Disability and Health and QOL Flashcards
What is disability?
Disability is a medical
concept that describes a
person who has a significant
impairment or loss of some
major species specific
behavior ( e.g. walking,
talking, seeing, hearing,
etc.), affect or aspect
A person may acquire a
disability at any point in life
through injury, accident,
disease or disorder or a
person may be born with a
disability
Social Model
If we accept the social model then persons
with disabilities may define their own lives as
they see fit, chose to do so
A corollary that follows from this claim is that they then may set their own goals, limits, possibilities
Changing Behavior
One of the difficult things to do is to learn how
to interact appropriately and inoffensively
with people whom we may not interact with
on a daily basis
The rules of social discourse and etiquette may differ according to culture, class, language, and age
And, yes, ability
What is Health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States
enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition
Disability is an evolving concept:
disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders full and effective participation in society on an equal
basis with others
Definitions of Disability & Health
Proposed new WHO definition will likely stress the concept of:
health as the ability to adapt and to self manage
What is Quality of Life?
an individual’s perception of their position in life in
the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns
QOL is subjective and embedded in a cultural, social, environmental context
QOL cannot be equated with health
status, but incorporates perceptions of this and other aspects of life
WHOQOL instrument includes 6 domains:
Physical
Psychological
Levels of independence
Social relationships
Environment
Spiritual
Health-related quality of life is a narrower subset of Quality of Life (QOL)
Domains include:
Physical
Mental
Social wellbeing
How Congruent are Self and Proxy Reports of QoL and HRQL?
In general, it is:
low to moderate
greater for observable (behavioral) domains such as physical functioning
lower for internal (subjective) states such as pain and emotion
Discrepancies between self and proxy reports of HRQL are greater
Proxy-reporters overestimate the negative impact of disability compared to self-reports
What is the Disability Paradox?
“Why do many people with serious and persistent disabilities report that they experience a good or excellent quality of life when to most external observers these individuals seem to live an undesirable daily existence?”
54.3% of the respondents with moderate to serious disabilities reported having an excellent or good quality of life confirming the existence of the disability paradox
Disability reconsidered: the paradox of physical therapy
“…we have the paradox of physical therapy—how do we practice in the medical model and intervene to minimize the effects of a disability while recognizing and celebrating disability as diversity?”
Moral of Disability
disability is a defect caused by moral lapse or sins
failure of faith, evil, or test of faith
brings shame to person with disability and his/her family
Medical model of Disability
defect/failure of bodily system that is inherently abnormal and pathological
abnormality due to genetics, bad health habits, or behavior
want a “cure”
Social model of Disability
disability is a social construct
problems reside in environment that fails to accommodate people with disabilities
sense of community and pride
Medical model Assumptions
Disability is a problem of the person caused by disease/ trauma
Treatment is needed
Must strive to overcome
Doctors know what’s best
Resulted in
Lonely state, social stigma
Expectation of “adhering to expert advice and making a good adjustment”
Social Model Assumptions
Disability is a socially created problem -not an attribute of the person
Created by the environment
Requires : Social activism to change the environment
What is Response Shift?
Response shift (RS) is defined as ‘‘a change in the meaning of one’s self-evaluation of a target construct” as a result of:
recalibration
reprioritization
reconceptualization
Recalibration:
change internal measurement standard
E.g. , Pain 10/10 for a fracture; fracture downgraded to an 8/10 after a kidney stone (new 10/10)
Reprioritization:
change in values/ order of importance in HRQL domains
E.g., work, recreation, family/ friends reordered post injury
Reconceptualization:
Redefinition - change in domains of QoL that are important
Disability language and models
Disability language continues to evolve
Stereotypes are still common
Many barriers to effective communication
Potential for misunderstanding, hurt, harm
Disability & Changes in Language
old vs new
Old language
> afflicted by
> crippled with
> handicapped
> victime of
> mentally retarded
New language
> challenged
> differently abled
> temporarily able-bodied
> intellectual disability
> neurotypical
Activity =
Activity is the execution of a task or action by an individual - individual perspective of functioning
Activity limitations are difficulties that an individual may have in executing activities
Participation =
Involvement in a life situation –societal perspective of functioning
Participation restrictions are problems that an individual may experience in life situations
Environment =
The physical, social, and attitudinal environment in which people live and conduct their lives
Barriers and facilitators are the terms used to qualify negative and positive environmental factors
Personal factors =
Contextual factors that related to the individual such as age, gender, social status, life experiences
Disablement Process
Gap between person & environment
Rehabilitation
Restorative approach to rehabilitation = Change the person
Compensatory approach = Change the environment
