Psychosocial Concerns with Physical Disabilities

Acquired Physical Disability

• May result from trauma or disease

• ex. SCIs, TBIs, stroke, limp amputations, burn injuries

• Sudden onset of the disability results in common stressors (dependence and vulnerability)

Psychological Implications of Physical Disability

• Psychological and emotional challenges must be negotiated not just with the onset of the injury itself, but also with the traumas and losses that occur as a consequence of the condition.

• An individual who sustains a life-changing injury is thrust into an unfamiliar and frightening hospital environment.

Psychosocial Changes that can accompany Physical Disability

Loss of independence

Sense of helplessness

Lack of privacy

Isolation

Changes in body image/functional ability

uncertainty regarding the future

Isolation

Can begin in the hospital setting
 Lack of control of one’s own body
 Lose freedom to spend time as wish, come and go as please, wear own clothes
 Can exist long after discharge from hospital
 Activity restriction – can create social isolation
 Architectural barriers - limit access to community resources and
accessible transportation, and positive social outlets
 Limited employment opportunities

• Attitudinal barriers

Pain

Medical procedures

Spasticity

Hypertrophic scarring

Mechanical or overuse pain from altered movement patters

Complications of weakness or paralysis

Body Image

People with acquired physical disability may grieve regarding physical changes and body image concerns, such as loss of a body part, paralysis, spasticity, incoordination, or atrophy

Lack of Relational Intimacy and Gender Role Issues

Sexuality is a vital part of the human experience, and it is important for self-esteem, self-concept, and quality of life

Cognition

• process of overcoming many of the physical challenges
  posed by a disability requires intensive occupational therapy to
  help the patient learn new information; master compensatory
  techniques for functional mobility, activities of daily living
  (ADLs), and community reintegration; and adapt to a new
  lifestyle.

• In addition, individuals who successfully adapt to life with a
  disability must become experts in managing their condition or
  diseas

Psychiatric Conditions Associated with Physical Disability

Depression and anxiety
 Grieving process should be expected for individuals with a newly acquired disability
 Individuals with disabilities have a substantially higher risk of experiencing mood disorders
(beyond normal process of grieving) compared with the general population.
 Consider treatment for mood disorders.
 Anxiety may manifest over fear of impending illness when disability is chronic.
 May be a reaction to the trauma

Functional Consequences of Generalized Anxiety Disorder (GAD)

• Excessive worrying impairs ability to work and complete things quickly and efficiently

• Worrying leads to muscle tension and feeling on edge, tiredness, difficulty concentrating, and sleep disturbances

• Lack of ability to encourage confidence in their children

• GAD accounts for 110 million disability days per year in the U.S. population

• Associated with decreased work performance, increased medical resource use, and increased risk for coronary morbidity

PTSD

Distressing quality of a life-threatening event places those involved at risk for developing PTSD
One report indicated that 44% of 62 people with SCI met the criteria for a diagnosis of PTSD relative to a sample of able-bodied controls

Substance Use interferes w/ rehab and recovery in several ways

• Personality characteristics of substance abuser

• meds prescribed to prevent seizures, control BP, improve pain and mood post-injury

• Negatively affects sleep, med compliance, nutritional intake, development of functional skills, + reintegration into family, work, and community roles

Psychiatric Conditions Associated with Physical Disability

Suicidal Ideation

Suicide in disabled population can take the form of overt action, self-neglect, or refusal of required care

Effects of Physical Disability on the Family

Family members undergo significant distress and are often unprepared for the tremendous emotional and mental demands

Compassion Fatigue

Impact on Occupational Performance

Role Changes

Past, Present, and future selves → recovery process = adequately mourn the past self, learn to cope, develop a new future self that is still fulfilling

Factors Related to Positive Adaptation

Coping: social support, gaining knowledge and communicating, generativity, resilience