Chapter 5
A New Normal, Disability?
“Disabilities Can Teach Us How to Live”
-Richard C. Senelick-
“Live as if you were to die tomorrow. Learn as if you were to live forever.”
― Mahatma Gandhi
My focus this chapter is on disability. I will address three types of disabilities. I shift to one form of impairment being a physical disability. I then focus on brain injury.
As of July 1, 2012, the United States Census Bureau reported that one of five people living in the United States have a disability. That figure stood at approximately 56.7 million people in 2010. Disability does not discriminate. It can be found in every ethnicity, gender, sexual orientation, age, religion, and socioeconomic status. Disability may involve physical, sensory, cognitive or intellectual impairment, mental disorder, or any other types of chronic. Thus, disability is an umbrella term for any physical, mental, or social condition that limits or restricts a person’s movements, thinking, or functioning. In reality, there is often a spectrum of ability or disability for each individual.
There are three types of ways a person could have a disability. The first is the developmental disability, which can occur within the womb of a mother.such a disability could be the result of one or more genetic chromosomal abnormalities. Prenatal exposure, for example, to substances, viral infections, or a preterm birth. Genetic abnormalities, generally, are caused by changes in an individual’s DNA. These abnormalities can range from a single base dictation involving just one gene to the addition or subtraction of an entire chromosome to the DNA sequence. As a result of these genetic changes, people with such genetic changes or predispositions show mental or cognitive deficiencies. Common examples are children with Down or Turn syndromes.
Another developmental disability is fetal alcohol syndrome. The most recent National Survey of Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2007) compared data on drug use among pregnant and non-pregnant woman. In general, the survey found that women have a lower prevalence of illicit drug, of all, and tobacco use versus the non-pregnant women of the same age (15 to 44 years of age). One hypothesis is the pregnant women were already conscious of what they were putting their bodies. This could explain why the survey found 4 percent of pregnant women engaged in illicit drug use. In addition, an estimated 11.8 percent of pregnant women reported alcohol use, 2.9 percent reported binge drinking, and 0.7 percent reported heavy drinking. If a woman drank diet soda during pregnancy her child could develop hyperactivity.
In 2012, there were an estimated 43.7 million adults age 18 or older in the United States that are diagnosed with a mental illness in the past year. This represented 18.6 percent of all adults. A mental disability is a medical condition that disrupts a person’s thinking, feeling, mood, ability to rate to others, in the individual’s daily functioning.
Serious mental illnesses include but are not limited to Major Depression, Schizophrenia, Bipolar disorder, Obsessive-Compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder. The stupendous news about mental illness is that recovery or ability to cope with such illnesses can be possible.
Most individuals with a mental disability can experience relief from his or her symptoms by actively participating in one’s treatment plan. The individual’s treatment plan defines the areas or problems of concern and outlines the progression of therapy. In a treatment plan the patient and doctor(s) will outline a medication schedule that said patient should follow. Prescription drugs, has its ups and downs but can be the relief that the patient might need to actively be a purposeful member of society.
Prescription drugs have their place in our medically advanced society. There are many diseases people would otherwise die from if not for prescription drugs, and some drugs make life easier when faced with a small ailment such as the flu or cough. Prescription drugs, as well, have a dark side. Serious misuse, dependency, and addiction them from too many prescription drugs dealt by hands of supposed responsible doctors and pharmacists. The pros and cons of these types of drugs must be carefully weighed because it affects you, your loved ones, and communities. The last form of disability is that one may occur during a person’s lifetime.
Research on physical disability is extremely limited (Asch, 1988; IRB, 2011). A physical disability or disabilities refers to the total or partial loss of one’s bodily functions (e.g., walking, gross or fine motor control, or bladder control) or loss of the body (e.g., amputation). Physical disability, in other words, is a limitation of a person physical functioning, mobility, dexterity, or stamina. A physical disability or disabilities can be temporary, short-term, or long-term. Some conditions might go into remission; others may common goal with no particular pattern, or be a more gradual deterioration. Some examples of physical disability, but not limited to, might be: cerebral palsy, spinal cord injury, amputation, multiple sclerosis, arthritis, or traumatic brain injury.
The United Cerebral Palsy Association estimates that more than 764,000 Americans have some degree of this illness. Cerebral palsy is a group of disorders that impair control of movement due to damage to the developing brain resulting in difficulties with movement, learning, hearing, seeing, and/or thinking. Cerebral palsy usually develops by age 2 or three and in most cases is not aggressive. This sometime debilitating illness is a leading cause of childhood disability. Much remains unknown about what causes the disorder; what evidence supports theories that infections, birth injuries, and poor oxygen supply to the brain before, during, and immediately after birth are common factors.
On May 27, 1995, Christopher Reeve became a quadriplegic after being thrown from a horse during an equestrian competition in Culpepper, Virginia. A spinal cord injury is any damage to the spinal cord or nerves at the end of the spinal canal. The severity of a spinal cord injury depends on two factors. The first is where exactly is the damage and the second is severity of damage to the spinal cord or nerves. The individual that suffered a spinal cord injury may devalue him or herself as a person. That should not be the case but in today’s society it is. No research from spinal cord injuries will make the injury to be someday repair. Research studies all over the world are addressing the issue.
Amputation is a surgical removal of all or part of a limb such as an arm, leg, hand, or foot. About 1.8 million Americans today are living with an amputation. There are many reasons why an amputation might occur. The most common is because of poor circulation because of narrowing of the arterial walls a person’s body. Without adequate blood flow a person cannot get oxygen and nutrients that a cell so vitally needs to survive. Other cases of amputees are accidents, cancerous tumors, serious infections, or frostbite.
Multiple sclerosis is a disease in which a person’s immune system attacks the protective myelin sheath on one’s own body. The myelin sheath insulates nerve impulses from neighboring nerve fibers, and it increases the speed of impulse through nerve axons. When the myelin sheath is damaged it disrupts the communication between his or her brain and the rest of the body.
Arthritis is inflammation of one or more of a person’s joints. The main symptom of arthritis are joint pain and stiffness, which typically worsen with age. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis causes cartilage to harden those animating the slippery tissue of the end of each bone. Look toward arthritis is an autoimmune disease that targets the lining of the joints. The main goal of treatment is proving a person’s life and reducing overall symptoms.
The third form of disability can be caused by an accident. Accidents can be specific, unexpected, unusual, and unintended external action which occurs at a particular time and place, with no preparation for or apparent and deliberate cause but with obvious effects.
Accidents on the road and in industrial environments can happen to anybody resulting in many extreme cases but specifically a TBI. The possibility of suffering a disability during a person’s lifetime is higher the only thing. The chances of a 20-year-old or older person may become disabled before he or she retires is just over one out of four persons of the United States. Accidents are not only the culprit for causing physical disabilities; back injuries, cancer, heart disease, arthritis, and other illnesses can cause this type of disability.
Head injury is a modern scourge of industrialized society. It is a major contributor to cause of death, a leading cause of death in young adults, and a major cause of disability. Brain injuries occur at all ages could peek in young adults, between the ages of 15 and 24. In this population, alcohol and drug intoxication have been the leading cause of brain injury. Lower socioeconomic status has also been associated with increased risk and that underscores the fact that this is precisely the population that had the greatest ability to access proper care. Men are affected three to four times as likely to suffer a brain injury than women. The major cause of brain injury differs in different parts of the country but in all areas motor vehicle accidents are the most in metropolitan ghettos were personal violence is prevalent.
Although traumatic brain injury (TBI) has been called, “the silent epidemic,” because of effective data about its epidemiology has proven difficult to obtain. For starters, the task is complicated because of the disagreement about the definition of a TBI; which can be clinically subtle and which is not always identified by hospital records. Falls are a primary cause of injury in early childhood. Brain injury is the principal factor in 50% of all traffic totality (Traumatic Brain Injury, Cope & Horn). The study also found that more than 70% of patients who are brain damaged and comatose are injured in motor vehicle accident. Gunshot wounds our actual causes of TBI for the whole sample. For all head injuries, 70% are considered “mild,” 20% are “moderate or severe,” and 10% are fatal (Traumatic Brain Injury, Cope & Horn).
The social, cognitive, and biological consequences a patient, family, and society may be catastrophic. Craniocerebral (e.g., brain), may be divided cording to the nature of the injury to the skull into three groups. The first is post head injury, second is a depressed, or lastly a compound fracture. The division is important in deciding whether surgical treatment is necessary for the patient. The prognosis, however, is dependent more on the nature and severity of the brain damage than the severity of the injury to the skull. In closed head injuries, there is either no visible injury or only a linear fracture to the skull. These cases are then subdivided into two main groups; with no significant degree of structural damage to the brain (e.g., concussion) and those with destruction of the brain tissue related to the edema, contusion, laceration, or hemorrhage.
An edema related issue in regard to the brain is when an individual’s brain becomes filled from a watery substance and is filled with pressure also known as brain swelling.
A contusion on a brain is a bruise of the tissue.
In regard to a cerebral laceration of the brain is a type of TBI where the tissue (e.g., pia mater or arachnoid) of the brain is torn or mechanically cut. The pia mater is the delicate innermost membrane enveloping the brain and spinal cord. The arachnoid mater is the middle meninge surrounding the brain and spinal cord.
Finally, we have cerebral hemorrhaging. Brain hemorrhaging, simply put, is when a person’s brain inwardly bleeds.
In simple depressed fractures the skull and pericranium remain intact but a fragment of the fractured bone is depressed inward to compress or injure the underlying brain. These cases can be, thus, subdivided according to the severity of the damage to the cerebral substance.
The complications of head injury include vascular lesions (e.g., hemorrhage, thrombosis, or aneurysms), infections (e.g., osteomyelitis, meningitis, or abscess), rhinorrhea, or leptomeningeal cysts injury or cerebral lesions to the cranial nerves and focal cerebral lesions. The sequelae of your heart came to induce seizures, psychosis, and other psychiatric disorders (e.g., PTSD).
The pathology of a concussion is the brief loss of consciousness after injury, with no immediate or delayed evidence of brain damage. The word to pay most attention to is, “brief,” but this criterion is open to interpretation. Concussions may be the loss of awareness for only a few seconds (e.g., a hockey player is checked by an opponent) or more severe injury, or consciousness may be lost for hours. The work of Denny Brown and Russell in 1941 experimental approaches the pathophysiology of a TBI found that brain stem damage was implicated to account for loss of consciousness.
If a coma lasts longer than six hours there is presumed to have brain tissue injury. It is now believed that there is a continual of diffuse brain injury that are caused by acceleration and deceleration of the head resulted in shearing or stretching of axon resulting in a diffuse axonal injury. This may be the case in many automobile accidents. The term diffuse axonal injury is used if a coma lasts longer than six hours. Coma for six to 24 hours is deemed a mild head injury; moderate or traumatic depends on the extent of the coma but where there is more my in coma there is likely to be associated with significant cerebral signs of evidence of cerebral bleeding; and has an unfavorable.
A mild brain injury has been described in three forms: a focal lesion in the corpus callosum (e.g., a communicative structure between hemispheres), a focal lesion on the brainstem, or a diffuse lesion. Focal lesions are circumscribed areas of injury to brain tissue following a brain injury. A diffuse lesion is an extensive lesion in white matter tracts spread throughout the area. Diffuse lesions are first microscopic and later manifest by axonal tearing throughout the white matter of the cerebral hemispheres. If the patient survives there may be later evidence of wallerian degeneration and later makes way for nerve deterioration.
Brain swelling after head injury may be caused in part by cerebral edema. A formal definition of brain edema, however, implied increase the content of extravascular rainwater. In posttraumatic brain swelling it is thought to be caused by an increase in the intravascular volume of blood in the brain; and is known as an abnormal vasodilation. The swelling may be diffuse or focal coinciding with a contusion or hemorrhage.
In the simplest visible injury to the brain, a contusion, the pia-arachnoid a brain is intact. The membranes have been torn in a laceration. Both types of lesions are found primarily in the frontal and temporal lobes and under the surface of these areas, where the brain comes into contact with bony features of one’s skull. If there is no diffuse axonal injury, brain swelling, or secondary hemorrhage, recovery may be excellent. Contusions are often found on autopsy reports of those with no clinical evidence of permanent brain damage.
The degree of damage to the meninges and cerebral hemisphere is due to the force of the blow. With minor injuries there may be petechial (e.g.,tiny capillaries) hemorrhages in the surface of the cortex and a mild degree of meningeal (e.g., protective coating) hemorrhage. With more severe injuries the meninges and cortical substances are torn and there may be excessive hemorrhagic neurosis (e.g., damage to nerves from any cause) of the cortex and that support the white matter. There may also be small or large bleeding into the basal ganglia, for other portions of the brain that are far removed from the site of injury.
Penetration of the skull by bullets, bombs, fragments, or other missile causes laceration, neurosis, and hemorrhage around the track of projectile.
The symptoms and signs of head injury is a disturbance of consciousness is the most common symptom of brain injury. A coma is a more prolonged, lasting for several hours, days, or weeks when there is swelling, hemorrhage, diffuse axonal injury, contusion, or restoration of the cortex. The duration of coma depends on the site and severity of injury. The loss of consciousness in patients with perforating wound of the skull and brain is related to the size of the projectile. Penetration of the frontal parietal lobes by foreign objects may not cause loss of consciousness, whereas those that pass through the petrous bone in the cerebellum and posterior fossa commonly produced coma.
Recovering from concussions depend on the severity and nature of the symptoms that are related to the degree of damage to the brain. Patients with a concussion may be normal within a few minutes. Others, however, maybe slightly dazed and complained of headaches for a few days. Headaches and dizziness may be present after injury regardless of the severity of the brain damage.
The prognosis of patients with head injury is related to the site and the severity of injury. In cases of minor mild head injury the course looks very promising for the patient. There may be loss of memory for the events that occurred within a short time before and after (e.g., posttraumatic amnesia) the accident. When a traumatic brain injury occurs death may occur immediately after or shortly following the injury.
A United States studied found out of 135 patients attending a hospital following a road traffic accident had been contacted one to two years after regarding pain in his or her neck. 85 the participants stated that he or she had suffered neck pain at some time following the accident as compared to 42 participants who were noted to have pain in the neck when examined soon after the accident. 31 of the participants still felt occasional pain one year after the accident in five had continuous pain at one year. Automobile accidents claim more lives than any type of accidental death and are responsible for an enormous amount of injuries. Most often in automobile accidents the term whiplash is given to most other end collisions. Whiplash is defined by a sprain in one’s cervical, thoracic, or lumbar vertebrae.
The results from the study did not only emphasize the responsibility that every American has behind the wheel but to every individual needs to pay more attention while driving. Thus, disability is a complex phenomenon reflecting an interaction between features of a person’s body and features of the society in which he or she lives.
Overcoming difficulties faced by individuals with disabilities acquires interventions to remove it from our mental and social barriers. Persons with a disability or disabilities have the same health care needs as do many able-bodied individuals (e.g., immunizations, cancer screening, and physicals) but with these disabled individuals experience a narrower margin of health and healthcare services because of poverty and social exclusion. This population may also be susceptible to secondary conditions like pressure sores, urinary tract or nosocomial infections.
2000 Bill Clinton Signs TBI Act
The traumatic brain injury act of 1996 was designed to have agencies of the United States Department of Health and Human Services conduct studies and establish innovative programs with respect TBI patients. As required by this act, the following federal report summarizes current knowledge about the incidences, causes, severity, associated disability, and prevalence of TBI. The majority of head injuries are caused by a vehicle accident, falls, sports, or assault.
In 2010, approximately 2.5 million individuals sustained a TBI (National Hospital Discharge Survey, 2010; National Hospital Ambulatory Medical Care Survey, 2010; National Vital Statistics System, 2010). All data sources are maintained by the CDC National Center for Health Statistics. A severe TBI not only impacts the life of that individual and his or her family, but it also has a large societal and economic toll. The estimated economic costs of TBI in 2010, including direct and indirect medical costs, is estimated to be a $76.5 billion! Additionally, the cost of fatal TBI’s and TBI’s requiring hospitalization, many of which are severe, account for approximately 90% of the total TBI medical costs.
Traumatic brain injury is the third leading cause of death and disability among individuals in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 die, 230,000 are hospitalized and survive, and an estimated 80,000-90,000 experience the onset of long-term disability. The rates of TBI related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and changes to hospital admission practices that shift the care of the person with less severe TBI from inpatient to outpatient settings.
The magnitude of TBI in the United States quires public-health measures to prevent these injuries and to improve the consequences that are sustained with this terrible injury. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in populations at greatest risk, and monitor the effectiveness of such programs. States follow registries builds on these surveillance systems can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities design, implement, and evaluate cost effective programs for people living with a TBI and for his or her families, addressing acute care, rehabilitation, and vocational, school, and community support.
At least four TBI’s occur every minute in the world (Center of Disease and Control and Prevention Traumatic Brain Injury, insert citation). TBIs are in the news a lot these days: a football player injured in a tackle, a soldier disabled by an explosion, a teen injured in a motor vehicle crash, an older adult is hurt in a fall, etc. A TBI is a serious public health threat in the United States. A TBI is an injury that disrupts how the brain works. TBIs may result from a bump, blow, jolt to the head, or penetration of one’s skull by a foreign object such as a knife or bullet. Common causes of TBI besides the ones listed above include sports, firearm injuries, blast (exposing) injuries, abusive head trauma, or being hit in the head by an object.
A traumatic brain injury (TBI) is defined by a severe blow, jolt, or penetration to the head that disrupts the function of the brain. Not all blows over jolt result in a TBI. The severity of such injury may range from “mild” (e.g., brief change in mental status or consciousness) to “severe” (e.g., an extended period of unconsciousness or amnesia after injury) no matter what the severity of injury is to an individual; he or she should report directly to a physician to receive appropriate care and treatment. A TBI can result in short or long-term problems with independent functions.
The leading causes of TBIs are 35.2 percent falls, 17.3 percent are from motor vehicle crashes, 16.5 percent are being struck by/against object, 10 percent are from assaults, and 21 percent are from unknown/other. When soldiers return from war that are plagued by TBIs. Blasts are the leading cause of TBI for active duty military personnel in war zones.
Many might wonder who might be at greatest risk for TBI in the military? Males are about 1.5 percent as likely than females to sustain a TBI. The two age groups that are at greater risk for TBI are 0 to four and 15 to 19 years of service in active duty in the military. Certain military duties (paratroopers) increase the risk of sustaining a TBI. African-Americans have a higher risk of death from a TBI.
Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated 60 billion in the United States in 2000. The Centers for Disease Control and Prevention estimates that at least 5.3 million Americans currently have a long-term a lifelong need help to perform activities of daily living as a result of a TBI.
According to one study, about 40 percent of those hospitalized with a TBI had at least one unmet need for services one year after his or her injury. The most frequent unmet needs had been improving one’s own memory and problem-solving skills, ability to manage stress and emotional upsets, controlling one’s temper, and improving job skills. Adults aged 21 to 64 with disabilities typically earned substantially less than those without disabilities. The median monthly earning for people with any kind of disability was $1, 961 compared to $2, 724 for those with no disability.
In conclusion, I hope that the reader can get the idea that disability is a serious issue affecting a wide range of individuals. I write this chapter to shed light on all forms of disability and to make a person realize that ignorant behavior should not be acceptable in today’s society. There have been numerous times where I have been discriminated against because I was different. I do not expect other individuals to fight or protests on my behalf but I am asking for is to be accepted and respected as a meaningful part of society.
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Great info!
Thank you!