Week 6 Flashcards

Question

Normalisation 1

Answer 1

Scandinavian approach (eg Nirje) emphasises the importance for the disabled person to attain adulthood by overcoming the ordinary challenges of life Compensatory services are needed to enable the disabled person overcome these challenges and also to live a life comparable to that of other people in society

Answer 2

US approach (wolfensberger) notes the ease by which disabled people are assigned derogatory labels because of the separateness of their appearance, environment or way of life Therefore wary of specialist services which identify disabled people as different proposes importance of them being associated with valued social roles. Now renamed ‘social role valorisation’

Answer 3

Closure of large institutions. Preference for ordinary domestic settings, domiciliary care. Suspicion of separate disabled services, schools Greater access for disabled people to universal public services, employment and community facilities this is enforced by law and political action

Answer 4

Rise of consumerism with people defining self as what they purchase from competing corporations Diminished sense of collective responsibility arising from less engagement with others and perception of others as a threat (culture of fear) May lead to loss of sense of people sharing universal rights disabled seen as ‘negative consumers’

Answer 5

Causes of LD very diverse and therefore multiple prevention strategies required Distinguish preconceptional causes (eg DS, PKU) prenatal (eg foetal alcohol syndrome), perinatal (obstetrical trauma) and postnatal (eg meningitis, cerebral anoxia)

Answer 6

Preconceptional. Prenatal (DS) or newborn (PKU) screening Prenatal. Folate therapy in pregnancy, health education to reduce alcohol consumption in pregnancy Perinatal. Optimal obstetric, neonatal care Postnatal. Health education to reduce accidents, vaccinations

Answer 7

High rate of chronic disorders. 60% of individuals have chronic disorders/disabilities in addition to LD. No specific set of disorders associated with each syndrome High rate of injuries. Less capacity to assess risk, higher prevalence of epilepsy, sensory impairments and mobility problems

Answer 8

4 times more likely to suffer common mental disorders than rest of population. May result from stress involved in coping with dependence, social exclusion Higher prevalence (10x) of autistic disorders Challenging behaviour associated with specific syndromes or resulting from physical distress, abuse, poor care

Answer 9

Life expectancy for people with LD has risen since early 20th century (when minority survived to adulthood). Low life expectancy in old hospitals because of infectious diseases, untreated illnesses This trend is still continuing, and mean age at death for people with more severe LD now in late 50s/early 60s in UK

Answer 10

But sex adjusted mortality rates for people with severe LD still 10-18 times higher than in general population Highest risk among people with greater severity of LD, DS, epilepsy and tube-feeding Most common causes of death are bronchopneumonia, cardiovascular disorders, and consequences of epilepsy

Answer 11

Disorders associated with the syndrome causing the LD eg DS has early onset of AD-type dementia and cardiovascular disorders and reduced immunity to infections Higher prevalence of other neurological disorders 20-30% with severe LD also have epilepsy Unhealthy lifestyle. Many people with LD lead sedentary lives and have a poor diet. Rates of obesity double that in rest of population. Poor quality care can result in chronic constipation because of low levels of roughage in diet, limited exercise and inadequate fluid intake Poor access to healthcare

Answer 12

GP learning disability register The learning disabilities health check scheme (annual health checks) Only 4.4 in every thousand patients has a recorded intellectual disability which represents only 23% of the estimated total population of adults in England with a learning disability

Answer 13

In the UK, learning disability services are delivered by community based teams led by the local authority some are in partnership with mental health foundation trusts Provide specialist help with complex needs

Answer 14

Poor access, several surveys have found that contacts with GP similar to general population but that there are high rates of untreated and undiagnosed disorders and low uptake of routine screenings and tests

Answer 15

Attribute discomfort to an illness Make appointment to see GP Get to GP surgery Speak to reception Wait in waiting room Communicate information to GP Understand GPs advice Collect prescription Take medication as directed

Answer 16

All are potentially difficult you may require the help of a family member/carer to arrange appointment take you to surgery and pharmacy, communicate with the GP on your behalf This requires an important additional step communicating your discomfort to the carer. Carer (and GP) may fail to identify illness because of ‘diagnostic over shadowing’

Answer 17

Limited research but shows: Hospital staff often unfamiliar and embarrassed in communication with PLD. Do not speak to the patient ask for consent or use expertise of carer Poor information to patient before admission about hospital procedures and at discharge Result is fear and distress with limited alleviation by nurses. No one saw it as their job to comfort the sick

Answer 18

Hospitals unwilling to make ‘concessions’ to special needs Lack of adapted facilities or room for wheelchairs Families expected to provide 24hr care Hospitals unwilling to meet additional care costs unless they could offset it to other agencies could delay admission

Answer 19

Hospitals often not informed in advance that patients has LD Little staff training in communicating with people with LD limited policy commitment to meeting needs of PLD in hospital (cf other communication minorities) Concern about risk to other patients Consent and liability issues not resolved

Answer 20

Identification of patients with LD on practice register Programme of routine health checks More appropriate waiting arrangements Routine use of double appointment time because of more complex communication Training to improve awareness among entire PHCT

Answer 21

Patient held data (eg medalert, life books, hospital passports) Preparation for admission (videos etc) Access by staff to communication therapists Specialist community support for PLD in hospital Improved communication environment in hospital Training for hospital staff in needs of PLD

Answer 22

TEACH is a way of learning and remembering how to make reasonable adjustments. Each letter of the word TEACH is the first letter of a key word to think about when supporting someone to access healthcare Time : this might be offering a double appointment with the GP or an early morning appointment when the waiting room is quieter Environment: this might mean the dentist visiting at home or the operating theatre nurses meeting the individual in casual clothes rather than in gowns and masks Attitude: this means treating everyone with dignity and respect and as an individual Communication : this means using accessible information to ensure it can be understood eg easy read leaflets, pictures, symbols or sign language Help: this means listening to others (family carers/supporters) and knowing where to get specialist help when needed (community learning disability nurse, acute liaison nurse, social worker, safeguarding teams)

Answer 23

People with learning disabilities need their voices heard Services should encourage self advocacy Positive self esteem leads to self empowerment Four approaches are self advocacy, independent advocacy, collective advocacy and legal advocacy

Answer 24

Being unable to see or unable to see very clearly How much one sees depends on a number of factors not just the level of sight The external environment may play a role You can still have poor vision but not fulfill the criteria for being registered

Answer 25

The ability of the eye to see detail Distance acuity: -each eye is tested separately using a snellen chart -tested at a distance of 6m- normal 6/6 -if cannot see the top letter at 6 metres then test at 5,4,3,2,1 Snellen chart comprises rows of letters of decreasing size labelled 60,36,24,18,12,9,6,5 Normal distance acuity ie 6/6 means that the row of letters with the number 6 underneath can be read at distance of 6m

Answer 26

Counting fingers CF Hand movements HM Perception of light PL No perception of light NPL, stone blind If visual acuity is not at least 6/9 then use pinhole test

Answer 27

Registration takes place on the recommendation of an opthalmologist Depends on how far you see down the eye chart and your field of vision Two categories: - severely sight impaired (previous known as blind) -sight impaired (previously known as partially sighted)] Based on vision in better seeing eye Form called certificate of vision impairment CVI

Answer 28

Group 1: people who have visual acuity worse then 3/60 snellen Group 2: people who are 3/60 snellen or better but worse than 6/60 snellen who also have contraction of their visual field Group 3: people who are 6/60 snellen or better who have a clinically significant contracted field of vision which is functionally impairing the person e.g significant reduction of inferior field or bi-temporal hemianopia

Answer 29

Group 1: people who are 3/60 to 6/60 snellen with full visual field Group 2: people between 6/60 and 6/24 snellen with moderate contraction of the field eg superior or patchy loss, media opacities or aphakia Group 3: people who are 6/18 snellen or even better if they have a marked field defect eg homonymous hemianopia

Answer 30

Very few blind people see nothing at all A minority can only distinguish light Some have no central vision others have no side vision Some see everything as a vague blur others a patchwork of blanks and defined areas

Answer 31

This includes: -people who are registered SSI or SI -people whose vision is better than the levels that qualify for registration -people who are awaiting or having treatment such as eye injections, laser treatment or surgery that may improve their sight -people whose sight loss could be improved by wearing correctly prescribed glasses or contact lenses Main causes sight loss: -uncorrected refracted error -age related macular degeneration -cataract -glaucoma -diabetic eye disease

Answer 32

The older you are the greater your risk of sight loss The majority of people registered SSI and SI are aged 75 and older The “oldest old” are at greatest risk of sight loss

Answer 33

At least 50% of sight loss can be avoided Many older people are needlessly living with sight loss almost 2/3 of sight loss in older people is caused by refractive error (shortsighted, long sighted, astigmatism) and cataract Both conditions can be diagnosed by a simple eye test in most cases the persons sight could be improved by prescribing correct glasses or cataract surgery

Answer 34

89% of visually impaired people live in low and middle income countries Globally uncorrected refractive errors are the main cause of visual impairment Cataracts remain the leading cause of blindness in low and middle income countries The number of people visually impaired from infectious diseases has greatly reduced in the last 20 years Millions of people remain at risk of visual loss due to the lack of eye care services

Answer 35

About 65% of all people who are visually impaired are aged 50 and older while this age group comprises of 20% worlds population An estimated 19 million children are visually impaired of these 12 million children are visually impaired due to refractive errors a condition that could be easily diagnosed and corrected 1.4 million are irreversibly blind for the rest of their lives Females have a significantly higher risk of being visually impaired than males

Answer 36

Uncorrected refractive errors Cataract Glaucoma Corneal opacities Diabetic retinopathy Childhood blindness Trachoma Onchocerciasis Age related macular degeneration is unavoidable

Answer 37

Eye disease caused by infection with bacterium chlamydia trachomatis It’s the leading cause of infectious blindness globally being responsible for 1.3 million cases of blindness It’s estimated that trachoma is endemic in 55 countries mainly Africa and Asia Trachoma blinds one person every 15 minutes

Answer 38

Caused by the filarial parasite onchocerca volvulus, which is transmitted by the Backfly simulium species. It mainly affects communities living near rivers The filarial worm is transmitted through the bites of infected back flies In the body the larvae form nodules in the subcutaneous tissue where they mature to adult worms These move through the body and when they die they cause a variety of conditions including blindness It’s endemic in 30 countries but mainly in Africa Currently about 300000 people are blind from onchocerciasis

Answer 39

The total estimated cost on the UK is estimated to be around £26.5 billion every year This cost is made up of: -direct health care costs such as NHS eye examinations, prescriptions, outpatient appointments and operations -indirect costs, such as unpaid carer costs and reduced employment rates -associated reduction in wellbeing and health due to sight loss

Answer 40

People from certain ethnic communities are at greater risk of some of the leading causes of sight loss yet many are unaware of this Black African and Caribbean people are 4-8x more at risk of developing certain forms of glaucoma compared to white people The risk of diabetic eye disease is around three times greater in south Asian people compared to whites people Black African and Caribbean people are also at higher risk of diabetic eye disease

Answer 41

Lower wellbeing Lack of emotional support Essential practical support is missing Relying on some form of support Financial struggles Travel and transport remains a major issue Feeling isolated from the people and things around them Limited choice about how to spend free time Poor access to key information

Answer 42

Government benefits but less if registered SI ECLO- eye clinic liaison officer Social worker, mobility officer, technical officer, rehabilitation worker Voluntary organisations e.g RNIB, guide dogs for the blind, focus birmingham Low vision aids, magnifiers etc

Answer 43

Also known as sight loss advisor or vision support service officer Work closely with medical and nursing staff in the eye clinic and the sensory team in social services They provide those recently diagnosed with an eye condition with the practical and emotional support which they need to understand their diagnosis, deal with their sight loss and maintain their independence

Answer 44

Registering as visually impaired isn’t compulsory but it can entitle you to a range of benefits including : -disability living allowance (DLA) or personal independence payment PIP a tax free benefit to help with any costs relating to your disability or illness -a reduction in the TV licence fee -a tax allowance -reduced fees on public transport -parking concessions

Answer 45

Change text and background colours Change fonts Make text larger Magnify screen Make the mouse pointer easier to see Get the computer to speak the text aloud

Answer 46

Waymap does not require any external signals. No GPS, no Bluetooth and no mobile signal are required, meaning that Waymap can navigate you anywhere and you are never left without navigation instructions Waymap has created a breakthrough technology that locates people accurately indoors and outside without signal or beacons using only smartphone. The app uses the sensors already on your phone that measure movement, direction and elevation to navigate via dead-reckoning

Answer 47

To walk in a straight line in the centre of the pavement unless there is an obstacle Not to turn corners unless told to do so To stop at kerbs and wait for the command to cross the road or to turn left or right To judge height and width so that it’s owner does not bump their head or shoulder How to deal with traffic