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PubMed1989

Impairment, disability and handicap in chronic respiratory illness.

Chronic obstructive airways disease (COAD) is a major, though neglected, medical and social problem in the United Kingdom today. Dyspnoea is one of the most distressing and disabling symptoms of COAD, which is itself the largest single cause of absence from work in the United Kingdom. 92 patients suffering from COAD were interviewed in order to assess impairment, disability and handicap. Measures included spirometric tests of lung function; the Fletcher breathlessness grading scale, the oxygen cost diagram and a visual analogue scale of dyspnoea; the Functional Limitations Profile (FLP); and the shortened 12 item General Health Questionnaire (GHQ-12), supplemented by the 7-item GHQ sub-scales of anxiety and severe depression. Low correlations were found between lung function and disability (-0.38, P less than 0.001), accounting for only 14% of the variance, and high correlations were found to exist between measures of dyspnoea and disability (-0.90, P less than 0.001). Major areas of disability and handicap included; household management, ambulation, sleep and rest, recreation and pastimes and work. Financial problems and difficulties, housing problems and problems of social isolation were also frequently reported. The paper goes on to discuss both the need for a more integrated approach to the care and rehabilitation of COAD patients and their families and for a complementary social perspective and approach to COAD and its treatment.

Persons with Disabilities↗
PubMed1992

Symptoms of impairment, disability and handicap in low back pain: a taxonomy.

The functional consequences on everyday living which result from chronic low back pain commonly require services which are difficult to access. This deficiency in meeting the needs of these patients is partially explained by inadequacies in clinical assessment. Medical evaluation may be exhaustive, but frequently the assessment of physical and psycho-social dysfunction at the personal and family level is inadequate. In low back pain, as with most chronic ailments, there is no agreed-upon taxonomy of the functional consequences of the disorder upon which to establish a comprehensive clinical appraisal. In this paper a taxonomy is presented for the impairments, disabilities and handicaps which result from chronic low back pain. The taxonomy has been based on data from a survey of 74 individuals with low back pain and is structured generally according to the International Classification of Impairments, Disabilities and Handicaps (WHO 1980). The taxonomy is proposed as a conceptual framework and vocabulary for both clinical practice and research. The taxonomy is not a measurement instrument nor does it indicate the frequency of occurrence of disabilities. A classification is basic to the advancement of scientific understanding, and usage of a standard vocabulary such as this plays an important role in establishing a responsive health service capable of meeting the needs of the population with chronic low back pain.

Activities of Daily Living↗
PubMedDate not supplied

Hearing abilities of Down syndrome and other mentally handicapped adolescents.

Down syndrome (DS) individuals are prone to auditory processing difficulties in a variety of audiological, short-term memory, and language tasks. The present study explored: (a) the hearing capabilities of DS adolescents and young adults relative to a sample of non-DS mentally handicapped (MH) individuals, and (b) the relationship between hearing ability and performance on several cognitive tasks. Samples of 26 DS and 26 MH trainable mentally handicapped individuals were matched on IQ and chronological age (CA). Audiometric data revealed greater hearing losses in DS than in MH individuals at five of the six tested frequencies, more DS conductive and mixed hearing losses, and particularly high DS losses in the high-frequency range. Measurement of the speech reception threshold revealed poorer reception of speech by the DS than the MH group. Classification of tympanograms indicated fewer normal ears and twice as many DS ears with middle ear problems reflecting no mobility or retraction of the tympanic membrane. Presence of DS middle ear difficulties was also confirmed by poorer elicitation of the acoustic (stapedius) reflex in DS subjects. Correlation of hearing variables with seven cognitive tasks administered on the same day revealed only one significant relationship after the statistical removal of the effects of CA and IQ: DS subjects with poorer hearing identified fewer words in a task in which a masking noise quickly followed a spoken word. This result suggests that group findings of DS auditory-verbal processing difficulties stem, in part, from subjects with hearing difficulties needing more time to identify spoken words.

Adolescent↗
PubMed1995

[Handicaps and the perinatal period. II. Perinatal pathology and severe deficiencies].

BACKGROUND: In the last two decades, the infant mortality rate has dramatically declined. But improved management of newborns may induce an increased prevalence of neurodevelopmental handicaps. The aim of this paper is to estimate the rate of major disabilities and their relationships to perinatal events. POPULATION AND METHODS: Three hundred and sixteen children born in 1984 and registered by the "Commission Départementale de l'Education Spéciale" (CDES) were included in the study. Among these, 97 had either cerebral palsy, blindness, deafness, or mental retardation. These 97 children were compared to 602 school age controls using a multivariate analysis (logistic regression). RESULTS: The rate of major disabilities among the 6-year old children is 3.4/1000. It was 5/1000 in 1972 and 4.3/1000 in 1976. This frequency is higher in the children who were preterm (odds ratio--OR = 4.8), small for gestational age (OR = 3.3) or suffered from perinatal asphyxia (OR = 32.8). These three factors accounted for 37.4% of major disabilities. CONCLUSION: This study emphasizes the relationships between perinatal events and some major handicaps but also shows that antenatal factors may be involved in neurodevelopmental problems.

Asphyxia Neonatorum↗
PubMed2005

Perceived qualitative benefits of cochlear implants in children with multi-handicaps.

OBJECTIVE: To determine families' perceived benefits of cochlear implants in children with multiple-handicaps. METHODS: Parents/guardians of a child with a cochlear implant for at least 3 months, under the age of 18 years and had least one additional disability were recruited for participation through rehabilitation therapists. Families who did not have a child enrolled in therapy at the study center were contacted by mail. Families were asked a number of open-ended and close-ended questions. Interviews were audiotaped and transcribed, with answers to open-ended questions coded by themes. RESULTS: We interviewed 19 families of 20 children and included 15 families of 16 children who had had at least 6 months of cochlear implant experience for this study. The mean time between implantation and study was 3 years (S.D.+/-2.2) with a range of 0.5-8 years. Children were highly compliant in wearing their device. Sixty-eight percent (11/16) of the children were enrolled in additional therapies beyond speech and aural rehabilitation therapies. Fifty percent of families (8/16) indicated they had no obstacles to accessing therapies. Insurance was the most common barrier to accessing therapies (18% of respondents). All children made communication progress post-implant as described by their families. All families felt that the cochlear implant team provided enough information prior to receiving the implant to help families make the appropriate decision about implanting their child. All families said that if they were to make the decision again, they would choose to have their child implanted. CONCLUSION: More children with multiple-handicaps are receiving cochlear implants. Very young children may undergo cochlear implantation only to be subsequently diagnosed with an additional impairment or disability at later ages. As a result, it is important to understand the specific needs of this population and the parental perceptions of benefit in order to provide the best services and opportunities for success with a cochlear implant. Although not all of the children gained gold standard speech and language outcomes, all children broadened their communication skills. In motivated families of children with additional disabilities, it is appropriate to provide them with the same opportunity to access audition and expand their communication abilities as any other child with a hearing impairment.

Awareness↗
PubMed2004

An investigation of the Voice Handicap Index with speakers of Portuguese: preliminary data.

Although the Voice Handicap Index (VHI) has been recognized as a useful tool for quantifying American English speakers' perceived consequences of voice disorder, it has not yet been widely applied in the clinic to study dysphonic patient populations, or tested with a normally speaking population. The purpose of this investigation was to obtain information about the VHI in a group of Portuguese speakers with voice complaints compared with an age- and gender-matched group of speakers without voice complaints. The results demonstrate that speakers with voice complaints have overall VHI total scores significantly higher than speakers without voice complaints (p < 0.001). This is also true for all VHI subscores in the emotional (p < 0.001), functional (p < 0.05), and physical (p < 0.001) domains. So, the assumption that a group with voice complaints has higher voice handicap impact than the matched control comparison group is justified for Portuguese speakers.

Adult↗
PubMed2005

Applying the Voice Handicap Index (VHI) to dysphonic and nondysphonic Hebrew speakers.

OBJECTIVE: To evaluate a translated version of the Voice Handicap Index (VHI) as a diagnostic tool for people with and without a laryngeal pathology, among Hebrew speakers. STUDY DESIGN: Parallel group design. METHODS: The VHI was translated and adapted to Hebrew. The translated version was, then, administered to a group of 182 patients with various laryngeal pathologies and a control group of 171 people with no laryngeal pathology. Based on the participants' responses to the VHI, statistical analyses were, initially, performed to assess validity and reliability, and then to evaluate group differences between the pathological and control groups and among the different pathological groups included in the study. RESULTS: Statistical analyses showed high reliability values of the Hebrew version of the VHI (overall Cronbach's alpha r = 0.976). Participants' scores were not affected by their age (P = 0.156) or gender (P = 0.261). The participants in the control group obtained significantly lower scores on the overall VHI score, as well as on all three subscale scores, in comparison with the pathological group (P < 0.001). In addition, within the pathological group, patients with neurogenic pathologies received higher scores than all other pathological groups, whereas patients with laryngeal inflammation received lower scores than all other pathological groups (P < 0.05). CONCLUSION: The VHI is a powerful tool for quantifying patients' perceptions of their voice handicaps, and it maintained its power across translation. The VHI was shown to be valuable for the assessment of speakers with, as well as without laryngeal pathologies.

Adolescent↗
PubMed2005

Male reproductive physiology as a sexually selected handicap? Erectile dysfunction is correlated with general health and health prognosis and may have evolved as a marker of poor phenotypic quality.

Many extravagant physical traits are selected because they are used as cues for mate choice (sexual selection). Why is mate choice driven by costly ornaments? A theory of sexual selection posits that extravagant traits are preferred because are reliable indicators of superior (heritable) phenotypic quality. In particular, the preferred traits can be expressed only in individuals with superior conditions because are handicaps which impose a high cost to the carrier. The human penis achieves its reproductive function by the complex neuro-vascular mechanisms that controls erection. Surprisingly, erectile dysfunction and infertility, two condition which nearly annihilate fitness, are widespread medical conditions which affect millions of people of any age worldwide. The very high incidence of erectile dysfunction appears as an evolutionary paradox. Impotence is associated with all major systemic diseases as well depression and stress. Stress is also one of the causes of infertility. Therefore, male reproduction appears to be extremely sensitive to internal and external stressors. Moreover, erectile dysfunction is a predictor of myocardial infarction and stroke, whereas men with regular sexual activity have lower risk of death due to coronary disease. This large body of medical literature makes erection the best case for a fitness indicator in the human male. We suggest that the fragility of male sexual physiology observed in modern society is the specific consequence of an evolutionary process driven by the handicap principle.

Animals↗
PubMed1987

The second individuation process in handicapped adolescents.

Blos has conceptualized adolescence as the stage when a second process of separation individuation takes place. It is assumed that maturational processes like physical and sexual development combined with higher levels of thinking play a dominant role in this process enabling the disengagement of the adolescent from the family. Various handicapping conditions may force the adolescent to stay closer to his/her family and hence interfere with the adolescent's separation-individuation. It is suggested that the nature of the interference will vary depending on whether the handicap is physical or cognitive. Both conditions appear to have differential effects on the separation individuation process. The influences of various parental attitudes are also discussed.

Adolescent↗
PubMed2003

Language development of a multiply handicapped child after cochlear implantation.

The presence of additional handicaps in hearing-impaired children makes the prediction of language ability after cochlear implantation unreliable. Only limited follow-up data on developmental improvement after implantation among multiply handicapped children is available. The present study reports the course of development (audiological and linguistic) after cochlear implantation in one subject with moderate mental retardation. Preoperatively, his language development showed 34 months delay when compared to chronological age. The difference had shortened to 23 months by 2 years post-surgery. The subject's cognitive delay had not changed upon 2-year follow-up. The cochlear implant can be credited to his improvement in language development.

Child↗
PubMed1999

Causes of hearing impairment in deaf pupils with a mental handicap.

An aetiological study was performed on 122 deaf pupils (57 aged < 20 years, 65 aged > 20 years) at the Institute for the Deaf in Sint-Michielsgestel, The Netherlands. Besides hearing impairment with thresholds of > 60 dB HL, all the participants had a mental handicap with a non-verbal IQ of 40-80. Sixteen per cent of them were of non-Dutch origin. The cause of hearing impairment was acquired in 48%, inherited in 17%, chromosomal in 4% and unknown in 30%. In comparison with other studies on the aetiology of childhood deafness, acquired causes predominated over inherited causes, which may be typical of deafness combined with a mental handicap. We found a significant predominance of non-Dutch pupils among the rubella aetiology cases and male predominance among the hearing impaired pupils in general.

Adolescent↗
PubMed2000

Performance of multiply handicapped children using cochlear implants.

OBJECTIVE: To explore the possibility of expanding implantation guidelines to include the multiply handicapped population and to determine the pattern of development of perceptual skills in deaf children who have other impairments. PATIENTS AND SETTING: The study group consisted of 31 profoundly deaf children with documented impairments in addition to deafness who were consecutively implanted. Twenty-nine of the children underwent implantation and were followed at NYU Medical Center for at least 1 year. INTERVENTIONS AND MAIN OUTCOME MEASURES: Routine audiometric measurements and closed- and open-set measures of speech perception were performed at the phoneme, word, and sentence level pre- and postoperatively. Analyses of variance were performed when possible. RESULTS: The study population showed substantial improvement after implantation in the ability to perceive phonemes, words, and sentences using audition alone. CONCLUSIONS: Multiply handicapped children obtain demonstrable benefit from cochlear implantation, with no increase in surgical complications, although the rate of growth of perceptual skills is slower than for deaf child with no additional complicating factors.

Audiometry, Pure-Tone↗
PubMedDate not supplied

Perception of hearing loss and hearing handicap on hearing aid use by nursing home residents.

The purpose of this study was to examine the perception of hearing loss and self-assessed hearing handicap on hearing aid use by nursing home residents. Sixty elderly individuals who had a hearing loss and wore hearing aids were given the Nursing Home Hearing Handicap Index and were asked specific questions related to hearing aid use. The overall results indicated that there was a moderate correlation among all three variables. It was determined that nursing home residents consistently use their hearing aids. However, amplification does not address all the communication needs of the nursing home resident. Assistive listening devices and environmental modification would improve communication ability and the quality of life of the nursing home resident.

Aged↗
PubMed2004

Bone quantitative ultrasound and nutritional status in severely handicapped institutionalized children and adolescents.

BACKGROUND & AIMS: Children with cerebral palsy (CP) have a high prevalence of pathologic fractures. Bone quantitative ultrasonography (QUS) has emerged as a radiation-free method for the assessment of bone quality and fracture risk. In this study, we applied QUS technique in order to investigate bone status in handicapped institutionalized children and adolescents. METHODS: This cross-sectional study included 87 handicapped institutionalized patients. Measurements of the velocity of ultrasound wave, speed of sound (SOS), at distal radius and midshaft tibia, were performed using Omnisense 7000S analyser (Sunlight Ltd., Tel Aviv, Israel). In addition, all the participants had a thorough evaluation of nutritional status, demographic and clinical characteristics. RESULTS: Forty-five of patients had either radius or tibia bone SOS lower than -1 SD, and 21% had either radius or tibia bone SOS lower than -2.5 SD. Using step-wise regression analysis, female gender (P=0.003) and stature (P=0.008) were correlated with radius SOS. Age (P=0.03) and fracture history (P=0.04) were negatively correlated with tibia SOS. CONCLUSION: In this group of children and adolescents with CP one-fifth had poor bone status as suggested by low tibia/radius SOS assessed by QUS. Female gender, stature, age and fracture history were significantly correlated with poor bone status.

Adolescent↗
PubMed1990

Diagnosing handicap using the behaviour of the fetus.

The study of fetal behaviour may have important implications for the prenatal diagnosis of handicap. Since behaviour reflects the integrity of the fetal neural system the examination of fetal behaviour enables neurological assessment of the fetus. This paper discusses present methods of assessing fetal well-being and their shortfalls and then considers current research using behaviour to identify the compromised fetus. Studies using both spontaneous and elicited fetal behaviour are discussed. The paper concludes that a greater understanding of fetal behaviour promises great advances in the antenatal detection of handicap or fetal compromise and may enable midwives to become more involved in the assessment of fetal well-being.

Embryonic and Fetal Development↗
PubMed1986

An eco-behavioral analysis of small community-based houses and traditional large hospitals for severely and profoundly mentally handicapped adults.

Recently, much interest has centered on the transfer of mentally handicapped people from institutions to other settings. Most studies in this area have focused indirectly on the behavior of the mentally retarded client, usually measured intermittently by global assessments such as the American Association On Mental Deficiency's Adaptive Behavior Scale. In contrast, the present study combined these indirect measures with direct continuous observation of each subject. In doing so, it examined the effects of such a transfer to small community-based homes on the behavioral functioning of severely and profoundly mentally handicapped adults. In addition, staff activity, in terms both of providing opportunities for engagement in activity and of consequating client behavior, was also measured. Two comparisons were made, those being between a group of clients in a small home and a comparable group in institutions and between the latter group when in the institutions and after having moved to a small home. Results show increased client functioning in the small homes, particularly in domestic activity and interaction with staff, and a markedly higher level of staff provision of opportunity to engage in activities. The results are discussed in terms of size, design, staff-client ratio, and staff training in small community-based residential services. The need for more research on the determination of staff performances is highlighted.

Activities of Daily Living↗
PubMed2001

Consequences of disease: testing the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH) model.

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) model proposes that there are three consequences of disease, impairment (I), disability (D) and handicap (H) and that they are sequentially related. This paper examines first, whether I, D and H can be measured independently and second, whether there is support for the sequential or causal relationship between the three constructs. Cross-sectional data from a representative sample of 101 disabled adults and longitudinal data from 108 myocardial infarction (MI) and 68 Stroke patients were used. Standard measures of I were used for each clinical condition. Measures of D and H were derived from the British version of the Sickness Impact Profile (SIP) and additional measures of D were available for the Stroke group. Judges classified SIP items according to ICIDH definitions of D and H. Correlation, Confirmatory Factor Analyses and Path Analyses were used to examine the main hypotheses. Valid measures of D and H were derived and there was evidence of separation of the three constructs for the Stroke patients but not for the other groups. For both Stroke and MI, I was not predictive of D and H. For Stroke, the best path model included a path from D to H, but not from H to D and this was found for self-report and performance measures of D. Using these measures, the ICIDH model was supported in that D predicted H for stroke, but there was no support for a path between I and D or between I and H. Further it was not always possible to distinguish the three constructs. Possible limitations in the measures and in the ICIDH model as a testable scientific model are discussed.

Activities of Daily Living↗
PubMed1988

The elderly, disabled and handicapped adult burned through abuse and neglect.

A retrospective review of 1152 acute burns treated at the University of Michigan Burn Center during the past 5.5 years identified 26 adult patients in whom abuse and neglect was suspected. These patients, 12 females and 14 males, had an average age of 42 years and average total body area burn (TBA) of 18 per cent. Eight of these cases were in situations in which the question of inflicted injury was raised and 18 were in situations of neglect and/or improper supervision. Seven (27 per cent) died from their injury. All of these adults were either very old, mentally impaired, and/or physically handicapped. Twenty-three were burned in health care facilities or institutions. Adult abuse in the elderly, handicapped and disabled population is similar to that found in child abuse and includes characteristic burn patterns, a story that does not fit the injury, and a delay in seeking medical care. An increased awareness of the problem is necessary for improved diagnosis and management of these patients.

Adult↗