IMPAIRMENT, DISABILITY & HANDICAP

The World Health Organisation introduced a useful way of thinking about the effects of disease with three terms – impairment, disability and handicap.

Impairment

Disease can impair the body for example in type II diabetes the body’s ability to deal with glucose in the blood stream is impaired.  In atherosclerosis, the basic disease process causing both heart attacks and strokes, including vascular dementia, the lining of the blood vessels is impaired.  The issue about impairment is that it may not result in any change that is noted by the person affected.  If the person notices a change, a symptom such as pain or a reduction in ability the term disability is used.

Disability

Some people, for example people with a mild degree of Parkinson’s disease,  at first may not notice any effect on their ability but almost always Parkinson’s disease causes disability and, as the term suggests this means loss of ability to walk or to stand or to bend elbows or to bend knees to give examples of different types of disability.

Handicap 

Sometimes the disability is relatively unimportant.  If for example the person develops a disability that makes it impossible for them to go upstairs but they live in a ground floor flat then they are not handicapped.  If on the other hand the same person lived in a house that only had an upstairs toilet, they would have developed a handicap which would have a social impact because they would become dependent on others. 
​ 

• The job of doctors and nurses is to minimise impairment
• The job of physiotherapists and teams of rehabilitation workers is to minimise disability, in addition we now know that the most important person involved in minimising disability is the person called the patient. What happens after the onset of a disabling condition is that the person may become even less active than they were before.  Sometimes this is a result of the impairment.  It is more difficult for someone with arthritis of the knee to be as active before they developed arthritis.  Sometimes however the effect is due to other people becoming anxious or concerned which leads them to be overprotective sometimes called “care”. We now know that if a long term condition is diagnosed the person should be prescribed activity therapy as well as drug therapy, what is called social prescribing.  If they develop another disabling condition the amount of activity prescribed may be increased but here, we are not talking about intensive gym work necessarily but activities like yoga, Pilates and tai chi.  
• Finally when disability has been minimised both by the intervention of physiotherapists and rehabilitation experts and by work done by the individual who has been affected occupational therapists have a vitally important part to play in minimising handicap not simply by providing aids and house adaptations but by helping the person identify ways they can solve crucially important problems like getting dressed independently or getting to the toilet in time.