Background: People with intellectual disability constitute approximately 2% of the population. They die prematurely, and often have a number of unrecognised or poorly managed medical conditions as well as inadequate health promotion and disease prevention. Methods: A cluster randomised controlled trial with matched pairs was carried out. The participants were adults with intellectual disability (n=453 in 34 clusters). The intervention was a health assessment program to enhance interactions between the adult with intellectual disability, their carer, and their general practitioner (GP). It promoted the systematic gathering of a health history and, subsequently, access to a GP for a guided health review and development of a health action plan. It also provided information about the health of adults with intellectual disability. Follow-up was for one year post-intervention, with outcomes extracted from GPs' clinical records. Interviews of adults with intellectual disability, their residential support staff and GPs were performed prior to and after the intervention period. Results: Increased health promotion, disease prevention and case-finding activity was found in ther intervention group. Compared with the control group there was a 6.6-fold increase in detection of vision impairment [95% confidence interval 1.9-40]; a 30-fold increase in hearing testing [4.0-230]; an increase in immunisation updates (tetanus/diphtheria a nine-fold increase [4.2-19]), and improvements in women's health screening (Papanicolau smears were eight times more common [1.8-35]). The intervention increased detection of new disease by 1.6 times [0.9-2.8]. Residential support staff and GPs largely supported the implementation of the health assessment process however interviews of adults with intellectual disability were uninformative. Conclusions: The Comprehensive Health Assessment Program (CHAP) produced a substantial increase in GPs' attention to the health needs of adults with intellectual disability with noncomitantly more disease detection, and the process was supported by residential support staff and GPs. The presumption that these will yield longer-term health benefits, while suggestive, remains unexamined.

No description available.

No description available.

This study investigates the extent and nature of the relationship between individual and disability characteristics (age, sex, degree of hearing loss, age at onset of hearing loss, time since onset of hearing loss, use of technology, and use of services), and adjustment to acquired hearing loss, and the role hope has in that relationship. A sample of 114 adults with hearing loss who had accessed hearing therapy services participated in the study. It was hypothesised that hope would interact with the individual and disability characteristics and therefore function as a moderating variable. The second hypothesis was that hope may be related to individual and disability characteristics as well as adjustment but actually provides the only significant pathway to adjustment; more simply, hope may be a mediator of adjustment. The results indicate that the degree of loss was the only statistically significant individual and disability characteristic related to adjustment. The trait of hope did not produce an interaction effect of statistical significance in the moderation model. However, the study does provide support for the hypothesis that the trait of hope serves is a mechanism by which the degree of loss affects adjustment. Hearing loss affects hope which in turn affects adjustment. In other words, hope was found to act as a mediating variable. The extent of this mediating role was substantial as hope was found to account for 45% of the relationship between the degree of loss and adjustment. Additionally, the study found that self-efficacy and personal meaning may influence hope and despair dimensions in different ways. The perception of one's ability to influence events is a major contributor to hopefulness while the construction of meaning appears to be related to lower levels of despair. Current research in the area of positive psychology indicates that individual traits are modifiable and therefore hope finding, hope bonding, hope enhancement, and hope reminding can instil and increase hope. The implication of these findings is that hearing rehabilitation programmes need to consider the role of hope in intervention strategies. The study suggests possibilities for future research including the investigation of more complex mediational chains, refining individual and disability variables, and assessing the effect of hope-focussed intervention strategies.

Vision impairment profoundly affects older people, yet we do not know specifically which areas of daily living are most affected by vision impairment. Nor do we know how daily levels of activity and independence differ for this population compared to others their age. Understanding these differences can enhance goal-setting practices and improve rehabilitation services for older individuals with impaired vision. This study examined activity, independence and life satisfaction of older adults living in the Manawatu region of the North Island of New Zealand, using an adapted model of the World Health Organization's International Classification of Functioning, Disability and Health. The adapted model introduced subjective dimensions of functioning including satisfaction with activity, independence and life. This study was conducted with registered members of the Royal New Zealand Foundation of the Blind and with a random selection of registered voters in the region. Results indicated that both age and vision impairment had significant main effects on activity and independence. An interaction of age and vision had effect on the number of recently relinquished activities participants reported, social comparisons of activity and independence, and on satisfaction with independence and with life. An examination of age cohorts assisted in an improved understanding of daily functioning for this population. Unique findings were that social comparison of activity and satisfaction with social support contributed more to overall life satisfaction than did activity and independence levels. Unexpectedly, the oldest age cohort of those with impaired vision reported a higher level of overall life satisfaction than did their sighted peers in the oldest age cohort or younger cohorts with impaired vision. Results of this study will enable a better understanding of daily life for older people, and the differences which can be attributed to vision impairment. Older people and those that provide rehabilitation services to them can use this information to set more realistic and appropriate goals for rehabilitation. The results of this study will also allow those involved in personnel preparation programmes to develop curricula to improve new practitioners' understanding of typical daily life of older people with and without impaired vision.

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009