biological foundation of behaviour discussed by including, structure and functions of the brain, nervous system, impulse transmission and the disorders of dementia and delirium, rehabilitation, and its types

1. BIOLOGICAL FOUNDATION OF
BEHAVIOUR AND OVERVIEW OF
COMMON NEUROLOGICAL
DISORDERS
UNDER THE JOINT GUIDANCE OF
DR. DIPANJAN BHATTACHARJEE AND MS. POOJA AUDHYA
PRESENTING BY
FATHIMA HASANATH, VIDHI MANDLOI AND ANANDU KS

2. CONTENTS
1) Brain, its structure and functions, neurons, neural
transmissions, synaptic transmission-overview.
2) Delirium, Dementia, Organic Psychosis, epilepsy, etc.-
historical view, classification, diagnostic features and
comorbidity
3) Rehabilitation: Psychosocial and vocational.

4. HUMAN BRAIN
 Human brain is an amazing three pound organ that controls all functions of
the body, interprets information from the outside world, and embodies the
essence of the mind and soul.
 It is protected within the skull, composed of the cerebrum, cerebellum and
brain stem.
 The human brain is one of the most complex systems on earth.
 The brain and the spinal cord make up the central nervous system, which
alongside the peripheral nervous system is responsible for regulating all bodily
functions.

6. STRUCTURE OF THE BRAIN
 The human brain is split up into three major layers: the hindbrain, the
midbrain, and the forebrain.
 The hindbrain is the well-protected central core of the brain. It includes the
cerebellum, reticular formation, and brain stem, which are responsible
for some of the most basic autonomic functions of life, such as breathing
and movement. The brain stem contains the pons and medulla
oblongata.
 The midbrain makes up part of the brain stem. It is located between the
hindbrain and forebrain. All sensory and motor information that travels
between the forebrain and the spinal cord passes through the midbrain,
making it a relay station for the central nervous system.

7.  The forebrain is the most anterior division of the developing vertebrate
brain, containing the most complex networks in the central nervous
system.
 The forebrain has two major divisions: the diencephalon and the
telencephalon. The diencephalon is lower, containing the thalamus and
hypothalamus (which together form the limbic system);
 the telencephalon is on top of the diencephalon and contains the
cerebrum, the home of the highest-level cognitive processing in the
brain.
 It is the large and complicated forebrain that distinguishes the human
brain from other vertebrate brains.

9. CEREBRAL CORTEX
 In humans, Cerebrum comprising the cerebral cortex and several subcortical
structures, including the hippocampus, basal ganglia, and olfactory bulb.
 The cerebrum is composed of Gray and white matter. Gray matter is the mass of
all the cell bodies, dendrites, and synapses of neurons interlaced with one
another, while white matter consists of the long, myelin-coated axons of those
neurons connecting masses of Gray matter to each other.
 The cerebral cortex, the largest part of the brain, is the ultimate control and
information-processing centre in the brain.
 The grey, folded, outermost layer of the cerebrum responsible for higher brain
processes such as sensation, voluntary muscle movement, thought, reasoning,
and memory.

10.  The cerebrum is divided into two halves; the right and left
hemispheres.
 They are joined by a bundle of fibres called corpus callosum that
transmits messages from one side to the other.
 Each hemisphere controls the opposite side of the body.
 In general, the left hemisphere controls speech, comprehension,
arithmetic and writing. The right hemisphere controls creativity,
spatial ability, artistic and musical skills.
 The left hemisphere is dominant in hand use and language in about 92
% of people.

12.  The cortex is made of layers of neurons with many inputs.
these cortical neurons function like mini microprocessors or
logic gates. It contains glial cells, which guide neural
connections, provide nutrients and myelin to neurons, and
absorb extra ions and neurotransmitters.
 The cortex is wrinkly in appearance. The “valleys” of the
wrinkles are called sulci (or sometimes, fissures); the “peaks”
between wrinkles are called gyri. One notable sulcus is the
central sulcus, or the wrinkle dividing the parietal lobe from
the frontal lobe.
 The cerebral hemispheres have distinct fissures which
divide the brain into lobes. Each hemisphere has 4 lobes;
frontal, temporal, parietal and occipital.

14. NEURONS
 A neuron can be defined as a nerve cell. The neuron is often thought of as the "building
block" of the nervous system.
 Neurons are the fundamental units of the brain and nervous system, the cells responsible
for receiving sensory input from the external world, for sending motor commands to our
muscles, and for transforming and relaying the electrical signals at every step in between.
 The human neural system is divided into two parts :
(i) the central neural system (CNS)
(ii) the peripheral neural system (PNS)
 The CNS includes the brain and the spinal cord and is the site of information processing and
control. The PNS comprises of all the nerves of the body associated with the CNS (brain and
spinal cord).

17. TYPES OF NEURONS

18. NEURONS FUNCTION
Sensory neurons carry messages from
the "outside world", the
sensory receptors, to
the spinal cord
and brain
Motor neurons carry the messages to
the "outside
world“.
Interneurons typically found in
integrative areas of the
CNS, are limited to a
single brain area.
NEURONS CHARECTARISTICS
Unipolar that only have one
projection that includes both
the dendrite and axon.
Bipolar There are also neurons that
have only one dendritic
projection
Multipolar the "typical" neuron has
multiple dendritic
projections and one axon
from the soma.

19. TRANSMISSION OF IMPULSES
 Neurotransmission (or synaptic transmission) is communication between
neurons as accomplished by the movement of chemicals or electrical
signals across a synapse.
 For any interneuron, its function is to receive INPUT "information" from other
neurons through synapses, to process that information, then to send
"information" as OUTPUT to other neurons through synapses.
 A nerve impulse is transmitted from one neuron to another through junctions
called synapses. The membranes of the pre- and post-synaptic neurons are
separated by a fluid-filled space called synaptic cleft.

20.  Chemicals called neurotransmitters are involved in the transmission of
impulses at these synapses. The axon terminals contain vesicles filled with
these neurotransmitters.
 When an impulse (action potential) arrives at the axon terminal, it stimulates the
movement of the synaptic vesicles towards the membrane where they fuse with
the plasma membrane and release their neurotransmitters in the synaptic cleft.
 The released neurotransmitters bind to their specific receptors, present on the
post-synaptic membrane. This binding opens ion channels allowing the entry of
ions which can generate a new potential in the post-synaptic neuron.

21. Terminal buttons of a neuron (axon terminals) contain the chemical
messengers, neurotransmitters, chemical messengers are responsible for
communication among neurons.

22. DEMENTIA
 Dementia refers to a disease process marked by progressive cognitive
impairment in clear consciousness.
 Dementia involves multiple cognitive domains and cognitive deficits cause
significant impairment in social and occupational functioning.
 Occurs in any age, more commonly in elderly age (Above 65 years).
 The dissorder can be progressive or static; permanent or reversible.
 Approximately 15% of people with dementia have reversible illness if
treatment initiated before irreversible damage takes place.

23. History of dementia;
 The term dementia derives from the Latin root demens, which means
being out of one’s mind.
 Dementia was first described in a book about mental illness in 1894, Dr.
Alois Alzheimer, a german neuropathologist who has a particular interest in
“nervous disorders” described changes in the brain caused by vascular
disease ( now known as vascular dementia).

25. CLASSIFICATION
 International Classification of Diseases (ICD) 10.
F00 - F03
DIAGNOSIS GUIDELINES
 Evidence of a decline in both memory and thinking which is sufficient to
impair social activities.
 The impairment of memory typically affects the registration, storage, and
retrievel of new information, but previously learned familiar material may
also be lost.
 Impairement in of thinking and reasoning capacity, and a reduction in the
flow of ideas.
 The processing of incoming information is impaired and to shift focus of
attention from one topic to another.
The above mentioned symtoms and impairments should have been evident
for at least 6 months.

26. DEMENTIA IN ALZHEIMER’S
DISEASE.
F00
Alzheimer’s disease is a primary degenerative cerebral disease.It is usually
insidious onset and develops slowly but steadily over a period of years (2-3
years).
DIAGNOSIS GUIDELINES
(a) Presence of a dementia as described above.
(b)Insidious onset with slow deterioration. While the onset usually seems
difficult to pinpoint in time, realization by others that the defects exist may
come suddenly. An apparent plateau may occur in the progression.

27. (c) Absence of clinical evidence, or findings from special investigations, to
suggest that the mental state may be due to other systemic or brain
disease which caninduce a dementia (e.g. hypothyroidism,
hypercalcaemia, vitamin B12 deficiency, niacin deficiency,
neurosyphilis, normal pressure hydrocephalus, or subdural
haematoma).
(d) Absence of a sudden, apoplectic onset, or of neurological signs of
focal damagesuch as hemiparesis, sensory loss, visual field defects, and
incoordinationoccurring early in the illness (although these phenomena may
be superimposedlater).

28. F00.0 Dementia in Alzheimer’s disease with early onset.
F00.1 Dementia in Alzheimer's disease with late onset
F00.2 Dementia in Alzheimer's disease, atypical or mixed type
F00.9 Dementia in Alzheimer's disease, unspecified

29. F01 Vascular dementia
DIAGNOSIS GUIDELINES
 The diagnosis presupposes the presence of a dementia as described
above.
 Impairment of cognitive function is commonly uneven, so that there may be
memory loss, intellectual impairment, and focal neurological signs.
 Insight and judgement may be relatively well preserved.
 An abrupt onset or a stepwise deterioration, as well as the presence of
focal neurological signs and symptoms

30. Associated features are: hypertension, carotid bruit, emotional lability with
transient depressive mood, weeping or explosive laughter, and transient
episodes of clouded consciousness or delirium, often provoked by further
infarction. Personality is believed to be relatively well preserved, but
personality changes may be evident in a proportion of cases with apathy,
disinhibition, or accentuation of previous traits such as egocentricity, paranoid
attitudes, or irritability.

31. F01.0 Vascular dementia of acute onset
Usually develops rapidly after a succession of strokes from cerebrovascular
thrombosis, embolism, or haemorrhage, In rare cases, a single large
infarction may be the cause.
F01.1 Multi-infarct dementia
This is more gradual in onset than the acute form, following a number of
minor ischaemic episodes which produce an accumulation of infarcts in the
cerebral parenchyma.
F01.2 Subcortical vascular dementia
There may be a history of hypertension and foci of ischaemic destruction in
the deep white matter of the cerebral hemispheres, which can be suspected
on clinical grounds and demonstrated on computerized axial tomography
scans.

32. F01.3 Mixed cortical and subcortical vascular dementia
Mixed cortical and subcortical components of the vascular dementia may be
suspected from the clinical features, the results of investigations (including
autopsy), or both.
F01.8 Other vascular dementia
F01.9 Vascular dementia, unspecified

33. F02 Dementia in other diseases
classified elsewhere
DIAGNOSIS GUIDELINES
 Presence of a dementia as described above; presence of features
characteristic of one of the specified syndromes, as set out in the following
categories.
 Onset may be at any time in life, though rarely in old age.

34. F02.0 Dementia in Pick's disease
A progressive dementia, commencing in middle life (usually between 50 and
60 years), characterized by slowly progressing changes of character and
social deterioration, followed by impairment of intellect, memory, and
language functions, with apathy, euphoria, and (occasionally) extrapyramidal
phenomena.
DIAGNOSIS GUIDELINES
(a) a progressive dementia;
(b) a predominance of frontal lobe features with euphoria, emotional blunting,
and coarsening of social behaviour, disinhibition, and either apathy or
restlessness;
(c) behavioural manifestations, which commonly precede frank memory
impairment.

35. F02.1 Dementia in Creutzfeldt-Jakob disease
A progressive dementia with extensive neurological signs, due to specific
neuropathological changes (subacute spongiform encephalopathy) that are
presumed to be caused by a transmissible agent. Onset is usually in middle
or later life, typically in the fifth decade, but may be at any adult age. The
course is subacute,leading to death within 1-2 years.
DIAGNOSIS GUIDELINES
Creutzfeldt-Jakob disease should be suspected in all cases of a dementia that
progresses fairly rapidly over months to 1 or 2 years and that is accompanied
or followed by multiple neurological symptoms. In some cases, such as the
so-called amyotrophic form, the neurological signs may precede the onset of
the dementia.

36. There is usually a progressive spastic paralysis of the limbs, accompanied by
extrapyramidal signs with tremor, rigidity, and choreoathetoid movements.
Other variants may include ataxia, visual failure, or muscle fibrillation and
atrophy of the upper motor neuron type. The triad consisting of
- rapidly progressing, devastating dementia,
- pyramidal and extrapyramidal disease with myoclonus, and
- a characteristic (triphasic) electroencephalogram is thought to be highly
suggestive of this disease.

37. F02.2 Dementia in Huntington's disease
A dementia occurring as part of a widespread degeneration of the brain. In a
proportion of cases, the earliest symptoms may be depression, anxiety, or
frank paranoid illness, accompanied by a personality change. Progression is
slow, leading to death usually within 10 to 15 years.
F02.3 Dementia in Parkinson's disease
DIAGNOSIS GUIDELINES
Dementia developing in an individual with advanced, usually severe,
Parkinson's disease.
F02.4 Dementia in human immunodeficiency virus [HIV] disease
F02.8 Dementia in other specified diseases classified elsewhere
F03 Unspecified dementia
F1x.73 Residual and late-onset psychotic disorder, Dementia

38. Treatments
 Pharmocology
 Cholinesterase inhibitors. These medications — including donepezil (Aricept),
rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a
chemical messenger involved in memory and judgment.
Side effects can include nausea, vomiting and diarrhea. Other possible side effects
include slowed heart rate, fainting and sleep disturbances.
 Memantine. Memantine (Namenda) works by regulating the activity of glutamate,
another chemical messenger involved in brain functions, such as learning and
memory. In some cases, memantine is prescribed with a cholinesterase inhibitor.
A common side effect of memantine is dizziness.
 Benzodiazepine for insomnia and anxiety.
 Anti depression and anti psychotic drugs for delusion and hallucination.
Side effects: paradoxical exitement, confusion, and increased sedation.

39. Therapies
Several dementia symptoms and behavior problems might be treated initially
using nondrug approaches, such as:
 Occupational therapy. An occupational therapist can show you how to
make your home safer and teach coping behaviors. The purpose is to
prevent accidents, such as falls; manage behavior and prepare you for the
dementia progression.
 Modifying the environment. Reducing clutter and noise can make it easier
for someone with dementia to focus and function. You might need to hide
objects that can threaten safety, such as knives and car keys. Monitoring
systems can alert you if the person with dementia wanders.
 Simplifying tasks. Break tasks into easier steps and focus on success, not
failure. Structure and routine also help reduce confusion in people with
dementia.

40. Lifestyle and home remedies
Dementia symptoms and behavior problems will progress over time.
Caregivers and care partners might try the following suggestions:
 Enhance communication. maintain eye contact. Speak slowly in simple
sentences, and don't rush the response. Present one idea or instruction at
a time. Use gestures and cues, such as pointing to objects.
 Encourage exercise. The main benefits of exercise in people with
dementia include improved strength, balance and cardiovascular health.
Exercise might also help with symptoms such as restlessness. There is
growing evidence that exercise also protects the brain from dementia,
especially when combined with a healthy diet and treatment for risk factors
for cardiovascular disease.
 Activity schedule
 Sleep hygiene
 Keep a calender

41. DELIRIUM
 Delirium is charecterised by an acute decline in both the level of consciousness
and cognition with particular impairement in attention.
 It is a serious disturbance in mental abilities that results in confused thinking and
reduced awareness of environment. The start od delirium is usually rapid - within a
hours or a few days.
 An etiologically nonspecific syndrome characterized by concurrent disturbances of
consciousness and attention, perception, thinking, memory, psychomotor
behaviour, emotion, and the sleep-wake cycle. It may occur at any age but is most
common after the age of 60 years. The delirious state is transient and of fluctuating
intensity; most cases recover within 4 weeks or less. However, delirium lasting,
with fluctuations, for up to 6 months is not uncommon

42. DIAGNOSIS GUIDELINES
(a) impairment of consciousness and attention (on a continuum from
clouding to coma; reduced ability to direct, focus, sustain, and shift
attention);
(b) global disturbance of cognition (perceptual distortions, illusions and
hallucinations - most often visual; impairment of abstract thinking and
comprehension, with or without transient delusions, but typically with
some degree of incoherence; impairment of immediate recall and of
recent memory but with relatively intact remote memory; disorientation for
time as well as, in more severe cases, for place and person);
(c) psychomotor disturbances (hypo- or hyperactivity and unpredictable
shifts from one to the other; increased reaction time; increased or decreased
flow of speech; enhanced startle reaction);

43. (d) disturbance of the sleep-wake cycle (insomnia or, in severe cases, total
sleep loss or reversal of the sleep-wake cycle; daytime drowsiness;
nocturnal worsening of symptoms; disturbing dreams or nightmares, which
may continue as hallucinations after awakening);
(e) emotional disturbances, e.g. depression, anxiety or fear, irritability,
euphoria, apathy, or wondering perplexity.
The onset is usually rapid, the course diurnally fluctuating, and the total
duration of the condition less than 6 months

44. F05.0 Delirium, not superimposed on dementia, so described
F05.1 Delirium, superimposed on dementia
F05.8 Other delirium
F05.9 Delirium, unspecified
F1x.03 Mental and behavioural disorders due to psychoactive substance
use, acute intoxication with delirium.
F1x.4 Mental and behavioural disorders due to psychoactive substance
use, withdrawl state with delirium

45. Treatments
The first goal of treatment for delirium is to address any underlying causes or
triggers — for example, by stopping use of a particular medication,
addressing metabolic imbalances or treating an infection. Treatment then
focuses on creating the best environment for healing the body and calming
the brain.
Supportive care
 Protecting the airway
 Providing fluids and nutrition
 Assisting with movement
 Treating pain
 Addressing incontinence
 Avoiding use of physical restraints and bladder tubes
 Avoiding changes in surroundings and caregivers when possible
 Encouraging the involvement of family members or familiar people

46. Pharmocological treatment
Antipsychotics are the most widely used drugs for the treatment of delirium-
related agitation but can have marked adverse effects.
 Antipsychotics; Haloperidol, Risperidone, Olanzapine, clozapine,
Quetiapine
Side effects can occur; Extrapyramidal syndrome, prolonged QT interval.
 Benzodiazepines
Side effects can occur; Paradoxical excitation, respiratory depression,
excessive sedation, confusion.

47. REFERENCES
 https://mayfieldclinic.com/pe-anatbrain.htm
 https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-of-the-
brain#:~:text=The%20brain%20is%20a%20complex,central%20nervous%20system%2C%20or%20CNS.
 Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: Diagnosis, prevention and treatment. Nature
Reviews. Neurology, 5(4), 210–220. https://doi.org/10.1038/nrneurol.2009.24
 Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J.,
Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi,
A., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet,
396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
 Mohan, A. (2014). Neural Control and Coordination.
 Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical
psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer.
 Stufflebeam, R. (2008). Neurons, synapses, action potentials, and neurotransmission. Consortium on Cognitive Science
Instruction.

49.  Mental health is a state of well-being in which a person realizes his/her own
abilities, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his/her community.
 Mental health has a low priority on the development agenda and for society in
general. There is a lack of knowledge about mental health issues, with
widespread stigma, prejudice and discrimination.
 The Convention on the Rights of Persons with Disabilities highlights that
persons with disabilities include those who have “mental impairments” and
emphasizes the need to: (i) ensure their full and equal enjoyment of all human
rights and fundamental freedoms; and (ii) promote their participation in civil,
political, economic, social and cultural spheres with equal opportunities.

50. DEFINITION
 Article 26, Habilitation and Rehabilitation, of the United Nations
Convention on the Rights of Persons with Disabilities (CRPD) calls
for:“… appropriate measures, including through peer support, to enable
persons with disabilities to attain and maintain their maximum
independence, full physical, mental, social and vocational ability, and
full inclusion and participation in all aspects of life”.
 This Report of WHO on rehabilitation defines rehabilitation as “a set of
measures that assist individuals who experience, or are likely to
experience, disability to achieve and maintain optimal functioning in
interaction with their environments”.

51.  The goal - is to help people with these disabling disorders develop
the emotional, social and intellectual skills needed to live, learn and
work in their homes and community.
 Rehabilitation comprises two sets of intervention strategies. The
first strategy is individual-centred and aims at developing the
person’s skills in interacting with the environment. The second
strategy is directed towards identifying and developing the
environmental resources to maximize their functioning in the
community. Most people will need a combination of both these
components for achieving full potential.
 Rehabilitation involves closing the gap between the individual’s
current skills and those needed for improved functioning.

52. ESSENTIAL PRINCIPLES OF
REHABILITATION
 Strategies must be tailored to the individual and family needs.
 Restoration of hope.
 Improve on existing strengths and abilities.
 Plans should be context specific.
 Environmental supports.
 Collaborative approach.
 Balance skill development and support.

53. GOALS OF REHABILITATION
 Prevention of the loss of function
 Slowing the rate of loss of function
 Improvement or restoration of function
 Compensation for lost function
 Maintenance of current function.
 Rehabilitation can be provided in a range of settings including acute care
hospitals, specialized rehabilitation wards, hospitals or centres, nursing
homes, respite care centres, institutions, hospices, prisons, residential
educational institutions, military residential settings, or single multi-professional
practices. Longer-term rehabilitation may be provided within community
settings and facilities such as primary health care centres, rehabilitation
centres, schools, work places or homes.

54. PROCESS OF REHABILITATION
Identify problems
and needs
Relate problems to
modifiable and
limiting factors
Define target problems and
target mediators, select
appropriate measures.
Plan, implement and
coordinate
interventions
Assess effects

55. ROLE OF PSYCHIATRIC SOCIAL
WORKER
 Psychosocial management of human problems and to improve the
psychosocial functioning of the individual.
 Restoration of impaired capacities
 Provision of individual and social resources.
 Prevention of social dysfunction.
 Detailed assessment of the person and the care givers for
providing total rehabilitation by using eclectic approach.

56. PSYCHOSOCIAL REHABILITATION
 Psychosocial rehabilitation (PSR) is a term used to describe treatments that aim to
restore the patient’s ability to function independently in the community. It not only
includes the medical and psychosocial treatment but also include ways to improve
social interactions, to promote independent living, and to encourage vocational
performance.

57. APPROACHES
 PSR is based on the key idea that people are motivated to achieve
independence and are capable of adapting in order to achieve their goals.
The process is highly individualized, person-centred, and collaborative.
 Some specific areas that psychosocial rehabilitation might address include
skills training and experiences designed to boost:
• Resilience and mental toughness
• Problem-solving
• Self-esteem
• Social skills
• Stress management

58.  PSR is holistic: strives to address areas of the person’s life that contribute to
overall mental and physical well-being.
 PSR is person-centred: Each client’s goals are individualized based upon
their specific needs or concerns.
 Areas of Concern: Key domains addressed through psychosocial rehab
include basic living skills, family relationships, peer and social relationships,
employment, education, recreation, health, and wellness.
 Effectiveness of PSR: A) It can improve life skills, B) can benefit overall
wellness, C) may help with serious psychiatric conditions.

59. PRINCIPLES OF PSYCHOSOCIAL
REHABILITATION
 All people have potential that can be developed.
 People have a right to self-determination.
 The emphasis is on the individual's strengths rather than their symptoms.
 Each person's needs are different.
 Professional services should be committed and take place in as
normalized an environment as possible.
 There is a focus on a social model of care (as opposed to a medical
model).
 It is cantered on the present rather than fixated on the past.

60. Those who might benefit from PSR
include:
 People who need help restoring their full functioning after treatment
 Those who are disabled and need ongoing assistance in multiple life
domains
 Individuals who, while functional, feel that they need a boost of support
and assistance
 People who lack the supportive environment and resources they need to
achieve full functioning
 Rehabilitation can help them learn basic skills that will allow them to
function and cope with their condition.

61. VOCATIONAL REHABILITATION
 Many patients who are engaged in meaningful activities, report a reduction in
symptomatology, and an enhanced sense of mastery over both ambient stress
and stressful life events.
 This redefinition of work therapy from passive "make work" approach to "an
active participatory" work restoration approach has resulted not only in a more
comprehensive system of evaluation, training and guidance but also in an
extensive array of vocational training and placement options.
 The two main paradigms currently dominating the practice of vocational
rehabilitation are known as
1. Train and Place
2. Place and Train

62. OBJECTIVES
 Vocational evaluation and adjustment of person with
disabilities.
 Assessment of medical, psychological, rehabilitation needs.
 Assist in developing rehabilitation plans.
 Distribution centres for various schemes
(scholarship/aids/appliances).
 Make referral to financing institution for funding self-
employment ventures.

63. PROCESS OF VR
EVALUATION
JOB SEEKING,
SKILL TRAINING
JOB ANALYSIS
JOB PLACEMENT AND
ACCOMMODATION
JOB FOLLOW-UP

64.  Vocational evaluation: defined as a comprehensive assessment that utilizes a variety of tools,
including paper and pencil tests, structured interviews and real or simulated work. It may use
work samples, situation assessment and on the job evaluations.
 Employment readiness: it includes 1)medical stability, 2)stamina and endurance, 3)
psychosocial factors such as individual support systems, 4)availability of adequate attendant
care, 5) transportation, 6)psychological motivation.
 Job seeking and skill training: it includes assist in developing job seeking skill training
(follow-up on job leads, resume writing, application completion, and interviewing skills) through
coaching, role playing and video taping.
 Job analysis: the factors that must be analysed are work environment, job tasks, productivity
(work atmosphere and cognitive demands).
 Job accommodation: requesting for accommodation
 Job follow up: ensure a successful outcome for both the individual and the employer.

65. REFERENCES
 Sekar, K., Parthasarathy, R., & Muralidhar, D., (2011), Handbook of
Psychiatric Social Work, Banglore:NIMHANS, Pp- 175-88.
 https://nimhans.ac.in/wp-content/uploads/2020/10/6.-Psychosocial-
Rehabilitation-Current-Trends_295-305.pdf
 https://www.who.int/disabilities/world_report/2011/chapter4.pdf
 https://www.verywellmind.com/psychosocial-rehabilitation-4589796
 https://www.who.int/disabilities/care/rehabilitation_guidelines_concept.pdf

66. THANK YOU