Disability in America Toward a National Agenda for Prevention : Summary and Recommendations (1991) / Chapter Skim
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TOWARD A COMPREHENSIVE APPROACH TO DISABILITY PREVENTION
TOWARD A COMPREHENSIVE APPROACH TO DISABILITY PREVENTION
Pages 4-13
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From page 4... ...
TOWARD A COMPREHENSIVE APPROACH TO DISABILITY PREVENTION Despite an officially stated national goal of independence and equality of opportunity for people with disabilities, current approaches to preventing disability and improving the lives of people with disabling conditions lack conceptual clarity and unity of purpose. Reducing the prevalence and incidence of disability poses challenges on many fronts and requires coherent, comprehensive responses rather than the piecemeal actions that now characterize medical, rehabilitative, and social programs related to disability.
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; and secondary conditions associated with primary disabling conditions (Chapter 7)
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In recent years, the term has fallen into disuse in the United States, primarily because people with disabling conditions consider handicap to be a negative term. Yet the shadow of "handicap" as a commonly used term hovers behind the concept of quality of life, and has the effect of reducing quality of life even though impairment, functional limitation, and disability do not necessarily do so.
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IMPAIRMENT -+• FUNCTIONAL LIMITATION -* DISABILITY Interruption or Loss and/or Restriction or lack Inability or interference of abnormality of of ability to perform limitation in normal bodily mental, emotional, an action or activity performing socially processes or physiological, or in the manner or defined activities structures anatomical structure within the range and roles expected or function; considered normal of individuals includes all losses that results from within a social or abnormalities, impairment and physical not just those environment attributable to active pathology; also includes pain Level of reference Cells and tissues Organs and organ systems Organism -- action or activity performance (consistent with the purpose or function of the organ or organ system)
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Identifying such factors can be a first step toward determining a mechanism of action in the disabling process and then developing preventive interventions. The disability research and service communities have not yet adopted a systematic, comprehensive conceptual model for understanding disability risk factors.
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These additional risk factors might include, depending on the stage of the model, diagnosis, treatment, therapy, adequacy of rehabilitation, age of onset, financial resources, expectations, and environmental barriers.
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In turn, each successive stage in the disabling process poses an increasing threat of diminished quality of life. Measures that reduce this threat -- for example, providing assistive technology that enables an individual to remain autonomous in at least some roles or modifying the work site to accommodate a person's limitations -- can be effective interventions for preventing disability.
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Research has led to a number of important measures for preventing potentially disabling conditions that are acquired during childhood or that are the product of events during prenatal development. For example, lead screening followed by environmental lead abatement programs can reduce the incidence of lead toxicity.
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A national study found that quadriplegia continues to be the outcome for half of all people who sustain spinal cord injuries; however, the proportion of people with quadriplegia who have neurologically incomplete lesions and therefore retain some motor control and sensation increased from 38 percent in 1973 to 54 percent in 1983. Disabilities Associated with Chronic Disease and Aging The prevalence of chronic disease -- incurable, long-lasting pathologies such as osteoarthritis, cancer, heart disease, and diabetes -- has increased to near-epidemic proportions in the United States.
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Secondary Conditions Associated with Disability People with disabling conditions are often at risk of developing secondary conditions that can result in further deterioration in health status, functional capacity, and quality of life. Secondary conditions by definition are causally related to a primary disabling condition and include decubitus ulcers, contractures, physical deconditioning, cardiopulmonary conditions, and mental depression.
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