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PubMed1996

Hearing aid use, central auditory disorder, and hearing handicap in elderly persons.

We compared self-reported handicap (Hearing Handicap Inventory for the Elderly, HHIE) scores before and after a 6-week period of hearing aid use in subjects drawn from a pool of 115 elderly persons with hearing impairment. Study patients (PTs) were divided into two categories according to whether scores on a dichotic listening test (Dichotic Sentence Identification Test, DSI) were normal or abnormal. In a subgroup of 63 persons who had not previously used amplification, subjects in the two DSI categories showed equivalent average HHIE scores. After 6 weeks of first-time hearing aid use, there was a significant improvement in average HHIE scores, but only in the DSI-normal category. In the subgroup with dichotic deficits (DSI-abnormal group), average HHIE scores did not change significantly after hearing aid use. In a subgroup of 89 PTs, we compared the self-assessed HHIE scores of the PTs with the HHIE scores rated by their significant others (SOs). In both DSI categories, the average handicap, as judged by the subject's SO, was significantly greater than the handicap as judged by the PT. In addition, both ratings reflected significant improvement after hearing aid use. It was the case, however, that improvement consequent on amplification was significantly smaller for subjects in the DSI-abnormal category. Finally, we show, in the entire pool of 115 PTs, that the effect of practice on the HHIE score is not sufficient to explain the improvement after amplification. Results affirm both the positive value of amplification and the negative impact of central auditory deficit as they affect the HHIE scores of the elderly hearing-impaired person.

Aged↗
PubMed1996

[Hearing handicap--an addition to audiometric hearing loss. Results of an exploratory study of auditory communication disorders in the elderly].

Hearing problems in elderly patients cannot be evaluated completely with conventional audiological tests in most cases. Two hundred and one subjects aged 60 years or more complaining of hearing problems were studied. The following tests were employed: pure-tone audiometry, the "Basler Satztest" (a German version of the SPIN-test assessing speech perception in noise), and a German version of a "Hearing Handicap Inventory for the Elderly" (HHIE). These latter versions were developed in our institution. An auditory handicap was found in one-third of subjects with mild hearing losses (PTA < 30 dB; n = 135) and in two-thirds of subjects with greater hearing losses (PTA > and = 30 dB; n = 65). The relatively weak correlations of the pure-tone audiogram (r = 0.49) or speech audiometry (r = 0.41) with HHIE indicate that more than 50% of the variance of the hearing handicap was due to non-audiologic factors. For this reason, we recommend that the handicap questionnaire be added to the audiometric evaluation.

Aged↗
PubMed1995

Rehabilitation of the handicapped child--what about the caregiver?

The mental health of caregivers of handicapped children (n = 68) and of caregivers of children with minor ailments (n = 40) was assessed using the General Health Questionnaire (GHQ). In the comparative study, the caregivers of handicapped children had a significantly higher mean score (6.8), which was above the threshold score of 4. This suggests that the task of caring for disabled children may have a stressful impact on the caregivers which may contribute to psychiatric morbidity. There is a need periodically to assess the mental health of the caregiver, even as the rehabilitation of the handicapped child progresses. Addressing the psychological disturbances in the caregiver should form part of the treatment of the handicapped child.

Adult↗
PubMed1998

[Home care service utilization by severely mentally and physically handicapped persons].

PURPOSE: To investigate the utilization of in-home services by severely mentally and physically handicapped persons at home in order to clarify the vital factors associated with the services. METHODS: Questionnaires were delivered to 174 severely mentally and physically handicapped persons who were registered with 8 institutions in Tokyo and Kanagawa prefecture through each institution. One hundred and thirteen respondents among them were the subjects of this study. As a conceptual model Andersen's model was adopted. RESULTS: (1) The age of subjects varied from 2 to 50. There were no subjects between the age of 7 to 17. The mean functional handicap severity score (SCORE) was 5.8 +/- 8.4 standard deviation. Ninety seven percent of main caregivers were mothers, even among the aged. (2) Over 1/2 of the subjects reported having utilized institutional services. On the other hand the percentage for visiting nurse service (VNS) and home help services were 28.3% and 7.7% respectively. (3) Subject who used V.N.S. had significantly higher SCORES and higher luck of health of caregivers. Caregivers utilized V.N.S. as a substitute to reduce their burden in activities care at home. On the other hand, users of institutional services showed high scores in difficulties with daily help and perceived difficulties with medical treatments: it showed that they sought institutional care to reduce there careburden. (4) Total number of used by each client for in-home service was explained only by both difficulties of daily help and SCORE from multiple regression analysis. CONCLUSION: Users of visiting nursing service expect highquality care based on current medical knowledge and also with the aim of caregiver's health. With the increasing age of caregivers it appears to be important to enhance visiting nurse services, reduce the caregiver burden, and provide active support of home care for the handicapped.

Activities of Daily Living↗
PubMed1997

[The use of chlorhexidine as a preventive and therapeutic means of plaque control in the handicapped. Review of the literature and definitive advise for application].

With respect to oral hygiene, most of the handicapped are very dependent. Moreover, it is shown that the higher the dexterity level, the poorer the oral hygiene. It's well documented that the use of Chlorhexidine (CHX) is an essential tool in oral care for the handicapped. The efficacy however, only becomes optimal after thorough plaque and calculus removal. From the literature, it becomes clear that the application of a 1% gel in prefabricated trays is the most efficient. Regarding mouthrinses, it's important to use big volumes in order to reach optimal contact with tooth surfaces. The use of a spray seems very handy but is quiet inefficient; no homogeneous diffusion of CHX can be obtained. The choice of any device for CHX application depends on the handicapping condition and on the knowledge and motivation of educators, and medical care takers. The present article summarizes the dental literature on the use of CHX in handicapped. An advice for well indicated use of CHX is proposed.

Aerosols↗
PubMed1985

Selective nontreatment of handicapped newborns: a critical essay.

The neonatal intensive care unit is the site of some of the most dramatic technology, complex decision-making and costly activity in the current range of medical institutions. Thus, the decisions made there are particularly visible, and of concern to a society which has increasingly scrutinized and challenged medical practices. Questions of marginal utility and cost-benefit relationships are becoming increasingly prominent. These concerns are heightened by the social and political tensions over issues of the time of initiation of life, quality of life, and assurances of equity for those less well off or handicapped from birth. Robert Weir's book, Selective Nontreatment of Handicapped Newborns, successfully summarizes the current dilemmas and identifies areas of uncertainty and lack of knowledge which cloud the decision-making processes. The book reviews the positions of the major protagonists of the last several years; inevitably, their positions will undergo continuous evolution in response to new data and vigorous political and public policy activity. Weir appropriately identifies the difficulty in arriving at an accurate prognosis as an important and prominent problem in decision-making about defective newborns. The population of surviving, compromised newborns is relatively unfamiliar and their problems remain largely unstudied. Weir's discussion of the desirability of the establishment of Infant Care Review Committees in those institutions which care for defective and handicapped newborns thoughtfully concludes that such committees are, on the balance, desirable. As experience accumulates with Infant Care Review Committees, they should serve the positive purpose of generating open discussion of legitimate disagreements. These committees will provide a forum in which decision-makers can disclose uncertainty, consider alternatives, and receive counsel.(ABSTRACT TRUNCATED AT 250 WORDS)

Persons with Disabilities↗
PubMed1978

Application of cost-benefit analysis to programmes for the prevention of mental handicap.

The paper is a discussion of the role of cost-benefit analysis in evaluating programmes for preventing mental handicap. It is divided into three broad sections. In the first section the technique of cost-benefit analysis is defined and the possible variants considered. It is concluded that policies for the prevention of mental handicap are most appropriately analysed using a mixture of monetary and non-monetary measures of outcome. The second section lays down some guidelines for undertaking a study: the importance of specifying alternatives to the policy being analysed; specifying input-output relationships; counting only the appropriate costs and benefits; and discounting costs and benefits which occur in the future. The third section looks at the current state of the art in the UK. It concludes that little cost-benefit analysis has been done in the field of mental handicap, indicates where work could usefully be directed, and highlights information that would have to be available before a cost-benefit study could give useful results.

Cost-Benefit Analysis↗
PubMed1978

Neonatal intensive care and the prevention of major handicap.

During the past 20 years there has been a great increase in the understanding of deranged physiological mechanisms in certain groups of newborn infants that were, in the past, at high risk for death or major handicap. Much information of direct clinical relevance has come from the study of experimental animals, particularly about the changes that occur in the lungs and circulation at birth. Work in progress on an animal model of intraventricular haemorrhage suggests that this, like many other causes of brain damage, is a potentially preventable condition. Technological advances, such as continuous blood-gas analysis, make the prevention of handicapping conditions simpler, but the application of modern methods can be expensive. Current evidence shows that neonatal intensive care saves lives, and that the incidence of major handicap in the survivors is reduced. Society will have to decide how much money should be put into this area of medicine, and it will also have to help neonatal paediatricians with the difficult ethical dilemmas that they are now having to face.

Animals↗
PubMed1978

Outcome for infants at high risk of major handicap.

Perinatal intensive care had been introduced in University College Hospital, London, by 1966. In the succeeding 10 years, 28-day mortality rates fell among infants of birth weight 1500 g or less. Among the survivors, the incidence of major handicap was 10% or less and the mean IQ increased to within the range expected for a normal population. Of the children aged 8 years or more 76% had no handicaps and were attending normal schools; 18% had minor handicaps or problems for which they were receiving extra help in normal schools; and only 6% were attending special schools. Throughout the 10 years of the study, the overall prognosis for these infants of very low birth weight improved significantly. Results among other high-risk groups were equally encouraging. Analysis of variance of the data from the infants who weighed 1500 g or less at birth indicated that perinatal complications, particularly illnesses associated with abnormal neurological signs or acidaemia in the infants around the time of birth, were the principal factors determining the condition of the survivors at follow-up. Thus, it is likely that additional refinements in the management of the perinatal period may result in further improvements in the prognosis of these and other high-risk newborns.

Achievement↗
PubMed2003

Correlation of dopamine transporter imaging with parkinsonian motor handicap: how close is it?

During the past decade, dopamine transporter (DAT) imaging with single photon emission computerized tomography (SPECT) or positron emission tomography (PET) has evolved as an objective in vivo marker of nigrostriatal neuron loss in Parkinson's disease (PD). We investigate the relationship between striatal DAT binding, measured with [(123)I]beta-CIT SPECT, and parkinsonian motor handicap in a sample of 59 PD patients with minimal to severe disability, and review published cross-sectional studies on the correlation between DAT imaging and motor symptoms in PD. Earlier studies as well as the present results show a good correlation between overall striatal DAT binding and global measures of disease severity such as the Hoehn and Yahr scale, the total score on the Unified Parkinson's Disease Rating Scale (UPDRS), and UPDRS activities of daily living, with a progressive decline of DAT binding with increasing disability. A number of studies found a significant inverse correlation of striatal DAT binding with UPDRS motor score. Bradykinesia, posture, gait, and other midline symptoms, such as speech and facial expression, compared with rigidity, seem to be more closely related to striatal DAT binding. By contrast, neither the severity of parkinsonian rest nor of action tremor is related to the degree of dopaminergic denervation as measured by DAT imaging. Motor symptoms in the clinically less affected body side show a closer correlation with striatal DAT binding than do symptoms occurring in the dominantly affected body side. The correlation of putamen and caudate DAT binding with parkinsonian motor handicap seems to be similar. Although there have been limited comparative studies applying [(18)F]fluorodopa PET and DAT imaging in the same group of PD patients, available data suggest that putamen [(18)F]fluorodopa uptake, when compared with striatal DAT binding, may be more closely related to parkinsonian motor handicap.

Activities of Daily Living↗
PubMed1989

Maternal attachment to handicapped infants and the relationship to social support.

The parent-infant attachment of 36 mothers with and without a handicapped infant was compared. A prospective, longitudinal design was employed with data collection at 1, 6, and 12 months postpartum. There were significant differences in attachment at 1 month, with mothers of handicapped infants exhibiting fewer attachment behaviors; there were no differences at 6 or 12 months. When the effects of the mother's prenatal social support were partialed out, there were no longer significant differences between the two groups, suggesting that social support buffers the effects of having a handicapped infant on attachment.

Persons with Disabilities↗
PubMed1982

Late results of hip and knee surgery in severely handicapped cerebral palsy patients.

Seventy-three involved cerebral palsied patients were reinvestigated 10 or more years after hip and/or knee surgery. The average age was 6.3 years at operation and 18.1 years at retest. The results were evaluated as to motor progress and hip position. While preoperatively none of the patients was independently ambulatory, this was true in 18 cases after surgery. Usually free gait however was insecure (household walking). All patients that had been unable to sit independently before surgery remained strictly wheelchair bound. The results of hip realignment differed according to degree of handicap: In 51 patients with preoperative motor age of 8 months or more 43 hip deformities had been present, that could be improved in 29 items and remained unimproved 14 times, while five new deformities developed. This meant 19 deformed hips in this group of patients. In 22 patients, whose motor age at surgery had been below 8 months, improvement of 30 deformed hips had been possible 25 times, but there were 13 newly developed changes and 5 unimproved, so that 18 hips still were found deformed. There was a marked tendency for a-symmetry after surgery: while the relation of unilateral to bilateral deformities was 21:26 before operation, this changed to 27:5 postoperatively. 15 patients developed scoliosis of more than 25 degree, 11 of them in the group with major handicap (n = 22). Our study stresses the ill prognosis of surgery in mostly handicapped cerebral palsied children.

Acute Disease↗
PubMed1983

Stimulus overselectivity in autistic, trainable mentally retarded, and non-handicapped children: comparative research controlling chronological (rather than mental) age.

Much of the comparative research on stimulus overselectivity has been flawed by either failure to control for chronological age and language ability of the subjects or reliance on the controversial technique of matching on mental age. The present study investigated the prevalence of overselectivity in autistic, trainable mentally retarded, and nonhandicapped children demonstrating some expressive speech. The ages of the children were between 6 years-6 months and 9 years-3 months. Thus, chronological age and language ability were controlled, rather than allowed to vary unsystematically. Results indicated no significant differences between the autistic and TMR samples, but significant differences between the handicapped samples and the non-handicapped group. Some, but not all, of the handicapped children displayed overselectivity.

Attention↗
PubMed1986

An inexpensive and portable talking-tactile terminal for the visually handicapped.

The visually handicapped computer user or programmer is faced with a very difficult task in interfacing with computing hardware. The types of equipment currently available for this purpose fall into one of several general categories: expensive, nonportable, and domain-specific. In the current paper, we describe a new terminal device designed specifically for the visually handicapped that answers all of the problems mentioned above. The work is already under way, with a prototype model is currently in use by a visually handicapped programmer on the development team. In the remainder of this paper we will present a report on the current status of our project as well as plans and milestones for future work.

Algorithms↗
PubMed1982

Sensory reinforcement in the mentally handicapped and autistic child: a review.

Sensory reinforcement was first studied by learning theorists working with animals in the 1950s. Attempts to examine the phenomenon with children followed in the 1960s, and the studies demonstrated that sensory stimuli could act like any other reinforcers with normal young children. Similar work with the autistic and mentally handicapped child arose in relation to both the study of receptor development and more treatment-oriented research. It now seems that even profoundly handicapped children can learn to operate simple levers when reinforced by sensory stimuli, and some handicapped children have learned quite complex skills through sensory reinforcement. There also appears to be a close relationship between stereotyped behavior and sensory reinforcement. The clinical implications of the studies reviewed are discussed.

Adolescent↗
PubMed1983

Siblings of handicapped children: a review.

Research is critically reviewed and evaluated, first, in order to determine if the presence of a handicapped child in a family uniquely affects the nonhandicapped siblings, and, second, to identify factors mediating the nature and power of those effects. In addition, projects involving sibling therapy, education, and training are described. Currently there are few well-controlled empirical investigations supporting the popular belief that, as a group, siblings are adversely affected by their handicapped brothers or sisters. Rather, only certain siblings appear to be vulnerable to negative reactions, depending on such factors as sibling sex and birth order, family socioeconomic status, and parental responses to the handicapped child. Recommendations are offered for improved research strategies and questions and for the careful evaluation of future educational and support services for siblings.

Adaptation, Psychological↗
PubMed1994

An advanced test of theory of mind: understanding of story characters' thoughts and feelings by able autistic, mentally handicapped, and normal children and adults.

Research has suggested that the core handicaps of autism result from a specific impairment in theory of mind (ToM). However, this account has been challenged by the finding that a minority of autistic subjects pass 1st- and even 2nd-order ToM tests while remaining socially handicapped. In the present study, able autistic subjects who failed ToM tasks, those who passed 1st-order, and those who passed 2nd-order tasks were tested with a battery of more naturalistic and complex stories. Autistic subjects were impaired at providing context-appropriate mental state explanations for the story characters' nonliteral utterances, compared to normal and mentally handicapped controls. Performance on the stories was closely related to performance on standard ToM tasks, but even those autistic subjects who passed all ToM tests showed impairments on the more naturalistic story materials relative to normal adult controls.

Adolescent↗
PubMed1989

The Adolescent and Adult Psychoeducational Profile: assessment of adolescents and adults with severe developmental handicaps.

The purpose of this study was to determine the reliability and validity of the Adolescent and Adult Psychoeducational Profile (AAPEP), an assessment instrument designed for adolescents and adults with severe developmental handicaps. Subjects were 60 adolescents and adults, 30 with autism and 30 with mental retardation but without autism. The groups were matched on age and IQ. Results suggested high interrater reliability on all function areas of the AAPEP (Vocational Skills, Independent Functioning, Leisure Skills, Vocational Behavior, Functional Communication, Interpersonal Behavior) and on all three scales (Direct Observation, Home, School/Work). Validity measures suggested that the recommendations generated from the AAPEP were viewed by blind experts as more helpful than those already generated for the individual clients and contained in their Individual Education Programs (IEPs) or Individual Habilitation Plans (IHPs). Informal measures indicated that parents and/or group home staff also found AAPEP recommendations helpful. Finally, reliability and validity measures were also encouraging for moderately and severely handicapped adolescents and adults without autism. The AAPEP appears to be an effective new instrument for those working with older handicapped clients.

Activities of Daily Living↗