Staff perception on including students with physical disabilities at a South African university.

Background: International and local policy frameworks on disability promote inclusive higher education practices for students with disabilities (SWD). However, the actual application of these frameworks concerning students with physical disabilities (SWPD) in any School of Health Care Sciences (SHCS) is uncertain in South African universities. Objectives: This study aimed to explore the perceptions of academic and admission staff on the inclusion of SWPD in SHCS at a South African university. The study was carried out at a University of Health Sciences in South Africa. Method: A qualitative study in which respondents (n = 12) were interviewed in depth about their perceptions on the inclusion of SWPD in the SHCS. Thematic analysis was used in the data assessment. Results: The results revealed three main themes: policy discourse, environmental effects on inclusion and SWPD enrolment. Respondents reported the lack of a disability inclusion policy and disability unit to support SWD in general. The respondents also noted that there were environmental challenges that could potentially affect the inclusion of SWPD in SHCS study programmes. Respondents also indicated that there was no SWPD enrolment as the university's current inclusion and/or quota system does not include SWD. Conclusion: The findings of the study showed a lack of disability inclusion policy, environmental challenges and lack of SWPD enrolment. Based on the study findings, it can be concluded that inclusion of SWPD at this university may be negatively influenced. Contribution: The study findings contribute to the field of disability and the inclusion of SWPD in higher education institutions (HEIs).

The Chaeli Campaign Journal Club: Strengthening evidence-based practice and contributing to practice-based evidence in under-resourced South African communities.

Background: The Chaeli Campaign is a Cape Town based non-profit organisation offering programmes largely for children and youth with disabilities in diverse under-resourced communities in South Africa. Their therapy team established a Health Professions Council of South Africa accredited interdisciplinary journal club in January 2012, with the aim to improve the team's service to the community. Objectives: Our first objective was to make our practice more evidence-based through reading systematically and critically in our field. Our second objective was to write up and share some of our practices to contribute to the generation of practice-based evidence. Method: First-person action research was applied. The core group of participants over time comprised two occupational therapists, one physiotherapist, two speech therapists, two teachers and four community development workers. Nine iterative cycles of planning, action, review and revised planning have been implemented on an annual basis in this non-formal, long-term action research project. Results: For over nine and a half years we have pre-read, discussed and completed evaluation questionnaires on 54 peer-reviewed journal articles, conducted 12 conference presentations and published three articles in accredited journals. Participants reported a broadened understanding of issues around disability, more reflective, contextually and culturally appropriate practice and improved interdisciplinary teamwork. Conclusion: The Chaeli Campaign journal club has built the capacity of therapists, teachers and community development workers to find, read, evaluate and use research evidence to improve their practice. It has also given participants the opportunity to ethically research, present and write up their grass roots interventions, thus contributing to locally applicable practise-based evidence. It is hoped that the sharing of our experience will assist and encourage other teams to start interdisciplinary journal clubs as a step towards facilitating two-way knowledge translation from evidence to practice and from practice to evidence.

Parental experiences on the role of wheelchairs in the lives of their children with mobility impairments: a qualitative exploration in Dubai.

PURPOSE: To explore parental experiences on the role of wheelchairs in the lives of their children with mobility impairments in Dubai. METHODS: Seven participants were recruited through purposive sampling and their experiences were explored by conducting semi-structured interviews. The audio recordings were transcribed and thematically analysed. RESULTS: The findings showed that wheelchairs were an essential part of the children`s lives, which enabled their participation in the home, the school and the community. Procurement processes were difficult owing to a lack of assessment and prescription processes as well as insurance companies providing little assistance with payment. The participants described Dubai as a wheelchair friendly city and two overarching themes emerged; firstly, The wheelchair: "It is her life", and, secondly, Participation: Isolation versus inclusion. CONCLUSION: The study is the first of its kind in Dubai and indicated that the wheelchair played an important role in the children's lives and allowed participation in life roles that brought joy and fulfilment. Without wheelchairs, children would be isolated and frustrated. However, some of the participants were not satisfied with their child's current wheelchair and felt the chair was not appropriate. Recommendations to specific stakeholders included: the development of policies to guide wheelchair service provision by government. In addition, insurance providers could collaborate with the government to adhere to the policy to ensure healthy lives and promote well-being for all.IMPLICATIONS FOR REHABILITATIONThe wheelchair provided children the mobility to participate in life roles instead of being isolated.Not all children had appropriate wheelchairs.Service providers and medical insurance did not give sufficient support during wheelchair selection and procurement.

Understanding the Attitudes of Communities to the Social, Economic, and Cultural Importance of Working Donkeys in Rural, Peri-urban, and Urban Areas of Ethiopia.

Working donkeys (Equus africanus asinus) are vital to the development and support of people's livelihoods in rural, peri-urban, and urban areas of Ethiopia. However, despite their critical role in providing transport, food security, and income generation to some of the poorest and most marginalized households, donkey contributions to human livelihoods have been largely unexplored. Donkey users, veterinary surgeons, business owners, and civil servants were interviewed to investigate the role humans play in shaping donkey lives while furthering our understanding of the social and economic impacts of working donkeys to human lives. Findings are discussed through seven guiding themes; donkeys as generators of income, the relationship between donkeys and social status, donkeys and affect, empowerment through donkeys, the role of donkeys in reducing vulnerability and encouraging resilience, donkey husbandry, and gender dynamics all of which gave a broader and richer insight into the value of donkeys. Donkeys are an important support in rural, peri-urban, and urban settings through the creation of economic security, independence, and participation in local saving schemes. In addition, donkeys provide social status, empowerment to marginalized groups such as women and the very poor and provide a sense of companionship. Whether the interviewee was a donkey user or a key informant appeared to influence their views on donkeys and their welfare, as did their location. The variations in views and practices between urban and rural settings suggests that assessing the socioeconomic value of donkeys in different locations within the same area or country is critical, rather than assuming that similar views are held between compatriots. Despite their centrality to many people's lives in Ethiopia, working donkeys often hold lowly status, are misunderstood, and given little husbandry and healthcare.

Community-based rehabilitation workers' perspectives of wheelchair provision in Uganda: A qualitative study.

BACKGROUND: The challenges of wheelchair provision and use in less resourced settings are the focus of global efforts to enhance wheelchair service delivery. The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood. OBJECTIVES: The aim of this study was to determine what CBR workers in three areas of Uganda perceived as (1) the challenges with wheelchair provision and use, (2) the factors contributing to these challenges, (3) the role they themselves can potentially play and (4) what facilitators they need to achieve this. METHOD: This qualitative study in the transformative paradigm comprised focus group discussions to gather perceptions from 21 CBR workers in three areas of Uganda, each with an operational wheelchair service, participant observations and field notes. Thematic analysis of data was implemented. RESULTS: Community-based rehabilitation workers' perceptions of challenges were similar while perceived causes of challenges differed as influenced by location, historical and current wheelchair availability and the CBR workers' roles. Their main responsibilities included assistance in overcoming barriers to access the service, transfer of skills and knowledge related to wheelchairs, follow-up of users for wheelchair-related problem-solving, and user and community empowerment. CONCLUSION: Community-based rehabilitation workers can contribute in various ways to wheelchair service delivery and inclusion of wheelchair users; however, their capabilities are not consistently applied. Considering the diversity of contextual challenges, CBR workers' range of responsive approaches, knowledge of networks and ability to work in the community make their input valuable. However, to optimise their contribution, specific planning for their training and financial needs and effective engagement in the wheelchair services delivery system are essential. KEYWORDS: wheelchairs; less resourced settings; community-based rehabilitation; wheelchair service provision; service steps; Uganda; empowerment; inclusion; assistive device.

Simple ideas that work: Celebrating development in persons with profound intellectual and multiple disabilities.

BACKGROUND: The purpose of this article is to share some lessons learnt by an interdisciplinary therapy team working with persons with profound intellectual and multiple disabilities (PIMD), implemented in diverse, low-income contexts over a period of 8 years. OBJECTIVES: The objective of all the activities described here was to provide increased stimulation and development opportunities for persons with PIMD within different settings (day care centre, residential centre or family home). METHOD: We used an iterative action-learning approach where we applied existing evidence in the given context, reflected on and adapted strategies in collaboration with stakeholders on a cyclical basis. We focussed on achieving our objectives through ongoing hands-on training of the carers involved with the clients as we felt that by providing them with the knowledge and skills needed, plus ongoing support, these programmes would be more sustainable. FINDINGS: It took some time to put systems in place in care settings, but once they became part of the daily routine, they provided increased opportunities for learning for clients with PIMD. In addition, there were often marked changes in individual clients' communicative and physical functioning, which in turn encouraged carers to find new and different ways to interact with, and stimulate, the persons with PIMD in their care. CONCLUSION: Our hope is that parents and carers or professionals working in the field of PIMD in low-income contexts elsewhere may find one, some or all of these simple ideas useful in providing opportunities for learning, development and enjoyment for persons with PIMD.

Inflammation in adult women with a history of child maltreatment: The involvement of mitochondrial alterations and oxidative stress.

The experience of maltreatment during childhood is associated with chronic low-grade inflammation in adulthood. However, the molecular mechanisms underlying this pro-inflammatory phenotype remain unclear. Mitochondria were recently found to principally coordinate inflammatory processes via both inflammasome activation and inflammasome-independent pathways. To this end, we hypothesized that alterations in immune cell mitochondrial functioning and oxidative stress might be at the interface between the association of maltreatment experiences during childhood and inflammation. We analyzed pro-inflammatory biomarkers (levels of C-reactive protein, cytokine secretion by peripheral blood mononuclear cells (PBMC) in vitro, PBMC composition, lysophosphatidylcholine levels), serum oxidative stress levels (arginine:citrulline ratio, l-carnitine and acetylcarnitine levels) and mitochondrial functioning (respiratory activity and density of mitochondria in PBMC) in peripheral blood samples collected from 30 women (aged 22-44years) with varying degrees of maltreatment experiences in form of abuse and neglect during childhood. Exposure to maltreatment during childhood was associated with an increased ROS production, higher levels of oxidative stress and an increased mitochondrial activity in a dose-response relationship. Moreover, the increase in mitochondrial activity and ROS production were positively associated with the release of pro-inflammatory cytokines by PBMC. Decreased serum levels of lysophosphatidylcholines suggested higher inflammasome activation with increasing severity of child maltreatment experiences. Together these findings offer preliminary evidence for the association of alterations in immune cell mitochondrial functioning, oxidative stress and the pro-inflammatory phenotype observed in individuals with a history of maltreatment during childhood. The results emphasize that the early prevention of child abuse and neglect warrants more attention, as the experience of maltreatment during childhood might have life-long consequences for physical health.

Using physical and emotional parameters to assess donkey welfare in Botswana.

INTRODUCTION: Working donkeys in Maun, Botswana contribute to people's livelihoods substantially through the provision of transport, ploughing and income generating activities. However, working donkeys suffer from various welfare issues that were investigated in this study to provide preliminary insights on their health and well-being. MATERIALS AND METHODS: An assessment protocol involving direct observations of the donkeys was developed and operationalised to assess physical and emotional welfare. Physical welfare parameters such as body condition score, abnormal limbs, impeded gait, eye abnormalities, sore and scar locations, hoof and coat condition were recorded. Emotional welfare parameters such as eyes, tail movement, ear position, neck position, posture and vocalisation were recorded. In addition, donkey-owner interactions were recorded and scored, as well as the donkey's response to environmental factors. A total cross-section of 100 donkeys sub-stratified by roles of riding, cart pulling and resting were randomly selected in eight villages and three urban wards and assessed during the period of May to August 2012. RESULTS: The findings reveals that the 100 adult working donkeys assessed were physically afflicted by poor BCSs of two (66 per cent), long and cracked hooves (50 per cent), sores on at least two locations on their body (53 per cent), scars on at least two locations on their body (86 per cent), and poor coat conditions (58 per cent). Emotionally, donkeys displayed unresponsiveness (35 per cent), avoidance (31 per cent), disinterest in hand sniffing (59 per cent), dull facial expression (33 per cent), tail stillness (89 per cent), neck stiffness and/or raised head (13 per cent) or head hanging low (32 per cent visibly withdrawn), and tense ears pointing back or to the side (69 per cent). By contrast, the remaining donkeys (31 per cent) exhibited a happy demeanour of curiosity, interest, alert facial expression, tail swishing, relaxed ears pointed to the side or forward and neck relaxed and/or level. CONCLUSIONS: This study offers preliminary findings from an investigation into the welfare of working donkeys in Greater Maun, Botswana, and provides baseline research to inform future research and strategies to enhance donkey well-being.

Communication training for centre-based carers of children with severe or profound disabilities in the Western Cape, South Africa.

The purpose of this paper is to provide a preliminary, qualitative review of an approach to training centre-based carers in supporting basic communication development and providing communication opportunities for the children with severe and profound disabilities in their care. In South Africa, these children are often the most neglected in terms of planning and providing appropriate interventions. For those with severe communication disabilities, an additional lack is in the area of the basic human right to meaningful interactions and communication. Sustainable strategies to provide opportunities for basic communication development of these children are urgently sought. Several effective international and local parent training programmes have been developed, but the urgent need remains to train centre-based carers who are taking care of groups of diversely disabled children in severely under-resourced settings. Non-profit organisations (NPOs) have been exploring practical centre-based approaches to skills sharing in physical rehabilitation, activities for daily living, feeding and support for basic communication development. As a freelance speech therapist contracted by four NPOs to implement hands-on training in basic communication for centre-based carers of non-verbal children, the author describes a training approach that evolved over three years, in collaboration with the carers and centre managements. Implications for training (for speech therapists and for community-based rehabilitation workers) and for further research are identified.

A journey towards inclusive education; a case study from a 'township' in South Africa.

The purpose of this case study was to relate part of the journey to appropriate education for two young children with physical disabilities in a low socio-economic peri-urban informal settlement - or 'township' - in South Africa. The part of the on-going journey described here spanned four-and-a-half years and included the two children, their families, their teachers, their community and a small team of rehabilitation professionals working for a non-profit organisation in the area. The rehabilitation professionals' goals were to provide support for the children, their families, their current special care centre and the school(s) they would attend in the future. The steps from the special care centre, to a mainstream early childhood development (ECD) centre for both of them, and then on to (a) a school for learners with special educational needs (LSEN) for one child and (b) a mainstream primary school for the other, are described. Challenges encountered on the way included parental fears, community attitudes and physical accessibility. Practical outcomes included different placements for the two children with implications and recommendations for prioritised parent involvement, individual approaches, interdisciplinary and community-based collaborations. Recommendations are given for clinical contexts, curricula and policy matters; for research and for scaling up such a programme through community workers.

Communication training for centre-based carers of children with severe or profound disabilities in the Western Cape, South Africa

The purpose of this paper is to provide a preliminary, qualitative review of an approach to training centre-based carers in supporting basic communication development and providing communication opportunities for the children with severe and profound disabilities in their care. In South Africa, these children are often the most neglected in terms of planning and providing appropriate interventions. For those with severe communication disabilities, an additional lack is in the area of the basic human right to meaningful interactions and communication. Sustainable strategies to provide opportunities for basic communication development of these children are urgently sought. Several effective international and local parent training programmes have been developed, but the urgent need remains to train centre-based carers who are taking care of groups of diversely disabled children in severely under-resourced settings. Non-profit organisations (NPOs) have been exploring practical centre-based approaches to skills sharing in physical rehabilitation, activities for daily living, feeding and support for basic communication development. As a freelance speech therapist contracted by four NPOs to implement hands-on training in basic communication for centre-based carers of non-verbal children, the author describes a training approach that evolved over three years, in collaboration with the carers and centre managements. Implications for training (for speech therapists and for community-based rehabilitation workers) and for further research are identified

A journey towards inclusive education; a case study from a 'township' in South Africa

The purpose of this case study was to relate part of the journey to appropriate education for two young children with physical disabilities in a low socio-economic peri-urban informal settlement ­ or 'township' ­ in South Africa. The part of the on-going journey described here spanned four-and-a-half years and included the two children, their families, their teachers, their community and a small team of rehabilitation professionals working for a non-profit organisation in the area. The rehabilitation professionals' goals were to provide support for the children, their families, their current special care centre and the school(s) they would attend in the future. The steps from the special care centre, to a mainstream early childhood development (ECD) centre for both of them, and then on to (a) a school for learners with special educational needs (LSEN) for one child and (b) a mainstream primary school for the other, are described. Challenges encountered on the way included parental fears, community attitudes and physical accessibility. Practical outcomes included different placements for the two children with implications and recommendations for prioritised parent involvement, individual approaches, interdisciplinary and community-based collaborations. Recommendations are given for clinical contexts, curricula and policy matters; for research and for scaling up such a programme through community workers