360 Social impact on lower limb disability among urban community dwelling residents in Sri Lanka

Purpose: Rehabilitation with assistive devices is of great benefit to people with limb disabilities, enabling them to lead independent and productive lives. While assistive devices improve the quality of life of persons with lower limb disabilities by facilitating activities of daily living, there are also many barriers to their use. This study aims to describe these barriers among community-dwelling persons with lower limb disabilities in central Sri Lanka.Methods: A community survey was conducted among adults between 18 and 59 years of age, to find persons with lower limb disabilities in Kandy Municipal Council area, in the central province of Sri Lanka. This was followed by purposive sampling to select a sub-sample of 12 individuals with unilateral lower limb disabilities for a qualitative study using in-depth interviews. Unilateral lower limb disabilities were identified using a clinical examination and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). A qualitative thematic content analysis was used to evaluate the interview text.Results: Participants described several barriers in using assistive devices, such as unaffordable assistive technology like wheelchairs and artificial limbs, unavailability of appropriate assistive technology, difficulties associated with repair and maintenance, and problems in accessibility. Limited knowledge of modern technology also restricted their choice of better devices. Psychological barriers and stigma in using assistive devices directly affected their social lives and day-to-day activities as well.Conclusion and Implications: People with lower limb disabilities face multiple barriers in using assistive devices. These barriers need to be addressed by improving local infrastructure and accessibility facilities, public awareness and funding, and ensuring continuous supply and maintenance services.

Objective: To assess and compare the oral hygiene and periodontal status among children with Poliomyelitis having upper limb disability, lower limb disability and both upper and lower disability at Udaipur city, Rajasthan, India.Study design: Total sample comprised of 344 Poliomyelitis children (upper limb disability: 33.4%; lower limb disability: 33.7%; both upper and lower limb disability: 32.9%) in the age group of 12-15 years. Clinical examination included recording Simplified Oral Hygiene Index and Community Periodontal Index. Analysis of variance (ANOVA), multiple logistic and stepwise linear regression were used for statistical analysis. Results: The mean OHI-S (2.52±1.05) score was found to be highest among children who had both upper and lower limb disability (p<0.05). The highest and lowest mean number of healthy sextants were found among those with only lower limb disability (4.53±2.05) and among those with both upper and lower limb disability (0.77±1.39), respectively (p<0.05). Stepwise multiple linear and multiple logistic regression analysis showed that the best predictor for oral hygiene and periodontal status was limb involved in the disability. Conclusion: The results of the study depicted an overall poor oral hygiene and periodontal status of the group. It was recognized that limbs involved in the disability had an impact on the oral hygiene and periodontal condition. The situation in this specialized population draws immediate attention for an integrated approach in improving the oral health and focus towards extensive research. Key words:Poliomyelitis, upper limb disability, lower limb disability, oral hygiene, periodontal status.

#109-S factors associated with labor force participation in people with disability

To investigate the association between self-reported low back pain (LBP) and lower limb disability as well as the association between neck pain and upper limb disability. A hundred twenty-six participants registered as a healthcare staff member were included in this cross-sectional study. The presence of neck and LBP were determined using the Nordic Musculoskeletal Questionnaire. Neck and LBP/disability were measured with the Neck Pain and Disability Scale (NPDS) and Oswestry Disability Index (ODI), respectively. Upper and lower limb disability were measured with the Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) and Western Ontario and McMaster Osteoarthritis Index (WOMAC), respectively. Participants reporting LBP had more musculoskeletal complaints in the lower limbs (p<0.001) and similarly participants reporting neck pain also reported more musculoskeletal complaints in the upper limbs (p<0.001). There was a correlation between the ODI and WOMAC in the participant reporting LBP during the 12 months (ρ=0.510, p<0.001) and during the last 7 days (ρ=0.674, p<0.001). The NPAD was correlated with the Quick-DASH in the participants reporting neck pain during the last 12 months (ρ=0.659, p<0.001) and the last 7 days (ρ=0.734, p<0.001). People reporting more severe LBP also reported high levels of lower limb disability. This association was also existing between the neck pain and upper limb disability.

To compare quadriceps sensorimotor function, lower limb functional performance and disability in patients with rheumatoid arthritis (RA) and healthy subjects, and to investigate the efficacy and safety of a brief rehabilitation regime. Quadriceps strength, voluntary activation, proprioceptive acuity and the aggregate time [aggregate functional performance time (AFPT)] taken to perform four common activities [aggregate functional performance time (AFPT)] were compared between 103 RA patients who had lower limb involvement and 25 healthy subjects. In addition, disability (Health Assessment Questionnaire), clinical disease activity and the plasma concentration of proinflammatory cytokines were measured in the RA patients. In a follow-on randomized controlled trial of rehabilitation, these variables were used as baseline data for 93 of the RA patients, who were randomized to a rehabilitation or a control group. Changes in the variables were analysed within and between groups. Compared with healthy subjects, RA patients had weaker quadriceps [mean difference 157 N; 95% confidence interval (CI) 125-189], poorer activation (8%, 95% CI 4.5-15) and proprioceptive acuity (0.8 degrees, 95% CI 0.4-1.3) and took longer to perform the AFPT (34 s, CI 23.5-44.8). Rehabilitation increased quadriceps strength (mean increase 61 N, 95% CI 28-95) and voluntary activation (8%, 95% CI 3-12.4) and decreased the AFPT (12.3 s, 95% CI -2 to 27.7) and subjective disability (0.21 HAQ points, 95% CI 0-0.35) without exacerbating disease activity. All the improvements were maintained at the 6-month follow-up. There was no change during the control period. Patients with RA that affected their lower limb had quadriceps sensorimotor deficits that were associated with lower limb disability. A clinically applicable rehabilitation regime increased quadriceps sensorimotor function and decreased lower limb disability without exacerbating pain or disease activity. For patients with well-controlled RA that causes lower limb involvement, the regime is effective and safe.

ObjectivesThe objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities.MethodsMass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis.ResultsPeople with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities.ConclusionsThese results show that people with physical disability have a higher vulnerability to obesity.

The purpose of this study was to examine independent and interactive roles of self-reported vision status and upper and lower limb disability as predictors of falls in people 65 and older. Data from the 2002 and 2004 panels of the Health and Retirement Study were analyzed using binary logistic regression. Results indicated a reduced or eliminated role of vision status after upper and lower limb disabilities were controlled. Gender differences were found with respect to health conditions that predicted falls; however, vision status was not found to have a moderating influence on upper and lower limb disability in predicting falls for men or women. Implications for exercise programs designed for older people with visual impairments are discussed.

To determine and compare the dental caries experience and treatment needs of children with Poliomyelitis at Udaipur, India. Total sample comprised of 344 children with Poliomyelitis (upper limb disability: 33.4%; lower limb disability: 33.7%; both upper and lower limb disability: 32.8%) in the age group of 12-15 years. Clinical examination included recording Dentition Status and Treatment Needs. Chi-square test, Analysis of variance (ANOVA), multiple logistic and stepwise linear regressions were used for statistical analysis. The mean decayed, missing, filled teeth (DMFT) score (4.47 ± 3.09) was found to be highest among children with Poliomyelitis having both upper and lower limb impairment (p < .05). Stepwise and logistic regression analysis showed that the best predictors for dental caries were disability, socioeconomic status and snacks in between meals. A significant relationship of dental caries with limb involved in impairment draws immediate attention for a planned approach in improving the oral health.

Currently there are not enough studies that compared frequent types of collective sports with regard to the prevalence of pain and disability of the lower limb. To determine the prevalence of lower limb pain and disability in team sports players. 388 athletes with average age 27.26 ± 4.69, from sports clubs at the national level were included in the study. The Oxford Hip Score was used to determine the prevalence of hip pain. The International Knee Documentation Committee was used to determine the prevalence of knee pain. The Foot and Ankle Disability Index was used to determine the prevalence of ankle pain. Hockey players had a prevalence of hip pain of 97.2% and a 14.3 times higher risk of developing hip pain compared with football and floorball players. Floorball players had a 81.9% prevalence of knee pain, with a 3.8 times higher the risk of knee pain compared with football and hockey. Floorball players had a 62.3% prevalence of ankle pain and a 1.8 times higher the risk of developing ankle pain compared with football and hockey players. The highest percentage of knee 81.9% and ankle 62.3% pain, as well as the greatest risk of pain, was found among floorball players. Hockey players had the highest prevalence (97.2%) and risk of developing hip pain.

Central Versus Lower Body Obesity Distribution and the Association With Lower Limb Physical Function and Disability

Charcot-Marie-Tooth (CMT) patients present mainly lower limbs disability, with slowly progressive distal muscle weakness and atrophy, but hands impairment is a relevant problem affecting the quality of life (QoL). The evaluation of the upper limb is of primary importance. Often these patients present subclinical disorders or report difficulties in manipulating objects, with little evidence in the most used outcome measures. We aim to investigate the impact of hand impairment in the perceived QoL of CMT persons and secondly whether the Disability of Arm, Shoulder and Hand (DASH) scale can be useful in assessing upper limb abilities in CMT. We recruited 23 patients with confirmed genetic diagnosis of CMT. We performed a clinical evaluation with Sollerman Hand Function Test (SHFT), Thumb Opposition Test (TOT) and CMT examination score (CMTES). We completed the clinical assessment with DASH scale and the Short form 36 (SF36) questionnaire for a subjective evaluation of upper limb disability and quality of life. All patients also underwent an instrumental evaluation with a hand-held dynamometer measuring hand grip and tripod pinch and a sensor-engineered glove test (SEGT) to evaluate finger opposition movements in a quantitative spatial-temporal way. As expected, we found significant differences between CMT and control group performances in both clinical and instrumental assessment. Concerning QoL, we found that total score of SF36 and the SF36 Physical Composite Score (PCS) correlate with all clinical and instrumental Outcome Measures (OMs), particularly with Tripod pinch strength and TOT, which are considered major determinants of manual dexterity in CMT. DASH scale correlates with most clinical and instrumental OMs. Not surprisingly, we also found a correlation with DASH work, because CMT affects young patients engaged in work activities. However, we found a low correlation with the TOT and the dynamometer suggesting that DASH may not be the best scale for remote monitoring of upper limb disorders in CMT patients. Nevertheless, the results of our study confirm the usefulness of SF36 in recognizing the impact of upper limb disability in these subjects suggesting its use even in the remote monitoring of physical functioning.

BackgroundChronic foot- and lower limb-related impairment are frequently reported by people with gout who also demonstrate altered gait and plantar pressure patterns when assessed during shod walking [1]. The impact...

Background: To retrain upper limb function after stroke, a high dose of activity-related therapy is recommended. However, observational studies indicate that the dose undertaken is minimal. While it is speculated that those with severe disability will perform less therapy, this remains to be explored.Objective: Quantify the dose and content of upper limb therapy performed by stroke survivors with severe upper limb disability during routine inpatient rehabilitation.Methods: Therapy provided by physiotherapists and occupational therapists to 32 stroke survivors receiving inpatient rehabilitation over 20 weekdays was recorded. Dose of individual and group therapy was analysed by discipline and severity of upper and lower limb disability. Dose and content of individual therapy was also analysed by functional domain.Results: On average, 46 minutes of individual and 11 minutes of group upper limb therapy were provided per participant, per day. Occupational therapists provided a higher dose of both individual and group therapy compared to physiotherapists (p&lt; 0.0005). Findings suggest that greater residual upper and lower limb movement can lead to provision of a higher dose of activity-related therapy. Within individual therapy, a higher dose (29 versus 17 minutes,p&lt; 0.002) and greater number (1218 versus 549) of impairment- than activity-related interventions were administered.Conclusions: The dose of activity-related upper limb therapy provided to stroke survivors with severe disability was limited. There is a need to identify interventions and models of service delivery that can increase the intensity and appropriateness of therapy that stroke survivors with severe disability undertake during inpatient rehabilitation.

To evaluate upper limb functioning, restrictions on participation and the independent contribution of upper and lower limb disability to participation in hereditary motor and sensory neuropathy 1a. Descriptive cross-sectional study. Forty-nine patients with hereditary motor and sensory neuropathy 1a. Perceived upper limb functioning was evaluated using the Michigan Hand Outcomes Questionnaire and participation restrictions with the Impact on Participation and Autonomy Questionnaire. Upper and lower limb domains of Guy's Neurological Disability Scale were used to determine their impact on participation restrictions. Limitations in upper limb functioning were perceived by 98% of the patients. Median scores ranged between 70 points for overall hand function and 100 points for aesthetics (scale 0-100). Patients were least satisfied with dominant hand performance. Most patients (46-78%) reported their participation to be sufficient. Restrictions were reported in the domains work, family roles, and autonomy outdoors. Minor problems with restricted participation were indicated by 22-55%, severe problems by 2-12%. Upper limb functioning correlated significantly with all participation subscales. Upper limb disability was independently associated with participation restrictions, whereas lower limb disability was not. Limitations in upper limb functioning were perceived by the majority of patients with hereditary motor and sensory neuropathy 1a and strongly related to restricted participation.

In Paralympic sports, to guarantee fair competition, it is necessary to identify those peculiar abilities that characterize the discipline and the motor limitations that may or may not most affect the athlete’s performance in a specific sports task, assigning an appropriate classification to the level of impairment. This study proposes a minimally invasive assessment system based on a single inertial sensor to support the investigation of the peculiarities of water polo with disabilities by analyzing players’ trunk inclinations during a simulated match and angular speeds in swimming tests. By comparing a small group of athletes of various classes and those without disabilities, we intended to evaluate whether athletes with lower limb disabilities may be disadvantaged compared to athletes with upper limb disabilities. The results suggest no difference in the mean percentage of time in vertical and horizontal positions when comparing players with and without disabilities, although specific impairments led to distinct behaviors (Δ = 0.9%, p = 0.841). Interesting insights emerged in swimming and turning situations in the water. Strong correlations (r &gt; 0.7, p &lt; 0.05) were found between swimming performance metrics and classification points. Furthermore, players with spasticity exhibited lower smoothness in turning movements, suggesting less fluid execution than those with other impairments affecting the same limbs. These findings highlight the IMU system’s potential to provide objective, quantitative data for refining WPA classification protocols.