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Training of Mid-Level Rehabilitation Workers for Community-Based Rehabilitation Programmes

GHOSH, R
PALANIVELU, V
TEBBUTT, E
DEEPAK, S
2021

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Purpose: There is a lack of trained rehabilitation professionals, especially in the small towns and rural areas of low and middle income countries. In India, a cadre of mid-level rehabilitation workers, the Rehabilitation Therapy Assistants (RTAs), are being trained by Mobility India, a Non-Governmental Organisation (NGO). This paper aims to assess impact of their training and experiences after the training.

 

Method: Data were collected from 3 different initiatives connected with the trained RTAs: an impact assessment of their training; interviews with RTAs during an evaluation; and a survey of 188 RTAs trained between 2002 and 2019.

 

Results: RTAs were shown to have good skills to provide rehabilitation interventions in the field and are appreciated by clients and other stakeholders. Most of the RTAs work for NGOs in CBR programmes, and in private hospitals and clinics. There does not seem to be a role for them in government services in most countries. The number of trained RTAs remains small in spite of the large needs. This may be due to lack of an accreditation system for RTAs and the low priority given to rehabilitation services in general in some countries.

 

Conclusions: The results provide useful information to strengthen RTA training courses. Training RTAs to provide rehabilitation services in smaller towns and rural areas of low and middle income countries can have a good impact through CBR programmes. However, this impact remains circumscribed to small areas where NGOs are active. Changes are needed in health systems for the inclusion of mid-level rehabilitation workers in primary health care services.

South African stakeholders’ knowledge of community-based rehabilitation

RULE, Sarah
ROBERTS, Anton
McLAREN, Pamela
PHILPOTT, Susan
September 2019

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Background: Community-based rehabilitation (CBR) is a complex concept and strategy that has been implemented in diverse ways globally and in South Africa. Internationally, some stakeholders have described CBR as confusing, and this may influence implementation. A southern African study reports that there is insufficient evidence of the understanding of CBR in the region to influence training, policy and practice.

 

Objectives: The aim of this study was to investigate South African stakeholders’ knowledge of CBR.

 

Method: This article reports on an electronic survey that was part of a larger mixed methods study. Based on the sample of 86 respondents, descriptive statistics were used to analyse the quantitative data and thematic analysis for the qualitative data.

 

Results: The majority of respondents had had exposure to CBR, but almost a quarter had no knowledge of the CBR guidelines and matrix. The results revealed varying knowledge concerning the key concepts of CBR, its beneficiaries and its funders. Respondents identified persons with disabilities as having a central role in the implementation of CBR. Problems with the visibility of CBR programmes were noted, as well as misunderstandings by many therapists.

 

Conclusion: The implementation of CBR, and its goal of ensuring the rights of persons with disabilities, is negatively affected by the confusion attached to the understanding of what CBR is. The misunderstandings about, and lack of visibility of, CBR in South Africa may hinder its growing implementation in the country in line with new government policies.

 

 

African Journal of Disability, Vol 8, 2019

Cross-sectional Survey to Assess Prevalence of Disability and Access to Services in Albay Province, The Philippines

HODGE, Marcus
BOLINAS, Amable
JAUCIAN, Erlynn
BONEO, Rebecca
SCHAPIRA, Allan
VILLANUEVA, Mary Mediatrix V
2017

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Aim:  A cluster randomized cross-sectional survey to assess the prevalence of disability and access to support services was conducted in Albay Province, the Philippines in April 2016.

 

Method:  The population-based survey methodologies developed by the Washington Group of the United Nations Statistical Commission and UNICEF were utilized.  A sample of 70 barangays (the 3rd level administrative division in the Philippines) was selected as clusters, with probability proportional to size, and 30 households were selected randomly in each barangay to be surveyed.

 

Results:  The estimated prevalence of disability using the standard criteria of the Washington Group and UNICEF among children (2-17 years old) was 2.0% and for adults (≥18 years old) it was 6.5%.  The estimated prevalence of disability was higher in rural than in urban areas.  Deficiencies in the performance of existing services were identified; access by children with disabilities to support services was lowest in rural highland and rural plain barangays.

 

Conclusions: There was a large unmet demand for support services addressing the needs of persons with disabilities in Albay Province, especially in rural highland areas.  Persons with disabilities were disadvantaged in access to education and employment; many had not been educated in their basic rights.

 

Implications:  To identify, educate and fully support persons with disabilities, community-based rehabilitation (CBR), health and other rehabilitation services must communicate effectively with each other, their current work should be mapped and analysed, their comparative strengths identified, and their future work coordinated.  It is a priority to educate persons with disabilities and their families about their rights, and facilitate their access to support services; this requires increased investment in communication targeting persons with disabilities and the communities, especially rural.  Providers caring for persons with disabilities need to work in partnership to identify unreached persons with disabilities.  Prevalence surveys, with stronger focus on the profiles and performance of CBR and related services, would add to the evidence-base to improve the quality and coverage of services for persons with disabilities.

CBR Workers' Training Needs for People with Communication Disability

YEAP, Choo Er
IBRAHIM, Hasherah
VAN DORT, Sandra
AHMAD, Kartini
YASIN, Md Syahrulikram
2017

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Aims:  In order for speech-language pathologists to work better together with CBR workers, there is a necessity to understand what they perceive as their training needs for people with communication disability (PWCD).

 

Method:  In 2013, a cross-sectional written survey was conducted with 421 Malaysian workers, using convenient sampling and a mixed-method approach. 

 

Results:  In-depth information on training needs from descriptive analysis of quantitative data and content analysis of qualitative data were obtained and discussed. 

 

Conclusion:  This study, although not generalizable, builds up the literature on worker training needs in developing countries, and would be of benefit for speech-language pathologists and worker trainers.

Educational Concerns of Students with Hearing Impairment in Secondary and Higher Secondary Classes in Mumbai, India

AICH, Dipak Kumar
MATHEW, Suni Mariam
2017

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Purpose: Although education, and higher education in particular, is considered a vehicle for empowerment, the enrolment of students with hearing impairment in secondary and higher secondary education is almost negligible in comparison to their hearing peers. This study was conducted in the city of Mumbai, India, with the aim of identifying the educational concerns of students with hearing impairment studying in secondary and higher secondary classes.

 

Method: The survey method was followed. A questionnaire, developed and validated by the researchers, was the study tool. The participants were 152 of the randomly selected 160 students with hearing impairment studying in secondary classes, and 42 of the randomly selected 45 students with hearing impairment studying in higher secondary classes. Percentage scores as part of descriptive statistics were calculated to arrive at the results.

 

Results: Various academic, administrative and personal concerns were identified among these students with hearing impairment in special schools.

 

Conclusions: As the focus of all educational programmes is on creating and promoting barrier-free education, the educational concerns identified in the current study cannot be ignored by schools, families and the community.

An Online Survey on Identification of Evaluation Capacity, Needs and Current Practice of Programme Evaluation in Community-based Rehabilitation

WEBER, Joerg
POLACK, Sarah
HARTLEY, Sally
2016

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Purpose: Evaluation of Community-based Rehabilitation (CBR) is important for developing good practice and providing a foundation for evidence of efficacy of practice. Since not much is known about the extent to which monitoring and evaluation (M&E) are carried out within CBR programmes, this study aimed to enhance knowledge by focussing on current M&E activities, the need and capacity of programmes to conduct evaluations and the challenges experienced. 

 

Method: An online survey of 15 questions was developed, field-tested and sent out to 236 CBR managers in Africa, Asia and Latin America.  

 

Results: The majority (86%) of the respondents indicated that their programmes had been evaluated in the past.While this was mainly done by international donors (87%), only around half of the respondents reported programme participants as the main audience. Just over half of the programmes (54%) included people with disabilities, their families and community members in evaluation processes. Insufficient financial resources were considered the most important challenge to conduct evaluation, particularly in the African region and among smaller programmes. The complexity of CBR was also indicated as an important barrier to evaluation.

 

Conclusions and Recommendations:  Although evaluations have been widely implemented in CBR programmes, many of them are not locally owned, and people with disabilities and their families are often not included in evaluation processes. The issues of limited financial resources and CBR complexity reflect current discussions in other areas of mainstream development. It is therefore recommended that models for evaluation in CBR should learn from, and be embedded in, ongoing developments in mainstream evaluation in international developm

Concurrent Validity of Mobility Disability Scale among Community-dwelling Individuals

Manikandan, Natarajan
Kumar, K B
Rajashekhar, B
2016

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Purpose: A new Mobility Disability Scale (MDS) has been developed to assess the level of mobility disability among community-dwelling individuals. For it to be used effectively, a systematic evaluation of the psychometric properties isrequired. This study was conducted to determine the concurrent validity of the MDS among community-dwelling individuals, as compared to the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM).

 

Method: Based on the survey of a semi-urban community, purposive sampling was used to select 52 individuals with mobility disability. All of them were evaluated using MDS and FIM FAM scales at the same time. Spearman’s Rankcorrelation coefficient was used to analyse the correlation of MDS scores with the FIM FAM scale scores.

 

Results: MDS scores had statistically significant negative correlation with FIM FAM total scale scores (r= -0.711) and the correlation was stronger when analysed with the mobility components of FIM FAM scales (r= -0.724).

 

Conclusion: The MDS possesses moderate concurrent validity with an existing functional scale. This indicates that it may be a suitable tool to quantify the level of mobility disability in persons with disability living in community.

 

Limitation: The psychosocial domain, though important, could not be compared with any gold standard measures due to unavailability of suitable scales.

Assessment of Rehabilitation Capacity in Ghana

Christian, Asare
et al
2016

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Purpose: This study describes a cross-sectional assessment of infrastructure, human resources, and types of rehabilitation interventions provided in a sample of healthcare facilities in Ghana. The objectives were to (a) develop and pilot a questionnaire assessing rehabilitation capacity in LMICs, and (b) provide initial data regarding available rehabilitation care in rural Ghana.

 

Methods: Data was collected from a sample of rehabilitation workers at 9 facilities, comprised of 5 regional and 4 district hospitals, located in seven of the ten geographical regions of Ghana. Participants completed a modified version of the World Health Organisation's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, adapted to reflect core indicators of rehabilitation infrastructure. Participating facilities were mailed questionnaires and agreed to subsequent site visits from the first author.

 

Results: There were several limitations associated with basic rehabilitation infrastructure. Consistent with previous research, significant human resources limitations were observed as hospital-based rehabilitation services were primarily rendered by 20 physiotherapists and 21 physiotherapy assistants across the 9 participating sites. No rehabilitation physicians were identified at any of the surveyed facilities. With regard to therapeutic interventions, management of musculoskeletal impairments was generally consistent with current evidence- based practices, whereas rehabilitative approaches for neurologic conditions were limited to physical rather than sensory-motor modalities.

 

Conclusions: For the first time there is study data which details the rehabilitation infrastructure, human resources, and interventions in Ghana. This study furthers the field through the adaptation and initial piloting of a rehabilitation assessment instrument that can be used in LMIC contexts.

 

Limitations: The questionnaire used for the study was modified from the questionnaire for assessing surgical care in resource poor countries, and has not yet been validated. Since the study was conducted in a convenience sample of rehabilitation/physiotherapy centres in Ghana, generalisability may be limited.

Educational Opportunity, Post-School Life and CBR: A Multisectoral Approach in Rural Sri Lanka

Higashida, Masateru
Kumar, M R Shantha
Nakashima, Yuko
2016

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Purpose: Inclusive education and post-school life are crossover issues that cut across societal lines and therefore need a multisectoral approach. This study examines the educational opportunities of children with disability and their post-school life in rural Sri Lanka.

 

Methods: The research was implemented with multiple sectors in a rural area of the North Central Province, from January - November 2014. Mixed methods were applied as follows: surveys with children with disability aged 2 to 18 years (n=103); case studies of children with disability who dropped out of or did not attend school (n=3); semi-structured interviews with ex-students with disability who had attended special needs classes (n=13); and, informal interviews with a CBR core group officer. Data was mainly analysed with qualitative procedures.

 

Results: The study consists of 3 parts. The first part revealed that in terms of the current educational opportunities among children with disability aged 2 to 18 years, approximately 31.1% utilised educational resources whereas 38.8% were at home with no special social activities. The case studies in the second part revealed the reasons for limited educational opportunities in the area and the barriers to educational access, which included family members’ attitudes and socio-economic aspects such as poverty. The third part, consisting of semi-structured interviews with ex-students with disability who received education but did not participate in the CBR activities, revealed 3 types of post-school lifestyle: ‘time mostly spent at home’, ‘household chores’ and ‘temporary agricultural work’. The interviews also indicated other barriers to post-school participation, such as a lack of network and information, negative experiences during the schooling period, and families’ priorities. 

 

Conclusions: Inadequate educational opportunities among children with disability and barriers to post-school social participation in rural Sri Lanka are revealed. This study argues the importance of the multisectoral approach to find unidentified children as well as to conduct comprehensive programmes.

Shoulder Pain among Rehabilitated Spinal Cord Injured Persons Using Manually Propelled Wheelchairs in the Gaza Strip: A Survey

EL ESSI, K
EL-SHAFIE, J M
AL HAWAMDAH, Z
ZAQOUT, S I
2012

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Shoulder pain among paraplegic persons has negative effects on their lives. The prevalence of shoulder pain among persons with spinal cord injury (SCI) varies from 30% to 70% in different studies and may be related to repetitive use of the shoulder during self-care and wheelchair-related activities.

 

Purpose: This study focused on the prevalence of shoulder pain and examined its effects on activities of daily living and social participation, and on functional, work and recreational or athletic activities. It also aimed to detect the degree ofsatisfaction with shoulder functioning in wheelchair users who were paraplegic due to spinal cord injury, in the Gaza strip.

 

Methods: Cross sectional study design was used to collect data from 80 persons with paraplegia, post rehabilitation, who were still using manual wheelchairs (MWC) for ambulation. After giving informed consent, the selected persons were interviewed directly in their homes, and filled questionnaires which included demographic data, Wheelchair User’s Shoulder Pain Index (WUSPI) and Shoulder Rating Questionnaire (SRQ).

 

Results: The prevalence rate of shoulder pain among paraplegics who use manual wheelchairs was 62%. Pushing a wheelchair for 10 minutes or more, and propulsion up ramps or inclines outdoors were the most common activities that caused and exacerbated shoulder pain. Sixty four percent from among the study sample mentioned that they had no limitation in shoulder-using ability during daily personal and household activities, while the rest experienced different degrees of limitation. Seventy-four percent reported no limitation during recreational or athletic activities, while the rest (26%) agreed that pain has variably limited their participation in these activities. Fourteen percent from the sample rated the overall degree of satisfaction with their shoulder functioning as fair, and the rest rated their satisfaction from good to excellent.

 

Conclusion: Shoulder pain, ranging from mild to severe, was highly prevalent among SCI paraplegics who use MWCs during their usual activities, and other activities which involve wheelchair propulsion. About two- thirds of the subjectsreported no limitation in shoulder use during daily personal and household activities and in recreational or athletic activities.

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