Physical disability

Chapter 59 Physical disability


Physical disabilities are limitations in the ability to perform activities and can be the result of such diverse conditions as cerebral palsy, rheumatoid arthritis, stroke, multiple sclerosis or accidental injury. As shown in Figure 1, the commonest disabilities in western industrialized countries are in locomotion, personal care activities (such as dressing, washing, feeding and toileting) and hearing. Approximately 21% of adults and children in the UK report at least one limiting long-standing illness. The prevalence of disability increases with age; approximately half of those over 75 years have locomotion limitations.


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Fig. 1 Prevalence of disabilities by age (percentage reporting each disability)


(adapted from Bajekal et al., 2001, with permission).


Activity limitations can result in social disadvantage. Disability present from birth, e.g. in cerebral palsy or cystic fibrosis, may disadvantage individuals throughout their lifetime and affect school, employment, marital, parenting and other social opportunities. By contrast, an injury as a young adult, a myocardial infarction in middle age or a stroke after retirement will have very different impacts on both the individual and his/her family.



Assessing disability


In research or clinical practice, levels of disability are assessed to ascertain the severity of the condition or to evaluate improvement or deterioration. Clinical assessments may be used to make decisions about medical care, referral to rehabilitation services (especially physio-occupational and speech and language therapists), provision of aids or adaptations to the home or recommendations for absence from work, pensions or welfare benefits.


Disability is typically assessed by measures of activities of daily living (ADL), which assess the person’s ability to perform everyday self-care or mobility activities. These measures assess activities that virtually everyone would wish to perform and, therefore, do not include activities that may be important for particular individuals. For example, the Barthel index (Johnston et al., 1995) includes personal toilet (wash face, comb hair, shave and clean teeth), feeding, using toilet, walking on level surface, transfer from chair to bed, dressing, using stairs and bathing.


There are two main methods of assessment: self-report and observation. The first requires individuals to describe difficulties experienced, and in the second they perform defined activities while a trained observer notes successes and failures. Self-report has the advantage of allowing the assessment of a wide range of activities, occurring in home and private situations, covering all times of day and night and over days, weeks or months. Observational methods are restricted to what can be assessed in the limited setting of the hospital or in the limited period available for a home visit; patients who can use the toilet independently in the hospital setting may not be able to do so at home if there is less space to manoeuvre or no support to lean on, and they may be even more disabled if they need to go to the toilet during the night if this involves additional flights of stairs. Also, electronic monitors e.g. pedometers, can record activity through the day, in the individual’s normal environment.



Models of disability


Three models of disability have each contributed to a broader understanding: medical, social and psychological. These have been combined in the World Health Organization’s International Classification of Functioning, Disability and Health

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Jun 10, 2016 | Posted by in PSYCHOLOGY | Comments Off on Physical disability

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