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PubMed2001

American Academy of Pediatrics: Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Committee on Children With Disabilities.

The use of complementary and alternative medicine (CAM) to treat chronic illness or disability is increasing in the United States. This is especially evident among children with autism and related disorders. It may be challenging to the practicing pediatrician to distinguish among accepted biomedical treatments, unproven therapies, and alternative therapies. Moreover, there are no published guidelines regarding the use of CAM in the care of children with chronic illness or disability. To best serve the interests of children, it is important to maintain a scientific perspective, to provide balanced advice about therapeutic options, to guard against bias, and to establish and maintain a trusting relationship with families. This statement provides information and guidance for pediatricians when counseling families about CAM.

Child↗

PubMed2001

Schedule for rating disabilities: disabilities of the liver. Final rule.

This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (38 CFR part 4) by revising the portion of the Digestive System that addresses disabilities of the liver. The intended effect of this action is to update this portion of the rating schedule to ensure that it uses current medical terminology and unambiguous criteria, and that it reflects medical advances that have occurred since the last review.

Diagnosis-Related Groups↗

PubMed1990

Making non-discriminatory fitness-for-duty decisions about persons with disabilities under the Rehabilitation Act and the Americans with Disabilities Act.

This article describes an assessment role performed by clinical psychologists in the employment context, and examines how it has been evaluated by the courts from the standpoint of discrimination against persons with disabilities. Guidelines are offered for making fitness-for-duty decisions which are legally defensible, and examples of the decision-making process are provided. Data-based limitations on professional expertise are articulated, and conclusions drawn are aimed at practicing psychologists and the courts dealing with these uncertainties. Issues are analyzed principally in courts dealing with these uncertainties. Issues are analyzed principally in relation to Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA), which has been passed by both houses of Congress.

Adult↗

PubMed1989

[Raising physically and psychologically disabled children and non-disabled children within the family].

The formation of close fraternal relations is of great importance for the personality development of the children as well as of their parents and for the relations arising between brothers and sisters with advancing age. With regard to these relations the parents can be partly relieved from the care, troubling them possibly all their life for their disabled child. This has to be considered more thoroughly in the educational advice for the parents of physically-mentally disabled children.

Child↗

PubMed1995

[Clinical studies of learning disability. Part II: A prospective study of children with risk factors for learning disability at three year-old screening].

We followed children with the risk factors for learning disability (LD) at the three year-old screening prospectively. The five risk factors were speech delay, hyperkinesia, delayed social skill, delayed comparative conception (big and small, long and short) and mutistic behaviour. We evaluated seventeen elementary school children using WISC-R and the Pupil Rating Scale Revised. Six of them were diagnosed as normal, six were learning-disabled, and five were mentally retarded children. We proposed that the screening of LD at three years by the risk factors were effective but only partially.

Child↗

PubMed1998

Cognitive and behavioral correlates of depression in learning-disabled and nonlearning-disabled adult students.

Cognitive and behavioral correlates of depression were examined in 33 learning-disabled (LD) and 99 nonlearning-disabled (NLD) adult students. Self-reported depressive symptomatology was significantly correlated with dysfunctional cognitions and reinforcement level in LD students. LD students reported engaging in significantly more unpleasant activities and experiencing significantly less pleasure than NLD students. There was a nonsignificant trend for LD students to report more depression than NLD students. These results are discussed in the context of cognitive and behavioral theories of depression.

Adolescent↗

PubMed2005

Training on the International Classification of Functioning, Disability and Health (ICF): the ICF-DIN Basic and the ICF-DIN Advanced Course developed by the Disability Italian Network.

The objective is to present training on the International Classification of Functioning, Disability and Health (ICF) prepared by the Disability Italian Network (DIN) and to present strategies of ICF dissemination in Italy. A description of DIN's training methodology, prepared in collaboration with World Health Organization (WHO) experts, is provided within its practical applications in health, labour, rehabilitation and statistical sectors. The ICF-DIN Basic Course is eight hours long and focuses on ICF basic principles, structure and application in different settings. The ICF-DIN Advanced Course, three days long followed by three months of distance learning, assumes Basic Course completion, and focuses also on ICF-checklist's coding and WHO-DAS II administration. The first training courses' outcomes, held in Italy and addressed to health, social and labour professionals, are provided. The feedback received by participants at the end of the courses showed that the main mistake they made was to consider ICF as an assessment instrument. The ICF-DIN training course was crucial in explaining the correct use of the ICF as a classification and to show its impact and usefulness on daily practice, particularly in multidisciplinary teams. The ICF-DIN courses already carried out in Italy show that this teaching methodology teaches how to avoid incomplete applications, simplification and misunderstanding of ICF's complexity.

Disability Evaluation↗

PubMedDate not supplied

Listening comprehension and recall abilities in adolescents with language-learning disabilities and without disabilities for social studies lectures.

Listening comprehension and recall abilities for social studies lectures were examined and compared in 20 adolescent males with language-learning disabilities (LLD) and 29 without disabilities (WD). Subjects viewed two social studies lectures with comparison and causation expository discourse structures and verbally responded to literal and inferential comprehension questions. Regardless of lecture type or question type, the group with LLD performed significantly more poorly than did the group WD. Both groups responded accurately to significantly more inferential questions for the causation lecture over the comparison lecture. Neither group demonstrated a significant difference with respect to their response accuracy for the literal questions across lecture types.

Adolescent↗

PubMed2003

A survey exploring the educational needs of care practitioners in learning disability (LD) settings in relation to death, dying and people with learning disabilities.

This paper presents the findings of a small scale pilot study which explored the educational base and needs of qualified care practitioners in Learning Disability (LD) settings in relation to death, dying and people with learning disabilities. Eighty questionnaires were sent to two NHS Trusts in the South of England. The response rate for the qualified care practitioners from Cherry Blossom (CB) was 100%, whereas for Greengages (GG), the response rate was only 25%. The response from the unqualified care practitioners was disappointingly low, hence we declared them null and void. The analysis of data highlighted major concerns: namely, a lack of consistent policy in the recording of death in residential homes for dying persons with LD; a lack of knowledge, particularly in psychosocial aspects and skills in care of dying persons. The majority of the qualified care practitioners surveyed highlighted the importance of communication with clients and their families. We recommend that communication and interpersonal skills in the care and management of the terminally ill persons with LD be the core component in the nursing curriculum which at present only indicates a trace of it. It is not made explicit that it is essential. This study supports the notion that issues of LD override and obscure physical illness. Our study also highlights ambiguity in the use of concepts and terminology, and demonstrates some limitations in our methodology. We propose that further research, using different methodological approaches, such as Ethnography, Ethnomethodology, or a combination of these, would be appropriate.

Cause of Death↗

PubMed2002

Subjective judgements of quality of life: a comparison study between people with intellectual disability and those without disability.

The present study investigated the relationship between objective and subjective measures of quality of life (QoL), and in particular, health status and primary care services. Thirty-one people with intellectual disability (ID) were interviewed using a QoL questionnaire. Thirty-one matched controls from the general population filled in a parallel questionnaire. The results in both groups support the findings of many researchers which indicate that satisfaction with aspects of life is generally high (i.e. approximate 75% of maximum possible satisfaction). The present study also confirms previous findings which indicate that satisfaction with aspects of life does not generally correlate with objective circumstances in either group. The importance that people attach to aspects of their lives did not generally correlate with their objective circumstances or their satisfaction with life. However, people with ID attached greater importance to all aspects of their lives than those without disability. This may be linked to their aspirations, preferences and opportunities for choice, and therefore, these factors may be a more meaningful way of considering their QoL. The present findings call into question the use of satisfaction as a general measure of QoL, and also indicate that the use of importance as a mediating variable in understanding satisfaction may not be a solution. The participants with ID had poorer health than the controls, and were significantly less satisfied with their health. Contrary to other findings, the present participants with ID reported that they had received more health checks than the controls over the previous year. Half of these checks had been carried out by 'special' services rather than primary care services.

Humans↗

PubMed2002

Environmental, medical, behavioural and disability factors associated with Helicobacter pylori infection in adults with intellectual disability.

In institutionalized adults with intellectual disability (ID), Helicobacter pylori infection occurs at approximately twice the rate it appears in the general population, and it may be responsible for the twofold higher rates of peptic ulcer disease and gastric cancer in this population. Medical, behavioural and additional environmental factors, as well as level of ID, may be related to the risk of infection with H. pylori. One hundred and sixty-eight adults with ID who were currently, had previously been or had never been institutionalized underwent a biopsychosocial evaluation. This included assessment of: level of ID using the Adaptive Behaviour Scale (ABS) Part I; levels of maladaptive behaviour using the ABS Part II; demographic, medical and environmental factors; as well as H. pylori tests using serology and faecal antigen. The overall rates of past or current infection with H. pylori in institutionalized and previously institutionalized participants were about twice that of the overall group of never-institutionalized participants, i.e. 87% and 79% compared to 44%, respectively (P < 0.001). The rates of H. pylori infection appeared to increase with age in the never-institutionalized group, but were consistently high across all ages in the other groups. The rate of infection was higher in those institutionalized for more than 5 years (95% versus 76%, P=0.02), in those with flatmates with excessive oral secretions (65% versus 21%, P < 0.001) or faecal incontinence (67% versus 27%, P < 0.001), and in those with more chronic illness and medications. All mean domain scores of the ABS Part I (Intellectual Disability) were significantly lower (indicating more severe ID) in the group currently infected with H. pylori compared to their non-infected counterparts. The majority of mean domain scores of the ABS Part II (Behaviour) were also worse, with half of these score differences reaching statistical significance in the currently infected group. The presence of alarm symptoms (e.g. vomiting, weight loss, haematemesis and melena), iron deficiency and body mass index were not significantly different in currently infected subjects. Adults with ID appear to be particularly at risk of infection with H. pylori. Environmental associations with infection include past or current institutionalization, a longer period of institutionalization, living with flatmates with excessive oral secretions and faecal incontinence. Medical associations include chronic disease and more medications, but not alarm symptoms or body mass index. Demographic associations may include increasing age in never-institutionalized adults, but no age effect in currently or previously institutionalized individuals. Psychosocial associations include more severe ID and maladaptive behaviour with current infection.

Adaptation, Psychological↗

PubMed2002

Feasibility, reliability and validity of the Spanish version of Psychiatric Assessment Schedule for Adults with Developmental Disability: a structured psychiatric interview for intellectual disability.

BACKGROUND: Over 30% of people with intellectual disability (ID) have a comorbid psychiatric disorder. However, there are few assessment instruments available for international use and cross-cultural validation studies of these instruments are rare. The aim of the present study was to standardize the Spanish version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD-10), a semi-structured interview for people with ID. METHODS: After a conceptual translation, feasibility (i.e. applicability, acceptability and practicality) and reliability analyses were carried out. The predictive validity of the PAS-ADD-10 CATEGO-5 codings was also examined (i.e. positive and negative predictive values). Four independent raters with wide-ranging experience in quantitative evaluation and psychiatric assessment of ID evaluated a sample of 80 subjects with ID and borderline intellectual functioning at the AFANAS occupational centre in Jerez, Southern Spain. The ICD-10 codes were used for psychiatric diagnosis. RESULTS: The practicality of the PAS-ADD-10 is limited because of the need for previous standardization of SCAN interviews. Nevertheless, its overall feasibility was judged adequate by raters and the PAS-ADD-10 was considered extremely useful for training. Test-retest and inter-rater reliability kappa values were moderate to high. The CATEGO coding showed limited validity because of overdiagnosis of anxiety disorders and underdiagnosis of mood and psychotic disorders (positive predictive value = 74%, negative predictive value = 76%). CONCLUSIONS: The PAS-ADD-10 is a useful tool for standard psychiatric assessment of people with ID; however, CATEGO codings show low validity and a series of modifications should be considered before this instrument is used extensively in Spain. In this regard, a study on the clinical usefulness of the PAS-ADD-10 in patients with ID and severe mental disorders has been undertaken.

Adolescent↗

PubMed2003

Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability.

BACKGROUND: Self-rating scales are widely used in general adult practice; however, there is no reliable and valid method for assessing state anxiety in people with intellectual disability (ID). The present study describes the development and psychometric evaluation of a new scale, the Glasgow Anxiety Scale for People with an Intellectual Disability (GAS-ID). METHODS: First, an item pool was generated from focus groups, a review of the literature and clinician feedback. Secondly, a draft scale was administered to 19 anxious and 16 non-anxious people with ID for further validation and appraisal of reliability. Thirdly, the scale was completed by 19 anxious, non-ID people for cross-validation with the Beck Anxiety Inventory (BAI). Finally, physiological concomitants were validated by pulse-oximetry. RESULTS: The 27-item GAS-ID discriminated anxious from non-anxious participants, had good test-retest reliability (r = 0.95) and internal consistency (alpha = 0.96), and was reasonably correlated with the BAI (rho = 0.75). The correlation between the physiological subscale of the GAS-ID and changes in pulse rate was moderately significant (rho = 0.52). CONCLUSIONS: This preliminary study suggests that the GAS-ID offers a psychometrically robust and practical (5-10 min) approach to the appraisal of anxiety in this population.

Adult↗

PubMedDate not supplied

IDEA (Intellectual Disability Exploring Answers): a population-based database for intellectual disability in Western Australia.

Despite the demands it places on individuals, families and the community, intellectual disability (ID) is a neglected area of public health. Accurate estimates of prevalence are sparse and range from 0.5 to 3.0%. The cause of the condition is unknown in at least 50% of cases. This paper describes the Intellectual Disability Exploring Answers (IDEA) database set up in Western Australia to provide an infrastructure for research and to facilitate the planning of service provision for people with ID. Since 1953 a database for ID has been maintained in Western Australia, a state with a population of 1.95 million in an area of 2.52 million km2. The current IDEA database aims to obtain ongoing population-based ascertainment of ID from providers of clinical and educational services, with the potential for linkage to a network of other state databases. The average prevalence of ID for children born in Western Australia over the years 1983-1996 was 15.2 per 1000 live births, with 50% ascertained only through the education system. During this time period 60% of cases were male. Of children with an ID born in Western Australia in 1980-1999 and surviving to 1 year, 30.1% had a birth defect, and the prevalence ratio of birth defects in this group compared to the population with no birth defects was 6.5 (CI 6.3-6.8).

Adolescent↗

PubMed1999

Aging with a disability: views from the National Institute on Disability and Rehabilitation Research.

As I move toward the completion of my term as Director of the National Institute on Disability and Rehabilitation Research (NIDRR), I see many examples of renewal in our field. For example, disability studies and rehabilitation science are emerging new areas of academic specialization, and we will all be involved in shaping the future of these endeavors. The field is recapturing its identity and relevance locally and internationally. Also, I see a considerable number of challenges that range from acute care in medical rehabilitation to universal design in engineering to overall technology policy. I see a challenge in moving research to practice, a challenge in funding, a challenge in service delivery locations, and a challenge in defining the role of the professional in order to build capacity for the future. I believe that the research field ignores practice at its own peril, including practice in older fields such as vocational rehabilitation and in newer fields such as cognitive science and access engineering. Practice must be determined by today's needs and those we foresee for tomorrow. For the NIDRR family, the Long-Range Plan provides a beacon to direct us into the new millennium.

Aged↗

PubMed1997

The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure.

BACKGROUND AND PURPOSE: The purposes of this study were (1) to assess the construct validity of the Shoulder Pain and Disability Index (SPADI) and (2) to determine whether the SPADI is more responsive than the Sickness Impact Profile (SIP), a generic health status measure. SUBJECTS: The sample consisted of 94 patients who were diagnosed with a shoulder problem and referred to six outpatient physical therapy clinics. METHODS: Clinically meaningful change was determined by use of an ordinal rating scale designed to determine whether the patient's shoulder function was improved, the same, or worse following treatment. Spearman rho correlations were calculated for the initial visit SPADI and SIP scores. The standardized response mean (SRM) was used to measure responsiveness for the patients who were judged to be improved. One-tailed paired t tests (alpha = .01) were used to determine whether differences existed among SRM values. RESULTS: Correlations between the SPADI and SIP scores ranged from r = .01 to r = .57. The SRM value was higher for the SPADI total score (SRM = 1.38) than for the SIP total score (SRM = 0.79). CONCLUSION AND DISCUSSION: Most correlations between SPADI and SIP scores provided support for the construct validity of the SPADI. The SPADI does not appear to strongly reflect occupational and recreational disability and is more responsive than the SIP.

Disability Evaluation↗

PubMed1998

Cultural and organizational aspects of application of the Americans with Disabilities Act to persons with psychiatric disabilities.

The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodation for persons with psychiatric disabilities. Most persons with a history of mental disorder work productively and do not require accommodation. Many persons with serious mental illness need accommodation but are conscientious and productive workers. Difficulties inherent in the Equal Employment Opportunity Commission (EEOC) guidelines are those of differentiating aspects of mental disorder from work-related conduct and the potential for manipulative persons to use the Act to excuse inappropriate behavior and ask for accommodation. A further problem is the potential for discouraging employers from hiring persons with mental illness because of the perceived difficulty of terminating them should their work prove unsatisfactory. If the ADA is to be effective, it must be seen as only one step in a larger process involving public education, effective mediation, meaningful assistance for employers, and wise implementation decisions that account appropriately for the social context.

Activities of Daily Living↗

PubMed2006

Analysis of the acute postoperative pain experience following oral surgery: identification of 'unaffected', 'disabled' and 'depressed, anxious and disabled' patient clusters.

BACKGROUND: Pain is defined as both a sensory and an emotional experience. Acute postoperative tooth extraction pain is assessed and treated as a physiological (sensory) pain while chronic pain is a biopsychosocial problem. The purpose of this study was to assess whether psychological and social changes occur in the acute pain state. METHODS: A biopsychosocial pain questionnaire was completed by 438 subjects (165 males, 273 females) with acute postoperative pain at 24 hours following the surgical extraction of teeth and compared with 273 subjects (78 males, 195 females) with chronic orofacial pain. Statistical methods used a k-means cluster analysis. RESULTS: Three clusters were identified in the acute pain group: 'unaffected', 'disabled' and 'depressed, anxious and disabled'. Psychosocial effects showed 24.8 per cent feeling 'distress/suffering' and 15.1 per cent 'sad and depressed'. Females reported higher pain intensity and more distress, depression and inadequate medication for pain relief (p < 0.001). Distress and depression were associated with higher pain intensity. The developed questionnaire had tested reliability (test-retest r = 0.89) and estimated validity. CONCLUSION: Cluster analysis showed constituent groups with a range of psychosocial effects in acute postoperative dental extraction pain and is associated with an increase in pain intensity.

Acute Disease↗