GENERAL KNOWLEDGE REGARDING HEALTH AND PERFORMANCE
A body of literature has accumulated regarding health, aging, and secondary conditions for adults with disabilities and for some specific disabilities of early onset. Most research has focused on disabilities and impairments that have higher prevalence rates (eg, cerebral palsy); are easy to associate with a disability group (eg, spina bifida, Down syndrome); benefit from organized, dedicated service programs (eg, muscle diseases); and therefore have attracted research funding to generate a significant body of knowledge about the condition.
The literature includes a combination of scientifically observed and anecdotal information as the database, often involving a “convenience” sample and a cross-sectional approach, with conclusions drawn from patient reports, clinical observations, and ICD-9 codes; none of these are standardized measures of individual characteristics or outcomes. Most studies identify health issues or concerns, with few challenging prevention or intervention strategies. Each factor in the interaction of disability and aging or secondary conditions has the capability to become a “negative feedback loop” (19) that may lead to further disability or a new health condition. There are studies using cross-disability groups that may have a higher representation of certain disability groups or may be small sample sizes, and consequently generalization to other disability groups should be considered with caution. In like manner, prevalence rates for some aging, secondary, and health conditions in disability-specific studies cannot be applied to all disability groups.Pain is a common health condition for adults with disabilities, as noted earlier, and may be seen earlier in early-onset disability groups, especially those with mobility impairments. Pain is also a common complaint in adults without disabilities, and there is an expected response from health care providers, including evaluation and treatment.
This should also be the expectation for those with disabilities, especially at younger ages. Any significant decrease or loss of motor skill, change in continence, change in typical activities, direct pain complaint, or “sluggishness” (20) requires further evaluation. Common musculoskeletal etiologies include poor ergonomics and biomechanics in tasks (secondary to deformity or limited motor control), underlying weakness and therefore overuse, hypertonia depending on the primary disability, and degenerative joint disease. Neurologic etiologies may also need to be considered, including general neuropathies, focal neuropathies (eg, carpal tunnel syndrome, ulnar entrapments), radiculopathies, and myelopathy or stenosis. Appropriate evaluation should be completed to determine the treatment strategy. Typical treatment strategies should be implemented and modified as needed, given the disability and improvement noted. Management may include traditional noninva- sive interventions (eg, analgesics, nonsteroidal antiinflammatory drugs [NSAIDs], therapy modalities), more aggressive pain management strategies (eg, manual medicine, trigger point injection, massage, spinal injections), and reevaluation of functional activities or positioning that may predispose to the pain complaints. For spasticity-related problems, use of tone management techniques can be helpful, including oral antispasticity medications, use of botulinum toxin injections for focal problems, or intrathecal baclofen. Surgical interventions should also be considered, and will require preplanning for rehabilitation, living arrangements, and supports postprocedure.There are anticipated health and performance changes with aging. The risk for additional health problems should be monitored and addressed as with the general population. However, people with disabilities are often not afforded typical screening as in the general population. Iezzoni et al reported those with mobility impairments did receive pneumonia and flu vaccines, but were less likely to receive other preventive services.
Women with severe mobility impairments in particular were less likely to receive Pap smear and mammography screening (21). Women with disabilities had less knowledge about cardiovascular risks and no screening for risk factors, despite their higher risk with low activity levels (22). However, Cooper described a minor modification in office-screening techniques for adults with intellectual disability that improved identification of risk factors and health needs, with improved health determinants (23). Additional health risks and conditions can affect general performance.Performance changes with aging include decrease in strength, balance, flexibility, coordination, and cardiopulmonary function, to name a few. The impact of these known aging changes on a person with mobility impairment is not well understood. Use of equipment, modifications to environment or activities, and joint protection all contribute to maintaining function over time. It is, however, known that persons with mobility impairments use more energy to perform mobility activities than their nondisabled peers. Therefore, exercise and activity to improve performance and maintain those improvements would seem intuitively obvious. In fact, there is scientific evidence that exercise and activities are effective for people with mobility impairments and that these activities can be managed through home programs and health clubs, not just traditional physical therapy programs (24,25). Simply continuing typical activities, even though considered “strenuous,” will not increase strength, conditioning, or performance. Exercise and activities should be a part of a health maintenance program for adults with mobility impairments.