In recent years, a focus on workers' ability, rather than impairment, has guided disability management services. However, a challenge with the notion of 'ability' is identification of the border between ability and inability. This article considers this gray zone of disability management in the case of a workers' compensation vocational retraining program for injured workers in Ontario.
In-depth interviews and focus groups were conducted with a purposive sample of 71 participants who were directly involved with the vocational retraining process. Workers in the program had on average incurred injury 3 years earlier. Procedural and legal documents were also analyzed. Principles of grounded theory and discourse analysis guided the data gathering and analysis.
A program focus on worker abilities did not allow for consideration of unresolved medical problems. Concepts such as maximum medical rehabilitation distracted attention from workers' ongoing chronic and unstable health situations, and incentive levers to employers directed some of the least capable workers into the program. As well, communication pathways for discussing health problems were limited by rules and provider reluctance to reveal problems. Therefore, workers completing the program were deemed 'employable', while ongoing and problematic health conditions preventing employment remained relatively uncharted and invisible.
This study reinforces how the shift in disability management paradigm to a focus on ability and return to work requires consideration of environmental conditions, including policies and programs and implementation. A focus on the environment in which worker ability can be enacted might be as important as a focus on improving individual worker characteristics.
The purpose of this study was to identify, from the personal perspective of students with disability, their needs for physical and social accommodations in upper secondary schools specially adapted for students with severe physical disabilities. The study also aimed to identify those areas of student-environment fit which were most often achieved. Forty-eight students in four schools in Sweden were assessed by occupational therapists using the School Setting Interview. Forty-seven students reported needs for accommodations in the school setting. The study indicates that schools generally were able to meet the students' accommodation needs in the physical environment. The schools also met students' accommodation needs for field trips, sport activities and assistance. Student-environment fit in occupations requiring reading, remembering and speaking was unsatisfactory. Accommodations on a general, group and individual level are highlighted and discussed. The study recommends that occupational therapists become more involved and offer society their expertise in barrier removal to a greater extent.
Clinical measures of seated postural control in adults are not standardized and most are derived from in-house tools. The purpose of this study is to adapt a pediatric instrument to evaluate seated postural control in adult wheelchair users.
The new instrument is called the Seated Postural Control Measure for Adults (SPCMA) 1.0. Five preliminary versions were pretested with some 20 adults by two raters and a group of experts.
This instrument comprises three sections: Section 1, level of sitting scale for adults (1 item, 7-point ordinal scale); Section 2, static postural alignment (22 items, 7-point ordinal scale); and Section 3, postural alignment after a dynamic activity, propulsion of the wheelchair on flat terrain and an incline (22 items, 7-point ordinal scale).
The SPCMA for Adults 1.0 improves the quality and uniformity of evaluations done by different raters, which facilitates more rigorous follow-up of clients over time, communication between professionals, and objective verification of the attainment of intervention objectives.
This paper describes the technical approach in the TUFFA (Technology Procurement for Disabled in Working Life) project and a model for cooperating areas of competence based on a holistic view of the individual's abilities, the environmental conditions at the work site, and technical solutions.
To evaluate an intervention aimed at enriching day centres for people with psychiatric disabilities by exploring staff experiences from developing and implementing the intervention.
Each staff group developed a tailor-made intervention plan, following a manual, for how to enrich the day centre. They received supervision and support from the research team. The study was based on focus-group interviews with a total of 13 staff members at four day centres. Narrative analysis with a thematic approach was used. A first round resulted in one narrative per centre. These centre-specific narratives were then integrated into a common narrative that covered all the data.
A core theme emerged: User involvement permeated the implementation process and created empowerment. It embraced four themes forming a timeline: "Mix of excitement, worries and hope", "Confirmation and development through dialogue, feedback and guidance", "The art of integrating new activities and strategies with the old", and "Empowerment-engendered future aspirations".
The users' involvement and empowerment were central for the staff in accomplishing the desired changes in services, as were their own reflections and learning. A possible factor that may have contributed to the positive outcomes was that those who were central in developing the plan were the same as those who implemented it.
OBJECTIVE: The purpose of this study was to describe functional performance in activities of daily living (ADL) and the use of technical aids among persons with late effects of polio. METHOD: Abilities in ADL of 150 participants 20 to 82 years of age were assessed with the Sunnaas Index of ADL, and the participants' use of technical aids was recorded. RESULTS: The activities in which most participants were independent were eating, daily hygiene, and communication. Many needed technical aids, adaptation of their homes, or both to perform mobility-related activities and to dress or undress, take a bath or shower, cook, or manage toilet visits. In total, 86 (57%) used mobility aids such as canes, crutches, and walkers. Thirty-one (21%) used wheelchairs within or outside the home. Bath and shower aids were the most commonly used technical aids other than mobility aids. The activity where most participants depended on others was housework. CONCLUSION: In spite of their disabilities, most participants performed well in many ADL, functioning independently by using technical aids and by living in an adapted environment.
To investigate user satisfaction with characteristics of powered scooters (scooters), frequency of use, and factors predicting daily scooter use.
Adult scooter users (n?=?59) in Denmark and Norway, mean age 74.5 (standard deviation 12.3) years.
Structured face-to-face interviews. The NOMO 1.0, the Quebec User Evaluation of Satisfaction with assistive devices (QUEST 2.0), and a study specific instrument were used to collect data. Descriptive statistics were applied, and regression analyzes were used to investigate predictors for daily scooter use. The International Classification of Functioning, Disability and Health (ICF) served as a framework for classifying variables and guiding the investigation.
Satisfaction with the scooter characteristics was high with most participants being very satisfied or quite satisfied (66.1-91.5%). Most scooters were used daily (36.2%) or several times a week (50.0%). User satisfaction with safety of the scooter [odds ratio (OR)?=?11.76, confidence interval (CI)?=?1.70-81.28] and reduced balance (OR?=?5.63, CI?=?0.90-35.39) increased the likelihood of daily use, while reduced function in back and/or legs (OR?=?.04, CI?=?0.00-0.75), tiredness (OR?=?.06, CI?=?0.01-0.51), and increased age (OR?=?.93, CI?=?0.87-1.00) reduced the likelihood of daily use. 52.8% of the variance was explained by these variables.
User satisfaction was high, and most scooters were used frequently. User satisfaction with safety, specific functional limitations and age were predictors for daily scooter use. Implications for Rehabilitation Scooters seem to be a beneficial intervention for people with mobility impairment: user satisfaction and frequency of use are high. Users' subjective feeling of safety should be secured in the service delivery process in order to support safe and frequent scooter use. Training of scooter skills should be considered in the service delivery process.
To describe an adult population with congenital limb deficiency (CLD) recruited through the National Resource Centre for Rare Disorders (TRS) in Norway: (1) demographic factors, (2) clinical features, (3) pain and (4) use of health care and welfare services.
Cross-sectional study. In 2012, a postal questionnaire was sent to 186 eligible persons with CLD, age 20 years and older.
Ninety-seven respondents, median-age 39 years (range: 20-82); 71% were women. The population was divided into two subgroups: (1) unilateral upper-limb deficiency (UULD) n = 77, (2) multiple and/or lower-limb deficiency (MLD/LLD). About 40% worked full-time, 18% received disability pensions and 64% reported chronic pain, mostly bilateral pain. Grip-improving devices were used more often than prostheses; 23% were previous prosthesis users. Use of health care and welfare services are described. No significant differences were found between the subgroups regarding pain or employment status.
Persons with CLD reported increased prevalence of chronic pain, mostly bilateral, and increased prevalence of early retirement. A greater focus on the benefits of the use of assistive devices, the consequences of overuse and vocational guidance may moderate pain and prevent early retirement. Further studies of more representative samples should be conducted to confirm our findings.
Most adults with congenital limb deficiency (CLD) live ordinary lives and experience normal life events. However, several report chronic pain and retire before normal retirement age. In spite of free and accessible prosthetic services, a large fraction chooses not to use prosthesis, more use grip-improving devices for specific activities. These preferences should be acknowledged by rehabilitation specialists. Focus on individually adapted environments, more information about the consequences of overuse, and vocational guidance may moderate pain and prevent early retirement.
Throughout the world all populations are seeing burgeoning numbers of "elders", defined as persons aged 65 year and older. In many countries, including Japan, the United States, Norway, Sweden and the United Kingdom, those aged over 65 are at or approaching 15% of the population. As their numbers have increased, so have their health care expenses, leading to extensive research on the health, well being, and life expectancy of these increasingly older elders. Today this group is further sub-divided: the young-old ages 65-74, the old-old ages 75-84, and the oldest-old ages 85+, for both health care and research purposes. However broad variation still characterizes even these groupings. Rates of frailty and disability increase with increasing age among these elders. For example, inabilities to complete at least one activity of daily living increased from about 5-7% at ages 65-69 years to about 28-36% at ages 85+ in 1987. Death rates continue to decline at all ages past 50 years and rates of disability seem to be doing the same. For the foreseeable future, we may expect increasing numbers of older, frail elders than in previous decades. Thus, people are not only living longer, they generally are healthier at advanced ages than were previous cohorts, thus "old age" disabilities of the 20th century will be put off to even older ages during the 21st century. As yet there is no clear way to assess senescent changes in humans, although activities of daily living, allostatic load, and frailty indices have all been suggested. One future need is greater development and use of universal and accessible design in all aspects of the built environment.