Attitudes towards persons with disabilities have been a concern for years. This study examined the attitudes of rehabilitation professionals towards persons with disabilities and toward educational accommodation. The attitudes were examined through the collection and analysis of three components of data. The components were included demographics, intensity of disability contact, and attitudes toward education accommodation.

Research has shown that skeletal muscle, despite showing a high degree of specialisation, has a remarkable ability to modif,' its properties. Understanding these changes is important for optimal response to therapeutic intervention. These studies investigated alterations in neuromuscular performance of quadriceps femoris muscle in normal subjects, before investigating changes in muscle and neural mechanisms in the first six months following stroke. Muscle ftinction studies were conducted to monitor the effects of selected patterns of long term electrical stimulation (P1 - uniform 8 Hz, P2 - mixed frequency, and P3 random high and low frequency) on quadriceps femoris of2l healthy subjects. Stimulated muscles showed significant increases in strength, fatigue resistance and relaxation times after 3 weeks and in force-frequency output after 6 weeks. Significant changes were observed in the stimulated muscles in Groups P2 and P3 indicating that a mixed or random pattern of activation induced greater changes than a uniform 8 Hz pattern. These studies together with soleus H reflexes were used to study concurrent changes in quadriceps femoris and Ta spinal reflex pathways of stroke patients and age-matched controls (n=1O). One month following stroke, both paretic and non-paretic muscles were more fatiguable and weaker than the muscles of controls and disynaptic and presynaptic inhibition were reduced in the paretic limbs. In subsequent months, the paretic muscles regained strength and inhibitory effects were restored. Subjective analysis suggested that different patterns of recovery related to walking ability at six months. In patients taking less than 15s to walk lOm (Group 1 n=5), the paretic muscles became significantly stronger and less fatiguable over time whereas the muscles of patients who took longer to walk lOm (Group 2 n=5) remained weaker and more fatiguable. Reciprocal inhibition was regained by 1 month in Group 1 and by 6 months in Group 2. These findings provide insight into long-term recovery and rationale for therapeutic intervention following stroke.

Thesis (M.S.)--Boston University

Thesis (Ed.D.)--Boston University

Thesis (M.S.)--Boston University

The transgender (TG) community has become more visible, both individually and collectively. The counseling professions, not unlike other professions, have lagged behind in their understanding of this population and their culture, an act that perpetuates stereotypes and supports unequal treatment. Among the many barriers faced by transgender individuals, barriers that block access to mental health and medical care are the most critical, as they can be life threatening (Shipherd, Green, & Abramovitz, 2010; Stotzer, Silverschanz & Wilson, 2013). Ignorance, bias, and discrimination are a common experience for those who are TG when trying to gain access to social services (Grant et al., 2010a). Accredited training programs that are responsible for training counseling professionals to work with all people, regardless of gender, vary in their extent and method of providing multicultural instruction, including information regarding TG individuals (Lewis, Bethea, & Hurley, 2009). A lack of uniform preparation for counselors may leave them unprepared to work with a population that is growing and becoming more likely to present for treatment. Supervisors are often counselors themselves with only two or more years of experience of training to establish their clinical licensure. Like counselors, they may have received minimal education with regard to transgender clients and culture during their masters training program. This study was an exploration of nine counselor supervisors’ experiences of providing supervision for counselors who worked with TG clients. Additionally, there was exploration into whether when supervising for counselors who are working with TG clients, what, if any changes occurred in the supervision relationship. Prominent themes emerged among the supervisors’ training experiences, their models of supervision and training, and their supervision alliances. An additional prominent theme among the supervisors interviewed was their trajectory of knowledge acquisition about transgender culture and needs. Most supervisors gained their knowledge through self-motivation, investigation, and self-direction. Likewise, the motivation that led the supervisors to seek more knowledge also compelled them to pass this on to others. Experiences from supervision preparation to supervision provision were explored, examined, and analyzed to identify common themes. Following the Grounded Theory (GT) methodology of Corbin and Strauss (2008), nine counseling supervisors, located throughout the United States, were interviewed. The population of interest for this study was unique and specific: counselor supervisors who supervised a counselor from a CORE or CACREP accredited program that was working with a TG client. The information from these interviews revealed a lack in formal training at both the Masters level for counselors and at the Doctoral level for supervisors. Through dialogue with these supervisors, a description of their experiences in their work and the relationships between themselves and their supervisees was exposed. Subsequent analysis revealed five themes: personal choice, multicultural skills to work with TG clients, lack of training, self-motivation to work with TG clients, and barriers to working with TG clients. Supervisors discussed their experiences of working with supervisees and their perception of necessary training to work with TG clients. Supervisees who lacked training struggled with such issues as language use and internalized hate. According to these participants’ training and education on the TG population was obtained in other venues such as conferences, on the job trainings, and from other certification organizations.

The literature on stroke reveals an increasing interest in the role played by social and emotional factors in rehabilitation after stroke. A comprehensive literature survey shows profiles of spontaneous recovery, the significance of a team approach to rehabilitation, patterns of prognostic significance for long-term recovery and adaptation and formulations of rehabilitation models for the Western world. The importance of depression as a major factor in demotivation to participate in rehabilitation and achieve long-term quality of life post-stroke emerges. From the literature survey a research design was formulated for the ecological study of a sample of 51 stroke patients at Ga-Rankuwa Hospital near Pretoria. The questionnaire was structured according to the Synchronous Systems Model, and data gathered from the biological, personal and environmental spheres of patients. Data was collected by a multidisciplinary team at three assessment times, three days, two weeks and three months post-stroke. These corresponded to the acute physical phase of stroke, the end of the hospitalisation period, and an assessment of patients once they had been discharged back into the community. Descriptive statistics were obtained on all variables and principle axis factor analysis was performed to verify the factorial structure of the tests. In order to establish whether group scores changed between assessments, t-tests for dependent measures were applied. Pearson Product Moment correlations were computed for the purpose of establishing relationships between variables. The results revealed dramatically differing biographical characteristics of the sample of stroke patients both premorbidly and at three months after the stroke. Significant recovery profiles emerged in both the physical and neuropsychological spheres at both the 14 day and 3 month assessments. Depression and the functioning at home and at work social sphere of role emerged as profiles of deterioration. At 14 days, depression was related to physical and cerebral functioning. This changed at three months, with depression also being significantly related to aspects of social functioning. On the basis of these results, depression after stroke was conceptualised as a severance of relational connectedness in the social ecological functioning of stroke patients. An ecological approach to rehabilitation is proposed that would seek to reframe the identity of stroke patients and establish relational connectedness post-stroke. / Psychology / D. Litt. et Phil. (Psychology)

Submitted by FABRICIO DINIZ DE LIMA null (fabriciodz@hotmail.com) on 2017-09-22T15:45:56Z No. of bitstreams: 1 Dissertacao_final_impresso.pdf: 2611089 bytes, checksum: 6e32f987f7522184fd5a8e5f764906ed (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-27T19:07:04Z (GMT) No. of bitstreams: 1 lima_fd_me_bot.pdf: 2611089 bytes, checksum: 6e32f987f7522184fd5a8e5f764906ed (MD5) / Made available in DSpace on 2017-09-27T19:07:04Z (GMT). No. of bitstreams: 1 lima_fd_me_bot.pdf: 2611089 bytes, checksum: 6e32f987f7522184fd5a8e5f764906ed (MD5) Previous issue date: 2017-08-23 / Introdução: O acidente vascular cerebral (AVC) é uma grave condição neurológica, que acomete pessoas do mundo inteiro, com elevada morbimortalidade e incapacidade funcional, tendo como principal manifestação o déficit motor, tornando a reabilitação imperativa. No entanto, alguns fatores comuns podem dificultar o sucesso da reabilitação, como a sarcopenia, que pode provocar prejuízo trófico e metabólico no hemicorpo denominado não afetado, correlacionando-se ao comprometimento funcional. Este trabalho busca avaliar alterações tróficas, metabólicas e funcionais no lado ipsilateral, em pacientes com AVC isquêmico, a fim de averiguar a correlação entre a sarcopenia e déficit funcional. Pacientes e métodos: Foram avaliados parâmetros antropométricos e morfológicos, realizados estudos de bioimpedância e executada a dinamometria em 21 pacientes com AVC isquêmico de circulação anterior em 2 momentos distintos: fases aguda (até 48 h após o ictus) e crônica (90 dias após o ictus). Resultados: 21 pacientes foram incluídos (57% do sexo masculino; média de idade de 67,09 anos, variando de 26 a 84 anos). Todos receberam avaliação contínua da equipe multiprofissional durante o estudo. Não houve redução estatisticamente significativa da massa muscular, quantidade de proteína, água, minerais, gordura e metabolismo basal e nem melhora da força muscular ipsilateral dos pacientes após 90 dias do ictus (p < 0,05). Conclusão: Não houve redução trófico-metabólica e nem piora funcional estatisticamente significativas no lado corporal ipsilateral ao infarto dos pacientes avaliados. A assistência precoce e contínua da equipe multiprofissional durante os primeiros 90 dias após o ictus conferiu aos pacientes um prognóstico de melhora funcional contralateral significativa, ao avaliar-se mRS, NIHSS, MRC e dinamometria. / Background: The stroke is a severe neurological condition, which affect worldwide people, causing high morbimortality and disability, whose main manifestation is weakness, making rehabilitation crucial. Although common factors may difficulty the successfully rehabilitation, such as sarcopenia, that causes trophic and metabolic impairment in the healthy body side, correlating to the functional damage. This study aims to evaluate trophic, metabolic and functional changes in the impaired body side in patients with ischemic stroke in order to find a correlation between sarcopenia and functional impairment. Patients and methods: We evaluated anthropometric and morphological parameters, performing bioimpedance and dynamometer studies in 21 patients with anterior circulation ischemic stroke in 2 distinct moments: the acute (ultil 48 h after ictus) and chronic phases (90 days after ictus). Results: 21 patients were included (57% men; mean age, 67,09 years; age range, 26 to 84 years). All patients were assisted continually during the study. They did not present ipsilateral muscle mass, protein, water, minerals and fat quantity decrement statistically significant neither enhanced strength 90 days post-stroke (p < 0,05). Conclusion: Patients evalueted did not present reduction statistically significant trophic and metabolic neither functional worse in the ipsilateral body side after unilateral stroke. The early and continuous assistance provided by rehabilitation team during the first 90 days post-ictus improved the functional prognostic in the contralateral side, according to mRS, NIHSS, MRC and dynamometry.

Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T13:51:18Z (GMT). No. of bitstreams: 1 Mota_LucasBrino_M.pdf: 1462710 bytes, checksum: b2e1fbb17a6de58bc91748c2bcb073f8 (MD5) Previous issue date: 2009 / Resumo: A escala de avaliação de Acidente Vascular Cerebral (AVC) da Chedoke McMaster (CM) foi desenvolvida baseada nos estágios de recuperação motora de Brunnstrom, 1970 e avalia o paciente hemiplégico em duas partes: Inventário do comprometimento Físico e Inventário de capacidades. O primeiro determina a presença e a gravidade de incapacidades físicas comuns em seis dimensões: dor no ombro, função do braço, mão, perna, pé e tronco. O segundo avalia as atividade funcionais e é divida em dois índices: função motora grossa e caminhada. O objetivo do presente estudo foi elaborar uma versão brasileira da escala de avaliação de AVC da Chedoke McMaster e avaliar a concordância inter e intra-examinador, a validade concorrente e a consistência interna. Realizou-se a tradução e adaptação cultural, treinamento dos avaliadores e pré teste. Posteriormente a escala foi testada em 26 pacientes que apresentavam hemiplegia secundária ao AVC. O nível de concordância inter-examinador e intra-examinador foi excelente (CCI>0,75; p<0,001) para todos os itens e apresentou alta consistência interna (0,79). O item total da Escala de Fugl Meyer (EFM) mostrou forte correlação com o item total do instrumento de medida estudado (r=0,715; p=0,001), bem como com o inventário de capacidades da CM com a Escala de Equilíbrio de Berg (EEB) (r=0,943; p<0,001), Índice de Barthel (r=0,919; p<0,001) e Medida de Independência Funcional (MIF) (r=0,717; p<0,001). Houve alta consistência interna para todos os itens com exceção do domínio ombro, este apresentou valor inferior a 0,4. Houve efeito teto para o domínio ombro e efeito solo para mão, braço e ombro. O presente instrumento traduzido e adaptado apresentou concordância assim como sua versão original, mostrou-se de fácil aprendizagem e aplicabilidade, além de avaliar o paciente em toda sua abrangência física, especialmente no desempenho de suas funções e não apenas na sua incapacidade física / Abstract: The Chedoke McMaster Assessment Stroke (CMAS) was developed based on the Brunnstrom motor recovery stages, and it is a two part measure consisting of a Physical Impairment Inventory and a Disability Inventory. First the impairment inventory determines the presence and severity of common physical impairments in six dimensions: shoulder pain, postural control, Arm, Hand, Leg and Foot; according to the seven stages of motor recovery (Brunnstrom). Then the Disability Inventory measures functional outcomes, and is made up of two indices, the gross motor function index and the walking index. The objective of the study was to develop a Brazilian version of the Chedoke McMaster Assessment Stroke and to evaluate the intra rater and inter rater reliability and the validity of the internal consistence of this version scale. The translations, cultural adaptations, evaluator training and pre-test were performed, and then a test evaluation of 26 stroke subjects. There was a high level of intra rater and inter rater reliability (CCI>0,75; p<0,001) and high internal consistency (0,79) for all the measures of the scale. The total Fugl-Meyer score showed strong correlation with the total score of the Chedoke McMaster Stroke Assessment (r= 0,715; p=0,001). The impairment and disability inventory of the CM showed strong correlation with the Berg Balance Scale (r=0,943; p<0,001), Barthel Index (r=0,919; p<0,001) and Functional Independence Measure (r=0,717; p<0,001). There was also a high internal consistency for all the dimensions of the CM, with exception of the shoulder dimension, that showed a value lesser than 0,4. There was a ceiling effect for the left shoulder dimension and a floor effect for the hand, arm and shoulder. The adaptation and translation of the CM scale in the present study showed agreement with the original version, demonstrated to be easy of learn and apply, and also to be able to evaluate the patient physical condition in a complete way, not only the physical impairment but also its functional performance / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

This study is to examine the meaning of recovery and its making process among people with mental health problems from a person-centered perspective in Hong Kong. By employing a qualitative research approach, this study attempts to explore the strategies and practices deployed by people with schizophrenia for overcoming the daily difficulties and challenges caused by their illness. A total of 14 persons with schizophrenia living in the community were invited to participate in the in-depth interview.. Three major types of strategies and practices employed by people with mental health problems are revealed in the study. They can be categorised into medical, personal and social practices. In the recovery process, it is suggested that people with mental health problems are active agents. Based on their social situations and resources, they creatively invent and deploy tailor-made coping strategies and practices for overcoming their daily struggles and challenges.. With the use of the person-centered perspective, it is evident that the meaning of recovery of persons with schizophrenia is highly subjective. Five emerging themes have been identified throughout the recovery process, including developing a social role, achieving acceptance of one's own mental health problems, developing a positive sense of self, developing a new meaning and purpose in one's life and finally, taking responsibility of one's wellbeing. These themes highlight the complexity and uniqueness of people with mental problems in Hong Kong.. In sum, the study bridges the research gaps in understanding the conceptualisation of recovery in the local context. It helps to extend the discussion and analysis of recovery beyond the western medical paradigms. Moreover, this study clarifies three major types of coping strategies and practices deployed by people with mental health problems, particularly those with schizophrenia, and attempts to establish an analytical framework in understanding these strategies and practices. Finally, the delineation of the decision making process, including the social context and the rationales of the use of various coping strategies and practices opens up new possibilities in understanding the mechanism of recovery.