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In spite of their greatly increased needs, multi-handicapped children as a group are not assessed earlier nor are they at a disadvantage in terms of quality of care if compared with other categories of handicapped. The group is not homogenous, however. Every subgroup has to be studied separately in planning strengthened services.
The pattern of care in 39 families with a mentally handicapped adult member, 20 with Down syndrome, 19 with autism, was studied. There were no significant differences between the mothers, the fathers, or the siblings of Down syndrome and autistic adults in the amount of help offered with physical care, domestic tasks, and supervision duties. However, the brunt of caring fell upon the mothers, with fathers helping mainly with supervision rather than physical care or domestic tasks. Siblings offered less help than fathers. The autistic subjects exhibited significantly more behavior problems. Methods of coping with problems differed: Parents of autistic adults were more likely to "give in" and less likely to tell the handicapped person to stop than parents of Down syndrome adults.
The motor and cognitive development of a visually handicapped child is delayed due to various constraints placed on learning by the handicap. The child requires a functional visual assessment, and assessment of mental & motor development. Based on these findings a total remediation programme needs to be worked out. This is individualised, integrated & includes stimulation of residual vision, optional use of residual vision and special measures to promote general development.
It is still unknown what if any relationships exist between intake of macronutrients by the elderly, and their functional or cognitive handicaps, particularly for free living elderly people. We investigated 226 men and 215 women, aged 65 or more, free living and in good health. They were randomly selected in the département of Bas-Rhin, after stratification for age, sex and residence (rural or urban). Handicaps and cognitive functions of each subject were assessed with the Géronte scale and the Mini-Mental State Examination (MMSE), respectively. Food intake was measured by a three-day record. A multiple correspondence analysis concluded that functional parameters and macronutrient intakes were rather independent. The relationships found were detailed by a backward stepwise logistic regression. In men, alcohol intake was associated with an improvement in functional and cognitive parameters, and polyunsaturated fatty acids with the capacity to move outside the home. In women, lipid intake increased the MMSE score. Overweight in women was linked with better functional and cognitive performances, and in men with the capacity to move outside the home. In both sexes, age worsened the score of functional and cognitive parameters. In conclusion, macronutrient intakes and functional or cognitive parameters were found to be mutually independent; this suggests that macronutrient deficiencies are of little importance in the worsening functional or mental autonomy of the elderly. The relationships found between functional variables and alcohol or polyunsaturated fatty acid intakes in men, and lipid intakes in women, and overweight in both sexes might evidence a better state of health.
The voice handicap index (VHI) was developed in the United States for subjective evaluation of a voice disturbance by the patient. The translation into German has been applied for a German population of patients. It was validated by the examination of 316 adult patients, 221 female and 95 male. The reliability of the VHI rests on a high Cronbach's alpha (0.96). A factor analysis in order to structure the items yields four factors that can be interpreted as negative voice experience (factor 1-explaining 20.83% of the variance after rotation), lack of assertiveness (factor 2-18.82%), lack of vocal power (factor 3-12.84%), and negative emotionality (factor 4-11.01%). The mean VHI scores differ significantly from each other in different degrees of voice disturbance as estimated by the patients themselves. The voice handicap index is qualified as a diagnostic tool for German-speaking countries.
PURPOSE OF THE STUDY: To examine bicycling habits of visually handicapped people in order to learn about the visual requirements. MATERIAL AND METHODS: Survey of patients (age range: 14-60 years) suffering from macular or tapetoretinal degeneration with no additional relevant handicap using a questionnaire. RESULTS: A total of 232 questionnaires were returned (62% of the questionnaires received by the participants). The results showed that if visual acuity dropped below 0.1, only 15% of the patients were able to ride a bicycle without accidents or near-accidents. This percentage increased for higher acuities between 33% (<0.2 > or = 0.1) and 67% (> or = 0.2 < or = 0.4). For visual field diameters <60 degrees and > or = 20 degrees approximately 18% were able to ride a bicycle safely and only 8% if the visual field diameter was below 20 degrees. For visual fields larger than 60 degrees diameter approximately 40% were able to ride a bicycle without problems. With a central scotoma of more than 10 degrees diameter only 21% of the patients could cycle safely, whereas with a central scotoma of 10 degrees and less this percentage increased to 47%. CONCLUSIONS: A visual acuity of less than 0.1 is not sufficient to ride a bicycle, and a visual acuity of less than 0.2 leads to a higher accident rate. A visual field diameter of less than 60 degrees or a central scotoma of more than 10 degrees diameter for the vast majority of patients does not allow safe cycling
Abstract Much has been written concerning the difficulties faced by visually handicapped persons when they access the internet. To solve some of the problems and to make web pages more accessible, we developed a tool we call the "Easy Bar," which works as a toolbar on the web browser. The functions of the Easy Bar are to change the size of web texts and images, to adjust the color, and to clear cached data that is automatically saved by the web browser. These functions are executed with ease by clicking buttons and operating a pull-down list. Since the icons built into Easy Bar are quite large, it is not necessary for the user to deal with delicate operations. The functions of Easy Bar run on any web page without increasing the processing time. For the visually handicapped, Easy Bar would contribute greatly to improved web accessibility to medical information.
In a nationwide survey on liveborn very preterm and/or very low birthweight infants in The Netherlands, mortality and handicaps at the corrected age of 2 years were studied in infants born to mothers with or without hypertensive disorders during pregnancy. The neonatal and in-hospital mortality was significantly lower in infants born to hypertensive mothers. In surviving infants, a similar handicap rate was found at the corrected age of 2 years for both groups.
Integrated control systems allow disabled people access to multiple functions from a single input device (for example a set of switches). Multiply handicapped users are thereby able to switch efficiently between wheelchair control, communication, computer access and control of their environment, without third-party help. Integrated systems have been developed for multiply handicapped children and adults in the Barnsley area. The design philosophy has concentrated upon utilizing, wherever possible, commercially available assistance devices and remotely controlling these via logic-based integrated control systems tailored to the needs and abilities of the individual client. This approach presents few problems as the inputs to commercially available devices are often based on simple switch control. The systems already supplied have proved, after an initial training period, to be easy to operate and have led to a considerable improvement in quality of life for the users. Computer-based, wheelchair-mounted integrated systems are now being developed. A prototype system currently emulates the logic-based controllers described above, employing the screen to display information on the current status of the system. Future development will move toward a more flexible system which will be able to read a variety of input signals and control a large number of outputs. The system will also have the facility to utilize software-based communications, keyboard emulation and environmental control packages as well as business and education software. Such a system could be easily set up, via software, for use by any disabled person.
We have photorefracted 360 infants and children of ages 2 months to 5 years from and around Tompkins County, New York, who were free of any obvious ocular pathology. From these studies we have established 95% confidence limits for largest cylinder, largest sphere, and spherical and cylindrical differences between eyes as a function of age. Using this normal data we have begun to photorefract handicapped children from special childrens' centers in and around Tompkins County. Our preliminary data indicate a higher prevalance (greater than 4 X ) of refractive anomalies in handicapped children, as compared to normal children, even when allowance for ocular pathology is made.
Urinary incontinence is a common symptom encountered in the elderly. To measure the handicaps associated with urinary incontinence due to detrusor instability an instrument consisting of 17 questions (Urinary Incontinence Handicap Inventory (UIHI)) was developed and validated in thirty elderly women. The results show that the instrument has a high Cronbach alpha coefficient (0.87) and high test-to-retest reliability (0.99, P < 0.0001). The total score on the UIHI correlates significantly with the results on the visual analogue scales representing perception of distress felt by the individual (r = 0.91, P < 0.0001) and the severity of the symptom r = 0.78, P < 0.0001).
The current DHSS guidelines on immunisation against hepatitis B in mental handicap hospitals recommend vaccination for personnel at risk directly involved in patient care (who may have direct contact with patients or their body fluids) and for new admissions into institutions where the incidence is known to be high. We report a serological survey of hepatitis B markers in over 99% of the residents of a large mental handicap hospital. Of 720 patients tested only one carried hepatitis surface antigen. This patient was anti-HBe positive. Only 4.5% of the residents carried any hepatitis marker. These results do not suggest the need for a local vaccination programme for patients or staff.
Current approaches to the assessment of intellectual level and functional ability with intellectually handicapped persons are focussing on information processing measures, rather than standardized power measures such as I.Q. The present study involves an examination of cognitive processing ability as defined by the information-integration model, and its relationship to success on a set of work samples, the latter having been defined as good predictors of later work success. Following the assessment of 50 intellectually handicapped adults, it was concluded that the basic tenets of information-integration theory are supported in this population, and that successive processing ability, as opposed to simultaneous processing or planning, has much to do with successful work sample performance. Results are discussed in terms of their implication for program planning and vocational training.
The purpose of this study was to determine the availability of and need for pediatricians specifically trained in the diagnosis and care of children with developmental disorders and/or other chronic handicapping conditions. Questionnaires were sent to department chairmen of 260 pediatric residency programs. Results of the survey are presented. On the basis of 73% responses, it is concluded that a need for pediatricians trained in developmental disorders and/or other chronic handicapping conditions exists. There were at the time of the study 32 open positions for pediatricians with such training. Eighty-four pediatric residents were interested in a fellowship and an additional 79 were considering it.
This article reviews a broad range of clinical and research material investigating the coping processes of individuals and families, particularly in response to a serious illness or handicapping condition in a child family member. The interactive effects of family and illness are established; then several theoretical, descriptive and empirical theories of coping are presented. Coping responses of family members and the family unit as a whole to minor illness, to chronic illness and handicapping conditions, to childhood cancer, and to death in childhood are all discussed. The article concludes with a discussion of the implications and benefits for the physician and other health care professionals in adopting a family-oriented treatment approach.
This paper considers coping styles of mothers and fathers of handicapped children. Cautioning against stereotyping, the authors find that mothers and fathers differ in how they appraise and cope with the stress of rearing a developmentally disabled child. The need for systematic investigation of gender-related coping styles in families with handicapped children is discussed.
A large-scale community screening study is proposed for Kuwait, using a schedule based on the 1980 WHO Classification of Impairments, Disabilities and Handicaps. The needs for accurate prevalence data are reviewed from the standpoints of establishing aetiological patterns, pinpointing opportunities for prevention and furnishing a sound basis for planning in a country with a rapidly growing population and still-developing network of care services. A permanent mechanism for monitoring prevalence trends and service needs is proposed in the form of a Multidisciplinary Handicap Register. Details of these proposals and their feasibility are discussed in the light of previous work.
Health authorities in the U.K. have, in recent years, become increasingly aware of the financial costs of health care provision, and have sought ways in which such costs can be reduced without detriment to the service provided. This study estimates cost functions for the case of a large hospital treating the mentally handicapped. Factors which influence the variation of costs between wards in the same hospital include, inter alia, the age of the residents, the severity of their handicap and the number of residents living on the ward. Costs vary non-linearly with the latter of those variables, and so the possible existence of an optimal ward size emerges. The paper concludes with the estimation of this optimum, together with an examination of factors which might cause the optimal ward size to vary.