Question

Health promotion for the disabled patient is a critical factor in the maintenance of good health. Provide an in-depth discussion on why community resources that focus on health promotion for the disabled person are crucial. 150 words

Answer 1

The principle underlying this Call to Action is that, with good health, persons with disabilities have the freedom to work, learn and engage actively in their families and their communities. Health and wellness are not the same as the presence or absence of a disability; they are broader concepts that directly affect the quality of a person’s life experience. Health education can have a measurable impact on empowering people with disabilities to improve their own health. Among some people with disabilities, there is a belief that the emphasis in health care has been directed at the primary prevention of disability rather than at prevention or reduction of secondary health conditions in people who have a disability. A health education program for persons with Down syndrome would include an altered set of objectives. Secondary conditions often observed in this population include obesity, low physical fitness, and poor dental hygiene. The health education program should emphasize a greater volume of daily physical activity and improved nutrition to reduce body weight and good dental hygiene that includes brushing and flossing properly. Many health care professionals would agree that terms such as “wellness” and “health promotion” are often not associated with people with disabilities.

The vast majority of people with disabilities are not obtaining the recommended amount of physical activity needed to confer health benefits and prevent secondary conditions (e.g., heart disease, deconditioning, obesity, osteoporosis). A possible reason for this high level of inactivity may be linked to the number of actual and perceived barriers to exercise reported by people with disabilities. The two primary concerns were that fitness instructors would not know enough about their disability to develop a safe program, and that fitness centers would not have the type of equipment available that they would be able to successfully use. Unfortunately, most professional training programs in fitness and exercise science do not include coursework related to training people with disabilities, and most professionals are unfamiliar with ways to adapt fitness classes or instruct clients in using equipment properly.

Better nutritional habits are a major concern for most people with and without disabilities, there may be some specific differences in diet and nutrition guidelines pertaining to people with specific types of disabilities. Issues related to accessing healthy foods, determining food interactions with commonly used medications to control various secondary conditions (e.g., spasticity, pain, seizures, depression), and establishing specific requirements for food supplements (e.g., vitamins, minerals, fluid intake) are all major concerns among people with certain disabilities. For example, people with spinal cord injury (SCI) have a higher rate of bone loss after their injury, which increases their risk of osteoporosis. Dehydration in persons with neurological conditions (i.e., SCI, multiple sclerosis) is another area of concern. Individuals who catheterize themselves are often reluctant to drink large amounts of fluids because of the higher possibility of an accident (reflex bladder voiding), or because it will require them to perform more frequent catheterizations. Dehydration can lead to other medical problems (e.g., syncope, orthostatic hypotension, hyper/hypothermia) and increase risk of injury (e.g., falls). Additional concerns related to nutrition may involve recommended dietary allowances (RDA) for certain nutrients. Changes in diet may be necessary because of altered metabolism or the influences of prescribed medications. Certain medications can suppress or increase appetite, alter nutritional balance, and increase fatigue.

Changes in health care financing have been having an impact in recent years on the traditional ways of doing things. The old fee-for-service delivery system has largely been replaced by new managed care initiatives. Many hospitals and rehabilitation centers are trying to find ways to reduce costs while still trying to maintain quality. With the introduction of managed care, research has shown that rehabilitation services have declined dramatically. Shorter hospital stays usually translate into less rehabilitation. Where it was once common practice to keep a patient in the hospital for as long as necessary to achieve what health care professionals considered adequate recovery, the incentive in health care today is cost reduction by truncating or eliminating services. Patients no longer have the luxury of leaving the hospital when they are close to resuming a normal daily routine. Today, they are told that they must continue their recovery in another setting, often without the ancillary services that are needed to achieve good progress. One of the major reasons for this transformation in health care is the perception among members of the business community that it is much too expensive. Health care became a topic of great discussion and debate, and managed care, or managed competition as some people would call it, became the code words for reducing costs.

Many health care professionals, including physical therapists, have known for years that what is needed is not a larger-based hospital system, but rather a health promotion/disease prevention agenda that strikes at the core of the problem. Unfortunately, under the traditional system of health care in the United States, most of the financial resources are spent on diagnosing and treating disease, which leaves little or no remaining funds for health promotion. Only after all is said and done with the nondisabled community, do people with disabilities get any attention.

A collaborative effort on the part of federal funding agencies, health care providers, researchers, consumers, and advocates aimed at raising the level of awareness concerning the health promotion needs of people with disabilities is finally emerging. One of the major themes behind the independent living movement is inclusion and participation in all aspects of society, including the right to maintain good health.

Given the proper guidance and direction from rehabilitation professionals, fitness centers are poised to become the future centers of health promotion for people with disabilities.

The conceptual model of health promotion for people with disabilities which takes into account the strong need to establish linkages between rehabilitation facilities and community-based fitness centers in order to extend the recovery process into the community. Fitness centers, with their ambiance and health-oriented focus, have the potential to become a logical extension of the rehabilitation continuum by offering a location in the person's natural environment to continue the recovery process, as well as serve as a bridge to other health promotion activities that often take place at these centers such as nutrition seminars, relaxation classes, and health fairs.

As the continuum of rehabilitation moves further into the community, physical therapists will have a growing number of opportunities to serve as itinerant consultants to local fitness centers. When the need arises to develop an exercise program for a new client with a disability, the physical therapist would assist in developing the program and would serve as the liaison between the primary care provider and the fitness instructor. The therapist would also be available to provide direct care if an individual needed specialized physical therapy services. As shown in the conceptual model of health promotion presented, the physical therapist and the fitness professional would work closely in providing the safest and most effective programs for people with disabilities along the entire health promotion continuum.

For this model to be successful, however, 3 things must occur. First, fitness professionals must strengthen their skills in health promotion and disability. A lack of knowledge in these areas will make it difficult to communicate with physical therapists and other rehabilitation professionals when providing services to individuals with disabilities. Second, the rehabilitation profession must embrace the concept of extending its services into community-based fitness centers. A stronger relationship must be established between fitness professionals and physical therapists. Without the guidance and support of physical therapists, it will be difficult for fitness instructors to provide high-quality programs to people with disabilities. Physical therapists can enhance their visibility in community-based fitness centers by offering lectures at these settings so that fitness instructors become familiar with the local therapists and how they can be of assistance when developing programs for people with disabilities. Another way to bridge the relationship between therapy and fitness is to develop media-related materials that describe the role of physical therapists and how they can be of assistance to clientele who have a disability. This material can be disseminated to the managers of local fitness centers. Third, because very few people with disabilities have the financial resources to join a fitness center, Medicaid and Medicare, insurance companies, and managed care organizations must be willing to pay for the membership and the consultative services of physical therapists who would work alongside fitness professionals in delivering health promotion programs to people with disabilities. Although in an era of downsizing this may sound improbable, the independent living movement and the freedom of choice over a person's health may lend support to the concept of receiving services in the community. Because space has become a premium in many hospitals, we may also begin to see more and more therapists providing rehabilitation in community-based fitness centers.

As a result of the growing interest among federal funding agencies to improve the health of people with disabilities, the Centers for Disease Control and Prevention (CDC) recently funded several new projects to examine the health promotion needs of people with disabilities. The aim of these projects is to reduce secondary conditions in people with disabilities by reducing or eliminating barriers that prevent them from participating in health-promoting activities.

Health promotion for people with disabilities must become a major focus for the new millennium. In the long run, preventing secondary health conditions by empowering people with disabilities to take control of their own health will be more cost-effective, and certainly more humane, than watching people with disabilities decline in function from a lack of good health maintenance. Health care professionals should join in this collective effort to enrich the lives of people with disabilities.