Extent Of Disability Research Articles

The effect of social transfers on the level of unemployment of disabled in EU countries

Abstract. Employment brings disabled people not only the necessary income for reasonable life, but also serves as an important part of social inclusion. It is rarely stressed in the literature that in order to find a job it is necessary to possess certain level of welfare. The role of the state in providing that for disabled cannot be underestimated. This way, social transfers may decrease unemployment among disabled people. On the other hand, classical literature suggests, that social transfers demotivate people from looking for a job thus increasing unemployment. This paper studies the effects or reduction in poverty among disabled caused by social transfers on the level of unemployment of disabled in EU countries on macro level. We use data collected by Eurostat in the European Union Labor Force Survey in 2011. Our results suggest that the bigger is the effect of social transfers on the level of poverty, the higher is the unemployment of disabled with only a basic activity difficulty. The effect of reduction in poverty caused by social transfers on unemployment of disabled with limitation in work caused by a health condition and/or a basic activity difficulty is not statistically significant.Keywords: unemployment, disabled, social transfers, povertyJEL classification: E24, Z13, H71(ProQuest: ... denotes formulae omitted.)IntroductionOne out of every six EU citizens between 16 and 64 is reported to have a long-standing health problem or disability although one third of those persons do not experience any restriction in their working abilities (Greve, 2009). These people may suffer difficulties in looking for and maintaining job, resulting in substantial unemployment within this segment of population. The levels of unemployment among disabled in European Union range from 4,9% in Luxembourg to 28,2 in Spain depending on the country and the extent of disability (see table 1). Existing results suggest that the situation is worse for disabled people with low education, for women than for men, for people with intellectual impairments and mental health conditions (Holland, et al., 2011; Greve, 2009; Applica et al, 2007; Achterberg et al., 2009).Severe unemployment among disabled people most of the EU countries attempt to relieve by adopting numerous strategies (Strielkowski and Hnevkovský, 2013). Contrary to earlier strategies, that focused at providing special conditions for employment of disabled, designed to take into account what the disabled cannot do, the recent employment strategies adopted in EU countries focus mostly on what disabled can do (see Ren L. R., et al., 2008 for the description of the concept). The main idea is to integrate disabled to the workforce rather than provide them with sheltered employment and other less valued compensatory employment (Greve, 2009). The current strategies focus on supporting part time work and job flexibility (shorter working hours, flexible attendance, work breaks, etc.) in the boundaries of regular employment. To motivate employers to provide disabled with such work contracts, most of European countries maintain some form of employment quotas for disabled with or without sanctions.While quotas may do their job if enforced, there are also some arguments against quotas. The first problem states that quotas are not always implemented fully (Gundersen, 2008; Greve, 2009). For example in Austria only 30% of companies obeyed the quota for disabled in 2002 (Zelderloo and Reynaert, 2007; Greve, 2009). In some countries, quota places may be traded. For example in the Czech Republic companies can reduce the minimal number of disabled necessary to employ if they buy products from other firms, which employ more than 50% of disabled. This practice provides the companies a legal opportunity not to comply with quotas. In addition, in order to fulfill the quota in the easiest and quickest way the firms may go for internal rather than external employment and target those disabled, who are the closest to the labor market leaving the others unattended. …

Extent and Background Factors of Physical and Mental Disability in Bangladesh

The extent of disability in Bangladesh in recent time has been examined and the potential background factors causing different types of disability have been identified. The data on disability in Bangladesh was taken from Sample Vital Registration System (SVRS), 2010 collected by Bangladesh Bureau of Statistics. Chi-square test of association showed that type of disability varies significantly with respect to area, sex, division and religion. Age has no significant association with disability. A trichotomous logistic regression model presented the relationship between different background factors and type of disability. The model shows that the disability rate is higher among urban people as compared to rural people. The disability rate in Barisal, Dhaka, Khulna and Rajshahi are significantly higher than Sylhet. The male are more likely to be mentally disabled than female. Both physical and mental disability is higher among non muslims as compared to Muslims. DOI: http://dx.doi.org/10.3329/dujs.v62i1.21962 Dhaka Univ. J. Sci. 62(1): 55-58, 2014 (January)

Development of a computerised decision aid for thrombolysis in acute stroke care.

BackgroundThrombolytic treatment for acute ischaemic stroke improves prognosis, although there is a risk of bleeding complications leading to early death/severe disability. Benefit from thrombolysis is time dependent and treatment must be administered within 4.5 hours from onset of symptoms, which presents unique challenges for development of tools to support decision making and patient understanding about treatment. Our aim was to develop a decision aid to support patient-specific clinical decision-making about thrombolysis for acute ischaemic stroke, and clinical communication of personalised information on benefits/risks of thrombolysis by clinicians to patients/relatives.MethodsUsing mixed methods we developed a COMPuterised decision Aid for Stroke thrombolysiS (COMPASS) in an iterative staged process (review of available tools; a decision analytic model; interactive group workshops with clinicians and patients/relatives; and prototype usability testing). We then tested the tool in simulated situations with final testing in real life stroke thrombolysis decisions in hospitals. Clinicians used COMPASS pragmatically in managing acute stroke patients potentially eligible for thrombolysis; their experience was assessed using self-completion forms and interviews. Computer logged data assessed time in use, and utilisation of graphical risk presentations and additional features. Patients’/relatives’ experiences of discussions supported by COMPASS were explored using interviews.ResultsCOMPASS expresses predicted outcomes (bleeding complications, death, and extent of disability) with and without thrombolysis, presented numerically (percentages and natural frequencies) and graphically (pictographs, bar graphs and flowcharts). COMPASS was used for 25 patients and no adverse effects of use were reported. Median time in use was 2.8 minutes. Graphical risk presentations were shared with 14 patients/relatives. Clinicians (n = 10) valued the patient-specific predictions of benefit from thrombolysis, and the support of better risk communication with patients/relatives. Patients (n = 2) and relatives (n = 6) reported that graphical risk presentations facilitated understanding of benefits/risks of thrombolysis. Additional features (e.g. dosage calculator) were suggested and subsequently embedded within COMPASS to enhance usability.ConclusionsOur structured development process led to the development of a gamma prototype computerised decision aid. Initial evaluation has demonstrated reasonable acceptability of COMPASS amongst patients, relatives and clinicians. The impact of COMPASS on clinical outcomes requires wider prospective evaluation in clinical settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-014-0127-1) contains supplementary material, which is available to authorized users.

A Feasibility Assessment of International Classification of Functioning, Disability and Health (ICF) Tool for Locomotion in Rural Community of Northern India

Abstract Background ICF is a valid tool to assess the degree and extent of disability, functioning, and health among patients. Its use in population to assess the disability is often limited. Aim To assess the feasibility of ICF tool in community settings among patients with any signs and symptoms of locomotion. Design Community based survey was carried out to assess the disability. Setting The studied individuals were assessed during house to house survey in a rural area of Himachal Pradesh, India. Any individual with any signs and symptoms of disability associated to locomotion was interviewed by the trained medical social worker at their home. Population Total 82 individuals were interviewed to study the degree and extent of disability related to locomotion. Methods An ICF tool version 2.1a as recommended by World Health Organisation was used for assessment. Results A total 82 people whom 58.5% were assessed using ICF tool and 40.0% of males and 50.0% of females observed with no problem of impairment for locomotion. Among those who reported, moderate level of impairment related to joints was observed among 32.4% females and 31.3 % males. Mild impairment for muscle power was present among 31.3% males and 29.4% of females. Assessment of extent of impairment observed that the lower limb was most commonly (about 40.0%) involved in both males and females. Both males and females were mostly observed with restricted performance for daily activities like using transportation, lifting/carrying of objects, walking and moving around using assisted equipment. About 47.9% and 31.3% of males responded that the design of building and technology for public use, as mild and moderate barrier respectively. Design of building for public use was observed as severe barrier among 38.2% of females. Conclusions Disability related to locomotor system involving lower extremities is most common form of disability. Mild to moderate level of impairment was observed among individuals with locomotor disability to carry out day to day activities. Rehabilitation impact ICF tool can be used to study the degree and extent of disability. A standard pattern of analysis and reporting the results would help to assess the effect of rehabilitative interventions in community settings.

Screening for Depression in Adult Patients with Multiple Sclerosis

Major depression and suicide are high among patients with MS. Despite the high prevalence of depression among persons with MS, only half of patients are screened and depression often remains undetected. Objective: To determine the correlation between the Beck Depression inventory-II (BDI-II) and the Beck Depression Inventory Fast Screen (BDI-FS), and to determine if the degree of disability as measured by the Expanded Disability Status Scale (EDSS) and the number of MS relapses were correlated with depression as measured by the BDI-II, and the BDI-FS. Methods: A sample of 34 persons with MS was selected from an urban neurological outpatient clinic in the Northeast United States. Descriptive, Chi-Square and Pearson correlations were used to analyze the data. Results: The sample was primarily female (71%), Caucasian (73.5%), married (56%), educated (67%), and lived with a partner or their family (68%). There was a significant positive correlation between the BDI-II and BDI-FS (r =0.82, p=0.01). The BDI-FS identified significantly more depressed persons than the BDI-II (X2=22.61, df=1, p< 0.001). There was no correlation between the extent of disability or number of MS relapses and depression as measured by either the BDI-II or BDI-FS. Conclusions: The study supports the ability of both tools to identify depressive symptoms among individuals with MS. The BDI-FS may be more efficient in identifying depression in the clinical setting among MS patients since it contains no items that assess symptoms commonly associated with MS.

Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease

Retrospective study. For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative spine disease. A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0±3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5-S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous spine surgeries, or postoperative complication rate. The incidence of L5-S1 pseudarthrosis after 1year in the S1, iliac, and plate groups was 19, 0, and 29%, respectively (p<0.05 iliac vs. plate). The incidence of screw loosening after 1year in the S1, iliac, and plate groups was 22, 4, and 43%, respectively (p<0.05 iliac vs. plate). Average Oswestry scores after 1year in the S1, iliac, and plate groups were 40±18, 42±20, and 58±18, respectively (p<0.05 both S1 and iliac vs. plate). The surgical treatment of multilevel degenerative spine disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.

Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO₂peak indicates functional impairment.

BackgroundMyalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multi-system illness characterized, in part, by increased fatigue following minimal exertion, cognitive impairment, poor recovery to physical and other stressors, in addition to other symptoms. Unlike healthy subjects and other diseased populations who reproduce objective physiological measures during repeat cardiopulmonary exercise tests (CPETs), ME/CFS patients have been reported to fail to reproduce results in a second CPET performed one day after an initial CPET. If confirmed, a disparity between a first and second CPET could serve to identify individuals with ME/CFS, would be able to document their extent of disability, and could also provide a physiological basis for prescribing physical activity as well as a metric of functional impairment.Methods22 subjects diagnosed with ME/CFS completed two repeat CPETs separated by 24 h. Measures of oxygen consumption (VO2), heart rate (HR), minute ventilation (Ve), workload (Work), and respiratory exchange ratio (RER) were made at maximal (peak) and ventilatory threshold (VT) intensities. Data were analyzed using ANOVA and Wilcoxon’s Signed-Rank Test (for RER).ResultsME/CFS patients showed significant decreases from CPET1 to CPET2 in VO2peak (13.8%), HRpeak (9 bpm), Ve peak (14.7%), and Work@peak (12.5%). Decreases in VT measures included VO2@VT (15.8%), Ve@VT (7.4%), and Work@VT (21.3%). Peak RER was high (≥1.1) and did not differ between tests, indicating maximum effort by participants during both CPETs. If data from only a single CPET test is used, a standard classification of functional impairment based on VO2peak or VO2@VT results in over-estimation of functional ability for 50% of ME/CFS participants in this study.ConclusionME/CFS participants were unable to reproduce most physiological measures at both maximal and ventilatory threshold intensities during a CPET performed 24 hours after a prior maximal exercise test. Our work confirms that repeated CPETs warrant consideration as a clinical indicator for diagnosing ME/CFS. Furthermore, if based on only one CPET, functional impairment classification will be mis-identified in many ME/CFS participants.

Skeletonization Technique in Coronary Artery Bypass Graft Surgery Reduces the Postoperative Pain Intensity and Disability Index

Benefits of the skeletonized internal thoracic artery (ITA) include increased graft flow, increased graft length, and reduced incidence of sternal complications. We conducted a randomized, double-blinded comparison of skeletonized versus pedicled ITA to assess the differences in pain intensity and extent of disability between the two types of harvesting procedures at one and three months follow-up. A total of 50 patients were included in our study. Twenty-five patients had undergone skeletonized grafting while the other half had undergone pedicled grafting. The patients were evaluated for their pain at one and three months postoperatively. Extent of disability was measured via Pain Disability Index and intensity of pain was measured via Visual Analogue Scale (VAS). The patients were also questioned about the details of their pain using Short Form McGill Pain Questionnaire. In the first month, the mean pain intensity measured through VAS was 30.4 ± 4.0 and 55.0 ± 5.7 mm in skeletonized and pedicle group, respectively. The pedicled group had significantly higher scores measured by all three scales at both one- and three-month intervals (p-values < 0.0001). Our results indicate that skeletonization of ITA significantly reduces postcoronary artery bypass graft surgery pain at both one- and three-month intervals. Long-term clinical trials involving larger sample sizes should be conducted to fully confirm the benefits of the skeletonization technique.

Active inflammation increases the heterogeneity of MRI texture in mice with relapsing experimental allergic encephalomyelitis

Inflammation modulates tissue damage in relapsing-remitting multiple sclerosis (MS) both acutely and chronically, but its severity is difficult to evaluate with conventional MRI analysis. In mice with experimental allergic encephalomyelitis (EAE, a model of MS), we administered ultra small particles of iron oxide to track macrophage-mediated inflammation during the onset (relapse) and recovery (remission) of disease activity using high field MRI. We performed MRI texture analysis, a sensitive measure of tissue regularity, and T2 assessment both in EAE lesions and the control tissue, and measured spinal cord volume. We found that inflammation was 3 times more remarkable at onset than at recovery of EAE in histology yet demyelination appeared similar across animals and disease course. In MRI, lesion texture was more heterogeneous; T2 was lower; and spinal cord volume was greater in EAE than in controls, but only MRI texture was worse at relapse than at remission of EAE. Moreover, MRI texture correlated with spinal cord volume and tended to correlate with the extent of disability in EAE. While subject to further confirmation, our findings may suggest the sensitivity of MRI texture analysis for accessing inflammation.

Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

Current surgical approaches for treatment of lumbar canal stenosis are often associated with relatively high rates of reoperation and recurrent stenosis. We have developed a new approach for treatment of this condition: sublaminar-trimming laminoplasty. To describe the surgical approach of sublaminar-trimming laminoplasty and to assess associated outcomes. Patients with extensive lumbar canal stenosis who received sublaminar-trimming laminoplasty from 2006 to 2008 were considered for inclusion in the study. The surgery comprised aspects of laminotomy and laminectomy. The following were assessed before surgery and 3years after surgery: leg and back pain by visual analog scale (VAS), extent of disability by Oswestry Disability Index (ODI), severity of back pain by Japanese Orthopedic Association Score for Back Pain (JOA), walking tolerance, and leg numbness. Complications were noted. A total of 49 patients were included in the study (mean age 65.6±10.6years). VAS leg and back pain, ODI, and JOA scores significantly changed from before surgery to 3years after surgery (P<0.001). Mean changes (95% confidence interval) were -6.2 (-6.7, -5.7), -4.3 (-4.8, -3.8), -21.4 (-23.4, -19.5), and 13.4 (12.1, 14.7) for leg pain, back pain, ODI, and JOA scores, respectively. Patients experienced significant improvements in walking tolerance and leg numbness (P<0.001). There were no instances of recurrent stenosis or postoperative spinal instability. Complications included intraoperative dural tear (n=2), postoperative urinary tract infection (n=2), and inadequate decompression and junctional stenosis during follow-up (both n=1). Sublaminar-trimming laminoplasty shows promise as an effective treatment for extensive lumbar canal stenosis.

Narrative Ethics and Vulnerability: Kristeva and Ricoeur on Interdependence

The character and extent of disabilities, especially cognitive disability, have posed significance problems for existing moral theories. Certain philosophers have even questioned the moral personhood of people with disabilities and have argued that people with profound cognitive impairments should not be granted the same moral status as those who are cognitively able-bodied. This paper proposes an alternative understanding of moral personhood as relational rather than individuated. This relational moral personhood finds its foundation in the clinical practice and psychoanalysis of Julia Kristeva and the hermeneutic narrative identity of Paul Ricoeur. One consequence of this relational personhood is a new understanding of moral status through narrative co-authorship rather than intellectual or social capacity. Another consequence is a refiguration of narrative identity as narrative interdependence.

Нейровизуализационные и клинические параллели у молодых пациентов с ишемическим инсультом, обусловленным аномалиями церебральных артерий

Ишемический инсульт является одной из глобальных проблем современной клинической неврологии. За последнее десятилетие отмечается тенденция «омоложения» церебрального ишемического инсульта (ЦИИ). При развитии очагового поражения после мозговой катастрофы у пациентов могут наблюдаться нейропсихологические нарушения. В исследование включены 64 (50,4 %) пациента в остром периоде ЦИИ с аномалиями церебральных артерий (ЦА), которые были разделены на 2 группы в зависимости от проводимой медикаментозной терапии. Наиболее частыми аномалиями интра- (ИЦА) и прецеребральных артерий (ПЦА) у пациентов с ЦИИ были патологическая извитость внутренней сонной артерии (ВСА) (62,5 %), гипоплазия позвоночной артерии (ПА) (75 %), гипоплазия одной задней соединительной артерии (29,7 %), полная задняя трифуркация одной ВСА (14,1 %).При оценке тяжести течения и степени инвалидизации по шкалам NIHSS и MRS установлено, что у пациентов I группы преобладала средняя степень тяжести (80 %) и умеренная степень инвалидизации (68,6 %). У 18 (62,1 %) пациентов II группы выявлена средняя степень тяжести неврологического дефицита и умеренная степень инвалидизации. Оценивая взаимосвязи эмоционально-личностных нарушений у пациентов с ЦИИ и вида аномалий ИЦА и ПЦА, мы не установили характерных особенностей. При сопоставлении тяжести когнитивных нарушений у пациентов с ЦИИ и вида аномалии ЦА установлено, что у 12,6 % пациентов I группы с полной задней трифуркацией правой ВСА, гипоплазией правой задней мозговой артерии (ЗМА), S-образной патологической извитостью и петлеобразованием ВСА наблюдались выраженные когнитивные нарушения. В случае комбинации аномалий ИЦА и ПЦА (полная задняя трифуркация левой ВСА и гипоплазия левой ЗМА) у 8 (27,6 %) пациентов II группы диагностированы умеренные интеллектуально-мнестические нарушения.Показано, что применение цитиколина (Цераксон) в комбинации с Актовегином у пациентов молодого возраста с ЦИИ, обусловленным аномалиями ЦА, позволило добиться более быстрого регресса неврологического дефицита (на 53,7 %), улучшения показателей когнитивных функций (на 4,6 ± 2,1 балла) и восстановления эмоционально-личностных расстройств в более ранние сроки (на 19,6 %).

Social, economic, and demographic factors affecting risk of severe disability and employability in India

Background: The prevalence of disability in India has been estimated at 1.8%; however, factors affecting the employment of persons with disability (PWD) in India have not been examined. Methods: Using nationally representative data from the National Sample Survey Organization, this paper examines factors that affect the impact of disability in terms of employment for persons with disability. Results: The extent of disability (represented by the person’s ability to perform self care activities) was lower for those from rural areas and of lower socioeconomic status. Disabled men were more likely to be employed than women (p&lt;0.001), as were rurally resident persons with disability who were likely to be employed than their urban counterparts (p=0.009). Individuals at a lower level of monthly expenditure (suggesting a lower socio-economic status) were more likely to change or lose work due to disability but were less likely to be unemployed or unable to work due to disability. Conclusions: The data suggests that PWD have variable employment status. The data provide important information for formulating and strengthening targeted strategies to empower them.

The lifetime history of traumatic Brain injury and associated outcomes: a state-wide population-based survey

BackgroundThe number of non-hospitalised cases of traumatic brain injury (TBI) exceeds hospitalised cases, and the extent of disability following non-hospitalised TBI is unknown.Aims/Objectives/PurposeDocument the lifetime history of TBI in a...

Disability due to gouty arthritis

Disability, or activity limitation, is a common problem in patients with gout. This study explores recent studies examining the nature and extent of disability in gout and addresses the merits and limitations of current self-reported measures of disability. Gout has a significant impact on patients' ability to perform normal self-care activities, recreational and social activities, and work. Comparative studies indicate that gout patients' physical functioning is strongly reduced and comparable to those with other severe rheumatic conditions. Moreover, gout has been shown to result in substantial work absence and reduced productivity. However, few studies have thoroughly examined the concept of disability in gout. Additionally, assessment of disability due to gout still seems particularly challenging and it is unclear whether current measurement instruments are sufficiently valid and accurate. Gout-related disability is an underestimated and understudied problem. More qualitative and quantitative studies are needed that examine the concept of disability in gout and its impact on patients' lives, both during and between disease flares. Moreover, future studies should try to identify gout-specific disability issues and examine the relevance and comprehensiveness of existing measures to further improve the assessment of disability in gout.

A Population-based Survey of Mental Disorders in Singapore

Mental illnesses are not only a growing public health concern but also a major social and economic issue affecting individuals and families throughout the world. The prevalence of mental disorders, the extent of disability caused by these disorders, and services utilisation of these patients has been well studied in developed countries. The aim of this study was to establish the prevalence of select mental disorders and their associated sociodemographic correlates in the adult Singapore resident population. This was a cross-sectional, populationbased, epidemiological study of adult Singapore residents aged 18 years and above. The subjects were randomly selected using a disproportionate stratified sampling method. The diagnoses of selected mental disorders including major depressive disorder (MDD), dysthymia, bipolar (bipolar I & II) disorders, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), alcohol abuse and alcohol dependence were established using the Composite International Diagnostic Interview, which is a fully structured diagnostic instrument that assesses lifetime and 12-month prevalence of mental disorders. Among the 6616 respondents (response rate of 75.9%), 12.0% had at least one lifetime affective, anxiety, or alcohol use disorders. The lifetime prevalence of MDD was 5.8% and that of bipolar disorder was 1.2%. The combined lifetime prevalence of the 2 anxiety disorders, GAD and OCD was 3.6%, with the latter being more common than GAD (0.9% and 3.0% respectively). The lifetime prevalence of alcohol abuse and dependence were found to be 3.1% and 0.5% respectively. Age, gender, ethnicity, marital status and chronic physical illnesses were all significant correlates of mental disorders. The identified associated factors would help guide resource allocation, policy formulation and programme development in Singapore.

The fate of the hip in spondylo-epi-metaphyseal dysplasia: clinical and radiological evaluation of adults with SEMD Handigodu type

This study was undertaken to document the fate of the hip with reference to its structure and function in patients with spondylo-epi-metaphyseal dysplasia tarda Handigodu type (SEMD(HG)). Radiographs of 271 adult patients with SEMD(HG) were studied to identify the pattern of long-term sequelae in the hips. Several measurements of the proximal femur and acetabulum were made to quantify morphological alterations in the hip. Fifty-four adult patients were examined and administered a questionnaire to evaluate the extent of disability attributable to the hips. Three patterns of changes in the hips were noted: 35% had acetabular protrusio, 33% had subluxation of the hip, and 32% had no protrusio or subluxation. Distinctly different anthropometric measurements and dimensional alterations around the hip were noted in these three patterns. Patients with protrusio were relatively tall while those with subluxation were the shortest. All the patients had developed degenerative arthritis of the hips by the fourth decade of life irrespective of the pattern of hip involvement. The reduction in the range of hip motion and fixed deformities were most severe in patients with protrusio. All the patients had significant disability and very low functional hip scores. Degenerative arthritis of the hip develops in the majority of patients with SEMD(HG); the symptoms are severe enough to warrant reconstructive surgery by the fourth decade of life. Protrusio or subluxation develops in a third of the patients each; both these complications will influence the surgical approach if total hip arthroplasty is planned.

Cerebral palsy: experiences of mothers after learning their child’s diagnosis

This study is a report of a study describing mothers' experience of learning that their child has been diagnosed with cerebral palsy. Learning a child's diagnosis of disability is a crisis for parents. Their reactions include shock, refusal to accept the diagnosis, anger, fear, and uncertainty about the extent of disability and associated impairment. Knowledge about parental reactions is based on studies conducted in western countries, many of which do not apply to Taiwan where Confucianism strongly influences cultural perspectives of family and disability. In this phenomenological study, data were collected in 2005-2006 using in-depth interviews and journaling with 15 Taiwanese mothers of children diagnosed with cerebral palsy. Hermeneutic analysis was undertaken of interview transcripts and journal notes. Four shared meanings associated with learning of their child's diagnosis were revealed: feeling out of control and powerless, mistrusting healthcare professionals, release and confirmation, and feeling blamed for not following traditional practices. Mothers experienced a loss of their 'ideal' child when their child was diagnosed with cerebral palsy. Expectations of 'normal' motherhood and fulfilling societal anticipation of giving birth to a healthy child were lost. Maintaining their husband's family honour and prosperity, as well as saving face in their community were threatened. Mixed feelings of disbelief, rejection, self-blame and sadness were compounded by uncertainty about their child's future. To promote better understanding of the child's condition, emotional support and information should be provided to the mother and family, both when informing them of the diagnosis and in the period after diagnosis.

Poster 19: Validation of the Modified Motor Score (mMS): A Subscale of the Unified Huntington's Disease Rating Scale (UHDRS) Motor Score

Background The UHDRS assesses various aspects of clinical function and capacity in Huntington's disease (HD). Items in the UHDRS motor section are heterogeneous, relate to various aspects of HD motor symptoms, and can be categorized as eye, involuntary, or voluntary movements. Items relating to voluntary movements appear to correlate strongly with the extent of disability, whereas the correlation between chorea and disability is less pronounced. These findings are supported by a preliminary analysis of baseline data from a phase 2 study of pridopidine (ACR16) in patients with HD (ACR16C007). Methods Motor scales from the UHDRS motor section were analyzed according to their metric properties and correlation with measures of functional disability, assessed by total functional capacity (TFC) and functional assessment (FA) scales. The following motor scales were analyzed, using data from the CARE-HD study dataset: UHDRS motor section items (TMS); TMS excluding eye movements; modified motor scale (mMS: TMS excluding eye movements, chorea, and dystonia), which assessed voluntary movements; chorea; and eye movements. Results The mMS subscale correlated strongly with TMS (ρ = 0.89; p Conclusions The mMS subscale appears to be a valid modification of the UHDRS motor score and has functional relevance, as demonstrated by strong correlations with functional assessments. This subscale of the UHDRS motor sections may offer a simple method of assessing response to treatment in patients with HD.

Vocal symptoms and acoustic changes in relation to the expanded disability status scale, duration and stage of disease in patients with multiple sclerosis

Vocal symptoms and acoustic measures of patients with multiple sclerosis (MS) are investigated in relation to the duration of the disease, stage of the disease and the degree of disability. Eighty-two patients were enrolled in this study (40 MS, 42 controls). In the MS group, the most common vocal symptoms were vocal breaks and vocal fatigue present in 10. None of the patients in the control group had voice breaks. In the male group, there was a significant decrease in the fundamental frequency, habitual pitch and maximum phonation time with a significant increase in Shimmer. In the female group, there was a significant decrease in the maximum phonation time only. There was no correlation between vocal symptoms and acoustic measures versus duration of the disease and extent of disability except for vocal fatigue which significantly associated with EDSS (expanded disability status scale) score. Patients with MS may develop vocal symptoms irrespective of the EDSS score, duration and stage of the disease. Vocal fatigue and vocal breaks are more common than hoarseness.