Fong Chan

Cognitive phenotypes in temporal lobe epilepsy

The objective of this study is to determine if distinct cognitive phenotypes could be identified in temporal lobe epilepsy. Epilepsy patients (n = 96) and healthy controls (n = 82) underwent comprehensive neuropsychological assessment. Adjusted (age, gender, and education) test scores for epilepsy subjects were grouped into cognitive domains (intelligence, language, visuoperception, immediate and delayed memory, executive function, and cognitive/psychomotor speed). Cluster analysis revealed three distinct cognitive profiles types: (1) minimally impaired (47% of subjects); (2) memory impaired (24%); and (3) memory, executive, and speed impaired (29%). The three cluster groups exhibited different patterns of results on demographic, clinical epilepsy, brain volumetrics, and cognitive course over a 4-year interval. The specific profile characteristics of the identified cognitive phenotypes are presented and their implications for the investigation of the neurobehavioral complications of epilepsy are discussed.

Motivational Enhancement Therapy in Addition to Physical Therapy Improves Motivational Factors and Treatment Outcomes in People With Low Back Pain: A Randomized Controlled Trial

OBJECTIVES To examine whether the addition of motivational enhancement treatment (MET) to conventional physical therapy (PT) produces better outcomes than PT alone in people with chronic low back pain (LBP). DESIGN A double-blinded, prospective, randomized, controlled trial. SETTING PT outpatient department. PARTICIPANTS Participants (N=76) with chronic LBP were randomly assigned to receive 10 sessions of either MET plus PT or PT alone. INTERVENTION MET included motivational interviewing strategies and motivation-enhancing factors. The PT program consisted of interferential therapy and back exercises. MAIN OUTCOME MEASURES Motivational-enhancing factors, pain intensity, physical functions, and exercise compliance. RESULTS The MET-plus-PT group produced significantly greater improvements than the PT group in 3 motivation-enhancing factors; proxy efficacy (P<.001), working alliance (P<.001), and treatment expectancy (P=.011). Furthermore, they performed significantly better in lifting capacity (P=.015), 36-Item Short Form Health Survey General Health subscale (P=.015), and exercise compliance (P=.002) than the PT group. A trend of a greater decrease in visual analog scale and Roland-Morris Disability Questionnaire scores also was found in the MET-plus-PT group than the PT group. CONCLUSION The addition of MET to PT treatment can effectively enhance motivation and exercise compliance and show better improvement in physical function in patients with chronic LBP compared with PT alone.

Demand-Side Factors Related to Employment of People with Disabilities: A Survey of Employers in the Midwest Region of the United States

Introduction Traditional vocational services ignore variables related to employer demands and the interaction of employer demand and the environment) as predictors of employment outcomes for people with disabilities. Recently, rehabilitation researchers have begun to advocate for the use of demand-side employment models to help people with disabilities obtain and retain employment. Aim To examine demand-side employment factors that may influence hiring and retention of people with physical disabilities. Method One hundred and thirty two human resources (HR) managers and line managers were surveyed and the data were analyzed using descriptive statistics and multiple regression and correlation analysis. Results Managers rated people with disabilities’ productivity and reliability between the neutral and agree range. Managers were neutral about their own knowledge of the Americans with Disabilities Act (ADA) and job accommodation and were similarly neutral about their company’s effort to include disability in the company’s diversity efforts. Hiring efforts were associated with the company’s diversity climate and inclusion of disability in diversity efforts. A hierarchical regression was conducted with results indicating that the demand side factors accounted for a significant portion of the variance in commitment to hire; knowledge of ADA and job accommodation and inclusion of disability in diversity efforts were found to be significantly associated with commitment of the company to hire people with disabilities. Conclusions HR and hiring managers in the current study were not overly enthusiastic about people with disabilities as reliable and productive employees. ADA and job accommodations training might improve these managers’ attitudes toward people with disabilities. Intervention at the senior management level should focus on changing company policies to include disability as part of the company’s diversity efforts.

Predicting employment outcomes of rehabilitation clients with orthopedic disabilities: A CHAID analysis

Purpose. To examine demographic and service factors affecting employment outcomes of people with orthopedic disabilities in public vocational rehabilitation programs in the United States. Method. The sample included 74,861 persons (55% men and 45% women) with disabilities involving the limbs or spinal column who were closed either as rehabilitated or not rehabilitated by their state-run vocational rehabilitation agencies in the fiscal year 2001. Mean age of participants was 41.4 years (SD = 11.2). The dependent variable is employment outcomes. The predictor variables include a set of personal history variables and rehabilitation service variables. Results. The chi-squared automatic interaction detector (CHAID) analysis indicated that job placement services significantly enhanced competitive employment outcomes but were significantly underutilized (only 25% of the clients received this service). Physical restoration and assistive technology services along with support services such as counseling also contributed to positive employment outcomes. Importantly, clients who received general assistance, supplementary security income, and/or social security disability insurance benefits had a significant lower competitive employment rates (45%) than clients without such work disincentives (60%). Conclusion. The data mining approach (i.e., CHAID analysis) provided detailed information and insight about interactions among demographic variables, service patterns, and competitive employment rates through the segmentation of the sample into mutually exclusive homogeneous subgroups.

Self-stigma, stages of change and psychosocial treatment adherence among Chinese people with schizophrenia: a path analysis.

ObjectivesMental illness stigma is one of the key causes for poor psychosocial treatment adherence. The objective of this study was to explore the link between self-stigmatization and adherence via path analysis with insight and readiness for change conceptualized as the possible mediators. The direct effects of psychopathology causing non-adherence were also tested.MethodOne hundred and five participants with schizophrenia were recruited from five psychiatric settings in Hong Kong. Data concerning their level of stigma, insight, stages of change, psychopathology, and psychosocial treatment adherence were collected. Path analysis was used to test two hypothetical models.ResultsThe findings supported the direct effects of self-stigma on reducing psychosocial treatment adherence, and its indirect influences mediated by insight and stages of change on treatment adherence. Psychopathology was also found to have a direct effect on undermining adherence. This model showed better model fit than the one which did not consider the direct effects of self-stigmatization and psychopathology.ConclusionTo conclude, this study deepened our understanding on the mechanism explaining how self-stigmatization undermines psychosocial treatment adherence. The findings provide direct implications on ways of formulating a self-stigma reduction program to combat self-stigma and its negative consequences.

Understanding Employers’ Hiring Intentions in Relation to Qualified Workers with Disabilities: Preliminary Findings

Introduction As part of the planning process for a larger survey study to examine factors affecting employers’ intention to hire and hiring of people with disabilities, a series of three semi-structured focus groups were held with key hiring decision makers, such as Human Resources directors, Chief Operating Officers (COOs), or Chief Executive Officers (CEOs) of small, medium, and large Seattle area companies. Aim The chief goals of the focus groups were to elicit and refine the participants’ beliefs, normative influences, and perceived control relative to hiring workers with disabilities. Method Narrative data obtained from the focus group discussion were examined using the Theory of Planned Behavior (TPB) to identify themes expressed by the focus group participants within the context of company size. Results Themes did vary by company size, but a prevailing concern across all companies related to questions about the efficiency/effectiveness of contact with vocational rehabilitation agencies. For both small- and mid-sized companies, there was a belief that people with disabilities could not do the work or were somehow less qualified. For large companies, convincing departmental and team managers that outreaching workers with disabilities would be a worthwhile hiring practice remained a challenge. Conclusion The themes derived from this study can be used to help occupational rehabilitation professionals develop educational and marketing interventions to improve employers’ attitudes toward hiring and retaining individuals with disabilities.

Return to Work After Cancer in the UK: Attitudes and Experiences of Line Managers

Introduction With improvements in diagnosis, treatment and survival rates, returning to work after cancer is of increasing importance to individuals and employers. Although line managers can play a potentially important role in the return to work process, research thus far has focused on the return to work process from the perspective of cancer survivors. Aim To explore the attitudes of line managers towards employees with a cancer diagnosis. Methods A short self-administered, on-line questionnaire was circulated to managers in the North East of England. Factorial structures of the line managers’ attitudes survey was examined using exploratory factor analysis and the effect of demographic characteristics and organisational variable on the attitudes of line managers was examined using multivariate analysis of variance (MANOVA). Results Line managers’ attitudes can be conceptualized according to five empirical factors: (a) fearful attitudes towards cancer survivors, (b) supportive attitudes, (c) line-managers’ perceived burden, (d) maintaining normality, and (e) financial benefits issues. Overall, line-managers hold relatively positive attitudes toward cancer survivors and are willing to support them in their effort to return to work. However, managers tend to harbour negative attitudes regarding the individual cancer survivors’ ability both to engage in work related activities and in meeting the demands of employment. MANOVA results also indicated that female managers hold more positive attitudes than male managers toward cancer diagnosis, less concerned about workload burdens of working with cancer survivors, and more willing to help cancer survivors maintain normality. Conclusions The results of this study suggest that employers/line-managers need to be provided with training, support, and resources to help them facilitate employment and job retention of employees diagnosed with cancer.

Predictors of Life Satisfaction in Individuals with Intellectual Disabilities.

BACKGROUND The purpose of this study was to examine factors that predict life satisfaction in individuals with intellectual disabilities (ID). Two groups of variables were studied: life skills (interpersonal, instrumental and leisure) and higher-order predictors (social support, self-determination and productivity). METHOD Fifty-six participants with ID were recruited from two community agencies in Wisconsin. Data were collected using both a self-report inventory, which was administered to each individual in an interview format, and a behaviour rating scale, which was completed by a knowledgeable staff member. Hierarchical regression was used to analyse the data. RESULTS Both sets of variables were found to explain a significant amount of the variance in life satisfaction. Within the sets, social support and interpersonal skills were individually significantly associated with life satisfaction. CONCLUSION It is hoped that the results of this study will help support providers organise services in such a way that maximises the life satisfaction of the consumers that they serve.

Structural Equation Modeling in Rehabilitation Counseling Research

Structural equation modeling (SEM) has become increasingly popular in counseling, psychology, and rehabilitation research. The purpose of this article is to provide an overview of the basic concepts and applications of SEM in rehabilitation counseling research using the AMOS statistical software program.

Intersectionality and Disability Harassment: The Interactive Effects of Disability, Race, Age, and Gender

A possible interaction among the characteristics of disability, race, gender, and age was examined with respect to formal allegations of disability harassment. Using data from the National Equal Employment Opportunity Commission (EEOC) Americans With Disabilities Act (ADA) Research Project, the authors examined whether there was an interaction among disability, gender, age, race, and employer characteristics when considering the proportion of harassment versus other forms of discrimination allegations. Using Exhaustive Chi-Squared Automatic Interaction Detector (Exhaustive CHAID) analysis, the authors detected several interaction effects. They discovered unique clusters of characteristics that place certain groups at a very high and very low risk for experiencing disability harassment. The findings are discussed in the context of past and future research on intersectionality and workplace implications.