CONCEPTS AND DEFINITIONS OF DISABILITY
The contemporary conception of disability proposed in the WHO International Classification of Functioning, Disability and Health (ICF) views disability as an umbrella term for impairments, activity limitations and participation restrictions. Disability is the interaction between individuals with a health condition (e.g. cerebral palsy, Down syndrome or depression) and personal and environmental factors (e.g. negative attitudes, inaccessible transportation, or limited social supports). Long ago there was great confusion over the meaning of terms such as impairment, handicap, or disability. Then, in 1980, the WHO provided great service by offering a clear way of thinking about it all in a little book called "International Classification of Impairments, Disabilities and Handicaps". All these terms refer to the consequences of disease, but consider the consequences at different levels. The disease produces some form of pathology, and then the individual may become aware of this: they experience symptoms. Later, the performance or behaviour of the person may be affected, and because of this the person may suffer consequences such as being unable to work. In this general scenario, Impairment was defined as "any loss or abnormality of psychological, physiological, or anatomical structure or function." Impairment is a deviation from normal organ function; it may be visible or invisible (screening tests generally seek to identify impairments). Disability was defined as "any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being." Impairment does not necessarily lead to a disability, for the impairment may be corrected. I am, for example, wearing eye glasses, but do not perceive that any disability arises from my impaired vision. A disability refers to the function of the individual (rather than of an organ, as with impairment). In turn, Handicap was defined as "a disadvantage for a given individual, resulting from impairment or a disability that limits or prevents the fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual." Handicap considers the person's participation in their social context. For example, if there is a wheel-chair access ramp at work, a disabled person may not be handicapped in coming to work there. Here are some examples:
Impairment - Speech production; Disability - Speaking clearly enough to be understood; Handicap - Communication I - Hearing; D - Understanding; H - Communication
I - Vision; D - Seeing; H - Orientation
I - Motor control, balance, joint stiffness; D - Dressing, feeding, walking; H - Independence, mobility I - Affective, cognitive limitations; D - Behaving, interacting, supporting; H - Social interaction, reasonableness Here is a diagram that suggests possible parallels between the impairment, disability & handicap triad, and the disease, illness and sickness triad. (The squiggly arrows are intended to indicate a rough correspondence)
"Patients do not come to their physicians to find out what ICD code they have, they come to get help for what is bothering them." A Positive Perspective? Quality of Life and the International Classification of Function The focus on disability takes a somewhat negative approach to health, perhaps not unreasonable since doctors are supposed to cure diseases. But starting in the 1980s clinicians began to set goals to achieve when the disease could not be cured, beyong merely controlling symptoms. The notion of Quality of Life gained prominence as a way to emphasize a positive perspective on health - health as a capacity to function and to live, even if the patient has a chronic condition. A central aim of care was to enhance the quality of the patient's function, and hence their ability to life as normal a life as possible, even if the...
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