Kenneth L. Robey

Self-structure in schizophrenia.

This study used a set-theoretical model to construct self-perception structures and person-perception structures for 10 recently hospitalized schizophrenic patients, 10 nonschizophrenic patients recently hospitalized for depression, and 10 nonpsychiatric subjects. Overall self-perception structures were significantly less elaborated in the schizophrenic patients when compared with either the psychiatric or the nonpsychiatric comparison group. No comparable differences were found for measures taken from the person-perception structures. The degree of elaboration of self in the particular context of self as psychiatric patient was found to be correlated (r = .74, p less than .01) with Global Assessment Scale ratings of current functional level in the schizophrenic group.

Modes and patterns of self-mutilation in persons with Lesch-Nyhan disease

Lesch-Nyhan disease (LND) is a rare X-linked recessive genetic disorder associated with cognitive impairment, choreoathetosis, hyperuricemia, and the hallmark symptom of severe and involuntary self-mutilation. This study examines data gathered from a survey of 64 families in the USA and abroad regarding the self-injury of their family members who have LND. The individuals with LND ranged in age from 1 to 40 years (mean 16 years 7 months, SD 11 years 2 months) and, with the exception of one, were males. The most common initial mode of self-mutilation, and the most frequently cited past or current behavior, was biting of lips and/or fingers. Other behaviors, in order of frequency, included head banging, extension of arms when being wheeled through doorways, tipping of wheelchairs, eye-poking, fingers in wheelchair spokes, and rubbing behaviors. Hierarchical cluster analysis identified patterns of association among the types of self-mutilation. Modes of self-mutilation in which external surfaces (such as a wheelchair component) served as instruments of self-injury tended to co-occur, as did biting of lips and fingers.

Desired educational outcomes of disability-related training for the generalist physician: knowledge, attitudes, and skills.

The problems adults with disabilities face obtaining quality primary care services are persistent and undermine national efforts to improve the health status of this group. Efforts to address this issue by providing disability-related training to physicians are hampered by limited information about what generalist physicians need to know to care for patients with disabilities. The authors consider the desired outcomes of disability-related training for generalists by exploring the contributions of the domains of knowledge, attitudes, and skills to patient-directed behavior and summarizing the empirical data.Because disability reflects a complex interplay among individual, interpersonal, institutional, community, and societal factors, generalist physicians can promote and protect the health of adults with disabilities by interventions at multiple levels. Thus, the authors use the social-ecological framework, an approach to health promotion that recognizes the complex relationships between individuals and their environments, to delineate the recommended knowledge, attitudes, and skills in the context of primary care. The importance of role models who demonstrate the three domains, the interactions among them, and issues in evaluation are also discussed. This clear delineation of the recommended educational outcomes of disability-related training in terms of knowledge, attitudes, and skills will support efforts to better prepare generalist physicians-in training and in practice-to care for adults with disabilities and to evaluate these training strategies.

Nursing Students' Self-Attributions of Skill, Comfort, and Approach When Imagining Themselves Caring for Persons with Physical Impairments Due to Developmental Disability

Fifty-two nursing students made self-attributions along a series of scales pertaining to skill level, comfort level, and interpersonal approach when imagining themselves providing care to an individual with no apparent physical disability, to a person who requires the use of a power-assisted wheelchair due to developmental disability, and to a person who requires the use of a power-assisted wheelchair and manual communication board. Factor analysis was used to reduce the self-attributional data to two dimensions: one reflecting perceived skill and comfort level, and the other reflecting the assumption of a rational versus intuitive clinical approach. Students attributed lower levels of skill and comfort to themselves, as well as a more intuitive approach, when imagining themselves caring for one who uses a power-assisted wheelchair, and to a greater extent, when imagining themselves caring for one who uses a wheelchair and a communication board, than for one without an apparent disability. Correlations of student age and number of years in nursing practice with self-attributions were investigated.

Structural Examination of Identity in an Individual with Severe Physical Disabilities

This paper explores the use of a structural modeling methodology in examining identity, particularly sources of disability-related identity, in an individual with severe physical disabilities. Free response self-descriptive data were obtained from an adult with spastic quadriplegic cerebral palsy who resides in a specialized school and hospital. These data were analyzed using a hierarchical classes algorithm. The resulting structural model is examined both with regard to the relative superordinance of specific disability-related identities and to the self-perceptual content associated with those identities. Research avenues that might benefit from the methodology are discussed.

Commentary: defining disability in health care education.

According to the 2008 American Community Survey, about 12% of the population of the United States is living with one or more disabling conditions. These conditions impact lives in a variety of ways, some with more or less direct impact on an individuals health and access to health care services. Although it has been 20 years since the passage of the Americans with Disabilities Act, people with disabilities still experience health disparities and a lack of access to the appropriate care. This commentary is part of a collection of articles that describe various aspects of incorporating content into the medical school curriculum to enhance the preparation of todays medical students to meet the needs of people with disabilities. The authors briefly describe the scope of the problem and define the population of people with disabilities that constitutes the focus of the work described in the other articles in this collection.