International disability studies最新文献

Objective: to evaluate the reliability of diagnostic assessment based on clinical observations by physical therapists.

Design: interobserver studies between two pairs of physical therapists.

Setting: two primary-care physical therapy practices.

Patients: all applying to the practices for treatment.

Exclusions: physical therapy in previous 3 months, or need for acute treatment.

Assessments: schedule derived from the ICIDH.

Results: agreement on disabilities better than on impairments, the latter revealing problems particularly with pain and restricted range of motion.

Conclusions: reliability of assessments of most of the categories considered was reliable; in two categories the reliability was poor, and the categories were modified.

Objective: to identify risk factors and likely causes for stroke in young women, as a basis for designing a strategy for stroke incidence reduction.

Design: retrospective chart review for comparisons between the sexes.

Setting: general and rehabilitation hospitals.

Patients: all 263 patients aged 17-45 years with stroke over a 15-year period.

Exclusions: patients seen at 14 general hospitals who were not referred to the Loewenstein.

Assessments: data on sociodemographic, anamnestic, and clinical aspects.

Results: stroke under the age of 30 years was more frequent in women, and in them the risk factors differed from those in an older population. The most frequent cause of stroke in the younger women was embolism, in the majority on the basis of a rheumatic valvular defect, whereas in young men the usual cause was atherosclerosis.

Conclusions: opportunities for preventive initiatives have not always been grasped, and more attention should be directed to such possibilities.

Objective: to evaluate the policy of admitting elderly blind patients with motor impairments for physical rehabilitation.

Design: retrospective chart review for comparisons between blind and visually intact patients with similar diagnoses.

Setting: geriatric rehabilitation hospital.

Patients: all patients with stroke, fractured hip, and lower limb amputation.

Exclusions: none.

Assessments: walking ability and functional performance (ADL), using the Barthel Index.

Results: overall outcome in blind patients was only slightly less favourable than in the visually intact, although, in comparison with premorbid status, only just over half were ambulatory at discharge and functional independence was less common.

Conclusions: elderly blind patients with motor impairments should be offered a trial by physical rehabilitation.

The handicap section of the ICIDH was developed with the experience of adults in mind. In its original form the H Code is not immediately applicable to young children with disabilities. The Classification Group of the Nordic Neuropediatric Association has developed an adaptation of the H Code for use in children aged 6-7 years, and the adaptation is presented in this paper.

Dynamic spirometry was examined in 23 non-smoking hemiplegic patients after the acute phase. The decrease of slow inspiratory forced capacity is related to motor impairment and does not vary with time. The forced inspiratory and expiratory vital capacities are similar to the slow inspiratory vital capacity in the first 6 months of the disease, but significantly decrease later independent of the motor impairment. The peak expiratory flow is highly variable but is clearly decreased, and is related to motor impairment. These results point to a restrictive respiratory syndrome due to mechanical limitation of thorax excursions caused by weakness, hypotonicity, and incoordination of the trunk musculature. The importance of long-term physiotherapy of the trunk is emphasized.

The need for early intervention with regard to children with developmental disabilities is of increasingly universal relevance. The means adopted in pursuit of this end will, however, vary appropriately across cultures. All intervention programmes will inevitably share many features in common, but to be truly effective, programmes need to take into account circumstances in the locality in which they operate. This notion is frequently paid 'lip-service', but many programmes across the globe still retain the essential character of services developed in the context of Europe or North America. What is required is a radical appreciation of the importance of service programmes reflecting the structure and functions of indigenous culture. A concept useful in this regard is that of sustainability, which is currently guiding much discussion concerning the nature of economic and agricultural programmes in the developing world. This term emphasizes the need to consider from the outset the mechanisms that will serve to support changes brought about on the formal introduction of intervention programmes. Using a behaviour analytic framework to examine the concept of sustainability, specific prerequisites of a 'sustainable service' within any particular setting are suggested. A resulting checklist of factors that should be considered in advance of service development may be a useful aid to service planners.

Two approaches to the ascertainment of physical independence handicap have been explored using data from a survey of disablement in the population. The survey used a two-stage methodology with an initial postal shift to ascertain those with selected disabilities, a stratified random sample of whom were followed-up with an in-depth interview. The first approach to handicap was direct ascertainment of the scale categories by means of a question in the interview schedule. The second approach was to synthesize the scale categories from the answers to interview questions about disabilities in activities of daily living and other relevant factors. The final synthesized algorithm gave a 75% match within one scale point with the direct question and 85% agreement with receipt of attendance allowance, a state benefit paid to those meeting certain criteria for dependence on others. The lessons learned from the work have been incorporated in a revised and expanded scale, which is suggested as a starting point for revision of physical independence dimension of handicap.

Since application of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) in its full form proved to be impractical, the use of selected parts, or of instruments based on the ICIDH, has been suggested. We have assessed the inter- and intra-rater reliability of disability ratings using a screening instrument, based on the D Code of the ICIDH. The level of functional abilities of all new patients (n = 39) seen by a resident at our outpatient clinic in an 11-week period was rated on a four-point scale for each of 28 items in five ability categories. Independent ratings were done by a resident and his supervisor (inter-rater reliability). Repeated rating by the resident was used to assess intra-rater reliability. Calculation of the inter- and intra-rater reliability was based both on the method of the relative agreement and on the measure kappa. The results showed relative agreements of greater than or equal to 82%, and kappa values of greater than or equal to 0.71 were found. This study shows that in a teaching hospital very satisfactory inter-rater and intra-rater reliabilities using a short instrument based on the D Code of the ICIDH can be achieved. It can therefore be recommended as a method for global disability rating.

A group of stroke patients were assessed over four occasions using the Nottingham stroke dressing assessment. A similar pattern of difficulty in dressing was found for both males and females. The consistency of ordering of problems was highly significantly correlated in each of the four assessments.