Poor functional health literacy : the silent disability for older people

In this information age, people are confronted by verbal, visual and written information. This is especially important in the health field, where information is needed to follow directions, understand prescriptions and undertake preventive behaviours. If provided in written form, much of this information may be inaccessible to people who cannot adequately read. Although poor literacy skills affect all groups in the population, older adults with fewer years of education seem to be particularly disadvantaged by an increasing reliance on written communication of health information. With older age comes a higher risk of illness and disability and a greater potential need to access the health system. As a result, poor literacy skills of older individuals may directly impact their health status. This paper explores the link between functional literacy and health, particularly for the older population, provides strategies to practitioners for the management of this problem, and suggests research initiatives in this area.

Understanding the literacy difficulties of students with Asperger's syndrome in middle years' classrooms

Among the students in Australian classrooms who are experiencing learning difficulties are increasing numbers of children who have been diagnosed with Asperger's syndrome. Although the general cognitive and language abilities of these students are comparable with most of their peers, they experience significant difficulties with social communication, social interactions and social-emotional/behavioural functioning. Despite indications that there are features inherent in Asperger's syndrome that are likely to have a negative effect on the development of advanced literacy skills, studies to date have primarily focused on social-emotional/behavioural challenges. Without effective literacy skills, however, students' access to educational and career opportunities may be curtailed. This article reviews features of Asperger's syndrome that appear to have a negative impact upon the development of advanced literacy skills and suggests ways in which inclusive classroom teachers could support the development of their learners.

The impact of pain on the quality of life of people with multiple sclerosis: A community survey

The purpose of this study was to examine the impact of pain on functioning across multiple quality of life (QOL) domains among individuals with multiple sclerosis (MS). A total of 219 people were recruited from a regional MS society membership database to serve as the community-based study sample. All participants completed a questionnaire containing items about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the preceding 2 weeks. Respondents who reported pain then completed an in-person structured pain interview assessing pain characteristics (intensity, quality, location, extent, and duration). Comparisons between participants with and without MS-related pain demonstrated that pain prevalence and intensity were strongly correlated with QOL: physical health, psychological health, level of independence, and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. These findings suggest that for people with MS, pain is an important source of distress and disability beyond that caused by neurologic impairments.

A longitudinal study of motivation and competence in children with Down syndrome : early childhood to early adolescence

Background Motivation has been identified as an area of difficulty for children with Down syndrome. Although individual differences in mastery motivation are presumed to have implications for subsequent competence, few longitudinal studies have addressed the stability of motivation and the predictive validity of early measures for later academic achievement, especially in atypical populations. Method The participants were 25 children with Down syndrome. Mastery motivation, operationalised as persistence, was measured in early childhood and adolescence using tasks and parent report. At the older age, preference for challenge, another aspect of mastery motivation, was also measured and the children completed assessments of academic competence. Results There were significant concurrent correlations among measures of persistence at both ages, and early task persistence was associated with later persistence. Persistence in early childhood was related to academic competence in adolescence, even when the effects of cognitive ability at the younger age were controlled. Conclusions For children with Down syndrome, persistence appears to be an individual characteristic that is relatively stable from early childhood to early adolescence. The finding that early mastery motivation is significant for later achievement has important implications for the focus of early interventions.

Optimisation of performance in top level athletes : an action-based coping approach : a commentary

INTRODUCTION In their target article, Yuri Hanin and Muza Hanina outlined a novel multidisciplinary approach to performance optimisation for sport psychologists called the Identification-Control-Correction (ICC) programme. According to the authors, this empirically-verified, psycho-pedagogical strategy is designed to improve the quality of coaching and consistency of performance in highly skilled athletes and involves a number of steps including: (i) identifying and increasing self-awareness of ‘optimal’ and ‘non-optimal’ movement patterns for individual athletes; (ii) learning to deliberately control the process of task execution; and iii), correcting habitual and random errors and managing radical changes of movement patterns. Although no specific examples were provided, the ICC programme has apparently been successful in enhancing the performance of Olympic-level athletes. In this commentary, we address what we consider to be some important issues arising from the target article. We specifically focus attention on the contentious topic of optimization in neurobiological movement systems, the role of constraints in shaping emergent movement patterns and the functional role of movement variability in producing stable performance outcomes. In our view, the target article and, indeed, the proposed ICC programme, would benefit from a dynamical systems theoretical backdrop rather than the cognitive scientific approach that appears to be advocated. Although Hanin and Hanina made reference to, and attempted to integrate, constructs typically associated with dynamical systems theoretical accounts of motor control and learning (e.g., Bernstein’s problem, movement variability, etc.), these ideas required more detailed elaboration, which we provide in this commentary.

Mainstreamed students with learning difficulties : failing and underachieving in the secondary school

Despite the rhetoric that students with learning difficulties are adequately supported within schools, the evidence suggests that they continue to experience school failure with devastating consequences. Students with learning difficulties are disproportionately represented as juvenile delinquents, as the unemployed and in mental health statistics. However, the defining of this group remains confused and imprecise and has not been a national priority. This has repercussions for both secondary schools and for the students themselves. This paper highlights research related to teaching practices, policies and school structure and their effects on the academic outcomes and emotional well being of students with learning difficulties. Finally, it makes a number of recommendations to change the status quo for these students.

Corneal confocal microscopy : a novel noninvasive means to diagnose neuropathy in patients with Fabry disease

ABSTRACT: Neuropathy is a cause of significant disability in patients with Fabry disease, yet its diagnosis is difficult. In this study we compared the novel noninvasive techniques of corneal confocal microscopy (CCM) to quantify small-fiber pathology, and non-contact corneal esthesiometry (NCCA) to quantify loss of corneal sensation, with established tests of neuropathy in patients with Fabry disease. Ten heterozygous females with Fabry disease not on enzyme replacement therapy (ERT), 6 heterozygous females, 6 hemizygous males on ERT, and 14 age-matched, healthy volunteers underwent detailed quantification of neuropathic symptoms, neurological deficits, neurophysiology, quantitative sensory testing (QST), NCCA, and CCM. All patients with Fabry disease had significant neuropathic symptoms and an elevated Mainz score. Peroneal nerve amplitude was reduced in all patients and vibration perception threshold was elevated in both male and female patients on ERT. Cold sensation (CS) threshold was significantly reduced in both male and female patients on ERT (P < 0.02), but warm sensation (WS)and heat-induced pain (HIP) were only significantly increased in males onERT (P<0.01). However, corneal sensation assessed withNCCAwas significantly reduced in female (P < 0.02) and male (P < 0.04) patients on ERT compared with control subjects. According to CCM, corneal nerve fiber and branch density was significantly reduced in female (P < 0.03) and male (P < 0.02) patients on ERT compared with control subjects. Furthermore, the severity of neuropathic symptoms and the neurological component of the Mainz Severity Score Index correlated significantly with QSTand CCM. This study shows that CCM and NCCA provide a novel means to detect early nerve fiber damage and dysfunction, respectively, in patients with Fabry disease.

How can secondary schools enact assessment policy for students with disabilities?

This report investigates effective ways secondary schools can enact curriculum policy related to assessment for learning with students with disabilities. Assessment for learning (AfL) has gained recent importance through inclusion in assessment policy. AfL is the frequent assessments of student progress that identifies learning needs and informs future teaching and learning. The application of AfL principles provides opportunity for teachers to improve the achievement of students with disabilities. AfL is an element of the Queensland P-12 Curriculum Framework. School leaders can use this report’s suggestions to make sense of policy; develop common and shared beliefs and actions; organize professional learning opportunities; arrange collaborative curriculum planning to influence staff to effectively implement curriculum policy.

Duplicity/complicity : misperforming the social drama of disability

In this paper, I investigate the (mis)performance of ‘passing’ in the context of bodies with disabilities. The desire to conceal, control or contain a body’s idiosyncrasies can be a deceitful act, complicit with dominant cultural assumptions about the benefits of fitting in. Passing, and the performative tricks, techniques and prostheses that support the ‘lie’ of passing, upholding a social contract in which a closeting-as-cure approach accommodates discomfort with difference. In this paper, I consider moments of non-passing, where people are caught out by mistakes or deliberate misperformances of the daily social drama of ability and disability. I reference the work of disabled artists Bill Shannon, Aaron Williamson and Katherine Araniello, who re-perform their daily personal interactions in the public sphere as a sort of guerilla theatre. Their work brings hidden assumptions about how disabled people should act and interact to the brink of visibility. It challenges passers-by to confront their complicity in these discourses by pressing them to re-perform their own spontaneous reactions to bodies that misperform the ‘lie’ of normalcy.

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.