Better health and functioning for PWDs

The National Disability and Prevention Week that was observed last week is a worldwide commemoration primarily to include and involve persons with disabilities ( PWD) in an envisioned “society for all” where the diversity of people, their needs, abilities, and aspirations are accommodated, and where an enabling environment to realize every one’s basic rights, fundamental freedoms, and meaningful life are provided.

There are more than a billion people in the world today who have disabilities where 15% of the global population having significant functional disabilities. The prevalence of disability is higher in low-income countries and has been rising because of the aging population and the global increase in chronic diseases, injuries, accidents, violence, and unhealthy lifestyle.

In the context of healthcare, we define three important but interrelated terms: impairment, disability, and handicap. Impairment is any loss or abnormality of psychological, physiological or anatomical structure or function. Disability is any restriction or lack of ability to perform an activity, as a result of impairment in the manner or within the range considered normal for a human being. Handicap is a disadvantage for a given individual resulting from impairment or disability that limits or prevents the fulfillment of a role that is normal for that individual, considering factors like age, sex, social, and cultural.

For example, a polio victim may have paralysis in his leg muscle (impairment), which causes his difficulty in walking (disability). He is then denied a job because the prospective employer believes that he cannot be an effective employee (handicap).

People with disability face widespread barriers to accessing services and experience poorer health outcomes, lower educational achievement, less economic participation, and higher rates of poverty than people without disabilities. They are more than twice as likely to report that both the health care facilities and skills of their health care providers are inadequate to meet their needs, and nearly three times more likely to report being treated badly.

Many of these barriers are avoidable and the disadvantage associated with disability can be overcome. Better health for people with disability, through improved access to health services, is a crucial enabling factor to participation and positive outcomes in areas such as education, employment, family and community, and public life.

Disability or handicap resulting from impairment presents in varying degrees, from mild to severe, to extreme and estimates revealed that some handicaps, perhaps as many as 80%, can be prevented. While there are thousands of known causes of disabilities, there are also a great number of cases where the exact cause of the impairment is not known.

The role of Physical Medicine and Rehabilitation specialists, commonly referred to as Physiatrists, is to diagnose, evaluate, and manage children and adult patients with physical and/ or cognitive impairment or disability. They have specialized training in nonsurgical treatment of neurological and musculoskeletal conditions, as well as impairment related to other organ systems (heart, lungs, etc.).

Physiatrists provide leadership to multidisciplinary teams focused on the restoration or development of physical, cognitive, social, recreational, occupational, and vocational function in people whose abilities have been limited by pain, disease, trauma or by congenital and developmental disorders.

Physiatrists realize the fact that disability is multidimensional and the product of an interaction between an individual’s certain conditions and his or her physical, social, and attitudinal barriers. The bio-psychosocial model embedded in the International Classifi cation of Health and Functioning (ICF) broadens the perspective of disability and allows medical, individual, social, and environmental infl uences on functioning and disability to be examined. Structurally, the ICF is based on three levels of functioning ( body functions and structures, activities, and participation) with parallel levels of disability (impairments, activity limitations, and participation restrictions). Human functioning is understood as a continuum of health states and every human being exhibits one or another degree of functioning in each domain, at the body, person and society levels. In the ICF language, contextual factors ( environmental factors and personal factors) also constitute disability. Environmental factors include availability of assistive devices, family and community support, supportive services and policies and attitudes of different people. Personal factors include health conditions ( diseases, disorders, and injuries). ICF conceptualizes disability not solely as a problem that resides in the individual but as a health experience that occurs in a context.

Investments in habilitation and rehabilitation and provision of assistive technologies are beneficial because they build human capacity and can be instrumental in enabling people with limitations in functioning to remain in or return to their home or community, live independently, and participate in education, the labor market, and civic life. In addition, they can reduce the need for formal support services, as well as reducing the time and physical burden for caregivers. For more information, please contact the St. Luke’s Medical Center Physical Medicine and Rehabilitation at 7230101/0301 ext. 5415 or 4177 (Quezon City) or 7897700 ext. 6039 (Global City).