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PubMed1984

A communication aid for the physically handicapped.

A communications aid for the severely handicapped is described. The aid is primarily intended to be mounted on an electric wheelchair and to be powered from the chair's battery. It may be operated by any two-switch input system or by more elaborate controls such as joy-sticks. The central unit of the aid is a purpose-built 8085 microcomputer, the operating program and data tables being sorted in a 2 kbyte EPROM. The input control is used to drive a cursor around an 8 X 8 letter board array, the selected alphanumeric character being output to a liquid crystal display. Up to 64 messages, each of no more than 15 characters, can be composed and stored by the user and recalled as required. The messages are stored in a 2 kbyte CMOS memory and are retained when the aid is switched off. It is a simple matter to increase the number of stored messages. The aid was designed with the needs of a particular 15 year old, athetoid child in mind and the results of his tests of the aid will be briefly discussed.

Biomedical Engineering↗
PubMed1988

Assessment of control ability in the physically handicapped.

A tracking task was developed in order to obtain parameters relevant to the design of control interfaces for the physically handicapped. Principles of construction and operation are given, and methods for obtaining parameters are described. Results are presented from evaluator use with a number of subjects covering a wide range of control abilities. Overall performance in the tracking task is compared to general physical ability and experience with other control devices. One task required a response to a target which moved between two possible positions after a constant or variable time interval; correlation was observed between variables representing overall speed and accuracy. For multi-level tasks, scores equal to total time on target were obtained for tasks of differing complexity. Their values are shown to contain information on both speed and accuracy of control. Factors affecting performance are discussed and useful parameters suggested. In particular, information derived from the first, simpler task was shown to correlate well with that from the more complex tests. This type of test provides a useful general method for the interactive design and assessment of control interfaces.

Adult↗
PubMed1995

The maltreatment of intellectually handicapped children and adolescents.

Eleven and a half percent of intellectually handicapped children in Castilla-León are subjected to maltreatment; in these, physical neglect is the most frequent. These findings come from a questionnaire (CEMND) specifically designed to detect and discover the prevalence of maltreatment in a sample of 445 mentally retarded children. It was discovered that problems between the child's parents, the child's behavior and the interaction between both aspects were significant factors in situations of maltreatment.

Activities of Daily Living↗
PubMed1991

Cost effectiveness of intradermal vs. subcutaneous hepatitis B vaccination for the mentally handicapped.

The currently available hepatitis B vaccine is being under utilized for reasons of cost and availability. To address this problem, we performed a recombinant hepatitis B vaccine trial comparing the currently recommended regimen of 10 micrograms subcutaneously (sc) in months 0, 1 and 6 with a more economical regimen of 2 micrograms intradermally (ID) in months 0, 1, 6. This trial assessed the immunogenicity of both regimens in 95 seronegative mentally handicapped patients. Forty four patients (aged 19-55 years, mean age 29.1 years) were vaccinated subcutaneously with recombinant vaccine and 51 (aged 19-52 years, mean age 28.3 years) were given intradermally. We found no significant difference in seroconversion between the subcutaneous group (93.2%) and the intradermal group (96.1%) 12 months after the first vaccination, but the antibody titres were lower in the intradermal group. We feel therefore that the dose should be increased slightly or further injections should be given. As the cost of intradermal vaccination is considerably lower than when using the subcutaneous route, underprivileged patients in institutions could the more readily be immunized against hepatitis B infection.

Adult↗
PubMed1986

Prevalence of hepatitis B markers in patients and staff in a hospital for the mentally handicapped.

Patients and staff at a hospital for the mentally handicapped were screened for markers of infection with hepatitis B virus. Of 436 patients, 14 (3.2%) were carriers of hepatitis B surface antigen (HBsAg), of whom four were carriers of hepatitis B e antigen (HBeAg) and were considered to be 'infectious'. One-quarter of the patients had markers of hepatitis B infection. Males were four times more likely to have markers than females; and 13 of the 14 carriers of HBsAg were male. Patients with Down's Syndrome (DS) were six times more likely to be HBsAg positive, but were not more likely to have markers of infection than other patients. Phenytoin therapy did not predispose to carriage of HBsAg. Of 439 staff members, 26 (5.9%) had markers of hepatitis B infection. It was not considered that staff were at increased risk of infection with hepatitis B virus at the hospital, and that post-exposure prophylaxis for hepatitis B should continue. It is suggested that patients with DS who are not immune to hepatitis B should be offered immunization.

Adolescent↗
PubMed1989

An outbreak of Trichuris trichiura in a mental handicap hospital.

An outbreak of Trichuris trichiura in a ward for the severely mentally handicapped affected 22 of 29 patients. There was concurrent carriage of non-pathogenic Entamoeba histolytica in 59% of these patients. Heavy contamination of soil was found in the patients' recreation area. The management of the outbreak is discussed.

Adult↗
PubMed1995

Large scale use of ciprofloxacin in the control of a Salmonella outbreak in a hospital for the mentally handicapped.

An outbreak of salmonella food poisoning occurred in a hospital for the mentally handicapped in July 1990. Salmonella enteritidis phage type 4 was identified in 101 patients and eight staff. Standard infection control measures were instituted. Ciprofloxacin was given to all resident patients and to all affected staff. The outbreak was rapidly controlled. There were no new cases after ciprofloxacin was started and there were no clinical relapses. Microbiological relapsers were retreated with ciprofloxacin. A gradual return to normal activity was possible and within two months the hospital was functioning normally. No salmonellae have been identified in the hospital since that time, confirming that the organism was eradicated, rather than just temporarily suppressed.

Ciprofloxacin↗
PubMed1988

Prevention of horizontal transmission of hepatitis B: efficacy of hepatitis B immunoglobulin and vaccine in an institution for the handicapped.

In a Japanese institution for the handicapped with confirmed continuous outbreaks of hepatitis B virus (HBV) infection by horizontal nosocomial transmission, 29 susceptible subjects (8 institutionalized children and 21 medical staff) were injected intramuscularly with anti-human HBs immunoglobulin (HB Ig) and subcutaneously with HB vaccine. All cases acquired HBs antibody after injection of HB Ig and seropositivity for HB after the third inoculation of HB vaccine was 78.6%. No new case of HB occurred among the study population throughout the period investigated. This suggested the effectiveness of HB Ig and HB vaccine in the prevention of horizontal nosocomial transmission of HBV.

Adolescent↗
PubMed1983

Development of morning self-care routines in multiply handicapped persons.

This study describes the use of reinforcement procedures to develop and maintain a complete morning self-care routine in multiply-handicapped and mentally retarded persons. Following the completion of initial training in each of six skill areas--toileting, showering, dressing, toothbrushing, bedroom cubicle cleaning, and bed linen removal--baseline data were taken on the extent to which 40 institutionalized adolescents and adults completed each task on a daily basis. Token reinforcement was later provided for the completion of each skill (single response contingency) using a multiple baseline design across behaviors. Results showed performance increases in five of the six behaviors, with some response decrement over time. During a final condition in which no tokens could be earned unless all six behaviors were completed (chained contingency), performance of each skill either increased further or was maintained at a high level.

Activities of Daily Living↗
PubMed1985

The impact of deinstitutionalization on activities and skills of severely/profoundly mentally retarded multiply-handicapped adults.

This study evaluated the change in activity patterns and skills of severely/profoundly mentally retarded, multiply-handicapped residents as they moved from large total care institutions to community living. Twenty-seven individuals were evaluated just before leaving the institution, 3 months post-exit, and 9 months post-exit. In comparison to a nondisabled reference group, residents were less active, mobile, social, and independent both in the institution and community. Residents did show, however, significant changes toward the nondisabled pattern of daily living after moving to the community. Clients improved in 4 of 16 skill areas within 3 months after entering the community: expressive communication, eating, serving meals and washing dishes, and meal preparation.

Activities of Daily Living↗
PubMed1985

Skin disease and handicap: an analysis of the impact of skin conditions.

This research sought to quantify the handicapping effect of skin conditions in a far more rigorous way than had previously been attempted. One hundred people who had attended a hospital outpatient clinic during a specified period for treatment of their acne, psoriasis or eczema were interviewed in their homes. A comprehensive and structured interview schedule was used and interviewees were encouraged to talk at length about the impact that their skin conditions had had on their lives. Detailed data were collected that show the serious effect that these diseases can have in several domains. The findings record not only the physical discomfort and inconvenience sufferers may meet but also the consequences for their personal and social life and daily functioning. There is evidence from interviewees' employment experiences of limited opportunities, and functional and interpersonal difficulties in the workplace. 64% of people said that their skin disease affected their socio-economic activity. The extent to which sufferers experienced embarrassment, anxiety, a lack of confidence and depression is documented. 40% of people felt that their social life was affected and there was evidence of particular stresses and demands in personal relationships. The social impact of skin disease is discussed.

Acne Vulgaris↗
PubMed1991

Use of N2O/O2/enflurane anesthesia for dental treatment of the handicapped.

To develop an anesthesia maintenance method that could be expected to maintain a reasonably stable state during dental treatment of the handicapped, three methods (N2O/O2 [0% enflurane (E), n = 12], N2O/O2/0.6% E [n = 8], N2O/O2/1.5% E [n = 7]) were evaluated in terms of changes in plasma levels of cortisol, epinephrine (EP), and norepinephrine (NE). During a treatment period of 60 minutes, cortisol levels increased in the 0% E group (from 9.5 +/- 1.8 micrograms/dL to 19.4 +/- 2.4 micrograms/dL, P less than .01), did not change in 0.6% E group, and decreased in 1.5% E group (from 9.3 +/- 1.7 micrograms/dL to 5.8 +/- 1.0 micrograms/dL, P less than .01). Epinephrine and NE levels increased in the 0% E group, but were suppressed in the 0.6% E and 1.5% E groups. It is suggested that N2O/O2 inhalation anesthesia supplemented with low-dose enflurane produces a stable state during dental treatment with respect to cortisol, EP, and NE responses.

Adolescent↗
PubMed1984

Factors associated with a good response to lithium in aggressive mentally handicapped subjects.

Twenty-five (25) mentally handicapped in-patient adults with persistent aggressive behaviour took part in a double-blind crossover trial lasting 5 months comparing the effects of lithium with placebo on aspects of aggressive behaviour. All patients were receiving neuroleptic and/or anticonvulsant drugs which were continued during the trial. Seventeen (17) of the patients showed greater improvement during the lithium phase compared to placebo. Multiple regression analysis was carried out to determine which of 17 background variables were related to outcome. The following factors were associated with a good response to lithium: less than one aggressive episode per week before starting treatment, overactivity, stereotypic behaviour, female sex and epilepsy. No patient became toxic during the investigation although lithium levels were maintained within the therapeutic range (0.5-0.8 mmol/l).

Adolescent↗
PubMed1990

Behavioral weight-loss for multiply-handicapped adults: assessing caretaker involvement and measures of behavior change.

Two groups of cerebral palsied, mentally retarded, overweight adults received training in seven behavioral self-control techniques for reducing caloric intake and increasing activity levels over the course of 19 weeks. One group's parents/caretakers had frequent contacts from the diet leader, (Home-Help Group); the other group, balanced with the first for degree of handicap, had no caretaker-directed communications other than initial notification (No Help Group). Measures of adherence were included to assess the process of behavioral change during the diet program. A significant treatment effect accrued for all participants in the diet program, with the Home-Help Group of dieters showing clinically, though not statistically superior weight loss at treatment end and at follow-ups through one year. Specific behaviors taught, such as replacing utensils after each bite and eating slowly, showed significant changes in the expected directions with weight change. Implications of the data for future treatment programs are discussed.

Adult↗
PubMed1990

Marathon runners: the intestinal handicap.

Intestinal complications following strenuous, protracted physical activity have been increasingly recognized. Diarrhea, sometimes associated with blood loss, described in marathon runners does not appear to be a common diarrhea but rather the clinical expression of ischemic enteropathy. On the basis of experimental evidence and some clinical data, it is suggested that prefeeding an elemental semi-hydrolyzed diet might reduce the incidence and severity of this intestinal handicap in marathon runners. Perhaps, more importantly, the potentially adverse effects of acute ischemic enteropathy on the cardiovascular system might be accordingly reduced.

Cardiovascular System↗
PubMed1983

Small-for-dates babies at the age of four years: health, handicap and developmental status.

221 small-for-dates (SFD) and 244 average-for-dates (AFD) children were personally examined at birth, and seen thereafter at regular intervals up to 4 years, when a thorough assessment was made. There was an excess of SFD children with major congenital abnormalities; but no difference between the groups in the number of children who were handicapped without congenital abnormality. Their general health was good, and the prevalence of specific disease or major ill-health did not differ. SFD girls seemed to have less acute hearing than AFD girls; but there was not difference for boys. The prevalence of squint, impaired vision, speech defects, and abnormalities of gross and fine motor movements were equally low in both groups. At 4 years the mean scores for five sectors of development were significantly lower in the SFD than the AFD group. Within group analyses of 16 variables and their effects on developmental scores showed no associations in either group according to maternal height and weight, birthweights of previous siblings, the presence or not of hypertension and pre-eclampsia, bleeding during pregnancy, asphyxia and injury at birth, or birth order. Within each group the net effect of the remaining eight factors was assessed; adjustment being made for the other seven variables. In the SFD group social class and method of delivery made a significant contribution to total scores. In the AFD group significant differences were found according to social class, sex, gestational age at birth and smoking. Method of infant feeding just failed to achieve significance. When all the children were considered together, and birthweight group included as an additional variable, no significant differences remained between the SFD and AFD groups for any sector of development.

Breast Feeding↗
PubMed1983

Large-for-dates babies at the age of four years: health, handicap and developmental status.

236 Average-for-dates (AFD) and 212 large-for-dates (LFD) children were personally examined at birth, and seen thereafter at regular intervals up to 4 yr, when a thorough assessment was made. No differences were found in the prevalence of handicap, health problems, speech and hearing defects, impaired vision or squint; and abnormalities of gross and fine-motor movements were equally low in both groups. At 4 yr the mean scores for five sectors of development were slightly higher in the LFD group, and the difference in total scores was significant; but when adjustment was made for sex and social class the difference became insignificant. Within group analyses of 16 variables and their effects on developmental scores showed no associations in either group according to maternal weight, height and siblings birthweight; hypertension, pre-eclampsia or bleeding during pregnancy; asphyxia or injury at birth. Within each group the net effect of eight factors was assessed; adjustment being made for the other seven variables. In the AFD group significant differences in total scores were found according to sex, social class, smoking, and method of infant feeding. In the LFD group social class and method of delivery made a significant contribution to total scores.

Analysis of Variance↗
PubMedDate not supplied

L-carnitine as a treatment of lethargy in children with chronic neurologic handicaps.

We present five cases of children with severe neurologic handicaps whose management was complicated by excessive lethargy. Treatment with L-carnitine in a dosage range of 35-50 mg/kg/day resulted in a marked improvement in alertness and arousability. In four cases, when L-carnitine was discontinued for a month, they all promptly became lethargic. When L-carnitine was re-started, the lethargy resolved and the improvement has been maintained for up to 14 months. In three children who were tested, serum carnitine levels (total and free) were normal before starting L-carnitine treatment.

Adolescent↗