Introduction

This module explores what a physical disability is. We begin by defining physical disability and discussing some of the causes of physical disabilities. Then, we examine how a physical disability is different from a developmental disability and the special adaptations people with physical disabilities may need to make. We will explore the impact of a physical disability on a person’s life, taking a closer look at the special stressors a person with a physical disability may have. Finally, we will discuss how the Home Health Aide/Personal Care Aide can best work with a person with a physical disability.

Unit A: What Is Physical Disability?

What Is a Physical Disability?

A physical disability is a disability that impacts a person’s ability to perform physical tasks or function in a physical way. A physical disability may or may not be developmentally related. Some developmental disabilities that we discussed in Module 6 may result in physical disability. For example, cerebral palsy is a developmental disorder in which someone has a physical disability. They have difficulty with motor coordination and use of their muscles. Other physical disabilities are the result of diseases, accidents, or traumatic injuries.

Causes of Physical Disabilities

An injury–related disability is one that is caused from an accident, injury, or trauma. For example, motor vehicle accidents can result in a spinal cord injury and cause paraplegia (loss of function of the lower body or legs) or quadriplegia (loss of the ability to use both the upper and lower part of the body or limbs). A person may also lose a limb due to an accident or as a result of a disease process. For example, due to impaired circulation, a person who has diabetes may have a foot or leg amputated (removal of a limb). Diseases that are progressive (become worse) can also result in a person having a physical disability. For example, muscular dystrophy (MD) is a progressive muscular disease that is inherited and which may become obvious at birth or later in life. People with MD have a gradual wasting away of their muscles and have difficulty with physically moving due to muscle twitching, stiffness, or atrophy (wasting away of muscle).

Musculoskeletal disorders such as arthritis can make a person become disabled. Arthritis means inflammation of the joints. A person with arthritis has stiffness, pain, and decreased mobility. Osteoarthritis, a common type of arthritis which mainly affects the elderly, occurs when there is a degeneration of the joints. It can make walking and use of one’s hands difficult. Rheumatoid arthritis is a type of arthritis that can affect people of all ages and often progresses to the point where mobility is greatly impacted. Diseases that occur suddenly and unexpectedly such as a cerebrovascular accident (CVA) or stroke can also cause physical disability. A cerebrovascular accident is when the blood and oxygen supply to the brain is impacted either due to a blocked artery or hemorrhage in the brain. Some people who suffer from a stroke may become unable to use their hands, feet, to dress or feed themselves, or even to speak.

Self-Check Activity m7-1

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Permanent versus Temporary Disabilities

While many of these types of physical disabilities are permanent, there are also temporary disabilities. A permanent disability is one a person will have for their entire lives. A temporary disability is one a person will have for only a short period of time. A person who suffered a stroke may only lose the ability to physically function for a short period of time. With rehabilitation, the person may regain their full or nearly normal ability to function. Another example of a temporary disability would be someone who has had a joint replacement surgery on their hip or knee. A person who has suffered a fractured (broken) limb such as an arm, leg, or pelvis also has a physical disability, but it is temporary. After the period of healing and rehabilitation, people with these types of physical disabilities will likely go on to return to their normal or near normal physical functioning.

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Unique Attributes of Physical Disabilities

A diagnosis of a physical disability is highly individual and unique. Depending on the type and cause of the physical disability, a person may be impacted in different ways. No two people with the same physical disability will necessarily have the same impairments of functioning. While some people may have difficulties with performing activities of daily living (ADLs) such as dressing and toileting, other people may be able to perform these tasks independently, but may be unable to walk or move normally.

A person with a physical disability may need to use adaptive equipment to help them get around. Some types of equipment a person with a physical disability may use are wheelchairs, walkers, and canes. For people who have lost a limb, they may have a prosthetic device, such as a leg or arm.A prosthetic device is a specially made and fitted artificial limb or body part. Prosthetic devices are used to help a person improve their appearance and ability to function (Leahy, Fuze & Grafe, 2013).

Some people may use adaptive equipment such as special shoes or boots to help them with mobility. People with vision or hearing disorders may use equipment such as glasses, hearing aids, walking canes for the visually impaired or even use guide dogs. The use of adaptive equipment such as special plates, cups, eating and writing utensils, and special furniture and supplies can help a person with a physical impairment become independent. Other members of the home health care team such as a Physical Therapist or Occupational Therapist can be very helpful in helping the patient and the HHA/PCA learn about and how to use special adaptive equipment. It is important to remember that every person is unique and will have different impairments of functioning, as well as abilities to adapt to their impairments.

It is also important to remember that adaptive equipment such as a wheelchair is a part of the person’s physical space (Johns Hopkins University, n.d.). The HHA/PCA should always ask permission before touching or moving a person’s wheelchair. They should take care to not lean on, touch, or push the wheelchair without permission (Johns Hopkins University, n.d.). The HHA/PCA should ensure that others also respect the patient’s physical space.

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Impact of a Physical Disability on Quality of Life

Support System

Many people with physical disabilities are able to lead independent lives or be fairly independent with additional support. Some may require some assistance with performing ADLs, while others require extensive assistance. Many people with disabilities are able to function just as a person without a physical impairment, while making adjustments for their disability. Some people who have temporary physical impairments may only need assistance for a short period of time while they are recovering. Having a support system can be very beneficial for a person with a physical disability. A support system is any person or group of people who can provide support in the form of emotional or physical support, such as assisting with completing tasks. Support systems can include family, friends, and social supports such as people from work, school, church, or other groups.

Stresses and Coping Skills

Every human being faces stressors in their lives. Stressors are anything that can cause stress, anxiety, frustration, and even anger or depression. They can at times make us feel overwhelmed. Stressors will impact each of us in different ways, depending on our coping skills. Using positive coping skills are helpful when dealing with stressors. For Home Health Aides/Personal Care Aides, it is important to help the patient express their feelings and thoughts and to help them use positive coping skills. In Module 5, we discussed unhealthy and healthy coping skills and how to help patients use healthy skills to cope.

In addition to the many stressors people face in their everyday lives, a person with a physical disability may face special stressors due to their individual situation. They may not be able to work and support themselves financially due to their physical disability. They may be reliant on others to provide their care. For example, if they are unable to complete activities of daily living (ADLs), they may require assistance or total care from another person.

There may also be a lack of opportunities for socialization for a person with a physical disability. Socialization means being able to interact with other people. This may be due to physical limitations, such as not being able to engage in physical activities, limitations placed on them due to equipment such as a wheelchair, or not being able to independently get around in the community. It may also be due to feelings of embarrassment. For a person with a temporary disability, they may not be able to drive or get out of bed at this time. This is a change that takes some adjustment. It can also lead to feelings of stress. Physical limitations may also make sexual intimacy more difficult in that a person with a physical disability may need to make adjustments in order to engage in intimacy. Making adaptive changes in order to fulfill sexual intimacy needs can cause a person stress.

For a person who was not born with a physical disability, it often takes time to adjust to the emotional and physical challenges their physical disability now poses. The person may have many different feelings about their situation. They may feel frustrated or even angry that they can’t perform tasks they used to. They may have anxiety about not being able to work and provide for their family while they are recuperating (healing). They may even become depressed and feel hopeless about their future.

For a person who was born with a physical disability, they too may have a variety of emotions about their situation. They may even go through periods of mixed or different emotions, such as become depressed for periods of time, especially during times of high stress. Families of a patient may also have all kinds of emotions as they deal with the physical care of the patient, financial burden, and unanswered questions about the future. It is important for Home Health Aides/Personal Care Aides to remember to use good communication skills and spend time listening to their patient and their families’ concerns. If they ever have a concern that person has developed a mental health issue, they should inform their supervisor. A patient may benefit from professional counseling and additional support as they learn to cope with their stressors and life changes.

Not having a strong support system or positive coping skills can negatively impact how a person copes with their physical disability and the stressors they face.Home Health Aides/Personal Care Aides can make a positive impact on their patient’s well-being by teaching them to use positive coping skills, listening to their concerns and feelings in an empathetic way, and using good communication skills. It may be helpful for the family of a patient to have someone such as a HHA/PCA to talk to about their worries, frustration, and concerns. If Home Health Aides/Personal Care Aides ever feel that the concerns of their patient or family are more than they can handle, or if they feel their patient would benefit from professional counseling, they should speak with their supervisor.

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Unit B: How the Home Health Aide/Personal Care Aide Can Help a Person with a Physical Disability

Home Care Goals for People with Physical Disabilities

Promoting Self-Care and Independence

In working with all people, it is important to promote independence. This is no different when working with people with physical disabilities. While they may have some limitations, such as not being physically able to walk or feed their selves this does not mean that a person with a physical disability is unable to be independent in all ways. Home Health Aides/Personal Care Aides should allow their patient with a disability to do all they can for themselves. They should not take over doing something just because they may be able to do it better or more quickly. Be patient and kind. Allow time for tasks to be completed and don’t rush the patient. When people feel they are working with someone who is patient and who gives them time to complete a task, they are more willing to try to do it themselves. This will give the patient a sense of independence and productivity. Never push a patient to do something they may not be able. This will only lead to a sense of failure and guilt.

Maintenance of Dignity and Self-worth

Caring for an adult with a physical disability is the same as caring for any other adult in the sense that they have the same basic needs. They need food, water, safety, love, a sense of belonging within their family and community, social interaction, and to develop a sense of independence and self-determination. Unlike other adults, they may require additional care. This care may be temporary or permanent. Due to their disability, they may not be able to do the same things as other adults, or the same things they once were able to do, such as live independently, go to work, or provide their own self-care. Or, they may be able to do many of these things, but need some additional support and to learn how to adapt with special equipment.

It is very important to remember that just because the adult may have impairments that they are not children. Even if they need to have complete care, they should be treated as an adult. Be respectful, courteous, and kind. Promote the patient’s dignity by being mindful of providing privacy, respecting confidentiality, including them in decisions, respecting their rights, and valuing their differences. Respect the patient’s physical space and be mindful of handling prosthetic devices carefully and seeking permission prior to pushing a person in a wheelchair. They should never be forced to go somewhere they do not want to. Remember that you are an important advocate for your patient’s rights.

Preservation of Normal Life Style

It is important to always remember to provide and assist the patient in having as normal a life as possible. This means working to support the patient’s physical, emotional, social, and spiritual needs. Home Health Aides/Personal Care Aides should seek ways to provide an environment in which their patient can be safely independent. Teach them to use adaptive and assistive equipment. Encourage them to complete tasks independently as much as possible. Provide encouragement and praise. Seek opportunities for the patient to socialize with others, to make choices, and to be as independent and self-reliant as possible.

Adults with physical disabilities also have sexual desires and needs, just like any other adult. Having a disability does not mean that they are incapable of sexual or emotional intimacy. People who have physical disabilities may need to make adjustments during sexual intimacy, but this does not mean that they are not capable of having sexual relationships and they do not desire them or have sexual feelings. Never make judgments or assume you know the sexual needs or behaviors of a person with a disability. Always be respectful of times needed for privacy.

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Role of the Home Health Aide/Personal Care Aide

The role of a Home Health Aide/Personal Care Aide will vary depending on the needs of the patient with a physical disability and their family. The Care Plan will direct them as to what their patient’s needs are and the tasks they are required to perform. Whenever in doubt about what they should be doing for their patient, they should seek guidance from their supervisor and ask for clarification. Remember that the patient’s needs and goals always come first. Help promote self-determination by encouraging them to set goals and helping them to achieve those goals.

For many patients, Home Health Aides/Personal Care Aides will assist with providing or assisting to provide self-care. The personal care skills learned in previous modules and in future modules in this course will all be used when working with a patient with a physical disability. This includes bathing, skin care and dressing, toileting, feeding, and assisting with ambulation or use of adaptive equipment.

Part of the job of a HHA/PCA while working with a person with a physical disability may be to help them learn to safely use adaptive equipment such as eating utensils and transfer devices such as wheelchairs or canes. This will help promote independence for the patient. Home Health Aides/Personal Care Aides should always keep in mind safety risks and work to provide a safe and clean environment for their patient. Ensure there are accessible routes for the patient in case of an emergency. If a patient’s home requires special adaptations to provide for the patient’s safety and independence, such as wheelchair ramps or safety bars in showers, speak with a supervisor about these needs.

Home Health Aides/Personal Care Aides will monitor their patient’s health as directed by the Care Plan. They may be asked to measure intake and output. They may assist with shopping, housekeeping and meal preparation for their patient. They may provide respite for the family or assist with child care. Using good communication skills is important and essential in doing the job well and meeting the needs of a patient. It will also be part of the job of Home Health Aides/Personal Care Aides to help teach patients who need help learning effective coping skills. Remember skills learned in how to be a good listener and demonstrate empathy for all patients and their families. Never assume you understand their individual experience. Allow them the space and time to express themselves.

As with all patients, an important part of the job of Home Health Aides/Personal Care Aides is to always be observing and documenting changes in physical, mental, emotional, or social health. Report any issues of concern to a supervisor immediately. Always document all observations and tasks completed. Be watchful of issues of concern in the home such as domestic violence, substance abuse, or child abuse. Report any concerns to a supervisor immediately.

Social, Cultural, and Environmental Influences in Caring for People with Disabilities

As we have discussed throughout this course, all people have different views of family, come from different cultures, and have different beliefs and values. Everyone has their own unique identities and we all have many parts to what makes us who we are. Regardless of whether the person has a physical disability, it is important to remember that all of these differences should be respected and valued. It is also important to keep in mind the unique physical limitations that a patient may have and what they mean to them. Home Health Aides/Personal Care Aides should never be judgmental about what a person can or can’t do. Remember to always see the person, and not the disability. Use terms the patient and family prefers when discussing physical disability and limitations. Don’t say things such as “He/she is crippled” or “He/she is disabled.” The patient is a person with a disability. Their disability does not define who they are. All it means is that the patient and the HHA/PCA may need to be creative in learning to adapt with any physical limitations. Focus on the word ability in the term disability.

Keep in mind that it may be more difficult for a person with a physical disability to access community resources due to physical limitations, and opportunities for socialization may be limited. They may also be concerned about going out in public with their disability and perhaps may be embarrassed by their physical limitations. While many people in our society are supportive of differences in others, there are some people who may make the patient uncomfortable with asking personal and intrusive questions about their disability, staring at them, or exclude them because of physical limitations. Home Health Aides/Personal Care Aides should provide support to their patient as they deal with their many emotions and help to teach others to accept differences we all have. Provide as many opportunities as possible for the person to interact with others and to remain an active member of their community.

Situations in Which People with Physical Disabilities May Require Home Care

A person with any type of physical disability, whether it is temporary or permanent, may benefit from home care. Home care services for a person with a physical disability are directed at helping the person meet their physical, emotional, and social needs. A person may have trouble performing activities of daily living (ADLs) independently. They may be unable to perform tasks such as bathing, dressing, toileting, or feeding themselves. They may be unable to transfer from a bed to a toilet or to safely get into the bath tub. A person with a physical disability may have difficulties with maintaining a clean home or shopping for and preparing food. A parent who has a physical disability may need assistance with child care for their children.

While some people may only need home care for a short time, such as while recuperating from an injury or surgery, other people may need home care throughout their lives to help them remain in their home rather than a long-term care facility. Dealing with the many stressors of everyday life, and as a result of their physical limitations, a person with a physical disability may require home care to provide the support they need. Home Health Aides/Personal Care Aides can help provide the emotional support the patient and family needs in addition to providing assistance with physical tasks such as transfers, meal preparation, household cleaning, and bathing.

Post-test

1. True or False: Physical disabilities may not only be due to developmental causes, and can occur at any time in a person’s life.
2. Which of the following are possible causes of physical disabilities? Select all that apply.
   1. Diabetes
   2. Motor vehicle accident
   3. Cerebrovascular accident (stroke)
   4. War-related injury
   5. Sports-related injury
   6. Traumatic Brain Injury
   7. Arthritis
   8. Work-related injury
3. True or False: Temporary disabilities are those a person only has for a short period of time until healing occurs, while permanent disabilities are those the person has throughout their entire lives.
4. True or False: Having a strong support system can help a person with a physical disability positively cope with stressors they face and adaptations they need to make in order to be as independent as possible.
5. True or False: People with physical disabilities experience a variety of emotions, including happiness, joy, anger, depression, and frustration.
6. Which of the following are adaptive equipment that a person with a physical disability can use to be as independent as possible? Select all that apply.
   1. Glasses
   2. Hearing aids
   3. Canes
   4. Walkers
   5. Wheelchairs
   6. Special shoes or boots
   7. Special writing and eating utensils
7. True or False: It is very important to remember that adults with disabilities, even those who require complete care are not children, and should be treated as an adult.
8. The HHA/PCA should keep in mind that disability does not define a person. All people should be treated as unique individuals with strengths and talents.

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Self-Check M7-1 Answers:

1. All of these choices are possible causes of physical disability.

FEEDBACK:

Physical disabilities may be congenital, as a result of an injury such as a motor vehicle or war injury, or may be as a result of a disease.

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Self-Check M7-2 Answers:

1. C

FEEDBACK:

A temporary disability is one that a person will have for only a short time. Fracturing (breaking) an arm or leg is an example of a temporary disability. Cerebral palsy, Muscular Dystrophy, and amputations are permanent disabilities that a person will have for their lifetime.

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Self-Check M7-3 Answers:

1. C

2. All of these are examples of adaptive equipment that may be used to help a person with a physical disability be as independent as possible.

FEEDBACK:

1. An artificial limb is an example of a prosthetic device. A prosthetic device is a specially made and fitted artificial limb or body part Wheelchairs, canes, special shoes for walking, and special eating utensils are examples of adaptive equipment.

2. Adaptive equipment is special equipment to help a person be as independent as possible. It can include special shoes, eating utensils, glasses, hearing aids, wheelchairs, and canes. Prosthetic devices are also considered adaptive equipment as they help a person to function more independently in their daily lives.

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Self-Check M7-4 Answers:

1. True

2. True

3. True

FEEDBACK:

1. Having a strong support system, which can include the HHA/PCA, family, friends, and people from the community can help a person with a physical disability cope with physical and emotional stressors within their lives.

2. People with physical disabilities may experience a variety of emotions, which can vary from time to time. HHA/PCAs should be observant of these changes in emotions and provide emotional support to the patient and family. If at any time, the HHA/PCA feels the patient and/or family would benefit from professional counseling, they should speak with their supervisor.

3. It is important for a HHA/PCA to always listen to a patient’s feelings and to help them use positive coping skills to help them better adapt to their situation and stressors.

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Self-Check M7-5 Answers:

1. False

2. True

3. False

FEEDBACK:

1. It is not okay to call a person “disabled” even if they do have a disability. Always use terms the patient and/or family prefers.

2. Patients regardless of disability or limitation should be provided with respect and privacy should always be maintained. For a person with a total disability who requires complete care, the HHA/PCA must remember that they are there to not only care for the patient, but to protect their privacy and dignity as well.

3. The HHA/PCA should encourage independence for all patients. This may mean that tasks will take longer than if the HHA/PCA completed the task on their own. It is okay to take extra time as this helps promote independence and positive self-esteem. This is an important task of the HHA/PCA.

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Post-Test Answers:

1. True

2. All are possible causes

3. True

4. True

5. True

6. All are adaptive equipment

7. True

8. True

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References

Johns Hopkins University. (n.d.). Physical disabilities. Retrieved from http://web.jhu.edu/disabilities/faculty/types_of_disabilities/physical.html

Leahy, W., Fuzy, J., & Grafe, J. (2013). Providing home care: A textbook for home health aides (4th ed.). Albuquerque, NM: Hartman.