Birhanu M. Addis, Demewoz W. Menna, Claire T. Davies
Background: Prosthetic and orthotic devices play a significant role in enhancing the quality of life for individuals with disabilities by improving mobility, health, psychological well-being, and socio-economic opportunities. However, access to these assistive devices remains a considerable challenge, particularly in resource-limited settings.
Objectives: The aim of this systematic review was to explore and categorise the existing barriers and challenges that affect access to limb orthoses and prostheses in sub-Saharan African countries.
Method: A systematic search of seven databases was conducted to identify relevant studies using the search terms: ‘prosthesis’ or ‘orthosis’ and sub-Saharan African countries and variations of each term. Quality assessment of each study was completed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale and the Oxford Levels of Evidence.
Results: Twenty-two journal articles were included for review following database search and screening, evaluating a total of 3726 participants. Results were organised into four generalised themes, and each theme was categorised into sub-themes.
Conclusion: The review identifies multifaceted barriers to accessing and utilising limb prostheses and orthoses in sub-Saharan Africa, primarily driven by economic constraints and cultural barriers. The lack of multidisciplinary rehabilitation teams further contributes to fragmented and inefficient service delivery. Orthotic and prosthetic training centers and colleges are underdeveloped, facing problems such as ineffective teaching methods, outdated curricula, inadequate research facilities, and a shortage of experienced professionals.
Contribution: This review synthesises evidence on barriers to prosthetic and orthotic access in sub-Saharan Africa, categorising challenges into thematic domains and highlighting gaps in service delivery, education, and workforce capacity to inform policy, practice, and future research directions.
Vocational rehabilitation. Employment of people with disabilities, Communities. Classes. Races
Luisa Petrocchi-Bartal, Katijah Khoza-Shangase, Amisha Kanji
Globally, many countries have promulgated extensive, contextually relevant disability legislative policies for children with hearing impairment/d/Deafness (HI/d/D). The alignment of policies with their implementation, with robust monitoring, is essential for effective early intervention (EI) and early education (EE) outcomes. The study’s purpose was to review current South African EI and EE regulations, acts, and policies in relation to children with HI/d/D from birth to age six. An adapted Arksey and O’Malley framework with inductive thematic analysis was applied to synthesise and evaluate relevant information. Documentation was sourced between 1993 and 2023 from the official South African government portal and Google online searches using keywords. While 7976 documents were initially identified with the broad search and 1249 with a refined category search, only 17 met the specific inclusion criteria for policies referencing hearing impairment in early intervention and education. Seventeen documents were selected for study inclusion, with sixteen mentioning HI/d/D and multi-disciplinary, multi-sectoral, family-centred, culturally sensitive considerations superficially. One document from the Department of Health (DoH) specifically addressed early hearing detection and intervention (EHDI). Three main themes emerged, including Partnerships, Participation and Integration, Screening, Identification and/or Intervention, and Education/Special Education. Greater engagement with South African EI and education policies is essential to strengthen implementation, especially across sectors and at the community level. Mandating EHDI guidelines is critical to improving service delivery and ensuring smoother transitions between health, education, and social services for children with hearing impairment.
Vocational rehabilitation. Employment of people with disabilities
Shaker El-Sappagh, Waleed Nazih, Meshal Alharbi
et al.
Mental health disorders (MHDs) have significant medical and financial impacts on patients and society. Despite the potential opportunities for artificial intelligence (AI) in the mental health field, there are no noticeable roles of these systems in real medical environments. The main reason for these limitations is the lack of trust by domain experts in the decisions of AI-based systems. Recently, trustworthy AI (TAI) guidelines have been proposed to support the building of responsible AI (RAI) systems that are robust, fair, and transparent. This review aims to investigate the literature of TAI for machine learning (ML) and deep learning (DL) architectures in the MHD domain. To the best of our knowledge, this is the first study that analyzes the literature of trustworthiness of ML and DL models in the MHD domain. The review identifies the advances in the literature of RAI models in the MHD domain and investigates how this is related to the current limitations of the applicability of these models in real medical environments. We discover that the current literature on AI-based models in MHD has severe limitations compared to other domains regarding TAI standards and implementations. We discuss these limitations and suggest possible future research directions that could handle these challenges.
Vocational rehabilitation. Employment of people with disabilities
This study explored partnerships that Centers for Independent Living (CILs) engaged in to deliver services for out-of-school youth (OSY) with disabilities who identify as Black, Indigenous, or people of color (BIPOC), a historically under-resourced group. The research team conducted semi-structured qualitative interviews with executive directors or staff at seven CILs that serve large populations of BIPOC OSY with disabilities. CILs that participated in this study formed collaborations to support youth with disabilities, including BIPOC OSY. CIL respondents discussed the partnerships they established with vocational rehabilitation agencies, community-based organizations, secondary schools, and institutions of postsecondary education, to provide bidirectional and one-way referrals and connect youth to volunteering, employment, and peer group opportunities. CILs and other organizations that serve transition-age youth might create similar partnerships, particularly with vocational rehabilitation agencies, to reach and engage their minority OSY consumers.
Louis-Pierre Auger, Emmanuelle Moreau, Odile Côté
et al.
<i>Objective</i>: To identify the factors influencing the implementation of telerehabilitation (TR) in a post-stroke early supported discharge (ESD) rehabilitation program as perceived by clinicians and managers. <i>Methods</i>: A descriptive qualitative design was used in collaboration with a Canadian ESD stroke rehabilitation program. After 15 months of pre-COVID-19 implementation and 4 months of COVID-19 implementation, 9 stakeholders (7 clinicians, 1 coordinator and 1 manager) from an ESD program participated in 2 focus groups online or an individual interview. Qualitative data were coded and analyzed semi-deductively for the pre-COVID-19 and COVID-19 phases using the Consolidated Framework for Implementation Research (CFIR). <i>Results</i>: Four categories emerged related to the CFIR, each with themes: (1) Telerehabilitation, which included “Technology” and “Clinical activities”; (2) Telerehabilitation users, which included: “Clients’ characteristics” and “Clinicians’ characteristics”; (3) Society and healthcare system, which included “Changes related to COVID-19” and “ESD program”; and (4) TR implementation process, which included “Planning” and “Factors that influenced practice change”. <i>Conclusions</i>: Factors impacting TR implementation in the ESD program were found to be numerous and varied according to the pre-COVID-19 or COVID-19 phases. Clinicians’ motivation regarding potential gains for them in using TR was key in its implementation during the COVID-19 period.
Vocational rehabilitation. Employment of people with disabilities
Robert Ngarambe, Jean Baptiste Sagahutu, Assuman Nuhu
et al.
Background: Limb loss limits functioning and restricts participation in various environments. Persons with lower limb amputations (PLLA) experience challenges ranging from self-care and independence to psychological disorders that negatively impact their functioning.
Objectives: To assess the functioning and the level of disability of PLLA with or without prostheses in Rwanda.
Method: A descriptive, cross-sectional study was conducted among PLLAs aged 18 years and above in 10 districts of Rwanda. A total of 247 participants were purposively selected to fill the questionnaires. Descriptive and inferential statistics using t-test and binary logistic regression were performed to analyse data using Statistical Package for Social Sciences (SPSS) (version 21.0).
Results: Out of 247 PLLA, 99 (40.1%) had prostheses and remaining 148 (59.9%) did not. Majority of PLLA without prostheses reported having more difficulties in mobility (s.d. 3.98), participation (s.d. 5.18) and life activities (s.d. 3.87). The majority of PLLA reported mild and moderate functioning in the domains of cognitive (odds ratio [OR] 8.842, 5.384 with 95% confidence interval [CI]) mobility (OR 16.154, 2.485 with 95% CI) and participation (OR 13.299, 15.282 with 95% CI).
Conclusion: Persons without prostheses demonstrated reduced level of functioning and high levels of disability compared to those with prostheses in all domains. However, the mobility, self-activities and the participation domains were the mainly affected.
Contribution: The study helps to understand the needs of the PLLA and emphasises that not only having prostheses can improve functioning but also emphasises the psychosocial aspects to reduce disability.
Vocational rehabilitation. Employment of people with disabilities, Communities. Classes. Races
Article 30 (5a) of the UNCRPD states that participation in mainstream sport should be a right for all individuals. However, many disabled people still face barriers to participation, and provision remains segregated and/or determined, at least in part, by the nature and degree of impairment. This paper explores the Mixed Ability (MA) model as an innovative approach to facilitating disabled people’s participation in, and engagement with, mainstream sport. It outlines findings from an evaluation of the Sport England-funded Mixed Ability Sport Development Programme, which saw the MA model trialed in a variety of sports. A participatory research design was employed to generate data with key stakeholder groups involved in the design and delivery of programme activities, as well as with MA participants. Analysis of the data identified three core themes: (i) defining MA sport; (ii) the impacts of MA sport; and (iii) challenges and enablers of MA sport. In discussing these, it is argued that the MA model can be a powerful approach to inclusion and help to shape meaningful change. Indeed, the data suggest that the impacts of MA activities can extend beyond the individual level and influence shifts in both sports club culture and wider perceptions around disability. The paper closes by considering the implications of the research and outlines recommendations for future practice in this area.
Vocational rehabilitation. Employment of people with disabilities
Objectives: Mortality from cardiovascular causes, including pulmonary embolism (PE), is the second most common cause of mortality in psychiatric patients. Signs and symptoms that are specific to PE include tachycardia and dyspnea. It rarely manifests as acute psychosis and other unspecific signs and symptoms. Many common treatment modalities for psychiatric disorders increase the risk of coagulopathies and conditions, such as catatonia are associated with an increased incidence of venous thromboembolism (VTE). PE is a preventable cause of death for psychiatric patients. Therefore, we present this case to emphasize the importance of VTE complications in psychiatric patients.
Case Presentation: A 56-year-old woman was hospitalized a week before admission due to aggression, restlessness, and disturbance. She was hospitalized more than 6 times with the diagnosis of “bipolar spectrum”. Based on available information, a diagnosis of “unspecified and related bipolar disorder” with akathisia (possibly doxepin and selective serotonin reuptake inhibitor [SSRI] induced) was considered. Doxepin, citalopram, and olanzapine were tapered. Also, sodium valproate tablet 200 mg/qid and propranolol tablet 20 mg/bid were added to her drugs. After two weeks, with no progress in relieving symptoms, tachycardia was detected. Therefore, consultation with an internal medicine specialist and more evaluation was requested. With a high level of D-dimer, and low saturation, we considered thromboembolism, the patient was sent to a general hospital, and then the diagnosis of VTE was confirmed.
Discussion: One of the vital causes of death in psychiatric wards is VTE. It is difficult to diagnose VTE in a psychiatric patient; therefore, it can increase the risk of mortality. Therefore, psychiatrists must perform essential assessments for patients with clinical suspicion. We publish this case to raise awareness of thromboembolic complications in psychiatric patients, especially hospitalized patients.
Medicine, Vocational rehabilitation. Employment of people with disabilities
The rehabilitation counseling profession, as an essential career, has been facing unforeseen and unprecedented complications as a result of the coronavirus-19 pandemic. As practitioners were required to begin completing their work virtually or using telehealth modalities, it became apparent that may be gaps in preparation for such a shift. It is as yet unknown what implication these changes have on employment rates of people with disabilities, in addition to other markers for independence (e.g., independent living). Implications of the sudden shift to virtual practice are especially of interest following the changes to the comprehensive system of personnel development legislated by the Workforce Innovation and Opportunity Act reauthorization of 2014. Decreased educational requirements may lead vocational rehabilitation (VR) employees to navigate a national crisis without the essential knowledge domains required for qualified provider status. The current study asked VR personnel to indicate their comfort and preparedness in various areas, in light of the pandemic and virtual service provision (N = 88). Items were assessed at three levels: Counselor, Agency, and Client. Taken together, the results indicate that the sample feels able to maintain evidence-based services, and that supervisors have been regularly available during this uncertain time. Implications for rehabilitation researchers, supervisors, and educators are discussed.
BACKGROUND: The Vocational Rehabilitation (VR) program provides support and services to people with disabilities who want to work. OBJECTIVE: Approximately one-third of eligible VR customers are employed when they exit the program. The remainder either exit without ever receiving services or without employment after receiving services. In this study, we explore how customer characteristics and VR services predict these outcomes. METHODS: We examined VR case level data from the RSA-911 files. Machine learning techniques allowed us to explore a large number of potential predictors of VR outcomes while requiring fewer assumptions than traditional regression methods. RESULTS: Consistent with existing literature, customers who are employed at application are more likely to exit with employment, and those with mental health conditions or low socioeconomic status are less likely to exit with employment. Some customers with low or no earnings at application who are not identified in prior studies are more likely than others to have poor program outcomes, including those with developmental disability who are under 18, customers without developmental or learning disabilities, and customers who do not receive employment or restoration services. CONCLUSIONS: VR counselors and administrators should consider implementing early, targeted interventions for newly identified at-risk groups of VR customers.
BACKGROUND: Despite the series of public policies being implemented to strengthen vocational rehabilitation (VR) services, individuals with disabilities remained at the substantial deficit in employment outcomes compared with individuals without disabilities. OBJECTIVE: We aimed to examine effects of vocational rehabilitation services on the employment outcomes for people with disabilities while accounting for individual characteristics and state economic conditions. Findings had implications for VR program improvement. METHOD: We used the RSA-911 data covering cases from 2015 to 2017, in addition to state unemployment rate and poverty rate in 2017 to address the research questions. A logistic regression model was estimated with Generalized Estimating Equations to predict the probability of successful case closure by individual demographic characteristics, number of VR services received, and state economic conditions. RESULTS: State economic conditions were not associated with employment outcomes among VR participants. Being female, Black, having physical disabilities, and not having a job at application were disadvantageous in employment outcomes. The more varieties of vocational services that individuals received, the higher odds of successful case closure. CONCLUSIONS: VR services have significant beneficial impact on individual employment outcomes. The strongest beneficial impact may be achieved by providing a combination of different types of services that are designed to help individuals find or sustain employment.
Gemma Diaz Garolera, María Pallisera Díaz, Montserrat Vilà Suñé
et al.
Las relaciones interpersonales influyen de forma significativa en la inclusión social durante los procesos de tránsito a la vida adulta de las personas con discapacidad intelectual. Disponer de una red social de apoyo se considera la cima de la inclusión social. Con el objetivo de explorar el papel de las relaciones de amistad en los procesos de vida independiente de las personas con discapacidad intelectual, así como el papel de los profesionales de apoyo, se han llevado a cabo grupos de discusión tanto con personas con discapacidad intelectual como con profesionales. Los resultados de este estudio muestran la visión que unos y otros tienen de la amistad, así como el
papel que consideran que desarrollan las amistades en los procesos de vida independiente
de las personas con discapacidad intelectual y el rol que desempeñan los profesionales de apoyo con relación a la promoción del establecimiento y mantenimiento de relaciones de amistad de las personas con discapacidad intelectual. Se considera necesario el diseño y desarrollo de acciones específicas que permitan a las personas con discapacidad identificar y/o ampliar su red natural de apoyo.
Psychology, Vocational rehabilitation. Employment of people with disabilities
V. Overchuk, Julia Kushnir, Оksana Shportun
et al.
The article considers fundamental aspects of ensuring the quality of life of persons with disabilities in Ukraine, recognition of their rights to a full life in society and the creation by the state of appropriate conditions for their rehabilitation and social integration. There have been significant changes in attitudes towards people with disabilities in recent decades. The basis of such changes is the recognition of their rights to a full life in society and the creation of appropriate conditions for their rehabilitation and social integration, but, despite the positive changes, the quality of life of people with disabilities lags far behind and does not meet today's requirements. Today in Ukraine, the employment of people with disabilities is part of vocational rehabilitation, the purpose of which is to provide them with work directly. The article is devoted to the study of the development and supports system of vocational training of persons with disabilities in Ukraine. Particular attention is paid to the structure of state and non-state institutions, through which vocational training of persons with disabilities is carried out. The critical shortcomings of the vocational education system of persons with disabilities in Ukraine are selected. In particular, in terms of financing such education, logistics for certain groups of persons with disabilities, as well as educational institutions and enterprises that need to adapt their place of study or work to the needs of persons with disabilities. The feasible analysis also indicates the shortcomings of the Procedure for choosing a profession for people with disabilities with the participation of medical and social expert commission (MSEC). Recommendations for overcoming these shortcomings are formulated separately.
En los últimos 10 años hemos visto incrementar el número de publicaciones relacionadas con la inclusión en las aulas universitarias de estudiantes con Trastornos del Espectro del Autismo, síndrome de Asperger o Autismo de alto funcionamiento. En este artículo, se resume la literatura sobre la presencia de estudiantes con Trastornos del Espectro del Autismo en la Universidad y se reflexiona sobre la necesidad de desarrollar programas específicos para su atención en el marco de los servicios de apoyo a los estudiantes con discapacidad u otras estructuras de servicios similares. Entre las medidas específicas, hemos encontrado experiencias sobre programas de sensibilización a profesores y estudiantes con la finalidad de generar una cultura sobre “el autismo”, programas para tratar la ansiedad, programas de prevención de salud mental, etc. En definitiva, medidas que, aunque están dirigidas a un colectivo en particular, pueden beneficiar a toda la comunidad universitaria.
Psychology, Vocational rehabilitation. Employment of people with disabilities
BACKGROUND: People with disabilities experience barriers to the labor market. Self-efficacy is frequently cited as a barrier to engaging in the workforce, and vocational self-efficacy influences participation in employment. Understanding factors that predict vocational self-efficacy will help promote the inclusion of people with disabilities in the workforce. OBJECTIVE: To examine factors that may predict the vocational self-efficacy of unemployed people with disabilities. METHODS: Adults with disabilities completed an online survey including demographic, disability, social, and strengths-based factors through a crowdsourcing data-collection tool. RESULTS: Results from a hierarchical regression analysis suggests that the ability to connect with others, family support, adaptation to disability, and fatigue are significantly related to vocational self-efficacy when accounting for all other variables. No demographic variables significantly contributed to the prediction of vocational self-efficacy after accounting for other variables. The final model accounted for 43% of the total variance in vocational self-efficacy. CONCLUSIONS: Results provide new directions for addressing vocational self-efficacy. The most significant variables in the model represent modifiable factors to be directly or indirectly addressed through rehabilitation counseling. More research is needed to determine best practices for addressing these factors through the rehabilitation process and promote vocational self-efficacy and labor market participation of people with disabilities.
Background: This research is part of a larger project on the exploration of inequalities in South African higher education. This current study focussed on the implementation of policies to eradicate inequalities in an inclusive education system.
Objectives: This article aimed to establish the implementation of policy by researching the lived experiences of students with specific learning disabilities (SLDs) studying in the university.
Method: A qualitative, systematic review was employed as the research methodology. Original peer-reviewed qualitative studies published between 1994 and 2017 were systematically reviewed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to ensure rigorous reviews. The Critical Appraisal Skills Programme (CASP) was used to guide the process of critical appraisal of the selected articles which resulted in a total of 10 articles being selected for reviewing. The target population of this research comprised undergraduate students diagnosed with SLD. Semi-structured interviews were the main data collection tools used in the studies that were reviewed. Data from the selected articles were extracted and synthesised.
Results: The dominant themes that emerged from the review were: (1) fear of stigmatisation; (2) gaps in policy implementation; (3) experiences vary across departments; and (4) self-determination and family support as success factors.
Conclusion: An important aspect in the transformation of higher education institution is to ensure the closing of the disjuncture between policy and implementation in support of students with SLD.
Vocational rehabilitation. Employment of people with disabilities, Communities. Classes. Races
Briano Di Rezze, Helena Viveiros, Ruxandra Pop
et al.
BACKGROUND: Adults with neurodevelopmental disability (NDD) have poor employment outcomes when compared to their peers without disabilities. Examining employment outcomes beyond common dichotomous descriptive metrics (i.e., employed versus unemployed) depends on the use of standard measures and structured procedures. OBJECTIVE: This review of vocational research literature focused on identifying measures of employment outcomes for adults with NDD. METHODS: Searches were conducted across five databases - ERIC, MEDLINE, CINAHL, HaPI, and PsycINFO. Screening was conducted in duplicate, with all disagreements adjudicated by the senior researcher. RESULTS: A total of 45 articles met inclusion criteria, and data extraction revealed that 64 different employment measures were used in these vocational research studies. CONCLUSIONS: This work summarizes the employment measures for people with NDD utilized in the literature. Descriptions of these measures were provided and coding by person and environment themes, which is a useful resource for planning future vocational research for people with NDD.
Background: The predominance of neck pain in all exclusive community has been expanding and women having more problems related to neck like neck pain. Muscukoskeletal neck pain is usually caused by myofascial trigger points (MTrPs) in neck and shoulder muscles. MTrPs are overly sensitive point in palpable taut bands of skeletal muscle fibers, that is painful on pressure.
Objective: This study was conducted to see work related neck pain due to MTrPs in different muscle group around neck and shoulder in female computer users.
Methodology: A cross-sectional survey was conducted in which self-administered questionnaire along with Visual analogue scale (VAS) was used. Basic instruction and information about study was given to participants. Total 50 participants were included in this study with myofascial triggers point in different muscles around neck and shoulder.
Result: Neck pain was more significant due to active MTrPs in levator scapulae and trapezius 17 (34%). Moderate and severe type neck pain occur due to active MTrPs in different muscle group. In majority of the participants neck pain was bilateral 34 (68%). Pillow was hard 35 (70%) with height greater than 5 inches 35 (70%). These participants having greater working hours >38hr/wk 39 (78%) with using mouse frequently 27 (54%).
Conclusion: Neck pain were more significant in patients using hard and high pillow (>5inches). Neck pain increased with having high working hours of computer use. Active MTrPs was more associated with hard and high pillow. Significant active MTrPs was found in levator scapulae and trapezius. Active MTrPs are more common in participants having mechanical neck pain.
Keywords: Neck pain, trigger points, prevalence, Myofascial release
Vocational rehabilitation. Employment of people with disabilities, Therapeutics. Psychotherapy