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Constraint - Induced Movement Therapy: Determinants and Correlates of Duration of Adherence to Restraint use Among Stroke Survivors with Hemiparesis

OLASUNKANMI, D O
OLASUMBO, S A
2012

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Background: Constraint-Induced Movement Therapy (CIMT) was developed to improve purposeful movement of the stroke-affected extremity by restricting the use of the unaffected extremity. The two main components of CIMT are the training of the more-impaired arm to perform functional tasks, and the restraint of the less-impaired arm. One challenge that the application of CIMT faces is in ensuring adherence to the use of restraint.

 

Purpose: There is a need to determine the factors that may influence adherence, as this would allow CIMT to be delivered more effectively, and prevent situations where unrealistic expectations are placed on stroke–affected individuals.

 

Methods: Thirty stroke survivors with hemiparesis who met the inclusion criteria were consecutively recruited from the physiotherapy out-patient clinics, using a purposive sampling technique. A structured questionnaire was used to obtain information on clinical and socio-demographic parameters. The participants were given a restraint and an adherence time log-book, to make a daily record during the period they wore the restraint. The adherence time log- book was collected at the end of every week of the 3-week study. Motor function and functional use of the upper limb were measured using Motricity Index and Motor Activity Log respectively. Data was analysed using mean and standard deviations, independent t-test and Spearman rho; p was significant at 0.05.

 

Results: Gender (p=0.73) and side affected/handedness (p=0.79) had no significant influence on the percentage duration of adherence to restraint use (DARU). The influence of socio-economic status was seen, with the participants of middle socio-economic status adhering for longer duration (p=0.02). Age had weak and no significant correlation with percentage DARU (p=0.55). There was significantly fair correlation between motor function/functional use at any stage (p=0.55) and the corresponding percentage duration of adherence to restraint use, except the functional use in the first week (p=0.44).

 

Conclusion: Socio-economic status should be considered when applying CIMT.

Mental Health and Quality of Life of Caregivers of Individuals with Cerebral Palsy in a Community Based Rehabilitation Programme in Rural Karnataka

DEEPTHI, N
KRISHANMURTHY, A
2012

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Background: Cerebral palsy is a type of non-progressive central nervous system disorder with multiple impairments. As there are sensory, communicatory and intellectual impairments, providing care at home may be stressful and affect to the physical and mental health of the caregivers. This in turn could interfere with rehabilitation of persons with cerebral palsy.

 

Purpose: This study assesses the mental health status and quality of life of caregivers of persons with disabilities. The study group consisted of caregivers of 23 children with cerebral palsy and intellectual disability.

 

Method: The needs of the children with disabilities were assessed using a pre- tested interview schedule, while caregivers were administered GHQ-28 and WHO-QOL.

 

Results: Thirteen (56.52%) of the primary caregivers tested positive for GHQ. The psychological and environmental domains of QOL were found to be most affected, while the physical and social domains were relatively better.

 

Conclusion: There was a significant (p<0.05) correlation between the GHQ scores and quality of life.

Quality of Life, Perceived Stigma, Activity and Participation of People with Leprosy-Related Disabilities in South-East Nepal

BROUWERS, C
VAN BRAKEL, W H
CORNIELJE, H
POKHREL, P
DHAKAL, K P
BANSTOLA, N
2011

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In Nepal, many people live with leprosy-related disabilities. The objective of this stdy was to evalate dierences in socio-economic characteristics, ality of life , perceived stima, activity and participation amon people aected by leprosy as a group and between this group and the general population, and to identify prime determinants of among the leprosy-aected people.

 

People with leprosy-related disabilities (N=100; 54DGI/46DGII) and community controls (N=100) were selected from Morang district, South-East Nepal, using uota sampling. , perceived stigma and participation and activity limitations were measured using the Nepali abbreviated version of the World Health Organisation Quality of Life (WHOQOL) assessment and the Nepali versions of the Jacoby Scale, Participation Scale and Green Pastures Activity Scale (GPAS), respectively.

 

Total QOL, participation and activity levels of people aected by leprosy were worse than those of the general population. Regression analysis showed that the ability to maintain a family, satisfaction with health, vocational training, se, activity and participation limitations (the laer for QOL only), perceived stigma and living situation (i.e. joint family, type of house) were signicantly associated with a deterioration in QOL and higher participation restriction in one or both of the grading groups.

 

There is an urgent need for interventions focused on uic referral of people with leprosy, to minimize the development of visible impairments, and social rehabilitation. The laer can be achieved by creating more public awareness, providing (nancial) support for income generating projects and /or vocational training to leprosy- aected people, and by encouraging them to be involved in all community development activities. The current results indicate that such measures would help improve the uality of life of people with leprosy-related disabilities.

 

Rehabilitation Services for Persons Affected by Stroke in Jordan

AL-ORAIBI, S
DAWSON, V L
BALLOCH, S
MOORE, A P
2011

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The purpose of this study was to explore the perceptions stroke survivors have of the rehabilitation services received by them in the Jordanian community. A secondary aim was to explore the impact of culture on providing appropriate services for stroke survivors.

 

Eighteen stroke survivors were recruited from an outpatient stroke rehabilitation programme. All 18 participants had been discharged from hospital for between one and six months. Semi-structured interviews were performed, either in thephysiotherapy outpatient clinic where the affected person was attending a clinic or in their homes. Transcription of interviews carried out in Arabic and thematic analysis was also carried out in that language by transcribers who were fluent in Arabic and English, using a back-translation method. Necessary measures were taken to ensure the accuracy, reliability and validity of the data collection and analysis.

 

Following thematic analysis, themes arising out of the data included physiotherapy and occupational therapy support in the community, out-patient rehabilitation clinic services, community clinic services and support from families, friends and neighbours. Participants expressed satisfaction with their therapists, but there were large areas of unmet rehabilitation need for stroke survivors in the Jordanian community such as a limited availability of occupational therapy services, insufficient amount of therapy services and poor medical support.

 

This study presents a unique contribution to knowledge relating to the experiences of stroke survivors in a developing country, and also shows how care systems are very dependent on cultural contexts, cultural beliefs and practices.

Children with learning disabilities: A phenomenological study of the lived experiences of Iranian mothers

KERMANSHAHI, S M
VANAKI, Z
AHMADI, F
KAZEMNEJAD, A
AZADFALAH, P
2009

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Nursing as a family-oriented profession involves supporting mothers of children with learning disabilities to gain an awareness of their role. However, few studies have explored the whole experience of such mothers. This study embarks on an understanding of lived experiences of Iranian mothers who have children with learning disabilities. A qualitative approach was adopted using the phenomenology of semi-structured interviews carried out with six Iranian mothers whose children attended a special school in Tehran. The data were analysed in line with van Manen’s suggestions. Two main themes were abstracted; being the centre of stress circles and being in the midst of life and death. Themes include care management challenges for self and child, experiencing through helplessness and hopefulness and experiencing self devote and self neglect. Overall, a majority of mothers experienced a stressful life. The study concludes that Iranian mothers’ lived experience of having children with learning disabilities can be likened to the constant swing of a pendulum between two polarities of positive and negative feelings. This knowledge can provide an heuristic to help health staff guide mothers in adjusting to their children who have learning disabilities.

The influence of HIV/AIDS on community-based rehabilitation in dar es salaam, Tanzania

BOYCE, William
COTE, Laurence
2009

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Community-Based Rehabilitation (CBR) is the method of choice for delivering services for people living with disabilities in many countries. HIV/AIDS is changing the daily lives of many women by adding to their responsibilities. How realistically can such women participate actively in community development activities like CBR? This paper examines the impact of HIV/AIDS on CBR in Dar es Salaam, Tanzania. Observational sessions and individual interviews were conducted with caregivers of children with disabilities, CBR workers and managers over a three month period. Among the findings was a significant decrease in CBR activities in families affected by HIV/AIDS. This change in family priorities was due to better knowledge of acute diseases and increased stigma of HIV/AIDS in comparison to disability. Older CBR workers were more likely to incorporate elements of HIV/AIDS care with CBR, while younger CBR workers were more likely to avoid HIV/AIDS support. The ability of CBR workers to adapt their working habits to an environment with high HIV/AIDS prevalence is linked to their sense of skill competence and their knowledge/beliefs about risk of infection. Further integration of CBR work with general health development initiatives may improve this situation.

Gendered experiences : marriage and the stigma of leprosy

TRY, Leonie
2006

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Stigma is rife in many areas of health and healthcare and it has implicit impacts that are often overlooked. Due to the continued social construction of the stigma of leprosy, it is clear that a greater understanding is needed of how stigma is experienced. This study considers the experiences of marriage of those vulnerable to stigmatisation due to leprosy and more specifically identifies different experiences of leprosy-affected women and men and the possible implications.

Sex, disability and motherhood : access to sexuality for disabled mothers

O’TOOLE, Corbett Joan
2002

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There is limited research into the sexual lives of mothers, particularly mothers with disabilities. This article examines the barriers to sexuality facing mothers with disabilities. These barriers include: stereotypes that disabled mothers are not sexual, lack of resources for essential aspects of parenting, and difficulty in creating time for personal and private adult activities. Recommendations are presented based on the experiences of disabled mothers.

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