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PubMed1978

The sexual needs of the handicapped.

One of the basic needs of life to the handicapped, as well as to all individuals, is the understanding of one's own sexuality. Sex education can help handicapped individuals in finding sexual satisfaction and may foster self-responsibility, maturity and positive actions toward other rehabilitation goals. Traditionally, the teachings of sexuality to handicapped persons have run into objections resulting from society's negative attitude toward the handicapped and parental apprehension regarding the decision-making skills of their children in relation to acceptable and unacceptable sexual behaviors. However, the Education for All Handicapped Children Act of 1975 has provided a way for parents and health professionals to put pressure on local, state and federal programs to allocate funds for the development of a sound sex education program. As professionals in health education it is our challenge and responsibility to see that the sexual needs of the handicapped are not forgotten.

Adolescent↗
PubMedDate not supplied

Video as a medium of oral health education for children with mental handicaps.

This study assessed the usefulness, appropriateness, and relevance of a video as an oral health education medium for children with mental handicaps and for preschool groups where children with mental handicaps and healthy children are taught together. The evaluated video was designed for children with mental handicaps but was also recommended for integrated groups. Forty children with mental handicaps from four special education classes and two nursery school groups, 151 normal children from 11 nursery school groups, and the teachers of these classes and groups evaluated the material. The assessment of the material's value was based on the teachers' records of their experiences with the material, their records of the children's opinions and discussions about the material, and their records of drawing interviews with the children. Based on the evaluation, it is apparent that, when used by trained teachers, professionally made videos designed for children with mental handicaps can be useful and valuable aids in educating children of different levels of mental and social development about oral health. Integrated groups need videos featuring both children with mental handicaps and normal role models and with a diversity of contents that will interest and challenge both types of audiences.E.

Adolescent↗
PubMed1994

Contribution of symptoms and beliefs to handicap in people with vertigo: a longitudinal study.

The purpose of the present study of people with recurrent vertigo (dizziness/dysequilibrium) was (a) to determine whether negative perceptions of symptoms contribute to handicap, and (b) to examine the physical and psychological factors predicting handicap over a seven-month period. Questionnaires assessing symptoms, anxiety and depression, handicap, and beliefs about the potential consequences of vertigo attacks were completed by 101 patients suffering from vestibular disorders. Three clusters of beliefs were identified: concern about loss of control, fear of serious illness, and anticipation of a severe attack. Fear of losing control and reported autonomic symptoms were significantly related to raw and residualized handicap scores, after controlling for somatization, vertigo severity, anxiety and depression. Initial levels of somatization predicted residualized handicap and emotional distress, while handicap levels predicted future emotional distress and vertigo. Negative perceptions of symptoms may contribute to an escalating cycle of vertigo, anxiety and restriction of activity.

Adaptation, Psychological↗
PubMed1982

First seven years of a new NHS mental handicap service 1974-81.

A new community-focused mental handicap service was started in a single-district area health authority in 1974. Almost 90% of all the severely mentally handicapped people in a population of 250,000 are now known to the service. Although two-thirds of long stay inpatients originally admitted with major behavioural problems have had them resolved, the remaining one-third with persisting problems are noted to have spent many years in large understaffed wards before transfer. Specialist services to mentally handicapped people are not synonymous with beds. The learning opportunities during the waking hours of a mentally handicapped person are where professional help must be concentrated, and extensive support services for those caring for the mentally handicapped at home must be set up. Absence of shared philosophies, policies, and planning among the health and local authorities has produced the problems and frustrations familiar to many professionals in mental handicap. Future developments must be based on clearly defined and declared principles.

Adolescent↗
PubMed1988

Health care of physically handicapped young adults.

Little is known about the health needs of physically handicapped young adults after they become too old for the paediatric service. To assess these needs 104 young people with physical handicaps were given a medical examination and interviewed. They had diverse physical handicaps, many of which were rare (41 subjects); 45 had cerebral palsy and 18 spina bifida. Mental handicap (42 subjects) and a need for special education (28) were also diagnosed. The state of health of all subjects was generally poor. Sixty one subjects had contractures of the lower joints and almost a quarter contractures of the upper joints; 26 had deformed feet. Consequently, many subjects (41) could not walk; only 13 could walk without difficulty. Urinary and bowel incontinence were prevalent (58 and 55 subjects, respectively) and with contractures and pressure sores resulted in skin problems (35 subjects). Kyphoscoliosis was present in 30 subjects, particularly those with spina bifida (10 out of 18), of whom one third had respiratory problems and almost half cardiac problems. Thirty one subjects had epilepsy. Many subjects (49) had difficulty communicating or some visual defect (27). Although over half the subjects had health problems that were severe enough to warrant intervention, less than a third were receiving any form of regular hospital care; regular contact with physiotherapists, speech therapists, and dentists was also poor. Moreover, the original diagnoses and prescriptions had not been reviewed regularly. Teams for handicapped adults should be set up in all district health authorities to provide a clinical and coordination service for all adults with physical and mental handicaps.

Adolescent↗
PubMed1983

Emotional adjustment of physically handicapped children: a comparison of children with congenital and acquired orthopaedic disabilities.

The purpose of the study is to test the hypothesis of no difference in the adjustment of children with congenital and acquired orthopaedic disabilities. A second aim is to determine the factors which may contribute to any differences in their adjustment. Forty children aged between eleven and sixteen years participated in the investigation. They were divided into congenital and acquired groups according to the development of the handicap. The results revealed that cases of acquired group had lower self-esteem, felt less happy, less autonomous, more anxious and more hypochondriac when compared with cases of the congenital group. The findings of marked differences in adjustment among congenital and acquired defect groups gives no support to the hypothesis. It is found that the congenital group experiences fewer adjustment problems than the comparison group with acquired defects. The impact of a physically handicapped child on a family may be damaging and may sometimes be catastrophic. A few families may be bound more firmly together by the experience, but in several, the stress imposed far outweighs the benefits. The demand that physically handicapped children make on society is also very substantial. Despite the apparent changes in the public's attitudes toward the handicapped, services available are still far short of the ideal. In the Isle of Wight survey (Rutter et al, 1970) dissatisfaction with the services available was expressed up to 80 per cent of the families studied irrespective of the severity of the handicap of the child. Little mention is made of the nature of the handicap itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Measuring the outcomes of day hospital attendance: a comparison of the Barthel Index and London Handicap Scale.

OBJECTIVE: To assess the ability of two scales to measure the effects of attendance at a geriatric day hospital. DESIGN: 'Before-and-after' measurements. SETTING: Day hospital serving a defined, urban, catchment area. SUBJECTS: One hundred and three consecutive new patients over a three-month period. INTERVENTION: Day hospital attendance for as long as the multidisciplinary team thought warranted. OUTCOME MEASURES: Barthel Index and London Handicap Scale. RESULTS: Seventy-six patients (74%) attended for broadly defined 'rehabilitation'. Measurements on the Barthel Index and London Handicap Scale were completed on 54 of these. Repeat measurements after discharge from the day hospital were achieved on 37 patients. Patients attended between two and 57 times, with a median of eight. Mean Barthel Index did not change over the period of attendance. There was a small improvement in mean handicap score. Eight patients were identified post hoc who attended for 10 or more sessions, and they experienced a large mean reduction in handicap. CONCLUSION: Overall, neither the Barthel Index nor the London Handicap Scale changed much during attendance at the day hospital. Generally very short lengths of attendance may have explained this. For patients with more prolonged attendance, who might be expected to change more, the London Handicap Scale proved more responsive than the Barthel Index.

Activities of Daily Living↗
PubMed2004

Is a day hospital rehabilitation programme associated with reduction of handicap in stroke patients?

OBJECTIVE: (1) To assess whether a rehabilitation day hospital programme is associated with a reduced handicap level of stroke patients. (2) To estimate the relationship between the London Handicap Scale (LHS) and other outcome measures. (3) To examine the effect of demographic parameters (age, gender, family status, education) on LHS scores. DESIGN: A prospective longitudinal survey. SETTING: An urban geriatric rehabilitation day hospital. SUBJECTS: Two hundred and seven elderly stroke patients admitted between December 1999 and February 2001. MAIN OUTCOME MEASURES: London Handicap Scale (LHS), Functional Independent Measure (FIM), Nottingham Extended ADL Index, timed get up and go test. RESULTS: LHS scores at discharge changed significantly (p < 0.008) for mobility, physical independence and occupation. The overall change in LHS score was 2.3 points (20%); effect size 0.43. A significant relationship was found between discharge score of LHS and admission score of FIM, Nottingham Index, timed get up and go and age. Multiple linear regressions did not identify a good predictor for the discharge score of LHS. Higher education was associated with higher LHS scores on admission (p = 0.016) but with less success in correcting handicap (p = 0.046). CONCLUSIONS: A day hospital programme is associated with reduced level of handicap in stroke patients. The LHS is a useful and simple scale for measuring change in these patients. LHS in stroke patients correlates with other outcome measures, yet they cannot be used interchangeably. A significant relationship between education and level of handicap exists.

Aged↗
PubMed1998

Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study.

OBJECTIVE: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. DESIGN: A long-term follow-up study of upper extremity RSD patients. SETTING: A university hospital. SUBJECTS: Sixty-five patients, 3-9 years (mean interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). MAIN OUTCOME MEASURES: Impairments: range of motion, moving two point discrimination, muscle strength of the hand and pain were measured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social functioning, role limitations due to physical problems and role limitations due to emotional problems) of the RAND-36. RESULTS: After RSD of the upper extremity, 62% of the patients are limited in activities of daily living (ADL) and/or instrumental ADL (IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strength are the most important impairments limiting ADL and IADL. Patients with limitations in ADL and IADL are significantly more handicapped than patients without limitations. Pain is the most important factor contributing to handicap. CONCLUSION: The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disability and handicap.

Activities of Daily Living↗
PubMed1984

Masticatory handicap, socioeconomic status, and chronic conditions among adults.

Analysis of data from some 8,300 adults, ages 25-74, shows an inverse relationship between the probability of having a masticatory handicap and socioeconomic status: lower socioeconomic status is associated with higher probability of having a masticatory handicap. Further, adults with a masticatory handicap among the low socioeconomic group have significantly lower intakes, adjusted for age, gender, and body mass, of calories and some nutrients than the non-handicapped. In the former, there is also a higher probability of three dietary-related chronic conditions developing: hypertension, heart attack, and diabetes mellitus. A masticatory handicap appears to have little effect on nutrient intake or the development of the chronic conditions among the high socioeconomic group. The evidence suggests that masticatory handicap is an added risk factor among the low socioeconomic group for these chronic conditions.

Adult↗
PubMed1991

Hearing impairment, coping and perceived hearing handicap in middle-aged subjects with acquired hearing loss.

Coping strategies are presumed to be modifying factors between a hearing impairment and the perceived handicap. The focus of this investigation was to explore audiological and psychological factors affecting the perceived handicap in hearing-impaired middle-aged subjects. The Hearing Measurement Scale, supplemented by a subjective estimation of the perceived handicap, was used as the dependent variable in a study of 62 subjects, heterogeneous as to type and severity of hearing loss and to hearing aid use. In a stepwise regression analysis, maladaptive communication strategies as well as active and constructive coping behaviours were found to increase the self-perception of hearing handicap. Other significant variables were severity of hearing loss and years of education. Tinnitus symptoms did not contribute to the explained variance in the perceived handicap, which was an unexpected finding. A conclusion that may be drawn from the present study is that active coping strategies tend to focus attention on disability and thereby increase perceived handicap.

Adaptation, Psychological↗
PubMedDate not supplied

The genesis of handicap: definition, models of disablement, and role of external factors.

Handicap has proved to be the most contentious and arguably most misunderstood concept of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). This paper reviews the definition and characteristics of handicap as presented in the original introduction to the ICIDH, and presents some of the alternative suggested definitions. Limitations in the way the original conceptual model for the consequences of disease was depicted have led to the development of alternative models which draw attention to the importance of external factors, particularly for the genesis of handicap. The nature of these external factors and the implications of alternative models for the testing of the conceptual framework are discussed. The expression of handicap as a product of an interaction of a person with impairment and disability and the environment draws attention to the options available for the decrease of handicap through the modification of the environment, and not only by attempting to ameliorate the impairment or disability.

Persons with Disabilities↗
PubMed1984

Social stigma and community recreation participation by the mentally and physically handicapped.

This paper presents research results on social stigma barriers to community recreation participation by the mentally and physically handicapped. Depth interviews with 180 physically handicapped, mentally retarded, and mentally ill persons from community and institutional residential settings were conducted to determine (a) their perception of negative, stigmatizing attitudes toward the handicapped, and (b) the degree to which these perceptions of community stigma restrict participation by the handicapped in community recreation. The study found that many handicapped people do perceive, and are affected by community stigma. Those with highly visible impairments are most likely to have experienced negative community reactions. The perception of stigmatizing attitudes leads to restricted recreation participation for some handicapped people, but not for others.

Analysis of Variance↗
PubMedDate not supplied

Comparison of the periodontal treatment needs of normal and handicapped children in Lagos.

The periodontal treatment needs of normal children and those who have mental and multiple handicaps are compared. There were 7.8% handicapped children who did not require any periodontal treatment compared with 1.5% of normal children. Similarly, a higher proportion of normal children (78.6%) compared with 59.4% of handicapped children needed professional oral prophylaxis and oral hygiene education. It was also found from the study that there was a greater need for professional oral prophylaxis in normal children and handicapped children living in institutions than in handicapped children staying with their parents at home. It was concluded that both normal and handicapped children require supervised oral hygiene measures till effective oral hygiene habit is established.

Adolescent↗
PubMed2002

Hearing loss and hearing handicap in users of recreational firearms.

This investigation sought to establish the prevalence of hearing loss and hearing handicap in a population of 232 recreational firearm users. Hearing handicap was calculated based on four methods using pure-tone threshold data from the American Academy of Ophthalmology and Otolaryngology, American Academy of Otolaryngology-Head and Neck Surgery, National Institute of Occupational Safety and Health, and American Speech-Language and Hearing Association in addition to the self-report Hearing Handicap Inventory for Adults-Screener (HHIA-S). Subjects (45 female and 187 male) ranging in age from 13 to 77 years (mean = 40 years, SD = 15.1) completed a short questionnaire regarding demographics and shooting practices followed by pure-tone air audiometry at Occupational Safety and Health Administration test frequencies of 500 to 6000 Hz. A total of 177 who exhibited varying degrees of hearing loss also received a face-to-face administration of the HHIA-S. Audiometric and HHIA-S results revealed that both high-frequency hearing loss and hearing handicap varied significantly as functions of age and occupation. Significant gender effects were observed audiometrically but not as a function of hearing handicap. HHIA-S scores varied significantly as a function of high-frequency (1000-4000 Hz) hearing loss. Correlation coefficients between the four different pure-tone methods of calculating hearing handicap and the self-reported HHIA-S were highest for pure-tone methods that do not employ 500 Hz in the calculation.

Adolescent↗
PubMedDate not supplied

A study on the dental disease of the handicapped.

Opinions vary as to what extent handicapped children differ in oral health from children without handicapping conditions. The present study was a comprehensive study and evaluation of oral health comparing 267 handicapped and 128 nonhandicapped persons with regard to caries rate, occlusion, and periodontal condition. The dft, dfs, and DMFT indices of handicapped according to age were significantly lower than those of nonhandicapped subjects. The prevalence of gingivitis in handicapped persons increased with age and was significantly higher than that reported for nonhandicapped subjects. The handicapped group had a significantly higher percentage of Class II and Class III occlusion than that observed in the comparison group.

Adolescent↗
PubMed1992

Quantifying handicap: a new measure of long-term rehabilitation outcomes.

According to the World Health Organization (WHO), handicaps exist when individuals are unable to fulfill expected social roles. Although ameliorating handicaps is one of the prime goals of rehabilitation, its effectiveness in this area is poorly measured and has not been documented empirically. Therefore, the Craig Handicap Assessment and Reporting Technique (CHART) was designed to quantify the extent of handicap in individuals. Using dimensions of handicap identified and described by the WHO, CHART uses measurable, behavioral terms to compare such individuals with the norms of able-bodied members of society. Test-retest, proxies, and independent raters have established the validity and reliability of CHART. Rasch analysis has verified the CHART scaling and scoring procedures. In addition, an initial application of CHART, with a group of 342 spinal cord injured individuals, is described. Beyond demonstrating the instrument's effectiveness in assessing the extent of handicap or social disadvantage, this application, by documenting rehabilitation outcomes, demonstrates the potential usefulness of CHART for program evaluation.

Activities of Daily Living↗
PubMed1992

Prevalence of intellectual handicap in Western Australia: a community study.

OBJECTIVE: To produce comprehensive community based data on individuals with intellectual handicap, the level of retardation, associated handicaps and demographic data. DESIGN: Multiple sources of ascertainment were used to identify all children in birth cohorts, 1967-1976 inclusive, who had an IQ less than 70. SETTING: The majority of cases were ascertained through Western Australian government agencies that provide services for the intellectually handicapped. Other sources included the support branch of the education department, private schools and the children's hospital. PATIENTS: In all, 1602 children, aged between 6 and 16 years, fitted the study criteria. RESULTS: The prevalence of intellectual handicap was found to be 8.9 per 1000 live male births and 6.3 per 1000 live female births with an overall rate of 7.6. The figures for mild, moderate, severe and profound retardation were 3.0, 2.4, 1.0 and 0.6 per 1000, respectively, with 0.8 per 1000 with an unknown IQ. Cerebral palsy occurred in 20% and epilepsy in 13% in addition to intellectual handicap. There was a significantly higher rate among those from rural compared with urban areas: 9.9 v. 6.5 per 1000 live births, respectively. CONCLUSIONS: This comprehensive epidemiological data on intellectual handicap in Western Australia will be of value in the planning of services, including screening and genetic counselling, and for the evaluation of care. The rural preponderance, in particular, is worthy of further evaluation.

Adolescent↗