bluuebunny/crossref_metadata_2025 huggingface dataset:
The Factor Structure of the UPDRS as an Index of Disease Progression in Parkinson's Disease
Authors: Evans Jonathan R. , Mason Sarah L. , Williams-Gray Caroline H. , Foltynie Thomas , Trotter Matthew , Barker Roger A.
Published: December 2019

The optimum method for evaluating disease progression in Parkinson's disease (PD) has not been established, and this has implications for clinical trials. The majority of previous studies have utilized change on the Unified Parkinson's disease Rating Scale (UPDRS) as an index of progression. However, the UPDRS has not been validated for this purpose. We utilized exploratory factor analysis (EFA) to evaluate the longitudinal properties of the UPDRS as an index of disease progression in PD. Data was derived from a representative cohort of 122 PD patients followed from diagnosis and assessed every 18–24 months for up to 7.9 years. For each subject the rate of change of each item on the UPDRS-3 was calculated and an EFA was performed using this data. Results were compared with those of previously published EFAs in cross-sectional PD cohorts. The UPDRS-3 retains a stable factor structure when used as an index of disease evolution. The 27 items reduced to 6 factors which accounted for 61.0% of the variance in disease progression. A dominant factor was identified which incorporated axial (gait/postural stability) symptoms and signs. Our analysis indicates that the UPDRS captures meaningful aspects of disease progression in PD, and that it is possible to identify symptom/sign complexes which evolve independently of one another. Progression in PD is predominantly characterized by the development of axial symptoms and signs. This result has implications for pathogenesis and should also inform natural history models of PD thereby allowing identification of meaningful outcome measures for clinical trials of disease-modifying therapies.
Gastrointestinal Disorders in Parkinson's Disease: Prevalence and Health Outcomes in a US Claims Database
Authors: Makaroff Lydia , Gunn Angus , Gervasoni Christophe , Richy Florent
Published: December 2019

The majority of patients with Parkinson's Disease (PD) will eventually develop gastrointestinal disorders (GIDs) such as dysphagia, constipation and gastroesophageal reflux. The objectives of this study were to examine the incidence of GIDs in PD patients in a US population, and to examine subsequent PD-related outcomes in patients with GIDs. In a US administrative health claims database, GID incidence increased over time to reach 65% at four years after PD diagnosis. To further investigate this relationship, a subset of patients was analysed in greater detail. Continuously treated PD patients with and without GIDs were matched by age, gender, comorbidities, treatment regime, US region and plan type. Their emerging health outcomes were followed up for two years. Outcomes included neuropsychiatric, motor and urogenital disturbances, as well as healthcare utilization and costs. Patients with GIDs had higher rates of psychosexual dysfunction, anxiety, depression, ataxia, pain, movement disorders, urinary incontinence and falls. Emergency room admissions, the number of drugs for pain, sleep and depression, PD-related healthcare costs and non PD-related healthcare costs also increased during the observation period in GID patients. This study indicated that GIDs may be associated with deleterious effects on some PD-related outcomes.
MPTP Mouse Models of Parkinson's Disease: An Update
Authors: Meredith Gloria E. , Rademacher David J.
Published: December 2019

Among the most widely used models of Parkinson's disease (PD) are those that employ toxins, especially 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Depending on the protocol used, MPTP yields large variations in nigral cell loss, striatal dopamine loss and behavioral deficits. Motor deficits do not fully replicate those seen in PD. Nonetheless, MPTP mouse models mimic many aspects of the disease and are therefore important tools for understanding PD. In this review, we will discuss the ability of MPTP mouse models to replicate the pathophysiology of PD, the mechanisms of MPTP-induced neurotoxicity, strain differences in susceptibility to MPTP, and the models' roles in testing therapeutic approaches.
Mitochondrial Dysfunction in Skin Fibroblasts from a Parkinson's Disease Patient with an alpha-Synuclein Triplication
Authors: Mak Sally K. , Tewari Deepika , Tetrud James W. , Langston J. William , Schüle Birgitt
Published: December 2019

Mitochondrial dysfunction has been frequently implicated in the neurodegenerative process that underlies Parkinson's disease (PD), but the basis for this impairment is not fully understood. The goal of this study was to investigate the effects of α-synuclein (α-syn) gene multiplication on mitochondrial function in human tissue. To investigate this question, human fibroblasts were taken from a patient with parkinsonism carrying a triplication in the α-syn gene. Unexpectedly, the cells showed a significant decrease in cell growth compared to matched healthy controls. With regard to mitochondrial function, α-syn triplication fibroblasts exhibited a 39% decrease in ATP production, a 40% reduction in mitochondrial membrane potential, and a 49% reduction in complex I activity. Furthermore, they proved to be more sensitive to the effects of the nigrostrial toxicant paraquat compared to controls. Finally, siRNA knockdown of α-syn resulted in a partial rescue of mitochondrial impairment and reduction of paraquat-induced cell toxicity, suggesting that α-syn plays a causative role for mitochondrial dysfunction in these patient-derived peripheral skin fibroblasts.
Bicycle Sign for Differential Diagnosis of Parkinsonism: Is it of Use in a Hilly Country Like Japan?
Authors: Miwa Hideto , Kondo Tomoyoshi
Published: December 2019

The loss of the ability to cycle after disease onset, the so-called “bicycle sign”, has been proposed as a new red flag for atypical parkinsonism. However, actual environments or situations for bicycling differ from one country to another, raising the question of whether “bicycle sign” could be universally applicable. The present study suggested that “bicycle sign” could contribute to earlier and better differential diagnosis of parkinsonism in a hilly country like Japan.
Rab1A Over-Expression Prevents Golgi Apparatus Fragmentation and Partially Corrects Motor Deficits in an Alpha-Synuclein Based Rat Model of Parkinson's Disease
Authors: Coune P.G. , Bensadoun J.C. , Aebischer P. , Schneider B.L.
Published: December 2019

Although the overabundance of human alpha-synuclein in nigral dopaminergic neurons is considered to play a pathogenic role in Parkinson's disease (PD), it remains unclear how alpha-synuclein leads to neuronal degeneration and motor symptoms. Here, we explored the effect of human alpha-synuclein in the rat substantia nigra following AAV-mediated gene delivery inducing a moderate loss of dopaminergic neurons together with motor impairments. A significant fraction of the surviving nigral neurons were found to express human αSyn and displayed a pathological fragmentation of the Golgi apparatus. This observation prompted further investigation on the role of the secretory pathway, in particular at the ER/Golgi level, in alpha-synuclein toxicity. To address this question, we co-expressed human alpha-synuclein with Rab1A, a regulator of ER-to-Golgi vesicular trafficking, and found a significant reduction of Golgi fragmentation. Rab1A did not protect the dopaminergic neurons from the alpha-synuclein-induced degeneration that occurred within several months following vector injection. However, we observed in animals co-expressing Rab1A an improvement of motor behavior that correlates with the rescue of normal Golgi morphology in alpha-synuclein-expressing dopaminergic neurons. The non-prenylable mutant Rab1A-DeltaCC did not produce any of the effects observed with the wild-type form of Rab1A, linking the protective role of Rab1A with its activity in ER-to-Golgi vesicular trafficking. In conclusion, Rab1A can rescue the Golgi fragmentation caused by the overabundance of alpha-synuclein in nigral dopaminergic neurons, improving the ability of the surviving neurons to control motor function in hemiparkinsonian animals.
Putaminal Upregulation of FosB/ΔFosB-Like Immunoreactivity in Parkinson's Disease Patients with Dyskinesia
Authors: Lindgren H.S. , Rylander D. , Iderberg H. , Andersson M. , O'Sullivan S.S. , Williams D.R. , Lees A.J. , Cenci M.A.
Published: December 2019

The transcription factor ΔFosB is a mediator of maladaptive neuroplasticity in animal models of Parkinson's disease (PD) and L-DOPA-induced dyskinesia. Using an antibody that recognizes all known isoforms of FosB and ΔFosB, we have examined the expression of these proteins in post-mortem basal ganglia sections from PD patients. The patient cases were classified as being dyskinetic or non-dyskinetic based on their clinical records. Sections from neurologically healthy controls were also included in the study. Compared to both controls and non-dyskinetic cases, the dyskinetic group showed a higher density of FosB/ΔFosB-immunopositive cells in the posterior putamen, which represents the motor region of the striatum in primates. In contrast, the number of FosB/ΔFosB-positive cells did not differ significantly among the groups in the caudate, a region primarily involved with the processing of cognitive and limbic-related information. Only sparse FosB/ΔFosB immunoreactivity was found in the in the pallidum externum and internum, and no significant group differences were detected in these nuclei. The putaminal elevation of FosB/ΔFosB-like immunoreactivity in patients who had been affected by L-DOPA-induced dyskinesia is consistent with results from both rat and non-human primate models of this movement disorder. The present findings support the hypothesis of an involvement of ΔFosB-related transcription factors in the molecular mechanisms of L-DOPA-induced dyskinesia.
Motor Imagery of Gait Tasks in Individuals with Parkinson Disease
Authors: Pickett Kristen A. , Peterson Daniel S. , Earhart Gammon M.
Published: December 2019

We developed a questionnaire to assess motor imagery (MI) of gait and administered it to 33 controls and 28 individuals with PD. Our goals were: 1) compare gait MI in individuals with and without PD, 2) determine whether walking performance relates to gait MI and 3) compare gait MI in individuals with PD with and without freezing of gait. Gait MI was not different between PD and controls. There was no correlation between walking performance and gait MI, and no difference in gait MI between freezers and nonfreezers. The gait imagery questionnaire may be useful for imaging studies involving imagined gait.
Medication errors through a national pharmacovigilance database approach: A study for Malta
Authors: Tanti Amy , Camilleri Miriam , Bonanno Patricia Vella , Borg John-Joseph
Published: December 2019

AIM: To identify medication errors in the Maltese pharmacovigilance database and describe the frequency and characteristics of these events. METHOD: A retrospective analysis of the Adverse Drug Events (ADEs) reported over 5 years in Malta was conducted. Medication errors were identified by comparing use against the product's Summary of Product Characteristics (SmPC) and then classified by type of medication error, seriousness and the stage of the medication use chain at which they occurred. RESULTS: 319 consolidated ADE reports met the inclusion criteria and were analysed. 56/319 consolidated ADEs were associated with serious patient harm. The 80–89 and the 50–59 age groups were associated with most medications used in error. 65% of errors originated in the community. Errors were identified in prescribing (52%), therapeutic monitoring (26%), patients' own (12%), dispensing (7%) and administration (3%) stages. The non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics were most commonly used in errors involving wrong doses, lack of therapeutic monitoring, interactions; contra-indications, prescribing for an unlicensed indication as well as an inappropriate duration of therapy. CONCLUSION: Pharmacovigilance databases are a useful source of information on medication errors and can be used to detect risks associated with the use of medicinal products.
Adverse drug reactions as a reason for admission to an internal medicine ward in Argentina
Authors: Alvarez Paulino A. , Bril Fernando , Castro Verónica , Meiville Itati , Gonzalez Claudio D. , Centurion Ignacio Gomez , Parejas Griselda , Riera Cristina Soler , Saubidet Cristian Lopez , Di Girolamo Guillermo , Keller Guillermo A.
Published: December 2019

BACKGROUND: Adverse Drug Reactions (ADR) are a major cause of morbidity and mortality worldwide. In spite of this, ADR are largely underreported and unrecognized. PURPOSE: Identify and characterize ADR related admissions to our internal medicine ward using a proactive multidisciplinary pharmacovigilance approach. METHODS: Within 24 hrs of admission 1045 patients admitted to the Internal Medicine Ward between August 2010 and February 2012 were screened for possible or probable ADR related admissions. RESULTS: Probable ADR accounted for 112 of 1045 admissions (10.7%, 95% Confidence Interval [CI]: 8.8–12.6%), of which only 16 (14.3%) were classified as unavoidable. NSAIDs were the drug group more commonly implicated in probable ADR-related admissions (17.0%), followed by antiplatelets (16.1%). In-hospital mortality of patients admitted due to probable ADR was 8.0% (95% CI: 2.9–13.1%). During this study period, 6% of internal medicine ward and 4% of critical care unit beds were occupied by patients with probable ADR. The estimated cost of care of these patients was 641,000 US dollars (USD). CONCLUSION: ADR are a frequent reason for admission to an Internal Medicine Ward in Argentina. The culprit drugs and interactions are similar to those reported in the literature. The cost is substantial and most of the ADR are potentially avoidable.
Is off-label use a risk factor for adverse drug reactions in pediatric patients? A prospective study in an Indian tertiary care hospital
Authors: Saiyed Mohd Masnoon , Lalwani Tarachand , Rana Devang
Published: December 2019

BACKGROUND: The lack of specific medicines and labeling recommendations for the pediatric population is a long-standing problem. Using data from an observational study of adverse drug reactions (ADRs) among pediatric inpatients, we aimed to test the hypothesis that off-label status is a risk factor for ADRs. METHODS: A prospective intensive surveillance was conducted at a pediatric ward of a public teaching hospital. Adverse events to labeled and off-label use were assessed for incidence, severity and predictors. A multivariate Cox proportional hazards regression model used to assess off-label use is a risk factor for ADR occurring. RESULTS: Off-label and labeled use were responsible for 34 (67%) and 17 (33%) ADRs respectively. Medicines which lacked complete pediatric labeling had the greatest odds for ADRs (9.21% of medicines in this category were implicated, OR 2.84 (95% CI 1.37–7.09). Number of off-label medicines given to patient significantly increased the hazard of an ADR (hazard ratio (HR) 1.28, 95% CI 0.43–3.78, P = 0.002). Number of medicines given also significantly increased the hazard (HR 1.2, 95% CI 0.80–1.71, P < 0.001). CONCLUSIONS: Use of off-label medicines were more likely to be implicated in an ADR than labeled medicines. This off-label use would be acceptable if evidence of potential benefits outweighs ADRs risk.
The FDA should test the safety of ECT machines
Authors: Breggin Peter R.
Published: December 2019

Electroconvulsive therapy (ECT) and the machines that deliver it have never been tested for safety and efficacy in order to receive approval from the FDA. The American Psychiatric Association and ECT advocates protested when the FDA took steps to classify the machines as posing “an unreasonable risk of illness or injury”, which would have required their testing before approval. Without requiring this testing, the FDA is now preparing to classify the treatment and the machines as safe. This article reviews evidence demonstrating that ECT is very harmful to the brain and mind, and concludes that the FDA should demand the usual testing, starting with animals, that is required before psychiatric treatments and machines are approved for marketing and use.
Drug-induced acute dystonia in a 7 year old child following the use of artesunate-amodiaquine: A case report
Authors: Fajolu I.B. , Lesi F.E.A.
Published: December 2019

Acute drug induced dystonias are commonly reported with antipsychotic drugs, however there have been reports of extrapyramidal symptoms following the use of 4-aminoquinolones such as chloroquine and amodiaquine for treating malaria especially in adults and adolescents. The aim of this report is to sensitize health care providers to the possibility of amodiaquine induced dystonia in children. We report a case of acute dystonic reaction following the use of artesunate-amodiaquine in a 7 year old boy who presented with tongue protrusion, inability to talk, torticollis, opistothonus and laryngeal spasm. Symptoms began about 22 h after treatment with artesunate-amodiaquine was initiated. The reaction was aborted with intravenous diazepam and the artesunate-amodiaquine was discontinued. Therefore, there is the need to conduct research on the prevalence of acute drug induced dystonia following the use of artesunate-amodiaquine in children especially in the community to evaluate the magnitude of this problem.
Assessing the risk of percutaneous dilatational tracheostomy in ICUs using a broad event-consequence-uncertainty perspective
Authors: Sollid Stephen J.M. , Eidesen Karianne , Aven Terje , Søreide Eldar
Published: December 2019

Background and objective: Probabilistic risk assessment methods are well suited for exploring hazards and threats in patient care due to their ability to analyse complex systems and include human factors. Adopting an event (A) – consequence (C) – uncertainty (U) perspective (referred to as the (A, C, U) perspective) the focus of the risk assessment is on predictions and uncertainty assessment of observable quantities. Uncertainty is the main component of risk, and probability is a tool for expressing this uncertainty. To demonstrate the feasibility of this perspective in risk assessment to improve patient safety, we have applied it to the high-risk activity of percutaneous dilatational tracheostomy in an intensive care unit. Methods: Using a Bayesian belief network, we modelled and analysed fault trees of two relevant adverse events: “Perioperative bleeding” and “loss of airway”. The analysis was based on a broad knowledge basis and incorporated risk influencing factors. Results: In the risk assessment we assigned the probability of “perioperative bleeding” at 8.0% and “loss of airway” at 0.05%. The uncertainty assessment identified operator and team performance to affect risk the most. Conclusion: Risk assessment according to the (A, C, U) perspective is a valuable tool to support decision-making in patient safety matters and explore risk influencing factors.
Long-term complication: Florida's death certification process and long-term care
Authors: Williams Leah , Dewey Hayley , Kapp Marshall B.
Published: December 2019

This article discusses the medical-legal aspects of death certification in Florida long-term care settings based on an examination of relevant Florida laws and federal guidelines and a comparison of those laws and guidelines to actual medical practice. A review of the health care literature and Florida law, supplemented by interviews with key informants, supports the conclusion that Florida statutes provide a clear protocol for efficient death certification, but do not ensure the accuracy of death certificates. The death certification process in Florida long term care settings could be improved through increased physician training, the development of quality controls, and the expanded use of electronic patient medical records.
Pharmacoepidemiology of antiepileptic drugs in children: Comparative analysis of efficacy and safety
Authors: Gamirova Rimma G. , Shaimardanova Rosa M. , Ziganshina Lilia E.
Published: December 2019

Pharmacoepidemiology analysis of efficacy and safety of antiepileptics was carried out in children (3 months–18 years old) registered with municipal children's epilepsy services: 548 children in 2005, 718 – In 2007 and 32 – In 2011. We used remission lasting for 1 year or longer, and 3 years or longer as primary effectiveness outcomes, and total number of people with adverse effects as a safety outcome. We found no advantages of newer antiepileptics over the older ones in terms of either efficacy or safety. Long-term follow up (more than 3 years) showed higher treatment response rate in patients with childhood versus juvenile absence epilepsy.
Tablet-based video modeling and prompting in the workplace for individuals with autism
Authors: Burke Raymond V. , Allen Keith D. , Howard Monica R. , Downey Doug , Matz Michael G. , Bowen Scott L.
Published: December 2019

The current study involved a preliminary job-site testing of computer software, i.e., VideoTote, delivered via a computer tablet and designed to provide users with video modeling and prompting for use by young adults with an autism spectrum disorder (ASD) across a range of employment settings. A multiple baseline design was used to assess changes in rates of completion with a complex, 104-step shipping task by four participants diagnosed with ASD. Baseline data were collected on accuracy of task completion after exposure to typical job-training involving instruction, modeling, and practice. The intervention involved video modeling and prompting with a 13 minute video depicting an individual completing job responsibilities that entailed checking to make sure materials were in working order, replacing defective items, packing materials in a container, entering information into a computer, and attaching a label to a container. Results suggested that video modeling and prompting were effective in helping individuals with autism complete a multi-step shipping task. Participants and their parents gave the device and software high ratings as an acceptable treatment for adults with autism to use in the workplace and intervention that complies with universal design principles. Implications for competitive job opportunities for individuals with autism are discussed.
Successful vocational outcomes: A multilevel analysis of self-employment through U.S. vocational rehabilitation agencies
Authors: Yamamoto Scott H. , Alverson Charlotte Y.
Published: December 2019

This study examined self-employment within the context of U.S. vocational rehabilitation (VR) to identify significant predictors of successful self-employment case closure, how these predictors changed over time, and whether there were differences in the likelihood of successful self-employment closure across states. To answer the research questions, five fiscal years (FYs) of RSA 911 data from 2003 to 2007, constituting more than a million cases, were analyzed using a two-level Hierarchical Linear Modeling (HLM). These years were selected because they occurred between the two most recent economic recessions. Statistically significant (p < 0.001) predictors of successful self-employment closure across the FYs were: gender, ethnicity, cost of VR services, education attainment, and public supports. The only difference occurred in FY 2004, when significant-disability status was also a significant predictor. Among the significant predictors, ethnicity had the largest effect, followed by education attainment and gender. States were significantly different in their likelihood of successful self-employment closures. Analyses of additional, more recent years of RSA data using HLM with other predictors are warranted to draw more definitive conclusions and develop substantive theoretical explanations. Limitations and implications of this study for researchers and VR agencies are discussed in conclusion.
Predictors of competitive employment of VR consumers with blindness or visual impairments
Authors: Darensbourg Brandi L.
Published: December 2019

The purpose of this study was to investigate the relationships among demographics and competitive employment outcomes of vocational rehabilitation consumers with blindness or visual impairments. Using a sample from the RSA-911 data file from fiscal year 2006, relationships were examined among 20 consumer demographic variables related to competitive employment outcomes. The methodology, results, limitations of the study, and implications for practice and future research are discussed.
A focus on natural supports in postsecondary education for students with intellectual disabilities at Western Carolina University
Authors: Kelley Kelly R. , Westling David L.
Published: December 2019

Postsecondary education opportunities for students with intellectual disabilities (ID) have increased over the past 40 years. Although programs vary, some have been designed to provide a fully inclusive learning experience. The University Participant (UP) Program at Western Carolina University (WCU) is a fully inclusive program where participants live in campus residence halls, audit classes, work in internships on campus, and participate in a wide variety of on-campus activities. An important part of the UP program is the student volunteers serving as natural supports or individuals providing necessary assistance in typical environments for UP Program participants throughout the day. This paper describes how the WCU UP Program uses natural supports to facilitate inclusive opportunities, responsibilities, recruitment, training, coaching, coordination, scheduling, and evaluation of work performance. We conclude with benefits of having undergraduate students serve as natural supports in postsecondary education programs.
Understanding the competencies needed to customize jobs: A competency model for customized employment
Authors: Harvey Jennifer , Szoc Ronald , Dela Rosa Michelle , Pohl Michelle , Jenkins Jessica
Published: December 2019

BACKGROUND: Customized employment (CE) has been shown to be a viable employment option for individuals with disabilities [1, 2], but to implement CE solutions, service providers need expanded capabilities that they may not have. OBJECTIVE: The specific purpose of this research was to develop a CE competency model embodying the knowledge, skills, abilities and other characteristics necessary to provide CE solutions. METHOD: Using a job analysis approach, data collection activities included interviews with subject matter experts (SMEs) and a series of iterative SME panel reviews to develop task, knowledge, skills and ability lists. Next, competencies were developed using a Q-sort methodology. The CE competency model was then verified to ensure its accuracy, completeness, and relevancy through SME ratings. RESULTS: The final model contained 31 tasks grouped into four CE components, and 84 KSAOs grouped into nine competencies. CONCLUSION: The CE competency model has a number of strengths that will make it a useful tool for the vocational rehabilitation field. Future research should seek to identify, develop or obtain objective measures of CE outcomes and test the relationship between the CE competency model and CE outcomes.
A randomized controlled trial of evidence-based supported employment: Nonvocational outcomes
Authors: Kukla Marina , Bond Gary R.
Published: December 2019

BACKGROUND: While the Individual Placement and Support (IPS) model of supported employment has been shown to improve competitive employment outcomes, randomized controlled trials have consistently failed to show improved nonvocational outcomes for IPS participants compared to participants receiving traditional vocational services. AIMS: This study evaluated the impact of IPS on nonvocational outcomes for clients with severe mental illness (SMI). METHODS: A longitudinal analysis of data from a randomized controlled trial compared IPS to a stepwise vocational approach on employment outcomes over two years. Nonvocational outcomes were symptoms, psychiatric hospitalizations, quality of life, and social networks. Results: Although the total sample showed improvement in several nonvocational domains over time, there were largely no differences between groups in nonvocational outcomes at follow-up or in their rates of improvement over time. CONCLUSIONS: Participation in supported employment alone is not sufficient to positively impact most nonvocational outcomes in people with severe mental illness.
Economic and programmatic indicators explain vocational rehabilitation employment rates of persons with cognitive disabilities
Authors: Nord Derek , Hewitt Amy , Nye-Lengerman Kelly
Published: December 2019

This national study investigated state economic health and state Vocational Rehabilitation (VR) services for persons with cognitive disabilities. Using 2004 to 2010 extant data from the Rehabilitation Services Administration (RSA) and the U.S Bureau of Labor Statistics (BLS) and the U.S. Census Bureau, this study explains variability in state VR services employment outcomes based on state economic performance and state-level VR factors. The results show state economic performance explains a significant amount of the variation in state VR employment rates for persons with cognitive disabilities. An additional significant amount of variation was explained after accounting for VR programmatic factors. These findings have broad economic and programmatic implications that should be considered to improve the employment rate of persons with cognitive disabilities.
Functional limitations in TBI and their relationship to job maintenance following work re-entry
Authors: Artman Laura K. , McMahon Brian T.
Published: December 2019

Using data from the Job Accommodation Network Information System (JANIS), the utility of self-reported functional limitations was examined in relationship to job maintenance for individuals with traumatic brain injury (TBI) who had returned to work. It was found that memory loss and attention/concentration concerns were the most common functional limitations reported. To further establish which limitations were associated with job maintenance, a binary logistic regression was applied. Results suggested that the presence of medical symptoms and emotional dysregulation were reliably and inversely associated with job maintenance. Implications are provided for further research as well as the practice of rehabilitation counseling.
Customized self-employment and the use of Discovery for entrepreneurs with disabilities
Authors: Heath Karen L. , Ward Karen M. , Reed Danielle L.
Published: December 2019

Discovery, a key component of the customized employment model, is a method to identify an individual's connections and supports, skills and interests through a series of interviews, conversations, and observations. The purpose of the StartUp Alaska research-demonstration project was to identify promising practices in the self-employment realm. The study included 71 participants with disabilities who were interested in or pursuing self-employment. Of the 71 participants, 33 individuals launched their business during the four-year project. Results based on a self-employment facilitator generated database and survey on individual participants indicated an association between successful business launch and the use of Discovery. While findings suggest an association, further research on all of the model components, including Discovery, Business Planning, and Virtual Incubator should be conducted.
Inclusive postsecondary education: Reimagining the transition trajectories of vocational rehabilitation clients with intellectual disabilities
Authors: Yamamoto Kathryn K. , Stodden Robert A. , Folk Eric D.R.
Published: December 2019

Persons who participate in postsecondary education (PSE) enjoy improved prospects for securing gainful employment and realizing greater independence. Historically, state vocational rehabilitation (VR) agencies have supported persons with disabilities to participate in PSE as a pathway to future employment. However, until recently PSE was not considered as an option for individuals with intellectual disabilities (ID) who were frequently encouraged to transition directly from school to employment or placements in community rehabilitation programs. With a growing recognition of the value of PSE as a quality placement for persons with ID and an increasing number of available programs, VR counselors and administrators face what may amount to a paradigm shift away from the traditional transition trajectory for clients with ID. This paper highlights how one VR agency assumed a leading role in the transition of students with ID into PSE through participation in a model demonstration based around three evidence-based practices: interagency team processes, person centered planning, and provision of essential PSE supports (educational coaches).
Persistence to degree completion: A profile of students with psychiatric disabilities in higher education
Authors: Koch Lynn C. , Mamiseishvili Ketevan , Higgins Kristin
Published: December 2019

Accumulating evidence indicates that although the enrollment of students with psychiatric disabilities in U.S. postsecondary institutions is on the rise, these students are not persisting to degree completion at the same rate as their peers without psychiatric disabilities. However, a national investigation of the persistence rates and characteristics of students with disabilities has yet to be conducted. This research study summarizes descriptive data from the Beginning Postsecondary Students Longitudinal Study (BPS: 04/09) data set on the characteristics and persistence rates of students with psychiatric disabilities (N = 350) enrolled in U.S. postsecondary institutions. The first-to-second year persistence rate of these students was 76.6% while the three year cumulative persistence and persistence to degree completion rates were 61% and 54.7%, respectively. The demographic and background characteristics of the participants resembled those of typical at-risk students in postsecondary education. Although their academic and social integration into their institutions was limited, chi-square analyses did reveal a significant association between first-to-second year persistence and how often students met with their academic advisors in their first year. These analyses also demonstrated a significant relationship between first-to-second year persistence and all three social integration variables examined in the study.
Efficacy of accommodations for students with disabilities in higher education
Authors: Schreuer Naomi , Sachs Dalia
Published: December 2019

BACKGROUND: Legislation and policy changes have enhanced enrolment of students with disabilities in higher education. These changes include establishing a duty to make ‘reasonable’ accommodations to educational institutions for the provision of accessible facilities and services in order to minimize barriers to equal participation in education. OBJECTIVES: To identify universal and personal accommodations that students with disabilities use; to assess students' appraisal of the accommodations' efficacy; to establish validity and reliability of the Physical, Human and Academic Accommodation Services (PHAAS), that evaluates the use of accommodations and their efficacy. METHOD: Study participants were 170 students with various disabilities from higher-educational institutions. Research tools included the PHAAS scale, and the College Student Experiences Questionnaire (CSEQ). RESULTS: Revealed significant correlations between the use of accommodations and: Grades Point Average, participation in student experiences, satisfaction with participation, and appraisal of the institution as a facilitating environment. CONCLUSIONS: Evaluating efficacy of accommodations is crucial to improve participation of students with disabilities in higher education. The study uncovered gaps in the application of accessibility and universal design principles, and lacunas in services provided. Thus, the evidence presented can aid managers and policy makers in high education and in workplaces to create an inclusive accessible environment.
Personal assistance for students with severe physical disabilities	in post-secondary education: Is it the deal breaker?
Authors: Stumbo Norma J. , Martin Jay K. , Hedrick Bradley N.
Published: December 2019

Persons with severe physical disabilities are disadvantaged in the postsecondary education and the workforce due to inadequate education and educational supports. One of these educational supports is the availability of reliable and trained 24/7/365 personal assistance. Without adequate access to personal assistance, individuals with severe physical disabilities simply cannot attend and graduate from postsecondary degree programs. It is clear that if individuals with high support needs cannot live within the educational environment, they will not be able to succeed in the educational environment. This article examines the nature of this problem, describes current models of postsecondary disability support structures, and explores the difficulties and challenges inherent in personal assistance service provision. It is hoped that this discussion will prompt broader discourse regarding postsecondary services for students with severe physical disabilities and impact their participation in higher education.
Post-school outcomes of students with disabilities: A quantitative	and qualitative analysis
Authors: Curtis Rebecca S. , Rabren Karen , Reilly AmySue
Published: December 2019

Post-school outcomes are measured by how successful students are integrating into their communities as productive citizens. Halpern's [10] "quality-of-life" transition outcomes were examined in this study using a mixed method research design of quantitative and qualitative measures. This study investigated a post-school outcomes survey administered in a southeastern state for the academic years 2003–2006 of former students who received special education services while in high school. The majority of the participants who provided data for both the survey and focus group methodologies had high incidence disabilities (i.e., learning disabilities, mental retardation, and emotional disturbance). Results from each data analysis method supported the findings of the other and each method contributed to the understanding of quality-of-life attainment as perceived by participants. Overall, the results of this mixed methods study illustrate that the use of focus group methodology compliments the post-school outcomes survey results by revealing the many reasons for participants' responses by answering how and why questions.
Evaluation of self-esteem as a worker for people with severe	mental disorders
Authors: Corbière Marc , Lanctôt Nathalie , Sanquirgo Nathalie , Lecomte Tania
Published: December 2019

Self-esteem plays an important role in the recovery, particularly the work integration, of people with severe mental disorders. The Rosenberg Self-Esteem Scale, a widely used instrument that taps into global self-esteem, has been adapted to specifically assess self-esteem as a worker. The present study aimed at validating the Rosenberg Self-Esteem as a Worker Scale and determining its sensitivity to change in people with severe mental disorders registered in Supported Employment programs. An exploratory factor analysis showed two emerging factors later supported by a confirmatory factor analyses. The first subscale was named "Individual Self-Esteem as a Worker", and the second subscale, was entitled "Social Self-Esteem as a Worker". A subsequent MANCOVA further showed that the past work experience has a significant main effect on the Individual Self-Esteem as a Worker subscale. Furthermore, results revealed that only the Individual Self-Esteem as a Worker subscale changes significantly when people obtain employment. Finally, work satisfaction and particularly items related to satisfaction regarding the supervisor were significantly related to the Individual Self-Esteem as a Worker subscale. Avenues of research are discussed concerning the crucial role of the supervisor in improving the self-esteem as a worker and the work integration of people with severe mental disorders.
Unmet health care needs and medical out-of-pocket expenses of SSI	children
Authors: DeCesaro Anne , Hemmeter Jeffrey
Published: December 2019

Children with disabilities may have substantial health care needs due to their physical, mental, or emotional impairments. For many, taking care of these needs is critical to prevent further deterioration in their health and to promote the successful transition to life as an adult. In this paper we examine the unmet health care needs and medical out-of-pocket (MOOP) expenses for a subgroup of children with disabilities – those collecting Supplemental Security Income (SSI) payments. Using the National Survey of SSI Children and Families (NSCF), we find that: (1) only 9 percent of SSI children report delaying or going without health care in the year before the interview and 24 percent report MOOP expenses; (2) Medicaid insurance reduces both the incidence of unmet needs and MOOP expenses for SSI children; (3) those with an unmet need have higher MOOP expenses and receive lower SSI payments; and (4) the vast majority of MOOP expenses are substantially less than SSI payments for most child recipients. In total, this research shows fairly good coverage of the medical needs and expenses of SSI youth before they transition to adulthood.
Changing circumstances: Experiences of child SSI recipients before	and after their age-18 redetermination for adult benefits
Authors: Hemmeter Jeffrey , Kauff Jacqueline , Wittenburg David
Published: December 2019

This paper provides an analysis of the dynamics of the transition of child Supplemental Security Income (SSI) recipients into adulthood using linked 2001–2002 National Survey of SSI Children and Families (NSCF) survey and Social Security Administration (SSA) administrative data. We examine the interaction of impairment status, reported health needs, and other self-reported indicators of human capital on SSI program and employment outcomes after age 18. Our primary objective is to examine the differences in pre-age-18 individual characteristics across subgroups of recipients by impairment status and determine whether these differences influence post-age-18 SSI participation and employment outcomes. We find that after controlling for measures of disability severity, duration, and human capital, youth with behavioral disorders and mental disorders other than mental retardation are much less likely to receive SSI at age 19. The findings also suggest that non-health factors, particularly education, employment, and social indicators, play an important role in the probability of a child SSI recipient being on adult SSI after age 18. Our findings indicate that, while some youth appear to be making a successful transition from child SSI benefits to adult benefits or other activities (off of SSI), others appear to have limited prospects for long-term self-sufficiency. A major concern is that some youth no longer on SSI after age 18, particularly those with behavioral disorders and mental disorders other than mental retardation, may not have been sufficiently prepared for life without SSI.
A decision tree for the use of auditory prompting strategies
Authors: Post Michal , Montgomery Joyce , Storey Keith
Published: December 2019

This article provides a decision tree for determining the most effective method of auditory prompting systems in order to increase workplace independence for employees with severe disabilities. A flow-through chart, The Auditory Prompts Decision Tree, is presented to guide this planning process. The Auditory Prompts Decision Tree is useful when analyzing why the breakdown in work performance is occurring and for selecting the types of auditory prompts that will support the employee's work performance needs. Specific examples from research studies are provided to illustrate the use of the Auditory Prompts Decision Tree for each type of auditory prompt.
Impact on quality of life and self-determination of a national program for increasing supported employment in Europe
Authors: Verdugo M.A. , Martín-Ingelmo R. , Jordán de Urríes F.B. , Vicent C. , Sánchez M.C.
Published: December 2019

Supported employment in many European countries is spreading somewhat slowly, with specific nationwide programs being required to enable significant progress in integrating people with disabilities and other limitations into the ordinary labor market. This article describes the Caja Madrid SE Program, deployed throughout every province in Spain, for people with disabilities and people who experience social exclusion. We set out the characteristics of the program, the profile of those taking part, and the results achieved in terms of employment between 2005 and 2007. Finally, we include the results of the research related to the participants' quality of life and self-determination.
Multiple sclerosis: Medical and psychosocial aspects, etiology, incidence, and prevalence
Authors: Rumrill Jr. Phillip D.
Published: December 2019

This article provides an overview of the etiology, incidence, and prevalence of multiple sclerosis (MS), one of the most common neurological disorders in the world. The author describes the demographic characteristics of people who incur MS, discusses the auto-immune processes that cause damage to the central nervous system, reports the most frequently occurring symptoms, and presents treatment and symptom management strategies that have proven efficacious in reducing the extent of disability associated with this chronic and unpredictable disease.
Predicting readiness to return to work in a population with multiple sclerosis
Authors: Pack Tresvil G. , Szirony Gary M.
Published: December 2019

Return to work is a key concept in vocational rehabilitation. Predicting readiness to return to work is salient to the process of vocational rehabilitation for individuals with Multiple Sclerosis. An individual's readiness to return to work has been shown to be an effective predictor of that person's actual return to work. A survey of a population of persons with MS (N = 663) was analyzed using correlation and multiple regression analyses. Severity of symptoms appeared to predict reported readiness to return to work over other factors. Issues including the relationship of self-efficacy to readiness to return to work are discussed. Further research is recommended.
Senate testimony regarding the reauthorization of the Workforce Investment Act (WIA) of 1998
Authors: Kiernan William E. , Hoff David
Published: December 2019

On July 16, 2009, Dr. William E. Kiernan provided testimony to the U.S. Senate HELP Subcommittee on Employment and Workplace Safety addressing ‘Modernizing the Workforce Investment Act (WIA) of 1998 to Help Workers and Employers Meet the Changing Demands of a Global Market’. The purpose of the hearing was to investigate how best to streamline a decision-making process that respects the necessary and complementary roles of the state, local areas, state legislatures and the federal government, and encourage regional arrangements: to explore how to ensure a dual customer approach that supports the needs of workers, jobseekers and employers; to discuss how to fully engage education partners, including community colleges and community-based organizations; and to explore the need for professional development for workforce system staff and partners. The panel was asked to address what works and should be preserved and refined in the current workforce system and what should be eliminated and, second, what innovative policy recommendations would modernize WIA. His testimony is provided in its entirety.