Disability, Impairment, and Marginalised Functioning

131st ENMC International workshop: Selection of Outcome Measures for Peripheral Neuropathy Clinical Trials: 10–12 December 2004, Naarden, The Netherlands

Disability is a complex phenomenon. It reflects an interaction between features of a person's body and features of the society in which he or she lives. International Classification of Functioning, Disability and Health (ICF), lays stress on the functional as well as the structural problem of a person. All the definitions of disability also include the disorders of the reproductive and endocrine system. So infertility and impotency should also be included in the category of disability. It affects the participation in areas of life and can have a disabling affect on an individual. Like any other disability the couple has to adapt and integrate infertility in their sense of self thus infertility comes as a major life crisis. Medically, infertility, in most cases, is considered to be the result of a physical impairment or a genetic abnormality. Socially, couples are incapable of their reproductive or parental roles. On social level, infertility in most cultures remains associated with social stigma and taboo just like the social model of disability. Couples who are unable to reproduce may be looked down upon due to social stigmatisation. Infertility can lead to divorces and separation leading to a broken family life. Without labelling infertility as a disability, it is difficult for the people to access services and welfare benefits offered by the government. Infertility treatments are highly sophisticated so they are very expensive and are even not covered by insurance and government aid.In the light of all this it becomes imperative to categorise infertility as disability.

The Capability Approach and Disability

The Working Alliance, consisting of building bonds, establishing goals, and developing tasks, has been deemed the cornerstone of helping professions, and has been found to significantly and reliably predict client outcomes. The importance of client characteristics and perceptions of working alliance has been established in the literature. Less is known about service provider qualities that impact the working alliance. This study utilized 104 rehabilitation service providers to assess the impact of education, work experience, and disability category on working alliance efficacy. Results indicate that rehabilitation service providers with more education had significantly higher working alliance efficacy pertaining to clients with physical disability. This suggests that master level rehabilitation service providers have greater confidence to build bonds, identify goals, and structure tasks when working with clients with physical disabilities. No differences were found between education groups on working alliance efficacy for psychiatric disability. Work experience was found to relate to working alliance efficacy for physical disability, not psychiatric disability. The results of this study provide initial support for the notion that rehabilitation service providers with more education and more work experience demonstrate a more effective working alliance in their efforts with clients who have physical disabilities. The non significant differences in psychiatric disability working alliance scores among service providers with varying education levels and work experience may be indicative of provider stigma or burnout when working with this population.

Poor readers who met low achievement and IQ‐discrepancy definitions of reading disability were compared with nonimpaired readers on their development of eight precursor and reading‐related skills to evaluate developmental differences prior to students’ identification as reading disabled. Results indicated no evidence for differences between the two groups of poor readers in the development of the eight skills, with three exceptions. Students in the IQ‐discrepant group demonstrated greater growth in letter sound knowledge, greater mean performance in visual‐motor integration at the beginning of first grade, and greater deceleration in rapid naming of letters. When compared to the nonimpaired group, low‐achieving readers demonstrated poorer performance and development in all skills, while the IQ‐discrepant readers demonstrated poorer performance and development in phonemic awareness, rapid naming of letters and objects, spelling, and word reading. The largely null results for comparisons between the two groups of poor readers challenges the validity of the two‐group classification of reading disabilities based on IQ‐discrepancy.

BackgroundPhysical disability is the main complication of leprosy. Although understanding the leprosy rate, prevalence, spatiotemporal distribution, and physical nerve characteristic trends is crucial for the implementation of leprosy control programs and identification of remaining challenges, these data are still unclear. We assessed physical disability trends among newly detected leprosy cases over the past 31 years in 129 counties and territories in Yunnan, China.Methodology/Principal findingsWe analyzed the data of newly detected leprosy cases from the Leprosy Management Information System in Yunnan, China, from 1990–2020. All available data related to physical disability were analyzed, including demographic characteristics (sex, age, ethnicity, education level); clinical characteristics (diagnosis duration, detection mode, contact history, leprosy reaction, skin lesions, nerve lesions, disability classification); World Health Organization (WHO) leprosy physical disability indicators; and nerve and eyes, hands and feet (EHF) involvement. A total of 10758 newly diagnosed leprosy cases were identified, and 7328 (65.60%), 1179 (10.55%) and 2251 (20.15%) were associated with grade 0, 1, and 2 disability (G0D, G1D, and G2D), respectively. Male sex, older age, Han ethnicity, urban employment, a longer diagnosis duration, a contact history, greater nerve involvement, and tuberculoid-related forms of leprosy were associated with increased prevalence rates of physical disability. The rates of physical disability in newly detected leprosy cases per 1 million population decreased from 5.41, 2.83, and 8.24 in 1990 to 0.29, 0.25, and 0.54 per 1 million population in 2020, with decreases of 94.64%, 91.17%, and 93.44% in G2D, G1D and total physical disability (G1D + G2D) rates, respectively. In the same period, the proportions of G2D, G1D and total physical disability decreased from 28.02%, 14.65%, and 42.67% in 1990 to 10.08%, 11.76%, and 21.85% in 2020, with decreases of 64.03%, 19.73%, and 48.79%, respectively. Nerve thickening was more common than nerve tenderness, and claw hand, plantar insensitivity, and lagophthalmos were the most frequently reported EHF-related disabilities.ConclusionsDespite general progress in reducing the prevalence of leprosy-related physical disability, the proportion of physical disability among leprosy disease remains high, especially in specific counties. This implies that leprosy cases are being detected at a later stage and that transmission in the community still exists. Further efforts focusing on early detection are crucial for leprosy control and the elimination of the disease burden.

Across the world, people with disabilities, advocacy companies, key nonauthorities and government stakeholders are trying to find approaches to enhance housing assist preparations for the disabled people. In order to do so, the housing industry should be more adaptive to meet the demand of the people with special needs. The government also needs to plan for suitable housing policies for all groups of people. Housing is the central focus for human being including the disabled people and houses that follow housing standard for the disabled will improve their quality of life. The objective of this paper is to study the preferences in terms of price, location and design factors in owning a residential property among the disabled community in Kuala Lumpur and Selangor. A survey questionnaires was distributed to 400 respondents of the disabled community. The survey focused on two categories of disability, which are the physical disability and visual impairment. The outcome of this study describes the preferences in owning a residential property in term of price, location and design of the property. Recommendation was then made on housing strategy in planning for the price, location and design of residential property for the disabled community in Kuala Lumpur and Selangor.

Preinjury mental health is said to be a major predictive factor in the rehabilitation progress of burn patients. However, it is unclear which component of rehabilitation (emotional v physical) is predicted by this variable; furthermore, the predictive validity of preinjury mental health has not been compared with physical variables. The present study compared preinjury mental health, physical variables, and length of hospitalization in predicting the rehabilitation progress of 59 major burn patients at three-month follow-up. Preinjury mental health was assessed by the Rand Mental Health Form; physical status, by the Upper Extremity Index (standard measures of upper limb joint mobility); and hospital stay, by the number of days of acute hospitalization. These variables were assessed at the time of discharge. Three-month rehabilitation outcome was measured by the Sickness Impact Profile, a self-report inventory that evaluates patient outcome in 12 different areas. These areas were in turn placed in the categories of disability (ie, difficulties in functioning in activities of daily living; eating) handicap (ie, difficulties in functioning in general areas of living; employment) and mental health status. In predicting mental health status at three months, preinjury mental health was significantly correlated. In predicting physical disability, physical factors were found to be important. Conversely, physical status was not significantly related to mental health outcome, and preinjury mental health was not related to physical disability. The results indicate the importance of defining outcome when attempting to predict rehabilitation progress of burn patients.

SAT0434 Participation in systemic lupus erythematosus – a cross-sectional analysis of the lula-cohort in germany 2015

To compare risk of neonatal morbidities between women with and without documented disability and to evaluate mediation of these associations by pre-term birth and caesarean delivery. Using data from the Consortium on Safe Labor (2002-2008; n = 223 385), we evaluated risk of 22 neonatal outcomes among singleton deliveries using ICD-9 codes to define physical (n = 1733), sensory (n = 250) and intellectual disability (n = 91). Adjusted relative risk (aRR) was estimated for each outcome among each category of disability, and among women with any disability using Poisson regression models with robust variance. Causal mediation methods evaluated pre-term birth and caesarean delivery as mediators. Compared with no disability, neonates of women with any disability had higher risk of nearly all neonatal outcomes, including pre-term birth (aRR = 1.77; 95% CI 1.62-1.94), small for gestational age (SGA) (aRR = 1.25; CI 1.11-1.41), neonatal intensive care unit (NICU) admission (aRR = 1.70; CI 1.54-1.87), seizures (aRR = 2.81; CI 1.54-5.14), cardiomyopathy (aRR = 4.92; CI 1.15-20.95), respiratory morbidities (aRR ranged from 1.33-2.08) and death (aRR = 2.31; CI 1.38-3.87). Women with disabilities were more likely to have a maternal indication for pre-term delivery, including pre-pregnancy diabetes (aRR = 3.80; CI 2.84-5.08), chronic hypertension (aRR = 1.46; CI 0.95-2.25) and severe pre-eclampsia/eclampsia (aRR = 1.47; CI 1.19-1.81). Increased risk varied but was generally consistent across all disability categories. Most outcomes were partially mediated by pre-term birth, except SGA, and heightened risk remained for NICU admissions, respiratory distress syndrome, anaemia and a composite of any adverse outcome (aRR = 1.21; CI 1.10-1.32). Neonates of women with disabilities were at higher risk of a broad range of adverse neonatal outcomes, including death. Risks were not fully explained by pre-term birth.

ObjectivesTo examine the prevalence of and the factors associated with a number of remaining teeth (NRT) <20 among adults with disabilities.DesignA community-based, cross-sectional descriptive study.SettingThis study was part of a...

Searching for disability in electronic databases of published literature

Disability, one of modern society's greatest public health problems, affects individuals, families, and society. Understanding the complex process of disablement, therefore, is critical given the current and projected increases in disability. Terminology in the field of disablement continues to breed confusion and controversy across and within disciplines. This article discusses some of the major models that have been developed to guide physical therapy researchers and clinicians in their thinking about disablement. Emphasis is on physical disablement because of its central role in physical therapy research and practice. Detailed descriptions are provided for two disablement formulations. One was developed in the 1960s by sociologist Saad Nagi. The other is the International Classification of Impairments, Disabilities, and Handicaps, developed for the World Health Organization. Both can serve as the basic conceptual architecture for disablement research in physical therapy. Researchers and clinicians need a common vocabulary and language for thinking and speaking about the process of disablement, although it appears premature to reach consensus on any one conceptual approach. Physical therapists should play an active role in guiding future research and scholarship on physical disablement.

Women with disabilities face substantial barriers to obtaining health care services. They are more likely than nondisabled women to smoke cigarettes, to be obese or overweight, to be physically inactive, and to report depressive symptoms, anxiety, and fears. Women with disabilities are often stigmatized as being asexual and experience higher rates of domestic partner and in-home abuse. Physical, communication, and attitudinal barriers within the health care system may prevent women with disabilities from receiving the care they need. This module discusses the definition of disability, prevalence and demographics of disability among US women, health conditions and risk factors, and general considerations in caring for women with disabilities. Selected health issues in caring for women with disabilities, including reproductive and parental rights, menstruation and fertility, contraception, preconception counseling, and menopause, are also discussed. Tables review components of the International Classification of Functioning, Health and Disability, examples of disability definitions, disability indicators using National Health Interview Survey data, health conditions causing chronic mobility disability for women ages 18 to 49, comorbid health conditions reported among women with and without disability, mental health conditions reported by women with and without disability, examples of women’s experiences with inaccessible medical equipment, examples of communication accommodations, and accessible labeling of prescription drug containers. Figures include the International Classification of Functioning, Health and Disability model of disability and graphs showing the percentage of women with basic action difficulties (BADs); with one or more BADs; with complex action limitations; with BADs by racial and ethnic groups; with indicated level of education and income among women with and without BADs; with indicated level of self-reported overall health among women with BADs; by smoking status among women with and without BADs; in body mass index category among women with and without BADs; with indicated physical activity level among women with and without BADs; with indicated heath care service use and lacking health insurance among women with and without BADs; and receiving Pap smears, mammography screening, and colon cancer screening among women with and without BADs. This review contains 12 highly rendered figures, 9 tables, and 86 references.

In the interest of providing inclusive education for students with disabilities within higher education and vocational formation, it is imperative that we examine how disability is understood by the actors involved. This research examines the definition of disability as it moves from an inclusive policy in México into practice at the macro, meso, and micro levels of implementation. Two key policy documents, one from the United Nations and one from México, were examined for how they define disability. Interviews, in which participants were asked to define disability, were conducted with government workers in key entities, program directors, and students with disabilities. The definitions from both documents and the interviews were categorized by specific constructs used in disability research including the social model, the medical model, the adaptability approach, and the International Classification of Functioning, Disability, and Health. A salient finding is that the construct of disability used within policies does not permeate to the actors involved in practice. To develop a clear understanding of this construct and in the interest of cohesion across implementation, a conversation between all actors would be beneficial.