[The concept of handicap]. / La notion de handicap.

The notion of disability appears recently in the medical and medico-legal field. It is the origin of a fundamental discussion about the health, and an ethical debate about human person. Indeed it drives to identify among the health users a particular group: disabled persons for whom the methods used with success in the field of diseases are not convenient. For ethical point of view: it is the identity of the person in a situation of disability, its dignity, its self-esteem and the respect through the regard of others which are in question. The debate was amplified when the project of a classification of handicap, as consequences of diseases, (Wood, WHO) was published, in 1980. Two tendencies were in opposition: one of them is "medicinal", following the opinion of Wood, the second is "anthropological and social", supported by scientific and disabled associations. The first proposition of Wood, after a long discussion, is abandoned. It is replaced by a "Classification of functioning, disability and health", adopted by the Mondail assembly of WHO in May 2002. This device is a compromise between the precedent tendencies. This document is heavy, confusing, imprecise and very difficult to use. We suggest a definition with dimensions, separating clearly the body modifications, the universal functional capacities for a human person and the situations of life. The subjectivity is individualised as a special dimension of assessment.

[Belated diagnosis of medullar compression in a case of post-polio syndrome]. / Découverte tardive dune compression médullaire à loccasion de la prise en charge dun syndrome post-polio.

The physiatrist observes about his practice individuals with sequela of old poliomyelitics. A part of them have unusual fatigue and muscular pains and weakness. The hypothesis of an evolution of neuro-biological mechanism suggested by few authors isn't, actually, demonstrated. More probably, the modifications of lesional and, functional changes with disability observed are the consequence of elderly effects and decreasing of physical activites. We report a case of spinal cord compression by intramedullar tumor, associated with a post-polio syndrome.

[The notion of health]. / La notion de santé.

There has been a good deal of discussion and though on the notion of health. The most widely employed definitions can be termed "physiological", focusing on organs and normality. These definitions result from the development of medicine around the concept of disease, leading Boissier de Sauvages, author of a disease classification that continued to be used until the current classification proposed by the WHO, to state that "health, considered in its historical context, is the concourse of phenomena designating life and perfect structures". The current WHO classification goes beyond the notion of disease and introduces the very positive concept of theoretically total "well-being". In light of the evolution in the reasons why people call upon the health care system, we propose considering health as an equilibrium describing an individual's capacity to cope with the environment and taking into account the available health care resources. Thus, as proposed by René Dubos, health is a "relatively trouble-free state devoid of suffering". We integrate the notions of handicap that we have developed in a four-dimensional approach where subjectivity plays a very important role. Our proposal totally changes the notion of cure: one can be diabetic and cured, paraplegic and cured.

[Complications of cervical spine manipulation. A case of "locked-in syndrome"]. / Complications de la manipulation cervicale. Une observation de "locked-in syndrome".

The current craze for cervical spine manipulation is due to its rapid and even dramatic results and to the ineffectiveness of many treatments prescribed by physicians. Complications of thoracic or lumbar spine manipulation are very rarely reported, but this is not the case with the cervical spine. We present the case of a woman who suffered a severely disabling complication caused by an "osteopathic" manoeuvre. This technique should be rejected as it is dangerous and as harmless methods can be used with good results in common cervicalgia, even if it is very severe.

Handicap assessment: setting the grounds for an effective intervention in the community.

Many instruments have been invented specially since the 70's to study and measure the consequences of illness and trauma; many of them simply evaluate the severity of lesions and the prediction of mortality, others evaluate morbidity. Nevertheless, none of these instruments evaluate the handicap globally. The classification of the World Health Organization, despite the fact that it contemplates the handicap in all its aspects, does not distinguish its different levels rigorously and it is not a valid instrument to quantify handicaps. The authors comment on their research and proposals for identification and quantification of the handicap. Three levels, related to "Body", "Capacities" and "Life situations", have been described and through them a useful inventory was created (published in 1998). This inventory makes it possible to establish a true medical-social and global evaluation of handicaps, providing a uniform record of the consequences of diseases, trauma or physiological features of the individual and a useful instrument for public health intervention and the promotion of human well-being.

Occupational handicap in victims of limb injuries.

The authors analysed 115 victims of limb injuries due to traffic accidents, to compare the medico-legal assessment by the rate of permanent disability (PD) with a tridimensional evaluation of the damage (lesion, function and situation), from a professional aspect. There was a high correlation between PD and lesional and functional sequelae. However, in professional situations only with those who were working full-time was there a high correlation with PD. PD gives only a lesional assessment. The authors propose a professional damage evaluation which considers the handicap of the individual in her/his ordinary work besides the lesion and function, as long as the assessment is personal and it is meant to reintegrate the victim completely in her/his professional life.