Disability Lecture Notes PDF

THE DISABILITY  objectives By the end of this lecture you should be able to: Define impairment Identify disability Recognize causes of disability define classification of disability Define handicap  Introduction: The Disabled persons constitu...

THE DISABILITY  objectives By the end of this lecture you should be able to: Define impairment Identify disability Recognize causes of disability define classification of disability Define handicap  Introduction: The Disabled persons constitute an important and crucial social problem that can not be ignored. The best form of assistance given to disabled persons is rehabilitation. It is generally accepted that rehabilitation should be a Comprehensive process, i.e. all the rehabilitation needs of a disabled person should be met during this process.  Man is a very complicated human creature who can be considered from many points of view. It may be said that man is a physical-psychic- social being, i.e. multi-dimensional entity being regarded as functionally integrated.  (I) Impairment: Impairment is defined as: A loss or abnormality of psychological, physiological or anatomical structure. Impairment or impairments of some organs or functions of the organism can constitute a Disability.  Impairment is concerned with the abnormalities of body structure and appearance or of organ and system functioning resulting from any cause. Eg. of impairments include; blindness, deafness, paralysis of a limb amputation…..  (II) Disability: Disability is defined as: A restriction or lack (resulting from an impairment) of ability to perform a normal activity of daily living which human being is able to perform in the manner or within the range considered normal Disability is the functional consequence of impairment  (III) Handicap: Handicap is a social concept A disadvantage for a given individual, resulting from impairment or a disability that limits or prevents the interaction with his physical and social environment. eg. of handicaps; being restricted to home, unable to use public transport, socially isolated  Simply we can say that; impairment refers to a problem with a structure or organ of the body Disability is a functional limitation regarding to a particular activity Handicap refers to a disadvantage in filling a role in life All disabled people are impaired, and all handicapped people are disabled A person can be impaired and not necessarily be disabled A person can be disabled without being handicapped  Factors influencing disability Along the path of disease to impairment and then disability, other factors come into play to influence it these factors include the following: 1. cognition 2. education 3. culture 4. psychological factors (gender, race and age) 5. physical environment 6. financial Someone with DM retinopathy may have a visual impairment, but may not be disabled by it because of a bright environment. In the night or dark room, he may become disabled. Similarly, a person with a stroke may be able to walk in the flat flooring of his own home, but outside, he can be disabled by stairs and the uneven pavement beside the road.  Disability may be classified as: 1- according the persistence (a) Temporary: Lasting for a definite period, e.g. limitation of movements of limbs due to temporary paralysis of muscles after a paralytic stroke or lost of function of a limb due to fracture of bone. (b) Permanent: Not expected to change or going on for very long time until the death, e.g. blindness, amputation of limbs.  2- according to time of onset (a) From the birth: From the first days of the life of the child due to some hereditary or congenital factors as well as due to some injuries during the labour. Acquired: Later in life of the person due to some diseases of injuries (accidents).  3- according to progression (a) Progressive - Deteriorating and leading to a more severe status: e.g. Partial vision due to optic atrophy (degeneration of optic nerve) leading to complete blindness or Mild limitation of movements of limbs due to muscular dystrophy leading to more severe limitations as a result of a progressive disease. (b) Regressive: Improving: and leading to advancement or complete (almost complete) recovery, e.g. Restoration of functions of limbs after paralytic stroke, as a result of exercises. N.B|A disability may or may not Constitute a handicap.  Causes of Disability: Several groups of factors may cause a disability, i.e. a mental or physical impairment of the human organism. Among them are: 1. Hereditary and congenital factors. 2. Diseases. 3. Malnutrition. 4. Traumas - injuries. 5. Natural changes in the organism due to aging.  DISABLITY PREVENTION Reducing the occurrence of impairments (first level prevention) Limiting or reversing disability caused by impairment (second level prevention) Preventing the transition of disability into handicap (third level prevention)  FIRST LEVEL PREVENTION- MOST EFFECTIVE Eradicating malnutrition- increasing food production & proper distribution. Disabling communicable diseases eg eradication of small pox. Immunization against communicable diseases like polio, tuberculosis, measles, whooping cough. Providing extensive coverage of perinatal care to children through primary health care.  Providing safe water and sanitation facilities. Attempts to reduce accident rates. Promote socioeconomic development of individuals and country as a whole. Health education. Limiting use of alcohol, and tobacco. Preventing child neglect and abuse.  2nd level prevention Provision of adequate drugs (e.g. for leprosy, tuberculosis, ear infections, hypertension, diabetes) Provision of essential surgery (e.g. in the treatment of wounds, fractures, limb injuries, and cataract)  Provision of rehabilitation as soon as possible during the span of disability. Effective system of referral to health centers at the district or regional level. Vocational and educational counselling. Can reduce the incidence & severity of disability by 10%-20%.  3RD LEVEL PREVENTION Includes rehabilitation. Orthopedic orthoses and prosthesis. Glasses for VD & low vision. Hearing aid for HD. Vocational schools and training for the disabled. Education and improving the economic status of disabled. Speech therapy, vocational training. Provision of jobs for the disabled.  Categories of Handicapped Persons: The handicapped persons are usually categorized into the following groups: 1.Physically handicapped persons i.e. persons with physical impairment (disability) of the organism. This group includes: a) Persons with locomotors system impairments (disability). b) Handicapped persons due to disorders of internal systems (organs). Persons with locomotors system impairments (disability Musculo-skeletal disorders – arthritis, fractures, myopathy, contractures, and amputations. The lower limbs serve as a prop to keep the body upright. If there is a breach in that prop, like a painful joint, a fractured bone, contractures, it would be difficult to maintain that posture. Weakness of muscles can result from disuse atrophy or myopathy Neurological disorders – peripheral neuropathy, stroke, Parkinson’s disease and deconditioning. These causes affect muscle strength, proprioception and balance of the person, as well as reaction of the person to falls. The inability of the person to stretch out their hands (fast enough) to grab a nearby object or to break the fall can lead to higher incidences of fractured hips rather than fractured wrists Handicapped persons with disorders of Internal Organs: Suffer from Chronic internal diseases like: Asthma, high blood pressure, stomach or duodenum ulcer, cancer, etc. Their disabilities are not obvious so; they are hidden inside and cannot be easy noticed by other people. Very often, persons with this type of disabilities do not accept themselves as handicapped persons, although they have been facing many difficulties and limitations in every-day situations and at work.  First of all, they are not able to do so called hard work which require physical strengths. They usually require good working conditions to prevent aggravation of their disability.  2-Sensorily handicapped persons: i.e. Persons with sensory impairments. This group includes: a. Visually handicapped persons. b. Hearing handicapped persons.  Visually handicapped persons Visual impairment, from cataract, retinopathy (e.g. diabetic retinopathy), is a common cause of ADL disabilities. The disability worsens when the environment is dark or cluttered, obstructing the path of the person Hearing handicapped persons. Ear disease causing vertigo can also cause imbalance, falls and immobility  3. Mentally handicapped persons: i.e. Persons with mental impairments. This group includes: a) Mentally retarded persons. b) Mentally ill persons. c) Persons suffering from epilepsy.  (a) Mentally Retarded persons: CAUSES OF MR- Illness during childhood 42% Head trauma in childhood 10%. Pregnancy and birth related problems 3%. Hereditary 2%. Unknown cause 23%.  The persons suffering from mental retardation or have limited some of the mental abilities, such as 1. perception 2. memory 3. making decision 4. judging 5. reasoning 6. solving problems Usually, all their mental processes are slower as compared with normal persons and their learning abilities are as a rule reduced. The mental development is usually expressed in intelligence level.  Intelligence: Intelligence: is the mental brightness, i.e. the ability of a person to 1. form ideas 2. retain and to recall memories 3. think 4. reason 5. solve problems 6. cope with changing conditions.  Intelligence or mental development is measured by special psychological method. The amount of scores reached by a given person in an intelligence test is called intelligence quotient (commonly abbreviated to IQ). It indicates on the intelligence of this person. In general, people can be graded in the following way taking into account their intelligence or mental retardation measured in IQ.  IQ is determined by administering assessments intended to determine a human's intelligence level. This intelligence level is expressed by a ratio of the mental age to the chronological age. IQ tests are often used for determining the intelligence of job applicants, military applicants, students, and others. An IQ test is generally administered by a psychologist;  IQ questions would be found on IQ tests. These questions are intended to assess a variety of mental abilities and skills, and therefore cover a wide range of different types of intelligence Analogies (mathematical and verbal) Pattern driven (spatial and mathematical) Classification Visual Spatial Logical  Which number should come next in the pattern? 37, 34, 31, 28 Find the answer that best completes the analogy: Book is to Reading as Fork is to: a. drawing b. writing c. stirring d. eating Find two words, one from each group, that are the closest in meaning: What number best completes the analogy: 8:4 as 10: a. 3 b. 7 c.24 d.5 Questions that ask for identification of missing pieces.  Superior intelligence  125 and above. Above average intelligence  111 - 124. Average intelligence  90 - 110. Borderline of normal intelligence and mental retardation  69 - 89. Mild mental retardation  52 – 67 Moderate mental retardation  36 – 51 Severe mental retardation  20 - 35 Profound mental retardation  below 20  (1) Profoundly and severely mental retarded persons: IQ (Below 20) Are the most mentally affected ones who are not able to learn, to work and look after themselves in such ordinary matters as washing, dressing and eating. The majority of the first ones cannot even stand and walk. They are confined to bed or armchair.  From the vocational rehabilitation point of view they are not trainable and employable. It means that they are not able to acquire the necessary vocational knowledge and skills, to do even very simple jobs. The only applicable form of keeping them busy is occupational therapy.  (2) Moderately mentally retarded persons: IQ (36-51) Individuals who can learn simple communication, elementary health and safety habits, and simple manual skills, but do not progress in functional reading or arithmetic  They can be trained and employed exclusively under sheltered conditions in special workshops or as home workers. They can be occupied in simple assembling works, packing articles, brush-making, toy- making, basket-making, cord-plaiting, simple weaving or knitting, etc. However, their mental development usually does not exceed that one of 7 - 8 year old child.  (3) Mildly mentally retarded persons: IQ(52-67) Are individuals who have more intelligence than the moderately retarded but have not reached yet the average level. Although they are able to attend school, usually a special school and to work at some jobs, they face difficulties in coping with everyday situations and problems. They are very dependent on other people.  Their mental development can be compared with that one of children of 11 - 12 years of age. From the vocational rehabilitation point of view they can be trained and employed in semi-skilled industrial work, in carpentry, leatherwork, sewing and knitting. Other impairment of intelligence Dementia : Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills , problem-solving language This decline is severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease accounts for 60 to 80 percent of cases.most common type of dementia Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies. symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia: 1. Memory 2. Communication and language 3. Ability to focus and pay attention 4. Reasoning and judgment 5. Visual perception People with dementia may have problems with: 1. short-term memory 2. keeping track of a purse or wallet 3. paying bills 4. planning and preparing meals 5. remembering appointments 6. traveling out of the neighborhood. Physical therapy, occupational therapy and speech-language pathology services can be beneficial to the person with dementia as well as their family and caregivers at various stages of Alzheimer's or dementia.???  Interventions In Dementia This includes the following: 1. Physiotherapy: Aims of Physiotherapy 1. To improve physical function (mobility, balance, coordination and strength). 2. To reduce risk of falls - changes in judgment and spatial control contribute to tendency to fall. Exercises improve balance and reduce the fear of falling. 3. To lift mood, ease stress and add calm 4. To improve general cardiovascular health. 5. To pass time in enjoyable way-provide a sense of accomplishment from the person with dementia. 6. To improve sleep - sleep disorders are common in dementia patients. Exercise can help them get into normal sleep routine. Role of PT 1- Aerobic and Endurance Exercises Recommend 30 minutes of cardiorespiratory endurance exercise each day. Walking, cycling and swimming are all examples of cardio/endurance exercises. If the person tires easily, especially those who are resuming a routine or just starting to exercise, it is perfectly acceptable to do 10-minute periods of exercise daily. Cardiorespiratory endurance exercise increases the body's ability to deliver oxygen and nutrients to tissues remove waste over sustained periods of time. After exercising consistently for a few weeks, there will likely be an improvement in the person's ability to exercise and ability to perform everyday tasks without getting winded and tired.  2- Strength and Resistance Training Ideally 10-15 repetitions of 8-10 exercises should be performed three times per week. Resistance may be applied with therabands, light weight dumbells It helps in building lean muscle mass, increasing metabolism, controlling blood sugar levels. 3- Stretching and Flexibility Exercises Stretching is vital to an exercise regimen. This helps muscles warm up and cool down gradually and improves and maintains flexibility, prevents injury, and reduces muscle soreness and stiffness.  4- Balance Training It is important in patients with dementia to improve confidence and reduce the risk of falling. As balance is position specific so both standing and sitting balance exercises are encouraged Balance training help the patient in improving general body coordination and provide better sense of surrounding space and environment Training should begin with weight shifts in both sitting and standing in order to help the patient develop an appreciation of his limits of stability. 1. By giving the slight push to patient and patient tries to maintain the balance. 2. Reaching activities. 3. Activities on ball 4. Instructed heel-toe standing, 5. partial wall squats , 6. single limb stance 7. with side kicks or back kicks and marching in place, all while maintaining light touch  5- Gait Training Gait re-education helps in improving mobility and functional ability without support. The major goals are to: 1- lengthen stride 2- broaden BOS (Base of Support) 3- improve stepping, improve heel–toe gait pattern, 4- increase contralateral movement and arm swing and provide a program of regular walking. Gait training exercises are: 1. Weight transfer; standing on single limb. 2. High stepping to strengthen the flexors. 3. Side stepping or crossed stepping with or without support. 4. To overcome shuffling pattern, draw foot marks or parallel lines with red or yellow colors ; then ask the patient to walk on it. 5. The patient should practice stopping, starting, changing direction. 6. Auditory cues can be effective in improving gait. 7. Turning of 180 degree should be practiced first then 360 degree 2. occupational therapist Assist in changing and enhancing environment to improve function and safety. When assessing a home or apartment for someone suffering from Alzheimer's, one of the most important things to consider is preventing access or use to areas or equipment that may harm the patient. Such dangers can include hazardous areas within the house like basements garages tool sheds the kitchen and bathrooms. Ensuring Safety Inside the Home A person suffering from dementia may not be able to rationalize the difference between safe and unsafe. The following steps are helpfule: Locking doors that lead to areas that contain tools, equipment, or materials that may prove harmful to the patient is necessary Removing electrical equipment or appliances from the bathroom and kitchen area will help to reduce the risk of electrical shock. KITCHEN : Something as innocuous as a kitchen blender may cause injury to someone suffering from cognitive function and loss. To prevent accidents 1. knives and cooking implements should also be stored in a safe, secure location 2. cooking appliances in the kitchen can be made safer by removing knobs 3. installing hidden circuit breakers and gas valves.  Bathrooms Whenever possible, bathtub and toilet areas should supply adequately anchored grab bars in both bathtub area and around the toilet. Products such as raised toilet seats, sidebars, or grab bars, make it much easier for a patient to access toileting needs Non-skid mats or other stick-ons should be placed in the bathtub and on top of bathtub surface to help prevent slipping. In many cases, those experiencing anxiety may feel much more comfortable sitting on a special stool or chair made for shower bathing. Environmental modifications such as: adding signs on bathroom doors and labeling drawers for socks and shirts may allow a person with dementia to function at the highest level possible for as long as possible. using color contrast when it comes to rugs, floor covering, bedding, and window coverings will help a patient to perceive space and depth within the home.  (b) Mentally ill persons: Mentally ill persons should be distinguished from the mentally retarded ones. They are persons suffering from severe mental illnesses called also psychoses. Mental illness is a condition which usually implies emotional disturbances, abnormalities in behavior and impairment of capacity for living normal life. It is a condition acquired later in the life and it may be of short duration, occur periodically or have lasting effects.  Mental illnesses may be psychogenic in their origin without any organic changes in the brain or they can be caused by such changes. The most common and serious psychoses are: schizophrenia, manic depressive psychosis, paranoia,  CAUSES OF MI Pregnancy and birth related problems 46% Unknown cause 36%. Illness during childhood 9%.  (III) Persons suffering from epilepsy: Epilepsy is a nervous disorder consisting in episodic disturbances of functioning of brain with some mental implications, in particular in later stages of this disease. The essential feature of epilepsy is a sudden loss of consciousness, usually associated with a convulsion, changes in sensations, movements, and involuntary functions, mental and emotional state.