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PubMed1990

[Plaque and gingivitis in children with cerebral palsy: relation to CP-diagnosis, mental and motor handicap].

UNLABELLED: A total of 105 children with cerebral palsy aged 14 and 15 years born in the eastern Denmark comprised the study group. The children were classified according to CP-diagnosis, mental handicap, motor handicap and information on plaque index, gingivitis index, and toothbrushing habits were collected. The analysis showed that the values for plaque and gingivitis indices were significantly higher than those of the control group. The specific CP-diagnosis, the mental handicap and the motor handicap did not seem to have definite influence on the child's plaque and gingivitis indices. Children with the mildest mental and motor handicap seemed to have lower plaque and gingivitis indices than those of the severely handicapped children. The highest gingival scores (5.2) were seen when the child and the parents together were responsible for the child's toothbrushing. The gingival index was 4.0, when the parents brushed the child's teeth and 3.7 when the children brushed their teeth on their own. Only 7 children used an electric toothbrush. The average gingival index in this group was 3.0, which was nearly the same as that of the control group. CONCLUSION: 1. Oral hygiene planning of the CP-child can only be made when an individual evaluation has been performed. 2. CP-children's oral hygiene has to be controlled frequently.

Adolescent↗
PubMed1986

Are the medical needs of mentally handicapped adults being met?

This paper reports on the apparent inadequate level of primary medical care provided to many of the 151 mentally handicapped people who attend an adult training centre. A large number of common medical problems were identified that were not known to the general practitioners and/or were not being managed, including problems known to be associated with Down's syndrome. Many trainees were further handicapped by unmanaged defects of hearing and vision. Contact rates with the general practitioner showed that the mentally handicapped adults did not place a greater burden on the doctor than the rest of the population. Comparing these rates with those for other vulnerable groups such as those aged over 75 years and under four years showed that only 28% of the trainees had an adequate consultation rate with the general practitioner.A lack of awareness among general practitioners of the special needs of this group is thought to be in part responsible but the major factor is the inherent problem of communication which exists almost universally in people who suffer from mental handicap. Ways of improving the situation are discussed with an emphasis on the need for a change in our attitudes towards mentally handicapped people. Reference is made to the desirability of increasing the cooperation between primary care and community mental handicap teams and the increasing importance of voluntary organizations.

Adult↗
PubMed1984

The community deals with the child who has a handicap.

Exclusion messages, however subtle, are interwoven into the community of the child who is handicapped. The subsystems of family, religion, neighborhood, education, health care, and financial assistance agencies have good intentions but frequently communicate poorly with the child and the parents. What is meant as a help becomes a hindrance for the child who must adapt to a limitation while continuing to move toward self-esteem, self-sufficiency, and skills that will enhance productivity and employability. No one negative message will destroy a handicapped child: it is the "history of learned inferiority" that cripples the child who is handicapped. Only when able-bodied individuals within the subsystems recognize the cumulative effect of these messages will the community be responsive to the real needs of the child who has a handicap. Nurses, schooled in sensitivity for the person, should resolve to be in the vanguard in this movement, becoming ever more sensitive to the needs of the handicapped. Such a giant step will begin a fresh and long-needed approach toward understanding those needs central to the well-being of the child who resides in the community and is also handicapped.

Attitude to Health↗
PubMed1980

The physical handicap and the body ego.

This paper has three parts. First, I reconsider the previously published analysis of Peter, the boy born with a severe congenital handicap. This time I focus on the boy's own major wish, not for the growth of normal arms, but to be accepted with pride by his mother as he actually was. I mention some thoughts concerning the deep-seated problems between mother and child occurring during the fusional phase and the consequent limitations this imposed upon the primary identificatory processes. In the second part of this paper a comparison is established between the fantasy life of this handicapped boy with the unconscious fantasy life of some obsessive-depressive patients experiencing minor, acquired, or temporary handicaps. The main point here is that the fantasy life of Peter is oriented towards ego-building while the fantasy life of the others is ego-inhibiting. A final comparison is attempted between, on the one hand, the psychological effects on this child of his own congenital handicap contrasted with, on the other hand, the effects on a physically normal child of the permanent physical handicap of one of the parents. The child in the second situation (handicap of a parent) seems more psychologically threatened in his body integrity and identity.

Achievement↗
PubMed1998

Evaluation of hearing handicap. The American Academy of Otolaryngology and American Council of Otolaryngology (AA0-ACO)

The American Academy of Otolaryngology and American Council of Otolaryngology (AAO-ACO) define hearing handicap as a disability to understand sentences under everyday vocal and listening conditions, and describe procedures for its estimation from pure-tone threshold hearing levels. Research now reveals that the AAO-ACO procedures underestimate measured hearing handicap by the equivalent of averaged pure-tone threshold losses of 17 dB at high-percentage handicaps to 35 dB at low-percentage handicaps. It is proposed that AAO-ACO procedures be modified as follows: (a) adjust hearing levels for presbycusis when estimating handicap due to noise or other factors than presbycusis; (b) change averaged hearing level "fences" from present 25 dB to 15 dB for 0 percent and from present 92 dB to 75 dB for 100 percent handicap; and (c) change weight for "worse" ear contribution from present 1/6 to 1/4 for binaural listening.

Adult↗
PubMed1996

Development of the Tinnitus Handicap Inventory.

OBJECTIVE: To develop a self-report tinnitus handicap measure that is brief, easy to administer and interpret, broad in scope, and psychometrically robust. DESIGN: A standardization study of a self-report tinnitus handicap measure was conducted to determine its internal consistency reliability and convergent and construct validity. SETTING: Audiology clinics in tertiary care centers in two sites. PARTICIPANTS: In the first investigation, 84 patients reporting tinnitus as their primary complaint or secondary to hearing loss completed the 45-item alpha version of the Tinnitus Handicap Inventory (THI). In the second investigation, 66 subjects also reporting tinnitus completed the 25-item beta version. OUTCOME MEASURES: Convergent validity was assessed using another measure of perceived tinnitus handicap (Tinnitus Handicap Questionnaire). Construct validity was assessed using the Beck Depression Inventory, Modified Somatic Perception Questionnaire, symptom rating scales (annoyance, sleep disruption, depression, and concentration), and perceived tinnitus pitch and loudness judgments. RESULTS: From the alpha version of the THI, we derived a 25-item beta version with the items grouped into functional, emotional, and catastrophic subscales. The total scale yielded excellent internal consistency reliability (Cronbach's alpha = .93). No significant age or gender effects were seen. Weak correlations were observed between the THI and the Beck Depression Inventory, Modified Somatic Perception Questionnaire, and pitch and loudness judgments. Significant correlations were found between the THI and the symptom rating scales. CONCLUSION: The THI is a self-report measure that can be used in a busy clinical practice to quantify the impact of tinnitus on daily living.

Activities of Daily Living↗
PubMed2002

Psychometric evaluation of a new handicap scale in immune-mediated polyneuropathies.

A new handicap measure, the Rotterdam nine-item handicap scale, was developed and its validity, reliability, and responsiveness evaluated in patients with immune-mediated polyneuropathies. We evaluated 113 stable patients, of whom 83 had Guillain--Barré syndrome (GBS), 22 had chronic inflammatory demyelinating polyneuropathy (CIDP), and 8 had a gammopathy-related polyneuropathy. We also studied 20 patients with recently diagnosed GBS (n = 7) or CIDP (n = 13) and changing clinical conditions (longitudinal group). Significant discriminatory validity and correlation with the Rankin scale were demonstrated for the Rotterdam nine-item handicap scale (stable group: Spearman's test, r = minus sign.76 to minus sign.78; longitudinal group: intraclass correlation coefficient, r =.83; P <.0001). Also, good reliability (r =.89--.98; P <.0001) and high responsiveness values (standardized response mean values >.8) were obtained for the Rotterdam nine-item handicap scale. In contrast to the Rankin scale, the Rotterdam scale not only provided information regarding mobility but also highlighted physical independence, occupation, and social integration. These results illustrate the clinical usefulness of the Rotterdam nine-item handicap scale under these conditions.

Activities of Daily Living↗
PubMed1981

Group-self identification and physical handicap: implication for patient support groups.

Relationships between attitudes toward self and attitudes toward handicapped persons based on semantic differentials and social distance measures for one nonhandicapped and five handicapped subsamples (N = 142) are presented. Among persons characterized by amputation, spinal cord injury, or stroke, over one third of the variation in evaluation of self was accounted for by evaluation of persons with handicaps like one's own. Among persons characterized by arthritis or emotional disturbance and among the nonhandicapped, evaluation of self was most closely related to evaluation for the average person. These results indicate strong group identification on the part of persons with more visible handicaps and a tendency toward dissociation on the part of those with less visible handicaps. The finding of high levels of identification within three of the five conditions studied suggests that group techniques may be beneficial in dealing with stigma and quality-of-life issues; the finding of dissociation among persons with other conditions suggests that such techniques should be employed with caution.

Affective Symptoms↗
PubMed1998

Handicap signalling: when fecundity and viability do not add up.

It is widely accepted that a requirement for honest handicap signalling is that higher-quality signallers pay lower marginal costs for advertising. This is a simple, powerful principle, but it is correct only if the fitness effects of fecundity and viability are strictly additive. Additivity would not be expected from most life history models. The general criterion for honest handicap signalling is that higher-quality signallers must have higher marginal fitness effects of advertising. This might result from higher benefits rather than lower costs. The general criterion implies the existence of a ridge on the fitness surface for two correlated characters, quality (or viability) and advertising. This has important implications for the design of experiments. Critical tests of the handicap hypothesis should establish that signallers of different quality are on a rising fitness ridge because of different cost-benefit trade-offs. The further question of whether receivers are maximizing their fitness requires additional experiments because handicap signalling does not require that the receivers maximize their fitness, only that they return benefits to signallers as an increasing function of the size of the signal. If receiver preferences are exaggerated by sensory bias or indirect selection, the resulting exaggerated signals may be consistent with the handicap principle. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1987

Psychosocial characteristics of preschool siblings of handicapped and nonhandicapped children.

This project examined psychosocial characteristics of 24 preschool-aged siblings of handicapped children in relation to a control group of 22 siblings of nonhandicapped children. Subjects were matched on family size and income, sibling age, birth order, sex, age spacing, and marital status of their parents. Results indicated no statistically significant differences between groups of children on measures of perceived self-competence and acceptance, understanding of developmental disabilities, empathy, and child care responsibility. Significant group differences were found where brothers of handicapped children were rated by their mothers as being more depressed and aggressive than brothers of nonhandicapped control children. Sisters of handicapped children were rated by mothers as being more aggressive than sisters of nonhandicapped children. Sisters of handicapped children and brothers of nonhandicapped children had significantly fewer privileges and more restrictions on their home activities than other groups. Results are discussed in relation to previous research on older siblings of handicapped children and the general literature on family stress and childhood disability and disease. The importance of examining sibling functioning via multiple measures of child behavior is stressed.

Aggression↗
PubMedDate not supplied

[Conception and goals of sports for handicapped in Switzerland].

The main objective of sport for the handicapped is the maintenance and improvement of physical performance. Sport for the handicapped is also a social hygienic question. We cannot ignore what is happening to the handicapped during their whole life-time: whether they get more and more stiff, unflexible and clumsy, lose their ability to move and become a burden to the society too early. Regular physical activity can work wonders. Many of them find the relation to the public life and their lost self-confidence returned as a result of participating in physical activity programs. They become happier and motivated for their daily work. They discover a new sense of life in proving to themselves that, in spite of their handicap, they are able to achieve considerable performances, a healthier state, and are generally happier and more flexible up to an old age. In conclusion, sport for the handicapped should achieve the following: give pleasure of life, increase courage, promote comradeship, reinforce self-confidence, improve independence, and take away inhibitions and inferiority complexes.

Persons with Disabilities↗
PubMed2006

Self-handicapping prior to academic-oriented tasks in children with attention deficit/hyperactivity disorder (ADHD): medication effects and comparisons with controls.

Examined self-handicapping prior to academic-oriented tasks in children with and without ADHD and examined whether stimulant medication influenced self-handicapping. Participants were 61 children ages 6 to 13, including 22 children with ADHD tested after taking a placebo, 21 children with ADHD tested after taking stimulant medication, and 18 non-ADHD controls. Participants completed three measures of self handicapping and also completed self-evaluations of their performance. Results showed greater self handicapping and more positive self-evaluations in children with ADHD than in controls regardless of medication condition. Findings suggest children with ADHD may use self handicapping to ameliorate the effects of experiencing high rates of academic failure.

Adolescent↗
PubMed1994

Comparison of perceived and actual rates of survival and freedom from handicap in premature infants.

OBJECTIVE: Our goal was to learn whether physicians delivering obstetric care accurately estimated rates of survival and freedom from handicap in premature infants. STUDY DESIGN: We surveyed by mail 409 obstetricians and general and family physicians reported to perform deliveries in Alabama to identify their perceptions regarding survival and handicap-free rates of infants born at gestational ages between 23 and 36 weeks, inclusive. Responses were compared with published national rates of survival and freedom from handicap by means of unpaired t tests. RESULTS: A total of 224 physicians responded (55%), and 183 were still practicing obstetrics. They significantly underestimated survival rates from 23 through 34 weeks' gestation (p < 0.05) and freedom from serious handicap from 23 through 36 weeks' gestation (p < 0.05). They advocated early treatment of preterm labor, but < 50% would perform cesarean delivery for fetal distress before 26 weeks' gestation. CONCLUSION: We conclude that physicians delivering obstetric care significantly underestimate survival and freedom from handicap in preterm infants. Perinatal care may be adversely affected by these misperceptions.

Persons with Disabilities↗
PubMed1991

Impairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age. The Collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands.

The Project On Preterm and Small for gestational age infants (POPS) was started in the Netherlands in 1983 to investigate the relation between prenatal/perinatal factors and mortality/morbidity in very preterm and very-low-birthweight infants. Of the 1338 liveborn infants (less than 32 weeks and/or less than 1500 g) 966 were enrolled in the five-year (chronological age) follow-up programme; 96% of these children were assessed during a home visit. The overall outcome was expressed as impairments, disabilities, and handicaps according to World Health Organisation criteria. Of the assessed children, 13% had a disability and 14% were handicapped, which are much higher frequencies than those found in the general population. Handicaps were due mainly to abnormalities of neuromotor function, mental development, or language and speech development. Compared with the handicap frequency in the same cohort at two years of age, a more favourable outcome at five years of age was seen in 10%, and a less favourable outcome in 7% of the children. The findings show that most of those high-risk children survived without handicap or serious disability at preschool age.

Child, Preschool↗
PubMed1994

Prediction of handicap and emotional distress in patients with recurrent vertigo: symptoms, coping strategies, control beliefs and reciprocal causation.

Factors predicting handicap and distress were examined in a longitudinal study of 101 patients suffering from recurrent vertigo (dizziness). Analysis of a questionnaire assessing coping strategies yielded four distinct individualised coping styles: problem-focused information-seeking; distraction; denial; and relinquishing responsibility. After controlling for the severity of physical and psychological symptoms and distress, handicap was negatively related to internal locus of control and positively correlated with relinquishing responsibility. Symptoms of somatic anxiety predicted an increase in handicap over a 7 month period, while handicap and somatic anxiety symptoms predicted an increase in distress. These results are interpreted in terms of a reciprocal causal relationship between handicap and distress, mediated partly by somatic symptoms. Parallels with pain, panic and phobia suggest that patients with vertigo might benefit from psychological therapies.

Adaptation, Psychological↗
PubMed2004

Administrative and financial responsibilities for sheltered housing for mentally ill and handicapped persons in Germany and its impact on housing supply.

BACKGROUND: The integration of mentally ill and handicapped persons in the society requires the availability of various forms of sheltered housing in the community, most important ambulatory (supported) housing facilities. In Germany the administrative and financial responsibility for sheltered housing for mental ill and handicapped persons is usually assigned to two authorities: the welfare authorities at Lander (state) level are responsible for hostels, the welfare authorities on community and district level are responsible for ambulatory housing. However some Lander have distributed these responsibilities differently and other Lander offer subsidy programmes to promote the implementation of ambulatory housing. OBJECTIVE: To evaluate the different modes of distributing the responsibilities for administration and financing of sheltered housing for their impact on the supply with ambulatory and stationary housing in the 16 German Lander. METHOD: (1) Analysis of the practise of distributing the responsibilities for housing between Lander and community welfare-authorities in the 16 Lander. Analysis of the subsidy programmes in the Lander that aim to promote the implementation of ambulatory housing. (2) Assessment of the capacities in housing for mentally ill and handicapped persons in the Lander. (3) Comparing (1) and (2). RESULTS AND DISCUSSION: Lander that have the responsibilities for ambulatory housing and for hostels organised on the same authority-level, offer generally more housing in ambulatory facilities and less in hostels than Lander that do not. However, three Lander, despite having all responsibilities for housing at one authority level, provide accommodation for mentally ill and handicapped persons predominantly in hostels. There are so far no indications whether it would be more favourable to have a unique authority for housing based on Lander or on community level. Subsidy programmes to promote the implementation of supported housing are successful if they sponsor at least 50% of costs and if they exist for a considerable duration of time. CONCLUSION: Organising the responsibilities for housing for mental ill and handicapped persons on one authority level and the availability of subsidy programmes have a positive impact on the supply with ambulatory housing. However other factors also have to be considered to influence the supply with ambulatory housing, such as political will, attitudes towards the mentally ill, interests of hostel operators, pre-existing hostel infrastructure, available funds. These factors need to be researched further.

Community Mental Health Services↗
PubMed2006

The voice handicap of student-teachers and risk factors perceived to have a negative influence on the voice.

A cross-sectional questionnaire survey was performed. The objectives of the study were to assess the psychosocial impact of current voice complaints as perceived by student-teachers with voice complaints in comparison with student-teachers without voice complaints, and to observe the pattern of risk factors in relation to their voice handicap. Subjects in the general population without a voice-demanding profession were selected as a reference group for limited comparison with the total group of student-teachers (future professional voice users). The respondents to the questionnaires were anonymous. Among the student-teachers, 17.2% reported current voice complaints in comparison with 9.7% of the reference group, and the odds ratio was 1.94, which showed the relative risk. Student-teachers had significantly greater total Voice Handicap Index (VHI) scores than the reference group (P = 0.034). The VHI subscale scores were not significantly different (P > 0.05). Student-teachers who reported current voice complaints had a significantly higher total VHI and subscale scores than student teachers without voice complaints (P < 0.001). Of the student-teachers without voice complaints, 17.0% had VHI scores greater than the 75th percentile. These persons may be neglecting their voice handicap and probably represent the false-negative cases in the estimation of voice complaints. Logistic regression analysis of each of the given risk factors with the VHI as the independent variable showed that the perceived negative influence of the given risk factors on their voices was significantly greater with increasing VHI scores across the VHI range. A significant correlation was observed between the number of perceived risk factors and increasing VHI scores across the VHI range. An increased awareness of risk factors in relation to their voice handicap would serve to motivate student-teachers to change factors that contributed to their voice problem. Attention to all risk factors, which the subjects perceive to be a risk, would aid in effective management of their voice handicap.

Adult↗
PubMed1987

Locally-based residential services for mentally handicapped adults: a comparative study.

The patterns of daily living, occupation and leisure activities, skills, behaviour and the structure and organization of living units were assessed for 2 groups of mentally handicapped adults, first in a large hospital and second, a year later in the new local units to which they were transferred. Similar assessments were carried out for individually matched control subjects who remained in the large hospital. For the less severely handicapped, more sociable residents who moved to an NHS hostel in the community, there were significant improvements on several of these measures. For the more severely handicapped, socially aloof people who moved to a ward in a small converted hospital in the district from which they had originally come, some changes on the environmental measures were found, but on the whole the unit was run along similar lines to the wards of the large hospital. There was little change in the pattern of the residents' day to day life. The controls who remained in the large hospital experienced very little change in environmental and life-style measures. The discussion focuses on the interaction between environmental factors and the handicaps of the individuals, and the influence of this interaction upon quality of care and life-style. The study was carried out during the early stages of the rundown to closure of the large mental handicap hospital.

Adult↗