Activity Limitation Flashcards
WHO definition of disability
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)
Models of disability
Medical - personal problem, pathology
Social - societal problems, limitations only one of many factors, concerns about discrimination
Medical models of disability
Individual/personal cause e.g. accident
Underlying pathology e.g. morbid obesity
Individual intervention
Individual change
Social models of disability
Societal causes e.g. low wages
Conditions related to environment e.g. damp
Social/politcal action needed
Social attitude change
GMC good medical practice on disability
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
Disability Discrimination Act 1995 disability definition
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.
Equality Act 2010 definition of disability
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.
Causes of under-development or physical limitation of absence
Genetic or chromosomal disorders
Accidents
Chronic diseases
Factors affecting responsibilities of doctor when treating a patient with a disability
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
Role of doctors in caring for a patient with a disability
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
Reaction to disability is dependent on
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
Disability causes disruption at what different levels
Personal
Economic
Social
Epidemiology of disability
Congenital Injury Communicable disease Non-communicable disease Alcohol Drugs Tobacco Mental illness Malnutrition
Primary prevention of disability
Prevention of disease onset in healthy individuals to reduce risk, severity and duration of disease/illness/injury
Secondary prevention of disability
Early detection of pre symptomatic disease
Screening programmes
Occupational screening
National screening
Tertiary prevention of disability
Reduce consequences of disease and disability and prevent deterioration
Limit disability and enhance quality of life
Primordial prevention of disability
Address social and environmental circumstances that predispose society to disease
Wilson and Junger criteria - knowledge of disease
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
Wilson and Junger criteria - knowledge of test
Suitable test or examination
Test acceptable to population
Case finding should be continuous
Wilson and Junger criteria - treatment of disease
Accepted treatment for patients with recognised disease
Facilites for diagnosis and treatment available
Agreed policy regarding home to treat as patients
Wilson and Junger criteria - cost considerations
Costs of case finding economically balanced in relation to possible expenditures on medical care as a whole
Types of discrimination as defined by 2010 Equality Act
Direct discrimination Associative discrimination Indirect discrimination Harassment Harassment by a third party Victimisation Discrimination by perception
Things to be included in etiquette when talking to and treating a patient with a disability
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
Approach to be taken when talking to a patient with a disability
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
Advantages of self-reported ADL
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)
Advantage of observational ADL
More objective
Disadvantage of observational ADL
Restricted to what can be carried out in hospital or on brief home visit
Items measuring daily function considered in Barthel Index of ADLs
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
Performance is limited by
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)
Health related quality of life includes
Physical, emotional, functional and social wellbeing. Based on gap between real and ideal, hope vs reality
Health related quality of life allows comparison of
functional health over time and between patients
Principle of compression of morbidity
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
Disadvantages of QUALYs
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
Interventions and initiatives that can be taken to reduce, prevent or limit the onset of disabling conditions
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
