Showing papers on "Physical disability published in 1992"

Measurement in Neurological Rehabilitation

Abstract: Part 1 Background to the choice and use of measures: pathology, impairment, disability, handicap - a useful model measurement and assessment - what and why? classification of impairment, disability and handicap choosing a measure. Part 2 Measurement at different levels: measures of pathology motor and sensory impairments cognitive and emotional impairments personal physical disability global disability measures, extended ADL and social interaction handicap and quality of life. Part 3 Measurement in practice: measurement in some specific diseases measurement in some specific circumstances. Part 4 Measures for use in neurological disability: measures of cognitive impairment and disability measures of motor impairment measures of "focal" disability activities of daily living (ADL) and extended ADL tests global measures of disability measures of handicap and quality of life measures of emotion and social interaction multiple sclerosis stroke scales head injury Parkinson's disease and other movement disorders miscellaneous measures.

Personal and political: A feminist perspective on researching physical disability

Abstract: Feminist theory and methodology have much to offer in understanding how disability research has been experienced as alienated research by disabled people However, feminist research has failed to apply its principles to disability and disabled women's subjective reality has found no place in mainstream feminist work The paper identifies the challenges for feminism in addressing the interests and reality of disabled women, asserting that it is not helpful to focus on ‘double disadvantage’ Disability research itself has much to learn from feminist methodology, in particular the principle of making the personal political The role of non-disabled researchers as allies of disabled people is discussed, and the importance of research which turns the spotlight on the way in which non-disabled society oppresses disabled people Finally, it is asserted that disability research and politics are of general relevance because the experience of disability is an integral part of a society characterised by fun

Service needs of families of children with severe physical disability

Abstract: Summary Service contacts, perceived helpfulness of services and needs for help were investigated in a sample of 107 families of young children with severe physical disability. Many families were in contact with a multiplicity of different services and overall frequency of contact was high. Despite this, there was evidence of considerable unmet need, particularly in the provision of information to families. Families with the highest levels of unmet need were likely to have experienced high levels of strain from life events and to have children with mental retardation as well as physical disability, fathers in those families were more likely to be unemployed and mothers were more likely to use passive optimism in coping with child problems. The findings indicate the importance of services which are easily accessible to parents, the provision of information to parents about such services, the co-ordination of services through a ‘link’ person and the accurate and individual assessment of family needs.

Functional limitations and disability among elders in the Framingham Study.

Abstract: BACKGROUND. The measurement of physical disability as an indication of the impact of disease is commonly seen in research. However, these measures often do not clearly differentiate between functional limitations and daily performance of an activity. METHODS. We measured the differences between self-reported disability and observed functional limitations in six activities of daily living tasks among community-dwelling elders. The value of functional limitations vs disability measures in determining risk factors for disablement was ascertained. RESULTS. Systematic differences were found among the 1453 participants. At least 89% of the time when a difference was identified, the subjects ranked disability greater than the functional limitations observed. For those who were cognitively impaired, discrepancies occurred up to 11% of the time. In determining risk factors for disablement, we found that neurological impairments were associated with both functional limitations and disability, while sociocultural fa...

Emotional changes with multiple sclerosis and Parkinson's disease.

Abstract: Multiple sclerosis (MS) and Parkinson's disease (PD) are relatively common neurological disorders. Both disorders are chronic and progressive, produce varying degrees of physical disability, and result in characteristic neuropathological changes to a variety of subcortical brain structures. Patients with MS or PD also exhibit a higher prevalence of emotional disorders relative to other patient groups with comparable degrees of physical disability. The present review (a) examines specific methodological issues associated with research in this area, (b) describes the range and severity of emotional disorders in MS and PD, and (c) examines both endogenous and reactive explanations to account for the increased prevalence of emotional dysfunction in these two disorders. Suggestions for future research are offered, as well as implications for treatment.

Physical disability among Canadians reporting musculoskeletal diseases.

Abstract: About one million Canadian adults are estimated to have physical disabilities attributed to a musculoskeletal condition, a prevalence of 50.1/1,000 adults (all rates expressed/1,000). The specific musculoskeletal disease rates were arthritis/rheumatism (27.2), back (16.2), "other" (4.6), trauma (3.6) and bone (0.6). More women reported disabling musculoskeletal disease (61.0 versus 38.6, respectively). Prevalence rates increased with age from 6.2 among Canadians aged 15-24 years, to 264.7 aged 85 years and over. Limitations of mobility were more common than those of agility. Adults in institutions reported more disabilities than did adults in households (means 7.7 and 4.4, respectively).

Providing care to persons with physical disability. Effect on family caregivers.

Abstract: Studies on caregiving often assume that outcomes will be problematic and assess negative factors, such as burden or stress. Results may be biased by detailing only the problems encountered. The current study assessed positive, neutral and negative aspects of caregiving and evaluated the impact of caregiving using criteria based on an accepted model of family functioning. Of 942 consecutive hospital admissions, 217 subjects required assistance in personal care and returned home with a primary caregiver. Caregivers reported moderately more anxious, depressive and somatic symptoms than expected from standardized tests, but these findings were not clinically or statistically significant. Family functioning was related to the duration of the caregiving experience. Family relations seemed to be a source of strength for caregivers, regardless of disability type. Further research is needed to determine if family functioning can be used to buffer against unfavorable aspects of caregiving or to enhance positive aspects of the situation.

The psychometric properties of the Center for Epidemiological Studies-Depression Scale (CES-D) when used with adults with physical disabilities.

Abstract: Psychometric properties of the Center for Epidemiological Studies Depression Scale (CES-D) were examined in a sample of 790 adults with physical disabilities and compared to the responses obtained from non-disabled samples (Craig and Van Natta, 1976; Radloff, 1977). Findings suggested the CES-D is a valid measure of depressive symptoms among adults with physical disabilities. Scores on the CES-D scale were not elevated by somatic issues related to physical disability as evidenced by the lack of statistically significant differences in the persistence percentages reported by adults with physical disabilities and non-disabled adults for four of the seven items composing the somatic dimension of the CES-D. Moreover, the factor structure obtained via principal components analysis was highly similar to that obtained with non-disabled adults. Likewise, the Cronbach alpha value for the total score was within acceptable ranges and scores on the CES-D scale were moderately correlated with scores on a numb...

Depression in rheumatoid arthritis: aetiology and treatment

Abstract: Previous reviews of psychological factors in arthritis have emphasized the methodological weaknesses of many studies, especially those attempting to measure personality after years of disabling disease. A number of recent studies have used reliable measures, and there is a growing consensus that the prevalence of depression is similar to patients with other medical conditions and that social stress and lack of social support are closely related to depression. The aetiology of such depression includes factors such as recrudescence of arthritis, physical disability, social problems consequent upon such disability and lack of social support. Treatment of the depression involves its recognition, adequate doses of antidepressants and psychological help to overcome marital or family problems and any co-existing phobias. Such treatment may reduce pain, improve functioning and mood, yet be regarded by the patient as ‘improved confidence’. This illustrates the importance of somatization in this population.

Depression in the early phase of MS : influence of functional disability, cognitive impairment and brain abnormalities

Abstract: This study investigated the relationship between depression, physical disability, cognitive deficit and brain abnormalities on magnetic resonance imaging (MRI) in patients with early MS. Eighteen relapsing-remitting MS patients were evaluated: depression was diagnosed according to DSM-III R and measured by the MMPI depression subscale, physical disability was assessed by using the Kurtzke Expanded Disability Status Scale (EDSS) and cognitive functions by means of an extensive neuropsychological test battery. A neuroradiologist blinded to clinical findings quantified cerebral lesion on MRI. Weighted brain area lesion score were developed according to number and size of cerebral lesions. On the basis of DSM-III criteria, six patients were classified as having major depression, seven patients had minor depression and five patients were without depressive symptoms. No significant differences were found among the three groups on both neuropsychological performances and weighted MRI lesion scores. However patients with major depression exhibit greater physical disability than the other MS subgroups. A significant correlation was found between MMPI depression subscale and physical disability. This study suggests that at least in the early phase of MS, depression appears more related to the physical disability than to the severity of pathological brain involvement.

Level of function predicts first stroke in the elderly.

Abstract: Our aim in this study was to assess physical function as a predictor of stroke incidence in a probability sample of noninstitutionalized elderly subjects with no previous history of stroke.The data were obtained from a prospective longitudinal study of 2,812 individuals aged 65 years of age and older living in New Haven, Connecticut. Incidence of stroke was monitored from the baseline interview in 1982 until December 1988 (n = 167). Physical function was measured by the Katz scale of activities of daily living and a three-item scale measuring gross mobility function (Rosow scale). Both measures of impairment of function were independently associated with stroke incidence controlling for age, sex, diabetes, hypertension, and angina (p less than 0.001).Our findings suggest that in elderly persons, physical disability is a newly identified risk factor for stroke.

The Cost of Disability in Older Women and Opportunities for Prevention

Abstract: Although women's life expectancy exceeds that of men, older women bear a higher burden of morbidity and disability. The purposes of this study were to determine the association between physical disability and levels of health care use and costs in older women and to investigate several potential risk factors for the development of physical limitations that may be amenable to clinical and public health interventions. The study population was 1337 women aged 65 and older who were members of a large health maintenance organization and who agreed to participate in a randomized controlled trial of health promotion interventions. Level of physical function at baseline was measured by the number of reported restricted activity days during the past year and by a six-item physical function scale that determined ability to perform a range of functional tasks from vigorous activity to daily hygiene. Level of physical function at baseline and the trajectory of functional status during 1 year of follow-up wer...

QALYs in mental health: a case study.

Abstract: The applicability of the Charing Cross health indicator (CH-X) to the field of mental health was investigated in a community setting using descriptive statistics and principal components analysis. The CH-X is based on assessments of (i) distress and (ii) disability. Our results suggest that with respect to quality of life in mental health settings measurements of distress may be of greater importance than disability. In addition, the CH-X may be insensitive to variations in the severity of mental disorder and may primarily reflect physical disability as opposed to social disability. QALYs methodology may require the adoption of a multidimensional measure of health in order to fulfil its proposed role in comparing medical and mental health programmes.

Physical diability after retirement and occupational risk factors during working life: a cross sectional epidemiological study in the Paris area.

Abstract: STUDY OBJECTIVE--The aim was to examine the relationship between exposure to occupational risk factors during working life and physical disability after retirement. DESIGN--The study was a cross sectional epidemiological survey of a representative sample of retired subjects belonging to a supplementary pension fund in the Paris area. SETTING--The study took place in the general community. PATIENTS--307 men and 320 women (63.1% of those approached) answered a questionnaire during home interviews. Their average age was 69 (SD4) years at the beginning of the survey. Whether or not subjects had been exposed to occupational risks was determined from their statements concerning the presence or absence of eight harmful environmental conditions while at work. Physical disability was defined as difficulty in carrying out seven basic activities of daily life. MAIN RESULTS--The results of univariate analyses showed significant relationships between exposure during working life to occupational risks including noise, heat, dust, carrying heavy loads, and awkward postures on the one hand, and the presence of a physical disability after retirement on the other. Multivariate analysis based on logistic regression models that took account of age, sex, and health impairments revealed a specific link between exposure to carrying heavy loads and physical disability after retirement. CONCLUSIONS--These results suggest that occupational risk factors might be important in determining such disability in retired people.

Rehabilitation in adults with human immunodeficiency virus-related diseases.

Abstract: The acquired immunodeficiency syndrome is a fatal disorder of cell-mediated immunity caused by the human immunodeficiency virus (HIV). As many as one million Americans infected with HIV can expect improved survival with more advanced treatment approaches. Complications of HIV infection occur in the brain, spinal cord, muscle, nerve, joints and other organ systems, which lead to extensive impairments. As survival increases, rehabilitation professionals can anticipate a greater number of referrals for the assessment and management of physical disability in persons with HIV infection. This article reviews HIV-related disease, impairment, disability and handicap pertinent to rehabilitation medicine. An agenda for future research is also proposed. Current knowledge and models or rehabilitation care can be applied to HIV-related physical disability in an effort to improve overall quality of life.

Aspects of Music Therapy Relating to Physical Disability

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‘Negative symptoms’, health, depression, and level of functioning among nursing home residents

Abstract: A six-month longitudinal design was used to assess the relations among functinal ability, medically disabling conditions, cognitive function, depression, and negative psychiatric symptoms in a nursing home sample. Seventy intermediate and skilled care residents were interviewed, with 51 completing the six-month follow-up. Negative symptoms were found to be related approximately equally to physical disability, boredom, and depression, but were not strongly predicted by any study variables. The most stable relationship observed was that between negative symptoms and functioning in the realm of activities of daily living (ADL). Negative symptoms predicted change in ADL functioning across the six-month period of the study. The findings have possible implications for predicting mortality and focusing interventions on what appears to be a general decline syndrome in nursing home elderly.

Diagnosis and disability in Geriatric Assessment Team clients: a pilot study.

Abstract: This study presents the results of a pilot study examining the diagnosis and disability levels of a sample of clients seen by four Victorian Regional Geriatric Assessment Teams (GATs). It identifies a clear relationship between the client disability profile and the resultant recommended care plan. As expected, clients recommended for nursing home care are the most disabled, although clients recommended for inpatient treatment/rehabilitation also have very high levels of physical disability. Recipients of hostel or Special Accommodation Home (SAH) recommendations, however, exhibit levels of physical disability comparable to those of clients with community care recommendations. The distinguishing factor here is the presence of cognitive disability, which substantially reduces the likelihood of retention in the community.

Influences of prolonged bed rest and cognitive impairment on nursing home residents.

Abstract: Seventy nursing home residents with and 87 without cerebrovascular diseases (CVD) were examined by the modified Stockton Geriatric Rating Scale (modified SGRS) which measures four aspects of impairments; physical disability, socially irritating behavior, communication failure and apathy. They were divided into 3 subgroups according to walking ability; prolonged bed rest, walking with aids and walking by themselves in both groups. Physical disability of mental decline was significantly aggravated more than that of normal intelligence in all the subgroups. Although communication failure and apathy of mental decline had deteriorated more than those of normal intelligence in prolonged bed rest in residents without CVD, apathy of the former had deteriorated more than that of the latter in walking by themselves in residents with CVD.

A therapeutic approach to physical disability.

Abstract: The nature and extent of physical disability within the UK is identified. Current therapeutic approaches to disability, impairment and handicap are examined and suggestions are made which may offer an improvement to existing services. Physiotherapists are urged to take a broader view of disablement and of its management, to improve communication and collaboration with colleagues and to extend their services by making proper use of helpers. The structure of physiotherapy education and training should take account of the complete needs of patient categories. Training in, and practice of, rehabilitation should have a shift of emphasis from hospital to community base. A proposal is made for the creation of a new, unitary, community-based rehabilitation profession.

Interferences in psychosocial development of seriously health-impaired and physically disabled children. Educational implications.

Abstract: Improvements in neonatal care and medical intervention have dramatically increased the number of seriously health-impaired and physically disabled children who now survive to enroll in elementary and secondary schools. Investigation into the post-secondary status of those populations reveals that few of them are employed or living independently. Some researchers have recently found that the disappointing status of these individuals correlates more significantly with psychosocial factors than with intelligence or severity of the disability. This paper describes the circumstances which typically surround children with serious chronic illness or physical disability in the context of Erikson's stages of psychosocial development and suggests strategies for educators regarding the social development of such individuals during the elementary and secondary school years.

Rehabilitation in Parkinson's disease, day care programs for demented patients, and aids for living and home modifications for patients with neurologic physical disability

Abstract: Publisher Summary This chapter discusses the rehabilitation in Parkinson's disease, day care programs for demented patients, and aids for living and home modifications for patients with neurologic physical disability. The major symptoms of Parkinson's disease, bradykinesia, tremor, and rigidity, lead to increasing physical inactivity as the disease progresses. This problem, coupled with increasing loss of automatic associated postural movements, which cause postural instability, make rehabilitation programs important in dealing with an individual with advancing Parkinson's disease. Rehabilitation programs largely consist of stretching exercises for the upper and lower extremities, walking, and exercise programs such as cycling to increase leg strength. Day care programs for severely intellectually impaired patients can at least relieve the care giver for brief periods of the responsibility of looking after the individual. In these programs, an individual with dementia may take part in physical and intellectual activities that appear to restore some interest in personal care, outside activities, and other people, and can relieve boredom and reduce social isolation. For most patients with neurologic physical disability, some program of home modification is necessary. The areas where home modifications are most needed are the bathroom, bedroom, and kitchen. Being able to dress and remain independent in performing usual daily hygienic routines are essential for patients to retain their self-respect and ability to live with others. The area around the bathtub or shower stall should be provided with several sturdy supports so that patients can balance themselves, pull themselves upright, or hold on securely while bathing.

Predictors of psychosocial functioning in multiple sclerosis : cognitive impairment, depression and physical disability

Abstract: A number of reports suggests that multiple sclerosis (MS) leads to certain changes in psychosocial functioning. Whether these changes are the direct result of specific symptoms of MS such as: physical impairments, depression or deficits in cognitive function, is not yet clear. Few studies have examined the relative effects of each of these symptoms on various measures of social and vocational activities. Therefore, the purpose of this study was to determine: 1) in a sample of MS patients in the early stages of a relapsing-remitting disease course, the prevalence of cognitive impairment and depression; 2) whether these two dimensions were independent of physical disability; and 3) whether cognitive impairment, depression, or physical disability was most predictive of the decline of psychosocial functioning. In order to discover whether each of the symptoms existed within the sample, the MS group was divided according to cutting scores established by the performance of the normal control group. First, a group of MS patients who were cognitively impaired was identified by scoring lower than the fifth percentile of the normals' scores on the Word Fluency Test. Thirty seven patients (20%) of the MS group scored in the impaired range. Validation of this impairment was assessed by performance on other neuropsychological tests. Neither diseaserelated nor demographic variables could account for the deficit. Similarly, a group of patients with a high level of depressive symptoms was identified by using the ninety-fifth percentile of

Transactional Analysis and Rehabilitation: An Integrative Approach to Disability

Abstract: This article integrates concepts from transactional analysis and the field of rehabilitation in order to suggest insights into the psychosocial aspects of physical disability that can help clients ...

Physical disability after retirement and occupa- tional riskfactors duringworkinglife: a cross sectional epidemiological studyintheParis area

Abstract: Studyobjective-The aimwastoexamine therelationship betweenexposure tooccupational riskfactors duringworkinglife and physical disability afterretirement. Design-Thestudywasacrosssectional epidemiological surveyofarepresentative sampleofretired subjects belonging toa supplementary pensionfundintheParis area. Setting-The studytookplaceinthegeneralcommunity.