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Road traffic injuries and rehabiliation. Factsheet.

HANDICAP INTERNATIONAL
March 2017

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The rate of road accidents is increasing globally and the resulting deaths, injuries, physical disabilities and psychological distress are creating a tremendous negative economic impact on victims, their families and society in general, especially in low and middle income countries. Common impairments and activity limitations from road traffic injuries are musculo-skeletal injuries, spinal cord injuries (SCI), traumatic brain injury and psychological distress and depression. Different examples of rehabilitation across the care cycle are provided. A case study of brain injury in Laos is provided. 

Evaluating the impact of a community–based parent training programme for children with cerebral palsy in Ghana

ZUURMOND, Maria
et al
January 2017

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"Cerebral palsy is the most common cause of physical disability in children worldwide, and yet in most low resource settings there are few services available to support children with cerebral palsy or their families. Research is required to understand the effectiveness of community and/or home based programmes to address this gap. This 2-year study aimed to evaluate a participatory caregiver training programme called ‘Getting to know cerebral palsy’ in Ghana. The training programme consisted of a monthly half-day support group with training, and a home visit, delivered across eight sites in Ghana over 10 months. A total of 76 families and children were included at baseline and 64 families followed up one year later at endline. Children were aged between 18months and 12 years with a mean of 3.8 years and a range of severity of cerebral palsy. Nearly all (97%) the caregivers were female and the father was absent in 51% of families. The study was a pre-post intervention design using mixed methods to evaluate the impact. A baseline and endline quantitative survey was conducted to assess caregiver quality of life (QoL) and knowledge about cerebral palsy and child feeding, health, and nutrition outcomes. Qualitative data was collected to explore the impact and experiences of the training programme in more depth".

School and classroom disabilities inclusion guide for low- and middle-income countries

BULAT, Jennae
HAYES, Anne
et al
January 2017

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This guide provides strategies and recommendations for developing inclusive classrooms and schools. We specifically address the needs of Sub-Saharan African countries, which lack the resources for implementing inclusive education. However, our strategies and recommendations can be equally useful in other contexts where inclusive education practices have not yet been adopted. Strategies for enhancing existing school and classroom environment and instruction include: modify the physical environment; modify classroom managment strategies; ensure social inclusion; adopt best instructional practices; apply strategies for students with sensory disabilities; and use assistive technologies. Strategies for adopting response to intervention include: tier by tier implementation; individualised education plans; and planning for school wide adoption of inclusive practices and a multilevel system of support.

 

 

Physical environments and community reintegration post stroke: qualitative insights from stroke clubs

BROOKFIELD, Katherine
MEAD, Gillian
2016

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This study investigated the environment’s role in community reintegration amongst persons with experience of stroke. Focus group discussions with 29 individuals recruited from community stroke clubs in Scotland revealed that stroke influenced a person’s perceptions, experience, use and enjoyment of the environment. Multiple specific (e.g. theatres, cafes) and more general (out-of-the- home) environments appeared capable of supporting community reintegration, providing settings in which individuals were able and willing to interact with others and participate in various functional, social and recreational activities. The article reflects on the study’s implications for policy and practice.

Quality of Life among Persons with Paraplegic Spinal Cord Injury

JAHAN, Humayra
ISLAM, Md. Shofiqul
HOSSAIN, Mohammad Sohrab
PATWARY, Md. Fazlul Karim
2016

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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

Physiotherapy care for adults with paraplegia due to traumatic cause: A review

GUPTA, Nalina
RAJA, Kavitha
2016

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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.

Childhood disability in Turkana, Kenya: Understanding how carers cope in a complex humanitarian setting

ZUURMOND, Maria
NYAPERA, Velma
MWENDA, Victoria
KISIA, James
RONO, Hilary
PALMER, Jennifer
2016

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Background: Although the consequences of disability are magnified in humanitarian contexts, research into the difficulties of caring for children with a disability in such settings has received limited attention.


Methods: Based on in-depth interviews with 31 families, key informants and focus group discussions in Turkana, Kenya, this article explores the lives of families caring for children with a range of impairments (hearing, vision, physical and intellectual) in a complex humanitarian context characterised by drought, flooding, armed conflict, poverty and historical marginalisation.


Results: The challenging environmental and social conditions of Turkana magnified not only the impact of impairment on children, but also the burden of caregiving. The remoteness of Turkana, along with the paucity and fragmentation of health, rehabilitation and social services, posed major challenges and created opportunity costs for families. Disability-related stigma isolated mothers of children with disabilities, especially, increasing their burden of care and further limiting their access to services and humanitarian programmes. In a context where social systems are already stressed, the combination of these factors compounded the vulnerabilities faced by children with disabilities and their families.


Conclusion: The needs of children with disabilities and their carers in Turkana are not being met by either community social support systems or humanitarian aid programmes. There is an urgent need to mainstream disability into Turkana services and programmes.

Work Ability Index: Validation and Model Comparison of the Malaysian Work Ability Index (WAI)

LAVASANI, Sobhan
WAHAT, Nor Wahiza Abdul
2016

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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. 

Development and functional demonstration of a wireless intraoral inductive tongue computer interface for severely disabled persons

STRUIJK, Lotte N S Andreasen
LONTIS, Eugen R
GAIHEDE, Michael
CALTENCO, Hector A
LUND, Morten Enemark
SCHIOELER, Henrik
BENTSEN, Bo
2016

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Purpose: Individuals with tetraplegia depend on alternative interfaces in order to control computers and other electronic equipment. Current interfaces are often limited in the number of available control commands, and may compromise the social identity of an individual due to their undesirable appearance. The purpose of this study was to implement an alternative computer interface, which was fully embedded into the oral cavity and which provided multiple control commands.

 

Methods: The development of a wireless, intraoral, inductive tongue computer was described. The interface encompassed a 10-key keypad area and a mouse pad area. This system was embedded wirelessly into the oral cavity of the user. The functionality of the system was demonstrated in two tetraplegic individuals and two able-bodied individuals

 

Results: The system was invisible during use and allowed the user to type on a computer using either the keypad area or the mouse pad. The maximal typing rate was 1.8 s for repetitively typing a correct character with the keypad area and 1.4 s for repetitively typing a correct character with the mouse pad area.

 

Conclusion: The results suggest that this inductive tongue computer interface provides an esthetically acceptable and functionally efficient environmental control for a severely disabled user.

Concurrent Validity of Mobility Disability Scale among Community-dwelling Individuals

Manikandan, Natarajan
Kumar, K B
Rajashekhar, B
2016

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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 isrequired. 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 Rankcorrelation 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.

Long-term training with a brain-machine interface-based gait protocol induces partial neurological recovery in paraplegic patients.

NICOLELIS, Miguel
et al
August 2016

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"Brain-machine interfaces (BMIs) provide a new assistive strategy aimed at restoring mobility in severely paralyzed patients. Yet, no study in animals or in human subjects has indicated that long-term BMI training could induce any type of clinical recovery. Eight chronic (3–13 years) spinal cord injury (SCI) paraplegics were subjected to long-term training (12 months) with a multi-stage BMI-based gait neurorehabilitation paradigm aimed at restoring locomotion. This paradigm combined intense immersive virtual reality training, enriched visual-tactile feedback, and walking with two EEG-controlled robotic actuators, including a custom-designed lower limb exoskeleton capable of delivering tactile feedback to subjects. Following 12 months of training with this paradigm, all eight patients experienced neurological improvements in somatic sensation (pain localization, fine/crude touch, and proprioceptive sensing) in multiple dermatomes. Patients also regained voluntary motor control in key muscles below the SCI level, as measured by EMGs, resulting in marked improvement in their walking index. As a result, 50% of these patients were upgraded to an incomplete paraplegia classification. Neurological recovery was paralleled by the reemergence of lower limb motor imagery at cortical level". It is hypothesised that this unprecedented neurological recovery results from both cortical and spinal cord plasticity triggered by long-term BMI usage."

Scientific Reports 6, Article number: 30383 (2016)
doi:10.1038/srep30383

'Brain training' technique restores feeling and movement to paraplegic patients

RADFORD, Tim
August 2016

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It is reported that eight paraplegics – some of them paralysed for more than a decade by severe spinal cord injury – have been able to move their legs and feel sensation, after help from an artificial exoskeleton, sessions using virtual reality (VR) technology and a non-invasive system that links the brain with a computer. "After just 10 months of what the Brazilian medical team “brain training” they have been able to make a conscious decision to move and then get a response from muscles that have not been used for a decade". The work is part of the Walk Again Project.

Impact of structured wheelchair services on satisfaction and function of wheelchair users in Zimbabwe

VISAGIE, Surona
MLAMBO, Tecla
VAN DER VEEN, Judith
NHUNZV, Clement
TIGERE, Deborah
SCHEFFLER, Elsje
2016

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Background: Providing wheelchairs without comprehensive support services might be detrimental to user satisfaction and function.

 

Objectives: This paper compares wheelchair user satisfaction and function before and after implementation of comprehensive wheelchair services, based on the World Health Organization guidelines on wheelchair service provision in less resourced settings, in Zimbabwe.

 

Method: A pre- and post-test study with a qualitative component was done. Quantitative data were collected with the Quebec User Evaluation of Satisfaction with Assistive Technology for adults and children and the ‘Functioning Every day with a Wheelchair Questionnaire’. Data were collected from 55 consecutively sampled wheelchair users, who received a new wheelchair in the study period. Qualitative data were collected through two audio recorded focus groups and two case studies and are presented through narrative examples.

 

Results: The proportion of adult users who were satisfied significantly increased for all wheelchair and service delivery aspects (p = 0.001 - 0.008), except follow-up (p = 0.128). The same was true for children’s post-test ratings on all variables assessed (p = 0.001 - 0.04), except training in the use of the device (p = 0.052). The biggest improvement in satisfaction figures were for comfort needs (44.3%), indoor mobility (43.2%), outdoor mobility (37.2%), safe and efficient, independent operation (33.5%) and transport (31.4%). The qualitative data illustrated user satisfaction with wheelchair features and services.

 

Conclusion: The wheelchair service programme resulted in significant positive changes in user satisfaction with the wheelchair, wheelchair services and function. It is recommended that the Zimbabwean government and partner organisations continue to support and develop wheelchair services along these guidelines.

Impact of inaccessible spaces on community participation of people with mobility limitations in Zambia

BANDA-CHALWE, Martha
NITZ, Jennifer C
DE JONGE, Desleigh
2016

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Background: The study investigated the perspective of people with mobility limitations (PWML) in Zambia, firstly of their accessibility to public buildings and spaces, and secondly of how their capacity to participate in a preferred lifestyle has been affected.

 

Objectives: Firstly to provide insight into the participation experiences of PWML in the social, cultural, economic, political and civic life areas and the relationship of these with disability in Zambia. Secondly to establish how the Zambian disability context shape the experiences of participation by PWML.

 

Method: A qualitative design was used to gather data from 75 PWML in five of the nine provinces of Zambia. Focus group discussions and personal interviews were used to examine the accessibility of the built environment and how this impacted on the whole family’s participation experiences. The nominal group technique was utilised to rank inaccessible buildings and facilities which posed barriers to opportunities in life areas and how this interfered with the whole family’s lifestyle.

 

Results: Inaccessibility of education institutions, workplaces and spaces have contributed to reduced participation with negative implications for personal, family, social and economic aspects of the lives of participants. Government buildings, service buildings, and transportation were universally identified as most important but least accessible.

 

Conclusion: Zambians with mobility limitations have been disadvantaged in accessing services and facilities provided to the public, depriving them and their dependants of full and equitable life participation because of reduced economic capacity. This study will assist in informing government of the need to improve environmental access to enable equal rights for all citizens.

Parental stress and support of parents of children with spina bifida in Uganda

BANNINK, Femke
IDRO, Richard
VAN HOVE, Geert
2016

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Background: Children with disabilities in Sub-Saharan Africa depend for a large part of their functioning on their parent or caregiver. This study explores parental stress and support of parents of children with spina bifida in Uganda.

 

Objectives: The study aimed to explore perceived stress and support of parents of children with spina bifida living in Uganda and the factors that influence them.

 

Methods: A total of 134 parents were interviewed. Focus group discussions were held with four parent support groups in four different regions within the country. The Vineland Adaptive Behaviour Scales, Daily Functioning Subscales and Parental Stress Index Short Form (PSI/SF) were administered to measure the child’s daily functioning level and parental stress levels.

 

Results: Parental stress was high in our study population with over half of the parents having a > 90% percentile score on the PSI/SF. Stress outcomes were related to the ability to walk (Spearman’s correlation coefficient [ρ] = −0.245), continence (ρ = −0.182), use of clean intermittent catheterisation (ρ = −0.181) and bowel management (ρ = −0.213), receiving rehabilitative care (ρ = −0.211), household income (ρ = −0.178), geographical region (ρ = −0.203) and having support from another parent in taking care of the child (ρ = −0.234). Linear regression showed parental stress was mostly explained by the child’s inability to walk (β = −0.248), practicing bowel management (β = −0.468) and having another adult to provide support in caring for the child (β = −0.228). Parents in northern Uganda had significantly higher scores compared to parents in other regions (Parental Distress, F = 5.467*; Parent–Child Dysfunctional Interaction, F = 8.815**; Difficult Child score, F = 10.489**).

 

Conclusion: Parents of children with spina bifida experience high levels of stress. To reduce this stress, rehabilitation services should focus on improving mobility. Advocacy to reduce stigmatisation and peer support networks also need to be strengthened and developed.

National guidelines on the provision of assistive technology in Papua New Guinea. Zero draft – April 2016

BRENTHALL, Lee
et al
April 2016

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The purpose of these National Guidelines for the Provision of Assistive Technologies (AT) in PNG is to provide a framework for a national standard of care in appropriate AT provision, for women, men, girls and boys with mobility, hearing and vision impairments, regardless of their age, location, ethnicity, and socio-economic background. It is hoped that these Guidelines will help ensure that users receive appropriate and affordable AT that suit their needs, daily activities and lifestyles, while satisfying minimum requirements for safety, strength and durability, and that service providers are trained in all steps of the service provision cycle.

Development of a contextually appropriate, reliable and valid basic Wheelchair Service Provision Test

GARTZ, Rachel
GOLDBERG, Mary
MILES, Alexandria
MILES, Rory
PEARLMAN, Jon
SCHMELER, Mark
BITTMAN, Sarah Jonassen
HALE, Judith
2016

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Purpose:

Currently, there is no internationally accepted way to measure the competency of wheelchair service professionals. The International Society of Wheelchair Professionals aims to develop a Wheelchair Service Provision – Basic Test as a preliminary step towards establishing a certification process. 

 

Method:

A team of wheelchair service provision experts developed test questions and conducted alpha and beta testing in order to validate them. Low-performing test items were eliminated. A pilot test was then conducted, which focused on developing a pass score, determining language barriers and validating the test as a measure of competency. 

 

Results:

90 participants completed one of three versions of the Wheelchair Service Provision – Basic Test. A pass score of 70% was established and 135 questions were accepted for the final test. Analysis of variance indicated there was a difference in scores based on language (p = 0.001), but not based on experience level. This result motivated translation in to the United Nations’ official languages.

 

Conclusions:

The results indicate that the Wheelchair Service Provision – Basic Test is a valid method for measuring basic competency of wheelchair professionals. Additionally, researchers recommend a skills assessment to help to ensure only qualified wheelchair professionals receive the certificate.

Translation of Revised Version of Developmental Coordination Disorder Questionnaire (DCDQ’07) into Kannada – Results of Validation

Girish, Srilatha
Raja, Kavitha
Kamath, Asha
2016

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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.

Making schools accessible to children with disabilities

2016

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Barrier-free access refers to universal access for all children to inclusive schools. While there are many barriers that need to be addressed — the curriculum, and teaching-learning practices and materials, among others — to make a school inclusive, this guidebook speci fi cally focuses on infrastructural barriers and provides practical, cost-effective and technical solutions for making the physical environment of a school safe, accessible and friendly for children with disabilities.

 

During accessibility audits conducted in 500 schools across 16 states in India in 2012-2014, it was found that due to lack of expertise and understanding of access standards amongst construction personnel and school administration, school infrastructure was often barrier- fi lled and unsafe for children with disabilities. This hampered their access to and use of classrooms, playgrounds, libraries, drinking water units, toilets, mid-day meal areas, and other areas.3 This guidebook has been prepared to:

 

i. Provide guidance on making the school infrastructure accessible for children with disabilities.

ii. Assess school facilities and infrastructure and provide design solutions based on national accessibility standards.

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