Primary and Secondary Disabilities
Disabilities that are direct consequences of a disease or condition are called primary disability. Paraplegia following spinal cord injury, hemiplegia , inability to walk following hip fracture are examples of primary disability.
On the other hand, disabilities that did not exist at the onset of the primary disability but develop subsequently are called secondary disabilities Secondary disability is indirectly related to the disease or condition that isresponsible for the primary disability. Examples are joint contracture In poliomyelitis, subluxation of the shoulder joint in hemiplegia, Tendoachiles contracture in muscle atrophy and decubiti in paraplegia.
Elderly people and those who have had a primary disability for an extended period are more susceptible to a secondary disability. Further, when the disease or condition causing the primary disability is accompanied by pain or spasicty, the prevalence of secondary disability increases. Negligence or ignorance on the part of paramedical personnel or family members results in placing the disabled in positions that foster secondary disability.
If the original disease diminishes skin sensation, particularly to pain or temperature, the patientis also predisposed to pressure sores (in paraplegics), trophic plantar ulcers in patients with diabetes and Hansen's disease ,all examples of secondary disability . Socio economical and vocational factors may have an indirect relationship to the causation of secondary disability.
DISABILITY LIMITATION
Disability limitation refers to preventing an increase in the intensity or Scope of an existing disability. This measure, therefore, becomes necessary after termination of active medical or surgical treatment and rehabilitation.Disability limitation is particulariy indispensable for those who are chronically ill or disabled and absolutely mandatory for geriatric patients. A person may be subjected to various levels of prevention simultaneously.
HANDICAP
When the extent of a disability is translated into a social context, theresultant entity is the handicap. The relation between these three conceptimpairment, disability and handicap is very subtle and can best be illustratedby examples.
If a person has lost a leg, the loss of the leg is the impairment. The disability would be inability to perform all activities related to the leg. primarily walking. The handicap would relate this disability to the persons role in society and for the same disability, i.e. inability to walk the handicap would vary according to the persons economic background, job and distance that hewould need to walk everyday.
If an impairment represents the problem at the tissue and organ level, and disability represents the problem at the whole-person level, then handicap represents the problem at the social level.
Examples of handicaps include difficulties with "social integration or"economic self-sufficiency".
It is apparent from this that a person may be handicapped without beingdisabled, an example would be a lathe worker with polio in one leg who may be Physically capable of operating the machine wearing a caliper, but precluded from doing so by the factory authorities, whom he approaches for a job, or his place of work may be too far off for him to be transported.
The WHO has identified 6 handicaps:
1. Locomotor (which forms 60% of all handicaps)
2. Visual
3. Hearing and speech
4. Cardiopuimonary
5.Mentally subnormal and
6 Emotionally disturbed.
Such handicapped individuals have problem with:
(a) Orientation,
(b) Physical independence,
(c) Mobility,
(d) Occupational integration,
(e) Social integration,
(f) Economic and
(g) Self-sufficiency.
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