assessing and managing handicap: an original concept

Assessing and managing handicap: an original conceptClaude Hamonet MD, PMR, PhD (social anthropology)Professor Emeritus with the Medical School in Creteil, University Paris-East-Creteil (UPEC).Department of PRM (Dr. Maigne) Hotel-Dieu de ParisFormer disability expert registered with the WHO in GenevaFormer Dean of the Communication and Insertion in the Society Department , Paris 12 UniversityFormer Professor (PRM) in Algiers.

7th Congress of the Pan-Arab Association ofPhysical Medicine and Rehabilitation Jeddah, Saudi Arabia 9-11 March, 2013 Thanks to Mohamed Khadiri, President of Morocco Association of disableds for arabic translation.

How to define disability within the health system ?

The debate on the definition of disability has been going round in circles for a long time.

The lack of clear conceptualization, induced simplifications, misunderstandings and misinterpretations.

The consequences are: the lack of reliable tools affecting the assessment of disabled people needs and the correct measurement (EBM) of effects in Rehabilitation.

The WHO’s failure to define and classify Disabilities The WHO biomedical propositions (ICIDH I, ICIDH II,

and, since 2001, International Classification of functionning-ICF) initiated by P.H.N. Wood (1980) are useless tools for diagnosing, defining and assessing disabilities.

The use of inaccurate and ambivalent terms as “activities” add to the already great confusion on a subject specifically requiring accurate words.

ICF separates : ORGANIC FUNCTIONS ANATOMIC STRUCTURES ACTIVITIES AND PARTICIPATION ENVIRONMENTAL FACTORS

Dr. Philip Wood, Manchester, 1985 at the time of my visit

The « Wood Project » 1980

We propose A new look….…at disabled persons, Situations of Disability

Saad Nagy (1965, Ohio State University, USA), Rehabilitation physician and anthropologist

Saad Nagy suggested the following formula to deal with chronic diseases and their consequences:

Pathology --> impairment --> functional limitation --> disability

The new proposal : Disability Identificationand Measurement System (DIMS)

An ergonomic and anthropologic approach of disability

An international proposal for the quantified identification of Disabilities

DISABILITY

BODILY CHANGES

FUNCTIONAL LIMITATIONS

OBSTACLES IN LIFE SITUATIONS

The four Dimensional Disability Diagram of Paris-East-Creteil University, Porto University, Montreal University and Tunis Social Affairs Ministry (1999).

SUBJECTIVITY

Four dimensional diagram of Disability of Paris-East-Creteil University, Porto University, Montreal University and Tunis Social Affairs Ministry (1999).

عاقة

أو ا ألمراض اإلصابات

في الصعوباتالحياتية الوضعيات

االضطرابات الذاتية الوظائفية

Four levels to analyze disabilitiesHanditest اإلعاقة درجة تقييم سلم

1) THE BODY: this level includes all the biological aspects of the human body

2) FUNCTIONS/CAPACITIES: This level comprises the physical and mental functions of the human.

3) LIFE SITUATIONS: This level addresses the confrontation where a person is faced with the reality of the physical, social and cultural environment.

4) SUBJECTIVITY: This level addresses the person’s point of view regarding his/her health status and social position

Functions ( االضطرابات ت قييم (الوظائفية-Position-holding and moving -Manipulation-Prehension-Communication including : Hearing, Vision-Cognition-Control of sphincters-Sexuality-Procreation-Adapting to physical activity-Mastication-Cough-Cutaneous protection against pathologic factor-Sleep, vigilance. Appearance and beauty

Situations in life ( في الصعوبات تقييمالحياتية (الوضعيات

-Daily Living activities -Social and affective life

family, friends, neighbours, leisure activities

-Occupation-School and education-Care constraints

Subjectivy (الذاتية)Self awareness on :- Body- Current functional capacities-Situation as a disabled person (feeling of

exclusion)

Severity scale (dependence scale)

0 No dependence, no hardship.

1 Discomfort (hardship) in the functional realization or in a situation.

2 Use of a technical aid, animal assistance or a drug,

3 A human aid is partially necessary

4 Impossible or the function or situation is totally compensated by other person.

The consequences for PMR are

A better identification of disability. A method for identify the needs of the

disabled persons. A method to choose the best rehabilitation

solution: technical aid, human aid, physiotherapy, occupational therapy…A method to assess the Rehabilitation results

An introduction of the human factor in Rehabilitation (by subjectivity)

Conclusion

There are two pillars in Rehabilitation:

1-Subjectivity (self awareness of the disabled person)

2-Situations : a disabled person is not a disabled one, but a person in a disabling situation.

« To believe in Rehabilitation is to believe in Humanity » Howard A. Rusk (the Founder of Rehabilitation Medicine , University of New-York 1947).

Thanks very much for your interest

Choukrane