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Changes in the quality of life of people with learning disabilities who moved from hospital to live in community-based homes.

This paper describes a longitudinal study of the change in quality of life experienced by 36 residents of community-based homes after leaving a hospital for people with learning disabilities. The measure used to evaluate quality of life was Living in a Supervised Home: A Questionnaire on Quality of Life (Cragg and Harrison, 1986). The questionnaire was completed before and after the study group left the hospital. The analyses of the scale shows that there has been a considerable improvement in the quality of life of people who have moved from hospital to community-based homes. Specific data are presented from quality of life sub-scales relating to the use of community facilities and contact with other members of the community.

Activities of Daily Living↗

Atypical brain development: a conceptual framework for understanding developmental learning disabilities.

This article presents ideas that are, in part, a response to the ambiguity in the neurological research on learning disorders, the growing awareness that developmental disabilities are typically nonspecific and heterogeneous, and the growing scientific literature showing that comorbidity of symptoms and syndromes is the rule rather than the exception. This article proposes the term atypical brain development (ABD) as a unifying concept to assist researchers and educators trying to come to terms with these dilemmas. ABD is meant to serve as an integrative concept of etiology, the expression of which is variable within and across individuals. ABD does not itself represent a specific disorder or disease. It is a term that can be used to address the full range of developmental disorders that are found to be overlapping much of the time in any sample of children. Although similar in spirit to the older term of minimal brain dysfunction (MBD), in that it closely links neurology with behavioral difficulties, ABD as proposed here differs in several ways. In support of the ABD conceptual framework, first, we consider the ABD concept in terms of its superiority to the older notion of MBD. Second, we provide a brief review of the burgeoning literature on the overlap of the various developmental disabilities. Third, we review some of the scientific literature that supports the ABD concept. Our sole purpose in proposing this concept is to initiate dialogue and debate on several critical issues across a wide variety disciplines. Hence, this article is not intended to be a definitive statement of a rigid perspective. It reflects neither a nonmalleable philosophical position, nor any type of condemnation of other perspectives. It does, however, reflect a data-based and philosophical trend visible in the field of learning disabilities, as well as the broader area of childhood developmental disorders.

Attention Deficit Disorder with Hyperactivity↗

Dyslexia and learning disabilities.

The approach to the child with dyslexia and learning disorders is multidisciplinary. The pediatrician can act as a guide for educators and should recognize the importance of early diagnosis and provide appropriate referral for the child and counselling for the parents.

Child↗

Learning disabilities identification: primary intervention, secondary intervention, and then what?

A broad consensus has been achieved regarding the importance of early primary and secondary interventions for children in academic domains for the purposes of improving overall academic competencies and preventing low achievement that often leads to a diagnosis of specific learning disability (SLD) and long-term special education placement. The characteristics of effective prevention programs generally are well established. The degree to which these programs prevent SLD is uncertain, and the subsequent procedures for determining SLD eligibility are very much at issue. Issues are discussed regarding what should be done about SLD identification after primary and secondary intervention efforts are proven inadequate for individual children.

Child↗

Language-based learning disabilities.

The purpose of this paper is to highlight the complexity of the relationship between oral language development and the acquisition of reading skills. As background information, a hierarchy of language development including factors related to both oral and written language is discussed. Case studies of two learning-disabled males are presented to illustrate the differences in reading skills between two children with similar language comprehension abilities. Discussion of the underlying processing deficits responsible for these differences is also included.

Adolescent↗

Development of the community nurse in learning disability: 2.

In order to carry out core skills practitioners should not only obtain a postbasic qualification to practise competently but also take up other specialised courses for effective intervention. This article, the second in a two-part series, analyses the difference between qualified and unqualified community nurses in learning disability.

Community Health Nursing↗

The challenge of evidence-based practice for learning disabilities.

There is an ever-increasing pressure on professionals within both health and social care settings to demonstrate evidence-based practice. The main aim of this article is to consider as problematic the challenge of evidence-based practice for both health and social care professionals, with particular reference to those working in the field of learning disabilities. The article addresses a number of issues, including the nature of evidence, the different types of evidence that professionals have at their disposal, and issues of reliability and validity concerning the kinds of approaches used to obtain such evidence. The challenges of implementing evidence into practice are also discussed in relation to ideology, organizational implications, and educational issues.

Bias↗

Protection by prosaposin against ischemia-induced learning disability and neuronal loss.

Prosaposin, the protein precursor of saposins A, B, C, and D which activate sphingolipid hydrolases, is abundant in several brain regions including the hippocampus. We infused prosaposin continuously for 7 days into the lateral ventricle of gerbils starting 3 hours before 3-min of forebrain ischemia. Using the step-down passive avoidance task, we demonstrated that ischemia-induced learning disability is prevented almost completely by prosaposin infusion. Subsequent light and electron microscopic examinations showed that pyramidal neurons in the CA1 field of the hippocampus as well as synapses within the strata moleculare, lacunosum/radiatum and oriens of the field were significantly more numerous in gerbils infused with prosaposin infusion than in those receiving saline infusion. These findings suggest that prosaposin possesses neurotrotrophic activity to protect hippocampal CA1 neurons from lethal ischemic damage.

Animals↗

General language performance measures in spoken and written narrative and expository discourse of school-age children with language learning disabilities.

Language performance in naturalistic contexts can be characterized by general measures of productivity, fluency, lexical diversity, and grammatical complexity and accuracy. The use of such measures as indices of language impairment in older children is open to questions of method and interpretation. This study evaluated the extent to which 10 general language performance measures (GLPM) differentiated school-age children with language learning disabilities (LLD) from chronological-age (CA) and language-age (LA) peers. Children produced both spoken and written summaries of two educational videotapes that provided models of either narrative or expository (informational) discourse. Productivity measures, including total T-units, total words, and words per minute, were significantly lower for children with LLD than for CA children. Fluency (percent T-units with mazes) and lexical diversity (number of different words) measures were similar for all children. Grammatical complexity as measured by words per T-unit was significantly lower for LLD children. However, there was no difference among groups for clauses per T-unit. The only measure that distinguished children with LLD from both CA and LA peers was the extent of grammatical error. Effects of discourse genre and modality were consistent across groups. Compared to narratives, expository summaries were shorter, less fluent (spoken versions), more complex (words per T-unit), and more error prone. Written summaries were shorter and had more errors than spoken versions. For many LLD and LA children, expository writing was exceedingly difficult. Implications for accounts of language impairment in older children are discussed.

Child↗

The treatment of men with a learning disability convicted of exhibitionism.

This paper reviews work on the treatment of men convicted of exhibitionism or indecent exposure. Recidivism is extremely high after treatments, with true figures on recidivism unavailable until 4 years after conviction. It is extremely difficult to control for treatment effects because of the ethical issues surrounding withholding of treatment, but cognitive techniques provide a promising treatment approach. The present study attempted to address all these issues for men with a learning disability. A cognitive treatment is presented and data are available for at least 5 years after conviction. An AB design was used and treatment effects were monitored carefully. Treatment dealt with the issues of accepting that the offense took place, taking responsibility for the offense, accepting the intention of the offending behavior, victim awareness, and behavior consistent with offending for four offenders. All the men responded to treatment, although one offender with only 1 year of probation responded less convincingly than others. Beliefs relating to indecent exposure being fun or not causing harm to women seemed most open to alteration. The beliefs in which the perpetrator thought that the victim shared responsibility for the offense and that women may take a long while to recover from such an incident, seemed the most difficult to alter. Individual characteristics of the case examples are discussed in terms of these general trends.

Adult↗

Music therapy, a description of process: engagement and avoidance in five people with learning disabilities.

A number of approaches exist within the field of music therapy. Some models for evaluating the efficacy of therapy have been adopted in the UK in recent years. These have measured the occurrence of specific behaviours within therapy, or compared music therapy with other interventions. There is a need to find reasonably reliable methods of describing change and the therapeutic process occurring within music therapy. This paper describes change occurring in five people with learning disabilities, in terms of their levels of engagement in therapy and in the therapeutic relationship. A method is provided to evaluate independent observers' perceptions of change in the patients over a 30-session period of therapy. A significant increase in levels of engagement over time was found. It was also found that the degree of change over time was not related to the mean level of engagement. The present authors discuss some subtle factors involved in therapeutic engagement for the five patients in the study, and stress the importance of a therapy which emphasizes the dynamics of interpersonal communication for people with limited opportunities to express thoughts and emotions.

Adult↗

Processing abilities associated with math skills in adult learning disability.

This study evaluated college adults (N = 138) referred for learning problems using a Cattell-Horn-Carroll based intelligence measure (Woodcock Johnson-Revised: WJ-R) and spatial and executive function neuropsychological measures to determine processing abilities underlying math skills. Auditory and visual perceptual (WJ-R Ga and Gv), long- and short-memory (WJ-R Glr and Gsm), crystallized and fluid intellectual (WJ-R Gc and Gf), and spatial and executive function (Judgment of Line Orientation [JLO] and Category Test) measures differentiated those with and without math deficits. Multiple regression revealed selective processing abilities (Gf, JLO, and Category) predicting about 16% of the variance in math skills after variance associated with general intelligence (also about 16%) was removed. Cluster analysis found evidence for a selective spatial deficit group, a selective executive function deficit group and a double deficit (spatial and executive function) group. Results were discussed in relation to a double deficit hypothesis associated with developmental dyscalculia.

Adolescent↗

The use of a low phenylalanine diet in response to the challenging behaviour of a man with untreated phenylketonuria and profound learning disabilities.

If phenylketonuria (PKU) is not treated from an early age with a reduced phenylalanine diet, irreversible brain damage may occur. Although dietary intervention can do nothing to alter this impairment once it occurs, there is some evidence to suggest that a low phenylalanine diet may help to reduce the level of behavioural disturbances frequently experienced by people with untreated PKU. Using this evidence, dietary intervention was used in response to the challenging behaviour of a 30-year-old man with profound learning disabilities. Initial improvements were observed, but overall the results were inconclusive. Possible confounding factors are discussed. An unusual reaction to neuroleptic medication whilst on the diet is also documented.

Adult↗

The effectiveness of services for people with learning disabilities.

The government white paper The New NHS has placed emphasis on service effectiveness and expects it to be measured. Clinical governance is expected to provide robust internal mechanisms for this. A National Institute for Clinical Effectiveness will provide a lead on clinical and cost-effectiveness and a Commission for Health Improvement oversee the quality of clinical services (Department of Health, 1997). Signposts for Success (NHS Executive, 1998) sets out good practice guidance for commissioners and providers of health services for people with learning disabilities. This states that its aim is to deliver 'person-centred services, equality of access, support to use services and social inclusion', person-centred services being defined as those that put 'service users' wishes and needs at the centre'. This article looks at how one trust is trying to meet these requirements following this guidance.

Benchmarking↗

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