health condition (diseases or disorders impairment ...€¦ · icidh views “disability” as...

Learning about persons with disabilities 2013-02-01 version 1

Learning about Persons with disabilities with Disabilities Old Definition of “Disability” Traditionally, there are two different viewpoints in understanding what is “disability”, namely the “medical model” and the “social model”. The medical model refers to the bodily injury caused by disease or accident in explaining the physical, psychological and social problems faced by persons with disabilities. In 1980, the World Health Organization (WHO) adopted the International Classification of Impairments, Disabilities and Handicaps (ICIDH) primarily based on the medical model. ICIDH views “disability” as impairments caused by disease or accident, which is the main reason for a person’s decrease in ability in daily living or work, and handicap in participating in social activities (such as school education, outside work).

Health Condition (Diseases or Disorders

Impairment

Disability

Handicap


The ICIDH definition places emphasis on the condition of a person’s disability and classifies and assesses the degree of disability and handicap mainly based on the types of diseases. The cause for disability is attributed to a person’s misfortune which leads to bodily injury caused by disease or accident, and brings about physical, psychological and social problems. The medical model advocates intervention through rehabilitation to “cure” or “rectify” the problems and difficulties faced by persons with disabilities. Those who fail to regain their bodily functions through rehabilitation would live a long-term handicapped life. The social model, on the other hand, regards “disability” as the barriers brought about by society, whose environment, culture and attitudes have caused persons with disabilities to lose part of their social living abilities. WHO Definition of “Disability” To supplement the classification of the medical model, the WHO announced in 2001 the International Classification of Functioning, Disability, and Health (ICF), merging both the medical and the social models to replace the ICIDH, and changing the understanding and framework for the cause of a person’s disability to the environment, systems and social attitudes which bring about the “disability”. ICF provides the understanding of human functioning in three different levels:

1. Body functions and structures, e.g. sensory function, speech function; 2. Activities, e.g. communication ability, learning ability and mobility; 3. Participation in life situations, e.g. taking part in social, cultural and community activities).

According to the ICF definition, disability is the loss of ability in one or more of the above functions, that is, impairment in body function or structure causing limitation in ability or barrier in participation. ICF has replaced the sole medical assessment in the past in evaluating a person’s disability or classifying the disability. Instead, it assesses a person’s body function and structure and determines how such function and structure may be affected by a person’s health condition, personal factors (such as age, education, habits) and the environment (e.g. technology, architecture, family support, social attitudes). Thus, this classification can be adapted for use across cultures, making it highly appropriate for heterogeneous populations.


Abstracted from: The International Classification of Function, Disability and Health (ICF) (WHO, 2001).

For example: The situation of an amputee When a person has lost both legs by amputation due to disease or accident, what would be the degree of disability inflicted upon him/her? There are different viewpoints according to the traditional medical model and ICF. The medical model looks at the condition of the person’s disability and assesses the degree of impairment and handicap as follows: Impairment: loss of both legs Disability: unable to walk and live an independent life Handicap: limitation in opportunities for education, outdoor activities or employment ICF not only looks at the person’s health condition, but also personal and environmental factors in assessing his/her body functions, abilities for activity and social participation: Health condition: loss of both legs Personal factors: emotional upheaval, reluctance to go out to have social contact Environmental factors: lack of barrier free access at the place of residence and in the community Body function and structure: loss of mobility in both legs Activity: limitation in mobility, assistance needed in some self-care activities Participation: limitation in opportunities for education, outdoor activities or

employment


ICF integrates the medical and social viewpoints on a person’s health condition when assessing the impact caused by the disability on all aspects of his/her living world (development, participation, environment, etc.). ICF emphasizes power of individuals’ autonomy and uses intervention to enhance their participation in society, taking into account possible barriers caused by environmental and personal factors. Using rehabilitation as an example, according to ICF reports, the relevant staff need to observe how the client would engage in everyday activities and record the condition of his/her body functions. Such records would be used to determine how his/her abilities can be improved, and to what extent the environment can be changed to enhance the degree of his/her performance. For instance, teaching a deaf child sign language would foster effective interaction and increase his/her participation in the family. Conceptually, ICF no longer attributes the limitation of a person with disabilities in activity and restriction in participation to his/her personal bodily impairment. It changes the traditional concept of disability, and makes people realize that such limitation in activity and restriction in participation is not only brought about by bodily impairment, but also caused by social attitudes, environment, and systems. As a result, the United Nations advocates changes in social attitudes, environment, and systems through the use of technology and barrier free facilities in reducing the limitation and restriction, so that persons with disabilities can equally participate in social activities like abled persons. Definition of Disability in Hong Kong According to the Disability Discrimination Ordinance in Hong Kong, “Disability” is defined broadly to include: “total or partial loss of bodily or mental functions or loss of a part of the body, the presence in the body of organisms causing (or capable of causing) disease or illness, a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction, a disorder or illness or disease that affects a person’s thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour. The definition covers a disability that presently exists, previously existed but no longer exists, may exist in the future or is imputed to a person.” According to the Hong Kong Rehabilitation Programme Plan (RPP) published by the Hong Kong Labour and Welfare Bureau in 2007, disability can be classified into the following categories:

1. Attention Deficit/Hyperactivity Disorder (AD/HD) “It is common for children and adolescents with AD/HD to have the following three symptoms: inattentiveness, hyperactivity and weak impulse control. These lead to chronic difficulties in social life, learning and work. These symptoms cannot be explained by any other objective factors and psychiatric conditions and are not meeting with the standards expected for a child’s intellectual ability or stage development. They are generally regarded as being related to brain dysfunction. As symptoms of AD/HD are most noticeable at the formal schooling age, healthcare professionals in this field usually provide diagnosis on children suspected of suffering from AD/HD at this stage.”

2. Autism


“Autism is a pervasive development disorder and frequently co-exists with a variety of other disabilities. In Hong Kong, children suffering from autistic disorder are diagnosed under the following criteria as laid down in the World Health Organisation’s International Classification of Diseases, 10th edition: (a) qualitative impairments in reciprocal social interaction; (b) qualitative impairments in verbal and non-verbal communication; (c) restricted, repetitive and stereotyped patterns of behaviour, interests and activities; and (d) developmental abnormalities which are apparent in the first three years of life.”

3. Hearing Impairment

The following classification of hearing impairment is adopted:

Degree of Hearing Impairment Definition

Profound Hearing loss greater than 90 dB

Severe Hearing loss from 71 to 90 dB

Moderately severe Hearing loss from 56 to 70 dB

Moderate Hearing loss from 41 to 55 dB

Mild Hearing loss from 26 to 40 dB

Normal Hearing loss up to 25 dB

4. Intellectual Disability

“Intellectual disability, in accordance with the definition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition, 1994, is a condition with the following features: (a) significantly sub-average intellectual functioning: an intelligence quotient (IQ) of

approximately 70 or below on an individually administered IQ test (for infants, a clinical judgement of significantly sub-average intellectual functioning);

(b) concurrent deficits or impairments in present adaptive functioning (i.e. the person’s effectiveness in meeting the standards expected for his/her age by his/her cultural group) in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety; and

(c) onset before the age of 18.

In addition, four degrees of severity can be specified, reflecting the level of intellectual disability: (a) mild – IQ level 50-55 to approximately 70; (b) moderate – IQ level 35-40 to 50-55; (c) severe – IQ level 20-25 to 35-40; and (d) profound – IQ level below 20-25.”


5. Mental Illness

The RPP defined persons with mental illness as: “Persons who suffer from a range of disorders due to their predisposition and/or physical, psychological and social factors. These lead to acute or chronic disturbances which are emotional, intellectual and/or behavioural and are accompanied, when illness is serious, by distortions of personality and social relationships.” Such psychiatric disorders may be classified broadly into three main categories: (a) “Psychoses – these are serious disorders in which impairment of mental functioning has

developed to a degree that interferes grossly with insight, ability to meet some ordinary demands of life or to maintain adequate contact with reality. Schizophrenia, which is perhaps the most disabling of all forms of mental illness, starts usually in the teens or early childhood. Another common group of psychoses, the affective psychoses, tend to occur later in life. These two groups are together included in a group of mental illness known as functional psychoses which may lead to prolonged residence in mental hospitals. They dominate the current provision of specialised psychiatric service. The other group of psychoses is the organic psychoses which includes common conditions such as acute confusional states and dementia, with the latter occurring mainly in the elderly.

(b) Neuroses – these are mental disorders without any demonstrable organic basis in which insight and reality testing is intact. Behaviour may be greatly affected although usually remaining within socially acceptable limits and without any disorganisation of personality. The severe cases of neuroses can be fairly disabling and there is considerable distress on the part of the patients.

(c) Others – these include personality disorders, psychophysiological disorder, alcohol dependence, drug dependence, etc.”

6. Physical Disability

Having regard to the advice of the Hong Kong Medical Association in 1994, the RPP adopts the following definition for a person with physical disabilities: “A person with physical disabilities is defined as a person who has disabilities of orthopaedic, musculoskeletal, or neurological origin which mainly affect locomotor functions, and constitute a disadvantage or restriction in one or more aspects of daily living activities.”

7. Special Learning Difficulties (SpLD)

“SpLD generally refer to difficulties in reading and writing (dyslexia), motor coordination disorder, specific dysphasia, etc., and the most common type is dyslexia. Dyslexia is not caused by mental deficiency, sensory impairment or the lack of learning opportunities. It is generally regarded as something relating to brain dysfunction. As a result of persistent and serious learning difficulties in reading and writing, persons with SpLD are unable to read and spell/write accurately and fluently. In general, dyslexia can be improved through appropriate


accommodation in teaching methods, tests and assessments, as well as proper use of information technology. The findings of overseas researches indicate that early identification and intervention for children with dyslexia can effectively improve their literacy skills.”

8. Speech Impairment

Speech impairment is usually affiliated with other disabilities. For the purpose of the RPP, speech impairment is defined as: “Persons with speech impairment as persons who cannot communicate effectively with others, or whose speech difficulty draws undue attention to their speech acts to such an extent that affects their academic, emotional and social developments.”

9. Visceral Disability

For the purpose of the RPP, a person with visceral disability is defined as: “A person with disabilities resulting from diseases or respective treatment. The disability, not being limited to locomotive functions in nature, constitutes disadvantages or restrictions in one or more aspects of daily living activities.”

10. Visual Impairment

The following definitions, which are based on the visual functioning of human being, are adopted in Hong Kong: (a) “Total blindness: persons with no visual function, i.e. no light perception. (b) Low vision:

Severe low vision – persons with visual acuity (refers to the visual acuity of the better eye with correcting glasses) of 6/120 or worse and persons with constricted visual field in which the widest field diameter subtends an angular subtense of 20 degrees or less, irrespective of the visual acuity; Moderate low vision – persons with visual acuity from 6/60 to better than 6/120; and Mild low vision – persons with visual acuity from 6/18 to better than 6/60.”


Causes of Physical Disabilities There are many different causes for physical disabilities, which may be congenital or caused by a condition or event in later life, resulting in impairment in mobility.

Congenital Acquired

Embryo abnormality Prenatal infection/genetic mutation

Diseases For example: diabetes, cardiovascular disease

Birth difficulties For example: lack of oxygen resulting in brain injury

Accidents (traffic, industrial, home, sports etc.)

Inherited diseases For example: muscular dystrophy

Occupational strain

Long-term bad posture

Elderly degeneration

Extended Questions Question 1: What is the main perspective/model in understanding the causes of disability according to the method of classification adopted in Hong Kong, and why? Question 2: Do you have knowledge of the assistive tools used by persons with disabilities? Please list them and explain what kinds of assistive tools are suited for use by what types of persons with disabilities. Question 3: Please look around and find: what types of physically disabilities are commonly found in Hong Kong? Question 4: Barrier free environment refers to building an unimpeded community for persons with disabilities to move around freely and encourage them to live independently. Please name the facilities in the community which can support the daily living of persons with disabilities and how they can be used. Sources of information:

An article dated 29 March 2010 in Hong Kong Economic Times

Hong Kong Rehabilitation Programme Plan (RPP) published by the Hong Kong Labour and Welfare Bureau, http://www.lwb.gov.hk/eng/advisory/rac/rpp_report.htm

WHO, World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva 2001

http://www.lwb.gov.hk/eng/advisory/rac/rpp_report.htm

health condition (diseases or disorders impairment ...€¦ · icidh views “disability” as...

Documents