The Impact of Disability

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The Impact of Disability Psychosocial Stressors

• Jeff Baker, Ph.D.
• Clinical Associate Professor, Orthopedics
  Rehabilitation
• Associate Professor, Health Promotion
  Gerontology
• Director, Psychology Training

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How is Trick or Treating Better than Sex

• 10. Youre Guaranteed to get at least a little
  something in the sack.
• 9. If you get tired, wait 10 minutes and go at it
  again.
• 8. The more horrible you look, the easier it is
  to get some.
• 7. You don't have to cuddle with the person who
  gave you candy.
• 6. It's OK when the person you're with fantasizes
  you're someone else, because you ARE someone
  else.
• 5. 40 years from now, you'll still want a lot of
  candy.
• 4. If you don't get what you want, you can always
  go next door.
• 3. Doesn't matter if the kids hear you moaning
  and groaning.
• 2. There is Less guilt the next morning.
• And the Number 1 Reason Trick-Or-Treating is
  Better Than Sex...
• You can "do" the whole neighborhood, Twice!!!
• http//home.attbi.com/n9ivo/whatswrong.swf

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Objectives

• Increase understanding of psychosocial Impact of
  Physical Disability
• Increase intervention strategies and knowledge
  regarding patients with disability
• Increase knowledge of ADA

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Psychosocial Aspects of Disability

• Loss of Income
• Decreased Self Esteem
• Increased feelings of depression
• Increased feelings of anxiety
• Loss of Independence
• Loss of mobility
• Dependent on Narcotics
• Dependent on Others for mobility, self care, etc.

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Psychosocial Components

• Definition Examples of CMC
• Patient Dynamics

Psychological
Social
Patient
Environment
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Human Needs

• Identify Needs
• Where will your patient fall in this hierarchy?
• Where do you fall in this hierarchy?

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Psychosocial Issues CMC
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Identify Issues

• Summarize the key issues involved in CMC
• Depression
• Dysthymia, Loss, Grief, End of Life Issues
• Anxiety
• Agitation, Stress, Fear, Tension, Anger

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Additional Psychosocial Issues

• Adjustment Disorders w/ major life changes
• Quality of Life
• Mobility
• Loss of Financial Support
• Acting Out
• Anger, Sexually, Passive Aggressive,
  Triangulation
• Withdrawal

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Providing Care

• Strengths
• Identify
• Needs Improvement
• Services Patient Care
• Increasing Quality of Life
• What is important to the patient

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Americans with Disabilities Act

• ADA was signed into law July 1991
• Provided law for increasing access for a person
  with a disability
• Instructed institutions to provide reasonable
  accommodations
• Did not provide funding
• Court Cases have recently challenged extent of
  disabilities covered under ADA

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Case 1 Review

• 31 YO SWM SCI T6 Para
• Diving Accident Age 28, mild concussion at Texas
  City Dike
• Admitted alcohol and marijuana use at time of
  accident, currently uses marijuana
• 2 Years Post Injury, significant searing and
  burning pain, rated 8 on 8/10 scale
• Takes 4-8 Vicoden ES per day, little relief, loss
  of sleep, agitation, depression, withdrawal
• Evaluated for DCS

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Impact of Disability

• Pt receiving SSI SSDI
• Receiving Approximately 540 per month
• Previously journeyman electrician, 1700 per
  month income
• Retrained in computer graphic design at COM,
  cannot find job for last 4 months
• Engaged, fiancée has been with him for 5 years.

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Impact on Quality of Life

• Sad, mild depressive symptoms
• Agitated and frustrated
• Cannot currently spend much time with 7 yo son
  but is participating in some activities such as
  fishing and throwing baseball
• Participates in satisfying sexual relationship
  with partner when pain rating is below 5 (not
  happened for last 3 months)

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Follow-Up

• Resources
• Discussion
• Additional Cases
• Role Play, if time

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Psychological Consequences

• Identify the major psychological consequences
  expected in each case
• Describe how you might respond as a PT, OT or PA
• What resources can you think of that might help?

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Diabetes, Amputation of the foot

• Patient is somewhat depressed
• Agitated that her PCP did not catch this sooner.
• Does not engage in OT/PT
• Has made several excuses over the last few
  scheduled times that she was too tired to
  participate.

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SCI, Male 26 YO

• Is on the acute Unit for 2 weeks and is now on
  Rehab but not interested in alternate mobility,
  wants to walk
• Girlfriend of 2 years is very resistant to doing
  any assistance with care.
• She has asked several questions about his sexual
  functioning.
• He is anticipating a large settlement from
  insurance.

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Stroke, 65 YO Female

• Has difficulty remembering where she is at.
• Has wandered off the rehab unit.
• Therapists are concerned regarding her safety as
  she lives alone in a 2nd story apartment.

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28 YO SWF PT Student

• About to go on affiliation
• Cannot Hear, but can read lips and understand
  sign language
• Concerned about safety of patients