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Physical Disability (physical + disability)
Selected AbstractsHighlights of Papers in Clinical Investigations Section: Depressive Disorder as a Predictor of Physical Disability in Old AgeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2001S-L Kivela In this longitudinal study with a 5-year follow-up, 786 subjects were assessed for the impact of depression on physical disability. Depression present at baseline did not predict lowering of functional abilities during the follow-up period. However, new-onset depression that was relapsing or long-term in course was associated with increased risk for lowering functional abilities, even when age, sociodemographic factors, physical diseases, and baseline disabilities were controlled. Depressed older people should be placed on a program to maintain their functional abilities through physical exercise and training in activities of daily living and intermediate activities of daily living. [source] Physical Disability and ObesityNUTRITION REVIEWS, Issue 10 2005Tsan-Hon Liou MD Nearly 20% of US citizens are disabled. Epidemiologic studies have shown that people with physical disabilities have a 1.2- to 3.9-fold increase in obesity prevalence. Obesity is becoming a serious problem in disabled individuals. The mechanisms by which obesity occurs in people with physical disabilities is not clear, but pathophysiological changes of body composition and energy metabolism, physical inactivity, and muscle atrophy all favor the development of obesity. Health professionals should identify disabled patients at risk and provide early prevention guidance. Research is needed to help generate detailed clinical guidelines to promote weight control among people with physical disabilities. [source] Management of physical disabilityDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2003Martin CO Bax No abstract is available for this article. [source] Impact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studiesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2009J. M. Rodriguez Gonzalez-Moro Summary Aims:, The severity of chronic obstructive pulmonary disease (COPD) is associated to patients' health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. Methods:, Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. Results:, In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91,30.25) vs. 21.4 (CI 95%: 20.8,21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. Conclusions:, COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters. [source] The needs of older people with dementia in residential careINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2006Geraldine A. Hancock Abstract Background People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes. Method The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high levels of needs. Two hundred and thirty-eight people with dementia were recruited from residential care homes nationally. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE). Results Residents with dementia had a mean of 4.4 (SD 2.6) unmet and 12.1 (SD 2.6) met needs. Environmental and physical health needs were usually met. However, sensory or physical disability (including mobility problems and incontinence) needs, mental health needs, and social needs, such as company and daytime activities, were often unmet. Unmet needs were associated with psychological problems, such as anxiety and depression, but not with severity of dementia or level of dependency. Conclusion Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia. Copyright © 2005 John Wiley & Sons, Ltd. [source] Increases in Serum Non-High-Density Lipoprotein Cholesterol May Be Beneficial in Some High-Functioning Older Adults: MacArthur Studies of Successful AgingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2004Arun S. Karlamangla PhD Objectives: To examine the association between changes in serum non-high-density lipoprotein cholesterol (non-HDL-C) over a 2.5-year period and risk of adverse health outcomes in the following 4.5 years in high-functioning older adults. Design: Prospective cohort, established in 1988, with a follow-up in 1991 and 1995. Setting:, Population-based, community-dwelling men and women. Participants: A random sample (n=267) from the MacArthur cohort (N=1,189). The cohort represented the highest-functioning tertile of 4,030 screened candidates aged 70 to 79. Measurements:, Change in non-HDL-C between 1988 and 1991 was measured as a predictor of health outcomes between 1991 and 1995, including all-cause mortality, and among survivors, incident heart attack or stroke, development of new disability in basic activities of daily living, and decline in performance on the Short Portable Mental Status Questionnaire. Results: More-positive change in non-HDL-C between 1988 and 1991 was associated with fewer adverse outcomes between 1991 and 1995. In individuals whose total cholesterol at baseline was in the middle two quartiles (195,244 mg/dL), each 10-mg/dL increase in the 1988-to-1991 change in non-HDL-C was associated with an adjusted mortality odds ratio (OR) of 0.67 (95% confidence interval (CI)=0.51,0.88). In individuals without cardiovascular disease at baseline, the adjusted OR for new physical disability was 0.79 (95% CI=0.65,0.95) and for cognitive decline was 0.81 (95% CI=0.67,0.98). Conclusion: Increases in cholesterol over time have beneficial associations in some older adults. The role of cholesterol changes in the health of older individuals needs further exploration. [source] Highlights of Papers in Clinical Investigations Section: Depressive Disorder as a Predictor of Physical Disability in Old AgeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2001S-L Kivela In this longitudinal study with a 5-year follow-up, 786 subjects were assessed for the impact of depression on physical disability. Depression present at baseline did not predict lowering of functional abilities during the follow-up period. However, new-onset depression that was relapsing or long-term in course was associated with increased risk for lowering functional abilities, even when age, sociodemographic factors, physical diseases, and baseline disabilities were controlled. Depressed older people should be placed on a program to maintain their functional abilities through physical exercise and training in activities of daily living and intermediate activities of daily living. [source] Experiences of loss and chronic sorrow in persons with severe chronic illnessJOURNAL OF CLINICAL NURSING, Issue 3a 2007Gerd Ahlström PhD Aims and objectives., The aims of the present study were to describe losses narrated by persons afflicted with severe chronic physical illness and to identify the concomitant occurrence of chronic sorrow. Background., Reactions connected with repeated losses are referred to in the literature as chronic sorrow, which has recently been described in conjunction with chronic illness. Design., A qualitative study with an abductive approach of analysis, including both inductive and deductive interpretations. Method., The study is based on 30 persons of working age with average disease duration of 18 years. The average age was 51 years. All of the persons had personal assistance for at least three months because of considerable need for help in daily life due to physical disability. Each person was interviewed twice. There was also an independent assessment of the deductive results concerning chronic sorrow. Results., The inductive findings show that all persons had experienced repeated physical, emotional and social losses. Most common were ,Loss of bodily function', ,Loss of relationship', ,Loss of autonomous life' and ,Loss of the life imagined'. ,Loss of identity' included the loss of human worth, dignity and a changed self-image. In addition, the deductive findings suggest that chronic sorrow exists in the study population. Sixteen of 30 participating subjects were assessed by both assessors to be in a state of chronic sorrow and there was an especially high agreement with respect to one criterion of chronic sorrow ,Loss experience, ongoing or single event' (28 of 30 subjects). Conclusions., This study shows that persons with severe chronic illness often experience recurring losses. These experiences are consistent with the phenomenon of chronic sorrow. Relevance to clinical practice., Knowledge of the existence of chronic sorrow in persons with chronic illness will enable nurses to support these persons in a more sensitive and appropriate way. [source] The relationship of perceived control to outcomes in older women undergoing surgery for fractured neck of femurJOURNAL OF CLINICAL NURSING, Issue 1 2003CPsychol, Chris Shaw BSc Summary ,,This paper examines the relationship between internal locus of control and recovery from surgery for fractured neck of femur in women over the age of 65 years, in order to inform strategies for nursing care. ,,Structured interviews were carried out at 5 and 30 days postsurgery with 112 women (mean age 78.6 years) in five general hospitals in the North of England. ,,Locus of control was assessed as a factor associated with the outcomes of physical disability (measured as dependence in activities of daily living) and psychological distress (measured using the Hospital Anxiety and Depression Scale). ,,Internal locus of control was significantly related to less physical disability, but no association was found between locus of control and depression and anxiety at 30 days postsurgery when age, 5-day measures and other 30-day outcome measures were controlled. ,,The findings suggest that nursing interventions that enhance perceived internal control by patients during rehabilitation may result in better physical outcomes. Further work is required to explore the relationship of control to psychological outcomes. [source] Changing negative attitudes towards persons with physical disabilities: an experimental interventionJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 1 2006Barbara Krahé Abstract An experimental study was designed and tested to change negative attitudes towards the physically disabled. A pre-post-test intervention was conducted including three conditions: (a) cognitive intervention; (b) cognitive and behavioural intervention involving equal-status contact with the target group; (c) no-intervention control. The sample consisted of 70 ninth grade students. Following baseline assessments of attitudes, attitude change was measured immediately following the intervention and at a follow-up three months post-intervention. The cognitive intervention provided information about physical disability and challenged stereotypic conceptions about the physically disabled. The behavioural intervention consisted of engaging in three paralympic disciplines under the instruction of a group of disabled athletes. The cognitive intervention alone did not result in significant changes in attitudes towards the physically disabled. However, the combined cognitive-behavioural intervention resulted in greater attitude change than the no-intervention condition, both immediately post-intervention and at a three months follow-up. The findings are discussed with regard to models of attitude change through equal-status contact. Copyright © 2006 John Wiley & Sons, Ltd. [source] Children with physical disability: Gaps in service provision, problems joining inJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2008Phillipa Clark Aim: To describe the reported experiences of the estimated 14 500 New Zealand children with a physical disability and those of their families and whanau (extended families). Method: We have used data from the Household Disability Survey conducted in 2002 to obtain this information. Results: These children and their carers reported a number of perceived unmet needs in all areas covered in the survey: service and assistance, transport, accommodation and education. Thus an estimated 24% reported an unmet need for equipment, and 10% an unmet need for home modification. Around 9% reported having to fund respite care themselves. Of particular note was the proportion of children who had difficulties joining in games and sport at school (59%), going on school outings or camps (28%), playing at school (47%), and or making friends (35%). In all, an estimated 67% of children had one or more problems taking part at school. Conclusion: More could be done to help such families and to facilitate the full participation of these children. [source] Vitamin D status of chronically ill or disabled children in VictoriaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2003A Greenway Objective: To establish the percentage prevalence of hypovitaminosis D in chronically ill or disabled children in Melbourne, Australia. Methodology: A group of inpatients at the Royal Children's Hospital, Melbourne, Victoria, as identified by the primary unit, were sampled to measure serum vitamin D and parameters of bone turnover. A second group of disabled children (outpatients) were also measured to establish vitamin D status. Results: Of the total population, 54.9% were found to have low serum 25 hydroxy (25OH) vitamin D levels. Of the inpatient group, 25.4% were vitamin D deficient (<30 nmol/L), and 27.1% were vitamin D insufficient (30,50 nmol/L). The mean 25OH vitamin D was 52.1 nmol/L. Of the outpatient group, 15.4% were vitamin D deficient, whilst 42.3% were found to be insufficient. The mean vitamin D level was 41.2 nmol/L. No difference attributable to intellectual versus physical disability was found. Anticonvulsant use and ambulatory status was not predictive of vitamin D status in the children examined. Of the total population, 0.05% were found to have secondary hyperparathyroidism. The mean 25OH vitamin D level of this subgroup was 30.6 nmol/L. Dark skin tone was found to be significantly associated with hypovitaminosis D (P = 0.001), where all five children with dark skin tone were found to have serum 25OH vitamin D levels <50 nmol/L. Of the seven disabled children (outpatients) found to be iron deficient, four had coexistent hypovitaminosis D. Conclusion: The percentage prevalence of hypovitaminosis D is high in both chronically ill, and physically/intellectually disabled children in Melbourne, Australia. Increased vigilance and recognition of this deficiency state is needed as an important health prevention strategy. [source] Blockheads, roundheads, pointy heads: Intellectual disability and the brain before modern medicineJOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES, Issue 2 2005C. F. Goodey Recent work on the conceptual history of intellectual disability has pointed to a discontinuity in the seventeenth century, identifying the concept as essentially modern in a more radical sense than mental illness or physical disability. However, Galenist accounts of intellectual impairment were clearly connected (via anatomy) to neurology, which could be taken as prima facie evidence that Galenism shares with modern medicine one of its basic explanatory approaches to intellectual disability. Close textual examination does not bear out this counter-claim, at least as far as the conceptual apparatus itself is concerned. However, it does reveal a degree of continuity in the medical mind-set as discourses of monstrosity were transposed from the domain of anatomy to that of post-Cartesian psychology. © 2005 Wiley Periodicals, Inc. [source] EQUALITY, FREEDOM, AND/OR JUSTICE FOR ALL: A RESPONSE TO MARTHA NUSSBAUMMETAPHILOSOPHY, Issue 3-4 2009MICHAEL BÉRUBÉ Abstract: This essay is a reply to Martha Nussbaum's "Capabilities and Disabilities." It endorses Nussbaum's critique of the social-contract tradition and proposes that it might be productively contrasted with Michael Walzer's critique of John Rawls in Spheres of Justice. It notes that Nussbaum's emphasis on surrogacy and guardianship with regard to people with severe and profound cognitive disabilities poses a challenge to disability studies, insofar as the field tends to emphasize the self-representation of people with disabilities and to concentrate primarily on the aesthetic and political representation of physical disability. The essay concludes with an account of a recent exchange with Peter Singer on the question of our social expectations of people with Down syndrome. [source] Delay in initiation and termination of muscle contraction, motor impairment, and physical disability in upper limb hemiparesisMUSCLE AND NERVE, Issue 4 2002John Chae MD Abstract The purpose of this study was to describe the relationship between the delay in initiation and termination of muscle contraction and clinical measures of motor impairment and physical disability in the affected upper limb of patients with hemiparesis. Electromyographic (EMG) activity of 26 long-term survivors of stroke was recorded during isometric wrist flexion and extension. Upper limb motor impairment and disability were assessed with the Fugl-Meyer motor assessment (FMA) and arm motor ability test (AMAT), respectively. Delay in initiation and termination of muscle contraction was significantly prolonged in the paretic arm. However, the delay was not significantly affected by stroke type, stroke level, side of hemiparesis, or presence of aphasia. Delay in initiation and termination of muscle contraction correlated significantly with FMA and AMAT. Abnormally delayed initiation and termination of muscle contraction may contribute to hemiparetic upper limb motor impairment and physical disability in hemiparetic patients. © 2002 Wiley Periodicals, Inc. 25: 000,000, 2002 [source] The FOOTSTEP self-management foot care programme: Are rheumatoid arthritis patients physically able to participate?MUSCULOSKELETAL CARE, Issue 1 2009PgCert, R. Semple BSc Hons Abstract Background:,The FOOTSTEP self-management foot care programme is a clinical and cost-effective programme for basic foot care in the elderly. The aim of this study was to determine if patients with rheumatoid arthritis (RA) would be physically able to participate. Methods:,A consecutive cohort of RA patients undergoing podiatry care underwent tests for sight, reach and grip strength to determine their physical ability to undertake self-managed foot care. Results:,Thirty RA patients (10 male, 20 female), with a median age of 61 years (range 42 to 84) and disease duration of 10 years (range one to 40), were recruited. All patients passed the sight test, whereas the reach and grip tests were passed by 77% and 67% of patients, respectively. Only 57% of patients passed all the physical tests. Patients who failed the physical tests were older, and had longer disease duration and higher physical disability, pain and general health scores but these were not statistically different. Conclusions:,Just over half the patients in this present cohort may be physically able to undertake some aspects of self-managed foot care, including nail clipping and filing, callus filing and daily hygiene and inspection. Copyright © 2008 John Wiley & Sons, Ltd. [source] Cost Analyses of Home Care and Nursing Home Services in the Southern Taiwan AreaPUBLIC HEALTH NURSING, Issue 5 2000Lian Chiu Sc.D. This study compares the cost of long-term care provided at patient homes with that of long-term care provided in nursing homes in southern Taiwan. Caring for a patient with a high degree of dependence at home is more expensive than caring for a patient in a nursing home facility when family costs and provider costs are considered together. This phenomenon is not demonstrated for patients with medium degrees of dependence. To be cost-effective, home care services should target patients with medium physical disability, and nursing home care should focus on patients with high levels of dependence. [source] Vascular cell adhesion molecule 1 as a predictor of severe osteoarthritis of the hip and knee jointsARTHRITIS & RHEUMATISM, Issue 8 2009Georg Schett Objective Osteoarthritis (OA) is a leading cause of pain and physical disability in middle-aged and older individuals. We undertook this study to determine predictors of the development of severe OA, apart from age and overweight. Methods Joint replacement surgery due to severe hip or knee OA was recorded over a 15-year period in the prospective Bruneck cohort study. Demographic characteristics and lifestyle and biochemical variables, including the level of soluble vascular cell adhesion molecule 1 (VCAM-1), were assessed at the 1990 baseline visit and tested as predictors of joint replacement surgery. Results Between 1990 and 2005, hip or knee joint replacement due to OA was performed in 60 subjects. VCAM-1 level emerged as a highly significant predictor of the risk of joint replacement surgery. Intervention rates were 1.9, 4.2, and 10.1 per 1,000 person-years in the first, second, and third tertiles, of the VCAM-1 level, respectively. In multivariable logistic regression analysis, the adjusted relative risk of joint replacement surgery in the highest versus the lowest tertile group of VCAM-1 level was 3.9 (95% confidence interval 1.7,8.7) (P < 0.001). Findings were robust in various sensitivity analyses and were consistent in subgroups. Addition of the VCAM-1 level to a risk model already including age, sex, and body mass index resulted in significant gains in model discrimination (C statistic) and calibration and in more accurate risk classification of individual participants. Conclusion The level of soluble VCAM-1 emerged as a strong and independent predictor of the risk of hip and knee joint replacement due to severe OA. If our findings can be reproduced in other epidemiologic cohorts, they will assist in routine risk classification and will contribute to a better understanding of the etiology of OA. [source] Systematic review of early intervention programmes for children from birth to nine years who have a physical disabilityAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 4 2010Jenny Ziviani Aim:, To systematically review the literature on the effectiveness of early intervention programmes for children with physical disabilities. Methods:, Twelve electronic databases were searched for articles published between 1990 and April 2008. The quality of articles was appraised using an adapted version of the Checklist for the Evaluation of Research Articles and the Physiotherapy Evidence Database (PEDro) scale. Results:, Ten studies were included in the review. Cross-sectional and interrupted time-series studies were of moderate methodological quality, whereas the non-randomised control trial was of moderate-to-high methodological quality. Studies differed considerably with respect to participants, types of intervention and outcomes measured. Conclusions:, Positive outcomes for both children and families have resulted from early intervention. However, methodological limitations hamper a more rigorous analysis of findings across studies. [source] Cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis with EDSS , 3.5ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2003R. M. Ruggieri Objectives , Previous papers have mainly demonstrated the presence and the frequency of cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis. The purpose of this study was to investigate subjects with the relapsing-remitting form of the disease and mild clinical disability (EDSS , 3.5), so as to quantify this deficit when the illness does not yet interfere with daily living and the ability to work. Methods , Fifty patients and 50 healthy controls were submitted to a wide neuropsychological battery, including Wechsler Memory Scale , I- (WMS), Benton Visual Retention Test , D- (BVRT), Raven Coloured Progressive Matrices (RCPM), Kohs' test (KT), Judgement of Lines Orientation , H- (JLO), Facial Recognition (FR) and Aachner Aphasie Test (AAT). They also underwent Clinical Depression Scale (CDQ) and State-Trait Anxiety Inventory (STAI). Results , The results show the presence of significant memory impairment on both WMS (P = 0.000) and BVRT (P = 0.000) in patients compared with controls. Patients were also impaired in abstract reasoning and problem-solving deficit (KT P = 0.003; RCPM P = 0.000) and in FR (P = 0.019). Cognitive decline correlated with illness duration (r = 0.761), but was independent of EDSS (r = 0.085). Conclusion , Cognitive decline was present even when physical disability was not yet severe, but it was mild and did not limit patients' ability to work. The cognitive impairment outlined was of the subcortical type and correlated with illness duration. This study emphasizes the importance of cognitive examination in clinical practice. It is suggested that a complete neurological examination include tests on memory and abstract reasoning. [source] Post-stroke quality of life and depressionACTA NEUROPSYCHIATRICA, Issue 5 2002Krystyna Jaracz Background: Studies on the determinants of the quality of life (QOL) after stroke bring differing results depending on the applied concept of QOL. This may lead to confusion about the contribution of various factors to the post-stroke QOL. Objective: The aim of the study was: (i) to investigate functional and psychological QOL in the individuals after the first ischemic stroke; (ii) to identify the most important correlates of QOL; and (iii) to examine the significance of depression among the other possible predictors of QOL. Methods: A hospital-based sample of 72 stroke patients was followed up to 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index and the Sickness Impact Profile. A multiple regression procedure was performed to examine relationships between QOL and the study variables. Results: In spite of good recovery, the psychological and functional QOL of the examined patients was impaired, although the negative impact of stroke was greater on the objective QOL than on the subjective QOL. Stroke-related impairment, depression, functional disability and marital status predicted 80% of the variance in the functional QOL. Emotional support, depression and functional disability explained 38% of the variance in psychological well-being. Conclusions: Depression and physical disability were the most important predictors of QOL after stroke since their impact on QOL was more robust in comparison to the remaining variables. For improving QOL, a comprehensive care for patients aimed at reducing physical dependence and ameliorating depressive symptoms could be recommended. [source] Having a say in health: involving young people with a chronic illness or physical disability in local health services developmentCHILDREN & SOCIETY, Issue 4 2003Jane Lightfoot Increasing attention is being paid to involving users in local NHS service development, and to involving young people as users in their own right. However, we know little about the views and experiences of young participants, especially those with a chronic illness or physical disability, which could inform more effective approaches to their involvement. The paper reports on research investigating the views of young patients and staff who have taken part in NHS service development projects, and suggests a range of issues for consideration when involving young patients in future. Copyright © 2002 John Wiley & Sons, Ltd. [source] Supporting pupils with special health needs in mainstream schools: policy and practiceCHILDREN & SOCIETY, Issue 2 2001Jane Lightfoot Education policy favouring ,inclusion', together with medical advances, mean that a growing number of pupils in mainstream schools may have health-related support needs in respect of a chronic illness or physical disability. Data from an empirical research study investigating these needs and carried out between 1996 and 1998 are used to reflect on the position of this group of pupils within policy guidance on special educational needs (SEN) and medical needs. Evidence of confusion and ambiguity, both in the guidance and its interpretation, suggests that the needs of this group remain somewhat hidden. More recent developments in special needs policy guidance are discussed in terms of the prospect for strengthening support for this group of pupils. Copyright © 2001 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||