Showing papers on "Physical disability published in 1993"

Risk and Resistance Factors in the Adaptation of Parents of Children with Severe Physical Disability

Abstract: Associations between descriptor variables of child characteristics, life events, parental resources and coping strategies and outcome measures of psychological distress, satisfaction with life and adaptation to the child were investigated for both mothers and fathers in a sample of families of children with severe physical disability. Results indicated high levels of psychological distress, particularly for mothers. Personality factors, coping strategies, life events and socio-economic disadvantage were related to outcome for both parents. For mothers, greater physical disability and communication problems in the child were risk factors; for fathers, child gender and feeding problems showed significant associations with outcome.

Risk factors for physical disability in an aging cohort: the NHANES I Epidemiologic Followup Study.

Abstract: Successful improvement in health in our increasingly aged population will depend in substantial part on reduction of age specific disability levels. In turn, the epidemiologic model suggests that this requires identification of risk factors, development of intervention models, and testing of these models. We attempted to identify risk factors for physical disability among 4,428 50-77-year-olds using baseline data collected in the first National Health and Nutrition Examination Survey (NHANES I) (1971-1975) linked to disability data collected 10 years later in the NHANES I Epidemiologic Followup Study. Results of forward stepwise linear regression analysis showed that the major characteristics contributing to greater disability (explaining at least 1% of the variability in scores) were older age at baseline, less nonrecreational activity, arthritis history, less education, female sex, and greater body mass index at age 40. Other factors associated with greater disability included a history of asthma, cardiovascular disease, abnormal urine test, less recreational activity, higher sedimentation rate, rheumatic fever history, lower caloric intake, positive musculoskeletal findings, histories of polio and allergies, lower family income, elevated blood pressure, lower serum albumin, history of tuberculosis, glucose in the urine, and histories of hip or spine fracture, chronic pulmonary disease, and kidney disease.

The Relationship of Visual and Hearing Impairments to Disability: An Analysis Using the Longitudinal Study of Aging

Abstract: Background Little is known about the relationships of visual impairment and hearing impairments to physical disability. The purpose of this work is to determine if persons 70 years of age and over with these impairments are at risk for increased disability in basic physical activities of daily living (ADLs) compared to persons without these impairments. Methods We used as our data source the baseline (1984) and the 1988 reinterview from the Longitudinal Study of Aging, a nationally representative survey of noninstitutionalized persons 70 years of age and older. To determine the relationships of visual impairment and hearing impairment to future four-year disability, we used multiple variable modeling, controlling for demographic variables, selected chronic conditions, and baseline disability. Results Persons with visual impairment were 1.37 (95% CI:1.20-1.57) times more likely to have increased disability in ADLs than those without visual impairment. Hearing impairment was not independently related to increased ADL disability. Conclusions Visual impairment by itself is an independent risk factor for future ADL disability. In light of the enlarging older population, maneuvers to ameliorate visual impairment may help to minimize the increase in numbers of disabled persons.

Self-Evaluation and Self-Concept of Adolescents With Physical Disabilities

Abstract: Fifty-three adolescents aged 14 to 18 years with diagnoses of cerebral palsy (n = 27), cleft lip or palate or both (n = 17), or spina bifida (n = 9) took part in this study examining their self-esteem, self-concept, self-acceptance, social self-efficacy, and values, as measured by standardized instruments. Comparisons were made separately for males and females with norms developed for adolescents without disabilities. Significant differences were found only on several aspects of self-concept: females with physical disabilities were lower in perceived social acceptance, athletic competence, and romantic appeal than the normative sample, and males with physical disabilities were lower in perceived scholastic competence, athletic competence, and romantic appeal. In addition, social self-efficacy was found to be a significant predictor of both independence and persistence in adolescents with disabilities, who were significantly less independent and persistent than were normative samples. The discussion focuses on the usefulness of the findings regarding social self-efficacy and the implications of the findings for occupational therapists.

Depressive symptoms, medical illness, and functional status in depressed psychiatric inpatients.

Abstract: OBJECTIVE: There is evidence that both psychiatric (especially affective) and medical illnesses contribute to physical disability. However, the differential contributions of specific psychiatric disorders and of medical pathology to functional status in psychiatric populations have not been studied. The authors therefore examined the contributions of depressive symptoms and medical illness to functional disability in depressed inpatients. METHOD: This prospective investigation included 109 psychiatric inpatients with DSM-III-R major depression. Regression techniques were used to examine the contribution of demographic variables (age, sex, education), depressive symptom severity (Hamilton Rating Scale for Depression score), psychiatric function (Global Assessment of Functioning Scale score), organ system pathology (Cumulative Illness Rating Scale score), and medical disability (Karnofsky Performance Status Scale score) to overall functional status (Instrumental Activities of Daily Living and Physical Self-Maintenance scores). These relationships were also examined in older and younger subgroups. RESULTS: Greater age, female sex, and illness factors all contributed to poorer functional status. Of the illness factors, psychiatric pathology contributed more to low functional status than did medical illness. The predictive power came specifically from the functionally based measures of psychiatric and medical illness; a quantitative measure of symptoms (Hamilton depression scale) or organ pathology (Cumulative Illness Rating Scale) did not significantly predict overall functional status. CONCLUSIONS: Clinicians and researchers should recognize that symptomatic and functional assessments tap related but different domains and that both psychiatric and medical illnesses contribute to overall disability.

Depressive Disorders Among Elderly People in Long-Term Institutional Care

Abstract: Depressive disorders are common among old people in residential and nursing homes. Outside Australia the prevalence rate for depressive symptoms in homes ranges from 30-75% while that for depressive disorders defined by psychiatric diagnostic criteria is well over 20% in many nursing home studies. These rates are between two and twenty times higher than those found among the elderly living at home. Evidence from Australia indicates that a problem of similar magnitude exists here. While physical disability is strongly associated with depression in these populations, it is not the only factor likely to be responsible for the initiation and maintenance of depression among those in long-term care. There is an urgent need for studies which will better define likely aetiological and maintaining factors for depression in institutional populations, as well as controlled trials of both pharmacological treatments and environmental improvements. In addition, research is needed to establish whether depression is an independent risk factor for mortality among institutional residents.

Development and validation of a physical performance instrument for the functionally impaired elderly: The Physical Disability Index (PDI)

Abstract: Article describes development of the Physical Disability Index (PDI), an observer-administered, performance-based instrument measuring physical disability in frail-elderly persons without severe cognitive impairment. Sixty-five items in four subscales encompassing Range of Motion (ROM), Strength (STR), Balance (BAL), and Mobility (MOB) were measured. Subjects were randomly selected frail nursing home residents (N = 103) with a Folstein Mini-Mental State Exam (MMSE) score of > or = 11. Using correlation matrices, cluster analysis, and regression techniques, the scale was reduced to 54 items. All individual item values were standardized and aggregated into subscale and summary PDI scores, each with a range of 0-100. Test-retest and interrater reliability were evaluated. Discriminant and convergent validity were established using MMSE, Physical Self-Maintenance Scale (PSMS), and Sickness Impact Profile-Physical Dimension (SIP-PD). PDI is a performance-based instrument that appears to discriminate among frail individuals with differing levels of physical function. Further testing is warranted in other populations of frail-elderly persons to ascertain its applicability and generalizability.

Oral disease and physical disability in community-dwelling older persons.

Abstract: Objective: The aim of this epidemiologic investigation was to determine whether poor oral health in older persons was associated with physical disability. Design: The study was a cross-sectional survey involving in-home interviews and dental examinations of older persons. Setting: A random sample of 68 cities and towns was selected from the six New England states, with stratification according to population size. Participants: The study sample consisted of 1,156 community-dwelling (non-institutionalized) individuals aged 70 and over, randomly selected from the Medicare beneficiary lists for each city and town. Measurements: Oral health was assessed by three dichotomous indices: edentulism (no teeth); current caries, including either coronal or root decay; and periodontal disease, as measured by gingival pocket depth. Physical disability was indicated by the subject's self-report of difficulty in the areas of personal care (eating, bathing, dressing, and using the toilet) and mobility (walking, bed transfer, getting outside), Additional independent variables included age, sex, number of teeth, education, living alone, oral hygiene practices, and time since last dental visit. Results: We found a direct association between specific areas of physical disability and current caries and edentulism. The risk of poor oral health did not increase with advancing age once the related risk factors were controlled for. Those subjects with mobility disabilities were at increased risk of tooth loss; those with personal care limitations were at increased risk of current caries. Conclusions: Physical disability should be added to the list of known risk factors for oral disease among the older population. Our findings call attention to the need for health care providers to screen for oral health problems among disabled older persons. Further gerontologic research is needed to identify the mechanisms linking physical disability with oral disease in older persons.

Self report functional disability scores and the use of devices: two distinct aspects of physical function in rheumatoid arthritis.

Abstract: OBJECTIVES--Self report scores of physical disability and the use of devices or assistance in performing activities are sometimes integrated in one index of physical function, although they are aimed at measuring different dimensions of physical disability The properties of both parameters were evaluated in two groups of patients with rheumatoid arthritis (RA) METHODS--A group of patients with RA of recent onset was compared with a group with established disease on four parameters of disability: use of devices, use of personal assistance, and scores on a validated Dutch version of the Health Assessment Questionnaire Disability Index, with and without integrating the use of devices or assistance Correlation coefficients among disability parameters were calculated In multiple regression analysis the influence of disease duration on the disability parameters was determined after disease activity, psychological wellbeing, and demographical characteristics had been controlled RESULTS--Functional disability scores were mainly related to inflammatory activity and psychological wellbeing, whereas the uses of devices had a strong relation with disease duration, independent of current disease activity Integrating these parameters of disability yielded a parameter that was still mainly associated with disease activity CONCLUSION--Self report scores of functional disability and the use of devices represent distinct dimensions of physical function in RA Integrating both parameters into one measure of physical disability does not provide an index adequately reflecting both dimensions The use of both parameters to measure outcome in long term clinical studies is recommended

Assessment of elderly people in general practice. 4. Depression, functional ability and contact with services.

Abstract: The aim of this study was to look at the interrelationship between depression, physical disability and contact with services. In a random sample of 239 people aged 75 years and over from nine general practices in north London, depression (as measured by a shortened version of the comprehensive assessment and referral evaluation schedule) was found to be significantly associated with being a woman, and inability to perform a number of activities of daily living. Consumption of three or more prescribed medicines, a home visit by the general practitioner in the previous three months and contact with health visitors and home helps were all significantly more likely among depressed patients. There were also significant associations between loss of functional abilities, measured using items from an activities of daily living scale, and use of certain services: general practitioner home visits and reduced mobility indoors and both home help and district nurse visits to those with difficulty in bathing. Multiple logistic regression analysis suggested that contact with services was principally associated with loss of mobility, although contact with home helps was independently associated with depression, when adjustment was made for functional impairment.

Recovery from physical disability after stroke: profiles for different levels of starting severity

Abstract: This study aimed to follow up a preliminary study and collect further information about the profiles of recovery from physical disabilities of people who had suffered a stroke. Prospective monitoring of 348 patients with stroke referred to physiotherapy in health districts throughout the UK was undertaken for a six-week period and a distinct time-related pattern of recovery from disability was again found. Significant differences related to age were identified, but were not found in relation either to side of stroke or sex. These profiles of recovery, together with earlier work monitoring recovery in 368 patients with stroke, provide important information not previously available about indices of recovery directly related to phsyiotherapy. A database on over 700 patients is now available, and can be used to monitor any changes which occur as a result of interventions by therapists. It is also suggested that the development of recovery curves may be a useful way of monitoring quality of care in the physiot...

The disabled elderly living in the community: care received from family and formal services.

Abstract: Objectives Based on a community sample, to assess the reasons disabled elderly people need care, the type of formal services they receive, the characteristics of their carers and the degree of psychological morbidity in these carers. Design and setting A community survey of people aged 70 or more years living in Canberra or Queanbeyan. Survey participants were asked to nominate informants, who were interviewed about the subjects' state of health. The informants provided information on need for care, services received and the role of carers. Informants also reported on their own health, including symptoms of anxiety and depression. Results Elderly people needed care because of physical disability more often than behavioural disability. Those with physical disability received more formal services and more help from health professionals than those with behavioural disability. Contact with general practitioners was high for both disabled and non-disabled subjects. Carers of the physically disabled had raised levels of anxiety and symptoms of depression, and poorer self-rated health, but carers of the behaviourally disabled did not. Wives, daughters and husbands made up the biggest categories of carers and around two-thirds of carers were women. Conclusion Family carers play an important role in maintaining disabled elderly people in the community and this role is often stressful. Formal services have to be aimed as much at the needs of the carers as at the disabled people themselves.

Women with Disability, Paralympics, and Reasoned Action Contact Theory

Abstract: The underrepresentation of women in the Paralympics movement warrants attention as the world prepares for Atlanta 1996, when Paralympics (conducted after the Summer Olympics) will attract approximately 3,500 athletes with physical disability or visual impairment from 102 countries. Barriers that confront women with disability, the Paralympic movement, and adapted physical activity as a profession and scholarly discipline that stresses advocacy and attitude theories are presented. Two theories (reasoned action and contact) that have been tested in various contexts are woven together as an approach particularly applicable to women in sport and feminists who care about equal access to opportunity for all women. Women with disability are a social minority that is both ignored and oppressed. Sport and feminist theory and action should include disability along with gender, race/ethnicity, class, and age as concerns and issues.

Would people with a disability in the highlands benefit from a community-based rehabilitation program?

Abstract: Community-based rehabilitation for those people with a physical disability is a policy promoted by the World Health Organization. In order to assess whether such a program might be useful to the disabled people of the highlands of Papua New Guinea a survey was conducted which first identified those people with a severe physical disability and then investigated the degree that they were handicapped in terms of their social and physical environment. The survey was performed in the Tari area of the Southern Highlands Province in conjunction with the Papua New Guinea Institute of Medical Research (PNGIMR). By using the PNGIMR demographic surveillance system it was possible to calculate a prevalence level of physical disability (including walking disability, deafness and blindness) of 46 per 10,000 (0.46%). A significant physical disability was identified in 114 people, of whom 54 were given personal interviews to establish their quality of life. The survey found the social and economic situation of disabled people to be generally good although there is a lack of basic material aids for handicapped people. The disabled people and their families do not need extra knowledge about how to care for their disabilities and a formal community-based rehabilitation program would be inappropriate, but they would find mobility aids such as wheelchairs and artificial limbs of enormous help. The regular health care services are widely used although both people with a disability and health service staff are not always aware of the types of treatment which can usefully be provided.(ABSTRACT TRUNCATED AT 250 WORDS)

Survey methods for the assessment of physical disability among children

Abstract: Estimates of the prevalence of physical disablement are based on results of population surveys. In investigations of this kind questionnaires are employed directed at the limitations on activities, resulting from long-term health problems including difficulty or an inability to perform activities of daily living, such as walking, dressing, reading and talking. This approach, however, is less appropriate for children, because many inabilities in young age merely indicate normal developmental phenomena. Researchers in several countries have dealt with the problem of how to obtain proper data on disability among children. This article reviews these approaches and concludes that questionnaires should reflect the significant activities which are common for children. Relevant screening items for three age groups (0–2, 3–4 and 5–7 years) are outlined. They show that in screening for disablement with children relatively general indications of disability must be accepted.

Flotation REST, Physical Therapy and Psychological Intervention in the Treatment of Physical Disabilities

Abstract: The use of flotation REST in the treatment of muscular disorders is relatively new. Until recently there existed only anecdotal reports of such application with a few individual patients. These suggested that flotation REST reduces muscle tone in patients with muscle hypertonicity.

Medical and psychosocial interventions

Abstract: The client group for whom we are particularly concerned have been identified in the introductory chapter, but in order to set the medical context refer to Wing and Morris (1981) who state: The commonest psychiatric diagnosis among people who use high dependency services is schizophrenia, but manicdepressive disorders, severe and chronic neurosis, and personality disorders are also frequent.... Moreover, many people have multiple impairments; the diagnosis of psychiatric disorder is associated with physical disability, blindness, deafness, epilepsy, alcohol or drug abuse.