Medicine, Disability, and Rehabilitation

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Medicine, Disability, and Rehabilitation

• BCE542 (Physical Disabilities, Rehabilitation,
  and Employment)
• Patrick Dunn, Ph.D.
• September 3, 2002

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Thinking about disability

• The World Health Organization (1980)
  distinguished between
• Impairment
• Disability
• Handicap

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Impairment

• Any loss or abnormality of psychological,
  physiological or anatomical structure or
  function.

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Impairments

• Impairments are physical, cognitive or emotional
  problems.
• Any improvement in impairments must be
  accomplished by medical/mental health
  professionals.

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Impairments are caused by medical/psychological
emotional conditions

• Sources of impairment
• Congenital (Cerebral Palsy)
• Genetic (Downs Syndrome)
• Infection (Rheumatic Heart Disease)
• Substances (Alcoholic Cirrhosis)
• Trauma (Burns, Spinal Cord Injuries)
• Autoimmune Factors (Rheumatoid Arthritis)
• Dysfunction of Body Organs or Systems (Kidney
  Failure, Type I Diabetes)

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Disability

• Any restriction or lack (resulting from
  impairment) of ability to perform an activity in
  the manner or within the range considered normal
  for a human being.

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Disabilities

• Impairments can result in disabilities
• Disabilities involve problems with performing
  some type of function.
• Disabilities that remain after impairments have
  been treated may be addressed by various
  therapists (PT, OT, etc.).

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Function
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Functions are the ability to perform basic
activities

• Disabilities are the inability to perform some
  type of activity (function)
• Functions may be physical, sensory/
  communicative, or emotional/cognitive.

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Physical Functions

• Walking, sitting, standing
• Lifting, Carrying
• Stamina/Exertion
• Balance/Coordination
• Sensitivity to environment (heat, cold,
  substances)

• Range of motion/flexibility
• Reaching handling, fingering
• Tolerance for injury or trauma
• Others..

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Sensory/Communicative Functions

• Seeing (near, far, depth perception, color
  perception)
• Hearing (level of perception)
• Touch sensitivity (especially with fingers)

• Tasting/smelling
• Speaking
• Writing
• Reading
• Others..

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Cognitive/Emotional Functions

• COGNITIVE
• Ability to learn new tasks
• Ability to plan/execute activities (executive
  functioning)
• Ability to maintain attention

• EMOTIONAL
• Ability to tolerate situations (stress, working
  with people, routine, etc.)
• Maturity
• Self-confidence
• Others.

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Loss of function and rehabilitation planning

• Activities (vocational, daily life, etc.) require
  individuals to perform certain basic functions.
• When an individual lacks the necessary functions
  to perform an activity, one of three things must
  happen if the individual is to be able to perform
  the activity

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Rehabilitation Planning

• Modify the activity (such as in job
  accommodation)
• Modify the individuals functional abilities (by
  teaching new skills or functions)
• or, do both.

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Determining Necessary Functions and Accommodations

• Identify an individuals functional capacities and
  disabilities
• Identify what functions an activity requires
• Determine which of these functions can be
  acquired or accommodated (modified)
• Are the accommodations reasonable?

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Finding an appropriate vocational goal

• Can the goal be reasonably accommodated?
• Person can be successful (productive) with or
  without accommodations
• Likelihood of injury to self or others is
  alleviated.
• Person can learn necessary skills or alternative
  methods of performing essential functions.
• Not all jobs can be accommodated for all
  disabilities

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Handicap

• A disadvantage for a given individual, resulting
  from an impairment or disability, that limits or
  prevents the fulfillment of a role that is
  normal, depending on age, sex, social and
  cultural factors, for that individual.

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Handicaps

• Alleviating handicaps involves modifying
  environments so that individuals with
  disabilities may perform desired or necessary
  roles despite any remaining loss in functional
  capacity.

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Handicap is a Function of the Environment

• It occurs when persons with disabilities
  encounter cultural, physical, or social barriers
  which prevent their access to the various systems
  of society that are available to other citizens.
  Thus, handicap is the loss or limitation of
  opportunities to take part in the life of the
  community on an equal level with others.

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Rehabilitation Counselors

• Can indirectly have impact upon alleviating
  impairments and disabilities (arranging for
  medical treatment and therapy).
• May have a more direct impact upon alleviating
  handicaps.

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Sources of Handicaps

• Social and Cultural
• Attitudes
• Beliefs
• Expectations
• Physical
• Demands of jobs/tasks
• Architectural/Sensory Access

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What can a rehabilitation counselor do?

• Understand functional aspects of disabilities and
  functional capacities of individuals
• Understand the functional demands of occupations
  and essential life activities.
• Understand how these things impact upon each
  other.
• Be a good counselor so that individuals can
  develop attainable goals (informed choice)
• Be an advocate and an educator.

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Medical Information and the Medical Profession
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How to become a physician

• 3-4 YEARS UNDERGRADUATE STUDY
• MEDICAL SCHOOL
• 2 YEARS LABORATORY COURSES
• TWO YEARS PRACTICAL EXPERIENCE
• DEGREE EARNED AFTER FOUR YEARS
• THREE YEARS OF INTERNSHIP
• LICENSING
• RESIDENCY FOR MEDICAL SPECIALTY

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Medical Specialties

• INTERNAL MEDICINE DISEASES OF THE INTERNAL
  ORGANS
• ORTHOPEDIC SURGERY MALFORMATIONS AND INJURIES TO
  BONES
• NEUROLOGY AND NEUROSURGERY ILLNESS OF THE
  NERVOUS SYSTEM
• PHYSIATRY REDUCTION OF THE RESIDUAL EFFECTS OF
  ILLNESS OR INJURY TO AN INDIVIDUAL.
• PLASTIC SURGERY PERFORMS RECONSTRUCTIVE SURGERY
  FOR CONGENITAL AND ACQUIRED PHYSICAL DEFECTS.

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Medical Specialties, continued

• CARDIOLOGY DISEASES AND DISORDERS OF THE HEART
  AND VASCULAR SYSTEM
• OPTHAMOLOGY DISEASES AND DISORDERS OF THE EYES
• OTOLARYNGOLOGY EAR, NOSE AND THROAT
• PREVENTIVE MEDICINE PREVENTION OF DISEASE,
  PUBLIC HEALTH.
• PSYCHIATRY MENTAL ILLNESS, EMOTIONAL PROBLEMS.
• RADIOLOGY XRAY AND FLOUROSCOPY.
• ALLERGIST SENSITIVITY TO SUBSTANCES
• DERMATOLOGY DISORDERS OF THE SKIN

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Medical Specialties (still some more)

• ANESTHESIOLOGY RELIEF OF PAIN (NOT JUST DURING
  SURGERY)
• OBSTETRICS/GYNECOLOGY CHILDBIRTH ILLNESSES
  PECULIAR TO WOMEN
• PEDIATRICS TREATMENT OF CHILDHOOD AILMENTS
• ONCOLOGY TUMORS AND CANCERS
• HEMATOLOGY DISORDERS OF THE BLOOD
• PATHOLOGY ORIGINS AND CAUSES OF DISEASE
• RHEUMATOLOGY AUTOIMMUNE DISEASES
• FAMILY PRACTICE GENERAL PRACTITIONERS

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Rehabilitation Counselors and Physicians What do
they know?

• Physicians
• Diagnose and Treat
• Indicate prognosis
• Indicate specific functional limitations of the
  individual
• Are NOT trained in understanding functional
  requirements of occupations or daily living.

• Rehabilitation Counselors
• Understand likely implications of different
  medical conditions
• Understand how functional limitations impact
  ability to work, perform daily activities.

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Getting what you need from a medical specialist

• You will need a diagnosis (eligibility for
  services)
• You will need specific information about the
  medical condition.
• Do you have it in existing records?
• Do you need to make a referral or write a letter
  (more on this in case management)

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Getting what you need from a medical specialist
(continued)

• First, make sure you have the right specialist.
• Look in the report for
• Diagnosis (what the physician thinks is wrong.)
• Prognosis (What is going to happen from here)
• Treatment (Can anything be done?)
• Ideas of individual functional limitations (most
  important)
• The information you obtain will be essential in
  helping a consumer choose a good vocational goal.

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Other Sources of Information
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Allied Health Specialties

• NURSING CARRYING OUT TREATMENT PROGRAMS OF
  PHYSICIANS.
• PHYSICAL THERAPY APPLICATION OF EXERCISE,
  MASSAGE, HEAT/COLD, ELECTRICITY, SOUND WAVES TO
  IMPROVE BODY FUNCTION.
• OCCUPATIONAL THERAPY APPLICATION OF PHYSICAL AND
  MENTAL ACTIVITY TO IMPROVE PHYSICAL OR MENTAL
  HEALTH.
• OPTOMETRY PRESCRIPTION OF EYEGLASSES FOR
  CORRECTION OF REFRACTIVE ERRORS
• DENTISTRY TREATMENT OF DISORDERS OF THE TEETH
  AND SURROUNDING TISSUE
• PHARMACY APPLICATION OF DRUGS
• PROSTHETIST FABRICATES PROSTHETICS (ARTIFICIAL
  LIMBS)

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Reference Books and Materials

• Physicians Desk Reference--information on
  medications and their effects.
• A good medical manual (such as a Merck Manual)
• The internet (but be careful!)