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At least 991 records · Page 55Linked to original sources
PubMed2000

Melatonin for the treatment of handicapped children with severe sleep disorders.

Sleep disorders are common in children with mental retardation and neurologic disorders. Melatonin, a recently developed natural compound, has been used successfully in sleep disorders. I report my experience with melatonin in an open, prospective trial to treat circadian rhythm sleep disorder in handicapped children. The sleep disorder had been present for at least 6 months and had not responded to at least one hypnotic drug. The therapeutic response was recorded according to the average number of hours asleep per 24 hours, average number of awakening per night, average number of nights with delayed sleep onset, and average number of nights with early morning arousals. Ten consecutive children (four males, six females; age range = 1-11 years, mean 5.4) were included. Nine children had documented mental retardation that was severe in six (67%). Most had epilepsy and visual impairment (70%). All children were monitored for 4-12 months (mean 7.5 months) after the initiation of 3-mg bedtime melatonin. Most (80%) had a dramatic response to melatonin. No side effects were reported. Melatonin is a well-tolerated, safe, relatively inexpensive, and effective drug, with minimal side effects, for the treatment of severe circadian rhythm sleep disorder in handicapped children. Wider use of this drug is recommended.

Child↗
PubMedDate not supplied

Handicap-related problems in mothers of children with physical impairments.

An inventory was developed for the measurement of handicap-related problems experienced by mothers of children with chronic physical conditions and an initial evaluation of its psychometric properties was completed in a sample of 119 mothers of children with physical or sensory impairments. Principal component analysis of the Handicap-related Problems for Parents Inventory (HPPI) yielded three subscales, which accounted for 54% of the total variance. The HPPI demonstrated excellent internal consistency for each scale and total score. It also generally had good test-retest reliability over 6-, 12-, and 18-month periods. There was minimal covariation between HPPI scores and demographic status. Concurrent validity was demonstrated by significant correlations between appropriate HPPI scales and measures of daily stress and the child's physical condition or disability status. Support for its construct validity was obtained when expected convergent and discriminant relationships were confirmed between HPPI scales and measures of maternal adaptation, maternal social support, and child behavior problems. Among other results, HPPI scores predicted maternal adaptation 18 months later. The potential uses of the HPPI in research and intervention with mothers of children with chronic physical conditions were discussed.

Adaptation, Psychological↗
PubMed1997

Disability and handicap 5 years after a head injury: a population-based study.

A population-based cohort of 407 head trauma patients has been studied since 1986 to estimate the prevalence of long-term disabilities and handicaps by means of a structured questionnaire. Five years later, 6-1 patients were deceased and 36 were lost to follow-up. Prevalence of subjective and behavioral complaints was high whatever the initial head trauma severity. Lethality in severe head injuries was 56%, and half of the survivors remained disabled. In minor and moderate head injured patients, most disabilities were related to extracranial injuries. Taking all disabilities into consideration, each year 24 per 100,000 patients of such a population are likely to suffer from at least one long-lasting disability, including 10 per 100,000 whose disabilities are due to extracranial injuries. Head injuries induce long-lasting handicap in 9 per 100,000 habitants which is severe in 2 per 100,000. These figures point to the need of reinforcing preventive actions and long-term care of these patients.

Abbreviated Injury Scale↗
PubMed1997

[Socio-educational management of children with genetic handicaps. I. Basic principles].

The authors describe the main characteristics of the educative management of the child with a handicap related to a genetic disease. The educative management must be started early, in parallel with the diagnosis procedures and medical management, and adapted to the nature of the handicap and the age. The best answer to the child's needs requires an individualized educative programme, collectively settled with the different professionals working with the child and the parents, taking into account its deficits and abilities, established for a given period of time, and regularly adapted according to the evolution.

Child↗
PubMed1988

Antenatal and perinatal causes of handicap: definitions and size of the problem.

The conditions of childhood that follow prenatal or perinatal problems are defined. These conditions are mental retardation in varying degree, the cerebral palsies, the syndrome of minimal cerebral dysfunction, language disorders and defects of hearing and vision. The difficulties in accurately measuring disability and handicap are discussed and an estimate of the size of the problem is offered. The contribution made by the low birthweight group is also considered and it is pointed out that, although within this group there is a much higher incidence of problems, the majority of children with handicapping conditions were of normal birthweight.

Cerebral Palsy↗
PubMed1988

Genetic causes of mental handicap and opportunities for prevention.

Prior to 1970 nearly one half of severe mental handicap (IQ less than 50) was unexplained and genetic causes were recognized in one third of all patients. In recent years the genetic contribution has risen to 50%, with the decline in importance of environmental causes and the growing recognition of X-linked forms of mental retardation and chromosomal microdeletion syndromes. Recognition of genetic conditions is vital for accurate assessment of recurrence risks and in order, in some instances, to provide specific prenatal diagnosis. With full utilization of existing prenatal screening procedures and a more detailed family history, severe mental handicap due to genetic conditions should be reduced by 30-40%.

Brain↗
PubMed1988

Infection of the fetus and the newborn: prevention, treatment and related handicap.

Congenital infection is uncommon and the cause of only a small proportion of handicap seen in children but some infections may be preventable or even treatable. As an example, the congenital rubella syndrome first described in the 1940s is preventable by use of the vaccine but cases still occur. It is hoped that with the introduction of the measles, mumps, rubella immunization for young children, rubella will become as rare in the UK as it is in the USA. Cytomegalovirus is now a more common cause of handicap than rubella but no vaccine has been developed. Although antiviral drugs are available for herpes simplex virus and vaccinia, infection mortality in the newborn is high, even following the use of these agents; many HSV infections in the newborn arise following primary and asymptomatic maternal infections so that treatment may start late in the course of the illness. The obstetrician needs to understand the natural history as well as possible investigations available for congenital infections. There may be warning signs which require action, such as herpetic lesions in the genital tract of the mother. Less specific abnormalities during pregnancy, such as intra-uterine growth retardation and spontaneous onset of preterm labour, may point to congenital infection. This chapter describes both antenatal and postnatal management of the major congenital infections. We have included recent research data that should influence clinical practice; studies on HSV which suggest that, for women with a history of recurrent infection, routine viral culture of the genital tract at the end of pregnancy is unnecessary; reports from both the USA and the UK that rubella immunization performed inadvertently during early pregnancy has not resulted in the congenital rubella syndrome. The chapter would not have been complete without a discussion of human immunodeficiency virus, of concern to the obstetrician and midwife. There is still much to be learned about the natural history of this infection in both the mother and infant.

Chickenpox↗
PubMed1988

Abnormal antenatal ultrasound findings and subsequent handicap.

The modern ultrasound technique in its various modes, real-time B-mode, M-mode, continuous and pulsed wave Doppler ultrasound, makes it possible to study in detail the fetal anatomy and function in utero. Fetometry allows for the evaluation of fetal size and growth and for detecting growth-retarded or macrosomic fetuses. Ultrasound seems, at present, to be the best method available in the detection of the growth-retarded fetus who is at risk of developing perinatal complications and subsequent handicap. Ultrasound can also be used when fetal growth retardation is suspected on clinical grounds. An absolute prerequisite for the proper use of ultrasound fetometry is the estimation of gestational age in early pregnancy. The high resolution of modern ultrasound scanners allows the antenatal detection of even minor fetal structural abnormalities. When lethal malformations are detected early in pregnancy, selective termination of pregnancy can be considered. Fetal abnormality detected in late pregnancy allows for optimal timing and mode of delivery leading to improved management and outcome, thus lowering the risks of subsequent handicap. Ultrasound examination of the extrafetal structures, e.g. umbilical cord, placenta and amniotic fluid volume, may add valuable clinical information. The finding of severe oligohydramnios is associated with increased perinatal mortality and morbidity. Fetal circulation can be evaluated by using the combination of real-time and pulsed Doppler ultrasound or, alternatively, by employing continuous wave Doppler ultrasound alone. Pathological changes in the blood velocity waveforms recorded from the fetal and umbilical arteries may signify very early signs of fetal hypoxia. The method has the potential of becoming a useful clinical method for fetal surveillance. The guidelines for a proper application in the perinatal medicine of the Doppler method have, however, not yet been established. In fetuses with cardiac arrhythmia and/or cardiac malformation, the Doppler investigation of the fetal circulation can be used to evaluate the haemodynamic alterations and, in cases of intrauterine treatment, to supervise and monitor the therapeutic effects. Fetal motor function can be followed and quantified with real-time ultrasound. Abnormal motor activity might indicate bad perinatal outcome. The predictive capacity of the test is increased when several variables are combined (e.g. the fetal biophysical profile score).(ABSTRACT TRUNCATED AT 400 WORDS)

Chromosome Aberrations↗
PubMed1991

An audit into the incidence of handicap after unilateral radical neck dissection.

Forty-six patients who had undergone a radical neck dissection more than six months previously were assessed to determine the degree of handicap that results from division of the accessory nerve. Employment problems, amount of pain, and social and recreational difficulties were assessed. Forty-six per cent of those in employment prior to their operation gave up their work specifically because of problems with their shoulder; this affected more manual than non-manual workers (11 out of 20 manual compared with zero out of four non-manual). Thirty per cent complained of moderately severe or severe pain related to the shoulder. The amount of pain could not be correlated with age, sex, side of operation in relation to handedness, physical build of the patient, or whether the patient had been treated with radiotherapy. Although this is the largest study to address this question since that of Ewing and Martin in 1952, the small numbers involved mean that if any such correlation exists then it may not have become apparent. In view of this incidence of pain and occupational handicap, we feel that efforts should be made to preserve accessory nerve function in cases where surgical clearance of the tumour field is not compromised as a result.

Accessory Nerve↗
PubMed1995

The cost of the Swedish handicap service system. Implications for technology assessment.

The total cost of the Swedish handicap system is estimated at US $10.7 billion for 1989. The cost is distributed across different authorities with separate legal and financial responsibility. The concept of technology must be extended to include consideration of both the resources spent and benefits gained in the public sector and the magnitude and distribution of transfer payments from social insurance to fulfill its function in handicap policy decision making.

Costs and Cost Analysis↗
PubMed1985

On the self-serving function of social anxiety: shyness as a self-handicapping strategy.

We tested the hypothesis that socially anxious or shy individuals use their anxiety symptoms as a strategy to control attributions made about their performances in social-evaluative settings (i.e., self-handicapping strategies). Specifically, we predicted that trait-socially anxious or shy persons would report more symptoms of social anxiety in an evaluative setting in which anxiety or shyness could serve as an excuse for poor performance than would individuals in (a) an evaluative setting in which shyness was precluded as an excuse or (b) a nonevaluative setting. Furthermore, we predicted that this self-protective pattern of symptom reporting would not occur for individuals who were not trait-socially anxious because these persons would not commonly use such symptoms as a self-handicapping strategy. Results supported these predictions for male subjects, but not for female subjects. Sex differences in the strategic use of shyness are discussed in relation to other research on sex differences in the etiology and correlates of social anxiety.

Anxiety↗
PubMed1985

Adler's psychology (of use) today: personal history of traumatic life events as a self-handicapping strategy.

We investigated the hypothesis that the reporting of a history of traumatic life events may serve as a strategy to control attributions about performance in an evaluative setting (i.e., self-handicapping). Following from Alfred Adler's early theorization in the psychology of use, as well as more recent theory and research on self-handicapping, we predicted that individuals would emphasize the adversity of events and experiences in their background when an uncertain evaluation was expected and when a traumatic background would serve as a suitable excuse for potential failure. Results generally supported the hypothesized self-protective reporting of traumatic life events.

Achievement↗
PubMed1991

Psychosomatic symptoms in medical outpatients: an investigation of self-handicapping theory.

Investigated self-handicapping theory as it relates to somatization in medical patients. We predicted that medical outpatients (N = 113) would report psychosomatic symptoms in response to events that threaten their self-esteem. As predicted, results of hierarchical multiple regression indicated that high-perfectionism patients reported somatic symptoms positively related to the number of events that jeopardize their sense of accomplishment, whereas low-perfectionism patients' somatic symptoms were not related to these events (p = .005). Contrary to prediction, high-dependency patients did not differ significantly from low-dependency patients in the relationship of somatic symptoms and events that threatened their interpersonal relationships (p = .115). Implications of these findings and the utility of self-handicapping theory for predicting somatization in medical patients are discussed.

Adult↗
PubMed1993

Stress in immigrant families with handicapped children: a child advocacy approach.

Poor immigrant families must cope with stress stemming from loss of home and adaptation to the host country. Those with handicapped children are also burdened with a parallel set of stressors in adapting to the handicap in an alien environment that may include a complex service system. Implications for practice are discussed with particular emphasis on advocacy to enhance delivery of services.

Child↗
PubMed1989

Preferential looking in the mentally handicapped.

We have assessed the feasibility of Preferential Looking (PL), using Teller Acuity Cards, for the estimation of binocular and monocular visual acuities in a group of mentally handicapped adults. Our results show the comparison between grating and recognition acuities, inter-observer variation, success rate, time taken and the sensitivity of this method in identifying monocular visual deficit in this group of subjects. The reasons for success or failure with PL methods in relation to criteria for mental handicap are discussed.

Adult↗
PubMed1995

Comparison of visual assessment tests in multiply handicapped children.

The aims of this study were to compare acuity estimates achieved with visual evoked potential (VEP) and acuity card techniques and to examine the success rates of each test in a group of multiply handicapped children. Subjects were 52 children (3-183 months) with multiple handicaps associated with prematurity (n = 17), congenital anomalies (n = 16), hypoxic insult (n = 10) and other disorders (n = 9). Success rates for completing the tests were: VEP 88% and acuity cards 85% (Keeler or Cardiff). The acuity card tests were less likely to be successfully completed in the severely disabled (p < 0.05) and in those children with nystagmus (p < 0.05). When both acuity cards were successful, results agreed to within +/- 1.75 octaves. Acuity card thresholds were significantly correlated with VEP thresholds (p < 0.02), but thresholds achieved with VEPs were better in children with poor vision.

Adolescent↗
PubMed1992

A survey of complete denture prosthetics for the elderly, the handicapped and difficult patients.

A survey was carried out to establish information on the facilities and management of the elderly and the handicapped and to evaluate the treatment of the difficult edentulous patient in general dental practice. A postal questionnaire was sent to a total of 1090 dentists in three regions of England and Wales. There was a 50.4% response. Ninety-nine per cent of practitioners were able to treat the ambulant elderly, whereas only 72% offered treatment if the patient was wheelchair dependent. Ninety-six per cent of all respondents undertook domiciliary visits. All practitioners provided prosthetic treatment (complete and partial dentures) for the elderly, whereas fewer felt able to treat the physically and the mentally handicapped. There was less conservative and periodontal treatment provided than prosthetic treatment. A similar pattern was obtained in all three regions. Forty-seven per cent preferred to treat difficult complete denture patients privately, 44% under the NHS and 6% not at all. There were regional variations in the referral patterns of these difficult denture cases. The majority of respondents considered that there should be more opportunities for postgraduate education in prosthetic dentistry.

Aged↗
PubMed1996

The use of general anaesthesia for tooth extraction in young handicapped adults in France.

The anaesthetic management of handicapped young adults is often difficult. However, few examples were found in the literature that attempted to specifically measure the frequency of general anaesthesia in the dental treatment of this group of patients. This paper focuses on the management of mentally or physically handicapped young patients undergoing extractions at a specialist dental service in Southern France. A survey of 184 young patients treated during a 39-month period, either under general (34 cases) or local (150 cases) anaesthesia was carried out. A minimum one-year follow-up period was used for each patient. The main characteristics of the patients who received general or local anaesthesia were compared and the factors which indicated the choice of general rather than local anaesthesia were assessed. This study attempts to define precise selection criteria, including dental and non-dental factors. Limited past treatment history was found to be a strong indicator of the need for general anaesthesia. The results of this study suggest that non-dental background factors were also important. The need for general anaesthesia was markedly increased in the groups with severe behavioural disturbances or low levels of contact with the general dental practitioner. If provision of regular dental services for disabled young patients can significantly reduce the need for general anaesthesia, care will have to be taken in developing the relationships between the hospital and general dental practitioner.

Adult↗