PERSONS WITH DISABILITIES CHAPTER 36 Legislation for disabled

PERSONS WITH DISABILITIES CHAPTER 36

Legislation for disabled persons • A. Discrimination in the workplace – 1. US. Vocational Rehabilitation Act of 1973, Section 503 • a. requires employers with federal contracts over $2500 to take affirmative action in employing and advancing qualified disabled employees. – 2. The law helps prevent discrimination

B. Physical Barriers to Independent Living – 1. Americans with Disabilities Act of 1992 • a. mandates universal changes nationwide – 1) barrier free design – 2) telecommunication systems for sensoryimpaired people » a) facilitates human needs for responsibility and freedom from health risks » b) continuous sequence – all aspects of the design are interrelated without limiting the use of any parts of the facility

C. Urban Mass Transportation Act of 1974, Section 16 – 1. Disabled and elderly people have the same rights as others to use mass transportation facilities and services – 2. requires that federal programs providing assistance in mass transportation support these rights by building accessible transportation services

Objective #1 • Dental Hygiene Student will: • Identify barriers to healthcare for clients with disabilities

Barriers to Healthcare • A. Cost – 1. primary barrier • B. Attitudes of Health Professionals – 1. fear and conflicting personal values may make an individual avoid treating the disabled • C. Client factors – 1. Oral care is frequently the lifeline for the disabled – 2. self esteem • a. physical positioning may

Objective #2 • Dental Hygiene Student will: • Explain how stereotypes and public attitudes affect the acceptance of physically and mentally challenged persons

Objective #3 • Dental Hygiene Student will: • Design a dental hygiene care facility that meets the federal barrier-free design standards for accessibility

Objective #3 • In groups of 3 or 4 describe what a dental facility should be like to meet the human needs of the disabled (be specific) • Use pg. 766 as guide

Objective #4 • Dental Hygiene Student will: • Contrast disability and handicap by definition and example • I. Disability – a condition that is either permanent or semi permanent and that interferes with an individual’s ability to don something independently

Disability • A. person is different because of trauma, birth defects, accidents, or disease – 1. may be physical, mental, or psychological

Handicap – the feeling a person may have regarding adequacy of performance either generally or under a particular circumstance

Objective #5 • Dental Hygiene Student will: • Identify positive and negative portrayal issues associated with persons with special needs

I. Negative Portrayals • A. A person is not a disability: the patient is a person who has a disability (be careful of wording) • B. Emphasizing the disability without a reason should be avoided. Try not to call attention to the disability unnecessarily

I. Negative Portrayals • C. Sensationalizing goal attainment implies that the patient was a victim. • D. Sensationalizing terms imply a false level of dependency • E. Patients with disability may not be sick

Objective #6 • Dental Hygiene Student will: • Distinguish between congenital, developmental, and acquired disabilities

Classification of Disabilities • A. Physical or mental impairment that substantially limits one or more life activities such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.

Classification of Disabilities • B. has a record of such an impairment that limits major life activities • C. is regarded as having such impairment

Developmental disabilities • A. one that occurs congenitally or during the developmental period of life (birth to 22 yrs) • B. chronic, continue throughout life, appear as mental, physical, or combined impairments

Acquired disabilities • A. occurs after age 22 yrs or is caused by disease, trauma, or injury to the body – 1. spinal cord paralysis from injury – 2. limb amputation because of disease – 3. limitations in range of motion from arthritis

Objective #7 • Dental Hygiene Student will: • Describe assistive devices for activities of daily living • I. Walking devices • II. Prosthetic devices • III. Assistive listening devices – A. close proximity or incorrect placement of the hearing aid may cause it to squeal • 1. high speed or ultrasonic may initiate this response

Aids for the visually impaired • A. Blind patient should be greeted by grasping hands of RDH • B. Have patient place non dominant hand on your elbow so you can lead • C. Give specific oral directions as you walk • D. Describe location of items in operatory

Aids for the visually impaired • E. patients may prefer canes or guide dog – 1. dog can come in operatory – 2. dog should be able to see patient

Assistive Speaking Devices • Can create sounds that mimic normal speech patterns for persons who have had surgical removal of the larynx and cannot make sounds from the throat. – Electronic speech devices – held against the throat detect vibrations of air passing through the throat as the person mimics normal speech

Assistive Devices for Paralyzed Persons A. Elimination devices • 1. care must be taken when moving patient not to pinch catheter

Assistive Devices for Paralyzed Persons – B. Communication devices • 1. mouthstick used mainly for communication – a. typing on a keyboard – b. pushing telephone buttons » 1) may cause occlusal trauma and accelerate existing periodontal disease » 2) may contribute to: » a) muscle fatigue » b) oral tissue trauma from inserting the stick » c) difficulty with inserting » d) unpleasant taste » e) TMJ discomfort » f) gagging

Assistive Devices for Paralyzed Persons • see pg. 772 “key considerations in the fabrication of a mouthstick appliance” • Assistive devices for Protection and Oral Function – 1. custom mouth protectors

Objective #8 • Dental Hygiene Student will: • Assess range of motion, grip strength, and finger closure when designing oral hygiene assistive devices

Objective #8 • I. Client Assessment – A. Range of motion • 1. assess ability to reach mouth – B. Grip strength • 1. arthritis and neuromuscular disorders experience difficulty holding a device that is too narrow or small – C. Skill level • 1. watch patient brush – D. ability to understand follow directions

Objective #8 • I. Client Assessment F. Assess the current oral status and selfcare techniques the range of opening of the mouth, and the activity of the oral musculature, especially the tongue. G. if caregiver is to provide OH homecare then that person must be educated and assessed

Objective #8 • Dental Hygiene Student will: • Assess range of motion, grip strength, and finger closure when designing oral hygiene assistive devices

Objective #8 • II. Customizing Oral Self-Care Devices – See figure 36 -5 pg. 774 – A. made of light weight, readily available, inexpensive material and easily constructed • 1. plastics are preferred because they resist water damage and are easily cleaned • 2. interchangeable parts • 3. ease of use and minimal set up time

Objective #9 • • I. II. Dental Hygiene Student will: Stabilize a patient during wheelchair transfers and professional care May need restraint or support devices, may need mouth prop See table 36 -4 pg 775

Wheelchair transfer Transferring from wheelchair to dental chair • 1. Assess patients ability to participate with the transfer • 2. determine level of coordination and balance • 3. it is not recommended that the patient be transferred by the clinician alone – a. see procedure 36 -2 pg. 778