cultural and school-related variables that contribute to children being excluded from schooling. Various strategies that have worked to bring out-of-school children into schools include alternative education, rebates and incentives, and community awareness programmes. Conclusions and Implications: The review found that there is insufficient research on out-of-school children with disabilities. However, research on the population of children without disabilities has implications that can be relevant to children with disabilities.
Violence Against Persons with Disabilities in Bidar District, India
Violence and sexual violence against persons with disabilities at community level are serious issues. Though CBR programmes and DPOs are expected to prevent violence and offer support to the victims, there is very little information about their role in this regard. Purpose: This research aimed to assess the level of violence and sexual violence experienced by DPO members, and the role played by CBR programmes in preventing it. Method: The study involved a non-random consecutive sample of 146 persons with disabilities from 3 sub-districts of Bidar district in Karnataka, India. Using a structured questionnaire, interviews were conducted by a group of trained DPO members and CBR workers, many of whom had personal experience of violence. The data was entered using Epi-Info and then converted into spreadsheet tables for analysis. Results: 58% of the sample reported having experienced violence and 14% reported experiences of sexual violence during the previous 12 months. Girls and women reported higher levels of violence at different age groups. Male children and young adults reported having experienced more violence, including sexual violence, than older men. The research did not provide conclusive evidence that participation in the CBR and DPO activities played a protective role. Conclusions: Violence and sexual violence against persons with disabilities are serious problems. More research on the subject, in terms of roles of CBR programmes and DPOs, is needed.
Survey of Reproduction Needs and Services: Situation of Persons with Spinal Cord Injuries
Purpose: This article explores the reproductive wants and needs of persons with spinal cord injuries (SCI), along with factors that influence these needs and the services available to them. Method: The study sample comprised persons with SCI from China Rehabilitation Research Centre who matched the research criteria and consented to participate. Data collection took place through questionnaires and in-depth interviews. After the objectives, contents and methods of the survey were explained, 63 respondents answered the questionnaire, and 17 of them (15 men and 2 women) agreed to participate in the in-depth interviews. All the respondents were above 18 years of age, either unmarried or married, and childless. Results: It was found that 85.7% of the respondents wished to have children. The more severe the SCI, the less was the desire for children. Those with higher levels of education were less inclined to have children. While financial situation had little impact on the wish for children, the impact of traditional concepts was significant. The reproductive experiences of other SCI clients had a significant influence on respondents’ desire to have children. More than 50% of the respondents were ignorant that they could have babies after SCI. 96.8% of them believed that a child played an important role in marital stability. Though 54% of the respondents wished to have their sexual and fertility problems addressed in medical and rehabilitation institutions, 93.7% said they had not received any such professional services during the previous year. Conclusions: Although most persons with spinal cord injuries are very keen to have children, their wants and needs are not recognised and little attention is paid to specialized service provision to address their needs. This study suggests that steps such as improving awareness, disseminating knowledge and setting up institutions to provide professional services are necessary to address reproductive needs and to protect the reproductive rights of persons with SCI.
A Population-based Study on the Prevalence of Impairment and Disability Among Young Cambodian Children
Purpose: This population-based study aimed to estimate the prevalence of impairment and disability and associated risk factors among children between 2 – 9 years of age in Cambodia. Method: A two-phase method was employed. In phase 1, children were screened using the Ten Question Screening Instrument (TQSI) developed for the World Health Organisation (WHO). Those identified positive, were then referred to phase 2 for a detailed multi-professional assessment. A further 10% of children pre-selected at random were also referred to phase 2. Treatment needs for children with disability and risk factors for their disability were also determined. Results: Prevalence of impairment was estimated at 15.59% (95% CI: 15.05, 16.14), disability at 10.06% (95% CI: 9.16, 10.1) and moderate/severe/profound at 3.22% (95% CI: 2.96, 3.49). Cognition (5.48%. 95% CI: 5.15, 5.83), speech (motor) (2.05%. 95% CI: 1.85, 2.27), speech (language) (1.80%. 95% CI: 1.61, 2.01) and hearing (2.51%. 95% CI: 2.29, 2.76) were the most common disabilities. History of difficult delivery, child’s age, major injury, gender and large family size were significant predictors of disability. Analysis of ‘false negatives’ in the validation group suggested that many parents and caretakers were unaware of their child’s disability. Treatment needs were found to be very high, approaching 100% for children with moderate or worse disabilities. Conclusions: Prevalence estimates based on this study are more than 10 times higher than those reported in Cambodia's 2008 National Census. The identified risk factors imply the need for substantial expansion of obstetric services. Education and awareness of disabilities in the population and strategies to prevent injuries require more government attention. Limitations: The main limitation was the relatively low response rate in phase 2, following referral from phase 1, despite efforts made to encourage attendance. This issue would need to be addressed in future work.
Investing in Community-based Physiotherapy
Using AVAZ to Enhance Communicative Abilities of a Child with Cerebral Palsy
Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments. Affected children can experience mild to severe difficulties in expression. Those with little or no functional speech frequently rely on non-speech communication systems to augment or replace natural speech. These systems include speech generating devices (SGDs). AVAZ is a portable speech synthesizer which can be controlled by the gross motor movements of a child with cerebral palsy. Purpose: This case study describes the outcomes of a pilot investigation that utilised AVAZ as a means of enhancing functional communication in a young girl with cerebral palsy. Method: A 7-year-old girl with cerebral palsy and complex communication needs was trained for 10 sessions to develop requesting ability by pointing to the desired pictures on the AVAZ. Results: After the training sessions, the child showed improvement in social interaction and functional communication. Conclusions and Implication: The collaborative efforts of an interdisciplinary team, comprising a speech pathologist, a physiotherapist, parents of the child and a social worker, made it possible to enhance the child’s confidence and functional communication using AVAZ. Hence it is important to pursue client-oriented, innovative and collaborative intervention approaches among team members.
Community-based Inclusive Education: Best Practices from Nicaragua, El Salvador, Guatemala and Honduras
This article highlights some lessons about the strategy of community-based inclusive education, drawn from in different programmes in Latin America. Having worked in the region for several years as a CBR advisor and special education teacher, the author provides insights into the progress that has been made. Early detection of disability followed by early education, with support from within the community, helps children with disability to participate in mainstream schools. Sensitisation of the public can overcome discrimination and exclusion. Teachers have to be trained to adapt teaching methods for the benefit of those with special needs. The author concludes that communities ought to initiate these strategies in their local schools as inclusive education is good for all children.
Physiotherapy Training to Enhance Community-based Rehabilitation Services in Papua New Guinea: An Educational Perspective
This paper describes the training of physiotherapists as community based rehabilitation (CBR) team members to assist persons with disabilities living in Papua New Guinea (PNG). At Divine Word University (DWU), PNG, a unique physiotherapy training programme integrates CBR into the curriculum and trains students to analyse and understand the basic needs of individuals with disability, and meet these needs within the scope of national and international policies. Community visits and clinical placements familiarise the students with the true situation of persons with disabilities. The specific outcome of the CBR unit is that students learn how to think critically and address the main issues faced by persons with disabilities and communities in the education, health, social, empowerment and livelihood domains. CBR plays a major role in assisting and promoting basic services for persons with disabilities within the limited resources available in countries like PNG. The authors conclude that equipping physiotherapy students with CBR skills will eventually lead to improvement in service delivery.
Community-Based Rehabilitation Programme Evaluations: Lessons Learned in the Field
Purpose: There is limited guidance available on the best ways to evaluate community-based rehabilitation (CBR) programmes. In this paper, we share lessons learned on suitable evaluation strategies for CBR through a South African programme evaluation. Method: An empowerment evaluation of an early childhood development programme was conducted in April 2012. At the end of the field visit, parents, staff members and managers provided feedback anonymously about what they liked and disliked about the evaluation, and offered their suggestions. The principal investigator documented the evaluation process in a journal, recording the barriers and facilitators encountered, the participation of the 3 groups and the effectiveness of the different strategies used. The data analysis followed the principles of grounded theory. Results: The main lessons learned about CBR programme evaluation are associated with strategies to: 1) foster active participation, 2) collect accurate and credible information, 3) build local capacity, and 4) foster sustainable partnerships. Time spent to promote a positive learning spirit and the use of participatory tools with all groups appeared critical to active engagement in evaluation activities. Sharing tools and experiences in context built more local capacity than was achieved through a formal workshop. The findings also highlight that a flexible model, multiple data collection methods, and involvement of all relevant stakeholders maximise the information gathered. Sensitivity to the impact of culture and to the reactions generated by the evaluation, along with ongoing clarifications with local partners, emerged as core components of sustainable partnerships. Conclusion: CBR evaluators must use a variety of strategies to facilitate active engagement and build local capacity through the evaluation process. Many of the strategies identified relate to the way in which evaluators interact with local stakeholders to gain their trust, understand their perspectives, facilitate their contribution, and transfer knowledge. Further research is needed on how to conduct empowering CBR programme evaluations.
Generation and Content Validation of Mobility Domains and Item Pool for Community-dwelling Individuals
Mobility disability can affect a wide range of activities, from difficulty in turning in bed to problems of riding a vehicle. The existing scales do not include all the relevant items for mobility within the community. There is therefore a strong need to develop a scale with items which are comprehensive and culturally relevant to community-dwelling individuals. Purpose: This study was conducted to generate the mobility domains and item pool for community-dwelling individuals, and to validate the content. Method: The method includedextensive research into literature on existing mobility scales, and direct interviews with 20 persons with chronic mobility disability who livewithin their community. The generated items were grouped under the relevant domains and subjected to content validation by 10 experts.Items were judged on the basis of relevance, and acceptance of the item or domain was conditional on a70% minimum level of agreement between the experts. Results: Ninety-nine items and 14 domains were generated by the literature search and direct interviews. The items were grouped under the 14 domains,according to their relevance and purpose. Content validation resulted in the elimination of 44 items and 5 domains as per the criteria for agreement. Items and domains were also modified to improve relevance and reduce ambiguity. Conclusion: A comprehensive mobility item pool for community-dwelling individuals, with items ranging from simple to the most challenging tasks under the proposed domains, has been generated and content validated. The development of a new mobility disability scale which uses these items, and evaluation of its psychometric properties is recommended. Limitation: Confirmatory factor analysis could not be done to evaluate the fit of items under proposed domains.
Breaking the Barriers: Ghanaians’ Perspectives about the Social Model
Purpose: The social model of disability emphasises the identification and removal of barriers to the inclusion of persons with disabilities in mainstream society. The study examines issues associated with the exclusion of women with physical disabilities in Tamale, Ghana, and makes recommendations for the effective participation and inclusion of persons with disabilities, especially the women, in society. Method: Data was gathered through in-depth individual interviews and focus group discussions. Purposive and snowball sampling were used to recruit 10 women with physical disabilities for the in-depth interviews. Purposive sampling was also used to recruit 14 representatives from government and civil society organisations for 2 multi-organisational focus groups. Using open coding and line-by-line analysis, themes and categories were identified. Themes that emerged from the focus groups and from the individual interviews were compared and contrasted to arrive at conclusions about the participation of women with physical disabilities in mainstream society. Results: Study participants identified barriers (attitudinal, institutional, architectural, transportation, and information) and suggested methods to eradicate them and foster inclusion. At the same time they felt that it was equally important to change certain attitudes of persons with disabilities (ignorance about available resources, opportunities and potential, low levels of self-confidence, and negative reactions to societal attitudes) which contribute to their exclusion from society. Conclusion: Advocacy interventions are recommended, which include public education, building relationships and mobilising the public for advocacy campaigns. Decision-makers need to be persuaded to make additional policies and/or enforce existing ones, to promote the inclusion and effective participation of persons with disabilities in society.
Children with Disability in Nepal: New Hope Through CBR?
Purpose: This study assesses the impact of a community-based rehabilitation (CBR) programme on the quality of life (QoL) of children with disability and their families. Methods: A qualitative approach was applied, using two techniques - a ranking line and semi-structured interviews. Nineteen children (ranging from 4 –18 years of age) were interviewed in their homes located in three villages - Chapakhori, Bokraha and Madesha - in Nepal. Results: Children with disability and their families ranked physical health, psychological health, empowerment and level of independence as the most important factors for their QoL. Of the 19 children, 13 had experienced positive changes in their life and 1 child reported a negative change. The positive changes related mainly to their physical health and functioning. The impact of these changes was felt in the ‘social’, ‘level of independence’ and ‘empowerment’ outcome categories. The children mentioned that they had more friends, experienced less stigma, could go to school and were more hopeful about the future. Conclusions: This CBR programme has brought about changes in the QoL of all children with disability and their families. The majority of them reported a positive impact.
Total Hip Arthroplasty Rehabilitation in Cambodia
Cambodia has recently seen the dawn of a new era in medical practice. Total hip replacement (THR) operations are now available for those who require these services. Post-operative rehabilitation is the crux of a successful hip replacement programme. In this article, the authors discuss their experiences in rehabilitating THR clients in Cambodia, and introduce what they think is the country’s first specific protocol for rehabilitation of post- THR clients. In 2007, the Children’s Surgical Centre became one of the first providers to offer THRs in Cambodia. From the start, physiotherapists have provided post-operative rehabilitation but, to date, there has been no official protocol to address the specific challenges for THR rehabilitation in this part of the world. Multiple social and cultural factors mean that established protocols from the developed world are not wholly suited to the needs of Cambodian clients. Bearing in mind the lower literacy levels, poverty, language barriers, specific cultural and economic needs of the clients and the unique forms of transportation in Asia, the authors have developed a programme, including a guide with simple Khmer instructions, customised pictures, and a separate client education sheet. The results seen among the THR clients seem promising -there is scope in the future to assess longer term outcomes of THR clients in Cambodia.
Barriers and Facilitators to Family-centred Paediatric Physiotherapy Practice in the Home setting: A Pilot Study
Purpose: Family-centred paediatric physiotherapy practice is a new and emerging concept in India. This study aimed to understand paediatric physiotherapists’ perceptions of the barriers and facilitators to such practice in home settings in Salem city in southern India. Methods: A phenomenological research design was employed in this study. Semi-structured telephone interviews were conducted with a convenience sample of 5 paediatric physiotherapists who offer treatment in the home setting. Open coding analysis revealed themes that were broadly categorised into barriers and facilitators to family-centred paediatric physiotherapy practice in these settings. Results: Physiotherapists identified several barriers such as educational status, frustrated family members, protective family members, cultural beliefs and external influences. Active participation of family members was perceived as a facilitator to family-centred practice. Limitations: This pilot study has a number of limitations. As the sample size was small and the participants were selected from a small city, the results may not be generalised to larger areas of India. Also, since the interviews were conducted in English, which was not the physiotherapists’ first language, some nuances of their perceptions may not have been reflected. Implications: The study suggests that paediatric physiotherapists need to have better understanding of parental attitudes, and family culture and beliefs, in order to improve the physiotherapist-family relationship and maximise the outcome for children.
Presentation and Impact of Pain in Persons with Post-Polio Syndrome: A Cross-sectional Survey Study
Purpose: It is a common and well‐recognised phenomenon that functional deterioration occurs many years after people are affected by poliomyelitis infection. This study aims to determine the presentation of pain in subjects with post-polio syndrome (PPS) and also the correlation between severity of pain and interference in activities of daily living (ADL). Method: A cross-sectional survey was conducted among 72 persons with PPS in Gujarat state in India. Each one was given a self-administered questionnaire which included an 11-point Numeric pain rating scale (NRS) for intensity of pain, questions about site, duration and diurnal variation of pain, and an 11-point Numeric pain rating scale for pain interference. Results: The study showed that 17 persons (24%) had only joint pain, 28 (39%) had only muscular pain and 27 (37%) had both joint as well as muscular pain. The highest number of subjects or 34 persons (47%) had knee pain, followed by 24 (33%) with shoulder pain, 21% with hip and 19% with low back pain. Muscle pain was maximum in arm musculature, as reported by 33 persons (45%), followed by pain in leg and foot muscles among 25 (36%) and 17 (23%) persons, respectively. Maximum number of subjects or 31% had pain while working which was relieved by rest, while 28 % had pain which continued all day. 43% experienced more pain in winter while 57% had no seasonal variation in pain. 30 persons (42%) had severe pain, 26 had moderate pain and only 16 had mild pain. Mean pain intensity was 5.88 ±1.52. Interference in ADL on NRS was 4.72 ±2.70. Interference in ADL and pain intensity were found to be positively correlated with Pearson’s co-efficient r=0.6295(p<0.0001). Conclusion: The majority of those who had recovered from polio experienced increased or new symptoms and problems in ADL, muscle pain, joint pain, and difficulties in walking.
India’s Disability Policy – Analysis of Core Concepts of Human Rights
Purpose: To analyse India’s National Policy for Persons with Disabilities (2006), using a Human Rights approach. Method: A framework analysis was carried out using EquiFrame, which analyses policies for inclusion and quality of Core Concepts of Human Rights and inclusion of Vulnerable Groups. Results: India’s National Policy for Persons with Disabilities scored 67% for Core Concept Coverage, 24% for Core Concept Quality and 42% for Vulnerable Group Coverage. This gave the policy an overall ranking of Low quality. Conclusions: The current policy for persons living with disabilities in India would benefit from being updated to encompass the Core Concepts of Human Rights. Limitations: Further analysis of policies in areas such as health, education, social protection and transport would lead to a more in-depth analysis of the country’s integration and streamlining of disability across all policies.
The Relationship Between Gross Motor Function and Quality of Life Among Children with Cerebral Palsy
Purpose: The aim of this study was to determine the relationship between gross motor function and quality of life among children with Cerebral Palsy (CP). Method:This observational analytical study with cross-sectional design, was conducted at Yayasan Pembinaan Anak Cacat (YPAC) Bandung, Sekolah Luar Biasa (SLB) Cileunyi, and Paediatric Neurology Clinic of Dr. Hasan Sadikin Hospital Bandung, Indonesia, from March 2011 to September 2012. Gross motor function was assessed using Gross Motor Function Scale (GMFCS). Cerebral Palsy-Quality of Life (CP-QOL) questionnaire for parent-proxy version was used to assess quality of life of children with CP. Statistical analysis was done using Spearman rank test to determine the relationship between variables. Results: Participants were 31 children with CP, between 4 -12 years of age. The most common type of CP was spastic quadriplegia (17 of the 31 children). Around 17 children had mild disability (GMFCS level I and II), 3 children had moderate disability (GMFCS level III), and 16 children had severe disability (GMFCS level IV and V). Majority of the parents had senior high school level education. Most of the fathers were self-employed while most of the mothers were housewives. Gross motor function was not significantly correlated to quality of life in general in children with CP (rs=-0.153, p=0.205). Although gross motor function was significantly correlated to pain and the impact of disability (rs=-0.313, p=0.043), other aspects of quality of life (social well-being and acceptance, feeling about functioning, participation and physical health, emotional well-being and self-confidence, access to services, and family health) were not significantly correlated (p>0,05) to it. Conclusions: Gross motor function in children with CP was correlated to pain and the impact of disability domain of quality of life.
Caregiver’s Involvement in Early Intervention for Children with Communication Disorders
Purpose: Since very young people benefit from early identification of communication disorders, the primary caregivers (generally the parents) become the fulcrum of the intervention services provided. This article studied the measures taken to empower caregivers, as part of the early intervention services offered at the All India Institute of Speech & Hearing (AIISH) in Mysore city in India, and the impact this has had on their wards’ progress. Method: A survey was conducted among the caregivers of 205 clients who availed of early intervention services. Five-pronged data was collected, pertaining to family demographic details, early intervention measures for their children with communication disorders, type and intensity of caregiver empowerment measures provided along with early intervention services, resultant caregiver participation in the education and training of their wards, and the consequent development in children with communication disorders. The mutual influences among these factors were analysed using simple correlation measures. Results: The findings revealed that informal, but continuous and consistent efforts to empower parents, such as counselling and guidance, had a better impact. Empowered caregivers in turn contributed towards the education and training of their children with communication disorders, resulting in improved development of their wards’ communication skills and academic achievements. Conclusion: The evidence adds strength to recommendations that caregiver empowerment and participation need to become integral components of early intervention services for young children with special needs.
Empowerment in Community-based Rehabilitation and Disability-inclusive Development
Purpose: This paper seeks to contribute to discussion on the understanding and measurement of empowerment of people with disabilities in developing countries. A novel, text analysis approach was used to depict the way in which empowerment is characterised in conventional measures in Western settings. This was then compared with depictions and analyses of the way in which empowerment is characterised in documents that have more relevance to developing countries. Method: First, computer-based content and concept analysis was applied to three key empowerment measures. This was compared with analysis of responses to a recent online survey of empowerment conducted by the United Nations Department of Economic and Social Affairs (UN-DESA). Visual representations in the form of “word clouds” were generated to depict key concepts within each data source. Second, to provide specific detail regarding how empowerment has been described in documents which relate to developing countries, more detailed computer-assisted lexical analysis was performed on the text of responses to the UN-DESA survey, and on the text of the Empowerment component of the CBR Guidelines. Results: Initial “word clouds” illustrated considerable discrepancy between concepts inherent in the three most relevant empowerment measures when compared with responses to the UN-DESA survey relating to empowerment in a development context. Subsequent lexical analysis depicted greater specificity and ranked the concepts associated with empowerment in key disability and development-related documents. Conclusions: Conventional Western measures of individual empowerment may not adequately encompass the broader social, economic and community orientation of empowerment as described in documents from disability and development circles. Further research is required to substantiate these novel and speculative indications.
Impact of Community-based Rehabilitation on Persons with Different Disabilities
There are some barriers that persons with different kinds of impairments commonly face, and there are also some impairment-specific barriers. Disaggregated data are needed to assess the impact of different CBR activities on different groups of persons with disabilities. Purpose: This article assesses the impact of CBR on key variables linked to the five domains of the CBR Matrix, on 4 groups of persons with disabilities - visual, hearing and speech, physical and intellectual disabilities. Method: A questionnaire survey was carried out involving 2,332 persons with disabilities, in a random stratified sample of villages covered by a CBR programme, in 9 sub-districts of Karnataka state (India) and in a control area. Data were collected pertaining to different activities in the lives of persons with disabilities. Through a participatory approach involving CBR workers and DPO representatives, some key indicators were identified to assess the impact of CBR on the five domains of the CBR Matrix - health, education, livelihood, social participation and empowerment. Results: Among all the 4 groups of persons with disabilities, the CBR programme was found to have had a positive impact across all the five domains of the CBR Matrix. However, there was no uniform impact on different variables among the 4 groups; different groups of persons with disabilities benefited differently from different activities. Persons with physical disabilities seemed to benefit in more areas compared to persons in the other groups. Conclusions: CBR programmes can have a positive impact on persons with visual, hearing and speech, physical and intellectual disabilities. Disaggregated data can help CBR programmes to identify groups of persons who benefit less from specific activities and adopt strategies to improve their participation.
The Role of Resource Information Centres in the Community Based Rehabilitation Framework
Community Based Rehabilitation (CBR) programmes aim to utilise the existing resources in the community for persons with disabilities. This paper describes the role of the Resource Information Centres (RICs) set up in the aftermath of the earthquake in Pakistan, as part of the CBR framework. The authors perused relevant literature and added inputs from their experience regarding the role of RICs. The majority of persons with disabilities are not aware of the facilities available in their local areas. The RICs could play a vital role in guiding them to access the existing facilities comprehensively. RICs also carry out a variety of activities that facilitate social integration of persons with disabilities.
Copyright (c) 2013 The Author(s) https://creativecommons.org/licenses/by/4.0
CBR for Inclusion of People with Mental Illness
In 2004, a Mental Health Pilot Project was implemented in Gujarat State, India, for the rehabilitation of persons with mental disorders in community settings, along the lines of the CBR model. The state government, in collaboration with the Royal Netherlands Embassy, selected the Blind People’s Association (BPA) to design and implement the programme. Working closely with NGOs and local communities, this private-public partnership established referral links with government hospitals to provide medicines and counselling to affected persons. At the end of 18 months, 1206 people (diagnosed with schizophrenia, mania, depression and epilepsy) had accessed psychiatric services on a regular basis, and 272 people had recovered and resumed their earlier occupations. As a result of the pilot project, it may be concluded that rehabilitation of people with mental illness is possible outside of hospital settings.
Protecting Children with Disabilities from Violence in CBR Projects: Why we need to work with a different form of child protection policy for children with disabilities
Children with disabilities encounter more violence in their lives than their peers without disability. Organisations involved in Community Based Rehabilitation (CBR) come across many cases of violence against the children they work with. Many organisations have no policy on child protection since it is not within the scope of their expertise. Others work with child protection policies that are hard to apply in the realities they deal with. Through research done in Ethiopia, with a recent update, the author attempts to show that there is a need for policies in CBR, that follow a community approach rather than an individual approach to child protection.
Use of Skype to Educate Underprivileged Blind Children in India: Motivations, Barriers and Teaching Strategies
Purpose: The primary objective of the study was to explore the barriers that volunteers face and the strategies they employ when teaching blind children via Skype. It also attempted to understand the difference in methodologies used in teaching blind children and other underprivileged children. Method: In February and March 2013 an online survey was conducted with 8 volunteer teachers who work with two development programmes in South India, supported by the Ann Foundation, a non-government organisation based in New York, United States. Results: Volunteers find that teaching blind children through Skype is challenging as well as rewarding. Poor internet connectivity in the remote villages of the country is a major technical barrier. The interaction barriers are lack of advanced learning devices and specific teaching expertise to maintain the children’s interest in learning. Strategies to enhance learning among the blind children included the use of contemporary topics, fun activities, songs and storytelling. Conclusions: There are a unique set of barriers when teaching blind children through Skype. While most of these can be overcome with facilitatory learning approaches, volunteer teachers continue to struggle with the barriers of poor internet connectivity and reluctance on the part of blind students to participate in the class. Limitations: The sample size was small, numbering only 8 volunteers who, however, provided many insights. Since they were based in different parts of the world, it was not possible to conduct one-to-one interviews, which might have yielded more information.
Effect of an Experiential Dysphagia Workshop on Caregivers’ Knowledge, Confidence, Anxiety and Behaviour During Mealtimes
Purpose: Children with cerebral palsy who have associated feeding difficulties are at risk of aspiration and poor nutrition. This study aimed to measure the changes in knowledge, confidence, anxiety and behaviour among 25 Sri Lankan mothers with responsibility for feeding children diagnosed with cerebral palsy, after they attended an experiential workshop. Methods: Data collection was done through pre- and post-workshop questionnaires, observations and semi-structured interviews. Results: There was a significant improvement in reported levels of knowledge and confidence and a decrease in the caregivers’ level of anxiety during mealtimes. The qualitative data analysis indicated changes in participant knowledge, particularly about the signs of aspiration and positioning during mealtimes. Observations showed better adherence to recommendations on communication, bolus size and utensils. Conclusion: The findings support the utility of experiential training for caregivers, to ensure that children with cerebral palsy are fed safely.
Evaluation of Environmental Barriers faced by Wheelchair Users in India
Purpose: Environmental factors restrict the extent to which people with disabilities can participate in society. The reduction of environmental barriers will increase their participation in the social, educational and vocational spheres of life. With the use of a valid and reliable tool - the Craig Hospital Inventory of Environmental Factors (CHIEF) questionnaire - this study aimed to evaluate the environmental barriers faced by wheelchair users in Bangalore city, India. Method: A convenience sample of 100 wheelchair users, between 16 and 40 years of age, and working in different institutions in Bangalore, participated in the study. The CHIEF questionnaire was administered to each participant. It consisted of multiple questions pertaining to the 5 components of environmental barriers faced by wheelchair users: Accessibility, Accommodation, Resource availability, Social support and Equality. Percentage values for the responses in each component were calculated. Results: The results showed that 52% of wheelchair users faced problems in Accessibility on a daily basis, and 77% of them felt the problem was big. With respect to Accommodation, 41% faced problems once a month and 50% of them felt that this was a big problem. The maximum percentage of participants did not face problems in Resource availability (43%), Social support (50%) and Equality (59%), and therefore these aspects were not felt to be a big problem. Conclusion: An understanding of the environmental barriers faced by wheelchair users can provide guidance in mapping policies and strengthening laws which would help to improve their quality of life.
The Rapid Assessment of Disability – Informing the Development of an Instrument to Measure the Effectiveness of Disability Inclusive Development Through a Qualitative Study in Bangladesh
Purpose: The Rapid Assessment of Disability (RAD) questionnaire was developed to provide governments and development agencies with an appropriate instrument to determine the prevalence of people with disability within their target populations, and to design and evaluate the effectiveness of disability inclusive activities in addressing their priorities and needs. Method: The RAD questionnaire was developed using two conceptual frameworks: the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), and the International Classification of Functioning, Disability and Health (ICF). Existing instruments were reviewed to inform the structure and content of the RAD questionnaire. The RAD questionnaire that was developed for field testing in Bangladesh comprised both a household questionnaire and a questionnaire for individuals within each household, with 5 sections: 1) Demographic information, 2) Assessment of functioning, 3) Awareness of rights of people with disability, 4) Well-being and quality of life, 5) Participation in the community. Prior to field-testing the RAD questionnaire in Bangladesh, a qualitative study was conducted to ensure the relevance of the questionnaire in the context of a developing country. In-depth interviews with 9 people with disability and a focus group of 8 parents of children with disability were conducted in Dhaka, Bangladesh. Results: Qualitative findings highlighted factors relevant to the lives of people with disability in Bangladesh, including discrepancies between the awareness and attainment of rights for people with disability, the wellbeing of people with disability and their families, as well as numerous barriers to full participation in their community. While the findings confirmed that the design and content of the questionnaire reflected all these aspects, some changes were made to the items in the questionnaire to ensure that it reflected the views of people with disability from the context of a developing country. Conclusion and Implications: This qualitative study was an important step in the development of the RAD questionnaire as it helped to achieve its aim - namely, to establish the prevalence of disability and to assist in the design and evaluation of disability inclusive interventions in the setting of a developing country.
Perceptions about Barriers to Sexual and Reproductive Health Information and Services among Deaf People in Ghana
Purpose: This study aimed to provide insights into factors that influence the acquisition, accessibility, and utilisation of Sexual and Reproductive Health (SRH) information and services by deaf people who communicate using Ghanaian Sign Language (GSL). Methods: The study explored deaf people’s perceptions about barriers to SRH information and services in Ghana. There were 26 participants in 3 focus groups: 10 executives of Ghana National Association of the Deaf (GNAD), 7 deaf adult males and 9 deaf adult females. A key informant, who had experience in working with deaf people, was also interviewed. Review of documents and observations helped to clarify data gathered from the focus groups. Results: Study findings indicated that when accessing SRH information and services in Ghana, deaf people encounter numerous barriers such as problems with communication, ignorance about deafness, negative attitudes, and services that are not customised to their needs. Conclusion: If it is to succeed, any SRH programme for the deaf community must make the eradication of communication barriers a priority, since communication is fundamental to all challenges that deaf people encounter.
Organisations of Persons with Disabilities and Community-based Rehabilitation
Over the last few decades, there has been a growth in community-based rehabilitation (CBR) programmes in different parts of the world. These programmes are regarded as one way of strengthening the implementation of the UN Convention on Rights of Persons with disabilities. CBR programmes and Organisations of persons with disabilities (DPOs) have developed parallel to one another and are interlinked in different ways. CBR can play a role in the setting up and strengthening of DPOs. On the other hand, DPOs can also initiate and run CBR programmes. Both share similar objectives in terms of respect for human rights of persons with disabilities. This article looks at the historical evolution of connections between CBR and DPOs, analyses some of the areas where their activities are interlinked, and presents 2 case studies - one from Santarem metropolitan area in Brazil and the other from Bidar district in India - to demonstrate those links.
Virtual Volunteerism and its Impact on International Community Development
An Integrated Multimodal Intervention of Remedial and Adaptive Approaches in Secondary Dystonia of Hand: A Case Report
Purpose: To evaluate an integrated approach of remedial and adaptive interventions that were employed to improve functional independence of a young woman with childhood-onset secondary dystonia of the right hand. Methods: The intervention involved inhibiting dystonic movements, functional training with correct movement patterns, and activity modifications. The techniques combined multiple modalities (static and dynamic orthoses, electrical stimulation, purposeful activities, and adaptations), therapeutic exercises (stretching, inhibitory strategies and strengthening), sensorimotor training and motor learning strategies. Results: After a year-long intervention of supervised therapy sessions and home programmes, there were improvements in dystonia severity (25%), hand functions (38%) and disability scores (30.3%). Conclusion: The intervention outlined is a positive therapeutic approach to enhance function in secondary dystonia of the hand.
Speech and Language Disorders in Children with Intellectual Disability in Bosnia and Herzegovina
Purpose: The goal of this study was to assess the prevalence of speech and language disorders (SLD) in children with intellectual disability. Method: The sample comprised 167 children of both sexes, with mild and moderate intellectual disability of varied etiologies. Data on their language disorders were taken from the educational records in the school files. Results: It was demonstrated that the total prevalence of SLD in this sample was high (71.3%). While there were no statistical differences in the prevalence of SLD in relation to the sex of the child, there were significant differences in relation to the level and etiology of intellectual disability. Conclusion: Given the high prevalence of SLD, it is necessary to provide speech and language therapy to all children with intellectual disability who attend regular schools and special education centres. Speech therapy should begin as soon as they are admitted to preschool and school institutions.
Effects of Multisensory Training on Balance and Gait in Persons with Type 2 Diabetes: A Randomised Controlled Trial
Purpose: Progressive deterioration of physical function occurs in persons with Type 2 diabetes and peripheral neuropathy. This study assessed the effects of multisensory training on balance and gait in persons with diabetic neuropathies. Method: Thirty two persons with peripheral neuropathies were enrolled, randomised, and subdivided into 2 groups - an experimental group of 16 participants with diabetes (65 ± 2.12 years) and a control group of 16 participants with diabetes (68 ± 2.17 years). For 6 weeks, both groups were given health education on diabetes for 30 minutes a week. In addition, the experimental group practised a multisensory exercise programme for 30 minutes, 3 times a week over 6 weeks. Outcome measures used were ‘timed up and go’ test for assessing balance and ‘6-minute walk’ test for gait. Standard descriptive statistics were used to report means, standard deviation, and range for baseline characteristics. Paired and unpaired ‘t-tests’ were used wherever necessary, to determine significant differences in data among groups and between pre-test and post-test scores (p<0.05). Results: By the end of the trial period, the intervention group showed a significant improvement in scores of the ‘timed up and go’ test (t= 14.7092), but there was no statistically significant difference in the ‘6-minute walk’ test scores (p=0.7206, t= 0.3644).There was no difference for both measures in the control group. Conclusion: The study showed that multisensory exercises could improve balance in persons with Type 2 diabetes and peripheral neuropathy. The findings suggest that along with physiological sensory factors, cognitive-behavioural factors and strengthening of the lower limb muscles should be considered when treating diabetic persons with gait alterations.
Early Care following Traumatic Spinal Cord Injury (TSCI) in a Rehabilitation Centre in Bangladesh - An Analysis
Purpose: The study aimed to explore the outcome of current practices in the treatment of persons with traumatic spinal cord injuries (TSCI) in Bangladesh, through the stages of rescue and first contact with physician, transportation to the tertiary hospital and intermediate admission. Methods: This observational study was conducted between June and August 2011, at the Centre for the Rehabilitation of the Paralysed (CRP), in Dhaka, Bangladesh. From the 113 persons with SCI admitted at CRP during this period, 56 persons with TSCI were selected. With the help of a questionnaire, data were collected from these persons or their attendants by trained staff, and also taken from hospital records. Data were processed and analysed by SPSS software version 16. Results: The male-female ratio among the study participants was 5.25: 1, with a mean age of 33.02 years. 55.3% of them were paraplegic, while 44.7% were tetraplegic. About 70% of the injuries were complete according to ASIA impairment scale (AIS) during admission at CRP. The most common causes of injury were falls (50%), followed by road traffic accidents (RTA) and carrying loads on the head. 74.8% of the injured persons had been rescued from the accident site by local people but only 16.1% had been transported by ambulance. The spine board had never been used. More than half of the injured received initial treatment only at a sub-district or district hospital where none of the requisite facilities were available. While being transported from one hospital to the other, 10.7% experienced neurological deterioration of some sort. Significant statistical correlation was found between mode of transfer (P <0.03) and intermediate admission (P<0.001) with neurological deterioration. Conclusions: There is an urgent need to implement pre-hospital trauma care in Bangladesh. Since resources and places for the rehabilitation of persons with TSCI are scarce, regional and national spinal injury centres should be established without delay. Limitations: The study focussed only on a small sample of persons with TSCI undergoing treatment at a single centre.
Social Skills Training of Children with Learning Disability
Purpose: The ability to recognise emotions in oneself and in others is a fundamental prerequisite to function successfully in the social world. Emotion recognition deficit in people with learning disability may therefore be an important contributory factor to deficits in social skills and poor social adaptation. This study aimed to examine the level of emotional understanding in students with learning disabilities (LD). Method: A pre-test, post-test equivalent groups design was adopted for this study. The focus was on identification of emotions through verbal and pictorial situations, and the appropriate expression of emotions. Training was provided to enhance the emotional understanding of students through the use of ‘I C ME’ module. The 6 emotions addressed in this study were anger, excitement, embarrassment, jealousy, love and anxiety. 30 children with LD, in the age group of 9-12 years, were selected for the study. Results: It was seen that while children with LD had difficulty in the identification of an emotion, they found it more difficult to express the emotion in a socially appropriate way. The post-test results indicated that the training provided to the students significantly improved their emotional understanding. Conclusions: The students learnt about the 6 emotions (anger, excitement, embarrassment, love, jealousy, and anxiety), the vocabulary associated with these emotions, and also the appropriate way to express, self-monitor and self-regulate each emotion. Limitations: Intervention was done for only 6 emotions.
The Application of ICF-based Functioning Data on Home Environment Adaptation for Persons with Disabilities
Purpose: This study illustrates how the International Classification of Functioning, Disability and Health (ICF) domains and qualifiers could be used to create functioning profiles of persons with disabilities in order to plan environmental changes. The outcome of the interventions can be measured by before-and-after comparisons of these profiles. Method: 33 persons with disabilities (11 each from three provinces), with an average age of 43 years, were interviewed between November 2011 and May 2012. 67% of them were male. The functioning profiles of all the subjects were used as guidelines for home environment adaptations. Results: The data helped to understand the limitations of persons with disabilities and identified the areas that needed enhancement to improve their functioning. Modification lay-outs were provided for all 33 persons with disabilities. Conclusion and Implications: It was demonstrated that the ICF framework could help create functioning profiles to guide modifications in the home environment. Future studies should examine whether ICF can measure actual changes that occur after the modifications.
Exploring Knowledge and Attitudes towards HIV/AIDS among Deaf People in Ghana
Purpose: By exploring the level of knowledge about HIV/AIDS and attitudes towards persons with HIV/AIDS among deaf people in Ghana, this article aims to identify and correct possible gaps in awareness. Methods: A participatory sexual and reproductive health (SRH) needs assessment was conducted, targetting deaf people who were fluent in the Ghanaian Sign Language (GSL). The study design was a two-phase, sequential, mixed methods approach. Three focus groups assisted in the development of a survey, which was then implemented for needs assessment data collection. The 179 study participants consisted of 26 focus group participants, 152 survey respondents and 1 key informant. Of the focus group participants, 7 were executives of Ghana National Association of the Deaf (GNAD), 10 were adult males, and nine were adult females. Apart from the key informant, all the participants were deaf persons. Results: The study indicated that many respondents still had misconceptions about HIV/AIDS and had difficulty identifying preventive methods, but their attitudes towards persons with HIV/AIDS was generally positive. Conclusion: More attention needs to be paid to the requirements of the deaf community and to designing HIV/AIDS programmes and services that are deaf-friendly and accessible.
Training CBR Personnel in South Africa to contribute to the Empowerment of Persons with Disabilities
Purpose: Recent conceptualisations of community based rehabilitation include empowerment of persons with disabilities as a key activity. This article reports on a study which explored the training of mid-level CBR workers in South Africa, with a specific focus on the ability of the course participants to address the oppression and empowerment of persons with disabilities. Method: Over a three-year period, one cycle of action research was conducted in a non-government organisation that conducts mid-level CBR training in South Africa. Data collection methods included in-depth interviews with staff, students and past graduates of the course, document analysis, participatory rural appraisal techniques and two focus group discussions with the students’ clients. Results: Personnel, who had been trained in CBR before the year 2003, were found to have some difficulty in explaining the social model of disability and the oppression of persons with disabilities at a cultural and structural level. It was noted that after changes were implemented in the CBR course, the students had an orientation to working with, rather than for, persons with disabilities. They began to understand the complexities of empowerment and also engaged in social action to address the oppression of persons with disabilities. Conclusions: The CBR Guidelines require a new skill-mix in mid-level CBR personnel. This study illustrates a possible training approach which can contribute to the development of these skills. Limitations: The findings of this action research study were intended to improve practices in a specific organisation. However, the insights gained can be used elsewhere. With the limited resources available for the project, external validation of the results was not possible. Triangulation of methods and data sources was used to address the possibility of researcher bias.
Disability Evaluation Related to Movement Disorders in India: A Need for Policy Revision
Disease and Disability in the Elderly: A Call for Research
Accessibility of Students with Physical Disability to Washrooms in Bungoma Bus Terminus, Kenya
Purpose: To assess the accessibility of students with physical disability to washrooms in Bungoma main bus terminus. Method: A case study approach was used. Data were collected through a structured questionnaire and an observation schedule. A total of 108 respondents from three schools participated in the study. Results: It was established that washrooms in the area were narrow and full of barriers which hampered access to the facilities. Respondents experienced difficulty in using the washrooms due to the narrow doors, high thresholds and lack of grab bars. Conclusion: This study concluded that the numerous barriers in the washrooms of Bungoma bus terminus hampered the safety and mobility of students with physical disability.
Perceptions of Primary Caregivers of Children with Disabilities in two Communities from Sindh and Balochistan, Pakistan
Purpose: This study explored the perceptions, attitudes and practices of primary caregivers towards children with disabilities in two communities from Sindh and Balochistan, in Pakistan. Method: Six focus group discussions and seven in-depth interviews were conducted with 37 women in the two communities – one urban and the other rural. Results: Primary caregivers perceived disability as physical, functional limitations and the absence of any functional body parts. Complications during pregnancy and delivery were regarded as the major cause of disabilities. Lack of financial resources and limited access to medical and rehabilitation services were identified as the main reasons for frustration among caregivers, resulting in their giving reduced attention to the child with disability. Caregivers felt that behavioural problems of children with disabilities were a major challenge, and also limited their participation in social activities. Conclusion and Implication: There is a need to raise awareness among the families of children with disabilities and in the community at large. Home-based community-level interventions are needed to reduce the social stigma attached to children with disabilities.
Excluded in Inclusive Schools: Experiences of Children with Disabilities, their Families and Teachers in Sri Lanka
Purpose: This study examined the experiences of children with disabilities, their parents and teachers at the special education units in 3 public schools, located in the Kandy district of Sri Lanka. Method: The participants were 20 children with disabilities, 18 parents and 8 teachers. In order to examine the influence of physical, social and psychological environments on children’s participation in learning, this qualitative study employed participatory tools, in-depth interviews, focus group discussions and non-participatory observations. The data were manually coded using thematic analysis. Results: Five themes emerged: attitudes, values and beliefs; support and relationships; devices and technology; natural and built environment; and services systems and policies. Factors facilitating or hindering learning were identified within each theme. Parents and teachers tend to focus on the children’s impairments and academic achievements. However, extracurricular activities and supportive relationships were found to promote student participation. Conclusions: Overall, the current practices in Sri Lankan education for children with disabilities did not meet the global recommendations. There is a need to design culturally compatible inclusive education models and to achieve a paradigm shift within all communities towards inclusion.
Problem Behaviour and Academic Grade Level Performance of Adjudicated Children with Juvenile Delinquency
Purpose: This paper attempted to profile the contemporary grade level academic performance as well as the frequency, spread and intensity of problem behaviour in relation to a few associated variables, of children adjudged as juvenile delinquents in India. Method: A cross-sectional exploratory survey design was employed, with randomised convenience sampling of 66 inmates, between 9 and 18 years of age, from two representative Observation Homes. To ascertain their current grade levels, a criterion referenced ‘Grade Level Assessment Protocol’ was prepared exclusively for this study. Another standardised ‘Behaviour Assessment Scale for Indian Children with Mental Retardation, Part B’ was used to profile their problem behaviour. Results: The contemporary academic performance results satisfy the conventional two-grade discrepancy criteria, usually postulated for identifying children with learning disabilities. Among the associated variables examined in this study, inmates who were booked under sections of the Indian Penal Code showed significantly greater academic grade discrepancy compared to the other children. Similarly, poorer academic performance, greater grade discrepancy, as well as higher frequency, spread and intensity of reported problem behaviour were found among children from intact family backgrounds, where parents were illiterates or educated below primary school level, and more among boys than girls, and among those in the 10-12 year age group. Conclusions: While these are tentative findings, they call attention to the need for extensive research on the possible links between academic performance, under achievement and learning disabilities, and juvenile delinquency in this country.
Factors related to Recovery and Relapse in Persons with Stuttering Following Treatment: A Preliminary Study
Purpose: The aim of the study was to investigate and compare factors related to recovery and relapse outcomes after treatment, among adults with stuttering. Method: The participants were 24 adults who underwent fluency therapy and reported for follow-up 6 months after cessation of treatment. Pre, immediate, post and 6-months post-treatment follow-up evaluations were done using stuttering severity instrument SSI-3. On the basis of total scores and severity obtained, participants were then grouped as either recovered or relapsed persons with stuttering. A questionnaire was administered to obtain their ratings for the different domains of factors that contributed to treatment outcomes. Results: A significant difference was found between both the groups with respect to factors contributing to recovery and relapse. The four domains which were found to be more responsible for treatment outcomes in persons with stuttering were: individual related, therapy related, environment related, and behaviour and personality related factors. Conclusion: The study was conducted with fewer participants, and it is possible that there could be many other pre-treatment and post-treatment factors such as attitude, anxiety, and speech naturalness which may influence the treatment outcomes in persons with stuttering. Future research should include these other factors.
Inclusive Education in Bangladesh: Are Pre-service Teachers Ready to Accept Students with Special Educational Needs in Regular Classes?
Purpose: The aim of this study was to examine pre-service special education (PSpE) teachers’ attitudes towards inclusive education (IE) for students with special educational needs (SEN) in Bangladesh. Method: 100 PSpE teachers from a leading teacher education institute in Bangladesh were purposively sampled. A 20-item based survey questionnaire was used to measure participants’ attitudes. Items of the survey were developed from a literature review in which Attitudes Towards Inclusive Education Scale (ATIES) by Wilczenski (1992), Concern about Inclusive Education Scale (CIES) by Sharma and Desai (2002), and Interaction with Persons with a Disability (IPD) Scaled by Gething (1994) were considered as the key specialist resources. Both descriptive and inferential statistics were utilised in the analysis. Results: The results revealed that while the PSpE teachers hold favourable attitudes towards students with SEN, they are concerned about some basic issues of inclusion. Practicum and close contact with children with SEN were found to be important variables which shaped the attitudes of the PSpE teachers. Implications of the findings are discussed and further suggestions are made as to how teacher education institutes may engage PSpE teachers more effectively with their programmes to promote better inclusive practices. Conclusion: The study suggests that there is a need for providing PSpE teachers with experiential learning prior to school practicum.
Leprosy: Knowledge and Attitudes of Physiotherapists in Nigeria
Purpose: The objectives of this study were to investigate the knowledge and attitudes towards leprosy of physiotherapists in Nigeria. Method: A cross-sectional survey of 330 physiotherapists, with minimum one year work experience in public hospitals in the 6 geo-political zones of Nigeria, was carried out. A pre-tested, self administered questionnaire with open and close ended questions was employed. Data obtained were analysed using descriptive and inferential statistics of Chi-square tests with Alpha level at 0.05. Results: The respondents’ mean and range of years of job experience was 8.6 +5.51 and 1 to 27 years respectively. Close to half (44.5%) of the physiotherapists had only a fair knowledge about leprosy and 165 (50%) had poor attitudes towards leprosy and persons with leprosy. There were significant associations between the schools of training and each level of knowledge (χ2 = 45.04; p= 0.0001) and attitudes of physiotherapists to leprosy and to persons who have suffered from leprosy (χ2 = 20.26; p = 0.009). There was, however, no significant association between years of job experience and each of knowledge (χ2 = 4.76; p = 0. 312), or attitudes of the physiotherapists to leprosy (χ2 =4.55; p = 0.337). Conclusions and Implications:It was concluded that a substantial number of physiotherapists in Nigeria had fair knowledge but poor attitudes towards leprosy. The institution of training appears to have an influence on their knowledge and attitudes. It is therefore recommended that educational and training programmes on leprosy should be organised and emphasised at the basic training institutions for physiotherapists. Purpose: The objectives of this study were to investigate the knowledge and attitudes towards leprosy of physiotherapists in Nigeria. Method: A cross-sectional survey of 330 physiotherapists, with minimum 1-year work experience in public hospitals in the 6 geo-political zones of Nigeria, was carried out. A pre-tested, self-administered questionnaire with open and closeended questions was employed. Data obtained were analysed using descriptive and inferential statistics of Chi-square tests with Alpha level at 0.05. Results: The respondents’ mean and range of years of job experience was 8.6 + 5.51 and 1 to 27 years respectively. Close to half (44.5%) of the physiotherapists had only a fair knowledge about leprosy and 165 (50%) had poor attitudes towards leprosy and persons with leprosy. There were significant associations between the schools of training and each level of knowledge (χ2 = 45.04; p = 0.0001) and attitudes of physiotherapists to leprosy and to persons who have suffered from leprosy (χ2 = 20.26; p = 0.009). There was, however, no significant association between years of job experience and each of knowledge (χ2 = 4.76; p = 0. 312), or attitudes of the physiotherapists to leprosy (χ2 = 4.55; p = 0.337). Conclusions and Implications: It was concluded that a substantial number of physiotherapists in Nigeria had fair knowledge but poor attitudes towards leprosy. The institution of training appears to have an influence on their knowledge and attitudes. It is therefore recommended that educational and training programmes on leprosy should be organised and emphasised at the basic training institutions for physiotherapists.
Risks to Client Confidentiality when Communicating Health Information to Blind and Partially Sighted Persons
Purpose: This research was carried out to give a more accurate picture of the particular needs of the blind and partially sighted people living in Scotland. It explores the risks to client confidentiality if information is not provided in accessible formats. Method: Data were gathered from a survey of 228 blind and partially sighted persons in 15 Health Authorities across Scotland. The survey reported NHS clients’ experiences of receiving health information in accessible reading formats. Results: The data indicated that about 90% of blind and partially sighted persons did not receive communications from various NHS health departments in a format that they could read by themselves. Conclusions: The implications for client privacy, confidentiality and the wider impact on life and healthcare have been highlighted. The implications for professional ethical medical practice and for public policy are discussed, and recommendations for improved practice are made.
Challenges Faced by Malaysians with Disabilities in the World of Employment
Purpose: This paper aims to explore and understand the challenges that are encountered by Malaysians with disabilities in the world of employment. Methods: A survey was undertaken in four Northern Malaysian states (Perlis, Kedah, Penang and Perak) to obtain the primary data. Two sets of questionnaires were formulated. The first questionnaire was addressed towards Malaysian people with disabilities, while the second one was for the employers. Descriptive statistics were used to explore, summarise and describe the data collected. Results: This paper argues that integrating people with disabilities into the mainstream workforce should be the way forward, given that they are a pool of untapped human resources. Crucially, this study also highlights some of the key challenges faced by Malaysian people with disabilities, such as discrimination and exploitation at work. Conclusions: This paper concludes that equal employment and training opportunities should be extended to Malaysian people with disabilities, in an effort to integrate them into the mainstream workforce. The existing Disability Act 2008 should be revised to address the challenges and issues highlighted in this paper.
Goal Oriented Activity Towards Life Skill Training: Preliminary Indications of a Task-intensive Approach to Manage Cerebral Palsy
Purpose: To devise a viable programme of intervention for older people with Cerebral Palsy (CP). Methods: Using focus group interviews, a ‘top down’ model of intervention was devised among older children and adolescents with CP. Ten participants volunteered and a custom tailored approach was employed, in keeping with the participants’ goals. Results: The outcomes are described qualitatively. Conclusions: There are preliminary indications that the programme is versatile and feasible. Further trials must be conducted before conclusive comments can be made.
Community-based Physiotherapy in Western India: Some Findings from Surveys
Purpose: The aim of this seven-year project was to understand the perceptions of different client populations (including physiotherapists) towards community health and rehabilitation methods and identify the "gaps" in the existing system. Method: A series of surveys were conducted on several populations with functional disabilities in different parts of western India. Results: It was found that community physiotherapists with adequate motivation, knowledge and skills are insufficient in number. It appears that the community at large is in need of cost-effective preventive strategies to deal with the health problems. Future research should identify the interests of community physiotherapists, and provide adequate resources to increase their existing numbers.
Quality of Life of Nigerians with Unilateral Lower Limb Amputation
Purpose: The aims of this study were to determine the QoL of Nigerians with lower limb amputation and to investigate the influence of some clinical and socio-demographic variables on it. Method: Forty-seven individuals with lower limb amputation participated in this study. Participants’ age, gender, marital status, occupation, time since amputation, level of amputation, affected limb and use of prosthesis were recorded. Quality of life was then measured using the WHO QOL-BREF. Data were analysed using mean and standard deviation, Mann-Whitney U test and Kruskal-Wallis test at 0.05 alpha levels. Results: Participants’ overall health and QoL scores were 3.6(SD 0.9) and 3.9(SD 0.7) respectively. Male subjects had significantly higher scores than females in the domains of physical health (p = 0.007), social relationships (p = 0.024) and overall health (p = 0.012). Prosthesis-wearing subjects scored significantly higher in the domains of physical health (p = 0.015), psychological health (p = 0.008) and environment (p = 0.011) and overall health (0.033), than those not wearing prosthesis. Level of amputation, leg dominance and pre-amputation occupational category had no significant influence on participants’ QoL. Conclusion: The findings of this study suggest that the QoL of individuals with lower limb amputation in Nigeria is moderate. The only factors which have significant influence on some QoL domains are gender and use of prosthesis. Implications: Individuals with lower limb amputation, particularly females and those not wearing prosthesis, require special attention. Clinicians should identify barriers to the use of prosthesis so as to enhance their quality of life.
Knowledge, Beliefs and Perception of Leprosy
Purpose: For intervention to be effective, it is essential that the knowledge, beliefs and perception of a specific social group are taken into account. This is particularly true of leprosy where the problems of social stigma and ostracism are more prominent than the disease itself. There are many misconceptions about the cause, methods of transmission, and treatment. The main objectives of the study were to examine the socio-demographic profile of persons with leprosy and to explore their knowledge, beliefs and perception about the disease and its initial symptoms, within a specific socio-cultural milieu. Method: Semi-structured interviews were held with a persons with leprosy at various clinics and care-homes for affected persons in and around Chandigarh, India. Those who had completed their treatment and those who were still undergoing treatment were included in the study. Data collection was done through case studies and in-depth interviews. Results: The name of the disease varied across different geo-cultural zones. Many respondents who were afflicted with only red patches and had no ulcers, believed that they suffered from a skin disease which would turn into leprosy if proper medication was not received. The perception of 64.9 % of the respondents was that leprosy resulted from supernatural causes like God’s punishment, karma, and sin. Conclusion: There is a need to educate persons with leprosy and their families about the etiology of the disease.
A Framework for Healthcare Provision to Children with Intellectual Disability
Purpose: The Kudumbashree mission, an initiative of the Government of Kerala state in India, has collaborated with Local Self Governments to set up ‘Buds’, a special school system for individuals with intellectual disability. The objectives of this study were to evaluate the structure and functioning of ‘Buds’ schools, to identify the healthcare needs of the students, and to conceptualise a framework for healthcare provision. Methods: A cross-sectional survey was conducted among 202 children at 11 registered ‘Buds’ schools in Kerala. A multidisciplinary team consisting of a psychiatrist, public health personnel and a social worker from the Medical Colleges of Kerala, visited the institutions. Data collection consisted of abstraction from medical records, interviews with parents, and clinical assessment and prescription of intervention by the specialists concerned. A pre-tested semi-structured questionnaire was used for every child. Using both quantitative and qualitative techniques, the public health personnel in the team evaluated the structure and functioning of the schools. Results: The most commonly associated condition was epilepsy, seen in 11.9% of the children, while 28.2% had behavioural problems. The medicines needed were mainly anti-epileptics and drugs for behavioural problems. Interventions for self help and social skill training were also among the important requirements. The infrastructure and other facilities were poor in many schools, with the average student to teacher ratio at 14:1. While these institutions were well utilised, functioning was good only in 27.2% of the schools. Healthcare services and visits by healthcare personnel were far from adequate. This study proposes a framework in which the Medical Colleges and Health Services can function together to deliver healthcare services to children at these schools, with linkages from the District Mental Health Programme (DMHP). Conclusion and Recommendation: Evidence that these schools are well utilised indicates a need to propagate this initiative in other areas of the state, country and other countries. However, improvements in infrastructure, human resources and other logistics are required. Besides, the healthcare needs of these children have to be addressed. A comprehensive healthcare programme through the existing system, using a multidisciplinary approach, needs to be developed.
Music as the Means to Stimulate Novelty and Challenge Seeking in Persons with Intellectual Disability
Purpose: The main aim of the study was to determine whether challenge seeking behaviour could be increased by stimulating persons with intellectual disability with music. The intention was also to evaluate whether the participants would attempt to seek challenges when they felt bored with a music experience. Method: Thirty adolescents and young adults with mild to moderate intellectual disability were randomly selected to take part in a repeated-measure experimental design, under three different conditions. In the first condition, the participants were provided adequate challenges through teaching fundamental musical skills. In the second condition, no optimal challenge was provided, and in the third condition, using special strategies, the participants were stimulated to look for novelty and challenge through involvement in creative musical tasks. Level of innovation, as an index of challenge seeking, was measured during the 8 minutes of free choice interval at the end of each condition. Results: Using Friedman’s ANOVA and Wilcoxon signed-rank test, the findings showed that the low and statistically similar levels of challenge seeking behaviour in conditions 1 and 2 significantly increased to a high level in condition 3. It confirmed that participants with intellectual disability are capable of demonstrating challenge seeking behaviour if they are stimulated to do so. The results also confirmed that the tendency to demonstrate challenge seeking behaviour during a boring musical situation was low.
Human Rights, Social Inclusion and Health Equity in International Donors' Policies
Background: Health policies have the potential to be important instruments in achieving equity in health. A framework – EquiFrame - for assessing the extent to which health policies promote equity was used to perform an equity audit of the health policies of three international aid organizations. Objective: To assess the extent to which social inclusion and human rights feature in the health policies of DFID (UK), Irish Aid, and NORAD (Norway). Method: EquiFrame provides a tool for analyzing equity and quality of health policies with regards to social inclusion and human rights. Each health policy was analyzed with regards to the frequency and content of a predefined set of Vulnerable Groups and Core Concepts. Results: The three policies vary but are all relatively weak with regards to social inclusion and human rights issues as defined in EquiFrame. The needs and rights of vulnerable groups for adequate health services are largely not addressed. Conclusion: In order to enhance a social inclusion and human rights perspective that will promote equity in health through more equitable health policies, it is suggested that EquiFrame can be used to guide the revision and development of the health policies of international organizations, aid agencies and bilateral donors in the future. Limitations: Analyses are limited to “policy on the books” and does not measure how effectively vulnerable groups are included in mainstream health policy work.
Alternative Responses to the Human Resource Challenge for CBR
This commentary outlines some ways of understanding CBR and offers corresponding suggestions for responding to the contemporary human resource challenge it is faced with. It is argued that CBR exists within an increasingly complex reality, characterised by new challenges, new approaches to development and numerous international principles and guidelines. In response, the authors advocate the use of multiple research methods, participatory action and contextualised ways of addressing human resource issues. They suggest that new understandings are required, for future CBR workers to be enablers of people with disabilities, agents of change in communities and societies, and champions of human rights. The complex reality of CBR suggests the need for a CBR cadre which is capable of creative and reflective reasoning. This might be achieved through the participatory development of contextualised training curricula, practical hands-on learning, the use of mentoring, and an emphasis on reflection and adaptability.
The Human Resources Challenge to Community Based Rehabilitation: The Need for a Scientific, Systematic and Coordinated Global Response
The World Report on Disability highlights some of the major challenges in the path to realisation of the rights of persons with disabilities as per the United Nations Convention. While the recently published guidelines on Community Based Rehabilitation show the way to address these challenges, effective implementation would require not only higher levels of investment in human resources, but also a significantly newer and different skill-set for the additional personnel. The authors suggest that a scientifically sophisticated, systematic and coordinated research programme, with global reach and participation, is needed for the establishment of a useful and robust evidence-base for Community Based Rehabilitation interventions. It is also suggested that the development of a new cadre of rehabilitation workers could be a key component of the programme, and could help to alleviate the extant crisis in human resources for health in many low-income countries.
Perceptions of City Dwellers of Kolkata, India about Speech and Hearing Disabilities
Copyright (c) 2012 The Author(s) https://creativecommons.org/licenses/by/4.0
Functional Independence and Quality of Life for Persons with Locomotor Disabilities in Institutional Based Rehabilitation and Community Based Rehabilitation - A Comparative Study
Purpose: To compare the functional independence and quality of life of persons with locomotor disabilities who undergo Institutional Based Rehabilitation (IBR) and similar persons who undergo Community Based Rehabilitation (CBR). Methods: Purposive sampling was done. Thirty males with locomotor disabilities -15 from IBR and 15 from CBR- were selected. Both the groups were first administered the Functional Independence Measure (FIM) questionnaire, followed by the Quality of Life (WHOQOL-BREF) questionnaire. Results: There were no significant differencse between IBR and CBR with regard to functional independence (t value = -1.810, P < 0.05), and with regard to Quality of Life (QOL) (t value of 0.468, P < 0.05).
Efficacy of Family Intervention in Acquired Head-Injury Cases in India
Purpose: In India, there are few studies on interventions for families of persons with acquired or traumatic brain injuries. This study aimed to test the efficacy of the Family Intervention Package (FIP) with caregivers of persons with head injuries. Method: The study was carried out at the Neuro-Surgery Department of the National Institute for Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. Ninety persons with severe head injuries and their caregivers were included in the study using the socio-demographic schedule and family interaction pattern scale. Results: The findings revealed that the Family Intervention Package (FIP) was effective in bringing about changes in the functioning of persons with head injuries, and interactions among their families in the experimental group, as compared to the control group. Conclusion: The multi-disciplinary team dealing with persons with head injury need to recognise the importance of multi-component FIP for this group and their families. The current FIP should be made a part of treatment in clinical settings.
Assessing Children with Language Impairments: A Study on Kannada, a South Indian Language
Purpose: This is one of the first comprehensive studies to assess receptive and expressive language skills in a South Indian language, Kannada. It demystifies language impairments and provides a model for future research to understand other languages in India and in countries around the world. Method: Language impairments were identified in 68 students of Grades 3 and 4, in elementary schools where Kannada was the medium of instruction. The children were assessed in different language components. The results were analysed in terms of their ages and their levels of functioning in each language component and sub-component. Results: As a group, the subjects showed no significant deficits in phonological and semantic skills; however, individual deficits and deficits within sub-component skills of semantics were noted. Mean and individual deficits in auditory reception, aural comprehension and receptive vocabulary were also noted. Deficits in syntax & verbal expression were notably significant. The extent of language delay increases with age, and plateaus at higher ages. Conclusion: Children with language impairments in Kannada, display many similar characteristics in terms of problems in different components of language. Early intervention is called for because the language delay increases as age advances. A thorough assessment reveals specific strengths and weaknesses in language components and skills. This can be used as a starting point to base remediation activities.
Inclusion of Children with Hearing Impairment in Schools: A Survey on Teachers’ Attitudes
Purpose: Inclusion of children with disabilities in mainstream classrooms has become the focus of extensive research in education. It has both academic and social benefits for all students, such as providing opportunities for communication and social interaction. The evaluation of teachers’ attitudes towards inclusion appears to be a good method to determine the success of the programme. Although this has been widely researched in many countries, the available evidence is not consistent. This study was undertaken in the state of Andhra Pradesh in India, to measure and compare teachers’ attitudes towards the inclusion of children with hearing impairment in schools. Method: A questionnaire developed by Giles and Tanner (1995) measuring three domains - (1) effective strategies for meeting the needs of all students, (2) the support for educational change in their district, and (3) inclusive education - was modified in keeping with cultural and geographical variations and used as the test tool. A hundred teachers of various Government and non-Government schools in 2 districts of Andhra Pradesh, India, participated in the study. Results: Higher scores on domain 1 indicate that teachers feel effective strategies to benefit students with disabilities should be implemented in schools. The results also indicate that most teachers are agreeable to the inclusion of students with disabilities in their classrooms. Significant difference in attitudes was observed, based on the teachers’ qualifications, teaching experience, gender, level of teaching and management. Conclusion: The study concludes that there is a need for intervention to foster more positive attitudes among teachers, if the implementation of inclusive education is to succeed. It also has implications for the framing of laws and policies for children with hearing impairments.
Impact Assessment of a Vocational Training Program for Persons with Disabilities in Bangladesh
Purpose: The aim of this study was to evaluate the effectiveness of a vocational training programme in enabling 261 persons with disabilities to find employment in Bangladesh. Methods: A qualitative method, which employed interviews and focus group discussions, assessed the effect of the training programme on key individual, societal and physical factors set out by the WHO International Classification of Functioning, Disability and Health (2001). Results: 157 persons with disabilities (60%) secured employment after training. Of these, 74% reported that they were able to provide a better livelihood for their families, 92% reported increased social acceptance, and 83% reported improvement in overall quality of life. Of those who did not find employment, 15% cited issues related to the training course, 6% mentioned discriminatory attitudes of potential employers and 12% had problems related to physical access. Conclusions and Implications: These results suggest that the vocational training programme improved the (re)entry of persons with disabilities into employment, which in turn aided their rehabilitation. However, discriminatory attitudes towards them at the workplace were reported.
Attitudes of Students towards Peers with Disability in an Inclusive School in Nigeria
Purpose: The majority of children and young people with disabilities live in developing countries where they face inequalities in education and other opportunities. Negative attitudes constitute one of the major barriers to the development of their potential. This study aimed to describe the attitudes of students without disability towards their peers with disability, and to assess the role that gender and interpersonal contact play in shaping these attitudes. Method: A cross-sectional study involving 107 students was carried out at an inclusive secondary school located in a peri-urban area in South Western Nigeria. Participants were recruited from a group of 118 students in the three junior classes and senior class one (JSS 1 to SSS 1). A semi-structured questionnaire containing items on the “Chedoke-McMaster Attitudes Towards Children with Handicaps (CATCH) scale”, which elicits responses on a Likert scale numbered 0 to 4 (0-strongly disagree, 4-strongly agree), was administered. Data analysis was done using Stata version 12. Descriptive analysis was carried out and association between variables was determined using independent two-tailed t-tests. Results: The Cronbach’s alpha coefficient of the scale was 0.83. The attitudes of students in the school were generally positive (M = 22.55, SD = 3.79). Female students had higher total scores (M = 24.76, SD = 2.78) than their male contemporaries (M = 19.84, SD = 3.05), t (103) = 8.55, p = .000. Having a friend/relative with a disability was associated with more positive attitudes among female students. Conclusions: In this inclusive setting, the attitudes of students towards their peers with disability were generally positive. Since interpersonal contact was associated with positive attitudes towards students with disabilities, interventions should be directed towards promoting interpersonal relationships in order to build an integrated society.
Quantitative Exploratory Evaluation of the Frequency, Causes and Consequences of Rehabilitation Wheelchair Breakdowns delivered at a Paediatric Clinic in Mexico
Purpose: The United Nations Convention on the Rights of Persons with Disabilities recognises assistive technology such as wheelchairs (WCs) as a tool for social inclusion for this population. In less resourced settings, organisations lack information about effective models of WC service provision. The goal of this study was to investigate the lifespan of WCs and whether they provided reliable mobility, at one clinic in Mexico. Methods: Caregivers of children, who had requested replacements for their WCs from a clinic in Mexico, were interviewed in Spanish. Among others, the questions pertained to repairs/modifications, adverse events and WC usage characteristics. The owners exchanged their WCs for new ones at the clinic, and the maintenance status of each returned WC was evaluated using the WC Assessment Checklist (WAC). Results: Twenty-three donated WCs, used by children aged 3 to 14 years for an average of 19 months, were evaluated. Brakes (n=18), seat and back-sling upholstery (n=11 and 7 respectively), and armrests (n=14) were the components that failed most frequently. A total of 26 adverse events due to WC failure were reported. Adverse events were significantly associated with poor WAC scores (rs=-0.544, p=0.007). Conclusions: Poor WC reliability, associated with adverse events which could undermine social engagement, indicates the need for a stronger WC and for regular maintenance. For instance, brake failures which were most often associated with adjustment issues, could have been resolved with maintenance, while seat and back-sling upholstery and armrest failures suggest that the WC may not be appropriate for the environment. Future work should investigate the robustness of these WCs using standardised methods (ISO 7176), as well as the impact of maintenance interventions on WC reliability.
Core Concepts of Human Rights and Inclusion of Vulnerable Groups in the Namibian Policy on Orthopaedic Technical Services
Purpose: Despite a highly progressive legislation and clear governmental commitment, living conditions among persons with disabilities in Namibia are systematically lower than among persons without disabilities. This implies that persons with disabilities are denied equal opportunities to participate and contribute to society, and consequently are denied their human rights. Methods: EquiFrame, an innovative policy analysis framework, was used to analyse Namibian Policy on Orthopaedic Technical Services. EquiFrame evaluates the degree of stated commitment of an existing health policy to 21 Core Concepts of human rights and to 12 Vulnerable Groups, guided by the ethos of universal, equitable and accessible health services. Results: A number of Core Concepts of human rights and Vulnerable Groups were found to be absent in the Namibian Policy on Orthopaedic Technical Services, and its Overall Summary Ranking was assessed as Moderate. Conclusion and Implications: The Namibian health sector faces significant challenges in addressing inequities with respect to its policy on Orthopaedic Technical Services. If policy content, or policy ‘on the books’, is not inclusive of vulnerable groups and observant of core concepts of human rights, then health practices are also unlikely to do so. This paper illustrates that EquiFrame can provide the strategic guidance for the reform of Namibian Orthopaedic Technical Services policy, leading to universal and equitable access to healthcare.
Sexual Health of Women with Spinal Cord Injury in Bangladesh
Purpose: To identify factors influencing the sexual health of women with spinal cord injury (SCI) in Bangladesh. Methods: This study used both qualitative and quantitative methods. The quantitative part used a case-control design. Cases were women with SCI and controls were age-matched women without SCI. Questionnaires were used to collect data concerning the sexual health status of women. Multivariate logistic regression was done to determine which factors had an independent effect on sexual health. In-depth interviews were held with a sub-group of women from both groups, and interview guides were used. The in-depth interview data was subjected to content analysis. Results: In total, 92 questionnaires were given out and 30 in-depth interviews were conducted. A relationship was found between physical factors and sexual health, as pain, vaginal dryness and physical discomfort were mentioned more frequently among women with SCI. Environmental and emotional factors such as stigma, satisfaction of the husband and support from the husband and friends had an influence on the sexual health of the women with SCI, as well as the other group of women. Conclusions: From interviews it became clear that most of the women with SCI were dissatisfied with their sexual health as compared to the women without SCI. However, environmental and emotional factors such as attitudes, support and stigma, rather than physical factors, were the most important influences on sexual health in both groups of women.
The New Millennium Development Goals and Inclusive Development
Dr. Pim Kuipers is an Associate Professor, Population and Social Health Research Program, Griffith Health Institute, Griffith University, and Principal Research Fellow, Centre for Functioning and Health Research, Queensland Health, Australia. With degrees in psychology and rehabilitation, he has worked as a psychologist in disability and rehabilitation services for a number of years. As a health services researcher, with a focus on improving health and rehabilitation services in community settings, he has conducted and led many research studies. Dr. Kuipers has also worked as a disability services project advisor in the Lao People's Democratic Republic, and has also advised and evaluated numerous CBR projects in Vietnam, Laos, Thailand, Myanmar and Pakistan.
Enhancing Eye-Hand Coordination with Therapy Intervention to Improve Visual-Spatial Abilities using ‘The Re-training Approach’ in Children with Down Syndrome: Three Case Studies
Eye-hand coordination and visual-spatial abilities are an integral part of a child’s development, since both skills are necessary for functional independence as well as for academic progress. Purpose: This study is aimed at understanding the relationship between visual-spatial abilities and eye-hand coordination based on the ‘Re-training Approach’. An underlying assumption of this approach is that skills learned for one task can be generalised to other areas. Method: Three children with Down syndrome were initially tested for eye-hand coordination, and the tests were repeated periodically throughout the intervention programme which comprised visual-spatial activities. Results: The authors observed that there was a steady improvement in the eye-hand coordination as well as the visual-spatial abilities of children involved in the intensive therapy programme. This improvement manifested in the reduction of time taken to perform the coordination tests and in the errors made while performing the tests.
Financial Aid for the Rehabilitation of Individuals with Spinal Cord Injuries in Bangladesh
In Bangladesh, a majority of individuals with spinal cord injuries (SCI) are either poor or very poor. In most cases, their families undergo extreme hardship as they lose the income of the only or main earning member, and are unable to bear costs of rehabilitation. Purpose: This mixed method study explored perspectives of individuals with SCI regarding financial aid in the form of interest-free loans for their treatment and rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP). Method: In the first part of the study, 10 semi-structured face-to-face interviews were conducted. In the second part of the study, 40 persons with SCI were surveyed. The qualitative method involved selection of respondents according to their age, sex and severity of disability. Quantitative interviews were conducted with all persons with SCI in the final stage of hospital rehabilitation, in the third quarter of 2008. Results: Though CRP provides financial support depending on the individual’s economic status, many persons with SCI needed additional funding from multiple sources, such as savings (42.5%), mortgaging assets (12.5%), selling assets (45%), receiving loans (37.5%), begging for money (42.5%), and receiving donations from relatives (47.5%) or the community (30%), to meet the direct and indirect costs of rehabilitation. Majority (85%) of those interviewed wanted to receive financial aid in the form of interest-free loans. 76.4% of them wanted the loans to be disbursed in two phases; initially, to offset some of their costs during rehabilitation at CRP, and thereafter, for economic reintegration in their community. The remaining 23.6% wanted the loan only for vocational reintegration. 70.59% of those interviewed proposed repayment in monthly instalments, while 17.64% suggested quarterly instalments and 11.76% favoured annual instalments. Over half of the participants (55.88%) wanted to have vocational training, and the rest wanted vocational training for their family members, to enable them to repay the loan. Conclusions: This study revealed that there is a huge demand for interest-free loans among people with SCI. An appropriately designed interest-free loan programme, which would be sensitive to individual needs, could save people with SCI and their families from bankruptcy. This would also make SCI rehabilitation programmes more sustainable, and possibly reduce over-dependence on the donors. Further action research is recommended to evaluate the effectiveness of such a course of action.
Inclusive Education for Students with Intellectual Disability
This paper traces briefly the evolution of Inclusive Education for students with special education needs (SEN) and discusses some significant challenges in its implementation. While the aim of Inclusive Education is to include all children with SEN in mainstream schools, there are many challenges that have to be overcome for their education to be meaningful. This paper focuses primarily on the inclusion of students with intellectual disability, since they are likely to be the largest number with special education needs in ‘inclusive’ schools. It offers the outline of a curriculum that may be derived from the mainstream one in use, and suggests a model that emphasises the replacement of age / grade placement, as is the present practice, with experience and maturity underpinning learning in persons with intellectual disability. The proposed model needs, of course, to be field-tested.
Functional Social Skills of Adults with Intellectual Disability
Purpose: The present study aimed to find the level of functional social skills of adults with intellectual disability, and attempted to analyse these skills with respect to gender, level of disability, type of school attended and number of years of schooling. Method: Descriptive method of research was employed for the study. The study sample consisted of 100 adults with intellectual disability, randomly selected through various special schools which provide vocational training in Kottayam district of Kerala state, in South India. Data on social skills of these individuals were collected through a standardised Functional Social Skills Assessment Scale developed by the authors. The data were analysed through arithmetic mean, standard deviation, independent t-test and one-way analysis of variance. Results: The results indicated that only 48% of the adults with intellectual disability in the study sample possessed functional social skills.
Shoulder Pain among Rehabilitated Spinal Cord Injured Persons Using Manually Propelled Wheelchairs in the Gaza Strip: A Survey
Shoulder pain among paraplegic persons has negative effects on their lives. The prevalence of shoulder pain among persons with spinal cord injury (SCI) varies from 30% to 70% in different studies and may be related to repetitive use of the shoulder during self-care and wheelchair-related activities. Purpose: This study focused on the prevalence of shoulder pain and examined its effects on activities of daily living and social participation, and on functional, work and recreational or athletic activities. It also aimed to detect the degree of satisfaction with shoulder functioning wheelchair users who were paraplegic due to spinal cord injury, in the Gaza strip. Methods: Cross sectional study design was used to collect data from 80 persons with paraplegia, post rehabilitation, who were still using manual wheelchairs (MWC) for ambulation. After giving informed consent, the selected persons were interviewed directly in their homes, and filled questionnaires which included the demographic data, Wheelchair User’s Shoulder Pain Index (WUSPI) and Shoulder Rating Questionnaire (SRQ). Results: The prevalence rate of shoulder pain among paraplegics who use manual wheelchairs was 62%. Pushing a wheelchair for 10 minutes or more, and propulsion up ramps or inclines outdoors were the most common activities that caused and exacerbated shoulder pain. Sixty four percent from among the study sample mentioned that they had no limitation in shoulder-using ability during daily personal and household activities, while the rest experienced different degrees of limitation. Seventy-four percent reported no limitation during recreational or athletic activities, while the rest (26%) agreed that pain has variably limited their participation in these activities. Fourteen percent from the sample rated the overall degree of satisfaction with their shoulder functioning as fair, and the rest rated their satisfaction from good to excellent. Conclusion: Shoulder pain, ranging from mild to severe, was highly prevalent among SCI paraplegics who use MWCs during their usual activities, and other activities which involve wheelchair propulsion. About two- thirds of the subjects reported no limitation in shoulder use during daily personal and household activities and in recreational or athletic activities.
Parental Stress in Raising a Child with Disabilities in India
Purpose: To determine the parenting stress and its determinants among parents of children with disabling conditions in India. Methods: The Parenting Stress Index – short form and a few open ended questions were administered to a convenience sample of sixty-six patient families in July, 2009 in the cities of New Delhi and Faridabad regions of Northern India through six non- governmental organizations (NGOs) that serve children with disabling conditions. Results: Female sex of the child was associated with higher stress related to failure of the child to meet parent’s expectations and to satisfy the parents in their parenting role. Parents engaged in more lucrative and prestigious occupations had more stress than parents engaged in less prestigious and lucrative occupations irrespective of their income. Many parents reported receiving little support from their extended families in taking care of their child. Religion was found to be a common coping resource used by the parents. Conclusion and Implications: Higher parenting stress in parents of girls raises the possibility of abuse and neglect. Little support from informal family resources underscores the need for developing formal resources for supporting the parents. The specific resources of parenting stress among parents of different socioeconomic status should be explored in future studies so that appropriate interventions can be planned.
A Comparative Analysis of Institutional Capacities for Implementing Disability Policies in East African Countries: Functions of National Councils for Disability
During the “African Decade of Persons with Disabilities (2000-2009)”, East African countries witnessed significant achievements, especially in the development of law, collection of statistics and in funding. However, many persons with disability are still marginalised from opportunities in education, healthcare and employment. Purpose: With the pre-supposition that the lack of institutional capacities for implementing disability policies is the one major stumbling-block which hinders widespread delivery of social services to persons with disabilities in low-income countries, this study makes a comparative analysis of institutional capacities in the disability sectors of Uganda, Kenya and Tanzania. Method: The research methods adopted were a literature survey and a field survey. The framework for analysis consists of: 1) capacities and functions of disability units in central governments, 2) relationships between central and local governments in the disability sector, and 3) relationships between governments and organisations of persons with disability (DPOs). Special attention is paid to the status, roles and functions of national councils for disability (NCDs), the independent statutory bodies recently established in each of the three countries, with clear authority and duties for the implementation of disability policies. The NCDs enable multi-sectoral stakeholders to be involved in the implementation of disability policies; therefore, positive relationships between the governments and DPOs are essential for the smooth functioning of the NCDs. Results: While the result of the field survey in Tanzania reveals several effective approaches for the smooth operation of the NCD, further study is needed to verify whether these approaches would be applicable to other East African countries such as Kenya and Uganda.
Unless action is taken now, at national and local levels, to ensure that the world’s one billion people with disabilities derive real and lasting benefits, the United Nations Convention on the Rights of Persons with Disabilities is in danger of being consigned to the graveyard of missed opportunities. Although many governments have signed and ratified the Convention, evidence of actual implementation is an immediate priority, especially in the midst of a global recession. The scene is now set for governments to bring their policies into line with the principles and Articles of the Convention and to provide regular reports to the Disabled Persons’ Committee of the United Nations High Commission on Human Rights. Use of the internet can ensure that accountability is made public and includes the full participation of people with disabilities.
Awareness About Benefits of a Disability Certificate Among Persons with Hearing Impairment in Kolkata, India
Awareness among Family Members of Children with Intellectual Disability on Relevant Legislations in India
Purpose: The present study was undertaken to assess the level of awareness on legislations relating to intellectual disability among family members in India. Method: A sample of 103 respondents attending home based training services for their wards at National Institute for the Mentally Handicapped (NIMH), India, were administered a thirty item questionnaire, classified into awareness of legislations, awareness of rights, concessions and benefits and life cycle needs. Results: There is a moderate level of awareness on legislative aspects. Educated respondents showed better awareness about legislations than less educated persons. Respondents were better aware of benefits and concessions because of their direct utility in their day-to-day activities. Conclusion: There is a need for creation of awareness and sensitization among parents and caregivers having persons with intellectual disability to enable them to receive optimum benefits. To reach the uneducated population the materials must also be made available in non-print media such as television, posters and illustrated pamphlets.
Rights, Equality, Educational Provisions and Facilities for Students with Disabilities in Thailand: Legal and Practical Perspectives over the Past Decade
This review aims to critically examine the present status of educational provisions and facilities for students with disabilities in Thailand, in accordance with the enforcement of various laws over the past decade (1992-2008). The legal essence of laws such as the Constitution of The Kingdom of Thailand 1997, the Rehabilitation of Disabled Persons Act 1991, and the National Education Act 1999, was typologically compared to actual situations, in terms of educational provisions and facilities, by reviewing a total of 25 research papers. The findings showed that there had been no further educational provisions and facilities for students with disabilities, despite indications within the laws. There are discrepancies between legislations and practices due to the ineffectiveness of law enforcement, and the negative attitudes of service providers and society towards students with disabilities. Therefore, positive attitudes of stakeholders have to be promoted, alongside the new laws.
Attitudes of Parents towards Children with Specific Learning Disabilities
Purpose: This study explored parental attitudes towards children with specific learning disabilities. Method: The study sample comprised parents of 60 children (30 boys and30 girls) with Specific Learning Disability (SLD) who attend the Child and Adolescent Psychiatry Out-Patient Department at National Institute of Mental Health and Neurosciences, Bangalore, India. The attitudes of parents were assessed using the Parental Attitude Scale. Results: The results revealed significant differences related to gender of the children on various domains of the scale. Conclusion: The study highlights the need to educate parents to lower their expectations for children with specific learning disabilities, and to strengthen the social support network of these children’s families.
Lady Health Workers (LHWs) as Flag Bearers for Children with Disabilities in Pakistan
Purpose: This study explores the perceptions, knowledge and attitudes of LHWs towards children with disabilities in Pakistan. It considers the feasibility of utilising the LHWs for prevention, early identification and management of disabilities for these children in the community. Methods: Two Focus Group Discussions (FGDs) were conducted with 15 Lady Health Workers (LHWs), and two In Depth Interviews (IDIs) with LHWs of both a semi-urban and a rural community of Pakistan. Results: LHWs were found to have major concerns and strong emotions regarding children with disabilities. They also revealed the insensitive attitude of community members towards these children. While they understood the major types and magnitude of disabilities better than lay persons, they lacked the knowledge to manage these disabilities. Consanguineous marriages were identified as the main cause of disabilities. LHWs reported that education and health facilities were lacking in semi-urban and rural areas, and demanded that the government provide these facilities for the children. They also expressed their willingness to work for these children, provided they had the approval of higher authorities and were given proper training. Conclusions: This qualitative exploratory study recommends that the existing primary health system be reviewed, and the possibility of introducing community based rehabilitation services, utilising LHWs’ services for children with disabilities, be examined. In this regard, it is imperative to assess the existing training modules of LHWs and to introduce modules on prevention, early identification, and management of children with disabilities. It is also necessary to employ mass media to spread awareness about persons with disabilities.
Improving Accessibility to Medical Services for Persons with Disabilities in Thailand
Purpose: This action research aimed at developing an action plan to improve the accessibility to home health care and assistive devices for persons with disabilities in a rural community, and to evaluate changes in the numbers of such persons who received appropriate home health care and assistive devices after a three-month implementation of the action plan. Method: The study was conducted at a sub-district of Maha Sarakham Province, Thailand. The main beneficiaries were 99 persons with disabilities (mean age55.4±18.7 years). Group meetings were organised for persons with disabilities, caregivers, and various community members. An action plan for improving the accessibility of persons with disabilities to home health care and assistive devices was collaboratively formulated and implemented for three months. Results: The main strategy for improving accessibility was to increase the competency of village health volunteers in providing home health care and assistive devices to persons with disabilities. After the three-month action plan implementation, the number of persons with disabilities who received appropriate home health care, i.e. at least once a month, significantly increased from 33.3% to 72.2% (Chi-square test, P<0.01, 95% CI 18.5 to 59.3). The number of persons who received assistive devices suited to their disabilities also significantly increased from 33.3% to 58.3% (Chi-square test, P=0.03, 95% CI3.5 to 46.5). Conclusions: Under the supervision of physical therapists and/or other allied health professionals, the village health volunteer is likely to be a key person for improving the accessibility to home health care and assistive devices for persons with disabilities in a rural community. Limitations: The study was limited to only one sub-district. No comparable areas were studied. Further, since the study recruited persons with disabilities from a rural community, applicability of the findings to persons with disabilities in an urban community should be considered judiciously.
The Role of Community Health Workers in the Mongolian CBR Programme
Purpose: This article aims to present the role of community health workers in the implementation of a comprehensive CBR Programme in rural Mongolia, and to explore the main challenges that arise in this specific geographical and socio-economic context. Methods: Qualitative data were collected through semi-structured interviews with CBR workers from three selected provinces; short meetings and interviews with respective provincial level CBR coordinators complemented the information acquired. Additionally, a workshop with national level CBR stakeholders was carried out in order to review and discuss the findings. Results: The study highlighted a number of practical barriers (including long distances and lack of transportation, low population density, and harsh climate conditions) which constrain the work of community health workers in the areas studied. In relation to disability, the study shed light on the difficulties found by community workers in shifting from a medical approach to disability to a new approach that emphasizes prevention and rehabilitation. Exploring interviewees’ experience in the five areas of CBR (health, education, livelihood, social, empowerment) the authors found that working in the areas other than health is perceived as difficult due to insufficient training as well as objective contextual barriers. Conclusions: Despite many challenges, CBR represents a significant improvement for disability action in rural Mongolia. In this context, the local community health workers are well suited and willing to act as CBR workers; nonetheless, more training and some tailoring work to adapt the Programme to the context is needed if all potential results are to be achieved. Limitations: This study did not include direct observation of CBR activities or consultation of beneficiaries and other stakeholders. Their involvement and consultation would certainly improve the understanding of all the issues raised.
Relevance of CBR for the Asia-Pacific Region
While the focus of CBR action is at the community level, it is pertinent to note some of the Asia-Pacific region’s overall development trends. In an interconnected world, these trends have significant implications for the practice of CBR and its advancement in the region. This paper discusses how CBR could give impetus to a community-supported self-help movement for change. The paper presents seven prisms for akaleidoscopic view to highlight some parameters that are unique to the Asia-Pacific scenario for CBR. The relevance of CBR for this region is discussed in relation to two groups of issues: the first refers to chronic issues of poverty, hunger and inequalities; and the second, to dramatic emerging challenges, from urbanisation to the current economic scenario.
Profile of Clients at the National Institute for Empowerment of Persons with Multiple Disabilities, India
Role of NGOs in Identification Camps for Persons with Intellectual Disabilities in India
Purpose: Identification camps for persons with disabilities are conducted by both government and non-government organisations (NGOs) in India, as a viable option for mass screening. However, it has been noticed that identification of persons with intellectual disability is hindered by various factors and the percentage of people identified tends to vary, depending on the agencies carrying out screening and identification. Methods: To validate this observation empirically, data collected from 33 identification camps was analysed post-facto. Results: The results confirmed that more people with intellectual disabilities were diagnosed at camps organised by NGOs, than at the ones held by government agencies. Conclusions: Qualitative analysis of contributory factors revealed certain salient features related to NGOs that contribute to more accurate identification of persons with intellectual disabilities in camps. This study highlights these factors, while drawing specific inferences for better identification and screening of persons with intellectual disabilities in the Indian context.
Determinants of Quality of Life in Nigerian Children and Adolescents with Epilepsy: A Hospital-based Study
Purpose: Though studies abound on the quality of life (QoL) in chronic illnesses, there has been little focus on children and adolescents. This study investigated the determinants of QoL in children and adolescents with epilepsy in a Nigerian Tertiary Mental Health Institution. Methods: The study involved 67 adolescents between 11 and 18 years of age, diagnosed with epilepsy. Depression was assessed using the Centre for Epidemiology Study Depression Scale, and their QoL was assessed using the Comprehensive QoL Scale (ComQol-S). Data was analysed using Spearman’s Correlation Coefficients and linear regression (p<0.05). Results: The mean age of the participants was 14.5±4.0 years. Twenty-two (32.8%) of them were depressed. Participants scored significantly higher (p<0.00) in health, productivity, community participation and emotional domains and total QoL scores in the subjective axis than in the objective axis of QoL. When controlled for age and gender, the lower the educational attainments of the participants, the higher was their depression scores. Depression, seizure frequency at presentation at the clinic, seizure frequency at onset and age predicted poor QoL. Parents’ socio-economic status predicted seizure frequency. Conclusion: There is a high prevalence of depression in Nigerian adolescents with epilepsy. Epilepsy has a negative impact on their QoL. Therefore, it is necessary to pay more attention to the condition in order to reduce the frequency of seizures and improve their psycho-social well-being.
Disability, Art and Potentiality: Reframing Disability as a Metaphor for Potentiality in the Islamic Republic of Iran
Background: There is a lack of studies examining the meanings attributed to disability in Eastern contexts. This is especially true in the case of the Islamic Republic of Iran. Studies – accessible for non-Farsi readers – dealing with the existence and position of persons with disabilities in contemporary Iran are rare. Purpose: The present study is part of an investigative journalistic project submitted to and approved by the Fund Pascal Decroos for Investigative Journalism. The aim of the project was to discover if and how progressive Iranian artists were able to work and express critical ideas in contemporary Iran. Method: Based on a journalistic stay of five weeks in the cities of Tehran, Isfahan, Shiraz and Yazd, the authors attempt to present a particular and up till now neglected perspective on disability in Iranian society. Interviews were conducted with contemporary Iranian artists, including painters, photographers and film directors to see how the bodily reality of disability was transformed into a meaningful, effective and efficient metaphorical instrument. Results: Some of the Iranian painters, directors and photographers considered the artistic representations of disability as a powerful means to engage in present-day political and religious public debate. For the artists the symbolic representations of disability enabled them to express their particular worldviews and give voice to their creative insights. For some, war-related disabilities mirrored the cruelty of military hostilities; for others it symbolized the struggle for freedom in Iranian society since the very beginnings of the Twentieth century. One of the results that came out of this journalistic investigation is that some Iranian artists turn towards disability issues and persons with disabilities in order to continue to publicly express their particular world-views. Conclusion: Given that the interviewed artists belonged to rather progressive circles of Iranian society, these findings are limited and cannot be generalized, but reflect one aspect of the manifold ways persons with disabilities are represented in contemporary society. In order to provide a complete view on the divergent positions of, and daily life circumstances faced by, persons with disabilities in Iran much more research is needed.
Interventions for Stigma Reduction – Part 2: Practical Applications
This paper reports the endeavours of the Working Group assigned to develop guidelines for interventions to reduce stigma. The group was comprised of academics and experienced field personnel, all of whom had either investigated stigma, implemented actions to address stigma, and/or had experienced stigma. The group’s mandate was to develop an intervention to reduce the stigma of leprosy, but while accepting that there are commonalities relating to stigma that cut across different health conditions, it was hoped that a generic intervention might be developed. This goal proved to be unattainable in the time given: condition-specific peculiarities and the diversity of cultural contexts presented significant challenges. The group agreed, however, that a considerable body of theory and expert opinion does exist, and that general strategies might be developed from this. The Working Group discussed a systematic review of such material. It also discussed other material that was considered to be important but had not met the criteria for the systematic review. One conclusion of the group’s deliberations was that a “Stigma Intervention Matrix” could be a useful guide for cross-checking the development of situation-specific stigma interventions. The Stigma Intervention Matrix is presented in this paper.
Interventions for Stigma Reduction–Part 1: Theoretical Considerations
The contributors to the Working Group that produced this paper are like countless others who are confronted by programme realities in developing countries, such as the pressure to respond to the challenge of stigma in environments of extreme poverty, the issues of scant resources and the requirements to adapt objectives accordingly, and the competing demands for relief and emergency aid. It is in such contexts that researchers have the responsibility of making evidence-based recommendations and yet, regarding stigma interventions, they are confronted by a domain almost devoid of reliable evidence. Without examples of comparable situations that can be reviewed, it may be possible to make progress only through recourse to theoretical concepts. Broad guidelines, based on respected theories, may prove to be a sound foundation on which intervention programmes can be designed. In this article, the discrete components of stigma that should be targeted in stigma intervention programmes are identified. It is also recommended that since stigma affects different levels in society simultaneously, stigma programmes should be multi-targeted and designed with an intention to adjust interactions between groups at different societal levels. This article lays the foundation for a companion article that presents a generally applicable method by which plans for stigma interventions can be assessed (Interventions for Stigma Reduction – Part 2: Practical Applications).
The Community Based Rehabilitation Programme of the University of the Philippines Manila, College of Allied Medical Professions
Purpose: This paper reports the process of development of a CBR programme by UP Manila College of Allied Medical Professions, and its impact on the stakeholders: persons with disabilities, students and alumni, CBR workers, local leaders and the agencies involved in the programme. Method: The impact of the programme was assessed through interviews, questionnaires, focus group discussions and review of secondary data and records. Results: The programme results show that the condition of persons with disabilities has improved and there has been a remarkable change in their knowledge, attitudes and skills. The positive attitudes, skills and values of students were enhanced, and the CBR programme was a “character builder” for them as rehabilitation professionals. The CBR workers who participated in the programme learnt to appreciate the potential of persons with disabilities and to accept their limitations. Another key result was the pledge by local leaders to sustain CBR in their own villages. Conclusions: The students and alumni reported that the CBR programme should be replicated for nation-building. The different stakeholders reported that it helped improve the quality of life of people with disabilities and contributed to community development.
Mental Health and Quality of Life of Caregivers of Individuals with Cerebral Palsy in a Community Based Rehabilitation Programme in Rural Karnataka
Background: Cerebral palsy is a type of non-progressive central nervous system disorder with multiple impairments. As there are sensory, communicatory and intellectual impairments, providing care at home may be stressful and affect to the physical and mental health of the caregivers. This in turn could interfere with rehabilitation of persons with cerebral palsy. Purpose: This study assesses the mental health status and quality of life of caregivers of persons with disabilities. The study group consisted of caregivers of 23 children with cerebral palsy and intellectual disability. Method: The needs of the children with disabilities were assessed using a pretested interview schedule, while caregivers were administered GHQ-28 and WHO-QOL. Results: Thirteen (56.52%) of the primary caregivers tested positive for GHQ. The psychological and environmental domains of QOL were found to be most affected, while the physical and social domains were relatively better. Conclusion: There was a significant (p<0.05) correlation between the GHQ scores and quality of life.
Constraint - Induced Movement Therapy: Determinants and Correlates of Duration of Adherence to Restraint use Among Stroke Survivors with Hemiparesis
Background: Constraint-Induced Movement Therapy (CIMT) was developed to improve purposeful movement of the stroke-affected extremity by restrictingthe use of the unaffected extremity. The two main components of CIMT are the training of the more-impaired arm to perform functional tasks, and the restraint of the less-impaired arm. One challenge that the application of CIMT faces is in ensuring adherence to the use of restraint. Purpose: There is a need to determine the factors that may influence adherence, as this would allow CIMT to be delivered more effectively, and prevent situations where unrealistic expectations are placed on stroke–affected individuals. Methods: Thirty stroke survivors with hemiparesis who met the inclusion criteria were consecutively recruited from the physiotherapy out-patient clinics, using a purposive sampling technique. A structured questionnaire was used to obtain information on clinical and socio-demographic parameters. The participants were given a restraint and an adherence time log-book, to make a daily record during the period they wore the restraint. The adherence time logbook was collected at the end of every week of the 3-week study. Motor function and functional use of the upper limb were measured using Motricity Index and Motor Activity Log respectively. Data was analysed using mean and standard deviations, independent t-test and Spearman rho; p was significant at 0.05. Results: Gender (p=0.73) and side affected/handedness (p=0.79) had no significant influence on the percentage duration of adherence to restraint use (DARU). The influence of socio-economic status was seen, with the participants of middle socio-economic status adhering for longer duration (p=0.02). Age had weak and no significant correlation with percentage DARU (p=0.55). There was significantly fair correlation between motor function/functional use at any stage (p=0.55) and the corresponding percentage duration of adherence to restraint use, except the functional use in the first week (p=0.44). Conclusion: Socio-economic status should be considered when applying CIMT.
A Low-intensity Approach for Early Intervention and Detection of Childhood Disability in Central Java: Long-term Findings and Implications for “Inclusive Development”
Purpose: This paper describes a qualitative follow-up study, conducted eight years after completion of a low-intensity early intervention and detection of childhood disability project in Central Java, Indonesia. The original project sought to increase the level of skills and engagement of existing community health volunteers, for the support of children with disabilities. This followup study explored long-term outcomes and implications for the inclusive development approach. Method: Semi-structured interviews were conducted with 18 of the original volunteers. Interview notes were translated and thematically categorised. Results: While the study was qualitative and descriptive, results indicate that despite the low intensity of the project, some early detection and prevention activities were still going on eight years later. Conclusions: The study suggests that a low-intensity initiative such as this, which is closely aligned with the goals of a government department, may indeed achieve some ongoing change by extending the focus of the department towards disability-related concerns. Implications: Implications are drawn for the emerging area of “inclusive development”, which similarly seeks to promote change in mainstream services for the benefit of people with disabilities.
Postural Reactions: An Elementary Unit for Development of Motor Control
Copyright (c) 2011 The Author(s) https://creativecommons.org/licenses/by/4.0
Availability and Accessibility of Treatment for Persons with Mental Illness Through a Community Mental Health Programme
This article describes experiences in implementing a community mental health and development project in a rural district in southern India, including the position of persons with mental illness when the project was initiated, the challenges the faced and the strategies that were developed to overcome these challenges. The authors conclude that when services are locally available, persons with mental illness can be treated and rehabilitated within their own community. They can live with dignity and their rights are respected. There is a great need for inclusion of persons with mental illness in the existing developmental activities and in disabled persons’ organizations.
Life Expectancy After Spinal Cord Injury In a Developing Country-A Retrospective Study At CRP, Bangladesh.
Purpose: To find out the average survival rate following Spinal Cord Injury (SCI) in Bangladesh. Method: 158 randomly selected death records of persons with SCI from the years 1979 to 1999, were analysed retrospectively in August 2009, at the Centre for the Rehabilitation of the Paralysed, (CRP), Savar, Dhaka, Bangladesh. The records showed that 91% were males and the mean age of sustaining injury was 33.85 years. Most of them were paraplegic (79.75%) and the injuries were traumatic in origin (86.1%). Overall, 56.4% of those admitted died within 5 years and only 16.4% survived beyond 10 years following SCI. Every four out of five affected persons died at home. Results: Though there was difficulty in comparing survival rates of persons with SCI in developing and developed countries, life expectancy among persons with SCI in the current study was found to be much lower than that of similar patients in developed countries. Conclusions: Further research on a larger scale, using an international standardised method to compare results, is essential to produce more accurate data. Special attention needs to be paid to improving the support systems for persons with SCI in the acute rehabilitation and reintegration phases of care in Bangladesh.
Role of Self-help Groups in Promoting Inclusion and Rights of Persons with Disabilities
Purpose:This study examined the role of self help groups in addressing some of the problems faced by persons with disabilities such as social exclusion, discrimination, lack of awareness about their rights and privileges, and absence of livelihood programmes. Method: One hundred persons with disabilities were randomly drawn for the study from 50 self help groups in 2 districts that were covered under a popular poverty alleviation programme implemented by the state of Andhra Pradesh in India. An interview schedule was used to collect information. Results: Before joining the group, some of the persons with disabilities were mostly confined to their houses, and viewed as less productive and incapable of leading a ‘normal’ life. After joining the groups, they came out of their seclusion and started to work together for their collective welfare and development. They gained knowledge about their rights and privileges and started income generation activities with the help of loans made available to them. They gained better acceptance within their families, but attitudes of their communities was slower to change. A feeling that “disability is not inability” seemed to have been internalized among the members of the groups. Conclusion: Self-help groups can be very effective in helping persons with disabilities to come out of their isolation and in promoting their participation and inclusion in societal mainstream.
Health-Related Quality of Life of Nigerian Children with Cerebral Palsy
Purpose: To assess the impact of cerebral palsy on health-related quality of life (HRQoL) of Nigerian children. Method: This is a cross-sectional survey. The study involved 54 children (33 males and 21 females), between 1 and 12 years of age, with cerebral palsy. They were consecutively recruited from two tertiary health institutions in Lagos, Nigeria. The socio-demographic details of the participants were obtained through interviews. Their HRQoL was assessed using the Child Health Questionnaire-Parent Form-28 (CHQ-PF 28). The questionnaire was completed by their parents, guardians or primary care-givers. Severity of motor disability was assessed and classified using the Gross Motor Function Classification System (GMFCS). Data were summarised using descriptive statistics. Chi-square was used to find the association between each of the selected socio-demographic variables and motor disability, and HRQoL. Results: Thirty-eight children (70.3%) were between 1 and 6 years of age, and 16 (29.7%) were between 7 and 12 years. The participants’ overall scores and scores on each domain of CHQ-PF 28 were very low. Majority (69.5%) were in GMFCS classification-level 1, 7 (13.0%) were in level 2, 12 (22.2%) were in level 3, 14 (25.9%) were in level 4, and 16 (29.6%) were in level 5. Age had significant effect (CI = 95%) on HRQoL of children with cerebral palsy. Severity of disability had negative impact (CI = 95%) on HRQoL of children with cerebral palsy. Conclusions: The health-related quality of life of Nigerian children with cerebral palsy is low, and is negatively affected by age and severity of disability.
Employability of People with Disabilities in the Northern States of Peninsular Malaysia: Employers’ Perspective
Purpose: This study investigates employers’ perspective towards employing people with disabilities in the northern states of Peninsular Malaysia. The research also endeavoured to identify factors that promote or hinder gainful employment of people with disabilities in Malaysia. Method: The data was collected through postal questionnaires distributed to several types of industries in the northern region of Malaysia. Results: The results indicated that most of the employers are in favour of employing persons with disabilities. However, very few have such enabling policies, or a mechanism to handle issues related to persons with disabilities, or a built environment which is fully accessible to persons with disabilities. They are also concerned about the ability of workers with disabilities to comprehend and follow orders, as well as the costs involved in employing and training them. These results imply that if employers want to fulfil their intentions of recruiting persons with disabilities, a lot has to be done to employ and sustain them in their jobs.
Assistive Technologies in a Workplace Environment: Barriers for the Employment of People with Disabilities
Purpose: The employment equity policies and implementation of technology-specific guidelines within the South African ‘Code of Good Practice on the Employment of People with Disabilities’, was created to encourage employment equity for employees with disabilities, by companies in Johannesburg. This study reports on the results of the investigation in assistive technologies in a workplace environment, and barriers for the employment of people with disabilities in the South African environment. Method: Qualitative data, collected from two retail and service companies in the form of semi-structured individual and focus group interviews, was analysed using a constant comparative method, identifying major themes and sub-themes. Results: A surprisingly small number of persons with disabilities were found to be employed by participating companies, which tended not to focus on these people when formulating their policies and plans. In addition, technological aspects of the Code were largely unacknowledged, with little effort being made to accommodate the needs of persons with disabilities. An even lower incidence of assistive technology usage was found, along with a large number of conceptual and perceived barriers that hinder the employment of people with disabilities and the implementation of appropriate technology.
Complexities in the Provision of Respite Care to Family Carers of Persons with Intellectual Disabilities
Purpose: Respite care is generally thought to benefit family carers of persons with intellectual disabilities and is regarded as an important component of family-centred services. However, the complexities associated with the provision of such services, from the carer’s perspective, have been rarely investigated. Method: This qualitative research study was carried out through a participatory action research process that involved collaboration among researchers and family members as co-researchers. Seven focus groups, involving seventy family carers (fifty mothers, fifteen fathers and five sisters), were held in seven locations across the Republic of Ireland. Results: Three main themes dominated the discussions. The first theme related to the ambivalence of carers towards using respite services, as expressed in their reluctance to relinquish care-giving for even a short period; the feelings of guilt they experienced; and the greater needs of other carers. The second theme related to the benefits of respite breaks, but these were solely with respect to the carer and other family members, rather than to the person with an intellectual disability. The third theme regarding the quality of provision was dominated by concerns for the care the person received in using the services. Conclusions: Respite care has the potential to make a difference, and these findings call for building much- needed alliances between all members of the family and professionals. This is in order to support one another through the difficulties associated with the redesign of existing respite provision, and the extension of these services to the growing number of carers who require respite breaks.
Promoting Prosocial Beliefs and Behavior Toward People with Disabilities in Nepal through a Children’s Entertainment-Education Program
Purpose This quasi-experimental field study examines the prosocial influences of a children’s entertainment-education television programme, Khushi Ko Sansar, on children’s beliefs and intended behaviour towards people with disabilities in Nepal. Method Pre-test and post-test survey data were gathered from 357 Nepali children from nine communities that took part in the study. The children were shown two television episodes in which the star of the programmes, a dog named Khush, befriends and visits people with disabilities. Results Post-test results show that children developed strong identification with Khush and adopted his prosocial beliefs and behaviour towards people with disabilities. Conclusions The authors conclude that the entertainment-education television programme, Khushi Ko Sansar, provided a positive role model for children who encounter people with disabilities. Implications of these findings suggest that entertainmenteducation media can improve the treatment of people with disabilities and can promote beneficial health beliefs and practices.
Sustainability Criteria for CBR Programmes – Two Case Studies of Provincial Programmes in Vietnam
Purpose: This paper aims to explore the conditions needed for sustainable community based rehabilitation (CBR) programmes for persons with disabilities in Vietnam, and to identify the conditions and opportunities missing at present for the implementation of such programmes. Method: Two CBR programmes in Vietnam, one medical based and one comprehensive (medical, educational, livelihood, social and empowerment), were evaluated for requirements and the current situation. Four factors were taken into account - human resources, organisational setting, social and political environment, and financing. Data were collected through interviews with programme managers and focus groups with stakeholders from provincial, district and communal levels, and with persons with disabilities. Persons with disabilities also completed a questionnaire to evaluate their satisfaction with the programme and their involvement in it. Results: The conditions needed for a sustainable CBR programme were identified: availability of human resources, training, monitoring and evaluation, collaboration, commitment and financing. The conditions missing at present were: a stable pool of human resources (in both programmes), collaboration between sectors and with local authorities (in the medical programme), and knowledge about how to maintain financing (in both programmes). Persons with disabilities were more satisfied with their involvement in the comprehensive programme than in the medical programme. Stakeholders proposed opportunities to increase sustainability; highest priority was given to a collaboration plan (comprehensive CBR programme) and to involvement of other sectors in the CBR Steering Committee (medical CBR programme). Conclusions: Few differences were found in conditions needed for sustainability of the medical and comprehensive programmes. The existence of disabled persons’ organisations (DPOs) seemed to be associated with the level of satisfaction persons with disabilities felt with their involvement in the programme. Limitations: The People’s Committee was not involved in this research, although their input was perceived to be important. Generalisation of the results of this study should be done with caution because health system structures and organisational levels of CBR differ.
Perceptions of Parents of Typical Children Towards Inclusive Education
The purpose of the study was to explore the perceptions of parents of typical children towards inclusive education and children with special needs. The research design was exploratory and descriptive in nature. Fifty parents of typical children of an inclusive school and 5 experts heading an organisation for children with special needs formed the sample. In-depth interviews were conducted to gain information on the awareness and understanding about an inclusive setup, descriptions and explanations of children with special needs, and advantages and disadvantages of an inclusive setup for children. In addition, draw and dialogue technique was used with parents and experts to supplement the data from the interviews, to elicit descriptions and understanding of children with special needs. Results showed positive reactions towards children with special needs. Parents supported inclusion, but suggested separate classes for academics. Experts’ descriptions of children with special needs were more technical than those of the parents.
Impact of Micro Credit Scheme for Persons with Physical Disabilities in Herat, Afghanistan
The present study presents the results and impact of the micro credit scheme of the International Committee of the Red Cross (ICRC) physical rehabilitation centre in Herat, Afghanistan. The author used a descriptive method to retrospectively analyse the data. Results showed that the repayment rate is 70% and impact 6 months after completing the loan is that 65% of the clients continued with their business, showing improved confidence and living conditions. There was an element of “exclusion by others”, which should be studied further and analysed through interactions with the neighbourhood community during the first interview at the client’s home. When necessary, an awareness programme should be carried out within the community. “Exclusion by staff” appears to exist for persons with paraplegia, as there is a trend to prioritise the sustainability of the scheme instead of its accessibility to the most vulnerable groups. Since the beginning of 2009 however, efforts are under way to register persons with paraplegia and to involve physiotherapists in their follow- up.
CBR Matrix and Perceived Training Needs of CBR Workers: A Multi-Country Study
CBR Matrix, proposed in the CBR Guidelines, provides a systematic framework for organising and analysing CBR activities. A sample of experienced CBR workers, active at community level in 7 countries , were asked for information about different activities they actually carry out, so as to understand the applicability of CBR Matrix framework in the field. The CBR workers were also asked to identify their most pressing learning needs in different areas of CBR Matrix. This study shows that CBR Matrix can be a useful framework to understand field-level activities in CBR projects. The study has identified a number of priority learning needs, in terms of different domains of CBR Matrix, and in terms of different disabilities. It also shows that globally, areas related to advocacy, lobbying, legal protection and rights-based approach, are the most important learning needs identified by CBR workers.
Impact of Physical Therapy on Burden of Caregivers of Individuals with Functional Disability
Advances in medical science have resulted in a concomitant increase in the life span of persons with disabilities. The prevalence of chronic disease, an aging population and the ongoing shift of the site of care from institutions to the community, have resulted in a significant increase in the informal care provided by family members and friends of those living with chronic illnesses. This in turn increases the burden on the family, by way of physical and psychological stressors. The objectives of this study were to identify the burden perceived by caregivers of individuals with functional disability, and to evaluate the effects of a tailored physical therapy intervention, or caregiver education, on the caregivers’ burden. Ninety seven persons were deliberately assigned, based on their accessibility, to the control group, caregiver education group and intervention group. Although there was no statistically significant difference between the groups, among caregivers of persons affected by moderate to severe disability, there were trends showing greater reduction in caregiver stress and burden in the intervention group. These trends and comments from individual participants point to an improvement in caregiver burden with physiotherapy intervention. Hence, it can be suggested that physiotherapy management of persons with disabilities must also include caregiver health.
Rehabilitation Services for Persons Affected by Stroke in Jordan
The purpose of this study was to explore the perceptions stroke survivors have of the rehabilitation services received by them in the Jordanian community. A secondary aim was to explore the impact of culture on providing appropriate services for stroke survivors. Eighteen stroke survivors were recruited from an outpatient stroke rehabilitation programme. All 18 participants had been discharged from hospital for between one and six months. Semi-structured interviews were performed, either in the physiotherapy outpatient clinic where the affected person was attending a clinic or in their homes. Transcription of interviews carried out in Arabic and thematic analysis was also carried out in that language by transcribers who were fluent in Arabic and English, using a back-translation method. Necessary measures were taken to ensure the accuracy, reliability and validity of the data collection and analysis. Following thematic analysis, themes arising out of the data included physiotherapy and occupational therapy support in the community, out-patient rehabilitation clinic services, community clinic services and support from families, friends and neighbours. Participants expressed satisfaction with their therapists, but there were large areas of unmet rehabilitation need for stroke survivors in the Jordanian community such as a limited availability of occupational therapy services, insufficient amount of therapy services and poor medical support. This study presents a unique contribution to knowledge relating to the experiences of stroke survivors in a developing country, and also shows how care systems are very dependent on cultural contexts, cultural beliefs and practises.
‘Welcome to My Life!’ Photovoice: Needs Assessment of, and by, Persons with Physical Disabilities in the Kumasi Metropolis, Ghana
Persons with physical disabilities face many architectural and social barriers to community participation. This research employed the ‘Photovoice’ method. The aim was to gain insight into the daily lives of persons with physical disabilities, and to assess their needs in the Kumasi metropolis. Participants in this study were trained and instructed to photograph their everyday activities, so as to document their struggles and concerns, to promote critical dialogue and to reach policymakers. Results indicated a number of concerns, such as poor accessibility to public toilets, transport and buildings, as well as a need for attitudinal change and equal opportunities. Other needs which were raised by the participants included economic empowerment, marketable vocational training, accident prevention, affordable and quality rehabilitation, and the establishment of emergency shelters. It was concluded that the most pressing needs of persons with disabilities were related to overall social, employment and accessibility issues. Finally, the ‘Photovoice’ methodology offered a suitable, structured, and participatory way to assess the needs of persons with disabilities. It gave this marginalised group a voice through photographs, and formed an excellent way of disseminating the findings of this study to the stakeholders involved.
The Communication Deall Developmental Checklist - Inter Rater Reliability
A checklist is ideal when assessing young children who are ‘difficult to test’. The Communication DEALL Developmental Checklist (CDDC) was developed by Karanth (1), to assess developmental skills of children up to the age of 6 years, along eight developmental domains, with norms based on an Indian population. Since all checklists depend on rater reliability, the aim of the current study was to establish inter rater reliability of the CDDC. Two senior Speech Language Pathologists used a 4-point rating scale, to assess 40 children with developmental disabilities (across the ages of 0-6 years) on the CDDC checklist. Each rater independently made two ratings during the assessment; the first as reported by the parent (PR1 and PR2), and the second based on the clinician’s own observation (CR1 and CR2). The correlation between CR1 and CR2, as well as PR1 and PR2 for each rater separately, was found to be high, suggesting that the CDDC provides a reliable baseline for the developmental skills of children up to 6 years.
The Face of Disability in Nigeria: A Disability Survey in Kogi and Niger States
The Leprosy Mission Nigeria conducted a disability survey in Kogi and Niger States of Nigeria in 2005, investigating the demographic characteristics of people with disabilities, including gender, age, religion, marital, educational, occupational, employment and economic status, understanding of disability and health-seeking behaviour. Information was gathered from a convenience sample of participants, across 30 randomly selected towns and villages in the two states. Twelve trained bilingual research assistants were used, to translate the English language questionnaire verbally into the local language of each participant. From the 1093 respondents studied, the most common disabilities involved vision (37%), mobility (32%) or hearing (15%). A third of these were less than 21 years of age and had no occupation, and 72% were Muslim. Over half of them had no education, 20% had primary, 8% secondary, 2% tertiary and 18% had Islamic education. Common occupations were begging (16%), studying (14%), farming (11%) and trading (8%).The majority were unemployed (61%) due to their disability. Over 70% were not able to access disability specific health services and 37% had an assistive device. Services accessed included health - mainstream (90%), traditional (61%) and counselling (58%); and other - rehabilitation (30%), assistive device provision (24%), welfare (22%), special education (15%), vocational training (10%) and economic empowerment (4%). These results are comparable with findings in other studies. Disability affects a person’s ability to participate in education, work, family life and religion, influences health-seeking behaviour and contributes to poverty.
Quality of Life, Perceived Stigma, Activity and Participation of People with Leprosy-Related Disabilities in South-East Nepal
In Nepal, many people live with leprosy-related disabilities. The objective of this study was to evaluate differences in socio-economic characteristics, quality of life (QOL), perceived stigma, activity and participation among people affected by leprosy as a group and between this group and the general population, and to identify prime determinants of QOL among the leprosy-affected people. People with leprosy-related disabilities (N=100; 54DGI/46DGII) and community controls (N=100) were selected from Morang district, South-East Nepal, using quota sampling. QOL, perceived stigma and participation and activity limitations were measured using the Nepali abbreviated version of the World Health Organisation Quality of Life (WHOQOL) assessment and the Nepali versions of the Jacoby Scale, Participation Scale and Green Pastures Activity Scale (GPAS), respectively. Total QOL, participation and activity levels of people affected by leprosy were worse than those of the general population. Regression analysis showed that the ability to maintain a family, satisfaction with health, vocational training, sex, activity and participation limitations (the latter for QOL only), perceived stigma and living situation (i.e. joint family, type of house) were significantly associated with a deterioration in QOL and higher participation restriction in one or both of the grading groups. There is an urgent need for interventions focused on quick referral of people with leprosy, to minimize the development of visible impairments, and social rehabilitation. The latter can be achieved by creating more public awareness, providing (financial) support for income generating projects and /or vocational training to leprosy- affected people, and by encouraging them to be involved in all community development activities. The current results indicate that such measures would help improve the quality of life of people with leprosy-related disabilities.
The ‘Social Model of Disability’ Met a Narrative of (In)Credulity: A Review
The article reviews components and recent discussion of the ‘Social Model of Disability’, with special focus on two books, Disability Rights and Wrongs by Tom Shakespeare, and The Social Model: Europe and the Majority World edited by Colin Barnes and Geof Mercer. The ‘Social Model’ calls for close and sceptical scrutiny, as it has become one of the most influential metanarratives in campaigns and publications of the ‘Disability Movement’, while tending to overlook the complexities experienced by many disabled people and their relatives. Some components of a Social Model appear in historical literature of Asia and the Middle East, lending credibility to its ongoing life as an interesting idea. Yet current anglophone advocacy of the model makes assumptions of universality that are questionable in the socio-economic situations experienced by much of the global population having disabilities. A calmer and better informed discussion of the model’s merits and flaws would contribute to greater understanding of global disability.