Problems faced by individuals with physical impairments include poor muscle control, weakness and fatigue, difficulty walking, talking, seeing, speaking, sensing or grasping (due to pain or weakness), difficulty reaching things, and difficulty doing complex or compound manipulations (push and turn). Individuals with spinal cord injuries may be unable to use their limbs and may use "mouth sticks" for most manipulations. Twisting motions may be difficult or impossible for people with many types of physical disabilities (including cerebral palsy, spinal cord injury, arthritis, multiple sclerosis, muscular dystrophy, etc.).
Some individuals with severe physical disabilities may not be able to operate even well-designed products directly. These individuals usually must rely on assistive devices, which take advantage of their specific abilities and on their ability to use these assistive devices with standard products. Commonly used assistive devices include mobility aids (e.g., crutches, wheelchairs), manipulation aids (e.g., prosthetics, orthotics, reachers) communication aids (e.g., single switch-based artificial voice), and computer/device interface aids (e.g., eyegaze-operated keyboard).
Neuromuscular impairments include:
Skeletal impairments include joint movement limitations (either mechanical or due to pain), small limbs, missing limbs, or abnormal trunk size.
Some major causes of these impairments are:
Arthritis
Arthritis is defined as pain in joints, usually reducing range of motion and causing weakness. Rheumatoid arthritis is a chronic syndrome. Osteoarthritis is a degenerative joint disease. 31.6 million people in the U.S. suffer from rheumatic disease. The incidence of all forms of arthritis is now estimated at 900,000 new cases per year.
Cerebral Palsy (CP)
Cerebral palsy is defined as damage to the motor areas of the brain prior to brain maturity (most cases of CP occur before, during or shortly following birth). There are more than 750,000 in the US with CP (children and adults), and 15,000 infants are born each year with CP. CP is a type of injury, not a disease (although it can be caused by a disease), and does not get worse over time; it is also not "curable." Some causes of cerebral palsy are high temperature, lack of oxygen, and injury to the head. The most common types are:
Spinal Cord Injury
Spinal cord injury can result in paralysis or paresis (weakening). The extent of paralysis/paresis and the parts of the body effected are determined by how high or low on the spine the damage occurs and the type of damage to the cord. Quadriplegia involves all four limbs and is caused by injury to the cervical (upper) region of the spine; paraplegia involves only the lower extremities and occurs where injury was below the level of the first thoracic vertebra (mid-lower back). There are 150,000 to 175,000 people with spinal cord injuries in the US, with projected annual increases of 7,000 - 8,000. Nearly 47% of spinal cord injuries result in paraplegia; 53% in quadriplegia. Car accidents are the most frequent cause (38%), followed by falls and jumps (16%) and gunshot wounds (13%).
Head Injury (cerebral trauma)
The term "head injury" is used to describe a wide array of injuries, including concussion, brain stem injury, closed head injury, cerebral hemorrhage, depressed skull fracture, foreign object (e.g., bullet), anoxia, and postoperative infections. Like spinal cord injuries, head injury and also stroke often results in paralysis and paresis, but there can be a variety of other effects as well. Currently about one million Americans (1 in 250) suffer from effects of head injuries, and 400,000 - 600,000 people sustain a head injury each year. However, many of these are not permanently or severely disabled.
Stroke (cerebral vascular accident; CVA)
The three main causes of stroke are: thrombosis (blood clot in a blood vessel blocks blood flow past that point), hemorrhage (resulting in bleeding into the brain tissue; associated with high blood pressure or rupture of an aneurysm), and embolism (a large clot breaks off and blocks an artery). The response of brain tissue to injury is similar whether the injury results from direct trauma (as above) or from stroke. In either case, function in the area of the brain affected either stops altogether or is impaired.
Loss of Limbs or Digits (Amputation or Congenital)
This may be due to trauma (e.g., explosions, mangling in a machine, severance, burns) or surgery (due to cancer, peripheral arterial disease, diabetes). Usually prosthetics are worn, although these do not result in full return of function. The National Center for Health Statistics of the US Public Health Service estimated a prevalence of 311,000 amputees in 1970. An incidence of approximately 43,000 new amputations per year is estimated, of which 77% occur in males, and 90% involve the legs. 40% of amputations are above the knee, 50% are below the knee, and 10% are at the hip.
Parkinson's Disease
This is a progressive disease of older adults characterized by muscle rigidity, slowness of movements, and a unique type of tremor. There is no actual paralysis. The usual age of onset is 50 to 70, and the disease is relatively common - 187 cases per 100,000.
Multiple Sclerosis (MS)
Multiple sclerosis is defined as a progressive disease of the central nervous system characterized by the destruction of the insulating material covering nerve fibers. The problems these individuals experience include poor muscle control, weakness and fatigue, difficulty walking, talking, seeing, sensing or grasping objects, and intolerance of heat. Onset is between the ages of 10 and 40. This is one of the most common neurological diseases, affecting as many as 500,000 people in the US alone.
ALS (Lou Gehrig's Disease)
ALS (Amyotrophic Lateral Sclerosis) is a fatal degenerative disease of the central nervous system characterized by slowly progressive paralysis of the voluntary muscles. The major symptom is progressive muscle weakness involving the limbs, trunk, breathing muscles, throat and tongue, leading to partial paralysis and severe speech difficulties. This is not a rare disease (5 cases per 100,000). It strikes mostly those between age 30 and 60, and men three times as often as women. Duration from onset to death is about 1 to 10 years (average 4 years).
Muscular Dystrophy (MD)
Muscular dystrophy is a group of hereditary diseases causing progressive muscular weakness, loss of muscular control, contractions and difficulty in walking, breathing, reaching, and use of hands involving strength. About 4 cases in 100,000 are reported.