There has been much work related to the evolution of recovery pathways following critical illness. COVID-19 presents a real opportunity to ensure full implementation of existing hospital and community based rehabilitation services for people recovering from critical illness, and to identify areas requiring further development in the post-COVID-19 era. The Life After Critical Illness (LACI) work stream of the Faculty (of Intensive Care Medicine, UK) was halfway to being delivered when the pandemic struck. This position statement and provisional guidance has been produced to support the pandemic and provide a national framework for future Critical Illness Recovery Services.
People with lung problems often feel short of breath. Many daily tasks can make you breathless, such as walking, getting dressed or doing jobs around the house. Being breathless can make you panic or feel frightened. When you learn how to control your breathing these feelings will not trouble you as much and you will be able to do more. When you are breathless, do not panic. Your breathing will settle.
In order to explore the experiences of persons with physical disabilities accessing and using rehabilitation services in Sierra Leone, interviews with 38 individuals with differing physical disabilities were carried out in three locations across Sierra Leone (Freetown, Bo and Makeni).
The analysis resulted in six themes: The initial and ongoing need for rehabilitation throughout life; Challenges with the cost of rehabilitation and transportation to reach rehabilitation services; Varied experiences with rehabilitation staff; Coming to terms with disability and facing stigma; The struggles without and opportunities with rehabilitation services; Limited knowledge and availability of rehabilitation services.
Addressing barriers to affordability, access, and availability of rehabilitation and addressing knowledge gaps, attitudinal barriers and stigma towards rehabilitation and persons with disability are discussed.
Disability and Rehabilitation, April 2020
This research article focuses on optimising the performance of frontline implementers engaged with NTD programme delivery in Nigeria. Three broad themes are examined: technical support, social support and incentives
Qualitative data was collected through participatory stakeholder workshops. Eighteen problem-focused workshops and 20 solution-focussed workshops were held in 12 selected local government areas (LGA) across two states in Nigeria, Ogun and Kaduna States
Human Resources for Health, 2019 Nov 1;17(1):79
These guidelines were developed to advance understanding of the needs and challenges of persons living with deafblindness and to promote their inclusion in society. The target audience are members of the CBM Federation with particular interest to, among others staff at Regional and Country Offices, Member Associations, co-workers, partners (including governments, education agencies, public and private service providers, and professionals), as well as persons living with deafblindness and their families.
Part One gives an overview of the impact deafblindness can have on an individual’s development and learning. It emphasises the need for a continuum of services and programmes, including early detection, referral, educational input, and family support.
Part Two outlines components of education and rehabilitation programmes. It provides guidelines on communication, holistic assessment procedures, assistive devices, advocacy and self-determination, transition planning, and discusses the importance of on-going regular access to health and therapeutic services.
Part Three considers how to improve and expand existing services through the provision of on-going personnel capacity building, and through networking with key stakeholders, to consider intersecting issues and service expansion. Each section includes an overview of the topic explored, some case studies and considerations for service implementation.
Sightsavers has produced a new film that sets out our work to make health care services accessible and inclusive for everyone. It focuses on our programmes in Bhopal, India and Nampula, Mozambique. This highlights how we work and share learnings globally, but also shows how programmes can be made locally relevant by working with partners with direct experience.
The film showcases some of the people who work hard to make our inclusive health programmes a success, from Sightsavers experts and government health workers to leaders of disabled people’s organisations.
To find out more our inclusive health work and how we are developing best practice in terms of inclusive health programmes, visit our website: https://www.sightsavers.org/disability/health/
This Collection is a joint initiative of the European Network on Independent Living (ENIL) and the European Disability Forum (EDF). It features examples from different EU Member States, which to a different extent facilitate the right to live independently in the community.
The examples are divided into four areas, presented in different chapters:
- Legislation and funding: State Funded Peer-Counselling – Estonia; Direct Payments – Ireland.
- Community-based support: Peer-Counselling for women with disabilities – Austria; Supported living for adults with intellectual disabilities – Croatia; Supported Decision-Making – The Czech Republic; Mobile Mental Health Units – Greece; Personal Assistance for People with Complex Disabilities – Sweden .
- Involvement of disabled people: Co-Production in Social Care – United Kingdom; Participation of Organisations of People with Disabilities – Italy
- Self-advocacy: Self-Advocacy of Disabled People – Romania
To learn more about the current status of IECD (inclusive early childhood development) and ECI (early childhood intervention) programs, three international organizations collaborated to conduct a global survey: RISE Institute; UNICEF; and the Early Childhood Development Task Force (ECDtf), which is within the Global Partnership on Children with Disabilities (GPcwd). This large survey was designed in 2016, was conducted in 2017, and the report was prepared in 2018.
The main objectives of the survey were to:
- Map current implementation of IECD and ECI programs and related activities;
- Describe key IECD and ECI program features;
- Identify gaps and challenges in providing accessible IECD and ECI services;
- Document factors associated with successful implementation and scale-up;
- Generate recommendations to inform future policy and program development and national planning and implementation efforts.
The online survey targeted a range of programs, and activities including IECD and ECI services; rehabilitation and habilitation services; humanitarian, emergency, and child Global Survey of Inclusive ECD and ECI Programs 8 protection services; advocacy campaigns; and research and evaluation projects.
Program respondents provided information on 426 programs that were implemented in 121 countries.
Background: Musculoskeletal diseases consume a large amount of health and social resources and are a major cause of disability in both low- and high-income countries. In addition, patients frequently present with co-morbid chronic diseases of lifestyle. The area of musculoskeletal disease is restricted by a lack of epidemiological knowledge, particularly in low- and middle-income countries.
Objectives: This pragmatic randomised controlled trial assessed the benefits of a 6-week physiotherapy intervention for middle-aged women with musculoskeletal conditions compared to usual care.
Method: A weekly 2-h educational programme utilising a workbook, discussion group and exercise class was presented for the intervention group, while the control group received usual care. The primary outcome was health-related quality of life. Parametric and non-parametric data were used to determine the equivalence between the groups.
Results: Twenty-two participants were randomised to the intervention and 20 to the control group. The control group demonstrated no within-group improvement in health-related quality of life items, compared to significant improvements in two items in the intervention group. The change in median utility score within the intervention group was twice as large as the change in the control group. With regard to self-efficacy, the intervention group demonstrated significant within-group changes in perceived management of fatigue and discomfort.
Conclusion: The positive impact of the intervention on the participants suggests that the programme should continue at the clinic in question, but should be presented at a more convenient time for participants who work, as recruitment to the study was less than anticipated. Primary health care systems in South Africa urgently need to put structures in place for effective management of the functional impact of chronic diseases of lifestyle and musculoskeletal conditions. It is time for physiotherapists and possibly other health care professionals to participate in the development of appropriate community level interventions to address the functioning and quality of life of individuals living with the diseases.
African Journal of Disability, Vol 8, 2019
"This publication summarizes the current gaps, needs and opportunities for intervention in the field of assistive technology in Tajikistan. The situational analysis was conducted under the leadership of the Ministry of Health and Social Protection, Republic of Tajikistan and with technical support from the WHO Country Office, Tajikistan. It was undertaken in collaboration with different Government ministries and State agencies, development partners, United Nations agencies, nongovernmental organizations, disabled people’s organizations and users of assistive products. It adopted a realist synthesis approach, responsive to the unique social, cultural, economic and political circumstances in the country. The evaluation focuses on assistive technology policy and governance, service provision and the impact of assistive technology on the health and well-being of individual users and their families, with the aim of improving access to high-quality, affordable assistive products in Tajikistan.
200 persons with disabilities participated in a survey designed to collect information on self-reported need for assistive products, user experiences and barriers to access. An additional 11 focus groups made up of persons with disabilities and older adults held indepth discussions on assistive technology. The major providers of assistive technology (Government facilities, nongovernmental organizations, local producers) were also interviewed as part of the research"
Pacific Disability Forum (PDF) is committed to advancing the rights of people with disabilities living in Pacific Island Countries (PICs). Developing an evidence base to understand more about deaf children and adults’ experiences and priorities will better assist communities, DPOs, organisations and governments to plan inclusive communities, policy and programs.
The development of the design was deliberately planned to be highly collaborative and the team met with 161 people who shared their views. This provided opportunities for deaf people and DPOs to contribute to the design, along with representatives from government, non-government and regional organisations. This collaboration occurred in three countries in the Pacific, namely Solomon Islands, Samoa and Fiji. Within Fiji, the design team met with deaf and DPO representatives of other PIC’s along with regional multi-lateral organisations such as UNICEF and the Pacific Island Forum Secretariat (PIFS). Consultations also occurred remotely with supporting organisations and development workers that are focused on disability inclusion in the Pacific. The design undertook a desk review to learn what is known about deaf children and adults in the Pacific region. Participatory methods ensured the process was highly respectful of the views of deaf people. DPOs, other organisations and governments will be asked to identify to what extent deaf children, adults and their families are participating in services, programs and establishments, and to identify potential supports required to increase deaf people’s participation. A capacity building element has been carefully built into the design. The report is divided into three parts. Part A rationalizes the design, with background information and a brief desk review to collect evidence from and about deaf children and adults in the Pacific. Part B describes the design development process and reports findings. Part C details the design for the situation analysis.
This report makes the case that integrated people-centred eye care is the care model of choice and can help meet the challenges faced. Chapter 1 highlights the critical importance of vision; describes eye conditions that can cause vision impairment and those that typically do not; reviews the main risk factors for eye conditions; defines vision impairment and disability; and explores the impact of vision impairment. Chapter 2 provides an overview of the global magnitude of eye conditions and vision impairment and their distribution. Chapter 3 presents effective promotive preventive, treatment, and rehabilitative strategies to address eye care needs across the life course. Chapter 4 starts by taking stock of global advocacy efforts to date, the progress made in addressing specific eye conditions and vision impairment, and recent scientific and technological advances; it then identifies the remaining challenges facing the field. Chapter 5 describes how making eye care an integral part of universal health care (including developing a package of eye care interventions) can help address some of the challenges faced by countries. Chapter 6 presents IPEC and explains the need for engaging and empowering people and communities, reorienting the model of care based on a strong primary care and the need for coordinating services within and across sectors; and creating an enabling environment. The report ends with five recommendations for action that can be implemented by all countries to improve eye care.
A literature review was conducted to identify core elements of interventions to promote resilience in individuals and family members in the face of discrimination in the case of leprosy. A multi-phase adapted scoping review of English literature and a narrative review of the Portuguese language literature were carried out. Three main intervention focus areas in our review were identified: individual level, social/community level and system level.
Lepr Rev (2019) 90, 88–104
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.
Disability, CBR and Inclusive Development, Vol 30, No 1 (2019)
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.
Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 95-103, Oct. 2019
The objective of this case study was to review how Cambodia, as an affected state, and Australia as a donor, promote the provision of victim assistance in sectors including health, rehabilitation, disability, socio-economic development and poverty reduction. It documents promising practices and proposes next steps to ensure the sustainability of victim assistance provision in the near and long-term future. This study aims to inspire the mine action community in both affected and donor states to increase its contribution to victim assistance. This case study focuses on both prongs of the integrated approach to victim assistance by describing: i) Broader multi-sector efforts that reach casualties, survivors and indirect victims; and ii) Specific victim assistance efforts to improve victims’ quality of life deployed by mine action stakeholders, other actors in charge of coordinating victim assistance in Cambodia, and Australia as a donor state. An analysis of these specific efforts revealed that they fall into one of two of the following categories: a) Bridging gaps in data collection and service provision, or b) Advocating for, and facilitating, a multisector response.
Humanity & Inclusion (HI) and the Cambodian Mine Action and Victim Assistance Authority (CMAA) conducted the study in November 2017 in seven provinces. The methodology comprised three steps: a desk review of project documents, national plans and policies from a range of sectors with a focus on programmes funded by Australia; interviews with key personnel from the mine action and the disability sectors; and a field survey comprising 31 individual indepth interviews with 19 survivors and 12 other persons with disabilities (23 male and 8 female), 12 focus group discussions as well as field visits to observe the initiatives described in this publication.
The Amputee Body Image Scale (ABIS) and its shortened version (ABIS-R) are self-administered questionnaires to measure body image perception of amputee. The aim was to assess the validity and reliability of the French ABIS (ABIS-F and ABIS-R-F).
Ninety-nine patients were included. The cross-cultural adaptation was performed according to the recommendations.
Journal of Disability and Rehabilitation, Volume 42, 2020 - Issue 5
This learning resource is the result of a partnership between World Vision Australia and CBM Australia that aims to improve inclusion of people with disabilities in World Vision’s Water, Hygiene and Sanitation (WASH) initiatives, including in Sri Lanka. The guidelines are based on experiences and observations from World Vision’s implementation of the Rural Integrated WASH 3 (RIWASH 3) project in Jaffna District, Northern Province, funded by the Australian Government’s Civil Society WASH Fund 2. The four year project commenced in 2014. It aimed to improve the ability of WASH actors to sustain services, increase adoption of improved hygiene practices, and increase equitable use of water and sanitation facilities of target communities within 11 Grama Niladari Divisions (GNDs) in Jaffna District.
To support disability inclusion within the project, World Vision partnered with CBM Australia. CBM Australia has focused on building capacities of partners for disability
inclusion, fostering connections with local Disabled People’s Organisations, and providing technical guidance on disability inclusion within planned activities. World Vision also partnered with the Northern Province Consortium of the Organizations for the Differently Abled (NPCODA) for disability assessment, technical support and capacity building on inclusion of people with disabilities in the project.
HYGIENE AT HOME FOR PEOPLE WITH HIGH SUPPORT NEEDS
This document is one of two developed in the Jaffna District and describes strategies that used to assist households and individuals in hygiene tasks at home. The strategies were designed to be low cost and were developed using locally available materials and skills in the Jaffna District of Sri Lanka.
NOTE: The development of this learning resource was funded by the Australian Government's Civil Society WASH Fund 2.
This rapid review looks at examples of existing literature on the availability of assistive technologies and efforts to make these technologies more affordable and accessible in developing countries. Needs and access to assistive technologies are overviewed. The discussion of market characteristics of assistive technologies covers availability, affordability, quality, appropriate design, and awareness and demand. Efforts to increase the affordability and accessibility of assistive technology are discussed covering: The Global Cooperation on Assistive Technology (GATE); the WHO Priority Assistive Products List; and EYElliance and eye health initiatives. Market shaping and community based approaches are discussed in this context.
This is a K4D helpdesk report. This report was commissioned by the UK Department for International Development (DFID)
This is a practical manual about mental health care, aimed at community health workers, primary care nurses, social workers and primary care doctors, particularly in low resource settings. It describes more than 30 clinical problems associated with mental illness, using a problem-solving approach to guide the reader through their assessment and management. It addresses the lack of understanding of mental health among many health workers. Mental health issues as they arise in specific contexts are described - in refugee camps, in school health programmes, as well as in mental health promotion. The final section helps the reader to personalise for a particular location, for example, by entering local information on voluntary agencies, the names and costs of medicines and words in the local language for symptoms.
This product is an update of the first edition 2003. It is also available as Open Access.
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