Managing symptoms in chronic disease: some dimensions of patients' experience

Providing a neuropsychology service for people with multiple sclerosis in an interdisciplinary rehabilitation unit

Multiple sclerosis (MS) is a chronic progressive disease with symptoms that are often difficult to interpret and distinguish from other neurological disorders. These symptoms are discussed together with psychological interventions, physical management and occupational therapies. A review of studies is presented as well as concepts for service provision for MS patients in the NHS. Finally, current practice in an interdisciplinary rehabilitation unit is discussed, and some recent advances in MS treatment are noted.

Disability, resources, role demands and mobility handicap

Research on disablement highlights a wide variability in the impact of disabling conditions on individuals' lives. However, in most of this work, the relationships between impairment/disability and features of individuals' social and physical environments are not specified conceptually. Recent conceptual work in the context of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) suggests that the impact of impairment/disability on individuals' lives is contingent on levels of resources and other aspects of social context. The research question addressed in this paper is whether selected social factors affect the impact of impairment/disability on mobility handicap, defined as 'the individual's ability to move about effectively in his/her surroundings'. Two types of social factors are considered: resources such as help from others or having a car available; and social role obligations such as having a job or visiting relatives. Data are derived from a 1986 probability sample of 570 individuals with disabilities living in communities in Calderdale, Yorkshire, England. Multiple-regression models indicate that the impact of walking disability on mobility handicap was reduced by availability of a car in the household and school or job obligations. Other impairments/disabilities, resources and social role demands examined did not act on mobility outcomes in this manner. Implications for conceptualizing and testing relationships between impairment, disability, handicap and social and physical environments are discussed. A critical task for future research is the investigation of personal and social resources and barriers that may moderate the impact of disability on individuals' lives.

Self-care and multiple sclerosis: a view from two cultures

The role of self-care in the management of chronic illnesses is essential to successful patient care. This paper compares and contrasts self-initiated self-care practices of 51 Danish and 35 American persons with multiple sclerosis at various levels of disability. Respondents were asked about ways they managed their symptoms and problems during periods of non-medical contact--including methods of following the medical regimen; alternative treatments; use of lay-referral systems; and, sources of information regarding physical, psychological, social, and environmental dimensions of coping with the illness. The two groups of respondents varied regarding adaptation strategies and primary sources of information used. The ultimate aim, however, of using these strategies was similar; to gain control over uncertainty, dependency, and physical and emotional decline. This study suggests that the empowering role of self-initiated self-care strategies in chronic illness may transcend differences in health care systems.

Disablement and the ideological crisis in health care

Disablement from chronic illness presents medicine with a constant reminder of the limits to its therapeutic effectiveness, and challenges the political legitimacy of Welfare States. In this regard, chronic illness forms a crucial component of the 'crisis' in health care. In this paper I look at the different ways in which disablement stimulates this crisis--for medicine, for political economy, and for disabled people themselves. In looking at responses to the crisis I detect a certain reluctance, or inability, to move away from an atomistic perspective which underpins much of our thinking on health and social policy, and much else besides. I conclude by arguing, against post-modern cynics, that a reasoned defence of the Welfare State requires a broader concept of self-sufficiency and a perspective which both acknowledges the need for help, and recognizes the extent to which the provision of help may further disempower the disadvantaged.