Physical Disability
Within society it is a common misconception that a person with a physical disability also has an impairment of other functions, such as intellect or learning ability. In most cases this is not true.
It is paramount that we adopt an individualised approach when attempting to support someone with a physical disability. In the vast majority of cases the person with the greatest awareness of needs and limitations associated with the physical disability is that person him or herself. It would always be helpful to have an open discussion around aspects of the disability, or issues relating to that person's specific disability.
Indeed the person with the disability may be happy to speak about their disability and answer any questions. In some cases it would be best practice to seek more information to prepare ourselves to support a new employee with a physical disability.
It may be beneficial to speak to a representative of a support organisation, for the people with the disability in question. Always consult initially with the person with the disability. The person has probably had many years of experience managing their disability, so draw on their expertise as much as possible.
In the beginning, there may be a period of settling in where the person and their team strike a balance between too much assistance or not enough assistance. Most of these issues relate to accessibility of doors, toilets, equipment, canteen facilities and so on.
Among the more common forms of physical disability are:
Spinal Cord Injury
The spinal cord runs through the bones of the spine called the vertebrae. The vertebral column acts like a telephone cable - sending messages of feeling and sensation to the brain. The brain translates them into responses such as pain or movement. When the spinal cord is injured or severed these messages are interrupted or cannot get through at all. Depending on the extent of the damage, a person will either be partially or completely paralysed from the point of damage or lesion. The spinal cord may have been injured in a road traffic accident, sport injury, industrial accident, household fall, cancer or a tumour.
Paraplegia results from a broken back. It means paralysis from the chest or waist downwards little or no feeling in the lower limbs. Tetraplegia or Quadriplegia results from a broken neck. It can result in paralysis of lower body and may affect the hands and arms. It can also affect chest muscles resulting in difficulty with breathing and coughing.
The extent of paralysis and the affect on specific bodily functions depends on the completeness of the lesion. If the spinal cord is only partly damaged some messages may continue to pass between the brain, muscles and organs. A person whose injury is termed 'complete' is more likely to have less feeling or control. A person whose injury is termed 'incomplete' is more likely to have some feeling and movement although sensation/sensitivity may be altered. Therefore these terms provide an insight to the extent of damage and consequently the disability itself.
Multiple Sclerosis
Multiple Sclerosis is the result of damage to myelin. This myelin is the protective sheath surrounding all the nerve fibres in the brain and spinal cord. It helps conduct electrical impulses between the brain or spinal cord. When it becomes damaged the messages are slower, distorted, or non-existent. Damaged areas of myelin are known as plaques or lesions. People are usually diagnosed between the ages of twenty and forty years.
Symptoms depend on the location of plaques (damaged areas) but can affect the eyes, brain stem, spinal cord, motor and/or sensory nerves.
MS varies from one person to another. It causes different symptoms which affect different parts of the body. Therefore we always have to avoid the trap of assuming that the term means exactly the same thing for every individual that has h diagnosis. It is possible to have a variety of symptoms at different times. Symptoms vary in severity and duration and may be obvious or hidden. Symptoms can include double or blurred vision, pain at the back of the eye, nerve pain in the eye, ringing in the ears, hearing problems, tingling in the legs, feet, arms or hands, numbness, giddiness, loss of balance, difficulty concentrating, forgetfulness, behavioural changes i.e. anxiety/depression, fatigue (especially in hot weather), difficulty in walking, muscle pain, speech problems and problems with bladder or bowel control
There are four types of MS:
Benign MS
Benign MS starts with a small number of mild attacks followed by complete recovery. It does not worsen over time and is not a permanent disability. The symptoms at first are usually sensory. It is only possible to classify people with Benign MS when they have little sign of the disability ten to fifteen years after onset of the disease. Very occasionally the disability may develop even after years of the disease remaining inactive. Approximately 20% of people have the benign form of MS
Relapsing - Remitting MS
Most people with MS start with this type. The initial attacks are followed by remissions. During periods of remission people have fewer or practically no symptoms. In terms of relapses, these are unpredictable with no definable cause. New symptoms may occur or previous symptoms recur during the relapse period. A relapse may last hours, days, weeks or months. It may also vary from mild to severe. Acute relapses may require hospital treatment. Remissions are periods of recovery and can last for years. It is estimated that around 25% of people with MS have this type
Secondary Progressive MS
This type of MS starts the same way as relapsing-remitting MS. After a series of repeated attacks remissions stop. MS then moves into a progressive phase. It is estimated that approximately 40% of people develop this type of MS. It usually happens within the fifteen and twenty years of first onset.
Primary Progressive MS
There are no distinct relapses and remissions in this type of MS. It is marked by steadily worsening symptoms and is a progressive disability. It can level off at any time or continue to get worse. Approximately15% of people with MS have this type which is also known as chronic progressive.
It is important to recognise that some days people with MS may be better than others and we need to establish a system of regular two-way feedback.
Arthritis
Arthritis means inflammation of the joints. There are over two hundred kinds of rheumatic disease; some are more common than others. Arthritis is often associated with the aging process but it can affect people of all ages. It is treated with various forms of medication. The benefit to each individual varies from person to person as do the side effects of the drugs. Many people with arthritis have to undergo joint replacement surgery more than once. Some of the more common forms include:
Osteoarthritis
This is connected to the aging process and is more prevalent in females. The cartilage that supports the joint becomes pitted rough and brittle. The synovial membrane and the joint capsule thicken and the space in which the joint can move becomes restricted. As a consequence the joint becomes stiff and painful and can swell. In severe cases cartilage breaks away from the surface of the bone and the bone ends rub against each other. The ligaments become strained and weakened
Rheumatoid Arthritis
Rheumatism is a term which describes aches and pains in muscles and joints. This is an inflammatory disease mainly affecting joints and tendons. The root of problem is with the body's natural defences which attack rather than protect. The end result is that the fluid in the joints becomes inflamed making movement painful. The joints become swollen as a result.
The effects of arthritis are profound. There is significant pain and loss of strength and the disability leaves individuals feeling generally unwell and tired. Fatigue, lack of stamina, difficulty concentrating and problems sitting for long periods are very common features of arthritis.
Brain Injury
Brain injury is a general term referring to any injury to the brain. It would be advisable to access comprehensive information on the topic of brain injury from organisations that support those who live with this disability. The brain is a very complex organ and there is need for specific information around the actual individual and the associated needs that arise in each case.
The following are all examples of brain injury: strokes and aneurysms, infections such as meningitis, hypoxia (lack of oxygen to the brain) and brain tumours. Neurotoxic disorders relate to drugs and alcohol, pesticides, gases, solvents where these substances lead to a brain injury.
Traumatic Brain Injury (TBI)
Traumatic Brain Injury (TBI) is injury to the brain resulting from externally inflicted trauma. There are two types of TBI:
- Closed: This is a blunt impact or blow to the head without penetrating the skull e.g. motor vehicle crash, fall.
- Open: This is when the skull is penetrated by a sharp object..
The major causes of TBI are road , followed by sports injuries, assaults and falls. The highest risk groups for sustaining TBI are children under five years of age, men aged between fifteen and thirty years, and the elderly.
TBIs are classified as mild, moderate or severe injuries, depending on the length of time a person has been unconscious and the loss of memory they have. It is important to acquire this information to help us understand the unique array of needs that may result for each individual. It would be helpful to discuss the extent of brain injury and its history with a family member and health professional. Sometimes the person may have difficulty discussing these details due to significant cognitive deficits that arise from the actual injury itself.
Mild TBI
Mild TBI is also known as a concussion. In most people, symptoms resolve within one to fourteen days. Some might have ongoing symptoms for up to three months, and in about 10% of people these symptoms persist for more than six months. This is known as Post Concussion Syndrome.
Moderate to Severe TBI
If a person has sustained a moderate to severe TBI, they are likely to have some level of physical, cognitive or behavioural disability. These include fatigue, physical problems, and mobility problems. There may also be significant pain through headaches, soft tissue pain, and/or touch sensitivity. Some people may experience speech articulation and/or swallowing difficulties. There may also be associated sensory difficulties i.e. hearing, taste, smell, vision, touch etc. Cognitive problems include attention and memory problems, reduced problem solving and speed of processing, language difficulties, cognitive inflexibility and impaired insight.
Often it is overlooked that there are some very significant emotional and behavioural problems associated with brain injury. Anxiety and depression can also be part of the everyday experience of brain injury. Absence of behaviour, for example lack of drive to do things or a desire to undertake but failure to initiate can be a regular theme. There can also be excess of behaviour. This would include agitation, impulsivity, and verbal and physical aggression Difficulty with social interaction and family relationships can be quite common too.
It is best practice to arrange an assessment of needs for each individual. This should include direct liaison with appropriate health professional for advice regarding the management of risk. There may be health and safety issues that will involve sensitive planning before placement.
