For the first time in history, numbers of people with severe physical disabilities such as spinal cord injury or polio are surviving to old age. Ageing-related changes combined with pre-existing impairments present new challenges for these individuals and for service providers. Implications for professionals include the need to foster more collaborative relationships between themselves and recipients, to emphasize services that enable independence, to coordinate new services, and to address issues of wellness, not only disability.

This paper describes a personal microcomputer model to match the need of the ambulatory disabled to the physical workplace. It is noted that back pain resulting from working from wheelchairs is the most common complaint of many who continue or return to work. The use of computer-aided design in matching the person to his/her workstation is described.

Physical handicaps often make it difficult to use an ordinary production car. Access can be a major problem for both driver and passenger, while the design of controls has to be matched to the functional capabilities of the individual driver. Provision of an adequate driving posture and storage for a wheelchair also have to be considered. Many of these problems can be overcome by suitable adaptations to the vehicle. Recent work in this field is reviewed to summarize the ergonomic guidelines that are available. The driving task also requires cognitive skills and adequate speeds of reaction as well as physical skills and capabilities. Better methods of assessing these are gradually being developed, but much further work is necessary in this area. Disabled drivers need instructors who are skilled in training for their special needs. New developments have occurred in powered controls and in their mode of operation, allowing greater numbers of severely disabled people to drive. Steering controls can now be produced which require virtually zero force or very little movement to operate, and driving with a single multi-function control can be expected in the very near future.

This paper describes two approaches to improving the employment prospects of those suffering from head injury. It is noted that unemployment within the first 7 years post-head injury is as high as 70% and that this contributes to the long-term difficulties faced by the head-injured and their families. A 'supportive' approach to employment involving the use of job coordinators or job coaches is described and a number of 'compensatory' strategies described. These two approaches are compatible and are derived from the individual needs of the head injured person in relation to retaining or seeking employment.

The purpose of this paper is to review the dynamics and functioning of families with a severely head-injured member. In order to stress the unique problems faced by persons with brain damage and their families, a comparison with spinal cord-injured individuals is presented. The review's major conclusion is that a head injury exposes the family to a complex of problems that are unique to this disability and, therefore, necessitates the delivery of special family support services focused on the family, rather than on the head-injured person.

Cystic fibrosis (CF) is a disease that has profound consequences on a family unit. As a genetically transmitted, chronic illness, it influences every aspect of family life, including time constraints, finances, and relationships among family members. The purpose of this article is to demonstrate the cumulative effect of the nursing diagnoses related to the pathophysiology of CF on the nursing diagnosis, Potential for Alterations in Family Process, when a family has a child with cystic fibrosis. This nursing diagnosis was first recognized by the North American Nursing Diagnosis Association (NANDA) in 1982. It is vital that nurses are able to differentiate between a family having difficulty coping with a child with CF in the home, and one that is coping well on its own. The children of families that are not coping well tend to be hospitalized more than those of families that are coping well. The families use the hospitalizations as rest periods for themselves. By recognizing the cues identified by NANDA of a family having problems, early intervention can be initiated before the family is in a crisis. The family must live with CF on a daily basis for the remainder of the child's life; therefore it must be able to function at its optimum level. It is nursing's responsibility to be able to recognize and assist the family in need. A knowledge of the nursing diagnosis, Alterations in Family Process, will assist nurses in fulfilling this obligation to the family.

Today more and more children are surviving childhood diseases that had been fatal in a previous generation. Medical advances and technology allow most children with cancer to enjoy long-term survival and cure. Research studies now show that there are late effects of treatment that affect growth, development, and cognitive functioning. Parents and teachers of long-term survivors of childhood cancer share concerns about deficits in cognitive functioning as it affects learning in school. Childhood cancer and the literature on cognitive late effects of treatment are discussed. Recommendations are made for early psychological evaluation and appropriate educational intervention.

The purpose of this exploratory pilot study was to determine the coping strategies used by adolescents with chronic illnesses and compare those strategies with the strategies used by their parents. Adolescent coping strategies were measured by the Jaloweic Coping Scale, while parental perceptions of their coping strategies were assessed using the Hymovich Chronicity Impact and Coping Instruments: Parent Questionnaire (CICI:PQ). Fifteen chronically ill adolescents and their parents were administered the tools. Analysis revealed that there were significant differences between the parent coping strategies and those of the adolescents in the sample. Adolescent responses on the three subscales of the Jaloweic Coping Scale were analysed using ANOVA, resulting in no significant differences in responses on the three subscales.

Coronary artery disease, overt or silent, is frequently present in patients who have suffered a cerebrovascular accident (CVA). Rehabilitation therapy of CVA patients is based mostly on physical activity, which may be limited by fear of overloading the cardiovascular system. Therefore, assessment of the severity of coronary heart disease in CVA patients is of utmost importance. In this study we assessed the usefulness of 24-hour electrocardiographic Holter monitoring in the evaluation of post-CVA patients during daily activities and rehabilitation. Of the 43 post-CVA patients, 24 (55.8%) revealed pathological changes on Holter monitoring and 17 (71%) had a history of coronary artery disease prior to CVA. Holter monitoring revealed mainly ventricular and atrial arrhythmias and in three patients detected transient ischaemic episodes. Only six patients (14%) showed aggravation of arrhythmia during rehabilitation therapy, without aggravation of ST-T changes. The mean maximum heart rate during regular daily activities was 104 +/- 20 beats/min, which was significantly higher than the mean maximum heart rate during physical therapy (100 +/- 18 beats/min; p less than 0.01) and during occupational therapy (87 +/- 18 beats/min; p less than 0.001). These findings indicate that more vigorous physical and occupational therapy can be prescribed to these patients. The performance of Holter monitoring in post-CVA patients is a valuable substitute to exercise testing, and is useful for cardiovascular evaluation during daily activities and rehabilitation therapy.

Hansen's disease leads to deformities of the lower and upper extremities. Eventually, these deformities become a serious handicap and limit the functional capabilities of the afflicted. This paper defines the characteristics of individuals suffering from Hansen's disease and demonstrates that disabilities caused by Hansen's disease can be overcome by: (i) use of splints, (ii) reconstructive surgery, (iii) modification of the articles and tools of daily use, and (iv) proper job--worker matching.

A population survey with the aim of obtaining information to facilitate the planning of services for younger physically disabled people provided the opportunity to explore the use of physical independence handicap in this context. A Phase 1 sift questionnaire was sent to one in three (25,167) occupied households in Calderdale, a district in Yorkshire, England, with a final 87% response rate. A Phase 2 in-depth interview was carried out on a stratified random sample of those identified as disabled in Phase 1. Interviews were obtained with 570 individuals aged 16-64 years, 93% of those available. The measure of physical independence handicap was derived from data obtained in the interview indicating need for help at infrequent or short intervals and immediate-needs dependence. The estimated prevalence of dependent people aged 16-64 in Calderdale is 26.6 per 1000 population (95% CI: 24.9-28.3). Rates were higher in females, and both prevalence and level of dependence increased with age. Disability in activities of daily living and locomotion was linked to the level of physical independence handicap. Problems with housework and collecting (including shopping) were most frequent for those who needed help on an infrequent basis, while self-care needs were substantial for the short and immediate-needs dependence groups. Only a small proportion reported receiving services in their home during the previous 12 months; 20% received services from a nurse and 10% the services of a local authority home help. Overall, 91% reported contact with the primary health care team within the previous 12 months and 68% with hospital and rehabilitation services.(ABSTRACT TRUNCATED AT 250 WORDS)

A consecutive series of 195 individuals who had had a stroke or brain trauma in 1986 responded in 1989 to a questionnaire about the consequences of the incident for occupational performance. The questionnaire contained 86 questions organized to correspond to the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH). The questions were distributed over 11 areas of occupational performance: work, leisure activities/social role, life satisfaction, sensori-motor, perceptual, intellectual, emotional function, sleep, personal care, domestic/housework/gardening, and temporal adaptation. None of the individuals considered they had attained the same level of occupational performance in all 11 areas as before the incident. Eight patterns of occupational performance were identified: 35% considered that they performed personal care at the same level and had the same temporal adaptation as before the incident, and that they had minimal impairment/disability in the other areas of occupational performance; 27% thought that they had a considerable degree of disability in all areas of occupational performance except for temporal adaptation; 8% thought that they had imbalance in temporal adaptation and severe performance difficulties in all 11 areas of occupational performance; 4% were dissatisfied with their life situation, and had a changed family role, did not practise the leisure activities they wanted, and had severe sleep problems; and for 9% the levels of performance varied a great deal and depended on the particular area of performance. The consequences of stroke or brain trauma for function and activity 3 years afterwards are considerable.

The pain syndrome repetition strain injury (RSI) has been variously interpreted as a psychogenic disorder, an overuse injury of upper limb musculature, and a state of peripheral neural irritability. A review of the history of work-related upper limb disorders was undertaken to ascertain whether RSI is a new medical phenomenon or an older syndrome in a new guise. In the mid-nineteenth century these disorders were known as either craft palsies or writer's and other occupational cramps. Not withstanding clinical evidence suggesting that most were associated with peripheral neural or muscular dysfunction, a body of influential medical opinion considered them all to be disorders of the central nervous system, appropriately termed the occupation(al) neuroses. During the twentieth century, as discrete occupational upper limb nerve lesions were delineated and the spasmodic form of writer's cramp was recognized as a torsion dystonia, a unifying concept of aetiology for the occupational neuroses of the nineteenth century became untenable. The RSI syndrome of the 1980s can be identified from early case descriptions of both scrivener's palsy and the neuralgic variety of writer's cramp. Contemporary hypotheses proposed to explain RSI are remarkably similar to those proposed for the occupation(al) neuroses.

Normative data on isometric back strength (IBS) are presented. The IBS of both sexes increased with chronological age, peaked at the third decade of life, and gradually declined thereafter. Males were significantly (p less than 0.001) stronger than females in all age groups, the difference ranging between 16 and 56%. A multiple regression equation was derived to predict IBS, as follows: Male IBS (kgf) = -77.71 - 0.91 age (yrs) + 0.67 height (cm) + 1.50 weight (kg) + 0.24 Quetelet index (R2 = 0.78; SE +/- 16.67 kgf) Female IBS (kgf) = -72.42 - 0.39 age (yrs) + 10.65 height (cm) + 0.08 weight (kg) + 1.04 Quetelet index (R2 = 0.62; SE +/- 10.75 kgf).