Pattens of disability and impairment / ADLs

how many people live with significant disability?

1.3 million (1 in 6)

What is driving this increase in disability?

• Increase in age of population

• increasing number of chronic conditions

Difference in degree attainment compared to general population?

25% vs 43%

Difference in employment vs general pop?

53% vs 81%

Difference in UK rented social housing?

25% vs 8 %

What is a disability?

Loss/ limitation of opportunities to take part in society on an equal level with others due to environmental or social barriers.

What is impairment?

Illness, injury or a congenital condition than either causes/ is likely to cause a loss or difference to function

• may be functional, physiological or psychological

What is the ICDH definition of a disability?

Disability = any restriction of ability to perform an activity in manner considered normal

What is the ICDH definition of impairment?

Impairment = any temporary/permanent loss of a body structure or function

• can be physiological/psychological

• it is a disturbance affecting functions

ICDH definition of handicap?

Handicap = disadvantage of a given individual (resulting from an impairment or disability) that limits/prevents fulfilment of a role that is normal for that individual

What are examples of global and generic outcomes of disability?

• Barthel index

• Functional assessment measure

• SF-36

• Nottingham health profile

• Health assessment questionnaire (HAQ)

• EQ-5D-5L

What is the definition of disability under the 2010 equality act?

A physical or mental impairment that has substantial and LT negative effect on your ability to do normal daily activities

What are the 3 different models of disability?

• Medical

• social

• biopsychosocial

How does the medical model view disability?

Sees disability as a physical/ mental deficit within and individual that requires a cure or medical intervention to return the person to ‘normal’

What does the medical model consider the underlying cause of disability?

Disease process or disorder

What does the medical model focus on?

• what the person lacks/ can’t do

• what is abnormal/wrong with the person

What is the sick role?

Classical sociological model of patient hood developed by Parsons in the 1960s

• disease = dysfunction of the body - therefore being sick is a role with social exceptions and responsibilities

• Sick person is exempt from social norms/activities and is not held responsible

How do the medical model of disability and the sick role interlink?

Those who have a disability = expected to take up the sick role

What is the social model of disability?

Believes that it is the social and environmental constraints on a person that disables them

• claims that current ‘ableist’ environments are inaccessible

• peoples attitudes are also to blame, rather than the impairment itself

What are some examples of ‘ableist’ physical/ social environmental constraints?

• inaccessible buildings

• poor sound systems

• lack of public awareness

• no lifts

• prejudices & patronising attitudes

What is the biopsychosocial model of disability?

It is an attempt to bridge the gap between medical and social factors

• integrates biological, psychological and social factors

What does the biopsychosocial model underpin?

WHO international classifications of functionality, disability and wealth (ICF)

What are the two components of ICF?

• Functioning and disability

• contextual factors

What are the two categories of functioning and disability?

• Bodily functions and structures (physiological/psychological functions, anatomical parts)

• Activities and participation (execution of tasks, involvement in life situations)

What are the 5 dimensions of patient centred care?

• Biopsychosocial perspective

• patient as a person - what does the illness mean for each patient?

• sharing power and responsibility - of patients health

• therapeutic alliance - shared goals of DR and pt

• Dr as a person - personal qualities of DR are important

What are ADLs?

Activities of daily living - everyday tasks (functional activities) that are an essential part of life that a person needs to look after themselves fully

What are the 4 categories of ADL?

• locomotion

• personal

• domestic/work

• leisure

What are some examples of ADLs?

• tying shoe laces

• brushing teeth

• washing yourself

• walking upstairs

What is the role of physiotherapists?

• assessment of physical impairment

• goal setting

• patient management

What are some examples of activities physiotherapist do?

Exercises/ manual therapy

hydrotherapy

electrotherapy

injection therapy

acupuncture

CBT

What are the roles of an OT?

• Functional assessments

• Goal setting

• Occupational issues

• QOL

• ADL maintenance/ reintroduction

How might you asses ADLs?

• through observation

• self reporting - active listening

• carefully worded questions

• clinical examinations

• validated questionnaires

• Specific lab tests = EMG, EEG

What are examples of specific outcome measures of back pain?

• Roland and Morris disability questionnaire

• Oswestry disability index

Examples of specific outcome measures?

• Lower extremity functionality scale

• Disability of arm, shoulder and hand scale