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Disability and Rehabilitation Jul 2024According to the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (The LSS Act), personal assistance (PA) aims to enhance good...
Tracing the refinement of policy tools for disability rights: a content analysis of how the granting process of state-funded personal assistance in Sweden is aligned with the LSS Act.
PURPOSE
According to the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (The LSS Act), personal assistance (PA) aims to enhance good living conditions for people with disability. The Act is operationalised by a policy tool, an instruction developed and refined by the Swedish Social Insurance Agency (SSIA) to grant PA. The study explores how this instruction is aligned with the LSS rationale and goals.
MATERIAL AND METHOD
Qualitative content analysis was applied on the material i.e., a government bill preceding the LSS Act and the policy tool, i.e., the SSIA instruction, versions 1994 and 2019.
RESULTS
The result shows that the instruction has deviated from the LSS Act over time, by decreasing users' access to community life, a shift towards health care activities, lack of support for the PA user, increased control and service-granting criteria.
CONCLUSION
This paper emphasises that the selection of policy tools goes beyond mere pragmatism, as they are subject to refinement procedures that have significant impacts over time. The deviations observed in fulfilling the objectives of the LSS Act highlights the importance of ongoing adjustments to policy tools to align with the original policy goals in order to promote disability rights.
PubMed: 38950573
DOI: 10.1080/09638288.2024.2362954 -
Seminars in Speech and Language Jun 2024Speech-language pathologists and board-certified behavior analysts both provide important support services to children who are candidates for augmentative and...
Speech-language pathologists and board-certified behavior analysts both provide important support services to children who are candidates for augmentative and alternative communication. Current assessment practices neglect critical socioecological factors that are necessary to inform communication-based interventions. By leveraging the unique knowledge, research, and expertise of both disciplines, an interprofessional approach to assessment may help realize individualized or precision interventions and personalized supports that address the unique communication needs of each person. The purpose of this article is to introduce a process-based approach to assessment called the "Applied Model of Interprofessional Collaboration-Assessment (AMIC-A)." The AMIC-A will be defined and detailed including the rationale for development, a description of the approach, and recommendations for implementation. A case study example is provided to illustrate implementation of the AMIC-A.
Topics: Humans; Speech-Language Pathology; Interprofessional Relations; Communication Disorders; Cooperative Behavior; Child; Communication Aids for Disabled
PubMed: 38950567
DOI: 10.1055/s-0044-1787651 -
Disability and Rehabilitation Jul 2024Recreational nitrous oxide (NO) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature...
Multidisciplinary rehabilitation following recreational nitrous oxide (NO) misuse: evaluating service provision and rehabilitation outcomes in a cohort with serious disability.
Recreational nitrous oxide (NO) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature characterising rehabilitation is limited. This study aimed to evaluate rehabilitation service provision for impairments resulting from NO misuse. A retrospective audit of hospitalised patients referred for rehabilitation for NO toxicity was conducted between 2015 and 2022 at a single metropolitan hospital. Data were collected medical record audit and analysed via descriptive and non-parametric statistics. 16 eligible cases were identified, aged 18-43 years (50% female/male), with increasing case frequency. 12 cases received inpatient rehabilitation episodes for multifactorial sensorimotor, cognitive and psychosocial impairments. Cases articulated diverse rehabilitation goals and received intervention from a median of 6 clinical disciplines. All cases required assistance to mobilise or perform self-care activities on admission. Functional Independence Measure (FIM) scores significantly improved with rehabilitation (median FIM 84[75-93] to 117[112-123], < .001). Despite gains in independence, all cases required referral for ongoing rehabilitation post-discharge. Demand for inpatient rehabilitation for disabling NO toxicity appears to be increasing. In this series, cases were young, exhibited serious impairments, and had multidisciplinary rehabilitation needs. Inpatient rehabilitation led to significant functional improvements, though ongoing disability was evident post-discharge.
PubMed: 38950561
DOI: 10.1080/09638288.2024.2365987 -
Disability and Rehabilitation Jul 2024Children with Special Health Care Needs (CSHCN) may experience disruptions in education due to extended hospitalizations. The purpose of this study was to describe how...
Experiences of patients, parents, and healthcare professionals in the process of transitioning from hospital to community after inpatient pediatric rehabilitation among children with special health care needs.
PURPOSE
Children with Special Health Care Needs (CSHCN) may experience disruptions in education due to extended hospitalizations. The purpose of this study was to describe how CSHCN experience educational supports during inpatient rehabilitation and identify the ongoing challenges when planning to return to school.
MATERIALS AND METHODS
Semi-structured focus groups were conducted with parents ( = 12), former patients ( = 20), and rehabilitation professionals ( = 8).
RESULTS
Through qualitative thematic analysis based on descriptive phenomenology, we developed three themes: such as instruction and schoolwork helped reduce the learning loss during hospitalization. However, these supports were sometimes complicated by lags in school approvals and challenges in coordination between systems. involved establishing necessary services to support CSHCN's educational and healthcare needs at school re-entry. However, families reported limited information and guidance as key barriers. 3) required continued support after discharge. The participants recommended that reassessment and adjustment of transition plans were often necessary to account for evolving developmental and educational needs but were not always received.
CONCLUSIONS
There is an ongoing need to improve communication between clinicians and educators, information for families, and long-term follow-up on the changing educational needs for CSHCN after rehabilitation.
PubMed: 38950559
DOI: 10.1080/09638288.2024.2362951 -
Neurosurgical Focus Jul 2024Prior studies have investigated associations between gender, symptom resolution, and time to return to play following sport-related concussion (SRC). However, there is a...
OBJECTIVE
Prior studies have investigated associations between gender, symptom resolution, and time to return to play following sport-related concussion (SRC). However, there is a notable gap in research regarding the association between gender and return to learn (RTL) in adolescents. Therefore, this study 1) compared the patterns of RTL between boys and girls who are high school student athletes, and 2) evaluated the possible association between gender and time to RTL after adjusting for covariates.
METHODS
A retrospective cohort study of a prospective surveillance program that monitored concussion recovery of athletes in high schools throughout the state of Maine between February 2015 and January 2023 was performed. The primary independent variable was gender, dichotomized as boys and girls. The primary outcome was time to RTL, defined by the number of days for an athlete to return to school without accommodations. Mann-Whitney U-tests were used to compare RTL between the boys and girls. Each athlete's RTL status was dichotomized (i.e., returned vs had not returned) at several time points following injury (i.e., 1, 2, 3, and 4 weeks), and chi-square tests were performed to compare the proportions who achieved RTL between groups. Multivariable linear regression analyses were performed to evaluate the predictive value of gender on RTL. Covariates included age, number of previous concussions, history of learning disability or attention-deficit disorder or attention-deficit/hyperactivity disorder, history of a psychological condition, history of headaches or migraines, initial Sport Concussion Assessment Tool (SCAT3/SCAT5) score, and days to evaluation.
RESULTS
Of 895 high school athletes, 488 (54.5%) were boys and 407 (45.5%) were girls. There was no statistically significant difference in median [IQR] days to RTL between genders (6.0 [3.0-11.0] vs 6.0 [3.0-12.0] days; U = 84,365.00, p < 0.375). A greater proportion of boys successfully returned to learn without accommodations by 3 weeks following concussion (93.5% vs 89.4%; χ2 = 4.68, p = 0.030), but no differences were found at 1, 2, or 4 weeks. A multivariable model predicting days to RTL showed that gender was not a significant predictor of RTL (p > 0.05). Longer days to evaluation (β = 0.10, p = 0.021) and higher initial SCAT3/SCAT5 scores (β = 0.15, p < 0.001) predicted longer RTL.
CONCLUSIONS
In a cohort of high school athletes, RTL did not differ between boys and girls following SRC. Gender was not a significant predictor of RTL. Longer days to evaluation and higher initial symptom scores were associated with longer RTL.
Topics: Humans; Male; Female; Brain Concussion; Adolescent; Athletic Injuries; Students; Athletes; Retrospective Studies; Sex Characteristics; Recovery of Function; Sex Factors; Learning; Cohort Studies; Prospective Studies; Schools; Return to School; Return to Sport
PubMed: 38950448
DOI: 10.3171/2024.4.FOCUS24130 -
Annals of Internal Medicine Jul 2024Acupuncture may improve degenerative lumbar spinal stenosis (DLSS), but evidence is insufficient.
BACKGROUND
Acupuncture may improve degenerative lumbar spinal stenosis (DLSS), but evidence is insufficient.
OBJECTIVE
To investigate the effect of acupuncture for DLSS.
DESIGN
Multicenter randomized clinical trial. (ClinicalTrials.gov: NCT03784729).
SETTING
5 hospitals in China.
PARTICIPANTS
Patients with DLSS and predominantly neurogenic claudication pain symptoms.
INTERVENTION
18 sessions of acupuncture or sham acupuncture (SA) over 6 weeks, with 24-week follow-up after treatment.
MEASUREMENTS
The primary outcome was change from baseline in the modified Roland-Morris Disability Questionnaire ([RMDQ] score range, 0 to 24; minimal clinically important difference [MCID], 2 to 3). Secondary outcomes were the proportion of participants achieving minimal (30% reduction from baseline) and substantial (50% reduction from baseline) clinically meaningful improvement per the modified RMDQ.
RESULTS
A total of 196 participants (98 in each group) were enrolled. The mean modified RMDQ score was 12.6 (95% CI, 11.8 to 13.4) in the acupuncture group and 12.7 (CI, 12.0 to 13.3) in the SA group at baseline, and decreased to 8.1 (CI, 7.1 to 9.1) and 9.5 (CI, 8.6 to 10.4) at 6 weeks, with an adjusted difference in mean change of -1.3 (CI, -2.6 to -0.03; = 0.044), indicating a 43.3% greater improvement compared with SA. The between-group difference in the proportion of participants achieving minimal and substantial clinically meaningful improvement was 16.0% (CI, 1.6% to 30.4%) and 12.6% (CI, -1.0% to 26.2%) at 6 weeks. Three cases of treatment-related adverse events were reported in the acupuncture group, and 3 were reported in the SA group. All events were mild and transient.
LIMITATION
The SA could produce physiologic effects.
CONCLUSION
Acupuncture may relieve pain-specific disability among patients with DLSS and predominantly neurogenic claudication pain symptoms, although the difference with SA did not reach MCID. The effects may last 24 weeks after 6-week treatment.
PRIMARY FUNDING SOURCE
2019 National Administration of Traditional Chinese Medicine "Project of building evidence-based practice capacity for TCM-Project BEBPC-TCM" (NO. 2019XZZX-ZJ).
PubMed: 38950397
DOI: 10.7326/M23-2749 -
The Journal of Spinal Cord Medicine Jul 2024
Topics: Humans; Disabled Persons; Spinal Cord Injuries
PubMed: 38950344
DOI: 10.1080/10790268.2024.2369491 -
Assistive Technology : the Official... Jul 2024This paper presents the results of a one-year study on mastery of assistive technology (AT). This study sought to develop a conceptual framework for talking about...
This paper presents the results of a one-year study on mastery of assistive technology (AT). This study sought to develop a conceptual framework for talking about mastery of AT and to create an instrument for measuring individual mastery. A Delphi Study was conducted with individuals with disabilities considered to be "power users" of AT, practitioners, and researchers. Participants were asked to: identify factors that are predictors and indicators of AT mastery, determine how to measure these factors and determine criteria for each factor for the stages of AT mastery (e.g. novice, context-dependent, transitional, and power user). The resulting measure is called the Continuum of AT Mastery (CATM).
PubMed: 38950126
DOI: 10.1080/10400435.2024.2362136 -
The Journal of Bone and Joint Surgery.... Jul 2024Vertebral compression fractures (VCFs) in older adults cause considerable health and socioeconomic burdens due to worsening ability to perform activities of daily...
BACKGROUND
Vertebral compression fractures (VCFs) in older adults cause considerable health and socioeconomic burdens due to worsening ability to perform activities of daily living. The long-term effects of VCFs on patient outcomes, particularly prolonged analgesic use and functional decline, remain unknown. The aims of this study were to examine long-term clinical outcomes and to determine the risk factors for persistent pain and functional disability after VCFs.
METHODS
This retrospective cohort study evaluated mortality, duration of analgesic use, and changes in care requirements in older adults with VCFs using claims data from a suburban prefecture in the Greater Tokyo Area. Patients were included if they were ≥65 years of age and had been diagnosed with a VCF between June 2014 and February 2019, as determined on the basis of International Classification of Diseases, Tenth Revision (ICD-10) codes; we also used claims data that could determine whether the patients underwent imaging examinations. Patients who discontinued outpatient visits within 1 month after the VCF diagnosis were excluded.
RESULTS
We included 18,392 patients with VCFs and a mean age of 80 years. Seventy-six percent of patients were women, and the median follow-up period was 670 days. At the index VCF diagnosis, 3,631 patients (19.7%) were care-dependent. Overall, 968 patients (5.3%) died within 1 year. Among the 8,375 patients who received analgesics, 22% required analgesics for >4 months. Factors associated with prolonged analgesic use for >1 year were female sex (odds ratio [OR], 1.39 [95% confidence interval (CI), 1.16 to 1.65]) and VCFs in the thoracolumbar region (OR, 1.95 [95% CI, 1.50 to 2.55]) or lumbar region (OR, 1.59 [95% CI, 1.23 to 2.04]) (the reference was the thoracic region). The care needs of 1,510 patients (8.2%) increased within 1 year. Patients with a preexisting care dependency had a 10 times higher risk of increased care need (30.2% [1,060 of 3,509]) than those who had been independent at the time of the index diagnosis (3.0% [450 of 14,761]) (p < 0.001).
CONCLUSIONS
Individuals with preexisting care dependency were more likely to experience functional decline following VCFs than those who were independent, which underscores the need for intensive and appropriate allocation of health-care resources to care-dependent patients.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
PubMed: 38950100
DOI: 10.2106/JBJS.23.01438 -
Journal For Nurses in Professional...
Topics: Humans; Staff Development; Disabled Persons
PubMed: 38949976
DOI: 10.1097/NND.0000000000001061