Physical Disability

Physical disability is a broad term that covers various health conditions, that affect a person’s functioning capacity across one or more domains such as movement, vision, hearing, dexterity or stamina. It can be temporary or permanent and has a substantial and long-term impact on a person’s quality of life – either making certain activities challenging or making the person dependent on others for their well-being or performing an activity. For some, the experience of living with a physical disability is quite pervasive, while for others it may be mild due to the nature of the disability and/or the support from their social environment.

According to the WHO, there are the following three dimensions of disability:

• Impairment: absence or significant difference in body structure or function, such as amputation of a limb, nerve damage, vision loss, arthritis, etc.
• Activity Limitation: difficulty in carrying out a task or action, like managing self-care tasks, problems in walking, etc.
• Participation Restriction: difficulty engaging in social or life situations, such as in social or leisure activities, obtaining education, getting healthcare services

There are various causes of a physical disability, which are grouped into the following two categories:

• Congenital or hereditary: The person has a physical disability since birth or due to problems caused during pregnancy or any accident/ injury during birth, or it develops later in life due to genetic issues, or problems with muscle cells.
• Acquired: Due to injury resulting from an accident or workplace hazard, a side-effect of other health conditions, spinal cord or brain injuries, etc.

Some of the predisposing factors that may result in physical disability are:

• Accidents: Research suggests that accidents cause less than ten per cent of physical disabilities. Examples are fractures, traffic accidents, occupational injuries, violent conflicts, etc.
• Diabetes: It increases the risks of developing heart disease, amputation of foot/legs, retinopathy which may result in blindness, kidney failure, peripheral neuropathy (pain in hands and feet from nerve damage), etc.
• Heart Disease: Heart conditions such as congenital heart defects may cause associated sensory impairments and atherosclerosis may result in the occurrence of a stroke or heart attack, resulting in the development of physical disability.
• Musculoskeletal problems: These affect the bones, joints and muscles, which may result in deformity or loss of limbs.
• Neuromusculoskeletal problems: These arise because of disorders, diseases or degeneration of the nervous system, due to which the person finds it difficult to perform controlled movements of affected body parts.
• Cancer: Cancer by itself can cause physical disability. Moreover, the side effects of its treatment such as radiation, chemotherapy and surgery may also cause physical disability.
• Poor socioeconomic status: Children from poor socioeconomic backgrounds are more likely to be malnourished and live in poor housing conditions, thereby increasing the risk of a physical disability.
• Age: risk of developing physical disability increases with age. Further, they are also likely to experience age-related health conditions earlier than usual.
• Physical deformities caused by other health conditions such as in the case of leprosy cured person.

The following are some of the common diseases causing physical disabilities:

• Arthritis: this presents as inflammation and pain in the joints. It has been estimated that arthritis limits the ability to work for pay for one in three adults suffering from arthritis.
• Cerebral Palsy: these are disorders which affect the person’s movement, coordination or balance. It is usually caused due to brain damage or abnormal brain development and may arise from a birth injury, jaundice or infection.
• Spina Bifida: In this condition, a baby’s spinal cord is not formed correctly, resulting in exposure of spinal nerves on the surface of the back due to gaps in the spine, instead of being inside the vertebrae column. People with this condition experience weakness in the legs, paralysis of the lower body, loss of bowel control or loss of bladder control, etc.
• Osteogenesis Imperfecta: Also called brittle bone disease, this condition is characterised by a small build with soft bones and deformed posture. The person experiences multiple fractures during their lifetime and may require crutches or a wheelchair for mobility.
• Muscular Dystrophy: In this condition, there is a progressive and irreversible loss of muscle mass and muscle weakness. It usually affects muscles around the neck, shoulders and hips. Its signs and symptoms include difficulty in walking, limited joint movements, trouble breathing or difficulty swallowing at later stages, etc.
• Poliomyelitis: Caused by the poliovirus, this affects the lower motor-neuron system and may result in weakness in the body and paralysis, which could even be fatal. While it can be prevented easily through the polio vaccine, the disease spreads through contaminated food or water or contact with an infected person. 
• Spinal Cord Injuries: When exposed to excessive pressure and/or loss of blood or oxygen supply, the spinal cord can get injured, resulting in paraplegia (partial or total damage to the motor and sensory functions below the chest) or quadriplegia (also called as tetraplegia, this refers to paralysis below the neck). 
• Acquired brain injury: This refers to the occurrence of a brain injury post-birth and can be caused by various factors such as stroke, drugs or alcohol, a cut-off of oxygen supply to the brain for a substantial time, trauma to the head, etc. The effect of brain injury depends on the severity of the injury and what part of the brain was involved. It can lead to trouble in problem-solving skills, vision loss, speech or hearing impairment, and restrictive physical movements. In some cases, it may also result in hemiplegia – i.e., paralysis of one side of the body where the motor and sensory functions of that side are affected.
• Epilepsy: This is a neurological condition which is characterised by increased electrical activity in the brain, resulting in periodic seizures. Seizures bring about unusual movements, and changes in behaviour and may even result in loss of consciousness. Some of the identifiable causes of epilepsy are structural abnormalities in the brain, brain injuries, brain infection, genetic factors, stroke, etc.
• Multiple Sclerosis: This condition is caused by damage to nerves due to erosion of their protective layer. It affects the person’s brain, spinal cord and optic nerves. It can result in various symptoms such as vision disturbances, fatigue, impaired motor control, pain, etc. This condition is lifelong and reduces the life expectancy of the person. 
• Dwarfism: An adult is considered a dwarf if they have a height of up to 4 feet 10 inches or less. In dwarfism, the average height is 4 feet. A person with dwarfism experiences a delay in developing their motor skills. Dwarfism is a physical disability but is not a disease.

A physical disability puts the person at greater risk for developing other health conditions, often called secondary conditions, such as:

• Mental health conditions, such as stress, depression
• Obesity due to reduced mobility
• Unintentional bodily injuries because of uncoordinated movements
• Suicidal thoughts
• Insomnia
• Loneliness
• Short-term or chronic pain
• Bowel or bladder issues
• Pressure ulcers due to long usage of wheelchairs or being bedridden
• Fatigue
• Flu-related complications like pneumonia

People with disabilities also experience certain co-morbid conditions such as heart disease, diabetes, high blood pressure, etc. Further, they may experience age-related health conditions earlier than usual because of the premature beginning of the ageing process. Behaviour-related issues such as alcohol and substance abuse or smoking, poor diet, and violence may also occur.

Symptoms of physical disability depend on the health condition one is affected with. General symptoms for a person with a disability are:

• Mobility: physical deformities, uncoordinated movements, inactive limbs
• Work Tolerance: Issues in standing, climbing or lifting due to, say, back impairment.
• Self-care: Not being able to take care of eating, dressing up, bathing, toilet, etc.
• Communication: Visual (low vision or blindness), hearing or speech impairments can result in significant loss of communication.

Further, there are signs for children that can help early identification of a potential physical disability. Some of these are as follows:

• Poor hand or finger coordination finds it difficult to pick objects
• Poor balance or stumbles frequently
• Has trouble voluntarily releasing objects
• Not able to place their hands in case of a fall
• Loose muscle tone and not able to hold their head up after about 3 months post-birth
• Has unusually tight muscle tone and refuses to sit up or bend the knees
• Do not reach for toys
• Is usually frustrated and calms down with difficulty
• Using only one hand

From a diagnostic perspective, the condition’s name or impairment is less important than the effect of the impairment on the person. What may be a physical disability for one person may not be for another, depending on the stage, severity, duration and type of impact of the health condition.

Physical disability is usually diagnosed by a primary healthcare provider or by a paediatrician in the case of young children. It involves taking a detailed history examination and investigation. A physical disability certificate is issued to the affected patient after a detailed discussion with a board of doctors who are specialists in the matter of disability.

Treatment options for physical disability depend on its exact type, cause and extent. In most cases, improvement is noted within a few starting years of the diagnosis. However, certain disabilities are progressive and the goal of treatment is to prevent further deterioration and maintain the condition as is.

The following programmes are helpful for a person with a physical disability:

• Rehabilitation programme: The goal is to help the person overcome the initial unstable conditions, assist them in learning to manage their condition confidently and thwart deterioration
• Physiotherapy: This involves aerobic exercises and/or electrotherapy which are customised to target relevant muscle groups, for improving cardiovascular functioning and strength and preventing regression into deformities. Some options for aerobic exercises are: swimming/water aerobics, wheeling oneself, wheelchair sports, rowing, etc.
• Speech Therapy: This is a specialised training and treatment programme aimed at improving communication skills.
• Occupational Therapy: This programme helps prepare the person to live successfully with their family and society. Through consistent practice, the person’s functional abilities and independent living skills are developed.

Certain physical disabilities cannot be prevented, especially those that are caused due to genetics or are hereditary. However, there are many physical disabilities whose occurrence or effect can be reduced using preventive efforts, which involve medical, educational and social strategies.

Preventive efforts are classified as:

• Primary prevention: Lessening the incidence of disability by eliminating risk factors. These efforts are aimed at the general population and typically include: care during pregnancy, post-birth care, immunization of newborns, etc.
• Secondary prevention: This is targeted toward a group of people most likely to suffer from physical disability. It also includes interventions to prevent impairments from occurring or permanently affecting the individual, such as lifestyle changes, counselling & educational programmes to help the person and their families cope with a physical disability.
• Tertiary prevention: This is implemented in case of the existence of a pathological condition, by promoting adjustment to the irremediable conditions and reducing any further complications or functioning loss. It depends on the early detection of conditions affecting a child’s development. Post-detection, the conditions are then treated using a combination of surgery, medication or diet. Consultations with specialists are also held to advise the parents/guardians on specific development or sensory issues. 

A person with a disability is also encouraged to eat nutritious food along with managing their body fat and remaining physically active.

Physical disability can be a devastating experience for a person, as they face severe prejudices and a lack of support from people. This is further compounded by the lack of infrastructure which is disabled-friendly, though there has been rising consciousness towards it, especially in urban areas. People with physical disabilities find their means of earning a livelihood on their own severely limited.

Early detection of physical disability helps manage the symptoms and depending on the condition, either reduce those to negligible or avoid fast progression. Physically disabled people are much more likely to develop secondary and co-morbid conditions, along with poor lifestyles which can be addressed through various therapeutic interventions.

Besides treatment, a person with a physical disability requires a lot of support from their loved ones to be able to successfully lead independent lives if their condition is not severely debilitating.