\r\n\tDespite their limitations such as encapsulation efficiency, liposomes are a well-established choice for a number of unconventional and conventional biological applications. The versatility of these lipid-based vesicles presents the importance of these nanoparticles in the future applications of nanotechnology besides targeted drug delivery. Overall, this book provides the necessary and relevant information about various aspects of liposomes and their use in nanomedicine.
\r\n\t
",isbn:"978-1-80356-366-4",printIsbn:"978-1-80356-365-7",pdfIsbn:"978-1-80356-367-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"62d8542d18b8cddcf507f7948b2ae74b",bookSignature:"Dr. Rajeev K. Tyagi",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11814.jpg",keywords:"Liposomes, Applications, Drug Delivery, Nanomedicine, Cancer Therapy, Cancer Nanomedicine, Monocytes, Ligand Anchoring, Lipid Vesicles, Transfection, Antigen Delivery, mRNA Delivery",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 22nd 2022",dateEndSecondStepPublish:"March 22nd 2022",dateEndThirdStepPublish:"May 21st 2022",dateEndFourthStepPublish:"August 9th 2022",dateEndFifthStepPublish:"October 8th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"A well-known researcher in developing mouse-human chimeras and drug delivery vehicles to study infectious diseases and beyond. Dr. Tyagi obtained his Ph.D. degree at Biomedical Parasitology Unit, Institute Pasteur, Paris, France, and worked at the University of South Florida, Augusta University, and Vanderbilt University Medical Center (VUMC), USA. Currently, he is leading a group at CSIR-Institute of Microbial Technology, India.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"269120",title:"Dr.",name:"Rajeev",middleName:"K.",surname:"Tyagi",slug:"rajeev-tyagi",fullName:"Rajeev Tyagi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRaBqQAK/Profile_Picture_1644331884726",biography:'Dr. Rajeev K. Tyagi earned Ph.D. degree at Biomedical Parasitology Unit, Institute Pasteur, Paris, France in June 2011 on a very challenging and interesting topic of malaria immunology/parasitology. He developed a long lasting, stable and straightforward laboratory animal model (humanized mouse model: a versatile mouse model) to study biology and immunology of infectious diseases and beyond. Dr. Tyagi worked as postdoc fellow in the laboratory of Dr. John Adams, University of South Florida, USA and received training to explore the potential of the developed “humanized mouse” to characterize attenuated asexual blood stage falciparum parasite to understand the innate immune response of the attenuated parasite (growth mutant). Also, he developed small laboratory human liver chimeric mice by transplanting the human hepatocytes in transgenic/immunodeficient mice (TK/NOG) at USF to study the least known liver stage infection of P. falciparum. Later on, he discovered novel dendritic like cell population called “pathogen differentiated dendritic cells (PDDCs)” when incubated with P. gingivalis and tracking of monocyte derived dendritic cells (MoDcs) in a reconstituted immunodeficient NOD.PrkdcscidIl2rg-/- (NSG) mice was carried out at Augusta University, USA to understand the host-pathogen interaction. Dr. Tyagi at the Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Vanderbilt University Medical Centre (VUMC), USA deployed his efforts to understand the role of IL-23R in the modulation of functioning of regulatory T cells and its role in the pathogenesis of colitis in an experimental humanized mouse. Currently, Dr. Tyagi has been leading a group at CSIR-Institute of Microbial Technology, Chandigarh, India and his lab is focused to:\r\n 1. Developing human-liver chimeric mice for huHep transplantation to study liver stage infection of P. falciparum and transition to asexual blood stage infection to test antimalarial drugs and vaccine candidates in one host. \r\n2. Study of drug resistance against Plasmodium falciparum\r\n3. Dendritic cells as "therapeutic vaccines" playing a crucial role in translational biomedical research.\r\n4. 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Introduction
Healthcare systems in transition countries must adapt to the many changes occurring in society as a whole. This is a very serious process requiring reforms that will significantly change the management and organization of healthcare at all levels. Bosnia and Herzegovina has suffered large scale destruction during the war (1992-1995), and all the medical capacities in the country sustained significant damage. The causes of demographic changes in transition countries include: the growth of urban populations, expansion of education, the modernization of society, the disintegration of the family, medical advances, increased income, decreased fertility and increased mortality (Loga S, 2011).
Community Based Rehabilitation (CBR) is strategy for rehabilitation, equal possibilities and social integration of all persons with disabilities. CBR program is implementing with joint effort of persons with disabilities, their families, community and related health, educational and social institutions. Before the 1992, medical rehabilitation in Bosnia and Herzegovina had been provided at the level of institutions, usually after the hospital or ambulant treatments. Model of Community Based Rehabilitation (CBR), which practically tested in all parts of Bosnia and Herzegovina, suggests numerous advantages when compared to the previous period, until 1992.
There is large number of health and educational institutions in the Canton of Sarajevo which are working on re/habilitation and education of children and adolescents with disabilities, but there isn’t unique database about the people with disabilities, as well as with cerebral palsy. Lack of unique database indicates poor network among the institutions and Associations in the Canton of Sarajevo.
A number of issues arise from the study “Family Quality of Life: Adult School Children with Intellectual Disabilities”. Four of the seemingly most important are: lack of organized community services for adults after they leave school; lack of a cantonal, state, or federal registration program that would improve coordination of health and social services and link to the European Register; necessity of conducting continuous education for the teaching staff at schools regarding effective curricula, for parents, and for health professionals; and the possibility of developing occupational and physical therapy programs for children, adolescent, and adults. The degree to which improvements such as these might affect family quality of life also needs to be examined in future study (Švraka E, Loga S, Brown I, 2011).
The goals of education and rehabilitation in Bosnia and Herzegovina, similar to most other countries of the world, are to work toward community inclusion, acceptance of diversity, optimal physical and mental health, and personal and social well-being. The focus on family quality of life is a step toward understanding how we can move closer to achieving these goals (Švraka, Loga, Brown, 2011).
The fact that concerns the most in the South-Eastern Europe is that many people with disabilities are isolated in their homes. One reason for this isolation is huge barriers that must face when they try to go out of their homes. Common premises, such as elevators, corridors and passages often are inaccessible. This only reinforces the fact that most laws on accessibility applies only to public buildings, so that investors who invest in private buildings can go unpunished for not fulfilling these regulations (Sestranetz, Adams, 2006).
1.1. Cerebral palsy
Cerebral palsy (CP) is characterized by nonprogressive abnormalities in the developing brain that create a cascade of neurologic, motor and postural deficit in the developing child. Cognitive, sensory and psychosocial deficits often compound motor impairments and subsequent functioning. Characteristically, the child with CP shows impaired ability to maintain normal posture because of a lack of muscle coactivation and the development of abnormal movement compensations. These compensatory patterns develop in certain muscle groups to maintain upright postures and move against gravity. Hyperactive responses to tactile, visual or auditory stimuli may result in fluctuations of muscle tone that often adversely affect postural control and further diminish coordinated responses in everyday activities (Rogers, Gordon, Schanzenbacher, Case-Smith, 2001).
Cerebral palsy (CP) occurs at present in about 2,2 per 1000 live born children in Sweden. Epilepsy occurs in 15% to more than 60% of children with CP, depending on the type of CP and the origin of the series, compared with 0,5% in the general population (Carlsson, Hagberg, Olsson, 2003).
According to the time of influence, causes of cerebral palsy can be divided to prenatal (from conception until beginning of the delivery), perinatal (beginning of the delivery until age of 28 days) and postnatal (from 29th day of age until two years of age). The majority of international studies indicates that the prevalence of the cerebral palsy is about 2-2,5 cases per 1000 born, although there are some reports about lower and higher prevalence rates (Nordmark, Hagglund, Lagergren, 2001).
Evidences indicated that 70-80 % of cerebral palsy is caused by the prenatal factors and that the birth asphyxia has a relatively minor role with the less than 10 % (Jacobsson & Hagberg, 2004).
Early diagnosis of CP symptoms followed with early intervention is crucial, as soon as possible.
With the rising incidence of CP in time, the distribution over the subtypes changed: fewer cases with diplegia and more with hemiplegic. The motor impairments of CP, in especially the spastic types, lead to other impairments of the musculoskeletal system; for example; among children and adolescents with quadriplegic CP, 75% have hip luxations, 73% contractures, and 72% scoliosis (Odding, Roebroeck & Stam, 2006).
About 40% of children with hemiplegic CP have normal cognitive abilities, while children and adolescents with tetraplegic CP are generally severely intellectually impaired (Odding, Roebroeck & Stam, 2006).
CP associated with epilepsy is far more frequently accompanied by intellectual disability than CP without epilepsy. Similarly, the combination of CP and intellectual disability is reported to be associated with a high risk of developing epilepsy (Carlsson, Hagberg & Olsson, 2003).
Many children with more severe spastic CP experience communication problems due to disturbed neuromuscular control of speech mechanism, i. e, dysarthria, that diminish the ability of the child to speak intelligible. However, substantial dysarthria are most often seen in children with severe CP and intellectual disability, while most children with mild or moderate CP and average cognitive level of functioning have normal or near-normal expressive language and articulation skills (Bottcher, 2010).
In the study of the influence of prenatal etiological factors on learning disabilities of children and adolescents with cerebral palsy in the Canton of Sarajevo, of all sample, 31 (38,75%) children with CP used nonverbal and sign communication, and 49 (61,25%) children used verbal communication (i.e. speech).
Depending of the study, the prevalence of visuomotor and perceptual problems among children with spastic CP varies from 39% to 100% (Stiers & Vanderkelen, 2002)
Professionals and parents need to be aware that children with cerebral palsy are at higher risk of psychological problems than their non-disabled peers and this may be attributable to problems in adjustment to their adverse circumstances as well as having an organic basis. Attention should be paid to the effective management of pain, particularly in children unable to self-report for whom a reliable instrument for assessing pain now exists. The difficulties most commonly reported here were peer problems; as these may have implications for later psychological adjustment, follow up work into adolescence and beyond will be important. It may be that for many children with cerebral palsy and their families, chronic psychological problems will have a greater impact than the physical impairments and this possibility also needs to be investigated in longitudinal studies (Parkes, White-Koning, Dickinson, Thyen, Arnaud, Beckung & all, 2008).
1.2. Occupational therapy for persons with cerebral palsy in the Canton of Sarajevo
The research was conducted through Project: „Occupational therapy for persons with cerebral palsy“, in homes of participants. The aim was to determine accessible housing for persons with cerebral palsy.
The client was Association of persons with cerebral palsy in the Canton of Sarajevo. The Association includes 315 members. Of that number, 123 (47,13%) are children and adolescents, age 4 up to 20 years, and 138 (52,87%) are adults.
Sample was consisted of 30 members of the Association of persons with cerebral palsy of the Canton of Sarajevo, age from 4 up to 53: 8 children (4-11 years), 14 adolescents (12-20 years), and 8 adults (21-53 years); 14 male (46,67 %) and 16 (53,33 %) female.
Nine participants had private houses, and 21 were living in flats.
The principal measure used was the Environmental Assessment – Home assessment form. The first part should deal with accessibility of the dwelling’s exterior, and the second half should be concerned with an assessment of the home’s interior. During the On-Site visit a tape measure and home assessment form are tools (Schmitz, 1988), translated and modified by the author (Švraka, 2007).
The part about accessibility of the dwelling’s exterior is made of 36 items: type of home, entrances to building or home, approach to apartment or living area (hallway, steps, door, and elevator). “Inside home” part consists of bedroom, bathroom, living room area, dining room, kitchen, laundry, cleaning, emergency and few other items.
The study was approved by parents of children with CP, or adults with CP, and president of the Association of persons with cerebral palsy in the Canton of Sarajevo. Before starting the data collection, the research aim and Environmental Assessment – Home assessment form were explained to parents and they agree to participate by signing consent.
Ideally, the physical and occupational therapists should accompany the patient on the home visit. They assume shared responsibility for assessing the patient’s functional level at home. Depending of the specific needs of the patient and/or family, a speech therapist, social worker, or nurse also may be included on the home visit (Shmitz, 1988).
Research was conducted during 3 months period trough home visits to clients. Basic inclusion criteria were:
Association members with severe motor disability,
Lower community engagement or majority of clients are not involved in some form of institution, continuous forms of education and/or re/habilitation.
Students of Department of physiotherapy, at Faculty of Health Studies in Sarajevo, who have completed their course of studies, apply the Environment assessment - Home assessment form in patient\'s home as part of practical education, in an environment that does not have the occupational therapy program. Supervision was performed by assistant professor of Faculty of Health Studies. Based on the initial assessment of the patient in the house/ On-site assessment, individual therapeutic programs/interventions were made in order to improve occupational performance.
Interventions which changed requirements of occupation was bringing large gymnastic ball in the home of all 30 patients.
Interventions that want to affect the environment, followed after the evaluation. In cooperation with the police and local community, students were working on improvement of accessibility: free parking places in front of the building, entrance ramps, accessible elevators.
Interventions that want to improve the ability of the person was the education in certain exercises for the improvement and preservation of posture, balance, coordination, increase the mobility and prevention of deformities deterioration, which influenced the personal competencies, i.e. skills related to motor performance, sensor abilities, cognitive ability and general health condition.
The Association of persons with cerebral palsy in the Canton of Sarajevo is member of Cerebral Palsy Association of Federation of Bosnia and Herzegovina which was established at 17. October of 2011. That day was announced as Day of persons with cerebral palsy of Federation of Bosnia and Herzegovina (FB&H). Cerebral Palsy Association members include five Associations of persons with cerebral palsy of FB&H, from five towns/Cantons: Sarajevo, Goražde, Zenica, Široki Brijeg and Sapna.
People with CP can lead active lives and make a valuable contribution to society. Art workshop of the Association of persons with cerebral palsy in the Canton of Sarajevo consists of 9 female members, 7 with CP and 2 with paraplegia. Middle age is 37,7 years; two youngest members are 27 years old, and oldest one is 58 year old. Five members use wheelchairs (3 with CP and 2 with paraplegia), one cane, and three of them are walking independently. It is necessary to reduce the numbers of sheltered workshops, and develop supported employment and self-employment, in other to reduce segregation of persons with disabilities and give support to social inclusion.
1.3. Assistive technology
Assistive technology (AT) is an umbrella term for a wide range of products. A commonly accepted definition is “any item, piece of equipment or product system whether acquired commercially off the shelf, modified or customized that is used to increase, maintain or improve functional capabilities of individuals with disabilities” (US Statute, 1988). Therefore in terms of devices or equipment it includes from walking sticks to environmental control systems (ECS), or simple dressing aids to communication aids (Cowan & Wintergold, 2007).
Assistive devices include ortho-prosthetic devices, wheel chairs, walking aids, technical aids and adapted controls for cars. Adequate assistive devices are often financially inaccessible to many users because of their high cost despite the fact that they should be covered by social and insurance schemes. Under the current system, most assistive devices are covered only partially by the state and require user co-payments, which can be exorbitant in cost. Within the socialist system, assistive devices were generally provided for free within the public health care system. This is a crucial issue in South East Europe as one of the largest barriers to accessing assistive devices is financial. Ortho-prosthetic devices are partially subsidized by the state and in most countries, co-payments have been set up but the financial burden is still heavy, especially for mid to low-income households. For example, in Bosnia and Herzegovina, co-payments can range from 10-50%, which can range from EUR 100-1,000 depending on the device. In the UN administered province of Kosovo there is an absence of a health care financing system so patients must pay the full price for their wheelchairs or other devices (Handicap International, 2004).
Mechanical assistive technology includes equipment such as manual wheelchair, postural management equipment, equipment for active exercise, protective devices, orthoses and aids for daily living. Provision of mechanical AT for children has its own unique challenges. Children are constantly changing as they grow and their abilities change and develop. Equipment therefore needs to be chosen with these aspects in mind. Adjustable equipment enables changes to be made according to a child’s needs. Adjustability within a device does tend to make equipment heavier, more complex and expensive but it will last longer and may be adjusted to fit the constantly changing needs of a child (Cowan & Wintergold, 2007).
The study of the influence of prenatal etiological factors on learning disabilities of children and adolescents with cerebral palsy in the Canton of Sarajevo was conducted with sample of 80 participants, children and adolescents with cerebral palsy in the Canton of Sarajevo, age from 6 up to 20 years; 25 children (age 6-11), and 75 adolescents (age 12-20). Mean age was 13,94 years, 47 male (58,75%) and 33 (41,25%) female. The sample was divided in two subgroups, first includes 30 participants whose mothers had problems during the pregnancy, and second includes 50 participants whose mothers didn’t have problems during the pregnancy.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWalking ability\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWalks without restrictions\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tHolding a hand\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWalker\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWheelchair\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic CP\n\t\t\t | \n\t\t\t | \n\t\t
\n\t\t\n\t\t\tSpastic Quadriplegic CP | \n\t\t\t2 | \n\t\t\t/ | \n\t\t\t1 | \n\t\t\t10 | \n\t\t\t13 | \n\t\t
\n\t\t\n\t\t\tSpastic Quadriplegic CP mixta | \n\t\t\t/ | \n\t\t\t/ | \n\t\t\t/ | \n\t\t\t3 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTriplegia | \n\t\t\t/ | \n\t\t\t/ | \n\t\t\t/ | \n\t\t\t1 | \n\t\t\t1 | \n\t\t
\n\t\t\n\t\t\tParaplegia | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t6 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t\t | \n\t\t
\n\t\t\n\t\t\tSpastic Hemiplegic CP (right) | \n\t\t\t5 | \n\t\t\t/ | \n\t\t\t/ | \n\t\t\t/ | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tSpastic Hemiplegic CP (left) | \n\t\t\t4 | \n\t\t\t/ | \n\t\t\t/ | \n\t\t\t/1 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t14 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t16 | \n\t\t\t33 | \n\t\t
\n\t
Table 1.
Structure of the sample of children with CP and epilepsy according to walking ability (Švraka, 2012)
Of 33 children with cerebral palsy and epilepsy, 14 (42,4%) were able to walk independently, 1 (3%) child needs to hold a mother’s or friend’s hand, 2 (6%) children walks with assistive device (walker), and 16 (48,5%) children were unable to walk, in need of wheelchair.
Of total sample of 80 participants, 34 (42,5%) were in need of wheelchair, and 46 (57,5%) were not.
Of total sample of 80 children, 42 (52,5%) were able to walk independently.
In the group of 30 participants, with illnesses during pregnancy, 13 (43,3%) were in need of wheelchair, and 17 (56,7%) were not. In the group of 50 participants, without illnesses during pregnancy, 21 (42%) were in need of wheelchair, and 29 (58%) were not.
Of 30 participants with illnesses during pregnancy, 17 (56,7%) were able to walk independently, and 13 (43,3%) were not. Of 50 participants without illnesses during pregnancy, 25 (50%), were able to walk independently, and 25 (50%) were not.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tMobility assistance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWheelchair\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWithout assistance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWalker, tripod, holding\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tSpastic Quadriplegic CP | \n\t\t\t7 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t9 (30%) | \n\t\t
\n\t\t\n\t\t\tSpastic Quadriplegic CP mixta | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 (16,7%) | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t4 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t5 (16,7%) | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t3 | \n\t\t\t3 | \n\t\t\t2 | \n\t\t\t8 (26,7%) | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tSpastic Hemiplegic CP | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t3 (10%) | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t20 (66,7%) | \n\t\t\t7 (23,3%) | \n\t\t\t3 (10%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Table 2.
Relation of cerebral palsy types and use of mobility assistance
Of 30 persons with cerebral palsy 20 (66.7%) use wheelchairs, 7 (23.3%) have independent mobility, without aid, and 3 (10%) persons walk with aid. Client with triparesis use a walking tripod.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tIntellectual abilities\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tMobility assistance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWheelchair\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWithout assistance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWalker, tripod, holding\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tNormal intellectual abilities | \n\t\t\t2 | \n\t\t\t6 | \n\t\t\t1 | \n\t\t\t9 (30%) | \n\t\t
\n\t\t\n\t\t\tBorderline intellectual abilities | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t1 (3,33%) | \n\t\t
\n\t\t\n\t\t\tMild intellectual disability | \n\t\t\t7 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t7 (23,3%) | \n\t\t
\n\t\t\n\t\t\tModerate intellectual disability | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t3 (10%) | \n\t\t
\n\t\t\n\t\t\tSevere intellectual disability | \n\t\t\t7 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t7 (23,3%) | \n\t\t
\n\t\t\n\t\t\tIQ not determined | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t3 (10%) | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t20 (66,7%) | \n\t\t\t7 (23,3%) | \n\t\t\t3 (10%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Table 3.
Relation of intellectual abilities and use of mobility assistance
Of 7 persons with independent mobility, 6 are with normal intellectual abilities, and 1 with moderate disability. All seven persons (23.3%) with severe intellectual disability use wheelchairs
The wheelchair and other wheeled seated mobility devices, such as scooters, have been and remain important technological devices in the field of rehabilitation. In North America, a substantial number of adults require wheeled seated mobility, with estimates indicating that over 179000 Canadians and over 1,5 million Americans utilize a wheelchair. With respect to the environment, wheeled seated mobility systems may increase the accessibility of the physical environment thereby increasing opportunities for interacting with the social environment (Reid, Laliberte-Rudman & Hebert, 2002).
2. Accessible home
Accessibility for all is a fundamental right, and any environmental barrier which denies access and free movement for persons with disabilities and other persons with reduced mobility is and must be recognized as discrimination (Howitt, 2003).
An accessible home is a pre-condition for independent living or self-determined living as it enables individuals to do what they need and desire to do as independently as possible within their living space. This definition is addressed to all people meeting difficulties in performing daily activities at home as a result of a disability. It means that not only people with physical disabilities, people who we automatically have in mind when talking about accessibility, but also people with sensory or intellectual disabilities or even elderly people who might have lost certain capacities and therefore meet obstacles in their homes - all need accessible housing. For some, this can be achieved with accessible features that are permanently fixed such as wide doors, grab bars, a tub seat in the bathroom or by using adaptable features adjustable in a short time without involving structural or material changes. For individuals with sensory disabilities, a blind person, for instance, requires tactile markings for changes in the floor level and Braille markings on appliances. Individuals with hearing impairments will need visual adaptations for things such as telephone ringers, the doorbell and smoke alarms. For wheelchair users, access may require ramps at the entrances, lower counters, no thresholds, wider toilets, a shower rather than a bathtub, and ensuring there is an accessible lift if the dwelling is above the ground floor (Consumer’s Guide to Accessible Housing, 2007).
Accessible living space is helping to enable an independent life and to provide way that people with disabilities live in the community. With personal assistant and accessible home, people with disabilities can live independently. Inadequate housing for people with disabilities has serious consequences. In the United Kingdom one study showed that there are over 4 million of people who have difficulties to move, but only 80000 are in accessible housing. Between 1980 and 1988 the number of homeless people with disabilities has increased by 92%, not including those who live in institutions or family homes (Sestranetz, Adams, 2006).
Children with CP may have limitations in all areas of human occupation to some degree. Functional performance in self-care and independent living, school and work performance, play and recreation may all need to be addressed at some point in the child’s life. Parents my require support and respite, as well as education, to care for child with CP to meet the needs of the family as a whole (Rogers, Gordon, Schanzenbacher, Case-Smith, 2001).
Another common problem people face in the region when adapting an inaccessible dwelling is that there are no services available to provide guidance and consultation on making the adaptations. In Calgary Canada, there is an Accessible Housing Society providing consultation services to people who wish to adapt their home. With this service, an occupational therapist and an architect visit individual homes to assess what needs to be adapted to suit the needs of the person and then draw up plans for modifications. They also provide information such as names of the relevant vendors and contractors, accessibility products and standards. There is no charge for the service if the client qualifies for income-tested government funding programs that include: Residential Access Modification Program, Residential Rehabilitation Assistance Program, Home Adaptations for Senior’s Independence under the Alberta government housing support programs. Under these programs, applicants who qualify receive a grant to make proper adaptations. The government housing support programs contain an accessible housing registry for people seeking barrier-free dwellings. This registry refers clients to available accessible housing while documenting housing needs for future planning and construction (Disability Monitor Initiative South East Europe, 2007).
2.1. Exterior accessibility
The entrance should be well lighted and provide adequate cover from adverse weather conditions. If a ramp is to be installed, there should be adequate space. The recommended grade for wheelchair ramps is 12 inches in ramp length for every inch of threshold height. Ramps should be a minimum of 48 inches (121,9 cm) wide with a nonslip surface. Handrails also should be included on the ramp, 32 inches (81,3 cm) in height and extend 12 inches (30,5 cm) beyond the top and bottom of the ramp (Schmitz, 1988).
Seven studies focused on aspects of the physical environment as it relates to accessibility issues and wheelchair accident. The most wheelchair accidents occur outdoors or on ramps. There remains a need for public buildings to implement barrier-free access changes for wheelchair users. Wheelchair users voiced concern about not being included in decisions regarding the design (Reid, Laliberte-Rudman & Hebert, 2002).
For wheelchair users, the entrance should have a platform large enough to allow the patient to rest and to prepare for entry. This platform area is particularly important when a ramp is in use. The door locks should be accessible to the patient. The door handle should be turned easily by the person. The door should be open and close in a direction that is functional for the person. A cane may be hung outside the door to help the wheelchair user close the door when leaving. The doorway width should be measured. Generally, 32 inches (81,3 cm) to 34 inches (86,3 cm) is an acceptable doorway to accommodate most wheelchairs. (Schmitz, 1988).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tPlace of living\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWidth of the entrance door (cm)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t62-75\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t76-82\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t83-92\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t93-102\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\t103-112\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tFlat | \n\t\t\t1 | \n\t\t\t8 | \n\t\t\t4 | \n\t\t\t- | \n\t\t\t1 | \n\t\t\t7 | \n\t\t\t21 (69,93%) | \n\t\t
\n\t\t\n\t\t\tPrivate house | \n\t\t\t2 | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t- | \n\t\t\t- | \n\t\t\t2 | \n\t\t\t9 (29,97%) | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t3 (9,99%) | \n\t\t\t13 (43,29%) | \n\t\t\t4 (13,32%) | \n\t\t\t0 | \n\t\t\t1 (3,33%) | \n\t\t\t9 (29,97%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Table 4.
Relations of the place of living and entrance door width
The range of width of the entrance door was from 62cm to 112 cm. Thirteen families (43,29%) had entrance door width between 76 cm to 82cm.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tPlace of living\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tElevator\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tYES\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNO\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tFlat | \n\t\t\t11 | \n\t\t\t10 | \n\t\t\t21 (69,93%) | \n\t\t
\n\t\t\n\t\t\tPrivate house | \n\t\t\t- | \n\t\t\t9 | \n\t\t\t9 (29,97%) | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t11 (36,63%) | \n\t\t\t19 (63,27%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Table 5.
Place of living and existing of elevator
Eleven families (36,63%) of persons with cerebral palsy, who live in flats have elevators. In private houses there are no elevators.
If there is raised threshold in the doorway, it should be removed. If removal is not possible, the threshold should be lowered to no greater than 0,5 inch (1,27 cm) in height, with beveled edges (Schmitz, 1988).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tThreshold\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tGender\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tFemale\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tMale\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tRaised threshold | \n\t\t\t14 | \n\t\t\t9 | \n\t\t\t23 (76,7%) | \n\t\t
\n\t\t\n\t\t\tWithout threshold | \n\t\t\t2 | \n\t\t\t5 | \n\t\t\t7 (23,3%) | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t16 (53,33%) | \n\t\t\t14 (46,67%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Twenty three families (76,7%) have raised entrance door thresholds made of different material: wood (16), concrete (3), metal (3), and one made of marble; 1 cm to 7 cm in height.
2.2. Interior accessibility
Inaccessible buildings and rooms crowded with furniture limit how children in wheelchairs move throughout the environment. Differences in the terrain or room surface also affect mobility. For example, a child who can run outdoors on an asphalt playground may trip and fall inside when walking on a rug. Other physical characteristics that the occupational therapist assesses relate to the type of furniture, objects, or assistive devices in the environment and whether they are usable and accessible. This includes the type of equipment, household items, clothing or toys. Sensory aspects of the physical environment often influence performance, e.g. the type of lighting, noise level, visual stimulation, and tactile or vestibular input of tasks (Shepherd, 2001).
Sufficient room should be made available for maneuvering or ambulating with an assistive device. Clear passage must be allowed from one room to the next. Unrestricted access should be provided to electrical outlets, telephones and wall switches. All floor coverings should be glued or tacked to the floor. This will prevent bunching or rippling under wheelchair use. Scatter rugs should be removed. Use of nonskid waxes should be encouraged. Raised thresholds should be removed to provide a flush, level surface. Doorways may need to be widened to allow clearance for a wheelchair or assistive device. Doors may have to be removed, reversed, or replaced with curtains or folding doors. All indoor stairwells should have handrails and should be well lighted. For patients with decreased visual acuity or age-related visual changes, contrasting textures on the surface of the top and bottom stair/s will alert them that the end of the stairwells is near. Circular band or tape also can be placed at the top and bottom of the handrail for the same purpose (Schmitz, 1988).
2.2.1. Bedroom
The bed should be stationary and positioned to provide ample space for transfers. Stability may be improved by placing the bed against the wall or in the corner of the room. The height of the sleeping surface must be considered to facilitate transfer activities. The mattress should be carefully assessed; it should provide a firm, comfortable surface. If the mattress is in relatively good condition, a bed board inserted between the mattress and box spring may suffice to improve the sleeping surface adequately. If the mattress is badly worn, a new one should be suggested. A bed side table or cabinet might be suggested; it will be useful to hold a lamp, a telephone, necessary medications, and a call bell if assistance is needed (Schmitz, 1988).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tParticipants\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tHeight of the bed (cm)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t | \n\t\t\t20 | \n\t\t\t21 | \n\t\t\t35 | \n\t\t\t36 | \n\t\t\t38 | \n\t\t\t40 | \n\t\t\t43 | \n\t\t\t44 | \n\t\t\t45 | \n\t\t\t46 | \n\t\t\t48 | \n\t\t\t50 | \n\t\t\t51 | \n\t\t\t55 | \n\t\t\t60 | \n\t\t\t | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tChildren *\n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tAdolescents\n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t2 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t | \n\t\t\t | \n\t\t\t3 | \n\t\t\t | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t14 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tAdults\n\t\t\t | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tTotal\n\t\t\t | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t7 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t3 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t4 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t30 | \n\t\t
\n\t
Table 7.
Height of the bed and age of the participants
Children (4-11 years); Adolescents (12-20 years); Adults (21-53 years)
Range of the height of the bed was 20 cm to 60 cm. The height of the bed of 7 participants was 40 cm.
The range of the height of the bed of children was 40 cm to 50 cm.
The range of the height of the bed of adolescents was 20 cm to 55 cm.
The range of the height of the bed of adults was 21 cm to 60 cm.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tParticipants\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWidth of the bed (cm)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t | \n\t\t\t55 | \n\t\t\t65 | \n\t\t\t68 | \n\t\t\t80 | \n\t\t\t90 | \n\t\t\t95 | \n\t\t\t100 | \n\t\t\t105 | \n\t\t\t110 | \n\t\t\t120 | \n\t\t\t125 | \n\t\t\t150 | \n\t\t\t162 | \n\t\t\t170 | \n\t\t\t220 | \n\t\t\t | \n\t\t
\n\t\t\n\t\t\tChildren | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\tAdolescents | \n\t\t\t | \n\t\t\t | \n\t\t\t1 | \n\t\t\t3 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t14 | \n\t\t
\n\t\t\n\t\t\tAdults | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t1 | \n\t\t\t | \n\t\t\t | \n\t\t\t2 | \n\t\t\t | \n\t\t\t | \n\t\t\t1 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t4 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t5 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t4 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t30 | \n\t\t
\n\t
Table 8.
Width of the bed and age of the participants
Range of the width of the bed was 55 cm to 220 cm. The width of the bed of 5 participants was 100 cm.
The range of the width of the bed of children was 55 cm to 162 cm.
The range of the width of the bed of adolescents was 68 cm to 170 cm.
The range of the width of the bed of adults was 90 cm to 220 cm.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tNight table\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tMobility assistance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWheelchair\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWithout assistance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWalker, tripod, holding\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tWithin patient’s reach from bed | \n\t\t\t6 | \n\t\t\t4 | \n\t\t\t0 | \n\t\t\t10 (33,3%) | \n\t\t
\n\t\t\n\t\t\tWithout patient’s reach | \n\t\t\t9 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t11 (36,7%) | \n\t\t
\n\t\t\n\t\t\tWithout night table | \n\t\t\t3 | \n\t\t\t2 | \n\t\t\t2 | \n\t\t\t7 (23.3%) | \n\t\t
\n\t\t\n\t\t\tWithout answer | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t2 (6,7%) | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t20 (66,7%) | \n\t\t\t7 (23,3%) | \n\t\t\t3 (10%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Table 9.
Relations of night table and mobility assistance
Of 30 persons with cerebral palsy, for 10 (33,3%) persons night table is within patient’s reach from bed, for 11 (36,7%) persons night table is not within patient’s reach from bed, 7 (23,3%) persons don’t have night table, and for two persons there are no answers.
Of 20 persons with wheelchair, for 6 persons night table is within patient’s reach from bed, and for 9 persons night table is not within patient’s reach from bed.
Of 7 persons with independent mobility, for 4 persons night table is within patient’s reach from bed, for 1 person night table is not within patient’s reach from bed, and 2 persons don’t have night table.
2.2.2. Bathroom
If door frame prohibits passage of a wheelchair, the patient may transfer at the door to a chair with casters attached. An elevated toilet seat will facilitate transfer activities (Schmitz, 1988).
Special equipment that gives support can help the child feel safe and secure. Bath hammocks fully hold the body and enable the parent to wash the child thoroughly. A simple, inexpensive way for giving security is to use a plastic laundry basket lined with foam at its bottom. Commercially, alight, inconspicuous bath support offers good design features. The front half of the padded support ring swings open for easy entry and then locks securely, holding the child at the chest to give trunk stability. Various kinds of bath seats and shower benches are available for the older child to aid bathtub seating transfers. For the child with severe motor limitations who is lying supine in the tub in shallow water, a horseshoe-shaped inflatable bath collar serves to support the neck and keep the child’s head above water level. A bath stretcher is constructed like a cot and fits inside the bathtub rim level or mid tub to minimize the caregiver’s bending while transferring and bathing the child (Rogers, Gordon, Schanzenbacher, Case-Smith, 2001).
Independent toileting is an important self-maintenance milestone with wild variation among individual children. Independence in toileting includes getting on and off the toilet, managing fastener, and clothing, cleansings after toileting, and washing and drying hands efficiently without supervision. With weakness and limited range of motion, the child may be unable to manage fastenings because of hand involvement or may have problems in sitting down or getting up from the toilet seat because of hip-knee contractions or quadriceps weakness. (Shepherd, 2001).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUse of toilet seat\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tUse of toilet pot\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tDiapers\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t6 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t3 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t19 (63,3%) | \n\t\t\t2 (6,7%) | \n\t\t\t9 (30%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Of total sample, 19 (63,3%) patients use toilet seats, 2 (6,7%) use toilet pot and nine (30%) need diapers.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWindow accessibility\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo window\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo bathroom\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tYES\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNO\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tBilateral spastic CP\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t1 | \n\t\t\t5 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t0 | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t3 | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t7 (23,3%) | \n\t\t\t16 (53,3%) | \n\t\t\t5 (16,7%) | \n\t\t\t1 (3,33%) | \n\t\t\t1 (3,33%) | \n\t\t\t | \n\t\t
\n\t
Table 11.
Window accessibility in the bathroom
Of 30 clients window in the bathroom is accessible for 7 (23,3%), and not accessible for 16 clients. One family has no bathroom and five families have no windows in the bathroom.
Grab bars (securely fastened to a reinforced wall) will assist in both toilet and tab transfers. Grab bars should be 1,5 inches (3,8 cm) in diameter and be knurled. For use in toilet transfers, the bars should be mounted horizontally 33 inches (83,8 cm) to 36 inches (91,4cm) from the floor. The length of the grab bars should be between 24 inches (61 cm) and 36 inches (91,4 cm) on the back wall and 42 inches (106,7 cm) on the side wall. For use in tab transfers they should be mounted horizontally 24 inches (61 cm) high measured from the floor of the tub (Schmitz, 1988).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tToilet seats grab bars\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tBathing tab grab bars\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tYES\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNO\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tYES\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNO\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tBilateral spastic CP\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t1 | \n\t\t\t8 | \n\t\t\t1 | \n\t\t\t8 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t0 | \n\t\t\t5 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t1 | \n\t\t\t4 | \n\t\t\t1 | \n\t\t\t4 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t1 | \n\t\t\t7 | \n\t\t\t1 | \n\t\t\t7 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t0 | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t3 (10%) | \n\t\t\t27 (90%) | \n\t\t\t6 (20%) | \n\t\t\t24 (80%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Table 12.
Toilet seats and bathing tab grab bars
Of whole sample of 30 persons, 3 (10 %) patients have toilet seats equipped with grab bars, and 27 (90%) patients do not have. Six (20%) patients have bathing tab equipped with grab bars, and 24 (80%) patients don\'t have.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tToilet seat height (cm)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t | \n\t\t\t39 | \n\t\t\t40 | \n\t\t\t41 | \n\t\t\t42 | \n\t\t\t43 | \n\t\t\t45 | \n\t\t\t | \n\t\t\t | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic cerebral palsy\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t1 | \n\t\t\t4 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t3 | \n\t\t\t2 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral cerebral palsy\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t7 (23,3%) | \n\t\t\t12 (40%) | \n\t\t\t4 (13,3%) | \n\t\t\t4 (13,3%) | \n\t\t\t1 (3,3%) | \n\t\t\t1 (3,3%) | \n\t\t\t1 (3,3%) | \n\t\t\t30 (100%) | \n\t\t
\n\t
Table 13.
Range of toilet seat height
Range of toilet seat height was 39 cm to 45 cm. Toilet seat height for twelve clients (40%) was 40 cm, for 7 (23,3%) was 39 cm, for 4 clients (13,3 %) was 41 cm, for other 4 was 42 cm, for one 43cm and for other one was 45 cm.
2.2.3. Kitchen
The height of counter tops (work space) should be appropriate for the wheelchair user; the armrests should be able to fit under the working surface. The ideal height of counter surfaces should be no greater than 31 inches (79 cm) from the floor with a knee clearance of 27,5 inches (69,8 cm) to 30 inches (76,2 cm). Counter space should provide a depth of at least 24 inches (61 cm). All surfaces should be smooth to facilitate sliding of heavy items from one area to another. Slide out counter spaces are useful in providing an over-the-lap working surface. For ambulatory patients, stools (preferably with back and foot rests) may be placed strategically at the main work area/s (Schmitz, 1988).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tFitting of wheelchair in the table\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tDoor clearance\n\t\t\t\t | \n\t\t\t\tNo answer \n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWithout table\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t | \n\t\t\tYES | \n\t\t\tNO | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tSpastic Quadriplegic CP | \n\t\t\t3 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t7 | \n\t\t
\n\t\t\n\t\t\tSpastic Quadripl CP mixta | \n\t\t\t4 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t0 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t4 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tSpastic Hemiplegic CP | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t10 | \n\t\t\t6 | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t20 | \n\t\t
\n\t
Table 14.
Accessibility of kitchen table for patients in wheelchairs
Out of 20 persons in wheelchairs, for 10 (50%) of them kitchen table is accessible. For 6 patients (20%) with wheelchairs, kitchen table is inaccessible: wheelchairs do not fit in the table. One patient in wheelchair does not have a kitchen table, he has a dining room table (40 cm)which is inaccessible. Range of kitchen table height was from 45 up to 120 cm, 16 different heights. Four (13.33%) of patients don’t have a kitchen table. Majority of patients, 5 (16.7%) have a kitchen table which is 75 cm height. Thirteen persons have a kitchen table which is from 70 to 77 cm in height.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCP\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tOpening refrigerator\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWithout refrigerator\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\ttotal\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t | \n\t\t\tYES | \n\t\t\tNO | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t4 | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t0 | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t3 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t5 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t14 | \n\t\t\t16 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t30 | \n\t\t
\n\t
Table 15.
Independent opening of the refrigerator and taking food
Refrigerator was accessible for 14 (46.7%) clients, which can independently open the door and take food. Refrigerator was inaccessible for 16 (53.3%) of clients. All clients have refrigerator.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCP\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tOpening refrigerator\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWithout freezer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\ttotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tYES\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNO\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tBilateral spastic CP\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t3 | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t0 | \n\t\t\t4 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t2 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t3 | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t10 | \n\t\t\t15 | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t30 | \n\t\t
\n\t
Table 16.
Independent opening of the freezer and taking food
Freezer was accessible for 10 (33.3%) clients, which can independently open it and take food. Freezer was inaccessible for 15 (50%) of clients. Two clients do not own a freezer, and three answers are omitted.
The sink may be equipped with large blade-tape handles, and a spray-hose fixture often provides improved function. Shallow sink 5 to 6 inches (12,7 cm to 15,2 cm) in depth will improve knee clearance below. As in the bathroom, hot-water pipes under the kitchen sink should be insulated to prevent burns (Schmitz, 1988).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tFitting of wheelchair under the sink\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tDoor clearance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWithout sink\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\ttotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tYES\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNO\n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tBilateral spastic CP\n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t0 | \n\t\t\t5 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t7 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t1 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t4 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t1 | \n\t\t\t2 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t3 | \n\t\t\t12 | \n\t\t\t1 | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t20 | \n\t\t
\n\t
Table 17.
Sink accessibility for patients in wheelchairs
Of 20 persons in wheelchairs, kitchen sink is accessible for 3 (15%) patients, or wheelchairs fit under the sink. For 12 patients (60%) in wheelchairs, sink is inaccessible. One patient does not have a kitchen dink and for two there is no answer on this question.
Tap on the kitchen sink can open and close 15 (50%) of clients. Kitchen sink tap is inaccessible for 12 (40%) of patients. One patient does not have a kitchen dink and for one there is no answer. Kitchen sink bottom is accessible for 16 (53.3%) of patients. Kitchen sink bottom is inaccessible for 11 (36.7 %) of patients.
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tOpening/closing shelves\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tInaccessible kitchen\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo shelves\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\tYES | \n\t\t\t\tNO | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t3 | \n\t\t\t6 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t2 | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t5 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t14 | \n\t\t\t15 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t30 | \n\t\t
\n\t
Table 18.
Shelves and cabinets accessibility in the kitchen for all patients
Shelves and cabinets in the kitchen are accessible (opening and closing) for 14 patients (46.7%), and inaccessible for 15 (50%) of patients. For one patient kitchen is not accessible because is too narrow.
Equipment and food storage areas should be selected with optimum energy conservation in mind. All frequently used articles should be within easy reach, and unnecessary items should be eliminated. Additional storage space may be achieved by installation of open shelving or use of peg boards for pots and pans. If shelving is added, adjustable shelves are preferable and should be placed 16 inches (41 cm) above counter top (Schmitz, 1988).
\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\tCerebral palsy\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTransport possibility\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tDoor clearance\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNo answer\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal\n\t\t\t\t | \n\t\t\t
\n\t\t\t\n\t\t\t\t | \n\t\t\t\tYES | \n\t\t\t\tNO | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t\t | \n\t\t\t
\n\t\t\n\t\t\n\t\t\t\n\t\t\t\tBilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tQuadriplegic CP | \n\t\t\t3 | \n\t\t\t6 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t9 | \n\t\t
\n\t\t\n\t\t\tQuadripl. CP mixta | \n\t\t\t2 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tTriparesis | \n\t\t\t1 | \n\t\t\t3 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t5 | \n\t\t
\n\t\t\n\t\t\tParaparesis | \n\t\t\t4 | \n\t\t\t3 | \n\t\t\t0 | \n\t\t\t1 | \n\t\t\t8 | \n\t\t
\n\t\t\n\t\t\t\n\t\t\t\tUnilateral spastic CP\n\t\t\t | \n\t\t
\n\t\t\n\t\t\tHemiplegic CP | \n\t\t\t2 | \n\t\t\t1 | \n\t\t\t0 | \n\t\t\t0 | \n\t\t\t3 | \n\t\t
\n\t\t\n\t\t\tTotal | \n\t\t\t12 | \n\t\t\t16 | \n\t\t\t1 | \n\t\t\t1 | \n\t\t\t30 | \n\t\t
\n\t
Table 19.
Possibility to transport necessities (food, dishes...) around kitchen
12 (40%) of patients can carry necessities from one end of the kitchen to another, and 16 (53.3%) cannot.
For 14 patients (46.7%) inaccessible are stove switches, which means they cannot use them, and for 10 (33.3%) are not. Four patients (13.3%) do not use the kitchen, and two patients (6.7%) did not give an answer.
Eleven patients (36.7%) can operate stove doors, 12 (40%) cannot, 4 (13.3%) does not use the kitchen, and 3 (10%) of patients did not answered
3. Conclusion
Based on the results of the evaluation with Environmental Assessment – Home assessment form, the study Occupation therapy for persons with cerebral palsy, in the Canton of Sarajevo, made proposals for changes in the environment to improve the accessibility of housing.
Educating persons with cerebral palsy and members of their families, with specific exercises to improve and preserve posture, balance, and coordination, increase the volume of mobility and prevent deformities deterioration, had an impact on the personal competencies, i.e. skills related to motor performance, sensor capabilities, cognitive ability and general health.
Private homes need to be converted according to the individual needs of tenants. As for the individual adaptation, arrangement of private space so that it is accessible, it requires precise planning according to the needs of people. Multidisciplinary team should lead that planning, and find such design solutions that overcome the problem of architectural barriers for people with disabilities to improve their quality of life.
Ideally, the physical and occupational therapists should accompany the patient on the home visit. They assume shared responsibility for assessing the patient’s functional level at home. Depending of the specific needs of the patient and/or family, a speech therapist, social worker, or nurse also may be included on the home visit.
It is necessary to open the Services or Counseling centers for accessible housing. As part of these services, occupational therapist and an architect should visit homes of persons with disabilities and assess what needs to be adapted to meet the needs of that person.
The significance of this research for the community is multiple: educational, scientific, humane and promotional.
The results provide a basis for further research in needs of these families and improvement of their quality of life.
4. Summary
Accessible design generally refers to houses or other dwellings that meet specific requirements for accessibility. The laws dictate standards dimensions and characteristics for such features as door widths, clear space for wheelchair mobility, audible and visual signals, grab bars switch and outlet height, and more.
The research was conducted through Project: „Occupational therapy for persons with cerebral palsy“, in homes of participants. The aim was to determine accessible housing for persons with cerebral palsy.
Sample was consisted of 30 respondents, members of the Association of persons with cerebral palsy of the Canton of Sarajevo, age from 4 up to 53: 8 children (4-11 years), 14 adolescents (12-20 years), and 8 adults (21-53 years); 14 male (46,67 %) and 16 (53,33 %) female.
The principal measure used was the International Environmental Assessment – Home assessment form. The first part should deal with accessibility of the dwelling’s exterior, and the second half should be concerned with an assessment of the home’s interior. During the On-Site visit a tape measure and home assessment form are tools (Schmitz, 1988), translated and modified by the author (Švraka, 2007).
The Association of persons with cerebral palsy in the Canton of Sarajevo is member of Cerebral Palsy Association of Federation of Bosnia and Herzegovina which was established at 17. October of 2011. That day was announced as Day of persons with cerebral palsy of Federation of Bosnia and Herzegovina (FB&H). Cerebral Palsy Association members include five Associations of persons with cerebral palsy of FB&H, from five towns/Cantons: Sarajevo, Goražde, Zenica, Široki Brijeg and Sapna.
Assistive devices include ortho-prosthetic devices, wheel chairs, walking aids, technical aids and adapted controls for cars. Adequate assistive devices are often financially inaccessible to many users because of their high cost despite the fact that they should be covered by social and insurance schemes. Under the current system, most assistive devices are covered only partially by the state and require user co-payments, which can be exorbitant in cost. Within the socialist system, assistive devices were generally provided for free within the public health care system. This is a crucial issue in South East Europe as one of the largest barriers to accessing assistive devices is financial.
Of 30 persons with cerebral palsy 20 (66.7%) use wheelchairs, 7 (23.3%) have independent mobility, and 3 (10%) persons require the use of particular device. Client with triparetic CP use a walking tripod.
The range of width of the entrance door was from 62cm to 112 cm. Thirteen families (43,29%) had entrance door width between 76 cm to 82cm.
Eleven families (36,63%) of persons with cerebral palsy, who live in flats have elevators. In private houses there are no elevators.
Twenty three families (76,7%) have raised entrance door thresholds made of different material: wood (16), concrete (3), metal (3), and one made of marble; 1 cm to 7 cm in height.
Of 30 persons with cerebral palsy, for 10 (33,3%) persons night table is within patient’s reach from bed, for 11 (36,7%) persons night table is not within patient’s reach from bed, 7 (23,3%) persons don’t have night table, and for two persons there are no answers.
Of total sample, 19 (63,3%) patients use toilet seats, 2 (6,7%) use toilet pot and nine (30%) need diapers.
Of 30 persons window in the bathroom is accessible for 7 (23,3%), and not accessible for 16 persons. One family has no bathroom and five families have no windows in the bathroom.
Of 30 persons, 3 (10 %) patients have toilet seats equipped with grab bars, and 27 (90%) patients do not have. Six (20%) patients have bathing tab equipped with grab bars, and 24 (80%) patients don\'t have.
Range of toilet seat height was 39 cm to 45 cm. Toilet seat height for 12 (40%) persons was 40 cm, for 7 (23,3%) was 39 cm, for 4 (13,3%) persons was 41 cm, for other 4 was 42 cm, for one 43 cm and for other one was 45 cm.
Three persons can enter the bathroom with wheelchairs. From whole sample, 3 (10 %) persons have toilet seats equipped with grab bars, and 27 (90 %) persons do not have.
Out of 20 persons in wheelchairs, for 10 (50%) of them kitchen table is accessible. For 6 patients (20%) with wheelchairs, kitchen table is inaccessible: wheelchairs do not fit in the table. One patient in wheelchair does not have a kitchen table, he has a dining room table (40 cm)which is inaccessible. Range of kitchen table height was from 45 up to 120 cm, 16 different heights. Four (13.33%) of patients don’t have a kitchen table. Majority of patients, 5 (16.7%) have a kitchen table which is 75 cm height. Thirteen persons have a kitchen table which is from 70 to 77 cm in height.
Refrigerator was accessible for 14 (46.7%) clients, which can independently open the door and take food. Refrigerator was inaccessible for 16 (53.3%) of clients. All clients have refrigerator.
Freezer was accessible for 10 (33.3%) clients, which can independently open it and take food. Freezer was inaccessible for 15 (50%) of clients. Two clients do not own a freezer, and three answers are omitted.
Of 20 persons in wheelchairs, kitchen sink is accessible for 3 (15%) patients, or wheelchairs fit under the sink. For 12 patients (60%) in wheelchairs, sink is inaccessible. One patient does not have a kitchen dink and for two there is no answer on this question.
Tap on the kitchen sink can open and close 15 (50%) of clients. Kitchen sink tap is inaccessible for 12 (40%) of patients. One patient does not have a kitchen dink and for one there is no answer. Kitchen sink bottom is accessible for 16 (53.3%) of patients. Kitchen sink bottom is inaccessible for 11 (36.7 %) of patients.
Shelves and cabinets in the kitchen are accessible (opening and closing) for 14 patients (46.7%), and inaccessible for 15 (50%) of patients. For one patient kitchen is not accessible because is too narrow.
12 (40%) of patients can carry necessities from one end of the kitchen to another, and 16 (53.3%) cannot.
For 14 patients (46.7%) inaccessible are stove switches, which means they cannot use them, and for 10 (33.3%) are not. Four patients (13.3%) do not use the kitchen, and two patients (6.7%) did not give an answer.
Eleven patients (36.7%) can operate stove doors, 12 (40%) cannot, 4 (13.3%) does not use the kitchen, and 3 (10%) of patients did not answered
Ideally, the physical and occupational therapists should accompany the patient on the home visit. They assume shared responsibility for assessing the patient’s functional level at home. Depending of the specific needs of the patient and/or family, a speech therapist, social worker, or nurse also may be included on the home visit.
It is necessary to open the Services or Counseling centers for accessible housing. As part of these services, occupational therapist and an architect should visit homes of persons with disabilities and assess what needs to be adapted to meet the needs of that person.
The results provide a basis for further research in needs of these families and improvement of their quality of life.
Acknowledgments
I thank the children and families, members of the Association of persons with cerebral palsy of the Canton of Sarajevo, Bosnia and Herzegovina, who participated in this Project.
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Introduction",level:"1"},{id:"sec_1_2",title:"1.1. Cerebral palsy",level:"2"},{id:"sec_2_2",title:"1.2. Occupational therapy for persons with cerebral palsy in the Canton of Sarajevo",level:"2"},{id:"sec_3_2",title:"1.3. Assistive technology",level:"2"},{id:"sec_5",title:"2. Accessible home",level:"1"},{id:"sec_5_2",title:"2.1. Exterior accessibility",level:"2"},{id:"sec_6_2",title:"2.2. Interior accessibility",level:"2"},{id:"sec_6_3",title:"Table 7.",level:"3"},{id:"sec_7_3",title:"Table 10.",level:"3"},{id:"sec_8_3",title:"Table 14.",level:"3"},{id:"sec_11",title:"3. Conclusion",level:"1"},{id:"sec_12",title:"4. Summary",level:"1"},{id:"sec_13",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'[Bottcher, L. (2010). Children with spastic cerebral palsy, their cognitive functioning, and social participation: a review. Child Neuropsychology, 16: 209-228.]'},{id:"B2",body:'[Carlsson, M.; Hagberg, G. and Olsson, I. (2003). Clinical aetiological aspects of epilepsy in children with cerebral palsy. Developmental Medicine & Child Neurology 2003, 45: 371-376]'},{id:"B3",body:'[“Consumer’s Guide to Accessible Housing” available at: http://www.abledata.com/abledata_docs/icg-hous.htm In: Disability Monitor Initiative South East Europe. (2007) Free movement of people with disabilities in South East Europe.]'},{id:"B4",body:'[Cowan, D. and Wintergold, A. (2007). Assistive technology. In: Physiotherapy for Children. pp 139-160 Butterworth Heinemann Elsevier ISBN-13; 978 0 750 68886 4]'},{id:"B5",body:'[Disability Monitor Initiative South East Europe (2007). Free movement of people with disabilities in South East Europe. An Inaccessible Right?]'},{id:"B6",body:'[Handicap International “Beyond De-Institutionalisation: The Unsteady Transition to an Enabling System in South East Europe”, Disability Monitor Initiative (Belgrade: Handicap International: 2004): 58 In: Disability Monitor Initiative South East Europe. (2007) Free movement of people with disabilities in South East Europe.]'},{id:"B7",body:'[Howitt, R. (2003). Member of European Parliament, President of the Disability Intergroup of the European Parliament. In: Disability Monitor Initiative South East Europe. (2007) Free movement of people with disabilities in South East Europe.]'},{id:"B8",body:'[Jacobsson, B. and Hagberg, G. (2004). Antenatal riscs factors for cerebral palsy. Best Pract Clinic Obstetric Gynaecol, 18 (3), 425-436]'},{id:"B9",body:'[Loga, S. (2011) Transition of Bosnian-Herzegovinian society and its impact on health protection. University of Sarajevo. International symposium. Proceedings: Bosnia and Herzegovina – 15 years of Dayton peace agreement. pp 225-241]'},{id:"B10",body:'[Nordmark, E.; Hagglund, G. & Lagergren, J. (2001). Cerebral Palsy in south Sweden. Prevalence and clinical features. Acta Pediatrica 90: 1271-1276]'},{id:"B11",body:'[Odding, E.; Roebroeck, M. E. & Stam, H. J. (2006). The epidemiology of cerebral palsy: Incidence, impairments and risk factors. Disability and Rehabilitation, 28(4): 183-191.]'},{id:"B12",body:'[Parkes, J.; White-Koning, M.; O Dickinson, H.; Thyen, U.; Arnaud, C.; Beckung, E. & all. (2008). Psychological problems in children with cerebral palsy: a cross-sectional European study. The Journal of Child Psychology and Psychiatry 49: 4, p. 405-413.]'},{id:"B13",body:'[Reid, D.; Laliberte-Rudman, D. & Hebert, D. (2002) Impact of wheeled seated mobility devices on adult users’ and their caregivers’ occupational performance: A critical literature review. Canadian Journal of Occupational Therapy. Volume 69, Number 5, pp 261-281 ISSN-0008-4174]'},{id:"B14",body:'[Rogers, S. L.; Gordon, C. Y.; Schanzenbacher, K. E.; Case-Smith, J. (2001) In: Case-Smith J. Occupational Therapy for Children, fourth edition. Mosby. An Affiliate of Elsevier Science. St Louis, London, Philadelphia, Sydney, Toronto. ISBN 0-323-00764-3]'},{id:"B15",body:'[Schmitz, T. J. (1988) Chapter 13: Environmental assessment. In: Physical rehabilitation: Assessment and treatment. Second edition. pp. 237- 251 ISBN 0-8036-6698-5]'},{id:"B16",body:'[Sestranetz, R. & Adams, L. (2006) In: Disability Monitor Initiative South East Europe. (2007) Free movement of people with disabilities in South East Europe.]'},{id:"B17",body:'[Shepherd, J. (2001) Self-Care and Adaptations for Independent Living. In: Case-Smith J. Occupational Therapy for Children, fourth edition. Mosby. An Affiliate of Elsevier Science. St Louis, London, Philadelphia, Sydney, Toronto. ISBN 0-323-00764-3]'},{id:"B18",body:'[Stiers, P. & Vanderkelen, R. (2002). Visual-perceptual impairment in a random sample of children with cerebral palsy. Developmental Medicine & Child Neurology, 44: 370-382.]'},{id:"B19",body:'[Švraka, E. (2007) Another side of life – Learning difficulties of children with cerebral palsy. Second enlarged edition. TDP d.o.o. Sarajevo ISBN 978-9958-9214-7-6]'},{id:"B20",body:'[Švraka, E.; Loga, S.; Brown I. (2011) Family quality of life: adult school children with intellectual disabilities. Journal of Intellectual Disability Research 55, pp 1115-1122.]'},{id:"B21",body:'[Švraka, E. (2012) Chapter: Children with cerebral palsy and epilepsy. In: Epilepsy- Histological, Electroencephalographic and Psychological Aspects. Edited by Dejan Stevanovic p. 251-276 INTECH Open Access Publisher of Scientific Books and Journals ISBN 978-953-51-0082-9 Printed in Croatia www.intechopen.com]'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Emira Švraka",address:null,affiliation:'- University of Sarajevo, Faculty of Health Studies in Sarajevo, Physiotherapy Department, Bosnia and Herzegovina
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Vervloed, Harry Knoors and Ludo Verhoeven",authors:[{id:"156051",title:"M.Sc.",name:"Gitta",middleName:null,surname:"De Vaan",fullName:"Gitta De Vaan",slug:"gitta-de-vaan"},{id:"157224",title:"Dr.",name:"Mathijs",middleName:null,surname:"Vervloed",fullName:"Mathijs Vervloed",slug:"mathijs-vervloed"},{id:"166523",title:"Prof.",name:"Harry",middleName:null,surname:"Knoors",fullName:"Harry Knoors",slug:"harry-knoors"},{id:"166524",title:"Prof.",name:"Ludo",middleName:null,surname:"Verhoeven",fullName:"Ludo Verhoeven",slug:"ludo-verhoeven"}]},{id:"43421",title:"Empowering Families in the Treatment of Autism",slug:"empowering-families-in-the-treatment-of-autism",signatures:"Jennifer Elder",authors:[{id:"156987",title:"Dr.",name:"Jennifer",middleName:null,surname:"Elder",fullName:"Jennifer Elder",slug:"jennifer-elder"}]},{id:"43419",title:"Collaboration Between Parents of Children with Autism Spectrum Disorders and Mental Health Professionals",slug:"collaboration-between-parents-of-children-with-autism-spectrum-disorders-and-mental-health-professio",signatures:"Efrosini Kalyva",authors:[{id:"158901",title:"Dr.",name:"Efrosini",middleName:null,surname:"Kalyva",fullName:"Efrosini Kalyva",slug:"efrosini-kalyva"}]},{id:"43417",title:"Early Intensive Behavioural Intervention in Autism Spectrum Disorders",slug:"early-intensive-behavioural-intervention-in-autism-spectrum-disorders",signatures:"Olive Healy and Sinéad Lydon",authors:[{id:"156296",title:"Dr.",name:"Olive",middleName:null,surname:"Healy",fullName:"Olive Healy",slug:"olive-healy"}]},{id:"43414",title:"Feeding Issues Associated with the Autism Spectrum Disorders",slug:"feeding-issues-associated-with-the-autism-spectrum-disorders",signatures:"Geneviève Nadon, Debbie Feldman and Erika Gisel",authors:[{id:"157283",title:"Dr.",name:"Erika",middleName:"G",surname:"Gisel",fullName:"Erika Gisel",slug:"erika-gisel"},{id:"157379",title:"M.Sc.",name:"Genevieve",middleName:null,surname:"Nadon",fullName:"Genevieve Nadon",slug:"genevieve-nadon"}]},{id:"42649",title:"Clinical Approach in Autism: Management and Treatment",slug:"clinical-approach-in-autism-management-and-treatment",signatures:"Rudimar Riesgo, Carmem Gottfried and Michele Becker",authors:[{id:"31995",title:"Prof.",name:"Carmem",middleName:null,surname:"Gottfried",fullName:"Carmem Gottfried",slug:"carmem-gottfried"},{id:"43615",title:"Prof.",name:"Rudimar",middleName:null,surname:"Riesgo",fullName:"Rudimar Riesgo",slug:"rudimar-riesgo"},{id:"160959",title:"Dr.",name:"Michele",middleName:null,surname:"Becker",fullName:"Michele Becker",slug:"michele-becker"}]},{id:"43411",title:"Building an Alternative Communication System for Literacy of Children with Autism (SCALA) with Context-Centered Design of Usage",slug:"building-an-alternative-communication-system-for-literacy-of-children-with-autism-scala-with-context",signatures:"Liliana Maria Passerino and Maria Rosangela Bez",authors:[{id:"30773",title:"Dr.",name:"Liliana",middleName:"Maria",surname:"Passerino",fullName:"Liliana Passerino",slug:"liliana-passerino"},{id:"158812",title:"MSc.",name:"Maria Rosangela",middleName:null,surname:"Bez",fullName:"Maria Rosangela Bez",slug:"maria-rosangela-bez"}]},{id:"43408",title:"Addressing Communication Difficulties of Parents of Children of the Autism Spectrum",slug:"addressing-communication-difficulties-of-parents-of-children-of-the-autism-spectrum",signatures:"Fernanda Dreux Miranda Fernandes, Cibelle Albuquerque de La Higuera Amato, Danielle Azarias Defense-Netvral, Juliana Izidro Balestro and Daniela Regina Molini-Avejonas",authors:[{id:"28286",title:"Dr.",name:"Fernanda Dreux Miranda",middleName:null,surname:"Fernandes",fullName:"Fernanda Dreux Miranda Fernandes",slug:"fernanda-dreux-miranda-fernandes"},{id:"38598",title:"Dr.",name:"Cibelle",middleName:null,surname:"Amato",fullName:"Cibelle Amato",slug:"cibelle-amato"},{id:"38599",title:"Prof.",name:"Daniela",middleName:null,surname:"Molini-Avejonas",fullName:"Daniela Molini-Avejonas",slug:"daniela-molini-avejonas"},{id:"158284",title:"MSc.",name:"Juliana",middleName:null,surname:"Balestro",fullName:"Juliana Balestro",slug:"juliana-balestro"},{id:"158286",title:"MSc.",name:"Danielle",middleName:null,surname:"Defense-Netvral",fullName:"Danielle Defense-Netvral",slug:"danielle-defense-netvral"}]},{id:"43407",title:"Early Intervention of Autism: A Case for Floor Time Approach",slug:"early-intervention-of-autism-a-case-for-floor-time-approach",signatures:"Rubina Lal and Rakhee Chhabria",authors:[{id:"28701",title:"Dr.",name:"Rubina",middleName:null,surname:"Lal",fullName:"Rubina Lal",slug:"rubina-lal"},{id:"158260",title:"Ms.",name:"Rakhee",middleName:null,surname:"Chhabria",fullName:"Rakhee Chhabria",slug:"rakhee-chhabria"}]},{id:"43405",title:"Early Communication Intervention for Children with Autism Spectrum Disorders",slug:"early-communication-intervention-for-children-with-autism-spectrum-disorders",signatures:"Gunilla Thunberg",authors:[{id:"31724",title:"Dr.",name:"Gunilla",middleName:null,surname:"Thunberg",fullName:"Gunilla Thunberg",slug:"gunilla-thunberg"}]},{id:"41296",title:"Atypical Sense of Self in Autism Spectrum Disorders: A Neuro- Cognitive Perspective",slug:"atypical-sense-of-self-in-autism-spectrum-disorders-a-neuro-cognitive-perspective",signatures:"Viktoria Lyons and Michael Fitzgerald",authors:[{id:"28359",title:"Prof.",name:"Michael",middleName:null,surname:"Fitzgerald",fullName:"Michael Fitzgerald",slug:"michael-fitzgerald"},{id:"165744",title:"Dr.",name:"Viktoria",middleName:null,surname:"Lyons",fullName:"Viktoria 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1. Introduction
\n
In the recent decades, empowerment has become an important theme in the social and behavioral sciences, and ideas about empowerment appear in the literature of a number of knowledge areas [1], adult education being a salient example [2, 3]. In social work, empowerment now has several meanings, referring both to the desired condition or state for which professional interventions aim and to the intervention methods to use in order to reach that state [4].
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The social work literature views the empowerment process, whether at the individual, group, or community level, as involving clients’ movement from feelings of helplessness to a sense of control over their behaviors and events in their lives [5, 6]. Gutierrez [7] has conceptualized empowerment as the acquisition of personal, interpersonal, or political power to improve the lives of marginalized people. The literature has explored in some detail approaches that can be used to help empower groups and communities (e.g., [8, 9, 10, 11]). However, there is less clarity on the intervention methods that can be used to promote empowerment at the level of the individual. Among other things, little is known about practitioners’ thinking about intervention techniques that may empower their individual clients. This is the case despite the fact that individual-level interventions are part and parcel of the work of social workers worldwide, whether in elder care, child welfare and protection, substance abuse, domestic violence, or many other areas of practice. A similar gap was recently noted in research on strength-based practice [12].
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Although the fundamental principles of the empowerment approach have been explored extensively in the theoretical and research literatures of social work, neither of these literatures is very specific as to which intervention approaches and techniques are the most appropriate to apply when working with individual clients [13]. Although social workers wishing to foster their clients’ empowerment [14, 15] have free rein in choosing and integrating a wide range of approaches in their practice, there has been little if any study to date of which approaches they prefer for the purpose. The main aim of the present study is thus to better understand how social workers perceive the empowering potential of techniques that can be part of their professional repertoire in their work at the individual level. Before stating the goals of the study, the remainder of this section reviews the literature on empowerment while focusing on techniques that can be used to foster empowerment at the individual level.
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1.1 Empowerment: definitions, processes, and potentials
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Empowerment refers both to the state where people feel that they can control their destiny and can take action to achieve their goals [16] and to the processes that enable them to attain that state. Most theoretical models of empowerment are based on the premise that all persons have the capacities to deal constructively with the challenges in their lives [2, 11, 16, 17], but that various external and/or internal factors may prevent these capacities from being fulfilled. Initially, the professional literature on empowerment focused on improving social policy and social services, especially for the socially disadvantaged [8, 18, 19]. Over time, the concept of empowerment took on additional meanings [16, 20, 21], especially attaining the desired existential condition for individuals, groups, or communities [4]. In addition, the term has been used to describe various intervention methods and processes (“empowering intervention”) that must be implemented to reach a desired end state. Some researchers see empowerment as a particular orientation which reflects both a concept and a process [22].
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The purpose of empowering interventions is to bring about and support a process by which a person or group moves from a state of helplessness or passivity to a sense of greater control over their lives and more ability to make decisions, to actively influence the course of their lives, and to attain their goals [17, 19, 23, 24, 25, 26, 27]. Through empowerment-based intervention, people can learn to change their emotions and manage situations so as to maintain a sense of control [16, 28] and develop interpersonal skills, such as the abilities to negotiate, to express their thoughts and feelings more clearly, and to better manage their anger [21, 28, 29].
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The empowerment process may include changes on the intrapersonal, interpersonal, or the community levels [6, 21, 24, 28]. On the intrapersonal level, empowerment involves acquiring knowledge, skills, and coping tools (e.g., independent action, negotiation, cooperation) needed for personal growth and action in one’s social arena [10, 21, 28]. On the individual level, it increases persons’ self-esteem [30, 31], decision-making ability, and sense of being able to act and achieve [16, 23], which in turn augment their confidence in their ability to manage their failures and to draw upon their inner strengths to carry out their tasks [32]. Other expected personal benefits of empowerment are increased motivation [16, 33] and augmented self-efficacy [34, 35]. At the interpersonal level, empowerment increases persons’ understanding of the need to build interactions with others [19, 33] and entails the development of various interpersonal and social skills [19, 28, 30, 36], including cooperation with others [7, 30, 37, 38] and ability to contribute to the work of groups, organizations, and other social entities [6].
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At the community level, empowerment means, among other things, increasing one’s awareness of existing differences in power, influence, and/or availability of resources in one’s own or the community’s environment, and developing understanding of the structural processes or systemic factors that create barriers that individuals or groups must contend with [6, 28, 39]. It also means increasing persons’ participation in policymaking processes, self-help and mutual support activities, and social and community activities, as well as belonging to activity groups at various levels [6, 40].
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1.2 Empowerment-related intervention techniques at the individual level
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The present study examines social workers’ perceptions of the potential of various intervention techniques to empower individuals. For this purpose, we first constructed a comprehensive list of such techniques, drawing upon O’Hare and colleagues’ [41, 42] classification of intervention techniques. Based on the analysis of the responses of veteran social workers and graduate students in social work, and using a preliminary database of 75 techniques representing a variety of intervention procedures and approaches, O’Hare and colleagues identified 26 techniques that were used more than others and grouped them into four types: case management, therapy, insight, and support. Based on this work, they compiled a questionnaire, the Practice Skills Inventory (PSI) [43]. In two follow-up studies [43, 44], they validated the conceptual framework they had developed and showed that experienced social workers do indeed use the various techniques cited in the PSI questionnaire.
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For the present study, we created an empirical tool to examine the use of the four categories of techniques described by O’Hare and Collins [43] and O’Hare et al. [44], as follows:
\nCase management techniques are used in the provision of social services [45]. Since applicants (i.e., clients, service recipients) usually need help in daily life tasks, the techniques include activities and services such as needs assessment, organizing service delivery, counseling, advocacy, help in procuring social assistance payments or with employment, housing, transportation, medical care, and so on [45]. Case management techniques are based, in part, on the assumption that social workers should mediate between applicants and the people and resources in the community and that they should help to engage other services or assistance that applicants may be unable or unmotivated to access [45, 46]. Since case management techniques may be applied mostly without the applicant’s involvement [45], they may appear to have little empowerment potential [47]. However, inasmuch as they help applicants take an active part in defining their needs, implementing various activities, and attaining their goals, social workers may regard some of them as having some potential to foster clients’ empowerment [48, 49].
\nTherapeutic techniques help applicants better understand their personal relationships and analyze how environmental factors affect their problems [43]. Such understanding may encourage persons to take measures to reduce the risks they face and to enlist others in helping them deal with the social and political obstacles they encounter [50]. The techniques include focusing on their clients’ strengths, supporting the development of the skills and qualifications they need, and cultivating a sense of self-worth and enthusiasm to make decisions more effectively [51, 52]. In the view of social workers, these techniques may give applicants the tools to cope with the stresses they face and to minimize dysfunctional ways of thinking that only add to their problems [53].
\nSupport techniques can be used by social workers to help their clients feel comfortable, to forge a relationship with them based on trust and empathy, and to facilitate the implementation of the therapeutic plan [54]. They are necessary for the empowerment process in that they provide emotional and social support to clients in the difficult process of change [5, 6, 19]. Among other things, they may foster a comfortable working environment [55] and increase clients’ self-confidence, motivation to work on their problems in therapy [54, 56], and readiness to open up to and confide in the social worker [43].
\nInsight techniques enable clients to carry out methodical self-examination so as to better understand themselves in their social and cultural contexts [57]. In the course of fostering insight, social workers help their clients to discover and reveal their feelings; to understand the past difficulties, experiences, and relationships that contributed to their present condition [54, 58]; and to learn from the past [59]. Developing insight in these and other matters involves strengthening clients’ critical awareness [9, 60], which allows them to assess their ability to change their situations, solve problems, and achieve their goals [43]. Studies show that developing insight is essential to the empowerment process [60, 61].
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1.3 Research goals
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The present study focuses on the four above discussed intervention approaches, case management, therapy, support, and insight, which together encompass the key methods available for helping individual clients. The work is a pilot study with three goals. First, we examine social workers’ perceptions of the empowerment potential of methods from all four types reviewed above, using a new research instrument described below. Second, we seek to explore how practitioners’ perceptions of the empowerment potential of different techniques are related to or affected by their level of exposure to the issue of empowerment in the course of their professional training or later on at work.
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Third, we seek preliminary evidence regarding the suitability of the research instrument for examining the perceptions of social workers from different cultures. This is because it is well documented that social workers’ cultural backgrounds affect their perceptions of the causes, nature, and solutions of problems [62, 63, 64, 65] as well as the techniques and strategies they use [66, 67]. Hence, the study was conducted on social workers from two different countries and cultures: Israel and the USA. Our intent is not to compare the perceptions of practitioners sampled from these two cultures, since we use convenience samples at this preliminary stage. Instead, we aim to examine patterns of results in order to inform hypothesis-building and methodologies for future studies in this unexplored area.
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2. Methods
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2.1 Participants and procedure
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The study sample consisted of 260 social workers from two countries: Israel (57% of the sample) and the USA (43% of the sample). Participants in Israel were selected from 27 Jewish and Arab communities, to provide a cross section of social workers in various positions at a range of Israeli welfare agencies and organizations. All the sampled social workers were engaged mainly in providing direct therapy to individuals or families. The sampling process combined stratified sampling and cluster sampling. Welfare offices were divided into two ethnic groups (based on whether the office in question was situated in a Jewish or Arab community), with a sample of offices within each stratum, to ensure representation of communities of different characteristics. Using directories published by the Israeli Ministry of Labor and Social Affairs, we contacted the director of each office to obtain approval of the data collection and to set up visiting dates. Explanations were provided about the study and the questionnaire to be put to the participants; respondents’ anonymity was assured. Most of the questionnaires were completed on site during the visit, but some were sent back by standard mail. In the Israeli sample, 220 questionnaires were handed out and 148 (67%) returned, with precisely half the respondents (74) being Jews and the other half (74) Arab.
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The second group consisted of a convenience sample of 112 social workers in the USA—comprising 43% of the study sample. Data were collected in three ways, to provide a varied sample of social workers of different backgrounds working in diverse contexts: (a) questionnaires were sent to 299 randomly selected members of the National Association of Social Workers (NASW) [68], 41 of whom responded; (b) questionnaires were sent to 199 social workers listed in the Yellow Pages and other online databases, 46 of whom responded; and (c) questionnaires were sent to 300 Boston University graduate students who were employed as social workers, 25 of whom responded. Each questionnaire was accompanied by a cover letter about the questionnaire and the anonymity of participants and a prepaid envelope for returning it by mail.
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Characteristics of the study participants in both samples are presented in Table 1. As can be seen, the percentages of men and women and the percentages of full-time and part-time workers were similar in the two groups. A larger percentage of the American respondents held master’s degrees, and they handled a smaller number of cases than their Israeli counterparts. In addition, the American respondents were older (mean age 48.28, SD 13.15) than the Israeli respondents (mean age 35.95, SD 9.76).
\n
\n\n\n\n\n\nVariable | \nUSA (%) | \nIsrael (%) | \n
\n\n\n\n\nGender\n | \n | \n | \n
\n\nMen | \n21.4 | \n15.5 | \n
\n\nWomen | \n78.6 | \n84.5 | \n
\n\n\nEducation\n | \n | \n | \n
\n\nBachelor’s degree | \n24.1 | \n76.0 | \n
\n\nMaster’s degree and above | \n75.9 | \n24.0 | \n
\n\n\nJob type\n | \n | \n | \n
\n\nFull-time | \n39.3 | \n50.7 | \n
\n\nPart-time | \n60.7 | \n49.3 | \n
\n\n\nNumber of applicants under social worker’s care\n | \n | \n | \n
\n\n1–40 applicants | \n64.3 | \n37.2 | \n
\n\n40+ applicants | \n25.9 | \n55.9 | \n
\n\nUnknown | \n9.8 | \n6.9 | \n
\n\n
Table 1.
Characteristics of participants in the two study groups, in percentage (N = 260).
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2.2 Instruments
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Participants answered a two-part questionnaire. The first part consisted of 26 Likert-type items that gauged the participants’ perceptions of the empowerment potential of intervention techniques of the four types discussed earlier. For US sample, the items were taken from the Practice Skills Inventory questionnaire developed by O’Hare et al. [42]; for the Israeli sample, names of the different techniques were translated and adapted for the Israeli context [69]. A description of the questionnaire items is provided in Table 2, grouped by intervention type. The subjects were asked to rate the empowerment potential of the technique described in each item on a Likert scale from 1 (low) to 5 (high). Table 3 presents the Cronbach’s alphas of the ratings of the techniques of each type. These show reliability scores within the acceptable range and not less than 0.70.
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\n\n\n\n\n\n\nIntervention techniques | \nUS Mean (SD) | \nIsrael Mean (SD) | \nT | \n
\n\n\n\n\nCase management\n | \n
\n\nAssessing clients’ their level of material resources (i.e., food, clothing, shelter) | \n2.94 (1.19) | \n3.08 (0.89) | \n−1.02 | \n
\n\nAdvocating on behalf of clients | \n3.16 (1.05) | \n3.15 (1.05) | \n0.08 | \n
\n\nAnalyzing social problems and policies relevant to the client’s problem | \n3.59 (1.01) | \n2.85 (1.16) | \n5.39**\n | \n
\n\nMonitoring the delivery of services provided by other practitioners | \n2.40 (0.98) | \n3.14 (1.16) | \n−5.39**\n | \n
\n\nProviding information about other services available to clients | \n3.02 (0.95) | \n3.76 (1.03) | \n−5.88**\n | \n
\n\nMaking referrals to other services | \n2.84 (1.06) | \n2.26 (1.11) | \n−3.04**\n | \n
\n\nNetworking with agencies to coordinate services | \n2.85 (1.12) | \n3.27 (1.06) | \n−3.02**\n | \n
\n\n\nTherapy\n | \n
\n\nHelping clients analyze how environmental factors affect their problems | \n4.23 (0.90) | \n3.80 (0.90) | \n3.80**\n | \n
\n\nEncouraging clients to take action on their problems | \n3.41 (1.12) | \n4.49 (0.68) | \n−8.98**\n | \n
\n\nCreating self-anchored scales with clients to monitor their progress | \n3.80 (0.96) | \n4.16 (0.72) | \n−5.15**\n | \n
\n\nHelping clients reduce dysfunctional ways of thinking that contribute to their problems | \n4.01 (0.91) | \n3.88 (0.88) | \n−1.00 | \n
\n\nHelping clients practice their new problem-solving skills outside of treatment visits | \n4.25 (0.84) | \n4.16 (0.77) | \n−1.82 | \n
\n\nTeaching clients specific skills to deal with certain problems | \n3.86 (0.92) | \n4.07 (0.81) | \n−3.28**\n | \n
\n\nEducating clients about how to prevent certain problems from re-occurring | \n3.75 (0.90) | \n4.20 (0.74) | \n1.18 | \n
\n\nTeaching clients skills to relieve their stress | \n4.13 (0.88) | \n3.91 (0.85) | \n0.95 | \n
\n\nHelping clients better understand their current personal relationships | \n4.00 (0.68) | \n4.28 (0.70) | \n−1.92 | \n
\n\nCoaching clients in how to make decisions more effectively | \n4.00 (0.93) | \n4.25 (0.71) | \n−4.32**\n | \n
\n\nTeaching clients how to monitor their own behaviors | \n4.05 (0.88) | \n4.54 (0.61) | \n2.03 | \n
\n\n\nSupport\n | \n
\n\nReflecting clients’ thoughts and feeling to help them feel understood | \n3.83 (0.94) | \n4.25 (0.79) | \n−2.89**\n | \n
\n\nProviding emotional support for clients | \n3.61 (1.03) | \n3.43 (0.98) | \n−2.42*\n | \n
\n\nPointing out clients’ successes in order to increase their self-confidence | \n3.56 (1.09) | \n3.56 (0.91) | \n−4.97**\n | \n
\n\nHelping clients to feel motivated to work on their problems in treatment | \n3.83 (0.94) | \n4.25 (0.79) | \n−3.81**\n | \n
\n\nHelping clients feel like they want to open up to you | \n3.61 (1.03) | \n3.43 (0.98) | \n1.47 | \n
\n\n\nInsight\n | \n
\n\nExploring with clients how past relationships contribute to the understanding of their current problems | \n3.56 (1.09) | \n3.56 (0.91) | \n0.01 | \n
\n\nGentle probing to help clients uncover troubling feelings | \n4.05 (0.86) | \n3.69 (0.99) | \n3.10**\n | \n
\n\nHelping clients learn from past experiences | \n3.75 (1.02) | \n3.91 (0.85) | \n−1.33 | \n
\n\n
Table 2.
Location and dispersion values of intervention techniques among subjects in Israel (N = 148) and the USA (N = 112).
\n*p<.05, **p<.001, ***p<.0001
\n
\n\n\n\n\n\n\n\nType | \nMean | \nSD | \nNumber of techniques of this type | \nCronbach α | \n
\n\n\n\nCase management | \n3.11 | \n0.76 | \n7 | \n0.82 | \n
\n\nInsight | \n3.82 | \n0.73 | \n3 | \n0.70 | \n
\n\nTherapy | \n3.97 | \n0.54 | \n11 | \n0.82 | \n
\n\nSupport | \n4.04 | \n0.59 | \n5 | \n0.72 | \n
\n\n
Table 3.
Location and dispersion values in ratings of intervention techniques, by type.
\n
The second part of the questionnaire comprised items that ranked the respondent’s level of exposure to the issue of empowerment on a Likert scale (from 1 = low, to 5 = high) in three contexts: during their academic studies, through written materials at the workplace, and through information provided at a lecture, continued professional training, or instruction at the workplace. In addition, this part included questions about personal and professional background variables, including gender, age, education, number of applicants under their care, years of experience, and others. So as not to inadvertently lead the participants to social desirability responses, the questionnaire did not explicitly use the term empowerment in its title or define the concept.
\n
\n
\n\n
3. Findings
\n
\nTable 2 shows the participants’ mean ratings of the empowerment potential of the 26 intervention techniques. As can be seen, on a scale of 1–5, the mean range from 2.26 (for item 6, “Making referrals to other services” in the Israeli sample) to 4.54 (item 18, “Teaching clients how to monitor their own behaviors,” in the Israeli sample), suggesting that there is substantial variability in the Israeli subjects perceptions of the empowering potential of different techniques, both within each sample and across the two samples. Table 2 also shows that the empowerment potential of half the items (13 of 26) was rated higher by the Israeli respondents than by their US counterparts. In most cases, the difference, although not large in absolute terms, is statistically significant. The biggest difference was in the rating of item 9 (“Encouraging clients to take action on their problems.”), which the Israeli participants rated as being of very high empowerment potential (4.49), but the US group rated only as moderate (3.41).
\n
There were also notable differences in standard deviations between the two groups. These are of interest as they reflect the in-group variability in the respondents’ views of the empowerment potential of each technique. For example, on the item with the largest inter-group mean difference (item 9), the ratings of Israeli group showed a great deal of consensus (SD = 0.68), while those of the US group showed a much larger dispersion (SD = 1.12). Although the differences were obtained only in convenience samples, which raises questions about their representativeness, these findings suggest that cultural differences may affect perceptions of the empowerment potential of intervention techniques.
\n
Next, to gain a more comprehensive picture of the subjects’ perceptions of the empowerment potential of the various techniques, we calculated each respondent’s mean rating on the items in each of the four types of interventions (as featured in the leftmost column of Table 2). Descriptive statistics for these grouped findings are presented in Table 3, and the three key patterns in these findings are discussed below.
\n
First, as the grand means in Table 3 show, the interventions with the highest overall mean ratings are those of the therapy and support types, followed closely by those of the insight type. Interventions of the case management type are perceived as having comparatively low empowerment potential. Repeated measures analyses of variance showed that the differences were significant: F (3,777) = 203.099 (p < 0.0001). A Bonferroni adjusted paired comparisons test showed a significant difference (with confidence level of 95%) between the mean ratings of case management techniques and those of the other three types. The ratings of insight, therapy, and support techniques were significantly higher than the rating of case management techniques and did not differ significantly from one another.
\n
Second, Table 3 also shows that although the mean rating of case management techniques is significantly lower than the ratings of the other three types, it is not low in absolute terms. Rated at well over 3 on a scale of 1–5, these techniques too are perceived as having substantial empowerment potential.
\n
Third, as can be seen in both Tables 2 and 3, there is noticeable variation in perceptions of the empowerment potentials of different techniques: Table 2 shows relatively large standard deviations and hence less consensus among respondents in the ratings of the empowerment potentials of insight and case management techniques compared to the potentials of therapy and support techniques. In general, there is considerable variation in the perceived empowerment potential of different techniques of all types: the ratings of more than half the techniques (16 of 26) range across the entire spectrum of the 1–5 scale, while the ratings of the 10 other techniques range between 2 and 5.
\n
A separate analysis was conducted on respondents’ self-reported exposure to information about empowerment and its association with empowerment potential ratings. The data are based on three questions, each asking the respondents to rate their level of exposure to empowerment issues in one of three contexts: academic studies (i.e., as part of the basic studies in social work), written materials at work (i.e., reading professional papers or practice-related manuals), and oral training at work (i.e., participation in workshops, lectures, etc.).
\n
\nTable 4 presents the distribution of exposure ratings in these three contexts, separately for the Israel and US samples. As can be seen, mean ratings, on a 0–4 scale, show a consistent pattern across both samples. Overall, mean ratings are not high and in some contexts even low. Respondents report more exposure to empowerment issues as part of basic academic training and lower levels of exposure at work, especially in the context of oral training, with the Israel sample ratings being somewhat higher. It is important to highlight that a sizeable proportion of both samples reports “very little” and even “no” level of exposure to empowerment in all contexts, with 24–46% in these two lowest categories in the Israeli sample and 18–70% in the US sample. (Note: We intentionally do not test for the significance of the differences between the samples in this regard, both because the sampling processes were not fully comparable and because our purpose is not to compare the samples but to gain an overall evaluation of patterns).
\n
\n\n\n\n\n\n\n\n\n\n\nContext | \nMean | \nSD | \nExtent of exposure to empowerment | \n
\n\n | \n | \n | \n0 No | \n1 Very little/superficial | \n2 Some | \n3 Intermediate level | \n4 A lot | \n
\n\n\n\n\nIsraeli sample (N = 148) | \n
\n\nAcademic studies | \n2.46 | \n1.29 | \n10.9 | \n12.9 | \n21.1 | \n29.9 | \n25.2 | \n
\n\nWritten materials at work | \n2.13 | \n1.25 | \n16.9 | \n10.1 | \n27.0 | \n35.1 | \n10.8 | \n
\n\nTraining at work | \n1.64 | \n1.34 | \n29.7 | \n15.5 | \n24.3 | \n21.6 | \n8.8 | \n
\n\n\nUS sample (N = 112) | \n
\n\nAcademic studies | \n2.66 | \n1.37 | \n12.5 | \n5.4 | \n25.0 | \n17.9 | \n39.3 | \n
\n\nWritten materials at work | \n1.17 | \n1.33 | \n46.4 | \n15.2 | \n22.3 | \n7.1 | \n8.9 | \n
\n\nTraining at work | \n0.97 | \n1.48 | \n56.3 | \n13.4 | \n18.8 | \n5.4 | \n5.4 | \n
\n\n
Table 4.
Level of exposure to information about empowerment, in three contexts, by country.
\n
Finally, Table 5 shows the associations between respondents’ exposure to information about empowerment and their ratings of the empowerment potential of different techniques. For this analysis, and to simplify the presentation of results, we grouped respondents into two groups based on their level of exposure to empowerment, with one group containing those reporting no to little exposure (range 0–2) and the other group containing those with higher levels of exposure. Bonferroni parity comparisons show that regardless of the degree of exposure (lower or higher) or means of exposure (in writing or orally), the pattern of findings presented in Table 3 was repeated. That is, case management-type interventions continued to be viewed as having lower empowerment potential, while the potentials of the other three types of techniques were rated as significantly higher. Table 5 highlights that even respondents with relatively little or no exposure to empowerment issues, who constitute a sizable portion of the combined sample, on average rated most of the techniques as having a moderate or high empowering potential, and their ratings do not differ significantly from those of respondents with higher levels of exposure to empowerment.
\n
\n\n\n\n\n\n\n\n\nLevel of exposure | \nType of intervention | \nContext of exposure | \n
\n\nWritten | \nTraining | \n
\n\nMean | \nSD | \nMean | \nSD | \n
\n\n\n\nLow (0–2) | \nCase management | \n2.86 | \n0.82 | \n3.00 | \n0.82 | \n
\n\n | \nInsight | \n3.87 | \n0.83 | \n3.86 | \n0.75 | \n
\n\n | \nTherapy | \n3.84 | \n0.65 | \n3.93 | \n0.53 | \n
\n\n | \nSupport | \n3.96 | \n0.71 | \n4.00 | \n0.60 | \n
\n\nHigh (3–4) | \nCase management | \n3.22 | \n0.71 | \n3.19 | \n0.72 | \n
\n\n | \nInsight | \n3.79 | \n0.69 | \n3.79 | \n0.72 | \n
\n\n | \nTherapy | \n4.02 | \n0.47 | \n4.01 | \n0.54 | \n
\n\n | \nSupport | \n4.08 | \n0.53 | \n4.08 | \n0.58 | \n
\n\n
Table 5.
Mean ratings of empowering potentials of intervention techniques, by grouped level of exposure to information about empowerment and context of exposure (combined sample, N = 260).
\n
\n\n
4. Discussion
\n
Even though the construct of empowerment occupies an important place in both social work practice and literature and with regard to both group-level and individual level practice, social workers’ views of the empowering potential of different intervention techniques have not been studied empirically or systematically. The current study is a first attempt to shed light on this topic, with a focus on techniques that are suitable for individual-level social work interventions, as classified by O’Hare and Collins [43] and O’Hare et al. [44] into four broad types: case management, support, therapy, and insight. In order to collect preliminary evidence regarding the suitability of the research instrument for examining the perceptions of social workers from different cultures, we surveyed social workers both in Israeli (Jewish and Arab) and the USA. Given the exploratory nature of the study, the intention was not to statistically compare these two sample (which were gathered in different ways) but rather to look for overall patterns that may inform further research and theorizing.
\n
The study yielded several surprising and important findings. First, the social workers rated all four types of intervention techniques as having quite high potential to foster empowerment at the individual-level. This finding raises questions about the validity of our assumptions. Given the importance ascribed to self-awareness and insight in the professional literature [54, 57, 58], our theory-based assumption was that social workers would regard intervention techniques in the areas of therapy and insight as having much higher potential to foster individual empowerment than case management and support techniques. Yet, the findings show that even though case management techniques were seen as having somewhat lower potential than therapy and insight techniques, their potentials, too, were rated as relatively high. Further, the pattern of findings was the same in the Israeli and US samples, suggesting that the findings are not limited to one culture but reflect a broad perception among social workers from diverse backgrounds.
\n
Second, the degree of exposure to the information about empowerment-related techniques seemed to have little effect on the perceptions of the empowering potential of the various techniques. Practitioners who reported having received little or no exposure to empowerment had almost the same views as practitioners who reported having received information about the subject, whether in their basic training and on the job. A similar pattern was noted by Douglas et al. [12], who reported that having a social work degree was not associated with strength-based practice, which is closely related to empowerment.
\n
Third, the findings highlight substantial variability in social workers’ perceptions of the empowering potential of the same techniques, even where the workers came from the same national culture. Such variability is also evident in the rather high standard deviations, which reflect an underlying dispersion of ratings of empowering potential. These three findings imply that perceptions of what is meant by empowerment and by “empowering” interventions may not be universal or even agreed upon. The lack of agreement may stem from a range of other differences, including in social work education and training, in the work environment, in agency-level or managerial messages, and/or in cultural factors, to name just a few. Further study is required to identify the sources or reasons for the lack of agreement observed in this study.
\n
Taken together, the three key findings presented above highlight the need to further understand and critically evaluate how notions of empowerment are conveyed in the course of social work training, both during the initial education and training and later on as part of various professional development activities. Of concern is the wide diversity both in the levels of exposure to information about empowerment in these contexts and in the actual perceptions of the potentials of different interventions or methods to foster empowerment at the individual level. The diversities imply that although social workers may use the same professional terminology related to empowerment, they may ascribe different meanings to the words.
\n
\n\n
5. Conclusions and future directions
\n
The above discussion has implications for social work education, practice, and research. In terms of education, they suggest a need for further investment in training. In terms of practice, they suggest the need for greater consensus among social workers on the link between their practice and system-wide goals related to clients’ empowerment [70]. In terms of research, they point to the need for further study of on two related issues: the perceptions of social workers in individual level practice regarding fostering their clients’ empowerment and the factors that may explain or are correlated with their diversity of views.
\n
The present study is an exploratory investigation which used new research tools based on brief descriptions of 26 intervention techniques in four areas: case management, support, therapy, and insight. The findings suggest that these techniques, each in its own way, have the potential to help clients to reduce their dysfunctional ways of thinking, to employ their new problem-solving skills outside the treatment context, and to make use of their strengths and prior achievements and understand their personal relationships, to prevent certain problems from recurring and to monitor current behaviors and set goals for the future. However, clearly the range of possible techniques that can be used as part of individual-level intervention is not limited to this collection and can be broader. Future research is needed to expand the pool of techniques covered in the present study and to examine their factorial structure.
\n
It is important to distinguish between social workers’ perceptions of or attitudes towards various practice methods and how they actually use the methods in their practice. The present study queried workers’ perceptions of or beliefs about methods but not their use of the methods. Nor did it ask their explanations for their beliefs or use of the methods. It would be of interest to examine why many social workers believe that case management techniques have relatively good potential to foster client empowerment. Mixed-method qualitative studies are recommended to answer this question and to gain as deeper understanding of workers’ personal meanings and perceptions of their actual practice [71, 72].
\n
The present study employed convenience samples from two countries, Israel and the USA, to generate preliminary information about social workers’ use of empowerment techniques. Future research, conducted on nationally representative samples, should examine the possible influence of cultural factors on notions of what constitutes empowerment and on ideas about what practices may support individual empowerment.
\n
Overall, this exploratory study contributes to highlighting an important gap in the research on social work practice. Although the findings show that practitioners from different cultural backgrounds hold somewhat different views of what methods can help them to empower their clients, little cross-country comparison has been conducted on this subject. Given the paucity of systematic research on this subject to date [14, 15], further research is needed to gain better understanding of the factors that affect both the choice and the impact of intervention methods that social workers actually employ in attempting to promote their clients’ empowerment at the individual level.
\n
In closing, it is essential to reiterate that the present study has focused on empowerment in the context of work with individual clients of social services. To date, the social work literature emphasizes that empowerment process can or should be addressed or promoted at the group or community level, where clients can explore collective notions of helplessness and ways of developing a joint sense of control over their behaviors and social environments [5, 6]. Little is known about how social workers perceive the relative efficacy or empowering potential of different intervention methods that are suitable for group-level or community work. The methodology developed for the present study may be applied, with adaptations where necessary, to future research, with the aim of promoting effective practice that can contribute to client empowerment at the individual, group, and community levels.
\n
\n\n',keywords:"empowerment, intervention techniques, nationality groups, cultural differences",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/71117.pdf",chapterXML:"https://mts.intechopen.com/source/xml/71117.xml",downloadPdfUrl:"/chapter/pdf-download/71117",previewPdfUrl:"/chapter/pdf-preview/71117",totalDownloads:1052,totalViews:0,totalCrossrefCites:1,dateSubmitted:"May 31st 2019",dateReviewed:"November 26th 2019",datePrePublished:"February 14th 2020",datePublished:"July 15th 2020",dateFinished:"February 14th 2020",readingETA:"0",abstract:"Even though empowerment is an intervention approach that occupies an important place in social work, social workers’ perceptions of intervention techniques that may empower their clients have not been examined. This paper reports the findings of a pilot study on the perceptions of social workers regarding the empowerment potential of various intervention techniques. Data were collected on convenience samples of social workers in Israel and the USA. The findings indicate that the social workers in the two countries broadly agree on the high empowerment potential of techniques aimed at helping clients to change their behaviors so as to make their conduct more functional and to augment their control over their lives but have differing perceptions regarding the empowerment potential of other approaches, including therapeutic approaches, aspects of service delivery, and means of providing support. Further study is recommended to better understand the relationship between social workers’ perceptions of the empowerment potential of different approaches and techniques and their cultural backgrounds.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/71117",risUrl:"/chapter/ris/71117",signatures:"Khawla Zoabi and Iddo Gal",book:{id:"6942",type:"book",title:"Global Social Work",subtitle:"Cutting Edge Issues and Critical Reflections",fullTitle:"Global Social Work - Cutting Edge Issues and Critical Reflections",slug:"global-social-work-cutting-edge-issues-and-critical-reflections",publishedDate:"July 15th 2020",bookSignature:"Bala Raju Nikku",coverURL:"https://cdn.intechopen.com/books/images_new/6942.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-475-6",printIsbn:"978-1-83880-474-9",pdfIsbn:"978-1-78985-210-3",isAvailableForWebshopOrdering:!0,editors:[{id:"263576",title:"Dr.",name:"Bala",middleName:null,surname:"Nikku",slug:"bala-nikku",fullName:"Bala Nikku"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"306883",title:"Dr.",name:"Khawla",middleName:null,surname:"Zoabi",fullName:"Khawla Zoabi",slug:"khawla-zoabi",email:"khawla_zoabi2011@hotmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1 Empowerment: definitions, processes, and potentials",level:"2"},{id:"sec_2_2",title:"1.2 Empowerment-related intervention techniques at the individual level",level:"2"},{id:"sec_3_2",title:"1.3 Research goals",level:"2"},{id:"sec_5",title:"2. Methods",level:"1"},{id:"sec_5_2",title:"2.1 Participants and procedure",level:"2"},{id:"sec_6_2",title:"2.2 Instruments",level:"2"},{id:"sec_8",title:"3. Findings",level:"1"},{id:"sec_9",title:"4. Discussion",level:"1"},{id:"sec_10",title:"5. Conclusions and future directions",level:"1"}],chapterReferences:[{id:"B1",body:'[\nBennett-Cattaneo L, Chapman AR. The process of empowerment: A model for use in research and practice. American Psychologist. 2010;65(7):646-659\n]'},{id:"B2",body:'[\nFreire P. The Politics of Education. South Hadley, MA: Bergin & Garvey; 1985\n]'},{id:"B3",body:'[\nFreire P. Education for Critical Consciousness. 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Creative Education. 2012;3(8):1397-1403\n]'},{id:"B32",body:'[\nBlanchard KH, Carlos JP, Randolph A. Empowerment Takes More Than One Minute. San Francisco: Barrett-Koehler; 2003\n]'},{id:"B33",body:'[\nLiden RC, Wayne SJ, Sparrow RT. An examination of the mediating role of psychological empowerment on the relations between the job, interpersonal relationships, and work outcomes. Journal of Applied Psychology. 2000;85(3):407-416\n]'},{id:"B34",body:'[\nBandura A. Self-Efficacy: The Exercise of Control. New York: W.H. Freeman; 1997\n]'},{id:"B35",body:'[\nHemric M, Eury AD, Shellman D. Correlations between perceived teacher empowerment and perceived sense of teacher self-efficacy. Journal of Scholarship and Practice. 2010;7:37-50\n]'},{id:"B36",body:'[\nGutierrez L, Parsons R, Cox E. Empowerment in Social Work Practice. Brooks/Cole Publishing Company; 1998\n]'},{id:"B37",body:'[\nKieffer CH. Citizen empowerment: A developmental perspective. Prevention in Human Services. 1983;1:9-36\n]'},{id:"B38",body:'[\nRiessman F. Ten self-help principles. Social Policy. 1997;27(3):6-11\n]'},{id:"B39",body:'[\nKane TJ. Giving back control: Long-term poverty and motivation. Social Service Review. 1987;61:405-419\n]'},{id:"B40",body:'[\nChapin R, Cox E. Changing the paradigm: Strengths-based and empowerment-oriented social work with frail elders. Journal of Gerontological Social Work. 2001;36:165-180\n]'},{id:"B41",body:'[\nO’Hare T, Collins P. Development and validation of scale for measuring social work practice skills. Research in Social Work Practice. 1997;7(2):228-238\n]'},{id:"B42",body:'[\nO’Hare T, Collins P, Walsh T. Validation of the practice skill inventory with experienced social workers. Research on Social Work Practice. 1998;8(5):552-563\n]'},{id:"B43",body:'[\nO’Hare T, Collins P. Matching practice skills with client problems: Using the practice skills inventory with experienced social workers. 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New York: Longman; 1992\n]'},{id:"B50",body:'[\nLopez-Baez SI, Paylo MJ. Social justice advocacy: Community collaboration and systems advocacy. Journal of Counseling and Development. 2009;87(3):276-283\n]'},{id:"B51",body:'[\nBarrett KM, Lester SV, Durham JC. Child maltreatment and the advocacy role of professional school counselors. Journal of Social Action in Counseling and Psychology. 2011;3(2):86-103\n]'},{id:"B52",body:'[\nTrusty J, Brown D. Advocacy competencies for professional school counselors. Professional School Counseling. 2005;8:259-265\n]'},{id:"B53",body:'[\nJoiner TA, Bartram T. How empowerment and social support affect Australian nurses’ work stressors. Australian Health Review. 2004;28(1):56-64\n]'},{id:"B54",body:'[\nO’Hare T. Essential Skills of Social Work Practice: Assessment, Intervention, and Evaluation. Chicago, IL: Lyceum Books; 2009\n]'},{id:"B55",body:'[\nRonen, Freeman. Introduction. In: Tammie R, Arthur F, editors. 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Her research interest is radiology and neuroscience technology and application. She had been trained as an imaging scientist at several prestigious institutes including Columbia University, the University of Pennsylvania, and the National Institutes of Health (NIH). Her research focuses on multi-modal neuroimaging integration such as MRI/PET and EEG/MEG instrumentation to make the best use of multiple modalities for better interpretation of underlying disease mechanisms. She is the author and editor of more than twelve books for well-known publishers including IntechOpen and Nova Science. She has published more than 100 papers and abstracts in many reputed international journals and conferences and served as reviewer and editor for several academic associations.",institutionString:"University of Southern California",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"University of Southern California",institutionURL:null,country:{name:"United States of America"}}},equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9629",title:"Electroencephalography",subtitle:"From Basic Research to Clinical Applications",isOpenForSubmission:!1,hash:"8147834b6c6deeeec40f407c71ad60b4",slug:"electroencephalography-from-basic-research-to-clinical-applications",bookSignature:"Hideki Nakano",coverURL:"https://cdn.intechopen.com/books/images_new/9629.jpg",editedByType:"Edited 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Cárdenas-Aguayo, M. del C. Silva-Lucero, M. Cortes-Ortiz,\nB. Jiménez-Ramos, L. Gómez-Virgilio, G. Ramírez-Rodríguez, E. Vera-\nArroyo, R. Fiorentino-Pérez, U. García, J. Luna-Muñoz and M.A.\nMeraz-Ríos",authors:[{id:"42225",title:"Dr.",name:"Jose",middleName:null,surname:"Luna-Muñoz",slug:"jose-luna-munoz",fullName:"Jose Luna-Muñoz"},{id:"114746",title:"Dr.",name:"Marco",middleName:null,surname:"Meraz-Ríos",slug:"marco-meraz-rios",fullName:"Marco Meraz-Ríos"},{id:"169616",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Cardenas-Aguayo",slug:"maria-del-carmen-cardenas-aguayo",fullName:"Maria del Carmen Cardenas-Aguayo"},{id:"169857",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Silva-Lucero",slug:"maria-del-carmen-silva-lucero",fullName:"Maria del Carmen Silva-Lucero"},{id:"169858",title:"Dr.",name:"Maribel",middleName:null,surname:"Cortes-Ortiz",slug:"maribel-cortes-ortiz",fullName:"Maribel Cortes-Ortiz"},{id:"169859",title:"Dr.",name:"Berenice",middleName:null,surname:"Jimenez-Ramos",slug:"berenice-jimenez-ramos",fullName:"Berenice Jimenez-Ramos"},{id:"169860",title:"Dr.",name:"Laura",middleName:null,surname:"Gomez-Virgilio",slug:"laura-gomez-virgilio",fullName:"Laura Gomez-Virgilio"},{id:"169861",title:"Dr.",name:"Gerardo",middleName:null,surname:"Ramirez-Rodriguez",slug:"gerardo-ramirez-rodriguez",fullName:"Gerardo Ramirez-Rodriguez"},{id:"169862",title:"Dr.",name:"Eduardo",middleName:null,surname:"Vera-Arroyo",slug:"eduardo-vera-arroyo",fullName:"Eduardo Vera-Arroyo"},{id:"169863",title:"Dr.",name:"Rosana Sofia",middleName:null,surname:"Fiorentino-Perez",slug:"rosana-sofia-fiorentino-perez",fullName:"Rosana Sofia Fiorentino-Perez"},{id:"169864",title:"Dr.",name:"Ubaldo",middleName:null,surname:"Garcia",slug:"ubaldo-garcia",fullName:"Ubaldo Garcia"}]},{id:"58070",doi:"10.5772/intechopen.72427",title:"MRI Medical Image Denoising by Fundamental Filters",slug:"mri-medical-image-denoising-by-fundamental-filters",totalDownloads:2564,totalCrossrefCites:17,totalDimensionsCites:30,abstract:"Nowadays Medical imaging technique Magnetic Resonance Imaging (MRI) plays an important role in medical setting to form high standard images contained in the human brain. MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. Watt",authors:[{id:"145620",title:"Dr.",name:"Gina",middleName:null,surname:"Forster",slug:"gina-forster",fullName:"Gina Forster"},{id:"146553",title:"BSc.",name:"Andrew",middleName:null,surname:"Novick",slug:"andrew-novick",fullName:"Andrew Novick"},{id:"146554",title:"MSc.",name:"Jamie",middleName:null,surname:"Scholl",slug:"jamie-scholl",fullName:"Jamie Scholl"},{id:"146555",title:"Dr.",name:"Michael",middleName:null,surname:"Watt",slug:"michael-watt",fullName:"Michael Watt"}]},{id:"26258",doi:"10.5772/28300",title:"Excitotoxicity and Oxidative Stress in Acute Ischemic Stroke",slug:"excitotoxicity-and-oxidative-stress-in-acute-ischemic-stroke",totalDownloads:7157,totalCrossrefCites:6,totalDimensionsCites:25,abstract:null,book:{id:"931",slug:"acute-ischemic-stroke",title:"Acute Ischemic Stroke",fullTitle:"Acute Ischemic Stroke"},signatures:"Ramón Rama Bretón and Julio César García Rodríguez",authors:[{id:"73430",title:"Prof.",name:"Ramon",middleName:null,surname:"Rama",slug:"ramon-rama",fullName:"Ramon Rama"},{id:"124643",title:"Prof.",name:"Julio Cesar",middleName:null,surname:"García",slug:"julio-cesar-garcia",fullName:"Julio Cesar García"}]},{id:"62072",doi:"10.5772/intechopen.78695",title:"Brain-Computer Interface and Motor Imagery Training: The Role of Visual Feedback and Embodiment",slug:"brain-computer-interface-and-motor-imagery-training-the-role-of-visual-feedback-and-embodiment",totalDownloads:1439,totalCrossrefCites:13,totalDimensionsCites:23,abstract:"Controlling a brain-computer interface (BCI) is a difficult task that requires extensive training. Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192666,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. 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Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3478,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3601,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:23,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81488",title:"Aggression and Sexual Behavior: Overlapping or Distinct Roles of 5-HT1A and 5-HT1B Receptors",slug:"aggression-and-sexual-behavior-overlapping-or-distinct-roles-of-5-ht1a-and-5-ht1b-receptors",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.104872",abstract:"Distinct brain mechanisms for male aggressive and sexual behavior are present in mammalian species, including man. However, recent evidence suggests a strong connection and even overlap in the central nervous system (CNS) circuitry involved in aggressive and sexual behavior. The serotonergic system in the CNS is strongly involved in male aggressive and sexual behavior. In particular, 5-HT1A and 5-HT1B receptors seem to play a critical role in the modulation of these behaviors. The present chapter focuses on the effects of 5-HT1A- and 5-HT1B-receptor ligands in male rodent aggression and sexual behavior. Results indicate that 5-HT1B-heteroreceptors play a critical role in the modulation of male offensive behavior, although a definite role of 5-HT1A-auto- or heteroreceptors cannot be ruled out. 5-HT1A receptors are clearly involved in male sexual behavior, although it has to be yet unraveled whether 5-HT1A-auto- or heteroreceptors are important. Although several key nodes in the complex circuitry of aggression and sexual behavior are known, in particular in the medial hypothalamus, a clear link or connection to these critical structures and the serotonergic key receptors is yet to be determined. This information is urgently needed to detect and develop new selective anti-aggressive (serenic) and pro-sexual drugs for human applications.",book:{id:"10195",title:"Serotonin and the CNS - New Developments in Pharmacology and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg"},signatures:"Berend Olivier and Jocelien D.A. Olivier"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"},{id:"80821",title:"Neuroimmunology and Neurological Manifestations of COVID-19",slug:"neuroimmunology-and-neurological-manifestations-of-covid-19",totalDownloads:41,totalDimensionsCites:0,doi:"10.5772/intechopen.103026",abstract:"Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Robert Weissert"}],onlineFirstChaptersTotal:17},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
\r\n\r\n\t
\r\n\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
\r\n\r\n\t
\r\n\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
\r\n\r\n\t
\r\n\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
\r\n\r\n\t
\r\n\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
\r\n\r\n\t
\r\n\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
\r\n\r\n\t
\r\n\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
\r\n\r\n\t
\r\n\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
",coverUrl:"https://cdn.intechopen.com/series/covers/24.jpg",latestPublicationDate:"May 23rd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"262440",title:"Prof.",name:"Usha",middleName:null,surname:"Iyer-Raniga",slug:"usha-iyer-raniga",fullName:"Usha Iyer-Raniga",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRYSXQA4/Profile_Picture_2022-02-28T13:55:36.jpeg",biography:"Usha Iyer-Raniga is a professor in the School of Property and Construction Management at RMIT University. Usha co-leads the One Planet Network’s Sustainable Buildings and Construction Programme (SBC), a United Nations 10 Year Framework of Programmes on Sustainable Consumption and Production (UN 10FYP SCP) aligned with Sustainable Development Goal 12. The work also directly impacts SDG 11 on Sustainable Cities and Communities. She completed her undergraduate degree as an architect before obtaining her Masters degree from Canada and her Doctorate in Australia. Usha has been a keynote speaker as well as an invited speaker at national and international conferences, seminars and workshops. Her teaching experience includes teaching in Asian countries. She has advised Austrade, APEC, national, state and local governments. She serves as a reviewer and a member of the scientific committee for national and international refereed journals and refereed conferences. She is on the editorial board for refereed journals and has worked on Special Issues. Usha has served and continues to serve on the Boards of several not-for-profit organisations and she has also served as panel judge for a number of awards including the Premiers Sustainability Award in Victoria and the International Green Gown Awards. Usha has published over 100 publications, including research and consulting reports. Her publications cover a wide range of scientific and technical research publications that include edited books, book chapters, refereed journals, refereed conference papers and reports for local, state and federal government clients. She has also produced podcasts for various organisations and participated in media interviews. She has received state, national and international funding worth over USD $25 million. Usha has been awarded the Quarterly Franklin Membership by London Journals Press (UK). Her biography has been included in the Marquis Who's Who in the World® 2018, 2016 (33rd Edition), along with approximately 55,000 of the most accomplished men and women from around the world, including luminaries as U.N. Secretary-General Ban Ki-moon. In 2017, Usha was awarded the Marquis Who’s Who Lifetime Achiever Award.",institutionString:null,institution:{name:"RMIT University",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:0,paginationItems:[]},overviewPageOFChapters:{paginationCount:0,paginationItems:[]},overviewPagePublishedBooks:{paginationCount:0,paginationItems:[]},openForSubmissionBooks:{},onlineFirstChapters:{},subseriesFiltersForOFChapters:[],publishedBooks:{paginationCount:0,paginationItems:[]},subseriesFiltersForPublishedBooks:[],publicationYearFilters:[],authors:{}},subseries:{item:{id:"23",type:"subseries",title:"Computational Neuroscience",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness",scope:"Computational neuroscience focuses on biologically realistic abstractions and models validated and solved through computational simulations to understand principles for the development, structure, physiology, and ability of the nervous system. This topic is dedicated to biologically plausible descriptions and computational models - at various abstraction levels - of neurons and neural systems. This includes, but is not limited to: single-neuron modeling, sensory processing, motor control, memory, and synaptic plasticity, attention, identification, categorization, discrimination, learning, development, axonal patterning, guidance, neural architecture, behaviors, and dynamics of networks, cognition and the neuroscientific basis of consciousness. 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