copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
Functional limitations are many and varied. I will try to explain the categories of limitations associated with the loss of function. As said before, the main issue of rehabilitation is not the medical condition, BUT the resulting limitation in functioning. The list outlined can be expanded and refined since research is continually finding new problems and solving other problems. The description here is brief - most of these limitations are associated with worldwide organizations that are doing research or assisting those with the limitations.
Meditate Word By Word On These Verses:
Luke 4:16-21.
1. Mobility Limitations
Mobility is the function of getting from one place to another. These limitations might be the results of various medical disabilities such as blindness, paralysis, retardation or emotional disturbances. A mobility limitation can also be the result of environmental barriers such as architectural barriers, an overprotective family, or types of transportation. The person who cannot go anywhere is socially isolated. The result is that social skills of communication are not learned and health may deteriorate since the person does not have the ability to be outside. Often, the color of their skin is very pale showing that they do not receive enough exposure to the sunlight.
The more obvious causes of limitations in mobility are sensory disorder, loss of motor control of the body, and amputation. A sensory deficiency is inability to process stimuli through the affected organ of the body. For example, a deaf person will have difficulty in reception of instruction and its interpretation. Hearing conveys environmental warnings - the sound of a car horn, the bell of the tram and the whistle of the train.
A vision loss eliminates many cues from the environment. We learn much from what we see in our environment. The person may not be able to visualize where he/she is in space and in relation to other objects. The numbers of a bus, street signs, and geographical landmarks are not clearly visualized for transportation from one place to another.
Musculoskeletal defects are caused from paralysis, amputation, and chronic diseases. The paraplegic or quadruplegic cannot move except by wheelchair. Sidewalk corners must be cut down for this person to move on the street. Elevator doors and apartment doors must be made wide enough for him/her to go through. Arthritis is a crippling disease that causes pain and decreased movement of the joints. Getting to standing position and bending over are especially difficult for those with arthritis. Cerebral palsy can result in spasticity, involuntary and uncoordinated movements. The amputee who cannot be fitted with a prosthesis must depend on a wheelchair. At times, standing on a prosthesis is painful. Balance may be impaired because the person does not have feeling as to where on the ground the artificial foot is placed.
What are the most difficult positions for a person with arthritis?
A. Narrow doors on an elevator or an apartment.
B. The standing or bending position.
C. When a person does not feel where on the ground the artificial foot is placed.
Architectural barriers are often insurmountable for the handicapped. Vocationally, they may be trained, but cannot get to the work place. The steps to the bus may be too high to climb and the steps to the subway impossible. Large streets are threatening because of the amount of time it takes to cross them. Even if a person is able to get to a job, the handicapped person may have trouble moving around in the workplace. Finally, the employer often must be taught to modify a workplace for the handicapped. Tools and equipment may have to be lowered or put within the reach of the employee. Often these modifications are not expensive, but they are not usual in the work place.
Question:
1. What are some of the architectural barriers that you have seen in your neighborhood?
There are also subtle causes of limitations in mobility. The subtle causes are pyschosocial and may be indirectly involved with mobility. For example, a depressed person may not have interest in the environment and sit for long periods of time. Anxiety reactions can cause a fear of things and people so the anxious person stays away from others in a small room or his/her apartment.
Then there are society's barriers. Attitudes toward those who are not perfect in form and function may be shunning or pity. Neither of these attitudes helps the disabled person. To shun him means that he is less valued than "normal". To pity is to feel sorry for the person but do nothing to help him/her to be able to live better. Giving them money may help for a little while, but it would be much nicer if these people were put into jobs they could do to earn a living and feel worthwhile. Instead, these people develop a dependency problem and due to dependency, they continually need someone to care for them, cutting into their family's free time.
Question:
2. Have you noticed any changes in the architectural barriers in recent years?
yes /
no.
The ability of the brain to process information also affects mobility. Brain injuries may cause poor judgment, disorganization, and difficulty in adjusting to new situations. Spatial judgment may be impaired so that a person may not be able to judge the distance between the sidewalk and the first step to a bus. Hemiplegics (those with strokes affecting one or the other side of the body) may become lost in new surroundings or ignore and distort objects that are on the paralyzed side.
Another cause of cognitive defect is mental retardation. Retarded people lack knowledge about the environment and its general lay out. They may not be able to read maps or street signs. They may not have ability to deal with new situations and when they are lost, they don't know how to ask for or follow directions.
A Mobility Rehabilitation Specialist knows techniques to help the person maneuver about in the environment to avoid obstacles encountered in travel. Also, physical therapists help to restore the functioning of damaged or worn muscles to healthy status. With psychological disorders, anxiety can be lessened through medication and the development of social skills.
Question:
3. How do you feel when you are in a new place and cannot find the street or house you need? (Any of the following answers may be correct. It depends on you!)
Confused.
Angry.
Afraid.
Calm.
2. Communication Limitation
Communication is a broad term that includes all the interactions between one person and another. All behavior is communicative - oral, written, verbal, tonal, postural, gestural, and facial. Affective and receptive mechanisms (hearing, visual, and oral) are affected by a wide range of disabilities.
Transmission is the act of sending an idea, concept, emotion, or feeling to another person. The primary transmitters of information are the tongue, hands, arms, and facial muscles. Other body parts can also transmit information. For example the shoulders may be shrugged, the head may be nodded, or the foot stomped angrily.
The inability to produce intelligible speech is frustrating. Speech disorders are caused by problems with the respiratory system or central nervous system disorders. The storage of communication symbols and their sounds takes place in the brain; therefore damage to the brain may affect memory. It can also affect the neurological signals that control the tongue and facial muscles to speak words. The mentally retarded who are incapable of abstract thinking are often handicapped by communication problems. Organic brain damage found in cerebral palsy is also a common reason for speech problems. Another problem is stuttering. This is usually due to the interrupted flow of speech due to high anxiety and tension. The person who stutters often has facial grimaces or spastic movement of the other body parts.
Question:
4. Have you tried to talk with a person who has a speech problem? What have you noticed about the manner in which they speak?
Treatment is to analyze the causes of the problem. A physician helps to identify the physical problems and the speech therapist devises a treatment plan for improving on the disorder. There are psychological problems that result from being unable to speak adequately. These problems may decrease as the person is more successful at speech.
The most common effect of having a speech problem is exclusion from desired groups and social isolation. Much of the process of educational development requires speech and requires verbal responses. If a person is not able to do this, even though he/she is bright, his vocational options may also be limited.
Cultural differences also affect speech. Foreign persons may misinterpret meanings and intentions of words they do not know. Since speech is limited in the new culture, the types of employment may also be reduced even though they are educated persons. Another aspect of expressive communication problems is psychological anxiety. Feelings of insecurity, low self esteem, defensiveness, and anxiety can affect the way a person presents him/herself and often it is a negative image.
Question:
5. How could you help a person communicate who cannot speak?
(One or more of the following answers may be correct.)
With a pencil and paper.
With an alphabet-and-picture board.
With a computer and e-mail.
With a laser transmitter attached to his forehead.
3. Sensory Limitation
All of the sensory organs are connected to their respective centers in the brain. The person makes use of these sensors to obtain information about the external environment. Sensory impairment usually occurs by damage to the nervous system. This impairment can then lead to limitations associated with the loss of an external sense, that is, sight, smell, hearing, taste, touch.
Internal senses are those that send messages to the brain about changes that take place within the body. They respond to physical or chemical stimuli in the different body systems as well as the positions of different parts of the body. Hunger, fatigue, pain, and thirst are such sensations.
What does Leviticus 19:14 say about the blind and the deaf?
There are visual impairments in this category. Perhaps the most common and least limiting are myopia (short sightedness), hyperopia (farsightedness), astigmatism (distorted vision) and presbyopia (faulty accomodation). Corrective lenses can correct these defects.
Cataracts are opacities of the lens or its capsule. There is no method of stopping this process. Surgical removal is necessary to remove the lens. A contact lens is put in place of the usual lens. It is important for the person with the unoperated eye and the operated eye to wear glasses against the sun. This operation is common in Russia, especially in Moscow and Cheboksary.
There are also disorders of the retina caused by diabetes, inflammation, detachment, or circulation problems. Often surgery may correct these problems, but those associated with circulation cause blindness.
Blindness varies with the amount of vision the person has. If severe, doctors try to maximize the hearing of the person so that he/she may use hearing cues for orientation and movement. Rehabilitation must include braille type for education and communicating.
Question:
6. Where do blind people work in your country?
Hearing loss is of three different types. The first is a blockage of sounds from the auditory nerves and is called a conductive hearing loss. Sensory-neural loss of hearing occurs when sounds reach the outside of the ear, but the nerves are unable to respond and transfer the sound to the brain. The last is a mixed type. Hearing loss can happen at any time and is due to scar tissue from infections, congenital malformations, and excessive noise or vibrations.
Deaf persons are usually unable to develop speech since they cannot hear a voice and its modulations in speech. The later the onset of hearing loss, the better able the person is to talk since he has language skills already. Most often, these people must be taught "signing".
The skin is our largest sense organ. The four basic skin senses are touch, pain, pressure, and temperature. Degeneration of the nerves (multiple sclerosis), spinal cord lesions (paraplegia and quadruplegia), medications, burns and strokes are the causes of loss of sensation. For all of these people, we must be aware that the position of their bodies is important so that the skin does not break down. Also, emotional security is lost for these people because they cannot often feel touch of another or give touch to show love and affection.
Trauma by smoke, fumes, or pollution can cause permanent damage to nerves in the nose. The result can be inability to taste food as well.
Along with ear problems, the inner ear hair cells can also be disturbed causing vertigo, loss of balance, nausea, and ringing in the ear. These problems are often caused by tumors, brain injury, and infections. For this person, walking is difficult and if the ringing in the ear is continuous, it may cause severe distraction and inability to concentrate.
Question:
7. How can we keep a damaged body (such as in a stroke or spinal cord injury) from further damage?
(One or more of the following answers may be correct.)
Prayer and anointing with oil.
Massage.
Staying in bed.
Regular light exercise.