Exploring the Integration of Disability Awareness into Tertiary Teaching and Learning Activities

A desire to have every student attending our University be aware of, and reflect on, disability in their studies and future careers, initiated our project to explore how to enhance disability awareness within all our University’s papers. In this project we systematically reviewed pertinent literature and ran an action research workshop for staff. Strategies to enhance disability awareness identified in the literature and workshop were presented and verified at an interactive conference presentation. Embedding disability awareness into curricula is challenging; staff considered themselves powerless to bring about change in their departments, but thought that one way to do so would be by modelling inclusive behaviour and by introducing subtle inclusive practices into papers taught. The identified strategies may be of use to others contemplating similar curricular modifications

Community Peer-Led Exercise Groups: Reasons for Success

Purpose: This paper considers reasons for the successful maintenance of community based, falls-prevention programs. While the physical achievement of such programs has been demonstrated through randomized trials, other features influential in ongoing membership have received less attention. This study examined the sustainability of a specific model of a community-based program in a New Zealand city: SAYGO, the strength and balance classes for older adults lead by older volunteer leaders recruited from local communities. Method: A qualitative, descriptive approach was used and first-hand knowledge of the experiences of those involved in the groups gathered. Data collection methods included individual interviews of two group organizers and seven focus groups: six with the members of the exercise groups (57 participants) and one with the peer leaders from these same groups (6 participants). Results: Three major themes emerged from the interviews. Two were related to the outcomes of the groups (ie. physical and social benefits). The third was concerned with the support needs of the groups to ensure their on-going maintenance. The aspect that most invigorated the participants was the social value of the group. Conclusions: A major feature that contributed to the sustainability of the peer led exercise groups was the positive social connectedness created by the modeling of a caring culture by the peer-leaders. This caring culture involves support and inclusion of every member and acting as a resource and confidant for individual issues. Because group leaders are similar in age and physical problems, it is expected that they will empathize with participants, and because of their community and agency links, it is expected that they will be able to act as a resource for information on issues related to the participants, therefore, stand between the formal and informal domains and are perceived to have knowledge and connections in both. This, we suggest, is a major, previously unconsidered feature in the sustainability of these groups

The Utility and Value of The Physiotherapy eSkills Training Online Resource During Work-integrated learning: A mixed methods study.

ABSTRACT Purpose: The purpose of this study was to determine the use and value of the Physiotherapy eSkills Training Online resource during work-integrated learning in naïve physiotherapy students. Method: A mixed methods study design was used. Participants: Forty-four final year physiotherapy students participating in neurological work-integrated learning units of study participated in this study. Intervention: Students had access to the Physiotherapy eSkills Training Online resource during their 6-week neurological work-integrated learning unit of study, which includes video footage and written information about 25 practical skills related to the physiotherapy management of stroke. Outcome Measures: Use of the Physiotherapy eSkills Training Online resource was examined by recording the number of hits on the resource, the number of students who accessed it, the number of times each student accessed it, and the time it was accessed. Students’ perception of the value of the resource was explored through semi-structured interviews. Results: There were 46 hits on the resource, by 13 (30%) students during the neurological work-integrated learning unit of study. Ten students accessed the resource twice or more. Double the number of hits occurred outside of work hours compared with during work hours. Qualitative analysis revealed five themes regarding the low usage of the resource by students: content of the resource; learning style; learning behavior and expectations; technical issues; and practical issues. Conclusion: Use of the resource was low, with only a small number of students using the resource on a few occasions. Value of the resource could not be clearly established

CD34+ Hematopoietic Progenitor Cell Selection of Bone Marrow Grafts for Autologous Transplantation in Pediatric Patients

AbstractCD34+-selection of hematopoietic grafts for patients undergoing autologous hematopoietic stem cell transplantation (HSCT) is frequently used to obtain a tumor-free graft. The majority of published experience is with peripheral blood stem cell (PBSC) products; only scant information has been published on bone marrow (BM) grafts. We reviewed our experience using CD34+ selection of BM grafts in children undergoing autologous BM transplantation. After obtaining institutional approval, we performed a retrospective review of the medical records of patients who underwent autologous stem cell collection at St. Jude. From January 1, 1999, to December 31, 2003, 373 patients underwent autologous HSCT; 131 received marrow grafts, 237 received PBSC grafts, and 5 received a combination. Seventeen patients underwent BM harvests for CD34+ selection of their stem cell grafts. Sixteen patients received 19 CD34 purified grafts processed on the Isolex 300i Magnetic Cell Selection System® device. Four patients were not included in the engraftment analysis as 1 did not receive the collected product, 1 received a tandem product, and 2 received products that were composed of 2 or 3 combined purified products. Following selection, marrow grafts contained a median of 1.4 × 106 CD34+ cells/kg (range: 0.09-8.3 × 106/kg) and a median of 0.014 ×108 total nucleated cell cells/kg (range: 0.001-0.09 × 108/kg). The median CD34% recovery was 30.9% (range: 9.3%-57.1%), with the median CD34 purity being 95.5% (range: 62.2%-98.8%). All patients engrafted. The median time to absolute neutrophil count ≥500/mm3 was 19 days (range: 12-35 days), and to platelet recovery was 28 days (range 18-37 days). No patient died from transplant-related complications. Our study demonstrates that CD34+-selection of marrow grafts is feasible, and these grafts are able to successfully reconstitute hematopoiesis in patients undergoing autologous BMT

Supported self-management in long-term conditions in an African context

Self-management is an important strategy to improve quality of life, appropriately manage long-term health conditions, and reduce the economic burden of long-term health conditions. However, equitable healthcare access remains an issue, and the focus on ‘self’ in self-management is problematic. Our review aims to explore the conceptualisation and evolution of supported self-management in an African context and its relevance to physiotherapy. A state-of-the-art review of the literature was undertaken by the authors. The authors knowledge of the subject area and a database search retrieved recent articles exploring patients’ and healthcare providers’ understanding of supported self-management in Africa. Relevant articles were read, and data summaries of included studies were extracted and tabulated. Findings were organised deductively. Sixteen studies, 11 primary research, and 5 reviews (2016–2023) undertaken in a variety of sub-Saharan countries with healthcare workers (~n = 177) and people (~n = 16 115) living with a mix of non-communicable and communicable conditions were considered in this state-of-the-art review. Self-management perceptions were drawn from Western authors spanning development research and understanding of the concepts in Western thinking. We conclude that imported concepts, such as supported self-management for long-term conditions, should be considered within local health delivery solutions. These should be embedded in an understanding of traditional African health systems. Clinical implications: There is a need to develop locally derived African solutions. Self-management strategies for long-term health conditions should be developed, considering traditional holistic African health systems

Balance assessment in Multiple Sclerosis and cerebellar ataxia: rationale, protocol and demographic data

A core set of standardized balance measures are required for use in rehabilitation among people with multiple sclerosis (MS) and cerebellar ataxia. An earlier systematic review and Delphi survey identified the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), Posture and Gait sub-component of the International Co-operative Ataxia Rating Scale (PG of ICARS) and the gait, sitting and stance sub-components of the Scale for the Assessment and Rating of Ataxia (SARA Bal) as suitable balance measures. This study aims to estimate the reliability, validity and interpretability of these measures. This study will recruit 60 participants with multiple sclerosis with secondary cerebellar involvement across four centres in New Zealand and the United States of America. Participants will be assessed and videotaped performing the BBS, TUG, SARA Bal and PG of ICARS by trained physiotherapists. Barthel Index, Expanded Disability Status Scale (EDSS), Disease duration, ICARS and SARA will also be assessed to determine validity. A second assessment to determine reliability will be conducted by assessors watching the video-recording. Data collection is in progress, 44 samples have been collected and the demographic data are presented. The findings of this study will recommend a core set of reliable, valid and interpretable measures that are suitable for clinical practice and research for the assessment of balance among adults with MS and cerebellar ataxia. Minimal Clinically Important Difference (MCID) and cut-off scores to predict the use of assistive walking device will be established

Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey

Background: Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted. Objective: To investigate which physical, personal, and amputee-specific factors predicted presence and intensity of low back pain (LBP) in persons with non-dysvascular transfemoral (TFA) and transtibial amputation (TTA). Design: A retrospective cross-sectional survey. Setting: A national random sample of people with non-dysvascular TFA and TTA. Participants: Participants (N = 526) with unilateral TFA and TTA due to non-dysvascular aetiology (i.e. trauma, tumours, and congenital causes) and a minimum prosthesis usage of one year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis Methods (Independent variables): Personal (i.e. age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (i.e. level of amputation, years of prosthesis use, presence of phantom limb pain, residual limb problems, and non-amputated limb pain), and physical factors (i.e. pain provoking postures including standing, bending, lifting, walking,sitting, sit-to stand, and climbing stairs). Main outcome measures (Dependent variables): LBP presence and intensity. Results: A multivariate logistic regression model showed that the presence of two or more comorbid conditions (prevalence odds ratio (POR) = 4.34, p = .01), residual limb problems (POR 22 = 3.76, p<.01), and phantom limb pain (POR = 2.46, p = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of PORand the results must be interpreted with caution. In those with LBP, the presence of residual limb problems (beta = 0.21, p = .01), and experiencing LBP symptoms during sit-to-stand task (beta = 0.22, p = .03) were positively associated with LBP intensity, while being employed demonstrated a negative association (beta = - 0.18, p = .03) in the multivariate linear regression model. Conclusions: Rehabilitation professionals should be cognisant of the influence that comorbid conditions, residual limb problems, and phantom pain have on the presence of LBP in people with non-dysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP

Disease risk analysis in sea turtles: a baseline study to inform conservation efforts

The impact of a range of different threats has resulted in the listing of six out of seven sea turtle species on the IUCN Red List of endangered species. Disease risk analysis (DRA) tools are designed to provide objective, repeatable and documented assessment of the disease risks for a population and measures to reduce these risks through management options. To the best of our knowledge, DRAs have not previously been published for sea turtles, although disease is reported to contribute to sea turtle population decline. Here, a comprehensive list of health hazards is provided for all seven species of sea turtles. The possible risk these hazards pose to the health of sea turtles were assessed and “One Health” aspects of interacting with sea turtles were also investigated. The risk assessment was undertaken in collaboration with more than 30 experts in the field including veterinarians, microbiologists, social scientists, epidemiologists and stakeholders, in the form of two international workshops and one local workshop. The general finding of the DRA was the distinct lack of knowledge regarding a link between the presence of pathogens and diseases manifestation in sea turtles. A higher rate of disease in immunocompromised individuals was repeatedly reported and a possible link between immunosuppression and environmental contaminants as a result of anthropogenic influences was suggested. Society based conservation initiatives and as a result the cultural and social aspect of interacting with sea turtles appeared to need more attention and research. A risk management workshop was carried out to acquire the insights of local policy makers about management options for the risks relevant to Queensland and the options were evaluated considering their feasibility and effectiveness. The sea turtle DRA presented here, is a structured guide for future risk assessments to be used in specific scenarios such as translocation and head-starting programs

Disease risk analysis in sea turtles: a baseline study to inform conservation efforts

The impact of a range of different threats has resulted in the listing of six out of seven sea turtle species on the IUCN Red List of endangered species. Disease risk analysis (DRA) tools are designed to provide objective, repeatable and documented assessment of the disease risks for a population and measures to reduce these risks through management options. To the best of our knowledge, DRAs have not previously been published for sea turtles, although disease is reported to contribute to sea turtle population decline. Here, a comprehensive list of health hazards is provided for all seven species of sea turtles. The possible risk these hazards pose to the health of sea turtles were assessed and “One Health” aspects of interacting with sea turtles were also investigated. The risk assessment was undertaken in collaboration with more than 30 experts in the field including veterinarians, microbiologists, social scientists, epidemiologists and stakeholders, in the form of two international workshops and one local workshop. The general finding of the DRA was the distinct lack of knowledge regarding a link between the presence of pathogens and diseases manifestation in sea turtles. A higher rate of disease in immunocompromised individuals was repeatedly reported and a possible link between immunosuppression and environmental contaminants as a result of anthropogenic influences was suggested. Society based conservation initiatives and as a result the cultural and social aspect of interacting with sea turtles appeared to need more attention and research. A risk management workshop was carried out to acquire the insights of local policy makers about management options for the risks relevant to Queensland and the options were evaluated considering their feasibility and effectiveness. The sea turtle DRA presented here, is a structured guide for future risk assessments to be used in specific scenarios such as translocation and head-starting programs