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At least 649 records · Page 36Linked to original sources
PubMed2006

One-trocar laparoscopy-aided gastrostomy in handicapped children.

BACKGROUND/PURPOSE: Percutaneous endoscopic gastrostomy has become a common technique to provide nutritional support to handicapped children with swallowing disorders; however, this technique is sometimes associated with serious complications. We report a novel method of 1-trocar laparoscopy-aided gastrostomy with special reference to its influence on gastroesophageal reflux (GER). METHODS: The subjects consisted of 22 profoundly handicapped children, aged from 1 to 14 years (median, 7 years). Twenty-four-hour esophageal pH monitoring was conducted preoperatively in all subjects and performed postoperatively in 12. The criteria for gastrostomy alone included no significant symptoms related to GER and distal esophageal acid exposure of less than 15%. Esophageal acid exposure was evaluated at the distal esophagus (P1) and at 10 cm proximal to P1 (P2). Stamm gastrostomy was performed by grasping the anterior gastric wall with forceps inserted through an operating channel associated with a laparoscope. Data are expressed as medians and ranges. RESULTS: There were neither perioperative mortality nor life-threatening complications except the detachment of the gastrostomy in one. Esophageal acid exposure was significantly increased postoperatively compared to preoperatively at P1 (2.1% [0.0%-4.7%] vs 4.6% [0.2%-8.7%], P = .02), but did not change much at P2 (0.2% [0.0%-1.5%] vs 0.8% [0.0%-7.6%], P = .07). No patient developed postoperative symptoms related to GER. CONCLUSIONS: One-trocar laparoscopy-aided gastrostomy is a feasible technique for handicapped children without symptomatic GER.

Adolescent↗
PubMed2005

Sexually selected signals are not similar to sports handicaps.

The handicap principle is a simple but powerful metaphor that has had a major impact on how biologists study and understand sexual selection. Here, I show that its application to signalling in sexual selection is not a valid generalization from its roots in economics. Although some signalling systems, with additive costs and benefits, have solutions that resemble sports handicaps, the signalling in sexual selection has multiplicative costs and benefits, and solutions that do not resemble sports handicaps. The sports analogy is technically incorrect, metaphorically misleading and a poor guide for empirical research on the signalling in sexual selection. The evolution of sexually selected signals is not a missing piece of Darwin's puzzle; it is an integral piece of the process of evolution by natural selection, and it should be approached with the same tools that we bring to bear on the evolution of other correlated traits involved in social interactions.

Animal Communication↗
PubMedDate not supplied

Social and psychological characteristics of elderly visually handicapped patients with the Charles Bonnet Syndrome.

The Charles Bonnet syndrome (CBS) is characterized by the presence of complex visual hallucinations in psychologically normal people. The syndrome occurs predominantly in the visually handicapped elderly. Little is known about its etiology and pathogenesis. The aim of this study was to examine the associations of CBS with psychological and social determinants. All subjects were patients older than 64 years from a low-vision unit. Using a case-control approach, 50 patients with CBS and 80 patients without visual hallucinations were interviewed about their educational level, social circumstances, number of social contacts, and ability to cope with visual handicap. Loneliness was measured with the De Jong-Gierveld-Kamphuis loneliness scale, and personality traits were examined with the Dutch-language short version of the Minnesota Multiphasic Personality Inventory ([MMPI] Nederlandse Verkorte MMPI [NVM]). Compared with the control group, significantly more CBS patients were lonely. Mean scores on the NVM shyness scale and extraversion scale were significantly higher and lower, respectively, in CBS patients. In multiple logistic regression analysis for the three determinants simultaneously, loneliness and low extraversion were significant predictors for CBS, but shyness was not. It is concluded that loneliness, low extraversion, and shyness are risk indicators for CBS in elderly visually handicapped people. The findings suggest that CBS is associated with a low quality of social contacts.

Adaptation, Psychological↗
PubMed2000

Evaluation of disability and handicap following injury.

Disability and handicap outcome measures are fundamental components of trauma system evaluation. These outcomes are described for survivors of major trauma, attended by the HEMS, London system. Together with measures of injury severity, three functional instruments (Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS) and return to pre-injury work status (RTW)) were used to measure outcome in 201 trauma patients. By 12 months post injury 84.1% of cases were independent in Motor FIM, 88.1% in Cognitive FIM, 79.1% had good outcomes in GOS (grades 4 and 5) and 69.2% had returned to work. The functional measures showed a statistically significant relationship with minor and major and trauma (ISS < 16 and > or = 16): FIM (motor p < 0.002; cognitive p < 0.0003), GOS (p < 0.002) and RTW (p < 0.002). Division according to severity of principal injury confirmed the greatest disability and handicap resulted from the severest injuries (AIS 4-5): 68.9% achieved independence in Motor FIM, 73% in Cognitive FIM and only 40% returned to work. When grouped according to body region of principal injury, neurological injury, particularly severe injury (AIS 4-5) to head and spinal cord regions showed the poorest outcomes. FIM, GOS and RTW are recommended as standard indicators of disability and handicap for trauma registries and outcome studies.

Adolescent↗
PubMed1983

School intervention for the neuromuscularly handicapped child.

School problems are common in children with neuromuscular disease irrespective of their degree of handicap. They are related to difficulties in transportation and access, difficulties with adaptation of school tasks to the motorically handicapped, and difficulties that arise because of misunderstanding of the disease processes by teachers and parents. Most of these can be easily rectified by efforts by the clinic staff to educate school personnel and to enlist them as members of the treatment team. In view of the importance of the school experience to this group of patients, it is urged that these problems be identified and aggressively managed by those involved in the care of neuromuscularly handicapped children.

Adolescent↗
PubMed2001

Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs.

OBJECTIVE: To determine the longitudinal relationship between beliefs about the consequences of dizziness and handicap levels in dizzy patients, and the effect of therapy on beliefs. METHODS: Symptoms, beliefs, and handicap were assessed at baseline and 6 months follow up in 76 primary care patients complaining of dizziness or vertigo, of whom 33 were assigned to treatment (i.e., vestibular rehabilitation). RESULTS: At baseline most patients believed that dizziness would have negative consequences such as falling, fainting, or losing control. Handicap levels at follow-up were predicted by baseline beliefs that dizziness would have negative consequences. Significant reduction in negative beliefs at follow-up was observed in the patients who received treatment, whereas there was no reduction in negative beliefs in the untreated patients. CONCLUSIONS: Negative beliefs about the consequences of dizziness sustain long-term restriction of activity, and can be modified by therapy.

Aged↗
PubMed1983

The visually handicapped child.

This overview of the visually handicapped child presents information on the early years, educational alternatives and appropriate content, the special problems of the multihandicapped child, and the impact of technology on the education and life of the visually handicapped. A list of agency resources serving the visually handicapped is provided.

Blindness↗
PubMed1981

Antecedents of handicap.

In the search to reduce the prevalence and severity of handicap in childhood, a high priority should be accorded to identifying and eradicating possible causes of brain damage; to achieving a uniformly high standard of perinatal care; and to eliminating other causes of disability. At he same time attempts must be made to improve attitudes to handicapped children and to support parents in their efforts to minimise the effects of disability. It should be accepted that expectations of perfection in the newborn infant set an impossibly high standard and are likely to create that rejecting environment which itself increases handicap.

Asphyxia Neonatorum↗
PubMed1981

Prediction of death and major handicap in very preterm infants by brain ultrasound.

A linear-array real-time ultrasound scanner was used to examine the brains of all 95 infants born at less than 33 weeks of gestation who were admitted to the neonatal unit of University College Hospital in 1979. Abnormalities were detected in 41 (43%). 36 infants had haemorrhages into the germinal layer (GLH) and/or ventricles (IVH). 8 infants had cerebral atrophy (together with GLH/IVH in 5 infants). 8 (13%) of 63 infants with normal scans or small (grade-I) GLH/IVHs died, whereas 19 (59%) of 32 infants with larger haemorrhages or other intracranial lesions died (p less than 0.0005). At follow-up, at a median corrected age of 45 weeks, only 2 (4%) of 53 infants with normal scans or grade-I haemorrhages had evidence of major neurodevelopmental handicaps, but 5 (38%) of 13 infants with more extensive haemorrhages or cerebral atrophy had major handicaps (p less than 0.005). Brain scanning with ultrasound in the first days of life identified most infants in the population studied who subsequently died or survived with handicaps severe enough to be detected within the first year.

Atrophy↗
PubMed1984

Training developmentally handicapped persons as supervisors in sheltered workshops.

Developmentally handicapped persons were taught to apply a behavioral supervisory strategy to maintain work rates of other developmentally handicapped clients in a sheltered workshop. In two experiments, each with two subjects, training procedures were examined in a multiple baseline across supervisory components within subjects. Results clearly demonstrated that the subjects learned to apply the supervisory components as a function of the training procedures. The subjects were approximately as effective as were regular staff for maintaining production rates of the workshop clients. Potential benefits of the supervisory training for the subjects as well as for the staff were discussed. The results suggest that the teaching of developmentally handicapped persons to perform more complex supervisory activities in sheltered work settings deserves greater attention than it has received in the past.

Adolescent↗
PubMed2006

[More on compensation of the handicapped child].

By adopting a heading enTITREd "solidarity towards handicapped people" within the French law dated March 4, 2002 on health reform, the government hoped to put an end to the controversy that ensued after the so-called "Perruche" ruling. Since then, several rulings have been given by administrative jurisdictions and it seems that debate in this area is far from over. The first point developed concerns issues raised about the concept of 'characterized malpractice' introduced under this law, the only type of malpractice that may render a doctor liable. A ruling by the Council of State on February 19, 2003 and two decisions by the Administrative Appeal Courts dated February 19 and April 20, 2004 gave an answer. Recent decisions, namely a ruling by the Council of State dated February 9, 2005, seem to confirm this impression. Characterized malpractice that can render a doctor liable is not gross neglect but rather neglect that is simple, certain and cannot be contested. However, due to its intensity and its proof, this type of neglect is more than just ordinary negligence. The second point discussed is the limitation of parents' compensable hardship attributable to medical malpractice. The law dated March 4, 2002 limited this compensation "solely to parents' hardship" to the exclusion of expenses incurred as a result of the child's handicap. National solidarity, which was intended to absorb this expense, is taking some time to become apparent. The legal decisions given since 2002 have thus brought about a certain level of unease both in public opinion and the legal profession. In June 2003, the Parisian Court of Appeal gave a surprising but apt ruling that may nevertheless bring certain concerns to the surface. To our knowledge, the Council of State has yet to issue an opinion on this subject. Doctors' liability in terms of the birth of child born with a congenital handicap is still a possibility.

Children with Disabilities↗
PubMed2000

Voice handicap index in singers.

The Voice Handicap Index (VHI) was developed to assess patients' perception of the severity of their voice disorder. The purpose of this study was to determine the degree of handicap expressed by professional and recreational presenters with a voice complaint. Singers (n = 106) and nonsingers (n = 369) with voice symptoms were studied. The results of the VHI for singers indicate that singers score significantly lower (less severe) on the VHI compared to nonsingers. Singers with vocal fold nodules had a lower mean VHI than singers with vocal fold cysts or polyps. Singers who perform classical music had the lowest mean VHI of all types of singers studied. A low VHI in singers may represent a significant handicap and should not be ignored when considering the severity of a singer's voice problem.

Adolescent↗
PubMed1998

[Definition and prevalence of school-age multi-handicaps].

BACKGROUND: Regulations concerning services for handicapped children in France have defined the notion of multi-handicap. There are, however, divergences in the procedures for applying this definition, and differences in the prevalence in different areas. This study is aimed at clarifying these two points. POPULATION AND METHODS: A survey in three French departments provided data about disabled children born between 1975 and 1985 who received services from the departmental committee for special education or from day hospitals. The data was systematically collected by a physician using medical files. RESULTS: The results showed that the group of multi-handicapped children was heterogeneous. The most restrictive definition (motor disability with profound mental retardation, bed-ridden or restricted to a chair) resulted in a prevalence of 0.73%. A broader definition based on the concept of zero autonomy, but excluding mild or moderate mental retardation, resulted in a prevalence of 1.28%. CONCLUSION: The importance of specifying the objectives of a definition selected for operational reasons is stressed in order to improve the estimation of specific needs.

Adolescent↗
PubMed1996

Nosocomial transmission of tuberculosis among mentally-handicapped patients in a long-term care facility.

SETTING: A long-term care facility at Saint-Brieuc hospital, France. OBJECTIVE: To investigate a nosocomial outbreak of culture-positive pulmonary tuberculosis in 6 (40%) of 15 mentally handicapped HIV-seronegative patients. DESIGN: The factors contributing to the outbreak were analyzed and the restriction fragment length polymorphism (RFLP) patterns of the six Mycobacterium tuberculosis strains were compared. RESULTS: RFLP analysis of the six strains demonstrated an identical banding pattern, thus confirming the spread of a unique strain. A prolonged period of contagiousness due to a delay in diagnosis of the source patient, as well as crowded living conditions in the facility, probably contributed to the outbreak. Surveillance of residents and staff in contact with the source patient resulted in the detection of five secondary cases. Because effective isolation of mentally handicapped patients in the long-term care facility turned out to be difficult, the six case-patients were transferred to the pneumology department, thus limiting the spread of tuberculosis to other residents and staff. CONCLUSIONS: The present outbreak emphasizes the difficulties of implementing control measures for preventing the nosocomial transmission of tuberculosis in long-term care facilities for mentally handicapped patients.

Adult↗
PubMed2001

[Sterilization of the mentally handicapped as a sacred process].

On the basis of the concept of sacredness, this article sheds light on the motivations of parents who request sterilization for their mentally handicapped child. Sterilization is characterized as a ritualized practice whose meaning and function must be clearly defined. With this surgical procedure, the special status of the mentally handicapped is established. They become "sacred" beings, who, by definition, are forbidden to reproduce. This concept of sacredness through sterilization emphasizes the representation of handicapped individuals in angelic forms.

Female↗
PubMed2002

Evaluation and treatment of epilepsy in multiply handicapped individuals.

The evaluation and treatment of patients with seizures and multiple handicaps are challenging. An orderly approach to these patients, however, can be especially rewarding. As in other patient populations, evaluation rests on the clinical cornerstones of history, examination, imaging, and electroencephalography. Several disease entities are overrepresented in the multiply handicapped population. Here, we review the principles of evaluation and some of the most common etiologies of recurrent seizures afflicting handicapped individuals. Practical issues that arise in institutional settings are highlighted, and basic treatment principles are discussed.

Journal Article↗
PubMed2005

The eye care profile and outcomes of multi-handicapped adults residing in Wayne County, Michigan group homes.

BACKGROUND: Patients with multi-handicaps present clinical challenges and are underserved. Central nervous system dysfunction and ocular disorders with this population are prevalent and well-documented. However, vision care outcomes data are limited and specific visual function recommendations to caregivers are rarely cited. METHODS: The charts of 110 multiply handicapped adults residing in 22 group homes in Wayne County. Michigan were retrospectively studied to identify ocular profiles and predictors of visual function. RESULTS: Sixty-five percent of the subjects were male and 80% were ages 26 to 55 years. There was no expressive language in 41%, and 37% were non-ambulatory. The median visual impairment level was moderate in both eyes (based on WHO). Significant associations between visual impairment level and subpopulations (such as seizure disorder, mental retardation without specific etiology, cerebral palsy, and Down syndrome) were identified. Successful spectacle wear statistically increased with higher refractive errors. Associations between cataract, nystagmus, and strabismus with particular subpopulations were significant (all P values < 0.0182). CONCLUSIONS: Clinicians who evaluate patients with multi-handicaps have few known predictors of treatment success. This study indicates that useful predictors of visual function can be made from refractive error, systemic conditions, and ocular diagnoses. No significant relationship was found with cognitive level and either vision impairment or spectacle use. The authors attribute successful implementation of recommendations to communication with group home caregivers.

Adult↗
PubMed1987

Differences in the quality of residential provision for mentally handicapped people.

This paper examines the quality of care in four types of residence for mentally handicapped adults in Britain. Data were gathered from 175 residents of 150 living units--mental handicap hospital wards, voluntary and private homes, local authority hostels and parental homes. Differences were apparent between the types of residence in terms of both residents' characteristics and care practices and routines. The findings indicate that some of the differences in care practices are not associated with differences in the residents' functioning. Additionally, alternatives to hospital care for mentally handicapped people are not providing demonstrably improved quality of care in several aspects of residential practice. A discussion of those aspects of care calling for more improvement is presented.

Activities of Daily Living↗