1 - Introduction

The debate on the definition of disability has been going round in circles for a long time. A lack of clear conceptualization has induced simplifications, misunderstandings and misinterpretations. The consequences are: the lack of reliable tools affecting the assessment of disabled people’s needs and the correct measurement (EBM) of effects in Rehabilitation.

2 - The WHO's failure to define and classify Disabilities

The WHO biomedical propositions (ICIDH I, ICIDH II, and, since 2001, International Classification of functioning-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” adds to the already great confusion on a subject specifically requiring accurate words.

ICF separates: ORGANIC FUNCTIONS, ANATOMIC STRUCTURES, ACTIVITIES AND PARTICIPATION, ENVIRONMENTAL FACTORS.

3 - Saad Nagy, a precursor

Saad Nagy (1965, Ohio State University, USA), Rehabilitation physician and anthropologist suggested the following formula to deal with chronic diseases and their consequences:

Pathology Impairment Functional limitation Disability

4 - We propose a new look at disabled persons: Disabling Situations

Disability Identification and Measurement System (DIMS)

It is an ergonomic and anthropologic approach of disability, an international proposal for the quantified identification of disabilities

5 - Assessment by « Handitest » uses four levels to analyze disabilities

- The body: this level includes all the biological aspects of the human.
- Functions/capacities: this level comprises the physical and mental function of the human person.
- Life situations: this level addresses the confrontation where a person is faced with the reality of the physical, social and cultural environment.
- Subjectivity: this level addresses the point of view of the person regarding his/her health status and social position.

The Functions: 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 traumatic factors, sleep, vigilance, appearance and beauty.

Situations in life: Daily living activities, social and affective life (family, friends, neighbours, leisure activities, school and education, occupation, care constraints.

Subjectivity: self awareness on body status, current functional capacities, situation as a disabled person (feeling of exclusion), the rehabilitation possibilities.

Severity scale (dependence scale):
0: No dependence, no hardship.
1: Discomfort (hardship) in the functional realization or in a situation.
2: Use of a technical aid, drug, or animal aid.
3: A human aid is partially necessary.
4: Impossible or the function or situation is totally compensated by another person.

6 - The consequences for PMR are:

a better identification of disability, a method for identify the needs of the disabled persons, 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).

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.

Reference

Hamonet Cl., “Disabling situations, an original concept connecting disease, disability and rehabilitation to assess and manage disabled persons.” 7th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2013), Beijing, China, June 16-20 2013.