Disability in America Toward a National Agenda for Prevention (1991) / Chapter Skim
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Appendix A: Disability Concepts Revisited: Implications for Prevention
Appendix A: Disability Concepts Revisited: Implications for Prevention
Pages 307-327
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From page 309... ...
Whether measured in prevalence or in social and economic consequences, the impacts are daunting. Although the questions they ask may be phrased somewhat differently, comprehensive disability surveys are fairly consistent in estimating that about 6.5 percent of noninstitutionalized Americans ages 18 through 64 are so severely disabled that they are not able to work (see, for example, Nagi, 1976; Social Security Administration, 1981, 1982~.
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From page 310... ...
The field is much in need of a theory to guide and advance research, to enhance understanding on the part of the professions and the public at large, and to better focus related policies and programs and improve their effectiveness. By theory I do not mean speculation but rather a set of interrelated concepts and empirically testable propositions that describe the phenomenon of disability and explain variance in its occurrence.
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From page 311... ...
Another milestone was the Vocational Rehabilitation Act of 1954, which adopted a formula for federal-state financing. The act permitted "the establishment of comprehensive rehabilitation facilities; the creation of specialized clinics of speech, hearing, cardiac, and other disorders; and the development of a variety of services that at one time would have seemed unattainable" (Switzer, 1965~.
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From page 312... ...
The committee's work was in response to the needs of workers' compensation programs which had been plagued by litigationsto develop standardized ratings legitimized by the professional and scientific standing of the AMA. The committee distinguished between impairment and disability by pointing out that "permanent impairment is a contributing factor to, but not necessarily an indication of, the extent of a patient's permanent disability." To the committee, "competent evaluation of permanent impairment requires adequate and complete medical examination, accurate objective measurement of function and avoidance of subjective impressions and non-medical factors such as the patient's age, sex, or employability." Because the committee's domain was defined as that of impairment, disability was left without further clarification.
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From page 313... ...
built on existing knowledge to construct a framework of four distinct but interrelated concepts: active pathology, impairment, functional limitation, and disability.
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From page 314... ...
In modern health practices, the organism is aided by surgical intervention, medication, and other forms of therapy to help regain equilibrium. Some means may become necessary over extended periods of time or indefinitely, as in the case of certain types of chronic diseases.
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From page 315... ...
It is important to note, however, that distinctions between indicators of functional limitations and those of disability can be established with sufficient clarity. Intelligence tests, scales of psychophysiological reactions, other psychometric tests, and clinical assessments have been used to identify functional limitations independent of whether, and to what extent, a person is limited in performing expected roles and tasks.
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From page 316... ...
A fourth issue concerns the lines of differentiation between functional limitations and disability and where such activities as those of daily living and use of transportation fit within the concepts of social roles and tasks. To Parsons (1958)
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From page 317... ...
Because of emphasis in public policy on concerns with dependence in economic and personal terms, and greater availability of support for studies of these dimensions, research developments were pushed largely in the direction of work disability and problems in independent living. However, the concept is inclusive of all socially defined roles and tasks.
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From page 318... ...
conditions often involves acute episodes. The course of these The same curve can be used to illustrate the different forms of functional limitations: physical, sensory, emotional, intellectual, and so on, as well as disabilities in the various roles and tasks (e.g., vocational, family, interpersonal and community relations, independent living)
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From page 319... ...
The present manual, published under this authority, represents a considerable recasting of the detailed proposals submitted to the Ninth Revision Conference.
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From page 320... ...
His illness heralds recognition of impairments, abnormalities of the body structure and appearance, and of organ or system function, resulting from any cause. Impairments represent disturbances at the organ level....
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From page 321... ...
Moreover, if "illness heralds recognition of impairments," what about impairments that are not associated with active pathology? Why does Wood's definition of impairment "any loss or abnormality of psychological, physiological, or anatomical structure or function" fail to make reference to awareness?
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From page 322... ...
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From page 323... ...
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From page 324... ...
In these distinctions, Wood fails to differentiate between limitations in social performance and the causes for these limitations, that is, between the "what" and the "why." A concept is concerned with the what a person is unable to work or is limited in performing a family role. Valuations, stereotyping, discrimination, service and benefits programs, labor market conditions, technological developments, architectural barriers, and other factors in the sociocultural and physical environment are causal influences that can facilitate or inhibit the optimal social performance of which a person is capable.
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From page 325... ...
Finally, the categories included under the handicap rubric significantly overlap with some of those under disability, such as in the case of family and occupational roles. Some of the categories included under the handicap concept actually represent summaries of items included under other concepts.
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From page 326... ...
Frameworks existed prior to his initiative, and studies and surveys conducted during and since the l950s have paid considerable attention to measurement (e.g., Commission on Chronic Illness, 1957; Trussel and Elinson, 1959; Srole et al., 1962; Nagi, 1969~. By the mid-1970s, there was much more in the literature, especially in the United States, than can be justifiably dismissed in a short paragraph.
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From page 327... ...
of the detailed proposals submitted to the Ninth Revision Conference," one has to wonder about the ability of the Conference to approve frameworks of concepts and terminology that meet Kaplan's criteria for classification. An unfortunate outcome is reintroducing confusion in concepts and terminology just as researchers, government agencies, and policy analysts have started to make significant gains toward shared concepts and common frames of reference.
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