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PubMed2003

Application of the Voice Handicap Index in 45 patients with substitution voicing after total laryngectomy.

We tested the Voice Handicap Index (VHI) in 45 patients with substitution voicing (that is, without the use of two vocal folds), the majority of them using tracheo-oesophageal speech. We introduced a corrected VHI score (VHI(corr)) whose values are in the range from 0 to 100 and which can be expressed as a percentage. As such, the VHI(corr) is a handy and transparent tool, and it seems to be suited for representing the handicap caused by the voice disorder when some items are unanswered as experienced in patients with substitution voicing. Interestingly, our data reveal that the voice handicap severity of this particular category of patients is (1) moderate and in the range of "common" dysphonia and (2) not affected by additional radiotherapy. It seems that the E domain is overstated due to the number of problematic items in the P and F domains.

Adult↗
PubMed1985

Perinatal factors associated with death or handicap in very preterm infants.

That death or major developmental handicap is associated with prematurity and low birth weight is well recognized. The importance of other perinatal factors related to presentation and management, however, is far from certain. In an attempt to elucidate the importance of some of these factors, data from 383 live-born infants delivered at 26 to 30 weeks' gestation were analyzed. All infants were born in a tertiary perinatal unit and long-term follow-up had been carried out on the survivors for at least 1 year. A group of 39 infants who died in the neonatal period and 34 infants with long-term handicap were compared with matched normal control infants. Perinatal factors related to outcome were analyzed and it was found that, while initial poor condition at birth was correlated with death, there were few predictors of subsequent handicap. More refined methods of both prenatal and neonatal assessment are required to define these factors.

Apgar Score↗
PubMed1984

Effects of moderator variables in reducing stress outcome in mothers of children with handicaps.

There have been numerous reports of relationships between stressful life events and outcome dysfunction expressed in physical and/or interpersonal spheres. This study investigated the variables that help buffer mothers from the stresses that result from bearing and rearing a child with a handicap. Stressors related to the handicapped child were scaled (HREC) and a moderate correlation (-0.37) was identified between these stressors and the health and marital adjustment (OUTCOME) of the mother. It was further uncovered that there was a moderator variable affecting the relationship between stressors and outcome, and it protected the mothers from the effects of the stressors. This moderator variable, labeled Resources (RES), consists of emotional support, physical help, etc. in raising the handicapped child. The effect was demonstrated empirically. Using a partial correlation procedure, the influence of RES was statistically held constant and the -0.37 correlation between HREC and OUTCOME dropped to -0.05. This accounts for the finding that those mothers with high stressors but high resources had fewer outcome problems than those with less resources. The study demonstrates the presence of a moderator variable influencing the relationship between life stress and dysfunction.

Adolescent↗
PubMed1991

Psychological and somatic distress in relation to perceived hearing disability, hearing handicap, and hearing measurements.

Acquired hearing loss has frequently been reported to cause strains in everyday life, but few attempts have been reported where the affliction is related to the concept of stress. In this within-subjects investigation of 48 middle-aged to elderly hearing impaired patients, the relationships between hearing measurements, experienced disability and handicap (HMS), and psychological and somatic distress symptoms (SCL-90(R)) were analyzed. The variations in experienced hearing disability was found to correlate to the occurrence of a few, but more severe distress symptoms, and by loss of hearing for high frequencies. The experienced handicap, defined as emotional responses and personal opinions, was found to correlate to a general level of distress. In particular those distress items expressing insecurity were related to handicap experience. It was suggested that insecurity in social settings, and diminished hearing for contextual sounds, could cause a perceived loss of control, which could induce stress reactions.

Adaptation, Psychological↗
PubMed1992

Symptoms, anxiety and handicap in dizzy patients: development of the vertigo symptom scale.

Questionnaires assessing symptoms, anxiety and handicap were completed by 127 vertiginous patients. Factor analysis identified four distinct symptom clusters which formed the basis for the construction of scales quantifying the number and frequency of symptoms of: (a) vertigo (of long and short duration); (b) autonomic sensations and anxiety arousal; and (c) somatization. Scores on the vertigo severity scale were significantly related to clinical diagnosis and had near-zero correlations with measures of anxiety. Vertigo severity, autonomic signs and depressed mood each independently contributed to variance in handicap, taking precedence over the relationship between handicap and trait and state anxiety. Our findings suggest that the familiar association between anxiety and vertigo may be mediated principally by autonomic symptomatology arising as a result of somatopsychic and psychosomatic processes.

Adolescent↗
PubMed1992

The load of genetic and partially genetic disease in man. IV. Severe visual handicaps and profound childhood deafness in Hungarian school-age children.

In Hungary, the school-age prevalences of severe visual handicaps and of profound childhood deafness have been estimated to be about 6/10(4) and 10/10(4), respectively. Most of these conditions have onset at birth or in early childhood and are aetiologically heterogeneous. Severe visual handicaps are grouped under 11 aetiological categories, their relative contributions to the prevalence being: perinatal damage syndrome (20%; half of this is due to retinopathy of premature infants), cataracts (15%), choroidoretinal degenerations (15%), congenital abnormalities of the eye (15%), syndromes (10%), high myopia +/- retinal detachment (7%), postnatal causes (5%), nystagmus (5%), optic atrophy (4%), bilateral retinoblastoma (2%) and prenatal causes (2%). Overall, Mendelian conditions (included under many of the above) account for about 50% with relatively more autosomal dominant than autosomal recessive and sex-linked entities, and acquired causes account for about 40% of the cases studied. No aetiology could be assigned in 10% of the cases. For profound childhood deafness, the rank order of the aetiological categories is: autosomal recessive entities (34%), postnatal causes (22%), perinatal causes (19%), autosomal dominant entities (17%), prenatal causes (5%) and unknown causes (3%). Severe childhood visual handicaps are responsible for about 60 years of loss of life per 10(4) live births and about 400 years of impaired life per 10(4) live births. Genetic causes account for one-quarter of lost life years and three-quarters of impaired life years. The comparable estimates for profound childhood deafness are: about 240 years of life loss per 10(4) live births (again, about one-quarter due to genetic causes) and about 640 years of impaired life per 10(4) live births (about one-half due to genetic causes). In all these calculations, it has been assumed that the average life expectancy at birth for an individual in the population is 70 years.

Adolescent↗
PubMed1996

Fetal cerebral Doppler studies as a predictor of perinatal outcome and subsequent neurologic handicap.

OBJECTIVE: To study the use of middle cerebral arterial Doppler findings in a group of high-risk fetuses as a predictor of adverse perinatal outcome, including subsequent neurologic handicap. METHODS: A group of very high-risk fetuses was recruited over a 2-year period for study. Weekly fetal biometries and Doppler studies of the umbilical artery and middle cerebral arteries were carried out until delivery. Main outcome indices analyzed included birth weight ratio (ratio of observed birth weight to mean birth weight for gestation), days of ventilator requirement, neonatal intracranial hemorrhage or periventricular leukomalacia, necrotizing enterocolitis, and follow-up data on major neurologic handicap and death. RESULTS: Seventy-four patients were recruited. One hundred thirty-four sets of examinations were made and prospective follow-up data were available for up to 2 years. The ratio of the umbilical and middle cerebral arterial resistance index was found to be inversely proportional to the birth weight ratio. Fetuses who had a high prenatal umbilical-cerebral Doppler ratio had significantly lower birth weight ratios than those with normal findings (0.72 versus 0.92; P < .001). The ratio was a more sensitive marker for growth restriction (sensitivity 78%) than conventional fetal biometry and umbilical arterial systolic-diastolic ratio. However, fetuses with high ratios did not have higher incidences of perinatal complications or subsequent neurologic handicap. CONCLUSION: Prenatal cerebral vasodilation is a sensitive marker for growth restriction and it seems to be a physiologic response to hypoxia. Fetuses with intrauterine cerebral vasodilation do not have increased risk for subsequent gross neurologic damage.

Adult↗
PubMed1987

Neurological handicaps among children whose mothers smoked during pregnancy.

Neurological handicaps among children up to age 14 whose mothers had smoked during pregnancy (N = 1,819) and control children born in Northern Finland in 1966 were studied. Altogether, 78 children of smokers and 62 controls had mental retardation (IQ less than 85), cerebral palsy, and/or epilepsy, either current or past. Neither the number of handicapped children nor the numbers of the various handicaps differed significantly with respect to maternal smoking, although the figures were higher among smokers. The children of the smokers had perinatal diseases and conditions known to cause long-term neurological sequelae significantly more often, but the actual number of such cases did not increase. Mortality up to the age of 14 years was statistically significant among children born to smokers.

Adolescent↗
PubMed1988

A week in the life of Mary: the impact of microtechnology on a severely handicapped person.

Microtechnology has an important role to play in maximizing the independence of severely handicapped people, especially those with few reliable voluntary movements. Such movements must be harnessed efficiently to provide control over all aspects of life including communication, mobility and the immediate environment. To highlight the role of microtechnology in the day to day life of a severely handicapped person living at home, a case study is presented. The systems Mary uses for communication and environmental control are described and their limitations discussed. Adaptive man-machine interfaces are proposed and foreseeable developments in the fields of speech technology and robotics are considered. Successful introduction of high technology devices requires a full appreciation of medical and social factors as well as those relating to the technology. This is achieved through close partnership between the clinical engineer and the rehabilitation consultant to the benefit of the severely handicapped person.

Communication Devices for People with Disabilities↗
PubMed1990

School nurses and health education for pupils with and without intellectual handicaps: a study conducted in Japan and Sweden.

The purpose of this study is to report the results from a questionnaire that was given to about 600 school nurses working in schools which have pupils with and without intellectual handicaps in Japan and Sweden, concerning their opinions on health education including sex and interpersonal relationships. The study was conducted during the spring 1987 in Sweden and during the autumn 1987 in Japan. The main results from this study concern differences between Japanese and Swedish school nurses when answering certain questions. These questions, for instance, concerned the nurses' working situation and their health education for pupils with and without intellectual handicaps. Of all the Japanese school nurses 27%, compared to 90% of the Swedish school nurses, taught about health including sex and interpersonal relationships in regular classes. Of school nurses having pupils with intellectual handicaps, only 1% of the Japanese school nurses, compared to 47% of the Swedish school nurses, taught their pupils these subjects. These differences merely seemed to be related to the educational system, including its curriculum, reflecting the general policy held within each country.

Attitude of Health Personnel↗
PubMed1986

Naturalistic observations of classrooms serving severely handicapped persons: establishing evaluative norms.

A naturalistic, observational analysis was conducted of 43 self-contained classrooms serving severely handicapped students. The primary focus of the observations was on levels of on-task student performance and student involvement in functional educational tasks. Results indicated that during designated instructional periods, slightly less than half of all student time was spent on-task. When students were on-task, almost two-thirds of their time involved nonfunctional instructional tasks. Results are discussed in terms of establishing norms for evaluating and improving educational services for the severely handicapped. Additionally, future research directions are noted, with a particular emphasis on investigating means of assisting educators in providing more useful teaching tasks for severely handicapped students.

Activities of Daily Living↗
PubMed1986

Mother-infant engagements in dyads with handicapped and nonhandicapped infants: a pilot study.

The purpose of this study was to investigate the effect of a handicapping condition on mother-infant interactions and, to investigate the conditions under which coordinated attention to an object and a person is demonstrated. This study provides a unique opportunity to make across-mother and within-mother comparisons of mother-infant interactions in two sets of fraternal twins. In each set, one infant was handicapped whereas the other was nonhandicapped. Microanalyses of several aspects of mother-infant free-play sessions showed that handicapped infants emitted fewer object-directed behaviors, had fewer instances in which their leads were followed, and spent relatively little time in joint attention with mother. The data also suggest that repetitive sequences with an object may be an important context in which coordinated attention is demonstrated.

Attention↗
PubMed1986

First diagnosis of severe mental handicap: characteristics of unsatisfactory encounters between doctors and parents.

This paper presents data from a study of 190 parents and discusses their reactions to being told that their child was likely to be severely mentally handicapped. Dissatisfaction was related to the child's age when the parents were first told about the impairment, which was itself related to the diagnosis of the child's condition. Parents of children with non-specific handicap were often not informed about the impairment until the second or third year of the child's life, while parents of children with Down's Syndrome were usually informed within a week of birth. The paper compares these two groups of parents and discusses the reasons for their dissatisfaction. The study showed that parents valued early acknowledgement of the problem, a sympathetic approach on the part of medical professionals, and the sharing of information and uncertainty. The reasons why parents of mentally handicapped children may continue to feel dissatisfied are discussed in the light of the theoretical literature on doctor-patient communication.

Adolescent↗
PubMed1996

Occupational handicap-free life expectancy in Bulgaria 1976-1992 based on the data of the medical expert commissions.

This article presents health expectancy calculations from Bulgaria for 1976-1992. The calculations are based on mortality statistics and data from a national information system from the Expert Medical Commissions on Working Capacity about loss of working capacity. Following internationally accepted terminology, the most appropriate term for the health expectancies presented here is "occupational handicap-free life expectancy' (OHFLE). Life expectancies were calculated as partial life expectancies from ages 16 to 59. Health expectancy calculations followed Sullivan's cross-sectional method with age and sex specific prevalence data on occupational handicap. Around 1985 a three- to four-fold increase in these prevalences occurred. The distribution of occupational handicaps over sexes, age groups and severity levels, however, remained fairly constant. The results show a decrease both in partial life expectancy within the age range 16-59 and in OHFLE at the age of 16 for men. For women a more or less stable partial life expectancy and a decrease in OHFLE at the age of 16 was found around 1985. The introduction of more incentives for people who successfully registered probably caused the decrease around 1985. Major social changes may have acted as confounding factors for the fluctuations after 1985. On the other hand the findings may reflect real changes in population health due to an increasing incidence in some major disease categories. The nation-wide system for assessment and registration of health related working incapacity has proved a useful source for an attempt to calculate OHFLE. Given uncertainties about the population health underlying these changes in OHFLE, however, it is recommended that health interview and health examination surveys should be considered as alternative routes for achieving a more comprehensive picture of population health in Bulgaria.

Adolescent↗
PubMed1979

The epidemiology of severe mental handicap.

Prevalence studies of severe mental handicap in an industrial area in the North West area of the United Kingdom have shown a marked increase between 1961 and 1977, with the hint of a reduction in the most recent years. Further analysis of causes of severe mental handicap shows that the prevalence of Down Syndrome is decreasing, certain causes remain constant in prevalence, and perinatal metabolic causes are shown to be increasing through a period of 15 yr ending in 1975. While improved survival of children influences the total prevalence, high mortality in some conditions makes the analysis of prevalence at birth more significant in considering changes in the pattern of aetiology. These studies are fundamental to the formulation of policies of prevention of severe mental handicap, whether these be social or dependent solely on health care services.

Adolescent↗
PubMed1991

The effects of fifth graders' socially directed behavior on motor and social responses of children with severe multiple handicaps.

Two elementary-aged boys with severe, multiple handicaps participated in social play activities with nonhandicapped fifth graders. Increases in all participants' socially directed behavior were observed consistent with teachers' instructions to play together. In addition to social behavior increases, both boys with handicaps showed increases in targeted motor responses when interacting with the fifth graders. Donald, for example, substantially increased the amount of extended arm reaching and grasping/manipulating. David increased the amount of time he kept his head in either a full or partially upright position. The results of the investigation are considered in terms of extending the positive outcomes of handicapped-nonhandicapped peer social interactions.

Adolescent↗
PubMed1991

Preschool siblings of handicapped children: interactions with mothers, brothers, and sisters.

The purpose of this investigation was to examine similarities and differences between young (aged 3 years to 6 years 9 months) siblings of handicapped and nonhandicapped children in their behavioral interactions with their mothers, brothers, and sisters. Behavior of mothers toward the different groups of children also was examined. Results revealed few differences between sibling groups in the quantity or quality of their interactions with family members. In comparison to the matched control children, siblings of handicapped children engaged in more parallel play and social play, and were more nurturing but no more likely to interact aggressively or to be commanding or directive with their brothers or sisters. Mothers in the experimental group were found to target significantly more nurturant behaviors toward their children compared to control mothers and were significantly more likely to deliver commands, directives, and reprimands to siblings of handicapped children than to any other child. Results are discussed in terms of their correspondence to previous observational and interview research.

Child↗
PubMed2004

Can laparoscopic antireflux surgery improve the quality of life in children with neurologic and neuromuscular handicaps?

PURPOSE: Children with neurologic and neuromuscular handicaps frequently have various symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study. METHODS: Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), and gastrostomy was performed concurrently in 52. The main symptoms were emesis/hematemesis in 40 and respiratory symptoms, including repeated respiratory infection and distress, in 31. RESULTS: There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those without recurrence. Respiratory symptoms were controlled unsuccessfully in 16 patients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease occurred in 10 patients, 7 of whom underwent a second Nissen fundoplication successfully. Thirteen died within the median follow-up period of 14 months. CONCLUSIONS: Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped children. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.

Adolescent↗