Disa Health Dictionary

Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner, or within the range, considered to be normal for a human being. The term disability reflects the consequences of impairment in terms of functional performance and activity by the individual. Disabilities thus represent disturbances at the level of the person. See also “handicap”; “impairment”.... disability

Learning disability, previously called mental handicap, is a problem of markedly low intellectual functioning. In general, people with learning disability want to be seen as themselves, to learn new skills, to choose where to live, to have good health care, to have girlfriends or boyfriends, to make decisions about their lives, and to have enough money to live on. They may live at home with their families, or in small residential units with access to work and leisure and to other people in ordinary communities. Some people with learning disabilities, however, also have a MENTAL ILLNESS. Most can be treated as outpatients, but a few need more intensive inpatient treatment, and a very small minority with disturbed behaviour need secure (i.e. locked) settings.

In the United Kingdom, the 1993 Education Act refers to ‘learning diffculties’: generalised (severe or moderate), or speci?c (e.g. DYSLEXIA, dyspraxia [or APRAXIA], language disorder). The 1991 Social Security (Disability Living Allowance) Regulations use the term ‘severely mentally impaired’ if a person suffers from a state of arrested development or incomplete physical development of the brain which results in severe impairment of intelligence and social functioning. This is distinct from the consequences of DEMENTIA. Though ‘mental handicap’ is widely used, ‘learning disability’ is preferred by the Department of Health.

There is a distinction between impairment (a biological de?cit), disability (the functional consequence) and handicap (the social consequence).

People with profound learning disability are usually unable to communicate adequately and may be seriously movement-impaired. They are totally dependent on others for care and mobility. Those with moderate disability may achieve basic functional literacy (recognition of name, common signs) and numeracy (some understanding of money) but most have a life-long dependency for aspects of self-care (some fastenings for clothes, preparation of meals, menstrual hygiene, shaving) and need supervision for outdoor mobility.

Children with moderate learning disability develop at between half and three-quarters of the normal rate, and reach the standard of an average child of 8–11 years. They become independent for self-care and public transport unless they have associated disabilities. Most are capable of supervised or sheltered employment. Living independently and raising a family may be possible.

Occurrence Profound learning disability affects about 1 in 1,000; severe learning disability 3 in 1,000; and moderate learning disability requiring special service, 1 per cent. With improved health care, survival of people with profound or severe learning disability is increasing.

Causation Many children with profound or severe learning disability have a diagnosable biological brain disorder. Forty per cent have a chromosome disorder – see CHROMOSOMES (three quarters of whom have DOWN’S (DOWN) SYNDROME); a further 15 per cent have other genetic causes, brain malformations or recognisable syndromes. About 10 per cent suffered brain damage during pregnancy (e.g. from CYTOMEGALOVIRUS (CMV) infection) or from lack of oxygen during labour or delivery. A similar proportion suffer postnatal brain damage from head injury – accidental or otherwise – near-miss cot death or drowning, cardiac arrest, brain infection (ENCEPHALITIS or MENINGITIS), or in association with severe seizure disorders.

Explanations for moderate learning disability include Fragile X or other chromosome abnormalities in a tenth, neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE), fetal alcohol syndrome and other causes of intra-uterine growth retardation. Genetic counselling should be considered for children with learning disability. Prenatal diagnosis is sometimes possible. In many children, especially those with mild or moderate disability, no known cause may be found.

Medical complications EPILEPSY affects 1 in 20 with moderate, 1 in 3 with severe and 2 in 3 with profound learning disability, although only 1 in 50 with Down’s syndrome is affected. One in 5 with severe or profound learning disability has CEREBRAL PALSY.

Psychological and psychiatric needs Over half of those with profound or severe – and many with moderate – learning disability show psychiatric or behavioural problems, especially in early years or adolescence. Symptoms may be atypical and hard to assess. Psychiatric disorders include autistic behaviour (see AUTISM) and SCHIZOPHRENIA. Emotional problems include anxiety, dependence and depression. Behavioural problems include tantrums, hyperactivity, self-injury, passivity, masturbation in public, and resistance to being shaved or helped with menstrual hygiene. There is greater vulnerability to abuse with its behavioural consequences.

Respite and care needs Respite care is arranged with link families for children or sta?ed family homes for adults where possible. Responsibility for care lies with social services departments which can advise also about bene?ts.

Education Special educational needs should be met in the least restrictive environment available to allow access to the national curriculum with appropriate modi?cation and support. For older children with learning disability, and for young children with severe or profound learning disability, this may be in a special day or boarding school. Other children can be provided for in mainstream schools with extra classroom support. The 1993 Education Act lays down stages of assessment and support up to a written statement of special educational needs with annual reviews.

Pupils with learning disability are entitled to remain at school until the age of 19, and most with severe or profound learning disability do so. Usually those with moderate learning disability move to further education after the age of 16.

Advice is available from the Mental Health Foundation, the British Institute of Learning Disabilities, MENCAP (Royal Society for Mentally Handicapped Children and Adults), and ENABLE (Scottish Society for the Mentally Handicapped).... learning disability

The amputation of a bone by cutting through the joint of which the bone forms a part.... disarticulation

UK legislation that provides for the identi?cation and care of individuals who have an incurable chronic or degenerative disorder. The patients are usually distinguished from elderly people with chronic disorders. Local authorities identify relevant individuals and arrange for appropriate services. The legislation does not, however, compel doctors and nurses in the community to inform local authorities of potential bene?ciaries. This may be because the individuals concerned dislike being on a register of disabled, or because questions of con?dentiality prevent health sta? from reporting the person’s condition.... chronic sick and disabled act 1970

A severe, chronic disability which is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains the age of 22; is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major life activity: self care, receptive and expressive language, learning, mobility, self direction, capacity of independent living, economic self-sufficiency; and reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care treatments or services which are of lifelong or extended duration and are individually planned and coordinated.... developmental disability

Measures that can be initiated among those with a disease, usually a chronic disease, to lessen or delay the impact of disability from that disease, e.g. averting renal complications among those with diabetes.... disability postponement

A modification of conventional life expectancy to account for time lived with disability. It is the number of healthy years of life that can be expected on average in a given population. It is generally calculated at birth, but estimates can also be prepared at other ages. It adjusts the expectation of years of life for the loss on account of disability, using explicit weights for different health states.... disability-adjusted life expectancy

The number of healthy years of life lost due to premature death and disability.... disability-adjusted life years (dalys)

Disabled persons in the United Kingdom have a range of services and ?nancial support available to help them to lead as normal and active a life as possible. O?cially, the disabled include those with signi?cant impairment of any kind, including impairment of sight and hearing, learning diffculties, and chronic illness as well as disablement due to accidents and the like.

Social services are provided by local-authority social-services departments. They include: practical help in the home (usually through home helps or aids to daily living); assistance in taking advantage of available educational facilities; help with adaptations to the disabled person’s house; provision of meals (‘Meals on Wheels’ or luncheon centres); and help in obtaining a telephone. Many of these facilities will involve the disabled person in some expense, but full details can be obtained from the local social-services department which will, if necessary, send a social worker to discuss the matter in the disabled person’s home. Owing to lack of funds and sta?, many local-authority social-services departments are unable to provide the full range of services.

Aids to daily living There is now a wide range of aids for the disabled. Full details and addresses of local o?ces can be obtained from: Disabled Living Foundation and British Red Cross.

Aids to mobility and transport Some car manufacturers make specially equipped or adapted cars, and some have o?cial systems for discounts. Details can be obtained from local dealers. Help can also be obtained from Motability, which provides advice.... disabled persons

A person with a physical or mental impairment that limits the individual’s capacity for independent living.... functionally disabled

Classification of health and health-related domains that describe body functions and structures, activities and participation. The domains are classified from body, individual and societal perspectives. Since an individual’s functioning and disability occurs in a context, this classification includes a list of environmental factors.... international classification of functioning, disability and health (icf) a

A systematic taxonomy of the consequences of injury and disease. See “disability”; “handicap”; “impairment”.... international classification of impairments, disabilities and handicaps (icidh)

Difficulty in one or more areas of learning in a child of average or above average intelligence.

Specific learning disabilities include dyslexia and dyscalculia, where there is a problem with mathematics.... specific learning disability

(DALY) a common research measure of disease burden that accounts for both morbidity and mortality. One year lived in full health is equivalent to one DALY. Disabilities and disease states are assigned a weighting that reduces this figure, such that a year lived with disability is equivalent to less than one DALY. Some studies also use social weighting, in which years lived as a young adult receive a greater DALY weight than those lived as a young child or older adult. See also health-adjusted life expectancy; quality of life.... disability-adjusted life year

(DLA) (in Britain) a state benefit payable to help with the extra costs of looking after a child under the age of 16 with special needs. It has two components: a care component, payable at three rates to children needing help with personal care; and a mobility component, payable at two rates to those aged 3 years or over who need help with walking. The rates depend on the level of help required. DLA for adults aged 16–64 years has been replaced by the *personal independence payment (PIP). People aged over 65 years with a disability and requiring help may be eligible for the attendance allowance.... disability living allowance

see Equality and Human Rights Commission.... disability rights commission

n. a carbohydrate consisting of two linked *monosaccharide units. The most common disaccharides are *maltose, *lactose, and *sucrose.... disaccharide

(in Britain) an Act providing for the identification and care of those suffering from a chronic or degenerative disease for which there is no cure and which can be only partially alleviated by treatment. Such people are usually distinguished from the elderly who may also suffer from chronic diseases. It is the responsibility of local authorities to identify those with such problems and to ensure that services are available to meet their needs. Identification can be difficult because of the lack of a clear and agreed definition of what constitutes a disability of such severity as to warrant inclusion in such a register.... chronic sick and disabled persons act 1970

a state benefit payable to a person disabled by injury or a prescribed industrial disease sustained or contracted in the course of employment (see occupational disease; prescribed disease). The benefit is payable as a weekly amount. The amount of the benefit depends on the degree of disablement as determined following assessment by a specialist. To be entitled to benefit, the disablement must be assessed as being at least 20% of total disability (1% in the case of pneumoconiosis, byssinosis, and diffuse mesothelioma). The benefit is payable if the claimant is still suffering disability two months or more after the date of the accident or onset of the disease. It is payable for a period assessed as the time for which the claimant is likely to suffer the disability. The assessment can be reviewed if the claimant’s condition deteriorates or if he or she is still disabled at the end of the period of assessment.... industrial injuries disablement benefit