The aim of this thesis is to determine the influence of assisted therapy of dogs and horses for people with musculoskeletal disabilities and sensory impairments. The operational objective is to define the status and position of a therapy with the assistance of a dog and a horse in the context of the complex rehabilitation of a client. The theoretical part concentrates on the issues of zootherapy and zooasistance as supportive methods for easing muscle spasms, the development of fine and gross motor skills, development of verbal and nonverbal communication and development of orientation in space. In the research part of the thesis there are used qualitative techniques of data collection (history and observation), all rounded off by grounded theory. By the carried out research there were found positive manifestations in both the social and psychological areas, as well as in the areas of communication and development of fine and gross motor skills of children with disabilities.

The main goal of diploma thesis Subjective and objective view on the importance of rehabilitation or individuals whit pgysical disabilities is to analyze rehabilitation meaning for the person with physical disabilities, specifically for a lady with muscular dystropgy from subjective and objective point of view. First chapters describe theoretical background of terminology, physical disability definition and characteristics, description of rehabilitation as whole and its elements. Following chapter focuses on research and case study. For the elaboration of the diploma thesis, were used analysis of professional literature, a qualitative research survey based on direct observation, interviews, anamnestic questionnaires and medical dokumentation analysis. The research revealed the importance of rehabilitation from a both objective and subjective point of view. Objective findings after intensive physioterapy during the rehabilitation stay were entirely consistent with the subjective feelings of the person who was the subject of the research. Key words: physical disabilities, muscular dystrophy, comprehensive rehabilitation

Magister Artium - MA (Women and Gender Studies) / Women with disabilities are marginalised in many aspects of societal participation. The majority of women with disabilities in Zambia do not have access to education and this has placed them amongst the poorest of people in the country. The study focuses on the experiences of women with physical disabilities and investigates the challenges they encounter in accessing education at tertiary level. The study comes at a time when the fight for gender equality has gained momentum and aims at promoting economic participation for all members of society without discrimination on the basis of sex or disability. The study engaged ten participants from a tertiary institution in Kamwala, Lusaka. I conducted a feminist qualitative research, which focused on the experiences of 19-30 year old female students with physical disabilities. I used semi-structured interviews in order to collect the data and drew on a qualitative thematic analysis to analyse the data. All standard ethical procedures were adhered to, including anonymity and confidentiality with respect to participants. The results of the study revealed that women with disabilities were often 'othered' due to myths and misconceptions that surrounded disability especially in the African- traditional context. The study also revealed that families played a very important role in ensuring that women and young girls with disabilities had a strong self-image, strong self-esteem and a strong sense of self and ensuring that they felt included within the homes and especially when accessing education. The study further revealed that where family support was lacking, participants faced challenges in accessing education compared to participants who received such support. More so, that educational opportunities in Zambia are generally gendered with more males than females in the education system, across the multiple levels. Access to the tertiary level for this group of women is compromised because challenges in accessing education start at the lower levels and have spill over effects in to the higher levels of education. Financial challenges experienced by women with disabilities and their families also led to fewer women with disabilities being able to participate in schooling. This is because where there were limited resources within the family, women, and girls with disabilities getting an education was not an option.

IntroduÃÃo: Os estados reacionais da hansenÃase, classificados como tipo 1 (reaÃÃo reversa - RR) e tipo 2 (Eritema Nodoso HansÃnico â ENH) e neurite isolada, levam ao risco potencial de desenvolver incapacidades e deformidades antes, durante o tratamento e apÃs a alta. Necessitam diagnÃstico precoce e tratamento adequado. Este estudo justifica-se pela escassez de estudos sobre ocorrÃncia, seguimento e fatores associados aos episÃdios reacionais apÃs a alta do tratamento especÃfico, bem como o desconhecimento dos problemas enfrentados do diagnÃstico, ao manejo terapÃutico, sob a perspectiva das pessoas com reaÃÃes hansÃnicas. MÃtodos: estudo transversal, a partir da populaÃÃo alvo identificada, consistindo de avaliaÃÃo neurolÃgica simplificada, exame dermato-neurolÃgico e entrevista individual (Projeto MAPATOPI). Foram incluÃdos cinco municÃpios em Ãreas do cluster: AraguaÃna (TO), Floriano (PI), Bacabal e Caxias (MA) e Marabà (PA). A populaÃÃo alvo consistiu de todos os indivÃduos que apresentaram reaÃÃes hansÃnicas, em pÃs-alta do tratamento poliquimioterÃpico, residentes e acompanhados nos serviÃos de saÃde no perÃodo de 2007 a 2009, independente da data de inicio de tratamento. Utilizou-se a comparaÃÃo do escore OMP (olho-mÃo-pÃ) ou EHF (Eyes-Hand-Foot) do diagnÃstico com o atual. Outro desfecho binÃrio utilizado foi analisar a presenÃa de incapacidade 0-1 no escore OMP atual. Na anÃlise binÃria utilizou-se o teste chi quadrado de Pearson. Naquelas associaÃÃes onde o valor esperado era menor que cinco utilizou-se o teste exato de Fischer. Resultados: foram incluÃdos 280 pacientes. 190 (67,9%) eram do sexo masculino. A idade mÃnima de 8 a 85 anos, com media de 46,5 anos. Seis eram menores de 15 anos e cinco entre 15 e 17 anos. A renda mÃdia por mÃs foi de R$ 1077,00 com valores entre R$ 60,00 e R$ 6.000,00 reais. Mais de noventa por cento residia na zona urbana. Quanto à escolaridade 53 (18,9%) eram analfabetos e 53,6% tinham o primeiro grau incompleto. No total 45 (16,1%) foram classificados como PB e 232 (83,7%) foram classificados como MB. A forma clÃnica predominante foi a dimorfa com 115(41,1%), seguida da virchowiana 82 (29,6%). A reaÃÃo tipo 1 estava presente em 104 (37,1%), tipo 2 (18,6%), a neurite isolada (13,9%). A neurite associada foi encontrada em 51,9% dos pacientes com tipo 2. A quantidade de episÃdios reacionais variou de um atà seis episÃdios. Um episÃdio foi desenvolvido por 215 (77,3%). O primeiro episÃdio ocorreu durante o tratamento para 121 (43,2%), seguido, em frequÃncia de ocorrÃncia, em pacientes pÃs-alta. O escore OMP (EHF) no diagnÃstico variou de 0 a 11 e na avaliaÃÃo atual, de 0 a 10, com maior distribuiÃÃo no intervalo entre 1 a 4. Quanto à piora do escore OMP 88/198 (44,4%) pioraram. Entre as variÃveis sÃcio-demogrÃficas, o risco de piora foi associado a: ser analfabeto (RP= 1, 64; IC de 95% 1,21 â 2,21; p=0,003), viÃvo (RP= 1,98; IC de 95% 1,20 â 3,96, p=0,013). E como fator de proteÃÃo ter segundo grau de escolaridade (RP= 0,4; IC de 95% 0,23 â 0,71 p=0,000). Quanto à piora do OMP associada a variÃveis clÃnicas, a forma clÃnica dimorfa (RP= 3,71; IC de 95% 1,00 â 13,70; p=0,009), ter reaÃÃo durante a PQT (RP= 1, 70; IC de 95% 1,13 â 2,54 P=0,004), ter algum nervo espessado ((RP= 1, 78; IC de 95% 1,30 â 3,08; p=0,024). Quanto ao percurso atà o diagnÃstico, a autopercepÃÃo foi encontrada em 240 (85,8%), entre os sinais e sintomas 176 (62,9%) buscaram os serviÃos por dermatoses em geral. Na busca do diagnÃstico, a atenÃÃo primÃria foi a primeira entrada para 95 (34%) na rede de assistÃncia. As principais manifestaÃÃes de reaÃÃes citadas foram sinais dermatolÃgicos 115 (42%) e neurolÃgicos 97 (35,4%). No total, 206/280 (73,5%) responderam que a hanseniase trouxe mudanÃas, problemas e transtornos para a sua vida. Dentre as mudanÃas intrapessoais, as alteraÃÃes fÃsicas tiveram papel importante para 129 (62,6%) participantes. Essas alteraÃÃes levaram a limitaÃÃes do seu desempenho no trabalho e renda, seguindo do comprometimento das atividades de vida diÃria. ConclusÃes: EpisÃdios reacionais agravam o comprometimento fÃsico, psico-social de participaÃÃo social e comprometem o trabalho e a realizaÃÃo das atividades de vida diÃria. à necessÃrio foco na qualidade de vida dos indivÃduos no pÃs-alta, principalmente entre aqueles com incapacidades fÃsicas instaladas. O escore OMP à um importante instrumento para detectar a progressÃo das incapacidades fÃsicas e deve ser utilizado no diagnÃstico, alta e durante os episÃdios reacionais em todos os pacientes. Os serviÃos de atenÃÃo primÃria e secundÃria dos municÃpios envolvidos necessitam melhorar o acompanhamento aos indivÃduos no perÃodo pÃs-alta, nÃo apenas para aqueles indivÃduos com incapacidades jà instaladas (grau um e dois), mas tambÃm naqueles que nÃo apresentaram incapacidades no momento da alta. EvidÃncias apontaram a necessidade do empoderamento das pessoas afetadas pela hansenÃase em lidar eficazmente com os sinais e sintomas de reaÃÃes apÃs a PQT. Sugere-se instituir um sistema de monitoramento e vigilÃncia dos estados reacionais por um perÃodo mÃnimo de seis meses atà cinco anos apÃs a alta, considerando a existÃncia de grupos de pacientes onde o comprometimento neurolÃgico ocorre lenta e silenciosamente, com possibilidade de danos nÃo sà fÃsicos, mas psicossociais. / Introduction: Leprosy reactions are classified as type 1 (reversal reaction - RR), type 2 (Erythema Nodosum Leprosum - ENL) and pure neuritis. These lead to a potential risk of developing disabilities and deformities before and during anti-leprosy treatment as well as after release from treatment (RFT). Reactions must be diagnosed early and treated effectively. This research is justified by the scarcity of studies on the occurrence of reactions, monitoring practices of patients and factors associated with reaction episodes after RFT. We know little about existing diagnostic problems, about case management from the perspective of the affected persons with reactions.Methods: Transversal study design, consisting of a simplified neurological examination, a dermato-neurological examination and interviews of the defined target group. Five municipalities were included in the cluster areas: Araguaina (Tocantins), Floriano (PiauÃ), Bacabal and Caxias (MaranhÃo) and Marabà (ParÃ). The target population consisted of all resident individuals with leprosy reactions after being released from multidrug therapy, who presented themselves to the health services in the period 2007 to 2009, regardless of the date of start of treatment. We compared the EHF (eye-hand-foot) scores at diagnosis and during the respondentsâ examinations. In another analysis we compared the presence of disability scores (0-1) to the current EHF scores. In the analysis we used the Chi square test and for those associations where the expected value was less than 5 we used Fischerâs exact test. Results: A total of 280 patients were included in the study. Of those, 190 (67.9%) were male. The ages ranged from 8 to 85 years, with a mean of 46.5 years. Six patients were under 15 years and five aged between 15 and 17 years. The average monthly income of the respondents was R$ 1,077.00 (around â400) with values between R$ 60 (â22) and R$ 6,000 (â2200). More than ninety per cent lived in urban areas. As for education, 53 persons (18.9%) were illiterate and 53.6% had an incomplete primary education. In total 45 patients (16.1%) were classified as PB and 232 (83.7%) were classified as MB. The predominant clinical form (Madrid classification) was dimorphous in 115 (41.1%) cases, followed by 82 lepromatous forms (29.6%). Type 1 reaction was present in 104 patients (37.1%), type 2 reactions in 18.6% of cases and pure neuritis in 13.9%. An associated neuritis was found in 51.9% of patients with type 2 reactions. The frequency of reaction episodes ranged from one to six. One episode only was developed by 215 patients (77.3%). The first episode occurred during anti-leprosy treatment for 121 patients (43.2%), followed in frequency of occurrence by patients after RFT. The EHF score at the time of diagnosis ranged from 0 to 11. At the time of the examination the EHF score range was 0-10, with a predominance of scores between 1 and 4. In 88 out of 198 patients (44.4%) their scores worsened. The risk of worsening was associated with the following socio-demographic variables: being illiterate (PR = 1.64, 95% CI: 1.21 - 2.21, p = 0.003), being widower (PR = 1.98, 95% CI: 1.20 - 3.96, p = 0.013). A protective factor was found: having completed secondary school education (PR = 0.4, 95% CI: 0.23 - 0.71 p = 0.000). Worsening of the EHF scores was associated with borderline leprosy (PR = 3.71, 95% CI: 1.00 - 13.70, p = 0.009), having had a reaction during MDT (PR = 1, 70; 95% CI 1.13 to 2.54 P = 0.004), and the presence of a thickened nerve (PR = 1, 78, 95% CI: 1.30 - 3.08 p = 0.024). In the patientsâ health seeking behaviour towards diagnosis, self-perception of symptoms was reported by 240 respondents (85.8%). Dermatological symptoms were the main complaint, in 176 (62.9%) cases. Primary health care services were the first point of entry for 95 patients (34%). The main reaction symptoms mentioned were of dermatological nature, in 115 (42%) cases Neurological complaints were mentioned by 97 (35.4%) respondents. In total, 206 out of the 280 patients (73, 5%) responded that leprosy brought about changes, problems and troubles in their lives. Among the intrapersonal changes, physical changes played an important role for 129 (62.6%) participants. These changes led to limitations in work performance and income, as well as causing restrictions in activities of daily living. Conclusions: Episodes of reactions worsen physical and psycho-social impairments, reduce social participation, cause problems at work and hamper activities of daily living. It is necessary to focus on the quality of life of individuals after RFT, especially among those with already established physical disabilities. The EHF score is an important tool to detect the progression of physical disability. The tool should be used in the diagnostic procedure, at the time of RFT and during reactions for all patients. Primary health care services and reference centres in the municipalities involved need to improve monitoring persons after RFT. Improved monitoring is needed not just in those patients with existing disabilities (DG1 and DG2), but also for those without disability present at discharge. Evidence indicates the need for empowerment of people affected by leprosy to deal effectively with the signs and symptoms of reaction after MDT. It is suggested to establish a system for monitoring and surveillance of reactions for a period of minimally six months up to five years after RFT. This surveillance is especially important considering that patients may develop neurological impairment gradually and without presenting symptoms, with the subsequent possibility of physical and psycho-social harm.

This thesis examines the requirements of children and adolescents with severe spinal cord injuries. The requirements are expressed by the parents of the children and by adolescents and are in contrast to official views of their 'needs'. There is no literature on the needs of these children and adolescents. The thesis thus begins with a examination of the literature on the needs of people with disabilities and people with spinal cord injury. Proponents of the social model of disability, which is based on the experiences of people with disabilities, contend that the main requirements of people with disabilities is ending their social marginalisation, and it is hypothesised that the requirements of the children and adolescents will be related to ending social marginalisation. Open-ended unstructured interviews with parents, parents and adolescents and adolescents alone ( a total of 20 interviews) provided data for analysis. Analysis of the data shows that the requirements of the children and adolescents, like adults with spinal cord injuries, differ from those of people with disabilities in that there are important concerns in addition to marginalisation.

The study population was children with physical disabilities who were not attending school and their parents. A sample of 19 participants was purposefully selected. A qualitative approach was used to explore the participants" attitudes, cultural beliefs, and challenges related to school attendance of children with physical disabilities. A content analysis approach was used for data analysis after translating and transcribing raw data from Tonga into English. The data were coded, categorized and themes of the content identified. Ethical procedures included, obtaining permission from the University of Western Cape, the Ministry of Community Development and Social Services in Zambia and Rural Health Centre. Signed consent from parents, consent from parents stating that their children can participate and assent from children was obtained. Anonymity and confidentiality of participants was emphasized and participants were reminded that their participation was voluntary. Participants had the freedom to withdraw without any prejudice. The results indicated positive attitudes of children and their parents towards school attendance of children with disabilities. The traditional and religious beliefs of parents did not influence or contribute to children with disabilities not attending school. The main reason why most children with physical disabilities were not attending school in Mazabuka district was due to physical and social barriers.

This thesis investigates coordination of the lower limb joints within the limb during walking. The researcher was motivated by her clinical experience as a paediatric physiotherapist. She observed that the pattern of lower limb coordination differed between normal children and those with cerebral palsy. Many of the currently used interventions did not appear to influence this patterning. As a precursor to evaluating the effectiveness of treatments in modifying coordination, a tool to measure coordination was required. The researcher initially investigated qualitative and then quantitative methods of measuring within limb coordination. A technique was developed that used relative angular velocity of two joints to determine when joints were in-phase, antiphasic or in stasis. The phasic parameters of hip/knee, knee/ankle and hip/ankle joints coordination were quantified. There were some significant differences between normal children and children with cerebral palsy. Asymmetry of these phasic parameters was identified, with children with cerebral palsy being more asymmetrical than normal children. The clinical utility of this technique was tested by comparing 2 groups of children before and after 2 surgical procedures. This showed some significant differences in phasic parameters between pre and post-operative data for one procedure. Low samples sizes mean that further work is required to confirm these findings. Data from this work has been used to calculate sample sizes to give an a priori power of 0.8 and further research is proposed and potential applications discussed. It is hoped that this technique will raise awareness of abnormal intra-limb coordination and allow therapists to identify key interactions between joints that need to be facilitated during walking training.

Reading is an essential skill for students with physical disabilities which opens up opportunities in many areas of an individual’s life including the acquisition of knowledge, the ability to read for enjoyment, and the chances of gaining employment. Students with physical disabilities often do not read fluently; however, there is a lack of research on instructional methods to address reading fluency with this population. Methodologies used with students who have physical disabilities are often borrowed from other populations (e.g., the use of repeated readings to increase fluency with students with learning disabilities). Additionally, advances in technology suggest the possible use of computers to model reading. This study employed a changing criterion design to examine the use of a treatment package consisting of repeated readings, computer modeling, error correction, and performance feedback on improving reading fluency with students with cerebral palsy. The areas of reading comprehension and accuracy were also examined. An analysis of the data demonstrated that all students were able to increase reading fluency, accuracy, and comprehension from first to final readings within a session (positive nontransfer effects). Analysis of the percentage of nonoverlapping data revealed that three of the four students also showed slight increases in reading fluency on novel passages (positive transfer effects). Although the results of this study indicated that the treatment package was effective with students who have physical disabilities, more research is needed to examine individual components of the treatment package and to evaluate the use of such methods over a lengthier period of time.

The study population was children with physical disabilities who were not attending school and their parents. A sample of 19 participants was purposefully selected. A qualitative approach was used to explore the participants" attitudes, cultural beliefs, and challenges related to school attendance of children with physical disabilities. A content analysis approach was used for data analysis after translating and transcribing raw data from Tonga into English. The data were coded, categorized and themes of the content identified. Ethical procedures included, obtaining permission from the University of Western Cape, the Ministry of Community Development and Social Services in Zambia and Rural Health Centre. Signed consent from parents, consent from parents stating that their children can participate and assent from children was obtained. Anonymity and confidentiality of participants was emphasized and participants were reminded that their participation was voluntary. Participants had the freedom to withdraw without any prejudice. The results indicated positive attitudes of children and their parents towards school attendance of children with disabilities. The traditional and religious beliefs of parents did not influence or contribute to children with disabilities not attending school. The main reason why most children with physical disabilities were not attending school in Mazabuka district was due to physical and social barriers.

For students with physical and health disabilities, the development of self-advocacy skills is critical to their future success. Characteristics that may inhibit the development of self-advocacy skills in this population include reliance on others for assistance across multiple areas requiring physical abilities, deficits in communication skills, and the development of learned helplessness. Instruction in self-advocacy is needed for this population of students in order to maximize future success and decrease learned helplessness (Angell, Stoner, and Fulk, 2010; Macdonald & Block, 2005; Roberts, 2007). For this study, the researcher provided instruction to four elementary age students with physical disabilities who exhibited characteristics of learned helplessness, including ineffective initiation of requests. Students used speech, sign, or gestures as their primary form of communication, and were able to use this form of communication as a reliable means of response during typical classroom activities, including social interactions and when responding to questions. When they needed to initiate a request for required materials during classroom activities, they made no response, ineffectively gestured, or made unrelated comments when prompted to complete an activity. Students who initiated requests ≤ 50% of presented opportunities were eligible to participate in this study. The intervention consisted of combined use of environmental arrangement and the system of least prompts in a multiprobe multiple baseline across participants design. Environmental arrangement strategies included missing materials or materials that were out of reach. The system of least prompts involved the following levels of prompting: (a) independent, (b) verbal – restatement of direction, (c) indirect verbal, and (d) verbal/model. Analysis of the data indicated that three of the four students increased their effective initiation of requests during intervention, and generalized this skill to new materials and novel settings. The fourth student exhibited noncompliant behaviors that interfered with his ability to reach criteria during intervention. These results support the effectiveness of this intervention in decreasing learned helplessness and increasing the self-advocacy skill of initiating requests with students with physical disabilities who have no interfering behaviors.