Carer reports of health status among adults with intellectual/developmental disabilities in Taiwan living at home and in institutions

Video-Based Behaviorally Coded Movement Assessment for Adolescents with Intellectual Disabilities: Application in Leg Dribbling Performance

Measuring motor performance in individuals with intellectual disabilities (ID) is quite challenging. The objective of this study was to compare the motor performances of individuals with ID and those with typical development (TD) during soccer dribbling through video-based behavior-coded movement assessment along with a wearable sensor. A cross-sectional research design was adopted. Adolescents with TD (N = 25) and ID (N = 29) participated in the straight-line and zigzag soccer dribbling tests. The dribbling performance was videotaped, and the footage was then analyzed with customized behavior-coding software. The coded parameters were the time for movement completion, the number of kicks, blocks, steps, the number of times the ball went out of bounds, the number of missed cones, and the trunk tilt angle. Participants with ID exhibited significantly poorer performance and demonstrated greater variances in many time and frequency domain parameters. It also revealed that participants with ID kicked with both feet while dribbling, whereas those with TD mainly used the dominant foot. The present findings demonstrated how the ID population differed from their peers in lower-extremity strategic control. The customized video-based behavior-coded approach provides an efficient and effective way to gather behavioral data and calculate performance parameter statistics in populations with intellectual disabilities.

Effect of Peer Victimization on the Long-Term Mental Health Status among Adults Users of Intellectual Disability Services: A Longitudinal Follow-Up Study

Caregiving for mental health among people with intellectual disabilities (IDs) in the ID services was reported as insufficient. The purposes of this study were to investigate five types of peer victimization (PV) experiences among adults with ID using ID services, and to gain a deeper understanding of the influence of PV experience on adults with ID’s long-term mental health status. A one-year longitudinal follow-up study was conducted from eight long-term care ID services (n = 176). Logistic regression analysis was applied to variables comprising personal characteristics, various types of PV experience and polyvictimization to predict period prevalence of psychiatric symptoms. The data indicated that nearly one-third of individuals with ID experienced at least one psychiatric symptom. The three most common psychiatric symptoms prevalent after one year were adjustment disorder, anxiety disorder, and somatoform disorder. Over the 1-year study period, approximately 40% of adults with ID reported experiencing PV. The most frequently reported types of PV were physical force (26%) and verbal victimization (22%). Polyvictimization was experienced by approximately a quarter of adults with ID. The findings suggest that PV is a common experience among adults in ID services. Thus, for a clearer understanding of mental health risks, caregivers should pay attention to adults with ID who experienced PV.

Health Services Accessibility And Expectations of Disabled People

Aim: In this study, it was aimed to investigate the distribution of disability types, treatment and rehabilitation needs, utilization of the basic services provided, and determination of expectations of disabled persons. Methods: This descriptive study was carried out in Hazro district of Diyarbakır. Of the 1069 individuals screened by a cross-sectional study, 148 disabled individuals were identified. A face-to-face meeting was provided with the families of these disabled individuals. The demographic characteristics of the disabled person, information on the types of disability, the use of health services and the questionnaire form which asks the expectation status were used. Results: The prevalence of disability was 13.8%. 51.3% of the disabled were male, 48.2% were not literate and 16.7% did not have any social security. It was determined that 37.8% of people with disabilities did not receive treatment for their disability and 98.0% did not benefit from rehabilitation services. It was found that 70.9% of the disabled did not receive education, 60.1% of them did not know about vocational and skill courses and 51.4% of them could not benefit from public transportation services. Families stated that, the disabled people do not go to any institution or rehabilitation center with 44.8% because of absence in the close environment; 26.9% stated that they do not know if there is any. It was found that the most important expectation of 50% of disabled people and their families from institutions and organizations is to provide health services easily. Conclusion: Disabled persons have difficulty in accessing health services and cannot benefit from rehabilitation services. Basic services such as education, vocational courses and public transport are also insufficient. In this sense, health and social service institutions have important duties.

Simple ideas that work: Celebrating development in persons with profound intellectual and multiple disabilities

BACKGROUND

The purpose of this article is to share some lessons learnt by an interdisciplinary therapy team working with persons with profound intellectual and multiple disabilities (PIMD), implemented in diverse, low-income contexts over a period of 8 years.

OBJECTIVES

The objective of all the activities described here was to provide increased stimulation and development opportunities for persons with PIMD within different settings (day care centre, residential centre or family home).

METHOD

We used an iterative action-learning approach where we applied existing evidence in the given context, reflected on and adapted strategies in collaboration with stakeholders on a cyclical basis. We focussed on achieving our objectives through ongoing hands-on training of the carers involved with the clients as we felt that by providing them with the knowledge and skills needed, plus ongoing support, these programmes would be more sustainable.

FINDINGS

It took some time to put systems in place in care settings, but once they became part of the daily routine, they provided increased opportunities for learning for clients with PIMD. In addition, there were often marked changes in individual clients' communicative and physical functioning, which in turn encouraged carers to find new and different ways to interact with, and stimulate, the persons with PIMD in their care.

CONCLUSION

Our hope is that parents and carers or professionals working in the field of PIMD in low-income contexts elsewhere may find one, some or all of these simple ideas useful in providing opportunities for learning, development and enjoyment for persons with PIMD.

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Background

The prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.

Objectives

The objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).

Setting

Leicestershire, UK.

Participants

Adults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.

Main outcome measures

The primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.

Data sources

Participants were recruited from general practices, specialist ID services and clinics, and through direct contact.

Results

A total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.

Limitations

We were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.

Conclusions

The results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.

Future work

Further work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.

Trial registration

ClinicalTrials.gov NCT02513277.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

Using computer-assisted method to teach children with intellectual disabilities handwashing skills

PURPOSE

To motivate children with intellectual disabilities (ID) to learn handwashing and improve their performance by using computer-assisted teaching method.

METHOD

A teaching program was implemented using a computerized teaching station with faucet, soap dispenser and towel dispenser as user interface. In response to the children's actions, animations were shown on the computer screen of the teaching station. A controlled study was conducted to compare the effectiveness of the proposed method (study group) with that of the convention teaching method (control group). Both groups of subjects attended a 30-min handwashing lesson twice per week for 2 months. Their performance was evaluated using a handwashing task checklist and a learning motivation questionnaire, and by measuring the completion time and assessing their hand cleanliness.

RESULTS

The computer-assisted teaching program improved the handwashing performance and learning motivation of the subjects. The study group appeared to outperform the control group. Observations reflected that the subjects were highly motivated to learn handwashing with the computerized teaching station.

CONCLUSION

The proposed method has the potential to facilitate the teaching and learning of handwashing skills for children with ID.

Perspectives on intellectual disability in Taiwan: epidemiology, policy and services for children and adults

PURPOSE OF REVIEW

The present review examines the most recent published references to epidemiology, healthcare needs and utilization and social and health policy relating to people with intellectual disability in Taiwan.

METHOD

Electronic searches of Medline, PubMed and PsychInfo literature using the key terms of epidemiology, etiology, welfare policy, health policy, health services, intellectual disability, learning disability and mental retardation as well as a thorough manual search for relevant literature.

RECENT FINDINGS

The administrative prevalence of intellectual disability was 0.318-0.396%, and men accounted for a higher percentage of cases than women in Taiwan. Institutionalized care still dominates disability services provided in this society, and the number of institutions and staff working therein has increased steadily in recent years. Many studies also identify the high risk for ill health accompanied by physical/mental diseases in people with intellectual disability, with this group also requiring more healthcare services than the general population in Taiwan. There are still many barriers to accessibility and availability of health and social services confronting people with intellectual disability and their caregivers under the National Health Insurance scheme in Taiwan.

SUMMARY

As a result of this review process, this paper suggests that future study should focus on an evaluation of the efficacy of current health and social policies related to people with intellectual disability, and that supportive health environments be initiated for this group of people living in institutions or in the community.

Functional impairment severity is associated with health status among older persons with intellectual disability and cerebral palsy

BACKGROUND

Studies have noted high rates of specific health disorders in adults with cerebral palsy (CP). However, it remains unclear how growing older with a lifelong neuromotor physical disability confers risk for health outcomes in adults who have both intellectual disability (ID) and CP.

AIM

To assess the relationship between health status in older adults with ID either with or without coincident diagnoses of CP.

METHOD

Health status data were drawn from 1373 adults aged 33 to 79 years with ID living in small group homes in New York State. Their health status was defined by the presence of common health disorders. Of these, 177 subjects had coincident CP. Prevalence data for nine diseases representing different organ systems were obtained and compared in individuals with and without CP. A Severity of Functional Impairment Index (SFII) was developed based on subjects' capabilities in activities of daily living (ADLs) and mobility. Two logistic regression analyses were conducted to determine if CP diagnosis was an independent predictor of health disorder prevalence, or rather exerted effects similar to those without CP via severity of functional impairment as determined by SFII scores. In addition, older age, gender, and severity of intellectual disability were examined as predictors of health disorder prevalence in all study subjects.

RESULTS

Individuals with CP had higher frequencies in four out of the nine health disorders (overweight/obesity, gastroesophageal reflux, urinary tract infections and dysphagia). Analysis revealed a statistically significant association between SFII score and CP diagnosis. CP diagnosis alone was a statistically significant predictor for all of the above four common disorders; however, after adjustment for SFII score was included in health disorder models, only dysphagia showed an independent correlation with a CP diagnosis.

CONCLUSION

With the exception of dysphagia, impairment in ADLs and walking capabilities, and not CP diagnosis alone, accounted for disparities in specific diseases. Although the diagnosis of CP may be correlated with functional impairment, it alone may play a minor role in determining health trajectories in older persons with conjoint ID and CP.

Health, mortality, and wellness issues in adults with cerebral palsy

For many years, children with cerebral palsy (CP) and their parents have been told that health and functional status stabilize by early adulthood. However, adults with CP report ongoing health conditions and aging and secondary conditions that are not always recognized or managed by their healthcare providers. There is a growing body of literature to better define the health, mortality, and wellness of those aging with CP. In general, adults with CP report good health, although health outcomes appear to be linked to the severity of CP and to increasing age. Studies reporting on lifespan warrant caution in interpretation because of biases in the survey and surveillance systems. It appears that lifespan of persons with CP is at or close to that of the typical population. The most commonly reported age-related changes and secondary conditions involve pain/fatigue, physical performance, and the musculoskeletal system. Not all adults have serious health problems, and many now recognize the aging process as a natural course of events. Few adults with CP engage in typical screening and health promotion activities due to a variety of barriers. There continues to be much to be learned and disseminated, in order to improve the care of adults with CP.

Reliability and validity of the revised Triple C: Checklist of Communicative Competencies for adults with severe and multiple disabilities

AIMS

Few tools are available to assess the communication skills of adults with severe and multiple disabilities functioning at unintentional to early symbolic levels. An exception is the Triple C: Checklist of Communicative Competencies. In this study, aspects of support worker and clinician agreement, internal consistency and construct validity of a revised version of the Triple C were explored.

METHOD

Triple C checklists were completed for 72 adults with severe intellectual disabilities (ID) by 118 support workers and stages were assigned by the researchers. Two support workers completed checklists for each of 68 adults with ID. Three researchers also conducted direct observations of 20 adults with ID.

RESULTS

The average support worker agreement for items across the five stages of the Triple C ranged from 81% to 87%; agreement for stage assignment based on first and second support worker checklists was moderate to high (k = 0.63). Internal consistency was high (KR20 = 0.97); the stages were found to tap one factor (accounting for approximately 74% of variance), interpreted to be unintentional to early symbolic communication. Agreements between stages based on researcher observations and support worker-completed checklists were 35% and 71% across first and second support workers.

CONCLUSION

The revised Triple C provides a reliable means of gathering data on which to determine the communication skills of adults with severe and multiple disabilities. The results support a collaborative use of the Triple C, such that a speech-language pathologist or other communication specialist works with a support worker to ensure understanding of the skills observed and development of appropriate intervention strategies.

A survey on mental health care for adults with intellectual disabilities in Asia

BACKGROUND

Mental Health Services for adults with Intellectual Disabilities (ID) in Asia is less described than those in the western world. With the improvements in the economy and medical care in Asia, there is an increase in awareness of mental health services for people with ID in this part of the world. A study was carried out to look into these aspects in Asian countries.

METHOD

A cross sectional survey using structured questionnaire was sent to 14 Asian countries/territories in 2005/2006 and returns were analysed in light of their demographics and health statistics.

RESULTS

The type and range of mental health services vary widely for people with ID in all the nine countries/territories that returned their questionnaires. Two of the respondent countries reported a lack of psychiatric services for their adult ID population.

CONCLUSIONS

In general, mental health services for people with ID in Asia do not keep pace with economic developments. More government commitment and international collaborations are necessary to improve the mental well-being of this population in Asia.

Health indicators and intellectual disability

PURPOSE OF REVIEW

Health disparities are evident between people with intellectual disabilities and the general population. Despite the potential of indicators for measuring disparities and planning interventions to address inequalities- currently a priority health policy target- few studies have mapped the physical or mental health of people with intellectual disabilities onto the growing territory of health disparities, health information systems and health indicators. This review summarizes recent publications about the role of indicators in gathering optimal health information on behalf of this segment of the population.

RECENT FINDINGS

Studies related to measures of the health of people with intellectual disabilities are presented in three sections: information captured in general population surveys; measures of health status of people with intellectual disabilities at country and regional levels; and their use of healthcare systems. The work of the Pomona group of European partners who have devised and applied a set of health indicators specifically for people with intellectual disabilities is presented.

SUMMARY

Health indicators yield data to identify health conditions, plan interventions and compare populations or segments of the population. It is suggested that better definitions, measures and surveillance will yield comparable information to inform public health policy and clinical practice.

Co-morbidity of psychiatric disorder and medical illness in people with intellectual disabilities

PURPOSE OF REVIEW

To examine the most recently published studies on the co-morbidity of medical and mental-health problems in people with intellectual disabilities.

RECENT FINDINGS

Studies that have been published in the review period have advanced our understanding and strengthened the evidence base on how to meet the complex healthcare needs of people with intellectual disabilities more effectively and reduce their health inequalities, as compared with the general population. In particular, there is much emphasis on epidemiology, epilepsy, dementia, use of psychotropic medications and health-screening intervention.

SUMMARY

In view of the common interface of medical and mental-health problems in people with intellectual disabilities, and the disparity in health they often face, initiatives should be taken to enhance their healthcare. Family carers, social-care providers, primary-care practitioners and specialist psychiatric teams can all play an important role in recognizing ill health and navigating access to the appropriate health services that people with intellectual disabilities need.