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PubMed1983

Learning disabilities with communicative disorders as related handicaps: a two-year study.

This study presents a demographic profile of learning-disabilities children with communicative disorders as related handicaps, and attempts to determine the analytical impact of including these children with children manifesting communicative disorders as primary handicaps. The purpose of this investigation emerged as a result of problems stemming from current definitions of learning disabilities as they relate to speech--language pathology and audiology, and from unavailable data on communicative disorders as related handicaps. The findings indicate that 0.35% of the school population were learning-disabled with communicative disorders as secondary handicaps; these children represented 30.2% of the service delivery for communicative disorders. The white: black ratio of 1.8: 1 did not coincide with the population ratio; this finding was unfavorable for blacks. Sex and race were confounding variables, with sex as the stronger one. Further, the study indicated that service delivery for language disorders and males were greater than in other communicative disordered populations.

Child↗
PubMed1982

A survey of state efforts in gathering information on child abuse and neglect in handicapped populations.

This paper reports the extent to which states assemble information on the incidence of abuse and neglect among handicapped populations. Data were collected from all states on the types of pre-existing disabilities cited on child abuse reporting forms and the perceived accuracy of this information. The study also sought to identify specific methods used to provide assistance to local agencies regarding the problems associated with abuse of the handicapped. Surveys were distributed to and completed by representatives of the designated child protection agencies within each state and the District of Columbia (n = 51). General findings were that although it is generally acknowledged in research that handicapped children represent a disproportionate number of abuse and neglect victims, nearly half of the states do not collect any information on "special characteristics." Forms from the remaining states exhibited much variation in style and in the competency of collection techniques. These results suggest a significant lack of services specifically designed to improve the awareness of field representatives on the influence of exceptionalities in abusive cases. This information indicates that training and prevention programs will remain basically inadequate until the relationship between handicapped conditions and abuse/neglect is more clearly defined.

Child↗
PubMed2006

Detection of hearing impairment and handicap in Paget's disease of bone using a simple scoring system: a case control study.

Paget's disease of bone is known to be associated with hearing loss but there are limited data on the prevalence of hearing impairment and handicap in people with Paget's disease. Previous published population studies have used patient-completed questionnaires or review of GP records, none have included audiometry. 80 Paget's subjects were selected at random from a hospital database, 75 (94%) entered the study and were matched by age and gender with 76 controls. All participants completed a screening questionnaire for hearing handicap, the HHIE-S; a questionnaire on perception of hearing-related handicap, noise exposure, hearing aids and GP consultations regarding hearing; and audiometry. The results show significant problems from hearing loss in people with Paget's disease of bone. Paget's patients were significantly more likely to perceive hearing handicap (P=0.0001), 41% Paget's patients rated themselves moderate-severe compared to none of the controls. Paget's patients were significantly more likely to report difficulties such as hearing normal speech, watching TV or hearing over background noise (all P=0.0001). They were more likely to consult their GP due to hearing problems (P=0.004) or tinnitus (P=0.0001), or use a hearing aid (P=0.0001). Audiometry confirmed higher rates of deafness in Paget's patients. 41/75 Paget's patients compared to 19/76 controls had at least 40 decibels hearing loss (dBHL) (P=0.0001). The HHIE-S proved to be an effective screening tool. A score of greater than 8 increased the odds ratio of detecting moderate hearing impairment (>40 dBHL) in people with Paget's disease by 5.1. The specificity of HHIE-S >8 as a screening tool to select for audiometry appears good, 1/46 (2%) of Paget's patients would have proved to have normal hearing thresholds. The sensitivity is better with worse hearing loss, 7/16 Paget's patients with moderate loss (>40 dBHL) and 2/25 with severe-profound loss (>60 dBHL) would have been missed. In conclusion, 55% unselected Paget's patients have at least moderate levels of hearing loss, compared to 25% of age and gender matched controls. Paget's patients and controls under-reported hearing problems, many of which can be ameliorated. Screening for hearing problems in Paget's disease of bone can be done using the HHIE-S.

Aged↗
PubMed2004

Wrist actigraphy in estimation of sleep and wake in intellectually disabled subjects with motor handicaps.

BACKGROUND AND PURPOSE: We studied the applicability of wrist actigraphy to sleep-wake estimation in patients with motor handicaps. PATIENTS AND METHODS: Concomitant polysomnographic and actigraphic recordings (16-24 h) were compared in three groups: normally moving subjects with normal sleep (n=10), sleep-disordered subjects without motor handicaps (n=13) and sleep-disordered patients with different motor disabilities (n=16). The motor abilities of the subjects were determined by clinical evaluation using a grading scale from 0 to 10. Their actual daily activity was calculated from the recordings as average activity scores. RESULTS: In the healthy subjects, the mean difference between actigraphic and polysomnographic total sleep estimation was negligible (-1 min), while in both sleep-disordered groups, sleep was highly overestimated by actigraphy. There was a significant correlation between the motor ability score and the discrepancy between actigraphy and polysomnography, but individual data points were highly scattered. A more consistent correlation was found between the average activity score/min in actigrams and the discrepancy of actigraphic with polysomnographic total sleep estimation (Spearman's r=-0.58, P=0.0001, n=39). When the recordings with very low average activity score were rejected from the analyses (two patients without and six with motor handicaps), the overestimation of sleep by actigraphy was reduced but it still remained in both sleep-disordered groups. The mean differences of total sleep between actigraphy and polysomnography were 72 and 121 min and the rank order correlation coefficients 0.80 and 0.71 in patients without and with motor handicaps, respectively. The median discrepancy in total sleep estimation was 6% in both sleep-disordered groups. CONCLUSIONS: In subjects with rudimentary motor abilities, a standard actigraphy can produce a signal, which is related to the amount of sleep scored in polysomnograms. The sleep parameters obtained by the two methods are not equal, however. The inspection of actigrams is more reliable than the clinical scaling of motor abilities in predicting the applicability of wrist actigraphy.

Adult↗
PubMed1999

Late onset polio sequelae: disabilities and handicaps in a population-based cohort of the 1956 poliomyelitis outbreak in The Netherlands.

OBJECTIVE: To investigate the prevalence of new neuromuscular symptoms, disabilities, and handicaps in a group of polio survivors. DESIGN: A self-constructed health questionnaire about neuromuscular complaints and disability and handicap levels during the stable period after recovery from polio and at present. SUBJECTS: Three hundred fifty subjects, derived from the 1,784 polio cases registered during the 1956 polio outbreak in The Netherlands. RESULTS: Respondents totaled 260 (74%), 27 of whom denied or did not recall having had paralytic poliomyelitis. The remaining 233 subjects comprised the study group (mean age, 44yrs; range, 39 to 77; SD = 6.3). Frequency of all neuromuscular complaints at present time was significantly higher than that during the stable period after polio (range in p of .001 to .004). Fifty-eight percent of cases reported an increase in muscle weakness in comparison with muscle condition during the stable period. Fifty-six percent reported an increase in disabilities, mainly a restriction in gait functions. Fifty-three percent reported increased handicaps with regard to occupation and social integration, and there was an increased need for adaptive measures and devices. CONCLUSION: Nearly 60% of a sample of Dutch survivors of the 1956 polio outbreak experience late onset polio sequelae, resulting in increased severity of disabilities and handicaps.

Adult↗
PubMed2000

Follow up of cochlear implanted handicapped children.

OBJECTIVE: To document progress and benefit of multi-handicapped children using cochlear implants. DESIGN: The evaluation of auditory responses to speech (EARS) test battery was performed on the children in this study at regular intervals following implantation. All children went through individually tailored intensive audiological rehabilitation programs following cochlear implantation. RESULTS: Individual results from ten multi-handicapped children receiving cochlear implants are presented in this paper. The majority of children in this study are successful implant users. Whenever possible, test scores are included as well as subjective case reports. CONCLUSION: Providing multi-handicapped children with cochlear implants can result in substantial benefit for both the child and parents. Multi-handicapped children are not contraindicated for cochlear implantation, although not all are considered to be good candidates.

Child↗
PubMed1982

Health care for handicapped adolescents: international legislative and policy trends.

Between 1970-1976, 45 countries enacted or made adjustments to laws on health care for the handicapped. This article explores some of the legal arrangements made to address the issue of health care for the handicapped adolescent. It reviews the legal definition of "handicapped" and analyzes the legislative support created for health care programs. Most programs are comprehensive. They focus on prevention, detection and reporting, as well as treatment and rehabilitation. Better care for disabled adolescents is one of the more important intended results of recent legislation directed to the handicapped. Rehabilitation has been increasingly recognized as a right. Prevention is an increasing focus. Legislation, however important, is only a beginning; it expresses the political will be create programs to address the issue. The challenge is to implement the law.

Adolescent↗
PubMed1998

Social disadvantage in the international classification of impairments, disabilities, and handicap.

The revision process of the international classification of impairments, disabilities and handicaps (ICIDH) is now in progress. Major changes are being considered which question one of the main fields, that of handicap, or social disadvantage. The scope of these changes goes beyond simple technical adjustments. It reaches the level where fundamental positions are adopted regarding the mainspring of public health policies. The purpose of this article is to review and discuss the main criticisms that have appeared in the literature about the dimension of handicap, including a study of the consequences that may result from keeping this dimension or from leaving it out. We suggest that the definition of handicap as a disadvantage has been overlooked, so that discussion has mainly taken place about the environment. Our opinion is that each criticism is based upon the emphasis given to a choice of strategy for preventing or reducing disablement. For some experts, the emphasis is on health care. For others, it is on social change. We share this interest in strategy. This is why we suggest that the conceptual framework is meant only for description, that it does not and should not include choices of strategy. We argue that it is the best way to promote appropriate description and therefore appropriate choice of strategies. Finally, we state that social disadvantage is a major dimension of the consequences of disorders and related problems, and should therefore remain in the framework, in order to provide appropriate information for better choices in strategy.

Persons with Disabilities↗
PubMed1975

Survey of incapacity associated with mental handicap at Rampton and Moss Side Special Hospitals: a comparison with the 1970 National Survey.

The results of a survey carried out at Rampton and Moss Side Special Hospitals into physical and behavioural incapacity associated with mental handicap are described and compared with the findings of the 1970 National Survey. The Special Hospital patients were found to be less mentally handicapped than similar patients in subnormality hospitals in the National Health Service. The prevalence of physical incapacity associated with mental handicap was also lower in the Special Hospitals but the Special Hospital patients were assessed as more behaviourally disordered. In both surveys the incapacities present were concentrated in the severely mentally handicapped patients. In the Special Hospitals survey the women, when compared with the men, were found to be more behaviourally disordered and to suffer from a greater degree of multiple severe incapacity. All the differences found between the two surveys are consistent with the statutory criteria for admission to a Special Hospital.

Activities of Daily Living↗
PubMed1986

Enhancing the prediction of self-handicapping.

Levels of test anxiety, Type A and Type B coronary-prone behavior, fear of failure, and covert self-esteem were studied as predictors of self-handicapping performance attributions for college women who were placed in either a high- (N = 49) or low- (N = 49) evaluative test or task situation. We hypothesized that test anxiety. Type A or Type B level, and their interaction would account for reliable variance in the prediction of self-handicapping. However, we also theorized that underlying high fear of failure and low covert self-esteem would explain the self-handicapping claims of test-anxious and Type A subjects. The results indicated that only high levels of test anxiety and high levels of covert self-esteem were related to women's self-handicapping attributions.

Adolescent↗
PubMed1996

Self-handicapping and intrinsic motivation: buffering intrinsic motivation from the threat of failure.

High and low self-handicappers (as measured by E. E. Jones & F. Rhodewalt's [1982] Self-Handicapping Scale) were asked to play a game of pinball (in a competitive or noncompetitive setting) after they had practices as much as they wanted on a related task (thus, not practicing could have served as a self-handicap). High self-handicappers who did not practice much became more involved in the game and subsequently reported enjoying the game more than high self-handicappers who practiced a lot. Furthermore, the effects on enjoyment were mediated by task involvement, suggesting that the protection afforded by self-handicapping affects intrinsic motivation by allowing the individual to become absorbed in the activity instead of focusing on performance concerns. Individuals who self-handicap may be providing themselves with the "breathing room" they need to become absorbed in an activity and to experience the activity as enjoyable.

Achievement↗
PubMed1998

Consequences of self-handicapping: effects on coping, academic performance, and adjustment.

Self-handicappers erect impediments to performance to protect their self-esteem. The impediments may interfere with the ability to do well and, as such, may result in poor adjustment. Using a longitudinal design, the present studies examined prospective effects of self-handicapping on coping, academic performance, and several adjustment-related variables (e.g., self-esteem). It was found that, compared to low self-handicappers, high self-handicappers reported higher usage of coping strategies implying withdrawal and negative focus. High self-handicappers performed less well academically, an effect that was mediated in part by poor study habits. Finally, high self-handicapping resulted in poorer adjustment over time, and poorer adjustment resulted in higher self-handicapping over time. These relations are consistent with the idea of a vicious cycle in which self-handicapping and poor adjustment reinforce one another.

Achievement↗
PubMed2001

Bone mineral density of visually handicapped women.

While physical activity is an essential factor for muscle performance and development and also for the maintenance of bone mass in the loaded bones, apparently low intensity of physical activity of blind persons may compromise the muscle performance and bone mineral density (BMD). Therefore, the aim was to study whether there are differences in BMD of the weight-bearing or non-weight-bearing bones between visually handicapped persons and those with normal sight. Nineteen visually handicapped premenopausal women and their matched pairs were recruited to the study. The mean age of the visually handicapped women was 39.9 years (SD 8.1) and that of the women with normal vision 39.7 years (6.5). BMD of the distal radius, femoral neck and trochanter was measured with dual energy X-ray absorptiometry (DXA), and isometric muscle strength of the extremities and trunk with a dynamometer. Between-group differences were compared with paired Student's t-test. The BMD at the femur was 8% higher in favour of the group with normal sight, whereas radial BMD was similar in the two groups. The t-score was -1.0 (95% confidence interval -1.5 to -0.5) for the femoral neck BMD and -0.7 (-1.1 to -0.2) for the trochanter BMD in the group with impaired vision. The respective t-scores for the group with normal sight were -0.3 (-0.9 to 0.3) for the femoral neck and 0 (-0.7 to 0.7) for the trochanter. Visual handicap seems to be a risk for lower BMD of the weight-bearing proximal femur, but not for lower BMD of the non-weight-bearing distal radius.

Activities of Daily Living↗
PubMed1998

Development of self-handicapping tendencies.

This study was undertaken to determine when U.S. children begin to self-handicap, that is, to reduce preparation effort before evaluations rather than applying themselves to do their best. The personal variables examined for their impact on practice behavior were gender, grade level, and self-esteem. The situational variables were time of the self-esteem test (before or after the evaluation task) and importance of the evaluation task. The results showed that (a) the 6th-grade boys were more likely than the 6th-grade girls to self-handicap, (b) the 3rd-grade children were not as affected as the 6th-grade children by the self-evaluation implications of performance evaluations, (c) self-handicapping by low-self-esteem and high-self-esteem 6th graders depended on recent experiences, and (d) the self-affirming experience of a self-esteem test reduced the motivation to self-handicap among high-self-esteem 6th-grade boys.

Achievement↗
PubMed2000

Outcome measures for complex regional pain syndrome type I: an overview in the context of the international classification of impairments, disabilities and handicaps.

PURPOSE: To determine the availability of relevant and objective outcome measures concerning complex regional pain syndrome type I (CRPS I) for rehabilitation medicine. METHOD: Outcome measures were classified according to the International Classification of Impairments, Disabilities and Handicaps. For each outcome measure a description of concept, operationalization into variables and instrument was given. We performed a PUBMED MEDLINE search (1980-1998) using the following keywords: complex regional pain syndrome, reflex sympathetic dystrophy, impairment, disability, handicap, (long-term) outcome and effect/efficacy. RESULTS: Most outcome measures were concentrated on impairments, whereas measures at the level of disabilities and handicaps, the most relevant levels for rehabilitation medicine, were mentioned in very few studies. Objective outcome measures were merely found at the level of impairment. CONCLUSION: The results indicate a need for the development of relevant outcome measures at the level of disabilities and handicaps that can objectively measure treatment efficacy for CRPS I.

Activities of Daily Living↗
PubMed1999

From handicap to disability: language use and cultural meaning in the United States.

The historical shift in discourse regarding disabled persons in the US is analysed by its core terms, handicap and disability. First, this shift in discourse is illustrated in the marketplace and in the context of the Americans with Disabilities Act. Then, discourse shifts are theoretically explicated through a semiotic and historical analysis. Last, the discouse shifts are theoretically explicated through a semiotic and historical analysis. Last, the discourses of handicap and disability are tested in their societal context, especially in the case of American youngsters who have directly experienced the shift in their own life course. Changes in terminology reflect a different logic of the understanding of disability as phenomenon. While 'handicap' reflects an era in which accessibility is central for understanding and practice, the concept of 'disability' shifted the attention to the individual's ability. The impact of such large discourse shifts is tangible in the lives of individuals with mental retardation in the experiences that shift from 'access' to 'ability'. Whereas in the handicap era, access is to be created, in the disability era this is replaced by ability. Professionals are reminded that the rehabilitation process takes on different meanings with shifting discourses.

Culture↗
PubMed1988

The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps.

The Functional Autonomy Measurement System (SMAF) is an instrument developed for the measurement of the needs of the elderly and the handicapped. Its elaboration was based on the World Health Organization's classification of impairments, disabilities and handicaps. A functional autonomy rating scale, using a four-level measurement scale, quantifies a subject's performance on 29 functions in five sectors of activity: activities of daily living, mobility, communication, mental functions and instrumental activities of daily living. For each function, the evaluator must also estimate available resources to compensate for any identified disability in order to estimate the handicap. The disability and handicap profile obtained is the basis for the prescription of home care or the allocation of chronic care beds. An inter-observer study concluded that the scale is reliable for evaluators from different professions in the community as well as in institutional settings. The instrument is rapid to administer (on average 42 min) and the reliability is not influenced by training. A study of concurrent validity has shown a strong correlation between the disability index obtained by the SMAF and the amount of required nursing-care time. This instrument can be used for clinical purposes and in epidemiological and evaluative research.

Activities of Daily Living↗
PubMed1998

The prevalence of diagnoses, impairments, disabilities and handicaps in a population of elderly people living in a defined geographical area: the Gospel Oak project.

OBJECTIVE: to measure the prevalence of impairments, disabilities and handicaps in a geographically-defined elderly population. DESIGN: cross-sectional analysis of an interview survey. SETTING: a single North London electoral ward (district). PARTICIPANTS: 654 residents (74%) over the age of 65 years were interviewed from a register of 889. A random sample of 225 had additional data collected which are reported in this analysis. MAIN OUTCOME MEASURES: point prevalence and distribution of the total number of reported diagnoses, impairments and disabilities, and distributions of the Office of Population Censuses and Surveys (OPCS) disability scale and the London Handicap Scale scores. RESULTS: participants had a median of three reported diagnoses and two impairments. Forty-three percent were in the least disabled OPCS disability category (i.e. below the disability threshold) and 41% were able to undertake all of 12 basic activities of daily living without difficulty. Overall handicap scores were heavily skewed towards no health-related disadvantage, with a median score of 83 out of 100, and 37% having a score of 90 or more. All indicators showed deteriorating health with increasing age, but age-adjusted gender differences were small. CONCLUSIONS: an elderly population's health problems were classified using a comprehensive framework, revealing high prevalences of diagnoses, impairments, disabilities and handicaps. The schema is appropriate for health care needs assessment and is a suitable basis for describing the population's health.

Aged↗