Neuropsychology in occupational rehabilitation: a new field of intervention?

The main goal of rehabilitation is social and vocational reintegration of handicapped people. Neuropsychological disorders prove to be particularly critical factors in this context. In many cases vocational retraining requiring good cognitive abilities and capacity is essential. Neuropsychological impairments can substantially diminish the chance of successful vocational rehabilitation. To assess the need for neuropsychological intervention within the scope of vocational rehabilitation programmes, 69 persons undergoing rehabilitation in the Berufsf?rderungswerk Sachsen-Anhalt, a non-profit organization devoted to vocational reintegration, were screened to identify individuals with cognitive deficits. Furthermore a brief multidimensional self-report inventory, the Symptom Checklist-90-R (SCL-90-R) was administered. In addition, the files of all participants were reviewed with regard to mental or neurological disorders. The study revealed cognitive deficits in a quarter to a third of the participants depending on the cognitive domain. Comparison of neuropsychological test performance of trainees with and without established diagnosis of pertinent diseases confirmed cognitive deficits in those with prior diagnosis of neurological disorder, as expected. Only for Divided Attention a significant correlation was found between neuropsychological deficits and psychiatric disorders as documented in the files. However, a considerable number of persons without corresponding medical-psychological pre-diagnosis were found to also perform poorly in particular tests. Furthermore it could be shown that subjectively experienced stress in trainees had a negative impact on reaction times in specific test procedures. These findings strongly suggest a need to supplement vocational rehabilitation by neuropsychological training programmes. When cognitive functional impairments are suspected, specific diagnostic assessments should be administered in order to select and implement appropriate interventions.     

The importance of company interests in shaping occupational rehabilitation programs: empirical findings from company-based retraining

The pilot project "Occupational Rehabilitation of Women Close to their Place of Residence" is orientated towards the dual system of vocational retraining by combining "on the job training" and "vocational theory in a vocational training school". Training on the job is one of the most important aspects in this programme, and data have therefore been gained from qualitative interviews with representatives of different firms. The results presented are based on the analysis of qualitative interviews with 13 employers involved in the pilot project. All interviewees underline: Training on the job alongside non-disabled persons is thought to offer good opportunities for lasting vocational integration since it enables trainees to grow accustomed to the conditions and demands of work and is thought likely to lead directly to employment. We discussed a range of mechanisms through which a societal obligation to train and/or employ disabled people could be implemented and highlighted the role of "rehabilitation services" which support the trainee by psychological, educational and social services and support the employer.     

新护士岗前培训方法的探讨及效果评价

目的探讨新护士岗前规范化培训的方法及效果。方法对135名新护士进行规范化的岗前培训,即在传统培训方法基础上增加了情感教育、团队文化教育、护理法律法规教育和护理安全教育。结果新护士对岗前培训课程满意度均在94．8％以上,其中对老师专业背景及课程内容结构的满意度最高,为98．5％。岗前培训前后新护士理论及技能考核成绩比较,均P〈0．05,差异具有统计学意义。结论新护士岗前规范化培训有利于新护士尽快适应临床环境,促进新护士的专业成长与发展。     

A comparative study of five groups of handicapped children in vocational rehabilitation.

This study explored the vocational and educational plans, work values, realism, initiative commitment to choice, and awareness of occupational information of five groups of handicapped children compared with a group of normal children in grades 6--12. Handicapped children tested significantly lower on all measures of vocational development. Only the cystic fibrosis group approached the high scores of the normal group. Age, grade, and social class were the best predictors of vocational development in all six groups. The findings confirmed the hypothesis that handicapped children are less prepared for vocational training and placement and consequently require special rehabilitation programs to prepare them for work.     

Assessment, education and placement: an integrated approach to vocational rehabilitation

Taking into account that a great number of people in the Netherlands are considered incapacitated for work, reintegration activities are becoming increasingly important. Thus far, no studies have been conducted in the Netherlands to investigate the long-term effectiveness of vocational rehabilitation programmes. This study assessed the long-term effectiveness of the programmes of three vocational rehabilitation centres. The centres relate their success to the proportion of trainees participating in the competitive labour market. The centres provide integrated programmes in certified occupational training and personal skills training. After five years, 80% of the trainees are working in the competitive labour market. In addition, their personal skills have improved. Within 4 to 7 years the decrease in social security costs of reintegrated employees will outweigh the total costs of the vocational training programme.     

Current educational practices with multiply handicpped pupils -- a problematic approach in special education (author's transl)]

The curricula of schools for the physically handicapped have, as yet, been influenced too much by those of regular schools. Which is why at special schools, too, the primary focus of all educational and therapeutic measures is placed on a qualification of the pupils. Also those pupils who, as a result of the severity of their disability, will not be able to enter vocational training are instructed on the basis of curricula modelled for the non-disabled. The purpose of the following article is to introduce this problem complex which has been present for years but not yet received satisfactory solutions. It is hoped that the described experiences gained with the three groups of pupils will stimulate the discussion.     

Vocational preparation and education of adolescent patients with epilepsy

Often young epileptics cannot begin a regular apprenticeship immediately after leaving school. Many cases show some somatic and psychointellectual retardation and delayed social development and maturation. Impairment of learning and concentration due to drug-side effects aggravates gaps in basic knowledge which result from frequent school absences due to epileptic illness. Attendance of a vocational training scheme for one year ensures that educational and social deficiencies can be reduced and the practice of daily work can be obtained. The epileptologist should pay particular attention to good compliance. The large variety of psycho-social and behavioural problems can be improved by event-orientated group psychotherapy. A vocational testing period can follow. Time and type of seizures have to be respected in vocational counselling. The vocational training centre for handicapped adolescents offers a comprehensive education by vocational instructors, epileptologists and psychologists.     

健康评估实践教学中学生标准化病人的培训

目的 探讨高职护理专业健康评估实践教学中学生标准化病人的培训方法与应用效果.方法 选取216名高职护理专业学生为培训对象,通过自编培训指南、遴选培训教师、安排培训时间、分模块采用师生“角色互换训练模式”分步训练,按考核标准进行遴选考试.结果 2005～2008级的216名护理专业学生中,遴选考试合格者136名,总合格率...     

Promoting exercise and sports in vocational rehabilitation of handicapped patients--a neglected aspect of rehabilitation?

Directed primarily at preventive and compensatory objectives, sports activities in the framework of vocational education are intended to enhance essentially the physical and psychic well-being of the young people in later employment. They even involve goals that are pertinent to occupational qualification. The reality of motor promotion of disabled young trainees through sports, however, does look unfavorable. Physical-motor deficits in the trainees, explained in terms of their particular biography, make up for an additional, acquired problem that can have far-reaching implications for their occupational future. Difficulties in view of systematic promotion, as well as possibilities and initial efforts towards improvement, are dealt with on the example of the vocational education centre for physically disabled young people of the Annastift, Hannover. Intensive motor promotion in more severely disabled young people during their vocational training has entailed noticably favourable results relative to coordination and physical fitness. Besides its effect of general activation, comprehensive, holistic sports-motor training above all seems to have a generalized effect on everyday and work-related tasks (such as gripping, walking).     

Medical professionalism: the trainees' views

Medical professionalism is deeply embedded in medical practice in the UK but, with changes in the modern healthcare climate, its nature and role have been increasingly challenged. The Royal College of Physicians (RCP) therefore convened a working party to consider the concept of medical professionalism, to clarify its value and purpose, and to define it. As part of this project, the RCP Trainees Committee was commissioned to survey trainees to obtain their views on the matter. A questionnaire was sent to 19,190 medical and surgical trainees, and 4,576 medical students; 2,175 responses were received. The results were clear. Junior doctors and medical students see medicine as a profession which is learnt through apprenticeship and defined by responsibility towards patients, and which requires qualities such as altruism and humility. They believe that professionalism maintains and improves patient care; that standards of care should be defined and regulated by the profession; and that training should be directed by the profession. Furthermore, the overwhelming majority think that a reduction in medical professionalism would lead to people leaving the profession.     

Chances and successes of vocational training of disabled youth in occupational and vocational school--findings of the BAR-pilot study "Regional Networks for Vocational Rehabilitation of (Learning-) Disabled Juvenile (REGINE)"

The pilot study "REGINE" was realized on initiative of the Federal Rehabilitation Council (BAR) to test the opportunities of vocational training of learning-disabled youth under "normal" conditions: That means the young people are trained in firms and regular vocational schools, and -- while doing so -- are supported by educational institutions. The project was finished successfully. The results of the evaluation, realized by the Institute for Empirical Sociology at the University of Erlangen-Nürnberg were already published in December 2003. They encourage making use of the opportunities of in-firm vocational training of disabled youth more frequently. More than half of the participants of the first REGINE-cohort successfully finished their vocational training. Nearly 40 % were taken over by the firm that provided vocationally trained, and 12.8 % found a job in another company. The second cohort showed even better results: the corresponding rates are 47.1 and 32.4 %. This success speaks in favour of this place of vocational training, particularly considering the difficult job situation. It seems to be possible, that disabled youth are successfully and cost-effectively trained vocationally, if an individual support of both youth and firms can be provided. Prerequisite for this is a conscientious preparation of the vocational training, which may already begin in the last classes of school. "Achilles heel" of the new place of vocational training for disabled youth is the theoretical training in regular vocational schools which usually can not meet the needs of the learning-disabled. These shortcomings had to be compensated by special educational institutions which are not financed by educational administration but by employment agencies (which actually have no jurisdiction over this kind of duties).     

麻风畸残患者实施自我护理3年效果

目的：探讨麻风畸残患者自我护理效果。方法：989例麻风残疾患者进行自我护理训练，发放自我护理手册和图解，提供必要的自我护理包，并定期随访3年。结果：患者红眼、眼痛、手皲裂、手溃疡、足皲裂、足溃疡等麻风继发性畸残分别较治疗前下降了78．95％、89．02％、91．86％、90．90％、93．85％和38．67％。且有87．06％的患者形成了自我护理行为。说明自我护理可被患者接受．而且效果肯定。结论：自我护理是预防和治疗麻风继发性畸残的重要手段。专业医务人员对患者的健康教育技巧、患者家属和乡村医生日常督导以及适宜的康复器材供应是治疗的关键．同时应开展小外科和矫形手术治疗以解决患者严重的兔眼和足底溃疡问题。     

Combined vocational education and industrial management--presentation of a cooperative project for improved integration of adolescents with learning handicaps]

Major structural labour market changes, i.e. dramatic losses in job opportunities for unskilled labour and continually rising levels of job requirements facing skilled workers on the one hand and an increasing demand for skilled workers on the other, are entailing enhanced job opportunities for disadvantaged societal groups, at the same time however also increasing the occupational risk of these populations, among them the learning disabled. The vocational training centres having for more than a decade been gaining experience in the vocational and social rehabilitation of this latter group, the project outlined is intended to make even better use of their potential. The main objectives of the project are: 1. optimizing the vocational training centres' range of placement-focussed measures by: intensifying industrial training periods, coordinated "start up" support on occupational entry, post-placement services; 2. transfer of the vocational training centres' technical knowledge and experience into industry-based training by: follow-along support services ("ausbildungsbegleitende Hilfen"), workshops on the initial vocational training of learning disabled young adults, and other forms of cooperation. Apart from reaching the goals outlined, the project is expected to give new impulse to the day-to-day practice of the vocational training centres as well as to generate even greater networking of the centres with their industrial environments.     

The school therapist and vocational education.

Students with disabilities are now placed in regular industrial arts and vocational training programs in secondary schools. Vocational educators agree that teachers need assistance in serving these students with special needs. This paper explores the contributions school occupational therapists can make to vocational education for handicapped students. Recommendations are included for therapists interested in moving into new roles in this field.     

Measuring leprosy-related stigma – a pilot study to validate a toolkit of instruments

Purpose.?Stigma negatively affects the quality of life of leprosy-affected people. Instruments are needed to assess levels of stigma and to monitor and evaluate stigma reduction interventions. We conducted a validation study of such instruments in Tamil Nadu and West Bengal, India.

Methods.?Four instruments were tested in a ‘Community Based Rehabilitation’ (CBR) setting, the Participation Scale, Internalised Scale of Mental Illness (ISMI) adapted for leprosy-affected persons, Explanatory Model Interview Catalogue (EMIC) for leprosy-affected and non-affected persons and the General Self-Efficacy (GSE) Scale. We evaluated the following components of validity, construct validity, internal consistency, test–retest reproducibility and reliability to distinguish between groups. Construct validity was tested by correlating instrument scores and by triangulating quantitative and qualitative findings. Reliability was evaluated by comparing levels of stigma among people affected by leprosy and community controls, and among affected people living in CBR project areas and those in non-CBR areas.

Results.?For the Participation, ISMI and EMIC scores significant differences were observed between those affected by leprosy and those not affected (p?=?0.0001), and between affected persons in the CBR and Control group (p?<?0.05). The internal consistency of the instruments measured with Cronbach's α ranged from 0.83 to 0.96 and was very good for all instruments. Test–retest reproducibility coefficients were 0.80 for the Participation score, 0.70 for the EMIC score, 0.62 for the ISMI score and 0.50 for the GSE score.

Conclusion.?The construct validity of all instruments was confirmed. The Participation and EMIC Scales met all validity criteria, but test–retest reproducibility of the ISMI and GSE Scales needs further evaluation with a shorter test–retest interval and longer training and additional adaptations for the latter.     

Hookworm and Nutrition

Enabling handicapped persons to compete for employment on the open market is the ultimate objective of vocational rehabilitation. Training toward this goal is provided by federally supported state agencies, but securing employment for the handicapped is often difficult. The most helpful factor in job placement is often the handicapped person's own initiative.     

Individual differences in nurse and teacher training students' attitudes toward and use of information technology

Students in both nurse and teacher training are now expected to learn to make effective use of IT for their profession. However, they enter training with a variety of experience in IT which will affect how they respond to further IT skills training. In this survey, 154 nursing and 128 teacher training students reported on the uses they had made of computers and their attitudes towards them. Also, as a sense of being in control of the computer is important for becoming involved in its use, they completed a questionnaire to locate their locus of internal control. The teacher training students were more likely than the nursing students to have access to a home computer, to use computers more often and to have used a greater variety of software. However, this may be a gender effect as a greater proportion of the teacher trainees were male. For both teacher training and nursing students, having a more internal locus of control was correlated with more positive attitudes towards computers. This finding is important for those introducing students to the use of IT in their professions, so that appropriate software and teaching styles involving less open-ended tasks may be provided for the less internally controlled individuals. Interestingly, a much stronger relationship between being more internally controlled and being less scared of using a computer was found for teacher trainees than for nurse trainees. Thus for nurse trainees it is more likely that there are other individual factors predisposing them to fear using computers.     

Recent advances in experimental leprosy.

Within the last 15 years we have learned to identify Mycobacterium leprae, determine its viability, screen the efficacy of antileprosy drugs, and monitor the bacilli for drug sensitivity. We have evidence that subclinical infections occur frequently among contacts of patients with leprosy and that the different manifestations of leprosy reflect differences in resistance to M leprae. We are developing hypotheses about the mechanism of these differences. We have experimentally transmitted lepromatous leprosy to normal armadillos, and from these we can obtain amounts of leprosy bacilli which fully substitute for harvests from in vitro cultures. Furthermore, if susceptibility of armadillos can be determined without infecting them and if we can breed them under controlled conditions, we would have an animal model for investigating fundamental and applied areas of leprosy which otherwise are intractable. How much our knowledge has advanced is illustrated by a project of the World Health Organization which calls for the preparation of pure, specific antigens from the now available abundance of leprosy bacilli, which might become valuable as diagnostic and epidemiologic tools and as immunoprophylactic and even immunotherapeutic weapons.     

Vocational Skills Interventions for Adults with Autism Spectrum Disorder: A Review of the Literature

With a disproportionately high unemployment rate, obtaining and maintaining employment is exceptionally difficult for individuals with autism spectrum disorders (ASD). Further, few individuals with ASD have been trained in the vocational skills needed to obtain gainful employment. The need to evaluate not only our current knowledge about the employment needs of individuals with ASD, but also to inquire about interventions, strategies, and supports in the workplace is pressing. The harsh reality of high unemployment rates for adults with ASD, and the consequently high cost of services, can be aided by examining the best practices for supporting employment. This review of the literature focuses on vocational training interventions targeted specifically to adolescents and adults with ASD. Twenty studies evaluating pre-employment, specific vocational skill training, and job retention interventions are discussed, trends in intervention characteristics are highlighted, and recommendations for future research are suggested.     

Learning dementia care in three contexts: practical training in day-care, group dwelling and nursing home

During the period 1996-1999, 18 licensed practical nurses (LPNs) received specialized training to become caregivers and mentors in the field of dementia care at the Silvia Home Foundation in Stockholm, Sweden. The aim of the study was to illuminate how the trainees utilized their practical training to learn about dementia care. The trainees gained practical training within three care models for elderly persons with dementia. The three forms of care and the context for practical training included the school's integrated day-care, a group dwelling and a nursing home. The findings show that the trainees made use of each training context in a similar fashion but there were differences between the contexts. A perspective of human dignity characterized the day-care. This was an opportunity for the nursing philosophy taught by the programme to be put to practical use, and for reflection and experiences pertaining to the individual patient to be developed. In the group dwelling, the trainees encountered patients with different forms of dementia and studied how the care-giving could be adapted to the individual patient's symptoms - the disease perspective. In the nursing home, the trainees chose a staff perspective in which they focused on organization, management and working conditions as well as staff attitudes and the effects of these factors on patient care.