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PubMed1994

Towards a measure of patient-perceived handicap in rheumatoid arthritis.

The impact of chronic disease on an individual depends not only on the severity of the disease, but on his/her life role i.e. his/her needs, expectations etc. The World Health Organization expresses the impact of chronic disease in terms of impairment, disability and handicap, where handicap is the social disadvantage resulting from disease. This article argues that the assessment of patient-perceived handicap is essential to the clinical management of chronic disease because it provides the physician with clinically relevant information about the meaning of disease for each patient, enabling treatment and intervention to be tailored to meet individuals' needs. The development of a method for assessing patient-perceived handicap using patient profiles with the object of supplying the physician with a simple clinical tool is described.

Adult↗

PubMed1988

The Hearing Handicap Inventory for the Elderly as a measure of hearing aid benefit.

Hearing impairment in older adults is associated with psychological and social difficulties. The goal of hearing aid fitting is to reduce the perceived handicap resulting from the hearing loss. Measures of self-perceived handicap are being increasingly incorporated into the clinicians armamentarium as an objective measure of the outcome of intervention. Eighteen elderly hearing-impaired males and their spouses responded to the Hearing Handicap Inventory for the Elderly (HHIE) prior to and following 1 year of hearing aid provision. Our findings revealed a significant reduction in the perceived emotional and social effects of hearing impairment following 1 year of hearing aid use. The reduction in perceived handicap, as measured using the HHIE, was greater for the hearing aid users than for their spouses. The findings attest to the construct validity of the HHIE as a measure of hearing aid benefit.

Aged↗

PubMed1989

Pupils' knowledge of mental handicap: a study of second year pupils in a British comprehensive school.

As a prelude to an awareness course in mental handicap an exploration was made of the relevant cultural knowledge of pupils in the second year of a comprehensive school. The study is in two parts. The first consists of a description of how gender differences emerged as an important theme in interviews with one class of pupils. In the second part the findings of a questionnaire study of 179 second year pupils are described and commented upon. Information was obtained on their experience, images and knowledge of and feelings about mental handicap. Their views on integration could be categorized under five headings (i) a productive learning experience for mentally handicapped pupils (ii) benefits to 'normal' pupils (iii) the need for a special environment (iv) being 'picked on' (v) not a productive learning experience for either party. Boy/girl differences were noted in responses to certain questions. In the discussion section, the implications for the curriculum are drawn out in relation to gender differences, pupils' existing knowledge of mental handicap, pupils' views on the important topic of integration, and language awareness.

Child↗

PubMed1982

The family with a handicapped child: a review of the literature.

Research is reviewed on the impact of a handicapped child on the family. While most authors agree that the presence of such a child is a family stressor, there have been few studies using control groups, analytical methods, representative samples, or adequate numbers. The wide age range of the children within and across studies and the diversity of populations confuse some issues and leave others unresolved. In addition, no instrument has been designed to measure specifically the stress in families of a handicapped child. Most authors have not taken into account the dynamic process of rearing a handicapped child, nor have they addressed the problems of having a mildly handicapped child.

Adolescent↗

PubMed2004

Development and validation of the voice handicap index-10.

OBJECTIVES/HYPOTHESIS: The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI). STUDY DESIGN: Item analysis of the VHI in individuals without voice disorders and patients with voice disorders and creation and validation of the abbreviated VHI. METHODS: Clinical consensus review of the VHI items was held to prioritize the clinical value of each of the VHI items (30 items in all). Item analysis of the VHI was performed using the VHI responses of 100 patients with voice problems and 159 control subjects. The 10 most robust VHI items were selected using the item analysis and clinical consensus results to form the Voice Handicap Index-10 (VHI-10). Statistical analysis comparing the validity of the VHI-10 with the VHI was performed with 819 patients representing a wide spectrum of voice disorders. RESULTS: Statistical analysis of the VHI and VHI-10 scores from the study group showed no statistically significant differences between the VHI and the VHI-10. Irrespective of diagnosis, the correlation between the VHI and the VHI-10 was greater than .90 (P = .01). The ratios of the VHI-10 to VHI scores for a variety of voice disorder categories were analyzed and found to be consistently greater than the expected value (33%). This suggests that the VHI-10 may be a more robust instrument than the VHI. CONCLUSION: The VHI-10 is a powerful representation of the VHI that takes less time for the patient to complete without loss of validity. Thus, the VHI-10 can replace the VHI as an instrument to quantify patients' perception of their voice handicap.

Disability Evaluation↗

PubMed2006

Impact of multiple etiology on dizziness handicap.

OBJECTIVE: Our aim was to find the ratio of multiple diagnosis in dizziness patients and to evaluate the effect of multiple etiologies on handicap level of the patient. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. INTERVENTION: The data of 703 patients (178 men and 525 women) were included in the study. Diagnoses of the patients were made in a multiple-specialty environment including otolaryngology, neurology, cardiology, internal medicine, and rehabilitation medicine. MAIN OUTCOME MEASURES: All patients filled the dizziness handicap inventory and pointed the severity of dizziness on a 10-point visual analog scale. RESULTS: Four hundred thirty-three patients (61.6%) have only one diagnosis, whereas 183 (26%) had two. Three diseases have been found in 34 patients (4.8%), and four diseases were present in eight patients (1.1%). The mean number of diagnosis in one patient was 1.32 +/- 0.71. There was a significant difference between two sexes on the number of disease. There was no correlation between age and the number of diagnosis. There was no significant difference in functional scale, but the statistically significant increases are present in both physical (p < 0.05) and emotional (p < 0.01) scales. There was no correlation between age and handicap levels. CONCLUSION: Multiple diagnoses were important factors on physical and emotional handicaps. It was also found that this problem is not limited with older age group.

Adolescent↗

PubMed2006

Unilateral deafness after acoustic neuroma surgery: subjective hearing handicap and the effect of the bone-anchored hearing aid.

OBJECTIVE: To evaluate the subjective hearing handicap in patients with unilateral deafness after acoustic neuroma surgery and the effect of the Bone-anchored Hearing Aid (BAHA) on test band. STUDY DESIGN: Fifty-nine consecutive patients with unilateral deafness after translabyrintine removal of an acoustic neuroma, treated in Denmark in 2001 and 2002, were included. The patients were asked to complete a questionnaire, which addressed the subjective handicap of unilateral deafness; 90% responded. These patients were invited to test the BAHA on test band, and the subjective and objective effects were recorded. RESULTS: Eighty percent of the patients thought that they had a subjective hearing handicap of some significance. However, only 50% accepted the invitation to test the BAHA. The overall subjective effect was positive, and a significant improvement in speech discrimination in noise with the BAHA was demonstrated. After the test, however, only about 50%, that is, 25% of all patients wished implantation for BAHA treatment. CONCLUSION: This study shows that unilateral deafness after acoustic neuroma surgery is thought as a handicap in most of the patients and confirms that treatment with the BAHA has positive subjective effects and improves speech discrimination in noise. However, only 25% of the patients wished implantation for BAHA treatment. The implications of these findings are discussed. Data from centers that perform simultaneous acoustic neuroma surgery and implantation for BAHA are necessary for firm conclusions.

Adult↗

PubMed2003

A motivational analysis of defensive pessimism and self-handicapping.

Two studies examined motivational influences on and correlates of defensive pessimism and self-handicapping and investigated the relationship between these two cognitive strategies and performance attainment. The findings indicated that defensive pessimism and self-handicapping have similar motivational profiles, with the primary difference being that self-handicapping represents the absence of approach motivation in the achievement domain, as well as the presence of avoidance motivation. Self-handicapping, but not defensive pessimism, was shown to undermine performance-attainment, and performance-avoidance goals were validated as mediators of this negative relationship. Issues regarding the functional nature of the two cognitive strategies are discussed.

Achievement↗

PubMed2001

Sexual selection of multiple handicaps in the red-collared widowbird: female choice of tail length but not carotenoid display.

Although sexual selection through female choice explains exaggerated male ornaments in many species, the evolution of the multicomponent nature of most sexual displays remains poorly understood. Theoretical models suggest that handicap signaling should converge on a single most informative quality indicator, whereas additional signals are more likely to be arbitrary Fisherian traits, amplifiers, or exploitations of receiver psychology. Male nuptial plumage in the highly polygynous red-collared widowbird (Euplectes ardens) comprises two of the commonly advocated quality advertisements (handicaps) in birds: a long graduated tail and red carotenoid coloration. Here we use multivariate selection analysis to investigate female choice in relation to male tail length, color (reflectance) of the collar, other aspects of morphology, ectoparasite load, display rate, and territory quality. The order and total number of active nests obtained are used as measures of male reproductive success. We demonstrate a strong female preference and net sexual selection for long tails, but marginal or no effects of color, morphology, or territory quality. Tail length explained 47% of male reproductive success, an unusually strong fitness effect of natural ornament variation. Fluctuating tail asymmetry was unrelated to tail length, and had no impact on mating success. For the red collar, there was negative net selection on collar area, presumably via its negative relationship with tail length. None of the color variables (hue, chroma, and brightness) had significant selection differentials, but a partial effect (selection gradient) of chroma might represent a color preference when tail length is controlled for. We suggest that the red collar functions in male agonistic interactions, which has been strongly supported by subsequent work. Thus, female choice targets only one handicap, extreme tail elongation, disregarding or even selecting against the carotenoid display. We discuss whether long tails might be better indicators of genetic quality than carotenoid pigmentation. As regards the evolution of multiple ornaments, we propose that multiple handicap signaling is stable not because of multiple messages but because of multiple receivers, in this case females and males.

Animals↗

PubMedDate not supplied

The education of physically handicapped children in normal schools.

This paper is based on our experience in the Central Remedial Clinic over a number of years that physically handicapped children do not in general do well in ordinary schools. An attempt is made to delineate some of the problems that may confront a handicapped child of generally average intelligence who attends a normal school. These problems are associated with the following conditions: specific learning difficulties, emotional problems, poor school attendance, large classes, limitations in ordinary teacher training and lack of remedial teachers and other special staff. The need for early and continued psychological and educational assessments is emphasized, and it is suggested that most young physically handicapped children of average intelligence would benefit from starting in a special assessment unit, to ensure as far as possible, correct school placement. This view is not currently held by a number of educational authorities who generally advise that physically handicapped children should go to ordinary schools if possible. We feel that this advice is not always in the best interests of the child. There is need for continuing friendly and informal communications between parents and members of the special school team.

Adolescent↗

PubMedDate not supplied

Special education in Denmark and integration of visually handicapped children in normal classes in the public school.

Experience over the last decade in integrating severely visually handicapped pupils in normal school classes is encouraging. We have learned that a visual handicap, no matter how severe, can be compensated for through materials, educational support, cooperation between the persons involved so that the child can be taught in the local school where he belongs and live as normal a life as possible. We are also aware of how things can be improved, but this is a question of economics and to some extent emotional attitudes in the pupil's environment. Although much is done to inform as many as possible in the child's milieu about what blindness is and what to do about it, we still meet problems of full acceptance of the handicap. It takes more than a decade to change emotional attitudes and because of this and because the first demand to any kind of teaching must be flexibility, the integrated education of the visually handicapped will never be a question of neither/nor but always a question of either/or.

Denmark↗

PubMedDate not supplied

Children with a handicap and their families.

The mothers' perceptions of the emotional and social stresses experienced by families who have children suffering from spina bifida, cerebral palsy or a limb deficiency, and the mothers' suggestions for easing situations that were causing them concern are recorded in this study. One hundred and sixteen mothers were interviewed. The children were between the ages of five and ten years at the time of the interview and were patients at the Royal Children's Hospital, Melbourne. The study investigates the problems of attending a public hospital and draws attention to the difficulties in communication between the hospital staff and parents. It emphasizes the physical demands made on the parents, particularly the mothers, in caring for a handicapped child and indicates the lack of supporting services in the home, such as home help and child minding services. The effect on the parental relationship and on brothers and sisters is studied and attention is drawn to the need for ongoing social work support to the parents, and that brothers and sisters should be included in the counselling services. Some of the difficulties encountered by the child with a handicap are recorded, in particular the problems of socialization and leisure time occupation. The parents' difficulties in rearing a handicapped child are discussed including their problem in talking to the child about his handicap. The mothers' comments about community attitudes to their child, and ways of alleviating these are also mentioned.

Australia↗

PubMedDate not supplied

Visual problems in the handicapped child.

The importance of carrying out a preliminary examination of vision and eye movements in all handicapped is stressed. In any case of doubt a full ophthalmological and orthoptic examination is essential and is best carried out in the congenial environs of a District Handicap Centre. Eight hundred and ninety-three children with a wide variety of handicaps were seen at the Leeds Regional Child Assessment Centre between 1972 and 1977, and 324 were found to have a visual or visuomotor defect. The types of defects are discussed under headings which describe the main handicap.

Autistic Disorder↗

PubMedDate not supplied

Measuring the effects of stress on the mothers of handicapped infants: must depression always follow?

As one aspect of the evaluation of an early intervention project with families of handicapped children, 25 mothers of severely handicapped infants were asked individually, as part of an in-depth interview, to complete the Malaise Inventory (Rutter et al. 1970) soon after the commencement of home-based therapy. They were also asked to complete the Inventory with regard to their feelings prior to home visiting, and the 20 mothers with surviving children were asked to complete it again after a 2 year period during which regular weekly visits and been maintained. A comparison group of 12 mothers with handicapped children of the same age, living in another part of the same county, who had not received home visiting, were also interviewed under similar conditions. A general decrease in the level of depression reported was found both during and at the end of the 2 year period. The complex nature of the relationship between the birth of a handicapped child and maternal depression is discussed and some implications drawn from the present study. The strengths and weaknesses of the Malaise Inventory for use within this context are also discussed.

Adaptation, Psychological↗

PubMedDate not supplied

Attitude of Yoruba of Western Nigeria to handicap in children.

An assessment was made of the attitude of the Yoruba of Western Nigeria to visual, auditory and physical handicaps in children. The results indicate that although a good number of the Yoruba community exhibits positive attitudes to handicaps in children, significant differences were observed between the attitudes of the Western-educated élite and their illiterate counterparts living in traditional settings. The Western-educated group is less favourably disposed to handicaps in children than their counterparts in the traditional settings. Finally, there is a need for public education about the ascertainment of handicaps in children, their care and education. Nurses have a major role to play in this regard.

Attitude to Health↗

PubMed1996

Attributes of nurses that determine the quality of care for mentally handicapped people in an institution.

This is an ethnographic study that examines, from the relatives' perspective, the attributes of nurses that are considered important in the caring process of mentally handicapped people in an institutional setting in Hong Kong. Twelve interviews were carried out with a family member who had a relative living in a special unit for severely mentally handicapped people. Empirical studies, mainly from the west, have shown that decisions to place a mentally handicapped family member in residential care is a complex process. Family characteristics, the relatives' characteristics as well as the availability of support, have been found to influence decisions about out-of-home placement. Once this decision has been made, a new caring relationship between nurse, family and relative needs to be established. The final categories that emerged from the data show that families have expectations about the nurses' competence and commitment to the job and about their relationships with the client and the family. Consequently quality is judged, not only by the way in which nurses work with the clients, but also by the way in which they work with the family. Implications for practice and education of nurses working with mentally handicapped people and for nursing administration in Hong Kong are discussed.

Anthropology, Cultural↗

PubMed1981

Position cues in discrimination behaviour of normal, Down syndrome and other mentally handicapped children.

Groups comprising twelve Down syndrome, twelve other mentally handicapped children and twelve normal children, matched for M.A., were tested on a visual discrimination task. There was some evidence to support the suggestion that certain types of mentally handicapped children attended to single cues, rather than to total configuration. There was also evidence of perceptual distortion resulting in reversal and attraction to "good form". Differences were detected between Down syndrome and non-Down syndrome handicapped children which were consistent with the suggestion that Down syndrome children characteristically show flexibility in approach to perceptual discrimination tasks. The results were not inconsistent with interpreting perceptual processes in handicapped and normal children as essentially similar.

Child↗

PubMed1983

Mortality in the mentally handicapped: a 50 year survey at the Stoke Park group of hospitals (1930-1980).

Mortality trends during the past 50 years in the population of a hospital group for the mentally handicapped are reported. There has been a marked change in the causes of death during this period. Whilst tuberculosis is no longer a major cause, other terminal respiratory tract infections are still prevalent. Deaths due to status epilepticus have decreased, with a concomitant increase in those due to carcinoma, myocardial infarction and cerebrovascular accident. Similarly, the mortality rate has altered significantly. Fifty years ago the patients' mortality was considerably higher at all age groups in comparison with the general population, whereas the difference is now relatively small. These changes have been most marked during the past 25 years, with the introduction of new drug therapy, better diet, care and environment for the mentally handicapped. The result of this is increased longevity in the mentally handicapped, in particular in those with Down's syndrome whose longevity has increased by 40 years, and over 30 years in others. These findings have important implications for the planning of future services for the ageíng mentally handicapped population, in hospital and in the community alike, with associated geriatric ailments, and pre-senile and senile dementias.

Adolescent↗