Severe Physical Disability Research Articles

Effect of standard feeding with a high-protein diet on arterial blood gases in patients admitted to the intensive care units: A study protocol for a double-blinded, randomized controlled clinical trial

Critically ill patients admitted to the intensive care units (ICUs) often face numerous challenges, including severe metabolic stress, systemic inflammation, and compromised immune function. Studies have suggested that critically ill patients frequently experience a negative nitrogen balance due to a hypercatabolic state, leading to impaired organ function and muscle wasting, which can cause severe muscle weakness and physical disability for years after discharge. Arterial blood gases (ABG) reflect patients' oxygenation and acid-base status and are crucial indicators of respiratory and metabolic function in critically ill individuals. We aim to address this by conducting a double-blinded, randomized controlled clinical trial to compare the effects of standard feeding with a high-protein diet on ABG in ICU patients. In this double-blinded, randomized controlled clinical trial, we will use block randomization of 80 patients aged between 18 to 65 years old and Patients expected to be hospitalized in the ICU for at least 3 days from Kosar Hospital, Kurdistan, Iran. The intervention group (n=40) will receive a protein diet (consisting of 18.7% protein, 45% carbohydrates, and 35% fat per 1000cc). A control group (n=40) will receive a standard diet (14.4% protein, 54% carbohydrates, and 32.4% fat per 1000cc) for the same duration in addition to usual care. The caloric requirements of each patient will be determined by a nutritionist based on their nutritional status, height, weight, age, and initial diagnosis, utilizing the Harris-Benedict formula. The parameters of ABG, including PO2, PCO2, SAO2, HCO3, BE, and pH, will be assessed. By optimizing protein intake through a high-protein diet, we aim to improve the nutritional status of patients and enhance their overall clinical outcomes. This reassures us of the potential benefits of our study.

A cross-sectional study to assess the pattern of work-related musculoskeletal disorder among class-IV workers of tertiary care centres in central India

Background: Musculoskeletal disorders (MSDs) are typically characterized by persistent pain and limitations in mobility and dexterity. They are highly prevalent and are the leading cause of severe long-term pain and physical disability. Providing stress-management training, encouraging regular breaks, and offering physical therapy and other treatments can alleviate the physical symptoms of work-related MSDs (WMSDs). Objectives were to assess the prevalence and patterns of WMSDs among class-IV workers and to identify the key factors contributing to WMSDs. Methods: The study was conducted at the Hamidia Hospital and Gandhi Medical College Bhopal. 350 class IV workers were selected using random sampling, and data were collected by direct interview. Results: Among all housekeeping staff, 82% showed symptoms of MSDs. Pain was predominantly reported in the lower back (49.3%), followed by the lower leg (32.9%). Among the 350 participants, 72 experienced mental stress manifested as difficulty falling asleep, restlessness, and anxiety. Gutkha, followed by smoking, was the most common substance abused by Class IV workers, which correlated with musculoskeletal pain. Participants with a BMI<18.5 and 25-29.99 reported more MSD pain compared to those with a normal BMI (18.5-24.99). Additionally, workers who did not exercise or exercised only 1-2 times a month experienced higher levels of pain. Conclusions: Class IV workers face physically demanding tasks, so regular breaks should be advised. Promoting literacy can aid in the prevention and early detection of MSDs. Basic interventions and counselling are essential to prevent chronic pain, mental stress, and the development of MSDs.

Hospital referrals, exclusions from hospital care, and deaths among long-term care residents in the Community of Madrid during the March–April 2020 COVID-19 epidemic period: a multivariate time series analysis

BackgroundFrom March 7 to April 7, 2020, the Community of Madrid (CoM), Spain, issued interventions in response to the COVID-19 epidemic, including hospital referral triage protocols for long-term care facility (LTCF) residents (March 18–25). Those with moderate to severe physical disability and cognitive impairment were excluded from hospital referral. This research assesses changes in the association between daily hospital referrals and the deaths of LTCF residents attributable to the triage protocols.MethodsDaily hospital referrals and all-cause mortality from January to June 2020 among LTCF residents and the CoM population aged 65 + were obtained. Significant changes in LTCF resident daily hospital referrals time series, and in-LTCF and in-hospital daily deaths, were examined with tests for breaks and regimes in time series. Multivariate time series analyses were conducted to test changes in the associations between LTCF resident hospital referrals with daily deaths in-hospital and in-LTCF, and in the CoM population aged 65 + when the triage protocols were implemented.ResultsAmong LTCF residents, hospital referrals declined sharply from March 6 to March 23, 2020. Increases in LTCF residents' daily deaths occurred from March 7 to April 1, followed by a decrease reaching pre-epidemic levels after April 28. The daily ratio of in-hospital deaths to in-LTCF deaths reached its lowest values from March 9 to April 19, 2020. The four versions of the triage protocol, published from March 18 to March 25 had no impact on further changes in the association of hospital referrals with daily deaths of LTCF residents in-hospital or in-LTCF.ConclusionsWhile LTCF residents’ deaths increased, hospital referrals of LTCF residents decreased with the introduction of the CoM governmental interventions on March 7. They were implemented before the enactment of the triage protocols, protecting hospitals from collapse while overlooking the need for standards of care within LTCFs. The CoM triage protocols sanctioned the existing restrictions on hospital referrals of LTCF residents.

Inclusive voices, inclusive lives: Lived experiences, stigma and discrimination faced by persons with disabilities in corporate India

Lived experience is a key construct in qualitative phenomenological research. It refers to the direct or firsthand experience of a situation by the person concerned, vis a vis the knowledge gained through second hand, mediated or cognitive sources. According to an estimate by the WHO, globally, 15 percent of the population live with some form of disability, and over 80 percent them in Low- and Middle-Income Countries. India has a population of over 1.3 billion, of which 2.2 percent live with some form of severe mental or physical disability. Persons with disability experience significant marginalization because of negative stereotypes associated with disability and persons impacted by it. In the last two decades, the lived experience movement, championed by persons with disability who highlight their needs, concerns, and rights is also tangible in the Indian subcontinent. This has resulted in significant impacts in the lives of persons with disability. The role of lived experience is a powerful antidote to the culture of stigma, shame, secrecy, and silence around disability. The study is a qualitative phenomenological approach that consists of focus groups and in-depth interviews with persons with disability to explore their lived experiences and perspectives of disability. This has the potential to widen the conversation on corporate perspectives on inclusion of persons with disability in the corporate workspace. Person with lived experience of disability are “experts by experience.” The authenticity of their lived experience endows them with the potential to emerge as robust change agents who can humanize society. The study is a compelling proof of concept for the need to integrate persons with disability as pivotal stakeholders in effecting disability inclusive policies and practices in corporate workspaces in the country. Keywords: Disability, Inclusion, Lived experience, Employment, Marginalization

Disability Associated with Chronic Graft-Versus-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation: Analysis of a Cross-Sectional US Patient Survey.

Chronic graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation (HSCT) is associated with poor health-related quality of life (HRQoL) and functional status. However, few studies have evaluated chronic GVHD-related disability and specific activity limitations from a patient perspective. The objective of this analysis was to assess physical, cognitive, and work disability, and describe factors predictive of disability in patients with chronic GVHD in the potentially employable general workforce. The cross-sectional, online, Living With Chronic GVHD Patient Survey was administered in 2020 to adult US patients who reported an active chronic GVHD diagnosis (i.e., within the previous 5years) following HSCT. Data included demographics, diagnosis, work status, chronic GVHD symptoms per the Lee Symptom Scale (LSS), and effects on daily living activities. Descriptive and correlational analyses informed composite disability definitions: (1) severe cognitive disability, (2) severe physical disability, and (3) work disability. Of 137 respondents with GVHD included in this analysis, 47.0% reported severe cognitive disability, and approximately two-thirds each reported severe physical disability (67.4%) and work disability (62.8%). Chronic GVHD severity/duration, symptoms (Lee Symptom Scale), and number of transplant specialists consulted were associated with all types of disability (univariable analyses). Severe cognitive disability was associated with the number of transplant specialists consulted, severe physical disability with female sex, and work disability with nonwhite race. In this analysis, we found that the presence of specific symptoms and the number of transplant specialists consulted were associated with all types of severe disability; female sex was predictive of severe physical disability and nonwhite race of work disability. These findings add to the understanding of chronic GVHD-associated disability, suggest a need for improved social support for patients, and highlight potential indicators for those most in need.

Effects of Aerobic Training on Sex Hormones in A Cuprizone Rat Model of Multiple Sclerosis.

Central nervous system damage in multiple sclerosis (MS) leads to severe physical disability and neurological defects. Sexual dysfunction and infertility in patients with MS have often been neglected in previous studies. Aerobic exercise is suggested to improve circulating testosterone levels and sexual function. Therefore, the purpose of this study was to investigate the effect of aerobic exercise on sex hormone levels in a cuprizone rat model of MS. In this experimental study, 30 male rats (aged 70 days, 154.55 ± 18.1 g) were randomly divided into five groups: MS, exercise-MS (EX-MS), MS-EX, EX-MS-EX, and normal control (control). MS was induced by feeding cuprizone pellets (0.2%) to the rats for six weeks. The exercise groups performed an aerobic exercise protocol on a treadmill five days/week for six weeks before and during the induction of the MS model. Serum testosterone, follicle stimulating hormone (FSH), and luteinising hormone (LH) levels were measured using the ELISA method with standard kits (ZellBio Germany). Luxol fast blue staining (LFB) of the corpora collosa were performed. The results showed a significant decrease in the serum levels of testosterone, FSH, and LH in the MS groups compared to the control group (P<0.05). There was a significant increase in the serum levels of testosterone, FSH, and LH in the EX-MS-EX, and EX-MS groups compared to the MS group (P<0.05). Aerobic exercise could improve the level of sex hormones in the cuprizone rat model of MS and may be used to attenuate sexual dysfunction in patients with MS.

White matter tract density index is associated with disability in multiple sclerosis

BackgroundThe association between common neuroradiological markers of multiple sclerosis (MS) and clinical disability is weak. Given that the disability in patients with MS may depend on the underlying structural connectivity of the brain, our study aimed to examine the association between white matter tracts affected by MS and the patients' disability using a new tract density index (TDI). MethodThis study included 53 patients diagnosed with MS, examined between 2019 and 2020. Manual lesion segmentation was performed on fluid-attenuated inversion recovery (FLAIR) images, and the density of white matter tracts encompassing the lesion (i.e., TDI) was calculated. Correlation analysis was employed to assess the association between TDI and disability. Additionally, the relationship between disability, TDI, and lesion-derived network metrics was examined by computing a partial correlation network. ResultsThe TDI significantly correlated with the expanded disability status scale (EDSS) (r = 0.30, p = 0.03). Furthermore, the patient's disability is linked solely through TDI to lesion-derived network metrics —a key metric that ‘bridges’ the gap between the brain lesion and disability. ConclusionsIn this study, MS lesions encompassing regions with high white matter tract density were associated and linked with severe physical disability. These findings indicate that TDI may be an outcome predictor that may connect radiologic findings to clinical practice.

Subjective Valuation of Screening for Spinal Muscular Atrophy and Analysis of its Influencing Factors: Evidence from Iran.

Spinal muscular atrophy is an inherited neurodegenerative disorder that typically leads to severe physical disability. The present study aimed to determine the subjective evaluation of this disorder screening and analyze its influencing factors in Iran. A cross-sectional study was performed using data from the second survey of women either pregnant or planning to become pregnant in Tehran, the capital of Iran, in 2022. The dependent variable was the willingness to pay for this disease screening test. The independent variables included sociodemographic, economic, and health characteristics, the history of this disease or other diseases of the person and family, and knowledge about this disease in the included population. Logistic regression was utilized to identify independent variables associated with the dependent variable, and the results were reported as unadjusted and adjusted odds ratios and P values with 95% CIs. A questionnaire was used as a research tool, and STATA 17 software was used for data analysis. The monetary value of spinal muscular atrophy (SMA) screening was calculated by estimating willingness to pay using the congenital valuation method. In total, 578 women were included. About 64.85% of respondents had a willingness to pay for SMA screening as the dependent variable, with a mean of $526. University education (P = 0.009) and pregnancy experience (P = 0.021) were associated with the dependent variable. Iranian women expressed their willingness to undergo screening tests, but due to financial constraints, they expected the government and nongovernmental organizations to bear most of the cost.

Promoting Patient Safety through Patient Involvement: A Qualitative Study of Nurses' Experiences and Perceptions

Background: Spinal Cord Injury (SCI) presents a significant challenge to healthcare systems worldwide, often leading to severe physical disability and psychological distress, including depression. The rehabilitation process for SCI patients is complex, necessitating a multidimensional approach that addresses both the physical and psychological aspects of recovery. The interplay between occupational performance and mental health among individuals with SCI remains a critical area of investigation, particularly in regions like Peshawar, Pakistan, where such studies are scarce. Objective: The primary objective of this study was to explore the association between occupational performance and depression among individuals with SCI in Peshawar, with a secondary aim of comparing occupational performance levels and their relationship with depression in this demographic. Methods: A cross-sectional study was conducted at the Paraplegic Centre Peshawar over a six-month period, utilizing convenience sampling to recruit 120 participants. Depression and occupational performance were assessed using the Beck Depression Inventory and the Barthel Index Scale, respectively. Data analysis was performed using SPSS version 22, with statistical significance set at p&lt;0.05. Results: The study found that 35.8% of participants experienced moderate depression, while mild mood disturbances and borderline clinical depression were reported by 21.7% and 12%, respectively. Severe and extreme depression were less common, observed in 9.8% and 1.1% of the sample. Regarding occupational performance, 37% were totally dependent, 50% were severely dependent, and 13% were moderately independent. Statistical analysis revealed a significant association between occupational performance and depression levels (Pearson Chi-Square = 17.986, p=.05; Likelihood Ratio = 18.683, p=.04; Fisher Exact Test = 9.214, p=.002). Conclusion: The study highlights a notable correlation between occupational performance and depression among SCI patients, emphasizing the need for integrated rehabilitation programs that address both physical disabilities and mental health concerns. Enhancing occupational performance through targeted interventions may reduce depression levels, thereby improving overall quality of life for SCI patients.

Determining the Level of Occupational Performance and its Association with Depression among Patients with Spinal Cord Injury

Background: Spinal Cord Injury (SCI) presents a significant challenge to healthcare systems worldwide, often leading to severe physical disability and psychological distress, including depression. The rehabilitation process for SCI patients is complex, necessitating a multidimensional approach that addresses both the physical and psychological aspects of recovery. The interplay between occupational performance and mental health among individuals with SCI remains a critical area of investigation, particularly in regions like Peshawar, Pakistan, where such studies are scarce. Objective: The primary objective of this study was to explore the association between occupational performance and depression among individuals with SCI in Peshawar, with a secondary aim of comparing occupational performance levels and their relationship with depression in this demographic. Methods: A cross-sectional study was conducted at the Paraplegic Centre Peshawar over a six-month period, utilizing convenience sampling to recruit 120 participants. Depression and occupational performance were assessed using the Beck Depression Inventory and the Barthel Index Scale, respectively. Data analysis was performed using SPSS version 22, with statistical significance set at p&lt;0.05. Results: The study found that 35.8% of participants experienced moderate depression, while mild mood disturbances and borderline clinical depression were reported by 21.7% and 12%, respectively. Severe and extreme depression were less common, observed in 9.8% and 1.1% of the sample. Regarding occupational performance, 37% were totally dependent, 50% were severely dependent, and 13% were moderately independent. Statistical analysis revealed a significant association between occupational performance and depression levels (Pearson Chi-Square = 17.986, p=.05; Likelihood Ratio = 18.683, p=.04; Fisher Exact Test = 9.214, p=.002). Conclusion: The study highlights a notable correlation between occupational performance and depression among SCI patients, emphasizing the need for integrated rehabilitation programs that address both physical disabilities and mental health concerns. Enhancing occupational performance through targeted interventions may reduce depression levels, thereby improving overall quality of life for SCI patients.

Near-cure in patients with Gadolinium deposition disease undergoing intravenous DTPA chelation.

To demonstrate and evaluate factors contributing to near-cures in patients with Gadolinium Deposition Disease (GDD) undergoing intravenous (IV) DTPA chelation. Patients who had undergone or are currently undergoing DTPA chelation for GDD were included in this report based on their medical records that showed their perceived improvement was at least 80% back to normal. A survey was developed that included factors commonly reported by patients treated in one clinic to determine if these 'near-cured' (pre-MRI baseline health) individuals possessed certain factors and lacked others. The anonymized survey was emailed to these individuals by the principal treating physician, the only investigator not blinded to the subjects. This report describes clinical documentation of patient status and their underlying factors in individuals treated by the primary author, and no research was performed. The survey was sent to sixteen individuals; Fourteen patients completed it (10 females; 41.1 ± 11.2y/o). The most common factor was the administration of ≤5 lifetime doses of a Gadolinium-Based Contrast Agents (GBCA) (12/14). Unconfounded agents triggering GDD were seen in nine subjects. Most subjects (12/14) initiated chelation in the first year after the causative GBCA, and most (11/14) underwent ≤10 chelations with DTPA. Good healthcare status prior to MRI was observed in 5 subjects. The majority (11/14) described their immune status as strong. Severe physical disability prior to chelation was seen in 1. Subjects with GDD can experience near-cure with IV DTPA chelation. Factors surveyed that predict near-cure include the start of chelation in the first year, few GBCA administrations, and good health status before MRI with GBCA injection. Nonetheless, a few patients with predictors of less successful outcomes still experienced near-cure.

RISK FACTORS FOR PHYSICAL DISABILITY IN PATIENTS WITH LEPROSY: A SYSTEMATIC REVIEW

Background: Leprosy is also referred to as Hansen disease. It is a chronic granulomatous infection generally caused by Mycobacterium leprae and Mycobacterium lepromatosis, both of which primarily affects the skin and peripheral nerves. Physical disability (PD) can occur before leprosy diagnosis, during treatment and post-release from treatment. However, although patients may be exposed to risk factors that potentiate the risk of more severe PD they stop being routinely evaluated once the treatment of active leprosy has been completed. The aim: This study aims to show about risk factor for physical disability in patients with leprosy. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 104 articles, whereas the results of our search on SagePub brought up 77 articles. The results of the search conducted for the last year of 2013 yielded a total 88 articles for PubMed and 48 articles for SagePub. The result from title screening, a total 7 articles for PubMed and 28 articles for SagePub. In the end, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.

Prominent veins sign is associated with malignant cerebral edema after acute ischemic stroke

Malignant cerebral edema (MCE) is often associated with severe physical disability and a high mortality rate. The current prediction of MCE is focused on infarct volume, and tools are relatively lacking. The prominent veins sign (PVS-SWI) is considered a marker of severely impaired tissue perfusion. This study aimed to determine whether PVS-SWI is associated with early-onset MCE. Patients with acute ischemic stroke (AIS) due to severe large arterial stenosis or occlusion (SLASO) from June 2018 to June 2020 were included. The ASPECTS score assessed the extent of PVS-SWI, and 4–10 was defined as a positive group. The primary outcome was MCE, defined as the deterioration of neurological function and midline structural excursions of >5 mm during hospitalization. The secondary outcomes included worsening of the NIHSS by ≥ 2 points, in-hospital death, and death within 1 year after stroke. Logistic regression was used to assess the correlation between PVS-SWI and outcomes. The study included 157 patients， 40 (25.5%) of whom developed MCE. PVS-SWI was more prevalent in patients who developed MCE (75.0% vs 45.3%; P = 0.001). In multivariate regression analysis, PVS-SWI was an independent predictor of MCE development in patients with larger infarct sizes (OR: 4.00， 95%CI: 1.54–10.35，p = 0.004). In patients with small infarct sizes, PVS-SWI was an independent predictor of a worsening NIHSS of ≥2(OR: 11.13， 95%CI: 2.26–54.89， p = 0.003）. However, PVS-SWI was not associated with death. The main finding of our study was that in patients with larger infarct sizes, a positive PVS-SWI increased the risk of developing MCE. In these patients, more interventions may be needed.

The Potential Role of Mesenchymal Stem Cells Derived Exosomes on the Healing of Grade II Experimentally Induced Skeletal Muscle Injury in Adult Male Albino Rats. Histological Study

Abstract Background Musculoskeletal injuries are the most common cause of severe longterm pain and physical disability. However, there is still no efficient treatment that leads to prevention of muscle fibrosis. Cell-Free therapy using mesenchymal stem cells (MSCs) derived exosomes could provide a new promising therapy. Aim To study the potential role of MSCs-derived exosomes on the healing of experimentally induced grade II skeletal muscle injury in adult male albino rats. Materials and Methods Forty male albino Wister rats were used in this study. Five out of them were used for isolation of exosomes. The rest were randomly divided into three groups. Group I (Sham group), Group II (muscle injury group left for spontaneous healing), Group III (muscle injury treated with exosomes). Rats from each group were subdivided into two subgroups; subgroup “a and b” in which rats were sacrificed after ten days and twenty days, respectively. Muscle specimens were collected and prepared for proper histological techniques. Immuno-histochemical staining for detection of collagen type I and developmental myosin (MHCd) were also done. Morphometric study and statistical analysis were also performed. Results Granulation tissue and inflammatory cellular infiltration with significant increase in the mean area percentage of collagen fibers were noticed in subgroups of untreated muscle injury compared to the corresponding exosomes treated subgroups. This was confirmed by collagen type I immune histochemical reaction. Group III (treated with exosomes) showed better muscle regeneration and significant decrease in muscle fibrosis. Significant increase in immunohistochemical reaction of developmental myosin was noticed in exosomes treated subgroups compared to corresponding untreated muscle injury subgroups. Conclusions Exosomes enhance muscle regeneration after induced muscle injury. Exosomes also decreased muscle fibrosis and improve muscle healing.

A CASE OF RELAPSING MULTIPLE SCLEROSIS MANAGEMENT WITH DISEASE MODIFYING THERAPY

Introduction. Multiple sclerosis (MS) is a chronic inflammatory disease characterized by central nervous system lesions that can lead to severe physical or cognitive disability as well as neurological defects. The pathologic hallmark of MS is focal demyelination within the brain and spinal cord. Currently, there is no definite cure for MS, immunomodulating and antiinflammatory agents can diminish its progression and decrease some of the pathological symptoms. Case report. We report a case of 18 years female patient. The patient had first approached to neurology hospital on May 2019 after upper respiratory tract infection with neurology symptoms, such as numbness on the right side and problems with balance as well as coordination. On neurological examination, she had involuntary laughing attacks. Muscle power: lower extremities proximal part – 5/5, distal part – 3/5, upper extremities 4/5. Reflexes are increased in all extremities, D=S. Babinski sign was positive bilaterally. There are bilateral dysmetria and adiadochokinesia. Gait is ataxic. Brain MRI: multiple white matter demyelinating lesions in the mesencephalon, pons and bulbus with contrast enhancement. Spine MRI: multiple white matter demyelinating lesions within C2-C4, C7-T4 , T5-T7 level, without contrast enhancement. She started on treatment methylprednisolone pulse therapy afterwards continued with oral steroid. After she had clinical and radiological improvement. 3 month later, she admitted to hospital with progressive walking disturbance and imbalance. She did MRI again and 6 months after and it revealed new contrast enhanced plaques in brain and spine. The progressive white matter lesions and clinical symptoms were judged as the MS relapse, the patient was given methylprednisolone for five consecutive days. Fingolimod was started at this time because the patient had no neurological improvement. She lost ability to walk without support. She has been taking Fingolimod for 1 year. (Lymphocyte count 0.59). In response to this therapy, her walking ability slightly improved and there were no new neurological symptoms. Since clinically and radiologically positive dynamics is observed in the patient, the treatment is continued with Fingolimod and patient is being monitored.

Frailty, Acute Brain Dysfunction, and Posthospitalization Disability Outcomes in Critically Ill Older Adults.

Identifying potentially modifiable factors that mediate adverse outcomes in frail adults with critical illness may facilitate development of interventions to improve intensive care unit (ICU) survivorship. To estimate the relationship between frailty, acute brain dysfunction (as reflected by delirium or persistent coma), and 6-month disability outcomes. Older adults (aged ≥50 years) admitted to the ICU were enrolled prospectively. Frailty was identified with the Clinical Frailty Scale. Delirium and coma were assessed daily with the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale, respectively. Disability outcomes (death and severe physical disability [defined as new dependence in 5 or more activities of daily living]) were assessed by telephone within 6 months after discharge. In 302 older adults (mean [SD] age, 67.2 [10.8] y), both frail and vulnerable patients had a higher risk for acute brain dysfunction (adjusted odds ratio [AOR], 2.9 [95% CI, 1.5-5.6], and 2.0 [95% CI, 1.0-4.1], respectively) compared with fit patients. Both frailty and acute brain dysfunction were independently associated with death or severe disability at 6 months (AOR, 3.3 [95% CI, 1.6-6.5] and 2.4 [95% CI, 1.4 -4.0], respectively). The average proportion of the frailty effect mediated by acute brain dysfunction was estimated to be 12.6% (95% CI, 2.1%-23.1%; P = .02). Frailty and acute brain dysfunction were important independent predictors of disability outcomes in older adults with critical illness. Acute brain dysfunction may be an important mediator of increased risk for physical disability outcomes after critical illness.

Treatment and Care for Children with Very Severe Mental and Physical Disability

We present two cases of severely disabled children who required tracheotomy and ventilatory management under long-term care at home. Both cases were infants who had survived life-threatening crises during the perinatal period and infancy. Even if their conditions have stabilized, they are always at risk of sudden changes. There are several preconditions for the long-term survival of such children, in which family plays a considerable part. Medical personnel should provide the best supportive care in both acute and chronic phases.

Quality of Life in Patients with Stiff-Person Syndrome: Evaluation Congruent with Patient Values using the Schedule-Direct Weighting Method

Patients with chronic progressive disease have a low health-related quality of life (HRQoL); however, various compensation mechanisms can improve and restore quality of life (QoL) even in cases of severe physical disability. In this study, we evaluate QoL according to patient value by individual QoL evaluation and identify QoL determinants in patients with stiff-person syndrome (SPS) to consider appropriate support measures. By 13 December 2020, SPS patients completed semi-structured interviews. For patients, the positive factors were "family support" and "parental care", while the negative factors were "physical symptoms" and "relationship with doctors". Parental care" was identified as the most important area, but satisfaction was low. Therefore, in each case, support is needed to ensure that the patient is satisfactory. In addition, "physical symptoms" are the strongest negative areas and can be alleviated with appropriate medical assistance. In addition, rehabilitation should work on pain relief caused by muscle spasms and stiffness.

Encountering disability in music: Exploring perceptions on inclusive music education in higher music education

This research study evaluated an Artist-in-Residence-project (AIR-project) at the Conservatory of Amsterdam, focusing on inclusive music education. For this project, the Conservatory invited the organization Drake Music Scotland to work with its students. The project’s aim was to provide students with practical skills regarding music technology, to discuss the social model of disability, and to play in an inclusive music ensemble with a musician with a severe physical disability. The perceived learning experiences of students, the experienced value of the project, and recommendations for its improvement were explored through online questionnaires with the students and online semistructured interviews with the AIR-project leader, the musician with a disability, and the two workshop leaders of Drake Music Scotland. Findings suggest that alongside learning practical skills regarding music technology, students changed or broadened their perceptions about people with disabilities and inclusive music-making in positive ways. Furthermore, participants valued that the project created a space in which “taking enough time” and “belonging” could be experienced; these values are important in inclusive music environments as they can empower musicians with disabilities. The main recommendation for similar projects was that students wanted to gain hands-on experience in inclusive music education.

Implications for Age and Sex Differences on Anti-Hyperglycemic Therapy Exposure and Incidence of Newly Diagnosed Multiple Sclerosis in Propensity Score Matched Type 2 Diabetics (P9-3.007)

<h3>Objective:</h3> To determine whether exposure to anti-hyperglycemic medications (A-HgM) is associated with risk of Multiple Sclerosis (MS) <h3>Background:</h3> MS is an autoimmune-mediated neurological disorder that affects the central nervous system and leads to severe physical and cognitive disability. There is mounting evidence linking metabolic disorders and MS with unclear impact of therapeutics used to treat type-2 diabetes mellitus (T2D) on the incidence of MS. <h3>Design/Methods:</h3> This retrospective cohort study used the Mariner claims dataset. Patients were required to be actively enrolled in Mariner claims records for six months prior and at least three years after the diagnosis of T2D without a history of previous neurodegenerative disease including MS. Patient records were surveyed for a diagnosis of MS starting 12 months post T2D diagnosis. Survival analysis was used to determine the association between A-HgM exposure and diagnosis of MS with subgroup analysis for the impact of age and sex on risk. A propensity score approach was used to minimize measured and unmeasured selection bias. The analyses were conducted between January 1st and April 28th, 2021. <h3>Results:</h3> In T2D patients younger than 45, A-HgM exposure was associated with a reduced risk of developing MS (RR: 0.22, 95%CI: 0.17–0.29, p-value &lt;0.001). In contrast, A-HgM exposure in patients older than 45 was associated with an increased risk of MS with women exhibiting greater risk (RR 1.53, 95% CI 1.39–1.69, p&lt;.001) than men (RR: 1.17, 95% CI: 1.01–1.37, p=0·04). Patients who developed MS had a higher incidence of baseline co-morbidities. Mean follow-up was 6.2 years with standard deviation of 1.8 years. <h3>Conclusions:</h3> A-HgM exposure in patients with T2D was associated with reduced risk of MS in patients younger than 45 whereas in patients older then 45, exposure to A-HgM was associated with an increased risk of MS particularly in women. These findings represent a call to investigate the interplay between the endocrine, immune and nervous systems in multiple sclerosis. <b>Disclosure:</b> Dr. Branigan has nothing to disclose. Miss Torrandell Haro has nothing to disclose. Francesca Vitali has nothing to disclose. Roberta Diaz Brinton, PhD has nothing to disclose. Kathleen Rodgers has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Proneurogen. Kathleen Rodgers has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Regulonix. Kathleen Rodgers has received intellectual property interests from a discovery or technology relating to health care.