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Barriers and Facilitators to Community Ambulation in Maharashtra, India: Perception of Individuals with Stroke

SHAIKH, Atiya A
ATRE, Janhavi Jagdish
2019

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Purpose: The study aimed to understand the self-perceived environmental barriers/ facilitators to community ambulation among stroke survivors in Maharashtra State, India.

 

Method: The Facilitators and Barriers Survey /Mobility Questionnaire (FABS/M) was used to collect information from a convenience sample of 50 individuals with stroke. Data was analysed using descriptive statistics in Statistical Package for Social Sciences (SPSS) 22.00.

 

Results: Curbs, gravel surfaces, rain, noise, and crowd were marked as barriers by 56%, 58%, 52%, 36% and 50% of the participants, respectively. Ramps, elevators, and flat surfaces were reported as facilitators by 42%, 70% and 82% of the participants, respectively. Participants also mentioned the absence of automatic doors and escalators in community areas (92% and 88%), specialised exercise equipment, handrails and specialised bathroom equipment at home (92%, 50% and 52%), and inaccessibility to public places (50%), as barriers to easy mobility. 

 

Conclusions: To enhance community mobility of individuals with stroke, environmental barriers should be reduced and facilitators should be enhanced. The marked absence of facilitators in the environment should be rectified and appropriate steps should be taken to enhance ambulation. 

 

Limitations of the study are the small sample size. Factors like balance, economic status, physical activity of the stroke individuals and severity of stroke were also not considered.

Accessibility of Public Buildings in Khulna, Bangladesh, for Wheelchair Users

FARZANA, Fawzia
2019

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Purpose: Physical accessibility is one of the fundamental rights of wheelchair users in order to ensure their integration into society. After Bangladesh ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) on November 30, 2007, there has been a paradigm shift in the government’s approach to ensure the welfare and rights of persons with disabilities through legislative and policy actions. This study assesses how accommodative the public buildings are for wheelchair users in Khulna, Bangladesh.

 

Method: All the public buildings in Khulna city - including government offices, public schools, colleges and universities, hospitals, libraries, post offices and court buildings -  were visited to assess the presence and suitability of facilities for wheelchair users, such as accessible parking, ramps, elevators, doors, and essential interior facilities like water closets and drinking-water fountains.  Bangladesh has no specific accessibility guidelines document, but accessibility requirements have been included in the Bangladesh National Building Code (BNBC) 2008. The study made its assessment using an abridged form of the Americans with Disabilities Act Accessibility Guidelines (ADAAG) and BNBC 2008.

 

Results: Only 6.7% (5) of the 75 public buildings were found suitable for wheelchair users. There is scope for modifications to be made in 28% (21) of the buildings which are currently unsuitable for wheelchair users.

 

Conclusion: The study revealed that public buildings are, in general, not very accommodative of wheelchair users. There is a need for modifications in infrastructure to ensure inclusive development of these individuals.

Social inclusion and mental health of children with physical disabilities in Gaza, Palestine

NASSER, Khaled
MACLACHLAN, Malcolm
MCVEIGH, Joanne
2016

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Purpose: Social inclusion of children with physical disabilities is essential for their mental health. The long-standing conflict and political instability in Palestine since 1948 has resulted in an unprecedented number of children with disabilities. This study aimed to assess social inclusion and mental health of children with physical disabilities in Palestine.

 

Method: A mixed methods research design was used. The 12-item General Health Questionnaire and a Social Inclusion Questionnaire were administered to 100 children with amputations, 12-18 years of age, in the Gaza Strip. Ten semi-structured interviews were also conducted with personnel working across civil society rehabilitation services in the area, particularly in services that focussed on the physical rehabilitation of children who had lost a limb.

 

Results: Quantitative findings indicated that 88% of children’s disabilities were caused by war-related incidents. While the sample of children showed on average relatively low levels of psychological distress, males reported feeling more socially included and having better mental health than did females. Furthermore, there was a strong positive correlation between mental health and social inclusion, and a moderate positive correlation between psychological distress and social inclusion. The qualitative data identified different factors that hinder social inclusion, mainly: political instability; under-resourced disability organisations; lack of coordinated efforts; and negative societal attitudes towards disability.

 

Conclusion: A new questionnaire for social inclusion was developed, which can now be used as a tool to assess social inclusion in similar contexts; as well as a culturally-adapted form of the General Health Questionnaire-12 to assess mental health. There is a clear need for service-providers to move beyond a medical model of care to one that embraces community-based rehabilitation and the realisation of rights, in order to promote the social inclusion and mental health of children with disabilities in Palestinian society.

The Application of ICF-based Functioning Data on Home Environment Adaptation for Persons with Disabilities

TONGSIRI, S
HAWSUTISIMA, K
2013

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Purpose: This study illustrates how the International Classification of Functioning, Disability and Health (ICF) domains and qualifiers could be used to create functioning profiles of persons with disabilities in order to plan environmental changes. The outcome of the interventions can be measured by before-and-after comparisons of these profiles.

 

Method: 33 persons with disabilities (11 each from three provinces), with an average age of 43 years, were interviewed between November 2011 and May 2012. 67% of them were male. The functioning profiles of all the subjects were used as guidelines for home environment adaptations.

 

Results: The data helped to understand the limitations of persons with disabilities and identified the areas that needed enhancement to improve their functioning. Modification lay-outs were provided for all 33 persons with disabilities.

 

Conclusion and Implications: It was demonstrated that the ICF framework could help create functioning profiles to guide modifications in the home environment. Future studies should examine whether ICF can measure actual changes that occur after the modifications.

Quantitative Exploratory Evaluation of the Frequency, Causes and Consequences of Rehabilitation Wheelchair Breakdowns delivered at a Paediatric Clinic in Mexico

TORO, M L
GARCIA, Y
OJEDA, A M
DAUSEY, D J
PEARLMAN, J
2012

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Purpose: The United Nations Convention on the Rights of Persons with Disabilities recognises assistive technology such as wheelchairs (WCs) as a tool for social inclusion for this population. In less resourced settings, organisations lack information about effective models of WC service provision. The goal of this study was to investigate the lifespan of WCs and whether they provided reliable mobility, at one clinic in Mexico.

 

Methods: Caregivers of children, who had requested replacements for their WCs from a clinic in Mexico, were interviewed in Spanish. Among others, the questions pertained to repairs/modifications, adverse events and WC usage characteristics. The owners exchanged their WCs for new ones at the clinic, and the maintenance status of each returned WC was evaluated using the WC Assessment Checklist (WAC).

 

Results: Twenty-three donated WCs, used by children aged 3 to 14 years for an average of 19 months, were evaluated. Brakes (n=18), seat and back-sling upholstery (n=11 and 7 respectively), and armrests (n=14) were the components that failed most frequently. A total of 26 adverse events due to WC failure were reported. Adverse events were significantly associated with poor WAC scores (rs=-0.544, p=0.007).

 

Conclusions: Poor WC reliability, associated with adverse events which could undermine social engagement, indicates the need for a stronger WC and for regular maintenance. For instance, brake failures which were most often associated with adjustment issues, could have been resolved with maintenance, while seat and back-sling upholstery and armrest failures suggest that the WC may not be appropriate for the environment. Future work should investigate the robustness of these WCs using standardised methods (ISO 7176), as well as the impact of maintenance interventions on WC reliability.

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