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PubMed1987

The health care of physically handicapped young adults.

It has been recognised for many years that the amount of health care received by physically handicapped young adults rapidly declines after they leave the paediatric services. However, little is known about their specific health needs at that stage of their lives, or how these needs may be best met by the statutory services. The results of this study indicate a considerable degree of unmet need and point to a failure by the Health Service to maintain a continuity of health care for young adults with physical handicaps. A policy is called for to set up multidisciplinary Handicapped Adult Teams, at District level, to provide a clinical service for all physically and multiply handicapped adults.

Adolescent↗
PubMed1988

On the application of the WHO handicap classification in rehabilitation.

In order to study the usefulness and limitations of the WHO ICIDH Classification of handicap, a consecutive group of 76 stroke patients was studied at admission and discharge from a rehabilitation ward. All patients were graded with respect to orientation, physical independence, mobility and social integration. Most patients had at admission a combination of severe handicaps in several areas; this was less so at discharge. Nearly half of the patients did not change their degree of handicap during their stay at the rehabilitation ward. Improvement was not dependent on length of stay in the rehabilitation, age or sex. We have had difficulty in differentiating between handicap and disability as defined in the WHO system and we seriously question the utility of using three distinct categories of functional consequences of disease. We believe that the WHO system is useful to describe the type and pattern of disablement in a group of patients admitted to a rehabilitation ward and provides information on staffing demands, criteria for admittance and discharge.

Adult↗
PubMed1987

School competence needs of mildly handicapped adolescents.

Mildly handicapped adolescents have been identified by their deficient social skills as well as by their learning difficulties. School failure may be due not only to academic difficulties but to ineffectiveness in meeting the demands of the school environment. Using a naturalistic emergent design, this study identifies specific areas of need in coping with the high school environment. Individual interviews were conducted with "stakeholders" in the education of mildly handicapped high school students: 41 teachers, 12 handicapped students, and 12 parents of handicapped students. An analysis of the qualitative data indicated that study and organizational skills, communication, and social skills are areas of particular concern. Specific skill areas are delineated (i.e., class participation, handling criticism, and test taking), and recommendations for direct instruction that could affect both school and postschool success are made.

Achievement↗
PubMed1987

Relative definition of handicap: implications for research.

According to a relative definition handicap arises in the relation between an individual (with a weakness, an impairment or a disability) and his/her environment. To identify handicap it is therefore necessary to use environmental criteria as well as individual ones. Several attempts have been made to take a relative definition as a basis for classification and research. These attempts, however, often end up using a traditional clinical perspective by reducing the highly complex environmental circumstances to the ability of the individual to handle those circumstances. This is the case with the terminology and classification schemes proposed by WHO (International Classification of Impairments, Disabilities and Handicaps: ICIDH). This is also what seems to have happened with the relative notion of mental retardation, presented 15 years ago in terms of "a social system perspective". One of the reasons might be the methodological problems involved in handling the complexity of social environmental factors. To transcend the clinical perspective and take the full consequences of the relative definition social and behavioral research need to focus on the social meaning of handicap as it manifests itself in daily life. This calls for an anthropological approach in studying the everyday lives of mentally retarded persons as well as studies of the role of the professional in labelling those persons.

Humans↗
PubMed1985

[Residences for mentally handicapped adults in an open environment].

The author describes the characteristic environment and afterwork leisure hours of a mentally handicapped woman residing in a hostel for mentally handicapped adults. Such hostels are described and presented as one of the possibilities of accommodating such individuals. These hostels are described as small-scale projects close to the original district in which the patients had grown up, the ultimate aim being the social integration of the inmates. The hostels in question were erected as homesteads for mentally handicapped adults who are mainly engaged in working in a sheltered workshop. The working principles are described, followed by an outline of the development of homesteads in the Federal Republic, listing the available capacities and future requirements. In addition, legal pointers are also given, besides a description of aspects of financing and constructional problems and of the tasks of residents and staff. From the description of a few essential structural and conceptional problems in this field, the article arrives at important demands to be made in future to both government and society. The article then points out the possibilities of continuing to set up suitable hostels for mentally handicapped adults in spite of strained financial budgets of the state and of the local communities. In the author's opinion, chances are offered by improving the cooperation between building societies and communities to ensure adequate housing in accordance with regional requirements.

Adult↗
PubMed1984

The primary physician's role in care for developmentally handicapped children.

Over the past ten years the needs and rights of handicapped persons have been widely emphasized, leading to major changes in their care. The primary physician has an important role in identification of handicapped children and in counseling and educating families. Training for physicians in these areas has only recently been introduced in some medical schools, residency programs, continuing medical education courses, and journals. The results of a survey of Arizona family physicians and pediatricians and parents of handicapped children confirm that primary physicians see handicapped children with regularity and generally have a clear perception of their role. Screening and counseling families about their child's disability appear to be major problem areas leading to parental dissatisfaction. The implications of these findings for future training efforts are discussed.

Arizona↗
PubMed1980

Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants.

Serum vitamin E concentrations were measured in 47 severely handicapped patients, aged from 4 to 23 years, and in 22 controls. Thirty-three of the handicapped patients with seizures were treated with phenytoin and phenobarbital; the remaining 14 patients were not treated. The serum vitamin E levels were lower in the handicapped than in controls. Among the handicapped, those treated with anticonvulsants showed much lower levels of serum vitamin E than those untreated. Ten patients under anticonvulsant therapy were selected to receive d-1-alpha tocopherol acetate, 100 mg/day, based on their low serum vitamin E levels (range of 0.27 to 0.61 mg/100 ml). After one month of tocopherol treatment, both their serum vitamin E levels and hemolysis tests returned to normal. During a three-month tocopherol treatment period, both the frequencies of seizure attacks and the electroencephalogram (EEG) patterns remained unchanged. Supplementation with vitamin E is recommended in some patients under anticonvulsant therapy.

Adolescent↗
PubMed1980

Children's attitudes toward handicapped peers.

As services for severely handicapped children become increasingly available within neighborhood public schools, children's attitudes toward handicapped peers in integrated settings warrant attention. Factor analysis of attitude survey responses of 2,392 children revealed four factors underlying attitudes toward handicapped peers: social-contact willingness, deviance consequation, and two actual contact dimensions. Upper elementary-age children, girls, and children in schools with most contact with severely handicapped peers expressed the most accepting attitudes. Results of this study suggest the modifiability of children's attitudes and the need to develop interventions to facilitate social acceptance of individual differences in integrated school settings.

Attitude↗
PubMed1981

The doctor's dilemma--how and when to tell parents that their child is handicapped.

As part of a larger study aimed at enhancing the development of young children with Down syndrome, information was collected regarding the time at and circumstances in which 32 couples were told of their child's handicap. In addition, the level of their present acceptance or rejection of their child in the family was assessed. The findings indicated that early disclosure of the handicap was one of the most important factors associated with parental acceptance and nurture of a mentally handicapped child. Other factors of importance were the nature of the information given by the informant and the position in the family of the handicapped child.

Persons with Disabilities↗
PubMed1981

[Integration of the mentally handicapped (author's transl)].

The integration of handicapped persons into the family and society has almost become a slogan. The expression is often used very uncritically, but the necessity for such efforts remains undisputed. Examples are given to show what approaches are possible and also what forms of integrational endeavors are unreasonable for the mentally handicapped and which are in no way always to be considered as suitable for the handicapped person. Under this catchword the full time establishments (institutions, psychiatric clinics with oligophrenic departments and homes) for the mentally handicapped are also considered, but equally critically. A discussion on the widely used nomenclature in the language of psychiatry, in textbooks or dictionaries which are not all encouraging for integration or even particularly human, is informative.

Education of Persons with Intellectual Disabilitie↗
PubMed1982

A study of handicapped children in a typical urban community in Cape Town.

The provision of health, welfare, education and community services for children with severe mental retardation and for those with cerebral palsy, and the extent to which these were made use of, were examined. There was found to be a lack of day training facilities and educational services for mentally handicapped children. Day training and educational facilities for the less severely affected children with cerebral palsy were good, but there were no facilities for the untrainable, severely handicapped children. The presence and management of additional handicaps were examined, as were the needs of patients and their families in the regard. The prevalence of mental handicap was 2,5/1000 children aged under 18 years and that of cerebral palsy 1,25/1000.

Adolescent↗
PubMed1982

Social facilitation influences on the oral reading performance of academically handicapped children.

Two competing theories of social facilitation, one stressing audience presence and the other stressing the threat of evaluation, were tested to determine their efficacy in predicting oral reading performance of 24 academically handicapped children. Each handicapped child participated in reading groups with 3 nonhandicapped children. Four conditions reflected audience and evaluation variables: alone/evaluation, alone/no evaluation, group/evaluation, group/no evaluation. Criterion was number of errors in oral reading. Results revealed a significant main effect for evaluation, indicating that academically handicapped children make more errors in oral reading in evaluative situations regardless of audience presence. Results were discussed in relation to mainstreaming. Specifically, the suggestion was made that it might be more advisable to educate academically handicapped children in highly structured settings, or nonevaluative environments, than to place them in classes with children of superior academic ability without meaningful preparation of intervention.

Child↗
PubMed1978

The development of motor competency in normal and slightly mentally handicapped children.

A study of the motor development and the corporal schema integration was carried out on 60 normal children aged between 6 and 10, and 40 slightly mentally handicapped children of 8 and 10 years of age. The deficiency at the level of manual rapidity is the most important element concerning the motive debility of mentally handicapped children. The tests show that there is no parallelism between the motive retardedness and the level of attainment of the corporal schema. In fact, the motor debility of 8 years old children is emphasized at the age of 10 with reference to normal children. On the other hand, if, at the age of 8, the mentally handicapped children have a lag of the corporal schema acquisition, these children have nearly overcome their retardedness at the age of 10. Therefore one can conclude that the motor retardedness of the slightly mentally handicapped children is not essentially due to a deficiency of the corporal schema integration.

Achievement↗
PubMed1995

Dizziness Handicap Inventory correlates of computerized dynamic posturography.

To assess the handicapping effect of dizziness related to posture and balance, the Dizziness Handicap Inventory (DHI) and Computerized Dynamic Posturography (CDP) were used to assess 101 consecutive patients referred for neurotologic evaluation of dizziness. Most patients, regardless of diagnosis, related some level of preexisting handicap, most often in the DHI Physical subscale. Generally, females and patients with bilateral lesions scored higher in all DHI subscales. No clinically useful correlations emerged between DHI and CDP testing, although DHI scores were marginally higher for patients failing CDP conditions. Functional balance ability could not be correlated with patient handicap, but a literature review suggests that the desynchrony between dizziness signs and symptoms may be related to underlying patient anxiety and differences in coping strategies.

Adaptation, Psychological↗
PubMed1994

[Handicap: definitions, treatment principles, recuperation process].

The traditional model of disease takes no account of its implications in daily life. The concept of handicap originates from the medical, social and economic dimension essential for the individual as well as for the community. Notions of impairment, disability and disadvantage were used to construct a relationship model involving the whole chain of phenomena linked to the initial disease (ICIDH). The handicap situation results from an incompatibility in the triple confrontation of an individual, a life scheme and an environment. Whether disadvantage occurs or not for a same type of impairment, depends on the situation. Handicap means maladaptation of an individual to his context or his environment. Given the endless possible schemes, an individualized and methodical analysis is imperative to deliver comprehensive treatments respectively applied to: the individual himself directly (to do again or to do otherwise) or indirectly by means of appliances to avoid disability (to cope with), the social, occupational, physical and economico-administrative environment (not to be faced anymore with) by restricting as far as possible the number of solutions which imply deviations from the ordinary environment and thereby "stigmatize" the handicap. The plan has to be changed when previous measures are proved ineffective (not to have to do anymore); another plan for life has to be actively constructed and adopted. Anyway, maintaining independence is a significant goal ("to lead one's life according to one's own rules").

Persons with Disabilities↗
PubMed1993

Pica in the mentally handicapped: a 15-year surgical perspective.

OBJECTIVE: To review the general surgical management of mentally handicapped persons with pica. DESIGN: A study of hospital records and a review of the current literature. SETTING: A community hospital. PATIENTS: Thirty-five patients from a large institution for the mentally handicapped were treated for well-documented pica on 56 occasions at the Orillia Soldiers Memorial Hospital between 1976 and 1991. INTERVENTIONS: Endoscopy and laparotomy for the removal of foreign bodies or to close perforations. RESULTS: Fourteen (25%) cases of pica were managed by observation only, but 42 (75%) cases required surgical intervention. There were 34 laparotomies. The complication rate was 30% and the death rate 11%. CONCLUSIONS: Pica is a serious health risk for mentally handicapped patients. Diagnosis and postoperative care can be difficult. Pica should be suspected in mentally handicapped patients with gastrointestinal symptoms.

Abdomen, Acute↗
PubMed1993

[An investigation of medical circumstances of the long-term hospitalized severely mentally and physically handicapped children in Sapporo district].

The author investigated medical circumstances of the severely mentally and physically handicapped children who needed to be treated for more than one month at general hospitals in Sapporo district using a questionnaire method followed by a direct observation. Fifty patients were identified and their chronological ages distributed from 5 months to 19 years old. The mean period of hospitalization was approximately 2 years. They could be roughly divided into two groups; high risk infants for severely mental and physical handicap; and the most severely mentally and physically handicapped teens needing hospital treatment for their lives. Etiology was congenital in 38% (CNS malformations, neuromuscular diseases, etc.), acquired in 36% (hypoxic brain damage due to accidents, CNS infections, etc.) and perinatal in 26% (all hypoxic ischemic encephalopathies). More than 90% of the patients showed abnormal brain CT scan and 20% had visual and/or auditory disturbances. A half of them needed artificial ventilation supports and/or tracheal cannulation. More than 60% received tube feeding therapies. From this evidence, it is considered that the long term hospitalized severely mentally and physically handicapped children have severe brain dysfunction which needs high medical technology and professionals. It seems that a little remedial supports to them is done in general hospitals at present in Sapporo district. Comprehensive treatment will hopefully be done for them in the near future.

Adolescent↗
PubMed1993

[Sterilization and the mentally handicapped: who decides?].

At the moment sterilization of mentally handicapped persons is carried out in a medical and a legal vacuum in Belgium as well as abroad. To give an adequate answer to the problem of sterilization of mentally handicapped adolescents in medical practice, Dr. J. Denekens undertook an extensive literature review and an empirical investigation comprising case-studies of 52 adolescents, their parents and family doctors. The adolescents, between the ages of 16 and 21, were selected at random from students attending schools for mentally handicapped persons in the province of Antwerp during the school year 1989-1990. This study and investigation resulted in the formulation of medical and ethical criteria to assist decision makers confronted with a request for sterilization from or on the behalf of a mentally handicapped person who may be unable to decide this issue alone. These criteria have been ordered in a useful and practical algorithm that enables a motivated, logical and ethically responsible decision to be taken. A proposal of procedure for such a sterilization request has been elaborated. The medical-ethical criteria, the algorithm and the procedure proposal come out right in time as the European Parliament is discussing a motion that deals with the legal part of the subject.

Adolescent↗