Disability Rehabilitation Research Articles

Comparison of the effectiveness of an e-health program versus a home rehabilitation program in patients with chronic low back pain: A double blind randomized controlled trial.

ObjetiveWe conducted a randomized double blind clinical trial, to compare the effectiveness of McKenzie exercises and electroanalgesia via an e-Health program versus a home rehabilitation program on functionality, pain, fear of movement and quality of life in patients with non-specific chronic low back pain.MethodsSeventy-four participants with non-specific chronic low back pain were randomized to either the e- Health program group (n = 39) or the home rehabilitation program group (n = 35). The interventions consisted of the e-Health program group performing McKenzie exercises and received transcutaneous electrical nerve stimulation, while the home rehabilitation group attended an information session to explain the exercises, which they then performed at home with printed instructions. Both groups performed 3 weekly sessions for 8 weeks. The following were analyzed main measures: pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline and at 2 months.ResultsIndependent samples Student’s t-tests showed that although the patients who followed the e-Health program showed significantly greater improvement than those who followed the home disability rehabilitation program in terms of intensity of pain, lumbar flexion mobility (P < 0.001), and the following dimensions of quality of life (P < 0.005), both groups improved significantly in the immediate post-treatment follow up compared with baseline scores.ConclusionsPatients with chronic low back pain who followed an unsupervised home intervention supported by an individualized video exercise program showed greater post-treatment improvement than those who followed the same program with printed instructions.

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and Attitude Regarding Childhood Behaviour Disorder Autism Among Mothers Child with Autism of Selected Developmental Centres of Agartala, Tripura, India

Abstract: Childhood Behaviour Disorder Autism is a fast growing problem worldwide according to presentscenario. 1 in 100 children in India are suffering from childhood behaviour disorder Autism. This disorder hasa drastic negative impact on the normal development of a child. Mothers are the primary care giver for theirchildren. So that a strong knowledge and attitude of mothers child with Autism is the vital factor in properguidance for behaviour management of their under developed child.Aim: The present pilot study was carried out with the aim of assessment of knowledge and attitude regardingchildhood behaviour disorder Autism among mothers child with Autism.Material and method: 50 mothers child with Autism were selected for present experimental pilot study.Purposive sampling technique, structured teaching programme, semi structured questionnaire based onknowledge and attitude were implemented. The present pilot study was carried out 6.1.2022 to 13.1.2022 in theDistrict Disability Rehabilitation Centre of Agartala.Result: pre-test knowledge of mothers about child hood behaviour disorder mean was 5.05, post-test knowledgeof mothers about child hood behaviour disorder mean was 11.75 with standard deviation 2.195,t test value18.160 and p value .000.So the result of pilot study of knowledge among mothers is significant. Pre-test positive(favourable) Attitude response mean was 10.7255, post test positive Attitude response was 13.2745, Standarddeviation of pre-test positive response 1.73296, t test value 50, df 50 and p value .000, so favourable attituderesponse is significant.Conclusion: Mothers with lower in education, non-availability of child development centres facility and financialsupport, lack of awareness regarding Autism negatively impacted the study result which significantly improvedin the end result of this experimental comparative study. Proper health education for improvement of knowledgeand attitude is an important key factor for mothers how they should treat and care their child. According to thestudy education of mothers, financial support, healthcare support are the most important factors which canimprove the knowledge and attitude of mothers.

Cycling kinematics in healthy adults for musculoskeletal rehabilitation guidance

BackgroundStationary cycling is commonly used for postoperative rehabilitation of physical disabilities; however, few studies have focused on the three-dimensional (3D) kinematics of rehabilitation. This study aimed to elucidate the three-dimensional lower limb kinematics of people with healthy musculoskeletal function and the effect of sex and age on kinematics using a controlled bicycle configuration.MethodsThirty-one healthy adults participated in the study. The position of the stationary cycle was standardized using the LeMond method by setting the saddle height to 85.5% of the participant’s inseam. The participants maintained a pedaling rate of 10–12 km/h, and the average value of three successive cycles of the right leg was used for analysis. The pelvis, hip, knee, and ankle joint motions during cycling were evaluated in the sagittal, coronal, and transverse planes. Kinematic data were normalized to 0–100% of the cycling cycle. The Kolmogorov-Smirnov test, Mann-Whitney U test, Kruskal-Wallis test, and k-fold cross-validation were used to analyze the data.ResultsIn the sagittal plane, the cycling ranges of motion (ROMs) were 1.6° (pelvis), 43.9° (hip), 75.2° (knee), and 26.9° (ankle). The coronal plane movement was observed in all joints, and the specific ROMs were 6.6° (knee) and 5.8° (ankle). There was significant internal and external rotation of the hip (ROM: 11.6°), knee (ROM: 6.6°), and ankle (ROM: 10.3°) during cycling. There was no difference in kinematic data of the pelvis, hip, knee, and ankle between the sexes (p = 0.12 to 0.95) and between different age groups (p = 0.11 to 0.96) in all anatomical planes.ConclusionsThe kinematic results support the view that cycling is highly beneficial for comprehensive musculoskeletal rehabilitation. These results might help clinicians set a target of recovery ROM based on healthy and non-elite individuals and issue suitable guidelines to patients.

Disability and Exclusion: Social, Education and Employment Perspectives

When the whole world is striving towards the inclusion of persons with disabilities (PwDs) in all walks of life, they are still among the vulnerable group who are at risk of social exclusion. The meaningful participation in societal activities is hindered by marginalisation at an individual level leading to unemployment and thus poverty. Disability, social exclusion and poverty are inextricably associated that despite poverty alleviation programmes, disability reforms, advocacy and disability acts, these marginalised group of disabled individuals still remain as victims. The dynamic relationship between these three is studied in this article to to examine some of the issues of the human rights approach towards disability rehabilitation. Due to the systemic, structural and attitudinal barriers, developing countries like India are still struggling to create an inclusive society. This article suggests measures to overcome the challenges faced by persons with disabilities so as to initiate steps towards successful inclusion.&#x0D;

Understanding Barriers to the Access to Healthcare and Rehabilitation Services: A Qualitative Study with Mothers or Female Caregivers of Children with a Disability in Indonesia.

Accessibility to healthcare and rehabilitation services for children with a disability (CWD) is essential to improving their health and wellbeing. However, access to the services, especially in many settings in developing countries with scarcity of resources, is still limited. As part of a qualitative study exploring impacts of caring for CWD on mothers or female caregivers and their coping strategies, this paper describes barriers for access to healthcare and rehabilitation services for CWD in Belu district, Indonesia. One-on-one, in-depth interviews were conducted with 22 mothers or female caregivers of CWD. Participants were recruited using a combination of purposive and snowball sampling techniques. These were supplemented with interviews with two staff of disability rehabilitation centers in Belu to understand any additional barriers. Data analysis was guided by a qualitative data analysis framework. Our analysis identified that lack of affordability of healthcare services (high costs and low financial capacity of mothers) was the key barrier for access to healthcare and rehabilitation services CWD. Religious or faith-based factors, such as being a non-Catholic (Belu is predominantly Catholic), converting from Catholic to other religions, and the belief in children’s disability condition as “God’s will”, were also influencing factors for lack of access to the services. Shortage of staff, distrust in the therapy skills of staff at rehabilitation centers, and unavailability of appropriately trained healthcare professionals were structural or system-related barriers. The findings indicate the need for government-owned and run disability rehabilitation centers (not faith-based), the provision of fully subsidised health insurance to provide free services, and the provision of qualified therapists and healthcare professionals (to build trust) in Belu and other similar settings in Indonesia.

Associations of Medicaid Expansion With Access to Care, Severity, and Outcomes for Acute Ischemic Stroke.

Multiple states have not expanded Medicaid under the Affordable Care Act, resulting in higher uninsured rates in states with high stroke burdens. This study aimed to evaluate the association of Medicaid expansion with changes in health insurance coverage, severity of presentation, access to care, and outcomes among patients with acute ischemic stroke. A retrospective, difference-in-differences analysis of Get With The Guidelines-Stroke registry data. The study population comprised first-time ischemic stroke admissions from 2012 to 2018 for patients aged 19 to 64 in 45 states (27 that expanded Medicaid and 18 that did not). A probable low-income cohort was defined based on having Medicaid, no insurance/self-pay, or undocumented insurance. Outcomes analyzed were indicators of health insurance status, stroke severity, use of emergency services, time to acute care, in-hospital mortality, receipt of rehabilitation, discharge disposition, and level of disability. In the starting population (N=342 765), Medicaid-covered stroke admissions rose from 12.2% to 18.1% in expansion states and from 10.0% to only 10.6% in nonexpansion states, while uninsured admissions declined from 15.0% to 6.7% in expansion states and from 24.0% to 19.2% in nonexpansion states. In the low-income cohort (N=95 086; 28% of starting population), Medicaid expansion was associated with increased odds of discharge to a skilled nursing facility (adjusted odds ratio, 1.33 [95% CI, 1.12-1.59]) and transfer to any rehabilitation facility among those eligible (adjusted odds ratio, 1.24 [95% CI, 1.08-1.41]) and lower odds of discharge home (adjusted odds ratio, 0.89 [95% CI, 0.80-0.98]). Expansion was not associated with any other outcomes. Medicaid expansion is associated with fewer uninsured hospitalizations for acute ischemic stroke and increased rehabilitation at skilled nursing facilities. More targeted interventions may be needed to improve other stroke outcomes in the low-income US population. Future research should evaluate the impact of health care reform on primary stroke prevention.

Features of medical and social examination of persons with HIV infection - AIDS when determining disability without specifying the period of re-examination

Purpose of research. Studying the features of approaches to determining the timing of disability in rehabilitation and expert diagnostics during the examination of persons with HIV infection - AIDS.&#x0D; Materials and methods. The research materials were the data of Rosstat of Russia, official state statistical reporting: form 7-social security "Information on the medical and social examination of persons aged 18 years and older" for 2019. The data of our own research included the protocols of persons who were examined for HIV infection in the bureau of medical and social expertiseof (MSE) St. Petersburg and other regions: 50 patients examined in the period from 01.01.2019 to 31.12.2020, (observation group) in comparison with the analysis data of 50 protocols of examination of HIV-infected in the period 2017-2018 (control group).&#x0D; Results and discussion. According to the results of the study, the disability group is determined reliably more often already during the initial examination without a re-examination period (48.64% versus 19%, c2 = 0.491 at the p 0.01 significance level) when carrying out the MSE taking into account the Government Decree No. 339. Establishing disability for patients with HIV-AIDS without a period of re-examination during the initial examination allows them to get out of the supervision of medical and medical-social services.Taking into account that a part of the contingent of patients with HIV-AIDS has a "special mentality" and the presence of psychological and social risks, the lack of systematic monitoring of their treatment and social patronage contributes to an increase in the severity

Reconceptualizing the Family to Improve Inclusion in Childhood Disability Research and Practice.

The World Health Organization's International Classification of Functioning, Disability and Health recognizes that environmental factors impact well-being and life participation for children with disabilities. A primary environment in which children grow and learn is the family. The importance of family has long been recognized in family-centered practice and family-centered research. Although family-centered services and research have been critically explored, the concept of family has received less critical attention in rehabilitation literature. The family construct is due for an updated conceptualization with careful consideration of the implications for childhood disability rehabilitation practice and research. Interrogating the family construct asks questions such as: who is included as a part of the family? Which family structures are prioritized and valued? What is the potential harm when some families are ignored or underrepresented in childhood disability practice and research? What implications could a modern rethinking of the concept of family have on the future of childhood rehabilitation practice and research? This perspective article raises these critical questions from the authors' perspectives as parents of children with disabilities, child focused rehabilitation professionals, and researchers that focus on service delivery in children's rehabilitation and family engagement in research. A critical reflection is presented, focused on how the construct of family affects children's rehabilitation practice and research, integrating concepts of equity, inclusion and human rights. Practical suggestions for children's rehabilitation service providers and researchers are provided to aid in inclusive practices, critical reflection, and advocacy.

Non-Invasive Brain–Computer Interfaces: Development and Rehabilitation for Motor Disability

Around 61 million people in the United States suffer from different forms of disability; of these, 13.7% suffer from a motor disability. Research in brain–computer interfaces (BCIs) has focused on curbing communication disabilities due to motor impairment. Many challenges and future developments lie ahead in the BCI world. The research on paradigms that guide the way to make communication easy for a person with motor impairment is the pillar of the BCI system. The purpose of this paper is to synthesize the developments in non-invasive brain–computer interface and evaluate them. The authors discuss components of the BCI system and how it is formed. Neurofeedback based on different modalities is also analyzed. The results from initial studies have been successful, but paradigms and neurofeedback technologies have immense development potential, which can change the face of BCI systems for rehabilitation of motor disability.

Exercise Training for Patients With Severe Aortic Stenosis in a Convalescent Rehabilitation Ward - A Retrospective Cohort Study.

Background: Exercise loading is contraindicated for patients with severe aortic stenosis (AS); however, everyday activities mandate the inclusion of a light load. The aim of this study was to investigate the efficacy and safety of exercise training for patients with severe AS who were admitted to a rehabilitation ward because of physical disability.Methods and Results: This historical cohort study was conducted at a single rehabilitation center in Japan. Patients admitted for rehabilitation of physical disability and those who met the definition of severe AS were analyzed. An exercise training program was implemented for patients with disability and severe AS. Cardiovascular symptoms during hospitalization were evaluated. Improvements in the performance of activities of daily living were assessed using the Functional Independence Measure (FIM). Eighteen patients undertook an exercise training program. The median patient age was 87 years (range 76–95 years). Of these patients, 3 died and another 3 were transferred to another hospital due to causes other than the exercise training program. None of the other patients experienced cardiovascular symptoms, and the FIM scores of 12 patients were significantly improved (median [range] scores at admission and discharge of 63 [32–88] and 87 [51–104], respectively; P<0.001).Conclusions: An exercise training program could be applied to patients with severe AS who were admitted for convalescent rehabilitation, because it can improve FIM scores.

Accelerating Reinforcement Learning using EEG-based implicit human feedback

Providing Reinforcement Learning (RL) agents with human feedback can dramatically improve various aspects of learning. However, previous methods require human observer to give inputs explicitly (e.g., press buttons, voice interface), burdening the human in the loop of RL agent’s learning process. Further, providing explicit human advise (feedback) continuously is not always possible or too restrictive, e.g., autonomous driving, disabled rehabilitation, etc. In this work, we investigate capturing human’s intrinsic reactions as implicit (and natural) feedback through EEG in the form of error-related potentials (ErrP), providing a natural and direct way for humans to improve the RL agent learning. As such, the human intelligence can be integrated via implicit feedback with RL algorithms to accelerate the learning of RL agent. We develop three reasonably complex 2D discrete navigational games to experimentally evaluate the overall performance of the proposed work. And the motivation of using ErrPs as feedbacks is also verified by subjective experiments. Major contributions of our work are as follows, (i) we propose and experimentally validate the zero-shot learning of ErrPs, where the ErrPs can be learned for one game, and transferred to other unseen games, (ii) we propose a novel RL framework for integrating implicit human feedbacks via ErrPs with RL agent, improving the label efficiency and robustness to human mistakes, and (iii) compared to prior works, we scale the application of ErrPs to reasonably complex environments, and demonstrate the significance of our approach for accelerated learning through real user experiments.

Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder

BackgroundAttention problems and decreased quality of life are frequently accompanied in Cerebral Palsy (CP), which can negatively affect rehabilitation of physical disability. However, the majority of affected children remain untreated in the aspects of attention or psychosocial factors. Equine-Assisted Activities and Therapies (EAAT) use horse as a therapeutic modality including grooming as well as mounted riding activities in which patients exercise and experience mounted stimulation. It is known to help improve attention in children with ADHD, so that it can be an exercise therapy that is expected to improvement of attention as well as rehabilitating effects in CP patients. EAA may be a promising strategy to address the unmet need for CP patients. This study aims to investigate the efficacy of EAA for children with CP, those with both CP and ADHD and confirm the comorbidity between CP and ADHD.MethodsForty-six children with cerebral palsy participated in this study. For the exercise group, they participated in a 40-min session twice a week for a 16-week period, while the control group engaged in daily life without any special treatments. Each children individually were assessed on attention and psychological wellbeing at baseline and post-treatment. Comorbidity were identified based on the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-5) and confirmed by Korean Kiddie-Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL).ResultsPerseveration rated using the Conner’s Performance Test (CPT) showed a significant decrease only in the exercise group (p < .024). However, no significant improvement in children’s quality of life was observed after EAA program compared with control group. Among the total participants, fifteen children (31.91%) were diagnosed with ADHD. When conducting an additional analysis with the subsample of CP patients diagnosed with ADHD, the d’, commission error and perseveration showed a significant decrease only in the exercise group. Children with CP and ADHD reported an improvement in quality of life both in exercise and control group, but only in the exercise group social functioning exhibited a significant difference.ConclusionThe positive effects of the EAA on attention and quality of life were confirmed. Children with CP in the exercise group were more capable to sustain their attention longer. Those with CP and ADHD showed an increase in attention and perceived to have better social skills after receiving 16 weeks of EAA compared to those in the control group. Considering high comorbidity of CP and ADHD, it seems that the EAA program could be the better alternative treatment for CP with attentional problem. The results of this study will contribute to growing evidence for the efficacy of EAA in children especially with CP and ADHD.Trial registrationThis trial was registered on ClinicalTrials.gov (NCT03870893). Registered 26 July 2017.

Quality of life, self-esteem, self-efficacy and social participation of persons living with mobility-related disability using mobility aids devices within select Nigerian communities

Background/purpose Disability has gained further global attention as a result of the integration of persons with disabilities into the societies. However, the association among quality of life (QoL), self-esteem (SE), self-efficacy (SEf) and social participation (SP) is inconclusive. This study was aimed to investigate the correlation among QoL, SE, SEf and SP in people living with mobility-related disability using mobility aid devices (MADs) in some selected communities of Enugu State. Methods This cross-sectional survey involved 200 consenting participants (mean age = 37.47 ± 13.00 years) purposively recruited from four different sampled communities who have community-based rehabilitation (CBR) services. Quality of life (QoL), SE, SEf and SP of participants were explored using 36-item Short Form Survey, Rosenberg Self-Esteem Scale, General Self-Efficacy Scale and Participation Scale respectively. Data obtained was summarised using frequency counts, mean, standard deviation and analysed using spearman’s Rank Order Correlation, Mann Whitney U and Kruskal-Wallis tests. Results The mean QoL, SEf, SE, and SP of the participants are 55.06 ± 10.67, 25.00 ± 5.57, 16.36 ± 4.33 and 35.60 ± 13.50 respectively, which imply moderate QoL and SEf, high SE and severe restricted participation. QoL, SEf, SE, and SP significantly correlated with one another (p < 0.05). There was no significant influence of gender and occupational status of the participants on their QoL, SE, SEf and SP (p > 0.05). Conclusion Persons living with mobility-related disabilities have moderate QoL and SEf, high self-esteem and severe restriction in SP. QoL, SEf, SE, and SP correlated with one another. The possibility of improving other constructs by targeting one can be explored in disability rehabilitation. IMPLICATIONS FOR REHABILITATION The increasing prevalence of disability presented the need to study four constructs of well-being (Quality of Life, Self-esteem, Self-efficacy and Social participation). The perception of one’s status and position in life can be negatively impacted upon by a mobility-related disability. Social participation may improve satisfaction and quality of life, which in turn could lead to better self-esteem and self-efficacy.

A Multidimensional Virtual Reality Neurorehabilitation Approach to Improve Functional Memory: Who Is the Ideal Candidate?

Aims: We aimed to identify the significant predictors of ecological memory amelioration after the Human Empowerment Aging and Disability (HEAD) rehabilitation program, a multidimensional treatment for chronic neurological diseases.Materials and Methods: Ninety-three patients with Parkinson disease (n = 29), multiple sclerosis (n = 26), and stroke (n = 38) underwent a multidimensional rehabilitation. We focused on changes after treatment on ecological memory (outcome measure) evaluated by Rivermead Behavioral Memory Test, Third Edition (RBMT-3). Minimal clinically important difference (MCID) after treatment were calculated for RBMT-3. The change score on RBMT-3 was categorized in positive effect, stabilization, or no effect of the treatment. Random forest classification identified who significantly benefited from treatment against who did not in terms of ecological memory functioning. Accordingly, logistic regression models were created to identify the best predictors of the treatment effect. A predicted probability value was derived, and the profile of the ideal candidate of HEAD protocol was shown by combining different ranks of significant predictors in a 3 × 3 matrix for each pair of predictors.Results: A significant number of cases reported positive effect of the treatment on ecological memory, with an amelioration over the MCID or a stabilization. The random forest analysis highlighted a discrete accuracy of prediction (>0.60) for all the variables considered at baseline for identifying participants who significantly benefited and who did not from the treatment. Significant logistic regression model (Wald method) showed a predictive role of Montreal Cognitive Assessment (MoCA; p = 0.007), 2-Minute Walk Test (2MWT; p = 0.038), and RBMT-3 (p < 0.001) at baseline on HEAD treatment effect. Finally, we observed a high probability of success in people with higher residual cognitive functioning (MoCA; odds ratio = 1.306) or functional mobility (2MWT; odds ratio = 1.013).Discussion: The HEAD program is a rehabilitation with effects on multiple domains, including ecological memory. Residual level of cognitive and/or motor functioning is a significant predictor of the treatment success. These findings confirm the intrinsic relationship subsisting between motor and cognitive functions and suggest the beneficial effects of physical activity on cognitive functions and vice versa.

Health Care to people with disability: the formation of teams and geographical distribution of the rehabilitation specialized component.

to analyze the composition of teams and the geographical distribution of the services and professionals of the Health Care Network for People with Disabilities (RCPD, initials in Portuguese). cross-sectional observational study developed from secondary data on the specialized component in rehabilitation, with a sample of 3,271 professionals. half of the services was observed in three broad regions; there is a greater representation of Specialized Services in Intellectual Disability Rehabilitation (SERDI, initials in Portuguese), private services and physiotherapists. We observed that most services had full teams; however, most of them do not comply with the minimum workload established by national policy. The Enlarged Health Regions of Jequitinhonha, Norte and the Centros Especializados em Reabilitação (CER, initials in Portuguese) modality presented the highest averages in terms of professionals and workload. Our results show a significant statistical association between full teams and private services. these results have the potential to contribute to the development of strategies to minimize the disparities found in the geographical distribution, in rehabilitation modalities, and public service investments.

Rapid assessment of Rashtriya Bal Swasthya Karyakram program implementation and beneficiary feedback at two district early intervention centers in Chhattisgarh State in India

Background: The Government of India launched the child health screening and early Intervention programme called Rashtriya Bal Swasthya Karyakram in 2014 to screen children from 0 to 18 years for the early detection of 4 D's (Defects, Diseases, Deficiency, and Developmental Delays including disabilities). Under this program, district early intervention centers (DEICs) are set up as nodal centers at the district level to manage the cases of 4Ds. There are few studies published evaluating the functioning of DEICs or reflecting the feedback from beneficiaries. Aims: The aim of this study is to assess the functioning and infrastructure of DEIC and beneficiary feedback. Methods: One good performing district (Raigarh) and one poor performing district (Raipur) were selected for rapid assessment. Observational check list according to norms was used for assessment of facilities, staffing pattern, and semi-structured questionnaire used for beneficiary feedback. Data were entered in Microsoft excel for the analysis. Results: DEIC Raipur was deficient in staff and infrastructure. Among all the referred cases, only 38.9% and 31.5% reached DEIC Raipur and Raigarh, respectively. DEIC Raigarh deserves special mention. It has special Orthotics unit, “Sensory garden,” and Disability Rehabilitation Center. Beneficiaries face many difficulties at DEIC despite having necessary referral forms. 73.4% parents said loss of daily wages was a deterrent to go to DEIC repeatedly for follow-up. Conclusion: There was a deficiency of staff and infrastructure in DEIC Raipur. DEIC Raigarh had a well-equipped rehabilitation center. It should be developed as “Model DEIC” for Chhattisgarh and explore the possibility of telemedicine to provide services to neighboring underserved districts. Beneficiary feedback was below satisfaction.

Childhood blindness and associated factors: An observational study at the district disability rehabilitation centre, West Tripura district, India.

Background:In India, about 50% of all childhood blindness is either preventable or treatable. Hence, controlling childhood blindness may be an effective way to reduce blindness in this country in the long run. Strategies to combat childhood blindness require accurate data regarding its magnitude, distribution, and determinants in a population. In this regard, district disability rehabilitation centres (DDRC) are working in India to diagnose and rehabilitate the subjects with blindness of various degrees.Objectives:The objectives of the study are to estimate the proportion of childhood blindness among the visually challenged subjects registered under the DDRC of West Tripura district, to find out the different ocular morbidities in this population and to study the factors associated with these disabilities.Materials and Methods:This facility-based cross-sectional study was conducted using secondary data from 2,260 visually challenged subjects enlisted in the DDRC of West Tripura district of India from June 1, 2018, to May 31, 2020.Results:The proportion of childhood blindness was found to be 3.89% (88) among the visually challenged subjects catered by the DDRC of West Tripura district. About 68.18% of the study subjects belonged to the lower socio-economic class as per BG Prasad's socio-economic classification, 39.77% subjects had 30% blindness and 15.90% subjects had 100% blindness. Among these 88 cases (134 eyes) of blindness, 20.14% were refractive error, 7.50% corneal opacities, 12.68% phthisis bulbi, 3.73% congenital cataract and pseudophakia, 2.98% congenital glaucoma, 23.88% congenital globe anomalies, 8.20% retinal diseases, 11.94% nystagmus and 8.95% were due to miscellaneous causes.Conclusion:Childhood blindness is still a public health problem in this part of India. Congenital globe anomalies were found to be the commonest cause followed by refractive errors.

‘Obuntu Bulamu’ – Development and Testing of an Indigenous Intervention for Disability Inclusion in Uganda

There is need to learn from indigenous knowledge and concepts when studying disability and inclusion in resource-constrained settings. We describe the development and testing of the ‘Obuntu bulamu’ intervention, a peer-to-peer support disability inclusion intervention, starting from indigenous interpretations of belonging and humanity. ‘Obuntu bulamu’ is an accepted and consistent behaviour that signifies a shared set of values that promote well-being, togetherness, and unity. The intervention was co-created and tested by a team of children, parents, teachers, disability rehabilitation workers, and academics in Uganda. It consists of training sessions, peer support meetings, and activities for children, parents, and teachers around the themes ‘peer support’, ‘disability’, and ‘belonging’. Through qualitative participatory methods the feasibility and acceptability of the intervention was evaluated with 64 children, 64 parents, and 33 teachers in 10 communities in Wakiso district, Central Uganda.

Assessing the effectiveness of the “I Can Feel Good” programme mindfulness module for a group of detained intellectually disabled patients

PurposeThis study aims to evaluate the clinical effectiveness of the Mindfulness module of the “I Can Feel Good” programme, an adapted dialectical behaviour therapy (DBT) informed skills programme for a group of intellectually disabled offenders (IDOs).Design/methodology/approachThe programme module was delivered to a group of five male IDOs detained under the Mental Health Act 1983 (Revised 2007) at an intellectual disability (ID) rehabilitation hospital based in the UK. The mindfulness module was 12 sessions in length, and it was evaluated using the emotional problems scale (EPS) and the cognitive and affective mindfulness scale-revised (CAMS-R) self-assessment and observational scale. These measures were administered pre- and post-module and used the staff report scales as a primary source of evaluation.FindingsNon-parametric testing revealed that there was a reduction in scores post module on the externalising behaviour problem scale of the EPS and increased scores on the CAMS-R observational scale, which would indicate clinical improvement in the IDO’s behavioural presentation, although it was not statistically significant. The internalising behaviour problem scale showed increased signs of anxiety post module, this could be related to increased self-awareness. The CAMS-R self-reported measure indicated reduced mindfulness qualities following the module.Originality/valueThe results indicate that following the mindfulness module, there was a reduced level of challenging behaviour displayed by the patients with increased signs of emotional regulation. There was also an observed reduction in symptoms of depression and low self-esteem post module.

Experience of families in accessing government-led support for children with disabilities in Bangladesh

Purpose The purpose of the study was to understand the experiences of families in accessing government support (i.e., disability allowances and rehabilitation services) for their children with disabilities (CWDs) in Bangladesh. Method We employed a qualitative descriptive method of study and interviewed 27 family members of CWDs. A thematic analysis was applied to analyze data using the following access dimensions to organize themes: availability, accommodation, accessibility, affordability, acceptability, and awareness. Results Participants shared both positive and negative experiences across the access dimensions in accessing government support. Participants appreciated the government’s effort in providing support to CWDs. In particular, disability allowances and coordinated rehabilitation services at one-stop were important for families. Further, positive attitudes, such as respect and support from providers, were reported by many families. However, a majority of participants reported a long wait time to get the disability allowance for CWDs. Participants also reported that a shortage of rehabilitation professionals in the public sector was a major concern. Finally, inaccessible infrastructure (e.g., facilities and transportation) and stigma were barriers for many participants of the study. Conclusion The results suggest that the government’s commitment “on paper” is yet to meet the needs of its intended beneficiaries “in practice”. There is a need for policy intervention to address barriers faced by families within the context of current access pathways. Implications for rehabilitation Shortage of rehabilitation services and limited availability of disability allowances [negatively] affect family member's access to government-led support for their CWDs in Bangladesh. The government has increased services for people with disability significantly but there is a need for it to ensure the availability of all forms of rehabilitation and increase the quota for disability allowances to meet the needs of families. It is imperative to improve mechanisms of monitoring the commitment of enacting tangible results from policies in order to ensure equitable distribution of disability allowance and rehabilitation services.