Return to Secondary Conditions Highlights
In general, the average number of
secondary conditions in one study of women with physical disabilities was 13
per woman, 5 of which were rated as severe or chronic.
Secondary
conditions have been defined as “Those physical, medical, cognitive, emotional,
or psychosocial consequences to which persons with disabilities are more
susceptible by virtue of an underlying condition, including adverse outcomes in
health, wellness, participation, and quality of life” (Hough, 1999, p.
186). Although some secondary conditions
can be prevented or decreased by a combination of health maintenance practices,
removal of environmental barriers, and improved access to effective medical
care, others are inevitable components of certain types of disabilities and can
be managed but not prevented. Some of the more common secondary conditions
include depression, hypertension, chronic pain, skin sores, fractures,
contractures, urinary tract infections, respiratory infections, unwanted weight
gain, excessive fatigue, and social isolation (Simeonsson & McDevitt, 1999
book).
The
health problems associated with aging
occur much earlier in women with physical disabilities than non-disabled women.
Women
aging with physical disabilities constitute one of the most seriously
disadvantaged and rapidly growing segments of the population of the
·
People
with physical disabilities, even those with severe physical disabilities, are
living longer lives and joining the rapidly growing population of persons aging
in the
·
Approximately
40% of women 65 years or older have at least one functional limitation. Thus,
aging with a physical disability is clearly a woman’s health issue.
·
National
data revealed that older women with three or more physical limitations differed
dramatically from women with no limitations in the following important ways:
o Social situation (e.g., less likely to
be married, more likely to be living alone),
o Health conditions (e.g., more likely to
have hypertension and depression),
o Socioeconomic position (e.g., less
likely to be employed, lower levels of education, more likely to be living in poverty),
and
o Access or utilization of health care
services (e.g., less likely to have private health insurance, less likely to
receive regular mammograms and pelvic exams).
·
Among
the challenges that exist for women aging with long-term physical disabilities
is the onset of new health problems and the increase in functional impairments.
o Persons with disabilities may
experience aging-related health conditions earlier than those without disabilities,
a phenomenon referred to as “accelerated aging”. Aging-related secondary
conditions may occur as early as the 30’s and 40’s, thus potentially adding to
the challenge of meeting mid-life role expectations.
o The secondary conditions experienced by
people aging with long-term physical disabilities are thought to be caused by
four factors:
§
Overuse
of an already weakened neuromuscular system (e.g., Turk, et al,, 1995).
§
Underuse
or misuse of the neuromuscular system as a result of problems with gait and
mobility or deconditioning (e.g., Krause, 1996)
§
Complications resulting from the original
injury, disease, or treatment received(Treischmann, 1987)
§
Poor
coping techniques and lifestyle behaviors
§
Environmental
and attitudinal barriers that limit access and/or opportunities for social
participation or health promoting activitie (e.g., DeJong, 1995;
o Women with physical disabilities
experience a number of specific secondary conditions that are believed to
worsen with age including: a) hypertension, b) nervous system disorders, such
as carpal tunnel syndrome, resulting from years of using manual wheelchairs, c)
respiratory problems that may become more life threatening with muscular
weakness, d) genitourinary problems resulting from years of infrequent
urination or bladder management programs, e) increased risk of pressure ulcers
due to thinning skin, and f) diminished physical and social functioning due to
increased muscle weakness. Other
examples of secondary conditions anticipated to increase in frequency or
severity with increasing age include: osteoporosis; endocrine disorders, such
as diabetes; pervasive fatigue; obesity or weight management difficulties; and
problems with immune function.
o Prevention of secondary conditions has
become a major public health goal incorporated into Healthy People 2010. Several
researchers have argued that the following are needed to reduce the risk of
aging-related secondary conditions:
§
Preventive
and assistive technology services provided at an earlier age,
§
Health
care providers who are more knowledgeable about aging-related health risks for
persons with disabilities,
§
Rehabilitation
services on a continual, as-needed, basis (not just post-acute phase), and
§
Accessible
health promotion programs.
·
Women
aging with long-term physical disabilities may need additional assistance from
family and friends as they age and potentially face increasing levels of
impairment; yet this increasing need may arise at the same time that sources of
support are aging and losing functioning themselves.
o Tangible support is often provided by
individuals of the same age or older who may be facing aging-related health
changes themselves. Informal care
assistance can be particularly problematic for women with disabilities because
they typically spend more years in a disabled state and are likely to spend
more of those years without a spouse.
Older women with physical disabilities are more likely than men to
report having unmet needs for personal assistance with activities of daily living,
and they also make up a far greater proportion of nursing home residents
o Women with physical disabilities are
more vulnerable to disruption in their social networks. Nearly a fourth of older women with moderate
to severe disabilities do not visit with anyone outside their household in a
typical week .
·
Although
there is a large literature on the development of physical disabilities late in
life, the literature on aging with a long-term physical disability is
relatively small.
o Current theories of aging do not
directly address the experience of persons aging with a long-term physical
disability.
o Researchers have often intentionally or
unintentionally excluded persons with physical disability from their
samples.
·
In
addition to the great need for research on women aging with long-term or
life-long physical disability, health promotion programs for women aging with a
disability are needed to help address the growing health needs of this
population. A few such studies have
recently been funded, including a NIDRR-funded health promotion program for
women with physical disabilities currently in progress at CROWD.
·
The
population of people aging with an early-onset physical disability is not
large, but the population is anticipated to grow and to have an impact on the
field of gerontology and the practice of aging service providers.
More (detailed)…
Although
arthritis is the most common primary
disabling condition among women, it is also a serious secondary condition that
can result, for example, from overuse of certain joints in walking with
crutches or pushing a wheelchair.
·
Arthritis
is one of the most common chronic health conditions in the
o It is a chronic disease affecting
synovial joints, particularly large weight-bearing joints.
o The incidence of osteoarthritis
increases with age with nearly 100% of both males and females showing signs of
osteoarthritis by age 75.
·
Osteoarthritis
is a secondary condition that commonly develops as people age with an
underlying primary disability. Like other secondary conditions, if left
undetected and untreated, it can result in secondary functional limitation or
disability.
·
In
one survey of secondary health conditions in women with physical disabilities,
66% reported experiencing a limitation due to arthritis in the past 3
months. In fact, arthritis ranked 2nd in terms of severity on a list of
43 secondary and other health conditions.
·
A
study conducted to determine which secondary conditions cause the most
limitation for persons with disabilities found that 42% of the persons surveyed
reported that arthritis had been a problem for them in the past year (arthritis
was not the primary condition). In this study, arthritis was 16th in a
list of 40 secondary health conditions in terms of severity.
·
Another
recent study of women with functional limitations reported that 37% indicated
that they experienced arthritis secondary to their primary disability.
·
Among
the causes of secondary osteoarthritis that have been identified are previous
rheumatoid arthritis, underlying orthopedic disorders or conditions affecting
normal mobility, and previous trauma.
·
Some
investigators working with persons with cerebral palsy or spina bifida have
discussed the contribution of microtrauma that occurs from walking on hips that
have abnormal biomechanics.
·
Among
persons with lower limb impairment, osteoarthritis of the upper extremities has
been associated with long-term manual wheelchair use.
·
Overweight
and obesity, known to be highly prevalent in women with physical disabilities,
are also known to contribute to osteoarthritis.
·
Osteoarthritis
as a secondary condition is anticipated to increase as people are living longer
with primary physical disabilities.
·
Treatment
of osteoarthritis as a secondary condition is important in order to relieve
pain and reduce additional disability, but prevention also needs to be
emphasized. While arthritis was not even
mentioned in earlier versions of Healthy
People, there are now a number of arthritis objectives, included an
objective related to prevention, in Healthy
People 2010. It could be argued that
prevention efforts are even more important for persons with life-long
disabilities who may experience the disabling effects of arthritis at an even
earlier age.
More (detailed)…
Circulatory problems, such
as swollen feet, are very common among women with mobility impairments.
·
Circulatory problems can be caused by a broad array
of disorders such as high cholesterol, high blood pressure, peripheral artery
and venous system disorders, vasomotor instability, varicose veins, deep-vein thrombosis, blood
clots, phlebitis, Raynaud's phenomenon, temporal arteritis as well as
atherosclerosis. These disorders can
create serious problems as secondary conditions among women with disabilities.
·
According to the preliminary findings of a study on
the cost of secondary conditions among women with physical disabilities
(n=443), the majority (60%) reported problems with circulation.
·
In a
recent survey of secondary health conditions in 443 women with physical disabilities,
60% reported experiencing a limitation due to circulatory problems in the past
3 months. In fact, these problems ranked 5th in terms of severity on a
list of 43 secondary and other health conditions.
·
Poor
circulation combined with immobility may put people more at risk for the
development of bed sores.
More (detailed)…
Women with physical disabilities have substantially higher rates
of depression than non-disabled
women.
More (general)… More (detailed)…
Although not as common as other conditions, diabetes is the most
troublesome secondary condition for women with physical disabilities.
·
Rates
of disability are substantially higher among persons with diabetes than among
persons without this disease.
·
One
study reported 65% percent of the people with diabetes attributed their
physical limitations to diabetes with 35% attributing their physical
limitations to other causes (diabetes as a secondary condition)
·
Preliminary
findings from another study found 30-35% of their sample of 443 women with
physical disabilities as having diabetes as a secondary condition.
·
Diabetes
is highly correlated with lack of mobility, potentially putting women with
disabilities at a higher risk for developing diabetes.
·
Another
study identified rates of physical limitations for people with diabetes as
higher among women than among men, and higher among blacks than among
whites. In 1996, 39% of person’s with
diabetes reported physical limitations when attempting major activities; 23%
reported being physically unable to perform major activities.
·
The
consequences of the coexistence of diabetes and disability include increased
use of health care services, unemployment, work absenteeism, and decreased
quality of life.
The most
common and troublesome secondary condition reported by women with
physical disabilities is fatigue.
·
Fatigue
is a secondary condition affecting many women with physical disabilities and
chronic health conditions. Fatigue was
the most frequently reported secondary condition endorsed by 78% of the women
with functional disabilities participating in one study.
·
Fatigue
can have a profound impact on the physical, psychological, and social
functioning of women with disabilities.
In one study, fatigue was found to account for 65% of the
disability experienced by participants with MS.
Fatigue can also lead to unemployment and is associated with
psychological distress, a sense of loss of control, and low positive
affect.
·
Despite
its prevalence and its profound impact on the population, fatigue has not been
well studied and has been virtually overlooked in some disabling
conditions.
·
Fatigue
is associated with a number of disabling health conditions, including MS,
systemic lupus erythematosus (SLE), postpolio syndrome (PPS), rheumatoid
arthritis, fibromyalgia, Parkinson’s disease, stroke, and numerous other
disabling conditions.
·
Among
women with MS, fatigue occurs even in those with mild disease and may be one of
the initial presenting symptoms.
Research has found a majority of patients with MS considered fatigue to
be either their worse or one of their worse symptoms.
·
Similarly,
a study on persons with SLE found a majority of participants described fatigue
as their most disabling symptom.
·
PPS
is another disabling condition in which fatigue is a nearly universal
experience. Some investigators have
argued that fatigue is the most commonly reported, most debilitating, and least
studied sequelae affecting polio survivors.
·
Although
similarities have been noted in mean fatigue scores across several disability
groups, the causes and triggers of fatigue may differ by disability type. For
example, fatigue in persons with MS appears to be exacerbated by heat and
mitigated by cool temperature more often than among persons with other
disabilities.
·
Fatigue
is a complex phenomenon that may result from a variety of causes, including
disease pathology, decreased muscle strength and endurance, overexertion,
comorbid conditions, environmental conditions, poor sleep, depression, and
anxiety.
·
Most
recently, investigators have begun differentiating physical and mental
components of fatigue. Because these two
components appear to have different correlates (e.g., only mental fatigue is
related to depression and anxiety), some have suggested that making such
distinctions can have implications for the treatment of fatigue, allowing
intervention strategies to be tailored to the type of fatigue experienced.
·
Treatment
for fatigue has lagged behind because of a lack of attention to this common,
debilitating secondary condition.
Recently, however, some investigators have begun to address the need for
effective treatment recommendations.
o A multidisciplinary approach to
treatment of fatigue has been recommended.
o With regard to MS, it has been
recommended that treatment begin with more cost-effective, nonpharmacologic
interventions, moving to pharmacologic treatment when fatigue is severe or when
individuals fail to respond to less costly strategies.
o Several drugs have been determined to
be effective in the treatment of fatigue in MS.
o Other strategies that may be helpful
include exercise, timed or scheduled periods of rest, making lifestyle
adjustments, improving one’s sleep, and avoiding heat exposure.
·
Despite
the fact that fatigue is such a common, debilitating secondary condition, there
remains a dearth of literature on the causes, consequences, and effective
treatments for fatigue secondary to a wide range of chronic disabling health
conditions. Some investigators attribute
this to the fact that health professionals have typically focused on specific
abilities without appreciating that people actually perform multiple tasks
concurrently and that their impact is cumulative over time. Clearly additional research is needed on this
phenomenon that has such a profound impact on the quality of life of women with
physical disabilities.
Although
women with physical disabilities are more likely to be overweight or obese,
have high blood pressure, and be less physically active than non-disabled
women, very little is known about their experiences with heart disease.
·
The
leading cause of death in women is coronary artery disease. Having a primary
disability does not exempt women from also acquiring heart disease. In fact it
may be more prevalent in this population.
However, women with disabilities may face additional difficulties getting
diagnosed and treated.
o
For
example, symptoms can be inappropriately attributed to the women’s disability,
and heart disease left under detected and untreated.
o
Additionally,
heart disease may cause increased functional limitation in women who already
may have severe limitations due to their primary disabling health conditions.
·
In
the preliminary findings of a study on secondary conditions, heart disease was
reported by 72 respondents in a sample of 443 women with physical disabilities.
·
Among
the 881 women responding to a national survey, 5% of women with physical
disabilities (n = 475) reported having heart disease, compared to only 2.5% of
the women without disabilities (n = 406).
·
Although
gender differences in risks for heart disease are rarely reported, some studies
have reported differences by disability type. For instance, in one study the
respondents with polio had more than twice the frequency of heart disease and
stroke compared to those with rheumatoid arthritis. Findings from another study
indicated that rheumatoid arthritis is associated with a greater risk for
cardiovascular disease than osteoarthritis.
·
No
research studies have been conducted on the prevention, risks, symptoms,
diagnosis, and treatment of heart disease in cross-disability samples of
women. Such research has the potential
to help improve the quality of life and health status of women with
disabilities nationwide.
·
Clearly,
there is a need for research studies designed to develop and evaluate heart
disease prevention and/or self-management intervention programs for women with
disabilities.
More (detailed)…
More
women with physical disabilities report being told by a medical professional
that they have high blood pressure than
do non-disabled women.
High
blood pressure is a major risk factor for heart disease and the greatest risk
factor for stroke and heart failure, and it can cause kidney damage. Problems
with high blood pressure constitute a major secondary condition for people with
disabilities. Although hypertension is found to be high in the general
population, it may be even more prevalent in women with disabilities.
·
Women
with disabilities commonly face problems with high blood pressure.
o According to the preliminary findings of
a survey on the health issues of women with physical disabilities (n = 386),
nearly 1 out of 4 women indicated that they had problems with
hypertension.
o Preliminary findings from another study
indicated that more than half (56%) of a sample of women with physical
disabilities (n = 443) reported problems with blood pressure.
·
In one analysis of population-based data, hypertension was more
frequently reported by women with functional limitations in all age groups than
among women without functional limitations.
·
Another
investigation of functional limitations of women at midlife revealed that women
with substantial limitations were three times more likely to report high blood
pressure than those without limitations.
·
The
National Heart, Lung, and Blood Institute provides clinical practice guidelines
for the prevention, detection, and treatment of high blood pressure.
·
Research
is needed to develop and evaluate prevention and self-management programs for
hypertension among women with disabilities.
More (detailed)…
Little
is known about how the symptoms of menopause
differ in women who have had mobility limitations most of their lives compared
with non-disabled women.
More (detailed)…
Osteoporosis occurs
much earlier and is more severe in women with mobility limitations than in
non-disabled women.
Preliminary studies clearly indicate
that low bone mass---specifically osteopenia and osteoporosis---is common in
women with disabilities by peripheral bone mineral density (BMD) screening.
Further, the findings indicate that women with disabilities do not receive
recommendations for diagnostic testing of the spine and hip and, as a result,
receive no therapy to prevent or treat osteoporosis. These findings suggest
that health care providers, including primary care providers and specialists,
are unaware of the prevalence of low bone mass and risk for osteoporosis and
osteoporotic fractures in women with disabilities. Moreover, these findings
suggest that the osteoporosis risk factors for women with disabilities are
either unknown or ignored.
Risk
factors associated with osteoporosis and osteoporotic fractures in these
studies of women with disabilities have included low BMD, steroid use, and
inadequate dietary intake of vitamin D, in addition to immobility, impaired
balance and coordination, and lower extremity weakness. There is little
information about the risk factors for osteoporosis in women across disabilities
or clinical predictors that could be used to identify women with severe
disabilities who would be candidates for osteoporosis treatment.
Overweight and obesity are
significantly more common among women with physical disabilities than among
non-disabled women.
Pain is a common secondary condition
in women with spinal cord injury, multiple sclerosis, stroke, and post-polio.
·
Chronic
pain has been found to impact functioning and complicate disability on many
levels.. Although more research is
needed, the following information summarizes what is known about the prevalence
and effects of chronic pain on women with disabilities or on interventions that
may help:
o Preliminary findings from one study on
women with physical disabilities reported at least an 80% prevalence rate for
pain as a secondary condition for each of the following disabilities: spinal
cord injury, spina bifida, post polio, cerebral palsy, neuromuscular disorders,
and traumatic brain injury. In addition,
67% of women with multiple sclerosis reported problems with pain.
o In one qualitative study, people with various physical disabilities
(spinal cord injury, acquired amputation, and cerebral palsy) described pain as
part of daily living that influences their lifestyle decisions. Pain was further described as being
experienced in multiple locations, with distinct sensations, and different
implications. Pain was also described as
very personal with little understanding from family and friends.
o A qualitative study of 18 women with physical
disabilities found that pain comprised one of the major factors that impeded
the ability of the women to engage in health-promoting behaviors.
o Another study found that women with
functional limitations due to a variety of chronic conditions averaged 12
secondary conditions in the past year.
These included, fatigue, immobility, physical de-conditioning,
spasticity, and joint pain,, followed by depression, chronic pain, access
problems, weight problems, and isolation. These secondary conditions were also
found to adversely affected health status and quality of life for women with
physical disabilities.
·
Little
research has examined the psychosocial impact of pain specifically on women
with disabilities. However, some
research has been conducted on pain as a secondary condition in people with
disabilities (majority male).
o At a physiological level, chronic pain
promotes a stress response characterized by fatigue, neuroendrocrine
dysregulation, dysphoria, myalgia, and impaired mental and physical performance
which can foster negative thinking and create a vicious cycle of stress and
disability.
o Most pain research has been on people
with spinal cord injuries. Results show:
§
Pain
has been found to result in psychological distress and limitations in activities
above and beyond the impact of spinal cord injury.
§
One
study found psychosocial factors (but not physiological factors) to be
associated with pain severity among people with spinal cord injuries.
§
Numerous
studies on people with chronic pain have found catastrophizing to be associated
with increased pain and physical and psychological dysfunction. Catastrophizing is ---(how study defines
it?) One study conducted on people with
chronic pain associated with spinal cord injury (30% women) found catastrophizing
to be significantly related to greater pain intensity, psychological distress,
and pain-related disability.
·
Pain
treatments should be evaluated for the efficacy with specific
disabilities. In some cases, medication
may be contraindicated.
o Medication to treat pain among people
with disabilities can be problematic due to complications with medication for
the underlying disability.
o Many practitioners support intensive
multidisciplinary (holistic – treating body, mind, and spirit) treatment
approaches for pain and found this biopsychosocial approach to be the most
successful (Gonzales et al., 2000; Guzman et al., 2001). However others still hold to a biomedical
perspective, focusing only on medical interventions, such as ---.
o Aromatherapy has been suggested as a
treatment for pain for people with multiple sclerosis.
o Cognitive-behavioral therapies have
proven to be effective treatment for people with chronic pain in general, and
research has begun focusing on this treatment for pain among people in which pain
is a secondary condition or a symptom of their primary disability. To date no studies have addressed the gender-
and disability-specific needs related to pain among women with disabilities.
§
Increased levels of self-efficacy or belief in one’s
ability to cope are associated with reduced levels of pain. Cognitive-behavioral stress
management training has been shown to reduce pain and other factors indirectly
via changes in self-efficacy, coping, and helplessness.
§
It
is clear that a pressing need exists for the development and evaluation of a
pain self-management intervention for women with disabilities, focusing on
cognitive-behavioral strategies such as self-efficacy and active coping
techniques.
More (detailed)…
Respiratory problems create a
serious secondary condition for women with disabilities causing problems that
can result in morbidity and/or mortality.
·
One study
on secondary conditions among women with functional limitations found 18.8% of
their sample to identify respiratory problems as a secondary condition.
·
Respiratory
muscle weakness in multiple sclerosis is usually described in the advanced
stage of the disease and accounts for majority of fatalities. However, it may also occur earlier during
relapse episodes and can also contribute to fatigue and increased sense of
effort.
·
Respiratory
complications are frequent in patients with acute cervical spinal injury
(CSI). Findings from one study suggested
that the number of respiratory complications experienced during the initial
acute-care hospitalization for CSI is a more important determinant of length of
stay and hospital costs than level of injury.
·
As this
population ages, we can anticipate an increasing need for rehabilitation
hospitals that specialize in respiratory care.
·
Home
mechanical ventilation (HMV) is known to be a successful therapy for chronic
respiratory insufficiency, with regard to long-term survival and has
demonstrated improvement in quality of life among people with neuromuscular
disorders and skeletal deformities (ie, restrictive lung disease) receiving
HMV. Participants receiving HMV reported good perceived health, despite their
severe physical limitations.
Many
women report sleep disturbance
resulting from weakened breathing muscles, pain, or overweight.
A
total of 265 (60%) of the 443 women who were enrolled in a year-long study of
secondary conditions in women with physical disabilities reported that sleep
disturbance had been a problem in the past three months. This prevalence is much greater than the
approximate 33% found in the general population in this country.
·
Sleep
disorders and disordered sleep are highly prevalent among the general
·
Women
with disabilities may experience sleep disturbances as a result of being
disabled and female. First, sleep
problems constitutes a common secondary condition among people with activity
limitations. Moreover, sleep disturbance is more common among females compared
to males in the
·
Various
research studies have reported sleep
disturbance by:
o 34% of persons with spinal cord injury,
o 75% of those with rheumatic disease,
o 42% with sleep-disordered breathing in
neuromuscular disorders, including post-polio syndrome, and
o 57% of a cross-disability group of
women.
·
Psychosocial
factors, not organic disease per se, are believed to contribute significantly
to sleep complaints in people with paraplegia due to spinal cord injury,
musculoskeletal (rheumatic) disease, and other physical disabling conditions.
·
The
cause of sleep disturbance associated with primary disabilities ranges from:
o Primary sleep disorders such as apnea
or narcolepsy,
o Secondary to psychiatric conditions such
as depression or anxiety, or
o Medical complications such as impaired
breathing, medication side effects, or frequent urination.
·
Regardless
of its cause, chronic sleep disturbance may exacerbate daytime functional
limitations, produce excessive daytime sleepiness and fatigue, lead to
secondary injury from traffic accidents and falls, increase chronic pain, and
promote emotional distress.
·
Sleep
disturbance in multiple sclerosis is associated with various factors such as
leg spasms, pain, immobility, and medication.
·
People
with spinal cord injury also commonly have periodic leg movements and sleep
apnea.
·
Research
is needed to understand and ameliorate sleep disturbance and other secondary
conditions among women with disabilities.
More (detailed)…
Women
with physical disabilities have substantially higher rates of stress than non-disabled women.
More (general)… More (detailed)…
According
to one report, alcohol and other drug
abuse disorders tend to increase as functional
limitation becomes more severe among women with disabilities.
More (general)… More (detailed)…
Weakness is a symptom of many
primary disabling conditions, such as neuromuscular disorders or paralysis, but
it is also a common condition secondary to arthritis in women.
Many women with physical disabilities
experience problems with weakness.
·
According to a study involving interviews on definitions and
meaning of health for women with physical disabilities, those whose disabling
conditions were relapsing and remitting or degenerative tended to define health
in terms of conditions that affect functioning, such as weakness, pain, or
energy level.
·
In one survey of 443 women with physical disabilities, 63%
reported experiencing a limitation due to weakness in the past 3 months. In fact, weakness ranked 9th in
terms of severity on a list of 43 secondary and other health conditions.
·
Weakness impacts a woman’s health promoting behaviors, such
as exercise and healthy diet. For
example, it may prevent some women from cooking or limits what they can cook to
only those foods and cooking utensils they can lift or manipulate.
·
Weakness is a critical issue for many women with physical
disabilities. Again, women with
postpolio are at risk of developing overuse weakness when exercising the
muscles most severely affected by the syndrome.
o It is important that
persons with postpolio are provided effective and accessible exercise programs
that will offer the benefits of conditioning without risking additional muscle
damage. Systems are being developed for
physicians and therapists to help persons with polio use muscles that are least
affected while resting the muscles that are continuing to weaken.
o
Overuse
weakness is common among people with late onset manifestations of polio, and it
is important that slowly progressive non-fatiguing exercise becomes as part of
their rehabilitation.
More (detailed)…
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