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This chapter provides an overview on the traditions and values of teaching students with traumatic brain injury (TBI). First, we discuss the prevalence, identification, and characteristics associated with TBI and how those characteristics affect learning, behavior, and daily life functioning. Next, we focus on instructional and behavioral interventions used in maintaining the traditions in classrooms for working with students with TBI. Findings from a review of the literature conclude that there are no specific academic curriculums designed specifically for teaching students with TBI; however, direct instruction and strategy instruction have been shown to be effective educational interventions. Current research on students with TBI is predominately being conducted in medical centers and clinics focusing on area of impairments (e.g., memory, attention, processing speed) rather than academic achievement and classroom interventions. Finally, we conclude with a list of accommodations and a discussion of recommendations for future work in teaching students with TBI.

There are no existing tools to capture resources needed to support people with intellectual disability in an inpatient setting on an individual patient basis. The purpose of this paper is to describe the development of a new tool called Universal Needs Based Resource Assessment (UNBRA).

Using the Delphi method, focus groups were used to generate factors determining resource use. From these, themes were identified, a scoring system was created and the UNBRA tool was developed. This was piloted in two NHS inpatient units and modified following feedback.

The UNBRA tool holistically assesses resource requirements of an individual with intellectual disability supported in an inpatient setting. It considers ten factors grouped into the six themes of staffing, indirect work, clinical/ multi-disciplinary work, incidents, carer link activity and discharge process. UNBRA scores allow intra- and interpersonal comparison as well as comparison between units and can support resource allocation and operational decision-making.

To the best of the authors’ knowledge, there is no suitable existing tool to capture individual resource requirements of patients in intellectual inpatient settings. The development of the UNBRA tool fills this gap.

The purpose of the study was to examine whether there were differences in the provision of non-pharmacological interventions based on the level of intellectual disability and the presence or absence of autism. Mental health conditions are often underdiagnosed in adults with intellectual disability and do not always receive psychological interventions as recommended by the National Institute for Health and Care Excellent guidelines. To realise the national UK programme’s aim of stopping the overuse of medications in people with intellectual disability, it is important that these individuals have access to appropriate non-pharmacological interventions. The authors examined the relationship between an individual’s level of intellectual disability and the presence or absence of autism with access to relevant non-pharmacological interventions from specialist community intellectual disability services.

A cross-sectional study of adults accessing four specialist intellectual disability services in North West England in 2019.

There was a high prevalence of mental health comorbidity, even higher for autistic adults. However, a relatively small percentage of the study population was receiving psychological interventions. The most frequent non-pharmacological intervention was a positive behaviour support plan, irrespective of comorbid mental illnesses.

Not having access to psychological interventions for the treatment of mental illness could result in poor health outcomes and increasing health inequalities. The study highlights the need for developing psychological interventions, particularly for those with moderate to severe intellectual disability and for those with associated autism.

This large sample study examined the relationship between intellectual disability level and the presence of autism with accessing psychological interventions.

This study aims to evaluate the dementia assessment and diagnosis care provided to adults with intellectual disability. The authors selected recommendations from the National Institute for Health and Care Excellence (NICE) standards which could be evidenced in clinical notes and aimed to identify characteristics which may be associated with improved adherence to these recommendations.

The study population was adults with an intellectual disability who were diagnosed with dementia between January 2019 and December 2022 by a UK-based intellectual disability service. Data to demonstrate adherence to selected recommendations and demographic and clinical characteristics were extracted from electronic patient records.

The authors identified 41 individuals. A mean of six of the eight recommendations were adhered to. There was low adherence with structural imaging to support dementia subtype diagnosis (9 individuals, 22%). This may be linked with the low percentage of people diagnosed with vascular dementia (1 individual, 2%) despite a national figure of 20%. No demographic or clinical characteristics were associated with level of adherence recorded. The authors found incomplete recording of diagnostic clinical coding in electronic patient records. This may disadvantage this population, as they cannot be readily identified for post diagnostic support or resource allocation.

To the best of the authors’ knowledge, this is the first study to examine adherence to these NICE guidelines in this population.

Autistic young people have health and care needs that may benefit from a multi-agency intervention. The “Current View” tool is routinely used in England to profile the needs of young people referred to mental health services. This study aims to examine associations between comorbidities and complex needs in autistic and non-autistic young people to assess the multifaceted needs of autistic young people.

A cohort study was conducted using data from the electronic patient record, comparing autistic and non-autistic young people to see which items in the four “Current View” tool categories were associated with autistic young people.

Issues associated with autistic young people were: “community issues”, “attainment issues” and “deemed child in need” (all p < 0.001). Autistic young people scored significantly more items (p < 0.05) in the categories complexity/contextual/educational factors. Comorbidities associated with autistic young people included anxiety, “behavioural difficulties”, “peer relationship difficulties” and “self-care issues” (all p < 0.001). There was an association with increased comorbidities and complexity factors in autistic young people which suggests increased support from agencies may be beneficial.

Few studies have used data in the “Current View” tool to assess young people referred to services. More use could be made of this data for planning and delivering services.

The purpose of this study is to consider informed consent with those who may be legally judged incapable of consent. Frequently individuals with traumatic brain injuries and intellectual disabilities may fall into this category. This paper seeks to consider aspects of guardianship, moral and legal implications and best practices for mental health professionals.

This practice piece reviews literature regarding informed consent, as well as pertinent issues in the professional literature regarding types of guardianship as well as the occurrence of “Lucid intervals.” Furthermore, literature from moral philosophy and current legal research was examined to fully provide readers with a grasp of the legal and ethical landscape of this issue.

The paper finds that treating consent as a one-time binary event is lacking in both practicality and nuance. Moral philosophy and issues regarding paternalism are raised, as well as practice approaches to assessment of capability and how to engage in therapy in meaningful ways.

This paper provides insight into providing dignity-affirming therapy with a population that is often not considered in the literature of mental health ethics. When it is considered, the suggestions are so vague as to be of limited use. This manuscript provides nuance and practical applications to be a therapist that promotes dignity in those who might have varying levels of capacity to consent.

This paper aims to report the findings of a survey study exploring perceptions about cognitive impairment. These findings are relevant to public health campaigns and education programmes.

A survey exploring respondents’ views and knowledge about mild cognitive impairment (MCI) was circulated via UK networks. A total of 417 respondents completed the survey, including people living with cognitive impairment (n = 10), care partners (n = 23), older adults (n = 83), younger adults (n = 83), general health-care professionals (n = 96), dementia specialist health-care professionals (n = 48) and dementia specialists (n = 40).

Respondents were more confident in their knowledge about dementia than cognitive impairment but wanted more information about both conditions. Younger adults were uncertain about many aspects of MCI, and were the most likely to view MCI as a normal part of ageing. Diet (45.1%, n = 188) and personal behaviour (63.8%, n = 266) were the least endorsed possible causes of MCI, suggesting a lack of awareness of lifestyle choices as risk factors for MCI.

The results highlight the need to provide education and awareness raising about MCI to enable people to seek help in a timely manner and be able to make informed lifestyle choices that may reduce their risk of MCI and dementia. Implementing education about MCI and dementia in schools is a key target, as younger people were the most uncertain or misinformed about these topics. It is clear that further public health initiatives around MCI are both warranted and welcomed by the general public.

Research with vulnerable groups is crucial to get their input into public policy design that will directly impact on them. However, there are many methodological and ethical challenges involved in encouraging participation from groups with a wide range of intellectual, cognitive and physical capacities while ensuring that the rights and well-being of participants are protected. Rather than exploring ethical theories, this chapter is a case study describing the practical ethical considerations that were involved in designing and holding a series of focus groups with adult health and social care service users from vulnerable cohorts. It is based on a series of focus groups which the Institute of Public Health (IPH) held with specified cohorts as part of a policy development process on adult safeguarding for the Department of Health (DOH) in Ireland. The four cohorts were people with intellectual disability, cognitive impairments, significant mental health challenges and nursing home residents. This chapter does not describe the findings of the focus groups but outlines the ethical and methodological considerations that arose in designing and conducting this research, and the practical ethical safeguards employed to mitigate risk and comply with Irish and EU General Data Protection Regulation (GDPR) legislation governing health research. It outlines the ethical issues around protecting confidentiality and using incentives to encourage participation, how individuals' capacity to give informed consent was maximized, the risk-assessment and mitigation procedures used to prevent harms arising and the measures put in place to provide follow-up emotional support to participants.

The purpose of this review paper is to address the substantial challenges of the outdated exoskeletons used for rehabilitation and further study the current advancements in this field. The shortcomings and technological developments in sensing the input signals to enable the desired motions, actuation, control and training methods are explained for further improvements in exoskeleton research.

Search platforms such as Web of Science, IEEE, Scopus and PubMed were used to collect the literature. The total number of recent articles referred to in this review paper with relevant keywords is filtered to 143.

Exoskeletons are getting smarter often with the integration of various modern tools to enhance the effectiveness of rehabilitation. The recent applications of bio signal sensing for rehabilitation to perform user-desired actions promote the development of independent exoskeleton systems. The modern concepts of artificial intelligence and machine learning enable the implementation of brain–computer interfacing (BCI) and hybrid BCIs in exoskeletons. Likewise, novel actuation techniques are necessary to overcome the significant challenges seen in conventional exoskeletons, such as the high-power requirements, poor back drivability, bulkiness and low energy efficiency. Implementation of suitable controller algorithms facilitates the instantaneous correction of actuation signals for all joints to obtain the desired motion. Furthermore, applying the traditional rehabilitation training methods is monotonous and exhausting for the user and the trainer. The incorporation of games, virtual reality (VR) and augmented reality (AR) technologies in exoskeletons has made rehabilitation training far more effective in recent times. The combination of electroencephalogram and electromyography-based hybrid BCI is desirable for signal sensing and controlling the exoskeletons based on user intentions. The challenges faced with actuation can be resolved by developing advanced power sources with minimal size and weight, easy portability, lower cost and good energy storage capacity. Implementation of novel smart materials enables a colossal scope for actuation in future exoskeleton developments. Improved versions of sliding mode control reported in the literature are suitable for robust control of nonlinear exoskeleton models. Optimizing the controller parameters with the help of evolutionary algorithms is also an effective method for exoskeleton control. The experiments using VR/AR and games for rehabilitation training yielded promising results as the performance of patients improved substantially.

Robotic exoskeleton-based rehabilitation will help to reduce the fatigue of physiotherapists. Repeated and intention-based exercise will improve the recovery of the affected part at a faster pace. Improved rehabilitation training methods like VR/AR-based technologies help in motivating the subject.

The paper describes the recent methods for signal sensing, actuation, control and rehabilitation training approaches used in developing exoskeletons. All these areas are key elements in an exoskeleton where the review papers are published very limitedly. Therefore, this paper will stand as a guide for the researchers working in this domain.