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The implementation of inclusive education in South Africa: Reflections arising from a workshop for teachers and therapists to introduce Universal Design for Learning

DALTON, Elizabeth M
MCKENZIE, Judith A
KAHONDE Callista
2012

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South Africa has adopted an inclusive education policy in order to address barriers to learning in the education system. However, the implementation of this policy is hampered by the lack of teachers’ skills and knowledge in differentiating the curriculum to address a wide range of learning needs. In this paper we provided a background to inclusive education policy in South Africa and a brief exposition of an instructional design approach, Universal Design for Learning (UDL) that addresses a wide range of learning needs in a single classroom. We reported on a workshop conducted with teachers and therapists in South Africa as a first attempt to introduce UDL in this context. Knowledge of UDL was judged to be appropriate and useful by the course participants in the South African context as a strategy for curriculum differentiation in inclusive classrooms. Furthermore, knowledge of the UDL framework facilitates dialogue between teachers and therapists and provides a relatively simple and comprehensive approach for curriculum differentiation. We therefore conclude that there is potential for this approach that can be expanded through further teacher training.

The Role of Community Health Workers in the Mongolian CBR Programme

COMO, E
BATDULAM, T
2012

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Purpose: This article aims to present the role of community health workers in the implementation of a comprehensive CBR Programme in rural Mongolia, and to explore the main challenges that arise in this specific geographical and socio-economic context.

 

Methods: Qualitative data were collected through semi-structured interviews with CBR workers from three selected provinces; short meetings and interviews with respective provincial level CBR coordinators complemented the information acquired. Additionally, a workshop with national level CBR stakeholders was carried out in order to review and discuss the findings.

 

Results: The study highlighted a number of practical barriers (including long distances and lack of transportation, low population density, and harsh climate conditions) which constrain the work of community health workers in the areas studied. In relation to disability, the study shed light on the difficulties found by community workers in shifting from a medical approach to disability to a new approach that emphasizes prevention and rehabilitation. Exploring interviewees’ experience in the five areas of CBR (health, education, livelihood, social, empowerment) the authors found that working in the areas other than health is perceived as difficult due to insufficient training as well as objective contextual barriers.

 

Conclusions: Despite many challenges, CBR represents a significant improvement for disability action in rural Mongolia. In this context, the local community health workers are well suited and willing to act as CBR workers; nonetheless, more training and some tailoring work to adapt the Programme to the context is needed if all potential results are to be achieved.

 

Limitations: This study did not include direct observation of CBR activities or consultation of beneficiaries and other stakeholders. Their involvement and consultation would certainly improve the understanding of all the issues raised.

Improving Accessibility to Medical Services for Persons with Disabilities in Thailand

NUALNETR, N
SAKHORNKHAN, A
2012

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Purpose: This action research aimed at developing an action plan to improve the accessibility to home health care and assistive devices for persons with disabilities in a rural community, and to evaluate changes in the numbers of such persons who received appropriate home health care and assistive devices after a three-month implementation of the action plan.

 

Method: The study was conducted at a sub-district of Maha Sarakham Province, Thailand. The main beneficiaries were 99 persons with disabilities (mean age 55.4±18.7 years). Group meetings were organised for persons with disabilities, caregivers, and various community members. An action plan for improving the accessibility of persons with disabilities to home health care and assistive devices was collaboratively formulated and implemented for three months.

 

Results: The main strategy for improving accessibility was to increase the competency of village health volunteers in providing home health care and assistive devices to persons with disabilities. After the three-month action plan implementation, the number of persons with disabilities who received appropriate home health care, i.e. at least once a month, significantly increased from 33.3% to 72.2% (Chi-square test, P<0.01, 95% CI 18.5 to 59.3). The number of persons who received assistive devices suited to their disabilities also significantly increased from 33.3% to 58.3% (Chi-square test, P=0.03, 95% CI 3.5 to 46.5).

 

Conclusions: Under the supervision of physical therapists and/or other allied health professionals, the village health volunteer is likely to be a key person for improving the accessibility to home health care and assistive devices for personswith disabilities in a rural community.

 

Limitations: The study was limited to only one sub-district. No comparable areas were studied. Further, since the study recruited persons with disabilities from a rural community, applicability of the findings to persons with disabilities in an urban community should be considered judiciously.

Constraint - Induced Movement Therapy: Determinants and Correlates of Duration of Adherence to Restraint use Among Stroke Survivors with Hemiparesis

OLASUNKANMI, D O
OLASUMBO, S A
2012

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Background: Constraint-Induced Movement Therapy (CIMT) was developed to improve purposeful movement of the stroke-affected extremity by restricting the use of the unaffected extremity. The two main components of CIMT are the training of the more-impaired arm to perform functional tasks, and the restraint of the less-impaired arm. One challenge that the application of CIMT faces is in ensuring adherence to the use of restraint.

 

Purpose: There is a need to determine the factors that may influence adherence, as this would allow CIMT to be delivered more effectively, and prevent situations where unrealistic expectations are placed on stroke–affected individuals.

 

Methods: Thirty stroke survivors with hemiparesis who met the inclusion criteria were consecutively recruited from the physiotherapy out-patient clinics, using a purposive sampling technique. A structured questionnaire was used to obtain information on clinical and socio-demographic parameters. The participants were given a restraint and an adherence time log-book, to make a daily record during the period they wore the restraint. The adherence time log- book was collected at the end of every week of the 3-week study. Motor function and functional use of the upper limb were measured using Motricity Index and Motor Activity Log respectively. Data was analysed using mean and standard deviations, independent t-test and Spearman rho; p was significant at 0.05.

 

Results: Gender (p=0.73) and side affected/handedness (p=0.79) had no significant influence on the percentage duration of adherence to restraint use (DARU). The influence of socio-economic status was seen, with the participants of middle socio-economic status adhering for longer duration (p=0.02). Age had weak and no significant correlation with percentage DARU (p=0.55). There was significantly fair correlation between motor function/functional use at any stage (p=0.55) and the corresponding percentage duration of adherence to restraint use, except the functional use in the first week (p=0.44).

 

Conclusion: Socio-economic status should be considered when applying CIMT.

The Community Based Rehabilitation Programme of the University of the Philippines Manila, College of Allied Medical Professions

MAGALLONA, M L M
DATANGEL, J P
2012

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Purpose: This paper reports the process of development of a CBR programme by UP Manila College of Allied Medical Professions, and its impact on the stakeholders: persons with disabilities, students and alumni, CBR workers, local leaders and the agencies involved in the programme.

 

Method: The impact of the programme was assessed through interviews, questionnaires, focus group discussions and review of secondary data and records.

 

Results: The programme results show that the condition of persons with disabilities has improved and there has been a remarkable change in their knowledge, attitudes and skills. The positive attitudes, skills and values of students were enhanced, and the CBR programme was a “character builder” for them as rehabilitation professionals. The CBR workers who participated in the programme learnt to appreciate the potential of persons with disabilities and to accept their limitations. Another key result was the pledge by local leaders to sustain CBR in their own villages.

 

Conclusions: The students and alumni reported that the CBR programme should be replicated for nation-building. The different stakeholders reported that it helped improve the quality of life of people with disabilities and contributed to community development.

Rehabilitation Services for Persons Affected by Stroke in Jordan

AL-ORAIBI, S
DAWSON, V L
BALLOCH, S
MOORE, A P
2011

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The purpose of this study was to explore the perceptions stroke survivors have of the rehabilitation services received by them in the Jordanian community. A secondary aim was to explore the impact of culture on providing appropriate services for stroke survivors.

 

Eighteen stroke survivors were recruited from an outpatient stroke rehabilitation programme. All 18 participants had been discharged from hospital for between one and six months. Semi-structured interviews were performed, either in thephysiotherapy outpatient clinic where the affected person was attending a clinic or in their homes. Transcription of interviews carried out in Arabic and thematic analysis was also carried out in that language by transcribers who were fluent in Arabic and English, using a back-translation method. Necessary measures were taken to ensure the accuracy, reliability and validity of the data collection and analysis.

 

Following thematic analysis, themes arising out of the data included physiotherapy and occupational therapy support in the community, out-patient rehabilitation clinic services, community clinic services and support from families, friends and neighbours. Participants expressed satisfaction with their therapists, but there were large areas of unmet rehabilitation need for stroke survivors in the Jordanian community such as a limited availability of occupational therapy services, insufficient amount of therapy services and poor medical support.

 

This study presents a unique contribution to knowledge relating to the experiences of stroke survivors in a developing country, and also shows how care systems are very dependent on cultural contexts, cultural beliefs and practices.

CBR matrix and perceived training needs of CBR workers: a multi-country study

DEEPAK, Sunil
2011

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CBR Matrix, proposed in the CBR Guidelines, provides a systematic framework for organising and analysing CBR activities. A sample of experienced CBR workers, active at community level in 7 countries , were asked for information about different activities they actually carry out, so as to understand the applicability of CBR Matrix framework in the field. The CBR workers were also asked to identify their most pressing learning needs in different areas of CBR Matrix.

This study shows that CBR Matrix can be a useful framework to understand field-level activities in CBR projects. The study has identified a number of priority learning needs, in terms of different domains of CBR Matrix, and in terms of different disabilities. It also shows that globally, areas related to advocacy, lobbying, legal protection and rights-based approach, are the most important learning needs identified by CBR workers.

Cochrane Rehabilitation

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Cochrane Rehabilitation is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice, combining the best available evidence as gathered by high quality Cochrane systematic reviews, with their own clinical expertise and the values of patients. Their vision is a world where decision makers will be able to take decisions according to the best and most appropriate evidence in this specific field. Cochrane Rehabilitation wants to improve the methods for evidence synthesis, to make them coherent with the needs of disabled people and daily clinical practice in rehabilitation

INCLUDE: A Community-Based Rehabilitation (CBR) learning community

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INCLUDE is an online learning community for community-based rehabilitation (CBR) that aims to inform and support CBR managers and interested stakeholders around the world.

It is an online programme that guides the user through different information modules based on the Community-based rehabilitation guidelines: health, education, livelihood, social and empowerment.

INCLUDE also provides tools to assist users to reflect on their own thoughts and experiences, and case studies that show CBR in action. INCLUDE allows the user to develop an action plan around management and the five components and corresponding elements of the CBR matrix.

These action plans can be stored and built on over time, and shared with others in the CBR community.

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