THE IMPAIRMENT AND DISABILITY OF PATIENTS WITH SEVERE MOTOR AND INTELLECTUAL DISORDERS.

针对严重运动障碍和智力障碍患者，我们研究了长期康复方案的原则。根据WHO（1980）的损伤与失能模型，对92例住院患者的损伤与ADLs及其与其他临床因素的关系进行了研究。基于损伤程度的结果显示，首先，青少年组比其他年龄组表现出更严重的损伤，产前和围产期障碍发生率更高。这些发现可能反映了最近围产期医学的显著进步。其次，部分患者骨骼畸形始于20岁，各损伤成分之间的显著相关性随着年龄的增长而下降。结果表明，青少年群体的运动和认知能力水平仍能反映其个体的发育历史，在早期阶段影响较大，而在老年阶段影响较小。残疾水平分析结果显示：①青少年组大多数患者的日常生活能力受到严重干扰；其次，我们发现在20岁以上的年龄组中，ADL水平高的患者减少，ADL水平极低的患者增加，并且注意到各ADL成分之间显著相关的数量在老年组中减少。最后，通过多变量分析发现，坐姿ADL能力可能由先天运动能力和智力能力组成，也可能由后天学习能力组成。因此，对于大多数患有严重运动和智力障碍的患者，我们应该以帮助他们在20岁之前最大限度地发挥其内在能力为目标，此后，我们应该改变长期康复计划的策略，以保持他们的获得性ADL，并防止继发性和年龄相关的损害的发展。少

For the patients with severe motor and intellectual disorders, we investigated the principles of rahabilitation programs for a long term. According to the impairment and disability model of WHO (1980), the impairments and ADLs and its relationship to other clinical factors of 92 institutionalized patients were examined.Results based on the impairment level showed that, firstly, the teen-age group revealed more severe impairment and suffered more frequently from pre-and peri-natal disturbances than the other older-age groups. These findings may reflect the recent noticeable advance in perinatal medicine. Secondly, deformity of skeletons began at age of 20s in some patients, and the significant correlations between each impairment component decreased in elder groups. Thirdly the multiple variable analysis between the sitting ability and the impairment elements revealed that the level of motor and cognition abilities in a teen-age group still reflect their individual developmental history … More during the early life, but little in elder groups.Results based on the disability level revealed that, firstly, abilities of ADL in most patients of the teen-age group were severely disturbed. Secondly, we founded that in the age-groups older than 20s patients with high ADL level decreased and patients with very low ADL level increased, and also noticed that the number of significant correlations between each ADL component decreased in elder groups. And lastly the multiple variable analysis of the sitting ADL ability revealed to be composed either of the congenital motor and intellectual ability, or of the acquired learning one.Therefore, in most patients with severe motor and intellectual disorders, we should aim to help them to maximize their internal ability till 20s, and thereafter it may be reasonable that we should change the strategy of the long term rehabilitation program both to maintain their acquired ADL and to protect against the progress of secondary and age-related impairment. Less