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PubMedDate not supplied

Voice handicap of laryngectomees with tracheoesophageal speech.

The evaluation of diagnostics and therapies includes more and more subjective, i.e. emotional and social aspects. Focussing on the handicap experienced by dysphonic patients, the Voice Handicap Index (VHI) has previously been found to be of significant clinical and scientific value for different voices. In this study the VHI questionnaire was applied to demonstrate the voice handicap of 20 male laryngectomees using tracheoesophageal voice (Provox), aged 65.5 +/- 8.7 years. Their VHI was 45.5 +/- 24.1, which was significantly higher than the score of patients with functional voice disorders, but differed only slightly from patients with organic laryngeal dysphonia. Focussing on individual data, VHI scores ranged from values similar to persons without voice disorder to maximum handicap of 101. Comparing the VHI scores with the laryngectomees' gradual self-perception of voice disorder severity, no consistent relationship was found. Considering the large interindividual differences, the VHI may serve as a valuable instrument for the assessment of individual interventional needs rather than for the identification of a general laryngectomees' handicap.

Aged↗
PubMed2003

Costs of stroke care according to handicap levels and stroke subtypes.

BACKGROUND: If new advances in stroke management are to be put into practice, crucial information about their costs needs to be considered in relation to clinically pertinent variables (e.g. handicap level and stroke subtypes). Details of costs throughout the entire period of stroke care are essential in the political decision-making process, in order to avoid other budget-balancing approaches, which are not always satisfactory. Our aim was to perform an in-depth evaluation of the direct medical cost of stroke care in a large cohort. METHODS: We included 435 consecutive patients with brain infarction in 12 primary-care and referral neurology departments. Information on acute care was prospectively collected. Information on postacute care was collected by research nurses' visits to the patient's or a relative's home 18-40 months after the stroke onset. We thus collected detailed information on handicap levels, stroke subtypes, acute hospitalization costs, rehabilitation, nursing care and ambulatory costs. This enabled us to calculate costs over an 18-month period after the initial acute hospital discharge. RESULTS: By the 12th month after discharge, the costs amounted to 17,799 euros (16,440-19,158) per patient; the initial hospitalization accounted for 42% of this cost, rehabilitation for 29% and ambulatory care for 8%. These costs were mostly concentrated within the first 3- to 6-month period. After 46 months without recurrence, the cost of ambulatory care outweighed the cost of the first 6 months. Handicap levels explained 43% of the variance of costs (p < 0.0001) and, according to the Rankin scale divided into 3 classes (0-2, 3 and 4-5), cumulative costs over time differed considerably. Stroke subtypes were not discriminating variables except for lacunar strokes, which were significantly less costly than the other groups. CONCLUSIONS: By providing a fairly comprehensive figure for the details of direct costs of stroke care over time, our study gives some clues about the economic burden of stroke care which is mostly driven by a high handicap level. This suggests that any early intervention aimed at reducing the handicap level will probably dramatically reduce this burden.

Aftercare↗
PubMed2000

Development of the Handicap Assessment and Resource Tool (HART).

An important determinant of whether people can live in community settings is the absence of significant handicap. People with considerable disabilities can live without handicap if they have adequate supports. Handicap, rather than disability, limits peoples' residence options. Disability assessment tools are commonly used to guide where people can live--these assess neither the resources available nor the personal-care handicap present. The Handicap Assessment and Resource Tool (HART) was designed to provide information about the personal-care issues (clothing, hygiene, nutrition, mobility, safety, residence and supports) relevant to choice of residence. The HART was tested by occupational therapists who are frequently expected to provide recommendations regarding disabled clients' residence options. It is a client-centred tool that addresses key occupational performance components of personal care. Pilot testing in hospital and community settings shows the HART is a comprehensive and practical tool that is acceptable to users and clients.

Activities of Daily Living↗
PubMed2004

Antroduodenal motility in neurologically handicapped children with feeding intolerance.

BACKGROUND: Dysphagia and feeding intolerance are common in neurologically handicapped children. The aim is to determine the etiologies of feeding intolerance in neurologically handicapped children who are intolerant of tube feedings. METHODS: Eighteen neurologically handicapped children, followed in the Tube Feeding Clinic at the Children's Hospital of Wisconsin who were intolerant of gastrostomy feedings. The charts of these 18 patients were reviewed. Past medical history, diagnoses, history of fundoplication and results of various tests of gastrointestinal function including barium contrast radiography, endoscopy and antroduodenal manometry were documented. RESULTS: Five of 11 children had abnormal barium upper gastrointestinal series. Seven of 14 had abnormal liquid phase gastric emptying tests. Two of 16 had esophagitis on endoscopy. All 18 children had abnormal antroduodenal motility. CONCLUSIONS: In neurologically handicapped children foregut dysmotility may be more common than is generally recognized and can explain many of the upper gastrointestinal symptoms in neurologically handicapped children.

Adolescent↗
PubMed1975

Drug therapy in mental handicap.

Definitions of mental handicap are imprecise in practice, and a wide spectrum of patients are provided for under this heading. There can be no question of specific treatment for 'mental handicap' as such. Many situations arising in institutions for the mentally handicapped derive from the nature of the institution and the regime. Drugs may be used 'faute de mieux' when environmental manipulation would be more appropriate. There is much over-prescribing, and the choice of drugs is not always logical; monitoring of dose is seldom employed. A major source of behaviour disturbance in the mentally handicapped is lack of suitable occupation. Apart from a few specific indications, use of sedatives and tranquillizers for the mentally handicapped should be seen as a holding device, to enable a different system of management to be adopted or to disrupt an undesirable behaviour pattern.

Boredom↗
PubMed1988

The mentally handicapped criminal offender. A 10-year study of two hospitals.

With mentally handicapped people now being moved into the community, information on mentally handicapped criminal offenders is valuable. A group of such offenders was examined by reviewing the case-notes of 92 patients referred on hospital order to two mental-handicap hospitals over 10 years. Compared with the general criminal population, these offenders' ages were higher, the ratio of male to female offenders was similar, and the proportion of married people was lower. The offences committed were for the most part serious, with a greater number of offences against property and public order in the subgroup whose intelligence were in the mentally handicapped range. Their tested intelligence fell almost entirely into the normal and mild mental-handicap range, suggesting that factors other than intelligence testing, such as social skills, were considered in their admission to the hospitals.

Adult↗
PubMed2003

Causal uncertainty, claimed and behavioural self-handicapping.

BACKGROUND: Causal uncertainty beliefs involve doubts about the causes of events, and arise as a consequence of non-contingent evaluative feedback: feedback that leaves the individual uncertain about the causes of his or her achievement outcomes. Individuals high in causal uncertainty are frequently unable to confidently attribute their achievement outcomes, experience anxiety in achievement situations and as a consequence are likely to engage in self-handicapping behaviour. AIMS: Accordingly, we sought to establish links between trait causal uncertainty, claimed and behavioural self-handicapping. SAMPLE: Participants were N=72 undergraduate students divided equally between high and low causally uncertain groups. METHOD: We used a 2 (causal uncertainty status: high, low) x 3 (performance feedback condition: success, non-contingent success, non-contingent failure) between-subjects factorial design to examine the effects of causal uncertainty on achievement behaviour. Following performance feedback, participants completed 20 single-solution anagrams and 12 remote associate tasks serving as performance measures, and 16 unicursal tasks to assess practice effort. Participants also completed measures of claimed handicaps, state anxiety and attributions. RESULTS: Relative to low causally uncertain participants, high causally uncertain participants claimed more handicaps prior to performance on the anagrams and remote associates, reported higher anxiety, attributed their failure to internal, stable factors, and reduced practice effort on the unicursal tasks, evident in fewer unicursal tasks solved. CONCLUSIONS: These findings confirm links between trait causal uncertainty and claimed and behavioural self-handicapping, highlighting the need for educators to facilitate means by which students can achieve surety in the manner in which they attribute the causes of their achievement outcomes.

Achievement↗
PubMed2005

Relations between female students' personality traits and reported handicaps to rhythmic gymnastics performance.

The present study evaluated the relative contributions of Self-esteem, Trait anxiety, and Public Self-consciousness to self-handicapping on a sex-typed task, within a specific academic sport context. Prior to the competitive examination used to recruit French Physical Education Teachers, female sport students (N = 74) were asked to list and rate on a 7-point scale handicaps which could be disruptive to their Rhythmic Gymnastics performance. Self-esteem did not account for significant variance in any category of handicaps. Trait Anxiety was negatively related to handicaps related to Rhythmic Gymnastics and to Social and Work Commitments. Public Self-consciousness was significantly related to endorsement of Friends and Family Commitments handicaps. These results were discussed in relation to the literature.

Adult↗
PubMed1985

Hearing disability and communication handicap for compensation purposes based on self-assessment and audiometric testing.

It is reasoned that for compensation or epidemiological studies an evaluation of hearing disability and the concomitant handicap must include the ability to perceive visual cues. A scaling procedure for hearing- and audiovisual communication handicap is presented. The procedure deviates in two ways from previous handicap assessments: (1) It is based on individual self-assessment of semantic speech perception but can be implemented by means of professional audiological test procedures. (2) The system does not make use of pure-tone auditory thresholds as a predominant audiological principle, but is based on speech perception. The interrelationship between auditory and audiovisual handicap is evaluated. A total score including audio- and audiovisual perception handicap is proposed and a suggestion for disability percentages is presented.

Audiometry↗
PubMedDate not supplied

Auditory-evoked response morphology in profoundly-involved multi-handicapped children: comparisons with normal infants and children.

The developmental and difference/defect theories have been used to explain auditory development in some multi-handicapped children. If developmental factors influence auditory response behaviors, it might be predicted that evoked potentials measured from the central auditory nervous system would reflect similar developmental influences in multi-handicapped children. The purpose of this study was to compare auditory-evoked-potential waveform morphology between profoundly-involved multi-handicapped children and normal infants and children. Auditory brainstem response (ABR) and middle-latency response (MLR) morphology were examined from waveform descriptions, wave detection, latency, amplitude, and spectral energy measures. The majority of handicapped subjects exhibited response morphology unlike that of normal children or infants. ABR/MLR morphology for handicapped children was characterized by depressed responses and substantial waveform variability. The results of this study tended to support the difference/defect theory.

Acoustic Impedance Tests↗
PubMedDate not supplied

The self-reported handicapping effect of hearing disabilities.

This study investigates the extent to which individuals see themselves as being handicapped by a hearing disability. Self-reports were obtained with the Amsterdam Inventory for Auditory Disability and Handicap which distinguishes five basic disabilities: intelligibility in noise, intelligibility in quiet, localization of sounds, distinction of sounds and detection of sounds. Responses of 239 hearing-impaired people with varying types of hearing loss have been examined. The occurrence of the five disabilities in the population as well as the self-reported limiting and annoying effect per disability has been examined. This study shows that the handicapping effects of the disabilities do not have equal weights. Handicap resulting from the inability to understand speech in noise is most strongly felt. This paper argues that the type of disability jointly determines the severity of a person's handicap.

Adult↗
PubMed1998

Psychometric evaluation of the Gothenburg Profile for measurement of experienced hearing disability and handicap: applications with new hearing aid candidates and experienced hearing aid users.

The Gothenburg Profile (GP) for measurement of experienced hearing disability and handicap was developed with content partly taken from the shortened Hearing Measurement Scale (HMS25). The GP consists of 20 items divided into two subscales. The first subscale measures Experienced Disability as to hearing speech (items 1-5) and sound localization (items 6-10). The second subscale targets the Experienced Handicap in social settings (items 11-15) and the personal reactions to the experienced handicap (items 16-20). In this study, data are presented for new hearing aid candidates (NewHA) (n=441) and for experienced hearing aid users (ExpHA) (n=476). Principal components factor analyses were conducted and a three-factor solution was obtained, supporting the two factors of the Experienced Disability subscale, but just confirming one factor in the Experienced Handicap subscale. The internal consistency reliability (coefficient alpha) was good (0.85 to 0.95) for the subscales as was the test-retest reliability. The ExpHA group expressed significantly greater disability (first subscale) as well as experienced handicap (second subscale). However, when controlling for hearing level the differences disappeared. The clinical use of the GP for assessment of rehabilitation needs is recommended.

Adolescent↗
PubMed2005

Validity, internal consistency, and test/retest reliability of a localization disabilities and handicaps questionnaire.

Psychometric evaluations were performed on a self-perceived localization disabilities and handicaps questionnaire. Twenty individuals with normal hearing bilaterally, twenty with profound unilateral hearing impairment (UHI), and ten with any degree of bilateral hearing impairment participated. Each subject completed the questionnaire. Comparisons of the responses of the subjects with normal hearing and those with UHI revealed significant differences among the groups for both disabilities and handicaps, establishing construct validity. Cronbach's Alpha correlational analyses of the responses of all subjects with hearing impairment revealed correlations of .900 (disabilities) and .800 (handicaps), establishing internal consistency. Each participant with hearing impairment was asked to complete the questionnaire again after three weeks. Pearson's correlational analyses of the responses at time one versus time two revealed correlations of .900 (disabilities) and .700 (handicaps), establishing test/retest reliability. This questionnaire is an appropriate tool for investigating the self-perceived localization disabilities and handicaps of individuals with hearing impairment.

Adult↗
PubMed2000

[Aged parents and aging handicapped persons: a new situation, an attempt to respond].

The longevity increase which characterises the society evolution at the end of the 20th century, also concerns the handicapped people. The fact is particularly outstanding for mentally handicapped people such as the Down's Syndrome population. We are nowadays discovering the first generation of the "over 40 year-old people". Among the eldest, many of them have never left home as specialised structures were non existent when they were young. Even those, not many of them in that age group, who have been able to have access to a CAT and to profit by a specialised centre, cannot carry on working after their 35th birthday, because of their early ageing, and because of their tiredness. Therefore, they are early excluded from the CAT, they lose their advantage of being in a specialised centre and they finely have to go back home. Many parents of mentally handicapped people who live at home, even though they are not yet too old, seem to get more and more tired with their ageing advance, which, day after day, makes their unremitting action harder and harder towards their child who is also getting older. The makers relate the innovating and experimental initiative of a "Hameau Services", nowadays located at Sommières-du-Clain, a rural parish in the south of Vienne country, which offers to welcome still valid ageing parents and their mentally handicapped ageing child who lives in their own house. The collective services which are assured by the managing association, tend to relieve them in their daily material tasks in the aim of contributing to the prejudice of the unexpected arrival of the manifestations of the subordination through a proposition of a better life quality of the handicapped adult and his parents.

Aged↗
PubMed2001

Handicap assessment: setting the grounds for an effective intervention in the community.

Many instruments have been invented specially since the 70's to study and measure the consequences of illness and trauma; many of them simply evaluate the severity of lesions and the prediction of mortality, others evaluate morbidity. Nevertheless, none of these instruments evaluate the handicap globally. The classification of the World Health Organization, despite the fact that it contemplates the handicap in all its aspects, does not distinguish its different levels rigorously and it is not a valid instrument to quantify handicaps. The authors comment on their research and proposals for identification and quantification of the handicap. Three levels, related to "Body", "Capacities" and "Life situations", have been described and through them a useful inventory was created (published in 1998). This inventory makes it possible to establish a true medical-social and global evaluation of handicaps, providing a uniform record of the consequences of diseases, trauma or physiological features of the individual and a useful instrument for public health intervention and the promotion of human well-being.

Activities of Daily Living↗
PubMed2000

A clinical evaluation of the hearing disability and handicap scale in men with noise induced hearing loss.

During the last 30 years several hearing disability and handicap questionnaires have been designed and used for clinical purposes. The present study includes a review of the most frequently used scales. The aim of the present study was to evaluate the reliability and validity of the Hearing Disability and Handicap Scale (HDHS), which is a shortened and modified version of the Hearing Measurement Scale. Correlations between the Hearing Handicap and Support Scale, the Communication Strategy Scale from the Communication Profile of the Hearing Impaired, pure tone audiometry and speech recognition scores in noise were analysed. Data from 168 men with noise induced hearing loss of different degrees was obtained. Also a test-retest was conducted. The disability section of the HDHS seemed accurate but offered no improvement of prediction compared to previous scales. Even though the reliability of the handicap section was sufficient, its validity and clinical use is discussed and suggestions about improvements given. Since standardised scales are necessary if results are to be compared worldwide, guidelines regarding the clinical use and benefit of hearing disability and handicap scales are required.

Journal Article↗
PubMed1975

The use of a registry case load survey in predicting trends in rehabilitative needs for the handicapped.

A special follow-up study of handicapped children was carried out to determine the level of residual disability in the caseload of the British Columbia Health Surveillance Registry. A total of 10,689 cases, aged seven or fourteen years were surveyed. Sixty-eight per cent of seven-year-olds and sixty-five per cent of fourteen-year-olds had a residual handicap. Of 3,131 seven-year-olds with a residual handicap, four per cent were not attending a school of any kind. Three per cent of the 4,094 fourteen-year-olds with a residual handicap were not attending school. These figures, along with prevalence statistics obtained through other Registry procedures provide useful minimal data for planning rehabilitative facilities for handicapped persons.

Adolescent↗
PubMed1992

The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States.

Among multiple gestations the magnitude of neonatal mortality, morbidity and postneonatal handicap is unknown. Although the proportion of multiple births has risen dramatically during the past decade, the proportion of total births in the United States is relatively small. The vast majority of multiples are low birth weight (LBW) or very low birth weight (VLBW), conditions that magnify both short-term and long-term risks. In this study, the risks for infant mortality and for postneonatal morbidity and handicap have been calculated from race-, plurality- and birth weight-specific mortality rates from the National Infant Mortality Surveillance (NIMS) Project and birth weight-specific postneonatal handicap rates from the Office of Technology Assessment report Healthy Children in proportion to the 1988 U.S. birth cohort. U.S. health objectives for the year 2000 for race-specific birth weight and infant mortality rates were used for comparison. Compared with that of singletons, twins' and triplets' relative risks for LBW are 10.3 and 18.8, respectively. Their relative risks for VLBW are 9.6 and 32.7. Compared with singletons, twins and triplets have relative risks for infant mortality of 6.6 and 19.4, respectively. For twins and triplets, postneonatal survivors' relative risks for severe handicap are 1.7 and 2.9 while those for overall handicap are 1.4 and 2.0, respectively. Recommendations for optimizing pregnancy outcomes in multiple gestations include liberalized weight gains, reduced physical effort and early, comprehensive prenatal care.

Persons with Disabilities↗