International disability studies最新文献

This paper offers an overview of problems involved in assessing respiratory disablement. Health status and quality of life research have become of increasing importance but critical gaps remain, especially in relation to the multidimensional consequences of chronic obstructive airways disease (COAD). It is argued that much existing psychosocial research has been long on the 'psycho' and short on the wider social consequences and dimensions of respiratory disablement. Many general measures of quality of life and disability are not well suited to assessment of these problems. There is a need to supplement general instruments with more disease-specific measures--many for breathlessness, the most disabling symptom of COAD, have been crude and insensitive. There is also a need to augment predominantly quantitative techniques with qualitative data derived from patients' and carers' perspectives. Wider implications of disability assessment at the welfare policy level are discussed, and the paper concludes by suggesting future research areas on respiratory disablement.

This paper considers an old topic from a newer perspective, that of current management theory. A high degree of differentiation is intrinsic to most rehabilitation inpatient facilities. At Loewenstein, patients are accommodated according to medical categories in purpose departments, of which medical and nursing staff are a part. Allied health professionals are organized in functional departments. Care is provided by a team derived from both types of department. A matrix organization is thus established, superimposing a patient care team (for lateral horizontal co-ordination) on the organization of functional departments (for vertical hierarchical co-ordination) and built around a temporary project, the individual patient. This organizational structure maximizes the advantages and minimizes the disadvantages of both types of department in solving the conflict between specialization and integration. It has facilitated effective and efficient vertical and horizontal co-ordination and enhanced the provision of care by a multidisciplinary rehabilitation team.

Stroke patients were observed in hospital over 3 days and their behaviour recorded. Patients were observed to spend a high proportion of their time inactive and solitary. This occurred most frequently in the ward day-room and reception area. There was little variation throughout the day in the distribution of different behaviours. The results indicate that on a stroke unit, designed to provide intensive rehabilitation, patients spend much of their time in non-therapeutic activities.

Vaccination against poliomyelitis in Egypt is described, including a historical perspective. Mass vaccination programmes have significantly reduced the incidence of the diseases, although it is far from being eradicated. Much disability has been prevented, though more work is needed to verify seroconversion rates in children after vaccination and to clarify the effect of environmental factors on success.

The study was designed to evaluate the effect of electromyographic (EMG) biofeedback on the recovery of arm function after stroke. Patients who had impaired arm function and were between 2 and 8 weeks after stroke were randomly allocated to receive either treatment incorporating EMG biofeedback or a control treatment in addition to their routine physiotherapy. The two groups of 20 patients were compared before and after 6 weeks of treatment and at follow-up 6 weeks later. There were no significant differences between the groups before treatment or at follow-up, but at the end of treatment those who received EMG biofeedback scored significantly higher on tests of arm function. Patients with severe impairment were shown to benefit most from EMG biofeedback but there was no difference in response to treatment according to patient's age or side of stroke. Men had higher arm function scores than women before and at the end of treatment, but not at follow-up.

Geriatric day hospitals are commonly used in the rehabilitation of stroke. However, there is little objective evidence about its effect for this condition. The potential advantages and disadvantages are finely balanced and further research, including cost-effectiveness analysis, is needed to define more clearly the role of this expensive facility.

Experience of myoelectric prostheses for unilateral below-elbow amputees in a large region of Great Britain is presented. Of the cases considered, 14 were adults and 29 were 16 years of age or less. The rejection rate was 25% overall but it was lower in adults, at 17%. Comparisons with published data and other aspects of myoelectric prostheses are discussed. Just over half the 37 amputees interviewed were independent in activities of daily living; independence was more common in the adults, at 77%. A very large proportion of myoelectric prosthesis users also used body-powered prostheses, demonstrating a need for both types of prosthesis for optimum rehabilitation. It is recommended that myoelectric prosthetic programmes should be carried out from specialized centres with comprehensive facilities for this expensive rehabilitation aid.

A follow-up study of 58 patients with spinal cord injury was conducted. As measure of function the Barthel index was used. There was correlation between functional capacity and ability of self-care as well as some social determinants. However, no association was found with employment rate or certain other determinants of independent living, such as going on a holiday. We conclude that the severity of the lesion is a fundamental factor in determining the outcome, but factors related to personal and psychosocial variables, not easily measured, also have great influence on the rehabilitation process.

The ATDPs have been the instruments most commonly used for the measurement of attitudes toward disabled persons. However, it has become increasingly apparent that these scales have serious shortcomings and that a new scale is due. A New Scale was developed for the purpose of measuring attitudes towards permanently and seriously physically disabled adults. The subjects used for the development of this scale consisted of students studying for a Bachelor of Science degree in physiotherapy. The scale has 50 scored statements and 25 interest statements. The scored statements were created so that they could not be answered on the basis of factual knowledge, and would be difficult to answer on the basis of remembered experience and reasonable argument. The interest statements did not contribute to the subject's score and were included for the purpose of keeping the subject's interest in responding to all the statements on the scale. A psychometric analysis of the 50 scored statements demonstrated that the New Scale has excellent discriminative ability, internal consistency, and reliability, good validity, and that the influence of agreement response and social desirability is minimal. In addition it is believed that the New Scale has a high degree of unidimensionality.

Chronic obstructive airways disease (COAD) is a major, though neglected, medical and social problem in the United Kingdom today. Dyspnoea is one of the most distressing and disabling symptoms of COAD, which is itself the largest single cause of absence from work in the United Kingdom. This paper reports on 92 patients suffering from COAD, who were interviewed in order to assess impairment, disability and handicap, and a smaller subsample of 24 of these patients who were followed-up using open-ended, semi-structured, tape-recorded interviews in order to cover in more detail some of the issues raised in the first quantitative stage of the study. Low correlations were found between lung function and disability (-0.38 p less than 0.001), accounting for only 14% of the variance, and high correlations between measures of dyspnoea and disability (-0.90 p less than 0.001). Major areas of disability and handicap included: household management, ambulation, sleep and rest, recreation and pastimes, and work. Financial problems and difficulties, housing problems and problems of social isolation were also frequently reported. The paper then attempts to explore the relationship between impairment, disability and handicap, drawing on both the quantitative and qualitative data collected in order to illustrate the variable nature of this relationship. The paper concludes by suggesting both the need for a more integrated approach to the care and rehabilitation of COAD patients and their families, and for a complementary social perspective and approach to COAD and its treatment.