HSC 3502-Study Guide Final Exam PDF

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HSC 3502--Study Guide Final Exam Disability Models ● WHO/ICIDH (1980)—International Classification of Impairment, Disability and Handicap; Impairment was defined as an abnormality in body structure or appearance; disability was defined as a restriction or lack of ability to perform an activity; and handicap was defined as a disadvantage the individual experienced as result of the impairment or disability ● WHO/ICF—International Classification of Functioning, Disability and Health ○ Body function: refers to physiological functioning of body systems, such as mental function, sensory function, function of the heart, or function of the immune system. ○ Body structure: refers to anatomical components of the body, such as the structure ○ ○

of the nervous system or the structure of the cardiovascular system. Impairment: loss or abnormality of function at the body system or organ level. Activity: refers to tasks or actions that individuals carry out in daily life, such as reading, writing, managing daily routines, dressing, and bathing.

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Activity limitation = unable to perform an activity due to disability Participation: refers to the individual’s involvement in activities of daily life or in

society. It includes the individual’s ability to fully participate in activities in the broader social system, such as going to school, holding a job, engaging in recreational activities, or being integrated into the community. ○ ○

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Participation restriction = unable to engage in participation due to disability Contextual factors ■ Environmental factors: refers to more than the physical environment, such as accessibility of buildings or the availability of accessible transportation. That is, it also includes products and technology, climate, and factors in the social environment. Environmental factors are divided into three levels’ Individual Level: individual systems of support; network Services level: services and resources available. Cultural/legal systems level: societal and cultural attitudes; political and legal factors. ● Personal factors: is recognized as an important interactive component in defining function but is not coded in the ICF because of the complexity and highly individualized nature of these factors. Personal factors include gender, race, education, occupation, and difficult-to-quantify human factors, such as past personal experiences, individual temperament, and other intrinsic characteristics, such as state of mind.

Medical model v Social model O Medical Model: focused on specific medical conditions that were viewed as “problems” and were intrinsic to the individuals experiencing them. It was diagnosis driven, emphasizing pathology, defining and characterizing the condition by standardized measures, and focusing on medical treatments and solutions to “eliminate” or control the condition, thereby returning the individual to “normal.” The underlying philosophy of the medical model emphasized “normalcy” based on valued societal roles and norms. However, the medical model has difficulty accommodating the types of permanent and chronic long-term care needs that promote optimal health and quality of life for people living with a disability. Further, the medical model relies heavily on measures and tests of the disease process, placing limited value on subjective reports of health and functioning, leading health providers to undervalue patient input concerning their treatment.

Social Model: Rather than viewing disability as a condition of the individual to be cured so that the person can conform to social norms, the social model emphasized societal and environmental barriers as primary contributors to disability. A key component of the social model was equality; thus a major focus was not to “cure” the individual but rather to make changes in society and the environment that would provide equality and opportunity. The social model paralleled the civil rights/human rights movements, which were the catalyst for the development of a number of social policies and legislative actions. In the United States, the Americans with Disabilities Act, enacted in 1990, established the right of individuals with disability to receive reasonable accommodations that would enable them to function in the environment and prohibited discrimination based on their disability. In contrast with the specific information defining what comprise diagnoses in the medical model, the social model has not historically distinguished who qualifies as a person with a disability, or how disability is measured or determined. ●

Biopsychosocial model (ICF) Biopsychosocial model- (Alternative to both) it is the complex interaction of biological, psychological, and social factors in combination that play a significant role in an individual’s ability to function

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WHO developed a unified, standard classification of consequences of health conditions influenced by the medical model defined by impairment, disability, and handicap insufficient to describe experience linear negative terms ○ ○ ○

Impairment: abnormality in body structure or appearance; Disability: defined as a restriction or lack of ability to perform an activity. Handicap: as a disadvantage the individual experienced as result of the impairment or disability.

Disability Assessment and Intervention ● Current prevalence of functional limitations (% of population) 20%

● 18.7% with a disability, 12.6% with a severe disability ● Capacity v. Performance: can do vs does do ○

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Capacity describes an individual’s ability to execute a task or an action, or more specifically the highest probable level of functioning that a person may reach in a given domain at a given moment. One must apply the capacity qualifier in the context of a “uniform” or: standard” environment; a heuristic for capacity could be what a person can do. The performance qualifier describes what a person does in his or her current environment; a heuristic for performance could be what a person does do. The gap between capacity and performance can be very useful in intervention targeting, informed by the ICF’s conceptual framework.

● Five types of intervention: ○

Remediation-Remediation involves addressing the underlying deficits that lead to difficulties with daily living skills. For example, a person may have difficulty learning new skills due to poor concentration. A remediation approach would mean that the person would engage in tasks to improve concentration.

influence biological, physiological, or neurological processes, such as range of motion, blood glucose management, blood flow-heart rhythm. Restoration- Re-establish performance skills, habits, and routines. Structuring tasks, giving feedback Establishment- if skills and habits have never been learned, establish new functions Modification-finding new ways to reach goals. modifications may be personal, environmental, technological, assistive. Changes in task, method. Devices or systems. Using an agent or care giver. Compensatory strategies. Maintenance- prevent further loss of functioning. Maintain current levels of achievement. “booster” sessions. Prevention- promote safety and prevent health problems. Identify risk factors. Example: remove trip rugs, install grab rails Health promotion- improve health, life satisfaction and well-being

● FIM (Functional Independence Measure)- For pediatrics: Wee-FIM ● quantifies the amount of assistance needed with activities of daily living ● scale from 1 to 7 Independence - 7 (complete safety) and 6 (modified with devices) Modified independence - 5 (supervision), 4 (minimal assistance), and 3 (moderate assistance) Complete dependence - 2 (Maximal assistance) and 1 (total assistance) Historical Views of Disability ● know general trends across the centuries, both positive and negative ● 16th century (1500’s) treatment of mental illness: people were identified as sick, but incarcerated in asylums ● 18th century (1700’s) - age of enlightenment: right of individual to live with dignity. People with disabilities subjected to ridicule, poverty, segregation, begging ● 19th century (1800’s) america: 1817 Gallaudet- first us school for deaf. 1829 Sam HowePerkins school for blind ● 20th century (1900’s) - charitable organizations, but Hitler era ● Hitler--1933: medicalized approach to “life unworthy of life”

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ideal physical form--people with disabilities did not conform to this sometimes seen as more insightful (Homer--blind but had insight into the mind) prejudice--Aristotle claimed that individuals with deafness were not educable disability is punishment from an angry God ○ mental illness = demonic possession ● mental illness started to be seen as a sickness, but they were incarcerated in asylums for their lifetimes ○ Pennsylvania Hospital was the first to include treatment ○ sensory deprivation ● 1938: first killing of an infant sanctioned by hitler ○ Social Darwinism- natural selection of the fittest. ○ Eugenics- segregation, sterilization. ○ Herbert spencer- should allow poor and weak to perish, rather than sustain existence through public relief and health programs

● Social Gospel Movement- misfortune vs misconduct. Social reform based on religious principles. Belief that social darwinism is cruel, without kindness and compassion. Morally superior can help morally inferior ● Know Nazi history of killing of people with disability- 5000 killed and criteria expanded to juvenile delinquency and jewish U.S. 20th Century Legislation ● Have general knowledge of the types of legislation impacting people with disabilities

● Workers Comp--employee doesn’t have to prove that the employer was negligent ● Soldier’s Rehabilitation Act--vocational rehab for injured veterans ○ Social Security Act--extended the vocational rehab program to civilians ■ blind, cognitive disabilities, individuals with mental illness ■ Made VR program permanent ■ amendments ● disability allowance ● medicare with tail coverage ● trial work period ● Americans with Disabilities Act (ADA): Four titles ○ Title 1: Employment (prohibits discrimination against individuals and required employers to provide reasonable accommodations).

○ Title 2: Public entities and transportation ○ Title 3: Public accommodations (requires newly constructed buildings to comply with ADA standards) ○ Title 4: Telecommunications ● Convention on the Rights of Persons with Disabilities (CRPD):

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concern over loss of sovereignty (against) weakening of federal system (against) reproductive rights (for) cumbersome or burdensome regulations (against) principles of the best interest of the child homeschooling (for) treaty doesn't abridge the definitions set form by the ADA international cooperation (against) ● Rehabilitation Act ○ severe disabilities (not behavioral disorders) ○ Independent Living demonstration ○ Individualized Written Rehabilitation Plan ○ Client Assistance Programs ○ definition of disability: impairment that limits a person in major life area, record of such; is regarded as having physical or mental impairment ○ 501 non discrimination, affirmative action in government hiring ○ 502 accessibility to public buildings Spinal Cord Injury (SCI) Know definitions: ● Complete Injury: Any injury that results in the complete loss of function below the point of injury ● Incomplete injury: Spinal cord injury in which some feeling or movement is still evident below the point of injury

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Paraplegia: Paralysis of the legs/lower body (T1-T12) Tetraplegia: Paralysis of all four limbs (Also quadriplegia) (C1-C8) ASIA Sensory/Motor Scales: ○ Myotomes: group of muscles that a single spinal nerve innervates. ○ Dermatome: area of skin that a single nerve innervates ASIA Impairment Scale ○ A: worst prognosis: Complete lack of motor/sensory function below the level of injury ○ B: Some sensation below the level of injury ○ C: Some muscle movement is spared below the level of injury, but 50% of the muscles cannot move against gravity ○ D: Most (>50%) of muscles are strong enough to move against gravity ○ E: Best prognosis: All neurologic function has returned Autonomic dysreflexia (AD): Syndrome in which there is a sudden onset of excessively high blood pressure. Symptoms include pounding headache, stuffy nose, profuse sweating, tight

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Heterotopic ossification (HO): Presence of bone in soft tissue where bone normally does not exist. Know functional abilities and technology/equipment needs at each level of complete injury:

High-Cervical Nerves (C1 – C4) Most severe of the spinal cord injury levels Paralysis in arms, hands, trunk and legs Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements. Ability to speak is sometimes impaired or reduced. When all four limbs are affected, this is called tetraplegia or quadriplegia. Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed May be able to use powered wheelchairs with special controls to move around on their own Will not be able to drive a car on their own Requires 24-hour-a-day personal care Low-Cervical Nerves (C5 – C8) Corresponding nerves control arms and hands. A person with this level of injury may be able to breathe on their own and speak normally. C5 injury Person can raise his or her arms and bend elbows. Likely to have some or total paralysis of wrists, hands, trunk and legs Can speak and use diaphragm, but breathing will be weakened Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently C6 injury Nerves affect wrist extension. Paralysis in hands, trunk and legs, typically Should be able to bend wrists back Can speak and use diaphragm, but breathing will be weakened

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Can move in and out of wheelchair and bed with assistive equipment May also be able to drive an adapted vehicle Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment C7 injury Nerves control elbow extension and some finger extension. Most can straighten their arm and have normal movement of their shoulders. Can do most activities of daily living by themselves, but may need assistance with more difficult tasks May also be able to drive an adapted vehicle Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

C8 injury Nerves control some hand movement. Should be able to grasp and release objects Can do most activities of daily living by themselves, but may need assistance with more difficult tasks ● May also be able to drive an adapted vehicle ● Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment ● ● ●

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Thoracic vertebrae are located in the mid-back. Thoracic Nerves (T1 – T5) Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles. Arm and hand function is usually normal. Injuries usually affect the trunk and legs(also known as paraplegia). Most likely use a manual wheelchair Can learn to drive a modified car Can stand in a standing frame, while others may walk with braces Thoracic Nerves (T6 – T12) Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury. Usually results in paraplegia Normal upper-body movement Fair to good ability to control and balance trunk while in the seated position Should be able to cough productively (if abdominal muscles are intact) Little or no voluntary control of bowel or bladder but can manage on their own with special equipment Most likely use a manual wheelchair Can learn to drive a modified car Some can stand in a standing frame, while others may walk with braces. Lumbar Nerves (L1 – L5) Injuries generally result in some loss of function in the hips and legs. Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment

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Depending on strength in the legs, may need a wheelchair and may also walk with braces

Sacral Nerves (S1 – S5) ● Injuries generally result in some loss of function the hips and legs. ● Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment ● Most likely will be able to walk Psychosocial issues following SCI: ● SCI as an acute, acquired disability ● Understand emotional reactions to injury including: ○ Shock ○ Anxiety ○ Denial ○ Anger—internalized and externalized ○ Grief and depression ○ Acknowledgement ○ Adjustment ● Coping- to deal with ● succumbing-to give in ● Positive vs. negative response to disability ● Coping strategies ● Quality of life following SCI: ○ Depression ○ Social support ○ Life satisfaction ● Vocational outcomes and accommodations ● Psychosocial issues and vocational outcomes ● Relationship of mobility, occupation, social integration, social support, life satisfaction, selfassessed health status & depression to FIM and ASIA scales

3 Responses to Disability 1. Cognitive- How one thinks about or chooses to view his or her disability. A positive cognitive response would be redefining reality rather than ignoring or denying it. 2. Behavioral- Mastery of the disability as evidenced by actions or behaviors. Positive response would be compliance with therapy, utilizing independent living skills. The easiest category to measure 3. Emotional- How one feels about the disability and manages his or her emotions. Coping (in further detail) ● Involves: Adjustment to Value Loss • Enlargement of scope of values • Subordination of physique relative to other values • Containment of disability effects ● Resilience: Ability to bounce back • Seek purpose/meaning • Stay connected • Use resources Quality of life following SCI: subjective in nature, with no universal meaning. No two people define QOL in the same way. Although quality of life may be viewed by some as optimal functioning at the highest level of independence, others may place greater emphasis on life itself, regardless of level of function.

Depression- hopelessness, apathy, or feelings of dejection and discouragement. Signs of depression include sleep disturbances, changes in appetite, difficulty concentrating, and withdrawal from activity. Social support- Do they have good access to support? Family support? Overall life satisfaction- Are they happy?

Vocational outcomes and accommodations Psychosocial issues- determine individuals’ reactions to a health condition and, consequently, their reactions to the recommendations given. Examples are greif, anxiety, anger, depression, and guilt. Vocational outcomes- Working means MORE than just making money. Work provides a sense of contribution, accomplishment, and meaning to life. loss of ability to work Traumatic Brain Injury (TBI) ● Traumatic- injury to the brain resulting from a bump, blow, or jolt to the head or penetrating head injury. ● Acquired- stroke, brain tumor, brain infection, lack of oxygen (anoxia/hypoxia- lack of oxygen, anoxia is more severe) ● Closed- blunt trauma to the head or acceleration of forces cause brain to move in cranium ● Open-skull is fractured or a foreign object penetrated the skull ● Mechanisms of TBI ○ Coup-contrecoup: Occurs both at the site of trauma and the opposite side of the brain. Coup is an injury on the initial site of impact. Contrecoup happens on the opposite side of the site of injury. ○ Diffuse axonal shearing: Rapid acceleration and deceleration of the brain, creating lesions in the brain’s white matter. ○ Focal lesion: Injury to the brain in a single location. Focal lesions and focal

contusions can result in isolated deficits of cognition, speech, sensory, and language functi...