CBR & Physiotherapy

1. COMMUNITY BASED
REHABILITATION

2. DEFINITIONS
• Community: A group of people with common interest
who interact with each other on a regular basis and/ or
a geographical, social or a government administrative
unit
• Rehabilitation: Combined and coordinated use of
physical, educational, vocational and social measures
for training and retraining an individual to highest
possible levels of overall functional abilities

3. CBR
“Need-based rehabilitation done in the community at community level by the
contribution of the community.”
"A strategy within community development for the rehabilitation, equalization of
opportunities and social integration of all people with disabilities“ (United Nations)
“A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction
and Social Inclusion of PWD.” (Joint Position Paper 2004,WHO, ILO, UNESCO)
“CBR is a strategy for enhancing the quality of life of disabled people by
improving service delivery, by providing more equitable opportunities and by
promoting and protecting their human rights” (E. Helander )

4. ENTRY POINT

5. EXIT POINT

6. HIDDEN & UNKNOWN SIGNIFICANCE

7. TOP-DOWN MODEL

8. BOTTOM-UP MODEL

9. COMMUNITY AS THE CORE

10. PRINCIPLE OF CBR
Equality, Social Justice, Solidarity, Unification, Dignity
சமத்துவம், சமூக நீதி, ஒற்றுமம, ஒருங்கிமைத்தல், கண்ணியம்
Not make special system for PWD.
Try to share system, services, anything available for non-
disabled people.
(Hollander, 1993)

11. HISTORY OF CBR ’70S
• Integrated in to the Primary Health System
(PHS)
• PHS trained Volunteers work as CBR
volunteers.
• Give Medical Rehabilitation, medicine.
Medical Model

12. HISTORY OF CBR ‘80S-’90S
• People started to say “ PWD needs not only
medicine, but education, vocational
opportunity everything non-PWD need.”
• Need Social Inclusion
Social Model

13. BREAKTHROUGH…
•To achieve inclusion, just education,
medicine, vocational opportunity is
enough?
Anything Else we need?

14. CHANGE IN PERSPECTIVE AFTER 2K
• Community Involvement
• PWDs Participation

16. THE CBR MATRIX
• The CBR matrix provides a structured
overview of thematic areas (health,
education), life conditions (livelihood, social)
and political strategies to improve the
situation (empowerment).

17. © World Health Organization

18. THE CBR MATRIX: HEALTH
உடல் நலம் சார்ந்த
CBR facilitates inclusive health by
working with the health sector to
ensure access for all people with
disabilities.
• Advisory services in blindness
prevention and sight restoration by
way of referrals, medical treatment or
surgery
• Organizing health promotion talks
through community durbars and
radio programmes
• Orthopaedic and Physiotherapy
services
• Prevention of childhood disabilities
using a multi-disciplinary team
• Mental health services (Management
of epileptic seizures and other
mentally related disorders)
• Prevention of childhood disability
activities through a multi-sectorial
collaboration
• Provision of rehabilitation services to
persons with disabilities
• Provision of basic assistive devices to
persons with disabilities
• Audiological services

19. THE CBR MATRIX : EDUCATION
கல்வி சார்ந்த
The role of CBR is to work with the education sector to help make
education inclusive at all levels, and to facilitate access to education
and lifelong learning for people with disabilities. This includes;
• Referrals of Children with disabilities to special Schools from
primary, secondary and tertiary
• Provision of lifelong learning activities for the severely disabled
persons
• Early Childhood intervention
• Integration of Children with mild disabilities into the regular
school system

20. THE CBR MATRIX: LIVELIHOOD
வாழ்வாதாரம் சார்ந்த
Under this component CBR is to facilitate access for people with
disabilities and their families to acquiring skills, livelihood opportunities,
enhance participation in community life and self-fulfillment
• Engaging vulnerable groups/individuals in economic activities (PWD’s
and mental health clients in productive income generating ventures)
• Microcredit for the vulnerable groups
• Vocational skill training/ skill development for young disabled
adults/persons with mental illness
• Linking persons with disabilities/individuals to financial institutions for
credit
• Animal rearing/Credit in-Kind system(cashless system)
• Handicrafts

21. THE CBR MATRIX: SOCIAL
சமுதாயஞ் சார்ந்த
Under this component CBR seeks to work with all stakeholders to
ensure the full participation of persons with disabilities in the social
life of their families and communities.
• Ensuring that the vulnerable groups that we work with/ for have
good relationship/marriages with the family/community members
• Ensuring culture/religious participation of the vulnerable groups
• Ensuring that persons with disabilities have access to justice

22. THE CBR MATRIX:
ADVOCACY AND EMPOWERMENT
ஆதரவு /அதிகாரம் சார்ந்த
Under this component, CBR seeks to assist persons with disabilities to develop
advocacy and communication skills and, to ensure that their environment
provides appropriate opportunities and support to allow them to make
decisions and express their needs and desires effectively.
• Awareness creation on rights based issues on disabilities
• Establishment of Disable People Organisations (DPOs)
• Establishment of Self-Help-Groups in working rights-based
• Establishment of community Development Committees to spear head
development at the community level.
• Social mobilization at the community level for development.
• Provision of training on group dynamics

23. CBR:
INSTITUTION TO COMMUNITY

24. STAKEHOLDERS OF CBR

25. PRINCIPLES OF CBR
• Community and client centered
• Focused on prevention and early
intervention
• Collaborators with institutional
facilities
• Consistence and flexible
• Promoters of consumer participation
and control
• Coordinated by referral system
• Interdisciplinary and multidisciplinary
• Focused on information sharing

26. REASONS FOR DEVELOPING CBR
• Institutional care blunts the personality and
motivation leading to over dependency
• High costs of rehabilitation at the hospitals
• In a community care, patients are enabled to
continue in their own accustomed environment and
to retain their social contacts and prevent isolation
• Institutional care places high burden on the relatives

27. ADVANTAGES OF CBR
• Wide coverage service can be achieved
• Community interaction and the empowerment
• Affordability
• Build up of manpower and resources
• Comprehensive and holistic development
• Awareness and acceptance
• Sustainability
• Wise use of local resources
• Need based planning

28. DISADVANTAGES OF CBR
• Improper care due to lack of specialized trainee
• Difficulties with evaluation
• Reducing the importance of professional services
• Unreliability of community involvement
• Limitation of local resources
• Difference in large scale co-ordination and co-
operation

29. SCOPE OF CBR
• Prevention of disability
• Identification of high risk infant
and mothers
• Early detection of disability and
management
• Assessment of felt needs of
disabled and family
• Home based or
neighborhood based
programs
• Parental involvement
• Play groups and integrated
schooling for children
• Organizations for and by
people with disabilities

30. DELIVERY OF
REHABILITATION CARE
• This is done though the following approaches:
• Institution based rehabilitation
• Homes
• Day care centers
• Out patient clinics
• Camp approach
• Community based care

31. INSTITUTION BASED CARE
• Continuous in patient care
• Program tailor made for individual patients
• Boarding and lodging provided
Advantages:
• Excellent professional
care
• Facilities for training and
research
• Diagnostic and
management care for
Disadvantages:
• Neglect by family
• No community
participation
• Costly

32. HOMES
• Permanency for patients
• Occasional visits by family
Advantages:
• Patients are
independent
• There is emotional
support
• Interaction among
homogenous groups
• Boarding and
lodging taken care of
Disadvantages:
• Isolation from
community
• Costly
• Poor medical
care

33. DAY CARE CENTERS
• Advantages:
• Cheaper
• Provides relief to the
family
• Interaction among
homogenous groups
• Disadvantages:
• Difficult to transfer
patients everyday
• Limited medical care
• Limited social integration
Patient brought in mornings and taken back in evenings

34. OUT PATIENT CLINICS
• Advantages:
• Cheap
• Professional help is
available for a limited
time
• Caters to large
population with
minimal handicap
• Disadvantages:
• Difficult to transport
• High percentage of
dropouts
• No follow-up
• No solution for severe
handicaps
• Can cater to large population
• Prevalent practice in developing countries

35. CAMP APPROACH
Advantages:
• Mass identification
• Statistical data can be
collected
• Patient can be guided on
what he or she can do
Disadvantages:
• Poor or no follow up
• Treatment is usually not given
• Benefit of camp is limited to
organizers capacity, publicity
and professionals who as
invited
• Out reach program
• Often institution based
• Patient is educated about his/ her handicap
• Caters to disabled population in remote areas

36. COMMUNITY-BASED CARE
• At the door-step of the individual
• Training the carers of the patient and
community workers
• Periodic check with multi-disciplinary team
• Cost-effective
• Benefit of reaching nooks and corner of the
society
• Individual beneficiaries:
• Persons with disabilities
• Family of individuals with disability
• Community beneficiaries:
• Community as a whole
• Multisectoral programs that work with
a variety of professionals

37. CBR IBR
Cost of treatment Cheaper Costly
Accessibility of
services
Accessible to all Only few institutions
are accessible to all
Extension of services Can be done without of
much cost
Not possible
Social rehabilitation Possible Not possible as patient
is away from family
Psychological
rehabilitation
Much Possible as they
have support of family
Not much possible
Skilled personal care Not given Given

38. Application of advanced
technique
Not possible Possible
Quality of service Good Better
Active participation Possible Not possible
Socio-Economic status Considered Not considered
Promotion of awareness Yes Not
Community interaction Done Not done
Evaluation Difficult Possible
Duration and location of
training
3 months-1 year, locally
trained
4 year degree,
institutionally trained
Goal of training
Interventions to prepare
the re-entry of client to
his home.
Interventions to discharge
patient from hospital.

39. INTENDED OUTCOMES OF CBR
• Individual and community knowledge of disabilities increases
• The community is involved in their own rehabilitation care, and
rehabilitation is delivered with collaboration from various sectors of
society
• Discrimination on the basis of disability and other factors (eg. gender)
in the health sector is reduced
• Access to rehabilitation services is improved
• Persons with disabilities more actively participate in education, work,
and community life
(ILO, UNESCO & WHO, 2010)

40. WHY IS COMMUNITY PHYSIOTHERAPY IMPORTANT?
• Global pandemic considerations
• Keeps people out of hospitals
• Supports rural communities
• Supports the ageing population
• Provides unmatched comfort

41. PHYSIOTHERAPISTS' ROLES IN CBR

42. THANK YOU 