International disability studies最新文献

Rehabilitation in the Philippines has in the past been based on the Western model, with an emphasis on hospital departments located in the major cities. This approach is inappropriate for the majority of disabled people in the Republic as 70% of the population live in rural areas. A community-based programme was devised using local volunteers who had simple training. These volunteers can identify and support disabled people in their own villages, avoiding long journeys and expensive institutional care.

Seventy-two adult patients suffering spontaneous subarachnoid haemorrhage (SAH) were investigated concerning early mortality. Five patients died within 3 weeks after the onset of clinical symptoms. A demonstrable bleeding source and a Hunt-Hess score greater than 2 were found to be powerful predictive factors for early mortality. Sixty-seven survivors of SAH were examined at an average of 85 months after their first bleeding with regard to working capacity. Various clinical variables and different rating scales during the acute and subacute stage of SAH were identified retrospectively, and their prognostic value for working capacity was investigated. We found that all clinical features at the acute stage of SAH were not predictive of limited working capacity. At the time of discharge, however, organic brain syndrome, focal neurological deficits and a low Barthel Index proved to be significantly related to impaired working capacity. A Hunt-Hess score greater than 2 on admission, and a demonstrable bleeding source, were powerful predictors for early death, but not for impaired working capacity of survivors of SAH.

The study consists of 276 patients who were hospitalized between 1980 and 1982 because of suspected lumbar disc herniation. Treatment choice was based on clinical indications only; no randomization was used. A total of 179 patients were treated surgically and 97 had continued conservative treatment. Both groups were followed-up 1 and 5 years later. Five-year follow-up results showed that 68% of operated patients still had pain in sciatic distribution and 21% were retired. Re-operation frequency was 13.8%. Of non-operated patients, 82% still had sciatica and 26% were retired. Reasons for outcome differences between the study groups are discussed.

This is a review of the problems of assessing impairments and disabilities affecting the arm after stroke, and of the various published measures already available. In routine clinical practice, motor impairment is best assessed using grip strength or the Motricity Index, and dexterity disability is best assessed using the Nine-Hole Peg Test or Ten-Hole Peg Test. No measures of sensation and tone are specifically recommended, primarily because validity and reliability has not been well established for the measures available. Other more complex tests appropriate for more detailed use in planning treatment or in research are discussed.

We investigated the relationship between impairment, as represented by limitation in range of movement and pain in the knee joint, and disability as measured by a series of activities of daily living in 123 patients with either rheumatoid arthritis or osteoarthrosis. A log-linear modelling technique found there was a positive association between functional limitation, as measured by reduction in angle of flexion, and disability. However, there was only a marginal relationship between pain in the knee joint and disability, and no association between pain and range of movement, which suggests that conventional beliefs that pain is a key factor in assessing health outcomes may need to be reassessed.

This review paper uses three recent publications from Independent Living Research Utilisation in Texas as an opportunity for examining social and cultural differences between USA and Great Britain in their responses to disablement. The paper suggests that there is much to admire in the voluntarism of political life in the USA, but that the social disadvantages experienced by many disabled people require a consistent public commitment to provide the resources necessary for living independently.

This paper describes a study to establish values for gradients which could be achieved by wheelchair users whilst using two different lengths of otherwise identical portable ramps. Sixty subjects each tested gradients of between 1:14 and 1:6 on portable ramps of 1 metre and 1.8 metres length. The results demonstrated that the majority of attendant-propelled, self-propelling, and powered wheelchair users could negotiate gradients of 1:8 and 1:6 on the shorter ramp with varying degrees of effort. A gradient of 1:10 on a short ramp presented few difficulties for the majority of wheelchair users. Although this work relates specifically to portable ramps, there is little to suggest that the results could not be applied to permanent ramps, including those used in the home.

A consecutive series of 155 patients with a first-ever stroke and who were registered with the Oxfordshire Community Stroke Project (OCSP) were followed up. Their receipt of remedial therapy was recorded and their functional recovery was measured using the Barthel index of activities of daily living. Only a minority of patients received remedial therapy during the first 6 months after stroke. Those who were admitted to hospital during the first month following their stroke, or who were severely dependent, were significantly more likely to receive remedial therapy than those who remained in the community or were less dependent. A comparison of functional recovery amongst a matched subsample of patients who received remedial therapy and those who did not showed that there was comparable recovery amongst patients who did not receive remedial therapy.

The transfer of training approach to the treatment of visual perceptual deficits was evaluated with three left hemiplegic and one bilateral hemiplegic stroke patients, using single case designs. The results showed little evidence of effective treatment for perceptual deficits, although there was a slight response to treatment for inattention deficits. Overall the changes were minimal. The importance of monitoring treatment is discussed.