Lecture # 011:
Limitations Causing Disability - Pain, Control of Bodily Movements, Uncertain Prognosis

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

10. Pain Limitation

A myriad of conditions cause pain: these include arthritis, neuralgias, migraine headaches and angina. To manage this variety, it is helpful to classify pain sensation by:
  1. duration (length of time - chronic or acute)
  2. origin of pain - physical or mental
  3. nature of disease that causes pain - malignant or benign
  4. the cause of the pain attack
  5. the limitations in ordinary life activities due to pain

There is variability among people to pain because of the nature of their disease, individual psychological situation, the sensory effects of pain, and cultural background.

Personality also affects pain. Stable personality traits are thought to help a person cope better with pain. There are thought-emotional patterns that affect pain. These are fear, fatigue, conditioning to pain, cultural norms, anxiety, expectations, and past experiences with pain. These negative emotions can worsen pain.

Meditate Word By Word On These Verses:
Luke 16:19-26.

Personal meaning of pain is hard to communicate. People have various tolerances for pain. Two methods have been devised to describe the intensity of pain objectively. The pain estimate type of evaluation is done when a patient is asked to rate his pain on a scale of 1 to 10. 10 means the worst pain and 1 is the least pain. The other scale is that a painful stimulus is given to a patient that matches the pain they have. Although both of these are used, there are discrepancies between the two measures.

Question:
1. One good way to assess a person's pain is to:
(Only one of the following answers is correct.)
ask the person to rate his/her pain according to a scale of one to ten,
use a painometer,
touch the part of the body with the most pain.

A number of different situations affect the perception of his pain and his reaction to it. A person can change the situation so the pain is stopped or is less irritating. Factors in the environment of a person such as temperature, noise, humidity, and posture can all affect the intensity of pain a person feels.

There are three reactions to pain:

1. Biological reaction - there is an involuntary aspect that includes variations in breathing, heart rate, perspiration, and muscles. The voluntary reactions are those that the person does to lessen the pain. For example, a person may change position or physical environment to decrease pain.

2. The behavioral response is dependent on several parts: motor (example: clenching of teeth), vocal (example: moaning), verbal (example: complaining or cursing), and social (example: withdrawal or impatience).

3. Non-behavioral responses include thought processes. These may include fear of pain, anxiety about family needs, loneliness caused by being alone due to pain. Depression may be a frequent problem.

Pain treatment should begin as soon as possible, to reduce its intensity. The treatment for pain may be drug therapy, which treats the symptoms of pain but not the cause. Surgical procedures can alleviate pain as well. There is also behavioral treatment of pain, which changes the response to pain.

Question:
2. The intensity of pain depends on:
(One or more of the following answers may be correct.)
length of pain in the body,
the individual's reaction to pain,
the cause of the pain.

11. Motivity Limitation

Motivity limitation is inability to produce, direct or control body movements. Motivity refers to the body's ability to move objects and do tasks using the skeletal system. Mobility means moving the body itself from one place to another.

Three types of motivity problems are described here:
1) those involving broad or gross movement, such as bending over,
2) those involving precise movements, such as writing with a pen,
3) the complete absence of movement as in paralysis or amputation. Defects of motivity vary greatly and depend on the type and complexity of the task required, the part of the body involved, and the degree of impairment. Most persons with physical disabilities have a motivity limitation. There are also mental and psychological disabilities that have motivity limitation.

We will list the components of the limitation of motivity and give examples:

1. Strength is shown by the intensity, power, and scope of movement. The overall physical condition of a person can influence the amount of strength in their movements. For example, when alcoholism begins to damage internal organs of the body, the entire body is weakened. Muscular dystrophy is a wasting disease, which directly reduces the strength of the body.

2. Speed is the act of moving swiftly or rapidly. Generally, if a task is familiar, it can be done more quickly. For the person with motion disorders, the rate of speed at doing a task may not increase even with practice. Those with orthopedic disabilities such as cerebral palsy, arthritis, or injuries to the hands and feet have a limitation of speed.

3. Endurance is the capacity to withstand pain or distress without difficulty. This means sustained movement. Examples of medical conditions that have decreased endurance are cardiac conditions where endurance causes chest pain or shortness of breath. Respiratory disorders such as asthma or emphysema affect endurance due to lack of enough oxygen.

4. Agility is the ability to move and change direction quickly. Reduced agility occurs with various physical, mental, and emotional disabilities. For example, the movements of an amputee with an artificial leg will not be as quick as a person with a normal leg.

5. Dexterity refers to skill and rapidity in physical activity, especially in using the hands and brain. An example of a medical condition relating to physical dexterity is carpal tunnel disease that results from working on a computer keyboard for long periods of time. With this disease, fine movements are painful and difficult to do. Mentally retarded or depressed persons may be unable to respond quickly because judgment and reaction time is slowed. Medications such a barbiturates and tranquilizers also limit mental dexterity.

6. Balance is the ability to keep the body in a state of equilibrium so that there is equal weight on both sides of the body. Our bodies have antigravity reflexes that normally straighten the body if it is unbalanced. Disorders involving these muscles can be so severe that the muscles cannot counteract the imbalance and its effect. Examples of medical conditions of imbalance are inner ear disease, brain damaged persons, and amputees. It is important to know if imbalance occurs only when the person moves or if it is the result of other factors such as riding in a car or other transport.

7. Perception is the awareness of environment through sensation. Perception involves touch and the knowledge of movement of body parts and where they are in space. Perception allows the person to know where the body is positioned at any given moment. The abilities of seeing, hearing, touching, and feeling affect the way a person responds with movement in daily life. Those persons whose vision has been damaged may have problems in estimating distance and depth. They also have a smaller field of vision. Those who have lost a sense of touch due to amputation or other disease such as stroke have difficulty with movements.

   Question:
   3. What types of motivity problems does a person with a stroke have?
   

    

   ---

    

8. Coordination is a harmonious and integrated action of various parts of the body. Walking, running, and playing various sports require coordination. This disability affects complex movements that involve integration on several groups of muscles such as the arm-leg coordination of walking. Ataxia that occurs in multiple sclerosis is the failure of muscle coordination for purposeful movement. Because of the irregularity of the action of their muscles, ataxic persons may stagger when walking.

9. Abnormal size of a person can be a limiting factor of motion. People who have unusual dimensions have difficulty with movements such as speed, coordination, and mobility. Examples of these are obesity, dwarfism, and gigantism. People outside the average range in their physical proportions may have trouble operating machines and using certain types of transport.

10. Spontaneous movement refers to actions or motions that happen without the control of a person's effort. Epilepsy causes spontaneous seizures and physical activity that is uncontrolled. The spasticity of a cerebral palsied person is a form of neurological damage that causes uncontrolled movement. Facial grimaces may be the result of nerve damage or psychological disorders.

Medical rehabilitation that uses physical exercise and physical training of muscles can help to restore physical function as much as possible when the problem is due to injury or disease. Two means of improving motivity involve the use of prosthetic and orthotic devices. Prosthetic devices are used to compensate for the loss of an extremity. Orthotic devices straighten or lengthen a part of the body to prevent deformity. The prosthetic devices all have limitations since they have no nerve or motor sensations to guide the hand or leg.

Such problems of prosthetics and orthotics have increased the research of biotechnology in an effort to make better devices for replacement of extremities and for the reattachment of severed extremities.

Question:
4. What motivity problems does a person with epilepsy have?

12. Uncertain Prognosis

An uncertain prognosis means that there is a medical condition that a person has that limits his planning for the future. Such diseases include cancer, multiple sclerosis, arthritis, seizures, cardiac disease, and other types of progressive diseases.

The psychological impact is often the result of fear associated with the unknown course of the disease. Becoming unable to use one's body normally and not being able to work cause mental anguish. There may be little certainty of how the disease will progress. For example, a person with arthritis may not know how long he/she will be able to walk, grasp a small object, or bend over. The epileptic does not know when and where a seizure will occur. The diabetic may slowly lose his/her eyesight.

Question:
5.1. Do you think believers might have problems with uncertain prognosis?
yes / no.
5.2. Why or why not?

The person may have a number of psychological reactions to his/her diagnosis: panic, nightmares, fear of losing intellectual abilities, fear of death, feelings of rejection, thoughts of suicide, and so on. Such people may withdraw from social activities and emotional involvement with others. The person and his family may panic and try one miracle cure after another in a desperate desire to have hope of healing. In a number of cases, there may be a period of relative health followed by periods of increased disease symptoms. For example, a person with cardiac disease may exercise for a few days without pain and then he/she may suddenly have pain with the beginning of exercise.

The rehabilitation counsellor needs to be aware of the change of situation and how it is affecting the person. This means that having a job or professional work and continuing work may not be possible depending on symptoms.

Question:
6. How can the church help a mother who is dying and is worried about her children's future?