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Auditory temporal acuity in normally achieving and learning-disabled college students.

Recent research has suggested that deficits in several metalinguistic/phonological abilities, such as short-term verbal memory and phoneme segmentation, may be etiologic factors in specific reading disability, and it has been speculated that these weaknesses may result from a more fundamental deficit in the processing of temporal, auditory stimuli. This study examined the auditory temporal processing skills of reading-disabled, math-disabled, and normally achieving college students. The math-disabled group was included to control for the possibility that poor temporal processing is a "marker" variable for learning disability rather than being related specifically to reading disability. Subjects were assessed on a battery of psychophysical tasks that included five tests of temporal processing. The reading-disabled group performed significantly more poorly on the temporal tasks but performed as well as the other groups on the simple pitch and loudness discrimination tasks. In spite of the significant difference on the temporal tasks, the majority of reading-disabled subjects performed within the same range as the subjects in the other two groups, and there were also some normally reading subjects who performed poorly on the temporal processing tasks. These findings suggest that poor temporal processing is neither a necessary nor a sufficient cause of reading disability, but that there is a modest association between the two domains.

Achievement↗

Acknowledging the extra care parents give their disabled children.

Around 150,000 families in the UK care for a severely disabled child under the age of 16. Many of these families receive assistance from the Family Fund Trust, which provides grants and information relating to the care of a severely disabled child. The aim of this study was to identify patterns of extra care needs among severely disabled children known to the Trust. Extra care needs are requirements for care not experienced by similarly aged non-disabled children. The research comprised analysis of 40,000 records from the Trust database and qualitative exploration of the extra care needs of disabled children with parents and Trust staff. Although all children require parenting, the care parents give disabled children generally exceeds that given to a non-disabled child. Quantitative analysis showed that the majority of children in the sample required extra assistance or supervision with multiple areas of daily life. With each of five activities (washing, dressing, meal times, during the night and keeping occupied), >70% of children needed extra help and, on average, each child needed extra help or supervision in six areas of daily life. Cluster analysis indicated distinctive combinations of extra care needs. Qualitative material indicated variety in extra care tasks undertaken (physical help, supervision, guidance) and causal factors (physical limitations, cognitive difficulties, behavioural problems). The findings confirm that severely disabled children have considerable extra care needs in many areas of daily life. Parents want professionals to recognize and offer explicit acknowledgement of the extra care they give their disabled children.

Activities of Daily Living↗

Primary health care provision for adults with a learning disability.

BACKGROUND: During the last decade, primary care has been designated as the main provider of health care to people with learning disabilities. Practice nurses based in primary care teams are increasingly the first points of contact with health services. They make an important contribution to promoting good health, with health screening and illness prevention work being a significant part of their role. However, little is known about their views or involvement regarding the provision of primary care for people with learning disabilities. There is therefore a need to explore the nursing perspective, from within primary care, on the current provision of care for people with a learning disability. RESEARCH AIM: To inform the learning disability service of the role of primary care in current service provision for people with learning disabilities. RESEARCH METHOD: A survey of all practice nurses currently employed by Grampian Health Board in Aberdeen was conducted in June 2001. An initial pilot study was conducted in primary care and learning disability services. Data collection took place during June and July 2001. All practice nurses working in the geographical region of Grampian were invited to participate. RESULTS: Communication barriers exist, preventing access to health screening and treatment for some people with learning disabilities. Independent living skills, for example dietary management and budgeting, require additional community support. These conditions pose complex problems for practice nurses and other members of the primary care team. CONCLUSION: This study indicates a need for closer support and partnership with the learning disability service. The factors necessary for providing health care to people with learning disabilities extend beyond the domain of primary care teams. The findings of this survey have important implications for education and support to enable carers and professionals to provide a high standard of care.

Adult↗

Violence in the care of adult persons with intellectual disabilities.

BACKGROUND: Violence, for example physical, psychological, financial and sexual abuse and neglect, exists and is an under-reported problem in caring situations involving adult persons with intellectual disabilities and their caregivers, where both parties can be seen as victims and perpetrators. AIMS AND OBJECTIVES: To investigate violent situations involving Swedish adult persons with intellectual disabilities and their caregivers in group-dwellings. DESIGN: A total population-based survey. METHODS: A questionnaire, including violence towards adults with intellectual disabilities and violence towards staff members during 1 year, was sent to all staff members (n = 164) from 17 care settings for adults with intellectual disabilities with a response rate of 74%. RESULTS: Thirty-five per cent of 122 respondents admitted they had been implicated in or witnessed a violent incident towards an adult person with intellectual disabilities and 14% of the staff members admitted they themselves had been the perpetrators. Sixty-one per cent of the staff members described various situations when they were exposed to violence from an adult person with intellectual disabilities. Physical violence was most frequently reported. Most of the aggression occurred in helping situations when persons with intellectual disabilities did not co-operate or when both actors reacted with violence. The violent situations led the staff members to feel powerless and inadequate. In order to cope they discussed with each other or with the manager. CONCLUSIONS: Violence seems to be accepted as a natural part of the daily care for adult persons with intellectual disabilities. Most of the violence is physical and psychological and occurs in close helping situations. RELEVANCE TO CLINICAL PRACTICE: Supportive interventions, i.e. supervision for the staff members and training of communication skills individually or in group for the adults with intellectual disabilities.

Adaptation, Psychological↗

Attention deficit hyperactivity disorder: review of ADHD in learning disability: the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation[DC-LD] criteria for diagnosis.

BACKGROUND: Attention deficit hyperactivity disorder [ADHD)]is believed to be common among people with learning disabilities. Classification systems in current use have presented diagnostic difficulties in this area, when used for people with learning disability (particularly adults). METHODS: A literature search using electronic databases was undertaken, and journals were hand-searched for articles relevant to the diagnosis of mental disorders in adults with intellectual disabilities. RESULTS: There is preliminary evidence that ADHD is more common in this population than among the non-learning-disabled population, and indeed that rates of hyperactivity increase with increasing severity of learning disability. There are also associations between ADHD and certain causal syndromes of learning disability. CONCLUSION: While available evidence suggests that ADHD may be common among children and adults with learning disabilities, research has been hindered by deficits in currently used diagnostic classification systems. With the recent development of criteria for the diagnosis of ADHD in learning-disabled adults, and the publication of these in Diagnostic Criteria for Learning Disabilities/Mental Retardation[DC-LD] there is scope for an increase in the level of interest in the study of ADHD among adults with learning disabilities.

Adult↗

Use of the Migraine Disability Assessment Questionnaire in children and adolescents with headache: an Italian pilot study.

OBJECTIVES: To determine the suitability of the Migraine Disability Assessment (MIDAS) Questionnaire for assessing disability in children and adolescents with headache and to obtain preliminary information about disability in different primary headaches. BACKGROUND: During the last decade, researchers have begun to employ standardized methodologies to investigate the global impact of primary headaches. Disease-specific instruments have been developed to measure headache-related disability. The MIDAS Questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS Questionnaire is an optimal tool to assess headache-related disability in adults. METHODS: Ninety-five patients aged 7 to 17 years with tension-type headache, migraine, or both completed the validated Italian form of the MIDAS questionnaire on 2 occasions. Test-retest reliability was assessed by the Spearman rank correlation test. The Cronbach alpha assessed internal consistency. The patients answered questions about the adequacy of the questionnaire. RESULTS: The Cronbach alpha was.8. Correlation coefficients were generally high for the overall MIDAS score and for the items investigating disability in school and in family/leisure activities; they were lower for the items about housework. Most patients thought that the MIDAS Questionnaire was useful (98.9%) and that it captured the impact of their headaches (58.9%); 41% thought that questions about disability in housework were useless, 44.2% suggested adding questions regarding inability to do homework. All primary headaches had a considerable impact on daily activities, but patients with migraine tended to have lower headache frequencies and lower total disability time; those with tension-type headache suffered more days in which activities, although performed, were substantially impaired. CONCLUSIONS: The MIDAS Questionnaire is useful for assessing disability in children and adolescents with different primary headaches. Minimal changes in the phrasing and content of the items would be sufficient to render the MIDAS specific for the younger population with headache.

Adolescent↗

Development of a novel method to predict disability after head trauma in children.

BACKGROUND/PURPOSE: Although analysis of functional independence measures (FIM) at discharge are useful for assessing extent of disability in head-injured children, there is no reliable method to predict the severity of disability at the time of admission. The authors developed a novel method to predict severe disability after head trauma on admission. METHODS: Head-injured patients, 2 to 16 years old, with FIM recorded at discharge (n = 3,491) were identified in our state trauma database for the period from 1993 through 1996. Patients categorized as completely dependent by one or more of the FIM (Feeding, Locomotion, Expression, Transfer Mobility, Social Interaction) were classified as disabled. Probability of disability (P(D)) was estimated based on regression weights for Glasgow Coma Scale (GCS), Injury Severity Score (ISS), age, and number of anatomic regions injured. Observed to expected disability rates were compared using a test data set of 2,553 patients entered in the database between 1997 through 1999. RESULTS: There was no statistically significant difference between observed and expected disability across all P(D) intervals, which suggests that the P(D) accurately predicted disability. CONCLUSIONS: P(D) offers a novel and reliable method for early prediction of likelihood of disability in children who sustain head trauma. Routine use of the P(D) may lead to earlier intervention to improve long-term results in head-injured children.

Activities of Daily Living↗

Access to nursing education by disabled students: rights and duties of nursing programs.

This paper outlines the rights and duties of nursing programs regarding access to nursing education for disabled students and the subsequent provision of services for them in the UK. Discussed briefly are the implications of these duties for nursing programs when disabled students are treated less favourably than their peers such as through a failure to make reasonable adjustments within the curriculum. Part IV of the Disability Discrimination Act (1995), as amended by the Special Educational Needs and Disability Act (2001), identifies such statutory duties and rights for nursing programs. For the purpose of this article, access to nursing education by disabled students and the subsequent service provision for these students in nursing programs is described as a game, using a conceptual framework by North. Different roles identified within the formal and informal legal rules, such as attitudes toward disabled students in nursing programs throughout the UK, are discussed briefly using this framework. It is noted that the rules of the game very much mirror the rules under Part II and Part III of the Disability Discrimination Act (1995) relating to disabled employees and disabled service users of public services, in force since December 1996. It is argued that lecturers and senior management teams in both nursing education and the health services occupy historical roles in the efficient design and playing of this game. The next step is to gradually align informal rules with formal rules, which can only be done through proper and correct education of key players.

Civil Rights↗

[Evaluation of the disability of ventilated patients].

OBJECTIVE: It is very important to investigate the patient's disability and pain. Interviews of intubated and tracheotomised patients were neglected because of inadaequate measuring methods. This is the first prospective study that evaluates the disability and pain of intubated and tracheotomised patients. METHODS: Disability, Hospital Anxiety and Depression Scale, Visuelle Analogue Scale, Glasgow Coma Scale and structured questions were used to investigate the disability and pain of ventilated patients. 26 patients of an interdisciplinary operative intensive care unit took part in the study. Sociodemographic parameters, ventilation, sedation and pain were evaluated. Doctors and nurses were asked to assess the patient's pain and disability. RESULTS: 17 intubated and 9 tracheotomised patients were included in the study. Mean intensity of pain was 30.3 (SD = 31.4), anxiety 40.8 (SD = 31.4), disability 30.0 (SD = 11.5) and disability caused by ventilation 61.9 (SD = 28.5). 46.2 % of the patients had a pathological subscale of anxiety and 50 % of depression in the Hospital Anxiety and Depression Scale. Nurses assessed the patient's disability and pain better than the doctors. CONCLUSION: A high disability has to be taken in account in the therapy of intubated and tracheotomised patients.

Adult↗

Relapses and progression of disability in multiple sclerosis.

BACKGROUND: The influence of the patterns of onset of multiple sclerosis and relapses of the disease on the time course of irreversible disability is controversial. METHODS: In 1844 patients with multiple sclerosis who were followed for a mean (+/- SD) of 11 +/- 10 years, we determined the time of the clinical onset of the disease, the initial course (relapsing-remitting or progressive) and the subsequent course (relapsing-remitting, secondary progressive, or primary progressive), the times of relapses, the time to the onset of irreversible disability, and the time course of progressive, irreversible disability. We used three scores on the Kurtzke Disability Status Scale (range, 0 to 10, with higher scores indicating more severe disability) as measures of the severity and progression of disability: a score of 4 (limited walking ability but able to walk for more than 500 m without aid or rest), a score of 6 (ability to walk with unilateral support no more than 100 m without rest), and a score of 7 (ability to walk no more than 10 m without rest while leaning against a wall or holding onto furniture for support). We used Kaplan-Meier analyses to determine the influence of relapses on the time to the onset of irreversible disability. RESULTS: The median times from the onset of multiple sclerosis to the assignment of a score of 4, a score of 6, and a score of 7 on the disability scale were longer among the 1562 patients with a relapsing-remitting onset of disease (11.4, 23.1, and 33.1 years, respectively) than among the 282 patients who had progressive disease from the onset (0.0, 7.1, and 13.4 years, respectively; P<0.001 for all comparisons). In contrast, the times from the assignment of a score of 4 to a score of 6 were similar in the two groups (5.7 and 5.4 years, P=0.74). The time course of progressive, irreversible disease among patients with the primary progressive type of multiple sclerosis was not affected by the presence or absence of superimposed relapses. CONCLUSIONS: Among patients with multiple sclerosis, relapses do not significantly influence the progression of irreversible disability.

Adolescent↗

Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum.

The aim of the present study was to explore the nature, extent and probable causes of nutritional deficiencies among children with disabilities living in Dharavi, a slum in Mumbai, India. A cross-sectional study was conducted to investigate whether the nutritional status of children with disabilities, aged 2-6 years (n 141), was worse than that of non-disabled sibling controls (n 122) and neighbour controls (n 162). Data on food patterns, anthropometry, micronutrient status and feeding difficulties reported by parents were collected. The mean weight for age of the children with disabilities (-2.44 (SD 1.39) Z scores; n 120) was significantly lower (P<0.05) compared with the sibling (-1.70 (SD 1.20) Z scores; n 109) and neighbour (-1.83 (SD 1.290) Z scores; n 162) control groups. The children with disabilities had significantly lower (P<0.05) mean haemoglobin levels (92 (SD 23) g/l; n 134) compared with siblings (102 (SD 18) g/l; n 103) and neighbours (99 (SD 18) g/l; n 153). Relative risk (RR) analysis indicated that the disabled children with feeding difficulties were significantly more likely (P<0.05) to be malnourished, by the indicator of weight for age (RR 1.1; 95 % CI 1.08, 1.20) compared with the disabled children without a feeding difficulty. They were also significantly more likely to be malnourished using the indicators of height for age (RR 1.3; 95 % CI 1.19, 1.43) and weight for height (RR 2.4; 95 % CI 1.78, 3.23) compared with the disabled children without a feeding difficulty. Feeding difficulties were identified as a risk factor for vulnerability to inadequate nutritional status among children with disabilities.

Acute-Phase Proteins↗

Potential contributions to disability theorizing and research from positive pyschology.

PURPOSE: Within the context of taking the perspectives of disabled individuals themselves more seriously, it is imperative that researchers and practitioners accord due primacy to the experiential worlds and everyday lived experiences of individuals with disabilities. Based on the premise that theoretical groundedness (along with methodological rigour) is integral to sound research, it is argued that the existing body of knowledge regarding the lived experiences of individuals with disabilities may be complemented by a conceptual placing of understandings of disability in relation to a prominent theoretical pathway at the moment, namely, the interdisciplinary emphasis on human strengths and wellness. METHOD: A critical engagement with key conceptualizations of disability entailed a focus on the development, strengths, and challenges of medical, social and psychologically based conceptualizations of disability. RESULTS AND CONCLUSION: The existing body of knowledge around disability may be extended and complemented by key concepts regarding human health/wellness from the field of Positive Psychology. Positive Psychology's keynote contribution to the study of disability and rehabilitation entails directing researchers and practitioners to the aim of building, reinforcing and extending disabled individuals' strengths and capacities in order to optimize their functioning in all areas of life, and thereby promote wellness.

Cerebral Palsy↗

Orthopedic disability, conformity, and social support.

The relation between physical disability, social support, and conformist behavior was tested in two studies. The first compared the conforming responses of persons who had orthopedic disabilities with those of able-bodied individuals and correlated perceived social support of those with the disability with their tendency to conform. The second was an experimental study in which university students made choices between actors who had disabilities and actors who were able bodied; orthopedic disability was signified by a person sitting in a wheelchair and social support by the choice of a teammate. Results showed that persons with disabilities (compared with those who were able bodied) reported a significantly higher tendency to conform and that this tendency was negatively related to reported levels of perceived social support. In the experimental study, conforming behaviors of both disabled and able-bodied actors elicited more social support than did assertive behaviors. The actors who had "disabilities" received less social support than those who were "able bodied," but the former were considered more original when they did not conform. The findings imply that individuals with orthopedic disabilities are expected to conform but, although their conforming behavior elicits social support within specific encounters, it does not affect overall social support across encounters.

Activities of Daily Living↗

Mothers and their disabled children: refining the concept of normalization.

Normalization refers to behaviors and intentions of the disabled to integrate into society by living life as do those without a disability. Although normal is assumed to be a desired state, the concept has not been explored from the perspective of disabled children and mothers and other family members. The objective of this study is to determine "what is normal" from the perspective of the person with the disability. Participant observation was conducted in a 6-day summer camp for 17 children with chronic, severe, life-threatening physical disabilities. The children normally received home care and were ventilator dependent. Data consisted of observations, field notes, photographs, and videos. To obtain data about the children's home life, audiotaped telephone interviews with their primary caregiver (16 mothers and 1 father) were conducted before and after the camp. This group had two distinct social reference groups: the "disabled world" of the disabled-as-normal and the "outside" world of the everyday-as-normal. Mothers identified with both reference groups according to the child's needs, abilities and capabilities, and the risk involved. Children with disabilities who normalize compare their abilities and capabilities to identify both within a disabled world ("like me") and the outside world, according to their needs. Normalization includes processes of identification with both the cultural dominant perceived as normal (with whom these children could identify cognitively) and handicapped children (with whom these children could identify both physically and cognitively).

Adaptation, Psychological↗

Health promotion needs of young people with disabilities--a population study.

PURPOSE: Few research studies have sought to examine the health promotion needs of young people with disabilities. This paper reports the association between self-reported disability and various health behaviours (tobacco and alcohol use, physical activity, sedentary activities) psycho-social outcomes and school satisfaction. METHOD: Cluster stratified random sampling was combined with a cross-sectional descriptive design to obtain 3918 school students attending year 6 (primary school), year 8 and year 10 (high school) throughout New South Wales (Australia), to complete a self-administered questionnaire. RESULTS: The prevalence of self-reported disability among this student sample was 5.8%. The most frequently reported disabilities were physical, sensory and learning disabilities. Students with disabilities reported similar health and educational outcomes as their able-bodied peers. However, they also reported lower levels of school satisfaction, greater voluntary absenteeism and were more likely to get drunk or smoke cigarettes. Students with disabilities reported higher levels of psycho-social distress. They were also as physically active as other students, but also spent more time engaged in sedentary activities. CONCLUSION: Students with self-reported disabilities exhibit attitudes and behaviours that are consistent with studies of students who are alienated from their school communities. Community-based health promotion interventions are required to address these issues in order to prevent the onset of secondary disease processes or additional disability.

Adolescent↗

Spiritual issues associated with traumatic-onset disability.

PURPOSE: The present study used a qualitative approach to discover the concepts used by people with a sudden-onset disability to express issues of spirituality. Using a cross-sectional time frame, the study sought to understand how spiritual issues were experienced at the onset of a disability from the perspective of the disabled person him or herself. The study also compared the perceptions of brain injury respondents to spinal cord injury respondents. METHOD: The qualitative approach was chosen to capture a detailed understanding of perceptions about spirituality, and the relationship of the disability to the disabled person's spiritual beliefs. The sample consisted of 16 individuals, all of whom had experienced a spinal cord injury or a brain injury. RESULTS: The main findings of the study were as follows: (1) Participants recovering from a disability described spiritual issues relating to five themes which arose directly from the data (awareness, closeness, trust, purpose, vulnerability) and relating to three relationships found throughout the literature on spirituality (intrapersonal, interpersonal and transpersonal). These eight dimensions can be combined to form a matrix, which serves as a framework for considering spiritual issues associated with disability; and (2) There were differences in the spiritual concepts described by the participants with brain injury compared to those with spinal cord injury. In particular, those with brain injuries seemed to place greater emphasis on the importance of their families, and to be more aware of the need for trust in view of their memory deficits. CONCLUSIONS: These results represent one of the earliest attempts to take an empirical approach to the development of theory in the area of spirituality and disability. Building on theory developed in other populations (palliative care and ageing), the study offers a theoretical model for clinicians, educators and researchers to better understand spirituality in the context of disability.

Acute Disease↗

Met and unmet needs reported by severely disabled people in southern England.

PURPOSE: To examine the met and unmet needs for rehabilitation of disabled people living in the community in Southern England. METHOD: A cross sectional interview study of people with a primary physical disability, aged 1665. Disabled people were randomly selected from two existing disability registers, which comprised disabled people who had been identified by community rehabilitation services as being in need of regular surveillance by formal assessment of their care needs. A new semi-structured needs assessment questionnaire was developed and validated for the study (the Southampton Needs Assessment Questionnaire, SNAQ). Level of disability was examined with the OPCS Disability and Severity Scales. RESULTS: Ninety three disabled people participated. Their median (IQR) OPCS score was 8 (6-10). Participants reported a median (IQR) of three unmet needs (2-7). The most prevalent unmet needs were for adaptations, equipment, physiotherapy and wheelchairs, rather than unmet needs for intellectual and social fulfilment. CONCLUSIONS: Disabled people who were already in touch with community rehabilitation services continued to express unmet needs for further services. Meeting the more basic needs relating to people's housing, equipment, physiotherapy and wheelchairs may enable them to be more independent and fulfilled in other areas of their lives.

Activities of Daily Living↗

Helping women with disabilities and domestic violence: strategies, limitations, and challenges of domestic violence programs and services.

PURPOSE: To describe the types of services provided to women with disabilities at community-based domestic violence programs in the state of North Carolina, the challenges faced, and strategies used to provide the services. METHODS: We conducted a statewide cross-sectional survey of community domestic violence programs and had a response rate of 85%. RESULTS: Of the participating programs, 99% provided services to at least one woman with a physical or mental disability in the preceding 12 months; 85% offered shelter services to women with physical or mental disabilities. Most respondents (94%-99%) reported that their programs were either somewhat able or very able to provide effective services and care to women with disabilities. The respondents also described challenges to serving women with disabilities, including lack of funding, lack of training, and structural limitations of service facilities. Strategies used by the programs to overcome these challenges were networking and coordinating care with organizations that specifically serve disabled populations. CONCLUSIONS: Domestic violence programs in North Carolina provide services to women with disabilities but are faced with challenges stemming from limited funding, physical space, and training. Collaborations between domestic violence and disability service providers are necessary to improving the services and care delivered to women with disabilities who experience domestic violence.

Community Mental Health Services↗