Assessing the driving potential of the handicapped.

Proper and early assessment of the handicapped person's potential for driving a vehicle depends upon an understanding of the factors involved in a driver evaluation. The driver evaluation factors discussed in this paper are: driving aids and their application; the handicapped driver's physical, perceptive, and cognitive capabilities; and the psychosocial characteristics that influence a client's ability and need for driving.     

The motor development of physically handicapped children as a central task of special education (author's transl)

A physical disability is always the starting point of a life-long process the dynamics of which are determined by the autonomy of the biological and psychological maturation, as well as by social influences. The motor development of the physically handicapped child is related to its personality formation. Motor and behavioural deficiencies can worsen and produce long-term effects. Therefore, starting as soon as possible, at best on a daily basis, physical education and kinesiotherapy must be used to compensate for these deficiencies and activate the forces of psychological and physical self-regulation. Physicians and kinesiotherapists must pay more attention to the normal need of movement of physically handicapped children. The motor development of the physically handicapped must become an integral part of the paedagogical responsibilities of physical education. For this reason, it is necessary that physical instructors with special qualifications are systematically employed in special schools and rehabilitation facilities.     

On the problem complex of the new act on the severely handicapped with respect to the workshop for the disabled (author's transl)]

One group of the disabled, i.e., the most severely handicapped, will not be able to benefit from the improvements brought about by the new Act on the Severely Handicapped, if the statutory orders of the Federal Government and the provisions of the Federal Employment Office are implemented as planned. In this event it would become extremely difficult for the severely physically handicapped to participate in the life of the community. The article demonstrates how a sheltered workshop for the disabled which, in part, looks after the most severely handicapped needing special care: - will not achieve recognition under 55 of the Act on the Severely Handicapped, - will not benefit from either institutional or individual support provided by the organisations of - the labour administration, - will not obtain contracts from either industrial or public enterprises because the orders cannot be set off against the equalisation payment, - cannot help their disabled employees to become eligible for social security benefits. This development which for the most severely handicapped represents a step backwards must be removed from those who are the most afflicted. It must not happen that efforts made at school to promote and integrate the disabled terminate in segregated facilities (nursing homes), which are run under different subsidy regulations. What is needed is a concept for appropriate care and support of the most severely handicapped and their integration into suitably equipped small groups within workshops for the disabled.     

Microcomputer-based communication augmentation systems for two nonspeaking, physically handicapped persons with severe visual impairment

Two different microcomputer-based communication systems were developed for nonspeaking physically handicapped individuals with severe visual impairment. One subject was 24 years old and had an inoperative optic glioma which impaired motor function as well as vision. The second subject was cortically blind with severe motor limitation secondary to an automobile accident which occurred at 17 years of age. Both communication systems employed speech synthesis as a control feature to compensate for visual impairment. Both subjects have learned to use their communication systems. The second subject has not achieved extended, independent system use due to reduced vigilance and attention span.     

Rehabilitation of the physically handicapped--a challenge to the Christian church?

The question of whether rehabilitation of physically disabled people constitutes a challenge for the Christian churches must be answered with a clear "Yes" by their members. The churches and hence the Christians themselves, must on the basis of their faith make it quite clear that rehabilitation of physically disabled persons is a holistic process involving body, mind, and soul. Physical care must therefore be matched by intensive spiritual assistance; that handicapped persons are of equal worth in the sight of God as the able bodied, hence do not constitute "unworthy life"; that physically disabled persons must be afforded an existence worthy of human dignity; that Christian communities should encourage volunteer work; that provision of good education and vocational training, as well as preparation for a meaningful life without gainful activity, must be given attention. All these emanate from the call to emulate Jesus Christ.     

肢残人群的心理腱康状况调查及分析

目的了解社区肢体残疾人群的心理健康状况。方法对上海市曹家渡街道14个居委的常住且具有残疾证的肢体残疾人运用《杜克OARS日常活动能力量表》进行问卷调查，重点包括精神生活满意情况、心理自我功能评估、服用精神类药物状况、接受医学心理干预情况等做统计分析。结果在精神生活满意度方面，感到生活无乐趣的人最多，大部分人的心理自我评估为普通。只有小部分人群曾得到过医学心理干预，在未接受过心理服务的人群中，有1／3的人希望今后能得到医学心理服务。结论关注社区肢残人群的心理健康问题将是今后开展肢残人群医学照顾工作的重点。     

Annonce du handicap

Telling parents that their child is handicapped is a very difficult medical act, heavily burdened with responsibility and a commitment to the future. For parents, it is a hugely painful drama, which throws doubt on their ability to give birth to and raise a normal child. Moreover, the announcement itself has its own dynamics and must be properly organized and prepared: in a suitable environment, the doctor must have time to explain why the baby or infant has poor health and disabilities, s/he must be able to answer the parents’ questions and offer practical and useful suggestions for the future. S/he must demonstrate empathy, compassion and availability. She must speak clearly and simply, avoiding technical terms.     

Children's attitudes toward physically handicapped peers and intervention approaches for attitude change

Children with physical handicaps are among those handicapped children who are placed in the regular public school classroom as the least restrictive environment possible for their education. Physical therapists are increasingly extending their service into school settings and are likely to be in the position to become advocates for the physically handicapped student. A review of research on attitudes held by nonhandicapped peers reveals that unfavorable attitudes toward physically handicapped students are prevalent. Strategies for the physical therapist to use in helping to promote positive peer attitudes toward physically handicapped children are presented.     

An independent living skills training program

The growing rehabilitation and consumer movement toward independent community living for disabled adults has placed new demands on the health care delivery system. Programs must be developed for the disabled adult that provide direct training in adaptive community skills, such as banking, budgeting, consumer advocacy, personal health care, and attendant management. An Independent Living Skills Training Program that uses a psychoeducational model is described. To date, 17 multiply handicapped adults, whose average length of institutionalization was 11.9 years, have participated in the program. Of these 17, 58.8% returned to community living and 23.5% are waiting for openings in accessible housing units.     

Seating arrangement as a predictor of small group interaction

Nursing, if it is truly to consider itself a science, must be research-based. This paper demonstrates how Steinzor's work on predicting patterns of small group interaction may be applied to the clinical setting. Steinzor hypothesized that seating arrangements help determine patterns of interaction. Many authors have since added to this hypothesis and their contributions are acknowledged and incorporated into this application study. This study's setting involved two nurses co-leading a counseling group for physically handicapped adults. Findings not only supported Steinzor's work but also point to the need for more studies whose findings may be applied and tested in the practice setting.     

To treat or not to treat: the controversy of handicapped newborns

When dealing with the prospects of treating, not treating, or delaying treatment for handicapped newborns, there is no room for error. Since that is an impossible premise, one must make the best possible treatment plan for the newborn. The parents and members of the health care team should be included in the decision making. Those involved must also remember that no decisions are final; if the infant's physical condition changes, the treatment plan may be reevaluated. Any errors must be made by promoting the best interests of the infant in question, by keeping the infant alive longer than necessary rather than providing a premature death. Never, under any circumstances, should an infant be starved, dehydrated, or outright killed; to do so is to violate the rights of the infant. The infant's rights to life without constant pain are also violated by the senseless prolongation of his life and the promotion of wrongful life through the excessive use of modern technology.     

Handicapped children in a developing nation--Bangladesh.

Bangladesh is a young, struggling nation that is emerging with strong religious and family networks and a positive hope for the future. Children are viewed as the step toward that future. The attitudes toward handicapped children were explored by examining the available health services and then conducting a survey of parents of handicapped children. Since there are few treatment facilities and these are located in cities, many children do not receive treatment. Family-oriented treatment in which therapeutic activities are incorporated into the child's daily routine and where therapists can train the child and family members, periodically reassess the child, and provide guidance and advice when necessary may be an effective way to treat handicapped children. Unlike more developed nations, the families of Bangladesh were not interested in institutions for their handicapped children, and expressed hope even in the face of serious disabilities. Providing training to these families could perhaps help them achieve that hope.     

A small observational study of the longevity of syringe driver sites in palliative care

Although the use of portable syringe drivers is common in palliative care, problems do occur. A small observational study of local practice was undertaken to establish the rate of syringe driver reactions and duration of sites; to determine whether a predictable relationship existed between the number of days on a syringe driver and the number of sites used consecutively; and to discover whether the location of a syringe driver site influenced the site longevity. Eighty-six syringe driver sites were established in 27 patients during the 3-month study period. Site duration ranged between 1 hour and 9 days (mean 2 days). An association was found between the number of days on a syringe driver and the number of sites used. However, this relationship is not close enough to predict when a site may be discontinued. Thirty-eight syringe drivers (44%) were discontinued because of site reactions. The location of a syringe driver site appeared to be an important factor influencing the site longevity, with cannula dislodgment three times more prevalent from the chest wall than the upper arm (P=0.05). However, the findings suggest that if it is possible to prevent dislodgement from the chest wall, then this site can be used for significantly longer before a site reaction develops (P=0.02). In view of the unpredictability of site reactions, it is concluded that sites must be assessed regularly and changed as soon as problems develop. As this was a small study in one unit without standardization of site reaction assessment, the results should be interpreted with caution. However, given the lack of published work in this area, this study contributes to the evidence base and raises important questions for both clinical practice and future research.     

老年人与交通事故的调查分析

目的中国目前正在经历老年人口与交通车辆的同时快速增长。随着人口的老龄化加剧以及社会的发展,老年驾驶者人数将预期明显增加。国际上对老年人交通安全的经验可能对中国即将增加的老年驾驶者有借鉴作用。方法检索并分析了中国以及一些发达国家,如美国等有关老年驾驶者以及交通事故安全的论文及论著。结果尽管老年人较少开车且普遍地使用安全带,但他们交通事故发生数以及死亡率较其他年龄组高。老年人视觉以及感知功能的损害也增加了发生交通事故的危险性,同时也产生了其独特的事故形式。与年轻人相比,在相同的受伤程度下,老年人体格上的衰退和疾病因素可能对会产生更坏的结果。虽然老年驾驶者在中国还是少数,与其他年龄组相比,老年人有较高的交通事故伤害率、步行者死亡率和较高的农村老年人受害率。结论国际上对老年人交通安全的经验,比如更好的道路安全设计,高可视安全标识和安全带法律的实施,安全带使用的公共教育,以及老年驾驶证的更新等对中国的交通安全设计者以及法律的制定者可能会有帮助。这些经验对损伤预防研究者在老年人交通事故危险因素的识别方面,以及对工程师在驾驶环境和车辆设计等方面也有着重要的意义。     

Attributes of nurses that determine the quality of care for mentally handicapped people in an institution

This is an ethnographic study that examines, from the relatives' perspective, the attributes of nurses that are considered important in the caring process of mentally handicapped people in an institutional setting in Hong Kong Twelve interviews were carried out with a family member who had a relative living in a special unit for severely mentally handicapped people Empirical studies, mainly from the west, have shown that decisions to place a mentally handicapped family member in residential care is a complex process Family characteristics, the relatives' characteristics as well as the availability of support, have been found to influence decisions about out-of-home placement Once this decision has been made, a new caring relationship between nurse, family and relative needs to be established The final categories that emerged from the data show that families have expectations about the nurses' competence and comittment to the job and about their relationships with the client and the family Consequently quality is judged, not only by the way in which nurses work with the clients, but also by the way in which they work with the family Implications for practice and education of nurses working with mentally handicapped people and for nursing administration in Hong Kong are discussed     

Facilitating attitude change toward the handicapped

Measurement in the shift of 424 normal children's perceptions of their handicapped peers was determined following their exposure to structured learning experiences of what it would be like to be handicapped. Attitude development and approaches used for attitude change are described. Significant positive shifts were found in children's perceptions of their handicapped peers' play capabilities, intelligence level, and self-concept. Attitudes toward mainstreaming remained unchanged. It is suggested that a viable receptivity exists in normal children's attitude development. The role of the occupational therapist in facilitating positive attitudes is discussed.     

Cardiac response to exercise: comparison of 3 ergometers

In order to establish guidelines for clinical decision making based on modified stress testing of physically handicapped individuals, 6 nonhandicapped volunteers exercised on 3 different ergometers, and their cardiac responses were compared. The ergometers were an upright bicycle, a supine bicycle, and an upright arm crank. The parameters measured were heart rate, rate pressure product, and oxygen consumption. Results showed that myocardial oxygen requirements are greater for upper extremity than for lower extremity exercise; the difference becomes increasingly more significant as exercise intensity increases. Myocardial oxygen requirements for supine exercise are greater than for upright exercise at low exercise intensity but lower at higher exercise intensities. Clinical implications of these findings must be interpreted cautiously as older disabled subjects may have different physiologic responses depending on the nature of their disabilities.     

Standard requirements for electric wheelchairs (author's transl)]

Electric Wheelchairs are driven on public roads. Neither an operating license, liability insurance nor special driving license is necessary according to Road Traffic and Road Licensing Regulations. Statutory regulations prescribe that these wheelchairs must be fitted with two independent brakes and adequate lighting equipment. Safety can be increased by: Totmann brake system - battery servicing - improved battery chargers and technical safety tests. Maintenance of the wheelchair prolongs its life. Social security agencies should allow a large number of the most severely handicapped people to benefit from medically prescribed wheelchairs.     

Get off the bus: sound strategy for injury prevention during a tornado?

INTRODUCTION: On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the "F Scale") struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris. METHODS: A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck. RESULTS: Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate = 79.2%). While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were less severe (median injury severity score (ISS) 1 versus 4). CONCLUSION: For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.