Work participation among middle-aged persons with cerebral palsy or spina bifida – a longitudinal study

Pain and labor outcomes: A longitudinal study of adults with cerebral palsy in Sweden

BACKGROUND

Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP).

OBJECTIVES

To estimate the association between pain and labor outcomes for adults with CP in Sweden.

METHODS

A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings.

RESULTS

Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement.

CONCLUSION

Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.

Environmental Factors that Impact the Workplace Participation of Transition-Aged Young Adults with Brain-Based Disabilities: A Scoping Review

Workplace participation of individuals with disabilities continues to be a challenge. The International Classification of Functioning, Disability and Health (ICF) places importance on the environment in explaining participation in different life domains, including work. A scoping review was conducted to investigate environmental facilitators and barriers relevant to workplace participation for transition-aged young adults aged 18-35 with brain-based disabilities. Studies published between 1995 and 2018 were screened by two reviewers. Findings were categorized into the ICF's environmental domains: Products and technology/Natural environment and human-made changes to environment, Support and relationships, Attitudes, and Services, systems and policies. Out of 11,515 articles screened, 31 were retained. All environmental domains of the ICF influenced workplace participation. The majority of the studies (77%) highlighted factors in the Services, systems and policies domain such as inclusive and flexible systems, and well-defined policies exercised at the organizational level. Social support mainly from family, friends, employers and colleagues was reported as a facilitator (68%), followed by physical accessibility and finally, the availability of assistive technology (55%). Attitudes of colleagues and employers were mostly seen as a barrier to workplace participation (48%). Findings can inform the development of guidelines and processes for implementing and reinforcing policies, regulations and support at the organization level.

Mental health guidelines for the care of people with spina bifida

Spina bifida's (SB) impact on cognitive, physical, and psychosocial functioning places individuals at risk for mental health concerns. This article discusses the SB Mental Health Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida and reviews evidence-based directions with the intention of helping individuals with SB achieve optimal mental health throughout the lifespan. Guidelines address clinical questions pertaining to the psychosocial impact of SB on mental health and adaptation, domains of mental health that are affected in individuals with SB, areas of resilience, common maladaptive behaviors that may impact people with SB, and resources or practices that are helpful in mitigating mental health issues in this population. Gaps in the research and future directions are discussed.

Factors Influencing Employment and Employability for Persons with Disability: Insights from a City in South India

Background:

There is a lack of evidence on barriers faced by persons with disability in accessing employment opportunities in India.

Aim:

This study was undertaken to ascertain both employee and employer perceptions on barriers existing among Information Technology (IT) and IT-enabled sectors to employ persons with disabilities.

Materials and Methods:

Two hundred participants from six IT/IT-enabled sector organizations were included in the study; study was conducted at Hyderabad, India. A semi-structured questionnaire was administered to the participants.

Results:

Physical access to and within the worksite was highlighted as a concern by 95% of respondents. Majority perceived that communication, attitude of people, discrimination, harassment at work place, and information were critical barriers. Only 3.8% of employers were aware that their company had a written policy on employing persons with disabilities. Employers stated that commitment and perseverance were important facilitators among persons with disabilities.

Conclusions:

Evidence from this study will help in planning need-based employment for persons with disabilities.

Course of employment in adults with cerebral palsy over a 14-year period

AIM

To explore the course of employment in adults with cerebral palsy (CP) over 14 years, and to identify subgroups at risk for unemployment.

METHOD

Sixty-five adults with CP (33 males, 32 females; baseline age 25y 8mo, standard deviation [SD] 3y 2mo; intellectual impairment 25%; bilateral CP 65%) participated in a prospective cohort study. Self-reports of employment and work hours per week in 1996, 2000, and 2010 were documented. The course of employment (including sheltered work) and work hours per week were analysed, using generalized estimating equations (GEE).

RESULTS

Overall, employment rate was stable over time (38-45%, p=0.413), but lower than in the general population (75-86%, p<0.001). Employment rates were specifically low in adults with intellectual impairment, bilateral CP, and in adults with Gross Motor Function Classification System (GMFCS) levels IV and V. Work hours per week declined (35.0 [SD 7.9] to 31.2 [SD 10.3], p=0.033), especially among females (32.3 [SD 6.4] to 23.4 [SD 7.4], p<0.001). Similar to the general population, females often worked part-time.

INTERPRETATION

Employment was low compared with the general population, but remained stable in the long term; however, work hours per week decreased. Adults with intellectual impairment, bilateral CP, and GMFCS levels IV and V are subgroups at risk for unemployment.

Predictors of permanent disability among adults with spinal dysraphism

OBJECTIVE Predictors of permanent disability among individuals with spinal dysraphism are not well established. In this study, the authors examined potential risk factors for self-reported permanent disability among adults with spinal dysraphism. METHODS A total of 188 consecutive individuals undergoing follow-up in an adult spinal dysraphism clinic completed a standardized National Spina Bifida Patient Registry survey. Chi-square tests and logistic regression were used to assess bivariate relationships, while multivariate logistic regression was used to identify factors independently associated with self-identification as "permanently disabled." RESULTS A total of 106 (56.4%) adults with spina bifida identified themselves as permanently disabled. On multivariate analysis, relative to completion of primary and/or secondary school, completion of technical school (OR 0.01, 95% CI 0-0.40; p = 0.021), some college (OR 0.22, 95% CI 0.08-0.53; p < 0.001), college degree (OR 0.06, 95% CI 0.003-0.66; p = 0.019), and holding an advanced degree (OR 0.12, 95% CI 0.03-0.45; p = 0.002) were negatively associated with permanent disability. Relative to open myelomeningocele, diagnosis of closed spinal dysraphism was also negatively associated with permanent disability (OR 0.20, 95% CI 0.04-0.90; p = 0.036). Additionally, relative to no stool incontinence, stool incontinence occurring at least daily (OR 6.41, 95% CI 1.56-32.90; p = 0.009) or more than weekly (OR 3.43, 95% CI 1.10-11.89; p = 0.033) were both positively associated with permanent disability. There was a suggestion of a dose-response relationship with respect to the influence of educational achievement and frequency of stool incontinence on the likelihood of permanent disability. CONCLUSIONS The authors' findings suggest that level of education and degree of stool incontinence are the strongest predictors of permanent disability among adults with spinal dysraphism. These findings will be the basis of efforts to improve community engagement and to improve readiness for transition to adult care in a multidisciplinary pediatric spina bifida clinic.

School success and participation for students with cerebral palsy: a qualitative study exploring multiple perspectives

PURPOSE

This qualitative study investigated perceived successful school experiences for students with cerebral palsy in Australia. Participation and appropriate support in school are complex concepts, although few studies have investigated all stakeholders' perspectives.

METHODS

Phenomenology informed the study that centered on the concept of a successful school experience. In-depth interviews occurred with students (n = 7), parents (n = 11), teachers (n = 10), school principals (n = 9) and allied health practitioners (n = 10) to gain the perspective from multiple vantage points. Specific research questions, interview guides and demographic questionnaires were configured for each group. Interviews were analyzed thematically within and between groups.

RESULTS

Three key themes emerged: Collaborative partnerships between families, schools and outside organizations; School culture and attitude is key; and, allied health practitioners are part of home and school teams.

CONCLUSIONS

Student and school success was impacted substantially by the capacity of adults in the student's life to collaborate - family, school professionals and allied health practitioners. An inclusive school culture was crucial to students with cerebral palsy. All parties needed to prioritize promotion of an open and positive school culture built around problem-solving inclusive practices. Involved people, such as allied health practitioners, bring knowledge and skills that are not otherwise readily available in school environments. Implications for rehabilitation Students with cerebral palsy have high needs at school and allied health practitioners have a role advocating for, educating and providing support to students within the school. Teachers of students with cerebral palsy need education, training and support from allied health practitioners. The need for allied health and rehabilitation services continues for children and youth with cerebral palsy outside of school and across the schooling years. School professionals; allied health practitioners; families and students can work together to improve the student experience.

Health and participation problems in older adults with long-term disability

BACKGROUND

More attention and understanding of the health and participation problems of adults with early and later onset disabilities in the Netherlands is needed.

OBJECTIVE

To explore health/participation problems and unmet needs in adults aged ≥40 years with long-term disabilities and their relationship with the time of onset.

METHODS

Participants were recruited in the Netherlands through newsletters and social media to participate in a web-based questionnaire. The questionnaire assessed background characteristics, (change in) health/participation problems, and unmet needs. Spearman's rho was used to examine the relationships with time of onset.

RESULTS

Of the 163 survey respondents, 42% acquired their disability before age 25 years and reported fatigue (77%), walking problems (66%), and pain (59%). In 21% of the respondents with early-onset disability fatigue, pain and depressive feelings co-occurred. Early-onset disability correlated with joint deformities, pain and anxiety. Participation problems included loss of income and fewer social activities. Early-onset correlated with the need for more information about diagnosis and prognosis.

CONCLUSIONS

People aged over 40 years with long-term disability have significant and increasing health and participation problems. Adults with early-onset disability are more likely to have health or participation problems than adults with late-onset disability. Early identification is needed for preventive care and access to specialized services that focus on improving and maintaining physical symptoms, energy management, and participation.

Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery

Objective:

To investigate long-term employment outcomes after resective epilepsy surgery in a national population-based cohort of adults.

Methods:

In the Swedish National Epilepsy Surgery Register, all adults who were operated with resective epilepsy surgery from 1995 to 2010 were identified. Two-year follow-up was available for 473/496, 5-year follow-up for 220/240, 10-year follow-up for 240/278, and 15-year follow-up for 85/109 patients.

Results:

There were no significant changes in employment outcome over time at group level, but for those with full-time employment at baseline, 79%, 79%, 57%, and 47% of seizure-free patients were in full-time work at 2-, 5-, 10-, and 15-year follow-up, compared to patients with benefits at baseline, where 16%, 27%, 31%, and 33% of seizure-free patients worked full time at these time points (p = 0.018 at 10 years). More patients with full-time work had ability to drive, a family of their own, and higher educational status than patients in part-time work or on benefits. Univariate predictors for employment at long term were having employment preoperatively, higher education, favorable seizure outcome, male sex, and younger age at surgery. Multivariate predictors were having employment preoperatively, favorable seizure outcome, and younger age.

Conclusions:

The best vocational outcomes occurred in seizure-free patients who were employed or students at baseline, which may reflect a higher general psychosocial level of function. Younger age also predicted better employment outcomes and it therefore seems plausible that early referral for surgery could contribute to better vocational outcomes.