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Original Research Articles

• Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries
  Stroke Rehabilitation in the Philippines: An Audit Study
• Knowledge of Primary School Teachers in Identifying Children with Learning Disabilities
• Virtual Reality Games as an Intervention for Children: A Pilot Study

Brief reports

• Accessibility and Participation of Persons with Disabilities in Tourism: Perspective of Tourism Workers in the Ashanti region of Ghana
• Attitudes of Parents towards the Behavioural Management of their Children with Intellectual Disability

Experiential Accounts

• Community-based Rehabilitation in a post-Soviet environment in Azerbaijan – Where Society meets Ideology
• Letters to the Editor
• Adapted Science Experimental Aids for Students with Visual Impairment

Original Research Articles

• Twenty-five years of Community Living: Changes in Support Staff Perceptions
• The Development of a New Quality of Life Questionnaire for Children with Hearing Loss - The Impact of Hearing Loss on Children (IHL-C): Field Testing and Psychometric Evaluation
• Nigerian Realities: Can we ignore Traditional Leadership in developing successful CBR?
• Inclusive Education at the crossroads in Ashanti and BrongAhafo regions in Ghana: Target not achievable by 2015
• Barriers in Using Assistive Devices among a Group of Community-dwelling Persons with Lower Limb Disabilities in Sri Lanka
• Variables Influencing Emotional Intelligence of Visually Impaired Students in Higher Education
• Effects of Motor Imagery on Upper Extremity Functional Task Performance and Quality of Life among Stroke Survivors

Reviews

• The Role of Community-Based Rehabilitation in Poverty Reduction

Purpose: Although cerebrovascular accident is a leading cause of mortality in the Philippines, there has never been a national survey of stroke client descriptors and rehabilitation practices. This paper reports on data from the audit of stroke care for inpatients in hospitals serviced by physiatrists.

Method: Audit was done of the medical records of stroke clients admitted to hospitals with rehabilitation units. Performance indicators for timely referral to rehabilitation were applied.

Results: A total of 1683 records were audited. The majority of clients had cerebral infarct followed by cerebral haemorrhage. The median length of stay was 7 days; stay was lengthier for haemorrhagic strokes. Only 54.1% of the clients were referred to rehabilitation, with a median delay of 3 days between admission and referral to rehabilitation. 25.4% of the clients had early referral to rehabilitation. 39.2% of the 1397 clients were referred to rehabilitation earlier than 2 days before discharge.

Conclusion: This Filipino study provides valuable information on stroke types and prevalence, demographics and rehabilitation practices. Despite the prevalence of post-stroke rehabilitation, it has been underutilised in the management of stroke.

Purpose: This pilot study explored the use of virtual reality-based games as an enjoyable yet effective intervention to improve skills in children with developmental disabilities. Although the intervention was primarily targeted at the enhancement of motor skills, the children’s communication, cognitive and social/emotional skills were also monitored and changes, if any, were tracked during this period.

Methods: Therapists guided 5 children (4 boys with Autism Spectrum Disorder and 1 girl with Learning Disability) while they played carefully chosen games on the Xbox-Kinect, in individual sessions. Each child attended between 4 and 6 sessions over a span of one month. Therapists used a 4-point rating scale to evaluate specific skills in each of the four domains (motor, communication, cognitive and social/emotional) at the beginning of the intervention, and again at the end.

Results: Pre-and post-intervention scores revealed that the children made significant progress, not only in certain motor skills but also in skills from the cognitive and social/emotional domains. None of the children regressed in any of the skills monitored from the different domains.

Conclusions: Initial findings indicate that virtual reality games provide a useful platform for building interventions for children with developmental disabilities. There is much scope for future research in this area. The results of the study provide insights into the skills which might require prolonged, consistent inputs during the intervention, and the ones which might be acquired quickly through leaps in learning. The different ways in which children with varied developmental profiles might benefit from virtual reality-based interventions were also highlighted.

Purpose: Based on a sample of employees with disability, this study aimed to: (1) evaluate the construct validity of work ability index (WAI), core self-evaluation scale (CSES) and job in general index (JIG), in order to make a valid and reliable assessment of their work ability, job satisfaction and core self-evaluation; (2) assess their levels of work ability, job satisfaction, and core self-evaluation; (3) investigate the associations of work ability with job satisfaction and core self- evaluation among them; and, (4) determine which demographic characteristics significantly affect the work ability of employees with disability.

Methods: The sample consisted of 275 employees with disability. Data was collected using a self-administered survey.The analysis focussed on: (1) CFA- for evidence of the construct validity of the employed scales; (2) Descriptive analysis - for evaluating the variables of the study; (3) Pearson correlation analysis – for understanding the simple correlation between variables of the study; and, (4) One-way ANOVA- for identifying the demographic factors that influence the work ability of employees with disability.

Results: The findings indicated that 29.5% of the participants had poor levels of work ability, while 35.3% reported moderate levels of work ability. Also, 49.1% of the participants reported moderate levels of core self-evaluation, and 70.5% exhibited high job satisfaction. In this study, work ability was found to be associated with core self-evaluation and job satisfaction. Significant differences in work ability levels were found in terms of age, level of education and employment status of the respondents.

Conclusion: Work ability among employees with disabilities did not seem to be influenced merely by individual health status. Attitudinal and dispositional factors appeared to have a significant impact on their levels of work ability. Thepotential positive impact of education and employment status on employees’ levels of work ability are highlighted in this study.

Purpose: Assessment of physical disability at the community level is essential for rehabilitation and supply of services. This study aimed to assess the prevalence of physical disability among adults in an urban community in Sri Lanka.

Methods: A descriptive cross-sectional study was conducted among 2460 adults (18 -59 years of age) who were selected using cluster sampling. Physical disability was measured using a Physical Impairment Examination Tool (PIET) and World Health Organisation Disability Assessment Schedule II (WHODAS II).

Results: Prevalence of physical disability was 4.2% (95% CI= 3.5-5.1). Physical disability was higher among people in the age group of 40-59 years (6.5%, n=64) than among those in the age group of 18-39 years (2.6%, n=39) (P<0.05). Physical disability was more prevalent among females (4.4%, 95% CI= 4.2-4.6) than males (2.6%, 95% CI: 2.4-2.8), and among Tamils (7.8%, 95% CI=5.1%- 10.5%) than Sinhalese (3.3%, 95% CI=2.4%- 4.1%). It was higher among those who were divorced/widowed (58.3%, 95% CI=30.4- 86.2) than among married people (3.6%, 95% CI=2.8- 4.4). The prevalence of physical disability was 7.1% (95% CI=4.6- 9.5) among people with primary education, 4.5% (95% CI=3.4- 5.6) among those with secondary education, and 1.8% (95% CI=0.8- 2.8) among those with tertiary education. It was higher among the unemployed (7.2%, 95% CI=5.7-8.7) than the employed (1.8%, 95% CI=1.1-2.5). Age, gender, ethnicity, marital status, education levels and employment status were significantly associated with physical disability. 

Conclusions: Though the prevalence of physical disability appears to be higher among Sri Lankan adults than among people in developed countries, it is less than among people in other South-East Asian countries. Associations with socio-demographic variables were consistent with other studies.

Purpose: The attitudes of support staff towards people with intellectual disability can greatly impact upon an individual’s quality of life and level of social inclusion. However, there are few studies that examine how perceptions and beliefs have changed within one organisation over the past few decades; a period during which there have been major social and government policy changes including deinstitutionalisation, inclusive education and the introduction of the United Nations Convention on the Rights of Persons with Disabilities. In conjunction with a 25th anniversary review of a community-living project in rural Australia, the current research replicated a study from 1987 that examined attitudes of staff with respect to people with intellectual disability, and thematically compared the findings of the two questionnaires.

Method: In 1987, a purpose-designed questionnaire was developed and completed by 15 direct care staff. This 10-item tool asked for basic demographic information and for the participants’ perceptions of people with intellectual disability and their own work roles in the disability sector. This tool was replicated in 2013 and was again completed by 15 direct care staff from the same organisation.

Results: The thematic analysis indicated a number of differences between the 1987 and 2013 cohorts in regard to their attitudes. The wide acceptance of the rights of people with intellectual disability was one key change. There was an age separation found within the 2013 cohort, with older participants (> 50 years of age) more likely to display similar attitudes to the 1987 group than the younger participants (<30 years old). Dealing with the problem of ageing-related issues, something that was not obvious 25 years ago, was now considered of major importance. There was evidence that disability support was increasingly recognised as a valid career choice, with a substantial difference in motivation found between the two age groups. Across both cohorts, direct exposure to the realities of the job was seen to be the best training for new employees.

Conclusions: The past 25 years have seen positive developments in both social acceptance and expectations for people with disabilities. Individuals are now viewed in a realistic but more positive light. As an exemplar of this change, concerns about individuals entering a consenting sexual relationship have changed dramatically, and what was once an issue of major concern is now no longer raised. While the training provided to staff has changed significantly over the past 25 years, on-the-job exposure to people with intellectual disability, combined with support from peers, is still perceived as vital for developing a quality support network.

Purpose: Rehabilitation with assistive devices is of great benefit to people with limb disabilities, enabling them to lead independent and productive lives. While assistive devices improve the quality of life of persons with lower limb disabilities by facilitating activities of daily living, there are also many barriers to their use. This study aims to describe these barriers among community-dwelling persons with lower limb disabilitiesin central Sri Lanka.

Methods: A community survey was conductedmong adults between 18 and 59 years of age, to find persons with lower limb disabilities in Kandy Municipal Council area, in the central province of Sri Lanka. This was followed by purposive sampling to select a sub-sample of 12 individuals with unilateral lower limb disabilities for a qualitative study using in-depth interviews. Unilateral lower limb disabilities were identified using a clinical examination and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). A qualitative thematic content analysis was used to evaluate the interview text.

Results: Participants described several barriers in using assistive devices, such as unaffordable assistive technology like wheelchairs and artificial limbs, unavailability of appropriate assistive technology, difficulties associated with repair and maintenance, and problems in accessibility. Limited knowledge of modern technology also restricted their choice of better devices. Psychological barriers and stigma in using assistive devices directly affected their social lives and day-to-day activities as well.

Conclusion and Implications: People with lower limb disabilities face multiple barriers in using assistive devices. These barriers need to be addressed by improving local infrastructure and accessibility facilities, public awareness and funding, and ensuring continuous supply and maintenance services.

Purpose: To assess the effects of Motor Imagery programme on upper extremity functional task performance and quality of life among stroke survivors.

Method: Thirty people who were diagnosed with stroke, were selected from the Department of Occupational Therapy, SVNIRTAR, Odisha, India, and consecutively assigned to control (n=15) and experimental (n=15) groups. The control group received conventional occupational therapy only, and the experimental group received conventional occupational therapy combined with Motor Imagery programme. Upper Extremity Motor Activity Log (UE-MAL) and Stroke Specific Quality Of Life Questionnaire (SSQOL) were used for assessment, before and after the intervention.

Results: The experimental group showed significant improvement compared to the control group (P<.004 & P<.001). The implication is that there is a good relationship between upper extremity functional task performance and quality of life (r= 0.928).

Conclusions: The Motor Imagery programme is a simple and very cost-effective treatment used in Occupational Therapy practice. It can be easily taught and learnt. The study concludes that Motor Imagery programme is effective in improving upper extremity functional task performance and quality of life among stroke survivors.