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Program Overview & Benefits

2 by Matthew Kaufman
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  • CITY OF LOS SANTOS |Medical health and rights assistance for the disabled
Program Overview
SPACER

  • What are disabilities?
    A disability is any condition of your body or mind that makes it more difficult for you to do one or more major life activities and interact with the world around you.

    There are many types of disabilities, such as those that can affect your:
    • Vision
    • Hearing
    • Movement
    • Thinking
    • Remembering
    • Learning
    • Communicating
    • Development
    • Mental health
    • Social relationships
    More than 1 in 4 adults in the San Andreas have some type of disability. Even though they all have disabilities, they can have a wide range of needs. For example, even people who have same type of disability can be affected in very different ways. Also, some disabilities are "visible" (easy to see), for example when someone is in a wheelchair. But other disabilities are "invisible" (hidden or not easy to see), such as problems with hearing, thinking, or learning.

    What causes disabilities?
    Disabilities can have different causes. Some disabilities are present at birth, while others may happen later in life.

    Causes of disabilities that are present at birth can include:
    • Disorders in single genes, such as Duchenne muscular dystrophy
    • Disorders of chromosomes, such as Down syndrome
    • Exposures (before birth) to infections or substances, such as drugs, alcohol, or cigarettes
    What causes disabilities?
    Disabilities can have different causes. Some disabilities are present at birth, while others may happen later in life.

    Causes of disabilities that happen later in life can include:
    • Injuries, such as spinal cord injuries, traumatic brain injuries (TBIs), and back injuries
    • Chronic (long-lasting) diseases, such as diabetes, heart disease, kidney disease, COPD, and arthritis
    • Cancer
    • Mental health problems
    • Stroke
    • Alzheimer's disease and other causes of dementia
    How can disabilities affect your health?
    Having a disability does not mean a person cannot be healthy. In fact, many people with disabilities report that their health as good or better. But they may have or be at risk of health problems related to their disability, called "secondary conditions." These conditions may include:
    • Bowel or bladder problems
    • Chronic pain
    • Diabetes
    • Fatigue
    • Heart disease
    • Injuries
    • Mental health problems, including depression and substance use disorders
    • Overweight and obesity
    • Pressure sores or ulcers
    Many of these conditions can be prevented, and there are treatments for them. It's also important for people with disabilities to get health care that meets their needs as a whole person, not just as a person with a disability.

    How can people with disabilities get and stay healthy?
    Just like for people who don't have a disability, having a healthy lifestyle is important for people who do have a disability. A healthy lifestyle includes:
    • Getting regular physical activity
    • Eating healthy foods in healthy portions
    • Limiting sun exposure and using sunscreen to prevent skin cancer
    • Not smoking, and if needed, getting help to quit smoking
    • Using medicines wisely
    • Not drinking alcohol or drinking in moderation
    • Getting help for any substance use or mental health problems
    • Staying in touch with family and friends
    What kinds of resources are there for people with disabilities?
    Managing a disability can sometimes be challenging. There are resources that can help:
    • Assistive devices and mobility aids can make daily tasks easier.
    • Schools can develop plans around the specific needs of a child with a disability. The goal of the plans is to give the child an opportunity to perform at the same level as other children their age.
    • Support networks, such as disability organizations, can help you learn more about resources for you and your family. Support groups can help you connect with other people who have the same disability. They can provide emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.
    • Government programs may provide benefits, job training, employment resources, and protection against discrimination.

Effects of Physical Activity on Prescription (PAP)

3 by Matthew Kaufman
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  • CITY OF LOS SANTOS |Medical health and rights assistance for the disabled
Effects of Physical Activity on Prescription (PAP)
SPACER

  • Brief Summary
    Physical inactivity is an increasing problem in the general population in society. However, in people with disabilities, inactivity is even more frequently reported. Physical activity on prescription (PAP) is a well-established method to enhance physical activity. The prescribed physical activity can be activities such as walking, cycling, swimming, or gardening, and should be performed over a longer period. In children with cerebral palsy, PAP has shown to be feasible to increase participation in physical activity and to reduce sedentary behaviour, and the habilitation services in the State of San Andreas have decided to offer PAP to all children and youth with disabilities. It is of great importance to study these interventions when applied on a broader group of patients than previously studied.

    The aim is to study the effects of an individualised and health-enhancing intervention in physically inactive people with autism, intellectual and physical disabilities. Also, the cost-effectiveness of PAP will be studied.

    he self-selected physical activity/activities may either be a physical activity organized by a club and/or an everyday activity such as walking a dog or riding a bicycle to school. Each participant fills in an activity logbook. Motivational interviewing will be used to support the participants. The Los Santos Occupational Performance Measure (LSOPM) can be used to identify what activities the participants are motivated to do, and to detect changes in the participants' perception of their performance of the activity. Quality of life will be monitored.

    Study specific questionnaires will be filled in regarding costs and background information. Data on health care use of the participants will retrospectively be collected and studied using the health care database in Region Skåne. Data will be collected at 3 months prior to the intervention, just before the intervention starts, when the intervention is finished, and at 6, 12 and 24 months after the intervention.

    Detailed Description

    Introduction:

    Physical inactivity is an increasing problem in the general population in society. However, in people with disabilities, inactivity is even more frequently reported. Physical activity on prescription (PAP) is a well-established method to enhance physical activity in adults in primary care. The prescribed physical activity should lead to moderate increase of the pulse, such as walking, cycling, swimming, or gardening, and should be performed over a longer period in order to achieve a change towards a more active lifestyle. The activity may be prescribed by a physiotherapist, physician, nurse, or other health professional. In children with cerebral palsy, PAP has shown to be feasible to increase participation in physical activity and to reduce sedentary behaviour, and the habilitation services in Los Santos have decided to offer PAP as an activity-enhancing intervention to all children and youth with disabilities. It is of great importance to study these interventions when applied on a broader group of patients (diagnoses and ages) than previously studied.

    Aim:

    The aim is to study feasibility as well as health effects of an individualised and health-enhancing intervention in physically inactive people with autism, intellectual or physical disabilities in the Department of Social Services in Los Santos. Also, cost-effectiveness of the intervention PAP will be studied using health-economic analysis methods.

    Method:

    Participants are recruited to this study by their clinical physiotherapists, who also will be carrying out the intervention with their patient in ordinary praxis. The selected activity should be adapted to the individual's interests, functional limitations and resources, and may either be a physical activity organized by a club and/or an everyday activity such as walking a dog or riding a bicycle to school. Each participant should report the dates and length of all activities during the 12 weeks that the study will last in an activity logbook.

    Measures:

    Motivational interviewing will be used to support the health enhancing change in lifestyle that PAP is expected to contribute to.
    The participants will be questioned about the amount of physical activity using the International Physical Activity Questionnaire (IPAQ) and will be using an accelerometer to objectively measure the activity during a full week (7 days).
    Los Santos Occupational Performance Measure (LSOPM) can be used to identify what activities the participants are motivated to do, and to detect changes in the participants perception of his/her performance of the activity.
    The Goal Attainment Scaling (GAS) is used for goal setting. GAS is an individualized outcome measure involving goal selection and goal scaling that is standardized in order to calculate the extent to which a patient's goals are met.
    To analyze the costs of the intervention, participants themselves and/or parents will be asked to report level of education, occupation, income, family constitution as well as direct or indirect costs for the selected activity. Also, the physiotherapists will report the amount of hours spent to prepare and carry out the activity as well as evaluate/measure the outcome of the intervention for each participant.
    The questionnaires directed to participants and/or parents on background information, health-related quality of life, reports of costs associated with the activity and evaluation will be distributed digitally via e-mail to a secure data capturing system using a unique code for each participant. For COPM, accelerometer and IPAQ data, the physiotherapist will report the results digitally to the secure data capturing system for his/her patient using the unique code for each participant.

    The cost- effectiveness will be studied by identifying, measuring, evaluating, and comparing the costs and effects for different interventions. In this project, PAP in people with different disabilities will be compared to a three- month period prior to the PAP intervention started, the participants are their own controls. This means that the comparison option is standard care, which would be the care the participant would have had if/when the intervention was not introduced/started.

    Data on health care use of the participants will retrospectively be collected and studied using the health care database in Los Santos.

    Data will be collected at 3 months prior to the intervention, just before the intervention starts, when the intervention is finished, and at 6, 12 and 24 months after the intervention.

    Arms and Interventions

    Participant Group/Arm Intervention/Treatment[/t]
    Active Comparator: Children and adolescents with physical disabilities
    20 children and adolescents with physical disabilities will participate in physical activity on prescription (PAP). They will be their own controls and will be compared with the other groups. Therefore, there is a baseline 1 and a baseline 2, with 3 months inbetween. After baseline 2, each participant will perform their PAP during 3 months. Assessments to evaluate the results will be performed directly after the 3 months PAP period, and after 6, 12 and 24 months.    		 Physical activity on prescription (PAP) is a well-established method to enhance physical activity in adults in primary care. The prescribed activity should lead to moderate increase of the pulse, such as walking, cycling, swimming, or gardening, and should be performed over a longer period of time in order to achieve a change towards a more active lifestyle. The activity may be prescribed by a physiotherapist, physician, nurse, or other health professional. PAP has shown to be feasible to increase participation in physical activity and to reduce sedentary behaviour in children with cerebral palsy.

    Motivational interviewing is used for our PAP with participants with disabilities. During PAP-period, the participants are asked to fill in an activity logbook.
    Active Comparator: Children and adolescents with intellectual disabilities
    20 children and adolescents with intellectual disabilities will participate in physical activity on prescription (PAP). They will be their own controls and will be compared with the other groups. Therefore, there is a baseline 1 and a baseline 2, with 3 months inbetween. After baseline 2, each participant will perform their PAP during 3 months. Assessments to evaluate the results will be performed directly after the 3 months PAP period, and after 6, 12 and 24 months.    		 Physical activity on prescription (PAP) is a well-established method to enhance physical activity in adults in primary care. The prescribed activity should lead to moderate increase of the pulse, such as walking, cycling, swimming, or gardening, and should be performed over a longer period of time in order to achieve a change towards a more active lifestyle. The activity may be prescribed by a physiotherapist, physician, nurse, or other health professional. PAP has shown to be feasible to increase participation in physical activity and to reduce sedentary behaviour in children with cerebral palsy.

    Motivational interviewing is used for our PAP with participants with disabilities. During PAP-period, the participants are asked to fill in an activity logbook.
    Active Comparator: Children and adolescents with autism
    20 children and adolescents with autism will participate in physical activity on prescription (PAP). They will be their own controls and will be compared with the other groups. Therefore, there is a baseline 1 and a baseline 2, with 3 months inbetween. After baseline 2, each participant will perform their PAP during 3 months. Assessments to evaluate the results will be performed directly after the 3 months PAP period, and after 6, 12 and 24 months.    		 Physical activity on prescription (PAP) is a well-established method to enhance physical activity in adults in primary care. The prescribed activity should lead to moderate increase of the pulse, such as walking, cycling, swimming, or gardening, and should be performed over a longer period of time in order to achieve a change towards a more active lifestyle. The activity may be prescribed by a physiotherapist, physician, nurse, or other health professional. PAP has shown to be feasible to increase participation in physical activity and to reduce sedentary behaviour in children with cerebral palsy.

    Motivational interviewing is used for our PAP with participants with disabilities. During PAP-period, the participants are asked to fill in an activity logbook.
    Active Comparator: Adults with physical or intellectual disabilities, or with autism
    20 adults with physical or intellectual disabilities, or with autism will participate in physical activity on prescription (PAP). They will be their own controls and will be compared with the other groups. Therefore, there is a baseline 1 and a baseline 2, with 3 months inbetween. After baseline 2, each participant will perform their PAP during 3 months. Assessments to evaluate the results will be performed directly after the 3 months PAP period, and after 6, 12 and 24 months.    		 Physical activity on prescription (PAP) is a well-established method to enhance physical activity in adults in primary care. The prescribed activity should lead to moderate increase of the pulse, such as walking, cycling, swimming, or gardening, and should be performed over a longer period of time in order to achieve a change towards a more active lifestyle. The activity may be prescribed by a physiotherapist, physician, nurse, or other health professional. PAP has shown to be feasible to increase participation in physical activity and to reduce sedentary behaviour in children with cerebral palsy.

    Motivational interviewing is used for our PAP with participants with disabilities. During PAP-period, the participants are asked to fill in an activity logbook.

Spine School for Parents With Disabled Children

4 by Matthew Kaufman
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  • CITY OF LOS SANTOS |Medical health and rights assistance for the disabled
Spine School for Parents With Disabled Children
SPACER

  • Brief Summary

    Our first aim in this study is to investigate the effects of neck exercise and information training given to parents of disabled children with non-specific neck pain on parameters such as pain, disability level, quality of life, posture, physical activity, and spinal curvature.


    Arms and Interventions

    Participant Group/Arm
    Intervention/Treatment
    No Intervention: Control Group
    Experimental: Study Group It will consist of sessions that include neck anatomy, biomechanics, proper posture, ergonomics and neck exercise training.


    Primary Outcome Measures

    Outcome Measure Measure Description Time Frame
    Assessment of Neck Pain Visual Analog Scale (VAS): VAS is a measurement generally used to assess pain intensity. VAS is a scale consisting of 10 cm horizontal lines numbered from 0 to 10. The "0" point indicates no pain; the "10" point indicates unbearable pain. The pain intensity felt by caregivers in their spine will be assessed with VAS. Participants will be asked to score the pain intensity felt during rest, activity and sleep between 0 and 10, and the results will be recorded. 20 weeks
    Assessment of Neck Pain Mc-Gill Melzack Pain Scale (MMAS): Participants' pain will be measured multidimensionally with MMAS. MMAS consists of 4 sections. The first section includes questions about the area of pain the patient has, the second section evaluates the pain in terms of perception and sensation, the third section includes questions about the relationship between pain and time, and the fourth section includes questions about the severity of pain. The scale is a 4-point Likert-type scale, and each item is scored between 0 and 3 (0: no pain; 3: the most severe pain), and a high total score indicates a high level of pain. The total pain score varies between 0 and 45 (0: no pain; 45: the most severe pain). 20 weeks
    Neck Disability Assessment The neck functionality of the participants will be assessed with the Neck Disability Index (NDI), which has validity and reliability. The index, which assesses daily living activities and symptoms, consists of a total of 10 sections. These sections include pain level, personal care, weight bearing, reading, headache, concentration, work life, driving, sleep status and recreational activities. A score between 0-4 is interpreted as no disability, a score between 5-14 is interpreted as mild disability, a score between 15-24 is interpreted as moderate disability, a score between 25-34 is interpreted as severe disability and a score above 35 is interpreted as total disability. 20 weeks
    Evaluation of Neck Joint Range of Motion Universal goniometer is the easiest method to reach for measuring joint range of motion. It is widely used in the clinic because it is practical and low-cost. However, since it is used in both hands during the measurement, it is difficult to provide joint stabilization. This situation increases the margin of error in the measurements. In the inclinometer, it is not necessary to determine the bone points applied in universal goniometer measurements. The advantage of this measurement over the universal goniometer is that it is more practical and has less margin of error. Its disadvantage is that it is more costly. 20 weeks
    Evaluation of Spinal Curvature Spinal Mouse (SM) is a computer-aided handheld electromechanical device. SM is a measurement tool developed to determine spinal column alignment, segmental and total curvatures, and vertebral motion angles in many planes. SM is a clinically applicable, valid, and objective method. In our study, the Idiag brand SM device will be used. The participants' clothes will be removed and measurements will be made with SM between the C7 (cervical) and S3 (sacral) regions. The data obtained from the measurement will be transferred to the computer via a wireless connection. On the computer, the data will be analyzed via the program and interpreted by the consultant. 20 weeks
    Posture Evaluation Posture analysis will be done with the CPAS (Corbin Posture Analysis Scale) prepared by Corbin and his friends. The participant will be evaluated with this scale in the posture analysis table from the lateral and posterior observations. The scale is scored between 0 and 3 (0: none; 3: severe) according to the severity of the disorder. The scores obtained by observing from the posterior and lateral are collected and classified in the final state (Poor ≥12; moderate 8-11; good 5-7; very good 3-4; excellent 0-2). 20 weeks
    Physical Activity Evaluation The physical activity level of the participants will be assessed with the International Physical Activity Questionnaire (IFQQ). The scale provides information about the time spent in sitting, walking, moderate and vigorous activities. The participants were asked how many days and how many minutes/hours they did vigorous and moderate exercise, walked and sat in the last 7 days. The criteria for evaluating the activities are based on the fact that each can be done for at least 10 minutes. A value called "MET minutes/week" is obtained by multiplying the minutes, days and metabolic equivalent (MET) values. 20 weeks
    Assessment of Quality of Life The Short Form-36 Quality of Life Scale (SF-36) will be used to assess quality of life. The scale consists of 8 different sub-dimensions (social function, physical function, emotional role difficulty, physical role difficulty, vitality (energy), pain, mental health, and general health) and a total of 36 items. Sub-groups are evaluated between 0-100 points, and "0 points" indicates poor health status, and "100 points" indicates good health status. 20 weeks

Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR)

5 by Matthew Kaufman
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  • CITY OF LOS SANTOS |Medical health and rights assistance for the disabled
Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR)
SPACER

  • Brief Summary

    The Mindfulness, Nutrition and Exercise to Optimize Resilience (MENTOR) program is offered through the National Center on Health, Physical Activity and Disability (NCHPAD). NCHPAD is funded by the Social Services Department, is a public health practice that offers health promotion programs and resources to people with mobility disabilities. The purpose of this project is to provide a free-of-charge wellness program designed to improve health and wellness for people with mobility and physical disability living in the San Andreas State.

    The objective of the MENTOR program is to improve wellness for people with mobility limitations. MENTOR is a free, 8-week program focusing on physical, mental, and emotional health for individuals with an existing disability or a recent diagnosis. The program provides core information on mindfulness, exercise, and nutrition. Participants get one-on-one health coaching and access to a fitness instructor, registered dietician, and mindfulness coach. The classes are virtual, and the exercise equipment needed for the classes will be mailed to participants.

    The research question is to measure the effectiveness and implementation of the MENTOR program.


    Arms and Interventions

    Participant Group/Arm
    Intervention/Treatment
    MENTOR is an 8-week group program conducted via videoconferencing, designed for individuals with physical disabilities in the United States to enhance their health and well-being. The program includes 1 hour per week of mindfulness training, 2 hours per week of exercise, and 1 hour per week of nutrition education. Participants will also receive personalized health coaching and have access to a fitness instructor, registered dietician, and mindfulness coach. Additionally, participants will receive information on 8 other areas, including self-care skills, core values, outdoor time in nature, rest/relaxation, contributing to others, arts and leisure, relationships, and spiritual practice, all taught by a trained health coach over the 8-week period. Participants will attend a group-based, 8-week online program (a total of 40 hours) via videoconferencing. The program is split into three wellness sections (Mindfulness, Exercise, and Nutrition) and eight other sections (self-care skills, core values, outdoor time in nature, rest/relaxation, contribution to others, arts and leisure, relationships, and spiritual practice). Participants will access all assessment and intervention tools on any mobile device (phone, tablet, laptop, desktop) using a password-protected identification (ID) to log in via their devices. Health coaches can create intake flows to collect health data and track analytics. Participants can see their goals, upcoming intervention sessions, and activities through the study application (app). Features of the study app include goal setting, where participants record their goals, zoom videoconferencing links for online classes and coaching sessions, and the ability to share materials with participants.



    Primary Outcome Measures

    Outcome Measure
    Measure Description
    		 Time Frame
    Connor-Davidson Resilience Scale (CD-RISC) This is a resilience measure to gain a better understanding of whether the program had any benefit to improving resilience. It consists of 10 items.The response scale has a 5-point range from 0 to 4. Scores are summed to provide a total score of 40, where higher scores indicate higher resilience. It measures the Effectiveness of the RE-AIM framework. Pre/Post 8-week Program



    Secondary Outcome Measures

    Outcome Measure Measure Description Time Frame
    Godin Leisure-Time Exercise Questionnaire (GLTEQ) A self-report measure of physical activity. It is a 7-day recall questionnaire that contains 3 questions pertaining to light, moderate, and vigorous intensity activity. Pre/Post 8-week Program
    Mindfulness Attention Awareness Scale (MAAS) This is a mindfulness scale which is used to identify potential changes in mindfulness.

    This scale contains 15 items that ask participants how frequently they have a certain experience, using a 6-point Likert scale from 1 to 6. The score is calculated by calculating the mean of these 15 items. Higher scores reflect more mindfulness.     		Pre/Post 8-week Program
    NCHPAD Wellness Assessment (NWA) This assessment has 3 dimensions which are physical, mental, and emotional/spiritual health. Each dimension has 5 questions, and an additional question assesses the overall wellness (16 questions total). Pre/Post 8-week Program
    Nutrition Questionnaire on Mindful Eating, Habits, and Knowledge It is a survey to identify which dietary advice people find confusing. It consists of 3 domains: nutrition knowledge (24 items), mindful eating assessment (2 items), and eating habits (13 items). Pre/Post 8-week Program
    Global Health It is a Patient-Reported Outcome Measurement Information System (PROMIS) Global Health Scale V1.2 for an overall evaluation of one's physical and mental health. It consists of 10 items. Pre/Post 8-week Program
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