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The need for optometric vision care for handicapped people is discussed. The high incidence of functional vision problems among the disabled population is presented. A vision clinic operated jointly by the New England College of Optometry and the Cotting School, a school for physically disabled children, is described. Suggestions for achieving successful involvement with the vision care of disabled people are presented.
This report describes the use of exercise testing in handicapped subjects to determine work capacity and the safety of exercise. Arm crank, bicycle, and wheelchair exercise studies are described by means of a few selected cases.
Gastrointestinal issues are a major chronic problem in 80 to 90% of children with cerebral palsy and in children with neurodevelopmental disabilities who are at special risk of developing malnutrition because of uncoordinated swallowing, gastroesophageal reflux, and constipation. In addition to poor linear growth, there is a decrease in muscle strength and coordination, impaired cerebral function leading to decreased motivation and energy. Significant neurodevelopmental progress can be achieved with improved nutritional status. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, occupational therapists, and dieticians, can make a major contribution to the medical wellbeing and quality of life of these children. Different neurological diseases ( eg, spinal dysraphism, syringomyelia, tethered cord syndromes) can give rise to gastrointestinal dysfunction and symptoms that may need different gastrointestinal or surgical management. The introduction of new drugs, including proton pump inhibitors and innovative endoscopic and surgical techniques in the management of gastroesophageal reflux disease and constipation also may have an impact on the treatment of neurologically handicapped children in the future.
OBJECTIVE: The purpose of the study was to determine whether a newly developed subscale of the Dizziness Handicap Inventory (DHI) could assist in the screening of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Retrospective case review. SETTING: Tertiary balance referral center. PATIENTS: Charts of 383 patients (mean age, 61 yr) with a variety of vestibular diagnoses (peripheral and central) were reviewed. INTERVENTIONS: Patients completed the DHI before the onset of physical therapy intervention. MAIN OUTCOME MEASURES: A newly developed BPPV subscale developed from current DHI items was computed to determine whether the score could assist the practitioner in identifying individuals with BPPV. RESULTS: Individuals with BPPV had significantly higher mean scores on the newly developed BPPV subscale of the DHI (p < 0.01). The five-item BPPV score was a significant predictor of the likelihood of having BPPV (chi2 = 8.35; p < 0.01). On the two-item BPPV scale, individuals who had a score of 8 of 8 were 4.3 times more likely to have BPPV compared with individuals who had a score of 0. CONCLUSION: Items on the DHI appear to be helpful in determining the likelihood of an individual having the diagnosis of BPPV.
OBJECTIVES/HYPOTHESIS: Recent developments in voice assessment propose the use of quality of life measurements. The Voice Handicap Index (VHI) is one of the most psychometrically robust and well-studied instruments among the various instruments for measuring quality of life. Two versions of VHI (VHI-30 and VHI-10) have been shown to be valid instruments for distinguishing dysphonic from nondysphonic individuals and also for documenting treatment effect for dysphonic patients. The VHI has been used worldwide; however, the psychometric properties of the Chinese version of VHI remains untested. This study aimed to investigate such properties of the Chinese VHI-30 and VHI-10 in the Hong Kong Chinese population. STUDY DESIGN: Psychometric analysis of the Chinese VHI-30 and VHI-10 in dysphonic patients and control subjects. METHODS: The original VHI-30 was translated into Chinese and was completed by 131 dysphonic patients and 54 nondysphonic individuals. The dysphonic patients also self-rated their dysphonic severity. RESULTS: Results showed high test-retest reliability and high item-total correlation for both Chinese VHI-30 and VHI-10. Both Chinese versions could be used to distinguish different dysphonic groups and between dysphonic and nondysphonic groups. Significant correlation was found between the VHI scores and the patients' self-rated dysphonic severity. CONCLUSION: The present study supported the original three-factorial structures of the VHI-30 and the use of the VHI for the Chinese population. It is shown that the Chinese VHI-10 is a strong representation of VHI-30 and is recommended for use in clinics because of its validity and ease of use by patients.
Male sand lizards (Lacerta agilis) with a specific restriction fragment length polymorphism fragment in their major histocompatibility complex (MHC) genotype ('O-males') are more resistant to ectoparasites (a tick, Ixodes ricinus) than are males that lack this fragment ('NO-males'). However, emerging evidence suggests that such adaptive immune responses are costly, here manifested by reduced body condition and a compromised defence against secondary infections by haemoprotid parasites that use the ticks as vectors. Subsequent to tick encounter, O-males suffer from a higher leucocyte-erythrocyte ratio, and higher haemoprotid parasitaemia, in particular in relation to vector encounter rate. Furthermore, O-males (i.e. successful tick defenders) with more haemoprotid parasites remaining in their blood stream were in better body condition, whereas this did not apply in NO-males, demonstrating that the adaptive immunoreaction can--in the short term--be energetically even more costly than being moderately parasitized. In agreement with Zahavian handicap theory, O-males had a (marginally) higher reproductive success than males that lacked this fragment.
The immunocompetence-handicap hypothesis suggests that the honesty of quality signals could be guaranteed if testosterone (T) suppresses immune function while enhancing male ornaments. In addition, it has been proposed that the cost of enhancing ornaments should be highest for males with small ornaments. Recently, the assertion that T causes obligate immunosuppression has been questioned. In this study, we tested whether elevated T levels would increase susceptibility to a viral infection, and whether this hypothesized effect would be most pronounced in males with small ornaments. We surgically inserted T implants into 15 male greenfinches (Carduelis chloris) and control implants into a further 15 males. All birds were then infected with a naturally occurring virus (Sindbis virus, Alphavirus genus), and each bird's daily viraemia (blood virus concentration) was measured for seven days. The specific antibody response was measured for eight weeks. T-implanted males did not exhibit increased viraemia or decreased antibody response, and males with small and large ornaments did not respond differently to T implantation. We did, however, find that T implantation decreased viraemia early in the course of the infection and increased viraemia late in the infection. Thus, our results demonstrate that T may act both to increase and to decrease viraemia.
Many species of deciduous trees display striking colour changes in autumn. Here, we present a functional hypothesis: bright autumn coloration serves as an honest signal of defensive commitment against autumn colonizing insect pests. According to this hypothesis, individuals within a signalling species show variation in the expression of autumn coloration, with defensively committed trees producing a more intense display. Insects are expected to be averse to the brightest tree individuals and, hence, preferentially colonize the least defensive hosts. We predicted that tree species suffering greater insect damage would, on average, invest more in autumn-colour signalling than less troubled species. Here, we show that autumn coloration is stronger in species facing a high diversity of damaging specialist aphids. Aphids are likely to be an important group of signal receivers because they are choosy, damaging and use colour cues in host selection. In the light of further aspects of insect and tree biology, these results support the notion that bright autumn colours are expensive handicap signals revealing the defensive commitment of individual trees to autumn colonizing insect pests.
The handicap hypothesis of sexual selection predicts that sexual ornaments have evolved heightened condition-dependent expression. The prediction has only recently been subject to experimental investigation. Many of the experiments are of limited value as they: (i) fail to compare condition dependence in sexual ornaments with suitable non-sexual trait controls; (ii) do not adequately account for body size variation; and (iii) typically consider no stress and extreme stress manipulations rather than a range of stresses similar to those experienced in nature. There is also a dearth of experimental studies investigating the genetic basis of condition dependence. Despite the common claim that sexual ornaments are condition-dependent, the unexpected conclusion from our literature review is that there is little support from well-designed experiments.
Many domestic appliances and much office equipment is controlled using a keypad and a small digital display. Programming such devices is problematical for the blind and visually handicapped. In this paper, we describe a device that may be used to read the displays on these devices. The device is designed to accept a description of the display being read, which specifies the types and locations of elements of the display. Images are captured using a handheld webcam. Images are processed to remove the distortions due to the camera orientation. The elements of the screen are interpreted and a suitable audio output is generated. In suitably illuminated scenes, the display data is interpreted correctly in approximately 90% of the cases investigated.
Self report measures of voice function are in frequent use, but have had inadequate psychometric evaluation. We aimed to perform a substantial factor analysis of two measures of voice impairment, the Voice Symptom Scale (VoiSS) and the Voice Handicap Index (VHI). Both the 30-item questionnaires were completed by 319 dysphonic voice clinic attenders (99M, 220F). Principal components analysis confirmed that both instruments reflected general voice abnormality. The VoiSS comprised three factors - impairment (15 items), emotional (8 items) and related physical symptoms (7 items) - each with a good internal consistency. Analysis of the VHI suggested that it contains only two subscales. When a three-factor solution was imposed on the data, analysis failed to support the currently advised three 10-item subscale interpretations. Instead, we found a physical (voice impairment) domain (8 items), a psychosocial domain (14 items) and a factor with 8 items related to difficulty in being heard. The VHI requires further statistical refinement to identify its subscale structure. The VoiSS was developed from 800 subjects and is psychometrically the most robust and extensively validated self report voice measure available.
The establishment of a general anaesthetic unit for dental surgery in a hospital for the mentally subnormal is described. The problems encountered in sedating the mentally handicapped patient in such a way as to permit an unhindered induction of anaesthesia are described together with the evolution of a technique of premedication using nitrazepam and droperidol. The medical problems complicating anaesthesia found in this group of patients are enumerated and their effects on the development of a suitable anaesthetic technique are described.
A sample of 1271 visually handicapped children has been analysed with regard to the degree and cause of visual impairment.
Among 200 children who had received routine ophthalmic and orthoptic examinations as part of their evaluation by a multidisciplinary assessment team, it was found that there was a high incidence of ocular defects. These defects included refractive errors (98 children), squint (74 children), nystagmus (15 children), cataract, retinopathy and optic atrophy. This high incidence of ocular defects emphasized the need for the routine ophthalmic examination of developmentally handicapped children in order to detect and treat ocular conditions which might otherwise have gone undetected, and enabled the visual sense of these children to be evaluated in relationship to their general development.
The local teacher has the immediate responsibility for the integrated education of the visually handicapped child. He gets frequent information and assistance from the county special teacher who is responsible to the public for the educational progress. When the child has his annual opthalmological examination, his medical history is explained and related to the performance of the child at an informal meeting. At this meeting, the ophthalmologist learns to understand the educational problems and the teachers learn what the pupil can see and the conditions under which he functions. All parties take great interest in the pupil's life after school hours, both as to leisure and to his relations in the family group. The parents are continually informed both by the teachers and the ophthalmologist, and a report of the medico-educational meeting is sent to the child's local physician and local ophthalmologist as well as the National Registry of Blindness.
Early education is an integral part of daily living. Early "special" education for handicapped children involves adapting the daily living environment to enable each individual child to make the optimum use of such ability and development potential as he has. Parents are the first and most important educator s of their children. It is the role of professional people to guide this early education via the parents. Early assessment, as a basis for such educational planning is discussed in general terms.
An experimental information and resource centre on handicap in children for the use of staff in the health, social and educational services was set up in an area of London serving four adjacent boroughs. As a first step, a questionnaire was widely distributed to potential users of the centre asking for information about their work, training and recent reading in this subject. Of 192 replies, those from health visitors, medical officiers, teachers and therapists are analysed. Lack of adequate training, both at basic and post-qualification level, as well as a failure to keep up to date with specialized journals, encouraged the establishment of the resource centre, which also planned to provide a course of lectures and seminars. The nature of the material collected is briefly described.
A support service for families with mental, physical, sensory or environmental handicap has evolved from a paediatric ward of a District Hospital. Expressed parental needs have been the source of evolutionary change. About 200 families use the various services of specific therapy, day or longer term residential relief, playgroups for those with special needs, school for the chronically ill. The location is a remodelled stately home on large grounds close to the centre of a city of 100 000, and serves a district of 300 000. The demand for permanent residential placement in the age group under 11 years in this area appears to have been reduced by 80%.