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Preliminary experiences in acute occupational therapy for in-patients with coronavirus-19 (COVID-19): leveraging assistive technology in three case studies of male veterans

RICH, Tonya
HICKS, Brandon
DAHL, Abigail
SULLIVAN, Elle
BARRETT, Benjamin
BEDORE, Beau
2020

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Purpose:

Coronavirus 2019 (COVID-19) was first identified in December 2019 with millions of cases reported globally in the succeeding months. Initial hospitalisation strives to minimise multisystem organ failure and of those that survive, individuals can present with profound rehabilitation needs. The purpose of this case series is to describe occupational therapy (OT) and special technology considerations for three male Veteran patients hospitalised with suspected or confirmed COVID-19. 

 

Methods: 

This is a descriptive case series using a retrospective electronic health record review at a Veterans Administration hospital. The case series includes three male Veterans with confirmed or suspected COVID-19 (ages 69–78) who were referred to OT. The cases were selected to demonstrate the novel use of technology and strategies to reduce the risk of transmission. In two of three of our cases, we describe acute rehabilitation with a focus on activity tolerance, participation in occupations, and discharge planning. In all cases, we measured vital signs and activity tolerance as primary outcomes. 

 

Results and conclusions: 

The findings suggest that outcome measures focussing on activity tolerance to maintain stable vital signs during the recovery phase is central to the progression of activities. We observed in our cases that the Person-Environment-Occupation-Performance (PEOP) model can guide practice and complement the medical model in management of these patients. We utilised technology to engage family members in the rehabilitation care and minimise exposure risks.

The association between tactile, motor and cognitive capacities and braille reading performance: a scoping review of primary evidence to advance research on braille and aging

MARTINIELLO, Natalina
WITTICH, Walter
2020

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PURPOSE

As the prevalence of age-related visual impairment increases, a greater understanding of the physiological and cognitive capacities that are recruited during braille reading and the potential implications of age-related declines is required.

 

METHODS

This scoping review aimed to identify and describe primary studies exploring the relationship between tactile, motor and cognitive capacities and braille reading performance, the instruments used to measure these capacities, and the extent to which age is considered within these investigations. English peer-reviewed articles exploring the relationship between these capacities and braille reading performance were included. Articles were screened by two researchers, and 91% agreement was achieved (kappa = 0.84 [0.81, 0.87], p < 0.01).

 

RESULTS

 2405 articles were considered of which 36 met the inclusion criteria. Fifteen investigated the relationship between tactile capacities and braille reading performance, 25 explored motor capacities, and 5 considered cognitive capacities. Nineteen instruments were used to measure tactile capacity, 4 for motor dexterity, and 7 for cognitive capacity. These studies focus on younger participants and on those who learned braille early in life.

 

CONCLUSIONS

  • Although this overview underscores the importance of tactile perception and bimanual reading, future research is needed to explore the unique needs of older adults who learn braille later in life.
  • The studies in this review underscore the importance of developing both haptic tactile perception and efficient hand reading patterns early in the braille learning process.
  • Practitioners should consider whether specific pre-braille readiness activities can be used to address the unique needs of older adults who may experience tactile, motor or cognitive declines.
  • Most of the studies in this review require replication before they should serve as reliable clinical guidelines; however, braille reading (like print) is a complex process that draws on multiple capacities that should be developed in unison.
  • The studies in this review focus heavily on younger participants and on those who learned braille early in life, and highlight the need for future research on braille and aging.

Covid-19 Income loss, risk of violence and the response of persons with disabilities and their representative organisations in Uganda

ADD International
November 2020

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Findings from this report show evidence that some persons with disabilities face multiple types of jeopardy during Covid-19: they are at an increased risk of violence and are suffering a dramatic loss in household earnings. They are also taking action: many plan to adapt their livelihood and are mobilising resources for their communities. Persons with disabilities ask government and NGOs to do more and to be more inclusive in their response to the crisis.

● Three of four respondents report increased risk of violence since the pandemic began. 77% of women and 80% of men report an increase in economic, physical, psychological and/or sexual violence after Covid-19.

● One in three women respondents report experiencing an increased risk of physical and/or sexual violence.

● Livelihood support could reduce violence risk. Three in four (76%) of respondents say livelihood support, such as start up capital for small business, would be very or extremely useful to them in order to reduce their risk of experiencing violence during Covid-19.

● Respondents report losing 64% of their monthly household income since the outbreak. After adjusting for purchase power parity, this is the equivalent of falling from 181 GBP to 65 GBP per month.

● Covid-19 support is unequal and insufficient for many. Where support has been distributed, one in two report that they do not receive the same protection support (ie PPE) as others; one in four report that they do not receive the same Covid-19 survival support (ie food); one in three report they do not receive the same Covid-19 information; and one in three say that support does not meet need.

● Most respondents will try something new. 59% indicate that they will start something new to make ends meet if the situation continues.

● OPDs are obtaining food support through lobbying, providing vital psychosocial support and information.

● Some OPDs are not able to respond because they are capacity-constrained.

● Government and NGOs can do more.


From these interviews and findings, some recommendations emerge for government and NGOs:

● Support livelihood to reduce violence risk and increase survival strategies.

● Increase access to capital.

● Meaningfully engage persons with disabilities and their respective organisations in response planning and implementation.

● Ensure distribution of support reaches persons with disabilities, more specifically the underrepresented groups.

● Change attitudes toward and increase knowledge about persons with disabilities.

WHO launches assistive technology capacity assessment (ATA-C)

WORLD HEALTH ORGANISATION (WHO)
November 2020

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WHO has developed the assistive technology capacity assessment (ATA-C) tool, a system-level tool to evaluate a country’s capacity to finance, regulate, procure and provide assistive technology. The ATA-C tool enables countries to better understand the current status and identify key actions to improve access to assistive technology: it can be used for awareness raising, policy and programme design and ongoing monitoring and evaluation.

The ATA-C is part of the WHO Assistive Technology Assessment (ATA) Toolkit, helping countries to collect effective and relevant data on assistive technology

Quality of wheelchair services as perceived by users in rural Bangalore district, India: a cross-sectional survey

GEILEN, Bart G
DE WITTE, Luc
NORMAN, Gift
GEORGE, Carolin Elizabeth
2020

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Background and aim:

This study investigated the current state of wheelchair services in Bangalore Rural district, as provided by Bangalore Baptist Hospital, and identified areas for improvement.

 

Method:

a cross-sectional survey was held among 50 wheelchair users. Data was collected on demographics, satisfaction, wheelchair skills and level of disability using QUEST, WST-Q and CHART-SF questionnaires.

 

Result:

Overall satisfaction can be described as more or less satisfied, scoring 3.8 out of 5. Wheelchair users were less satisfied with the services compared to the wheelchair itself. The skills a wheelchair users had were strongly correlated with satisfaction scores (p < 0.01). Differences in satisfaction between genders were observed and related to multiple factors.

 

Conclusion:

Wheelchairs should be easy to use with support services being easily accessible. A wheelchair should be delivered together with a training program to provide the user with the skills to operate and maintain the wheelchair. There are gender-wise differences in satisfaction towards wheelchair services that influence satisfaction.

Impact of the FindMyApps program on people with mild cognitive impairment or dementia and their caregivers; an exploratory pilot randomised controlled trial

BEENTJES, Kim M
NEAL, David P
KERKHOF, Yvonne J F
BROEDER, Caroline
MOERIDJAN, Zaïnah D J
ETTEMA, Teake P
PELKMANS, Wiesje
MULLER, Majon M
GRAFF, Maud J L
DRÖES, Rose-Marie
2020

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Purpose

FindMyApps is a web-based selection-tool and errorless learning training program to help people with mild dementia/Mild Cognitive Impairment (MCI) and caregivers find user-friendly apps. In preparation of a definitive trial, the impact and feasibility of the FindMyApps intervention on self-management and engagement in meaningful activities, including social participation, was explored.

 

Materials and methods

An exploratory pilot randomised controlled trial (trial registration approval number: NL7210) with pre/post measurements was conducted with community-dwelling people with mild dementia/MCI and their caregivers (n = 59) in the Netherlands. Dyads in the experimental group (n = 28) received training to use the tablet and FindMyApps, and the errorless learning method was taught to their caregivers. Control group dyads (n = 31) received a tablet (without FindMyApps), instructions on tablet-use and links to dementia-friendly apps. Validated instruments were used to assess person with dementia’s self-management, meaningful activities and social participation, caregiver’s sense of competence and both their quality of life.

 

Results and conclusions

No statistical significant group differences on the outcomes were found. Small to moderate effect-sizes in favour of the FindMyApps group were found for self-management and social participation. Caregivers tended to have more positive care experiences. Subgroup analyses showed that people older than 70 benefitted more from FindMyApps regarding self-management and higher educated people benefitted more regarding social participation. FindMyApps is feasible for the target group and may have potential to improve self-management and social participation. For a future definitive effectiveness trial a larger sample size is recommended, as well as taking into account the possible impact of education and age.

Moral distress and ethical decision-making of eldercare professionals involved in digital service transformation

FRENNERT, Susanne
2020

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Aim

Technology affects almost all aspects of modern eldercare. Ensuring ethical decision-making is essential as eldercare becomes more digital; each decision affects a patient’s life, self-esteem, health and wellness.

 

Methods

We conducted a survey and interviews with eldercare professionals to better understand the behavioural ethics and decision making involved in the digital transition of eldercare.

 

Conclusion

Our qualitative analysis showed three recurrent roles among eldercare professionals in regard to digital service transformation; makers, implementers and maintainers. All three encountered challenging and stressful ethical dilemmas due to uncertainty and a lack of control. The matter of power relations, the attempts to standardize digital solutions and the conflict between cost efficiency and if digital care solutions add value for patients, all caused moral dilemmas for eldercare professionals. The findings suggest a need for organizational infrastructure that promotes ethical conduct and behaviour, ethics training and access to related resources.

Postural asymmetries, pain, and ability to change position of children with cerebral palsy in sitting and supine: a cross-sectional study

CASEY, Jackie
ROSENBLAD, Andreas
RODBY-BOUSQUET, Elisabet
2020

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Purpose: To examine any associations between postural asymmetries, postural ability, and pain for chil- dren with cerebral palsy in sitting and supine positions.

 

Methods: A cross-sectional study of 2,735 children with cerebral palsy, 0-18years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification sys- tem levels I–V, sex, age and report of pain were used to determine any relationship between these variables.

 

Results: Over half the children had postural asymmetries in sitting (n1⁄41,646; 60.2%) or supine (n1⁄41,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor func- tion. Children unable to maintain or change position independently were at higher risk for postural asym- metries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2).

 

Conclusions: An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain.

Teaching for inclusion – a review of research on the cooperation between regular teachers and special educators in the work with students in need of special support

PAULSRUD, David
NILHOLM, Claes
2020

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This article presents a review of qualitative research on interprofessional cooperation between regular teachers and special educators published from 2005 to 2019. The aim of the review was to gain knowledge about how different forms of cooperation take shape and about factors at multiple levels that facilitate or constrain cooperation as a means of achieving inclusion. In total, 25 studies were selected. The results are discussed in relation to Thomas Skrtic’s theory of bureaucracies within the school organisation in order to compare and analyse different forms of interprofessional cooperation and schools’ organisations of special educational work. Cooperative teaching, special educational consultations and mixed forms of cooperation were found to entail different benefits and challenges related to communication and the cooperating actors’ roles. Facilitating factors included personal chemistry, an equal distribution of power and responsibilities and support from the school management through provision of professional development and adequate planning time. In several studies, a flexible cooperation was argued to be hindered by curricular constraints and standardised testing. Education policy is therefore emphasised in this review as important for understanding the conditions under which school staff are responsible for inclusion.

Do both ‘get it right’? Inclusion of newly arrived migrant students in Swedish primary schools

TAJIC, Denis
BUNAR, Nihad
2020

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The aim of this article is to advance knowledge on how Swedish primary schools organise education and what strategies they deploy to ensure inclusion and attainment of newly arrived migrant students. The article is based on semi-structured interviews with 30 teachers and school administrators, and one-year of fieldwork undertaken in two multicultural urban primary schools in the Stockholm region. One of the schools initially places students in separate classes, while the other one places them directly into mainstream classes. Both are evoking inclusion and attainment as a reason for using their respective models. As such, do both ‘get it right’? Using inclusion as the theoretical and conceptual framework this article addresses the broader question: How is the meaning of inclusion constructed in the processes of its practical implementation in these two schools? The results show the ambitious tale of inclusion in both schools was, in the process of the construction of its meaning and implementation, reduced to some of its aspects. Teachers and school administrators are allowed to include or leave out of their model whatever they deem necessary, obsolete, expensive or unrealistic and still fitting under the umbrella of inclusion. Sometimes it works, sometimes it does not, and both schools ‘get it right’ and ‘wrong’ in some aspects.

Teachers’ and parents’ attitudes towards inclusion of pupils with a first language other than the language of instruction

KAST, Julia
SCHWAB, Susanne
2020

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Due to the rising linguistic heterogeneity in schools, the inclusion of pupils with a first language other than the language of instruction is one of the major challenges of education systems all over the world. In this paper, attitudes of in-service teachers, pre-service teachers and parents towards the inclusion of pupils with a first language other than the language of instruction are examined. Additionally, as the paper focused on how the participants perceive the development of this pupils in different school settings (fully included, partly included, fully segregated).


Data from 1501 participants were investigated. Descriptive results showed that pre-service teachers’ attitudes towards the inclusive schooling of pupils with different language skills in composite classes were rather positive, while attitudes of in-service teachers and parents rather tend to be neutral. Regarding the results concerning the participants’ attitudes towards the pupils’ development in different school settings, all three sub-groups belief that pupils with German as first language would develop in a more positive way, compared to pupils without German as first language. Moreover, the migration background of pre-service teachers and parents had a positive influence on the participants’ attitudes.
 

Gap Analysis: the inclusion of people with disability and older people in humanitarian response Part 2. Beyond the evidence: Implications for innovation and practice

PRYOR, Wesley
MARELLA, Manjula
ROBINSON, Alex
November 2020

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The first part of the Gap Analysis was published in July 2020, which presented the findings of an academic literature review and grey literature review.

Part 2 of the Gap Analysis presents the insights from individuals working in humanitarian response, disability inclusion and older age inclusion. This report begins by looking at how an agenda for the inclusion of people with disability and older people in humanitarian response has been established. The report then considers the ways in which standards and guidance inform humanitarian practice and the challenges associated with translating commitments into practice. Finally, the report identifies seven areas where there are key gaps and opportunities presenting the potential for innovation in research and practice

Increasingly consulted, but not yet participating: IDA global survey report on participation of Organisations of Persons with Disabilities

INTERNATIONAL DISABILITY ALLIANCE (IDA)
November 2020

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This new report presents the findings of the first-ever global survey led by OPDs on their participation in decision making processes of governments, the UN system and funding agencies.

The IDA Global Survey is part of a strategy to hold decision-makers accountable for their commitments under Articles 4.3 and 32 of the UN Convention on the Rights of Persons with Disabilities (CRPD). Based on testimonies collected from OPDs in 165 counties, the report assesses the quality, depth, scope and relevance of the OPDs participation in programmes and policies, and offers recommendations for governments, the UN system and funding agencies.

Estimating assistive product need in Cameroon and India: results of population‐based surveys and comparison of self‐report and clinical impairment assessment approaches

BOGGS, Dorothy
KUPER, Hannah
MACTAGGART, Islay
MURTHY, GVS
OYE, Joseph
POLACK, Sarah
November 2020

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To estimate population need and coverage for distance glasses, hearing aids and wheelchairs in India and Cameroon, and to explore the relationship between assistive product (AP) need measured through self‐report and clinical impairment assessment.

Population‐based surveys of approximately 4000 people each were conducted in Mahabubnagar district, India and Fundong district, Cameroon. Participants underwent standardised vision, hearing and musculoskeletal impairment assessment to assess need for distance glasses, hearing aids, wheelchairs. Participants with moderate or worse impairment and/or self‐reported difficulties in functioning were also asked about their self‐reported AP need.

 

https://doi.org/10.1111/tmi.13523

Inclusion and exclusion in humanitarian action The state of play.

BARBELET, Veronique
WAKE, Caitlin
November 2020

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This paper provides the foundation for a multi-year study on inclusion and exclusion in humanitarian action being carried out by the Humanitarian Policy Group (HPG) at ODI. It seeks to make sense of the concept of inclusion in humanitarian action, explore how it relates to humanitarian principles and other core concepts and outlines some of the key issues and challenges preventing more inclusive humanitarian action. Drawing on existing practice and evidence from a review of academic and grey literature, the study argues that vulnerability is a critical, but challenging, lens to inform the prioritisation of humanitarian assistance and protection, and that it has failed to lead to more inclusive humanitarian action. 

If not now, when? Keeping promises to older people affected by humanitarian crises

McGIVERN, Verity
November 2020

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This report looks at the extent to which older people’s rights are being upheld in emergencies and their needs met. The picture it paints is a bleak one. Although some efforts are being made to support older people, overall, the humanitarian system is failing by the standards it has set itself.
 
The report draws on the findings of needs assessments carried out by HelpAge International in the 13 months to the end of 2019. We interviewed 8,883 people aged 50 to 80 - plus affected by natural disasters, conflict or socioeconomic crises in 11 countries in Africa, Asia, Latin America and the Middle East.
 
Since the data was collected, COVID-19 has swept across the globe. The pandemic has both increased the need for humanitarian aid and disrupted its delivery. The response to coronavirus has thrown into stark relief the gulf between the risks older people are facing and the level of support available to them. The findings in this report provide important lessons for improving this response
 

Menstrual Hygiene Management: Challenges and Coping Strategies for Adolescents with Disabilities in the Kumasi Metro of Ghana

Enoch, Acheampong
Nadutey, Alberta
Afful, Barbara Fosua
Anokye, Reindolf
2020

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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.

Life Accomplishment, Social Functioning and Participation of South-Eastern Nigerians with Lower Limb Amputation

Akosile, Olusanjo Christopher
Okonkwo, Arinze Christian
Maruf, Adesina Fatai
Okoye, Chiebuka Emmanuel
2020

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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.

Teachers’ Attitudes towards Inclusion of Blind or Partially-Sighted Students in Secondary Schools in Nigeria

Ajuwon, Paul M
Chitiyo, George
Onuigbo, Liziana N
Ahon, Adaka T
Olayi, James E
2020

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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 to teach students with disabilities.; 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 were generally positive. 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 may need to be implemented to increase teachers’ knowledge base and expand their experiences in line with established policies and legislation.

Physical Activity of the Community- Dwelling Elderly Population in Gujarat, India: A Cross-Sectional Study

Patel, Samira Sirajulhak
Gupta, Nalina
Parmar, Lata
2020

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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.

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