A hospital-based self-harm register in Mysore, South India: Is follow-up of survivors feasible in low and middle income countries?

Background: In high-income countries, dedicated self-harm surveillance systems are regarded as a key component in suicide prevention strategies, which suggests they may be important in low- and middle-income countries where rates of suicide are higher and risk factors for self-harm are different, provided they can be shown to be feasible in those settings.Methods: We established a hospital based self-harm register in Mysore, South India. A subset of participants was followed-up after two years. Results: Of the 453 who were examined at baseline, the vast majority (80%) were from rural areas, nearly a quarter were illiterate and 65 (14%) were diagnosed with depression. Compared to men, women tended to be younger, single, from rural areas, unemployed, with lower levels of educational attainment and higher levels of disability. Of the 453, 371 (80%) were successfully contacted by cellphone at 2 years. There were no significant differences in baseline variables between those followed-up and those who were not, including sociodemographic features, rates of depression, severity of disability and severity of suicidal intent. All participants reported that psychosocial assessment offered at baseline was helpful and that they would recommend assessment to othersConclusions: Findings from this study indicate that our self-harm register was a feasible and useful resource, and that contact and follow up are acceptable and feasible.

Correction to: A probabilistic projection of beneficiaries of long‑term care insurance in Germany by severity of disability

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study

Background: Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life.Objective: To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou.Method: This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests.Results: A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments.Conclusion: Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments.Clinical implications: [AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.

Commentary on: the informal culture of a direct care staff team supporting people with intellectual disabilities who present with behaviours that challenge

Purpose The purpose of this paper is to provide a commentary on Banks et al., and sets the wider context. Design/methodology/approach It provides a brief narrative review of the literature on the factors that determine the quality of life of people with intellectual disabilities, including the impact of culture. Findings Key to ensuring good quality of life outcomes is support that is facilitative, enabling and empowering which can compensate for severity of disability and improve people’s experiences. This approach is called Active Support. Improving quality of life is a key part of preventing and responding to behaviours that challenge. Culture is an important factor in ensuring staff are motivated to work in such ways but is likely to be intertwined with many other factors. Originality/value This paper summarises the key literature on what is needed to improve outcomes for people with intellectual disabilities. It introduces the importance of exploring how the different dimensions of culture interact and how culture, practice, processes and structures might work in a much more complex and intertwined fashion than previously conceptualised.

The effect of patient-specific factors on responsiveness to robot-assisted gait training in patients with bilateral spastic cerebral palsy

BACKGROUND: No general recommendations are yet available for the application of robot-assisted treadmill therapy for children with cerebral palsy regarding the length and intensity of the intervention. OBJECTIVE: The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-assisted gait training (RAGT) in patients with bilateral spastic cerebral palsy. METHOD: During 12 months, the patients underwent 1–4 blocks of RAGT, representing 16–82 TUs. The following parameters were evaluated before (V0) and after each therapeutic block (V1–V4): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). We evaluated the change in motor functions in relation to the severity of disability, age, gender and number of therapeutic units. RESULTS: Ninety-seven patients aged between 3.7 and 27 years (mean age 10.02 years (SD±5.29); Gross Motor Function Classification System level I [n = 5], II [n = 25], III [n = 48], IV [n = 19]) underwent 16–82 TUs (overall average number 34.06 TUs, SD±16.41) of RAGT. In the patient group, we recorded clinically meaningful improvement and statistically significant improvement (p < 0.001) in gross motor functions with gradual increase in the effect size after each therapeutic block. Using correlation and regression analysis, we found a statistically significant associations between the number of therapeutic units, severity of disability, and improvement in motor functions after RAGT. CONCLUSION: We have identified two determinants –the severity of disability and the number of therapeutic units –which could have a decisive and predictive character in setting rehabilitation/designing programmes. The duration of the applied RAGT period, frequency and intensity could be a crucial factor for the potential of improvement in children with BS-CP.

Body composition and bone mineral density in athletes with a physical impairment

Background The impact of the type and the severity of disability on whole-body and regional body composition (BC), and bone mineral density (BMD) must be considered for dietary advice in athletes with a physical impairment (PI). This study aimed to investigate the impact of the type and the severity of disability on BC, the pattern of distribution of fat mass at the regional level, and BMD in athletes with a PI. Methods Forty-two male athletes with spinal cord injury (SCI, n = 24; age = 40.04 ± 9.95 years, Body Mass Index [BMI] = 23.07 ± 4.01 kg/m2) or unilateral lower limb amputation (AMP, n = 18; age = 34.39 ± 9.19 years, BMI = 22.81 ± 2.63 kg/m2) underwent a Dual-Energy X-Ray Absorptiometry scan. Each athlete with a PI was matched by age with an able-bodied athlete (AB, n = 42; age = 37.81 ± 10.31 years, BMI = 23.94 ± 1.8 kg/m2). Results One-Way Analysis of Variance showed significant differences between the SCI, AMP and AB groups for percentage fat mass (%FM) (P < 0.001, eta squared = 0.440). Post-hoc analysis with Bonferroni’s correction showed that athletes with SCI had significantly higher %FM vs. the AMP and AB groups (25.45 ± 5.99%, 21.45 ± 4.21% and 16.69 ± 2.56%, respectively; P = 0.008 vs. AMP and P < 0.001 vs. AB). The %FM was also significantly higher in the AMP vs. the AB group (P < 0.001). Whole-body BMD was negatively affected in SCI athletes, with about half of them showing osteopenia or osteoporosis. In fact, the mean BMD and T-score values in the SCI group (1.07 ± 0.09 g/cm2 and −1.25 ± 0.85, respectively) were significantly lower in comparison with the AB group (P = 0.001 for both) as well as the AMP group (P = 0.008 for both). The type of disability affected BC and BMD in the trunk, android, gynoid and leg regions in SCI athletes and the impaired leg only in AMP athletes. Conclusions In conclusion, the type of disability and, partly, the severity of PI impact on BC and BMD in athletes with a PI. Nutritionists, sports medicine doctors, clinicians, coaches and physical conditioners should consider athletes with SCI or AMP separately. Athletes with a PI would benefit from specific nutrition and training programs taking into account the type of their disability.

Empirical investigation into teachers’ attitudes towards inclusive education: A study of future faculty of Qatari schools

Disabled students are capable of learning and growing equally to normal students, therefore the educational infrastructure of many developed countries is inclined towards an inclusive educational system. However, such students, unfortunately, are not treated well in developing countries where teachers’ attitudes are a key hindrance to an inclusive education system. This study assesses future faculty attitudes towards inclusive education in Qatari independent schools. A mixed population from Arabic studies, Islamic studies, English language, social studies, mathematics, and science sections of both primary and secondary programmes are selected from the College of Education at Qatar University. The Questionnaire of Attitudes towards Inclusion (QAI) is designed for populations of all genders and sections. Data are analysed statistically initially using the t-test and, later with descriptive statistics in SPSS software. The research findings suggests that future faculty show a positive attitude concerning with inclusive education. However, this attitude toward teaching special children varies which depends on the severity of disability and the nature. Further, teachers prefer to teach mild special children for instance those with learning disabilities. Additionally, the findings reveal no substantial differences in future faculty attitudes to special children in inclusive education with respect to gender or specialization. The study emphasizes the importance of academic and psychological preparation of teachers in Qatari independent schools to understand the nature of disability and motivate them to enhance their acceptance of children with disabilities. Keywords: Disabled students, inclusive education, Qatari independent schools, special education, teaching attitude

Statodynamic disturbances of functions as one of the reasons for the accumulated disability of the population in the Rostov region

In the course of the study, it was possible to identify the weighted average values of the burden of static-dynamic diseases among the female and male population of young age. A continuous study was carried out in 2020 on the basis of the Main Bureau of Medical and Social Expertise in the Rostov Region. In the course of the work, a database was compiled on the accumulated disability in the Rostov region for people aged 18–45 years (23,248 cases). In the course of the study, five age-sex groups were identified: 1) 18–25 years old, 2) 26–30 years old, 3) 31–35 years old, 4) 36–40 years old, 5) 41–45 years old. The study of indicators of a separate age group included the calculation of the frequency of accumulated disability, assessment of the structure of the contingent, taking into account the causes and severity of disability. Statistical processing of the data obtained was carried out by comparing the average values in the Statistica 10 application program. In the first studied age group, the incidence of accumulated disability is 87.9 cases per 10 thousand of the population, among them 17.7 cases per 10 thousand of the population are people with disabilities. statodynamic disturbances (20.1%). In the second group, the frequency of general disability is 70.9 cases per 10 thousand of the population, among them 17.0 cases per 10 thousand of the population are people with disabilities with staticdynamic disorders (24.0%). In the third group, the incidence of accumulated disability is 119.1 cases per 10 thousand of the population, among them 31.4 cases per 10 thousand of the population are disabled persons with static-dynamic disorders (26.4%). In the fourth group, the incidence of accumulated disability is 182.0 cases per 10 thousand of the population, among them 54.7 cases per 10 thousand of the population are people with disabilities with static-dynamic disorders (30.0 %). In the fifth group, the frequency of general disability is 276.2 cases per 10 thousand of the population, among them 82.9 cases per 10 thousand of the population are people with disabilities with static-dynamic disorders (30.0 %). Thus, the indicator of accumulated disability with statodynamic disorders is higher in the fifth age-sex group of the study (82.9 cases per 10 thousand population); in the structure of the severity of disability, the third group prevails.

Disability in multiple sclerosis is related to thalamic connectivity and cortical network atrophy

Background: Thalamic atrophy is proposed to be a major predictor of disability progression in multiple sclerosis (MS), while thalamic function remains understudied. Objectives: To study how thalamic functional connectivity (FC) is related to disability and thalamic or cortical network atrophy in two large MS cohorts. Methods: Structural and resting-state functional magnetic resonance imaging (fMRI) was obtained in 673 subjects from Amsterdam (MS: N = 332, healthy controls (HC): N = 96) and Graz (MS: N = 180, HC: N = 65) with comparable protocols, including disability measurements in MS (Expanded Disability Status Scale, EDSS). Atrophy was measured for the thalamus and seven well-recognized resting-state networks. Static and dynamic thalamic FC with these networks was correlated with disability. Significant correlates were included in a backward multivariate regression model. Results: Disability was most strongly related (adjusted R2 = 0.57, p < 0.001) to higher age, a progressive phenotype, thalamic atrophy and increased static thalamic FC with the sensorimotor network (SMN). Static thalamus–SMN FC was significantly higher in patients with high disability (EDSS ⩾ 4) and related to network atrophy but not thalamic atrophy or lesion volumes. Conclusion: The severity of disability in MS was related to increased static thalamic FC with the SMN. Thalamic FC changes were only related to cortical network atrophy, but not to thalamic atrophy.

Walk and Run Test in Patients with Degenerative Compression of the Cervical Spinal Cord

Impaired gait is one of the cardinal symptoms of degenerative cervical myelopathy (DCM) and frequently its initial presentation. Quantitative gait analysis is therefore a promising objective tool in the disclosure of early cervical cord impairment in patients with degenerative cervical compression. The aim of this cross-sectional observational cohort study was to verify whether an objective and easily-used walk and run test is capable of detecting early gait impairment in a practical proportion of non-myelopathic degenerative cervical cord compression (NMDCC) patients and of revealing any correlation with severity of disability in DCM. The study group consisted of 45 DCM patients (median age 58 years), 126 NMDCC subjects (59 years), and 100 healthy controls (HC) (55.5 years), all of whom performed a standardized 10-m walk and run test. Walking/running time/velocity, number of steps and cadence of walking/running were recorded; analysis disclosed abnormalities in 66.7% of NMDCC subjects. The DCM group exhibited significantly more pronounced abnormalities in all walk/run parameters when compared with the NMDCC group. These were apparent in 84.4% of the DCM group and correlated closely with disability as quantified by the modified Japanese Orthopaedic Association scale. A standardized 10-m walk/run test has the capacity to disclose locomotion abnormalities in NMDCC subjects who lack other clear myelopathic signs and may provide a means of classifying DCM patients according to their degree of disability.