Search results for: neurological rehabilitation

Authors: Salem Alsanusi, Abdulla Alakad

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An experimental investigation to study the behaviour of under flexure reinforced concrete T-Beams. Those Beams were loaded to pre-designated stress levels as percentage of calculated collapse loads. Repairing these beans by either reinforced concrete jacket, or by externally bolted steel plates were utilized. Twelve full scale beams were tested in this experimental program scheme. Eight out of the twelve beams were loaded under different loading levels. Tests were performed for the beams before and after repair with Reinforced Concrete Jacket (RCJ). The applied Load levels were 60%, 77% and 100% of the calculated collapse loads. The remaining four beams were tested before and after repair with Bolted Steel Plate (BSP). Furthermore, out previously mentioned four beams two beams were loaded to the calculated failure load 100% and the remaining two beams were not subjected to any load. The eight beams recorded for the RCJ test were repaired using reinforced concrete jacket. The four beams recorded for the BSP test were all repaired using steel plate at the bottom. All the strengthened beams were gradually loaded until failure occurs. However, in each loading case, the beams behaviour, before and after strengthening, were studied through close inspection of the cracking propagation, and by carrying out an extensive measurement of deformations and strength. The stress-strain curve for reinforcing steel and the failure strains measured in the tests were utilized in the calculation of failure load for the beams before and after strengthening. As a result, the calculated failure loads were close to the actual failure tests in case of beams before repair, ranging from 85% to 90% and also in case of beams repaired by reinforced concrete jacket ranging from 70% to 85%. The results were in case of beams repaired by bolted steel plates ranging from (50% to 85%). It was observed that both jacketing and bolted steel plate methods could effectively restore the full flexure capacity of the damaged beams. However, the reinforced jacket has increased the failure load by about 67%, whereas the bolted steel plates recovered the failure load.

Keywords: rehabilitation, strengthening, reinforced concrete, beams deflection, bending stresses

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Authors: Lateef Hakim Zai Khyber, Syed Rashid Ali

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In the post 9/11 era, a new trend has developed of terrorist profiling on the basis of the ethnic, religious, political, psychological, social, and economic background of the terrorists to anticipate and assess the possible risk and to prevent and prosecute the suspected before they commit any violent act. The same profiling approach was adopted in different militant or terrorist de-radicalization and rehabilitation programs across the world in order to evaluate and identify the reasons and causes for joining terrorism in terms of push and pull factors. This paper attempts to explore and investigate the profiles of the detainees in the Sabaoon de-radicalization and Emancipation program, which aimed at de-radicalizing the former militants of Tehrik-e-Taliban (TTP) Pakistan in the Swat valley of Pakistan. This research attempted to use qualitative methods for collecting data, including a number of formal and informal open-ended interviews with the former staff members of Sabaoon to explore various aspects of the program, such as various approaches used at Sabaoon for terrorist profiling. It conducts a thorough examination of the profiles of the terrorist through their socioeconomic, ideological, emotional, intellectual, and psychological conditions and orientations, personal details, family issues, social preferences, etc. The study finds out that the majority of the terrorists belonged to the marginalized groups or lower class, including underprivileged tenants and poor laborers, of society having no access to land. They possess almost the same profiles, including low socioeconomic status, absence of a father or strict behavior of parents, large and combined families, lack of education, lack of religious understanding, etc. They also possess some common traits such as anxiety disorder, emotional instability, aggressive impulses and insecurity, depression, inferiority complex, lack of critical thinking and logical reasoning, authority-seeking behavior, and revenge-seeking behavior.

Keywords: terrorist profiling, Sabaoon, de-radicalization, rehabilitation, Swat, Pakistan, juvenile militants

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Authors: Ryan Goh, Nicholas Beech

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Introduction: Le Fort I Osteotomies, although are common procedures in Oral and Maxillofacial Surgery, carry a degree of risk of unfavourable propagation of the down-fracture of the maxilla. This may be the first reported case in the literature for meningoencephalitis to occur following a Le Fort I Osteotomy. Case: A 32-year-old female was brought into the Emergency Department four days after a Le Fort I Osteotomy, with a Glasgow Coma Scale (GCS) of 8 (E3V1M4). A Computed Tomography (CT) Head showed a skull base fracture at the right sphenoid sinus. Lumbar puncture was completed, and Klebsiella oxytoca was found in the Cerebrospinal Fluid (CSF). She was treated with Meropenem, and rapidly improved thereafter. CSF rhinorrhoea was identified when she was extubated, which was successfully managed via a continuous lumbar drain. She was discharged on day 14 without any neurological deficits. Conclusion: The most likely aspect of the Le Fort I Osteotomy to obtain a skull base fracture is during the pterygomaxillary disjunction. Care should always be taken to avoid significant risks of skull base fractures, CSF rhinorrhoea, meningitis and encephalitis.

Keywords: meningitis, orthognathic surgery, post-operative complication, skull base, rhinorrhea

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Authors: Sibel Ecemiş Kılıç, Muhammed Aydoğan

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The rapid development of culture tourism has drawn attention to conserving cultural values especially by developing countries that would like to benefit from the economic contribution this type of tourism attracts. Tourism can have both positive and negative outcomes for historical settlements and their residents. The accommodation-purposed rehabilitation and revitalization project in “Sigacik Old City Zone” are to be discussed with spatial, economic, social and organizational dimensions. It is aimed to evaluate the relationship between the development of tourism and sustainable heritage conservation.

Keywords: Sığacık, urban conservation, sustainable tourism, Seferihisar

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Authors: Siphesihle Hlongwane

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Background: Globally, alcohol consumption, smoking, and the use of illicit drugs kill more than 11.8 million people each year. In sub-Saharan Africa, substance abuse is responsible for more than 6.4% of all deaths recorded and about 4.7% of all Disability Adjusted Life Years (DALYs), with numbers still expected to grow if no drastic measures are taken to curb and address drug use. In a setting where substance use is rife, understanding contextual factors that influence an individual’s perceived eligibility to seek rehabilitation is paramount. Using the candidacy framework, we unpack how situational factors influence an individual’s perceived eligibility for healthcare uptake in adolescents and youth with substance use disorder (SUD). Methods: The candidacy framework is concerned with how people consider their eligibility for accessing a health service. The study collected and analyzed primary qualitative data to answer the research question. Data were collected between January and July 2022 on participants aged between 18 and 35 for drug users and 18 to 60 for family members. Participants include 20 previous and current drug users and 20 family members that experience the effects of addiction. A pre-drafted semi-structured interview guide was administered to a conveniently sampled population supplemented with a referral sampling method. Data were thematically analyzed using the NVivo 12pro software to manage the data. Findings: Our findings show that people with substance use disorders are aware of their drug use habits and acknowledge their candidacy for health services. Candidacy for health services is also acknowledged by those around them, such as family members and peers, and as such, information on the navigation of health services for drug users is shared by those who have attended health services, those affected by drug use, and this includes health service research by family members to identify accessible health services. While participants reported willingness to quit drug use if assistance is provided, the permeability of health care services is hindered by both individual determinations to quit drug use from long-time use and the availability of health services for drug users, such as rehabilitation centers. Our findings also show that drug users are conscious and can articulate their ailments; however, the hunt for the next dose of drugs and long waiting cues for health service acquisition overshadows their claim to health services. Participants reported a mixture of treatments prescribed, with some more gruesome than others prescribed, thus serving as both a facilitator and barrier for health service uptake. Despite some unorthodox forms of treatments prescribed in health care, the majority of those who enter treatment complete the process of treatment, although some are met with setbacks and sometimes relapse after treatment has finished. Conclusion: Drug users are able to ascertain their candidacy for health services; however, individual and environmental characteristics relating to drug use hinder the use of health services. Drug use interventions need to entice health service uptake as a way to improve candidacy for health use.

Keywords: substance use disorder, rehabilitation, drug use, relapse, South Africa, candidacy framework

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Authors: Lilah Inzelberg, David Rand, Stanislav Steinberg, Moshe David Pur, Yael Hanein

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Human facial expressions carry important psychological and neurological information. Facial expressions involve the co-activation of diverse muscles. They depend strongly on personal affective interpretation and on social context and vary between spontaneous and voluntary activations. Smiling, as a special case, is among the most complex facial emotional expressions, involving no fewer than 7 different unilateral muscles. Despite their ubiquitous nature, smiles remain an elusive and debated topic. Smiles are associated with happiness and greeting on one hand and anger or disgust-masking on the other. Accordingly, while high-resolution recording of muscle activation patterns, in a non-interfering setting, offers exciting opportunities, it remains an unmet challenge, as contemporary surface facial electromyography (EMG) methodologies are cumbersome, restricted to the laboratory settings, and are limited in time and resolution. Here we present a wearable and non-invasive method for objective mapping of facial muscle activation and demonstrate its application in a natural setting. The technology is based on a recently developed dry and soft electrode array, specially designed for surface facial EMG technique. Eighteen healthy volunteers (31.58 ± 3.41 years, 13 females), participated in the study. Surface EMG arrays were adhered to participant left and right cheeks. Participants were instructed to imitate three facial expressions: closing the eyes, wrinkling the nose and smiling voluntary and to watch a funny video while their EMG signal is recorded. We focused on muscles associated with 'enjoyment', 'social' and 'masked' smiles; three categories with distinct social meanings. We developed a customized independent component analysis algorithm to construct the desired facial musculature mapping. First, identification of the Orbicularis oculi and the Levator labii superioris muscles was demonstrated from voluntary expressions. Second, recordings of voluntary and spontaneous smiles were used to locate the Zygomaticus major muscle activated in Duchenne and non-Duchenne smiles. Finally, recording with a wireless device in an unmodified natural work setting revealed expressions of neutral, positive and negative emotions in face-to-face interaction. The algorithm outlined here identifies the activation sources in a subject-specific manner, insensitive to electrode placement and anatomical diversity. Our high-resolution and cross-talk free mapping performances, along with excellent user convenience, open new opportunities for affective processing and objective evaluation of facial expressivity, objective psychological and neurological assessment as well as gaming, virtual reality, bio-feedback and brain-machine interface applications.

Keywords: affective expressions, affective processing, facial EMG, high-resolution electromyography, independent component analysis, wireless electrodes

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Authors: Dragos Dragomir-Stanciu, Leon Marsh

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Background As a response to the gaps identified in recent research in the provision of residential care to address co-occurring health needs, including mental health problems and complexities Gamble Aware has facilitated the possibility to provide a new service which would extend the NGTS provision of residential rehabilitation for gambling disorder with complex and co-morbid presentation. Gordon Moody, together with Adferiad have been successful in securing the tender for this service and this presentation aims to introduce FOLD, the resulting model of treatment developed for the delivery of the service. Setting As a partnership, we have come together to coproduce a model which allows us to share our clinical and industry knowledge and build on our reputations as trusted treatment providers. The presentation will outline our expertise share in development of a unified approach to recovery-oriented models of care, clinical governance, risk assessment and management and aftercare and continuous recovery. We will also introduce our innovative specialist referral portal which will offer referring partners the ability to include the service user in planning their own recovery journey. Outcomes Our collaboration has resulted in the development of the FOLD model which includes three agile and flexible treatment packages aimed at offering the most enhanced and comprehensive treatment in UK, to date, for those most affected by gambling harm. The paper will offer insight into each treatment package and all recovery model stages involved, as well as into the partnership work with NGST providers, local mental health and social care providers and lived experience organisation that will enable us to offer support to more 100 people a year who would otherwise get “lost in the system”. Conclusion FOLD offers a great opportunity to develop, implement and evaluate a new, much needed, whole-person and whole-system approach to counter gambling related harms.

Keywords: gambling treatment, partnership working, integrated care pathways, NGTS, complex needs

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Authors: M. Saard, A. Kolk, K. Sepp, L. Pertens, L. Reinart, C. Kööp

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Introduction: Social competence is often impaired in children with acquired brain injury (ABI), but evidence-based rehabilitation for social skills has remained undeveloped. Modern technology-based methods create effective and safe learning environments for pediatric social skills remediation. The aim of the study was to implement our structured model of neuro rehab for socio-cognitive deficit using multitouch-multiuser tabletop (MMT) computer-based platforms and virtual reality (VR) technology. Methods: 40 children aged 8-13 years (yrs) have participated in the pilot study: 30 with ABI -epilepsy, traumatic brain injury and/or tic disorder- and 10 healthy age-matched controls. From the patients, 12 have completed the training (M = 11.10 yrs, SD = 1.543) and 20 are still in training or in the waiting-list group (M = 10.69 yrs, SD = 1.704). All children performed the first individual and paired assessments. For patients, second evaluations were performed after the intervention period. Two interactive applications were implemented into rehabilitation design: Snowflake software on MMT tabletop and NoProblem on DiamondTouch Table (DTT), which allowed paired training (2 children at once). Also, in individual training sessions, HTC Vive VR device was used with VR metaphors of difficult social situations to treat social anxiety and train social skills. Results: At baseline (B) evaluations, patients had higher deficits in executive functions on the BRIEF parents’ questionnaire (M = 117, SD = 23.594) compared to healthy controls (M = 22, SD = 18.385). The most impaired components of social competence were emotion recognition, Theory of Mind skills (ToM), cooperation, verbal/non-verbal communication, and pragmatics (Friendship Observation Scale scores only 25-50% out of 100% for patients). In Sentence Completion Task and Spence Anxiety Scale, the patients reported a lack of friends, behavioral problems, bullying in school, and social anxiety. Outcome evaluations: Snowflake on MMT improved executive and cooperation skills and DTT developed communication skills, metacognitive skills, and coping. VR, video modelling and role-plays improved social attention, emotional attitude, gestural behaviors, and decreased social anxiety. NEPSY-II showed improvement in Affect Recognition [B = 7, SD = 5.01 vs outcome (O) = 10, SD = 5.85], Verbal ToM (B = 8, SD = 3.06 vs O = 10, SD = 4.08), Contextual ToM (B = 8, SD = 3.15 vs O = 11, SD = 2.87). ToM Stories test showed an improved understanding of Intentional Lying (B = 7, SD = 2.20 vs O = 10, SD = 0.50), and Sarcasm (B=6, SD = 2.20 vs O = 7, SD = 2.50). Conclusion: Neurorehabilitation based on the Structured Model of Neurorehab for Socio-Cognitive Deficit in children with ABI were effective in social skills remediation. The model helps to understand theoretical connections between components of social competence and modern interactive computerized platforms. We encourage therapists to implement these next-generation devices into the rehabilitation process as MMT and VR interfaces are motivating for children, thus ensuring good compliance. Improving children’s social skills is important for their and their families’ quality of life and social capital.

Keywords: acquired brain injury, children, social skills deficit, technology-based neurorehabilitation

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Authors: Zain Khan, Steve Ahn, Kathy Monypenny, James Fink

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In Australian public hospitals, there were approximately 34,000 reported inpatient falls between 2015 to 2016. The gold standard for diagnosing intracranial injury is non-contrast enhanced brain computed tomography (CTB). Over a three-month timeframe, a total of one hundred and eighty (180) falls were documented between the hours of 4pm and 8am at a large metro hospital. Only three (3) of these scans demonstrated a positive intra-cranial finding. The rationale for scanning varied. The common indications included a fall with head strike, the presence of blood thinning medication, loss of consciousness, reduced Glasgow Coma Scale (GCS), vomiting and new neurological findings. There are several validated tools to aid in decision-making around ordering CTB scans in the acute setting, but no such accepted tool exists for the inpatient space. With further data collection, spanning a greater length of time and through involving multiple centres, work can be done towards generating such a tool that can be utilized for inpatient falls.

Keywords: computed tomography, falls, inpatient, intracranial hemorrhage

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Authors: Jayanti Pujari

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The present study attempts to find out the barriers faced by adult women with an Intellectual disability during their training at vocational training centres offered by rehabilitation institutes. As economic independence is the ultimate aim of rehabilitation, this study tries to focus on the barriers which restrict the adult women with intellectual disability in equipping themselves in required skill which can really empower them and help them in independent living. The objectives of the study are (1) To find out the barriers perceived by job coaches during training given to women with intellectual disability (2) To find out the barriers perceived by the parents of women with intellectual disability who are undergoing vocational training and (3) To find out the barriers perceived by the women with intellectual disabilities during the vocational training. The barriers have been operationalised in the present study from three perspectives such as behavioural barriers, competency related barriers and accessibility barriers. For the present study three groups of participants(N=60) have been selected through purposive nonprobability sampling procedure to generate the data. They are( 20) job coaches who are working at vocational centres, (20) parents of women with intellectual disabilities, (20) adult women with intellectual disabilities. The study followed a descriptive research design and data are generated through self developed questionnaire. Three sets of self-developed and face validated questionnaires were used as the tool to gather the data from the three categories of sample. The questionnaire has 30 close ended questions and the respondents have to answer on a three point scale (yes, no, need help). Both qualitative and quantitative analysis was conducted to test the hypothesis. The major findings of the study depict that the 87% of the women with intellectual disability perceived highest barriers related to competency whereas barriers related to behaviour and accessibility are perceived lowest. 92% of job coaches perceived barriers related to competencies and accessibility are highest which hinder the effectiveness of skill development of women with intellectual disability and 74% of the parents of adult women with intellectual disability also opines that the barriers related to competencies and accessibility are highest. In conclusion, it is stressed that there is need to create awareness among the stakeholders about the training and management strategies of skill training and positive behaviour support which will surely enable the adult women with intellectual disability to utilise their residual skill and acquire training to become economically independent.

Keywords: economic independence, intellectual disability, skill development, training barrier

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Authors: Catarina Ferreira Rebelo, Luis Madeira de Carvalho, Fernando González González

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The order Passeridae corresponds to the richest and most abundant group of birds, with approximately 6500 species, making it possible to assert that two out of every three bird species are passerines. They are globally distributed and exhibit remarkable morphological and ecological variability. While numerous species of parasites have been identified and described in wild birds, there has been little focus on passeriformes. Seventeen passerines admitted to GREFA, a Wildlife Rehabilitation Center, throughout the months of October, November and December 2022 were analyzed. The species included Aegithalos caudatus, Anthus pratensis, Carduelis chloris, Certhia brachydactyla, Erithacus rubecula, Fringilla coelebs, Parus ater, Passer domesticus, Sturnus unicolor, Sylvia atricapilla, Turdus merula and Turdus philomelos. Data regarding past history was collected, and necropsies were conducted to identify the cause of death and body condition and determine the presence of parasites. Additionally, samples of intestinal content were collected for direct/fecal smear, flotation and sedimentation techniques. Sixteen (94.1%) passerines were considered positive for the presence of parasitic forms in at least one of the techniques used, including parasites detected in necropsy. Adult specimens of both sexes and tritonymphs of Monojoubertia microhylla and ectoparasites of the genus Ornithonyssus were identified. Macroscopic adult endoparasitic forms were also found during necropsies, including Diplotriaena sp., Serratospiculum sp. and Porrocaecum sp.. Parasitism by coccidia was observed with no sporulation. Additionally, eggs of nematodes from various genera were detected, such as Diplotriaena sp., Capillaria sp., Porrocaecum sp., Syngamus sp. and Strongyloides sp., eggs of trematodes, specifically the genus Brachylecithum and cestode oncospheres, whose genera were not identified. To our knowledge, the respiratory nematode Serratospiculum sp. found in this study is being reported for the first time in passerines in the Iberian Peninsula, along with the application of common coprological techniques for the identification of eggs in the intestinal content. The majority of parasites identified utilize intermediary hosts present in the diet of the passerines sampled. Furthermore, the discovery of certain parasites with a direct life cycle could potentially exert greater influence, particularly in specific scenarios such as within nests or during the rehabilitation process in wildlife centers. These parasites may impact intraspecific competition, increase susceptibility to predators or lead to death. However, their cost to wild birds is often not clear, as individuals can endure various parasites without significant harm. Furthermore, wild birds serve as important sources of parasites across different animal groups, including humans and other mammals. This study provides invaluable insights into the parasitic fauna of these birds, not only serving as a cornerstone for future epidemiological investigations but also enhancing our comprehension of these avian species.

Keywords: birds, parasites, passerines, wild, spain

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Authors: Rajlakshmi Banerjee, Sujoy Banerjee

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The prevalence of malnutrition, as the most common cause of morbidity and mortality increases with old age, especially in developing countries like India, because of many factors out of which dentate status is one. It affects diet, nutritional status and general health due to reduced chewing ability and poor food choices. Aim and Objective: This study aimed to evaluate the effect of nutritional status, dietary intake on the Oral Health-related Quality of life (OHRQoL) of elderly edentulous complete denture wearing patients and to know whether they are at a higher risk of malnutrition. The objective was to assess the need to include dietary and nutritional counselling during Prosthodontic rehabilitation of elderly edentulous patients. Materials and method: A cross-sectional study was conducted among 200 elderly denture wearing patients above 60 yrs of age from Nagpur, Maharashtra. The majority of study subjects (60%) were between the age group 60 and 75 years. Mini-Nutritional Assessment (MNA) Questionnaire was used to assess nutritional status and General Oral Health Assessment Index (GOHAI) questionnaire was used to determine the Oral health related Quality of life of these patients.Descriptive statistics was used to analyze data using SPSS version 21. Results: Among the assessed subjects, nearly 80% of them had total scores of GOHAI between 12 and 57 which require ‘needed dental care.’ As per MNA, 10.5% had adequate nutrition, 70 % were at risk of malnutrition, and remaining 19.5 % of subjects were malnourished. There was a significant correlation between GOHAI and MNA scores. A strong association was found between mean GOHAI and MNA scores and thereby nutritional status and OHRQOL.Conclusion: The use of conventional dentures increases the risk of malnutrition in the elderly due to inability to eat and chew food properly and therefore severely affecting the quality of life. Dietary analysis and counselling should be strictly incorporated into geriatric treatment planning during Prosthetic rehabilitation.

Keywords: general oral health assessment index, General Oral Health Assessment Index (GOHAI), nutritional assessment, mini-nutritional assessment, Mini-Nutritional Assessment (MNA), quality of life

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Authors: Kenneth A. Rostowsky, Alexander S. Maher, Nahian F. Chowdhury, Andrei Irimia

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The clinical significance of cerebral microbleeds (CMBs) due to mild traumatic brain injury (mTBI) remains unclear. Here we use magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and connectomic analysis to investigate the statistical association between mTBI-related CMBs, post-TBI changes to the human connectome and neurological/cognitive deficits. This study was undertaken in agreement with US federal law (45 CFR 46) and was approved by the Institutional Review Board (IRB) of the University of Southern California (USC). Two groups, one consisting of 26 (13 females) mTBI victims and another comprising 26 (13 females) healthy control (HC) volunteers were recruited through IRB-approved procedures. The acute Glasgow Coma Scale (GCS) score was available for each mTBI victim (mean µ = 13.2; standard deviation σ = 0.4). Each HC volunteer was assigned a GCS of 15 to indicate the absence of head trauma at the time of enrollment in our study. Volunteers in the HC and mTBI groups were matched according to their sex and age (HC: µ = 67.2 years, σ = 5.62 years; mTBI: µ = 66.8 years, σ = 5.93 years). MRI [including T1- and T2-weighted volumes, gradient recalled echo (GRE)/susceptibility weighted imaging (SWI)] and gradient echo (GE) DWI volumes were acquired using the same MRI scanner type (Trio TIM, Siemens Corp.). Skull-stripping and eddy current correction were implemented. DWI volumes were processed in TrackVis (http://trackvis.org) and 3D Slicer (http://www.slicer.org). Tensors were fit to DWI data to perform DTI, and tractography streamlines were then reconstructed using deterministic tractography. A voxel classifier was used to identify image features as CMB candidates using Microbleed Anatomic Rating Scale (MARS) guidelines. For each peri-lesional DTI streamline bundle, the null hypothesis was formulated as the statement that there was no neurological or cognitive deficit associated with between-scan differences in the mean FA of DTI streamlines within each bundle. The statistical significance of each hypothesis test was calculated at the α = 0.05 level, subject to the family-wise error rate (FWER) correction for multiple comparisons. Results: In HC volunteers, the along-track analysis failed to identify statistically significant differences in the mean FA of DTI streamline bundles. In the mTBI group, significant differences in the mean FA of peri-lesional streamline bundles were found in 21 out of 26 volunteers. In those volunteers where significant differences had been found, these differences were associated with an average of ~47% of all identified CMBs (σ = 21%). In 12 out of the 21 volunteers exhibiting significant FA changes, cognitive functions (memory acquisition and retrieval, top-down control of attention, planning, judgment, cognitive aspects of decision-making) were found to have deteriorated over the six months following injury (r = -0.32, p < 0.001). Our preliminary results suggest that acute post-TBI CMBs may be associated with cognitive decline in some mTBI patients. Future research should attempt to identify mTBI patients at high risk for cognitive sequelae.

Keywords: traumatic brain injury, magnetic resonance imaging, diffusion tensor imaging, connectomics

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Authors: Lingling Li, Peng Zhao, Runze Guan, Alice Jones, Tao Yu

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Background: Shoulder pain and weakness are associated with complex pathologies and often precludes weightlifters from participation in training. The role and mode of exercise training in weightlifters with shoulder pathology remains unclear. Objectives: This case report described an exercise program in management of an elite weightlifter with primary complaint of right shoulder pain and weakness. Methods: A 22-year-old weightlifter presented with 2-year duration of right shoulder pain and weakness which was worsened by routine weightlifting training, and symptoms were not relieved with steroid injection, manual therapy nor usual physiotherapy. There was a limitation in all active range of motion especially horizontal extension (13ᵒ) and external rotation (41ᵒ) with pain intensity at 4/10 and 10/10 (numeric pain rating score) respectively. Muscle weakness was most significant at supraspinatus and teres minor, 38% and 27% respectively compared to his left shoulder (hand-held dynamometry, Micro FET2). An exercise training program focusing on improving mobility was designed for this athlete following a comprehensive physical assessment. Exercises included specific stretching, muscle activating and scapular stability training; once per day, and for 60 minutes each session. All exercises were completed under instruction as pain allowed. Quantitative assessment was conducted at the end of each week for 3 weeks. Outcomes: After the program, the athlete was pain-free in all movements except the O’Brien active compression internal rotation test, the pain was however reduced from 10/10 to 3/10. The horizontal extension and external rotation range increased to 79ᵒ to 120ᵒ respectively, and strength of all rotator cuff muscles returned to normal. At 1-month follow up, the athlete was totally pain-free and had returned to normal function and weightlifting training activities. The outcomes sustained through 6-month and one year. Conclusion: This case report supports the use of a mobility-focused exercise program for management of shoulder pain and weakness in an elite weightlifter athlete.

Keywords: exercise training, mobility, rehabilitation, shoulder pain, weightlifting

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Authors: Neeta Khurana, Ritu Sharma

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This paper is an impact assessment study of the rehabilitation work done for Chhara women in the rural precincts of Ahmedabad. The Chharas constitute a denotified tribe and live in abject poverty. The women of this community are infamous absconders of law and active bootleggers of locally made liquor. As part of a psychological study with a local NGO, the authors headed a training program aimed at rehabilitating and providing these women alternate modes of employment, thereby driving them away from a life of crime. The paper centers on the idea of women entrepreneurship and women empowerment. It notes the importance of handholding in a conflict situation. Most of the research on Chharas is either focused on victimising them for state-sponsored violence or mostly makes a plea on reconditioning them in the mainstream. Going against this trend, this paper which documents the study argues that making these poor women self-dependent is a panacea for their sluggish development. The alienation caused due to the demonisation of the community has made them abandon traditional modes of employment. This has further led the community astray into making illegal country liquor causing further damage to their reputation. Women are at the centre of this vicious circle facing much repression and ostracisation. The study conducted by the PDPU team was an attempt to change this dogmatic alienation of these poor women. It was found that with consistent support and reformist approach towards law, it is possible to drive these women away from a life of penury repression and crime. The aforementioned study uses empirical tools to verify this claim. Placed at the confluence of the sociology of gender and psychology, this paper is a good way to argue that law enforcement cannot be effective without sensitisation to the ground realities of conflict. The study conducted from which the paper borrows was a scientific survey focused on markers of gender and caste realities of the Chharas. The paper mentions various dynamics involved in the training program that paved the way for the successful employment of the women. In an attempt to explain its uniqueness, the paper also has a section on comparing similar social experiments.

Keywords: employment, gender, handholding, rehabilitation

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Authors: Hsin-Chieh Lee, Fen-Ling Kuo, Jui-Chi Lin

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Background: Upper extremity functional impairment that occurs after stroke includes hemiplegia, synergy movement, muscle hypertonicity, and somatosensory impairment, which result in inefficient and inaccurate movement. Robot-assisted rehabilitation is an intensive training approach that is effective in sensorimotor and hand function recovery. However, these systems mostly focused on the proximal part of the upper limb rather than the distal part. The device used in our study was Gloreha Sinfonia, which focuses on the distal part of the upper limb and uses a dynamic support system to facilitate the whole limb function. The objective of this study was to investigate the effects of robot-assisted therapy (RT) with Gloreha device on sensorimotor, and ADLs in patients with stroke. Method: Patients with stroke (N=25) participated AB or BA (A = 12 RT sessions and B = 12 conventional therapy (CT) sessions) for 6 weeks (60 min at each session, twice a week), with 1-month break for washout period. The performance of the patients was assessed by a blinded assessor at 4 time points (pretest 1, posttest 1, pretest 2, posttest 2) which including the Fugl–Meyer Assessment-upper extremity (FMA-UE), box and block test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, a grip dynamometer for motor evaluation; Semmes–Weinstein hand monofilament and Revision of the Nottingham Sensory Assessment for sensory evaluation; and the Modified Barthel Index (MBI) for assessing the ADL ability. Result: RT group significantly improved FMA-UE proximal scores (p = 0.038), FMA-UE total scores (p = 0.046), and MBI (p = 0.030). The EDC exhibited higher efficiency during the small block grasping task in the RT group than in the CT group (p = 0.050). Conclusions: RT with the Gloreha device might lead to beneficial effects on arm motor function, ADL ability, and EDC muscle recruitment efficacy in patients with subacute to chronic stroke.

Keywords: activities of daily living, hand function, robotic rehabilitation, stroke

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Authors: Karima Abdel Aty Hassan Mohamed, Manal Mohamed Ismail, Mona Hassan Gamal Eldein, Ahmed Hassan Hussein, Abdel Aziz Mohamed Elsingerg

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Background: Patellofemoral pain (PFP) is a common musculoskeletal pain condition, especially in females. Decreased hip muscle strength has been implicated as a contributing factor, yet the relationships between pain, hip muscle strength and function are not known. Objective: The purpose of this study is to investigate the effects of strengthening hip abductors and lateral rotators on pain intensity, function and hip abductor and hip lateral rotator eccentric and concentric torques in patients with PFPS. Methods: Thirty patients had participated in this study; they were assigned into two experimental groups. With age ranged for eighty to thirty five years. Group A consisted of 15 patients (11females and 4 males) with mean age 20.8 (±2.73) years, received closed kinetic chain exercises program, stretching exercises for tight lower extremity soft tissues, and hip strengthening exercises .Group B consisted of 15 patients (12 females and 3 males) with mean age 21.2(±3.27) years, received closed kinetic chain exercises program and stretching exercises for tight lower extremity soft tissues. Treatment was given 2-3times/week, for 6 weeks. Patients were evaluated pre and post treatment for their pain severity, function of knee joint, hip abductors and external rotators concentric/eccentric peak torque. Result: the results revealed that there were significant differences in pain and function between both groups, while there was improvement for all values for both group. Conclusion: Six weeks rehabilitation program focusing on knee strengthening exercises either supplemented by hip strengthening exercises or not effective in improving function, reducing pain and improving hip muscles torque in patients with PFPS. However, adding hip abduction and lateral rotation strengthening exercises seem to reduce pain and improve function more efficiently.

Keywords: patellofemoral pain syndrome, hip muscles, rehabilitation, isokinetic

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Authors: Jeanne Gallee, Sofia Vallila-Rohter

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Technology-based applications are increasingly being utilized in aphasia rehabilitation as a means of increasing intensity of treatment and improving accessibility to treatment. These interactive therapies, often available on tablets, lead individuals to complete language and cognitive rehabilitation tasks that draw upon skills such as the ability to name items, recognize semantic features, count syllables, rhyme, and categorize objects. Tasks involve visual and auditory stimulus cues and provide feedback about the accuracy of a person’s response. Research has begun to examine the efficacy of tablet-based therapies for aphasia, yet much remains unknown about how individuals interact with these therapy applications. Thus, the current study aims to examine the efficacy of a tablet-based therapy program for anomia, further examining how strategy training might influence the way that individuals with aphasia engage with and benefit from therapy. Individuals with aphasia are enrolled in one of two treatment paradigms: traditional therapy or strategy therapy. For ten weeks, all participants receive 2 hours of weekly in-house therapy using Constant Therapy, a tablet-based therapy application. Participants are provided with iPads and are additionally encouraged to work on therapy tasks for one hour a day at home (home logins). For those enrolled in traditional therapy, in-house sessions involve completing therapy tasks while a clinician researcher is present. For those enrolled in the strategy training group, in-house sessions focus on limiting cue use in order to maximize lexical retrieval attempts and naming opportunities. The strategy paradigm is based on the principle that retrieval attempts may foster long-term naming gains. Data have been collected from 7 participants with aphasia (3 in the traditional therapy group, 4 in the strategy training group). We examine cue use, latency of responses and accuracy through the course of therapy, comparing results across group and setting (in-house sessions vs. home logins).

Keywords: aphasia, speech-language pathology, traumatic brain injury, language

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Authors: Geum Yeon Sim, Tyler Pigott, Julio Vasquez

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A 38-year-old obese female with no apparent past medical history presented with left knee pain. Six months ago, she sustained a left knee dislocation in a motor vehicle accident that was managed with a skin graft over the left lower extremity without any reconstructive surgery. She developed persistent pain and stiffness in her left knee that worsened with walking and stair climbing. Examination revealed healed extensive skin graft over the left lower extremity, including the left knee. Palpation showed moderate tenderness along the superior border of the patella, exquisite tenderness over MCL, and mild tenderness on the tibial tuberosity. There was normal sensation, reflexes, and strength in her lower extremities. There was limited active and passive range of motion of her left knee during flexion. There was instability noted upon the valgus stress test of the left knee. Left knee magnetic resonance imaging showed high-grade (grade 2-3) injury of the proximal superficial fibers of the MCL and diffuse thickening and signal abnormality of the cruciate ligaments, as well as edema-like subchondral marrow signal change in the anterolateral aspect of the lateral femoral condyle weight-bearing surface. There was also notable extensive scarring and edema of the skin, subcutaneous soft tissues, and musculature surrounding the knee. The patient was managed with left knee immobilization for five months, which was complicated by limited knee flexion. Physical therapy consisting of quadriceps, hamstrings, gastrocnemius stretching and strengthening, range of motion exercises, scar/soft tissue mobilization, and gait training was given with marked improvement in pain and range of motion. The patient experienced a further reduction in pain as well as an improvement in function with home exercises consisting of continued strengthening and stretching.

Keywords: ligamentous injury, trauma, rehabilitation, knee pain

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Authors: Alphonso Goliath

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With mandatory minimum sentences, even with its qualification of “substantial and compelling circumstances”, the sentence severity for violent crimes has increased substantially to combat crime. Considering the upsurge in violent crime, the paper argues that minimum sentences failed to prevent or curb violent crime. These sentences deprive offenders more than what is reasonably necessary of their freedom to curb the offense and punish the offender. Minimum sentences amount to cruel, inhuman, and degrading punishment unjustified and vulnerable to constitutional challenge.

Keywords: constitutionality, deterrence, incapacitation, minimum sentencing legislation, prison overcrowding, rehabilitation, recidivism, retribution, violent crime

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Authors: Niloufar Yadgari

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GANs are a potent form of deep learning models that have found success in various fields. They are part of the larger group of generative techniques, which aim to produce authentic data using a probabilistic model that learns distributions from actual samples. In clinical settings, GANs have demonstrated improved abilities in capturing spatially intricate, nonlinear, and possibly subtle disease impacts in contrast to conventional generative techniques. This review critically evaluates the current research on how GANs are being used in imaging studies of different neurological conditions like Alzheimer's disease, brain tumors, aging of the brain, and multiple sclerosis. We offer a clear explanation of different GAN techniques for each use case in neuroimaging and delve into the key hurdles, unanswered queries, and potential advancements in utilizing GANs in this field. Our goal is to connect advanced deep learning techniques with neurology studies, showcasing how GANs can assist in clinical decision-making and enhance our comprehension of the structural and functional aspects of brain disorders.

Keywords: GAN, pathology, generative adversarial network, neuro imaging

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Authors: Kumar Gular, Viswanathan S., Mastour Saeed Alshahrani, Ravi Shankar Reddy, Jaya Shanker Tedla, Snehil Dixit, Ajay Prasad Gautam, Venkata Nagaraj Kakaraparthi, Devika Rani Sangadala

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Background: Despite trunk control’s significant contribution to improving various functional activity components, the independent effect of trunk performance on quality of life is yet to be estimated in stroke survivors. Ascertaining the correlation between trunk control and self-reported quality of life while evaluating the effect of demographic and clinical characteristics on their relationship will guide concerned healthcare professionals in designing ideal rehabilitation protocols during the late sub-acute stroke stage of recovery. The aims of the present research were to (1) investigate the associations of trunk performance with self-rated quality of life and (2) evaluate if age, body mass index (BMI), and clinical characteristics mediate the relationship between trunk motor performance and perceived quality of life in the sub-acute stroke population. Methods: Trunk motor functions and quality of life among the late sub-acute stroke population aged 57.53 ± 6.42 years were evaluated through the trunk Impairment Scale (TIS) and Stroke specific quality of life (SSQOL) questionnaire, respectively. Pearson correlation coefficients and mediation analysis were performed to elucidate the relationship of trunk motor function with quality of life and determine the mediation impact of demographic and clinical characteristics on their association, respectively. Results: The current study observed significant correlations between trunk motor functions (TIS) and quality of life (SSQOL) with r=0.68 (p<0.001). Age, BMI, and type of stroke were detected as potential mediating factors in the association between trunk performance and quality of life. Conclusion: Validated associations between trunk motor functions and perceived quality of life among the late sub-acute stroke population emphasize the importance of comprehensive evaluation of trunk control. Rehabilitation specialists should focus on appropriate strategies to enhance trunk performance anticipating the potential effects of age, BMI, and type of stroke to improve health-related quality of life in stroke survivors.

Keywords: sub-acute stroke, quality of life, functional independence, trunk control

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Authors: Manjusha R. Vagal, Shyam K. Shrivastava, Umesh Mahantshetty, Sudeep Gupta, Supriya Chopra, Reena Engineer, Amita Maheshwari, Atul Buduk

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Vaginal stenosis is a common side effect associated with pelvic radiotherapy in cervical cancer patients which contributes negatively to woman’s health and prevents adequate vaginal/cervical examination. Vaginal dilation with a dilator is routine practice and is internationally advocated as a prophylactic measure to preserve vaginal patency. This retrospective study was carried out with the aim to know the usefulness of vaginal dilation following pelvic radiation therapy in cervical cancer patients in India. Data from medical records of 183 cervical cancer patients, which met the study criteria, were collected related to the stage of the disease, treatment received, commencement period of dilation post radiation therapy, sexual status and side effects associated to dilation practice. Data related to vaginal dimensions as per the length of insertion of a small, medium and large dilator were collected on regular follow-ups until 36 months and/or more. Vaginal dimensions as measured with the length of medium dilator insertion were used for analysis of dilation therapy results using paired t-test. Patients who underwent vaginal dilation with dilator maintained vaginal patency, also the mean vaginal length significantly increased, from 8.02 cm ± 2.69 to 9.96 ± 2.89 cm with a p value <0.001. There was no significant difference found on vaginal patency with different intervals of initiation of dilation therapy. At the third year and more following dilation therapy, significant increase in vaginal length observed with a p value of 0.0001 in both sexually active and inactive patients. Compilation of vaginal dosage during brachytherapy was inadequate, and hence, the secondary objective of the study to determine the effect of radiotherapy on the outcome of rehabilitation intervention was not studied in detail. This retrospective study has found that dilation therapy with vaginal dilators post pelvic radiotherapy is effective in preventing vaginal stenosis and improving vaginal patency and cannot be substituted with vaginal intercourse. Sexual quality of life assessment in the Indian population needs much attention.

Keywords: dilator, sexually active, vaginal dilation, vaginal stenosis

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Authors: Derradji A., Ben El Mamoun M., Zakaria E., Charadi I. Anrur

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The issue of dilapidated buildings represents a significant opportunity for constructive and beneficial interventions in Morocco. Faced with challenges associated with aging constructions and rapid urbanization, the country is committed to developing innovative strategies aimed at revitalizing urban areas and enhancing the sustainability of infrastructure, thereby ensuring citizens' safety. Through targeted investments in the renovation and modernization of existing buildings, Morocco aims to stimulate job creation, boost the local economy, and improve the quality of life for residents. Additionally, the integration of sustainable construction standards and the strengthening of regulations will promote resilient and environmentally friendly urban development. In this proactive perspective, LABOTEST has been commissioned by the National Agency for Urban Renewal (ANRUR) to conduct an in-depth study. This study focuses on the technical expertise of 1800 buildings identified as dilapidated in the prefectures of Rabat and Skhirat-Témara following an initial clearance operation. The primary objective of this initiative is to conduct a comprehensive diagnosis of these buildings and define the necessary interventions to eliminate potential risks while ensuring appropriate treatment. The article presents the adopted intervention methodology, taking into account the social dimensions involved, as well as the results of the technical expertise. These results include the classification of buildings according to their degree of urgency and recommendations for appropriate conservatory measures. Additionally, different pathologies are identified and accompanied by specific treatment proposals for each type of building. Since this study, the adopted approach has been generalized to the entire territory of Morocco. LABOTEST has been solicited by other cities such as Casablanca, Chefchaouen, Ouazzane, Azilal, Bejaad, and Demnate. This extension of the initiative demonstrates Morocco's commitment to addressing urban challenges in a proactive and inclusive manner. These efforts also illustrate the endeavors undertaken to transform urban challenges into opportunities for sustainable development and socio-economic progress for the entire population.

Keywords: building, dilapidated, rehabilitation, Morocco

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Authors: M. Fry, L. Fitzpatrick, Julie Considine, R. Z. Shaban, Kate Curtis

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Introduction: The vast majority of older Australians lives independently and are self-managing at home, despite a growing number living with a chronic illness that requires health intervention. Evidence shows that between 50% and 80% of people presenting to the emergency department (ED) are in pain. Australian EDs manage 7.2 million attendances every year and 1.4 million of these are people aged 65 years or more. Research shows that 28% of ED patients aged 65 years or more have Cognitive impairment (CI) associated with dementia, delirium and neurological conditions. Background: Traditional ED service delivery may not be suitable for older people who present with multiple, complex and ongoing illnesses. Likewise, ED clinical staff often perceive that their role should be focused more on immediate and potential lifethreatening illness and conditions which are episodic in nature. Therefore, the needs of older people and their family/carers may not be adequately addressed in the context of an ED presentation. Aim: We aimed to explore the utilisation and characteristics of older people presenting to four metropolitan EDs. Method: The findings being presented are part of a program of research exploring pain management practices for older persons with long bone fractures. The study was conducted across four metropolitan emergency departments of older patients (65years and over) and involved a 12-month randomised medical record audit (n=255). Results: ED presentations across four ED sites in 2012 numbered 168021, with 44778 (26.6%) patients aged 65 and over. Of the 44778 patients, the average age was 79.1 years (SD 8.54). There were more females 23932 (53.5%). The majority (26925: 85.0%) of older persons self-referred to the ED and lived independently. The majority arrived by ambulance (n=18553: 41.4%) and were allocated triage category was 3 (n=19,507:43.65%) or Triage category 4 at (n=15,389: 34.43%). The top five triage symptom presentations involved pain (n=8088; 18.25%), dyspnoea (n=4735; 10.7%), falls (n=4032; 9.1%), other (n=3984; 9.0%), cardiac (n=2987; 6.7%). The top five system based diagnostic presentations involved musculoskeletal (n=8902; 20.1%), cardiac (n=6704:15.0%), respiratory (n=4933; 11.0%), neurological (n=4909; 11.0%), gastroenterology (n=4321; 9.7%). On review of one tertiary hospital database the vital signs on average at time triage: Systolic Blood Pressure 143.6mmHg. Heart Rate 83.4 beats/minute; Respiratory Rate 18.5 breaths/ minute; Oxygen saturation 97.0% and Tympanic temperature 36.7 and Blood Glucose Level 7.4mmols/litre. The majority presented with a Glasgow Coma Score of 14 or higher. On average the older person stayed in the ED 4:56 (SD 3:28minutes).The average time to be seen was 39 minutes (SD 48 minutes). The majority of older persons were admitted (n=27562: 61.5%), did not wait for treatment (n= 8879: 0.02%) discharged home (n=16256: 36.0%). Conclusion: The vast majority of older persons are living independently, although many require admission on arrival to the ED. Many arrived in pain and with musculoskeletal injuries and or conditions. New models of care need to be considered, which may better support self-management and independent living of the older person and the National Emergency Access Targets.

Keywords: chronic, older person, aged care, emergency department

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Authors: Seema Singh Parmar, Shweta Chauhan

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Aims & Objectives: To evaluate the presence of various psychiatric disorders in patients reporting with a headache as the only symptom. Methodology: 200 patients with the chief complain of a headache who visited the psychiatric OPD of a tertiary care were investigated. Out of them 50 who had pure psychiatric illness without any other neurological disease were investigated, and their diagnosis was made. Independent sample t-tests were applied to generate results. Results: The most common psychiatric diagnosis seen in the sample was Depression (64%) out of which 47% showed features of Depression with anxious distress. Other psychiatric disorders seen were Generalized Anxiety Disorder, Panic Attacks, Somatic Symptom Disorder and Obsessive Compulsive Disorder. For pure psychiatry, headache related illnesses female to male ratio was 1.64. Conclusion: The increasing frequency of psychiatric disorders among patients who only visit the doctor seeking treat a headache shows the need for better identification of psychiatric disorders because proper diagnosis and target of psychiatric treatment shall give complete relief to the patient’s symptomatology.

Keywords: anxiety disorders, depression, headache, panic attacks

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Authors: A. Assad, T. Zayed

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Water networks (WNs) are responsible of providing adequate amounts of safe, high quality, water to the public. As other critical infrastructure systems, WNs are subjected to deterioration which increases the number of breaks and leaks and lower water quality. In Canada, 35% of water assets require critical attention and there is a significant gap between the needed and the implemented investments. Thus, the need for efficient rehabilitation programs is becoming more urgent given the paradigm of aging infrastructure and tight budget. The first step towards developing such programs is to formulate a Performance Index that reflects the current condition of water assets along with its criticality. While numerous studies in the literature have focused on various aspects of condition assessment and reliability, limited efforts have investigated the criticality of such components. Critical water mains are those whose failure cause significant economic, environmental or social impacts on a community. Inclusion of criticality in computing the performance index will serve as a prioritizing tool for the optimum allocating of the available resources and budget. In this study, several social, economic, and environmental factors that dictate the criticality of a water pipelines have been elicited from analyzing the literature. Expert opinions were sought to provide pairwise comparisons of the importance of such factors. Subsequently, Fuzzy Logic along with Analytical Network Process (ANP) was utilized to calculate the weights of several criteria factors. Multi Attribute Utility Theories (MAUT) was then employed to integrate the aforementioned weights with the attribute values of several pipelines in Montreal WN. The result is a criticality index, 0-1, that quantifies the severity of the consequence of failure of each pipeline. A novel contribution of this approach is that it accounts for both the interdependency between criteria factors as well as the inherited uncertainties in calculating the criticality. The practical value of the current study is represented by the automated tool, Excel-MATLAB, which can be used by the utility managers and decision makers in planning for future maintenance and rehabilitation activities where high-level efficiency in use of materials and time resources is required.

Keywords: water networks, criticality assessment, asset management, fuzzy analytical network process

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Authors: Tamara Grujic, Mirjana Bonkovic

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Measurements and quantitative analysis of kinematic parameters of human hand movements have an important role in different areas such as hand function rehabilitation, modeling of multi-digits robotic hands, and the development of machine-man interfaces. In this paper the assessment and evaluation of the reach-to-grasp movement by using computerized and robot-assisted method is described. Experiment involved the measurements of hand positions of seven healthy subjects during grasping three objects of different shapes and sizes. Results showed that three dominant phases of reach-to-grasp movements could be clearly identified.

Keywords: human hand, kinematics, measurement and analysis, reach-to-grasp movement

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Authors: Mariette Swanepoel, Terry Ellapen, Henriette Hammil, Juandre Williams, Timothy Qumbu

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The biomechanical consequence of pes planus is a topic seldom reviewed in regards to energy expenditure and predisposition to injury. However its comprehension in the field of foot rehabilitation, pre-and post-surgery is fundamental to successful patient management. This short communication unites the present literature to provide the reader with better insight on the consequence of pes planus, foot mechanics and its predisposition to injury at the foot and tibiofemoral joint. Further, the consideration of synergistic dominance of the foot invertors to compensate for the ineffective torque production of the fibularis longus due pes planus is presented.

Keywords: pes planus, fibularis longus, synergistic dominance, injury

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Authors: Anthonia Emmanuel Inaja

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The role of the counseling services by Special Educators, Guidance Counsellors and psychologists alike to Families and Parents of children with special needs cannot be over-emphasized. This paper examined the vital role of counseling services and its impact on the emotional and physical readiness of parents to initiate and support the education and rehabilitation needs of their children. The paper considered the importance of counseling, when counseling services are best required preparing the mindset of parents and family members as well as the immediate community of the social needs child.

Keywords: counseling, families, special, needs, children, problems, prospect

Procedia PDF Downloads 500