This paper presents a further exploration of the conceptual scheme proposed in the International Classification of Impairments, Disabilities, and Handicaps which links underlying condition, impairment and disability. It examines the proposal that three general patterns of impairment profile might be expected depending on whether the underlying condition affects control (as in stroke or multiple sclerosis), mechanical performance (as in arthritis) or energy (as in cardiorespiratory conditions). Examination of patterns of functional limitation shows more resemblance between conditions in each of these groups than between the groups lending support to the proposal.
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Secondary analysis of data carried out in a national survey of the disabled is used to explore the relationship between underlying condition, impairment and disability, where the conditions are considered in three groups depending on whether they affect control, mechanical performance or energy. Comparison of impairment and disability profiles highlights the role of functional limitation in mediating between disease and disability. Disability profiles were found to be less associated with the underlying condition than were impairment profiles, but this can to some extent be explained by the nature of the functional limitation.
A study to measure the prevalence of motor disability and impairment using an interview survey and a follow-up medical examination has been carried out in a rural area in KwaZulu, South Africa. A 10% random cluster sample yielded 1659 individuals of all ages. One hundred and forty-three were reported to have motor disability, giving a crude motor disability rate of 86/1000. One hundred and twenty-six were followed up and 86 had demonstrable impairment, giving a crude motor impairment rate of 52/1000. The commonest impairment was osteoarthritis of the hips (20/1000) which may be the same disease as has been reported in neighbouring areas and to which the name Mseleni joint disease (MJD) has been applied.
A survey was undertaken on use of bath seats, and whether diagnosis, age, sex, living conditions and payment for the aid(s) influenced their use. Eighty-two per cent of patients were found to use their aids. Only diagnosis influenced the use significantly (p = 0.008). With correspondence analysis those with joint disease showed closest relationship with permanent use. Those with spinal cord injury showed closest relationship with no use.
This is a prospective study of recovery of aphasia in 19 stroke patients selected from 117 consecutive hospital admissions by virtue of having significant aphasia and surviving 13 weeks. Aphasia was measured using the Frenchay Aphasia Screening Test (FAST) at frequent intervals from early after stroke. A wide variation in speed and extent of recovery was seen, particularly when compared with mean scores. Patients who made the most recovery had started to improve by 40 days post-stroke. An aphasic patient's FAST score at 13 weeks post-stroke could be predicted from his first score (within 2 weeks).
New users in Scotland of Possum PSU3 environmental control equipment were investigated over a 2-year period. At the conclusion of the study, of 48 disabled people, some 9 months after installation, 29 (60%) were still using the equipment, seven (15%) still had the equipment but were not using it, seven (15%) had had the equipment removed or cancelled at their request, and five (10%) had died. Of the 29 users eight (28%) were having specific operational difficulties. Analysis of a series of factors which could have influenced the outcome of the study did not reveal any one statistically significant factor affecting the success or failure of the use of the equipment for the whole sample. Individual case studies did reveal some problems which should be attended to, and which are relevant to occupational therapists.
Patients with chronic ataxia resulting from traumatic central nervous system (CNS) damage frequently attain a gait pattern dependent upon upper extremity weight-bearing (UEWB). Traditional attempts to train these patients may perpetuate UEWB dependency, by not allowing optimal facilitation of balance and associated movement control required for independent ambulation. In the present study an ambulation retraining approach designed to facilitate coordination and balance while minimizing UEWB was used. This approach can allow the patient to train outside of the clinic; only about 5% of the actual therapy hours involved a therapist.
Fifty patients who underwent total hip replacement were examined within 3 months by two independent investigators with respect to functional impairment of the sacroiliac joint. Several well-defined clinical tests were used, e.g. spine test, standing flexion test, Menell's sign, tenderness of the sacroiliac joint. The results of both investigators were comparable, with corresponding results in 94 per cent. Nearly 30 per cent of the patients showed functional impairment of one sacroiliac joint. This finding may partly cause the gluteal or low back pains which are reported by patients after hip replacement.
Waiting to receive coronary graft surgery presents patients and their spouses with a stressful episode which nevertheless holds out the possibilities of symptom relief and improved quality of life. This study examines differences between couples in their experience of waiting, approach to surgery and expectations of treatment benefit. These differences, conceptualized in terms of a theory of adjustment to illness, are discussed in relation to their practical implications for helping patients and spouses to prepare for surgery and its possible outcomes.
This paper reviews evidence relating to the incidence, prevalence, and likely workload upon the NHS in relation to neurological diseases, particularly those causing long-term disability. Three studies suggest that a population of 250,000 people will contain about 5000 people with disabling neurological disease, of whom 1500 will be sufficiently disabled to require daily assistance. The review highlights the scarcity of reliable information concerning the epidemiology of neurological diseases and their disabilities, and emphasizes the need to plan neurological services at the level of the district general hospital serving a population of 250,000 people.
The strength of 16 muscle groups was measured bilaterally in 38 hemiparetic stroke patients. The relationship between the strengths and gender, weight, age, side of paresis and time since onset were calculated for each muscle group. Although often correlated with the strength of the non-paretic muscle groups; gender, weight and age were very rarely correlated with the strength of the paretic muscle groups. Side of paresis was only correlated with the strength of four non-paretic muscle groups. Time since onset was generally unrelated to strength. Final strength was always correlated with initial strength on the paretic side. These results suggest that cerebrovascular accidents disrupt some of the normal strength relationships on the hemiparetic side, and that the severity of the hemiparesis early in rehabilitation may provide a good indication of the severity to be expected later in rehabilitation.
This paper presents a further exploration of the conceptual scheme proposed in the International Classification of Impairments, Disabilities, and Handicaps which links underlying condition, impairment and disability. It examines the proposal that three general patterns of impairment profile might be expected depending on whether the underlying condition affects control (as in stroke or multiple sclerosis), mechanical performance (as in arthritis) or energy (as in cardiorespiratory conditions). Examination of patterns of functional limitation shows more resemblance between conditions in each of these groups than between the groups lending support to the proposal.
The conceptual scheme put forward in the International Classification of Impairments, Disabilities, and Handicaps suggests that impairment should be related to disability. This paper examines the proposition that disability should be related to impairment in terms of parts of the body involved, both in the physical requirements to carry out a given activity and as regards the site and types of functional limitation, by secondary analysis of data collected in a survey of disabled people in Great Britain. Factor analysis of data on functional limitations showed that these impairments could be considered in four groups representing manual dexterity, movements of the arm, strength, and lower limb function. These were found to be correlated with ability in self-care activities depending on the part of the body involved in the activity.
This paper describes preliminary studies on a screening test for aphasia which takes 3-10 minutes to complete and which is suitable for use by general practitioners, junior medical staff and other non-specialists. Data are presented to show that it is a reliable, valid assessment. Using cut-off values derived from normal people, the test is sensitive, but its specificity is limited by such associated factors as hemianopia. Using cut-off values derived from patients known to have aphasia, its specificity is improved. An abnormal result needs to be interpreted in the light of all available clinical information. The test should help identify patients with linguistic disturbance.
The extent and type of care provided by relatives and friends living with a stroke patient was studied among 120 6-month survivors. Eighty-one (68%) carers felt that they had to give more help than before the stroke. The patients looked after by these 81 carers were more functionally disabled, more cognitively impaired, more often had speech impairment and urinary incontinence than the 39 patients whose companions did not give any extra help. Only a third of patients had been left unattended for all or part of the day prior to the interview and 18 per cent required attention every night. The majority (85%) of patients receiving help from companions were under regular review by health or social services. Over two-thirds of carers felt that providing support had had an adverse effect on their lives.
In the past children with cerebral palsy have been assessed by evaluation of the most important functions found to be disturbed in this condition. Such evaluation provides a database for planning long-term rehabilitation. The approach has been transformed by introduction of the ICIDH. From a practical point of view it is useful to concentrate evaluation on only the typical and important disabilities associated with cerebral palsy. It is recommended that, where the severity scale is not applicable to particular disabilities, appropriate means of scaling the severity of involvement should be developed.
The applicability of the theoretical framework of the ICIDH to the practice of psychiatry is discussed. A critical analysis reveals some major conceptual difficulties with respect to the distinction between mental disorder and psychological impairment, and also between social disability and handicap. The principle of the triaxial classification, impairment----disability----handicap, has eventually been challenged. It is proposed to direct clinical research on psychological impairments as objective signs of psychological dysfunctions, and social disabilities as restrictions of social role performance.
