"I miss work:" employment experiences and attitudes of adults with acquired disabilities who use assistive technologies

PURPOSE

This study explored employment experiences and attitudes of adults who acquired mobility, motor, and/or communication disabilities and who use assistive technologies.

MATERIALS AND METHODS

Semi-structured interviews were conducted with seven adults about their employment experiences after acquiring their disabilities. After analysis of interview results, six participants completed surveys about their attitudes towards crowdsourcing and remote work.

RESULTS

Findings indicate that adults can continue working with accommodations when they feel supported and valued by their employer. However, participants frequently compared their pre-disability work performance with their post-disability performance and at times, left work because they did not feel they were performing to their own expectations, regardless of the support of their employer. Participants experienced feelings of loss, regret, and identity change after acquiring their disabilities and after leaving work. Most participants did not have specific knowledge of available work alternatives which could accommodate their health and accessibility needs. When presented with accessible work alternatives, the majority of participants increased their interest in learning more about those options.

CONCLUSIONS

Whether through work or other pursuits, individuals in this population retain a strong desire to participate and contribute to society. However, it should not be assumed that adults with acquired disabilities are inherently aware of available, alternative options to traditional work. Future research on increasing awareness of accessible options for societal engagement for this population should be explored.

The burden of global outbreaks: Photos of the daily lives of children with congenital Zika syndrome during the COVID-19 pandemic

INTRODUCTION

In Brazil, more than 3500 children with congenital Zika syndrome (CZS) face difficulties participating in activities of daily living, which may be aggravated by health emergencies, such as the COVID-19 pandemic. Participation could be defined as the individual's involvement in daily life situations, and participation restrictions are problems that may arise in involvement in everyday situations.

AIM

To explore the daily lives of children with CZS during the COVID-19 pandemic using photographic narratives captured by mothers and discuss possible strategies to improve participation results.

METHODS

In this participatory action research, seven young Brazilian mothers acted as co-researchers using photovoice to describe the experiences of their children with CZS (from 2 to 5 years old). Also, mothers contributed to validate the contents. The research was conducted online and included the following steps: pilot study, recruitment, individualized training, sociodemographic interview, photovoice training, photo taking, focus group for contextualization, data transcription and analysis and validation of analyses by the mothers.

RESULTS

Content analysis revealed five categories that influenced the participation of the children: participation preferences, family relationships, access to healthcare, access to education and social isolation. Regarding participation preferences, mothers reported their children's desire to play with peers and family members and have autonomy. Mothers described the family environment as a happy, peaceful and safe place for the children. Lack of therapy was perceived to negatively impact the health of children; thus, treatments were considered essential for child development. Access to education included accessibility of remote education and a perceived lack of infrastructure and pedagogical preparation. Last, social isolation due to COVID-19 directly affected the daily lives and behaviour of the children, interrupting therapies and medical appointments.

CONCLUSION

The photos and narratives captured several aspects of the daily lives of children with CZS impacted by the COVID-19 pandemic, reinforcing the importance of considering the negative effects of social isolation and offering education and social assistance to promote participation and integral health.

PATIENT/PUBLIC CONTRIBUTION

Consistent with a participatory action research framework, Mothers acted as co-researchers and participated in all stages of the research, especially in validating the data analysed by the researchers.

Antifat Bias of OT and Physical Therapy Assistants

Date Presented 04/01/2022

Health care professionals’ antifat bias results in substandard quality of care that contributes to health disparities. OT and physical therapy assistants are key stakeholders in rehabilitation; however, little research examines these clinicians’ antifat bias. This study examined OT assistant and physical therapy assistants’ explicit and implicit antifat bias and find that the majority hold antifat bias with demographics and beliefs correlating with the findings.

Primary Author and Speaker: Laura Vanpuymbrouck

Contributing Authors: Carli Friedman, Heather Feldner

Ableism of OT and Physical Therapy Assistants

Date Presented 04/02/2022

Bias in health care contributes to health disparities of people with disabilities (PWD). OT and physical therapy assistants are key stakeholders in rehabilitation; however, little research examines these clinicians’ bias toward PWD. This study examined OT and physical therapy assistants’ explicit and implicit disability bias, and the results show that the majority are implicitly biased toward PWD despite the majority being explicitly not biased. Implications and recommendations on approaches to address concern are discussed.

Primary Author and Speaker: Laura Vanpuymbrouck

Contributing Authors: Carli Friedman, Heather Feldner

Anti-Fat Biases of Occupational and Physical Therapy Assistants

Fat people are highly stigmatized, and anti-fat bias is pervasive resulting in stigma, prejudice, and discrimination, including in health care. The aim of this study was to explore occupational and physical therapy assistants' anti-fat biases. We analyzed secondary weight implicit association tests from 5,671 occupational/physical therapy assistants. The overwhelming majority (82%) of occupational/physical therapy assistants were implicitly prejudiced against fat people. Interventions for occupational/physical therapy assistants' anti-fat biases are critical, especially with increasing prevalence and responsibilities of occupational/physical therapy assistants in the provision of rehabilitation services.

Evaluation of a passive pediatric leg exoskeleton during gait

BACKGROUND

Children with hemiparesis are commonly prescribed ankle foot orthoses to help improve gait; however, these orthoses often result in only small and variable changes in gait. Research with adult stroke survivors has suggested that orthoses that extend beyond the ankle using long, passive tendon-like structures (i.e. exotendons) can improve walking.

OBJECTIVES

The aim of this study was to quantify the impact of an exotendon-based exoskeleton on pediatric gait.

STUDY DESIGN

Repeated-measures study.

METHODS

Two typically-developing children and two children with hemiparesis completed a gait analysis, walking without and with the exoskeleton. The exotendon was tested at three stiffness levels.

RESULTS

All children were able to walk comfortably with the exoskeleton, with minimal changes in step width. Walking speed increased and lower limb joint symmetry improved for the children with hemiparesis with the exoskeleton. Each participant had changes in muscle activity while walking with the exoskeleton, although the impact on specific muscles and response to exotendon stiffness varied.

CONCLUSION

Exotendon-based exoskeletons may provide an alternative solution for optimizing gait in therapy and in the community for children with hemiparesis. Determining the optimal stiffness and configuration for each child is an important area of future research.

Explicit and implicit disability attitudes of healthcare providers

PURPOSE/OBJECTIVE

Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers' clinical decision making, less research has focused on providers' attitudes about disability. The aim of this study was to examine providers' explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people's explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna's (2008) model of two-dimensional prejudice to compare provider's explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers' explicit and implicit attitudes.

RESULTS

While on average, provider's explicit attitudes (M = 4.41) indicated little prejudice, their implicit attitudes (M = 0.54) revealed they moderately preferred nondisabled people-they were aversive ableists. Correlates of providers' explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability).

CONCLUSIONS/IMPLICATIONS

This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study's findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impacts of early powered mobility provision on disability identity: A case study

BACKGROUND/PURPOSE

Providing powered mobility technology to people with disabilities is a common rehabilitation practice. However, the relationship between powered mobility introduction and identity development, when considered in the context of lived experiences of children with disabilities and their families, is not well understood. Investigating this relationship is timely given the emergence of alternative, community-based early mobility opportunities using adapted mobility toys whose impact may contrast experiences using powered wheelchairs typically provided in rehabilitation settings.

METHOD

Using a qualitative, ethnographic case study approach, in-depth interview and field observation data were collected with 2 children and families, 1 who received a traditional powered wheelchair and the other who received an adapted mobility toy. A grounded theory approach guided the data analysis, and emerging themes were discussed until consensus was reached between Heather Feldner and families.

RESULTS

Findings revealed four themes: (1) dys/function of mobility technology; (2) daily Life, play, and participation; (3) emerging self/advocacy; and (4) complex family/industry interplay.

CONCLUSION

Similarities and differences were present within the situated experiences of each family. Experiences were foregrounded by instances of emerging identity development throughout provision processes that were influenced by caregiver perceptions of disability (positive vs. negative), aesthetics and function (medical vs. adventure), and perceived intent of the devices (an opportunity for freedom vs. prolonging need for undesired mobility equipment). These findings highlight the varied dynamics and spheres of influence this transaction may have on the developing identity of children with disabilities, which may ultimately help inform future models of provision and rehabilitation practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

EXERCISE, MANUAL THERAPY AND POSTURAL RE-EDUCATION FOR UNCONTROLLED EAR TWITCHING AND RELATED IMPAIRMENTS AFTER WHIPLASH INJURY: A CASE REPORT

BACKGROUND AND PURPOSE

Whiplash Associated Disorders and the interventions used to remediate them are well documented in physical therapy literature. However, specific interventions for spasms of the neck musculature that also involve constant ear twitching have yet to be addressed. The purpose of this case report is twofold. First, to describe comprehensive physical therapy management and outcomes for a subject with uncontrolled ear twitching and related musculoskeletal impairments, and second, to discuss the physical therapist's approach to evidence-based care when faced with a paucity of literature addressing physical therapy interventions for subjects with uncontrolled ear twitching.

CASE DESCRIPTION

The subject was a 14-year-old female who sustained a right anterolateral whiplash injury when struck in the head by a volleyball seven months prior to physical therapy. Beginning five months after that injury, she experienced uncontrolled and constant superior/inferior movement of her right ear (hereafter described in this report as a twitch) in addition to facial and cervical pain from her initial injury. She was unable to participate in high school athletics due to her pain. A multimodal treatment approach including exercise, manual therapy, and postural reeducation was utilized during the subject's episode of care.

OUTCOMES

After eight treatment sessions, the subjects's cervical range of motion and upper extremity strength improved. The reported frequency of ear twitching decreased, as did reports of neck and shoulder pain. In addition, her Neck Disability Index improved from a score of 22, indicating moderate disability, to 9, indicating mild disability and she was able to return to sport activity.

DISCUSSION

With limited research to direct intervention, clinical reasoning was utilized to formulate an effective therapeutic intervention. A combination of manual therapy, exercise, and postural reeducation intervention was effective for this subject and could assist in guiding interventions for similarly unique clinical presentations in the future. Further research is needed to examine the etiology of ear twitching caused by muscle spasm and to develop additional evidence-based interventions for Whiplash Associated Disorders.

LEVEL OF EVIDENCE

Level 4.

Sensitization to storage mites in house dust mite (Dermatophagoides pteronyssinus) allergic patients. Comparison of a rural and an urban population

In this study, sera collected from 50 patients (24 females, 26 males) with Type I allergy to house dust mite (Dermatophagoides pteronyssinus) were investigated for IgE antibodies specific for eight different mite species including storage mites of the families Pyroglyphidae, Glycyphagidae and Acaridae. According to their environment the patients were divided into two groups. Group I consisted of 24 (11 women, 13 men) farmers working and living in rural regions of Austria (Styria, Lower Austria), group II included 26 citizens of Vienna (13 women, 13 men). As expected, RAST investigations revealed a higher rate of sensitization to storage mites in the farmer group. Comparing the two patient groups, sensitization to Lepidoglyphus destructor and Tyrophagus putreus was markedly increased in the farmer group. However, the sensitization rate to storage mites was also considerably high in city dwellers. Elevated levels of IgE specific for Euroglyphus maynei were more frequently observed in the urban collective. RAST-inhibition experiments suggest a partial crossreactivity between house dust mites and storage mites. In their living environment, patients with perennial Type I allergy are exposed to multiple different mite-derived allergens in addition to the well-known house dust mite allergens. These allergens lead to sensitization and are therefore of clinical importance.

Sensitization to storage mites in house dust mite (Dermatophagoides pteronyssinus) allergic patients. Comparison of a rural and an urban population

In this study, sera collected from 50 patients (24 females, 26 males) with Type I allergy to house dust mite (Dermatophagoides pteronyssinus) were investigated for IgE antibodies specific for eight different mite species including storage mites of the families Pyroglyphidae, Glycyphagidae and Acaridae. According to their environment the patients were divided into two groups. Group I consisted of 24 (11 women, 13 men) farmers working and living in rural regions of Austria (Styria, Lower Austria), group II included 26 citizens of Vienna (13 women, 13 men). As expected, RAST investigations revealed a higher rate of sensitization to storage mites in the farmer group. Comparing the two patient groups, sensitization to Lepidoglyphus destructor and Tyrophagus putreus was markedly increased in the farmer group. However, the sensitization rate to storage mites was also considerably high in city dwellers. Elevated levels of IgE specific for Euroglyphus maynei were more frequently observed in the urban collective. RAST-inhibition experiments suggest a partial crossreactivity between house dust mites and storage mites. In their living environment, patients with perennial Type I allergy are exposed to multiple different mite-derived allergens in addition to the well-known house dust mite allergens. These allergens lead to sensitization and are therefore of clinical importance.

Characterization of Micropolyspora faeni antigens by human antibodies and immunoblot analysis

IgG, IgM and IgA antibody responses against Micropolyspora faeni (Mf) antigens were studied by means of immunoblotting experiments using 70 sera derived from three groups of farmers, namely patients with extrinsic allergic alveolitis (EAA) due to thermophilic actinomycetes (n = 25), patients without EAA but with hay exposure (n = 14), and patients suspected to have EAA (n = 31), and 27 sera from two groups of control persons (healthy laboratory workers, n = 13; healthy farmers, n = 14). Patients with EAA showed IgG, IgM and IgA antibody responses mainly against the antigens with molecular weights (MW) of 11, 12, 25, 35 and 60 kD ("major antigens"), and in addition, but less often, against six antigens with MW in the range of 15 to 62.5 kD ("minor antigens"). The other two groups of patients and also the exposed control persons showed very similar results; however, the antibody response in healthy farmers was substantially weaker in comparison to the three groups of patients and was almost limited to the major antigens with MW 11, 25 and 60 kD. Although patients with proven EAA had higher amounts of antibodies, there was no correlation between this antibody response and the onset of disease. The results indicate the necessity of including at least the major antigens with MW of 11, 25 and 60 kD in all extracts used for in vitro diagnosis of Mf-induced EAA.

[Health management--physical therapy in chronic nonspecific airway diseases. Prevention and rehabilitation]

First of all there is a description of the temporal change of a cure at a spa to a modern treatment for rehabilitation. Today treatments for rehabilitation are methods treating COLD in addition to medical care of a general practitioner or a specialist and the function of a hospital in acute and severe diseases the third practicability of treatment. Treatment in a sanatorium is preferred by social assurances. Diagnostic management and physical treatment, physical training and education in health represent an extensive medicine program. The cooperation of sanatorium of medicine rehabilitation with social workers for professional rehabilitation guarantees a transition from medical to professional rehabilitation, with the purpose to achieve an improvement for patients with bronchopulmonal handicaps in their social and professional situation.

[Extrinsic allergic alveolitis: comparison of 2 methods (Ouchterlony gel precipitation and ELISA) for antibody detection in routine diagnosis]

Sera from 58 patients with suspected extrinsic allergic alveolitis (EAA) were tested in parallel by the double diffusion test and the "enzyme-linked immunosorbent assay (ELISA)" using 10 different antigen solutions (extracts from thermophilic actinomycetes, various mycetes, pigeon serum, pigeon droppings and the wheat weevil sitophilus granarius). The ELISA technique was more sensitive than the double diffusion test in detecting antibodies to the panel of antigens used. However, by using several antigen dilutions the number of sera positive sera with the double diffusion test increased and an overall correlation of 93.1% with the ELISA was achieved. The results of the study are discussed with regard to the advantages and disadvantages of both test systems for the in vitro diagnosis of EAA.

[Some observations on farmer's lung (author's transl)]

Sera from 72 patients--29 females, 43 males--with symptoms suggestive of farmer's lung were tested by the Ouchterlony double diffusion technique using 10 different antigen solutions (extracts from mycetes and thermophilic actinomycetes, pigeon serum, extracts from pigeon droppings and Sitophilus granarius). In 23 cases precipitating antibodies were observed and Micropolyspora faeni was the most common antigen responsible for positive reactions. In 17 seropositive patients the diagnosis of exogen allergic alveolitis was established by clinical and laboratory findings. Measurements of immunoglobulins in these sera showed pronounced elevation of IgG and slightly elevated levels of IgA; IgM, IgE and C 3 c levels were in the normal range. The results are discussed with regard to the classification of farmer's lung as an occupational disease in Austria since December 30th, 1980.