ABSTRACT Understanding the nature of methodological innovation, adaptation and disruption in social science methods is a complex challenge. I take a particular case – researching with people with profound intellectual disabilities as subjects of knowledge – and show my development and application of a new approach for examining methodological innovation within it. The paper outlines the stages of selecting papers claiming methodological progression; mapping relationships between methodological developments; extracting target data from the papers; coding the data extracted; and seeking patterns and meaning. The outcome is learning how innovations come about, their nature and journeys within a small field where the people and their ways of knowing have been seen as unresearchable. The paper concludes that disrupting the assumption that people with profound disabilities cannot tell their perspective has been a catalyst for methodological development, and the approach to studying this was effective in clarifying the interconnected nature of such innovations.

Neuromuscular signatures differentiating functional and impaired cases in full-thickness rotator cuff tears.

ABSTRACT In Philippine special education, the transition program for students with disabilities incorporates a critical component – specifically, a curriculum designed to equip students for one of five targeted exit outcomes: higher education, entrepreneurship, employment, middle-level skills or a functional life path. This transition curriculum framework is at its early stage of implementation to deliver basic education to students with severe and profound disabilities who are contained in multi-age classroom settings, hence non-graded classes. In this paper, we aim to identify the approaches in the use of the curriculum framework and the implementation challenges and gaps. We focused on the reports from 23 Schools Divisions (schools grouped by city or province) in one region. Our analysis revealed the following key themes: narrow focus on basic skills, teachers practice in non-graded classes, and the support for students in the program. The observed oversimplification of learning experiences, a prevalent input-output curriculum model and support aligning more with programmatic than individual student goals, highlight critical gaps in inclusive practice and underscore the need for curriculum developers and implementers to fundamentally rethink student-centred approaches.

This study aimed to identify risk factors for epilepsy severity in institutionalized adults with profound intellectual and multiple disabilities. We analyzed patients aged 20 years or older who were institutionalized in two long-term care facilities because of profound intellectual and multiple disabilities from childhood. We examined the relationship between epilepsy severity and possible risk factors, such as patients' clinical characteristics (e.g., cause and level of disability), brain imaging and electroencephalography findings, and antiseizure drug treatment. Epilepsy severity was classified into five levels according to seizure frequency. We compared patients aged < 40 years (younger group) and those aged ≥ 40 years (older group) according to the fact that the average life expectancy for individuals with profound intellectual and multiple disabilities typically ranges from 40 to 60 years. We recruited 151 patients, with a median age of 44 years (range, 20 -74 years). The cause of disability was congenital or unknown factors in 89 patients (58.9%), perinatal brain damage in 45 (29.8%), and acquired brain injury in 17(11.3%). The relationship between age and epilepsy severity differed between the two age groups. In patients aged < 40 years, those with most severe group (Severity 5) were significantly older than those with milder group (Severity 2) (p = 0.010) and second severe group (Severity 4) (p < 0.01). Conversely, in patients aged ≥ 40 years, those with most mild group (Severity 1) were significantly older than those with Severity 4 (p = 0.027). Epilepsy tended to be more severe in patients with more profound disability, those with a greater extent of diffuse abnormalities on brain imaging, and those who had developed myoclonus. In older group, the presence of focal epileptic paroxysms was an independent risk factor for epilepsy severity. Epilepsy severity in adults with profound intellectual and multiple disabilities follows a divergent age-dependent trend, showing an increase before age 40 and a potential decline thereafter. Brain dysfunction and diffuse imaging abnormalities remain consistent risk factors across all ages. The presence of focal epileptic paroxysms on electroencephalography was a specific risk factor for severe epilepsy in patients aged ≥ 40 years.

BackgroundSpinal cord injury results in profound neurological disability driven initially by primary mechanical damage and subsequently by secondary injury processes characterized by progressive neuroinflammation. Intravenous administration of human amniotic mesenchymal stem cells (MSC) has emerged as a promising therapeutic approach; however, the optimal timing of administration and its relationship to dynamic immune responses remain unclear.MethodsA rat contusion model of spinal cord injury was used to evaluate the effects of intravenous MSC administration at three post-injury time points: days 1, 3, and 7. Functional and histological assessments were performed for each group. Systemic inflammatory responses were evaluated through blood analysis of neutrophil and macrophage counts, systemic inflammation index (SII), and plasma proteomics. Local immune responses were assessed by quantifying infiltrating immune cells within the injured spinal cord.ResultsThe most substantial improvement in locomotor function was observed in the day-1 treatment group, followed by the day-7 group, whereas the day-3 group showed minimal benefit. The day-3 group also demonstrated a trend toward greater lesion length and increased macrophage infiltration 28 days after injury. MSC administration reduced SII in the day-1 and day-7 groups but not in the day-3 group, which instead showed an increased systemic inflammatory response. Analysis of spinal cord tissue demonstrated that MSC treatment on day-1 effectively reduced neutrophil infiltration, which peaks at this time point, while day-7 administration reduced macrophage infiltration during its peak phase. In contrast, MSC administration on day-3 failed to attenuate either neutrophil or macrophage accumulation. Plasma proteomic profiling revealed enhanced complement and coagulation pathway activation specifically on day-3.ConclusionsThe therapeutic efficacy of intravenously administered MSC is highly dependent on the timing of intervention. Optimal benefit is achieved when treatment coincides with peak activation of a dominant target immune cell population and avoids the peak of complement and coagulation signaling. These findings support a phase-matched therapeutic strategy to maximize MSC effectiveness following spinal cord injury.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13287-026-05018-0.

Large-core anterior circulation ischemic stroke (LCIS) complicated by malignant cerebral edema (MCE) remains a leading cause of early death and profound disability even in the era of endovascular thrombectomy (EVT). As EVT indications have expanded to include patients with large ischemic cores, more patients survive the initial ischemic insult but continue to face substantial risk of space-occupying edema, underscoring the need for standardized neurocritical care pathways. This narrative review summarizes evidence published between 2015 and 2025 from PubMed and Web of Science, emphasizing randomized trials, meta-analyses, high-quality observational cohorts, and major guidelines. Contemporary neurocritical care guidance increasingly treats LCIS as a distinct syndrome and recommends structured surveillance, timely osmotherapy, and consideration of decompressive hemicraniectomy (DHC). Recent large-core EVT trials show that, in carefully selected patients, EVT can improve functional outcomes, but it does not eliminate mortality or severe disability and is associated with higher risks of hemorrhage, while edema-related deterioration remains common after reperfusion. For patients who develop space-occupying middle cerebral artery infarction, early DHC consistently lowers mortality and increases the proportion of survivors with moderate disability. Meanwhile, predictive models and emerging deep-learning approaches are enhancing early risk stratification for MCE, supporting earlier escalation of monitoring and intervention. Overall, LCIS with MCE should be approached as a dynamic, time-sensitive condition that benefits from early recognition and a pragmatic, sequenced pathway integrating risk prediction, medical management, and surgical decompression when indicated. Future work should refine multimodal prediction tools, clarify DHC thresholds in reperfused patients, and develop more effective anti-edema therapies. An American Heart Association science advisory (published online 17 December 2024) synthesized the randomized evidence supporting EVT in selected large-core strokes and highlighted key implementation considerations.

Communication interventions can facilitate communication between people with profound and multiple learning disabilities (PMLD) and familiar partners such as family and educational setting staff, including speech and language therapists. Various communication interventions are routinely used but their clinical and cost-effectiveness are unclear. Intensive Interaction (II) is one intervention that focuses on early interaction abilities. II can be delivered by staff in educational settings and/or at home. Despite many settings already implementing II, staff are sometimes untrained or have not received up to date training, potentially leading to inconsistencies in how the technique is applied and the quality of the interactions. We will provide structured training in II to educational setting staff and parents/carers with coordinated activities developed jointly for each child/young person to be delivered within the educational setting and at home. This study aims to establish whether Intensive Interaction delivered within educational settings improves communication skills of children and young people with PMLD. A multi-site pragmatic cluster randomised controlled trial comparing usual care with Intensive Interaction and usual care. Clusters will be educational settings. This study will recruit 330 participants (aged 3-25years) with PMLD from 66 educational settings within Great Britain. Each participant will have a corresponding teacher, parent/carer, and interventionist. Potential participants will be screened by their educational setting for eligibility prior to giving informed consent. Data will be collected at baseline, 32weeks, and 52weeks post-randomisation and will assess health and educational outcomes including participants' communication skills, behaviour, wellbeing, and quality of life. The primary outcome is communication skills, measured by the Communication Complexity Scale (CCS) at 32weeks post-randomisation. Setting staff will video record an interaction with each participating child/young person. Communication will be coded by members of the research team blinded to allocation using the CCS. This study addresses a much used but currently under-researched intervention and results will inform the support provided to children and young people with PMLD in their educational settings and at home. The trial was prospectively registered on the ISRCTN registry on 3rd May 2023 (registration number: ISRCTN81099965, https://www.isrctn.com/ISRCTN81099965 ).

INTRODUCTION: Osteoarthritis (OA) constitutes the most prevalent degenerative joint disease worldwide, imposing a profound burden of chronic pain, functional limitation, and disability on the aging population. Conventional physiotherapy serves as the established cornerstone of conservative management, primarily targeting biomechanical optimization and symptom control. Concurrently, Low-Dose Radiation Therapy (LDRT) has experienced a significant clinical resurgence as a non-pharmacological intervention hypothesized to modulate synovial inflammation and halt structural disease progression. However, high-quality clinical evidence remains profoundly contested and polarized. The objective of this comprehensive systematic review is to rigorously evaluate the comparative efficacy of LDRT versus conventional physiotherapy and sham treatments, specifically focusing on the resolution of symptomatic complaints and the alteration of disease progression in OA patients. METHODS: A comprehensive systematic review protocol was executed in strict alignment with PRISMA guidelines. Efficacy data, adverse event rates, and radiological/clinical progression metrics were systematically extracted from peer-reviewed databases and recent oncological and rheumatological trial registries up to the year 2025. The risk of bias was appraised utilizing the Cochrane Risk of Bias 2 (RoB 2) tool. The statistical analysis isolated standardized mean differences (SMD), hazard ratios (HR), relative risks (RR), and confidence intervals (CI) to quantify treatment effects, categorizing findings into symptomatic efficacy, disease progression, and safety profiles. RESULTS: The systematic synthesis integrated diverse trial archetypes, encompassing over 3,000 cumulative patients across multiple cohorts. Conventional physiotherapy demonstrated consistent, short-term efficacy in functional restoration (SMD – 0,166, 95% CI -0,422 to 0.088) and pain reduction (SMD -0.175). Conversely, the most recent 2025 meta-analysis indicates that LDRT yields no statistically significant symptomatic benefit over sham interventions globally (SMD -0.92, P = 0.13). However, modern stratified trials, such as the ASTRO 2025 randomized controlled trial, revealed that a specific 3.0 Gy LDRT regimen yielded significant responder advantages over sham treatments (70.3% vs 41.7%, P=0.014). Most crucially, decade-long longitudinal data indicate that LDRT significantly reduces the hazard of profound clinical disability (Adjusted HR 0.24, 95% CI 0.11 to 0.48) and decreases the incidence of total joint arthroplasty (HR 0.60). Adverse events were measurably higher in LDRT cohorts (RR 1.44). DISCUSSION: The dichotomy in LDRT outcomes points to a highly complex interplay between radiobiological dose thresholds and the profound placebo responses documented in sham-controlled arms. Biologically, LDRT upregulates the Nrf2 antioxidant response, downregulates inducible nitric oxide synthase (iNOS), and polarizes macrophages toward the anti-inflammatory M2 phenotype, effectively arresting the osteoimmunological cascades that drive joint destruction. Physiotherapy remains universally effective for muscular and functional preservation, while LDRT's utility appears tightly restricted to delaying structural progression and end-stage disability in select demographics. CONCLUSION: Conventional physiotherapy maintains its mandate as the primary, biologically safe, and effective first-line intervention for OA. LDRT presents a potent but highly debated alternative that effectively alters long-term disease progression and disability trajectories but carries a measurable increase in localized adverse events and oncogenic risk. LDRT should currently be reserved for refractory clinical phenotypes or implemented strictly within controlled investigational frameworks.

Background: Deep brain stimulation (DBS) has traditionally followed diagnosis-driven, nucleus-centered targeting paradigms. Increasing evidence supports a circuit-based framework in which clinical outcomes depend on modulation of symptom-relevant networks rather than diagnostic labels alone. This approach is particularly relevant in mixed movement disorder phenotypes such as dystonic tremor, where the most disabling symptom may not align with the conventional surgical target. Methods: We report a clinically illustrative single case treated using a symptom-oriented, connectome-informed DBS strategy. Clinical phenotype, tremor severity, functional impairment, prior medical and botulinum toxin treatments, and longitudinal outcomes were systematically reviewed. DBS target selection prioritized the dominant, treatment-refractory symptom rather than the underlying dystonia diagnosis. Surgical planning incorporated high-resolution MRI with patient-specific thalamic segmentation using Brainlab Brain Elements®, followed by postoperative lead localization and volume of tissue activated visualization with the SureTune™ platform. Results: A 54-year-old left-handed woman with long-standing cervical dystonia developed a severe, markedly asymmetric dystonic tremor predominantly affecting the left upper limb, resulting in profound functional disability. Instead of conventional bilateral globus pallidus internus DBS, unilateral right ventral intermediate nucleus (VIM) DBS was selected to engage tremor-related cerebellothalamic circuits. Rapid and marked improvement was observed, with tremor severity reduced to mild levels within 15 days after stimulation onset. At 6-month follow-up, overall tremor severity improved from 49 to 13 points on the Fahn-Tolosa-Marin Tremor Rating Scale, corresponding to a 73.5% reduction. This improvement was associated with restoration of legible handwriting, independent feeding and drinking, and recovery of bimanual fine motor function. Clinical benefit remained stable throughout follow-up, without stimulation-related adverse effects. Conclusions: This case illustrates the feasibility of a symptom-oriented, connectome-informed DBS strategy in selected patients with dystonic tremor. When symptom expression and network involvement are markedly asymmetric, selective unilateral modulation of the tremor-dominant circuit may achieve meaningful and durable functional improvement. Further studies are needed to assess the generalizability of this approach.

This study explores the relationship between special education teachers' resilience and various factors, including gender, income level, professional experience, school administration support, partner compatibility, and student disability levels. The study was undertaken with 329 special education instructors stationed in Istanbul, using a relational survey model. Data were gathered through a personal information form and the Brief Resilience Scale and analyzed using Pearson Correlation and Multiple Linear Regression Analysis. The findings reveal that teachers with lower incomes tend to have lower psychological resilience, while those who receive strong administrative support and have better partner compatibility in the workplace demonstrate higher resilience. Educators engaging with learners exhibiting mild impairments manifest greater tenacity compared to those instructing pupils with moderate to profound disabilities. In contrast, gender and professional experience do not significantly influence psychological resilience. Regression analysis results indicate that the examined variables collectively explain 59 percent of the variance in resilience levels. These findings highlight the importance of enhancing administrative support, fostering collaboration among teachers, and implementing psychological support programs, particularly for educators working with students with severe disabilities. Future studies should incorporate expanded sample sizes and longitudinal research approaches to cultivate a more nuanced comprehension of this subject.

We begin this commentary with a brief analysis of "Making Medical Decisions for Children with Profound Cognitive Disabilities: Pluralism and the Best Interest Standard," by Pierce Randall, and "A Life Worth Sustaining? Bestowed Worth and Pediatric Care," by Daniel T. Kim and Xiang Yu, in the same issue of the Hastings Center Report. These two articles examine decision-making for children with profound cognitive disabilities and critique the relational potential standard found in pediatric ethics. We agree with the authors that the relational potential standard risks using children as a means to other people's ends. We also raise two additional concerns: the standard is incongruent with parents' self-descriptions, and it neglects the concept of goodness, which we take to be the fundamental concern of pediatric ethical analysis. We close with a brief discussion of goodness and consider how goodness might serve as the lodestar of pediatric ethics.

Requests by parents or other caregivers for treatment to prolong the lives of minors with profound cognitive disabilities can be ethically challenging. Some patients have very limited capacity for conscious experience, and so it becomes difficult to say that a longer life is truly good for them. For such cases, some commentators have proposed the relational potential standard as an alternative to the best interest standard. Yet, if the relational potential standard holds that requests for care ought to be honored because they respect patients' familial relationships even though they provide no benefit to patients themselves, then the proposal is objectionable. We have good ethical reasons to accept at least one element of the best interest standard: the exclusionary criteria that no one's interests but the patient's should count when making medical decisions on their behalf. This paper defends a pluralistic conception of what can be in a severely cognitively disabled minor patient's interests. This approach can yield the same result that proponents of the relational potential standard want (honoring requests for care even when providers doubt that these requests are in the patient's best interest) while avoiding committing clinicians to honoring unreasonable requests that discount the patient's other interests.

Lennox-Gastaut syndrome (LGS) is a rare and severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, mandatory tonic seizures, cognitive and behavioral impairment, and distinctive electroencephalographic features, including slow spike-wave discharges and generalized paroxysmal fast activity. Despite decades of therapeutic advances, LGS remains associated with profound lifelong disability and the absence of a single disease-defining molecular mechanism. Recent advances in genetics, neurophysiology, and network neuroscience have reframed LGS as a convergent network encephalopathy, in which diverse genetic, structural, metabolic, immune, and acquired insults funnel into shared molecular hubs, leading to thalamocortical network dysfunction. This framework helps explain the limited efficacy of purely syndrome-based treatments. This review synthesizes current evidence on electroclinical phenotyping, molecular and network pathogenesis, and contemporary diagnostic workflows and proposes a molecule-to-precision-therapy framework for LGS. We critically appraise pharmacologic, dietary, surgical, and neuromodulatory therapies, emphasizing drop seizures as a major driver of morbidity. Among available treatments, cannabidiol shows the most consistent and clinically meaningful efficacy for drop seizures, with benefits extending beyond seizure counts to seizure-free days and caregiver-relevant outcomes. Finally, we highlight key gaps and future directions, including etiology-stratified trials, network-guided interventions, and outcome measures that capture long-term developmental and quality-of-life impacts.

Primary hyperparathyroidism (PHPT) is characterised by autonomous overproduction of parathyroid hormone (PTH), resulting in hypercalcemia and multisystem complications. Although routine calcium screening has reduced advanced skeletal disease in many regions, severe manifestations such as osteitis fibrosa cystica (OFC) still occur in resource-limited settings. We report a case of a woman in her 30s who presented with profound disability after 4-5 years of progressive bone pain, fatigue, proximal myopathy and eventual loss of independent ambulation, requiring her to drag herself on the ground. Imaging revealed generalised osteopenia, subperiosteal bone resorption, a 'salt and pepper' appearance of the skull, codfish vertebrae, anterior bowing of long bones and multiple lytic lesions consistent with advanced OFC. Laboratory investigations revealed marked hypercalcemia (14.3 mg/dL), hypophosphataemia (1.49 mg/dL), elevated alkaline phosphatase (781 U/L) and elevated intact PTH (iPTH) (1110 pg/mL), confirming PTH-dependent hypercalcemia. A 4D-CT scan localised a left inferior parathyroid adenoma (LIPA), and a renal ultrasound showed bilateral nephrocalcinosis. Following preoperative stabilisation with saline diuresis and intravenous zoledronic acid, she underwent minimally invasive parathyroidectomy (MIP) with an immediate postoperative fall in PTH, indicating biochemical cure. However, she developed hungry bone syndrome (HBS), requiring intensive intravenous and oral calcium supplementation along with active vitamin D therapy. This case highlights the catastrophic skeletal consequences of delayed PHPT diagnosis. It underscores the importance of early recognition of metabolic bone disease to prevent irreversible disability and systemic complications, particularly in low-resource settings.

Decompressive craniectomy (DC) seemed to reduce the risk of death or profound disability (modified Rankin Scale score, 5-6) after deep intracerebral hemorrhage (ICH) by an absolute 13% (95% CI, 0%-26%) in the SWITCH trial (Swiss Trial of Decompressive Craniectomy versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage). Whether the effect of DC differs by ICH location is unknown. Post hoc analysis of participants with supratentorial severe deep ICH from the intention-to-treat population of the SWITCH randomized controlled trial. We categorized ICH as involving (1) the basal ganglia (BG) alone, (2) BG and the posterior limb of the internal capsule (PLIC), or (3) BG, PLIC, and thalamus. We examined the interaction between ICH location and DC's effect on primary (modified Rankin Scale score, 5-6) and secondary outcomes (death; full modified Rankin Scale score range) at 180 days using unadjusted and adjusted logistic or survival models. Of 197 participants comprising the trial's intention-to-treat population, 184 were available for analysis (median age, 61 years; 59 women; 91 randomized to DC plus best medical treatment; and 93 to best medical treatment). ICH involved BG alone in 26 (14%), BG+PLIC in 94 (51%), and BG+PLIC+thalamus in 64 participants (35%). The marginal risk of the primary outcome after adjustment for age, ICH severity, and volume was lower with DC by 15.6% (95% CI, -49.2% to 18.1%) in participants with ICH of BG alone, by 11.4% (-29.3% to 6.6%) in those with ICH of BG+PLIC, and by 9% (-31% to 12.9%) in those with ICH of BG+PLIC+thalamus, without evidence for treatment-by-location interaction (P=0.95). Secondary outcome analyses yielded consistent results. The potential benefits of DC seemed preserved regardless of the location of severe deep ICH. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02258919.

When parents request life‐sustaining treatments for children who suffer from profound neurocognitive disabilities or are at the end of life, the typical ethics advice for clinicians is to accommodate the request. It can be unclear what interests such children have, and being unable to assess those interests, a clinician will tend to honor parents’ requests to continue treatments if the associated pain can be palliated. But how is the clinician not participating in using a profoundly vulnerable child merely to satisfy parental interests? In what sense can their actions be experienced as worthwhile? These circumstances can be morally distressing for clinicians, and recent efforts to justify the practice according to a relational potential standard seem problematic. We therefore propose an alternative meaningfulness standard, which builds on a notion of bestowed worth to explain how a clinician's duty to treat in these cases can be meaningful, and why it need not entail using the child as a mere means.

Retinitis pigmentosa: Diagnosis and management.

IntroductionThe Oliver McGowan Mandatory Training (OMMT) on Learning Disability and Autism was developed to address recognized gaps in healthcare professionals' education and training. Under the Health and Care Act, 2022, healthcare providers are required to ensure staff receive role-appropriate training in autism and learning disabilities. In response, NHS England introduced OMMT as a standardized national programme to support the development of a skilled and inclusive healthcare workforce, aligned with the NHS Long Term Workforce Plan (2023). This study reports on the first pilot implementation of Tier 1 OMMT within a higher education institution, involving students enrolled in Nursing, Biomedical Science, Physician Associate, Optometry, and Pharmacy programmes at Aston University, UK.Materials and methodsThe interdisciplinary Tier 1 training consisted of a 90-min e-learning module and a 1-h interactive webinar featuring experts by experience and facilitators. This study evaluated healthcare students' understanding pre- and post-training. Data on autism and learning disabilities awareness was collected via Jisc Online Surveys. Likert scale data were analyzed quantitatively, and free-text responses examined using thematic analysis to evaluate training effectiveness.ResultsPost-OMMT training results showed significant improvements in students' confidence in verbal communication and using various methods to communicate with autistic individuals and those with learning disabilities (p < 0.0001). Students reported enhanced understanding and awareness of autism and mild, moderate, severe and profound learning disabilities (p < 0.0001). Thematic analysis highlighted those students valued learning from experts by experience. Post-training participants recognized the benefits of individualized healthcare, the need for reasonable adjustments, and the importance of multidisciplinary team approaches in providing equitable care for autistic people and people with learning/intellectual disabilities.DiscussionThis interdisciplinary training enhanced healthcare students' understanding of autism and learning disabilities, equipping them with key skills for future NHS roles and supporting improved outcomes for neurodivergent populations. Embedding such training across all HEIs is essential to prepare professionals to not only treat, but also understand, respect, and advocate for autistic and learning-disabled individuals.

According to unofficial data as of 2020, there were 144 thousand citizens with visual impairments in Ukraine, among whom approximately 40 thousand people had significant visual impairment, which led to profound disability of these people. The number of visually impaired people is about 1 thousand people per million population. Of this number, more than 10 thousand children have the status of disabled people due to diseases of the organ of vision. Every year, about 12 thousand people are recognized as disabled in Ukraine due to visual impairments. At the same time, modern society is increasingly oriented towards the principles of inclusion and equal opportunities, which necessitates a rethinking of approaches to the social rehabilitation of persons with disabilities, in particular people with visual impairments. Effective communication is one of the key factors in the successful integration of such persons into the social environment, since it is through communication that a sense of belonging, self-esteem, and social competence is formed. Communicative adaptation helps blind people overcome barriers to perception, develop interaction and self-expression skills, which contributes to their self-realization and active participation in community life. Interpersonal communication remains an important component in the adaptation of people with visual impairments. For people with visual impairments, the communication process has specific features due to sensory limitations, psychological barriers and social conditions. Loss or significant reduction in visual perception changes the structure of communicative interaction, since a significant part of non-verbal information becomes inaccessible. This creates additional difficulties in establishing contacts, understanding the emotional state of the interlocutor and maintaining social ties. In this context, public associations play an important role, among which the Ukrainian Society of the Blind (UTOS) remains one of the key centers of assistance and support for the blind.

This study proposes the development of a contactless emergency assistance system designed for individuals with severe physical disabilities (tetraplegia and no voice but normal mouth movements) to address the limitations of traditional emergency bells in sudden emergencies.The core technology of the system includes artificial intelligence facial recognition and fuzzy motion algorithms to identify facial movements.After the auxiliary signal is triggered, the system uses Message Queuing Telemetry Transport (MQTT) technology to activate warning lights and speakers.The signal is then transmitted to the LINE application on a computer or smartphone platform via Wi-Fi, notifying caregivers to provide timely assistance.Experimental results show that the system has a userfriendly interface and an accuracy rate of about 96.69%.This study is the successful development of an emergency assistance system controllable by quadriplegic patients.The one-to-many alarm device can establish a safe net, effectively help individuals with severe physical disabilities proactively seek help, reduce the risk of accidents, and alleviate caregiver shortages.For quadriplegics, this technology offers a unique alternative with significant advantages over commercially available manually operated or voice command call bells.