Impairment,disability, and the ICIDH model III: Underlying disease,impairment, and disability

Secondary analysis of data carried out in a national survey of the disabled is used to explore the relationship between underlying condition, impairment and disability, where the conditions are considered in three groups depending on whether they affect control, mechanical performance or energy. Comparison of impairment and disability profiles highlights the role of functional limitation in mediating between disease and disability. Disability profiles were found to be less associated with the underlying condition than were impairment profiles, but this can to some extent be explained by the nature of the functional limitation.     

Quality of life in Parkinson's disease

Parkinson's disease(PD) is a slowly progressive neurodegenerative disease. QOL improvement could be the main endpoint in some clinical trials, such as in those carried out in palliative care or incurable disease. Several instruments that assess to QOL of PD(PDQOL) have been established such as SF36, PDQ39 and PDQL. This article is reviewed about the importance for the improvement of PDQOL and the influence to PDQOL from the point of view from the epidemiological studies in Japanese population. The various approaches to the patients are necessary for the improvement of PDQOL.     

Caring for family with Alzheimer's disease and Parkinson's disease: needs, challenges and satisfaction

A convenience sample of 40 family members caring for an individual with either Alzheimer's disease (AD) or Parkinson's disease (PD) completed the Caregiver Assistance Measure (CAM) to identify the types of assistance that would be most helpful in caring for a family member at home. The CAM measures three categories or types of assistance: care knowledge and skills, self-care, and resource acquisition. Caregivers also completed open-ended questions about the difficulties and the satisfactions of caregiving. The PD and AD caregivers agreed on the importance of 75% of the assistance items on the CAM. In addition, both groups of caregivers identified issues related to care knowledge and skills and selfcare as the most difficult aspects of caregiving. These findings suggest many caregiver needs may be common across chronic illness populations and provide initial support for the development and testing of standardized interventions for caregivers.     

Spousal perspective of Parkinson's disease in middle life

An interpretive study in America explored the experience of living with a partner who has Parkinson's disease (PD) in middle life. Challenges experienced by eight spouses and their ways of coping with these challenges were examined. The convenience sample of five wives and three husbands were 44-58 years and had been married 4 months to 30 years. Spouses described the most significant challenges as watching their partner struggle and be frustrated; and renegotiating their lives. The coping strategies most frequently used were maintaining their own life, encouraging their partner to stay active and involved, and seeing the challenges they experienced as secondary. The context of living with a partner with Parkinson's disease is illuminated and strategies that spouses find most effective in coping with their partners illness are identified.     

Impairment,disability, and the ICIDH model I: The relationship between impairment and disability

The conceptual scheme put forward in the International Classification of Impairments, Disabilities, and Handicaps suggests that impairment should be related to disability. This paper examines the proposition that disability should be related to impairment in terms of parts of the body involved, both in the physical requirements to carry out a given activity and as regards the site and types of functional limitation, by secondary analysis of data collected in a survey of disabled people in Great Britain. Factor analysis of data on functional limitations showed that these impairments could be considered in four groups representing manual dexterity, movements of the arm, strength, and lower limb function. These were found to be correlated with ability in self-care activities depending on the part of the body involved in the activity.     

Impact of nonmotor symptoms on disability in patients with Parkinson's disease

Patients with Parkinson's disease have nonmotor symptoms (NMS) that, although poorly considered, have an impact on their quality of life. In contrast, the effect on disability is not systematically evaluated. Adult patients were consecutively enrolled and administered the Non-Motor Symptoms Questionnaire and the WHO Disability Assessment Schedule. Student's t-test was used to assess the difference in the disability score between patients declaring and not declaring NMS. In total, 86 patients were enrolled and reported a median of nine NMS. Patients reporting symptoms in cognitive, emotional, cardiovascular, and sleep functions, as well as those reporting more than nine symptoms as a whole, also reported higher disability levels. The presence of NMS, including little evaluated areas connected to cardiovascular and sleep functions, negatively impacts disability in patients with Parkinson's disease.     

Validity of the life satisfaction questions, the life satisfaction questionnaire, and the satisfaction with life scale in persons with spinal cord injury

Post MW, van Leeuwen CM, van Koppenhagen CF, de Groot S. Validity of the Life Satisfaction questions, the Life Satisfaction Questionnaire, and the Satisfaction With Life Scale in persons with spinal cord injury.ObjectiveTo assess and compare the validity of 3 life satisfaction instruments in persons with spinal cord injury (SCI).DesignCross-sectional study 5 years after discharge from inpatient rehabilitation.SettingEight rehabilitation centers with specialized SCI units.ParticipantsPersons (N=225) with recently acquired SCI between 18 and 65 years of age were included in a cohort study. Data were available for 145 persons 5 years after discharge.InterventionsNot applicable.Main Outcome MeasuresThe Life Satisfaction questions (LS Questions), the Life Satisfaction Questionnaire (LiSat-9), and the Satisfaction With Life Scale (SWLS).ResultsThere were no floor or ceiling effects. Cronbach α was questionable for the LS Questions (.60), satisfactory for the LiSat-9 (.75), and good for the SWLS (.83). Concurrent validity was shown by strong and significant Spearman correlations (.59–.60) between all 3 life satisfaction instruments. Correlations with measures of mental health and participation were .52 to .56 for the LS Questions, .45 to .52 for the LiSat-9, and .41 to .48 for the SWLS. Divergent validity was shown by weak and in part nonsignificant correlations between the 3 life satisfaction measures and measures of functional independence and lesion characteristics.ConclusionsOverall, the validity of all 3 life satisfaction measures was supported. Despite questionable internal consistency, the concurrent and divergent validity of the LS Questions was at least as good as the validity of the LiSat-9 and the SWLS.     

Impairment and disability rating in low back pain

LBP is one of the two most common forms of disability in Western society (mental illness is the other), and remains a thorny problem in the arena of disability evaluation. Disability evaluation after LBP differs whether the pain is work-related or not. If work-related, guidelines for disability evaluation differ by jurisdiction and type of employment (e.g., private vs. federal employee). When outside of the workplace, thresholds for disability differ between entitlement programs (Social Security Disability) and private insurance programs (long-term disability insurance). In the patient without obvious findings, the disability evaluating physician needs to be caring and compassionate and yet maintain an objective stance with the understanding that there may be significant psychosocial overlay in patients with nonobjective pain complaints. Although some would argue that objective independent medical evaluation is an oxymoron, psychiatrists have excellent training and perspective with which to do so. The patient suffering from catastrophic brain injury or spinal cord injury offers a useful contrast--on the most severe end of the disability spectrum--to the patient with persisting low back complaints but normal physical examination. As a society, we have to wisely manage the funds that comprise our social "safety net" in order to provide for persons with severe disability who cannot provide for themselves. It would then follow that patients with minor impairments/disabilities should receive minor (i.e., noninflated) ratings. Psychiatrists need to enable rather than disable their patients.     

Continuity challenges of Parkinson's disease in middle life.

This interpretive study explored the experience of having Parkinson's disease (PD) in middle life. The researcher examined how persons with PD (N = 16) coped with challenges to their sense of self and a future of limited horizons. Participants were ages 42-59 years (mean age = 48 years) and had been diagnosed for a range of 1-16 years. In-depth interviews, focusing on day to day experiences, coping episodes and future hopes and concerns, were conducted on 3 occasions. Findings indicated that participants maintained an intact identity by sustaining a sense of continuity with their pre-Parkinson's self. They dealt with the progressive nature of their illness of by keeping open a range of possibilities for the future. This study advances understanding of the challenges experienced by those with PD and suggests ways in which nurses may be able to be more effective in supporting individuals who are living with this disease.     

Relationship of life satisfaction to impairment, disability, and handicap among persons with spinal cord injury living in the community.

The level and correlates of the life satisfaction of persons with spinal cord injury who are residing in the community were investigated. One hundred men and 40 women were chosen randomly from a cohort of 640 persons with spinal cord injury residing in a 13-county area in southeast Texas. The mean Life Satisfaction Index-A (LSIA-A) was lower than reported previously for persons in the general population. The LSIA-A was not correlated significantly with chronologic variables, the ASIA Total Motor Index Score, or a self-report version of the Functional Independence Measure. The LSIA-A was associated positively with self-assessed health, perceived control, and social support, as well as with the Social Integration, Occupation, and Mobility dimensions of the Craig Handicap Assessment and Reporting Technique. From the standpoint of an augmented version of the World Health Organization model of disablement, the life satisfaction of persons with spinal cord injury appears to be influenced, albeit indirectly, by selective aspects of their social role performance (handicap), but not by their degree of impairment or disability.     

One-year follow-up of mild traumatic brain injury: cognition, disability and life satisfaction of patients seeking consultation.

OBJECTIVE: To investigate cognitive function, symptoms, disabilities and life satisfaction of patients with mild traumatic brain injury who accepted consultation one year post-trauma. DESIGN: Prospective study. PATIENTS: Sixty-nine patients (16 accepted the consultation offered, 53 declined). METHODS: At follow-up, the patients answered questionnaires about symptoms, disabilities (RHFUQ) and life satisfaction (LiSat-11). The patients who underwent consultation and their healthy control subjects were administered a neuropsychological evaluation. RESULTS: In the group undergoing consultation, the number of cognitive tests with outcomes below cut-off limits (-1.5 SD) was statistically significantly higher compared with a control group (21 tests in 11 patients vs 8 tests in 7 control subjects; p=0.025). The number of patients with one or more disability was statistically significantly higher among patients with consultation than without (94% and 34%, respectively; p<0.001). Total RHFUQ score was statistically significantly higher for the group with consultation than without (5.9 +/- 3.7 and 1.1 +/- 2.3, respectively, p<0.001). The group with consultation exhibited a lower level of life satisfaction (41.5 +/- 10.4 vs 45.8 +/- 13.8 for the non-consulting group; p=0.057). CONCLUSION: The high frequency of occurrence of disabilities and lower cognitive functioning, together with the lower level of life satisfaction, appear to characterize patients choosing consultation 1 year post-injury. This highlights the importance of offering consultation for persons suffering mild head injuries.     

Antioxidants, supplements, and Parkinson's disease

OBJECTIVE: To review the use of antioxidants and other supplements for the prevention and treatment of Parkinson's disease (PD). DATA SOURCES: Biomedical literature was accessed through MEDLINE (1996-June 2005); key search terms included Parkinson's disease, coenzyme Q10 (CoQ10), antioxidants, supplements, and glutathione. Pertinent references cited in those articles were also evaluated for inclusion in this review. DATA SYNTHESIS: Three main antioxidants or supplements have been studied for use in the prevention or treatment of PD: tocopherol, CoQ10, and glutathione. These agents have been studied because of their potential to alter the course of 2 common theories of PD pathogenesis: free radical generation and mitochondrial complex-1 deficiency. The literature search revealed 3 large clinical studies of tocopherol (2 observational, 1 prospective randomized), 4 trials of CoQ10, and 1 study of glutathione. With the exception of the large observational studies with tocopherol and one study of CoQ10 that enrolled 80 patients, each of the other studies retrieved included fewer than 30 patients and were conducted for 3 months or less. Antioxidant supplementation, in particular tocopherol, did not appear to alter the course of PD. However, in 2 of the studies of CoQ10 and in the study of glutathione, a small but statistically significant improvement in PD symptoms was observed. CONCLUSIONS: At present, antioxidants and supplements appear to have a limited role in the prevention or treatment of PD. Of those reviewed here, CoQ10 appears to provide some minor treatment benefits. More study is necessary to determine whether CoQ10 has a significant role as primary or adjunctive therapy in PD.