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Psychiatric disturbance in mentally handicapped patients. A prospective study of current clinical usage of depot fluphenazine in hospitals for the mentally handicapped.

One hundred and two mentally handicapped and severely mentally handicapped patients with behaviour disorders and superadded mental illnesses which, in most cases, had not responded adequately to oral medication, entered a 12-week study of fluphenazine decanoate depot injections. Some of the patients had the additional complications of epilepsy, organic brain damage, and physical handicap. Highly significant overall improvements occurred, irrespective of such factors as the patient's age, sex, degree of mental handicap, or co-existence of epilepsy, or brain damage. Hyperpyrexia was not encountered. Extrapyramidal disturbance in 22 of the patients, were mostly well controlled by antiparkinson medication; eight of the 12 patients with pre-trial extrapyramidal abnormalities lost these during the study. Fluphenazine decanoate injections proved a reliable drug-delivery system, which may improve difficult behaviours and enable the mentally handicapped patient to be more receptive to behaviour-shaping exercise, aimed at improving long-term personality adjustment.

Adolescent

[Social representation of the physically handicapped person. "Overcoming one's handicap": effects of family situation and of income].

Continuing the study of social representation of the physically handicapped, the authors of this article study the influence of income and family situation on the evaluation of a fictive handicapped person. In creating twelve portraits by crossing the modalities of these variables, they arrive at a factorial plan which allows them to prove the effect of income and family situation as well on the positive adjectives marked on a list of personality traits as on the evaluations given by means of a scale ranging from "has overcome his handicap very poorly" to "has overcome his handicap very well". Although the evaluations are in general favorable and in spite of the fact that only little information was given to the subjects, the responses are significantly different. In addition, the relation between the number of positive adjectives attributed and the values received on the scale make it evident that the notion of having well or poorly "overcome one's handicap" is socially evaluated. Finally, the interaction observed between the two studied variables shows that the fact of having a professional occupation is clearly more important if the described person is unmarried than if he is married.

Adaptation, Psychological

Horticultural therapy--aspects of land use for the mentally handicapped. A system of planning for the requirements of the mentally handicapped gardener.

An increasing number of facilities for the mentally handicapped use horticulture, agriculture and gardening in their training programmes. This paper contains a review of: (1) some aspects of land use as a medium for leisure, rehabilitation, therapy and training for the mentally handicapped, (2) employment, both sheltered and open, in land use as reflected in a recent survey, (3) the variety of knowledge available through the medium of land use. The main emphasis of the paper deals with: (1) the need for planning, (2) a suggested planning system that assists the instructor in understanding the requirements of the mentally handicapped gardener when he approaches a given job, (3) some problems peculiar to land use work with the mentally handicapped. In conclusion the authors briefly examine: (1) the need for assessment, (2) the need to distinguish between production and training, (3) suggestions towards an expansion of the planning system to take in other areas of the horticultural unit than were originally described, (4) social activities connected with the horticultural activities described, (5) the hierarchy identified through the use of a particular planning system.

Agriculture

Nondiscrimination on the basis of handicap relating to health care for handicapped infants--Office of the Secretary, HHS. Proposed rules.

The notice of proposed rulemaking proposes to modify existing regulations to meet the exigent needs that can arise when a handicapped infant is discriminatorily denied food or medically indicated treatment. Several current regulatory provisions are proposed to be modified to allow timely reporting of violations, expeditious investigation, and immediate enforcement action when necessary to protect a handicapped infant whose life is endangered by discrimination in a program or activity receiving federal financial assistance. Recipients that provide health care to infants would be required to post a conspicuous notice in locations that provide such care. The notice would describe the protections under federal law against discrimination toward the handicapped, and would provide a contact point in the Department of HHS for reporting violations immediately by telephone. Notice and complaint procedures have been effective instruments for deterrence and enforcement in a variety of civil rights contexts. The Secretary believes that the proposed rule provides the best means to ensure that violations can be reported in time to save the lives of handicapped infants who are denied food or are otherwise imperiled by discrimination in the provision of health care by federally assisted programs or activities.

Congenital Abnormalities

Visual handicaps of mentally handicapped people.

Recent literature concerning visual handicaps of mentally handicapped people was reviewed. Topic areas considered were etiology and epidemiology, visual acuity, color vision, and educational techniques. The material considered indicated that a large proportion of mentally handicapped people are affected by some form of visual handicap and the extent to which further specialization of care and training techniques is required in order to limit the extra disadvantages imposed by such defects.

Adolescent

Classification of handicaps in 6-7-year-old mentally retarded children. Usefulness and inter-observer agreement of a child adapted handicap code of WHO's ICIDH.

This paper reports on the clinical use of a classification of handicaps in 6-7-year-old mentally retarded children. A child-adapted handicap code of WHO's ICIDH was used. It was easy to manage and added valuable information to the child's medical status and psychosocial evaluation. The inter-observer agreement was most satisfactory. The handicap dimension of 'social integration' ought to be regarded as 'social interaction' and needs to be specified further.

Child

Nondiscrimination on the basis of handicap; procedures and guidelines relating to health care for handicapped infants--HHS. Final rules.

These are final rules on procedures and guidelines relating to nondiscrimination on the basis of handicap in connection with health care for handicapped infants. These rules are issued under the authority of section 504 of the Rehabilitation Act of 1973, which prohibits discrimination on the basis of handicap in programs and activities receiving Federal financial assistance.

Congenital Abnormalities

[Psycho-social aspects of dental care for the handicapped. An investigation into dental care for handicapped children living at home].

An investigation was carried out to determine those factors that play a decisive part in dental care for handicapped children living at home. Data were obtained by interviews with parents of 32 mentally retarded and cerebral palsied children, 20 attendants, 48 general dental practitioners and 19 dental hygienists in two districts in The Netherlands. The dental health of 21 children was clinically examined. Parents experienced many problems in maintenance of oral hygiene as well as in finding a dentist for their child. They perceived drooling, halitosis and oral-facial malfunctions as the most important oral problems. Poor levels of oral hygiene were found in the handicapped children and the normative treatment needs were high. Dentists and dental hygienists shrank from treating disabled patients mainly because of inadequate knowledge and training. The results of this study were discussed in the context of planning dental health care for the handicapped.

Cerebral Palsy

[Early stimulation of the handicapped and potentially handicapped children--breakthrough of a concept].

The author describes the importance and value of early stimulation within the overall concept of working with handicapped persons. A brief definition and scientific arguments are given. Data on the historical development of this relatively recent field are given considerable space, as are details on concepts and organisation. Problems and weak points of the system are pointed out. From the aspect of the fact that the family is the centre of child activities, it is important to make it quite clear that early stimulation of rehabilitation must be an interdisciplinary, "open" and holistic "assistance" system for parents and families as a whole. A point worth considering is whether the system, which had so far been restricted mainly to children with handicaps in somatic field, can also be extended to cover children whose handicaps are mainly caused by psychosocial factors.

Achievement

Leisure activities of young adults not receiving mental handicap services who were in a special school for mental handicap as children.

The subjects of this study were 22-year-old adults who had attended a special school for children with mental handicap. Since leaving school, they had dropped out of the mental handicap services. The subjects' leisure activities were compared with peers who had always attended regular classes as children. The subjects engaged in fewer types of activities than the comparisons and had fewer activities that involved interpersonal relations, especially with non-family peers. The size of these differences was influenced by marital status.

Adult

Dyskinesia in mentally handicapped women: relationship to level of handicap, age and neuroleptic exposure.

The prevalence of dyskinesia in a randomly selected set of 61 mentally handicapped women with a range of diagnoses, levels of IQ and exposure to neuroleptics was assessed using the Abnormal Involuntary Movements Scale (AIMS). Overall, 64% of patients had dyskinesia on the AIMS. There was no correlation with neuroleptic exposure, although 43% of patients had been significantly exposed. There was no correlation between the presence of dyskinesia and the original handicapping diagnosis, and there was no increase in dyskinesia as the patients age increased. There was a significant increase in dyskinesia as IQ fell. This study backs the contention that there is a close association between cognitive impairment and movement disorder.

Adult

Differential influence of various instructional factors on self-concepts of handicapped and non-handicapped children in mainstreamed physical education classes.

The purpose of this study was to determine the differential influence of students' expression of effort, school, teachers' expectations, sex, being handicapped/non-handicapped, grade, teachers, and race on self-concept of 28 handicapped and 108 non-handicapped children in mainstreamed physical education classes (K-3). The Martinek-Zaichkowsky Self-concept Scale measured self-concept and two unpublished tests were used to test students' expression of effort and teachers' expectations. A stepwise multiple regression technique was applied to self-concept to determine the comparative influence of the eight independent variables. Data analysis showed that three of the independent variables contributed significantly to the variability of self-concept. Students' expression of effort had the strongest influence followed by school and teachers' expectation of students' ability to reason.

Child

The ICIDH: format, application in different settings, and distinction between disability and handicap. A critique of papers on the application of the International Classification of Impairments, Disabilities, and Handicaps.

Recent papers on the ICIDH generally agree about the need for and the usefulness of the ICIDH, although inevitably some difficulties are reported in applying it. Some of these stem from the context and professional purpose of the assessments (on the whole the rehabilitation setting was found to be less problematic than community surveys), and others from the application to particular sub-groups, such as children, the elderly, the mentally ill, or those with milder or fluctuating disability. Most problems concerned the nature of the relationship between disability and handicap and the distinction between these concepts. This review suggests an alternative formulation of the disablement model which shows handicap as arising out of an interaction between impairment and disability and the environment in which the individual lives, the resources available, and the social and cultural setting. While on the whole optimistic, the papers reviewed indicate that there is still more work required both on a practical and conceptual level.

Disability Evaluation

[Handicapped children and children at risk for handicaps in Bavarian integrated kindergartens--initial results of a survey].

The survey "integrative preschool education - an inquiry in Bavarian preschools/kindergartens" aimed to obtain a representative picture of the situation of handicapped children in regular preschool settings - as opposed to special institutions. In this paper we present information regarding distribution among different group-sizes as well as different defining/diagnosing systems. We also investigated the influence of certain ecological conditions such as size of place where the preschool is situated and distance between preschool and the nearest special institution. Furthermore we gained insight into the conditions which hinder and those which promote the admission of handicapped children.

Child, Preschool

A handicapped child means a handicapped family.

The medical history of a 16-year-old severely handicapped girl and the social history of her family are traced, with particular emphasis on the extent to which the handicap affected each member of the family. The role of the general practitioner is also highlighted.

Adolescent

A parental perspective on the Honeylands Home Visiting Project for severely handicapped infants provided by three mothers of older handicapped children.

Three mothers of severely handicapped children, who had not attended Honeylands nor received any home visiting, were asked to attend and participate in the monthly group meetings for the second year of the three year project (Rayner 1978). They each then decided to visit a family with their home therapist. They comment on the responsibility undertaken by all parties to this work; parents, therapist and supportive team.

Adaptation, Psychological

Social interactions among preschool handicapped and non-handicapped children.

An integrated group of preschool children were observed during free-play using categories adapted from Strain, Shores & Kerr (1976) and Strain & Timm (1974). A continuous recording 5-min time-sampling technique was employed. Neither developmental age nor the presence or absence of handicap were found to be indicators of the total number of interactions, initiations or responses between children. However, children of similar developmental age interacted with one another more frequently than those of dissimilar developmental age. Developmentally more advanced children initiated interactions more frequently with adults than developmentally less advanced children. Wider environmental influences on interaction patterns were also implicated by the findings.

Child Behavior

Age and functional abilities of people with a mental handicap: evidence from the Wessex mental handicap register.

Functional behaviours in relation to age were investigated using data from approximately 3000 people on the Wessex Mental Handicap Register. The main functional data on the register, the National Development Team's 24-item questionnaire, were cluster and factor analysed to derive a series of client-defining variables. Age-trends were analysed in relation to self and community care skills (activities of daily living and instrumental activities of daily living), problem behaviours, chronic medical conditions, mobility and sensory abilities. Generally, it was found that differential mortality leads to an older population in good health and with a high level of functional skills. As with the general population, however, people over 70 years old show increasing prevalence of age-related infirmities.

Activities of Daily Living