Discourse on Intellectual Disability and Improved Access to Assistive Technologies in Malawi.

Assistive technologies are one of the five elements under the Health Component of the World Health Organization CBR Guidelines that Malawi is using to implement the Community Based Inclusive Development (CBID) Programme. The technologies enhance independent living by removing barriers that come due to disability or old age and should, therefore, be prioritized. However, Malawi does not have a straightforward way of providing Assistive Technology. Individuals are considered upon the assessment of their needs whose intervention with respect to assistive products may not be available. This is mostly the case with persons with intellectual disabilities, in which there is very little expertise to work with, in Malawi, although they require assistive products to improve their quality of life just like other persons with disabilities. There are many sectoral policies and laws in Malawi, nonetheless, they do not have a positive input on persons with intellectual disability to access assistive technologies in terms of availability (provision), affordability (cost), and appropriateness (suitability and quality). Therefore, this paper intends to demonstrate the barriers that are faced by persons with intellectual disabilities, examine the policies, and pieces of legislation that would have influenced better access and maps the way on how barriers can be removed to ensure that Assistive Technologies are readily and easily accessed.

Guided growth for the treatment of moderate leg-length discrepancy.

The purpose of this study was to evaluate the effectiveness and complication rate of guided growth for the treatment of patients with a moderate leg-length discrepancy. The authors retrospectively reviewed all patients treated with guided growth for a moderate leg-length discrepancy at their institution between October 2004 and December 2010. Thirty-four patients met the inclusion criteria from an initial cohort of 105 patients. All patients were followed until screw removal or maturity occurred. Nine patients had a developmental leg-length discrepancy, and 25 had a congenital leg-length discrepancy. Average age was 12.6 years (range, 7-16 years). Average leg-length discrepancies, as measured on standing long-leg radiographs from the top of the pelvis, the top of the femoral heads, and the center of the ankle to the top of the femoral heads, were 22, 19, and 17 mm, respectively. Average discrepancies at screw removal or maturity were 13, 10, and 11 mm, respectively. Twenty of 33 patients had a leg-length discrepancy of less than 1 cm at maturity or screw removal. The leg-length discrepancy change in patients who underwent guided growth of the tibia was minimal. Leg-length discrepancies in patients who underwent guided growth of the femur or both the femur and the tibia changed by an average of 10 mm. One patient had a mechanical axis change greater than 1 zone, and 1 patient required treatment for angular deformity after being treated for a leg-length discrepancy. Guided growth is a safe and effective technique for treating moderate leg-length discrepancies.

Investigation of the metabolic changes in visual cortex due to visual stimulation using high field magnetic resonance spectroscopy at 7.0 T / 中华放射学杂志

Objective To investigate the metabolic changes in the visual cortex due to visual stimulation using high field functional proton magnetic resonance spectroscopy at 7.0 T.A clear picture of brain metabolism and neurotransmitter activity during activation was expected to be established.Methods Nine healthy subjects participated in this study. All MR measurements were acquired using a 7.0 T MR system and a 16-channel SENSE head coil. An initial fMRI scan was performed prior to spectroscopic acquisition in order to determine the activated region in the visual cortex.A cubic ROI of 2 cm× 2 cm × 2 cm was positioned inside the activated region for functional MRS acquisition.A short TE STEAM sequence was used for acquiring the MRS data. The functional paradigm comprised 6.6 min baseline followed by 13.2 min of visual stimulation and 19.8 min recovery.Summed averaged spectra for visual stimulus off and visual stimulus on were analyzed separately using LC Model and internal reference of water. A Wilcoxon signed rank test was conducted to compare the metabolite changes. ResultsDuring stimulation,concentration in Asp [ ( 3.20 ± 0.28 ) μmol/g ],Gln [ ( 2.07 ± 0.10 ) μmol/g ] and Gly [ ( 1.65 ± 0.11 )μmol/g ] was found to be significantly decreased,compared with that of ( 3.52 ± 0.28 ),( 2.25 ± 0.10 ) and ( 1.85 ± 0.11 ) μmol/g in rest ( Z =- 2.073,- 2.073 and - 2.429,respectively,P ＜ 0.05 ).The level in Glu [ ( 11.50 ± 0.11 ) μmol/g],GSH[ (2.45 ± 0.10) μmol/g] and Lac[ (0.89 ± 0.05) μ.mol/g]due to neuronal activation was found to be significantly increased,versus resting concentration of ( 11.28 ± 0.11 ),( 2.28 ± 0.10 ) and (0.79 ± 0.05 ) μmol/g,respectively ( Z =2.521,2.310,2.016,respectively,P ＜0.05).Glc level [ (1.54 ± 0.23 )μmol/g] exhibited a tendency to decrease throughout the period of stimulation,compared with that of [ (1.78 ± 0.28 ) μmol/g ] in rest,but the decrease did not reach statistical significance (Z =- 1.897,P ＞ 0.05 ).ConclusionsUsing a novel visual stimulation paradigm and 1 H MRS at 7.0 T and LC Model,the metabolic response to activation have been able to be observed.The observed changes of Asp,Glc and Lac concentrations in response to visual stimulation suggests that sustained neuronal activation raises oxidative metabolism to a new steady state.The observation of increased Glu with decreased Gln during stimulation can be interpreted as a stimulus driven increase in excitatory neurotransmitter cycling.The elevated GSH in the visual cortex in response to visual stimulation is a new observation.Possible explanations for this include detoxification of reactive oxygen species.