Clinical Care of Patients with Disabilities

Define disability and distinguish it from chronic illness

 * Disability
 * a physical or mental impairment that substantially limits one or more major life activities (definition from Americans with Disability Act, 1990). May continue indefinitely, requiring supportive services
 * Ex: blindness, deafness, speech impairment, quadriplegia


 * Chronic illness
 * long term (6 mo-1 yr) disease that may lead to disability. May worsen over time, leading to death.
 * Ex: diabetes, osteoporosis, coronary artery disease, chronic kidney disease

Define the various levels of loss of function (ie, disease, impairment, disability, and handicap)

 * Disease: pathological condition impairing bodily functions, caused by a variety of internal and external factors, leading to specific signs and symptoms such as pain, dysfunction, stress, and/or death (Wikipedia)
 * Broad term that may include impairment, disability, and handicap


 * Impairment: partial or complete weakening, damage, or deterioration of a body part, organ or system, usually as a result of injury or disease (http://medical-dictionary.thefreedictionary.com/impairment)
 * Disability: a physical or mental impairment that substantially limits one or more major life activities (Americans with Disability Act)
 * Includes impairment


 * Handicap: a mental or physical defect that interferes with normal functioning and ability to be self-sufficient in society
 * Note--this is one of those “words to avoid” (pg 63 syllabus) because it implies helplessness, fewer freedoms and stigma. People with disabilities may be able to function and be self-sufficient given the right environmental supports.

Describe services for the deaf

 * 1) Hearing amplification devices for office visits
 * 2) *Amplifying head-set or battery-powered amplifiers with a small microphone
 * 3) *Stethoscope: patient wears stethoscope, you speak into bell (Warning: works best in fictional settings like "House of God")
 * 4) Hearing aids can restore conductive hearing loss and high-frequency sensorineural loss
 * 5) *traditional analog hearing aids convert sound to continuous electrical signal
 * 6) *digitalized hearing aids: digitized waveform can be manipulated to accommodate the patient’s specific needs. New, very $$$$
 * 7) Cochlear implant: for patients with severe sensorineural hearing loss
 * 8) Assistive devices
 * 9) *Nonacoustic signals: flashing lights, vibrating devices
 * 10) *Loud bells, ringers for telephones
 * 11) *Telecommunications Devices for the Deaf (TDD or TTD)

Describe generic services for persons who happen to be disabled

 * 1) Accommodations for people with disabilities as required by the Americans with Disability Act. For example
 * 2) *wheelchair ramps, railings if possible (if not, doctors should make home visits)
 * 3) *interpreters
 * 4) *adequate lighting, large-print reading materials, well-marked elevator buttons and floor signs
 * 5) Assistance from personnel of public and private transportation services for use of transportation services—must assist with ramps and lifts, allow service animals, and reserve seating (required by Americans with Disabilities Act)
 * 6) *Psychiatrists, certified in physical medicine and rehabilitation
 * 7) *Rehabilitation specialists
 * 8) *National resources – see objective #5

Describe the differences in health care needs/problems of persons with a disability
We identify 6 major unique needs/problems compared to the general population:
 * 1) Narrower margin of health compared to non-disabled people. Have less "reserve"
 * 2) *Disabled people suffer the same illnesses as non-disabled people but they are more susceptible to them, especially URIs, pneumonia, and pressure sores
 * 3) Limited insurance coverage
 * 4) Risk of acquiring chronic health conditions at early ages
 * 5) *CAD, Type II DM
 * 6) Onset of new health conditions a secondary functional loss with more physical limitations
 * 7) *Important to prevent pressure sores – inspect and clean skin, change positions frequently
 * 8) Longer, more complicated course of treatment before restoration of previous functional status
 * 9) The need for durable medical equipment devices and other technologies which require detailed knowledge by both physician and patient
 * Other specific needs:
 * prevention of secondary disabilities including selective screening, counseling, and prophylaxis
 * health maintenance: nutritional counseling, good dental health, cardiovascular fitness