Developing additional competition classes for athletes with intellectual impairments: Conceptual approach and efficacy of an ICF derived measure.

The purpose of para sport classification systems is to minimize the impact of impairment on competition outcome. Currently, athletes with intellectual impairment (II) compete in one class, regardless of the extent of activity limitation resulting from their impairment. Consequently, athletes with II that cause relatively minor difficulty in sport have a competitive advantage over athletes who have intellectual impairments that cause more significant advantage. This research investigated the efficacy of a measure of health-related functional impairment, derived from the World Health Organization International Classification of Functioning, Disability, and Health (ICF), as a tool to classify athletes with intellectual impairments (II) into groups with impairments that cause similar activity limitation. The first study used a Delphi technique to identify the most relevant codes within the ICF from which a measure of impairment presence and severity was derived. The second study investigated whether the measure could discriminate between groups of II athletes organized into three competition groups, and whether these groups could be predicted by ICF score. The ICF-based questionnaire shows promise as a conceptual approach and as a tool in this context, but this is a preliminary step before establishing a sport-specific approach to classification.

Conceptual model of sport-specific classification for para-athletes with intellectual impairment.

The present paper describes the conceptual basis of evidence-based classification of para-athletes with intellectual impairment (II). An extensive description of the theoretical and conceptual foundation of the system as currently conceived is provided, as are examples of its applications in the three sports included in the Paralympic programme for II-athletes in 2020 (i.e., athletics, swimming and table tennis). Evidence-based classification for II-athletes is driven by two central questions: i. How can intellectual impairment be substantiated in a valid and reliable way, and ii. Does intellectual impairment limit optimal sport proficiency? Evolution of the system and current best practice for addressing these questions are described, and suggestions for future research and development are provided. Challenges of understanding and assessing a complex (multifaceted and intersectional) impairment in the context of sport also are considered.

Using the RUG-III classification system for understanding the resource intensity of persons with intellectual disability residing in nursing homes.

Since 1991, the Minimum Data Set 2.0 (MDS 2.0) has been the mandated assessment in US nursing homes. The Resource Utilization Groups III (RUG-III) case-mix system provides person-specific means of allocating resources based on the variable costs of caring for persons with different needs. Retrospective analyses of data collected on a sample of 9707 nursing home residents (2.4% had an intellectual disability) were used to examine the fit of the RUG-III case-mix system for determining the cost of supporting persons with intellectual disability (intellectual disability). The RUG-III system explained 33.3% of the variance in age-weighted nursing time among persons with intellectual disability compared to 29.6% among other residents, making it a good fit among persons with intellectual disability in nursing homes. The RUG-III may also serve as the basis for the development of a classification system that describes the resource intensity of persons with intellectual disability in other settings that provide similar types of support.

Behavioural and emotional problems in people with severe and profound intellectual disability.

BACKGROUND: People with severe and profound levels of intellectual disability (ID) are frequently examined as a single group in research. However, these two groups may be significantly different, particularly in the area of emotional and behavioural difficulties. METHOD: The Developmental Behaviour Checklist (DBC) was completed by parents and caregivers of 107 people with severe ID and 22 people with profound ID at four time periods across 12 years. Regression analyses were used to examine trends in sub-scale scores across time and groups. RESULTS: Significant differences between the groups of people with severe and profound ID were found. People with profound ID had significantly lower scores across all sub-scales except Social Relating. This was usually related to fewer items being selected as present for people with profound ID, as opposed to the scores being attributable to lower item severity scores. CONCLUSIONS: There are significant differences between groups of people with severe and profound ID in scores on the DBC, indicating differences in behavioural and emotional problems. Caution should be exercised by researchers treating these two disparate groups as a single group, and by practitioners translating such findings into practice.

[Self determination as an axis to evaluate and intervene with intellectually disabled people]. / La autodeterminación como eje de evaluación e intervención en la Discapacidad Intelectual.

The article describes in an original way the concept of self-determination, including an analysis of its components and effects. The authors detail two groups of disorders of self-determination: subjective dissipation and subjective alienation. They sustain that this theoretical framework explains more fully the clinics of Intellectual Disability (DSM's Mental Retardation) and is more useful than IQ to orient teaching, therapeutic and rehabilitative interventions. The authors propose that the level and profile of self-determination of a person with intellectual disability should be utilized to sub-classify people with mental retardation diagnose, replacing the ranges of IQ traditionally used, and criticized as well, for useless.

Diagnóstico y clasificación en discapacidadintelectual / Diagnosis and classification on intellectual disability

El diagnóstico de la discapacidad intelectual así como los sistemas de clasificación dela misma han constituido un tema de interés principal para todos aquellos que intentancomprender este fenómeno y acercarse un poco más al complejo entramado de intervenciónen este campo. El objetivo de este artículo consiste en realizar un pequeño recorridosobre las implicaciones, peligros y beneficios de los sistemas de clasificación en el campode la discapacidad intelectual para finalmente abordar el enfoque multidimensional con elque los profesionales de la salud y los servicios se acercan actualmente a la misma (AU)

The diagnosis of intellectual disability and classification systems have been a maintopic of interest to all those who try to understand this phenomenon and get a little closerto the complex intervention in this field. The aim of this article is to undertake a short historical tour on the implications, dangers and benefits of classification systems in the fieldof intellectual disability to finally address the multidimensional approach with whichhealth and services professionals are approaching now to that disability (AU)

Caracterización: fenotípica de varones adultos condiagnóstico de síndrome X frágil / Phenotypic characterization of adult men diagnosed with fragile X syndrome

El síndrome X frágil (SXF), constituye la primera causa de discapacidad intelectualhereditaria. Es una de las alteraciones más frecuentes aunque no siempre bien conocidapor los profesionales de la salud, los educadores y la sociedad. El desconocimiento provocaque un porcentaje importante de afectados esté sin diagnosticar. Hay importantes diferenciasentre comunidades autónomas, en algunas, el síndrome esta infradiagnosticado,no llevándose a cabo la detección, el consejo genético ni la adecuada intervención educativa.Tras revisar las características generales del SXF, presentamos el estudio realizado enla provincia de Burgos, recogiéndose datos de 273 varones con discapacidad intelectual,57 fueron estudiados genéticamente resultando 13 nuevos afectados.Al menos, el 9,5% de varones atendidos en los centros de discapacidad intelectual en laprovincia de Burgos, no diagnosticados por síndromes o discapacidades excluyentes,están afectados de SXF.La hoja de recogida de datos (HRD-1), seleccionó los participantes a estudiar genéticamentey con las modificaciones se ha obtenido la HRD-2, que consideramos sirve comoprotocolo facilitador para la preselección de posibles varones adultos afectados (AU)

Fragile X syndrome (FXS) is the first known cause of hereditary intellectual disability.Although one of the most common alterations, it is not always well known by health professionals,educators and society in general. This lack of knowledge means that a significantpercentage of those affected are not diagnosed. Major differences among autonomouscommunities exist; in some of them, the syndrome is under diagnosed, due to non-detection,lack of genetic counselling or adequate educational intervention. After reviewing thegeneral characteristics of FXS, we hereby present the study conducted in the province ofBurgos, where data was gathered from 273 males with intellectual disability. 57 of themwere genetically studied, resulting in the detection of 13 new cases of FXS. The data collectionsheet (HRD-1) was the basis for selecting the participants to be studied; this, afterundergoing the necessary modifications, resulted in HRD-2. We believe that this sheet canbe used as a protocol to facilitate the pre-selection of possible affected adult males.At least 9.5% of males treated at the centres for the intellectually disabled in theprovince of Burgos, who have not been diagnosed with syndromes or exclusive disabilities,suffer from FXS (AU)

Capacity of persons with mental retardation to consent to participate in randomized clinical trials.

OBJECTIVE: Adults with mental retardation have histories of cognitive and adaptive deficits posing unique ethical challenges for research consent assessment. This study examined the capacity of persons with mental retardation to consent to participate in randomized clinical trials. METHOD: A total of 150 adults (50 each with mild and moderate mental retardation and 50 comparison subjects without mental retardation) responded to a set of consent questions for a hypothetical randomized clinical trial testing a medication for aggressive disorders. Intelligence, adaptive behavior, medical treatment history, and consent history were evaluated. Univariate and multivariate methods were used to compare performance across and within groups. RESULTS: Comparison subjects scored significantly higher on measures of consent capacity than participants with mild mental retardation, who scored higher than those with moderate mental retardation. Most subjects with mental retardation were able to make a participation choice, and many understood research methods and appreciated the protagonist's disorder and the consequences of participation. Almost half of those with mild mental retardation understood human subject protections. Performance was weakest on understanding the purpose of research and reasoning about whether to participate, suggesting vulnerability to the therapeutic misconception. Psychiatric and experiential factors did not predict consent capacity. CONCLUSIONS: While adults with mental retardation as a group showed consent deficits, many attained consent capacity scores comparable to those of comparison subjects. Investigators should consider individual differences and a consent format suited to deficits in language, memory, and attention before restricting consent opportunities for persons with mental retardation.

Classification of residents in nursing homes in Tuscany (Italy) using Resource Utilization Groups Version III (RUG-III).

BACKGROUND AND AIMS: Samples of nursing homes in Tuscany (Italy) classify their residents and determine their case-mix according to the Resource Utilization Groups System, Version III (RUG-III). METHODS: A large sample of nursing homes was selected, based on willingness to participate, representation of both public and private institutions, and wide geographic representation. Two registered nurses assessed all residents using the RUG questionnaire. The information collected was then used to group residents into 44 RUGs, and facility-specific case-mix indices were calculated using the RUG-specific weights previously validated in Italy. RESULTS: A total of 3981 residents from 93 nursing homes were assessed. Most residents were over 75 years old (87.4%) and women (68.6%). A large percentage was classified into RUGs within the following primary categories: reduced physical function (33.6%), impaired cognition (17.6%) and clinically complex (17.6%). The resulting nursing home case-mix indices ranged from 0.627 to 1.108 (mean 0.807+/-0.110). No significant association was found between type of facility, level of fees, or extent of staff in the nursing homes and their case-mix indices. CONCLUSIONS: RUGIII can provide information on types of nursing home residents and their care needs. This is useful for monitoring and evaluating long-term care services for the elderly, and allows for more effective planning and allocation of staffing and financial resources.

Incidencia lesional en competición de atletismo de alto nivel de deportistas paralímpicos / Number of injuries in high athletics competition of paralympics sportsmen

El deporte paralímpico de alta competición, que tiene un desarrollo muy notable en cuanto al número de participantes y al nivel de dedicación y de competición, no ha generado amplias investigaciones respecto a su incidencia lesiona!. El presente trabajo analiza la incidencia lesional en el atletismo de deportistas paralímpicos de alta competición, concretamente en el Campeonato de Europa celebrado en Assen (Holanda) en año 2003 y en el que la Selección Española participó con un total de 34 atletas (28 varones) pertenecientes a las federaciones españolas de Deportes para Ciegos (FEDC) con 17 atletas, a la de Deportes de Minusválidos Físicos (FED MF), con 8 atletas y a la de Deportes de Paralíticos Cerebrales (FEDPC) con 9 atletas. Se describen los diagnósticos específicos, las clasificaciones de los deportistas y las pruebas en las que participaron. Se recogieron un total de 50 lesiones que afectaron a 24 de los 34 deportistas (70,58%). Todas fueron agudas ylas más frecuentes fueron las musculares (50% del total) con 6 sobrecargas de adductores, 4 sobrecargas en zona dorsolumbar, 4 en isquiotibiales y 3 en cintura escapular. Hubo 6 contracturas. Se observaron 2 roturas fibrilares y 3 tendinitis. Salvo una herida por compresión de la silla, no se encontraron lesiones específicas de los grandes discapacitados. Las lesiones afectaron preferentemente a las extremidades inferiores (64%), a las extremidades superiores (12%) yal tronco (8%). La incidencia lesional fue de 1,47 lesiones/deportista en el grupo de atletas ciegos, de 1,22 en los paralíticos cerebrales y de 0,75 en los discapacitados físicos

Paralympic sport of high competition has a very remarkable development as far as the number of participants and to the level of dedication and competition, however there are few investigations about the injuries that this kind of sport produces. The present work analyzes the number of injuries in athletics of paralympics sportsmen ofhigh competition, concretely in the Championship of Europe celebrated in Assen (Holland) in 2003, where the Spanish Selection participated with a total of 34 athletes (28 men) belongs to the Spanish federations of Sports for Blinds (FEDC) with 17 athletes, to the one of S ports of PhysicalDisabled (FED MF), with 8 athletes and to the one of Cerebral Palsy Brain (FEDPC) with 9 athletes. The specific diagnoses, the classifications of the sportsmen and the tests are described in which they participated. A total of 50 injuries took shelter that affected to 24 of the 34 sportsmen (70.58%). AlI the injuries were acute and the most frequent were the muscular ones (50% of the total) with 6 overuse of adducers, 4 overuse in back-Iumbar zone, 4 in hamstrings and 3 in shoulder joint complex. There were also 6 spasm muscle, 2 strains and 3 tendinitis. Except for a wound by compression of the chair there were not specific injuries ofhandicapped sportsmen. The injuries preferredly affected to the lower extremities (64%), upper extremities superior (12%) and trunk (8%). The injuries rate was of 1.47 injuries/sportsman in the group of blind athletes, 1.22 in cerebral palsy ones and 0.75 in the physical disabled ones

Health indicators for people with intellectual disabilities: a European perspective.

People with intellectual disabilities make up about 1% of the population of Europe. As trends toward community life advance, they have become more visible and more likely to access generic health systems. Yet evidence suggests that there are striking disparities between the health of this group and that of the general population. Increased longevity means that adults in this group expect to live longer lives and thus to encounter age-related risks for various health conditions. The 'Pomona' project, funded by the EU Health Monitoring Unit, aims to develop a set of health indicators for people with intellectual disabilities. It will build on the work accomplished by the team developing ECHI--European Community Health Indicators. This article outlines the rationale for the project, key elements in its implementation and expected outcomes.

Survey of nursing and medical profile prior to deinstitutionalization of a population with profound mental retardation.

During the planning stages of deinstitutionalization, the importance of nursing services must be recognized and given priority consideration in the community placement of persons with serious developmental disabilities. The objective of this study was to survey the medical and nursing profile of a group of nonambulatory, institutionalized individuals with profound mental retardation in anticipation of their nursing and medical needs in the community. Data were collected from the Individual Habilitation Plans of 55 individuals who had resided in a residential facility for individuals with mental retardation and were scheduled for community placement Serious medical problems in decreasing frequency were constipation (96%), seizure disorder (70%), poor dental hygiene (67%), cerebral palsy (62%), scoliosis (61%), contractions (41%), aspiration (44%), skin lesions (40%), and dysphagia (22%). Considering the complexity of health issues encountered in this population, adequate nursing and medical planning are critical to the wellness and successful community placement of a population with special needs.

Community learning disability teams: the need for objective methods of prioritization and discharge planning.

As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.

A brief integer scorer for the SF-12: validity of the brief scorer in Australian community and clinic settings.

OBJECTIVE: The SF-36 and the shorter SF-12 are widely used in clinical research and increasingly so in practice. Scoring is complex and the validity of a brief scorer for the SF-12 in a community and a clinic sample was examined. METHOD: The sample comprised respondents with complete data on the SF-12 from the community sample in the 1997 Australian National Survey of Mental Health and Well-being (n = 10,641) and from a clinical sample from the Clinical Research Unit for Anxiety and Depression (n = 1,725). Each SF-12 was scored by the standard method (using weights to five decimal places) or by the brief method (using weights that are integers only). RESULTS: Scores generated by the standard scorer correlated almost perfectly with the brief scorer in both the community and clinic samples. Means and standard deviations were similar and no individual scores deviated by more than 2.89 in the community sample or by 3.06 in the clinical sample. IMPLICATIONS: The brief, rounded integer scorer for the SF-12 is an appropriate substitute for the standard scorer when hand scoring is an advantage.