This document discusses community-based rehabilitation (CBR), including its definition, objectives, principles, nature, and components. It describes the roles of various sectors like health, education, employment, and media in supporting CBR. It outlines the advantages of CBR and roles of community health nurses in areas like awareness, early detection, rehabilitation programs, and modifying attitudes. CBR aims to improve participation and inclusion of persons with disabilities through a multidimensional approach with positive impacts on individuals and communities.

1. PRESENTED TO: PRESENTED BY:
MRS. MANJULA THAKUR ANUPAMA
TUTOR, NINE PGIMER M.SC. NURSING 2ND
YEAR

2. CONTENT OUTLINE
• Introduction of rehabilitation
• Objectives of rehabilitation
• Principles of rehabilitation
• Nature of rehabilitation
• Definition of community based rehabilitation
• Objectives of CBR
• Principles of CBR
• Components of CBR
• Multi sectoral support for CBR
• Advantages of CBR
• Role of community health nurse in CBR

3. REHABILITATION
• Rehabilitation is defined as “a set of interventions designed to optimize
functioning and reduce disability in individuals with health conditions in
interaction with their environment”.
• According to WHO “Rehabilitation is the combine and coordinated use of the
medical, social, educational and vocational measures for training and re-training
the individual to the highest possible level of functional ability”.

4. OBJECTIVES OF REHABILITATION NURSING
There are four broad objectives of rehabilitation nursing
 To restore affected abilities to the highest possible level of function.
 To prevent further disability /handicap.
 To protect the person abilities.
• To assist the person’s present abilities.

5. PRINCIPLES OF REHABILITATION
• Rehabilitation should begin during the initial contact with the patient.
• Restoring the patient to independent or to regain his pre-illness/pre-disability
level of function in as short a time as possible.
• Maximising independence within the limits of the disability.
• Realising goals based on individual patient assessment and to guide the
rehabilitation programme.

6. CONT..
 He must be an active participant .
 The activities of daily living are facilitated
 The individual with a disability is encouraged to wear his clothing enhances
self-esteem and dignity .
 Motivates the patient and helps him to attain social independence.
 Focus is on the needs of groups of people with specific condition .
 Every patient has a right to the rehabilitation services.

7. NATURE OF REHABILITATION
This may be of two types:
1. Institutional based rehabilitation
2. Community based rehabilitation

8. INSTITUTIONAL BASED REHABILITATION
Rehabilitation is performed in the institute that may be regional rehabilitation,
district rehabilitation or research rehabilitation center or in the special educational
institute (i.e., Deaf and dumb school, school for MR children, etc)
It may be done in the special rehabilitation unit of the hospital (physiotherapy,
speech therapy of vocational therapy centres). This is a new strategy, a unique
concept of WHO, to provide universal coverage of rehabilitation to all segment of
the society.

9. COMMUNITY BASED REHABILITATION
Community based rehabilitation is characterized by active role of people with
disabilities, their families and community in the rehabilitation process. In CBR
knowledge and skills for the training of disabled people are transferred to the
disabled adults themselves and to their families and the community .

10. DEFINITION OF COMMUNITY BASED
REHABILITATION
• According to WHO, CBR may be defined as “strategy within community
development for the rehabilitation, equalization of opportunities, and social
integration of all people with disabilities.
• CBR is implemented through the combined efforts of disabled people
themselves, their families and communities, and the appropriate health,
education, vocational and social services”.

11. OBJECTIVES OF COMMUNITY BASED
REHABILITATION
 To identify all persons with disability in the community.
 To provide required rehabilitation services to disabled people.
 To create awareness about all issues related to disability
 To transfer rehabilitation related skills to the community members.

12. PRINCIPLES OF CBR
1. INCLUSION
2. PARTICIPATION
3. SUSTAINABILITY
4. EMPOWERMENT
5. SELF-ADVOCACYAND
5. BARRIER FREE ENVIRONMENT.
6. GENDER SENSITIVITY AND SPECIAL
NEEDS
7. EQUITY
8. FACILITATION

13. 1.INCLUSION
• CBR works to remove all kinds of barriers which block people with disabilities
from access to the mainstream of society. Inclusion means placing disability
issues and people with disabilities in the mainstream of activities.

14. 2. PARTICIPATION
• CBR focuses on abilities, not disabilities. It depends on the participation and
support of people with disability, family members and local communities. It also
means the involvement of people with disabilities as active contributors to the
CBR programme, from policy-making to implementation and evaluation, for the
simple reason that they know what their needs are.

15. 3.SUSTAINABILITY
• CBR activities must be sustainable beyond the immediate life of the programme
itself. They must be able to continue beyond the initial interventions, and be
independent of the initiating agency. The benefits of the programme must be
long-lasting.

16. 4. EMPOWERMENT
Local people – and specifically people with disabilities and their families,
ultimately may make the programme decisions and control the resources. This
requires people with disability taking leadership roles within programmes. It means
ensuring that CBR workers, service providers and facilitators include people with
disabilities and that all are adequately trained and supported. Results are seen in
restored dignity and self-confidence.

17. 5. EQUITY
CBR emphasizes equality of opportunities and rights – equal citizenship.
Raising awareness CBR addresses attitudes and behavior within the community,
developing understanding and support for people with disabilities and ensuring
sustainable benefits. It also promotes the need for and benefit of inclusion of
disability in all developmental initiatives.

18. 6. SELF ADVOCACY
CBR consistently involves people with disabilities in all issues related to their
well-being. Self advocacy is a collective notion, not an individualistic one. It
means self-determination. It means mobilizing, organizing, representing, and
creating space for interactions and demands.

19. 7. FACILITATION
CBR requires multisectoral collaboration to support the community and to address
the individual needs of people with disability, with the ultimate aim of an inclusive
society

20. 8. GENDER SENSITIVITY AND SPECIAL NEEDS
CBR is responsive to individuals and groups within the community with special
needs.

21. 9. PARTNERSHIPS
CBR depends on effective partnerships with community-based organizations,
government organizations and other organized groups.

22. COMPONENTS OF COMMUNITY BASED
REHABILITATION
 Creation of a positive attitude towards people with disabilities.
 Provision of education and training opportunities.
 Provision of rehabilitation services e.g. Physical therapist, occupational therapist.
 Creation of micro and macro income generating opportunities.
 Provision of care facilities.
 Prevention of the cause of disabilities.
 Monitoring and evaluation.

23. MULTI-SECTORAL SUPPORT FOR CBR
Support from the social sectors:
Examples: disability pensions, technical aids and adaptations, vocational training
and employment, and co-ordination of referrals for individuals who require
services from other sectors.

24. SUPPORT FROM NGOS AND THE LOCAL
COMMUNITY
Most communities have a variety of non-governmental organizations (NGOS) and
groups that can contribute to a CBR program.

25. SUPPORT FROM THE HEALTH SECTORS
The declaration of Alma Ata (1978) is states that primary health care (PHC) is the
key to attaining health for all. It also states that the PHC needs to address the main
health problems in the community, providing promotive, preventive, curative and
rehabilitative services.

26. PHC can play a major role in this context both as a
provider and supporter:
• Early identification of impairments and providing basic interventions.
• Referrals to specialized services such as physical, occupational and speech
therapies; prosthetics and orthotics; and corrective surgeries.

27. SUPPORT FROM THE EDUCATIONAL
SECTOR:
Adapting the content of the curriculum and methods of teaching.
Ensuring that classrooms, facilities and educational materials are accessible.
Children with multiple or severe disabilities may access education through the
use of innovative methods best suited to their context.

28. SUPPORT FROM THE EMPLOYMENT AND
LABOR SECTOR:
Collaboration with the employment and labor sectors. Productive and decent
work in a conducive environment
Equal employment opportunities through national policies and legislation;

29. SUPPORT FROM THE MEDIA
All CBR stakeholders should work closely with the media to identify priorities
and to provide relevant information.

30. ADVANTAGE OF COMMUNITY BASED
REHABILITATION
 Home based
 Less expensive
 Existing community response and resources
 Focus on quality rather than quantity
 Multiple approaches based on community needs.

31. LIMITATIONS OF CBR PROGRAMMES
• Different priorities in poor- survival needs has more priorities than solving problems of
disabled. CBR program should therefore be focusing on essential needs.
• Complex organization-
• Low field activity- educated workers rarely go to field and also find hard to communicate
with low educated disabled people.

32. CONT..
• Low social status to cbr worker- frontline cbr is low profile job so less educated
workers may influence quality of services provided
• Lack of community ownership- breakdown of traditional social structure that
contribute to several problems
• Expensive approach- as focus on quality.

33. PRIMARY HEALTH CARE &
REHABILITATION
Primary health care is essential health care on practical scientifically sound and
socially acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and at
cost that the community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self determination.

34. CONT..
 Community based rehabilitation is fully consonant with the concept of primary
health care. This approach promotes awareness, self-reliance and responsibility
for rehabilitation within the community.
 It builds on manpower resources in the community, including the disabled
themselves, their families and other community members.
• CBR encourages the use of simple method and techniques that are acceptable,
affordable, effective, and appropriate to local setting.

35. CONT..
 CBR program must be flexible so that it can operate at the local level and within
the context of local conditions.
 In case of leprosy, the social implications of the disease are closely interwoven
with the cultural traditions of society. Every society considers health and
disease, and life & death in different ways and this influences the attitude taken
by the community towards patient.

36. COMMUNITY BASED REHABILITATION
PERSONNEL
 CBR workers are gross root workers delivering services in a community.
 Supervisors or medico social workers who organize and support gross not
workers.
 Professional such as surgeons, physiotherapist, vocational trainers, counselors to
whom referrals can be made from the community.

37. CBR workers are key in the implementation of CBR. They
are usually the main person in contact with the family.
They are able to:
 As a local advocates on behalf of people with disabilities and their families with
the health services personnel
 Provide liaison and continuity of care in the community on behalf of
professional e.g. Continued supervision of home programs
 Provide positive role model for services users if they themselves have a
disability.

38. USEFUL INITIATIVES FOR COMMUNITY
BASED REHABILITATION
 Social counseling
 Training in mobility and daily living skills
 Providing or facilitating access to loans
 Community awareness raising

39. ETHICAL ISSUES IN REHABILITATION
NURSING
 Rehabilitation nurses are confronted with issues that need resolution in areas where
answers are not readily found. Important examples of ethical areas likely to create
conflicts are listed below.
 Care of potentially vulnerable populations, including the elderly, prisoners, children,
cognitively impaired populations.
 Changes in death certification decision based on technological advances in death.
 Proposed legislation for assisted suicide and related movements.

40. CONT..
 Controversies over individual’s right to live and right’s to die .
 Acute care medical issues involving life and death decisions .
 The issues of resources allocation and patient selection, the ethics of team care
and ethical issues in goal setting ,as they relate specifically to rehabilitation
medicine ,are examined in some detail.
 The issues raise an ethical question about CBR being an appropriate strategy for
the rehabilitation of people with impairments in developing countries .

41. REHABILITATION COUNCIL OF INDIA
 Rehabilitation council of India was set up as registered society in 1986.
 On September ,1992 the RCI act was enacted by parliament and it became statutory body in
22 June 1993.
 The act was amended by parliament in 2000 to make it broad based and its specific role is to
develop, standardize and regulate training programmes/courses at various levels in the field
of rehabilitation and special education

42. CONT..
• It also maintains the central rehabilitation register for qualified
professionals/personnel in the area of rehabilitation and special education and
promotes research in special education. The act also prescribes punitive actions
against unqualified persons delivering services to the disabled peoples.

43. 16 CATEGORIES OF PROFESSIONALS/PERSONNEL
HAVE BEEN COVERED UNDER THE RCI ACT ARE
 Audiologist and speech therapists
 Clinical psychologists
 Hearing and ear mould technicians
 Rehabilitation engineers and technicians.
 Special teachers for educating and training
the handicapped.
 Vocational counsellors, employment
officers and placement officers.
 Multi-purpose rehabilitation
therapists technicians.
 Speech pathologists
 Rehabilitation psychologists

44. CONT..
 Rehabilitation social workers
 Rehabilitation practitioners in mental
retardation
 Orientation and mobility specialists
 Community based rehabilitation
professionals
 Rehabilitation counsellors,
administrators
 Prosthetists and orthotists.
 Rehabilitation workshop managers

45. ROLE OF COMMUNITY HEALTH NURSE IN
REHABILITATION
 Assessment of the patients physical, mental, socioeconomically and vocational status.
 Diagnosis of the therapeutic, physiotherapeutic, vocational, education, training and supportive needs of the
client.
 Deciding the minimum acceptable improvement in the patient’s health, capacity for independence and
productivity level.
 Formulation of plan of action to meet the decided minimum standards.
 Implementing the action plan.
 Evaluation of the result of interventions.
 Modification of plan of action, if necessary

46. Additional qualification for community health
nursing in rehabilitation
 Excellent listening skills
 High order counselling abilities
 Exceptional problem-solving skill.
 The ability to adopt innovative methods to help the patient realize.

47. ROLE OF NURSE IN COMMUNITY BASED
REHABILITATION
 Create awareness of the problem in the community.
 Reduce the consequences of the disabilities by early detection (educate the
family and the community in early detection of the disability)
 Provide early intervention
 Establish adequate number of aids in appliance and workshops to fabricate
atrophic, prosthetic and other items

48. CONT..
 Appropriate need-based rehabilitation programme.
 Train families in functional rehabilitation
 Modify inappropriate attitude of the family are community towards disability.
 Arrange meeting of families with children having similar disabilities-so that
they will be mutually supportive.
 Provide recreation facilities for disabled children .

49. Results. Although CRFs work with individuals, groups, families and the community, they appear
to have had a stronger impact on individuals with disabilities rather than the community at
identified and were related to the poor recognition of the scope of practice of CRFs as well as to
out certain tasks.
Conclusions. Although the results suggest that CRFs have had a positive impact, there are still a
number of issues that need to be addressed. These include proper support of CRFs and
government departments to ensure the future of CBR in South Africa.

50. Results: CBR has a positive impact on the well-being of persons with disabilities participating in
the programme and particularly on their participation within the family and the society at
a multidimensional and positive impact on individual and collective capabilities; on individual,

51. SUMMARY
Today we have discussed about
• Introduction of rehabilitation
• Objectives of rehabilitation
• Principles of rehabilitation
• Nature of rehabilitation
• Definition of community based rehabilitation
• Objectives of CBR

52. CONT..
• Principles of CBR
• Components of CBR
• Multi sectoral support for CBR
• Advantages of CBR
• Role of community health nurse in CBR

53. CONCLUSION
• Community-based rehabilitation (CBR) can make a lasting difference in the life
of persons with disabilities.
• CBR improves participation and inclusion of persons with disabilities in the
family and in the community.

54. REFERENCES
 Gulani K.K textbook of community health nursing .Delhi, published by kumar
publishers .
 Park K “textbook of preventive and social medicine “25th edition published by bhanot
publishers.
 Manivannan d shymala. Textbook of community health nursing, new delhi ,published
by satish kumar jain .
 Lal sunder ‘textbook of preventive and social medicine 4th edition, published by CBS
publishers

55. CONT..
• Chappell P, johannsmeier C. The impact of community based rehabilitation as
implemented by community rehabilitation facilitators on people with disabilities,
their families and communities within south africa. Disability and rehabilitation.
2009 jan 1;31(1):7-13.
• Biggeri m, deepak s, mauro v, trani jf, kumar j, ramasamy p. Do community-
based rehabilitation programmes promote the participation of persons with
disabilities? A case control study from mandya district, in india. Disability and
rehabilitation. 2014 aug 1;36(18):1508-17.