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PubMed1999

[Sexual violence in the reality of life in mentally handicapped young girls and women--results of a research project].

Subject of the study is the situation of 12- to 25-year-old girls and women from Berlin with a mental handicap who have experienced sexualised violence. 367 residential institutions of the Behindertenhilfe Berlin (aid for the handicapped) as well as 15 selected advice and consultancy facilities with amongst others a range of offers on problems of sexual violence. The return from the residencies was 68.7%. The gained individual data for the first time show the belonging to a sex for the residents. The group that was relevant for the study--altogether 147 girls and young women--was cared for in 31 institutions. The heads of the institutions provided information about more than 116 of these inhabitants. Every third to fourth resident (32 out of 116) was concerned by sexualised violence. This high extend of experience of sexualised violence in mentally handicapped female residents is directly opposed to an utterly insufficient psychosocial care situation. On one side the access to the questioned advice and consultancy centres is considerably limited for this clientele. Furthermore, heads of institutions of the Behindertenhilfe rather fall back on experts with medical-psychiatric knowledge, but not necessarily with knowledge of the handling of problems of sexual violence. Suggestions for the necessary improvement of the care situation of concerned girls and women with a mental handicap are being made.

Adolescent↗
PubMed2001

Evaluation of handicap and socio-economic status in patients with multiple sclerosis--data from a population-based survey in the sanitary area of Calatayud, northern Spain.

There are a few reports about handicap and socio-economic status in patients with multiple sclerosis (MS) based on epidemiological studies. The objective of our work is to evaluate handicap in patients with multiple sclerosis in the sanitary area of Calatayud, northern Spain, as well as the socio-economic situation--in comparison with patients from other parts off the world. In this study we included 34 patients with clinically definite MS found in a long-term and prospective population-based survey. For assessing the handicap degree and socio-economic status we used the Environmental Status Scale (ESS) recommended by the International Federation of MS. We compared the results with those found in 1116 patients from 7 different international series. The global mean score in ESS was 9.9 (sd 9.3, range 0-31). The mean score for the item "actual work status" was 3.3 (sd 2.3, range 0-5), for the item "financial/economic status" was 1 (sd 1.7, range 0-5), for the item "personal residence/home" was 0.8 (sd 1, range 0-4), for the item "personal assistance" was 1.2 (sd 1.7, range 0-5), for the item "transportation" was 1.5 (sd 1.7, range 0-5), for the item "community health services" was 0.7 (sd 1.3, range 0-5) and for "social activity" was 1.3 (sd 1.5, range 0-4). In the comparative assessment we found that our patients were better in all items, but in the item "actual work status" where our patients yielded higher scores than those obtained in other series. Socio-economic status measured with ESS correlates well with the degree of impairment measured with EDSS and it is more favourable than previously recognized, except for "actual work status" item. The high rate of labour incapacity in our series could be due to the considerable restrictions handicapped people have to cope with in order to find employment in rural areas.

Activities of Daily Living↗
PubMed2001

Disability and handicap among elderly Singaporeans.

Singapore's elderly population has been growing rapidly and is expected to constitute more than 25 percent of the total population by the year 2030. The ageing process brings with it a host of health problems. Here the question arises--Are the increasing years of life going to create a high proportion of sick and disabled elderly people, or a rich human resource of healthy senior citizens? Since more women are living longer than men, who would face a higher risk of disability and handicap? These questions are yet to be answered in Singapore. This paper seeks answers to these questions. The study is based on a sample survey of 1209 elderly Singaporeans living in Kampong Glam, Kreta Ayer and Bukit Merah parliamentary constituencies which have some of the highest proportions of the aged population. The results revealed that more than half of the aged had a disability and the rate of disability was significantly higher among the women as compared to the men. More than one-third of the elderly had a handicap and the rate of handicap among the women was twice as much as that among the men. Severity of handicap was directly correlated with age.

Aged↗
PubMed2002

[The Perruce decree, an opportunity to question the acceptance of a handicap and the relationship between physicians, justice and society].

The 'Perruche' decree (confirmed by the Paris Court of Cassation in November 2001) recognizes the right of those born with a handicap to claim for compensation. However, there is a fear that this decree might lead to deviations in the requests submitted for systematic compensation, simply because of a handicap or prejudice, even in the absence of a medical error. The interest of the 'Perruche' decree is that it once again raises the question of the management of handicapped people in our society and the lack of sufficient help from the State. The decree also emphasizes the strong subjacent risk that a handicap could be considered as a failure or a medical error. The excessive ideology of a 'perfect' child may therefore provoke the reject of the idea that a human being may be born with a deficiency or "imperfection". It also reminds us that medical practice remains exposed to errors and incertitude and that a zero risk does not exist, contrary to certain fantastical beliefs fostered by the principle of precaution. The hazard may correspond to the notion of incertitude. But it must not be confused with an error and it implies that which is unforeseeable. It is important that physicians stall the faith in the power of ultramodern techniques. Conversely, they should not claim a right to systematic error, when errors in fact hide authentic faults. The medical discourse must therefore remain responsible.

Congenital Abnormalities↗
PubMed1975

Psychological problems of the physically handicapped patient.

There is increasing concern about the difficulty encountered by handicapped patients in obtaining adequate dental health care. In addition to the problems of availability and accessibility of dental care there are social and psychological problems affecting the acceptability of dental health care. To overcome these difficulties the dentist must understand the bases of his own perceptions as well as those of his patients which interact in the dentist-patient treatment situation. Although many of the physical problems can be solved by such measures as wheel chair ramps, the major difficulty is the social acceptability of the handicapped. The same degree of handicap may cause different problems depending on the way in which the individual adjusts to it. Orofacial defects cause particular difficulties because they cannot be hidden in the same way as, for example, a missing or deformed limb. Often the relatively minor defects encountered in dental practice may cause greater problems than a more major deformity, since the near normal person strives harder to be considered as normal. Studies of babies' responses to normal and abnormal facial appearances have demonstrated the tremendous importance of the facial area in communication. Smiling responses were common with a normal face whereas grotesque faces induced anxiety in children. In later life facial abnormalities tend to evoke both aesthetic and sexual aversion so interfering with the process of social interaction. The dentist must become more aware of the psychological state of physically handicapped patients and of his own reaction to them.

Adaptation, Psychological↗
PubMed2002

[Medical prevention of handicap in Tunisia].

The handicap, phenomenon too often badly discerned, constitute a problem of public health of part his frequency, his gravity and his cost. Interventions aiming to warn the handicap are located to three levels: primary, secondary and tertiary. The measures as the vaccination, the education about health, the hygiene of the setting, the prenatal surveillance, aiming to reduce and even eradicate the transferable illnesses, is applied and integrates in the setting of the different national programs since years 80. The most important are the national program of vaccination and the national program of perinatality. The precocious tracking of deficiencies and their hold in charge is related to centers of cares of basis health, to the regional units of rehabilitation and the school and academic medicine. The sanitary measures of tertiary prevention of the handicap summarize themselves in two types of measures: the rehabilitation and the equipment. The handicap, multi-dimensional phenomenon, require a concerted multidisciplinary action between professionals of health, social business, jurists and community.

Persons with Disabilities↗
PubMed2003

Anesthetic management of dental procedures in mentally handicapped patients.

BACKGROUND: Providing dental care to a mentally handicapped patient is a challenge to both dentist and anesthesiologist. This study was aimed to describe the anesthetic methods which were used to facilitate dental treatments in mentally handicapped patients at a medical university hospital in Taiwan during a three-year period. METHODS: The data referring to anesthetic techniques to facilitate dental treatments during the period from Dec. 1, 1997 to Nov. 30, 2000 were retrospectively collected. In the period, there were four different anesthetic techniques in application: nasal mask technique combined with intravenous sedation, total intravenous anesthesia, laryngeal mask intubating general anesthesia and endotracheal intubating general anesthesia. Basic characteristics of patients were compared with student t-test between groups according to anesthetic technique used. Intraoperative and postoperative complications and complaints collected were analyzed by chi-square test between anesthetic techniques. P value less than 0.05 was considered statistically significant. RESULTS: The anesthetic records of 1201 mentally handicapped patients who underwent dental procedures over the three-year period were reviewed. Anesthesia was accomplished with nasal mask technique combined with intravenous sedation in 10 patients, with intravenous anesthesia in 112 patients, with endotracheal intubation anesthesia in 249 patients and with reinforced laryngeal mask anesthesia in 826 patients. Four patients were excluded from study because of changing of anesthetic method during the dental procedure. The use of nasal mask combined with intravenous sedation and intravenous anesthesia caused a higher incidence of intraoperative hypoxemia (P < 0.05) in comparison with the groups of endotracheal intubation anesthesia and reinforced laryngeal mask anesthesia. Although patients anesthetized by intravenous anesthetics had less postoperative complaints or complications but the difference was not statistically significant (P > 0.05) when group comparison was made. Patients who were anesthetized by volatile agents through endotracheal tube had the highest rate of postoperative complication although the difference was of no significance (P > 0.05) when comparison between groups was made. CONCLUSIONS: We provided four different anesthetic methods for 1197 mentally handicapped patients who underwent dental procedures in three years. All anesthetic methods had their advantages and disadvantages. Using reinforced laryngeal mask or endotracheal intubation for general anesthesia to facilitate dental procedures for such patients had greater intraoperative safety than other two methods. However, less postoperative complaints or complications were revealed with the methods of nasal mask combined with intravenous sedation and intravenous anesthesia.

Adolescent↗
PubMed2003

[Sports for handicapped persons between the text and its implementation].

The sports activities must occupy a paramount place in the schooling of the handicapped pupils. Indeed in addition to the development of the physical capacities, the sports activity has a positive impact on the development of the capacities of the communication and thus the integration of the pupil handicapped in his educational, family and social circle and on progress of psychomotor acquisitions. The national plan of education and the law N94-10 of August 3, 1994 relating to the sports activity in educational and university circle took part in the development and the promotion of the sports activities in the educational structures. This measurement, applied in the centers of specialized education, did not deny concerned the handicapped pupils provided education for in the colleges and normal colleges. What are the causes? Does there exist a remedy? How to introduce the sport for handicapped into the normal establishments?

Communication↗
PubMed1992

Assessment of the need for education and/or training in the dental care of people with handicaps.

A survey questionnaire was sent to members of the British Society of Dentistry for the Handicapped to investigate their opinions about the need for education and training of dentists in the delivery of oral care to people with handicaps. Their educational experience was explored. Views on education and training were investigated in relation to timing, content and methods. Three hundred and sixty five questionnaires were sent and the total response rate was 67.4 per cent. There was a higher percentage of females than males and a higher percentage of 30 to 39 year old subjects in the sample. The data were analysed using the 'Survey Plus' program. A high proportion of respondents thought there was a need for education and training of dentists in the delivery of care to people with handicaps (70 per cent). Their views on training provided information on three main issues: the type of training course, and the content and methods of training or education. In-service training, observation of other dentists and continuing education courses were opportunities that people considered would have helped them. Although views varied, there was a notable desire for contact with experienced clinicians, particularly the observation of them carrying out treatment, the opportunity for participating in teaching methods, discussions and problem-solving aids. The involvement of carers and of people with handicaps themselves was suggested. Undergraduate and postgraduate education were both considered important, although postgraduate training was the more highly favoured. In relation to the content of training, behaviour management, communication skills and appropriate treatment planning were most commonly identified. This information will be useful for those wishing to establish courses.

Adult↗
PubMed1992

Treatment accessibility for physically and mentally handicapped people--a review of the literature.

This paper presents a review of the literature concerning the access of physically and mentally handicapped people to dental care, and the attitudes of dentists towards them. It is particularly concerned with access for those who are housebound, or restricted to wheelchairs. Accessible dental care facilities and information about them may have been difficult to locate in the United Kingdom. This situation may improve in the near future as family health services authorities have data obtained from dentists registering with them under the new National Health Service contract, and general dental practice leaflets are required to provide information on wheelchair access. Transport systems may severely limit the ability of some handicapped people to travel to otherwise accessible surgeries. Professional and societal attitudes towards handicapped people are ambivalent. It has been shown that professional attitudes towards handicapped people, and willingness to treat them, increases with training in this field. At present, this training has a low priority in many dental schools.

Attitude of Health Personnel↗
PubMed1977

Stereotypic attitudes and behavioral intentions toward handicapped children.

Fifty-six junion-high-school pupils were questioned about their attitudes toward mentally retarded and crippled children. Same- and opposite-sex ratings of stereotypes and behavioral intentions were obtained. Results indicated a significant main effect for handicap condition, with stereotypic attitudes toward the crippled child being more favorable than attitudes toward the mentally retarded child. No differences in attitudes toward the two handicapping conditions emerged on the measure of behavioral intentions. Sex of the subject and sex of the handicapped child being rated did not significantly affect attitude scores in this study. The data were discussed in relation to the many methodological difficulties encountered in attitude research toward handicapped populations.

Adolescent↗
PubMed1977

Handicapped children in a developing nation--Bangladesh.

Bangladesh is a young, struggling nation that is emerging with strong religious and family networks and a positive hope for the future. Children are viewed as the step toward that future. The attitudes toward handicapped children were explored by examining the available health services and then conducting a survey of parents of handicapped children. Since there are few treatment facilities and these are located in cities, many children do not receive treatment. Family-oriented treatment in which therapeutic activities are incorporated into the child's daily routine and where therapists can train the child and family members, periodically reassess the child, and provide guidance and advice when necessary may be an effective way to treat handicapped children. Unlike more developed nations, the families of Bangladesh were not interested in institutions for their handicapped children, and expressed hope even in the face of serious disabilities. Providing training to these families could perhaps help them achieve that hope.

Bangladesh↗
PubMed1978

Some problems of the severely handicapped.

Acceptance of the severely handicapped in our community is limited. It may be limited by lack of experience, as 'the chicken and the egg' syndrome applies--do we keep the handicapped away from the public because of adverse reaction, or does the public react adversely because the handicapped are kept away? I work with handicapped children and their families, and therefore the following article is related to children.

Anxiety↗
PubMed2002

The development and clinical trial of a Driving Simulator for the handicapped.

We developed a Virtual Reality Driving Simulator in order to safely evaluate and improve the driving ability of the handicapped. The Virtual Environment consists of 18 sections (e.g. a speed limited road, a strait road, a curved road, a left turn course, etc) and each section is linked naturally. For the interface of our driving simulator, an actual car was adapted for realism and then connected to a computer. We also equipped it with hand control driving devices especially adapted for the handicapped. A beam projector was used so that the subjects could see the virtual scene on a large screen which was set in front of them. The subjects selected for this trial were 10 normal drivers with valid driving licenses and 15 patients with thoracicor lumber cord injuries who had prior driving experience. For evaluation, 5 driving skills were measured including average speed, steering stability, centerline violations, traffic signal violations, and driving time in various road conditions such as strait and curved roads. The normal subjects manipulated the gas pedal and the brake with their feet while the patients manipulated a hand control with their hands. After they finished driving the whole course, the participants answered the questions such as "How realistic did the Virtual Reality Driving Simulator seeme to you?" and "How much was your fear reduced". The five driving skills measured between the two groups (normal vs. handicapped) did not show any significant differences (p > 0.05). And in the three kinds of road conditions (a speed limited road and roads with a sharp curve and left-hand turn), the average speed of the handicapped group was 45.6 Km, less than 61.2 Km (p<0.05) of the normal group. In all, 11 patients (73%) reported that their fear of driving was reduced. Furthermore, their average score on the degree of realism question was 51.5%.

Adult↗
PubMed2004

Vision preference in dynamic posturography analysed according to vestibular impairment and handicap.

OBJECTIVE: The objective of this work was to characterise the implications of vision preference derived from the sensory organisation test of computerised dynamic posturography, in terms of impairment, disability and handicap. MATERIAL AND METHOD: This was a prospective assessment of 88 patients suffering from dizziness who denied experiencing any visually induced vertiginous symptoms. The level of impairment of each patient was estimated by performing a complete analysis of vestibular function by means of the caloric and rotatory stimulation tests. Disability and handicap were determined with the Dizziness Handicap Inventory questionnaire (DHI). RESULTS: The results of the caloric test in patients were independent of vision preference although canal paresis was more frequently abnormal in patients without visual preference. No differences were found in the results of rotatory stimulation by means of impulse and sinusoidal tests, both at high velocities of stimuli, in between patients with and without vision preference. Similarly, the responses in the DHI, a common questionnaire for vestibular disability and handicap and, specifically to questions addressing the problem of visual and vestibular disability, were not able to differentiate either group of patients. Nevertheless, we have found that patients with vision preference tend to have poorer balance. CONCLUSION: We consider that in the patients studied here, vision preference must be considered as a normal finding as this represents a normal strategy in a subject that relies more heavily on visual cues for his or her postural control.

Adult↗
PubMed1979

Expectations of teachers for physically handicapped and normal first grade students.

A descriptive study was conducted to determine whether teachers held different student role expectations for physically handicapped first grade students than they did for physically normal students. Contrary to predictions, results demonstrated that the teachers held statistically significantly higher expectations for the physically handicapped students. Such differences might be due to social desirability (responding in what appears to be a socially acceptable manner), or to a "haloing" of expectations for physically handicapped students. The teachers' inflated expectations could result in negative reactions toward handicapped students who do not demonstrate anticipated behaviors or live up to inflated expectations.

Adult↗
PubMed2005

Need for interceptive intervention for malocclusion in handicapped children in Lagos, Nigeria.

Orthodontic care for handicapped children in Nigeria has generally been neglected. There is a need for baseline data for effective planning of orthodontic services for this population group. The purpose of this study was to determine the need for interceptive orthodontic intervention in handicapped children in Lagos, Nigeria. The sample consisted of 106 handicapped children, 60 boys and 46 girls who were 7-10 years old, selected from 5 special schools in Lagos. Overall, forty-nine (46.2%) of the children had a need for interceptive orthodontic treatment. Orthodontic intervention was needed in 20.7% of the children due to crossbite of the anterior and lateral segments. Extraction was indicated in 4.7% of the children with retained primary teeth and in 1.9% of children with erupted supernumerary teeth. Orthodontic treatment or education was needed in 16.1% of the children due to oral habits. Three(2.8%) of the children presented with proclination of the maxillary anterior teeth with moderate spacing. In 10.4% of the children, there was a need for further inspection in order to follow-up the development of the occlusion. This study has revealed a significant need for interceptive orthodontic treatment among handicapped children in Lagos, Nigeria. Appropriate policy action and strategies to improve oral health education and provide publicly funded programmes will be required.

Age Distribution↗
PubMed1985

[Parents of a handicapped child (review of American literature).].

The presence of an handicapped child is a cause of major stress in a family and the source of serious upheavals. For the parents, this occurence can promote personal growth or lead to dissatisfaction or an inadaptive process that will influence their life on many levels: personal, conjugal, familial and social. The handicapped child's birth itself affects the parents and triggers many emotions, feelings behaviors and attitudes. The parents find themselves in a complex and irreversible situation to which they have to adapt. They have to organize their life in order to provide favorable conditions for the development of the child while preserving their own and their family's integrity. This article presents the different stages the parents have to go through to achieve a certain peace of mind. It also describes the reactions of the handicapped children's siblings in terms of their feelings and needs and underlines the determining role of the parents towards them. The professionals involved in those situations have to understand the underlying family dynamics. Their objective is to help the parents provide a stimulating environment to the handicapped child while preserving harmony in their family.

English Abstract↗