Intervenções Assistidas por Animais na expressão psíquica de Deficientes Intelectuais Adultos (IAA e Deficiência intelectual) / Intervenciones Asistidas por Animales en la expresión psíquica de Deficientes Intelectuales Adultos (IAA e Deficientes Intelectuales) / Animal-Assisted Interventions in the Psychic Expression of Intellectually Disabled Adults (IAA and Intellectually Disabled)

INTRODUÇÃO: Esta pesquisa problematiza a interação entre sujeitos adultos com Deficiência Intelectual e cães, sob a perspectiva das Intervenções Assistidas por Animais (IAA). OBJETIVO: Descrever os efeitos da IAA na expressão verbal e não verbal de conteúdos psíquicos em sujeitos adultos com deficiência intelectual. MÉTODO: Pesquisa de natureza qualitativa. Participaram 04 sujeitos do sexo feminino, idades entre 39 a 63 anos, com deficiência intelectual. Cão co-terapeuta: Amin, da raça Golden Retriever, 7 anos, selecionado de acordo com critérios de protocolos internacionais, conduzido pela pesquisadora. Foram realizadas 07 sessões de IAA, em grupo, com duração de 35 minutos cada, no decorrer de 03 meses. Foram aplicados os testes HTP e Wartegg realizados pré e pós sessões de IAA, cujos resultados foram analisados comparativamente intra sujeito. RESULTADOS: Na população estudada verificou-se em todos os sujeitos a expansão da personalidade e a redução da ansiedade pós IAA, além do aumento de verbalização e o cão como forte instrumento motivador. CONCLUSÃO: Os resultados desta pesquisa indicam a ocorrência de modificações psíquicas, verbais e não verbais, em diferentes graus, nos sujeitos com DI estudados.

INTRODUCTION: This research problematizes the interaction between adult subjects with Intellectual Disability and dogs, from the perspective of Animal-Assisted Interventions (IAA). OBJECTIVE: To describe the effects of IAA on verbal and nonverbal expression of psychic contents in adults with intellectual disabilities. METHOD: Qualitative research. Four female subjects, aged between 39 and 63 years, with intellectual disability participated. Dog co-therapists: Amin, Golden Retriever, 7 years old, selected according to criteria of international protocols, conducted by the researcher. There were 07 IAA sessions, in a group, lasting 35 minutes each, during the course of 03 months. The HTP and Wartegg tests were performed before and after IAA sessions, the results of which were analyzed comparatively. RESULTS: In the studied population, all subjects showed personality expansion and reduction of anxiety after IAA, in addition to increased verbalization and the dog as a strong motivating instrument.. CONCLUSION: The results of this research indicate the occurrence of psychic, verbal and nonverbal expression changes in different degrees in subjects with DI studied.

INTRODUCCIÓN: Esta investigación problematiza la interacción entre sujetos adultos con discapacidad intelectual y perros, desde la perspectiva de las intervenciones asistidas por animales (IAA). OBJETIVO: Describir los efectos de la IAA en la expresión verbal y no verbal de contenidos psíquicos en sujetos adultos con discapacidad intelectual. MÉTODO: Investigación de naturaleza cualitativa. Participaron 04 sujetos del sexo femenino, edades entre 39 a 63 años, con discapacidad intelectual. Perro co-terapeutas: Amin, de la raza Golden Retriever, 7 años, seleccionado de acuerdo con criterios de protocolos internacionales, conducido por la investigadora. Se realizaron 7 sesiones de IAA, en grupo, con una duración de 35 minutos cada una, en el transcurso de 03 meses. Se aplicaron las pruebas HTP y Wartegg realizadas pre y post sesiones de IAA, cuyos resultados se analizaron comparativamente. RESULTADOS: En la población estudiada se verificó en todos los sujetos la expansión de la personalidad y la reducción de la ansiedad post IAA además de una mayor verbalización y el perro como un fuerte instrumento de motivación.. CONCLUSIÓN: Los resultados de esta investigación indican la ocurrencia de modificaciones psíquicas, expresión verbal y no verbal en diferentes grados en los sujetos con DI estudiados.

"Moving on" through the locked ward system for women with intellectual disabilities.

BACKGROUND: The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how "moving on" is defined and perceived. METHODS: The study reports on an ethnographic study using the field-notes and the 26 semi-structured interviews with detained women and staff on three wards. RESULTS: We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. CONCLUSION: The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements.

Psychoeducational assessment of students with intellectual disability: professional-action framework analysis.

BACKGROUND: The right to educational inclusion for students with intellectual disability (SWID) requires the development of good assessment and intervention practices from holistic perspectives not exclusively focused on the academic limitations that SWID may present. These practices are settled in Spain, via regulations drawn up by each Autonomous Community (AC). The variety of existing regulations demands a critical review of the decisions taken to promote the inclusion of those students. METHOD: current regulations-in-force in each AC that regulate attention to diversity (AD) have been were analyzed by using a checklist that includes the variables that defining each stage of the AD process and the ways of providing supports that favor the development, learning and participation of SWID. RESULTS: attention to diversity measures in each AC emphasize organizational and curricular issues, with no AC following holistic approaches in both assessment and intervention, but rather neglecting self-determination and the promotion of quality of life for SWID. CONCLUSIONS: guidelines for the development of new legal frameworks and professional practices based on the latest evidence-based models of attention to SWID and on the results are discussed.

Music for All: Including young people with intellectual disability in a university environment.

We investigated a continuing education course in creative music making, initiated to promote the inclusion of young people with intellectual disability in a university setting. Despite organizers' attempts to foster diversity within the student cohort, enrolments were almost exclusively from students who had intellectual disability. Being in the university environment, and in a place of higher learning, seemed to be valued by some. However, students' main focus was on group musicking in a dedicated music room rather than interacting with the wider university community. Those who did not identify as disabled believed it was important to continue to address the barriers to wider inclusion. While acknowledging the risks around mediating the social interactions of young people with intellectual disability, we argue that future courses should include activities specifically designed to bring them to classes with typical students and to the wider activities of the university.

Low-Intensity Cognitive Behavioural Therapy-Based Music Group (CBT-Music) for the Treatment of Symptoms of Anxiety and Depression: A Feasibility Study.

BACKGROUND: Music has the potential to be an effective and engaging therapeutic intervention in the treatment of mental illness. This research area remains underdeveloped. AIMS: This paper reports the feasibility of an innovative low-intensity CBT-based music (CBT-Music) group targeted to symptoms of depression and anxiety. METHOD: A total of 28 participants with symptoms of depression and anxiety who were attending community mental health services were recruited for the study and randomized into TAU (treatment as usual) plus low-intensity CBT-Music (treatment) or to TAU alone (control). The treatment group consisted of a 9-week music group that incorporated various components of CBT material into a musical context. Feasibility was the primary outcome. The secondary outcomes were a reduction in depression, anxiety (Hospital Anxiety and Depression Scale) and disability (WHO Disability Assessment Schedule 2.0) assessed at baseline and 10 weeks. RESULTS: Recruitment proved feasible, retention rates were high, and the participants reported a high level of acceptability. A randomized control study design was successfully implemented as there were no significant differences between treatment and control groups at baseline. Participants in the treatment group showed improvement in disability (p = 0.027). Despite a reduction in depression and anxiety scores, these differences were not statistically significant. CONCLUSIONS: A low-intensity CBT-based music group can be successfully administered to clients of community mental health services. There are indications of effectiveness in reducing disability, although there appears to be negligible effect on symptoms of anxiety and depression. This is the first report of a trial of a low-intensity CBT-based music group intervention.

Non-pharmacological interventions for people with epilepsy and intellectual disabilities.

BACKGROUND: Approximately 30% of patients with epilepsy remain refractory to drug treatment and continue to experience seizures whilst taking one or more antiepileptic drugs (AEDs). Several non-pharmacological interventions that may be used in conjunction with or as an alternative to AEDs are available for refractory patients. In view of the fact that seizures in people with intellectual disabilities are often complex and refractory to pharmacological interventions, it is evident that good quality randomised controlled trials (RCTs) are needed to assess the efficacy of alternatives or adjuncts to pharmacological interventions.This is an updated version of the original Cochrane review (Beavis 2007) published in The Cochrane Library (2007, Issue 4). OBJECTIVES: To assess data derived from randomised controlled trials of non-pharmacological interventions for people with epilepsy and intellectual disabilities.Non-pharmacological interventions include, but are not limited to, the following.• Surgical procedures.• Specialised diets, for example, the ketogenic diet, or vitamin and folic acid supplementation.• Psychological interventions for patients or for patients and carers/parents, for example, cognitive-behavioural therapy (CBT), electroencephalographic (EEG) biofeedback and educational intervention.• Yoga.• Acupuncture.• Relaxation therapy (e.g. music therapy). SEARCH METHODS: For the latest update of this review, we searched the Cochrane Epilepsy Group Specialised Register (19 August 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) via CRSO (19 August 2014), MEDLINE (Ovid, 1946 to 19 August 2014) and PsycINFO (EBSCOhost, 1887 to 19 August 2014). SELECTION CRITERIA: Randomised controlled trials of non-pharmacological interventions for people with epilepsy and intellectual disabilities. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the inclusion criteria and extracted study data. MAIN RESULTS: One study is included in this review. When two surgical procedures were compared, results indicated that corpus callosotomy with anterior temporal lobectomy was more effective than anterior temporal lobectomy alone in improving quality of life and performance on IQ tests among people with epilepsy and intellectual disabilities. No evidence was found to support superior benefit in seizure control for either intervention. This is the only study of its kind and was rated as having an overall unclear risk of bias. The previous update (December 2010) identified one RCT in progress. The study authors have confirmed that they are aiming to publish by the end of 2015; therefore this study (Bjurulf 2008) has not been included in the current review. AUTHORS' CONCLUSIONS: This review highlights the need for well-designed randomised controlled trials conducted to assess the effects of non-pharmacological interventions on seizure and behavioural outcomes in people with intellectual disabilities and epilepsy.

Wadaiko performance enhances synchronized motion of mentally disabled persons.

People with mental disabilities tend to lack communication skills and have difficulty with interpersonal relationships. Interpersonal communication skills were examined in two people with Down Syndrome with regard to playing wadaiko (Japanese drum). Motion analysis compared single play and two-person play in which one participant was more skillful than the other. The effect of wadaiko play was quantified using two different methodologies: motion delay and hit-timing analysis and visual analog-scale (VAS) ratings before and after play. The motion analysis indicated that the study participants became mutually synchronized in playing wadaiko, and that a participant played more accurately when he played with a senior member. VAS ratings indicated that participants felt more positive after practicing wadaiko than before and self-confidence improved. Synchronized gestures of wadaiko performance may be an effective therapy for people with limited communication skills.

[From disability to the adunatos: some thoughts on disability and somatoform pain disorder]. / De l'invalide à l'adunatos: réflexions sur l'invalidité et le trouble somatoforme douloureux.

Disability, especially if related to a psychiatric disorder, such as somatoform pain disorder, is characterized by medical, psychological, relational, social and societal, as well as financial and political aspects. This manuscript, part of a PhD thesis which reflects on a possible dialogue between an ancient text and the modern conceptualization of disability, tries to address the phenomenological, historical and political dimensions of disability.

An integrative review of what contributes to personal recovery in psychiatric disabilities.

The aim of this integrated literature review is to identify what people with psychiatric disabilities experience as contributing to their personal recovery. The study design is based on Whittemore and Knafl's integrative review and includes 14 qualitative peer-reviewed articles. The analysis reveals three main themes: recovery as an inner process; recovery as a contribution from others; and recovery as participating in social and meaningful activities. If mental health nurses adhere to the personal recovery perspective, nursing practice will focus on the patients' needs, conveying hope and supporting the patient in the recovery process.

Audiometric screening of a population with intellectual disability.

OBJECTIVE: Evaluation of pure-tone audiometry (PTA) in hearing screening of a population with mild to profound intellectual disability (ID). DESIGN: PTA was performed at six frequencies at the screening level 20 dB HL. Referral criteria were threshold levels ≥ 25 dB HL at two or more frequencies for one ear or both. STUDY SAMPLE: 1478 participants aged 7-91 years were included. RESULTS: 1470 (99.5%) people cooperated in screening of which 1325 (90%) could be tested on both ears at all six frequencies. A majority, 987 (66.8%), performed ordinary PTA, 234 (15.8%) conditioned play audiometry, and 249 (16.9%) behavioural observation audiometry. Six hundred and sixty-nine (45%) passed and 809 (55%) failed according to referral criteria. Of those failing, 441 (54.5%) accepted referral to clinical evaluation. CONCLUSIONS: PTA with slight modifications is applicable for screening of a population with mild to profound intellectual disability. The most challenging and time-consuming activity is to introduce the test procedure in a way that reduces anxiety and establishes trust.

Feeding therapy for children with food refusal.

Disabled children suffer not only from their primary disease, but also from other complications, including food refusal. The purpose of this study was to elucidate the relationship between these conditions and food refusal in disabled children. The effectiveness of feeding therapy in treating food refusal was also examined. The study subjects were 67 disabled children (35 boys and 32 girls; mean age at initial examination: 6.5 years, SD: 6.0 years) who attended the Nippon Dental University Hospital between April 2004 and August 2008. Of them, the 13 subjects who were diagnosed as those who refused food received feeding therapy combined with desensitization therapy for hypersensitivity. Approximately 20% of the subjects showed food refusal symptoms. Primary disease, respiratory impairment and gastroesophageal reflux were not causes of food refusal in this population. There was a significant relationship between food refusal and hypersensitivity (p = 0.021). After receiving feeding therapy, six of the seven subjects with hypersensitivity but without dysphagia at initial examination recovered from food refusal. Food refusal did not significantly correlate with tube feeding. Hypersensitivity and/or tube feeding may induce food refusal. For subjects with these conditions, feeding therapy combined with desensitization therapy is effective in achieving recovery from food refusal.

Creating change: using the arts to help stop the stigma of mental illness and foster social integration.

Stigma is a social justice problem that plagues persons with psychiatric disabilities, their families, and society. It fuels the fear underlying discrimination; undermines consumer self-efficacy; and blocks rehabilitation, recovery, and social integration. The author hopes to create a passion for change and suggest a way that everyone can help stop stigma. This approach is simple: to nurture the artistic talent many clients possess and connect them with public venues for their artworks. On display, too, will be the "ability" in "disability." This will reduce stigma while building self-efficacy and empowerment. Anecdotal evidence supports this hypothesis. However, research is needed; a design for a study to test this hypothesis is described. Significantly, an antistigmal arts intervention can be conducted by any aware practitioner; one does not need to be an art therapist or have any background in art, only a desire to make a difference and resources on which to draw.

Cancer information needs of people with intellectual disability: a review of the literature.

The lifespan of people with an intellectual disability has increased significantly in recent years; however, this has resulted in a rising incidence of age-related illnesses including cancer. The World Health Organisation has expressed concern as evidence suggests prevalence rates for cancer are increasing for this group. The needs of people with a cancer diagnosis and an intellectual disability are beginning to be highlighted; however, there appears to be a substantial dearth of services including appropriate cancer information. This presents alarming obstacles and barriers to high-quality cancer care impacting on treatment, management and overall survival rates for this client group. Furthermore, a number of policy and research reports directed at the health needs of people with an intellectual disability have continually highlighted the need for accessible information and effective communication. Having access to cancer information should be considered a crucial part of providing optimum holistic care for this client group. Cancer professionals should assess the unique information needs of people with an intellectual disability as mainstream information does not meet their requirements. Furthermore, health professionals working in intellectual disability settings must also address their knowledge and information deficits in this regard. This paper presents a review of the literature with a specific focus on the cancer information needs of people with an intellectual disability.

Clinical and benefit--cost outcomes of teaching a mindfulness-based procedure to adult offenders with intellectual disabilities.

The effects of a mindfulness-based procedure, called Meditation on the Soles of the Feet, were evaluated as a cognitive-behavioral intervention for physical aggression in 6 offenders with mild intellectual disabilities. They were taught a simple meditation technique that required them to shift their attention and awareness from the precursors of aggression to the soles of their feet, a neutral point on their body. Results showed that physical and verbal aggression decreased substantially, no Stat medication or physical restraint was required, and there were no staff or peer injuries. Benefit-cost analysis of lost days of work and cost of medical and rehabilitation because of injury caused by these individuals in both the 12 months prior to and following mindfulness-based training showed a 95.7% reduction in costs. This study suggests that this procedure may be a clinically effective and cost-effective method of enabling adult offenders with intellectual disabilities to control their aggression.

Capacity to consent to sexual relationships in adults with learning disabilities.

People with learning disabilities used to be seen as asexual or promiscuous and were discouraged from expressing their sexuality. However, with the growth of the rights movement, attention has turned to the dilemma of how to both empower and protect people with learning disabilities in relation to their sexuality. A recent research project showed that, on average, adults with learning disabilities knew much less about sex and understood much less about sexual abuse than non-disabled young people aged 16 years. Sex education made a significant difference to their knowledge and understanding however. The implications of the study for services for people with learning disabilities and for definitions of capacity to consent to sexual relationships are discussed.

Psychological treatment of reported sleep disorder in adults with intellectual disability using a multiple baseline design.

BACKGROUND: The literature on sleep disturbance in adults with intellectual disability (ID) is sparse. Although prevalence rates for sleep disorders appear similar to those of non-disabled populations, previous treatment studies have largely been comprised of uncontrolled cases. Therefore, the present study adopted a single-case experimental methodology to evaluate behavioural sleep intervention. METHODS: A screening questionnaire was posted to 384 adults with ID and the sleep pattern of respondents with possible sleep disorders was further assessed using a structured diagnostic schedule. From the sleep-disordered subgroup, 12 participants were selected for a 4-week behavioural sleep intervention that was evaluated using randomly allocated, multiple-baseline, across-subjects designs and within-subject interrupted time series analyses (ITSAs). RESULTS: A total of 155 adults with ID (83 females and 72 males; mean age = 32 years, SD = 16.5 years), or their carers, completed the questionnaire (return rate = 40%). The application of sleep diagnostic criteria revealed that 17% had clinically significant difficulty getting to sleep and 11% had difficulty remaining asleep. Nine out of the 12 participants recruited for the intervention completed all the experimental phases, thus providing three sets of three multiple-baseline designs. Visual inspection of within- and between-subject effects suggested beneficial treatment-specific effects across a range of target variables. The ITSA confirmed significant effects (P < 0.05) or trends (P < 0.10) for six out of the nine participants. CONCLUSIONS: Behavioural sleep management may improve sleep pattern or sleep-related functioning in the majority of adults with ID who have significant sleep problems. The single-case methodology is helpful in addressing the heterogeneity of individual presentation, although clinical trial methodology is required to confirm these findings on a larger scale.