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Disability
A disability is a condition or function judged to be significantly impaired relative to the usual standard of an individual or group. The term is used to refer to individual functioning, including physical impairment, sensory impairment, cognitive impairment, intellectual impairment, mental illness, and various types of chronic disease.

Disability is conceptualized as being a multidimensional experience for the person involved. There may be effects on organs or body parts and there may be effects on a person's participation in areas of life. Correspondingly, three dimensions of disability are recognized in International Classification of Functioning, Disability and Health (ICF): body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restrictions.) The classification also recognizes the role of physical and social environmental factors in affecting disability outcomes.

The ICF is World Health Organization's (WHO's) framework for measuring health and disability at both individual and population levels. The ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001(resolution WHA 54.21). Unlike its predecessor, which was endorsed for field trail purposes only, the ICF was endorsed for use in Member States as the international standard to describe and measure health and disability.

The ICF puts the notions of "health" and "disability" in a new light. It acknowledges that every human being can experience a decrement in health and thereby experience some degree of disability. Disability isn't something that only happens to a minority of humanity. The ICF thus "mainstreams" the experience of disability and recognizes it as a universal human experience. By shifting the focus from cause to impact it places all health conditions on an equal footing allowing them to be compared using a common metric – the ruler of health and disability. Furthermore ICF takes into account the social aspects of disability and doesn't see disability only as a "medical" or "biological" dysfunction. By including Contextual Factors, in which environmental factors are listed ICF allows to records the impact of the environment on the person's functioning.

The Medical Model

The medical model is presented as viewing disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals. In the medical model, management of the disability is aimed at a "cure," or the individual’s adjustment and behavioral change that would lead to an "almost-cure" or effective cure. In the medical model, medical care is viewed as the main issue, and at the political level, the principal response is that of modifying or reforming healthcare policy.

The Social Model

The social model of disability sees the issue of "disability" as a socially created problem and a matter of the full integration of individuals into society. In this model, disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Hence, the management of the problem requires social action and is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life. The issue is both cultural and ideological, requiring individual, community, and large-scale social change. From this perspective, equal access for someone with an impairment/disability is a human rights issue of major concern.

The Market Model

The market model of disability is a new model that builds on the social model in recognizing people with disabilities and their Stakeholders represent a large group of consumers, employees and voters. This model looks to personal identity to define disability and empowers people to chart their own destiny in everyday life, with a particular focus on economic empowerment. This model makes no judgments about ability, focusing on tangible and measurable results. Its mantra is "results, at all levels, create value". By this model, based on U.S. Census data, there are 1.2 billion people in the world who consider themselves to have a disability. An additional two billion people are considered Stakeholders in disability (family/friends/employers), and when combined to the number of people without disabilities, represents 53% of the population. This model states that, due to the size of the demographic, companies and governments will serve the desires, pushed by demand as the message becomes prevalent in the cultural mainstream.
Types of Disabilities
Types of disabilities include various physical and mental impairments that can hamper or reduce a person's ability to carry out their day to day activities. These impairments can be termed as disability of the person to do his or her day to day activities.

These impairments can be termed as disability of the person to do his day to day activities as previously. A disability can be broken down into a number of more specific categories, which include the following:

Mobility Disability

Mobility disabilities can stem from a wide range of causes and be permanent, intermittent or temporary. Among the most common permanent disorders are musculoskeletal disabilities such as partial or total paralysis, amputation or severe spinal injury, types of arthritis, muscular dystrophy, multiple sclerosis (MS), head injury and cerebral palsy. Additionally, conditions such as respiratory and cardiac diseases may also impair mobility. Any of these conditions may impair the strength, speed, endurance, coordination and dexterity necessary for proper hand function.

Vision Disability

You are considered to have an eyesight disability if you don’t have normal vision even if you wear eyeglasses or contact lenses. Visual impairment may be caused by several eye diseases like age related muscular degeneration, cataracts, and more. There are vision impairments that can be treated medically, but there are some that can’t be corrected medically after accidents, inherited ocular disorders, or disease damage.

Hearing Disability

Hearing disabilities includes people that are completely or partially deaf. People who are partially deaf can often use hearing aids to assist their hearing. Deafness can be evident at birth or occur later in life from several biologic causes, for example Meningitis can damage the auditory nerve or the cochlea.

Communication Disability

This is defined as impairment in the processes of speech, language or hearing.

Cognitive Disability

Cognition is another word for thinking. It includes many different functions including our abilities to pay attention, learn and retain information, solve problems, and use language to express thoughts. Cognitive disability refers to people with dyslexia, a brain-based type of learning disability that specifically impairs your ability to read, and other learning difficulties. Learning problems, on the other hand, differs from someone who has a serious mental impairment.

Psychological Disorders

Affective Disorders - Disorders of mood or feeling states either short or long term. Mental Health Impairment is the term used to describe people who have experienced psychiatric problems or illness.

Personality Disorders - Defined as deeply inadequate patterns of behavior and thought of sufficient severity to cause significant impairment to day-to-day activities.

Invisible Disabilities

Invisible disabilities are those that aren't immediately apparent to others. It's estimated that 10% of people in the U.S. have a medical condition considered a type of invisible disability.
Expanded Disability Status Scale
The Kurtzke Expanded Disability Status Scale (EDSS) is used as a measure of disease progression by assigning a severity score (0-10) to the patient's clinical status. Although the scale doesn't correspond linearly to common progression points for many patients, its widespread use and ease of implementation allow its use as a standardization measure for clinical trials.

Today the EDSS is the gold standard for measuring impairment in MS.

The Functional Systems (FS) are the main 8 parts of the CNS regulating body functions.
• Pyramidal - weakness or difficulty moving limbs
• Cerebellar - coordination loss or tremor
• Brainstem - speech and swallowing problems
• Sensory - touch and pain, numbness or loss of sensations
• Bowel/bladder - the abnormal functioning of
• Visual - loss of function
• Cerebral - mental function loss
• Other - any other neurological findings due to MS

Scores that range from 1.0 to 4.5 refer to patients who are fully ambulatory. Scores that are 5.0 to 9.5 indicate an impairment.


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Expanded Disability Status Scale (EDSS):
0.5 Normal neurologic examination (all grades 0 in FS; cerebral grade 1)
1.0 No disability, minimal signs in one FS (i.e., one grade 1 excluding cerebral grade 1)
1.5 No disability, minimal signs in more than one FS (more than one grade 1 excluding cerebral grade 1)
2.0 Minimal disability in one FS (one FS grade 2, others 0 or 1)
2.5 Minimal disability in two FS (two FS grade 2, others 0 or 1)
3.0 Moderate disability in one FS (one FS grade 3, others 0 or 1), or mild disability in three or four FS (three or four FS grade 2, others 0 or 1)
3.5 Fully ambulatory but with moderate disability in one FS (one grade 3 and one or two FS grade 2) or two FS grade 3, others 0 or 1, or five FS grade 2, others 0 or 1
4.0 Fully ambulatory without aid, self-sufficient, up and about some 12 hours a day despite relatively severe disability consisting of one FS grade 4 (others 0 or 1), or combinations of lesser grades exceeding limits of previous steps; able to walk without aid or rest some 500 meters (0.3 miles)
4.5 Fully ambulatory without aid, up and about much of the day, able to work a full day, may otherwise have some limitation of full activity or require minimal assistance; characterized by relatively severe disability, usually consisting of one FS grade 4 (others 0 or 1) or combinations of lesser grades exceeding limits of previous steps; able to walk without aid or rest for some 300 meters (975 ft)
5.0 Ambulatory without aid or rest for about 200 meters (650 feet); disability severe enough to impair full daily activities (i.e., to work a full day without special provisions); usual FS equivalents are one grade 5 alone, others 0 or 1, or combinations of lesser grades usually exceeding specifications for step 4.0
5.5 Ambulatory without aid or rest for about 100 meters (325 ft); disability severe enough to impair full daily activities; usual FS equivalents are one grade 5 alone, others 0 or 1, or combinations of lesser grades usually exceeding specifications for step 4.0
6.0 Intermittent or constant unilateral assistance (cane, crutch, brace) required to walk about 100 meters (325 ft) with or without resting; usual FS equivalents are combinations with more than two FS grade 3+
6.5 Constant bilateral assistance (canes, crutches, braces) required to walk about 20 meters (65 ft); usual FS equivalents are combinations with more than two FS grade 3+
7.0 Unable to walk beyond about 5 meters (16 ft) even with aid, essentially restricted to wheelchair; wheels self in standard wheelchair a full day and transfers alone; up and about in wheelchair some 12 hours a day; usual FS equivalents are combinations with more than one FS grade 4+; very rarely pyramidal grade 5 alone
7.5 Unable to take more than a few steps; restricted to wheelchair; may need aid in transfers, wheels self but cannot carry on in standard wheelchair a full day; may require motorized wheelchair; usual FS equivalents are combinations with more than one FS grade 4+
8.0 Essentially restricted to bed or chair or perambulated in wheelchair; but may be out of bed much of the day; retains many self-care functions; generally has effective use of arms; usual FS equivalents are combinations, generally grade 4+ in several systems
8.5 Essentially restricted to bed for much of the day; has some effective use of arm(s); retains some self-care functions; usual FS equivalents are combinations, generally grade 4+ in several systems
9.0 Helpless bed patient; can communicate and eat; usual FS equivalents are combinations, mostly grade 4
9.5 Totally helpless bed patient; unable to communicate effectively or eat/swallow; usual FS equivalents are combinations, almost all grade 4+
10 Death due to MS
Fatigue Severity Scale (FSS)
The Fatigue Severity Scale (FSS) is a method of evaluating the impact of fatigue on a person. This won't determine a degree of disability but rather provide information that can be used to make that determination at a later time.

The FSS is a short questionnaire that requires the individual to rate their level of fatigue. The questionnaire contains nine statements that rate the severity of your fatigue symptoms. Each statement must be read and then circle a number from 1 to 7, based on how accurately it reflects the persons condition during the past week and the extent to which they agree or disagree that the statement applies to them.

During the past week: < Disagree   |   Agree >
My motivation is lower when I am fatigued. 1 2 3 4 5 6 7
Exercise brings on my fatigue. 1 2 3 4 5 6 7
I am easily fatigued. 1 2 3 4 5 6 7
Fatigue interferes with my physical functioning. 1 2 3 4 5 6 7
Fatigue causes frequent problems for me. 1 2 3 4 5 6 7
My fatigue prevents sustained physical functioning. 1 2 3 4 5 6 7
Fatigue interferes with carrying out certain duties and responsibilities.    1 2 3 4 5 6 7
Fatigue is among my three most disabling symptoms. 1 2 3 4 5 6 7
Fatigue interferes with my work, family, or social life. 1 2 3 4 5 6 7
Total Score:

Once the questionnaire has been completed, then score the results and evaluate the level of fatigue. Simply add all the numbers you circled to get the total score. A total score of less than 36 suggests that one may not be suffering from fatigue. A total score of 36 or more suggests that the individual may need further evaluation by a physician.