Eliciting perceptions of satisfaction with services and supports from persons with intellectual disability and developmental disabilities: a review of the literature.

BACKGROUND: Assessing the perceptions of individuals with intellectual disability (ID) and developmental disabilities (DD) is an essential part of evaluating and planning services and an important component of respect for self-direction and autonomy. It can be difficult, however, to assess satisfaction in such a way that individuals with disabilities' actual perceptions of satisfaction are accurately represented because of intellectual and communication difficulties they may have, the restricted range and nature of service systems, and the limitations of strategies used by some researchers. METHOD: The purpose of this literature review was to systematically examine research studies designed to solicit personal satisfaction information from individuals with ID and DD. We reviewed 29 studies that met inclusion criteria to determine (1) who were participants in the studies, (2) what processes researchers used to obtain opinions and perspectives of persons with ID and DD, and (3) how researchers ensured the credibility, accuracy and voluntariness of participants' responses. RESULTS: Findings revealed that most of the research participants had ID with higher IQs and limited needs for supports. Researchers utilised a variety of processes to elicit perceptions of satisfaction. Most studies employed individual interviews; researchers addressed comprehensibility of questions in a number of ways (e.g. use of visuals, adjusting wording of questions, providing clear examples). Few studies reported training interviewers or taking into account participants' primary language or cultural background. No studies reported educating participants about how to understand the satisfaction information data or how to use it in advocating for more appropriate supports. CONCLUSIONS: Assessing the satisfaction with supports and services of individuals with ID and DD is complex particularly for persons with extensive support needs. Continued research using varied conceptual frameworks and new technologies is needed. Also helpful will be teaching persons with disabilities about the assessment process and how to use its results.

Hemodynamic effects of aerobic vs resistance exercise.

Previous studies suggest that aerobic exercise lowers blood pressure (BP), while isometric exercise increases BP, at least transiently. The purpose of this study was to examine the hemodynamic effect of a 6-week training period of aerobic exercise or weight training. Twenty deconditioned healthy males ages 18-36, self-selected a training regimen. The aerobic group exercised 30 min/day, 4 times each week to achieve 60-80% maximal heart rate. The resistance group lifted weights at 65-80% maximal voluntary contraction; 3-4 sets of 8-12 repetitions; 3 day/week using large muscle groups. Hemodynamic measurements of heart rate, BP, venous capacitance, forearm blood flow, and vascular resistance were made at baseline and week 6 by plethysmography and analyzed by 2-way ANOVA. The groups showed no differences in baseline characteristics. A training effect was confirmed by a decrease in resting heart rate in the aerobic group (71.5 +/- 4.4 to 64.5 +/- 3.7, beats per minute, P = 0.004), and an increase in total work capacity in the weight lifting group (6231 vs 7508, P = 0.01). Forearm blood flow increased similarly in both groups, averaging 17% (3.5 +/- 0.2 vs 4.2 +/- 0.2 ml 100 g/min, P = 0.03), while forearm vascular resistance fell 19% (28.8 +/- 1.7 vs 24.3 +/- 1.7 mm Hg/ml/min 100 g, P = 0.08). The main differences between the groups after training was found in their response to isometric stress (1/3 maximal handgrip). The weight-lifting group had a greater increase of forearm blood flow and venous capacitance, less increase in systolic BP (SBP) and a greater fall of forearm vascular resistance, (P < 0.05) while the aerobic group had less increase in SBP and heart rate (P < 0.04) but no significant change of forearm hemodynamics. We conclude that both aerobic and repetitive weight programs have short term favorable effects on resting forearm BP and resistance. The exercise programs differ in altering the individual's physiologic response to subsequent isometric stress. However, exercise training of longer duration or greater intensity or frequency could alter these results.