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PubMed2003

[Development of rheumatoid arthritis functional handicap assessment questionnaire: preliminary study].

OBJECTIVE: To construct a handicap assessment questionnaire for rheumatoid arthritis and to determine if the concept of "participation" can replace the one of "handicap". METHODS: Selection of daily life domains and items was based on the International Classification of Impairment Disability and Handicap "ICIDH" and on some others handicap epidemiological studies. The questionnaire was tested among rheumatoid arthritis patients. The relation between handicap and participation was investigated. Statistics analysis was performed with Systat.9 program. Spearman's correlation coefficient between 2 quantitative variables was examined. RESULTS: Six among the 7 "ICIDH" domains were included in the questionnaire. Each of them was explored with many items. Forty-six items were included; each item was explored in 4 chapters:participation assessment with VAS (Visual Analogical Scale) before rheumatoid arthritis and during the study; difficulties: need of help, environment accessibility, patient's satisfaction, feeling of devalorization; patient's propositions;handicap assessment with VAS; other questions were added in some particular items. Thirty patients were included in the study (23 women), the average age was 51 years. Five patients didn't understand the meaning of "Handicap".This study allows us to eliminate 2 items, to add 2 others and to ameliorate 1 of them. Correlation between handicap and participation was moderate to bad. CONCLUSION: This questionnaire allows to explore rheumatoid arthritis handicap. Each domain of the daily life can be assessed separately. The main difficulties are the length and the impossibility to be self-administered. Handicap and participation probably assess different concepts or are differently understood by patients.

Activities of Daily Living↗
PubMed1991

Self-reported versus behavioral self-handicapping: empirical evidence for a theoretical distinction.

The present study was an investigation of how Ss would respond when given 2 self-handicapping options, 1 behavioral (withdrawal of practice effort) and 1 self-reported (reporting high levels of stress). Ss anticipating a diagnostic test of intellectual ability were given different instructions regarding the effects of stress and practice on test performance. Ss were told that (a) stress only, (b) practice only, (c) both stress and practice, or (d) neither stress nor practice affected test scores. Ss were then given the opportunity to self-report a handicap on a stress inventory and to behaviorally self-handicap by failing to practice before the test. High self-handicapping men and women showed evidence of self-reported handicapping, but only high self-handicapping men behaviorally self-handicapped. However, when both self-handicaps were viable, both high self-handicapping men and women preferred the self-reported over the behavioral self-handicap.

Achievement↗
PubMed1990

Handicaps in Algiers according to a household survey.

In order to assess the prevalence of handicaps in Algiers, a cluster sampling survey was carried out among 827 households, ie 5670 inhabitants. A questionnaire was used to identify people with handicaps according to several criteria using the International Classification of Impairments, Disabilities and Handicaps. The overall prevalence of handicaps is 147.6 per thousand inhabitants. The increase in prevalence with increasing age is striking particularly for the most serious handicaps. Disabled people depending on others represent 7.3% of handicapped people and 1.0% of the surveyed population. This also shows that 6.9% of households look after dependent handicapped people, more than half of whom are over 60 years old. About 8% of children under 15 have handicaps which impede or prevent schooling. About 7% of the handicaps resulted from accidents. Because of the nature of handicaps it is easy to collect such data.

Adolescent↗
PubMed2004

Re-examining the effects of noncontingent success on self-handicapping behaviour.

BACKGROUND: Self-handicapping refers to the practice on the part of certain individuals to handicap their performance when poor performance is likely to reveal low ability. Noncontingent success (feedback that is inflated relative to performance) is more likely to promote self-handicapping behaviour than noncontingent failure (failure feedback based on false or misleading information). However, the reasons for the differing effects of these forms of performance feedback on self-handicapping behaviour remain obscure. AIMS: The present study sought an explanation for the differing effects of these forms of performance feedback, testing the assumption that students high in self-handicapping behaviour would react more negatively following noncontingent success, reporting more unstable and external attributions, higher anxiety, and a greater propensity to claim handicaps than those low in self-handicapping behaviour. No differences were expected on any of these measures for high relative to low self-handicappers following either noncontingent failure or success. SAMPLE: Participants were 72 undergraduate students, divided equally between high and low self-handicapping groups. METHOD: High and low self-handicappers were assigned to one of three performance feedback conditions: noncontingent failure, success and noncontingent success. High and low self-handicappers were then given an opportunity to claim handicaps prior to completing measures of attributions and state anxiety. Subsequently, they completed 12 remote associate tasks, serving as an assessment of performance, and 16 unicursal tasks, assessing practice effort. RESULTS: Following noncontingent success, high self-handicappers reported greater anxiety, more unproductive attributions and claimed more handicaps than low self-handicappers. However no differences were evident for high and low self-handicappers following either noncontingent failure or success. High self-handicappers also performed poorly on the remote associates tasks and reduced practice effort on the unicursal tasks. CONCLUSIONS: These findings confirm the adverse effects of noncontingent success for high self-handicappers, while failing to provide evidence that noncontingent failure has any more adverse effects on high relative to low self-handicappers.

Adult↗
PubMed1995

Retrospective investigation of medico-legal autopsy cases involving mentally handicapped individuals.

Mentally handicapped individuals were involved in some way in 64 (17.7%) of the total of 362 medico-legal autopsy cases during the past 13 years. Among these 64 cases, 32 were suicides committed by mentally handicapped persons (18 males and 14 females). The most common method of suicide was drowning (65.6%). Five cases were homicides suddenly and unexpectedly committed by mentally handicapped persons. In four of the five cases, the victim was a member of the assailant's family; this was considered to be a characteristic of homicides committed by mentally handicapped persons. On the other hand, there was only one case in which a mentally handicapped person was victimized, that of a 34-year-old female with schizophrenia who was strangled by her mother. In 19 cases, infanticide was committed by mentally handicapped mothers ranging in age from 17 to 40 years old; approximately 80% of the infanticide victims were infants of less than 6 months, and this was the age range most at risk of victims. There were two cases involving either double suicide or murder followed by suicide; in one case, the 45-year-old mother of a mentally handicapped 18-year-old son with congenital hydrocephalus set fire to her own house, and both perished in the fire, and in the other, a 65-year-old schizophrenic female fatally stabbed her neighbor, a 68-year-old female, and then she also cut herself fatally. There were three cases in which mentally handicapped individuals died due to freezing, and one in which an epileptic died suddenly due to status epilepticus. In order to prevent these tragic events, at first, it is necessary to much better understand the circumstances of the mentally handicapped individuals and their families without prejudices against them. The authors propose that a more comprehensive psychiatric medical care including the following systems should be established in Japan: 1) Day care for the mentally handicapped person, especially after the discharge as well as during admission, and support for their relatives, 2) Therapeutic drug monitoring to assess the effective level of psychotropic drugs and to suppress the side effects in the patients receiving the psychotropic drugs for a long time.

Adolescent↗
PubMed1985

The handicapped child and child abuse.

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.

Brain Injuries↗
PubMed1990

Increased survival rate in very low birth weight infants (1500 grams or less): no association with increased incidence of handicaps.

The incidence of major handicaps was studied in a selected high-risk population of 1919 very low birth weight (less than or equal to 1500 gm) infants born between 1976 and 1985. Seventy-four percent of these infants were discharged alive. We have handicap information on 632 infants who have been followed for up to 7 years of age; 462 were evaluated at 18 months or later. Patients lost to follow-up represent 55% of the eligible population, but inpatient morbidity factors were available for the entire population and were used to calculate synthetic estimates of handicap rates. The overall incidence of severe major handicaps at 18 months was 18.0% (83/462). Cerebral palsy was found in 7.6%, and 6.5% were mentally retarded (IQ less than or equal to 70). Severe retinopathy of prematurity was present in 5.5%, and 5.4% of the infants had neurosensory hearing loss. Thirty-one infants (6.7%) had more than one handicap, the most common combination being cerebral palsy and mental retardation. Outcome of infants grouped by 250 gm birth weight intervals was compared for two periods (1976 to 1980, and 1981 to 1985); the numbers of survivors in each birth weight group increased during the second period, especially in the 500 to 750 gm and the 751 to 1000 gm groups. The observed incidence of major handicaps decreased from the first 5-year period to the second 5-year period (p less than 0.001). The largest decreases in the observed proportion handicapped occurred in the two lowest birth weight groups. The incidence of multiple handicaps also dropped; again, the two lowest birth weight groups showed the largest decrease. We conclude that an increased survival rate of very low birth weight infants need not be associated with an increased incidence of major handicaps.

Birth Weight↗
PubMed1990

Biological signals as handicaps.

An ESS model of Zahavi's handicap principle is constructed. This allows a formal exposition of how the handicap principle works, and shows that its essential elements are strategic. The handicap model is about signalling, and it is proved under fairly general conditions that if the handicap principle's conditions are met, then an evolutionarily stable signalling equilibrium exists in a biological signalling system, and that any signalling equilibrium satisfies the conditions of the handicap principle. Zahavi's major claims for the handicap principle are thus vindicated. The place of cheating is discussed in view of the honesty that follows from the handicap principle. Parallel signalling models in economics are discussed. Interpretations of the handicap principle are compared. The models are not fully explicit about how females use information about male quality, and, less seriously, have no genetics. A companion paper remedies both defects in a model of the handicap principle at work in sexual selection.

Animal Communication↗
PubMed1997

Impairment, disability and handicap as risk factors for depression in old age. The Gospel Oak Project V.

BACKGROUND: An association between disablement and late-life depression is often reported in cross-sectional studies. However, many lack effect sizes, and do not control for confounding. Therefore, it is difficult both to quantify the overall impact of poor health on depression and to understand which aspects are most salient. METHODS: A catchment area survey of all over 65-year-old residents of an electoral district in London, UK, using a population register derived from a door-to-door census was undertaken. Depression was measured using SHORT-CARE, and the consequences of disease classified according to the WHO International Classification of Impairments, Disabilities and Handicaps. RESULTS: Six hundred and fifty-four subjects were interviewed out of an older population of 889. The prevalence of SHORT-CARE pervasive depression was 17%. Impairment, disability and, particularly, handicap were strongly associated with depression. The adjusted odds ratio for depression in the most handicapped quartile compared with the least was 24.2 (8.8-66.6). The population attributable fraction (PAF) for depression attributable to handicap was 0.78. The PAFs for recent life events and female gender were much lower. Handicap explained most of the depression associated with individual impairments and disabilities. Adjusting for handicap abolished or weakened the associations between depression and social support, income, older age, female gender and living alone. CONCLUSIONS: Even given some uncertainty in distinguishing handicap and depression as constructs, and the impossibility of deciding direction of causality, it seems likely that handicap is of central significance to late-life depression. Handicap may be more amenable to intervention than either impairment or disability.

Activities of Daily Living↗
PubMed2002

Predictors of handicap situations following post-stroke rehabilitation.

PURPOSE: Many stroke survivors have to cope with impairments and disabilities that may result in the occurrence of handicap situations. The purpose of the study was to explore bio-psycho-social predictors of handicap situations six months after discharge from an intensive rehabilitation programme. METHODS: At discharge from a rehabilitation programme, participants were evaluated with instruments measuring motor, sensory, cognitive, perceptual, affective and psychosocial impairments and disabilities that may play a role in the development of handicap. Some other demographic and clinical variables, and those related to rehabilitation, were also collected. Six months later, they were re-assessed in their own environment in order to document their handicap level with the Assessment of Life Habits (LIFE-H). RESULTS: One hundred and thirty-two stroke patients participated in the discharge evaluation and 102 of them also participated in the handicap measurement. Relationships between handicap level and impairments and disabilities were all statistically significant. Multiple regression analyses indicated that affect, lower extremity co-ordination, length of stay in rehabilitation, balance, age and comorbidity at the end of an intensive rehabilitation programme are the best predictors of handicap situations six months later (adjusted R(2): 68.1%). CONCLUSIONS: In spite of its exploratory nature, this study revealed that, among a substantial number of personal characteristics, some were more related to a handicap measure and have greater predictive value. Other studies should be carried out to validate these findings and to consider more environmental factors in order to better understand factors related to the development of handicap situations.

Aged↗
PubMed1999

Handicap questionnaires: what do they assess?

BACKGROUND AND PURPOSE: There is an increasing need to get insight into the social and societal impact of chronic conditions on a person's life, i.e. person-perceived handicap. The purpose of this study is to report how current handicap questionnaires assess handicap. METHOD: A literature search using both Medline and the database of the Dutch Institute of Allied Health Professions (NPi) was conducted for handicap questionnaires. Questionnaires were included if addressing handicaps or life roles, environmental influences and social consequences of a disease. Excluded were questionnaires focusing on only impairments, disabilities or quality of life. RESULTS AND CONCLUSION: 20 questionnaires were identified. Handicap is not uniformly defined in these questionnaires. Based on different concepts, the various questionnaires encompass different domains and different aspects are emphasized in similar domains. Fourteen questionnaires assess society-perceived handicaps, and do not address the life roles, care needs or individual problem-experience. Six questionnaires are to some extent person-perceived, but a generic person-perceived handicap questionnaire could not be identified. It is concluded that development of a generic person-perceived handicap questionnaire is essential for adequate assessment of needs, outcome, and relevance of rehabilitation interventions from the individual's point of view.

Activities of Daily Living↗
PubMed1994

Definitions and determinants of handicap in people with disabilities.

Researchers have made a distinction between disability and its social and psychological consequences, now known as handicap, both conceptually and in terms of intervention. More work is needed in standardizing and refining the assessment of handicap and in highlighting risk factors for its development. Epidemiology has major contributions to make in understanding handicap in both aging and young populations. Data on the prevalence and incidence of handicap are scarce and difficult to obtain. Efforts are needed in the following areas: 1) contributing to the methodology of handicap assessment through the provision of valid and reliable scales; 2) defining and identifying risk factors for handicap formation, which underscores the need for analytic studies in this regard; 3) understanding the dynamics of these factors in the production of disadvantage, which calls for more qualitative and in-depth interviews with persons with handicaps; and 4) formulating critical points of intervention at the personal and community levels for handicap prevention. Such efforts will assist policy-makers in formulating appropriate and acceptable policies for safeguarding the opportunities of people with disabilities, ensuring their optimal participation in society, and enabling them to lead independent and self-sufficient lives. Efforts to evaluate the effect of legislation, both existing and recent, on handicap development are also called for. These efforts may help to reduce the gap between disabled and nondisabled people and improve the quality of life for people with disabilities and their families.

Activities of Daily Living↗
PubMed2003

Change in dizziness handicap after vestibular schwannoma excision.

OBJECTIVE: To evaluate the change in dizziness handicap after translabyrinthine vestibular schwannoma excision. STUDY DESIGN: Prospective administration of the Dizziness Handicap Inventory preoperatively and at 3 and 12 months postoperatively; retrospective review of case notes. SETTING: A tertiary referral neuro-otology clinic. PATIENTS: A total of 100 consecutive patients who had vestibular schwannomas excised between June 1998 and November 2001 and who had completed Dizziness Handicap Inventories preoperatively and at 3 and 12 months postoperatively. INTERVENTIONS: Translabyrinthine excision of a unilateral sporadic vestibular schwannoma; preoperative and postoperative generic vestibular rehabilitation exercises. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory scores. RESULTS: For most patients, dizziness handicap does not worsen postoperatively. However, for those in whom it does, dizziness handicap becomes significantly worse between preoperative and 3-month postoperative time points but then does not continue to decline. Tumor size, sex, and magnitude of preoperative canal paresis significantly affect the degree of change in handicap. Age, the presence of central vestibular system abnormalities, and the nature of the patient's principal presenting symptom have no effect on this handicap change. CONCLUSIONS: These findings help the clinician in counseling the patient preoperatively about dizziness handicap to be expected postoperatively. In particular, the clinician is now able to take an informed and positive stance in the event of a severe canal paresis preoperatively.

Aged↗
PubMed2004

Change in hearing handicap after translabyrinthine vestibular schwannoma excision.

OBJECTIVE: To evaluate the change in hearing handicap after translabyrinthine vestibular schwannoma excision. STUDY DESIGN: Prospective administration of the Hearing Handicap Inventory preoperatively and at 3 and 12 months postoperatively. SETTING: A tertiary referral neurootology clinic. PATIENTS: A total of 119 consecutive patients who had vestibular schwannomas excised between May 1998 and July 2002 and who had completed Hearing Handicap Inventories preoperatively and at 3 and 12 months postoperatively. INTERVENTIONS: Translabyrinthine excision of a unilateral sporadic vestibular schwannoma; pre- and postoperative hearing therapy and rehabilitation. MAIN OUTCOME MEASURES: Hearing Handicap Inventory scores. RESULTS: Sixty-one percent of patients showed no change in their hearing handicap between preoperative and 3-month postoperative measures. Fifty-eight percent showed no change between preoperative and 12-month postoperative measures. Twenty-five percent of patients had a worsening in their hearing handicap when comparing preoperative and 12-month postoperative scores, and these patients were those with a better hearing class preoperatively. Seventeen percent of patients showed an improvement in their hearing handicap over this same time period, and the reasons for this remain unclear. Neither age nor tumor size had an effect on change in hearing handicap. CONCLUSIONS: The findings of the current study can be used during preoperative patient counseling. In particular, the clinician is now able to take an informed and positive stance about the hearing handicap to be expected postoperatively.

Audiometry, Pure-Tone↗
PubMed1994

The need for assessment of sensory functioning in ageing people with mental handicap.

Within the framework of a study on the ageing process of people with mental handicap in the Netherlands, information about visual and hearing impairments in 1583 people with mental handicap living in group homes or institutions was obtained from their physicians by means of a written questionnaire. Of the people with Down's syndrome (DS) who were older than 50 years of age, 46% had a visual impairment, whereas approximately 13% of subjects with other causes of mental handicap at the same age experienced similar visual impairment. Hearing loss in this age group was reported in 28% of people with DS, but only in 8% of subjects with other causes of mental handicap. The most common eye condition was cataracts, and the most frequent cause of hearing impairment was infection. In people with severe and profound mental handicap of all ages, sensory impairments were more frequent than in persons with mild or moderate mental handicap. Glasses or hearing aids were rarely used by people with severe or profound mental handicap. Assessment of visual and hearing impairments in people with mental handicap seemed clearly indicated, especially in those aged 50 years and older, in those with DS, and in those with severe or profound mental handicap.

Adolescent↗
PubMed1994

Handicap one year after a stroke: validity of a new scale.

The aim was to determine the handicap experienced by subjects one year after a stroke, and assess the acceptability, validity, and reliability of a new handicap measurement scale. A cross sectional survey of 141 survivors of a cohort of consecutive hospital admissions with acute stroke was undertaken. The London handicap scale (a new health outcome measurement scale), Barthel index, Nottingham extended activities of daily living scale, Nottingham health profile, Geriatric depression score, and a global life satisfaction scale were used. 94 subjects (67%) responded to a single mailing; 89 (95%) responses were usable. Mean handicap was 0.40 (range 0.06-1.0, SD 0.20) on a scale of 0 (maximum handicap) to 1 (no handicap). All handicap dimensions showed a wide range of problems, with physical independence and occupation particularly affected. Correlations between handicap score and other outcome measures were all in the expected direction and of about the strength expected (0.36 < r < 0.69). The reliability coefficient was 0.91, limits of agreement +/- 0.19. The measurements demonstrated substantial handicap one year after a stroke, reflecting considerable unmet rehabilitation needs. The scale proved acceptable to subjects, and the results were consistent with good validity.

Activities of Daily Living↗
PubMed2003

Connecting impairment, disability, and handicap in immune mediated polyneuropathies.

BACKGROUND: In the World Health Organisation (WHO) International Classification of Impairments, Disabilities, and Handicaps (ICIDH), it is suggested that various levels of outcome are associated with one another. However, the ICIDH has been criticised on the grounds that it only represents a general, non-specific relation between its entities. OBJECTIVE: To examine the significance of the ICIDH in immune mediated polyneuropathies. METHODS: Four impairment measures (fatigue severity scale, MRC sum score, "INCAT" sensory sum score, grip strength with the Vigorimeter), five disability scales (nine hole peg test, 10 metres walking test, an overall disability sum score (ODSS), Hughes functional grading scale, Rankin scale), and a handicap scale (Rotterdam nine items handicap scale (RIHS9)) were assessed in 113 clinically stable patients (83 with Guillain-Barré syndrome, 22 with chronic inflammatory demyelinating polyneuropathy, eight with a gammopathy related polyneuropathy). Regression analyses with backward and forward stepwise strategies were undertaken to determine the correlation between the various levels of outcome (impairment on disability, impairment on handicap, disability leading to handicap, and impairment plus disability on handicap). RESULTS: Impairment measures explained a substantial part of disability (R(2) = 0.64) and about half of the variance in handicap (R(2) = 0.52). Disability measures showed a stronger association with handicap (R(2) = 0.76). Combining impairment and disability scales accounted for 77% of the variance in handicap (RIHS9) scores. CONCLUSIONS: In contrast to some suggestions, support for the ICIDH model is found in the current study because significant associations were shown between its various levels in patients with immune mediated polyneuropathies. Further studies are required to examine other possible contributors to deficits in daily life and social functioning in these conditions.

Adolescent↗
PubMed1997

Determinants of handicap 1 and 3 years after a stroke.

A total of 361 consecutive admissions to hospital with acute stroke were followed up to examine the determinants of handicap 1 year and 2-3 years later. Handicap was measured using the London Handicap Scale, and data were collected on initial stroke severity, disability, mood and sociodemographic variables. Ninety-five of 170 survivors returned handicap questionnaires at 1 year, 102 of 149 survivors at 2-3 years, and 58 on both occasions. Mean handicap score decreased slightly between 1 and 2-3 years (45-48 on a 0-100 scale, 95% confidence interval for difference -1 to +7, p = 0.09). At both 1 and 2-3 years handicap was associated with pre-stroke disability, 1-year score disability, initial stroke severity and mood. Age and sex were associated at 1 year but not at 2-3 years. In multivariate analyses disability, stroke severity and mood were independently associated with handicap. None of the variables examined predicted change in handicap score. The study demonstrates the overriding importance of stroke severity (impairment) and disability in determining handicap. In comparison, social variables were less important.

Activities of Daily Living↗