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PubMed1999

Measuring handicap in multiple sclerosis.

Handicap, shortly to be renamed participation, is a well defined though somewhat neglected entity which addresses an important aspect of the impact disease has on the individual. It is particularly relevant in Multiple Sclerosis (MS) which has such a major impact on issues such as employment, relationships, transport and social integration. Few validated measuring tools exist, and the generic London Handicap Scale is probably the best currently available but is only appropriate for group comparison. Handicap should be monitored in MS and is particularly appropriate in the evaluation of rehabilitation strategies.

Disability Evaluation↗
PubMed2005

The development and validation of a handicap questionnaire for children with a chronic illness.

INTRODUCTION: This paper describes the development and initial psychometric evaluation of the Handicap Scale for Children (HSC). This questionnaire is based on the London Handicap Scale (LHS), a valid and reliable utility instrument for measuring social participation in adults. METHODS: A multidisciplinary research group was involved in developing the HSC. The questionnaire was tested in 114 children with a chronic disease and 239 healthy children in the 8-18 age range. Relating the Health Utility Index Mark 3 (HUI3) attributes to corresponding HSC scores tested the assumption that a negative health status would lead to participation problems. RESULTS: Questionnaire development resulted in a five-dimension questionnaire: mobility, physical independence, daily activities, social integration and orientation. Each dimension included one item with a six-point response scale. A higher score indicates greater handicap. Feasibility testing with 10 children showed that none of the children experienced difficulties in filling in the questionnaire. Conceptual validity, measured by correlations between the dimensions of the HSC and HUI3, was satisfactory. As expected, moderate correlation coefficients between predefined pairs of HUI and HSC attributes were found; other correlation coefficients were low. Criterion validity was also satisfactory, as shown by large differences between the healthy and the chronically ill group and by several criteria within the chronically ill group. CONCLUSION: Based on this initial evaluation, the questionnaire seems feasible and valid for use with children in the age range 8-18 years.

Adolescent↗
PubMed1999

The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA).

OBJECTIVE: To report on the feasibility and psychometric properties in terms of homogeneity and construct validity of a newly developed handicap questionnaire focusing on person-perceived handicaps: the Impact on Participation and Autonomy (IPA). DESIGN: Cross-sectional. SETTING, subjects and outcome measure: One hundred consecutive individuals from the outpatient clinic of the department of rehabilitation of an academic hospital administered the new questionnaire IPA. RESULTS: The results show good homogeneity and construct validity of the IPA. Factor analysis showed that the scale consists of four factors, explaining 68% of the total variance: social relationships, autonomy in self-care, mobility and leisure, and family role. Homogeneity of the four subscales was considered good, Cronbach's alpha ranged from 0.84 (family role) to 0.87 (social relationships). Feasibility in terms of the number of missing values and administration time needed was satisfactory. CONCLUSION: The first results suggest that the IPA promises to be a useful handicap questionnaire. Further research is needed to establish test-retest reliability, convergent validity and responsiveness to change.

Activities of Daily Living↗
PubMed1984

Hypocholesterolaemia in cancer and other causes of death in the mentally handicapped.

Serum cholesterol levels were estimated in 313 mentally handicapped patients who subsequently died from various causes. Although cholesterol levels in the mentally handicapped are lower than those in the general population, it was found that there was still an association between relatively low serum cholesterol values and mortality due to cancer of the colon. Similarly, patients who died from myocardial infarction had relatively high serum cholesterol levels. The mechanism of the relationship between hypocholesterolaemia and cancer of the colon is unclear, but the increasing longevity of the mentally handicapped is an important factor which has contributed to a rising incidence of cancers, particularly gastrointestinal forms, in this group.

Aged↗
PubMed1986

Depression in mentally handicapped patients: diagnostic and neuroendocrine evaluation.

The dexamethasone suppression test was administered to 12 mentally handicapped depressed patients. One of the four patients with major depressive disorder, but none of those with other diagnoses, failed to suppress cortisol production. The International Classification of Diseases and the Newcastle Diagnostic Index were found to be unreliable for use with severely mentally handicapped patients. Modifications are proposed which would allow the Research Diagnostic Criteria and Hamilton Rating Scale for Depression to be applied to patients with any degree of mental handicap.

Adolescent↗
PubMed1991

The motor disorders of mental handicap. An overlap with the motor disorders of severe psychiatric illness.

Among 236 in-patients in one hospital for the mentally handicapped, there was a significant relationship between the amount of motor disorder (rated using a comprehensive check-list) and the severity of mental handicap, the presence of associated psychiatric disorder and the use of neuroleptic medication. The population was fairly evenly divided between those currently, previously and never having received neuroleptic medication. All categories of motor disorder, including abnormal movements, were present in all three subgroups. Neuroleptic medication appeared to modify the expression of motor disorder rather than producing it de novo. The range and frequency of motor disorders was comparable with that in patients with severe psychiatric illness. A common cerebral basis for the motor disorders of patients with mental handicap and severe psychiatric illness is suggested.

Adult↗
PubMed1991

The psychiatric symptoms, diagnoses and care needs of 100 mentally handicapped patients.

One hundred randomly selected residents of a mental handicap hospital originating from Dundee were interviewed using a standardised assessment based on the modified Standardised Clinical Interview Schedule. Information on certain behavioural items and self-care skills was obtained from nursing staff and case records. An ICD-9 diagnosis could be made for 80 individuals, including diagnoses usually reserved for children. Thirty subjects were regarded as needing long-term psychiatric mental handicap hospital care. All but one of the remaining 70 subjects required a staffed residential placement and all but 15 some form of out-patient or short-term in-patient provision from specialist health services. The findings indicate a need for approximately 30 psychiatric mental handicap beds per 100,000 population.

Adult↗
PubMed1991

Psychopathology of people with mental handicap and epilepsy. II: Psychiatric illness.

The prevalence of psychiatric illness was studied in 150 epileptic mentally handicapped people (both hospital in-patients and living in the community) and a matched group of 150 non-epileptic controls. The Profile of Abilities and Adjustment (PAA) scale was used for the initial screening of psychiatric illness. Mildly to moderately handicapped individuals who had good communication skills and scored positively on the PAA schedule for psychiatric illness were interviewed using the PSE interview schedule. Severely mentally handicapped individuals who scored positively on the PAA's psychiatric illness subscale were observed and information was gathered from their medical notes and carers. A psychiatric diagnosis was made using DSM-III-R criteria. The non-epileptic group showed significantly more psychiatric illness than the epileptic group. Psychiatric illness was diagnosed in 25% of the cohort.

Adult↗
PubMed1984

Physician-parent communication in the diagnosis of child handicap: a brief review.

It is physicians who are often charged with telling families that their child is handicapped. The manner in which that charge is fulfilled has been found to influence family ability to respond to the shock and pain of learning that their child is handicapped and to begin adapting to an altered future. In this review the problems and potential in physician-parent communication in diagnosing child handicap are discussed, in the context of the available literature. Specific strategies, and broader approaches to enhancing physician-parent communication in this difficult situation are outlined.

Child↗
PubMed1988

Facilitating play in hospitalized handicapped children: the design of a therapeutic play environment.

The development of a play environment is described, including a play structure that was designed to facilitate symbolic play in hospitalized, handicapped children. The effect of the structure on play was tested on handicapped children aged 2 to 13 years who were verbal and able to use at least one hand. Twenty-five pretest and 25 posttest observations were conducted and data were coded into play and nonplay categories. Results indicated decline in aimless wandering and nonplay activities, with a concomitant increase in both partial and symbolic play. The implications for play among hospitalized, handicapped children are discussed.

Child↗
PubMed1985

Providing a more appropriate education for severely handicapped persons: increasing and validating functional classroom tasks.

We evaluated a teacher training and supervision program for increasing the involvement of severely handicapped adolescents and adults in functional educational tasks. The program, consisting of a brief in-service followed by supervisory prompts and feedback, was accompanied by large increases in functional tasks in three classrooms. In addition, generalized increases occurred during nontargeted times in the classroom and the changes during both the targeted and nontargeted times were maintained over a 44-45 week period. In two subsequent experiments, surveys provided social validation for the criteria for functional versus nonfunctional tasks in that: (a) relevant individuals reliably categorized functional tasks as representing typical living, work, social, and leisure situations and (b) experienced clinicians consistently rated tasks previously categorized as functional as being more useful for severely handicapped persons than tasks categorized as nonfunctional. Results are discussed in terms of the relationship of functional classroom tasks in the overall provision of appropriate educational services for severely handicapped students.

Activities of Daily Living↗
PubMed1986

A direct prompting strategy for increasing reciprocal interactions between handicapped and nonhandicapped siblings.

We investigated the effects of a sibling training procedure, consisting of direct prompting and modeling, on the occurrence of reciprocal interactions between nonhandicapped and handicapped siblings. Data were obtained for training, generalization, and follow-up. Results of a multiple-baseline design across three pairs of siblings showed that: direct prompting of interactions was an effective strategy for increasing reciprocal interactions between handicapped and nonhandicapped siblings; the training procedure resulted in increased levels of initiations and responsiveness to initiations; reciprocal interactions between siblings generalized to larger play groups or across settings; reciprocal interactions between handicapped subjects and untrained, nonhandicapped peers increased without direct training; the siblings' levels of interactions were maintained at 6 mo follow-up; and these findings were judged socially valid by the siblings' parents.

Behavior Therapy↗
PubMed1986

Parent education project II. Increasing stimulating interactions of developmentally handicapped mothers.

Two studies are reported on the assessment and training of parent-child interactional skills in developmentally handicapped mothers. Study 1 compared the interactions of eight developmentally handicapped versus eight nonhandicapped mothers during play with their young (6-25 months) children. Results showed that the former group generally interacted much less with their children and that they were less likely to praise appropriate child behavior and imitate child vocalizations. Study 2 attempted to remediate these deficits, using a training package consisting of discussion, modeling, feedback, social reinforcement, and self-recording. Results showed, first, that the training did increase the targeted skills to well within the range found for the nonhandicapped mothers. Second, training effects generalized from the group instructional setting to the mothers' own homes. Third, newly acquired skills were generally maintained at or above levels found for the nonhandicapped mothers over a 5- to 10-month follow-up period. Finally, all seven children showed increases in vocalizations concomitant with parent training. The results suggest that developmentally handicapped mothers can be taught to provide more effective and stimulating interactions to their young children.

Adult↗
PubMed1987

Unprogrammed effects of training high-status peers to interact with severely handicapped children.

We examined the effects of a peer initiation intervention with high- and low-status nonhandicapped students on the behavior of untrained peers toward handicapped students. In the context of a counterbalanced withdrawal design, high- and low-status nonhandicapped students were taught to direct social initiations to eight severely handicapped students during recess activities. The interactions of the high-status students resulted in higher levels of initiations by untrained peers toward the handicapped students than did the interactions of the low-status students. Social response levels were also differentially affected by the status of the peer initiator.

Autistic Disorder↗
PubMed1988

Identifying reinforcers for persons with profound handicaps: staff opinion versus systematic assessment of preferences.

We evaluated a systematic means of determining stimulus preferences among seven profoundly handicapped persons. Preferences were determined by observing student approach responses to individual stimuli. Results indicated that there were differential stimulus preferences across the multiply handicapped participants. However, results of the systematic assessment did not coincide with the results of a more traditional, caregiver-opinion method of assessing student preferences. A second experiment was then conducted with five participants to evaluate whether stimuli that were assessed to consistently represent preferences would function as reinforcers in skill training programs. Results indicated that stimuli that were systematically assessed to represent student preferences typically functioned as reinforcers when applied contingently. However, preferred stimuli as reflected by caregiver opinion did not function as reinforcers unless those stimuli were also preferred on the systematic assessment. Results are discussed in terms of assisting profoundly handicapped persons by (a) improving the effectiveness of training programs by increasing the likelihood of using stimuli that have reinforcing value and (b) increasing the overall quality of life by providing preferred stimuli in the routine living environment.

Adolescent↗
PubMed1989

The use of 0.2% chlorhexidine spray as an adjunct to oral hygiene and gingival health in physically and mentally handicapped adults.

Chlorhexidine has been used as an aid to or replacement for oral hygiene measures in special needs groups such as the handicapped. Previous studies have indicated that spray delivery of chlorhexidine is both effective and acceptable. This study evaluated twice daily use of a 0.2% chlorhexidine spray as an adjunct to toothbrushing in a group of physically and mentally handicapped adults attending a day training center. The study was a double-blind, placebo controlled, cross-over design involving two 31 days regimens separated by 30 days. Plaque, bleeding on probing, and pocketing were measured at the beginning and end of each regimen. There were clinically and statistically significantly lower plaque and bleeding scores at the end of the chlorhexidine compared to the placebo period. Pocketing was also significantly less after chlorhexidine, although in clinical terms the difference was small. The apparent acceptability and effectiveness of the regimen suggests that small doses of chlorhexidine delivered by sprays may be of considerable value as an aid to oral hygiene in handicapped individuals.

Adult↗
PubMed1976

Family planning services for persons handicapped by mental retardation.

The National Children's Center, Inc., and Planned Parenthood of Metropolitan Washington joined in organizing a special family planning service for persons handicapped with mental retardation. The limited utilization, despite considerable community recruitment efforts, and the few problems encountered with patients served suggest that handicapped individuals can be seen at lower cost and at greater efficiency in regularly scheduled clinics, provided staff are attuned to their special needs. Informal interviews with residential center and clinic staff, with parents, and with clients confirm the need for (a) strengthening in-service training in sex education and contraception to prepare potential clients for more effective use of family planning services; (b) counseling with parents who place a high priority on training for independent community living but are reluctant to face the sexuality of their dependent offspring; and (c) increasing community awareness of the legitimate needs and rights of hard-to-reach handicapped persons in preventing unwanted pregnancies.

Adolescent↗
PubMed1977

Assessment and attempted modification of future teachers' attitudes toward handicapped children.

In a study designed to determine whether future teachers have negative sttitudes toward groups of exceptional children based upon the labels attached to these children, 13 special education majors and 32 students majoring in other fields of education were administered the Personal Attribute Inventory at the beginning and conclusion of an introductory course in special education. Results for labels, physically handicapped, educable mentally handicapped, and learning disabled, indicated that the latter two were evaluated significantly less positively than the first on both pre- and post-course testings. There were no significant differences between the respondents' pre- and post-course ratings of the three labels. Interestingly, special education majors were significanlty more positive in their pre- and post-course evaluations than non-special education majors. These findings certainly are not supportive of "mainstreaming" children who have been categorized as either learning disabled or educable mentally handicapped.

Attitude↗