A Narrative Review of Contemporary Global Perspectives into Epidemiology, Treatment, and Prognosis of Vertebrobasilar Strokes

Blood flow interruptions to the posterior cerebral circulation hallmark vertebrobasilar strokes (VBS), leading to mortality and significant disabilities, yet optimal therapy prevails unpublished. Recent epidemiological evidence indicates that VBS account for nearly 1/5 of all ischemic strokes globally, with acute basilar artery occlusion (BAO) contributing significant disabilities in nearly 1/3 of the victims. The prevalence of VBS in Africa is close to 5%, majorly in large intracranial vessels. Etiologically, Stenosis accounts for 20% of all VBS, while aneurysms face up to a 3% rupture rate. Furthermore, intravenous alteplase is the gold standard medical therapy for the cases presenting within 3 to 4.5 hours post-baseline regarding management options. Nevertheless, there is no consensus for BAO beyond 4.5 hours post-onset. Stent retrievers are the first-line endovascular reperfusion therapy device proposed. However, an 18% risk of in-stent restenosis is a significant drawback. Comprehensive prognostic factors are addressed in this review. However, prospective, multicenter, controlled studies are needed to clarify the time window dilemmas facing posterior circulation strokes. This narrative review explores recent VBS epidemiology, management advances, and prognosis.Rwanda J Med Health Sci 2021;4(3):418-429

Expert Perspectives on the Inclusion of Students With Significant Disabilities in Schoolwide Positive Behavioral Interventions and Supports

Schoolwide Positive Behavioral Interventions and Supports (SWPBIS) is a framework intended to benefit all students in a school. However, recent research suggests that students with significant disabilities may not fully participate in SWPBIS. Given the complex reasons for varied involvement in SWPBIS (e.g., student educational placement), the purpose of this study was to investigate expert perspectives on the extent to which students with significant disabilities should be included in SWPBIS. Overall, experts agreed students with significant disabilities should be included in all tiers of SWPBIS, receive instruction in schoolwide rules and expectations, and have the opportunity to participate in schoolwide reward systems. Experts shared differing perspectives on the ways behavior violations of students with significant disabilities should be documented.

380. Environmental Contamination with SARS-CoV-2 in Nursing Homes

Background The COVID-19 pandemic has disproportionately affected nursing home (NH) patients, accounting for 5% of all cases and 32% of all COVID-19 deaths nationwide. Little is known about the frequency and persistence of SARS-CoV-2 environmental contamination in NHs. We characterize SARS-CoV-2 contamination in the rooms of COVID-19 patients and common areas in and around COVID-19 units. Methods A prospective cohort study was conducted at four NHs in Michigan between October 2020 and January 2021. Clinical research personnel obtained swab specimens from high-touch room surfaces of COVID-19 infected patients, up to three times per patient. Weekly swab specimens from six high-touch surfaces in common areas were also obtained. Demographic and clinical data were collected from patient clinical records. Our primary outcome of interest was the probability of SARS-CoV-2 detection from specific environmental surfaces in COVID-19 patient rooms. Results One hundred four patients with COVID-19 were enrolled and followed for 241 visits. Patient characteristics included: 61.5% over the age of 80; 67.3% female; 89.4% non-Hispanic white; 50.1% short-stay. The study population had significant disabilities in activities of daily living (ADL; 81.7% dependent in four or more ADLs) and comorbidities including dementia (55.8%), diabetes (40.4%) and heart failure (32.7) (Table 1). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient room surfaces, 191 common area swabs). Figure 1 shows contamination rates at sites proximate and distant to the patient bed. SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Over the course of follow-up, 89.4% (93/104) of patients had SARS-CoV-2 contamination in their room at least once (Figure 2). Environmental contamination detected on enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination. Table 1. Clinical and Demographic Characteristics of the Study Population Including Short- and Long-stay Patients Figure 1. Contamination of Environmental Surfaces Relative to Distance from Patient Bed Figure 2. SARS-CoV-2 on Swab Specimens Collected – Patient-level, Visit-level, and Swab-level Conclusion We conclude that environmental contamination of surfaces in the rooms of COVID-19 patients is nearly universal and persistent. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment. Disclosures All Authors: No reported disclosures

Alignment of Supplementary Aids and Services With Student Needs and Placement

Trends in the supplementary aids and services (SAS) written in individualized education programs (IEPs) for students with significant disabilities (a) in different educational placements, (b) with and without behavior support plans (BSP), and (c) with and without complex communication needs (CCN) are examined using multivariate analysis of variance. Results show no significant differences in SAS for students across separate, resource, and inclusive placements. Students with BSPs had significantly more collaborative and behavior SAS than those without BSPs. Students with CCN had significantly more social-communication SAS than those whose IEPs indicated little to no communication support needs; however, 51.1% of students with CCN had no social-communication SAS. Findings raise concern around the extent to which SAS are considered before placement decisions, the high frequency of paraprofessional support for students with BSPs, and the low frequency of social-communication SAS written for students with CCN. Implications for policy, practice, and future research are provided.

Sciatic nerve-conditioned medium with the addition of Croton blanchetianus Baill essential oil promotes morphological plasticity in spinal cord cultured cells

Spinal cord injury is a devastating condition that leads to significant disabilities. The treatment for this problem is a challenge in neuroscience, and it is necessary to combine different strategies to obtain functional recovery outcomes. There are many herbal natural products, such as Croton blanchetianus Baill (CB) essential oil, a Brazilian semi-arid bush with neuroprotective substances tested in regeneration processes and synaptic plasticity. Thus, this study analyzed the cellular plasticity of spinal cord neurons and glial cells in the presence of sciatic nerve-conditioned medium (SNCM) before the addition of CB essential oil. Cell morphology was assessed over 96 hours, and immunocytochemistry analyses were conducted for GFAP, GAP-43 and NeuN. Photomicrographs were made by scanning electron microscopy (SEM). Morphological analysis showed evident trophic development in the groups that received CB essential oil (P>0.000), immunoreactivity for GFAP, GAP-43 and NeuN and the plasticity of these cells were confirmed by SEM. This pioneer study about the plasticity of spinal cord neurons and glial cells opens new possibilities and techniques with essential oils for cell therapy in the presence of SNCM, which promoted neuroprotective action.

A Tiered Approach for Training Paraeducators to Use Evidence-Based Practices for Students With Significant Disabilities

Paraeducators play an important role in the education of students with significant disabilities. They can best contribute to improving student outcomes when they are skilled in using evidence-based practices. Tiered training is a practical and promising solution for how teachers can train teams of paraeducators to use evidence-based practices. Like a Response to Intervention (RTI) model for students, tiered staff training involves providing initial training for groups of paraeducators, monitoring their performance, and then providing follow-up coaching to only the paraeducators who need extra support. In this article, each step of tiered training is described with examples. This step-by-step guide is informed by a series of research studies in which tiered training was tested with more than 60 paraeducators who serve students with significant disabilities in public schools.

Employment first and transition: Utah school-to-work initiative

BACKGROUND: Utah’s School-to-Work Initiative is funded by a Partnerships in Integrated Employment Systems Change grant. Our project focuses on building school-level collaborative teams to support transitioning students with the most significant disabilities. Participating students complete work experiences and paid internships leading to permanent competitive integrated employment prior to exit. OBJECTIVE: By integrating two predictors for post-secondary employment, our framework implements customized employment to demonstrate Employment First for students with the most significant disabilities. METHODS: An advisory board evaluated applications and selected Utah secondary schools representing urban, suburban, and rural areas. We provide professional development on transition during biannual community of practice meetings. Subject matter experts provide technical assistance to collaborative teams on implementing the customized employment. RESULTS: Eight school districts have collaborative teams that serve nine secondary schools. We blend funding from VR, Medicaid Waiver, and WIOA to support students with significant disabilities obtain competitive integrated employment. Students’ outcomes have been challenged by the lack of employment providers for customized employment, the turnover of staff in agencies, and the limited resources for English language learners. CONCLUSIONS: We have successfully blended funding and collaboratively support 82 students with significant disabilities and families navigate the adult agency process.

Launching a statewide employment first initiative: Indiana’s work to include coalition

BACKGROUND: After decades of local, state and national efforts to increase employment outcomes for individuals with disabilities, progress has been slow, with a mere 17.9% of persons with a disability employed in 2020 compared to 61.8% for persons without a disability (U.S. Bureau of Labor Statistics, February 2021). Individuals with disabilities have demonstrated their abilities and desire to work, including those with significant disabilities, yet our country remains entrenched in outdated and ineffective models of day services (i.e., sheltered workshops, non-work programs) and precious public dollars continue to be used for these services that congregate and segregate individuals, pay subminimum wages, and deny individuals their human and civil rights. OBJECTIVE: The purpose of this article is to describe one state’s efforts to advance employment for working age individuals with disabilities through a statewide Employment First initiative called Work to Include. Indiana is now in its third year of this grassroots initiative driven by a coalition of self-advocates. Major activities of the initiative are discussed, including passing Indiana’s Employment First law, holding statewide Town Hall meetings, establishing 11 local Work to Include teams, developing and implementing a state Employment First plan, launching local and statewide Disability Employment Awareness month campaigns, using social media and webinars to disseminate information, hosting Employment First Summits, and collaborating with employers and state agencies to promote employment outcomes. CONCLUSION: Next steps toward systems change are discussed, including the establishment of an Employment First office at the state and securing an Executive Order from the governor to make the state a model employer.

A Place of Belonging: Including Individuals With Significant Disabilities in Faith Communities

Faith is central to the flourishing of so many children and adults with significant disabilities and their families. For congregations striving to be a place of inclusion and belonging for their entire community, the theological call to welcome people with disabilities can introduce a host of questions: What does it mean to be a community marked by belonging? What strategies and supports should we adopt to include people well? How can others assist us in this essential endeavor? This article presents a framework for reflecting on the practices and commitments of local congregations that contribute to belonging within a community of faith.