Showing papers on "Physical disability published in 1991"

Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning

Abstract: We designed a study to assess the specific contribution of cognitive dysfunction to multiple sclerosis patients9 problems in daily living. Based on the results of a comprehensive neuropsychological test battery, we classified 100 MS patients as either cognitively intact (N = 52) or cognitively impaired (N = 48). In addition to a neurologic examination, MS patients completed questionnaires on mood and social functioning, underwent a comprehensive in‐home occupational therapy evaluation, and were rated by a close relative or friend regarding specific personality characteristics. While there were no significant differences between the two groups on measures of physical disability and illness duration, patients in the cognitively impaired group were less likely to be working, engaged in fewer social and avocational activities, reported more sexual dysfunction, experienced greater difficulty in performing routine household tasks, and exhibited more psychopathology than cognitively intact patients. These findings suggest that cognitive dysfunction is a major factor in determining the quality of life of patients with MS. NEUROLOGY 1991;41:692‐696

The use of the Health Assessment Questionnaire (HAQ) to determine physical disability in systemic sclerosis.

Abstract: The health assessment questionnaire (HAQ), a self-administered instrument to determine physical disability, was completed by 211 patients with systemic sclerosis who subsequently received scleroderma examinations. The mean HAQ disability index for the entire group was 0.92. Patients with high skin scores had significantly higher disability indices as compared to patients with low skin scores (p < 0.001). Higher disability indices were found for patients with joint pain, tendon rubs, and contractures. However, the presence of ulcers on the digital tip did not interfere with patients' abilities to function as measured by this scale. Intensive hand evaluations were performed on a subset of these 211 patients with systemic sclerosis (n = 80). Grip strength, thumb abduction, wrist extension, and motion of the index and middle fingers significantly correlated with the HAQ scores (p < 0.01). The findings from this study suggest that patients with systemic sclerosis have significant physical disability. Furthermore, the HAQ appears to be useful in assisting health professionals in quantitating this disability.

Children with chronic illness: family and parent demographic characteristics and psychosocial adjustment.

Abstract: This paper presents the results of an epidemiologic study that compares and contrasts psychosocial characteristics of parents and family units of children with chronic illness or physical disability (chronic health problems) with those of healthy children. Data were derived from the Ontario Child Health Study of 1869 randomly selected families, with 3294 children aged 4 to 16 years. In the absence of significant differences between parents and families of children with chronic illness alone and those with physical disability, these groups were combined for analysis, for which odds ratios (OR) or t tests were used. Significant positive findings included increased rates of parental treatment for "nerves" (mothers' OR = 2.1, fathers' OR = 1.9) and increased maternal negative affect scores (Bradburn Affect Balance Scale) (P less than .001) among parents of children with chronic health problems. Important negative findings (95% confidence interval of the OR included 1) included no increase in single-parent families (OR = 1.2), social isolation (OR = 1.0), or alcohol problems (OR = 1.2) among parents of children with chronic health problems. Categorically defined family dysfunction did not differ between the two groups (OR = 1.1). These data contrast with several clinic-based studies and suggest that, in a widely generalizable population survey, families of children with chronic health problems including physical disability do not suffer a marked excess of dysfunction, although some indicators of individual parent psychosocial problems were modestly elevated.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of cognitive impairment in a community survey of multiple sclerosis.

Abstract: A one in two alternate sample (N = 200) from a population-based register of 411 people with multiple sclerosis (MS) was studied. Out of this sample, 147 people with MS and 34 people with rheumatoid arthritis were interviewed at home and completed a battery of neuropsychological tests. Cognitive impairment was found in 46 per cent of those with MS, with memory impairment in 34 per cent and failure on tests of frontal lobe function in 33 per cent. Physical disability was associated with cognitive impairment. Memory impairment was more common in those who had had MS for 10 years or more. A significant minority of people with mild physical disability and some who had had MS for less than a decade nevertheless had cognitive impairment. Relationships between cognitive impairment, other disease variables and psychosocial factors were examined. Counselling and rehabilitation programmes for people with MS and their families should take account of cognitive deficits that may be present.

Benefits of sport and physical activity for the disabled : implications for the individual and for society

Abstract: An increase of physical activity is commonly recommended to those with physical disability, but it is necessary to distinguish competitive sport from fitness programmes, remedial gymnastics and active recreation. Potential benefits of enhanced activity are reviewed. Likely psychological gains include an improvement of mood-state, with a reduction of anxiety and depression, an increase of self-esteem and feelings of greater self-efficacy. Sociological gains include new experiences, new friendships, and a countering of stigmatization. Perceived health is improved, and in a more long-term perspective there is a reduced risk of many chronic diseases. Finally, there is a greater likelihood of employment, with less absenteeism and enhanced productivity. Both the health and the industrial benefits have a potential to yield cost savings that could make an important contribution toward the expense of suitably adapted physical activity programmes. It is concluded that the physically disabled should be encouraged to engage in physical activity, although further large-scale longitudinal studies are needed to determine the optimal type of programme for such individuals.

Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain.

Abstract: Pain-related work disability can be influenced by a number of medical, physical, and psychosocial factors. The present study investigated the role of perceived disability, occupational stress, pain, and distress in patients with chronic pain disorders who work despite pain and patients who are work disabled. A total of 165 patients referred to a multidisciplinary pain treatment center for chronic pain (> 6 months) were studied. The two groups were compared on age, gender, education, marital status, duration of pain problem, pain severity, psychological distress, perceived disability, and perception of the work environment. A discriminant function analysis was computed entering pain severity, distress, perceived disability (physical and psychosocial) and work environment variables. The two groups were equivalent on age, gender, education, marital status, and duration of pain problem. The groups differed on diagnosis and insurance coverage with the work-disabled group diagnosed with low back pain and receiving Workers Compensation coverage more frequently than working controls. Univariate analyses indicated that the work-disabled group reported higher pain severity, perceived physical and psychosocial disability, and job stress than their working cohorts. The discriminant function analysis indicated that the perception of physical disability, supervisor support, distress, and work pressure were capable of correctly classifying patients with chronic pain who continued to work from those who were work disabled. These findings indicate the importance of evaluating perceived disability and job stress, and if present, directing intervention effort at these factors in order to facilitate work re-entry.

The importance of social relationships for infertile couples' well-being

Abstract: Social relationships capacity for mitigating the negative impact of stress on physical and psychological well-being has been well documented. Hundreds of studies have examined the influence of social relationships on the way in which people cope with chronic and acute Stressors such as bereavement, malignant disease, unemployment, rape, physical disability, pregnancy, and work overload (see Broadhead, Kaplan, James, Wagner, Schoenbach, Grimson, Heyden, Tibblin, & Gehlbach, 1983; Gottlieb, 1983; House, Landis, & Umberson, 1988; Kessler, Price, & Wortman, 1985; and Wallston, Alagna, DeVellis, & DeVellis, 1983, for reviews of this literature).

Disease and psychosocial factors related to physical functioning in rheumatoid arthritis.

Abstract: One hundred and fifty-five patients with rheumatoid arthritis (RA) were randomly selected from a tertiary care outpatient rheumatology clinic. Disease, treatment, psychosocial and demographic data were collected to test a biopsychosocial model of Physical Functioning as determined by the Arthritis Impact Measurement Scales (AIMS). Cross-sectional and longitudinal hierarchical and stepwise regression analysis were performed to identify variables associated with Physical Functioning. The results of the hierarchical regression revealed that only the disease and psychosocial sets of variables were significant. Stepwise regression revealed that Disease Severity (disease set) and Arthritis Helplessness (psychosocial set) accounted for 37% (longitudinal) to 60% (cross-sectional 12 months---greater than 12 months) of Physical Functioning variance. Our results suggest a role for the inclusion of psychosocial factors in studies of the development of physical disability in patients with RA.

Tracking progress toward national health objectives in the elderly: what do restricted activity days signify?

Abstract: Restricted activity days is the measure by which the 1990 health objectives for prevention of functional disability in older adults will be evaluated. Yet its significance in older populations is poorly understood. We evaluated its use as an outcome measure for a randomized trial designed to impact upon physical function in elderly HMO enrollees. As predicted, restricted activity days was more correlated with physical disability measures than with other health status measures. Distributional properties and rates of missing data were shortcomings.

Investigating the proxy effect and the saliency principle in household based postal questionnaires.

Abstract: STUDY OBJECTIVE--The aim was to investigate two possible sources of bias inherent in using a household based postal questionnaire, the "proxy effect", inaccurate reporting about characteristics of others, and the "saliency principle", reporting of only the most salient features. This is of importance in surveys concerned with screening the population to identify individuals with certain characteristics, and so possibly relying on one member of the household to reply on behalf of all others. DESIGN AND SETTING--A two stage survey of disablement in the population was undertaken. A first phase postal questionnaire was sent to 25,168 households in Calderdale, West Yorkshire, England, to ascertain the prevalence of physical disability and of troubles with the joints. The second phase comprised in depth interviews with a sample of individuals identified in the first phase as being disabled. RESPONDENTS--A total of 21,889 postal questionnaires were returned (87%) representing households containing 42,826 people aged 16 years and over. A disproportionately stratified random sample of 950 respondents reporting disability was taken in the second phase. Of these 891 were still available, and 838 (94%) were interviewed. MEASUREMENTS AND MAIN RESULTS--The postal questionnaire found that almost 29% of those who lived "alone" (without another adult) reported some level of disability, compared to only 10% of those who lived with others. The difference remained significant after standardisation. This apparent underreporting or "proxy effect" was present for reporting about disability overall, but not for severe disability (dependence on help of others), which suggests the operation of the "saliency principle". Reporting on joint troubles appeared to be affected by the proxy effect both for any joint problems, and when more than five joints were affected. Analysis of a small set of postal questionnaires from respondents who reported joint problems only at interview and where we could identify who had completed the postal questionnaire supports the hypothesis of a proxy effect; two thirds of the original postal questionnaires had been completed by a proxy. The results were further complicated by an interaction between reporting of disability and joint troubles: the greater the level of disability, the less likely the reporting of joint troubles. CONCLUSIONS--The findings have general implications for studies involving postal household screening questionnaires, and raises additional concerns about those that are multitopic in content. In surveys of symptoms and minor disability, a proxy effect is likely to be operative. This effect is not apparent for obvious and long standing problems such as dependence on others for help. However the interaction between the reporting of disability and joint symptoms carries important implications for the development of multitopic postal screening questionnaires.

Depression in the elderly in the community: Effect of physical illness and selected social factors

Abstract: Depressive illness in the elderly may be the result of a physical illness, the cause of secondary physical problems, coincidental tophysical illness or the result of an aetiological factor common to both conditions. Analysis of a cross-sectional community sample of 396 elderly people showed depression to be significantly linked to presence of headaches, dyspnoea, and malignant disease known to the patient. It was not linked with heart disease nor arthritis per se, although those on anti-arthritic or analgesic medication were significantly more depressed. The subjective description of physical health given by the patient also correlated strongly with depression. Depressive illness is sometimes unrecognized and frequently untreated with a consequent reduction in quality of life for many patients. Clinicians must be aware of the possibility that depression may coexist with physical illness, and that both conditions may need appropriate treatment. Further analysis of the above sample, controlling for physical illness and the additive effect of the variables concerned, showed depression to be positively correlated with adverse social factors such as not going out because of physical disability, feeling lonely, having a shopper and having hearing difficulties. The home help service was identified as a probable protective factor, implying the importance of this service in supporting the emotional as well as the physical needs of its clients.

Application of Personality Theories and Counseling Strategies to Clients With Physical Disabilities

Abstract: This article describes how certain relevant theoretical concepts, intervention methods, and criteria for determining therapeutic change, which are borrowed from several personality theories and counseling approaches, can be useful in counseling people with physical disabilities. The clinical utility of each discussed personality theory is explored in the context of the efforts directed at (a) gaining insight into the psychosocial impact of physical disability, (b) counseling for personal adjustment to the disability, and (c) becoming familiar with theory-specific guidelines for assessing therapeutic changes. It is argued that counselors who serve clients with disabilities ought to choose those interventions most congruent with their own theoretical orientation, academic training, work setting, and nature of the disability condition.

Parental and professional views of the needs of families with a child with severe physical disability

Abstract: The study examined parents' and paediatricians' views of the prevalence of needs for help in a number of different areas related to child and family functioning. Twenty-four paediatricians estimated the percentage of families who would need help in each area and their estimates were compared with data from 107 parents who responded about their own needs. Parents and paediatricians largely agreed on the areas of greatest need but in other areas paediatricians tended to overestimate the negative impact of the child on the family and parents' needs for help in teaching the child. Paediatricians with more years experience were likely to be more accurate in their estimates, as were those who placed greater emphasis on giving information about other services to parents and the importance of their own continued involvement with the family. Results are discussed in relation to their implications for parent-professional partnership, the need for more emphasis on communication skills in medical training an...

Incidence of sexual dysfunction in neurologic disability

Abstract: Patients and their families are frequently faced with changes in sexual behavior after the onset of a neurologic disability. Health professionals who familiarize themselves with the physical and psychological problems affecting sexuality can facilitate diagnosis and enhance the success of treatment programs. This article will review the available literature on the incidence of sexual dysfunction in neurologic disabilities frequently seen in the rehabilitation setting including stroke, brain injury, spinal cord injury and multiple sclerosis. Quality of life for survivors of these disorders may be improved through comprehensive rehabilitation programs that address the issues of sexuality.

Disability in persons hospitalized with AIDS.

Abstract: This study documents the types and degree of disability seen in persons with AIDS at discharge from acute hospitalization. Based on 37 discharge evaluations using the Functional Independence Measure (FIM), 60% required human assistance in at least one of 18 FIM areas. Thirty-two percent required human assistance in five or more areas. Fifty-one and 38% required human assistance in stair climbing and ambulation, respectively. Feeding and bathing required assistance in about 33% and transferring to tub or shower in 25% of the sample. Increasing disability was associated with longer duration of AIDS diagnosis and increasing lengths of hospital stay (P less than 0.01 and P less than 0.05, respectively). There were individuals who remained nearly functionally independent up to 30 months after an AIDS defining event. The overall variability in function, however, was not significantly different between those with diagnoses less than and greater than 12 months. We conclude that significant physical disability exists in persons with AIDS at discharge from acute hospitalization. Consultation with and intervention by rehabilitation professionals may be helpful in the management of physical disability in this population and setting.

Clinical issues relating to the diagnosis of mild dementia in a British community survey.

Abstract: • Many epidemiologists base their diagnoses of dementia on scores on brief cognitive tests, but the border between normal aging and mild dementia is so poorly understood that simple demarcations cannot adequately encapsulate the wealth of clinical material that needs to be taken into account in assigning diagnostic labels. Data from a British study of the prevalence and natural history of dementia, in which diagnoses of dementia were made by clinicians using a new, standardized interview schedule, are presented to demonstrate the effects of physical disability, psychiatric illness, and other factors on memory impairment and performance in everyday life. Our purpose is not to insist that clinicians are always correct but rather to highlight the complexities involved and the need for investigators to be more open about the way in which they distinguish between physical, psychiatric, and cognitive infirmities.

Ageing and severe physical disability: patterns of change and implications for services.

Abstract: For the first time in history, numbers of people with severe physical disabilities such as spinal cord injury or polio are surviving to old age. Ageing-related changes combined with pre-existing impairments present new challenges for these individuals and for service providers. Implications for professionals include the need to foster more collaborative relationships between themselves and recipients, to emphasize services that enable independence, to coordinate new services, and to address issues of wellness, not only disability.

A case analysis in human sexuality: Counseling to a man with severe cerebral palsy

Abstract: This article is a case analysis of a 25-year-old man, named Michael, who has cerebral palsy, generalized athetosis. His physical disability is severe and he has a profound speech disorder. Michael is functioning cognitively within the range of borderline intelligence. Michael requested human sexuality counseling. At the onset of counseling Michael stated that due to his physical disability he was neither able to masturbate nor could he find a sexual partner. Four key areas in sexuality and disability are discussed: (1) recognition of the individual with a severe disability as a sexual being, (2) masturbation as a valid sexual activity, (3) seeking an appropriate romantic involvement, and (4) the process involved in making a referral to a sex surrogate. The entire course of treatment is outlined along with the impressions of the counselor.

Perceptions of role assessment tools in the physical disability setting.

Abstract: Various role assessment tools in occupational therapy have been developed to help the clinician understand role performance and role adjustment and guide the structure of intervention This study was designed to examine the clinician's perceptions of standardized role assessment tools in physical disability settings A random sample of 450 occupational therapists was surveyed to learn about therapists' knowledge of four published role assessment tools The study also examined the frequency of tool use in the acute care hospital, the rehabilitation center, and the long-term care facility The results from 236 questionnaires (a 52% response rate) indicated that more than half of the respondents reported that their current initial evaluation did not effectively address role performance Additionally, most of the therapists surveyed had a poor understanding of the four standardized role assessment tools, and only 5% were using an assessment instrument in their practice The respondents reported a desire to learn more about these instruments and how they affect treatment planning Training implications, educational opportunities, and recommendations for future research are discussed

Assessing toileting skills and habits in an adult day care center.

Abstract: In a structured assessment of mobility and toileting skills, all the continent clients but only 46.2% of incontinent clients were able to toilet themselves, even with verbal and physical guidance. Unobtrusive observation of toileting habits indicated that incontinent clients used the toilet less often than continent clients and used more staff assistance to do so. On mental status examination, incontinent clients scored significantly lower than continent clients. Incontinence in this population is a multidimensional disorder in which physical disability is a predominant factor.