Psychotherapy with physically disabled patients

With the last decades, health care interventions have been more productively attuned to actualizing the potential for optimal recuperation of every patient. Unique and important contributions of psychotherapy to this effort include: 1) A formulation which synthesizes an understanding of clinical behaviors, reality-based physical limitations and risks with an appreciation of the patient's mechanisms of defense, ego strengths and weaknesses, and transference expectations which impact the treatment process; 2) The utilization of individual psychotherapy (focused on "insight") in combination with supportive individual and group experiences. For children and adolescents struggling with age-appropriate physical-developmental and social issues or learning disabilities, psychoeducational approach for disabled youngsters has proven very beneficial. 3) Occasional crises occur which involve the spouse or relatives more than the index patient. Working to provide supportive Couple or Family System intervention is sometimes as essential as caring for the disabled individual. 4) Numerous Group Therapy approaches have proven efficacious. Treatment in a group setting is attractive to those who are concerned about cost-containment. Unfortunately, groups for disabled are often "didactic" and utilize a format that provides factual information about disabilities, medical procedures, and sometimes an intellectual discussion of "emotional answers" for certain types of problems or conditions. Groups that facilitate self-disclosure and emotional interactions among the members accomplish more meaningful results. In conclusion, we wish to emphasize the importance of developing rigorous scientific research in the area of disabilities which will match the excellence of clinical work already being done in the field. Gaining an accurate and more thorough understanding of the psychological reality of a disabled person's internal world may be a key to facilitating his or her self-esteem and optimal adaptive functioning.     

Reflection on the 1976 Toronto Olympiad for the physically disabled.

A report is given on the various aspects of the 1976 Olympiad of the Physically Disabled. The aspects discussed are the historical background, planning and preparation of the Games, accommodation for amputees, blind and paraplegics, transport, games site, organisation of sports events, medical supervision, publicity of the Games, standards of performance and records and last, but by no means least, politics and sport.     

The mental health needs of the severely physically disabled

Severely physically disabled individuals, advocates for the disabled, and rehabilitation and mental health professionals were surveyed to determine their perceptions of the need for services for 12 mental health problems encountered by persons with physical disability and the kinds of services needed. All groups surveyed agreed that vocational, social-interpersonal, personal-emotional, self-concept, and marital-family problems were in greatest need of services, but their perceptions of the extent of service need for each of the 12 problems differed significantly. The groups unanimously perceived rehabilitation counseling as the most needed service but differed significantly in their perception of the extent of service need for other services that were also highly rated, such as family, group, and individual therapy; peer counseling; respite care; and social skills training. The groups unanimously agreed that services designed to treat major mental illness were the least needed.     

Aspect of body image in physically disabled youth

The following study compares body awareness and body satisfaction of physically handicapped and normal adolescents. In addition the correlations between self image were investigated in the group of handicapped adolescents. The comparison showed handicapped youths to have more negative body image. The handycap-associated differences between the 2 groups were paralleled by equally significant gender-associated differences within the group of handicapped adolescents. The differences are similiar to ones described in the literature as typical for normal adolescents. No evidence was found of minimizing or disavowing the illness or of shame for the handicapped body. Instead, a strong wish for contact with healthy youths was evident. The results of the study underline the importance of body-associated psychotherapeutic intervention supplementing the many therapeutic measures of handicapped adolescence.     

Tongue thrust swallowing in severely physically disabled children

In five patients with severe physical and mental disabilities, a feeding pattern with tongue thrust was assessed videofluoroscopically. Forward and backward movements of the tongue associated with movements of the mandible propelled the bolus, and the insufficiently formed bolus spilled out anteriorly and laterally in part. The swallowing reflex was accompanied by tongue thrust. After the reflex, a part of the bolus frequently remained on the vallecula and pyriform sinuses. The suckle pattern shown by infants is suggested to remain and develop into this feeding pattern with tongue thrust.     

Joint deformity patterns in severely physically disabled patients

Deformity patterns of the spine and upper and lower extremities were investigated in 64 patients with severe physical disability. Among the subjects, C-shaped and S-shaped scoliosis was found in 48 and nine, respectively. The hips were windblown in 20, adducted in 22, and abducted in seven. Knees were flexed in 39 and extended in four. Deformities of the ankle and upper extremities were variable. The most common combination, which was C-shaped scoliosis with convexity to the adducted side of hips, windblown hips, flexed knees, and dorsiflexed ankles, was noted among nine patients. Joint deformity patterns in the 43 patients with spastic tetraplegia were not significantly different from those in the 21 patients with dyskinesia.     

Sleep problems in physically disabled children and burden on caregivers

Aim

The present study was implemented to investigate relationships between sleep problems in physically disabled children and sleep quality and perceived burden of caregivers.

Methods

Subjects comprised 100 caregivers of disabled children, including 96 mothers, 2 fathers and 2 grandmothers. Questionnaires included demographic data for children and caregivers, sleep problems of children, and sleep quality (Pittsburgh sleep quality index (PSQI)) and perceived burden on caregivers (Japanese version of the Zarit Burden Interview (J-ZBI)). The sleep problems of children were evaluated according to the following five categories: “Problems initiating and maintaining sleep”; “Problems with sleep-related breathing”; “Problems with excessive somnolence”; “Problems with circadian rhythm”; and “Problems with sleep-related movement”.

Results

The children comprised 66 boys and 34 girls (age range, 1–17 years). Of these, 65 children could not sit up and 35 could. A total of 88 children were found to have one or more categories of sleep problems. The most common sleep problem was “Problems initiating and maintaining sleep” (64.8%), followed by “Problems with sleep-related movement” (59.1%). J-ZBI was significantly higher in caregivers of children with “Problems initiating and maintaining sleep”. PSQI scores were significantly higher in caregivers of children with “Problems with sleep-related breathing” and “Problems with circadian rhythm”. A significant correlation was identified between perceived J-ZBI and PSQI of the caregiver.

Conclusions

Increased focus on the sleep problems of disabled children is needed, particularly in relation to the sleep quality and perceived burden of caregivers.     

Correlates of anxiety symptoms in physically disabled older women.

OBJECTIVE: The authors describe characteristics that are associated with chronic anxiety symptoms and examine the use of anxiolytic and antidepressant medications in physically disabled women with and without symptoms of anxiety. METHODS: Participants were 791 physically disabled women age 65+ years who participated in the Women's Health and Aging Study for 2-3 years. Anxiety symptoms were measured with four questions from the Hopkins Symptom Checklist, and women were categorized as having no anxiety, intermittent anxiety, and chronic anxiety symptoms. Health-related characteristics, medications, physical functioning, physical activity, and psychosocial variables were also measured. RESULTS: Forty-nine percent of women reported no anxiety symptoms; 41% reported intermittent symptoms; and 10% reported chronic symptoms of anxiety. Depressive symptoms and lack of emotional support were significant correlates of intermittent anxiety symptoms, whereas depressive symptoms, negative life events, and lack of emotional support were significant correlates of chronic anxiety symptoms. Over the course of 3 years, 20.3% of women with no anxiety, 33.0% of women with intermittent anxiety, and 48.7% of women with chronic anxiety symptoms took anxiolytic and/or antidepressant medications. CONCLUSION: Anxiety symptoms are common among disabled older women. Psychosocial variables were significantly different in women with intermittent or chronic anxiety symptoms, versus women without anxiety.     

Oral motor patterns during feeding in severely physically disabled children

Oral motor patterns during feeding were investigated in 58 patients with severe physical disability. Five patients showed a pattern resembling sucking. Twenty-nine exhibited an up-and-down movement of the jaw and protrusion of the tongue. Among these, the mouth opened when the food entered and the lips closed before swallowing in 20 patients; the mouth was constantly open in nine. Eight had an up-and-down movement of the jaw without protrusion of the tongue. These patterns were frequently seen in patients with spastic tetraplegia caused by neonatal asphyxia and compensated for oral motor impairment. Sixteen patients showed lateral movement of the jaw at some time during feeding; in these patients the texture of the food was more coarse than in those with other patterns.     

Present status and problems of schools for physically disabled children from the viewpoint of a school physician

We evaluated the problems of physically disabled children in schools, and clarified the roles of school physicians and the appropriate state of child neurologists. The range and severity of disabilities of disabled children in schools have gradually been increasing. Although nurses were assigned to provide medical care, the roles of school nurses differ among schools. In addition, about 50% of primary care physicians for these children are not Board-Certified Child Neurologists. Therefore, the instructions of medical care by primary care physicians to teachers and nurses are not well structured, and increase the physical and mental stress of teachers and school nurses. Thus the importance of the roles of school physicians has been increasing. As a school physician, I would request the followings to the Japanese Society of Child Neurology: (1) a proposal concerning support for commuting methods, (2) further improvement in postgraduate education in medical care and support for physically disabled children, (3) the standardization of written instructions for school, and (4) a proposal concerning the roles of nurses in school for disabled children.     

Partner abuse in physically disabled women: a proposed model for understanding intimate partner violence

PROBLEM: Physically disabled women are a population at significant risk for intimate partner violence. METHOD: This study used a qualitative research design to address the abuse experience of physically disabled women. FINDINGS: The participants identified multiple incidences of abuse, focusing on how the abuse began, proceeded, and terminated. A model was constructed to depict the abuse experience. The progression of abuse triggers, responses of the women, the abuse episode, the after-effects, and the slow return to usual routines were identified. CONCLUSIONS: A model, which is different from Walker's Cycle of Violence (Walker, 1979; 2000), was constructed to demonstrate the journey of women with disabilities through the abuse.     

Major depression and depressive symptomatology among the physically disabled. Assessing the role of chronic stress

Although it is generally agreed that life stress represents a risk factor for depressive symptomatology, there is less agreement on the significance of such stress for the occurrence of major depression. Indeed, it has been suggested that stress factors of importance for depressive symptoms may be irrelevant for major depression. We report results based on a large sample of physically disabled and nondisabled adults that contradict this suggestion. The physically disabled show seriously elevated rates of both depressive symptomatology and major depressive disorder. Subgroup analyses confirmed the finding on depressive symptomatology within all age-gender groupings and the finding on major depression for young and middle-aged men and women but not for the aged. It is argued that these findings can be attributed to differences in chronic stress associated with disability status. We conclude that chronic stress represents a significant risk factor with respect to both depressive symptomatology and major depressive disorder.     

Factors related to adaptive behavior changes among profoundly mentally retarded, physically disabled persons

Changes in adaptive competence over a 1-year period of profoundly mentally retarded, physically disabled persons living in a moderately sized residential facility or in small community programs were examined. No evidence was found to indicate that habilitative growth was greater for residents in the small community programs. Indeed, residents of the moderately sized facility showed evidence of skill acquisition whereas community residents declined slightly in adaptive skill. Within community programs, presence of a relevant goal was positively related to change in independent living skills, and clients with musculoskeletal impairments tended to regress in motor and eating skills. These data suggest that client characteristics and habilitative program content are significant predictors of client growth, and size of the residence is probably not as important for delivery of effective services.     

Vitamin B(12) deficiency and depression in physically disabled older women: epidemiologic evidence from the Women's Health and Aging Study

OBJECTIVE: It has been hypothesized that adequate concentrations of vitamin B(12) and folate are essential to maintain the integrity of the neurological systems involved in mood regulation, but epidemiologic evidence for such a link in the general population is unavailable. This study examined whether community-dwelling older women with metabolically significant vitamin B(12) or folate deficiency are particularly prone to depression. METHOD: Serum levels of vitamin B(12), folate, methylmalonic acid, and total homocysteine were assayed in 700 disabled, nondemented women aged 65 years and over living in the community. Depressive symptoms were measured by means of the Geriatric Depression Scale and categorized as no depression, mild depression, and severe depression. RESULTS: Serum homocysteine levels, serum folate levels, and the prevalences of folate deficiency and anemia were not associated with depression status. The depressed subjects, especially those with severe depression, had a significantly higher serum methylmalonic acid level and a nonsignificantly lower serum vitamin B(12) level than the nondepressed subjects. Metabolically significant vitamin B(12) deficiency was present in 14.9% of the 478 nondepressed subjects, 17. 0% of the 100 mildly depressed subjects, and 27.0% of the 122 severely depressed women. After adjustment for sociodemographic characteristics and health status, the subjects with vitamin B(12) deficiency were 2.05 times as likely to be severely depressed as were nondeficient subjects. CONCLUSIONS: In community-dwelling older women, metabolically significant vitamin B(12)deficiency is associated with a twofold risk of severe depression.     

The Chicago perspective on design for the disabled

This article describes the efforts made by the city of Chicago to promote total access and full participation for people with disabilities. The process that the Chicago Mayor's Office for People with Disabilities (MOPD) undertook to ensure that other city departments and sister agencies incorporated accessible programs and physical accessibility considerations into their own buildings, programs, and processes is described. Some of the major accomplishments made by the department include the addition of an accessibility review added to the building permit process and a rewrite of the Chicago Building Code that requires more accessibility features in single-family homes and smaller apartment buildings. Examples are given of how thinking beyond the minimum accessibility requirements can better meet the needs of people with a disability.