Religion and disability: clinical, research and training considerations for rehabilitation professionals

Purpose. This article (i) reviews existing research on the relationships that exist among spirituality, religion, and health for persons with disabilities; and (ii) compares different theoretical coping models (i.e., spiritual vs. psychoneuroimmunological).

Background. Over the past decade interest has increased in relationships among spirituality, religion, and health in both the mainstream media (e.g., Newsweek) and scientific literature (e.g., Koenig). In general, research has concluded that religion and spirituality are linked to positive physical and mental health outcomes. Most religion and health research has focused on populations with life-threatening diseases (e.g., cancer, cardiovascular disorders, AIDS) with minimal attention to persons with chronic, life-long disabling conditions such as brain injury, spinal cord injury, and stroke. However, religion is used by many individuals with disabilities to help them adjust to their impairments and to give new meaning to their lives.

Conclusions. Religion and spirituality are important coping strategies for persons with disabilities. Practical suggestions for rehabilitation professionals are provided regarding: (a) strategies to enhance religious coping; (b) methods to train rehabilitation professionals about religious issues; and (c) issues to consider regarding future research on rehabilitation and religion.     

Clinical psychology and disability studies: bridging the disciplinary divide on mental health and disability

Abstract

Purpose: Clinical psychology and disability studies have traditionally occupied very different academic, philosophical and political spaces. However, this paper aims to illustrate the positive consequences and implications of attempts to understand and bridge this disciplinary divide. Method: A narrative review format was used with evidence selected pragmatically as opposed to systematically. The construction of the argument determined the evidence selected. Results: The concept of psycho-emotional disablism, which originated within disability studies, is argued to be a useful concept to bridge the divide between understandings of distress from both disability studies and clinical psychology perspectives. However, this can be usefully augmented by psychological research on the mechanisms through which disablism can affect individuals. Conclusion: Perspectives from both disability studies and clinical psychology can be usefully combined to bring important new perspectives; combined, these perspectives should help – on theoretical, service and social levels – to improve the mental health of disabled people.

• Implications for Rehabilitation

• Mental health is an important determinant of overall health-related quality of life and psychological therapy should be available for those disabled people who would value it.

• Psychological therapists working with disabled people should be more aware of the challenging social context in which disabled people live.

• Understandings of distress should not just include individual factors but also incorporate the psychological impact of stresses caused by societal barriers preventing inclusion.

• Psychologists should be more willing to work and engage at a societal and political level to influence change.

     

基于ICF模式的康复心理学:学科范式与内容北大核心CSCD

目的应用ICF的生物-心理-社会的功能与残疾模式,探讨基于ICF的康复心理学的研究内容与范式。方法采用ICF的功能与残疾理论,从康复科学和心理科学的学科架构出发,应现代康复科学发展的要求,在ICF功能架构下构建现代康复心理学的研究内容与范式。结果ICF构建了一个涉及到身心和环境的整体康复模式。基于ICF的功能模式,现代康复心理学研究的主要内容不仅涉及身体层面的功能和结构,更要研究活动和参与,强调个体与环境的交互作用。现代康复心理学涉及的领域不仅包括身体功能障碍的心理康复,还包括活动干预和环境干预。基于ICF的架构可以采用共同的术语和编码方法,使康复心理学工作者能够与相关学科专业人员进行多学科和跨学科交流。结论基于ICF构建现代康复心理学的研究理论架构与研究范式,可以形成融入心理科学和康复科学的康复心理学体系。     

Using mixed methods in disability and rehabilitation research.

This paper will discuss the theoretical design considerations and the practical integration of quantitative and qualitative methods in disability and rehabilitation research, which have gained recent popularity among researchers of various disciplines. Whereas quantitative experimental and survey approaches allow researchers to draw generalizable conclusions that apply to a particular population as a whole, qualitative methods capture the depth of respondents' experiences in their own words. Qualitative methods may be used to explore new topical areas prior to implementing a population-based survey, or they may follow quantitative approaches to explain findings in greater detail. We will discuss research findings from two recent studies of rehabilitation industry professionals and people with physical disabilities to exemplify the utility of mixed-method designs in disability and rehabilitation research. The article will conclude with recommendations for rehabilitation nursing researchers to apply both qualitative and quantitative methods in their research practice.     

基于世界卫生组织康复胜任力架构的康复心理学专业人才胜任力研究

目的 应用世界卫生组织康复胜任力架构(RCF),构建康复心理学专业人才的胜任力架构,开发康复心理学方向研究生的课程体系。方法 运用RCF及其情景化指南,结合《国际功能、残疾和健康分类》的生物-心理-社会功能和残疾理论,对接康复的学科发展和康复职业能力要求,研究康复心理学专业人才的胜任力及其培养模式。结果 构建了基于RCF的康复心理学专业人才胜任力架构;采用基于胜任力的教育(CBE)模式对接康复职业能力与岗位职责标准,明确培养目标;基于RCF与CBE模式设计康复心理学专业人才培养课程体系,有助于培养适应团队工作模式的应用型人才。结论 基于RCF的康复心理学专业人才胜任力研究整合了教育系统的学科发展与职业能力的社会需求,为推动康复心理学专业人才的培养提供了思路与方法。     

Cooperation of return-to-work professionals: the challenges of multi-actor work disability management

Purpose: This article explores which concrete factors hinder or facilitate the cooperation of return-to-work (RTW) professionals in a complex system of multiple stakeholders.

Method: The empirical material consists of in-depth interviews with 24 RTW professionals from various organizations involved in work disability management in Finland. The interviews were analyzed using thematic content analysis.

Results: The study revealed several kinds of challenges in the cooperation of the professionals. These were related to two partly interrelated themes: communication and distribution of responsibility. The most difficult problems were connected to the cooperation between public employment offices and other stakeholders. However, the study distinguished notable regional differences depending primarily on the scale of the local network. The main areas of improvement proposed by the interviewees were related to better networking of case managers and expansion of expertise.

Conclusions: The article argues for the importance of systematic networking and stresses the role of public employment services in the multi-actor management of work disabilities. The article contributes to existing work disability case management models by suggesting the employment administration system as an important component in addition to health care, workplace and insurance systems. The study also highlights the need for expansion of expertise in the field.

• Implications for Rehabilitation

• Cooperation between RTW professionals in public employment offices and other organizations involved in work disability management was considered inadequate.

• In order to improve the cooperation of RTW professionals, the stakeholders need to create more systematic ways of communication and networking with professionals in other organizations.

• There is a need to expand the expertise in work disability management and rehabilitation, partly by increasing the role of other professionals than physicians.

     

Outcome of comprehensive medical rehabilitation: An analysis based upon the impairment,disability, and handicap model

The World Health Organization model of disablement was applied to patients 2 years after admission to rehabilitation centres. Various established measures were also applied. This study confirmed the usefulness of the concept of impairment, disability and handicap, as well as the applicability of the scoring methods in predicting rehabilitation outcome.     

Rethinking the relationships between disability,rehabilitation, and society

This paper provides a critical review of contrasting ways of thinking about the nature of disability in society. It highlights the dominance of the medical model of disability whereby medical and rehabilitative professionals and practitioners tend to conceive of disability as an individual physiological and/or medical condition requiring the afflicted individual to be given appropriate medical and/or rehabilitative support. As the paper suggests, such perspectives are problematical because they reduce the understanding of disability to the conditions of the individual ‘patient’ and ignore wider social and environmental influences in engendering a state of disability. Thus, the paper highlights other perspectives on disability and society which suggest that social, attitudinal, and environmental barriers in society are an important component in disabling people with physical and/or mental impairments. In this sense, breaking down disabling social practices against people with disabilities might be as important, if not more so, than seeking to cure physical and/or mental impairments.     

Developing a tool for evaluating community-based rehabilitation in Uganda

Purpose.?The overall purpose of this study is to use the conceptual criteria of the ‘Joint Position Statement (JPS)’ (see http://www.ilo.org/public/english/employment/skills/download/jointpaper.pdf)on Community-based rehabilitation (CBR), together with the data collected from a CBR programme in Uganda (Tororo) to generate a prototype CBR evaluation tool.

Method.?A case study approach is used to examine the Tororo CBR programme. Project documentation was examined to generate base line data which was used to inform sampling for interviews and focus group discussions. These were conducted with a wide range of stakeholders. The interview and focus group data are recorded, translated, transcribed and imported into a computer-assisted analysis programme, NVivo. The data was analysed in two stages: (i) data led development of themes (ii) allocation of the generated themes to the conceptual structure of the ‘JPS’. A third stage uses the data to generate an outcome measurement tool for evaluating CBR programmes.

Results.?Fifty different themes were identified during the analysis and used to construct a questionnaire framed around the concepts of the ‘JPS’. In addition, the questionnaire reflected the words and phrases used by participants. The outcome is a short and feasible tool for evaluating CBR programmes.

Conclusion.?The ‘JPS’ has been used as a framework for the analysis of qualitative data to generate the basis of a prototype evaluative questionnaire which can now be piloted, amended and then used for the evaluation of other CBR programmes.     

电针联合康复训练治疗帕金森病的临床研究

目的:观察电针联合康复训练治疗帕金森病(PD)患者的疗效.方法:PD患者87例,随机分为3组各29例,A组采用康复训练联合电针治疗;B组仅接受康复训练;C组仅接受电针治疗.结果:治疗60d后,3组患者韦氏综合评定量表中肌强直、姿势、步态、协同动作评分均较治疗前降低,且A组更低于B、C组(均P＜0.05);3组Bl评分均较治疗前明显提高,且A组更高于B组,B组更高于C组(均P＜0.05);3组UPDRSⅢ评分均较治疗前明显降低,且A组更低于B组,B组更低于C组(均P＜0.05);3组运动总有效率比较,A组＞B组＞C组(均P＜0.05).结论:电针联合康复训练能一定程度地改善PD患者的临床症状,提高患者的日常生活活动能力、生活质量及临床疗效,其疗效优于单独使用康复训练或者电针治疗.     

SCIRehab: a model for rehabilitation research using comprehensive person,process and outcome data

Purpose.?This article aims to present a comprehensive conceptual model of the SCIRehab project, which merges the International Classification of Functioning, Disability, and Health (ICF) focus on outcomes with the practice-based evidence (PBE) research design, which focusses on process and also quantifies person and outcomes details. The SCIRehab methodology operationalised this conceptual model to implement the most data-intensive study of spinal cord injury to date. We discuss the conceptual and methodological contributions of SCIRehab and how this comprehensive research approach may complement randomised controlled trials.

Methods.?PBE methodology applied to the SCIRehab study used extensive clinician input to develop taxonomies of each discipline's interventions and an electronic point-of-care documentation system to capture extensive details of the rehabilitation process. Traditional medical record abstracting and follow-up surveys were used to capture details on patient characteristics and outcomes achieved by 12 months post-injury.

Results.?Not applicable.

Conclusions.?Although data collection is not complete, the SCIRehab project has made major contributions to rehabilitation research, including a comprehensive conceptual model of person, process and outcome domains; discipline-specific taxonomies of rehabilitation interventions; and an electronic documentation system to capture details of the rehabilitation process.     

Virtual reality,disability and rehabilitation

Virtual reality, or virtual environment computer technology, generates simulated objects and events with which people can interact. Existing and potential applications for this technology in the field of disability and rehabilitation are discussed. The main benefits identified for disabled people are that they can engage in a range of activities in a simulator relatively free from the limitations imposed by their disability, and they can do so in safety. Evidence that the knowledge and skills acquired by disabled individuals in simulated environments can transfer to the real world is presented. In particular, spatial information and life skills learned in a virtual environment have been shown to transfer to the real world. Applications for visually impaired people are discussed, and the potential for medical interventions and the assessment and treatment of neurological damage are considered. Finally some current limitations of the technology, and ethical concerns in relation to disability, are discussed.     

Disability awareness training for disability professionals

Purpose : This article describes work at the Virginia School of the Deaf and Blind in Hampton, Virginia, USA. Disability sensitivity training in businesses and government organizations has become a more important activity in the United States since the Americans with Disability Act (ADA) of 1992 was published. That act of the US Congress required organizations to hire and make reasonable accommodations for the disabled. Issue : Lack of sensitivity or awareness of the plight of the disabled in business and government continues to be a distinct problem requiring attitude changes and training, but this problem can become acute even for professionals in organizations dedicated to the care and education of the disabled. Conclusion : Professionals tend to become inured to the hardships of others and lose sight of the need for both verbal and non-verbal sensitivity in the workplace. and training of professionals is vitally important and necessary, but in the real world of working with people who have disabilities more practical action type training is needed. It is far too easy for practitioners to lose sensitivity in both verbal and non-verbal communication     

The International Classification of Functioning,Disability and Health (ICF) in vocational rehabilitation and disability assessment in Slovenia: state of law and users' perspective

Objective. This study illustrates the use of the ICF in vocational rehabilitation and disability assessment in Slovenia.

Method.?A review of the Slovenian law about vocational rehabilitation was performed. A survey was developed and group and individual interviews were conducted with professionals involved in vocational rehabilitation who use the ICF.

Results.?The vast majority of the respondents believe that ICF helps to create a common language for multidisciplinary communication. The main advantages of the ICF identified by the respondents are that it provides a holistic view of the person, assesses complexities of functioning, provides a unified language and offers a quick and easy insight into functioning. The disadvantages of ICF are complicated terminology and subjectivity of the assessor. A difficulty encountered by the users is that by law, only body functions of the ICF are assessed. Additional qualitative analysis of the users' understanding of ICF and its purpose revealed heterogeneity. Significant differences between public and private organisations were found.

Conclusion.?ICF is a promising tool for use in vocational rehabilitation and disability assessment in Slovenia. A major challenge is the lack of interface between ICF and policies on vocational rehabilitation in Slovenia.     

Burn care and rehabilitation in Australia: health professionals’ perspectives

Objective: To understand health professionals’ perspectives of burn care and rehabilitation.

Design: Qualitative and semi-structured interviews.

Setting: Australian burn and rehabilitation units.

Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings.

Results: The data portrayed the health professionals’ perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care.

Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes.

• Implications for rehabilitation

• Burn care and rehabilitation remains a complex and challenging area of care.

• Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase.

• Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.

     

National Institutes of Health research plan on rehabilitation

One in five Americans experiences disability that affects their daily function because of impairments in mobility, cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The National Institutes of Health (NIH) recently published a Research Plan on Rehabilitation that provides a set of priorities to guide the field over the next 5 years. The plan was developed with input from multiple Institutes and Centers within the NIH, the National Advisory Board for Medical Rehabilitation Research, and the public. This article provides an overview of the need for this research plan, an outline of its development, and a listing of six priority areas for research. The NIH is committed to working with all stakeholder communities engaged in rehabilitation research to track progress made on these priorities and to work to advance the science of medical rehabilitation.     

《国际功能、残疾和健康分类儿童和青少年版》类目在儿童脑外伤随访中的应用

摘要 目的：通过《国际功能、残疾和健康分类儿童和青少年版》（ICF-CY）在儿童脑外伤康复评定和随访的应用的研究,促进其在康复工作中的应用。 方法：建立2009年1月—2012年1月在温州医学院附属第二医院康复科首次住院脑外伤患儿的档案,选取19个ICF-CY身体功能及活动和参与的二级类目、Barthel指数（BI）、格拉斯哥结局量表（GOS）对受伤年龄在2岁以上的患儿伤后1—2年的预后情况进行随访评定,并分别对ICF-CY与BI、GOS进行相关分析。 结果：①47例住院患儿中,有结果的随访病例数40例（85.11%）,失访人数6例,死亡人数1例,随访时间平均（16.60±4.89）个月,随访结束时平均年龄（84.63±37.52）个月。②身体功能方面,智力功能（b117）、记忆功能（b144）、步态功能（b770）恢复情况较差。活动与参与方面,精巧手的使用（d440）、四处移动（d455）、盥洗自身（d510）、学校教育（d820）/学龄前教育（d815）、参与游戏（d880）恢复情况较差。③相关性分析提示ICF-CY评分与BI得分、GOS分级呈显著负相关。 结论：ICF-CY类目作为儿童脑外伤的随访内容,可以从整体水平上评估儿童脑外伤的健康状态,但要在临床上得到广泛应用仍需要很长的路要走。     

社区精神分裂症患者社交技能缺陷康复的训练

目的:精神分裂症患者社会交往技能缺陷是精神分裂症患者认知功能障碍的重要表现之一,用抗精神病药物治疗社会交往技能缺陷的收效甚微,探讨社会交往技能训练对精神分裂症患者社交技能缺陷康复的作用。方法:将148例病情明显好转以上的出院精神分裂症患者随机分为社会交往技能训练组(74例)和对照组(74例)。两组皆在门诊常规治疗,而训练组同时接受《社会交往技能训练程式》训练10周,并随访12个月。以SAD、SDSS、复发率和再住院率来评定疗效。结果:无论在训练或随访期间,训练组从训练第4周以后各时点的SAD均值和第6周以后各时点的SDSS均值皆显著优于对照组,P均<0.01;随访结束时两组间复发率比较无显著性差异,P>0.05,但训练组再住院率(19%)显著低于对照组(37%),P=0.022。结论:社会交往技能训练能有效地提高精神分裂症患者的社交技能,并有效降低患者再住院率。     

Benefits and barriers to physical activity for individuals with disabilities: a social-relational model of disability perspective

Abstract

Purpose: To provide a qualitative overview of selected research on physical activity (PA) engagement by people with physical disabilities from a social relational model perspective. Method: Selected articles that exemplify some of the paradoxes, nuances, contrasting perspectives and complexities of the knowledge base in this area are discussed within a disability studies framework. Results: PA is arguably more important for people with disabilities relative to people without disabilities although they are quite inactive. Individuals who are physically activity enjoy a range of benefits spanning physiological, emotional, cognitive and social categories. Unfortunately many people cannot enjoy the benefits of PA because of the many medical, psychological, social and environmental barriers they face making PA quite difficult. Conclusions: Rehabilitation professionals can provide a better standard of care to clients if they are aware of the benefits and barriers of PA.

• Implications for Rehabilitation

• Rehabilitation professionals should understand behavior change strategies and their application to people with disabilities in order to help their clients initiate and maintain physical activity (PA).

• Rehabilitation professionals should be aware of how they might convey low PA expectations to their clients and simultaneously understand the unique challenges faced by their clients in attempting to incorporate PA into their lives on a regular basis.

• Rehabilitation professionals should be familiar with local disability friendly exercise facilities and adapted sport programs in order to steer their clients towards such opportunities.

     

Intellectual disability in Africa: implications for research and service development

Abstract

Although intellectual disability (ID) is probably the largest impairment grouping on the African continent, few indigenous research and evaluation studies have been undertaken. This article is an initial attempt to relate service delivery issues to an African research agenda. We critically analysed the available literature, drawing on academic publications and those of non-governmental agencies. In this process we identified several key issues for further investigation, namely: understanding ID in African contexts, access to education and health care, the provision of appropriate assistance and support, and income generation. We relate our analysis to the recommendations made in the World Report on Disability but with a specific focus on ID in Africa. The need for mainstreaming and prioritising ID in non-disability related and across impairment programmes is highlighted. We note the importance of families and emphasise the need to draw on informal and traditional forms of care and participation. The need for reliable research evidence to support practice is highlighted. We conclude with a call to action by and on behalf of individuals with ID to be included in the development priorities of the continent.

• Implications for Rehabilitation

• Service provision for people with intellectual disabilities in Africa is not always well served by insights obtained from western research agendas.

• Appropriate and effective rehabilitation requires an understanding of the context and the environment in which the disabled person operates.

• Indigenous research into the provision of support to families and the inclusion of persons with intellectual disability into mainstream programmes as well as disability specific provision is recommended.