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Assessing and managing handicap: an original concept

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

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Assessing and managing handicap: an original concept

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  1. 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 PhysicalMedicine and Rehabilitation Jeddah, SaudiArabia 9-11 March, 2013 Thanks to Mohamed Khadiri, President of Morocco Association of disableds for arabic translation.

  2. 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 consequencesare:the lack of reliable toolsaffecting the assessment of disabled people needsand the correct measurement (EBM) of effects in Rehabilitation.

  3. The WHO’s failure to define and classifyDisabilities 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 • ANATOMIC STRUCTURES • ACTIVITIES AND PARTICIPATION • ENVIRONMENTAL FACTORS

  4. Dr. Philip Wood, Manchester, 1985 at the time of myvisit

  5. The « Wood Project » 1980

  6. We propose A new look…. …atdisabledpersons, Situations of Disability

  7. Saad Nagy (1965, Ohio State University, USA), Rehabilitation physician and anthropologist SaadNagy suggested the following formula to deal with chronic diseases and their consequences: Pathology --> impairment --> functional limitation --> disability

  8. The new proposal : Disability Identificationand Measurement System (DIMS) An ergonomic and anthropologic approach of disability An international proposal for the quantified identification of Disabilities

  9. DISABILITY BODILY CHANGES FUNCTIONAL LIMITATIONS SUBJECTIVITY OBSTACLES IN LIFE SITUATIONS The four Dimensional Disability Diagram of Paris-East-Creteil University, Porto University, Montreal University and Tunis Social Affairs Ministry (1999).

  10. عاقة الأمراض أو الإصابات الذاتية الصعوبات في الوضعيات الحياتية Four dimensional diagram of Disability of Paris-East-Creteil University, Porto University, Montreal University and Tunis Social Affairs Ministry (1999). الاضطرابات الوظائفية

  11. Four levelsto analyzedisabilitiesHanditestسلم تقييم درجة الإعاقة 1) THE BODY:thislevelincludes 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 leveladdresses the confrontation where a personisfacedwith the reality of the physical, social and cultural environment. 4) SUBJECTIVITY:This leveladdresses the person’s point of viewregardinghis/herhealthstatus and social position

  12. Functions(تقييم الاضطرابات الوظائفية) -Position-holding and moving -Manipulation-Prehension -Communication including : Hearing, Vision -Cognition -Control of sphincters -Sexuality-Procreation -Adapting to physicalactivity -Mastication -Cough -Cutaneous protection againstpathologic factor -Sleep, vigilance. Appearance and beauty

  13. Situations in life (تقييم الصعوبات في الوضعيات الحياتية) -Daily Living activities -Social and affective life family, friends, neighbours, leisureactivities -Occupation -School and education -Care constraints

  14. Subjectivy(الذاتية) Self awareness on : - Body - Currentfunctionalcapacities -Situation as a disabledperson (feeling of exclusion)

  15. Severityscale (dependencescale) • 0No dependence, no hardship. • 1 Discomfort (hardship) in the functionalrealization or in a situation. • 2 Use of a technicalaid, animal assistance or a drug, • 3 A humanaidispartiallynecessary • 4 Impossible or the function or situation istotallycompensated by otherperson.

  16. The consequences for PMR are • A better identification of disability. • A method for identify the needs of the disabledpersons. • A method to choose the best rehabilitation solution: technicalaid, humanaid, physiotherapy, occupationaltherapy… A method to assess the Rehabilitationresults • An introduction of the human factor in Rehabilitation (by subjectivity)

  17. Conclusion There are twopillars in Rehabilitation: 1-Subjectivity (self awareness of the disabledperson) 2-Situations : a disabledpersonis not a disabled one, but a person in a disabling situation. « To believe in Rehabilitationis to believe in Humanity» Howard A. Rusk (the Founder of RehabilitationMedicine , University of New-York 1947).

  18. Thanksverymuch for yourinterest • Choukrane

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