Health and Wellness Agenda
As a result of the steady improvement in medical care and social support systems during the last 50 years, persons with disabilities are healthy, conducting active and productive lives, and generally living longer.
The medical paradigm must now shift from that of illness and disease to one of health and wellness. The health care delivery system must view persons with disabilities through a typical health maintenance and preventive medicine approach. This requires a change in attitudes and care models. Both prevention and promotion strategies should be employed: prevention of activities that lead to illness and disease (eg, smoking cessation, dietary discretion, routine laboratory and examinations, protected sexual activity) and promotion of activities that improve general well-being (eg, stress management, exercise) adapted to meet individual requirements and performance (Table 15.4) (279,280). However, positive health behaviors require social, health, and community resources. The more resources a person has, the more likely that individual will engage in health promotion and protective behaviors (281). Again, access is an important issue. Availability of information in appropriate modalities and the education of consumers are important. To participate in positive health behaviors, one must be interested, be ready to make changes, have the needed resources, and have a supportive environment. Early involvement of adolescents with mobility impairments in health promotion activities may pave the way for maintaining these behaviors into adulthood.Since musculoskeletal conditions are the most common age-related changes and secondary conditions that
451
15.4
Health Preventive Screening Services*
| HEALTH CONDITION | RECOMMENDATION FOR GENERAL POPULATION | MODIFICATION NEEDED |
| Hypertension | >18 yrs and annually | None |
| Immunizations | Follow schedule | None |
| Cardiac, vascular diseases | Men: >35 yrs; possibly 20 yrs with CAD risks | None |
| Lipid | Women: >45 yrs with CAD risks; possibly 20 yrs with risks | |
| Abdominal aortic aneurysm Cancer | Men: age 65-75 yrs if ever smoked | Accessible procedure environment |
| Colorectal | Men and women, screening >50 yrs | Accessible procedure environment |
| Women's health | May need 1:1 assist | |
| Breast | Annual mammogram >40 yrs | Accessible office exam table and procedure environment |
| Clinical exam, every 3 yrs 20s-30s, annual >40 yrs Self-exam option >20 yrs MRI only with high risk, annually | May need 1:1 assist | |
| Cervical | Screening begins 3 yrs postintercourse, not later 21 yrs | Accessible procedure environment |
| Age 30 yrs, with 3 normal Pap tests, screen 2-3 yrs >70 yrs, 3 normal Pap tests and no abnormals or risks may discontinue D/C after total hysterectomy and no risks | May need 1:1 assist | |
| Prostate Metabolic | Offer PSA and digital exams >50 yrs, not required High risk, test 40 yrs; if normal, begin routine 45 yrs >75 yrs not required | Office exam table accessibility |
| Obesity | Screening for all, with counseling and behavior interventions offered | Requires accessible scale |
| Diabetes mellitus Mental health | Screening for asymptomatic sustained blood pressure >135/80 mm Hg | None |
| Depression | Screening if able to diagnose, treat, follow-up | May require modification to queries; requires support to diagnose and treat |
| Dementia | Insufficient data to recommend in general population | Important to question in DS |
| Violence | Not recommended for general population | High incidence of violence and abuse in disability; offer opportunity to discuss |
| Tobacco use | Recommend regular screening and offer cessation interventions | None |
| Exercise Aging | Unclear that screening is effective in the general population | Exercise is an important activity for those with motor impairments; has been shown to be effective for improved performance, pain control, weight management |
| Vision | Presbyopia, cataract, macular degeneration, and glaucoma increases with increasing age—unclear screening is effective | Accessible examination |
| Hearing | >50 yrs, hearing decreases; unclear if screening is effective | Accessible examination |
| CAD, coronary artery disease; MRI, magnetic resonance imaging; D/C, discontinue; PSA, prostate-specific antigen; DS, Down syndrome. Adapted from Ref 286. | ||
affect performance, it would seem most reasonable to view typical physiatric strategies and interventions as preventive management techniques.
Use of adaptive equipment, energy-conservation techniques, joint protection, and ergonomic positioning may enhance function, decrease musculoskeletal complaints, and possibly prevent or delay some functional changes. Personal attitudes (of the person with a mobility impairment or their personal support system) may have to change before a person with impaired mobility will consider such assistance or be supported in considering the value of employing supportive (less independent) techniques.Exercise is a well-known health-promoting behavior, and its effects are positively demonstrated in persons with disabilities (24,282-286). Benefits of a regular exercise program include improved fitness, weight reduction, improved mood, and improved sleep. It is also known that persons must be judicious in participating in exercise programs, given the issues of fatigue and pain. Of course, care must be taken in prescribing exercise for persons with impaired mobility; they should participate in an appropriate program of exercise or activity, especially keeping in mind their risk factors for musculoskeletal injury. Jogging or running started by young adults without disabilities more often resulted in discontinuation of exercise because of joint pain than for persons who started a similar exercise program in their middle years, leading one to believe that long-term, high-impact exercise may result in pain. Aquatics programs can eliminate the wear and tear to joints. Adults with cerebral palsy tend to report perceived changes in balance and then fear of falling, which usually improves with a general fitness program. Exercises, including strengthening exercises, are not contraindicated for persons with spasticity. Generally, adults and young adults with developmental disabilities do not participate in routine fitness or exercise programs. This may be as much from limited knowledge in this area as from attitudes of care providers and persons with disabilities relative to exercise as a self-directed, nonmedical, or leisure activity. Consideration of exercise programs at home, in a health club, or as part of an individual recreation program (with or without modifications) must be initiated earlier than adulthood to achieve long-term participation. And, just as in the nondisabled population, priorities for persons with mobility impairment should include exercise and fitness.
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