Showing papers on "Physical disability published in 2001"

Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years.

Abstract: Objective To reassess, in a cohort of patients with early-onset multiple sclerosis, the long-term evolution of cognitive deficits, their relationship to the disease's clinical progression, and their effects on daily life. Design Ten years after our baseline assessment, we again compared the cognitive performance of patients and control subjects on a neuropsychological test battery. Clinical and demographic correlates of cognitive impairment and their effects on everyday functioning were determined by multiple linear regression analysis. Setting The research clinic of a university department of neurology. Participants Forty-five inpatients and outpatients with multiple sclerosis and 65 demographically matched healthy controls from the original sample. Main Outcome Measures Mean scores of both groups on the neuropsychological test battery in initial and 2 follow-up evaluations (about 4 and 10 years, respectively); number of cognitively impaired subjects, defined by the number of subtests failed; regression coefficients measuring the relationship between clinical variables and cognitive outcome and between mental decline and everyday functioning assessed by the Environmental and the Incapacity Status Scales. Results Previously detected cognitive defects in verbal memory, abstract reasoning, and linguistic processes were confirmed on the third testing, at which time deficits in attention/short-term spatial memory also emerged. Only 20 of 37 patients who were cognitively unimpaired on initial testing remained so by the end of the follow-up, when the proportion of subjects who were cognitively impaired reached 56%. Degree of physical disability, progressive disease course, and increasing age predicted the extent of cognitive decline. Disability level and degree of cognitive impairment were independent predictors of a patient's handicap in the workplace and in social settings. Conclusions In the course of a sufficiently long follow-up, cognitive dysfunction is likely to emerge and progress in a sizable proportion of patients. As multiple sclerosis advances, neurological and cognitive involvement tend to converge. Limitations in a patient's work and social activities are correlated with the extent of cognitive decline, independent of degree of physical disability.

The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research.

Abstract: Depression and anxiety disorders are associated with excess disability. The authors searched the recent geriatric literature for studies associating late-life depression or anxiety with physical disability. Studies showed depression in old age to be an independent risk factor for disability; similarly, disability was found to be a risk factor for depression. Anxiety in late life was also found to be a risk factor for disability, although not necessarily independently of depression. Increased disability due to depression is only partly explained by differences in socioeconomic measures, medical conditions, and cognition. Physical disability improves with treatment for depression; comparable studies have not been done for anxiety. The authors discuss how these findings inform current concepts of physical disability and discuss the implications for future intervention studies of late-life depression and anxiety disorders.

Have We Oversold the Benefit of Late-Life Exercise?

Abstract: Background Increasing exercise among older adults to improve function and prevent or decrease disability is widely promoted in developed countries. This review seeks to critically evaluate the degree to which existing scientific evidence supports these claims. Methods A literature review was performed in Medline and Best Evidence databases for the years 1985 to 2000. Experimental and quasi-experimental aerobic and resistance exercise interventions were reviewed for impairment, function, and disability outcomes. The impact of exercise on specific impairments, functions, and disabilities was examined by summarizing the findings reported across all studies. Results Thirty-one studies were identified. Impairment and functional outcomes were reported in 97% and 81% of the studies, respectively; half of the studies examined disability outcomes. The most consistent positive effects of late-life exercise were observed in strength, aerobic capacity, flexibility, walking, and standing balance, with over half of the studies that examined these outcomes finding positive effects. Of the studies that examined physical, social, emotional, or overall disability outcomes, most found no improvements. In the five studies that reported reduced physical disability, the effect sizes ranged from .23 to .88. Conclusions Late-life exercise clearly improves strength, aerobic capacity, flexibility, and physical function. Existing scientific evidence, however, does not support a strong argument for late-life exercise as an effective means of reducing disability. This may be due, in part, to methodological limitations in studies that have examined disability outcomes. On the other hand, the theoretical basis of interventions aimed at reducing disability may need to extend beyond exercise and address behavioral and social factors.

The association of multiple visual impairments with self-reported visual disability: SEE project.

Abstract: PURPOSE. This report examines the relationship bem-een psychophysical measures of visual impairment and self-reported difficulty with everyday visual tasks in a population-based sample of individuals 65 years of age and older.METHODS. Community-dwelling residents (n = 2520) of Salisbury, MD, between the ages of 65 and 84 were recruited for the study. Visual acuity under normal and low luminance, contrast and glare sensitivity, stereoacuity, and visual fields were measured. Subjective physical disability was assessed with the Activities of Daily Vision Scale (ADVS).RESULTS. In multiple regression analyses adjusted for demographic factors, cognitive status, depression, and number of comorbid medical conditions, each of the vision tests except low luminance acuity was independently associated with lower ADVS scores. The analyses indicate that a factor of 2 reduction in visual acuity or contrast sensitivity, comparable with that observed in mild to moderate lens opacity, was associated with a three- to fivefold odds of reporting difficulty with daily tasks. Although age alone was a significant risk factor for disability, it was not associated with overall ADVS score, once visual impairment and other chronic medical conditions were taken into account.CONCLUSIONS. Visual acuity, contrast and glare sensitivity, stereoacuity, and visual fields are significant independent risk factors for self-reported visual disability in an older population. Visual impairment defined by acuity alone is not the only dimension of the association with subjective disability. Additional vision measures are required to understand the impact of vision loss on everyday life.

Depressive Disorder as a Predictor of Physical Disability in Old Age

Abstract: OBJECTIVES: To determine whether the occurrence of depression predicts physical disability in older people. DESIGN: A longitudinal epidemiological study with a follow-up of 5 years. SETTING: A comparison between depressed and nondepressed participants. PARTICIPANTS: The series consisted of the persons who participated in the longitudinal epidemiological study on depression in old age performed in Ahtari, Finland. The first round of interviews and examinations was performed in 1984/1985 and the second round in 1989/1990. The study series (N = 786) was composed of persons functionally independent in activities of daily living (ADLs) during the first round and alive and participating in both rounds. MEASUREMENTS: Depression was determined according to DSM-III criteria. Physical functional abilities were measured with self-assessments of ability to manage ADLs. RESULTS: In bivariate analyses, depression at the baseline did not predict lowering of functional abilities during follow-up, but the occurrence of depression with a long term or relapsing course during follow-up and the onset of depression during follow-up in persons not depressed at the baseline predicted lowering of functional abilities during follow-up. The logistic regression analyses showed the presence of the following variables measured during the first round—older age, low basic education, poor self-perceived health, and occurrence of a physical disease—and the onset of the following diseases during follow-up—any physical disease, neurological disease, cerebrovascular disease, or depressive symptoms (in persons nondepressed at the baseline)—predicted lowered functional abilities after a follow-up of 5 years. CONCLUSION: Depression that developed during the follow-up in previously nondepressed persons was associated with an increased risk for lowering of functional abilities, even when controlling for age, sociodemographic factors, physical diseases, and baseline disabilities. Depressed older people are at high risk for physical disability, and an individually planned program to maintain their functional abilities by training in ADLs and instrumental activities of daily living (IADLs) and physical exercise should be included in their treatment.

Physical Disability and Sexual Esteem

Abstract: The current study investigated the impact of physical disability on sexual feelings, sexual experiences, and sexual esteem. Thirty-five respondents (18 males and 17 females), with physical disabilities between 19 to 60 years (SD = 10, mean = 38) participated in focus groups where they discussed how their physical disability impacted on their sexuality. They also responded to a series of questions that were designed to examine disability-specific issues in sexual esteem using a four-point Likert-type scale. The data demonstrated that the participants struggled with many social and sexual barriers that were associated with having a physical impairment. This appeared to lead to increased feelings of negativity in many participants, including a belief that they were less sexually desirable than an able-bodied person and that having a disability seriously limited their sexual expression. The implications of these findings for practitioners and suggestions for future research are discussed.

Behavioural and emotional difficulties in students attending schools for children and adolescents with severe intellectual disability.

Abstract: Background: For several decades, researchers and clinicians have been aware of an increased prevalence of psychiatric disorder in children with intellectual disability. However, there are few research studies exploring this issue. Methods: The parents of 123 children attending schools for children with ‘severe learning difficulties’ completed the Developmental Behaviour Checklist (DBC) in order to identify those children with clinically significant behavioural and emotional problems. Comparisons were made with norms for the DBC and a range of child variables were investigated as possible correlates of disorder. Results: Some 50.4% of the children scored above the cut-off on the DBC for psychiatric disorder. The child's severity of physical disability was related most strongly to parental ratings of behavioural and emotional problems. There were also effects for the child's age and the absence of Down's syndrome. Conclusions: The present study confirms previous research findings of a high prevalence of behavioural and emotional difficulties amongst children with intellectual disability, and identifies a number of correlates of disorder which require further investigation.

Factors associated with home environmental problems among community-living older people

Abstract: Purpose : This paper describes the types of difficulties older people have with their home environments and the factors associated with having such difficulties. Method : Data were used from 296 study participants of the University at Buffalo's Consumer Assessments Study that examines the home modification needs and environmental difficulties of older people. A combination of socio-demographic variables, health and functional status indicators and measures of psychosocial well-being were used to predict environmental problems. Results : An average of 13 problems with the environment that posed as a barrier to safe and independent performance was observed in homes. It was found that most difficulties occurred in bathrooms, kitchens, bedrooms and access to entryways and rooms. Hierarchical multiple regression analysis showed that having home environmental problems was most strongly associated with younger age, being female, being of minority status, having pain, and greater physical disability. Conclusion :...

Self-efficacy and goal importance in the prediction of physical disability in people following hospitalization: a prospective study.

Abstract: Objectives. This prospective study evaluates the role of self-efficacy and goal importance in predicting decreases in disability in activities of everyday living. Method. Disability, self-efficacy and goal importance were each assessed before and at 3 and 9 months after participants underwent joint replacement surgery. Results. Disability had decreased at 3 and 9 months post-surgery assessments. Self-efficacy beliefs were higher at 3 and 9 months following surgery while goal importance was increased at 9 months but not at 3 months. Medical variables and prior disability predicted disability at 3 months. Social-cognitive variables did not contribute to the prediction of 3 months disability. Pre-surgery goal importance and self-efficacy at 3 months were independent predictors of disability at 9 months after controlling for pre-surgery and 3 months disability. Evidence also suggested that goal importance and self-efficacy interacted to predict levels of disability at 9 months following surgery. Conclusions. The findings demonstrate that recovery is governed not solely by medical phenomena but also by psychological variables and suggest that modification of these variables may have an impact on recovery outcomes. Moreover, attention should be paid to the timing of such intervention and to the length of follow-up.

The Abused Mind: Feminist Theory, Psychiatric Disability, and Trauma

Abstract: I show how much psychiatric disability is informed by trauma, marginalization, sexist norms, social inequalities, concepts of irrationality and normalcy, oppositional mind-body dualism, and mainstream moral values. Drawing on feminist discussion of physical disability, I present a feminist theory of psychiatric disability that serves to liberate not only those who are psychiatrically disabled but also the mind and moral consciousness restricted in their ranges of rational possibilities.

The Impact of Physical Disability on Body Esteem

Abstract: The current study investigated the impact of physical disability on body esteem A total of 35 people (18 males and 17 females) with physical disabilities between 19 to 60 years (mean = 38 years, SD = 10), participated in focus groups where they discussed their feelings about how their disability affected their body esteem They also responded to a series of questions that were designed to examine disability-specific issues in body esteem using a four point Likert-type scale The data demonstrated that the body esteem of the participants was commonly affected by physical disability It also suggested that feedback from the social environment is a likely mediator of body esteem Suggestions for future research and implications for clinicians are discussed

Age variations in personal agency and self-esteem: the context of physical disability.

Abstract: Objectives: This study examines howage patterns in health control, self-efficacy, and self-esteem are influenced by age-correlated social status, health, personality, and social integration variabl...

Relationship Between Private Religious Activity and Physical Functioning in Older Adults

Abstract: This study sought to further understand the relationship between physical functioning and use of private religious activity in older adults. Subjects were age 65 or older from urban and rural counties in North Carolina who participated in the Duke University Established Populations for Epidemiologic Studies of the Elderly (Duke/EPESE). A total of 3,851 subjects responded to a question that inquired about their use of prayer, meditation, or Bible reading in 1986. Their response was correlated to number of impairments in activities of daily living (ADLs) (n = 3,791). Subjects who indicated use of private religious activity either dailyor neverhad the greatest number of impairments. Those who prayed or meditated one time per weekhad the least number of impairments. This cross-sectional finding is explained in terms of both changes in private religious activity in response to increasing physical disability and changes in physical disability in response to private religious activity. Previous research has found that prayer is often used as an effective coping mechanism with various sicknesses and chronic conditions. Further studies are needed to examine older individuals' health over time and evaluate their use of private religious activity to see its impact over time on physical disability.

Subjective health measures and acute treatment outcomes in geriatric depression.

Abstract: Background Prior research suggests that elderly patients are less likely to respond to antidepressant treatment if they have low self-rated health. However, successful treatment for depression has been associated with improvement in self-rated health and other health measures. Objectives To examine measures of self-rated health, physical disability, and social function as predictors of treatment response in late-life depression, and to assess these same health measures as treatment outcomes. We hypothesized that greater impairment in these measures would predict poorer treatment response, and that these measures would show significant improvements with recovery from depression. Method Subjects were enrolled in a depression intervention study for people aged 60 and older with recurrent unipolar major depression; they were assessed with measures of self-rated health, physical disability, and social functioning at baseline and at the end of treatment. Baseline measures were compared between the 88 remitters, 11 non-remitters, and seven dropouts. Additionally, changes in the measures were examined in subjects who recovered from the index depressive episode. Results Subjects with poorer self-rated health at baseline were more likely both to drop out of treatment and to not respond to adequate treatment. This relationship was independent of demographic measures, severity of depression, physical and social functioning, medical illness, personality, hopelessness, overall medication use, and side effects or non-compliance with treatment. Conclusion Although this finding is preliminary because of the small number of dropouts and non-remitters, it suggests that lower self-rated health may independently predict premature discontinuation of treatment for depression. Additionally, subjects who recovered from depression showed significant improvements in self-rated health, physical disability, and social functioning. Copyright © 2001 John Wiley & Sons, Ltd.

Orthodontic treatment for disabled children--a survey of patient and appliance management.

Abstract: The objective of this article was to investigate the management problems encountered during the orthodontic treatment of children with disability, and took the form of a retrospective analysis. The...

Tracking ability in subjects symptomatic of cumulative trauma disorder: does it relate to disability?

Abstract: Symptoms of upper extremity cumulative trauma disorders (CTDs) often include weakness, discomfort, pain, numbness and stiffness, which are generally assessed clinically by using static tests or isolated movements Little is known about the dynamic, functional ability of the upper extremity in CTD, yet, more than impairment, performance variables may relate to disability The objectives of this study were to determine whether a manual tracking task was sensitive to the presence of symptoms associated with CTD and whether tracking performance related to disability Forty-five volunteers who had frequently experienced one or more symptoms consistent with upper extremity CTD for at least 1 year and 22 control subjects performed the manual tracking task Using a hand-held stylus over a digitizing tablet, subjects tracked a target that moved pseudo-randomly and was displayed on a computer screen The root mean square error of the linear difference between target and stylus positions provided a measure of overall performance accuracy Quadrant specific performance was also calculated to determine whether the location of the target (hence hand and wrist position) influenced performance Additionally, the symptomatic group completed the Disability of the Arm, Shoulder and Hand (DASH) questionnaire reflecting physical disability level Performance accuracy was poorer in symptomatic subjects than controls (p<0001) and was influenced by target location (p<00001) The overall performance was associated with physical disability (r = 054) The findings suggest that tracking performance is sensitive to the presence of CTD symptoms and related to disability level Further validation is required to determine whether the performance measure is sensitive to disease progression or intervention-induced changes

Disability and stress: a study in perspectives

Abstract: In today's society, having a disability can add enrichment and challenge to aspects of life. It can also increase the likelihood of marginalisation within society as people have been shown to react to disability in many discriminatory and stereotypic ways. People with disability often have to face feelings of fear, guilt, pity or discomfort in others in addition to physical barriers and limitations that may be inevitable consequences of some forms of disability. These authors hypothesise that, because of additional challenges in life, people with a disability may report higher than average stress levels. The study aimed to reveal what aspects of life bother people with different forms of disability. Ninety-nine adults with a visual, intellectual or physical disability completed a self-report stress scale. Contrary to expectation, total stress levels did not seem to be unusually high. All participants acknowledged their disability, but only half regarded it as a stressor in itself. Participants with a visu...

Claiming disability in the field of geography: Access, recognition and integration

Abstract: The topic of physical disability has long been neglected in the field of geography. Geographers have challenged this neglect by undertaking studies of, for, and by persons with disabilities. This paper extends that challenge by examining the roles that disability and persons with disabilities play within the field of geography itself. The recognition and integration of persons with disabilities includes concerns with physical access, but also requires an examination of the institutional means by which geography departments, publications and conferences have worked and can work to challenge ableism: the neglect of disabled people's lives and perspectives. After centuries of exclusion, the recognition and integration of disability into society will surely be an issue of profound importance in coming years. We need geographers prepared and willing to study these processes.

From Dis-Ability to Difference: Conceptual and Methodological Issues in the Study of Physical Disability

Abstract: This paper discusses conceptual and methodological concerns in the study of physical disability and the human body from the perspective of a phenomenologically informed sociology.1 The study of physical disability and the human body has claimed the attention of philosophers, social scientists, psychologists, physicians, public health administrators, insurers, and so forth, each of whom brings a unique disciplinary perspective as well as distinct research interests and goals. In this paper I identify theoretical and conceptual biases in the study of disability that: (1) tend to narrow its understanding to a unitary phenomenon, i.e., as a dysfunction (either patho- physiological or psychological) affecting only the individual; (2) hamper its conceptualization as a form of difference; and (3) restrict the ability of persons with disabilities to live independent and respectful lives. Further, I demonstrate how socio-political conceptions of disability raise many theoretical and practical questions regarding research, as well as fostering the uncritical use of notions of normality and difference.2 Contemporary research on disability and the human body is faced with a challenge: to describe and analyze the world of disability within its social, political and human contexts without perpetuating biased assumptions, ignoring bodily differences, and marginalizing the experience of disability.3 This paper suggests that a phenomenologically-informed sociology can help researchers meet this challenge. Instead of seeing able-bodied and dis-abled persons as separate and opposed, disabled embodiment may be conceived as a form of human diversity, thus moving towards an understanding of dis-ability as difference. This paper discusses how researchers can reach this understanding through the phenomenological technique of bracketing and by listening to the criticisms offered by disability advocates and writers.

Correlates of psychiatric morbidity in patients with leprosy.

Abstract: The relationship between psychiatric morbidity in 30 leprosy patients under treatment as assessed by the General Health Questionnaire (GHQ-12) and certain variables of their illness and psychosocial factors is examined in this paper. Physical disability and duration of illness were the illness variables considered; knowledge and adjustment were the psychosocial variables included. Bell's Adjustment Inventory (BAI) measured the latter, psychiatric morbidity was positively correlated with physical disability (p 0.05). The importance of appropriate knowledge, social stigma and physical disability in leprosy is discussed in addressing the psychiatric morbidity of leprosy patients.

Nursing Students' Self-Attributions of Skill, Comfort, and Approach When Imagining Themselves Caring for Persons with Physical Impairments Due to Developmental Disability

Abstract: Fifty-two nursing students made self-attributions along a series of scales pertaining to skill level, comfort level, and interpersonal approach when imagining themselves providing care to an individual with no apparent physical disability, to a person who requires the use of a power-assisted wheelchair due to developmental disability, and to a person who requires the use of a power-assisted wheelchair and manual communication board. Factor analysis was used to reduce the self-attributional data to two dimensions: one reflecting perceived skill and comfort level, and the other reflecting the assumption of a rational versus intuitive clinical approach. Students attributed lower levels of skill and comfort to themselves, as well as a more intuitive approach, when imagining themselves caring for one who uses a power-assisted wheelchair, and to a greater extent, when imagining themselves caring for one who uses a wheelchair and a communication board, than for one without an apparent disability. Correlations of student age and number of years in nursing practice with self-attributions were investigated.

Economics of Disability Research Report #4: Estimates of the Prevalence of Disability, Employment Rates, and Median Household Size-Adjusted Income for People with Disabilities Aged 18 though 64 in the United States by State, 1980 through 2000

Abstract: This report replicates Economics of Disability Reports 1, 2, and 3, with some minor changes. These reports contain the prevalence of a disability, employment rates, and median household size-adjusted income between states over the 1980s and 1990s. In response to the requests of state officials to generate statistics that reflect the population they serve, this report includes people aged 18 through 64 rather than people aged 25 through 61. The new age group is more likely to include those who enter the labor force after high school, during college, and post-college as well as those people who have decided not to take early retirement. In addition, at the request of state officials, the statistics in this report are not separated by gender because most government agencies do not make a strong distinction between men and women, even though men and women face different labor market conditions. This report uses data from the March Current Population Survey to estimate the prevalence of a disability, employment rate, and median household size-adjusted income among the non-institutionalized working-age (aged 18 through 64) civilian population in the United States, and for each state and the District of Columbia for the survey years 1981 through 2000 and income/employment years 1980 through 1999. Two definitions of disability that are commonly used in the literature—work limitation and work disability—are utilized. The prevalence of a work limitation and work disability varies greatly across states and over time. The employment rate of persons with work limitations relative to that of persons without a disability varies greatly across states. However, over the last 20 years the relative employment rate of those with work limitations dramatically declined overall and in most states. Consequently, the decrease in the relative employment rate for persons with work limitations induced the growth in the median household size-adjusted income of those with work limitations to fall below that of the rest of the working population in the vast majority of the states.

Pain, disability, and physical therapy in older adults: Issues of patients and pain, practitioners and practice

Abstract: Pain in older adults is a complex multidimensional (biopsychosocial) problem that is always unpleasant and is frequently associated with physical disability, psychosocial distress, and reduced quality of life. Physical therapists knowledgeable about pain are in an excellent position to identify and manage problems related to pain and pain-related dysfunction for this older population. Unfortunately, although pain is prevalent, complex, and integral to health care, it has not been integral to health care education. Inadequate knowledge has led to inadequate assessment and management. Current evidence shows that optimum pain and disability management is predicated on a sound assessment. Optimal management of the person with pain involves education and activity guided by practitioners knowledgeable about the complexities of pain. Recommendations regarding pain and disability assessment and management by physical therapists are provided.

Employment and physical disability

Abstract: Employment for people who experience significant disability has increased dramatically over the past years. Throughout the country, literally thousands of people are going to work each day. Yet, this number represents little more than 1/3 of the people with disabilities who are of working age and want to work. For people who experience physical disabilities, this number is even less. The authors whose articles appear in this special edition travel around the country providing training and technical assistance in areas that effect employment. The people we train tell us frequently why people who experience physical disability are not working: people need to be in negotiated jobs rather than competing for existing jobs based on a job description; staff don’t know how to negotiate with employers; it takes longer to assist someone in finding a job, thus it requires more funding; employers are reluctant to hire someone with physical disabilities; too much technology is required; employers won’t pay for accommodations; physical disability is a significant disability and it is just too difficult – the reasons go on and on. Innovation by a few practitioners has made a great difference in the lives of people with physical disabilities. Hopefully this edition will provide information that will assist others in their efforts to include people with physical disabilities in the world of work.

Economics of Disability Research Report #5: Economic Outcomes of Working-Age People with Disabilities over the Business Cycle – an Examination of the 1980s and 1990s

Abstract: We examine the rate of employment and the household income of the working-age population (aged 25-61) with and without disabilities over the business cycles of the 1980s and 1990s using data from the March Current Population Survey and the National Health Interview Survey. In general, we find that while the employment of working-age men and women with and without disabilities exhibited a procyclical trend during the 1980s business cycle, this was not the case during the 1990s expansion. During the 1990s, the employment of working-age men and women without disabilities continued to be procyclical, but the employment rates of their counterparts with disabilities declined over the entire 1990s business cycle. Although increases in disability transfer income replaced a significant fraction of their lost earnings, the household income of men and women with disabilities fell relative to the rest of the population over the decade. Economic Outcomes of Working-Age People with Disabilities over the Business Cycle: An Examination of the 1980s and 1990s

Activity Use in Occupational Therapy: Occupational Therapy Students' Fieldwork Experience

Abstract: This article explores the results of a small quantitative study conducted with 54 occupational therapy students. The data, gathered using a purpose-designed questionnaire, were based on respondents' reports of the 662 activities seen during their fieldwork education. These were categorised using headings from the Canadian Occupational Performance Measure (Law et al 1994).The findings showed that client-related leisure activities were the most frequently seen in all practice settings (physical disability, mental health and learning disability). The activities seen most often consisted of those in the ‘quiet recreation’ category. Activities aimed at productivity, and particularly at household management, were also widely spread. Such activities formed a smaller but consistent percentage of those seen in all fields of practice. Self-care, and in particular personal care, activities were most prevalent in physical disability settings, but formed a lower percentage of the activities seen elsewhere.This article...

Living with physical disability in the Amish community

Abstract: With significant changes in the nation’s demographics as well as the enactment in 1990 of the Americans with Disabilities Act, health and social service providers have had to respond to changes in client needs and service delivery. Concomitantly, in recent years, social workers have begun to pay increasing attention to multicultural issues among their clients. The pluralism of beliefs and values woven through the fabric of American life has, unfortunately, often been overshadowed by the dominant culture. As such, it has perpetuated stereotypes and myths about minority groups, including people of diverse ethnicities and abilities. In an effort to dispel stereotypes, enhance multicultural awareness, and improve professional knowledge and competence, this study explored the lived experience of a dual minority group that has rarely been heard; Amish persons with physical disabilities. The researcher investigated the perceptions of twelve Amish persons with physical disabilities who use wheelchairs. He utilized a grounded theory approach. Data was collected through in-depth face-to-face interviews within each participant’s home in the largest Amish settlement in the United States. Data was then analyzed by the constant comparative method and negative case study in order to delineate and describe emergent themes. The six emergent themes were: 1) acceptance, 2) gathering, 3) accommodation, 4) slow-time, 5) self-reliance, 6) healthcare.