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copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
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Why should we care for a person who will never again be a fully productive member of society? First of all, because a person's worth is primarily not economic, it does not depend on what that person can produce; instead each person's worth is primarily spiritual: every person is created in the image of God, and although injured by sin, can be restored into the image and likeness of Christ. Every Christian, not just a handicapped person, finds himself in this process of restoration, which the Bible calls "sanctification."
The Christian has had the basic sin problem solved by Christ's atoning death, but next he needs to work together with God and with others to solve the limitations in his body, soul and spirit caused by sin. This is rehabilitation or restoration. Rehabilitation is a problem-solving process that focuses on the handicaps or limitations that remain after a medical problem is solved. The rehabilitationist is concerned with the impact or effect of the disability.
Meditate Word By Word On This Verse:
The Apostle Paul writes in 1 Thes. 5:23 about the three areas of human nature, and our struggle toward wholeness.
There are three words that stand for phenomena that affect the handicapped. They are limitation, disability, and handicap. They are defined as follows:
Disability: A long-term or chronic condition that results from a disease or illness, or from an inherited, congenital or later trauma to the mind or body.
Limitation: Hindrance or negative effect in the performance of tasks or activities. May also be adverse and visible mental, emotional, or physical disability. Examples of the above disability may be inability to follow directions due to slow learning, difficulty in relationships with people due to neuromuscular impairment, allergic reactions, seizure that cause unconsciousness that limit what a person can do.
Handicap: A handicap is a disadvantage or barrier to normal performance to any desired role in life (such as - familial, educational, social, or vocational). It is caused by a limitation or other problems associated with the disability.
The three stages of rehabilitation are implied in the three types of definitions. The first phase is medical repair of the disability by doctors and other paramedical professionals. When the medical treatment is partially successful, the next stage begins. The patient has survived, but with some limitations requiring a rehabilitation team who can provide technical aids, physical aids or adjustment strategies. The final phase occurs when the limitations causing the handicap call for non-medical treatment and here the rehabilitationist is the key person. Thus rehabilitation is a course of action for preserving a person's life, training him and finally, finding a place in society for him.
"I can do something.
I can't do everything, but...
it doesn't give me the right to do nothing."
This is true both for the handicapped person, and also for the rehabilitationist. We once attended a conference where a person who was completely paralyzed in the arms and legs due to an automobile accident gave a speech. He said that before his accident there were about 15,000 professions he could choose from, but after his accident his choices were limited to only 11,000 professions. The handicapped person can't do everything now he could do earlier, but there are still thousands of things he can do. Also, the rehabilitationist sees people every day who have enormous problems, and sometimes these problems can begin to overwhelm him, and cause him to "freeze" or want to give up. So he needs to remember that he can't do everything for everyone, but instead focus on what he can do with his specialized training and experience for the four, five or six people God has led him to care for.
The medical implications of a disability are many. Severity of disablement refers to the extent of the disorder. For example, an amputation that is lower on the body may not be as severe as one closer to the trunk of the body. If one has an amputated toe, usually one can still walk without losing balance. However, if a person's leg is amputated above the knee, he has a worse problem with walking and being fitted with a prosthesis.
With Down's Syndrome, the IQ test is used to measure ability. From:
84-100 - there is no mental retardation;
70-83 - borderline, indicating that the child may very well be able to learn in a normal classroom with help from a teacher's assistant;
55-69 - mild, indicating that the child is able to learn in a special classroom;
35-54 - trainable to learn to care for himself and work a limited amount;
20-53 - severely incapacitated for any training and needs constant care;
0-19 - profoundly retarded with no ability and is subject to frequent illnesses and may die from them.
Handicaps are of various kinds. A medical disability may handicap or limit a person at school, work, home. or in other ways. For example, the person who has cerebral palsy may not be able to talk and therefore, is limited in his ability to communicate. The types of handicaps may be modified by other personal characteristics of the person. For example a person may be paralyzed, but with assistive equipment is able to use his/her mind to become a representative in the government. The nature and severity of the handicap is also affected by environment. If a child is moderately mentally retarded and no one teaches him, his retardation may become more severe than the child who is taught by a patient and understanding teacher.
Question 1: What is the difference between a disability and a handicap?
Limitations are variable according to the person's environment. A person who is mildly disabled because of a paralyzing disease may become profoundly disabled if he/she is not able to obtain proper equipment for living. If his/her environment is only one room with no stimulation, he becomes uninterested and withdraws into himself. He/She may cease to attempt to talk or communicate in any way. Also, limitations vary within groups of handicapped persons. One person may become depressed and listless while the other person with the same disability strives to live and learn. This may be due to circumstances other than environment.
Question 2: What examples of limitations have you seen in your experience?
Evaluating a person with disability is not merely the physical limits from normal, but also the psychological, social, and economic factors. A physician is unable to determine the person's adaptability to employment, his/her social adjustment, or learning ability. A physician can only measure defects, since this is what he is trained to observe. It is a complex relationship between the handicapped condition and a variety of social attributes that make up a person and his abilities.
An example of this complex relationship is the problem of unattractiveness. A person may be able to work, but because of appearance people socially reject him and the person feels this rejection. After a few interactions where he feels rejection, he/she expects to be rejected, and with this type of cyclical reaction, the person has a social limitation. You may recall the rejection of a drunk on the subway. He has two problems - his alcohol addiction causes him to be poor and dress poorly. He may be bruised from fights he has while drunk and he probably smells. He is rejected by other passengers due to the handicap of alcoholism. No one can tolerate his appearance or smell. They look at him, cover their noses and move away to the other end of the car.
Question 3: A person with altered appearance may have a social limitation from:
(Only one of the following answers is correct.)
constant rejection based on his appearance,
rejection based on his ability,
rejection due to social standards.
The psychosocial impact of disability may be the largest handicap for the disabled person. In Russia, a physical defect is cause to leave the newly born child in the hospital and then he is taken to the orphanage for life. Because of this, children are often emotionally and psychologically deprived. In adults, the disabling condition causes frustration, grief, and depression. However, disability may cause other emotions - hope, reward of small achievement in physical or mental functioning, and optimism. It is the personal meaning of disability that is crucial in rehabilitation. The same child who was left in an orphanage because of a small defect may become a leader in his community. The study of variations in the physical body that affect the psyche of the person is called somatopsychology. The crisis of disability or death has been divided into the stages of shock, defensive retreat or denial, acknowledgement, and adaptation. The first three stages require that a person find help through others, and the last stage is one of growth. A newly disabled person may see himself as a person of no worth because before his disability happened he saw such people as having no value.
Question 4: The stages of crisis in death or disability are:
(Only one of the following answers is correct.)
shock, defensive retreat, acknowledgement, and happiness,
denial, worthlessness, acknowledgement, and adaptation,
shock, defensive retreat, acknowledgement, and adaptation.
Impact of Disability on Vocation and Country
Disability also reduces the degree of freedom in vocational choice and forces the handicapped person to a restricted range of jobs. Limitations of function simply reduce one's employment options. For example, deafness is a limitation in communication, and some jobs, such as a telephone operator, require communication that a deaf person cannot do. But there are a great many other jobs that can be performed without hearing ability, such as printing. Still other job requirements can be adapted so that the requirement to hear is not necessary. A light flasher can be used instead of a bell sound for machine processing jobs. In fact, I have seen this used in a bakery.
Still further, through rehabilitative equipment such as hearing aids, deaf and hard of hearing people can overcome their limitation and are able to do a variety of jobs. Another approach to the limitation of communication of a hearing impairment is a professional education so that difficulty in hearing is compensated for by other expertise.
Question 5: What expressions have you heard about handicapped persons in your country?
There are two other terms helpful to understand disability and vocational handicap. An occupational handicap is the result of limitation in function so that the tasks of an occupation cannot be done. This requires fixing the limitation or changing the occupation. For example, if a person loses a leg and cannot walk to his job in a government office, a good artificial leg can help him to get to his job.
An employment handicap is difficulty in getting a job because of employer ignorance or prejudice pertaining to the physical or other characteristics of the handicapped person. This person is able to do the required work but cannot due to the employer's attitudes. Because handicapped persons have different abilities and needs, each one must be carefully evaluated for his abilities to work.
Question 6: Does pity help a person to become independent?
yes /
no.
It is also important to remember that the degree of handicapping cannot be predicted by a medical diagnosis. For example, a medical diagnosis may be severe, but the will and the ability of the handicapped person may compensate for the handicap. For example, we know a lady in Ioshkar-Ola who is without an arm and part of her leg. Her parents always encouraged her to accomplish what she could. She is a bookkeeper for the local rehabilitation government agency, a mother of two grown sons, and a housekeeper.
It is important to remember that everyone is occupationally handicapped in one way or another. There are all sorts of jobs in the world with differing tasks and demands. But no one individual has the abilities to do all of them. Only gradually has society begun to recognize that the severely disabled can be productive members in their communities.
Question 7: Have you ever seen a handicapped person at work? If so, write your example.
Here are some of the variables to finding a good job for the handicapped:
a. Inexperience due to lack of opportunity to develop work personality of habits.
b. Deficiencies due to lack of learning opportunities.
c. Negative concepts about the self - lack of motivation, inferiority feelings, etc.
d. Disincentives such as the loss of social monetary benefits.
e. Lack of positive attitudes of the society the handicapped person lives in.
f. Employer ignorance and bias about handicapped persons.
g. Environmental barriers such as unsuitable housing and unavailable transportation.
h. Unfavorable market conditions.
i. Deficiencies in organization of services for the handicapped - in government administration and rehabilitation agencies.
j. Inadequate government funding for comprehensive rehabilitation.
The number of handicapped people in a country affects the whole population. How is this so? If the number of disabled persons is great, and it is about 20-30% in Russia, it costs the government money since they live on government pensions. The people of a country must pay taxes for pensions for the handicapped. This is how most governments operate. If however, the government budget is low, there are decreased payments for the handicapped and it is difficult for them to live. If they are rehabilitated and find jobs, the government does not have to spend money from the budget to support them.
Question 8: Is the population of your country growing or decreasing? Why?
The prevalence of a disability refers to the total number of cases of disability in the general population. Thus far, in the republics of Russia where I have lived, I have not been able to find that data. In fact, the professors of the local teachers' college could not find the data when they approached the government offices. It is important to know who is disabled, the type of disability and where these handicapped persons are located in the region so that they can be helped. It is also important to plan for the health services of the region so that perhaps disability can be prevented at birth or in the place of work. Incidence refers to the number of new cases of disability that occur each year.
Question 9: How many adults (except retired people) should work to produce enough goods for the country?
(Only one of the following answers is correct.)
100%
75% - 85%
50% - 60%
There is a profile that the government may draw from its analysis of the prevalence of disability. For example, in the U.S., the average disabled person is disabled as the result of an accident; there are usually two or more resulting disabilities; the average age for the disabled is 53 years; often they are divorced; they have lower educational level than the rest of the population; their income is half of the normal working person who had the same job; minorities are injured more frequently than Caucasians; the medical costs of the handicapped are twice as much as for the non-disabled.
Question 10: What may handicapped persons be able to do to help your country?