Posts Tagged disability
According to a 2015 report, approximately 43.5 million informal (unpaid) caregivers provided care to an adult or child in the previous 12 months.
Additionally, while individuals with disabilities of any age may need assistance from caregivers, older people are more likely to develop disabilities, and more likely to require personal assistance and support. The population of people over the age of 65 is projected to increase significantly in the coming decades, likely resulting in a greater need for caregivers, both paid and unpaid.
How is the ADA relevant to caregivers and individuals with disabilities who need their assistance and support?
State and local government agencies (called “public entities”) and private businesses like stores, restaurants, movie theaters, amusements parks, etc. (called “places of public accommodation”) need to do a number of things to make sure people with disabilities can access goods and services, including:
- Provide aids and services to communicate effectively with individuals who have hearing, vision, or speech disabilities (e.g., read labels or tags aloud, describe items, provide materials in large print, Braille, or electronic formats for individuals who are blind or have low vision; exchange written notes, provide assistive listening devices, sign language interpreters, or captioning services for individuals who are deaf or hard of hearing);
- Make “reasonable modifications in policies, practices, or procedures” to ensure equal opportunities.
- This means public entities or businesses may need to do things a little differently or adjust rules, on an individual, case-by-case basis, so that a person with a disability can access services or participate in programs. This may include accommodating a caregiver who is providing assistance to a person with a disability.
This fact sheet addresses some of the most frequently asked questions about the ADA and caregivers.
Are businesses required to provide a personal assistant or caregiver for a person with a disability?
Generally, no. Businesses and public entities are not required to provide services of a “personal nature,” such as assistance with eating, toileting, or dressing, although facilities that generally provide such services (e.g., hospitals or child care centers for very young children), must provide services equitably to individuals with disabilities.
However, there are many “reasonable modifications” that may be needed on an individual basis and would not be considered “personal services.” For example:
- A medical office may need to complete a medical form on behalf of a patient who cannot hold a pen or pencil,
- A restaurant kitchen may be asked to cut food into smaller pieces before serving, or
- An employee at a grocery store may need to assist a person with low vision to find products.
Do caregivers and personal assistants get free admission?
The ADA does not guarantee free or discounted admission to the caregivers of individuals with disabilities. There may be times, however, when a person with a disability cannot access goods or services without personal assistance, and a public entity or business may need to consider offering free or discounted admission to ensure equal access. Generally, this will need to be assessed on a case-by-case basis.
Some considerations in making this decision include:
- Can the person with a disability have full access and enjoyment of the activity without a personal assistant?
- Is the caregiver attending to support the person with a disability, or is the caregiver attending for his own benefit?
- Can the business afford the cost of offering free admission?
- What is the value of admission (e.g., a $10 admission to an uncrowded skating rink, or a $500 ticket to a popular, limited seating concert) compared to the resources of the entity (e.g., a small non-profit on a shoestring budget, or a large institution or business)?
- Does the business already offer discounts or other deals on admission?
Are caregivers guaranteed a seat with the person they are assisting at a ticketed seating event?
It may depend on various factors. At many ticketed, assigned seating events (particularly where the seats have a high value), caregivers will need to purchase a ticket in order to be seated. Purchasing tickets for adjacent or nearby seats will simply depend on availability. Venue operators do not have to move other patrons who have already purchased tickets for specific seats.
If the individual with a disability needs an accessible seating location, he or she may purchase up to three additional tickets for adjacent or nearby seats, if such seats are available at the time of purchase and other patrons are allowed to purchase up to four tickets. Again, the venue is not required to relocate other patrons who have already purchased tickets for specific seats so that the caregiver can sit beside the person with a disability.
In some cases, caregivers will not need to be seated or remain within the venue for the duration of an event. They may, however, need to assist the individual to his or her seating location and return during an intermission or at the end of the event. Venue operators may need to make a reasonable modification of their policy to allow a non-ticketed caregiver to accompany the person with a disability to and from the seating location.
Can caregivers accompany a person of the opposite gender into a public restroom?
Caregivers of the opposite gender may be able to accompany a person with a disability into a gender-specific public restroom, but it may depend on a number of factors, and may require getting employees at the location to help by checking on whether the restroom is occupied, waiting until it is empty, and ensuring that no one else enters while it is being used by the individual and the caregiver.
This may be easier where there are single-user restrooms, or where the facility is not very crowded or busy. However, it may be more challenging at busier facilities, those with multiple toilet stalls and/or urinals, or those that include changing or showering elements (such as at a fitness facility) where users spend more time in the space.
Do caregivers have a right to accommodations such as sign language interpreters?
Caregivers may certainly have disabilities themselves. If a caregiver is a person with whom the agency or business would normally communicate, then the caregiver is entitled to effective communication.
The ADA regulations that cover private businesses and state and local governments include provisions for ensuring effective communication with “companions” of individuals accessing goods or services. A companion may be a “family member, friend, or associate.”
For example, hospital staff often talk to a patient’s spouse, family member, or caregiver about the patient’s condition, diagnosis, and needed care. A caregiver who is deaf may need a sign language interpreter so they will be able to participate effectively in these conversations, understand things they need to know to support and assist the patient, make plans for the patient’s discharge, etc.
For more information, see the U.S. Department of Justice’s fact sheet on Effective Communication(link is external).
If a caregiver has a service animal, can she bring the animal with her into public places while she is providing support services to a person with a disability?
If a caregiver has a disability and uses a trained service animal, she has the same rights as any other individual with a disability. Service animals are permitted in almost all areas of public facilities and private businesses covered by the ADA.
For more information on service animals, see the ADA National Network’s fact sheet on Service Animals.
Are caregivers permitted to stay overnight in a hospital that strictly limits visiting hours?
Permitting a caregiver to remain overnight may be a reasonable modification of policy and procedure, if the caregiver is needed by a patient with a disability. Some individuals with disabilities may need specific support that is difficult for hospital staff to provide. For example, an individual with an intellectual or cognitive disability may need specific support to facilitate communication or understanding.
A hospital would not have to accommodate an overnight stay for a caregiver if it would fundamentally alter operations or provision of medical services, or cause an undue burden (a significant difficulty or expense). A hospital would generally not be required to provide the caregiver a bed, or any other product or service intended for patients.
In the case of a natural disaster or other emergency, are caregivers permitted to go to the same shelter as the person for whom they provide care and support?
It may be a reasonable policy modification to permit a caregiver, who might otherwise be directed to a different shelter, to stay with the person they assist, whether in a typical mass care shelter or a specially equipped medical shelter.
Emergency managers and shelter operators should not assume that people with disabilities need to be housed in medical shelters. Many individuals with disabilities can be sheltered in neighborhood mass care locations, and in some cases, the assistance of a caregiver may prevent an individual from being unnecessarily diverted to a medical shelter.
For more information on emergency shelters, see the U.S. Department of Justice’s publication on The ADA and Emergency Shelters: Access for All in Emergencies and Disasters(link is external).
Are caregivers permitted to stay overnight at a housing community that does not allow overnight guests or that states there are not enough bedrooms for an additional person?
Accommodating caregivers who need to stay overnight may be a reasonable policy modification. However, the only housing covered by the ADA is public housing provided by a state or local government, or housing that is secondary to another type of program or business covered by the ADA (such as a dormitory at a state university). The ADA does not cover private housing.
The Fair Housing Act covers a variety of residential settings, ranging from typical private apartment complexes to many of the same residential programs covered by the ADA (e.g., long-term shelters operated by public agencies).
Find more information on the Fair Housing Act(link is external) through the U.S. Department of Housing and Urban Development.
Injury disclosure is a very personal decision, and I often review this with my clients prior to commencing the job-search process. First of all, the job goal you are aiming for needs to be suitable to maximise your chances of success. Does the job goal utilise some of your strengths? Are you able to complete the inherent requirements of the role? Inherent requirements are the essential requirements of the job. For example, if you are applying for a job as a truck driver, but you do not have a truck licence, the employer is under no obligation to hire you, whether you have a disability or not. You must be qualified for the job you are applying for. If you are qualified for the job, but your disability means that you may struggle with some aspects of it, the employer is required to make ‘reasonable accommodations’ to enable you to do the work. For countries who have anti-discrimination laws, the employer could be found to be discriminating if they do not hire you (or if they fire you) because of disability-related issues if it is found that job modifications, equipment, etc., could have been provided to enable you to do the work, and you can fulfil the inherent requirements of the work. In Australia and America, anti-discrimination laws do not require an employer to make adjustments or accommodations if the cost of doing so would be unreasonable. For example, if installing an elevator would be the only way to enable an employee with a disability to access areas of a worksite that were essential to the job, but the cost of providing the elevator was excessively high, it could be considered unreasonable to expect the employer to do this. Anti-discrimination laws may differ in each country, so it is important to know your rights.
It is also important to have medical approval from your specialist to confirm that you are medically fit to work. If the job you wish to undertake is safe, suitable, and sustainable, you will need to consider whether you want to disclose your injury or disability to the employer. Some people may choose to disclose during the application process. Some may choose to disclose during the interview process or after they get the job. Some may choose not to disclose at all.
Employers receive many applications for one vacant position, and I personally believe that the decision to interview someone following receipt of their application should be based on skills. If, however, you will need some significant (yet reasonable) work adjustments, they may take some time to implement, so advising the employer early on can build trust and facilitate a plan for your commencement. Approaching the discussion with a solution-focused framework will help your negotiations.
If the workplace modifications you require are less costly, such as an ergonomic chair, or are practical accommodations, such as adjusting work hours to cope with fatigue, it may be better to have those conversations at the interview, rather than in your application for the job.
If you have developed effective memory management strategies and other strategies to manage your injury limitations and have trialled your ability to cope with the work, you may not need to disclose your injury. This is a personal decision. If your injury is related to work insurance, however, you should talk to a lawyer regarding what you may be required by law to disclose on a job application form that seeks information about work-related injuries. This will differ between countries.
By Nicole Yeates, Best-selling author of Holding on to Hope, Finding the ‘New You’ after a Traumatic Brain Injury
Disabled people have sex – it happens!
Here at Disability Horizons, we’re always trying to change society’s negative perceptions of disability and bust misconceptions. This is particularly true when it comes to sex and disability.
We’ve been looking at what people search online, and this includes the phrases ‘disability and sex drive’ and ‘sex when disabled’. Is this people believing that disabled people are asexual, with no wants, desires or needs? Or is this disabled people themselves unsure whether they can have sex with their condition?
Either way, ahead of Valentine’s Day, we’re sharing disabled people’s sex stories to prove what’s possible and break down the taboo. Here, our resident shop reviewer Zec talks openly about his sex life as a married disabled man.
The first thing I want to get straight with this article and for anyone searching those terms – disabled people have sex. We do it to the best of our ability and, it may come as a big surprise to people, but many of us do it very well!
Before I go on, I should just warn you that I am going to talk very frankly about sex – I am not the type to hold back. I will speak from my experience and point of view and speak candidly!
So don’t say that I didn’t warn you. But at least you have a choice – the poor editors at Disability Horizons don’t and I apologise for that (except I don’t really ).
Disability and sex drive
I haven’t always been disabled. In 1997, I was also diagnosed with myalgic encephalomyelitis, more commonly known as ME or chronic fatigue syndrome (CFS) – you can read more about how I became disabled in my first article on Disability Horizons. One of the first things I was worried about wasn’t losing the ability to walk, it was saying goodbye to my sex life.
When my pain levels started to grow, my mobility became increasingly problematic. I also had multiple knee surgeries, and too many years on crutches damaged my shoulders and wrists, so I started to use a wheelchair. I suddenly had this feeling of impending doom, that my sex life would never be the same again.
Happily, I now look back at that and laugh because, shock horror, my sex life is now better than it ever was.
Despite the fact that disabled people and those with health conditions have many varying physical and mental impairments, just like an able-bodied person, we still have those same desires, wants and the need for sex.
When people are aroused, their brain releases the chemicals oxytocin and endorphins, and it’s no different if you’re disabled. It just means that we have to approach sex differently.
My sex life as a disabled married man
I am very fortunate, I haven’t had to date or find a partner as a disabled person. No, I lured the girl of my dreams in my early 20s, married her and had children before becoming disabled.
For me when it comes to sex, I not only have the problem of a physical disability but also constant pain to varying levels and periods of extreme physical and mental fatigue.
But my brain does not seem to understand this and even on the worst of days, it suddenly nudges me and says, “By the way, you are feeling horny, have some chemicals.”
And so, there I am, laid in extreme pain and/or with fatigue and feeling aroused. Great!
Quite often in these circumstances, when I turn and look at my wife and she somehow knows what I am thinking, she says, “No, aren’t you in enough pain already?” She is right because even on the best of days, the act of sex will cause a big flare-up that can last for days.
But it’s worth it! I am willing to cause myself all manner of harm when I have an erection – and I don’t mean that in a kinky, spank me, tie me up and hurt me kind of way. I mean that I don’t care if I have days of payback because I have had sex.
Adjusting our sex life
So how do we get around these issues? The first thing we needed to do was change our positions. We had to forget doggy style because of my knees and pain, which my wife actually tells me is a bonus of me being disabled.
We’ve also had to forget the missionary position too, and sometimes, when my hips are playing up, I can’t make any sort of thrusting movement. In addition, sometimes penetrative sex is just not possible.
If I had gone back in time and told a 20-year-old me that this would happen, I think I would have cried a little. But the truth is, it really isn’t a problem.
And yes, despite these changes, I still say that our sex life now is better than it was before! We’ve been together for 31 years, so we know each other well and we were able to work out my new limits together. Also, as we’ve had to rethink things and do them differently, we’ve also had to slow it down, which isn’t a bad thing.
So we take things as they come, depending on how I am feeling with my ever-changing condition.
On a good day, when fatigue is only a slight problem and my pain levels are down to a three (and yes, that is a good day), I can go mad and fill my boots (poor choice of words, but you get what I mean).
On days like that, I am able to have penetrative sex. That is usually done with my wife on top, me being the big spoon or with my wife on her back, me on my side next to her and her leg nearest me over my side (no idea what the name of that position is).
I know right, practically a gymnast – go me! Of course, that is after the introductory foreplay to get all right bits to the right level and ready.
Disabled sex aid equipment
So let’s skip to the complete opposite end of my disability and what happens when my pain levels are high and or my fatigue is more problematic (but not at a level where it is impossible to do anything).
In these circumstances, we use sex toys or aids – and it’s taken our sex life to the next level. We had used sex toys before, but only really a basic vibrator for my wife that was rarely used.
Now, we use loads, most of which I have reviewed a few on my website, www.satonmybutt.co.uk. So, on a bad day, we stick to foreplay and use sex toys for an orgasm rather than penetrative sex.
For some reason, people view sex toys as a bit naughty, a kink and something that we must not talk about. But the truth is that everyone should have at least one sex toy and, for disabled people, they are a game-changer.
I have to confess that when we received the first sex toy for men, I was a tad embarrassed and hesitant to use it. But after testing a few, I have found a very good one that we can use for me when I can’t physically manage to have sex. Everyone has the right to orgasm, even if they don’t have a partner.
There is a massive range of sex toys for either the penis or vagina (and other bits) and many sold online now come in very discreet packages. There are also some amazingly innovative and inclusive sex toys on the market. There are even hands-free toys and some that can be controlled via a remote or smartphone.
The Pulse from Hot Octopuss enables someone who can’t get an erection due to erectile dysfunction or spinal cord injury, to orgasm, that is amazing. There is also a Pulse Duo where a partner can get on top and an area of vibration will take care of their needs.
There is a lot of sex equipment available too!. These can range from simple, covered foam wedges to help with positioning, to large pieces of furniture. Some of these will even have the option to house a sex toy for hands-free pleasure. Check out Bedroom Adventures for products like these!
There still needs to be more sex toys designed for disabled people, but there is a lot out there to start with.
So, the answer to the questions on having sex when you’re disabled and sex drive is that where there is a will, there is a way! And I really believe that people shouldn’t be embarrassed about the topic, especially when it comes to disability.
Do not feel ashamed – the desire for sex is a basic and primal urge that every living creature has, and just because we are disabled, that does not mean that we should suppress those urges!
By Zec Richardson
More on Disability Horizons…
- How to satisfy yourself as a single disabled person
- Disabled sex positions: how to enjoy explosive sex comfortably
- Spice up your sex life: top toys and positions for disabled people
- Thinking outside of the box if you’re disabled can make your sex life explosive
[Abstract] Detecting physical abilities through smartphone sensors: an assistive technology application
It is important to promote assistive technologies to improve quality of life. The proposed SmartAbility Android Application recommends assistive technologies for people with reduced physical abilities, by focussing on actions that can be performed independently.
Materials and methods
The SmartAbility Application uses Android built-in sensors, e.g., accelerometer and gyroscope and application programming interfaces (APIs) to detect physical abilities, e.g., head movements and blowing and recommend suitable assistive technologies. This is supported by a MySQL database that stores assistive technologies and mappings between abilities. The underpinning research is the SmartAbility Framework that culminates the knowledge obtained during previously feasibility trials and usability evaluations.
The Application was evaluated by pupils (n =18) at special educational needs schools with physical conditions, including cerebral palsy, autism and Noonan syndrome, and assessed through the NASA Task Load Index (TLX) and System Usability Scale (SUS). Analysis using the Adjective Rating Scale highlighted that the Application achieves “Good Usability”.
The SmartAbility Application demonstrates that built-in sensors of Android devices and their APIs, can detect actions that users perform, e.g., head movements and speaking. The Application contains a database where assistive technologies are mapped to physical abilities, in order to provide suitable recommendations. It will be disseminated to assistive technology charities and manufacturers and be used by healthcare professionals as part of the rehabilitation process. Future developments of SmartAbility include the creation of a second Application designed specifically to recommend assistive technologies for the education sector, based on users’ physical and cognitive abilities.
- IMPLICATIONS FOR REHABILITATION
- Assistive technology is any item, equipment or piece of software designed to increase, maintain or improve the functional capabilities of people with disabilities.
- SmartAbility should be introduced into rehabilitation to promote awareness of assistive technologies that are suitable for the physical abilities of the user.
- Our research highlighted that physical abilities can be detected using built-in sensors of Android devices, e.g. accelerometer and gyroscope.
- Involvement of the intended user community during evaluations is essential to ensure that a smartphone application is suitable for people with reduced physical abilities.
- Assistive technologies can support the rehabilitation of people with reduced physical abilities by providing increased independence and improved quality of life.
[Abstract] Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review
INTRODUCTION: During the last decades, many studies have been carried out to understand the possible positive effects of vibration therapy in post-stroke rehabilitation. In particular, the use of localized muscle vibration (LMV) seems to have promising results. The aim of this systematic review is to describe the use of LMV in post-stroke patients to improve motor recovery, reducing spasticity and disability in both upper and lower limb.
EVIDENCE ACQUISITION: A search was conducted on PubMed, Scopus, Pedro and REHABDATA electronic database. Only randomized controlled trials have been included, excluding no-localized vibratory treatments and other pathological conditions. Fourteen studies met the inclusion criteria and were included in this review.
EVIDENCE SYNTHESIS: Collectively, the studies involved 425 stroke patients. Most studies included chronic stroke patients (ten) and treated only the upper limb (eleven). There is evidence that LMV therapy is effective in reducing spasticity and improving motor recovery, especially when associated with conventional physical therapy.
CONCLUSIONS: LMV may be a feasible and safe tool to be integrated into traditional and conventional neurorehabilitation programs for post-stroke patients to reduce spasticity. Analysis of the available clinical trials do not allow us to indicate vibration therapy as effective in functional motor recovery, despite some studies showed encouraging results. Further studies, with larger size of homogeneous patients and with a shared methodology are needed to produce more reliable data especially on the lower limb.
[ARTICLE] F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology – a feasibility study – Full Text
Globally, there is a growing use of Information and Communication Technology (ICT), including mobile phones, tablets and computers, which are being integrated into people’s daily activities. An ICT-based intervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation and facilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention.
Three teams comprising occupational therapists and physiotherapists who work in neurological rehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke to participate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) and the participants with stroke rated their performance and satisfaction with the activities associated with the three goals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke Impact Scale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks.
All of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningful improvement of ≥2 points was found in four participants regarding performance and in six participants regarding satisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platform were 44–100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation.
The results indicate that the most beneficial part of F@ce was the person-centred, goal-setting process and SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts about their goals. This encouraged them to be more active. The only downside mentioned was that they felt under an obligation to practice, although this was described as “a positive obligation”.
Digitalisation in society, as well as in health care and rehabilitation, has increased rapidly in recent years [1, 2]. In line with this development, the Swedish government has created a vision of becoming a global leader in digital health solutions by 2025 . Digitalisation can be a valuable tool for increased participation in society for people with disabilities as after stroke [3, 4]. There are a range of concepts and definitions that address different aspects of digitalisation in health care such as e-health, tele rehabilitation and health informatics. In this study, the term Information and Communication Technology (ICT) is used, including all technologies that are used interactively for communication and transfer of information, such as mobile phones, tablets and computers, as well as the applications and software of such devices .
The ability to manage activities in daily living (ADL) and participate in everyday life, including work, leisure and social activities, is often restricted after a stroke [6,7,8,9]. Thus, the everyday life after stroke has been described as chaotic and receiving rehabilitation to manage ADL is often a priority [8, 10]. The development of more user-friendly ICT solutions has created opportunities to provide ICT-supported rehabilitation services that could reduce some of the unmet needs of rehabilitation that are reported by people who have had stroke . Although the evidence concerning the effectiveness of ICT is inconclusive [3, 4], a recent review has shown that interventions using ICT have beneficial effects on motor, higher cortical and mood disorders . It has also been shown that ICT used as an alternative to face-to-face interventions could improve participation in daily life after stroke .
ICT could be utilised in rehabilitation after stroke to monitor rehabilitation progress and interact at a distance [3, 4]. The use of a mobile phone or computer has been shown to promote participation in everyday life and create a sense of security [11, 12]. Furthermore, the use of ICT-based interventions could reduce the number of home visits, thereby saving time and travel costs, particularly in rural areas [12, 13]. ICT solutions have also shown to enable person-centred care [14, 15] and facilitate communication and feedback from healthcare professionals [3, 16]. A concern among people with stroke is their potentially limited ability to manage different ICT devices. Earlier research has found that people could encounter a range of difficulties [11, 17, 18] but that people with acquired brain injury such as stroke could benefit from using ICT in their daily lives [11, 19]. Moreover, ICT could be successfully introduced and used within rehabilitation after acquired brain injury, regardless of age or previous use . However, support is often needed, particularly when using a new device or when something unexpected happens .
A client-centred ADL intervention (CADL) was developed with the aim of enabling agency in activities and participation in everyday life among persons with stroke [21, 22]. The CADL was based on phenomenology with the lived experiences of the person as a point of departure for the intervention . The client-centred approach included building a therapeutic relationship and ensuring that the person was actively involved in the goal setting and planning of the rehabilitation [24,25,26]. The CADL was delivered by occupational therapists and evaluated in a randomized controlled trial (RCT) [21, 22] along with qualitative studies [27,28,29]. The results of the RCT [21, 22] were inconclusive but the qualitative studies emphasized that sharing  and transparency  between therapists and the patients were benefits of using a client-centred approach. It was also shown that the CADL appeared to enhance the involvement of patients in goal setting and individualisation of the rehabilitation. In the present study, the CADL was further developed by following the Medical Research Council (MRC) guidelines for the development of complex interventions .
The results of the CADL study is a part of the evidence base in the development of the new intervention called F@ce that is presented in this study. One conclusion from the CADL evaluations was that all members of a stroke rehabilitation team should use the intervention. This is also recommended in the Swedish national guidelines for stroke care  and in this new intervention F@ce, the multidisciplinary teams were included. In line with the new multidisciplinary approach, the term client-centred was replaced with person-centred. The terms client-centred and person-centred are based on the same underlying theories as described by Rogers . The person-centred approach views the person as having the potential to change and the therapist as being a facilitator in this process [32, 33].
The potential benefits and obstacles for using ICT within a person-centred rehabilitation intervention for people after stroke remain largely unexplored. Although healthcare professionals and persons with stroke have reported high levels of acceptance and satisfaction when using ICT interventions in stroke care, few studies have explored the outcome of such interventions [3, 34]. Thus, to meet the vision of the Swedish government , further research on the development and use of ICT within rehabilitation is needed.
Our assumption was that ICT could be used as a tool for reinforcing person-centred rehabilitation through increased sharing  and transparency . According to the MRC guidelines, an important stage in the development of new interventions is conducting a feasibility study before testing on a larger scale . Thus, this study had the following aim: to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention.[…]
[Abstract] Addressing sexuality among people living with chronic disease and disability: A systematic mixed methods review of knowledge, attitudes and practices of healthcare professionals.
To systematically review healthcare professionals’ practices and attitudes towards addressing sexuality with people who are living with chronic disease and disability.
SCOPUS, PubMed, PsycINFO, CINAHL, AMED and MedLine were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched.
Eligible studies reported on knowledge, attitudes and behaviours of healthcare professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool.
Characteristics of included studies were recorded independently by two authors. Differences were resolved through discussion or by a third author.Data Synthesis A sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI: 10.6% to 18.9% (I2=94.8% P <0.000)) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the impact of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed.
Despite recognising the value of sexuality to health and wellbeing most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multi-component implementation programs are needed to improve health professionals’ knowledge, competence and comfort when addressing sexuality for people living with chronic disease and disability
The links between disability, activity limitation and participation restriction are well established. Recent and continued advancement of technology, particularly smart home and communication technologies, presents new ways in which some of the limitations and restrictions experienced by people with disabilities can be overcome. The aim of this scoping review was to explore the impact of smart home and communication technology on the outcomes of people with disabilities and complex needs.
This review involved systematic searching of four databases, hand searches and data extraction. Eligibility criteria included  participant outcomes of  technology used within the home  among adults with a disability and complex needs.
Of the 2400 studies identified, 21 met our inclusion criteria. Studies were characterized by significant diversity in relation to disability and type of technology. Overall, technology appeared to improve independence, participation and quality of life among people with a disability and complex needs. Despite this, ethical considerations were raised given the vulnerability of this population, including potential risks through social participation and privacy concerns of using monitoring technology.
Smart home and communication technology can improve outcomes for people living with disabilities and complex needs. However, a number of factors impact the successful implementation of technology, including personalization, flexibility and ongoing support to the person with a disability and their close others. Future research should utilize high-quality study designs and established measures of important outcomes for this group.
- IMPLICATIONS FOR REHABILITATION
- There is a broad range of smart home and communication technology devices and systems available that may support the independence and participation of people with disabilities and complex needs; however, high-quality evidence documenting the impact of technology is lacking.
- Soft-technology supports, including assessment, training and evaluation of technology implementation, may play just as important a role in shaping outcomes as the technology itself.
- Systematic research is required to ensure there is quality evidence to inform investment in both technologies, and the soft-technology supports that promote its successful use.
Sex is for every body — as long as the person you are being intimate with is a consenting adult. People with disabilities account for 20 percent of the population, but aren’t represented nearly as much as they should be when it comes to advertising, media and even pornography. Representation is important because everyone is entitled to a healthy and fulfilling sex life.
“The biggest myth is that people with disabilities are asexual or cannot have sex,” Eva Sweeney, host of “Cripping Up Sex With Eva,” told The Mighty. “I think this myth stems from the infantilization of people with disabilities. While some people with disabilities are asexual, the majority want and have sex.”
Just like most things in life, sex too can be modified. Whether you have a disability, your partner does or both of you do, there are plenty of ways to get creative in the bedroom.
“Disability can affect sex but not in a bad way,” Sweeney said. “Different kinds of bodies might need to be more creative in the bedroom but this only spices things up and creates more conversation which is good for any relationship.”
Here are five poses Sweeney recommends for couples looking to spice things up in the bedroom — or any room, really.
1. Laying Down Side Straddle
When it comes to oral sex, Sweeney recommends having the person with a disability lie on their side and have their partner stimulate them orally from behind. “This position is great for people with spastic hips,” Sweeney added.
2. Modified Doggy-Style
Doggy-style is a fun position for couples looking to switch things up. If you need to sit and can’t be the one doing the thrusting, ask your partner to back themselves on to you, moving back and forth.
Sweeney recommends talking to your partner before getting started. “Ask questions, respectful questions, and listen to your partner,” she said. “Also, you might want to feel your partner’s body before you get into the sexy time so you have a better understanding of how your partner’s body works.”
Another oral sex position Sweeney recommends is “69.” “I would recommend 69, where one partner lays on his back and the other partner backs himself up on top,” she explained.
4. Modified Missionary
This modified missionary position is a great option if one person is able-bodied. Have the able-bodied partner stand at the bedside while the disabled partner lays at the edge of the bed. Add some pillows to the mix to help position yourself comfortably.
If it’s your first time with a new partner and a position requires you to move out of your wheelchair before you get into “sexy mode,” walk your partner through the transfer. Alternatively, Sweeney said, you can ask your aide to show them how to do the transfer.
5. Giving Oral Sex From Your Wheelchair
If you want to give oral sex from your wheelchair, ask your partner to lie on the edge of the bed and place the lower half of their body on your lap.
If you aren’t a fan of oral sex or want to explore your sexuality on your own, Sweeney recommends looking into toys. “There are so many toys to help you explore your sexuality,” she said. “Most people can find something that works for them.”
Jordan Davidson is The Mighty’s Managing Editor. Follow her on twitter @JA_Davids or email her at email@example.com
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