DISABILITY AND REHABILITATION APPROACH DR.N.C.DAS
DISABILITY AND REHABILITATION APPROACH-Disability is the dysfunction of any part of the body or mind leading to difficulty in performing one or more activities.-When a disease progresses to chronic stage leads to impairment of certain functions. TYPES OF DISABILITY PHYSICAL NEUROLOGICAL MENTAL OR LOCOMOTOR DISABILITY SPEECH VISUAL HEARING
CONSEQUENCES OF DISABILITYINDIVIDUAL FAMILY EFFECTS COMMUNITY
MANAGING CONSEQUENCES Changing attitude of people to wardshandicap. Preventing disability throughinterventions. Early detection and prompt treatment. Rehabilitation of handicap. Orientation training of health staff. School health program for earlydetection. Medical research.
PREVENTION OF DISABILITYPRIMERY SECONDARYPREVENTION PREVENTION PREVENTION TERTIARY PREVENTION
PRIMERY PREVENTIONA. FOR INDIVIDUALS• Immunisation of pregnant mothers and infants• Vit. A drops to children (1to 6 yrs) 6 doses at 6month interval.• Iron and folic acid tablets to pregnant mothers.• Syrup iron-folic acid to children.• These can be achieved through PHC and NRHM efforts.
B. FOR COMMUNITY i. Health education regarding high risk pregnancy. ii. Antenatal, natal and post natal care. iii. Avoid early age or late pregnancy to avoid malformation. iv. Avoid unconsanguinous marriages to prevent thalasaemia. Rh incompatibility. v. Delivery by trained dai. vi. Iodised salt for goiter prevention.
SECONDARY PREVENTION1. Mile stone growth monitoring by field workers.2. Early detection of trachoma, night blindness and treatment3. School health checkup programme.4. Mobile health checkup vans .5. Early detection of disease and prevent disability .
TERTIARY PREVENTION1. Extensive IEC campaign to create favorable opinion and attitude of people towards handicap. 2. Create mass and community efforts to limit disability. 3. Schools for blinds, dumb and deaf, and mentally retarded children. 4. Physiotherapy and occupational therapy training institutions.5. Grant in aid to voluntary organisations forhandicap welfare.
INTERVENTION FOR DISABILITY PHYSICAL PSYCHOLOGICAL INTERVENTIONSVOCATIONAL EDUCATIONAL
A. PHYSICAL INTERVENTION-Appropriate exercise therapy for joint movements.-Restoring the function of affected part by physiotraining.-Provision external appliances and splints.-Relief of pain by application of hot & cold formulation.-Bladder and bowel exercise to control incontinence.-Training in daily activities to restore lost function.-Education of patients to maintain the physical statusand returning to normal life.
B. PSYCHO-SOCIAL INTERVENTION-The process of rehabilitation is not completewithout psychosocial intervention.-To raise the morals of the patient, counselling,positive attitude and support.-Sympathetic attitude of doctors, family membersand community support.-Psycho therapy for depression, anxiety,personality changes and suicidal tendency.-Financial support, work place support to raise themorale & take away depression.
C. EDUCATIONAL INTERVENTION-Efforts to be made to continue the education.-Integrated education for disabled child in normal school.-Pre school training, parents counselling-Special training in speech and language-Orientation and mobility training for blinds-Day to day living and practices training and skill developmentD. DISABILITY FRIENDLY INFRASTRUCTURES--Special parking place for disables-Ramps with guards at the entrance-All stair cases must have side railing, disable friendly liftsand toilets- Adequate number of wheel chairs for their movement.- Special transport system for reaching various areas ofhospital.
E. VOCATIONAL INTERVENTION-Efforts be made to promote vocational training for earning according to level of disability.- Exploring the type and extent of vocational training suiting the level of disability.- One should be caring, sympathetic and supportive in assisting the disabled.- Vocational training centers, suitable for level of disability by GOI and their placement.
OBJECTIVE OF REHABILITATION-The basic objective of rehabilitation is torestore the physical, social and psychologicalpotential to a level, so that he canindependently function and carry on anindependent life.-Prevent disability and return to normalcy.- Maximum level of restoration throughdifferent interventions.-Training in vocational methods to suit workingwith residual disability and earn a lively andindependently.
REHABILITATION APPROACHES OR STATEGIESCOMMUNITY INSTITUTIONAL BASED BASED STRATEGIES OUTREACH SERVICES
COMMUNITY BASED REHABILITATION-This is a strategy of developing rehabilitation services inthe community so as to equalization of opportunity for all.-Attempt for social integration of disabled.-There is a collective effort of disabled, family andcommunity in rehabilitation.-Along with physical exercise, health education andvocational-training are imparted for self independent working andearning.
INSTITUTIONAL BASED REHABILITATION -Disabled persons are provided training in hospitals/ rehabilitation centers. -Exercises under supervision. - Functions as a referral center for community rehabilitation center.
OUT REACH PROGRAMMESThe experts from hospital visit the community orhome for providing education & training to disables in :-Self Care-Ambulatory Effect-Communication-Vocational Guidance-Camps are also organized from time to time in ruralarea where community facility is not available.-Efforts are on to integrate the community rehabilitationcenters with institutions to provide maximumrehabilitation coverage to all parts of the country.
WELFARE MEASURESa) Scholarship to physically handicap for going to school.b) Admission quota for disables in schools and collages.c) Seats are reserved for handicap in Govt .services.d) Separate employment exchange for handicap.e) Handicap friendly environment in offices and hospitals, lifts ,toilet, ramps, wheel chairs and porters.. f) Seats are reserved for handicap persons in buses and transports. g) Special transport allowance to handicaps and concessional rail tickets with free attendants. h) Setting up of rehabilitation centers at district and PHC level. I ) Availability of artificial limbs, appliances in concessional rates.
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