| Neonatology
Examples to illustrate the differences among the terms
"impairment," "disability," and "handicap."
1. CP example: David is a 4-yr.-old
who has a form of cerebral palsy (CP) called spastic diplegia.
David's CP causes his legs
to be stiff, tight, and difficult to move. He cannot stand
or walk.
Impairment: The inability to move the legs easily
at the joints and inability to bear weight on the feet is an impairment.
Without orthotics and surgery to release abnormally contracted
muscles, David's level of impairment may increase as imbalanced
muscle contraction over a period of time can cause hip dislocation
and deformed bone growth. No treatment may be currently
available to lessen David's impairment.
Disability David's inability to walk is a
disability. His level of disability can be improved with
physical therapy and special equipment. For example, if
he learns to use a walker, with braces, his level of disability
will improve considerably.
Handicap David's cerebral palsy is handicapping
to the extent that it prevents him from fulfilling a normal role
at home, in preschool, and in the community. His level of
handicap has been only very mild in the early years as he has
been well-supported to be able to play with other children, interact
normally with family members and participate fully in family and
community activities. As he gets older, his handicap will
increase where certain sports and physical activities are considered
"normal" activities for children of the same age.
He has little handicap in his preschool classroom, though he needs
some assistance to move about the classroom and from one activity
to another outside the classroom. Appropriate services
and equipment can reduce the extent to which cerebral palsy prevents
David from fulfilling a normal role in the home, school and community
as he grows.
2. LD example: Cindy is an 8-year-old
who has extreme difficulty with reading (severe dyslexia). She
has good vision and hearing and scores well on tests of intelligence.
She went to an excellent preschool and several different special
reading programs have been tried since early in kindergarten.
Impairment While no brain injury or malformation
has been identified, some impairment is presumed to exist in how
Cindy's brain puts together visual and auditory information.
The impairment may be inability to associate sounds with symbols,
for example.
Disability In Cindy's case, the inability
to read is a disability. The disability can probably be
improved by trying different teaching methods and using those
which seem most effective with Cindy. If the impairment
can be explained, it may be possible to dramatically improve the
disability by using a method of teaching that does not require
skills that are impaired (That is, if the difficulty involves
learning sounds for letters, a sight-reading approach can improve
her level of disability).
Handicap Cindy already experiences a handicap as
compared with other children in her class at school, and she may
fail third grade. Her condition will become more handicapping
as she gets older if an effective approach is not found to improve
her reading or to teach her to compensate for her reading difficulties.
Even if the level of disability stays severe (that is, she never
learns to read well), this will be less handicapping if she learns
to tape lectures and "read" books on audio tapes.
Using such approaches, even in elementary school, can prevent
her reading disability from interfering with her progress in other
academic areas (increasing her handicap).
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