Intellectual disability and sexuality : attitudes of disability support staff and leisure industry employees

Background: The attitudes of support staff and others in the community towards the sexuality of individuals with an intellectual disability (ID) have the potential to influence opportunities for normalised life experiences in the area of sexuality. ----- Method: A sample of 169 disability support staff and 50 employees from leisure and services industries completed the Attitudes to Sexuality Questionnaires (Individuals with an Intellectual Disability [ASQ–ID], and Individuals from the General Population [ASQ–GP]). ----- Results: Support staff and leisure workers reported generally positive attitudes towards the sexuality of individuals with an ID, but men were seen as having less self-control than women. Support staff were more cautious in their views about parenting, and both groups considered a lower level of sexual freedom to be desirable for women with an ID compared to women who are developing typically. Conclusions Attitudes of both groups are generally quite positive in relation to ID and sexuality.

Dancing with nature : rhythm and harmony in extreme sport participation

Research on extreme sports has downplayed the importance of the athletes' connection to the natural world. This neglect stems, in part, from the assumption that these activities derive their meaning primarily from risk. The authors' long-term research reveals that the interplay between adventure athletes and the natural world is, in fact, crucial for many participants. This study used hermeneutic and phenomenological analysis of first-hand accounts of these sports and interviews with 15 veteran participants. These included BASE jumpers, big-wave surfers, extreme skiers, waterfall kayakers, extreme mountaineers and solo rope-free climbers. Participants spoke extensively about developing a deep relationship with the natural world akin to an intimate 'dance' between actively engaged partners. Our experience-based analysis has found that extreme sports aficionados do not simply view the natural world as a commodity, a stage for risk taking, or vehicle for self-gratification. On the contrary, for veteran adventure athletes the natural world acts as a facilitator to a deeper, more positive understanding of self and its place in the environment. For some, nature was described as omnipresent and ubiquitous, and a source of innate power and personal meaning. The authors explore how these findings may augment the delivery of more 'ecocentric' programmes in the outdoor adventure field.

A discrete-trial approach to the functional analysis of aggressive behaviour in two boys with autism

Intervention to reduce challenging behaviour may be enhanced when based on a prior functional analysis. The present study describes a discrete-trial approach for the functional analysis of aggressive behaviour in two boys with autism. Twenty brief assessment trials were conducted in the classroom by the teacher under each of three conditions (i.e., attention, task and tangible). The results showed a clear pattern to each child's aggressive behaviour and suggested logical intervention strategies, although the study is limited because it involved only two children. The discrete-trial approach would appear to represent a practical and ecologically valid technique for conducting a functional analysis of challenging behaviour in applied settings

The neuro-muscular and musculo-skeletal characterization of children with joint hypermobility

In children, joint hypermobility (typified by structural instability of joints) manifests clinically as neuro-muscular and musculo-skeletal conditions and conditions associated with development and organization of control of posture and gait (Finkelstein, 1916; Jahss, 1919; Sobel, 1926; Larsson, Mudholkar, Baum and Srivastava, 1995; Murray and Woo, 2001; Hakim and Grahame, 2003; Adib, Davies, Grahame, Woo and Murray, 2005:). The process of control of the relative proportions of joint mobility and stability, whilst maintaining equilibrium in standing posture and gait, is dependent upon the complex interrelationship between skeletal, muscular and neurological function (Massion, 1998; Gurfinkel, Ivanenko, Levik and Babakova, 1995; Shumway-Cook and Woollacott, 1995). The efficiency of this relies upon the integrity of neuro-muscular and musculo-skeletal components (ligaments, muscles, nerves), and the Central Nervous System’s capacity to interpret, process and integrate sensory information from visual, vestibular and proprioceptive sources (Crotts, Thompson, Nahom, Ryan and Newton, 1996; Riemann, Guskiewicz and Shields, 1999; Schmitz and Arnold, 1998) and development and incorporation of this into a representational scheme (postural reference frame) of body orientation with respect to internal and external environments (Gurfinkel et al., 1995; Roll and Roll, 1988). Sensory information from the base of support (feet) makes significant contribution to the development of reference frameworks (Kavounoudias, Roll and Roll, 1998). Problems with the structure and/ or function of any one, or combination of these components or systems, may result in partial loss of equilibrium and, therefore ineffectiveness or significant reduction in the capacity to interact with the environment, which may result in disability and/ or injury (Crotts et al., 1996; Rozzi, Lephart, Sterner and Kuligowski, 1999b). Whilst literature focusing upon clinical associations between joint hypermobility and conditions requiring therapeutic intervention has been abundant (Crego and Ford, 1952; Powell and Cantab, 1983; Dockery, in Jay, 1999; Grahame, 1971; Childs, 1986; Barton, Bird, Lindsay, Newton and Wright, 1995a; Rozzi, et al., 1999b; Kerr, Macmillan, Uttley and Luqmani, 2000; Grahame, 2001), there has been a deficit in controlled studies in which the neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility have been quantified and considered within the context of organization of postural control in standing balance and gait. This was the aim of this project, undertaken as three studies. The major study (Study One) compared the fundamental neuro-muscular and musculo-skeletal characteristics of 15 children with joint hypermobility, and 15 age (8 and 9 years), gender, height and weight matched non-hypermobile controls. Significant differences were identified between previously undiagnosed hypermobile (n=15) and non-hypermobile children (n=15) in passive joint ranges of motion of the lower limbs and lumbar spine, muscle tone of the lower leg and foot, barefoot CoP displacement and in parameters of barefoot gait. Clinically relevant differences were also noted in barefoot single leg balance time. There were no differences between groups in isometric muscle strength in ankle dorsiflexion, knee flexion or extension. The second comparative study investigated foot morphology in non-weight bearing and weight bearing load conditions of the same children with and without joint hypermobility using three dimensional images (plaster casts) of their feet. The preliminary phase of this study evaluated the casting technique against direct measures of foot length, forefoot width, RCSP and forefoot to rearfoot angle. Results indicated accurate representation of elementary foot morphology within the plaster images. The comparative study examined the between and within group differences in measures of foot length and width, and in measures above the support surface (heel inclination angle, forefoot to rearfoot angle, normalized arch height, height of the widest point of the heel) in the two load conditions. Results of measures from plaster images identified that hypermobile children have different barefoot weight bearing foot morphology above the support surface than non-hypermobile children, despite no differences in measures of foot length or width. Based upon the differences in components of control of posture and gait in the hypermobile group, identified in Study One and Study Two, the final study (Study Three), using the same subjects, tested the immediate effect of specifically designed custom-made foot orthoses upon balance and gait of hypermobile children. The design of the orthoses was evaluated against the direct measures and the measures from plaster images of the feet. This ascertained the differences in morphology of the modified casts used to mould the orthoses and the original image of the foot. The orthoses were fitted into standardized running shoes. The effect of the shoe alone was tested upon the non-hypermobile children as the non-therapeutic equivalent condition. Immediate improvement in balance was noted in single leg stance and CoP displacement in the hypermobile group together with significant immediate improvement in the percentage of gait phases and in the percentage of the gait cycle at which maximum plantar flexion of the ankle occurred in gait. The neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility are different from those of non-hypermobile children. The Beighton, Solomon and Soskolne (1973) screening criteria successfully classified joint hypermobility in children. As a result of this study joint hypermobility has been identified as a variable which must be controlled in studies of foot morphology and function in children. The outcomes of this study provide a basis upon which to further explore the association between joint hypermobility and neuro-muscular and musculo-skeletal conditions, and, have relevance for the physical education of children with joint hypermobility, for footwear and orthotic design processes, and, in particular, for clinical identification and treatment of children with joint hypermobility.

A comparison of two procedures for increasing spontaneous requests in children with autism

The missing-item format and interrupted behaviour chain strategy have been used to increase spontaneous requests among children with developmental disabilities, but their relative effectiveness has not been compared. The present study compared the extent to which each strategy evoked spontaneous requests and challenging behaviour in three children with autism. Sessions where a needed item was withheld (missing-item format) were compared to sessions involving the removal of a needed item (interrupted behaviour chain strategy). Comparisons were conducted across three activates in an alternating treatments design. Both strategies evoked spontaneous requests with no significant difference in effectiveness. Few differences were obtained in the amount of challenging behaviour evoked but the two conditions, although a moderate inverse relationship between spontaneous requesting and challenging behaviour was observed. The results suggest that theses two procedures yield similar outcomes. Concurrent use of both strategies may enable teachers to create a greater number of opportunities for requesting.

The performance of a prolonged reading task by students with low vision

Purpose: Students often read for long periods and prolonged reading practice may be important for developing reading skills. For students with low vision, reading at a close working distance imposes high demands on their near visual functions, which might make it difficult to sustain prolonged reading. The aim of this study was to investigate the performance of a prolonged reading task by students with low vision. Method: Forty students with low vision, aged from eight to 20 years and without any intellectual, reading or learning disability, were recruited through the Paediatric Low Vision Clinic, Buranda, Queensland. Following a preliminary vision examination, reading performance measures—critical print size (CPS), maximum oral reading rates (MORR), near text visual acuity— were recorded using the Bailey-Lovie text reading charts before and after a 30-minute prolonged reading task. Results: The mean age of the participants was 13.03 ± 3 years. The distance and near visual acuities ranged between -0.1 to 1.24 logMAR and 0.0 to 1.60 logMAR, respectively. The mean working distance of the participants was 11.2 ± 5.8 cm. Most of the participants (65 per cent) in this study were able to complete the prolonged reading task. Overall, there was no significant change in CPS, MORR and near text visual acuity following the prolonged task (p > 0.05). MORR was significantly correlated to age and near text visual acuity (p < 0.05). Conclusions: In this study, students with low vision were able to maintain their reading performance over a 30-minute prolonged reading task. Overall, there was no significant increase or decrease in reading performance following a prolonged reading task performed at their habitual close working distances but there were wide individual variations within the group.

Meniscal repair in the elite athlete : results of 45 repairs with a minimum 5-year follow-up

Background The preservation of meniscal tissue is important to protect joint surfaces. Purpose We have an aggressive approach to meniscal repair, including repairing tears other than those classically suited to repair. Here we present the medium- to long-term outcome of meniscal repair (inside-out) in elite athletes. Study Design Case series; Level of evidence, 4. Methods Forty-two elite athletes underwent 45 meniscal repairs. All repairs were performed using an arthroscopically assisted inside-out technique. Eighty-three percent of these athletes had ACL reconstruction at the same time. Patients returned a completed questionnaire (including Lysholm and International Knee Documentation Committee [IKDC] scores). Mean follow-up was 8.5 years. Failure was defined by patients developing symptoms of joint line pain and/or locking or swelling requiring repeat arthroscopy and partial meniscectomy. Results The average Lysholm and subjective IKDC scores were 89.6 and 85.4, respectively. Eighty-one percent of patients returned to their main sport and most to a similar level at a mean time of 10.4 months after repair, reflecting the high level of ACL reconstruction in this group. We identified 11 definite failures, 10 medial and 1 lateral meniscus, that required excision; this represents a 24% failure rate. We identified 1 further patient who had possible failed repairs, giving a worst-case failure rate of 26.7% at a mean of 42 months after surgery. However, 7 of these failures were associated with a further injury. Therefore, the atraumatic failure rate was 11%. Age and size and location of the tears were not associated with a higher failure rate. Medial meniscal repairs were significantly more likely to fail than lateral meniscal repairs, with a failure rate of 36.4% and 5.6%, respectively (P < .05). Conclusion Meniscal repair and healing are possible, and most elite athletes can return to their preinjury level of activity.

Everyday life and the edges of existence : wrongs with no name or the wrong name?

Actions for wrongful life, as they have come unfortunately to be styled, encompass various types of claim. These include claims for alleged negligence after conception, those based on negligent advice or diagnosis prior to conception concerning possible effects of treatment given to the child's mother, contraception or sterilisation, or genetic disability. This distinguishes such claims from those for so called wrongful birth, which are claims by parents for the cost of raising either a healthy or a disabled child where the unplanned birth imposes costs on the parents as a result of clinical negligence. Two of the more controversial cases to have reached the High Court of Australia which are if interest to us here in the past decade are Cattanach v Melchior where the court, by a narrow majority (McHugh, Gummow, Kirby and Callinan JJ; Gleeson CJ, Hayne and Heydon dissenting) acknowledged recovery for wrongful birth. In the second joined appeals of Harriton v Stephens and Waller v James; Waller v Hoolahan the court overwhelmingly precluded a ‘wrongful life’ claim (Gleeson CJ, Gummow, Hayne, Callinan, Heydon and Crennan JJ; Kirby J dissenting). Both cases raised issues around the sanctity and value of life and the nature of harm and the assessment of damages, and this brief note affords us the opportunity to consider the way in which the ‘life as legal loss’ arguments were treated by the various judges in both cases.

Psychosocial outcomes of Hong Kong Chinese diagnosed with acute coronary syndromes: a prospective repeated measures study.

BACKGROUND: Western studies have suggested that emotional stress and distress impacted on the morbidity and mortality in people following acute coronary events. Symptoms of anxiety and depression have been associated with re-infarction and death, prolonged recovery and disability and depression may precipitate the client's low self-esteem. This study examined perceived anxiety, depression and self-esteem of Hong Kong Chinese clients diagnosed with acute coronary syndrome (ACS) over a 6-month period following hospital admission. OBJECTIVES: To examine: DESIGN: A prospective, repeated measures design with measures taken on two occasions over a 6-month period; (1) within the 1st week of hospital admission following the onset of ACS and (2) at 6 months follow up. SETTING AND PARTICIPANTS: Convenient sample of 182 voluntary consented clients admitted with ACS to a major public hospital in Hong Kong who could communicate in Chinese, complete questionnaires, cognitive intact, and were haemodynamically stable and free from acute chest pain at the time of interview. METHODS: Baseline data were obtained within 1 week after hospital admission. The follow-up data was collected 6 months after hospital discharge. The Chinese version of the Hospital Anxiety and Depression Scale (HADS), State Self-esteem Scale (SSES), and Rosenberg's Self-Esteem Scale (RSES) were used to assess anxiety and depression, state self-esteem, and trait self-esteem, respectively. RESULTS: Findings suggested gender differences in clients' perception in anxiety, depression and self-esteem. Improvements in clients' perception of these variables were evident over the 6-month period following their acute coronary events. CONCLUSION: The study confirmed the western notion that psychosocial problems are common among coronary clients and this also applies to Hong Kong Chinese diagnosed with ACS. Further studies to explore effective interventions to address these psychosocial issues are recommended.

Disability, deinstitutionalisation and discourse : an analysis of institutional reform policies in Queensland, 1994-1996

The closure of large institutions for people with intellectual disability and the subsequent shift to community living has been a feature of social policies in most western democracies for more than two decades. While the move from congregated settings to homes in the community has been heralded as a positive and desirable strategy, deinstitutionalisation has continued to be a controversial policy and practice. This research critically analyses the implementation of a deinstitutionalisation policy called Institutional Reform in the state of Queensland from May 1994 until it was dismantled under a new government in the middle of 1996. A trajectory study of the policy from early conceptualisation through its development, implementation and final extinction was undertaken. Several methods were utilised in the research including the textual analyis of policy documents, discussion papers and newspaper articles, interviews with stakeholders and participant observation. The research draws on theories of discourse and focuses on how discourses of disability shape policy and practice. The thesis outlines a number of implications for policy implementation more generally as well as for disability services. In particular, the theoretical framework builds on Fulcher's (1989) disabling discourses - medical, charity, lay and rights - and identifies two additional discourses of economics and inclusion. The thesis argues that competing disability discourses operated in powerful ways to shape the implementation of the policy and illustrates how older discourses based on fear and prejudice were promoted to positions of dominance and power.

Loneliness and classroom participation in adolescents with learning disabilities : a social cognitive view

Students with learning disabilities (LD) often experience significant feelings of loneliness. There is some evidence to suggest that these feelings of loneliness may be related to social difficulties that are linked to their learning disability. Adolescents experience more loneliness than any other age group, primarily because this is a time of identity formation and self-evaluation. Therefore, adolescents with learning disabilities are highly likely to experience the negative feelings of loneliness. Many areas of educational research have highlighted the impact of negative feelings on learning. This begs the question, =are adolescents with learning disabilities doubly disadvantaged in regard to their learning?‘ That is, if their learning experience is already problematic, does loneliness exacerbate these learning difficulties? This thesis reveals the findings of a doctoral project which examined this complicated relationship between loneliness and classroom participation using a social cognitive framework. In this multiple case-study design, narratives were constructed using classroom observations and interviews which were conducted with 4 adolescent students (2 girls and 2 boys, from years 9-12) who were identified as likely to be experiencing learning disabilities. Discussion is provided on the method used to identify students with learning disabilities and the related controversy of using disability labels. A key aspect of the design was that it allowed the students to relate their school experiences and have their stories told. The design included an ethnographic element in its focus on the interactions of the students within the school as a culture and elements of narrative inquiry were used, particularly in reporting the results. The narratives revealed all participants experienced problematic social networks. Further, an alarmingly high level of bullying was discovered. Participants reported that when they were feeling rejected or were missing a valued other they had little cognitive energy for learning and did not want to be in school. Absenteeism amongst the group was high, but this was also true for the rest of the school population. A number of relationships emerged from the narratives using social cognitive theory. These relationships highlighted the impact of cognitive, behavioural and environmental factors in the school experience of lonely students with learning disabilities. This approach reflects the social model of disability that frames the research.