Pain Assessment in People with Intellectual Disability: Improving Skills of Health and Educational Personnel at Istituto Serafico of Assisi, Italy.

BACKGROUND: Assessment of pain in people with intellectual disability (PWID) is a difficult clinical task. Poor knowledge and confidence in assessing pain in PWID result in underestimation and undertreatment. Available resources for healthcare personnel and caregivers on pain assessment in PWID are still very limited. The aim of the study was to measure the level of knowledge and confidence in assessing pain in PWID of health and education personnel at Istituto Serafico, before and after training. SUBJECTS AND METHODS: The Istituto Serafico is a neuro-rehabilitation center caring for people with complex disabilities. Nurses, rehabilitation therapists, social health workers (SHW) and educators were invited to participate in a 4-hours theoretical and practical training. Participants were assessed through a knowledge and confidence questionnaire on pain assessment in PWID, administered before and after the training. RESULTS: 123 participants attended both the theoretical and practical sessions. Median age was 43 years (range 23-67); 89 were females and 34 males. They were 10 (8%) nurses, 9 (7%) rehabilitation therapists, 77 (63%) SHW, 27 (22%) educators. Only 7 (6%) participants (5 nurses and 2 SHW) declared to have previously received formation on pain. Participants who felt "quite confident" in assessing pain increased from 28% to 73% after the training. The median score to the 24 knowledge questions raised from 15/24 correct answers (range 6-22, 62.5%) in the pre-test to 21/24 (range 11-24, 87.5%) in the post-tests (p=0.001) Conclusions: The study highlights the great need of education programs for health and educational personnel working with PWID on pain assessment and the potential to improve knowledge and confidence through theoretical and practical training. A greater awareness of pain causes, clinical manifestations and consequences of untreated pain, could improve patient care, quality of life and rehabilitation goals.

The Relationship Between Math Anxiety and Math Achievement: Differentiating the Role of Learning Math Anxiety and Math Evaluation Anxiety.

BACKGROUND: Math anxiety (MA) is considered one of the variables that cause poor performance in contexts where mathematical competence is required. SUBJECTS AND METHODS: The survey involved 28 Italian students in the first year of secondary school (corresponding to grade nine of English-speaking schools and of the Italian INVALSI evaluation system). The students, examined at the beginning of the school year, scored below the threshold of sufficiency in the calculation skills assessment test. This data analysis takes into consideration the development of their math performance; the hypothesis is that the level of MA may differentiate students who are able or not able to achieve the competencies expected by the course of study. RESULTS: Students who transitioned from an inadequate score to a sufficient one over the school year, exhibited significantly lower levels of MA compared to students who did not score sufficient on the math test at the end of the year. However, the significant difference primarily pertained to the "learning math" subscale, while the "math evaluation" subscale showed no significant differences between the two groups. CONCLUSIONS: Our results suggest the possibility of using the assessment of MA levels to identify the presence and type of emotional difficulties associated with the study of mathematics. Specifically, in individuals with difficulties in learning mathematics, the presence of a dissociation between the two AMAS subscales could suggest different approaches to educational intervention.

Assessment of math anxiety as a potential tool to identify students at risk of poor acquisition of new math skills: longitudinal study of grade 9 Italian students.

Introduction: Numerous international educational institutions have sounded the alarm about the gradual increase in the number of students failing to achieve a sufficient level of proficiency in mathematical abilities. Thus, the growing interest in identifying possible solutions and factors interfering with learning seems justified. In recent years, special attention has accrued to the possible role played by emotional factors. Methods: In the present investigation, students in the first grade of a technical vocational secondary school are followed to assess the influence of math anxiety (MA) on the development of skill acquisition in calculus. A math skills assessment test is administered on two occasions, at the beginning and end of the school year. Results: Results highlighted that the score on the anxiety scale, administered at the beginning of the year, negatively correlated with the score obtained on the mathematics test, administered at the end of the school year: the higher the level of anxiety, the worse the performance. Furthermore, the score obtained in the second administration makes it possible to divide the students tested into two groups: students who improved their performance and students who did not benefit at all from repeating the test. In these two groups, an analysis of the relationships between the outcome of the end-of-year mathematics test and the level of MA at the beginning of the year showed that MA correlates negatively with performance only in students who will fail to acquire new expertise in mathematics over the course of the school year. Discussion: The results suggest that MA may interfere with the smooth development of math skills. Assessing the level of MA at the beginning of the school year could prove to be a useful tool in identifying which and how many students are at risk of failing to achieve the skills expected from the usual course of instruction. A consideration of anxiety as one of the variables at play in the genesis of learning difficulties may prompt educators to modify teaching methodology and strategies by increasing focus on the impact of the emotional dimension on learning.

Learning and Participation of People with Multiple Disabilities through Rite and Rhythm: Description of the Catechetical and Liturgical Experience of the Serafico Institute of Assisi.

Through the description of the catechetical and liturgical experience of persons with multiple disabilities at the Serafico Institute of Assisi, we intend to initiate a discussion on the specific value that Rite and Rhythm have for learning and social participation of persons with severe physical, Psychic and sensory disabilities, from an integral educational and rehabilitative prospective. In summary, our attempt is to focus on elements such as the enhancement of non-verbal language within the Eucharistic liturgy, the ritual (in its characteristic of repetition) as an opportunity for learning, rhythm as an opportunity for spatial-temporal and social-relational movement.

Affective Disorders in Complex Disabilities: Strategies Empowerment for Improving the Lifestyle of the Disabled Person.

The concept of physical and intellectual disability has experienced a series of changes and evolutions over time with regard to approach, classification and rehabilitation-therapeutic programs, since it contemplates a heterogeneous clinical phenomenology in terms of severity, complexity, pervasiveness and severity of the diagnosis. The significant repercussions on the quality of life mean that a comprehensive approach is required with attention to the physical, social, emotional, sensory and cognitive profile, and that there is a need for the adoption of classification systems and assessment tools that are different and in some ways pioneering, so as to guarantee the surpassing of the concept of disability as a "mere defect" physical and/or impairment and/or loss of psychological, physiological or anatomical function (Holden & Gitlesen 2003, Linden 2017, WHO 2001). It is exactly in contemplation of a bio-psycho-social model, that the International Classification of Functioning, Disability and Health (ICF) arises, which possesses a neutral position with respect to etiology and a complementarity with the ICD-10 classification (WHO 2001), since it allows the functional diagnosis (i.e. a specialized analytical description of the potential and deficits in relation to the pathology) proposing a detailed analysis of the possible social consequences of disability by evaluating the residual capacities and measuring the "social skills" (WHO 2001).

Evaluation of the Quality of Rehabilitation Treatment in Neurodevelopmental Disorder.

Complex disability is very difficult to manage. It usually subtends very serious clinical pictures, because it affect several body systems, or because it is associated with intellectual disability and behavioral disorders. Often affected patients are unable to communicate their basic needs. All these factors combine to make the management of these patients very complex, and those who care for them realize how important it is to find a way to detect their state and to identify their potential capabilities. Developing appropriate rehabilitation programs for these patients requires additional effort and an assessment capacity that is as objective as possible. Few scales cited in the literature are capable of evaluating these aspects in patients with complex disabilities, among them the Barthel Index (Mahoney & Barthel 1965) and the Vineland Adaptive Behavior scale II (Sparrow et al. 2005). The majority of these scales often tend to depict the data regarding the disease to a degree of severity that precludes adequate individual rehabilitation program development. There is a dire need for a more appropriate instrument, an observational grid that is capable of identifying the potential of this patient population and evaluate the effectiveness of rehabilitation interventions provided. The aim of the study is to evaluate the efficacy of rehabilitation interventions in a group of patients with IQ <32 (determined by the Vineland II scale) using an evaluation tool created ad hoc called D-Rubrics, designed with the intent to identify "micro-differences" between baseline (T0) and post-rehabilitation (T1). The goal is part of a more long term-term objective which involves developing an effective assessment tool for patients with complex disabilities. Such an assessment tool should be practical, easy to administer and useful in both clinical and research settings.

Mathematics Anxiety and Cognitive Performance in Adolescent Students.

Several studies highlight that many students feel negative feelings about mathematical learning and that the mathematics anxiety seems to play a central role in mathematical performance. More specifically students with higher level of maths anxiety are less efficient in mathematical tasks. The aim of this study was to investigate the relationship between specific mathematics anxiety as assessed by AMAS, trait and state anxiety as assessed by STAI-Y, and mathematical skills assessed through the ABCA tests in a sample of 83 adolescent students (78.3% males) without diagnosis of dyscalculia and cognitive disorder attending their first year of secondary school. Results showed that 38% of the students referred high level of maths anxiety. Independent T-test revealed that female students referred a higher level of maths anxiety as well as of trait and state anxiety than male ones, while there were no differences in the mathematics performance. The simultaneous multivariate linear regression analysis showed that maths anxiety was influenced by trait anxiety and in its turn has an impact on the high level mathematics performances (i.e. arithmetic facts). Understanding the relationships between maths anxiety and maths learning and performance may have relevant implications in clinical, educational and didactic practice.