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Equipped for Inclusion: Report of the Strategy Forum: Equipment and Adaptations

Appendix 1: Terminology

Disabled and older people are often forced to live with the consequences of labels and definitions that are created by others and applied inappropriately. Stereotypes can be established, perpetuated and mishandled. The meanings of words can become confused. It is therefore important that we make it clear what we mean when we speak about disabled people and impairment. Consideration of the language that best captures this agenda for the future is required.

Medical model of disability

In what became codified as the International Classification of Impairment, Disability and Handicap [ICIDH] a three-tiered nomenclature was used to establish standard definitions rooted in a medical model, in which:

• impairment means lacking all or part of a limb, or having a defective limb, organ or mechanism of the body
• disability is the loss or reduction of functional ability
• and handicap is seen as the disadvantage or restriction of activity caused by disability

Impairment is a characteristic, feature or attribute of an individual that is long term and may or may not be the result of disease, injury or congenital condition. It may affect that individual's appearance in a way that is not acceptable to society, and/or affect the functioning of the individual's mind or body, either because of or regardless of society. It may also cause pain or fatigue, affect communication or memory and/or reduce consciousness.

Impairment can include an alteration in sensory perception. For example, it is possible for a person who has paralysis of a leg to deny that their leg exists; an inability to differentiate between hot and cold, sharp or blunt and other natural 'warning bells' can increase the risk of injury during many everyday tasks; a diminished sense of smell can result in an inability to detect a gas leak.

Someone with a severe communication impairment or limitation in their ability to make themselves understood via speech, writing, or whose ability to understand what others are saying or what is written, will be restricted in their ability to participate in information exchange via speech, writing or non-verbal means. They may also have impairment in specific functions such as attention, memory, perception, and language as well as in speech and voice, together with physical, motor and sensory impairments affecting their ability to compensate.

Researchers, writers and community activists [many of them disabled people] have worked to change this view of 'disability'. Their intention has been to shift the focus of attention from questions of medical and functional capabilities to an understanding of disability within a social model. As part of this effort there have been alternative definitions offered for some of the terminology used to discuss disability.

Social model of disability

Under a social model 'disability' is the disadvantage or restriction of activity caused by a society which takes little or no account of people who have impairments and thus excludes them from mainstream activity. Disability is therefore not the same as impairment. All equipment and adaptation services should be seen in this context.

Revised versions of the International Classification of Illness Disability and Handicap [ICIDH] categories have alternatives that suggest that:

• impairment is the lack of part of or all of a limb, or having a defective limb, organ or mechanism of the body
• disability is the loss or limitation of opportunities that prevents people who have impairments from taking part in the normal life of the community on an equal level with others due to physical and social barriers.

The Royal National Institute of the Blind [RNIB] had changed its terminology from 'visual impairment' to 'people with sight problems' to promote broader awareness to people who do not consider themselves visually impaired but who benefit from advice, information, equipment, etc.

Some groups representing disabled people have suggested the use of the term 'people with practical problems' rather than 'disabled', however this is not universally supported.

The Disability Discrimination Act

The Disability Discrimination Act 1995 [DDA] defines disability as: "A person has a disability for the purposes of this Act if he has a physical or mental impairment, which has a substantial and long-term adverse affect on his ability to carry out normal day-today activities."

The difficulty with this definition, for many disabled people and their organisations, is that it ties the so-called problems of disability exclusively to the impairments of individual people. The Disability Discrimination Act confuses 'physical or mental impairment' with 'disability', when the latter is really about questions of disadvantage and discrimination. This perpetuates a medical rather than a social model of disability. The 1995 Act is based upon understandings of disability formulated during the 1960s and 1970s.

Equipment and adaptations

Legislation and guidance have historically used the term 'aids', however reference to 'equipment' is increasingly preferred as a more acceptable alternative.

The term 'equipment' is generally used to describe products that are portable in nature, and that help someone to carry out an activity that they were having difficulty with or were unable to do. For example:

• a walking stick to provide support and security when walking
• a seat for the bath when it is difficult to get up and down
• a guard for a dinner plate to push food against when using only one hand

The term 'adaptation' is used where a change to the fabric of the building is required. For example:

• widening a door way so that a wheelchair can pass through
• fitting a second stair handrail to give extra support and reassurance
• taking the bath out and replacing it with a shower

However demarcations between the two are not always clear.

Occupational therapy

Within the context of community care there is a tendency for any reference to equipment and adaptations to be considered to be about the range of products and work provided by the local authority. These are usually assessed for and organised by occupational therapists [OTs] and support staff working with them. Because of this, equipment and adaptation services within local authority social work services are routinely referred to as 'occupational therapy' services. This tends to cause considerable confusion in relation to the potentially very different roles that occupational therapists perform in a wide variety of settings. Whilst core skills remain the same, interventions and expertise may be quite different.

Equipment and adaptation services involve a variety of professional disciplines working within a range of services and organisations, and although OTs have a key role to play in these services the two are by no means synonymous - a common misperception.

Alternatives

Rehabilitation technology is used to encompass wheelchairs and seating, prosthetics, orthotics, and environmental control systems, together with related developments in electronic assistive technology.

The Audit Commission report 'Fully Equipped' [2000] was criticised by organisations and groups representing people using services for using the term 'disability equipment'. The language was considered by some to be derogatory and the associated negative connotations a barrier to more people using such products. Preferences expressed included 'assistive technology' or 'equipment for independence'.

According to the Foundation for Assistive Technology [FAST] "Assistive Technology is a product or a service that enables independence". The scope of AT is therefore considerable, ranging from handrail and window catches to stair lifts, walk-in showers, environmental control systems and other applications of sensor technology also referred to as 'EAT' or electronic assistive technology. However, it is unlikely that 'assistive technology' would mean anything to the general population.

The Disabled Living Centres Council [DLCC] uses the phrase 'products for easier living' to refer to a group of products that have historically largely only been available through statutory services, following an assessment of need. They are increasingly acknowledged as not requiring any specialist knowledge to select or use them.

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