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PubMed1989

Attitudes towards mild and severe mental handicap in Israel.

Attitudes towards mild and severe mental handicap were examined, as well as whether these attitudes are influenced by social class, sex, religiosity, and order of questionnaire presentation. A second concern was the effect on these attitudes of country of origin, namely Israeli Jews of Western, Yemenite, and Iraqi origin. A random sample of 360 adults completed the Jordan six-dimensional attitude scale on mental handicap. There was a more positive attitude to mild than to severe mental handicap. None of the remaining variables - including country of origin - affected the attitudes.

Adult↗
PubMed1978

Auditory handicap of hearing impairment and the limited benefit of hearing aids.

The aim of this article is to promote a better understanding of hearing impairment as a communicative handicap, primarily in noisy environments, and to explain by means of a quantitative model the essentially limited applicability of hearing aids. After data on the prevalence of hearing impairment and of auditory handicap have been reviewed, it is explained that every hearing loss for speech can be interpreted as the sum of a loss class A (attenuation), characterized by a reduction of the levels of both speech signal and noise, and a loss D (distortion), comparable with a decrease in speech-to-noise ratio. On the average, the hearing loss of class D (hearing loss in noise) appears to be about one-third (in decibels) of the total hearing loss (A + D, hearing loss in quiet). A hearing aid can compensate for class-A-hearing losses, giving difficulties primarily in quiet, but not for class-D hearing losses, giving difficulties primarily in noise. The latter class represents the first stage of auditory handicap, beginning at an average hearing loss of about 24 dB.

Adolescent↗
PubMed1986

Impact of a handicapped child on mental health of parents.

In a cross sectional study the mental health of parents of physically and mentally handicapped preschool children was compared with that of parents of healthy preschool children. The social networks of the parents with handicapped children were also studied to determine factors that might influence psychiatric morbidity. The mothers of the handicapped children showed significantly more psychiatric morbidity than the control mothers, but the fathers did not show the same deleterious effect on mental health.

Adult↗
PubMed1974

Exeter project for handicapped children.

A project in Exeter has tried to increase the contribution of the paediatric department of a district general hospital to the long-term care, support, and treatment of handicapped children and their families. They include an infant care unit, day units for handicapped children, and holiday projects, and are based on close links with the educational and social services. The availability of such a family support unit may diminish the strain on the families of handicapped children and help them to maintain normal family and social relationships.

Child↗
PubMed1988

Involuntary orofacial movements in hospitalised patients with mental handicap or epilepsy: relationship to developmental/intellectual deficit and presence or absence of long-term exposure to neuroleptics.

Among 42 adult patients with mental handicap who had received treatment with neuroleptic drugs, the prevalence of orofacial dyskinesia increased with age and those with such involuntary movements were characterised by a considerably greater degree of mental handicap. Similar associations were found among a group of 15 patients with epilepsy. Two of seven other mentally handicapped patients and one of eight other epileptic patients showed indistinguishable orofacial dyskinesia, despite no record of them having received neuroleptic drugs.

Adolescent↗
PubMed1991

Assessment of scales of disability and handicap for stroke patients.

BACKGROUND AND PURPOSE: The purpose of the study is to compare the reliability of the Barthel activities of daily living score, which assesses disability, with the Rankin scale, which assesses handicap, and to determine their mutual agreement. METHODS: Fifty patients with stroke of varying severity were identified by a community-based stroke register and interviewed by two of three research nurses on two occasions that were 2-3 weeks apart. RESULTS: There was no evidence of a systematic difference between the first and second measurements. Repeatability was assessed using a kappa statistic with quadratic disagreement weights (kappa w) to take account of extreme differences. This measure was very good for both Barthel (kappa w = 0.98) and Rankin (kappa w = 0.95) scales. There was also excellent agreement between raters for the Barthel scale (kappa w greater than or equal to 0.88), but some indication of disagreement (kappa w = 0.75) between raters for the Rankin scale. Analysis of variance confirmed these findings. A conversion from the Barthel to the Rankin scale can be derived by assigning the most common Rankin score for the subjects with a given Barthel score, producing a kappa w of 0.91 for agreement. CONCLUSIONS: The Barthel scale is a more reliable and less subjective scale for assessing disability, from which a Rankin handicap score can then be derived to enable those managing stroke patients to assess aspects of handicap as well as disability.

Activities of Daily Living↗
PubMed1993

A comparison of five stroke scales with measures of disability, handicap, and quality of life.

BACKGROUND AND PURPOSE: Recently much debate has arisen on the appropriateness of assessing stroke outcomes with stroke impairment scales. Our purpose was to study the relationship between long-term impairments and functional outcomes in terms of disability, handicap, and quality of life. METHODS: We studied 87 patients who had a stroke 6 months earlier. Impairments were scored on five stroke scales: the Orgogozo Scale, the National Institutes of Health scale, the Canadian Neurological Scale, the Mathew scale, and the Scandinavian Stroke Scale. Disability was assessed with the Barthel Index, handicap with the Rankin scale, and quality of life with the Sickness Impact Profile. The linear relationship between stroke scales and functional scales was assessed with correlation coefficients. We used regression analyses to explain functional health. RESULTS: The stroke scales were highly related to one another (range, r = -.85 to .92). The correlation between stroke scales and functional scales was < .70 and decreased from Barthel (mean r2 = 47.5%) to Rankin (mean r2 = 36.5%) to Sickness Impact Profile (mean r2 = 33%). Stroke scales were rather poorly correlated with patients' psychosocial conditions (mean r2 = 11.5%). Functional health status was mainly related to leg power and orientation. The standardized stroke scale weights of the explanatory items were lower than their standardized regression weights. CONCLUSIONS: Stroke scales only partly explain functional health. The impact of impairments on functional outcomes seems to be underestimated by the stroke scale weights. The correlation patterns give empirical support to the hierarchical structure of the International Classification of Impairments, Disabilities and Handicaps.

Aged↗
PubMed1995

The clinical meaning of Rankin 'handicap' grades after stroke.

BACKGROUND AND PURPOSE: The Rankin Scale is a frequently used handicap index in stroke outcome research. However, relatively little is known about its validity. The purpose of this study was to investigate the clinical meaning of Rankin grades by identifying the functional health aspects that contribute to Rankin scores. METHODS: We studied 438 patients 6 months after stroke. Data were collected on the following functional health indicators: alertness, communication, independence, disability in activities of daily living, mobility, instrumental disability, social interaction, and recreation. Disability in activities of daily living was assessed with the Barthel Index, whereas the other indicators were measured with subscales of the Sickness Impact Profile. The association between functional health and Rankin Scale was expressed in terms of relative frequencies and Somers' D statistic. Linear regression analysis (after ordinal transformation) was used to identify the significant health factors that explain Rankin scores. RESULTS: Mobility, disability in daily and instrumental activities, and living arrangements showed a stronger association with Rankin scores (Somers' D range, 0.60 to 0.74) than cognitive and social functioning (Somers' D range, 0.34 to 0.47). Disability in activities of daily living turned out to be the most important explanatory factor of Rankin scores (R2 = 67%). CONCLUSIONS: The Rankin Scale is not a pure handicap measure but should be viewed as a global functional health index with a strong accent on physical disability. The index is useful as a simple and time-efficient outcome measure in largescale multicenter trials. It is argued that at present there is no clear need to assess handicap as the primary outcome in medically oriented stroke intervention studies.

Aged↗
PubMed1995

Classification of walking handicap in the stroke population.

BACKGROUND AND PURPOSE: The limited walking ability that follows a stroke restricts the patient's independent mobility about the home and community, a significant social handicap. To improve the in-hospital prediction of functional outcome, the relationships between impairment, disability, and handicap were assessed with clinical measures in 147 stroke patients. METHODS: The patients' level of functional walking ability at home and in the community was assigned by expert clinicians to one of the six categories of a modified Hoffer Functional Ambulation scale at least 3 months after discharge. A 19-item questionnaire was further used to assess current customary mobility of the subjects. Functional muscle strength and proprioception were tested, and walking velocity was measured. RESULTS: The significant indicators of impairment, upright motor control knee flexion and extension strength, differentiated household from community ambulators. The addition of velocity improved the functional prediction. Proprioception was clinically normal in all walkers. The validity of the criteria for the six levels of walking handicap was confirmed statistically. Stepwise discriminant analysis reduced the ambulation activities on the questionnaire from 19 to 7. Redefinition of the criteria for patient classification using the coefficients and constants of the seven critical functions improved the prediction of patient walking ability to 84%. CONCLUSIONS: The results of this study offer a quantitative method of relating the social disadvantage of stroke patients to the impairment and disability sustained. The measurement of therapeutic outcome in relation to the social advantage for the patient would allow more efficient standardization of treatment and services.

Activities of Daily Living↗
PubMed2005

Effects of vestibular and balance rehabilitation on sensory organization and dizziness handicap.

This retrospective study was undertaken to assess balance recovery and dizziness handicap in 32 patients after a vestibular and balance rehabilitation program. Outcomes were compared between 12 patients with peripheral vestibular disorders and 20 patients with central or mixed balance disorders. The patients were tested with posturography (sensory organization test [SOT]) and the Dizziness Handicap Inventory (DHI) before and after their therapy program. The vestibular SOT, composite SOT, and functional DHI scores obtained before and after exercise were significantly improved in both the peripheral and central groups. The visual SOT mean scores obtained before and after therapy were significantly different only for the group with central or mixed vestibular disorders. Changes in SOT scores were not directly correlated with changes in DHI scores. Outcome measures of vestibular rehabilitation protocols confirmed objective and subjective improvement of balance and dizziness handicap in patients with peripheral and central vestibular disorders.

Dizziness↗
PubMed1991

Patterns of physical and sexual abuse of communicatively handicapped children.

Evidence suggests that handicapped children are at increased risk for abuse and neglect. Communicatively impaired youngsters are particularly vulnerable because of their limited ability to report the maltreatment. Of 482 abused handicapped children evaluated at Boys Town National Research Hospital, 212 had hearing impairment, 87 speech language disorders, 39 learning disorders, 43 behavioral-emotional disturbances, 74 mental retardation, 5 visual impairment, 3 cleft lip or palate, and 19 other disorders. The perpetrator was either a relative or a "trusted other" in 97.2% of sexual abuse cases. Handicapped males were much more likely to be victims of sexual abuse than nonhandicapped males in the general population. Children being educated in residential schools were more likely to be sexually abused than mainstreamed youngsters. These children may be at risk for abuse from a wide variety of potential perpetrators, including teachers, dormitory counselors, van drivers, clergy, classroom aides, older students, peer siblings, scout leaders, abused peers, baby-sitters, and custodians.

Adolescent↗
PubMed1997

Perceived hearing handicap of patients with unilateral or mild hearing loss.

Using the Hearing Handicap Inventory for Adults (HHIA), we assessed self-perceived hearing handicap in a sample of 63 patients having either unilaterally normal hearing or a mild hearing loss (pure tone average < or = 40 dB hearing level). Large intersubject variability in responses to the HHIA confirmed observations that reactions to minimal hearing impairment vary greatly among patients. The individual differences in responses highlight the importance of quantifying the perceived communication and psychosocial handicap, which cannot be determined from the audiogram alone. An item examination of responses to the HHIA revealed a number of emotional and social-situational problems encountered by patients with minimal hearing loss.

Adolescent↗
PubMed1989

Disciplining handicapped students: legal issues in light of Honig v. Doe.

Court decisions interpreting the effect of the education for All Handicapped children Act on traditional forms of public school discipline have raised many question. This article reviews these decisions and confirms that most forms of minor disciplinary remedies remain available to educators so long as they are also used with nonhandicapped students. However, many legal problems arise with expulsion and long-term, or indefinite, suspensions of handicapped students, especially in the light of the recent Supreme court ruling regarding the expulsion of handicapped students.

Child Behavior Disorders↗
PubMed1989

Collaborative skill instruction for promoting positive interactions between mentally handicapped and nonhandicapped children.

Structuring cooperative learning activities has been shown to be an effective technique for integrating handicapped and nonhandicapped students. Previous research in this area has focused on the relative effects of cooperative versus competitive and individualistic learning situations upon peer relations and academic achievement. Few investigations have examined the various elements within the cooperative learning model that appear to promote positive peer interactions among handicapped and nonhandicapped students. The present study evaluated the influence of collaborative skill instruction versus no collaborative skill instruction on the social interaction behaviors of moderately/severely handicapped and nonhandicapped students participating in group science activities. These data reveal that students receiving collaborative skill instruction interacted more positively with one another than those who did not receive the instruction.

Adolescent↗
PubMed1990

The Handicapped Children's Protection Act of 1986: time to pay the piper?

The Education for All Handicapped Children Act (EAHCA), Public Law 94-142, provides for a free, appropriate public education for handicapped children, as well as due process procedures. However, the EAHCA does not directly address relief available to parents who successfully allege inappropriate actions by school. In this article, we examine case law that has provided three primary types of relief (injunctive relief, tuition reimbursement, and attorneys' fees) in special education lawsuits. The Supreme Court's decision in Smith v. Robinson, (1984) which removed attorneys' fees for action under the EAHCA, is analyzed. The congressional reaction to Smith v. Robinson and the Handicapped Children's Protection Act of 1986, Public Law 99-372, is described, and case law relying on that act is examined.

Child↗
PubMed1983

Head injury and mental handicap.

A clinical and pathological study of head injury and the implications in mental handicap are outlined. Non-accidental injury as a form of child abuse is suspected as contributing considerably to the cause of mental handicap in populations resident in long-stay hospital, but this is unlikely to be the best environment for such patients. A number of mentally handicapped epileptic patients who injure their heads during fits and patients who repeatedly bang their heads as a feature of self-injurious behaviour are exposed to progressive neurological deficits associated with lesions in the brain which could further impair the efficiency of brain function.

Adult↗
PubMed1990

Mobility of the young adult physically handicapped patient following lower limb surgery in childhood.

Fifty-six cases seen consecutively in a young adult physically handicapped clinic were assessed with regard to their mobility. In addition an attempt was made to review the long term outcome of lower limb orthopaedic operations in these patients with physical handicap. The patients were subdivided into four groups and it was found that in three of the groups, patients who could only walk with a walking aid or who were wheelchair bound had had more surgical procedures than those who walked independently in adulthood. As problems in the young adult physically handicapped patients are defined so further work will be required to determine the best way they should be treated.

Adolescent↗
PubMed2001

An assessment of the spectrum of disability and handicap in multiple sclerosis: a population-based study.

OBJECTIVES: To establish the spectrum of disability and handicap in a population based sample of multiple sclerosis (MS) patients. BACKGROUND: Much knowledge exists about the epidemiology of MS but, despite its importance for health and social service planning, there remains relatively little data on the extent and nature of disability and handicap in this population. METHODS: In a prevalence study in the north-east of N. Ireland, 288 patients (Poser criteria) were identified. Disability and handicap were assessed using the Incapacity Status Scale and Environmental Status Scale of the Minimal Record of Disability for MS. RESULTS: Both scales were completed for 248 (86%) of patients. Just 71 (29%) are fully independent in all basic ADL's of bathing, dressing, grooming and feeding. Fifty-seven (23%) are unable to climb a flight of stairs and 102 (42%) acknowledge problems with sexual function. Sixty-one (25%) were working essentially full-time and 53 (21%) had no external financial support. Forty-five (18%) had changed residence due to MS, 12 (5%) were institutionalised and 86 (35%) required assistance for at least 1 h/day with ADL's. Eighty-one (33%) were unable to drive a car or use public transport. Forty-two (17%) access community services for at least 1 h/day on average. CONCLUSIONS: This data gives a clear indication of the considerable range of basic health and social issues in a typical MS community. Further work is required to establish patient perceptions of the adequacy of care provision and whether standards of care for MS patients are being met.

Activities of Daily Living↗