三种手术方式对腰椎间盘突出症临床疗效的影响

目的探讨三种手术方式对腰椎间盘突出症(LDH)临床疗效的影响。方法 2007年1月~2012年10月于我科行手术治疗LDH的患者中选择110例患者,男63例,女47例;年龄18~73岁,平均45岁;均为单节段椎间盘突出(L3/46例,L4/560例,L5/S144例)。分别采用腰椎间盘髓核摘除术(A组,40例)、椎间融合联合单侧椎弓根螺钉内固定(B组,51例)、腰椎间盘髓核摘除联合棘突间稳定装置X-STOP系统植入(C组,19例),3组患者一般资料比较差异均无统计学意义(0.05)。每位患者术前及术后末次随访时通过完成欧洲五维健康量表及进行Oswestry功能障碍指数评分,比较评分改善情况。结果 110例患者均获得随访,平均随访时间18个月(6~38个月),末次随访时EQ-VAS评分、EQ-5D健康指数和ODI评分组内比较均明显改善(0.05),组间比较均无统计学差异(0.05)。结论对于单纯LDH可行腰椎间盘髓核摘除术,LDH合并腰椎不稳者可行椎间融合+单侧椎弓根螺钉内固定,对于椎间盘突出合并椎管狭窄,尤其是临床症状在屈曲位缓解的患者尤其适宜椎间盘髓核摘除联合棘突间动态内固定。     

609例听力残疾与听力康复状况分析

目的：通过对参与评残资料较为完整的609例听力残疾状况分析,了解掌握听力残疾者现状,便于针对性的进行听力康复指导。方法收集听力残疾者的相关数据,主要致残原因等,采用GSI原61诊断型听力计,对听力残疾者进行纯音测听,按0.5、1.0、2.0、4kHz均值进行残疾评定,并根据听力残疾者状况给予相应的听力康复指导建议。结果609例中,听力残疾：一级393例(64.5%);二级104例(17.1%);三级81例(13.3%);四级31例(5.1%)。结论本组听力残疾者以一级残疾为多占64.5%,多数患者因听力损失较重而失去了听力康复机会,因此早期发现和诊断,早期听力补修,早期训练的三早原则是听力残疾者康复的重要保证。     

Using assistive technology for schoolwork: the experience of children with physical disabilities

Aim.?This study explored the experience of children with physical disabilities using assistive technology for participation with schoolwork to gain a greater understanding of their perspectives and subjective experiences.

Method.?A qualitative study involving thematic analysis of in-depth interviews of the child with a parent or significant adult. Purposeful sampling from a larger study recruited five children aged between 10 and 14 years, with differing physical disabilities who attended mainstream schools. All children used computer-based assistive technology.

Results.?All of the children recognised that assistive technology enabled them to participate and reduced the impact of their physical disability, allowing independent participation, and facilitated higher learning outcomes. Issues related to ease of use, social implications and assistive technology systems are discussed.     

Involving children in the development of assistive technology devices

Purpose.?To investigate the implementation of a web-based survey for involving children in the design of assistive technology devices within the primary school environment.

Method.?Children were recruited within their normal school environment. They completed tasks within the survey that sought to gather their personal preferences about assistive technology devices. From six primary schools, 257 children (mean age?=?9 years and 8 months, SD?=?1.51; 123 males, 134 females) including children with cerebral palsy (N?=?11), varying levels of deafness (N?=?7), global developmental delay (N?=?2) and Down's syndrome (N?=?1) participated. Observations were taken whilst the children completed the survey tasks.

Results.?All children were able to complete the tasks from the survey, although children with disabilities had higher completion times and most required a form of assistance from support assistants and/or sign language interpreters.

Conclusions.?The use of the web-based survey provided a novel means with which to involve children with and without disabilities in the design of assistive technology devices within a primary school environment. In order for the survey to be utilised more widely, issues that arose when involving children with disabilities need to be addressed.     

The World Report on Disability as a blueprint for international,national, and local aphasia services

Abstract

This commentary aims to extend the debate of the lead article authors () by translating the nine recommendations of the World Report on Disability into a plan of action for the aphasia community. Solutions for the advancement of aphasia science and services are presented at international (macro), national (meso), and local (micro) levels. Implications for speech-language pathologists and aphasia service delivery are discussed. An overarching call to action is the need for speech-language pathologists to support a strong and vibrant aphasia community at all levels, so that the voices of people with aphasia can be heard.     

An ecological approach to understanding barriers to employment for youth with disabilities compared to their typically developing peers: views of youth,employers, and job counselors

Abstract

Purpose: The purpose of this study is to explore the extent to which youth with physical disabilities encounter different barriers to finding employment compared to their typically developing peers. Methods: This study draws on 50 qualitative in-depth interviews with a purposive sample of 31 youth (16 typically developing and 15 with a disability), and youth employers and job counselors knowledgeable about employment readiness among adolescents (n?=?19). We utilize Bronfrebrenner’s ecological framework to reveal the complex web of factors shaping youth’s labor market outcomes. Results: Only half of youth with a disability were working or looking for work compared to their peers. The findings show this was a result of different expectations of, and attitudes toward, youth with disabilities. For many youth with a disability, their peers, family and social networks often acted as a barrier to getting a job. Many youth also lacked independence and life skills that are needed to get a job (i.e. self-care and navigating public transportation) compared to their peers. Job counselors focused on linking youth to employers and mediating parental concerns. Employers appeared to have weaker links to youth with disabilities. System level barriers included lack of funding and policies to enhance disability awareness among employers. Conclusions: Youth with physical disabilities encounter some similar barriers to finding employment compared to their typically developing peers but in a stronger way. Barriers to employment exist at several levels including individual, sociostructural and environmental. The results highlight that although there are several barriers to employment for young people at the microsystem level, they are linked with larger social and environmental barriers.

• Implications for Rehabilitation

• Clinicians working with youth should promote the development of skills that can lead to improved self-confidence and communication skills for youth. Encourage the development of extracurricular activities and social networking to build these skills and to make contacts for finding employment.

• Clinicians should support youth with disabilities and their parents in practicing independence skills (such as self-care, self-advocacy and navigating public transportation) they need prior to seeking employment.

• Vocational rehabilitation professionals should educate youth on how to disclose their condition to a potential employer, how to ask for ask for accommodations and how to market their abilities.

• Clinicians should help to link youth with disabilities to volunteer opportunities and to employers. Advocate for disability awareness training for employers regarding how to accommodate people with disabilities and the potential they offer in the workplace.

     

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.

     

GM3 synthase deficiency in non-Amish patients

PurposeBiallelic loss-of-function variants in ST3GAL5 cause GM3 synthase deficiency (GM3SD) responsible for Amish infantile epilepsy syndrome. All Amish patients carry the homozygous p.(Arg288Ter) variant arising from a founder effect. To date only 10 patients from 4 non-Amish families have been reported. Thus, the phenotypical spectrum of GM3SD due to other variants and other genetic backgrounds is still poorly known.MethodsWe collected clinical and molecular data from 16 non-Amish patients with pathogenic ST3GAL5 variants resulting in GM3SD.ResultsWe identified 12 families originating from Reunion Island, Ivory Coast, Italy, and Algeria and carrying 6 ST3GAL5 variants, 5 of which were novel. Genealogical investigations and/or haplotype analyses showed that 3 of these variants were founder alleles. Glycosphingolipids quantification in patients’ plasma confirmed the pathogenicity of 4 novel variants. All patients (N = 16), aged 2 to 12 years, had severe to profound intellectual disability, 14 of 16 had a hyperkinetic movement disorder, 11 of 16 had epilepsy and 9 of 16 had microcephaly. Other main features were progressive skin pigmentation anomalies, optic atrophy or pale papillae, and hearing loss.ConclusionThe phenotype of non-Amish patients with GM3SD is similar to the Amish infantile epilepsy syndrome, which suggests that GM3SD is associated with a narrow and severe clinical spectrum.     

Behavioural phenotype of a patient with a de novo 1.2 Mb chromosome 4q25 microdeletion

A female patient, 20 years of age, is reported with a history characterized by developmental and psychomotor delay, and during grammar-school period increasing learning problems, ritualistic behaviours and social withdrawal. Subsequently, challenging and autistic-like behaviours became prominent. The patient showed mild facial dysmorphisms, long thin fingers with bilateral mild short V metacarpals, and hyperlaxity of the joints. Neuropsychiatric examination disclosed obsessive, ritualistic behaviours and vague ideas of reference. Neuropsychological assessment demonstrated mild intellectual disability, mental inflexibility and incongruent affect. MRI-scanning of the brain showed no relevant abnormalities. Genome wide SNP array analysis revealed a 1.2 Mb de novo interstitial microdeletion in 4q25 comprising 11 genes, that was considered to be causative for the developmental delay, perseverative cognitive phenotype and dysmorphisms.To the authors knowledge, this is the first report of a de novo 4q25 microdeletion that presents with a specific behavioural phenotype.