Disabled people say 'Nothing about us without us'

Nutritional Intake and Sensory Processing in School-Aged Children with Autism Spectrum Disorder

Background: Individuals diagnosed with autism spectrum disorder (ASD) commonly experience sensory processing that differs from general-population norms, and the autistic lived experience of eating includes preferences for routine, and sensory processing difficulty related to scents, tastes, temperatures, and textures of food. Meanwhile, research indicates that nutrients involved in one-carbon metabolism (OCM) may be related to sensory processing. Methods: This study enrolled 33 school-aged children with autism to assess whether OCM nutrient intake is associated with sensory processing. Parents completed two parent-report assessments: the youth and adult food frequency questionnaire (YAFFQ), and a sensory processing tool, Sensory Profile 2 (SP2). Results: Participant data showed generally good nutritional profiles mirroring those of general-population U.S. children. A group-binarized linear regression model showed the following relationships (p < 0.05): vitamin B12 consumption had a negative association with the SP2 Oral and Sensor domain scores. Choline intake had a positive association with the SP2 Avoider domain score. Vitamin B1 showed a positive association with the SP2 Visual domain score. Conclusions: These results support the possible existence of a relationship between sensory symptoms and OCM nutrient consumption levels in school-aged children diagnosed with autism. Future research is needed to confirm and explore the potential for causality.

Exploring therapeutic alliance in spinal cord injury rehabilitation: Control, identity, and liminality

BACKGROUND

The therapeutic alliance (TA) has emerged as a key principle in enhancing the quality of health and rehabilitation services.

PURPOSE

This study aimed to explore patient perspectives on the influence of TAs with practitioners during inpatient rehabilitation following spinal cord injury (SCI).

METHODS

Using a qualitative methodology, (n = 18) in-depth interviews were conducted with inpatient participants. Interviews were transcribed verbatim and analyzed using reflective thematic analysis. The study was grounded in a social constructionist epistemology, employing theories of liminality and psychotherapy as theoretical frameworks.

RESULTS

Patient narratives suggest TAs are central to the rehabilitation experience. Additionally, analysis of patient stories revealed that patients entered a state of liminality upon admission. The primary theme, "Control as Enabling: Transition, the Marge," highlighted during rehabilitation, patients navigated an identity separation and transition phase central to liminal spaces. Where practitioners accommodated patients' identity journeys, meaningful TAs were established, enhancing rehabilitation. Conversely, when control was constrained, TAs weakened, increasing identity risks. TAs were found to be instrumental in protecting and preserving pre-SCI identity as well as facilitating movement through the liminal phase.

CONCLUSION

This research underscores the significance of TAs in SCI rehabilitation, demonstrating their role in enabling patient control, safeguarding identity, and facilitating the potential exit from liminality. To address the unique needs of SCI patients, it is recommended that SCI practitioners receive specialized TA training and professional development.

Disability-Specific Education in US Internal Medicine Primary Care Residency Programs: A Survey of Program Directors

Phenomenon: The dearth of disability-specific education in United States medical schools and residency programs has perpetuated health care inequities experienced by people with disabilities. In this study, we surveyed internal medicine primary care residency program directors about the disability-specific education they offer their learners, their attitudes toward physicians' preparedness to care for people with disabilities, and their perceived challenges to offering more robust disability-specific education. Approach: We developed an on-line survey and forwarded it in 3 weekly emails during October of 2022 to 104 primary care residency program directors. We collected basic information about the residency programs and queried whether they were providing disability-specific education to their residents, which topics were being covered, and perceived barriers to offering additional disability-focused curricula. Data analyses included descriptive statistics, chi-squared, and independent samples t-tests. Findings: Forty-seven program directors responded (response rate 45.2%). The largest plurality of programs was in the Northeast, their average number of primary care residents was 15.6, most (67.4%) hosted primary care clinics in hospitals or academic centers, and 55.6% had affiliated divisions or departments of rehabilitation medicine. The majority of respondents felt that both internists and their own residents (88.3% and 77.8%, respectively) are inadequately educated in the care of people with disabilities, yet only 13 (28.9%) offered disability-focused curricula, and they tended to be narrow in scope. Only 8 of those 13 respondents (61.5%) reported that their disability curricula were required, rather than optional. Participants listed a number of barriers to implementing disability-focused education including a lack of advocacy for such work (65.2%), lack of time in the curriculum (63.0%), lack of expectation by educational governing boards that physicians understand disability-specific care considerations (60.9%), and lack of affiliated expertise in the care of people with disabilities (52.2%). Insights: While the program directors training future primary care physicians largely understand that physicians are inadequately prepared to offer equitable health care to individuals with disabilities, few of them are offering disability-specific education to their residents and most see significant barriers to doing so.

How to maximise asynchronous video resources that have been co-produced with patient partners

Ensuring that health professional education is person centred is vital in the pursuit of person-centred clinical care. However, the volume of person-centred care content varies broadly in health professional education. One acknowledged approach to designing curriculum that is person-centred is to embed resources that have been co-produced by patients with lived and living experience. In this article, we aim to provide a guideline for the inclusion of asynchronous interdisciplinary video resources that have been co-produced by patients with lived and living experience.

Attitudes towards people with disabilities across different healthcare undergraduate students: A cluster analysis approach

BACKGROUND AND PURPOSE

Negative attitudes towards disability amongst healthcare professionals endanger social inclusion of people with disabilities (PwD). This study aimed to investigate the attitude of undergraduate healthcare students of various disciplines towards PwD, including specific aspects of their attitude.

METHODS

We assessed the attitudes of university students, including physiotherapy, speech therapy, nursing, social work and medical students, through the Greek Interaction with Disabled Person Scale (IDPS) in a survey. Data were analysed using a two-step clustering technique.

RESULTS

Four hundred-eighty undergraduate healthcare students (21.4 ± 5.3 years-old; 135 males, 345 females) were recruited. Two-step cluster analysis identified three homogenous subgroups labelled Least positive attitude (42.3%), Moderately positive attitude (26.9%), and Most positive attitude (30.8%) groups. Τhe main differences in healthcare students' attitudes between the three distinct groups appeared to be in feelings of sympathy, fear and susceptibility towards disability, suggesting that these aspects of attitude needed to be primarily addressed. Results also revealed that females, being in higher semester/year of studies, having completed a clinical module with PwD and having frequent contact with PwD were related to more positive attitudes.

CONCLUSION

Taking into account that the majority of the healthcare students' sample yielded least and moderately positive attitudes, towards PwD, further actions should be taken for promoting more positive attitudes towards disability. A social model in teaching to increase student's awareness of PwD and skills to work with these people, having PwD themselves teaching such modules, focussing on positive experiences and reminding the students of the benefits of having positive attitudes towards PwD, as well as promoting ways to increase the contact of healthcare students with PwD (such as teaching in co-operation with organisations of PwD or finding alternative clinical placements with PwD), can be beneficial in promoting more positive attitudes towards disability.

Using a community-based system dynamics approach for understanding inclusion and wellbeing: a case study of special needs education in an eastern African refugee camp

BACKGROUND

Children with disabilities face unique challenges in humanitarian aid settings and education may provide protective measures against abuse and exploitation. There are growing calls for inclusive education of children with disabilities in formal education, but little guidance exists on how to enhance inclusion in complex and resource-constrained contexts of humanitarian settings.

CASE PRESENTATION

This study used a community-based system dynamics approach to understand key stakeholders' perspectives of the drivers and effects of inclusion and wellbeing for children with disabilities, and to elicit recommendations to enhance educational inclusion in a refugee camp in Eastern Africa. Community-based system dynamics sessions, designed based on group model building scripts and facilitated by a team of four people, took place with organization staff, community leaders, and parents and caregivers of children with disabilities. The process produced a causal loop diagram depicting the stakeholders' perspectives of how multiple components interact in a system to drive inclusion and wellbeing of children with disabilities over time.

CONCLUSIONS

Findings indicate participants have a broad conceptualization of inclusion, highlighting the value of community interaction and importance of meeting basic needs, and also demonstrate that including children in mainstream educational settings in a complex humanitarian context requires a more nuanced approach given the lack of existing resources to support Western models of educational inclusion fully.

In silico Gene Set and Pathway Enrichment Analyses Highlight Involvement of Ion Transport in Cholinergic Pathways in Autism: Rationale for Nutritional Intervention

Food is the primary human source of choline, an essential precursor to the neurotransmitter acetylcholine, which has a central role in signaling pathways that govern sensorimotor functions. Most Americans do not consume their recommended amount of dietary choline, and populations with neurodevelopmental conditions like autism spectrum disorder (ASD) may be particularly vulnerable to consequences of choline deficiency. This study aimed to identify a relationship between ASD and cholinergic signaling through gene set enrichment analysis and interrogation of existing database evidence to produce a systems biology model. In gene set enrichment analysis, two gene ontologies were identified as overlapping for autism-related and for cholinergic pathways-related functions, both involving ion transport regulation. Subsequent modeling of ion transport intensive cholinergic signaling pathways highlighted the importance of two genes with autism-associated variants: GABBR1, which codes for the gamma aminobutyric acid receptor (GABAB 1), and KCNN2, which codes for calcium-activated, potassium ion transporting SK2 channels responsible for membrane repolarization after cholinergic binding/signal transmission events. Cholinergic signal transmission pathways related to these proteins were examined in the Pathway Studio environment. The ion transport ontological associations indicated feasibility of a dietary choline support as a low-risk therapeutic intervention capable of modulating cholinergic sensory signaling in autism. Further research at the intersection of dietary status and sensory function in autism is warranted.

Design journey of an affordable manual standing wheelchair

PURPOSE

Only 1 in 10 people with disabilities can access assistive devices, underlining the critical need for low-cost assistive products. This paper describes the design evolution of a manual user-operated standing wheelchair (SWC), translating from prototype to product.

METHODS

The SWC design has been refined over 5 years through multiple iterations based on comments from user trials. The SWC product, Arise, provides standing functionality, facile outdoor mobility, affordability, customisability, and is aesthetically pleasing. A one-time fitting and training ensure optimal effort for operation, correct posture, and comfortable user experience. The SWC accommodates users of different sizes and body weights (up to 110 kg) and minimises user effort with the use of a gas spring. Incorporating discrete adjustments enables customisation while retaining the advantages of mass manufacturing, which is necessary for ensuring affordability.

RESULTS

The SWC has been field-tested and well received by over 100 wheelchair users, and Arise was launched recently by the industry partner.

CONCLUSIONS

It should be noted that RESNA cautions on the use of any standing device without medical consultation. Nevertheless, with appropriate dissemination and awareness, it is anticipated that the affordable SWC product, Arise, will immensely benefit the eligible users and make a difference in their quality of life.Implications for RehabilitationProvides standing functionality, outdoor mobility, affordability and customisabilityAccommodates users of different sizes and body weights in a mass-manufacturable designErgonomic design reduces net user effort during sit-to-stand, stand-to-sit activityDesign iterated and refined based on feedback from over 100 user trials.

Educating health science students about disability: Teachers' perspectives on curricular gaps

BACKGROUND

People living with disabilities are significantly more likely than their peers to find health professionals' skills and facilities inadequate. The 66th World Health Assembly called for better health care for people with disabilities including more inclusive health services and a stronger focus on professional training.

OBJECTIVE

To explore how teachers at a New Zealand university perceived the need, approaches, and systemic challenges to enhance disability education for health professionals in training.

METHODS

Qualitative analysis of interviews with 11 key informants teaching in population health, medicine, nursing, pharmacy, and optometry training programmes. Transcribed interview recordings were analysed using a general inductive approach.

RESULTS

The participants described a range of teaching approaches that they used to increase disability awareness among their students. However, these were largely ad hoc individually driven initiatives reflecting personal interests. Participants identified a critical need to develop and implement a systematic, integrated approach to enhance disability education particularly from a social justice perspective among students in health disciplines. Engaging people with lived experience of disability in teaching and course design, and senior administrative commitment were identified as necessary to address current gaps in education.

CONCLUSIONS

In order to develop a health professional workforce competent to respond to the needs of people with disabilities, greater attention is required at a strategic level to enhance the profile of disability education in health curricula. Meaningful engagement of people with disability and senior leadership commitment are critical components that can enable effective progression of this agenda.

Signaling Inclusivity in Undergraduate Biology Courses through Deliberate Framing of Genetics Topics Relevant to Gender Identity, Disability, and Race

The study of genetics centers on how encoded information in DNA underlies similarities and differences between individuals and how traits are inherited. Genetics topics covered in a wide variety of undergraduate biology classrooms can relate to various identities held by students such as gender identity, disability, and race/ethnicity, among others. An instructor's sensitive approaches and deliberate language choices regarding these topics has the potential to make the critical difference between welcoming or alienating students and can set a tone that communicates to all students the importance of diversity. Separating the sperm/egg binary from gendered terms in coverage of inheritance patterns, along with inclusion of transgender people in pedigree charts, may make the classroom more welcoming for students of diverse gender identities. Choosing nonstigmatizing language and acknowledging disability identities in discussions of genetic conditions may help students with visible and invisible disabilities feel validated. Counteracting genetics-based pseudoscientific racism and the stereotype threat to which it contributes may be facilitated by more thorough integration of quantitative and population genetics topics. Instructors may thus potentially enhance retention of students of diverse backgrounds in biology through careful consideration and crafting of how human differences are described and connected with principles of genetics.