4. Living with chronic impairment Flashcards
What is chronic illness understood as?
Understood as an experience that disrupts peoples self image; coming to terms with it is a narrative process
Definition of physical disability?
Disability by early theorists viewed as a personal trait and that it was medicalised.
Physical disabilities are limitations in the ability to perform activities and can be the result of such diverse conditions as cerebral palsy, rheumatoid arthritis, stroke.
How are disabilities assessed?
- Assessed by measure of activities of daily living (ADLs) which assess the persons ability to perform everyday activities
- Can either be childhood (genetic) related disability, acquired (traumatic, arthritis, stroke etc), age related (degeneration, Alzheimer’s etc)
Definition of impairment?
Deterioration in the functioning of a body part, organ or system that can be temporary or permanent. Can result from injury or disease.
Name 3 models of disability
1) Medical model
2) social model
3) psychological
Describe the medical model of disability and critiques
- Regarded disability as a direct consequence of underlying disease/disorder)
- Therefore, reductions in disability can only be achieved by treating underlying pathology
- However, pathology is poor predictor of mobility (e.g. Joint degeneration in OA patients)
- traditional model engenders stigamatising language
- The model does not recognise social and psychological factors
- The role of impairment on disability as well as social and environmental factors is needed
- Medical model does not distinguish between impairment and disability
Describe the social model of disability
re-frames disability as a form of social oppression, caused by disabling environments.
Stigma/fear → Inaccessible transport/building/education → lack of employment opportunities/adjustments → disabling world is the problem
- Emphasis that activity limitations results from social/environmental constraints
- People are limited not only by medical condition but by behaviour of people towards them and environmental barriers (such as inaccessibility of buildings, poor sound system)
- Person may be less disabled when activity is supported (compassionate attention of others)
- Social participation may affect activity limitations and impairment – joining social club may result in increased activity, reducing joint stiffness)
3 Critiques of social model of disability
- serves a political purpose but it doesn’t allow for the idea that people are disable by both society and their bodies (Shakespeare & Watson,2001)
- Doesn’t consider pain or frailty.
- doesn’t take into account psycho social aspects of impairment (psycho-emotional diablism)- (Thomas 2004)
Describe psychological model of disability
- Emphasizes activities performed by someone with a health condition are influenced by the same psychological processes that affect the performance without disabilities
- Individuals will be motivated to engage in activities they like it, thus believing they can do it
- People with identical health may face different activity limitations due to varying emotions
- Depressed/anxious people more likely to be limited because of associated cognitions
- Ample evidence to suggest that psychological factors can predict disability outcome
- Can result in better prognosis of condition due to strong belief of recovery
What is ICF?
(international classification of functioning model) WHO, 2001. These models (social, medical and psychological) have been combined in the World Health Organization’sInternational Classification of Functioning, Disability and Health(ICF) 2001.
What does it do?
Integrative model allows appropriate multidisciplinary management of disability
- ICF identifies 3 components of disability:
- Impairments to body structures and functions (accommodates medical model)
- Activity limitations
- Participation- restrictions they experience
Diagram of ICF
health condition
(disorder/ disease)
⬐----------------------------------↕---------------------------↴
body functions + structures ↔ activities ↔Participation
↑ \_\_\_\_\_\_\_\_\_\_↱\_\_\_\_\_\_\_ \_\_\_\_\_\_↰\_\_\_\_\_\_ | Environmental factors| | personal factors| |\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | |\_\_\_\_\_\_\_\_\_\_\_\_\_ |
Interactions between the components of ICF
Example of ICF panic disorder and spinal cord injury
Refer to lecture living with chronic impairment lecture slide 21 + 22
3 influential ideas of the impact of chronic illnesses on identity and strategies for adapting
- Charmaz (1984)-’loss of self’
This is when images of self are altered as a result of chronic illness. They observe their former self-images crumbling away without the
simultaneous development of
equally valued new ones.
- Bury (1982) ‘biographical disruption’
Michael Bury describes chronic illness as a biological disruption.
States that his ‘contention is that illness, and especially chronic illness, is precisely that kind of experience where the structures of everyday life […] are disrupted, Chronic illness involves a recognition of the worlds of pain and suffering, possibly even of death, which are normally only seen as distant possibilities or the plight of others.’
- Williams (1983) ‘narrative reconstruction’
Gareth Williams believes ‘that the way in which people’s
beliefs about the aetiology [cause] of their particular affliction (arthritis) need to be understood as part of a more comprehensive imaginative enterprise
- Adapting to impairment involves
processing biographical disruption and
building new life narratives
Discuss how environmental factors can contribute to disability
Social model of disability- locates the problem of disability in the disabling world.
individuals are limited not only by their medical condition per se but also by the behaviour of other people towards them and by environmental barriers such as the inaccessibility of buildings or poor sound systems. These additional features can make it impossible for them to participate fully.
