Longitudinal assessment of disability amongst patients of bipolar and unipolar depressive disorders presenting to a tertiary care center in North India

Objectives: To assess and compare the changes in disability scores associated with Bipolar Depression (BD) and Unipolar Depression (UD) over 1 year. Methods: A longitudinal study was taken up in adults diagnosed with unipolar or bipolar depressive disorder with current depressive episode. Diagnosis was made according to Schedule for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton’s Depression (HAM-D) rating scale and Hamilton’s Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London handicap Scale (LHS) at baseline, 6 and 12 months. Results: Sixty participants were recruited (42 UD and 18 BD). No significant differences were seen in socio-demographic parameters, except higher education levels and males being overrepresented in UD. Significant differences at baseline were seen in HAM-D ( p = .001) and HAM-A ( p = .003) scores. The extent of disability was seen to correlate with severity of illness only in case of BD at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment ( p < .001). LHS showed significant improvement over time in UD ( p < .001), but not BD ( p = .076). Percentage individuals meeting cut-off for benchmark disability (>40%) were comparable at baseline but were significantly more in the BD at 12-months ( p = .049). Conclusion and implications: Disability in psychiatry occurs equally amongst unipolar and bipolar depressive disorders and tends to improve over time, although the level of improvement may differ. It may not always correspond to severity of illness. These factors should be considered while certifying disability.

Experience in the implementation of the programme of psychological correction of emotional states of disabled convicts

The article presents the results of the verification of the programme of psychological correction of the emotional states of disabled convicts, developed on the basis of a “time” approach and including three main blocks “Past”, “Present” and “Future”. The study involved 68 convicts serving sentences in a maximum security correctional colony (20 people with a disability group and 48 people without a disability). Evaluation of emotional states was carried out using the following methods – TOBOL (Lyudvig Vasserman, Aleksandr Vuks, Boris Iovlev, El'vira Karpova), State-Trate Anxiety Inventory by Charles Spielberger (in Juri Hanin's adaptation), Differential Emotions Scale by Carroll Ellis Izard, the questionnaires of the need for achievement for communication (by Yuri Orlov), the test of frustration reactions (by Saul Rosenzweig).The dynamics of changes in emotional states during the psychocorrectional programme was assessed using the SHPANA technique (Yevgeniy Osin). Wilcoxon signed-rank test, Friedman test, cluster analysis were used for statistical analysis. The results of the verification indicate the effectiveness of the psychological correction programme based on the “time” approach, with disabled convicts serving sentences in a correctional colony. The participants in the experimental group showed positive changes in the dynamics of positive affect. The data also substantiated the need to use an individually differentiated approach in correcting the emotional states of persons with a disability group.

ASSESSMENT OF THE CORRELATION BETWEEN FAMILY BURDEN IN PRIMARY CAREGIVERS AND DISABILITY IN PATIENTS WITH SCHIZOPHRENIA

Background: Schizophrenia is one of the most devastating, and a chronic, relapsing mental illness associated with increased morbidity, poor quality of life and low recovery rates. In India, families are the major providers of long-term care and they represent an important supportive, social network for patients with schizophrenia. Indian families experience significant degrees of burden in the care of their relatives with schizophrenia. Illness severity and patients' disability have a direct positive relationship with perceived family burden. Methods: This study is a cross-sectional study, done to assess the correlation between family burden in primary caregivers and disability in patients with schizophrenia. 60 patients with schizophrenia and their primary caregivers were recruited from the outpatient and inpatient units of Department of Psychiatry, Government Rajaji Hospital, Madurai. IDEAS (Indian Disability Evaluation Assessment Scale) scale was used to assess the disability of patients with schizophrenia and BAS (Burden Assessment Schedule) of SCARF (Schizophrenia Research Foundation) was used to assess the family burden in their primary caregivers. Results: Among the 60 primary caregivers, (48.3%) were having caregiver burden between 50 and 70%. (56.4%) of female caregivers had burden range 50- 70%. (56.5%) of caregivers delivering care for patients with illness between 15 and 20 years experienced burden >70%. Statistical analysis revealed that the correlation between caregiver burden and disability was statistically significant. Conclusions: The severity of caregiver burden increases with increasing grades of disability and indicates that caregiver burden affects the overall outcome of schizophrenia Keywords: Schizophrenia, Caregiver burden, Disability, Outcome

Necessity of developing a disability evaluation guideline

Background: Although doctors expend their best effort in treating their patients’ illnesses or injuries, the patients may retain some disabilities even after treatment. Accordingly, some conflicts occur between the patients’ expectations of financial compensation for their disabilities and the financial manager’s policy to efficiently distribute limited resources. The mediation of these social conflicts requires the determination of the degree of physical disability, which can be done by doctors alone. Hence, a reliable disability evaluation guideline should be established. However, currently, only a few educational programs on disability evaluation are available for doctors and there is no reliable guideline for disability evaluation.Current Concepts: There were attempts to implement the American Medical Association guideline in Korea; however, it is currently not being used efficiently because it is quite complicated and unsuited to Korean settings. Mcbride’s disability evaluation, published 60 years ago, is being used, but it is not realistic and unreasonable in Korea. To prepare a standard guideline for disability evaluation, the Korean Academy of Medical Sciences published a booklet, “Disability Evaluation Guideline: Explanation and Case Studies”, based on the American Medical Association guideline. The academy published the booklet’s revised version (2nd edition), ‘Disability evaluation guideline and utilization’, in 2016. However, Korean Academy of Medical Sciences guideline still not being used because it is too complicated to use.Discussion and Conclusion: Fair disability evaluation is a social responsibility given to doctors, and there should be a useful guideline for disability evaluation that reflects the characteristics of each medical society or association.

COMPETENCY-BASED PHYSIOTHERAPY EDUCATION IN INDIAN CONTEXT

The education system in the health care profession is evolving with an increase in knowledge and tremendous advances in technology as per the emerging needs of society. The trend in Physiotherapy education should also change as our knowledge base changes and as the needs, or the perceived needs, of patients, medical practitioners, clinician physiotherapists, and society change. This change occurs through planning and accepting the concept of the dynamic nature of the curriculum. Competence-based education (CBE) is pertinent to this shift and is widely implemented in various universities and institutions overseas. Physiotherapy professional helps to restore movement and function when someone is affected by injury, illness or disability. The development of competent health care professionals is the need of an hour, to achieve this curriculum should be well structured with the attainment of the desired competency as the final goal. Competence-based education encompasses identification of competency, components of competency, teaching-learning methods, vigorous assessment tools, and proper planning for implementation by the institution. Comprehensive examination, functional impairments, disability evaluation, and functional diagnosis are the basic required competencies in Physiotherapy Undergraduate. Thus the objective of this review is to provide a brief idea about its significance in physiotherapy schools and currently how the implementation is under process at Physiotherapy Institutions under Datta Meghe Institute of Medical Sciences (DMIMS) an autonomous institute in Maharashtra, India.

Feasibility of a school-based physical activity intervention for adolescents with disability

Background Adolescents with disability are less active and have lower levels of physical fitness than their typically developing peers. Schools are ideal settings to address this; however, few school-based interventions have been designed and evaluated among this group. Therefore, the aim of this pilot study was to determine the feasibility of a time-efficient school-based physical activity intervention for adolescents with disability. Methods A non-randomized pilot trial was conducted with adolescents in the special education unit at one secondary school in New South Wales, Australia. Sixteen grade 11 and 12 students (aged 17.3 ± 0.7 years) participated in the 2-month physical activity intervention. Two classroom teachers were trained to facilitate the delivery of a high-intensity interval training (HIIT) program, known as Burn 2 Learn adapted (B2La). Teachers were asked to deliver 2–3 weekly HIIT sessions for a period of 2 months. Four domains of feasibility (acceptability, implementation, adaptability, and practicality) were assessed using quantitative measures at the student and teacher levels (e.g., observations, process evaluation questionnaires, and heart rate [HR] monitoring). Data were also collected from three learning and support teachers who assisted classroom teachers with intervention delivery. Preliminary efficacy of the intervention on measures of adolescents’ functional capacity (6-min walk/run test) and muscular fitness (sit-to-stand test and modified push-up test) were analyzed using paired sample t-tests. Results Moderate-to-high levels of program satisfaction were reported by both students (80% rated “Good” or “Excellent”) and teachers (100% rated “Good” or “Excellent”). Teachers reported delivering 2.5 ± 0.7 sessions per week during the study. Based on researcher session observations, the program was delivered effectively by teachers (14/20). However, HR data indicated session intensity was lower than intended. The program was considered “adaptable” by teachers, with several observed modifications to HIIT sessions to cater for the needs of adolescents with disability. No adverse events were reported. We observed improvements in preliminary efficacy measures. Conclusions Our findings suggest it is feasible to train teachers to deliver a school-based HIIT program for adolescents with disability. Evaluation of B2La within a larger-scale effectiveness trial is warranted. Trial registration ACTRN12621000219886.

An Ecocultural Perspective on Learning Disability: Evaluation of Familial and Cultural Factors and Presentation of an Integrated Model

Ecocultural theory defines culture as a broad context that includes the tasks, goals, beliefs, values, and resources of society. According to ecocultural theory, culture shapes families’ resources, routines, goals, and parenting practices. In turn, these characteristics of family ecology and parenting determine child development. Ecocultural theory is one of the modern approaches that examine the adaptation of children with disabilities and their families. This chapter aims to outline the relationship between cultural values and families’ support resources, and their influence on adaptation of the families and their children with learning disability (LD) within the framework of ecocultural theory. Previous studies supported that cultural values determine public knowledge, awareness, beliefs, and attitudes about LD. This chapter outlines both the detrimental and positive effects of the public knowledge, beliefs, and attitudes on families’ support resources. Also, families’ diversified support resources are detailed, and their differential influences on family and child development are elaborated. In the chapter, an integrated model is presented based on findings of previous empirical studies and ecocultural perspective. The model might enhance a culturally sensitive understanding of the experience of families and children. This chapter can also guide researchers in developing more comprehensive and effective intervention programs for the target group.