Presentation on theme: "Assessing and managing handicap: an original concept Claude Hamonet MD, PMR, PhD (social anthropology) Professor Emeritus with the Medical School in Creteil,"— Presentation transcript:
Assessing and managing handicap: an original concept Claude Hamonet MD, PMR, PhD (social anthropology) Professor Emeritus with the Medical School in Creteil, University Paris-East-Creteil (UPEC). Department of PRM (Dr. Maigne) Hotel-Dieu de Paris Former disability expert registered with the WHO in Geneva Former Dean of the Communication and Insertion in the Society Department, Paris 12 University Former Professor (PRM) in Algiers. 7th Congress of the Pan-Arab Association of Physical Medicine and Rehabilitation Jeddah, Saudi Arabia 9-11 March, 2013 Thanks to Mohamed Khadiri, President of Morocco Association of disableds for arabic translation.
How to define disability within the health system ? The debate on the definition of disability has been going round in circles for a long time. The lack of clear conceptualization, induced simplifications, misunderstandings and misinterpretations. The consequences are: the lack of reliable tools affecting the assessment of disabled people needs and the correct measurement (EBM) of effects in Rehabilitation.
The WHO’s failure to define and classify Disabilities The WHO biomedical propositions (ICIDH I, ICIDH II, and, since 2001, International Classification of functionning-ICF) initiated by P.H.N. Wood (1980) are useless tools for diagnosing, defining and assessing disabilities. The use of inaccurate and ambivalent terms as “activities” add to the already great confusion on a subject specifically requiring accurate words. ICF separates : ORGANIC FUNCTIONS ORGANIC FUNCTIONS ANATOMIC STRUCTURES ANATOMIC STRUCTURES ACTIVITIES AND PARTICIPATION ACTIVITIES AND PARTICIPATION ENVIRONMENTAL FACTORS ENVIRONMENTAL FACTORS
Dr. Philip Wood, Manchester, 1985 at the time of my visit
We propose A new look …. …at disabled persons, Situations of Disability
Saad Nagy (1965, Ohio State University, USA), Rehabilitation physician and anthropologist Saad Nagy suggested the following formula to deal with chronic diseases and their consequences: Pathology --> impairment --> functional limitation - -> disability
The new proposal : Disability Identification and Measurement System (DIMS) An ergonomic and anthropologic approach of disability An international proposal for the quantified identification of Disabilities An international proposal for the quantified identification of Disabilities
DISABILITY BODILY CHANGES FUNCTIONAL LIMITATIONS OBSTACLES IN LIFE SITUATIONS The four Dimensional Disability Diagram of Paris-East-Creteil University, Porto University, Montreal University and Tunis Social Affairs Ministry (1999). SUBJECTIVITY
Four dimensional diagram of Disability of Paris-East-Creteil University, Porto University, Montreal University and Tunis Social Affairs Ministry (1999). عاقة ا لأمراض أو الإصابات الصعوبات في الوضعيات الحياتية الذاتية الاضطرابات الوظائفية
Four levels to analyze disabilities Handitest سلم تقييم درجة الإعاقة 1) THE BODY: this level includes all the biological aspects of the human body 2) FUNCTIONS/CAPACITIES: This level comprises the physical and mental functions of the human. 3) LIFE SITUATIONS: This level addresses the confrontation where a person is faced with the reality of the physical, social and cultural environment. 4) SUBJECTIVITY: This level addresses the person’s point of view regarding his/her health status and social position
Functions ( تقييم الاضطرابات الوظائفية ) -Position-holding and moving -Manipulation-Prehension -Communication including : Hearing, Vision -Cognition -Control of sphincters -Sexuality-Procreation -Adapting to physical activity -Mastication-Cough -Cutaneous protection against pathologic factor -Sleep, vigilance. Appearance and beauty
Situations in life ( تقييم الصعوبات في الوضعيات الحياتية ) -Daily Living activities -Social and affective life family, friends, neighbours, leisure activities -Occupation -School and education -Care constraints
Subjectivy ( الذاتية ) Self awareness on : - Body - Current functional capacities -Situation as a disabled person (feeling of exclusion)
Severity scale (dependence scale) 0 No dependence, no hardship. 0 No dependence, no hardship. 1 Discomfort (hardship) in the functional realization or in a situation. 1 Discomfort (hardship) in the functional realization or in a situation. 2 Use of a technical aid, animal assistance or a drug, 2 Use of a technical aid, animal assistance or a drug, 3 A human aid is partially necessary 3 A human aid is partially necessary 4 Impossible or the function or situation is totally compensated by other person. 4 Impossible or the function or situation is totally compensated by other person.
The consequences for PMR are A better identification of disability. A better identification of disability. A method for identify the needs of the disabled persons. A method for identify the needs of the disabled persons. A method to choose the best rehabilitation A method to choose the best rehabilitation solution: technical aid, human aid, physiotherapy, occupational therapy… A method to assess the Rehabilitation results An introduction of the human factor in Rehabilitation (by subjectivity) An introduction of the human factor in Rehabilitation (by subjectivity)
Conclusion There are two pillars in Rehabilitation: 1-Subjectivity (self awareness of the disabled person) 2-Situations : a disabled person is not a disabled one, but a person in a disabling situation. 2-Situations : a disabled person is not a disabled one, but a person in a disabling situation. « To believe in Rehabilitation is to believe in Humanity » Howard A. Rusk (the Founder of Rehabilitation Medicine, University of New-York 1947).
Thanks very much for your interest Thanks very much for your interest Choukrane Choukrane