Activity Limitation

Question 1

WHO definition of disability

Answer 1

New;
Body and structure impairment - abnormalities of structure, organ or system function (organ level)
Activity limitation - changed functional performance and activity by the individual (personal level)
Participation Restrictions - disadvantage experienced by the individual as a result of impairments and disabilities (interactions at social and environmental level)

Question 2

Models of disability

Answer 2

Medical - personal problem, pathology

Social - societal problems, limitations only one of many factors, concerns about discrimination

Question 3

Medical models of disability

Answer 3

Individual/personal cause e.g. accident
Underlying pathology e.g. morbid obesity
Individual intervention
Individual change

Question 4

Social models of disability

Answer 4

Societal causes e.g. low wages
Conditions related to environment e.g. damp
Social/politcal action needed
Social attitude change

Question 5

GMC good medical practice on disability

Answer 5

Doctors must not unfairly discriminate against patients by allowing their personal views to adversely affect their professional relationship with patients or the treatment they provide or arrange. This includes disability as well as many other factors. You should challenge colleagues who do not comply with this guidance and be aware of own attitudes and prejudices of disability and address this by finding out about common disabilities

Question 6

Disability Discrimination Act 1995 disability definition

Answer 6

Person with disabilities is one with physical, sensory or mental impairment which has a substantial, adverse and long term (>12 months) effect on ‘normal’ day to day activities.

Question 7

Equality Act 2010 definition of disability

Answer 7

Disability is one of the characteristics protected under this legislation as well as age, race and sexual orientation. A person has a disability if they have a mental or physical impairment that has a continuing effect on their ability to perform day to day activities.

Question 8

Causes of under-development or physical limitation of absence

Answer 8

Genetic or chromosomal disorders
Accidents
Chronic diseases

Question 9

Factors affecting responsibilities of doctor when treating a patient with a disability

Answer 9

Attitudes will pass on to patients and those you teach
Listen to patients and learn
Own age and culture will affect views
Questionable whether you can truly empathise with a patient with a physical disability

Question 10

Role of doctors in caring for a patient with a disability

Answer 10

Assess disability
Co-ordinate multidisciplinary team providing care
Intervene in form of rehabilitation
Therapeutic/Prosthetic approaches
Avoid cliche of treating the body, not the patient

Question 11

Reaction to disability is dependent on

Answer 11

Nature of disability
Information base of the individual - intelligence, education, access to info
Personality of individual
Role of individual - loss or change of role
Mood and emotional reaction
Reaction of others around them
Support network of individual

Question 12

Disability causes disruption at what different levels

Answer 12

Personal
Economic
Social

Question 13

Epidemiology of disability

Answer 13

Congenital 
Injury 
Communicable disease 
Non-communicable disease 
Alcohol 
Drugs 
Tobacco 
Mental illness 
Malnutrition

Question 14

Primary prevention of disability

Answer 14

Prevention of disease onset in healthy individuals to reduce risk, severity and duration of disease/illness/injury

Question 15

Secondary prevention of disability

Answer 15

Early detection of pre symptomatic disease
Screening programmes
Occupational screening
National screening

Question 16

Tertiary prevention of disability

Answer 16

Reduce consequences of disease and disability and prevent deterioration
Limit disability and enhance quality of life

Question 17

Primordial prevention of disability

Answer 17

Address social and environmental circumstances that predispose society to disease

Question 18

Wilson and Junger criteria - knowledge of disease

Answer 18

Condition should be important
Must be recognisable latent or early symptomatic stage
Natural course of condition, including development from latent to severe disease, should be adequately understood

Question 19

Wilson and Junger criteria - knowledge of test

Answer 19

Suitable test or examination
Test acceptable to population
Case finding should be continuous

Question 20

Wilson and Junger criteria - treatment of disease

Answer 20

Accepted treatment for patients with recognised disease
Facilites for diagnosis and treatment available
Agreed policy regarding home to treat as patients

Question 21

Wilson and Junger criteria - cost considerations

Answer 21

Costs of case finding economically balanced in relation to possible expenditures on medical care as a whole

Question 22

Types of discrimination as defined by 2010 Equality Act

Answer 22

Direct discrimination 
Associative discrimination 
Indirect discrimination 
Harassment 
Harassment by a third party
Victimisation 
Discrimination by perception

Question 23

Things to be included in etiquette when talking to and treating a patient with a disability

Answer 23

Don’t give assistance before first asking if patient wants it
Don’t be upset if assistance refused
Don’t be afraid to use figures of speech which refer to the impairment
Don’t use disabled as a noun (i.e. the disabled)
Don’t use negative language e.g. handicapped, crippled, retarded, deformed
Don’t use nouns ending in “-ic” e.g. an epileptic, a diabetic

Question 24

Approach to be taken when talking to a patient with a disability

Answer 24

Etiquette
Patient-centred approach
Think what can be done to achieve best possible function
Diagnosis and assessment of disability
Work with multidisciplinary team, voluntary services and social work

Question 25

Advantages of self-reported ADL

Answer 25

Allows assessment of wide range of activities in home and elsewhere at all times of day and night and over days, weeks and months
Individual can report on important activities to them (e.g. gardening, walking the dog, reading)

Question 26

Advantage of observational ADL

Answer 26

More objective

Question 27

Disadvantage of observational ADL

Answer 27

Restricted to what can be carried out in hospital or on brief home visit

Question 28

Items measuring daily function considered in Barthel Index of ADLs

Answer 28

Feeding
Moving from wheelchair to bed and return 
Grooming
Transferring to and from a toilet 
Bathing
Walking on a level surface
Going up and down stairs 
Dressing 
Continence of bladder and bowel

Question 29

Performance is limited by

Answer 29

Actual loss of function (e.g. by physical limitation)
Restrictions on function (e.g. advice on not to perform certain physical activities)
Premature termination of activity and suboptimal performance (e.g. limitation due to pain and fatigue, environment, attitude and motivation)

Question 30

Health related quality of life includes

Answer 30

Physical, emotional, functional and social wellbeing. Based on gap between real and ideal, hope vs reality

Question 31

Health related quality of life allows comparison of

Answer 31

functional health over time and between patients

Question 32

Principle of compression of morbidity

Answer 32

The objective of increasing lifespan should be associated at the same time with an increasing quality of life or a reduction in disability: no point in increasing lifespan if disability high and quality of life low

Question 33

Disadvantages of QUALYs

Answer 33

Patient’s QUALYS assessed and decisions made on how well treatment went for them then treatment with most acceptance can be applied exclusively but pts are unique and responds individually to treatments
QUALYs are well designed and robustly tested but tend to be value-laden and subjective e.g. that being in a wheelchair is of less value
Resources are finite

Question 34

Interventions and initiatives that can be taken to reduce, prevent or limit the onset of disabling conditions

Answer 34

Public health e.g. folic acid in early pregnancy to reduce spina bifida incidence
Disease prevention interventions e.g. screening, immunization, health promotion and education (stop smoking)
Disease modifying drugs
Splints and aids e.g. arthritis
Physiotherapy and occupational therapy
Rehabilitation
Occupational and environmental medicine