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PubMed1991

Impairment, disability, handicap and medical expenses of persons aging with spinal cord injury.

Data from 205 Craig Hospital patients with spinal cord injuries (SCI) were analysed with regard to level of injury, age, length of time since SCI, disability (as measured by the Functional Independence Measure), handicap (as measured by the Craig Handicap Assessment and Reporting Technique), and average annual costs for services relating to the SCI. Differences in disability, handicap, and costs of care were analysed by chronological age and length of time since injury. Older individuals showed significant increases in disability and handicap. When chronological age was added to the number of years post-injury, significant increases in disability, handicap, and costs of care were noted at all neurological levels.

Adolescent↗
PubMed1990

Dental hygienists' attitudes towards dental care for people with a mental handicap and their perceptions of the adequacy of their training.

A survey was undertaken among a group of dental hygienists to investigate potential barriers to providing dental care to people with mental handicap. Barriers similar to those indicated in studies on dentists were shown to be experienced by hygienists. Concerns were mainly related to perceived problems with communication and lack of understanding of the client group, rather than lack of cooperation of the patient. Degrees of concern in treating handicapped patients were shown to be related to type of handicap. Twenty-five (73.5%) of the hygienists surveyed (n = 34) felt that the training they had received, in relation to preparing them to work with mentally handicapped people, was inadequate; 28 (82%) felt that special training was necessary, over and above general hygienist training. However, most hygienists (73.5%) felt more positive about treating people with mental handicaps after a period of post-qualification work experience.

Adult↗
PubMed1983

A home-centered instructional communication strategy for severely handicapped children.

Family involvement is an essential element of language intervention with severely handicapped children for several reasons. First, the parent-child interaction is the focus of normal language development, and can be a powerful impetus in language learning for handicapped children. Second, limited generalization and maintenance of skills often occur when they are acquired in environments that do not also teach the appropriate use of skills. Third, parents can be successful intervention agents and may generalize their skills to other interactions with their child. Training conducted in the home must be compatible with that environment: it should involve only those skills that are of immediate use in the home. The Instructional Communication Strategy described herein represents such a program. It is a synthesis of training strategies used with normal and handicapped children, and is applicable regardless of child's level of functioning, age, or handicapping condition. This training model involves considerable modification in the role of speech-language pathologists dealing with the severely handicapped. The professional's skills are best utilized for assessment, program development, monitoring progress, and training specialized skills. The parents provide most of the direct training; however, professionals are also utilized for the child's maximum benefit.

Child↗
PubMed1987

Augmenting communicative interaction between handicapped and nonhandicapped preschool children.

A peer-mediated intervention designed to promote communicative interaction by 3 handicapped children with behavioral, social, and communicative deficits in an integrated preschool was evaluated. All 6 normally developing preschoolers in the class were taught facilitative strategies. A multiple baseline design across subjects was used in combination with withdrawal designs for 2 of the subjects. Significant increases in communicative interaction occurred when the peers were prompted to use the strategies with the 3 handicapped classmates. In particular, increases in the handicapped children's response rates were demonstrated during free play observations. In addition, fewer initiations by the handicapped children during the peer intervention was shown to be attributable to reductions in teacher prompting. Generalization to other settings was demonstrated by 1 subject. Although most strategy use by peers was prompted during the initial intervention phases, prompting dropped gradually while peer strategy use was maintained by the end of the study. Results of this study have implications for refining our ability to tailor interventions individually to improve treatment effectiveness based upon the characteristics of handicapped children.

Child Behavior Disorders↗
PubMed1986

Audiologic and nonaudiologic correlates of hearing handicap in black elderly.

The purpose of this study was to explore the contributions of audiologic and nonaudiologic factors, including medical, social, economic, and psychological, towards understanding hearing handicap in black elderly. One hundred hearing-impaired black elderly subjects from Harlem Hospital were given audiologic evaluations, including speech recognition tests under varied conditions. Audiologic factors were significantly related to hearing handicap, measured by the Hearing Handicap Scale (HHS) and the Hearing Handicap Inventory for the Elderly (HHIE), with stronger correlations for speech recognition measured at 50 dB HL in a sound field than at 40 dB SL under earphones. Once hearing loss was taken into consideration, nonaudiologic factors (measured on the Multidimensional Functional Assessment Questionnaire), particularly the dependability dimension of social support and the lethargy and paranoid dimensions of mental health, emerged as contributing predictor variables for HHS and HHIE scores. These findings suggest that a multidimensional approach is key to understanding and remediating hearing handicap in black elderly.

Black or African American↗
PubMed2005

[Quality of life and voice handicap of laryngectomees using tracheoesophageal substitute voice].

BACKGROUND: Health-related quality of life (QoL) and subjective health have become popular constructs for the evaluation of both efficacy and efficiency of diagnostic and therapeutic procedures in medicine. QoL is considered a multidimensional construct encompassing physical, mental and social facets of life. It is an accepted outcome parameter not only in international classification systems such as ICIDH and ICF, but as well in clinical guidelines and disease management programs. Measuring quality of life allows for comparison of different diseases though it certainly lacks disease specific aspects. Thus, it has to be assumed that in patients with distinct functional deficits QoL cannot cover all aspects that are important for the individual patient. This study focuses on laryngectomies and their self-evaluation of post-laryngectomy speech. It is well known that these patients experience a decreased QoL compared to patients after partial laryngectomy or healthy persons. In this study, the impact of voice restoration on the laryngectomies' QoL was evaluated. PATIENTS AND METHODS: In 20 male laryngectomies aged 62 +/- 8 years, relations between QoL and voice handicap were evaluated using two instruments as proposed in the international literature, i. e. the Short-Form Health Survey (SF-36) and the Voice Handicap Index (VHI). All patients had successfully been using tracheoesophageal substitute voice for at least one year. Complete data sets were available from all patients. Data were analysed using Microsoft Excel and Sigma Plot, Jandel Corp. software packages. RESULTS: Results of both the SF-36 and the VHI reveal wide interindividual ranges. There are statistically significant correlations (p < 0.05) between the SF-36's scales General Health and Vitality and the VHI, whereas no correlations were found between social and psychological scales and the voice handicap. DISCUSSION: Wide ranges of the data obtained reveal that obviously both health related quality of life and voice handicap are not affected in a group specific way. So, both tests are of clinical value to depict individual aspects of wellbeing after laryngectomy. The combination of VHI and SF-36 illuminates correlations between general and special subjective aspects. Strikingly, the laryngectomies' social and psychological status is not related to their voice handicap. Data allow for conclusion that laryngectomies' substitute voice problems do not affect social aspects of quality of life in a disease specific way, at least as long as voice restoration was successful at all.

Aged↗
PubMed1998

[Injury risk of competitive, handicapped cross-country skiers in training nd competition].

Injuries caused by cross country skiing have been poorly investigated in handicapped athletes. The dynamic sliding shape of motion makes this sport to a suitable discipline for people with a deficit of locomotion. Visual handicapped people with a guide are able to improve their motoric skills, co-ordination, orientation and body self-consciousness in the track. Since handicapped athletes are performing in international competitions the training intensity to fulfill the requirements, but also the risk of overstrain induced injuries got increased, like in other high-performance sports. Our study examined injuries and overuse syndromes of the German National Team Ski Nordic during the Paralympics in Tignes/ Albertville (1992). Lillehammer (1994) and the training period in preparation for the Paralympics in Nagano (March 1998). The incidence and kind of injuries in the competitive handicapped cross country skier was comparable with non-handicapped athletes, but the injury pattern was different.

Adult↗
PubMed2001

Factor analysis and correlation between Dizziness Handicap Inventory and Dizziness Characteristics and Impact on Quality of Life scales.

In order to assess the different dimensions of disability and handicap analyzed in the Dizziness Handicap Inventory (DHI) and Dizziness Characteristics and Impact on Quality of Life (UCLA-DQ) questionnaires a factor analysis study was done. The instruments used were the corresponding transculturally adapted versions of the originals into Spanish. The study included 337 patients with dizziness, independent of location and etiology, who were able to respond to all the items in the questionnaires given before vestibular testing. Factor analysis was used to determine the structure of both scales; a principal components analysis with orthogonal rotation (Varimax) was conducted on data collected from the patients. A three-factor solution was obtained in the DHI and a two-factor solution for the UCLA-DQ. The factors obtained from the DHI were related to vestibular handicap, vestibular disability and visuo-vestibular disability; the factors from the UCLA-DQ were related to frequency and severity of dizziness. There was no coincidence between the items in each of the factor obtained in the DHI questionnaire and the items in the subscales provided in the original version. The main relation between factors was found between vestibular handicap and frequency. The DHI and UCLA-DQ questionnaires are multidimensional questionnaires for the assessment of the impact of dizziness and provide a model for vestibular disability and handicap.

Adolescent↗
PubMed2005

Balance performance and self-perceived handicap among dizzy patients in primary health care.

OBJECTIVE: To study the diagnostic panorama at a primary health care centre where the physiotherapist is specialized in dizziness. To study balance measures of dizzy patients as well as measures of self-perceived handicap and to analyse whether these measures correlate. DESIGN: Retrospective study of computerized medical records. SETTING: A primary health care centre in Malmö, Sweden. SUBJECTS: A total of 119 patients with dizziness, 73 women and 46 men, aged from 22 to 90 years. MAIN OUTCOME MEASURES: Diagnoses according to specified criteria. Four balance measures: tandem standing, standing on one leg, walking in a figure of eight, and walking heel to toe on a line. The Dizziness Handicap Inventory (DHI). RESULTS: Six different groups of diagnoses were found: multisensory dizziness, peripheral vestibular disorder, dizziness as a symptom caused by whiplash-associated disorder, unspecific dizziness, phobic postural vertigo, and dizziness of cervical origin. The group with multisensory dizziness performed poorer on the balance measures than the other groups. The group with phobic postural vertigo had the highest total scores on DHI, while the vestibular group had the lowest total score. Subjects over 65 years old had more disturbances in balance, but a lower level of self-perceived handicap, than subjects aged 65 or younger. DHI did not correlate with any of the balance measures. CONCLUSIONS: Self-perceived handicap, measured with DHI, and disturbed balance measured with clinical methods, do not necessarily correlate. Elderly patients with dizziness seem to have more disturbances in balance than younger patients but a lower level of self-perceived handicap.

Adult↗
PubMed2000

The Leeds Assessment Scale of Handicap: its operationalisation, reliability, validity and responsiveness in in-patient rehabilitation.

PURPOSE: This paper describes the application of the handicap dimension of the International Classification of Impairments, Disabilities and Handicaps. METHOD: A method of assessing four of the six roles (or areas of expected competency) was developed and applied to an in-patient population, aged 16 to 65 years, receiving specialist rehabilitation following neurological damage. Handicap assessment was a collaborative process by a multidisciplinary team. Difficulties were experienced in measuring inter-rate reliability in the busy, clinical setting. RESULTS: We conclude that handicap assessment in an in-patient rehabilitation unit which uses a multidisciplinary approach to treating patients with complex physical, sensory and cognitive problems is both feasible and useful. CONCLUSION: The developed scale, The Leeds Assessment Scale of Handicap, provides a valid and valuable summary of human disadvantage, complementing the common disability assessments.

Activities of Daily Living↗
PubMed1998

The subjective handicap of epilepsy. A new approach to measuring treatment outcome.

It is now widely acknowledged that the impact of epilepsy on the individual extends beyond the occurrence of seizures, and that there is a need for outcome measures sensitive to these consequences. Until now these instruments have largely been developed within a 'quality of life' framework. The technical and conceptual difficulties that arise with measuring quality of life have led us to develop a more focused measurement model, the 'Subjective Handicap of Epilepsy' (SHE) scale, based on the World Health Organization's concept of handicap. The scale contains 32 items in six subscales: 'Work and activities' (eight items), 'Social and personal' (four items), 'Self-perception' (five items), 'Physical' (four items), 'Life-satisfaction' (four items) and a 'Change' scale (seven items); and it takes on average < 10 min to complete. The scale's test-retest reliability was found to be satisfactory (intra-class correlation coefficient was 0.8-0.9 in 110 subjects). The test-retest interval (24 h to 8 weeks) had no influence on the reliability. The reliability was also not affected by minor recent fluctuations in seizure frequency. The internal consistency of the scales was 0.8-0.9 (Cronbach's alpha). The construct validity of the scale was examined in a sample of 287 clinic attendees at a university neurology clinic in the UK. The scales were highly sensitive to the handicapping effects of increasing seizure frequency, employment status, the impact of epilepsy on career choice and the subject's own opinion as to the major determinant of their quality of life. The scales were also sensitive, retrospectively, to the benefits of successful epilepsy surgery in a cohort of 105 patients. Scales focusing specifically on handicap were more sensitive to group differences in seizure frequency in the clinic population, and to outcome after epilepsy surgery, than the 'Life-satisfaction' scale and the Epilepsy Surgery Inventory 55 (ESI-55) scales. This supports the contention that measuring 'subjective handicap' may be a more sensitive, and more useful, approach to assessing the impact of interventions on the long-term consequences of epilepsy than current methods.

Adult↗
PubMed1980

Children's attitudes toward physically handicapped peers and intervention approaches for attitude change.

Children with physical handicaps are among those handicapped children who are placed in the regular public school classroom as the least restrictive environment possible for their education. Physical therapists are increasingly extending their service into school settings and are likely to be in the position to become advocates for the physically handicapped student. A review of research on attitudes held by nonhandicapped peers reveals that unfavorable attitudes toward physically handicapped students are prevalent. Strategies for the physical therapist to use in helping to promote positive peer attitudes toward physically handicapped children are presented.

Attitude↗
PubMed1983

Assistance to families with handicapped children.

The article deals with the problem of developing models for assistance to families with handicapped children in developed and developing countries. In order to avoid unintended and undesirable effects, it is necessary to gain a thorough insight into local conditions and the families own experience of their needs. The example of Norway is used to illustrate this. An interdisiplinary project, a cooperation between a social anthropologist and a child psychiatrist, has studied "handicapped families" and the effects of the aid programs on their ability to cope with the problems of daily life. 171 families with pre-school children with nine different handicaps were interviewed about their life situation, their needs and the aid they received. In Norway one of the main problems in giving aid to "handicapped families" is the underutilisation of the aid that is available. More information must be gathered of the processes that influence the coping ability of the "handicapped family" in both developed and developing countries. Further assistance programs should be based on such knowledge.

Adolescent↗
PubMed1987

The General Handicapped Attitude Scale (GHAS): a construct validation study.

The construct validity of the General Handicapped Attitude Scale (GHAS) (Bujik, 1986a) was investigated. The results showed that, within a group of 44 spinal cord lesioned patients (lesion levels varying from cervical 4 to lumbar 4), the scores on the GHAS subscales: Acceptance, Social Consequences and Bottom (the "psychicsubstratum") did not correlate with scores for the severity of the handicap. They did however correlate significantly with scores for the personal attitude towards the handicap. The GHAS subscale Help-Independence correlated significantly with both the severity of and the attitude towards the handicap. Dropping 4 out of the 9 items of the GHAS subscale reduced the correlation with the severity of the handicap to an insignificant level, while neither the validity nor the reliability of the scale were seriously impaired.

Adaptation, Psychological↗
PubMed1997

The outcome of scoliosis surgery in the severely physically handicapped child. An objective and subjective assessment.

STUDY DESIGN: A prospective, functional assessment based on physical ability and independence in daily activities was performed of patients who had severe physical handicaps and spinal deformities and were undergoing scoliosis surgery. OBJECTIVES: To determine whether improving spinal alignment and truncal balance improved the functional abilities of handicapped patients. SUMMARY OF BACKGROUND DATA: Loss of truncal stability compromises the physical independence of children who are severely handicapped. Physiologic function also may be compromised. It is not clear whether improving truncal balance actually improves their level of independence or merely halts further deterioration. METHODS: Twenty patients with significant physical handicaps resulting from neuromuscular disorders or multiple congenital anomalies and significant spinal deformity and truncal imbalance were treated surgically to realign and stabilize their spines. Their level of physical independence was evaluated before surgery, including their ability to sit, ambulate, and complete activities of daily living. Evaluation was done before surgery, 6 months after surgery, and 12 months after surgery. A subjective assessment of cosmesis also was made. RESULTS: Corrective spinal surgery resulted in a deterioration of physical ability for the first 6 months. Most patients subsequently returned to their preoperative level of function. An improvement of function exceeding their preoperative level was not seen after 12 months. The cosmetic results of surgery were excellent. CONCLUSIONS: Corrective spinal surgery in patients with severe physical handicap should be performed early to preserve function and should not be dictated solely by the severity of the curvature. Improvement in the patient's level of independence may not necessarily occur after truncal stabilization. Cosmetic results in these patients with severe disabilities were extremely gratifying to the patients and their caregivers.

Activities of Daily Living↗
PubMed2004

The performance-perceptual test and its relationship to unaided reported handicap.

OBJECTIVE: Measurement of hearing aid outcomes is necessary for demonstration of treatment efficacy, third-party payment, and cost-benefit analysis. Outcomes are usually measured with hearing-related questionnaires and/or tests of speech recognition. However, results from these two types of test often conflict. In this paper, we provide data from a new test measure, known as the Performance-Perceptual Test (PPT), in which subjective and performance aspects of hearing in noise are measured using the same test materials and procedures. A Performance Speech Reception Threshold (SRTN) and a Perceptual SRTN are measured using the Hearing In Noise Test materials and adaptive procedure. A third variable, the discrepancy between these two SRTNs, is also computed. It measures the accuracy with which subjects assess their own hearing ability and is referred to as the Performance-Perceptual Discrepancy (PPDIS). DESIGN: One hundred seven subjects between 24 and 83 yr of age took part. Thirty-three subjects had normal hearing, while the remaining seventy-four had symmetrical sensorineural hearing loss. Of the subjects with impaired hearing, 24 wore hearing aids and 50 did not. All subjects underwent routine audiological examination and completed the PPT and the Hearing Handicap Inventory for the Elderly/Adults on two occasions, between 1 and 2 wk apart. The PPT was conducted for unaided listening with the masker level set to 50, 65, and 80 dB SPL. RESULTS: PPT data show that the subjects with normal hearing have significantly better Performance and Perceptual SRTNs at each test level than the subjects with impaired hearing but that PPDIS values do not differ between the groups. Test-retest reliability for the PPT is excellent (r-values > 0.93 for all conditions). Stepwise multiple regression analysis showed that the Performance SRTN, the PPDIS, and age explain 40% of the variance in reported handicap (Hearing Handicap Inventory for the Elderly/Adults scores). More specifically, poorer performance, underestimation of hearing ability and younger age result in greater reported handicap, and vice versa. CONCLUSION: Reported handicap consists of a performance component and a (mis)perception component, as measured by the Performance SRTN and the PPDIS respectively. The PPT should thus prove to be a valuable tool for better understanding why some individuals complain of hearing difficulties but have only a mild hearing loss or conversely report few difficulties in the presence of substantial impairment. The measure would thus seem to provide both an explanation and a counseling tool for patients for whom there is a mismatch between reported and measured hearing difficulties.

Adult↗
PubMedDate not supplied

Shed preconceived ideas...look, listen... A response to Sheridan's position on the spontaneous play of handicapped children.

Sheridan's article concerning the importance of spontaneous play for learning in handicapped children reflects both a historical and a contemporary negative valuation of 'handicapment'. Specifically, the authors suggest that contemporary views of handicapment fail to take into consideration the social and cultural concomitants of handicapment and in fact create an atmosphere wherein learned helplessness and self-fulfilling prophesies thrive. This state of affairs can only serve to perpetuate contemporary negative valuations of those individuals culturally labelled as 'handicapped'.

Attitude↗
PubMedDate not supplied

Observations of young normal and handicapped children.

An observational study was made of 1-2-year-old children, and of mentally handicapped children functioning at a similar level, to determine the extent to which they involved themselves in play with toys and other objects and the extent to which their day was "empty". Observations of normal children were made in their homes and in day nurseries; observations of mentally handicapped children were made at home, in day care centres (special schools) and in the schools and wards of subnormality hospitals. In no setting were children interacting with adults for more than 20% of their non-routine time. These findings seem to justify concern over independent play with toys and other objects. The handicapped children in all settings had "emptier" days than the normal children, this being accounted for by greater amounts of inattentive handling of objects and self-stimulation and lesser amounts of social interaction and attentive play. However, attentive play scores for the handicapped children varied markedly with setting. In appropriate circumstances, there can be as much spontaneous contact with objects in handicapped children as in normal children at a similar development level. Despite current concern over the effects of day care on the development of very young children, normal children in day nurseries did not differ from normal children at home, either in attentive play scores or in the proportion of nonroutine time spent interacting with adults.

Adolescent↗