Reflections on Normalcy, Disability, Impairment, and Handicaps
Noble (2013) reminds us that the World Health Organization (WHO, 1980) offered definitions for impairment, disability, and handicap. Impaired hearing was defined (more or less) as "loss of function due to physical disorder or injury" and assessed by clinical tests. Hearing disability was noted to be an experienced loss or reduction in the ability to hear or discriminate in everyday listening situations. Handicap was defined as a disadvantage or limitation in everyday life from impairment or disability (including emotional distress secondary to communicative failures and/or limits), and Noble suggested "Handicaps can be seen as non-auditory consequences of reduced hearing" (page 16).
Nonetheless, Noble reports that the disability/handicap distinction…disappeared…in the International Classification of Functioning, Disability and Health (ICF, WHO, 2001) document and "the term disability now covers impairments as previously defined along with two new concepts: activity limitation and participation restriction." Noble reports that the potential for confusion is more than apparent as "limiting someone’s activity" sounds an awful lot like "restricting their participation." Noble states, "The ICF does not serve well the experiences, interests, and needs of people whose hearing is declining" (page 18). Noble comments that "normality of hearing may not be reliably detected by gauging the ability to detect simple signals in simple contexts…"(page 31) and "there are contexts in the everyday world in which it is difficult to hear…"regardless of the status of the auditory and nervous systems.
Beck and Nilsson proposed (2013) that the time has come to re-think and alter our screenings and diagnostic protocols as we know so much more about the auditory system in 2013, than we did half a century ago (and more) when core protocols were established. Noble states that one point seems quite clear: A standard test of detection of tones in quiet background conditions may not provide a reliable measure of hearing function across the range of circumstances in which people typically have to operate" (page 34).
For More Information, References, and Recommendations
Noble W. (2013) The Concepts of Disability and Normality (Chapter Two), in Self- Assessment of Hearing. Plural Publishing.