Physical Disability
Physical disabilities can vary widely, and are not just restricted to using a wheelchair or wearing a back brace. Some conditions appear invisible but result in a physical disability. Physical disabilities mean that the person has limited control of some or all of their voluntary muscles.
It is difficult to generalise physical disabilities, each person will have different causes, symptoms and management strategies. There are a number of reasons why someone may have a physical disability, such as accidents or medical conditions.
Medical conditions may include:
- Cerebral Palsy
- Spina Bifida
- Muscular Dystrophy/Atrophy
- Multiple Sclerosis
- Nervous system diseases
- Circulatory diseases
- Respiratory diseases
- Arthritis
- Other musculo-skeletal disorders
- Head injury/stroke
- Post-polio syndrome
- Inherited conditions passed on genetically (for example limb deficiency)
- Exposure to drugs or chemicals during pregnancy (for example Thalidomide)
Types of physical disability and their consequences
Everybody with a physical disability is an individual and no two people are exactly the same, even though they may have sustained similar injuries or have similar conditions. There may be obvious consequences of having a physical disability, such as the need to be in an environment which is physically accessible, but not everyone will require this. Some of the major types of physical disabilities are listed below, followed by strategies for providing support.
Spinal cord injury
Spinal cord injury is usually the result of an accident (for example car or sport accidents). The vertebra of the spine are displaced or crushed, which injures the spinal cord or the spinal column. Damage is often permanent and irreversible. When the spinal cord is damaged, the messages and signals to and from the brain cannot get through, resulting in paralysis (loss in function and feeling of the area below the level of the injury). This might mean that the person will use a wheelchair. Muscle spasm in paralysed muscles is also common and often exacerbates the disability.
Paraplegia
If the spine is injured below the level of the neck the person is said to have paraplegic limitations, and will be paralysed to some degree in the legs and abdomen. Movement in the trunk and chest will depend on the height of the injury.
Quadraplegia
If the neck is broken or the spine is injured in the neck region, the arms can be fully or partially paralysed. This means all four limbs will be affected and the person may have difficulty with breathing, coughing and clearing their chest.
Autonomic paralysis
As well as parts of the nervous system that control movement and transmit sensation, the body has another system which controls the involuntary functions of internal organs and glands – the autonomic nervous system. It is outside but close to and connected with the spinal cord – its messages control the bowel and bladder, male (not female) blood circulation, pressure and sweating. Damage to the spinal cord will usually affect the autonomic nervous system.
The major causes of spinal injuries are:
- Motor vehicle accidents
- Diving accidents
- Falls and crushes
- Sports injuries
- Other trauma (such as gunshot wounds or physical abuse)
Cerebral Palsy
Cerebral palsy refers to the damage to areas in the brain which control movement (motor areas). Sometimes these messages from the brain to other parts of the body can be short circuited, which results in difficulty in controlling different muscles. A person with Cerebral Palsy may experience weak and stiff muscles or uncontrolled movement.
No two people with Cerebral Palsy are alike. For instance, one person with Cerebral Palsy may use a wheelchair and have slurred speech another may just have a little trouble walking. Cerebral Palsy may affect speech, sight, hearing and/or intellectual capacity. If a person with Cerebral Palsy talks slowly, slurring their words, it does not mean that they cannot understand what you are doing or saying. It simply means that there has been damage to the part of the person’s brain which controls their speech and mouth muscles, not their ability to understand.
Cerebral Palsy can not be cured, but it is not degenerative. However the effects on the person can often change as they grow older.
Some of the implications for people with Cerebral Palsy are:
- Limited mobility and the use of aids such as calipers, braces or walking aids,
- Difficulty with activities such as standing, walking, sitting, eating and drinking
- Absent or slurred speech
- Use or communication aids such as boards, signing or technological aids
- Difficulty for some in reading and writing because of perceptual problems
- Coordination problems.
Spina Bifida
Spina Bifida is a developmental defect, which occurs within the first six weeks of pregnancy. It is caused by a combination of genetic and environmental factors. Some of the spinal bones, which normally protect and cover the delicate nerves of the spinal cord, do not close. Consequently the spinal nerve tissue protrudes through this gap and forms an open swelling on the back.
This could occur anywhere from the back of the head to the lowest part of the spine. Even though surgery at birth closes the gap, the damage to the spinal nerve tissues can never be repaired.
The degree of paralysis will depend on the extent of damage to the spinal cord and the position of the lesion. Usually there is some paralysis and loss of sensation in the legs and lower trunk. This can result in:
- A need to use a mobility aid such as calipers, crutches, a walking frame, walking sticks or a wheelchair
- Hydrocephalus, sometimes known as water on the brain, managed by a surgically inserted shunt which directs the fluid to another part of the body for absorption
- Vision impairment and/or learning problems
All of these associated disabilities will vary from person to person.
Multiple Sclerosis
Multiple Sclerosis (MS) is a neurological condition, which affects the central nervous system. The central nervous system acts like a telephone switchboard, sending electrical messages along the nerves to various parts of the body. These messages control all our everyday movements and processes. The nerve fibres in the central system are wrapped in a protective sheath of fatty material called myelin which, like plastic around electric cable, insulates the nerves and helps the smooth flow of messages to different parts of the body. In people who have MS, the myelin breaks down and is replaced by scar tissue. This results in the messages being distorted, completely blocked or being sent to the wrong area.
The symptoms vary from person to person but may include:
- Vertigo (dizziness)
- Eye trouble (such as double vision)
- Speech difficulties, including slurring of words
- Spasticity and/or weakness in the arms or legs
- Loss of coordination
- Numbness or 'pins and needles'
- Staggering, loss of balance or dragging of the feet
- Extreme fatigue
- Memory lapses
These symptoms are unpredictable and the well being of someone with MS will vary from day to day. With proper management, the effects of MS can be minimised and in most cases people affected by MS can still lead independent, active, satisfying lives. MS affects more women than men, with symptoms generally appearing between the ages of 20-50 and more often in people living in temperate climates. It is not yet known what causes MS.
What you can do
- Look, listen, understand and treat the person as you would like to be treated
- Do not assume assistance is needed – ask first
- Accept the person's right to refuse help
- Be aware of what is accessible and inaccessible to people in wheelchairs or with mobility restrictions (see accessibility checklist)
- Do not talk about the person as if they were not present
- Do not ask personal questions about the disability or origin until you know the person well enough
- Conversation should always be directed at the person, not at any companion who may be with them
- Do not separate the person from their special aids or equipment
- Be aware of the environment and the difficulties it may present
- Find ways of communicating with the person. Maintain eye contact, sit down if appropriate
- Be willing to communicate in different ways if necessary, such as a communication board or other verbal or non verbal cues
- Be patient when talking to someone with a communication difficulty.
- Resist the temptation to interrupt or to answer on their behalf. At first the person's speech may be difficult to understand but after a while it usually becomes easier to follow
- Do not lean on the person's wheelchair unless you have their permission – it is their personal space
- Do not try to move the person or their wheelchair without their permission to do so, only give a push when asked to