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Early rehabilitation in conflicts and disasters

LATHIA, Charmi
SKELTON, Peter
CLIFT, Zoe
Eds
January 2020

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When emergencies strike, there is a huge surge in the need for Early Rehabilitation. Early Rehabilitation for patients with traumatic injuries in conflicts and disasters is now recognised as being an integral part of a patient’s recovery. However, the majority of rehabilitation professionals in countries that experience such emergencies do not have all the skills needed to treat all of the injuries. HI, in collaboration with leading organisations (ICRC, MSF-France, CBM, Livability & the WHO), has created this educational resource package to fill this gap

Each chapter of this handbook has been written by experts in their field. It includes pictures and evidence based treatment protocols to help rehabilitation professionals around the world to delivery high quality early rehabilitation intervention. Chapters included are:

  • Key Challenges in Delivering Early Rehabilitation in Conflicts and Disasters
  • Early Rehabilitation Patient Assessment and Treatment - the Basics
  • Early Rehabilitation of Fractures 
  • Early Rehabilitation of Peripheral Nerve Injuries
  • Early Rehabilitation of Amputees
  • Early Rehabilitation of Acquired Brain Injuries
  • Early Rehabilitation of Spinal Cord Injuries
  • Early Rehabilitation of Burns

Videos accompany each of the chapters. The handbook contents are directly linked to modules taught on disasterready.org where there are additional accompanying resources designed to be used in conflict and disasters settings

Combating PTSD in the Military

Bradley University
October 2019

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PTSD in veterans is a serious issue, but many former service members and their loved ones do not know how to identify the condition or seek treatment. Because PTSD affects mental health and can be hidden, it can be difficult for health practitioners and other individuals to gauge its severity. Additionally, PTSD in veterans is often misunderstood by the public to be a condition that only affects combat veterans or those who have encountered violence firsthand. And even those who understand PTSD in veterans and its potential long-lasting harms still may not know all of its wide-ranging symptoms.

Included here are tips, tools and resources that can help friends and families of veterans who may be suffering from PTSD. 

Disability Inclusion Helpdesk Report No: 15 : Mental health and psychosocial support (MHPSS) in Syria: concepts, reality and effectiveness of interventions

LEE, Harri
ZIVERI, Davide
PFEFFER, Lauriane
July 2019

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Summaries on the findings from the following queries:

Define mental health and psychosocial support (MHPSS) and intended outcomes of these interventions (at the global level).

What is the evidence on the nature of the problem and the scale of need for MHPSS services in Syria?

What is the evidence on effectiveness of MHPSS interventions in Syria?

Emergency trauma response to the Gaza mass demonstrations 2018–2019. A one-year review of trauma data and the humanitarian consequences

OLIM, Nelson
HALIMAH, Sarah
Eds
May 2019

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The specific goals of this publication are first, to conduct an analysis of 1 year of conflict related trauma in Gaza; second, to highlight the role of the Health Cluster partners, including the World Health Organization (WHO) as the cluster lead agency, in supporting the local health system; and third, to document success stories, challenges and lessons learnt

Impact of parenting a child with cerebral palsy on the quality of life of parents: A systematic review of literature

RAMANANDI, Vivek H
PARMAR, Trupti Rudra
PANCHAL, Juhi Kalpesh
PRABHAKAR, M M
et al
2019

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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.

 

 

Disability, CBR and Inclusive Development, Vol 30, No 1 (2019)

Psychosocial disability in the Middle East

BOLTON. Laura
May 2018

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A K4 helpdesk report, commissioned by DFID (UK), provides a rapid review of literature to provide best estimates of psychosocial disability in specific countries in the Middle East.

Topics discussed include:

Prevalence and different forms of mental health conditions and psychosocial disability

Factors influencing prevalence

Differences across demographics

Provision for those with psychosocial disabilities

Inclusion of marginalised Aboriginal and Torres Strait Islander peoples with neurocognitive disability in the National Disability Insurance Scheme (NDIS)

TOWNSEND, Clare
McINTYRE, Michelle
LAKHANI, Ali
WRIGHT, Courtney
WHITE, Paul
BISHARA, Jason
CULLEN, Jennifer
2018

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Given the ambiguity surrounding the extent and experience of neurocognitive disability (NCD) among marginalised Aboriginal and/or Torres Strait Islander peoples in Australia, evidence regarding the level and nature of NCD is crucial to ensure equitable access and inclusion into the National Disability Insurance Scheme (NDIS). This paper reports the results of the implementation of The Guddi Protocol (a culturally informed and appropriate screening protocol for Aboriginal and/or Torres Strait Islander peoples) at two locations in Queensland. Results indicated high levels of NCD, and additional qualitative data revealed a number of factors associated with the complex disablement of study participants, namely: i) intergenerational trauma; ii) a social context of disadvantage, marginalisation and exclusion; and iii) the nonidentification of disability. The results are linked to implications for NDIS inclusion for this population, and recommendations are made. Unless the extent and nature of complex disability and the issues surrounding culturally safe policy, and service design and engagement are addressed with and by Aboriginal and Torres Strait Islander peoples, including those who experience complex disablement, marginalised people will continue to be effectively excluded from the NDIS.

 

Disability and the Global South, 2018, Vol.5, No. 2

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. 

Mental health and trauma in asylum seekers landing in Sicily in 2015: a descriptive study of neglected invisible wounds

CREPET, Anna
RITA, Francesco
REID, Anthony
et al
January 2017

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While the medical conditions of newly migrated asylum seekers to Sicily were being addressed, the mental health of those who may have experienced trauma before, during, or after their migration was not addressed. "Médecins sans Frontières (MSF), in agreement with the Italian Ministry of Health, provided mental health (MH) assessment and care for recently-landed asylum seekers in Sicily. This study documents mental health conditions, potentially traumatic events and post-migratory living difficulties experienced by asylum seekers in the MSF programme in 2014–15." 

Not forgetting severe mental disorders in humanitarian emergencies: a descriptive study from the Philippines

WEINTRAUB, Ana Cecilia Andrade de Moraes
et al
November 2016

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"In response to the Typhoon Haiyan in the Philippines, Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) decided to concentrate its efforts in the severely affected area of Guiuan and its four surrounding municipalities. The MSF-OCB intervention included a comprehensive approach to mental health, including care for people with pre-existing and post-disaster severe mental disorders. Based on this experience of providing MH care in the first five months after Typhoon Haiyan, we report on the monthly volume of MH activities and beneficiaries; sociodemographic and care seeking characteristics of beneficiaries receiving MH counselling/care, stratified by the severity of their condition; profile and outcomes of patients with severe mental disorders; prescribing practice of psychotropic medication; and main factors facilitating the identification and management of individuals with severe mental disorders"

International Health, Vol.8, No.5, pp. 336-344

Doi: 10.1093/inthealth/ihw032

The 2015 Nepal earthquake(s): Lessons learned from the disability and rehabilitation sector's preparation for, and response to, natural disasters

LANDRY, Michel
SHEPHARD, Phillip
LEUNG, Kit
RETIS, Chiara
SALVADOR, Edwin
RAMAN, Sudha
November 2016

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This article outlines lessons learned from 2015 Nepal earthquake that can be applied to future disasters to reduce overall disability-related outcomes and more fully integrate rehabilitation in preparation and planning. Information is presented on disasters in general, and then specficially on the earthquake(s) in Nepal. Field experience in Nepal before, during, and after the earthquake is described, and actions that can and should be adopted prior to disasters as part of disability preparedness planning are examined. Emerging roles of rehabilitation providers such as physical therapists during the immediate and postdisaster recovery phases are discussed. Finally, approaches are suggested that can be adopted to “build back better” for, and with, people with disabilities in postdisaster settings such as Nepal.

 

Physical Therapy, Volume 96, Issue 11, 1 November 2016, Pages 1714–1723

https://doi.org/10.2522/ptj.20150677

 

Problem Management Plus (PM+) Individual psychological help for adults impaired by distress in communities exposed to adversity

WORLD HEALTH ORGANIZATION
2016

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With this manual, the World Health Organization (WHO) is responding to requests from colleagues around the world who seek guidance on psychological interventions for people exposed to adversity.

The manual describes a scalable psychological intervention called Problem Management Plus (PM+) for adults impaired by distress in communities who are exposed to adversity. Aspects of Cognitive Behavioural Therapy (CBT) have been changed to make them feasible in communities that do not have many specialists. To ensure maximum use, the intervention is developed in such a way that it can help people with depression, anxiety and stress, whether or not exposure to adversity has caused these problems. It can be applied to improve aspects of mental health and psychosocial well-being no matter how severe people’s problems are.

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.

Injuries, death, and disability associated with 11 years of conflict in Baghdad, Iraq : a randomized household cluster survey

LAFTA, Riyadh
et al
August 2015

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“The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.” The quantitative study shows the methodology used in the collection of data, the findings discovered through evaluation of the data gathered, and interpretation of how to best use those findings to serve specific populations”

 

 PLOS ONE, 10(8)

Participation and quality of life outcomes among individuals with earthquake-related physical disability: A systematic review

NUNNERLEY, Joanne
DUNN, Jennifer
McPHERSON, Kathryn
et al
May 2015

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A literature review to evaluate quality of life and participation outcomes of individuals with earthquake-related physical injury. A systematic review was performed searching MEDLINE, Embase, PsychINFO, CINAHL and AMED electronic databases from 1966 to January 2014. Studies that measured quality of life or participation outcomes among individuals who acquired a physical disability as a result of an earthquake injury were included, with no limits on research design. The search yielded 961 potentially relevant articles after removal of duplicates. Of these, only 8 articles met the inclusion criteria. Seven papers were reviewed from the following 5 earthquakes: 2001 Gujarat earthquake, India; 2008 Wenchuan earthquake, China (also known as the Sichuan earthquake); 2005 Kashmir earthquake, Pakistan (27); 2009 Padang earthquake, Indonesia; 2010 Port-au-Prince earthquake.

Journal of Rehabilitation Medicine, vol.47, no.5, 2015, 385-393

10.2340/16501977-1965

Culture, Politics and Global Mental Health

TRIBE, Rachel
2014

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This paper critically examines some of the assumptions and politics which underlie the global mental health (GMH) movement; and explores the issue of cultural awareness within western psychiatric thinking and practice. The way distress is labelled has a range of consequences for the individual, their family and society, as well as those who may control or negotiate the descriptors used, the actions taken as a result of these and the resources subsequently allocated. This paper will examine if these are the most useful principles, and if so, who might be the main beneficiaries of these. The importance of context, international, national and health politics, in addition to wealth and power differentials cannot be ignored in the way that the global mental health debate is constructed. Diagnostic classification systems, such as the Diagnostic Statistical Manual (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD), are not neutral documents as is frequently assumed but carry a range of assumptions and represent a number of interest groups. Different cultural constructions, explanatory health beliefs, idioms and local ways of dealing with distress often appear to be seen as additional layers of meaning within the current debate, rather than as the central organising concepts they are for many people. Yet the transfer of western psychiatric ideas and the uncritical generalisation of them around the world (even if made with the best of intentions) can undermine the rich traditions and cultural heritage of many low- and middle-income countries (LMICs) and could be viewed as a form of neo-colonialism. There are many angles to this debate, including the use of language and the fact that some cultures have concepts and long traditions around ‘mental health’ which are different from those used in ‘the west’. The paper will use the diagnostic category Post Traumatic Stress Disorder (PTSD) as an example to illustrate many of the points made.

 

Disability and the Global South, 2014, Vol. 1 No. 2

Disability associated with exposure to traumatic events : results from a cross-sectional community survey in South Sudan

AYAZI, Touraj
et al
May 2013

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"There is a general lack of knowledge regarding disability and especially factors that are associated with disability in low-income countries. We aimed to study the overall and gender-specific prevalence of disability, and the association between exposure to traumatic events and disability in a post-conflict setting. We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire (HTQ) was applied to investigate exposure to trauma events. Disability was measured using the Washington Group Short Measurement Set on Disability, which is an activity based scale derived from the WHO’s International Classification of Disability, Functioning and Health. The estimated prevalence of disability (with severe difficulty) was 3.6% and 13.4% for disability with moderate difficulties. No gender differences were found in disability prevalence. Almost all participants reported exposure to at least one war-related traumatic event. The result of a hierarchical regression analysis showed that, for both men and women, exposure to traumatic events, older age and living in a polygamous marriage increased the likelihood of having a disability. The finding of association between traumatic experience and disability underlines the precariousness of the human rights situation for individuals with disability in low-income countries. It also has possible implications for the construction of disability services and for the provision of health services to individuals exposed to traumatic events"
BMC Public Health, 13:469

Infertility : why can’t we classify this inability as disability?

KHETARPAL, Abha
SINGH, Satendra
2012

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"Disability is a complex phenomenon. It reflects an interaction between features of a person's body and features of the society in which he or she lives. International Classification of Functioning, Disability and Health (ICF), lays stress on the functional as well as the structural problem of a person. All the definitions of disability also include the disorders of the reproductive and endocrine system. So infertility and impotency should also be included in the category of disability. It affects the participation in areas of life and can have a disabling affect on an individual"
Australian Medical Journal, Vol 5, No 6

Disability and health related rehabilitation in international disaster relief

REINHARDT, Jan
LI, Jianan
GOSNEY, James
et al
August 2011

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Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. The objective was to examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. A qualitative literature review and secondary data analysis were carried out. 

 

Global Health Action

http://dx.doi.org/10.3402/gha.v4i0.7191 

Psychological first aid : guide for field workers

WORLD HEALTH ORGANIZATION (WHO)
WAR TRAUMA FOUNDATION (WTF)
WORLD VISION INTERNATIONAL
2011

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"This guide covers psychological first aid which involves humane, supportive and practical help to fellow human beings suffering serious crisis events. It is written for people in a position to help others who have experienced an extremely distressing event. It gives a framework for supporting people in ways that respect their dignity, culture and abilities. Despite its name, psychological first aid covers both social and psychological support"

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