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[Speech rehabilitation in aphasia in the concept of International Classification of Impairments, Disabilities and Handicaps (ICDH0)].

A neurogenic disorder of acquired speech, aphasia not only is a speech disorder but also implies restriction in communicative independence. In line with the WHO's principle of attending to the consequences of disease as well, speech rehabilitation has to deal not only with aphasia in terms of speech disorder (i.e., impairment) but also with aphasia in terms of communicative ability disorder (i.e., disability) as well as with aphasia in terms of psychosocial interference (i.e., handicap). Current speech therapy orientations can be assigned to these three dimensions and the need for these three levels of approach can be assessed accordingly in light of the course of the condition. Given the speech disorder's frequently limited amenability to therapeutic intervention, a psycholinguistics-communication oriented speech rehabilitation as well as counselling and psychologically focussed measures are increasingly relevant to enable a more appropriate response to reduced communicative independence and ensuing psychosocial handicaps.

Aphasia↗

Dental caries and oral hygiene amongst 12-14 years old handicapped children of Bombay, India.

The present study was carried out to assess the oral health status of children suffering from different handicapping conditions studying in various schools of Bombay. A total of 593 handicapped children in the age group of 12-14 years were included in the study. The prevalence and severity of dental caries was found to be highest in the cerebral palsy group and lowest in the blind group. In general, in all the groups the decayed (D) component took predominance over the missing (M) and filled (F) components. Periodontal status was assessed using the CPITN and it was found that the bleeding & calculus components were higher than the healthy components in all the groups and almost all the children required treatment in the form of deep scaling and/or prophylaxis and oral hygiene instructions. The study confirmed the need of curative and preventive services towards these neglected children of the society.

Adolescent↗

Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome.

This study assessed the test-retest reliability/repeatability and 95 percent confidence intervals (CIs) of the Tinnitus Handicap Inventory (THI) and developed categories for classifying self-perceived tinnitus handicap severity. Twenty-nine adults with tinnitus as their primary auditory complaint served as subjects. The THI was administered on two occasions (mean interval 20 days) using a paper-pencil format. Results support the contention that the THI is psychometrically robust. Specifically, the test-retest reliability/repeatability was high. Additionally, the 95 percent CI for the THI was 20-points, indicating that a 20-point or greater change had to occur from test to retest for a change to be considered statistically significant at the 5 percent confidence level. Quartiles calculated from raw scores were used to create a matrix of values representing tinnitus severity. We conclude that the THI is a brief, easily administered, and psychometrically robust measure that evaluates the impact of tinnitus on daily living.

Adult↗

Costs in providing facilities for treatment of handicapped patients under general anaesthesia.

The cost of providing dental treatment for severely mentally/physically handicapped patients under general anaesthesia in a specially designed unit are investigated in this study. The costs involved in the provision of such treatment were found to be high at 613 IR Pounds per patient. It is recommended that the full potential of primary care services for handicapped patients be developed in order to reduce the use of these necessary, but expensive secondary care facilities. It is also recommended that such facilities should be shared with other services in order to reduce overall costs.

Anesthesia, Dental↗

[Deficiency, disability and handicap in multiple sclerosis: a population-based study in Valladolid].

INTRODUCTION: Apart from impairment there is hardly any other assessment of the repercussions of multiple sclerosis (MS) in population studies. OBJECTIVE: To analyze the functional state of en epidemiological series of patients in the Valladolid health district. MATERIAL AND METHODS: A descriptive transversal study of a geographically defined population base. During a period of three months and complementing a prevalence study, were assessed, by means of the Minimal Record of Disability, impairment, disability and handicap in a series of 51 patients (33 women and 18 men) with clinically defined MS, who lived in the area on 1 March 1997. RESULTS: There was a primarily progressive evolution in 21.6% of the patients, and secondarily progressive in 11.8%. Average follow-up time was 9.1 years (range 1-41) and average age of onset 27.8 years (range 14.7-51.0). The distribution of scores on the Expanded Disability Status Scale was bimodal (average and interquartile range: 3.0 (1.5-5.0). 80.4% of the patients continued to be ambulatory. 21.5% had frequent urinary incontinence or required a long-term urinary catheter. Less than 20% needed help with day to day activities. 78% of the patients complained of some degree of fatigue, and 51% had difficulties with social relationships. 59.4% of the patients had full-time jobs and 70.6% had no financial problems. CONCLUSIONS: The study shows that the functional state of persons with MS is better than was thought, and that assessment of the consequences of this illness should include disability and handicap profiles.

Adolescent↗

[Management under ambulatory general anesthesia of handicapped children in dentistry-oral medicine].

The management of handicapped patients and children is often considered by the dentist as a challenge. The success depends on establishing the right initial contact with the patient and obtaining his acceptance of the treatment without disturbing the psychosomatic equilibrium existing between body, affectivity and mind. Should dental treatment under general anesthesia, therefore, be considered as a failure or rather as a strategy in dentistry, which permits the eradication of all infectious centers and ensures the maintenance of a sufficient masticatory capability for the handicapped patient?

Affect↗

A screening version of the Dizziness Handicap Inventory (DHI-S).

OBJECTIVE: This study aimed to develop a screening version of the Dizziness Handicap Inventory (DHI). STUDY DESIGN: Three separate prospective investigations are reported that assess: 1) the equivalency of the screening version of DHI (DHI-S) for the DHI; 2) the test-retest reliability of the DHI-S; and 3) whether abnormal performance on balance function testing is associated with greater scores on the DHI-S. SETTING: The investigation was conducted in the Balance Function Laboratory of the Division of Audiology at Henry Ford Hospital, which is a tertiary care setting. PATIENTS: There were 281 consecutive patients (for investigations 1 and 2) and 45 consecutive patients (for investigation 3) seen for balance function testing. INTERVENTIONS: There was a 1-week interval between test and retest administrations of the DHI-S. MAIN OUTCOME MEASURES: Comparability of the DHI-S for the DHI and the test-retest reliability of the DHI-S were assessed with a Pearson Product-Moment correlation coefficient. Scores on the DHI-S for patients with and without abnormal balance function tests were assessed with an analysis of variance. RESULTS: Results showed that scores on the DHI-S had high comparability for the total score on the DHI (r=0.86). The short-term, test-retest reliability for the DHI was high (r=0.95). Abnormal performance on the sensory organization subtest of computerized dynamic posturography was associated with significantly greater scores on the DHI-S. CONCLUSIONS: Results support the contention that DHI-S is a psychometrically robust screening measure of self-perceived dizziness disability-handicap.

Activities of Daily Living↗

Which infants should live? On the usefulness and limitations of Robert Weir's Selective Nontreatment of Handicapped Newborns.

The moral dilemmas of selective nontreatment of handicapped newborns have been widely discussed in the United States since the early 1970s. Weir's book is the first systematic ethical analysis of the pertinent legal and medical factors. His book is reviewed in light of the current government regulations and the formation of Infant Care Review Committees in U.S. hospitals. Weir develops ethical criteria for decision-making about malformed infants and suggests decisions about treatment be made on the basis of disease categories. The implications of Weir's recommendations for a number of critical cases are discussed.

Persons with Disabilities↗

Contraceptive management for female adolescents with mental retardation and handicapping disabilities.

Adolescent girls with mental retardation and handicapping disabilities have a need for sexual counseling and contraceptive management. Societal attitudes have changed, allowing these patients to experience normal and satisfying sexuality. The reproductive health concerns of these patients are extensive. Contraceptive selection varies with regard to the mental and physical capabilities of individual patients. The use of barrier methods, intrauterine devices, oral contraceptives, intramuscular medroxyprogesterone acetate, and sterilization has been discussed thoroughly in the past. No formal studies have been performed to evaluate the use of subdermal levonorgestrel implants in patients with mental retardation and physical disabilities.

Adolescent↗

Prosthetic functional therapy. A new method for rehabilitation of the orally handicapped patient.

A new approach to the rehabilitation of individuals who are orally handicapped after surgery offers direct support to dysfunctioning oral musculature, as well as physiologic conditioning to redirect tongue posture. Prosthetic functional therapy can be used to improve problems of speech, swallowing, drooling, and mastication in cases where structural loss of neuromuscular impairment have affected the functional competence of oral tissues. Patients who experience this therapy become highly motivated to succeed in rehabilitation as a result of a positive feedback that is provided by improvement in functional competence. Patients express both satisfaction and comfort and tend to progress favorably in the course of therapy.

Adult↗

Collaborative study of very-low-birth-weight infants. Correlation of handicap with risk factors.

Two large maternity services studied consecutive inborn infants (birth weight range, 500 to 1,500 g) born between 1977 and 1978. The multidisciplinary team members used identical assessment methods and documentation. Of 259 long-term survivors, 252 (97.3%) were seen at 2 years of age. Survival rates for hospitals 1 and 2 were 68.5% and 69.0%, respectively. Cerebral palsy rates for hospitals 1 and 2 were 11.8% and 11.2%, respectively. Major handicaps (cerebral palsy, mental developmental index [MDI] on the Bayley scales less than 69, epilepsy, deafness, or blindness) occurred in 30 (18.6%) and 17 (17.3%) of hospitals 1 and 2 survivors, respectively. Both cerebral palsy and developmental delay (MDI below 75 without severe or moderate cerebral palsy) were significantly correlated with a number of perinatal variables, but none were common to the two hospitals. Of the 30 children with cerebral palsy, 15 (50%) were not ventilated, and 28 (93%) had a five-minute Apgar score greater than 4; there was no indication that selective treatment to prevent cerebral palsy was possible.

Blindness↗

Large sequential outbreaks caused by influenza A (H3N2) and B viruses in an institution for the mentally handicapped.

During the mixed epidemic caused by influenza A (H3N2) and B in the 1992-1993 season in Japan, large sequential outbreaks occurred in an institution for mentally handicapped people where none of the residents or staff members had been immunized. During the influenza A outbreak (A/ Beijing/32/92-like strain) in January, 37.0% of the residents (85/230) and 31.4% of the staff (75/239) had an influenza-like illness. During the influenza B outbreak (B/Panama/45/90- and B/Beijing/184/ 93-like strain) in late February, 59.0% of the residents and 24.3% of the staff had an influenza-like illness. As many as 25.2% of the residents had two episodes of influenza-like illness during the season, as opposed to only 5.4% of the staff members. Mixed epidemics probably have a severe impact on institutionalized high-risk people, adversely affecting them almost twice as much as influenza epidemics caused by a single virus.

Adolescent↗

A comparison of the Weschsler Intelligence Scale for Children-Revised and Leiter International Performance Scale for a group of educationally handicapped adolescents.

Compared the WISC-R and Leiter International Performance Scale IQs for a sample of 42 educationally handicapped adolescents, who ranged in age from 13.1 to 16.5 years. Pearson product-moment correlation coefficients and correlated t-values were computed for the data analyses. The results indicated a pattern of positive correlations between WISC-R Verbal, Performance, and Full Scale scores and Leiter scores. WISC-R Verbal, Performance, and Full Scale IQs were found to be significantly higher than Leiter IQs. The findings suggest that generally the same pattern exists for the WISC-R and Leiter as for the WISC and Leiter.

Adolescent↗

Interaction of young children on a ward for physically handicapped as demonstrated by the present game.

Conducted the "present" game with 25 children who ranged in age from 4-6 to 9-10 and who were residing on a ward for the physically handicapped. The game was played 10 times; each session lasted 15 minutes. Children who received the present most frequently had fewer behavioral problems, had been hospitalized longer, had higher IQs on the WISC, Binet, and simplified tests developed in Japan, and had better use of their lower extremities than did other patients.

Child↗

Autism--assessment and placement under The Education for All Handicapped Children Act: a case history.

Over the years, various clinicians diagnosed a school-aged child as mentally retarded, mentally retarded with autistic-like features, or autistic. A school district sought to place the child locally in a school for mentally retarded children, while the child's parents desired replacement in a residential school that specialized in the education of autistic children. After a due process hearing, the child was placed in a school for autistic children. The case demonstrates the importance of independent mediation and professional assessment in placing handicapped children and examines free appropriate public education in the context of Board of Education of the Hendrick Hudson Central School District vs. Rowley (1982).

Adolescent↗

Reliability and factor structure of the Chinese GHQ-30 for parents with preschool mentally handicapped children.

The Chinese version of the General Health Questionnaire (GHQ-30) was administered to 381 parents of preschool mentally handicapped children, along with other instruments that assessed their stress, mental health, coping styles, and care-giving patterns. The GHQ-30 was found to have high internal consistency as a scale and high item-total correlations for most of the items. Factor analysis with a four-factor solution showed that four factors were abstracted from the scale, namely, anxiety, depression, interpersonal dysfunctioning, and inadequate coping. It also was found that the factors extracted could be reproduced reliably in two random subsamples and that the factor structure derived from the present sample corresponds to the previously reported data on the dimensionality of the Chinese GHQ-30.

Adaptation, Psychological↗

Main causes of major mental handicap: prevalence and epidemiology.

The prevalence of educational subnormality of a severe form (between 3 and 3.6 per thousand children of school age) and the prevalence of cerebral palsy (between 2 and 2.4 per thousand) have been fairly stable up to recent years. This stability has also applied to the relative proportions of the different major causes contributing to the handicaps. Where the ascertainment of such conditions is good, their prevalence monitored and the life expectancy of affected individuals estimated, any changes in prevalence can be used to measure the effectiveness of new forms of prevention, or alternatively to indicate the existence of new environmental hazards. Only a multi-pronged campaign against many of the recognized causes will have a substantial impact on prevalence.

Adolescent↗

Perinatal risk factors in children with serious motor and mental handicaps.

Fifty children with marked neurological abnormality manifested by moderate or severe motor disability and severe mental retardation were compared with a large control population with respect to prospectively ascertained perinatal characteristics. None of 60 prenatal factors distinguished the affected group from controls. In labor and delivery, lowest fetal heart rate in the second stage of labor, arrested progress of labor, and use of midforceps discriminated between the two groups. Neonatal characteristics of children who were later severely handicapped differed from controls, particularly with respect to difficulty in initiating and maintaining respiration, intracranial hemorrhage, neonatal seizures, low birth weight and small head circumference, lowest hemoglobin or hematocrit, and overall neurological status. Multivariate analysis, including factors from all epochs, indicated that intracranial hemorrhage and neonatal seizures were the strongest independent discriminators between the neurologically impaired children and controls.

Asphyxia Neonatorum↗