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2 Evolving Concepts of Disability
Pages 18-29

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From page 18...
... originally provided to guide decision making included the loss of vision, hearing, or speech; loss of use of two limbs; progressive diseases such as diabetes, multiple sclerosis, and heart and lung conditions that have resulted in major loss of physical function; terminal cancers; and neurological or mental impairments requiring institutionalization or constant supervision.1 Subsequently, the concept of disability has changed in recognition that disability, as distinct from impairment, is not just inherent in the individual and his or her medical condition but is the result of the interaction between the person with impairments and features of the socioeconomic environment in which the person lives, such as the presence or lack or acces 1 These examples were first published by the director of the disability program in the Social Security bulletin in 1957 (Hess, 1957:15)
From page 19...
... Some of these models of disability are described next in this chapter, followed by a discussion of how the SSA process for determining disability matches with current concepts of factors contributing to disability, especially the role of the Listings criteria in the process. CONCEPTUAL MODELS OF DISABILITY This section presents the conceptual evolution of disability in terms of a series of models that have been proposed since the advent of the Social Security Disability Insurance (SSDI)
From page 20...
... He noted that not all impairments or functional limitations result in disability; two individuals with similar pathologies, impairments, and functional ca TABLE 2-1 Comparison of Components of Models of Disablement Components of the Model External Model Cells/Tissue Organ Person Society Barriers Nagi, 1969 Pathology Impairment Functional Disability limitation IOM Modi- Pathology Impairment Functional Disability Social and fication of limitation physical Nagi Model, environment 1991 ICIDH Disease Impairment Disability Handicap (WHO, 1980) NCMRR, Patho- Impairment Functional Disability 1993 physiology limitation Vergrugge- Pathology Impairments Functional Disability Jette, 1994 limitations IOM, 1997 Pathology Impairment Functional Disabililty limitation ICF Body functions Activity Participation Personal and (WHO, 2001)
From page 21...
... . The ICIDH made conceptual distinctions, based on Nagi, among impairment, functional limitations (which, however, WHO called "disability")
From page 22...
... These included (Verbrugge and Jette, 1994) : • Basic activities of daily living -- including behaviors such as basic personal care • Instrumental activities of daily living -- including activities such as preparing meals, doing housework, managing finances, using the telephone, and shopping
From page 23...
... These can include medical and rehabilitation services, medications and other therapeutic regimens (e.g., exercise or physical activity) , external supports available in the person's social network, and the physical environment." Verbrugge and Jette stimulated research into the impact of risk factors, intra-individual factors, and extra-individual factors on impairment, functional limitation, and disability and how they influence the disablement process.
From page 24...
... , and lifestyle/behavioral factors are involved in reversing the disabling process, i.e., rehabilitation, or the enabling process. The enhancements include bidirectional arrows between the various states of the enabling–disabling process to indicate that the disabling process (described in the 1991 IOM model)
From page 25...
... In the ICF, disability and functioning are seen as outcomes of interactions between health conditions and contextual factors. Contextual factors include external environmental factors, such as social attitudes, architectural characteristics, and the legal system, and internal personal factors, such as sex, age, coping styles, social background, education, profession, and other factors that influence how disability is experienced by an individual (WHO, 2001:214)
From page 26...
... Because children are not expected to engage in substantial gainful activity, childhood disability under SSI is defined as a physical or mental condition or combination of conditions that causes "marked and severe functional limitations" and is expected to last (or has lasted) at least 12 months or to result in death.
From page 27...
... Listings criteria are mostly measures of the severity of impairment and degree of functional limitations on organs or body systems (e.g., treadmill tests, pulmonary function test, range of motion of joints, and IQ tests)
From page 28...
... 1994. A short physical performance battery assessing lower extremity function: Association with self-reported disability and predic tion of mortality and nursing home admission.
From page 29...
... 1998. Lower body functioning as a predictor of subsequent disability among older Mexican Americans.


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