Community Based Rehabilitation.ppt

1
Community Based
Rehabilitation

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Rehabilitation
 The combined and coordinated use of medical,
social, educational and vocational measures for
training and retraining the individual to the highest
possible level of functional ability.
 Social integration- The active participation of disabled
and handicapped people in the mainstream of
community life

3
Rehabilitation
 Rehabilitation is a process that assists people with
disabilities to develop or strengthen their physical,
mental and social skills to meet their
individual/collective specific skills
 Rehabilitation traditionally involves provision of
therapy (physical, occupational and speech) in
various settings like special institutions, hospitals,
out-patient clinics or community homes.

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History of rehabilitation
 AD400-1400- people ridiculed the handicapped and
regarded them with suspicion
 Some nobles used physically handicapped as jesters
 Many handicapped people were burned as witches
 Spartans let deformed children die of exposure
 In Rome, parents could legally drown a disfigured
infant

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History of rehabilitation
 1800s- Attitude towards handicaps began to change-
people began to pity
 Handicaps were brought to bring shame on
themselves and their families
 Most handicapped people were kept hidden away at
home or in special institutions
 Mid 1900s – Important advances were made in the
treatment of handicapped
 During and after world war II extreme efforts were
made to rehabilitate disabled servicemen
 Military hospitals established rehabilitation centers

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Areas of concern in rehabilitation
 Medical rehabilitation
 Vocational rehabilitation
 Social rehabilitation
 Psychological rehabilitation

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Examples of rehabilitation
 Establishing schools for the blind
 Provision of aids for the crippled
 Reconstructive surgery in leprosy
 Muscle re-education and graded exercise in
neurological disorders
 Change of profession for a more suitable one
 Modification of life in general (for TB, Cardiac
patients)

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Three major strategies in rehabilitation
 Institutions based rehabilitation (IBR)
 Out reach programme for rehabilitation
 Community based rehabilitation (CBR)

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Institution based rehabilitation
 Assessment
 Informal education
 Vocational counseling and training
 Use of aids and appliances
 Are the common services offered
 Often run by NGO/private management
 Depend on external funding
 Children from middle and upper class are benefited
 Located only nearer to/in towns and cities

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Outreach programmes
 Through periodic visits by specialists, social workers and
rehabilitation workers
 Less population covered
 Sustainability

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Impairment, Disability, Handicap
definitions
 Impairment
Any loss or abnormality of psychological,
physiological or anatomical structure and function
 Disability
Any restriction or lack of ability to perform an activity
in the manner or within the range considered normal
for a human being
 Handicap
A disadvantage for a given individual, resulting in an
impairment or disability that limits or prevents the
fulfillment of a role that is normal for that individual

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Classification of disabilities
 Locomotor disabilities
 Visual disabilities
 Communication disabilities
 Mental retardation
 Cerebral palsy
 Mental illness
 Multiple disabilities

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Causes of disability
 Macro-economic conditions
 Nutritional deficiencies
 Weapons and violence
 Chemical substances
 Other causes

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Situational analysis of disabilities
Estimated number of physically disabled persons
in India are 16.154 million
 8.939 million people of locomotor disability
 4.005 million visually disabled,
 3.242 million hearing disabled
 1.966 million speech disabled
 78.32% (12.65 million) of physically disabled
people are living in rural area
 proportion of males is higher (58.93%) than
females

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Age-wise distribution of physically disabled
Out of every 1,000 disabled
 398 are in 60+ age group,
 425 in 15-59 age
 150 are in less than 14 years age

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Visual and hearing disabilities are more common in
60+ age group
Out of every 1,000 visually disabled
 717 are in 60+ age group
 526 out of 1,000 hearing disabled are in 60+ age
group

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Out of every 1,000 people with locomotor disability
 251 are in less than 14 age group
 487 are in 15-59 age group
Out of 1,000 speech disabled
 539 are in 15-59 age group

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Incidence of all kinds of physical disabilities
 Increases after 45 years
 Very high after 60 years of age
Out of every 1,000 people with physical disability
 278 have onset in 45-59 age
 511 have onset after 60 years of age.

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As per population data provided by UNFPA Geneva
1995
 Prevalence of severe and moderate disability in India
is estimated as 4.6%
 The predicted prevalence by 2020 is 5.25%

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Community Based Rehabilitation (CBR)
Introduction
 Many people in the world-have/face problem to get
help for their disability
 City institution are far away and cost too much
 Idea of CBR is that disabled people should have the
right to a good life
 Help they need should be offered –at a low cost
 Help offered to them and their family should suit their
usual way of living

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CBR (Introduction)
 They should be able to take up jobs and earn their
living
 They should be able to take a full part in all the
activities of their village, town or city
 They should be respected for being men and women,
girls and boys
 Information should be given to people in a way they
understand

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 CBR is a strategy within general community
development for rehabilitation, equalization of
opportunities and social inclusion of all children and
adults with disabilities.
 CBR is implemented through the combined efforts of
people with disabilities themselves, their families and
communities, and the appropriate health, education,
vocational and social services.

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 Community based rehabilitation is characterized by
the active role of people with disabilities, their families
and the community in the rehabilitation process.
 Knowledge and skills for the basic training of disabled
people are transferred to disabled adults themselves,
to their families and to the community members
 Personnel skilled in rehabilitation technology train
and support community workers, and provide skilled
intervention as necessary

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 It calls for the full and coordinated involvement of all
levels of society
 Community
 Intermediate
 National
• It seeks the integration of the interventions of all
relevant sectors
 Educational
 Health
 Legislative
 Social
 vocational

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 At the community level
 Seen as a component of an integrated community
development programme
 Should be based on decisions taken by its members
 Should rely as much as possible on the mobilization of
local resources
 Family of the disabled person is the most important
resource
 Community should support the basic necessities of life
and help the families who carry out rehabilitation at home
 A community structure (committee) should be set up to
provide the local management

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 At the intermediate level
 Network of professional support services should be
provided by the government
 Its personnel should be involved in the training and
technical supervision of community personnel
 Should provide services and managerial support
 Should liaise with referral services

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 At the national level
 Seeks the involvement of the government in the
leading managerial role
 Concerns planning, implementing, coordinating and
evaluating the CBR system
 In cooperation with the communities, the intermediate
level and the non governmental sector

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CBR background - technical
advances and rehabilitation
 World War II -many countries had large numbers of
disabled servicemen
 survived serious injury due to medical advances
 were able to reintegrate into their communities due to
advances in technical aids, appliances and assistive
technology
 A new specialty, rehabilitation, rapidly developed
 A United Nations Rehabilitation Unit was established
in 1951 to facilitate the transfer of these new medical
and technical advances to developing countries.

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Definitions
By UN
 “A strategy within community development for the
rehabilitation, equalization of opportunities and
social integration of all people with disabilities”
By Einar Helander
 “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”

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Principles of CBR
 Inclusion
 Participation
 Sustainability
 Empowerment
 Self advocacy

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Components of CBR
 Health
 Promotive
 Preventive
 Curative
 Rehabilitative
 Assistive devices

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Components of CBR
 Education
 Early childhood development
 Non formal education
 Basic education
 Higher education
 Special and transitory

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Components of CBR
 Livelihoods
 Skills training
 Access to capital
 Income generating activities
 Open employment
 Economic contribution and social protection

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Components of CBR
 Empowerments
 Self help groups
 Disabled peoples organizations (DPOs)
 Social mobilization
 Political empowerment
 Language and communication

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Components of CBR
 Social
 Legal protection
 Culture and religion
 Sports and leisure
 Relationships, marriage and family
 Personal assistance

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Prevention of disabilities
 Efforts of UNICEF and WHO
 Child survival, protection and development
 Immunization
 Improved infant feeding practices
 Child growth monitoring
 Home based diarrhea management
 Drinking water
 Environmental sanitation
 Birth spacing
 Education of girls

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Prevention of disabilities
 Efforts of Government of India
 Universal immunization program
 Reproductive and child health program
 Leprosy eradication program

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The Persons with Disabilities (Equal
Opportunity, Protection of Rights and Full
Participation) Act 1995
 The PWD Act was implemented in 1995
 Envisages equal opportunities, protection of right and full
participation of people with disability
 Prevention and early detection of disabilities is the most
important component of the Act.

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Various Measures Under The Act
 To undertake surveys, investigation and research
concerning the cause of disabilities.
 To promote various methods of preventing disabilities.
 To screen all the children at least once in a year for the
purpose of identifying at risk and cause of disability.
 To provide facilities for training to the staff at the primary
health centre.

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Activities to be taken by the Govt. & local bodies
 Prevention and early detection of disabilities
 Education
 Employment
 Nondiscrimination
 Research and development
 Affirmative action
 Social security
 Grievance redressal
 Mass awareness

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Penalties
 Imprisonment upto 2 years or a fine upto Rs 20000

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Various Measures Under The Act
 To sponsor awareness campaigns and disseminate
information for general hygiene.
 To take measures for prenatal, perinatal and
postnatal care of the mother and child.
 To educate the public through the preschools,
schools and primary health centers with the help of
village level workers and Anganwadi workers.
 To create awareness amongst the masses through
television, radio and other mass media on the causes
of disabilities and preventive measures to be
adopted.

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National trust for welfare of persons with
Autism, Cerebral Palsy, Mental Retardation
and Multiple Disabilities Act 1999
Objectives
 To enable and empower persons with disability to live as
independently and as fully as possible within and close
to the community to which they belong
 To strengthen facilities to provide support to persons with
disabilities to live within their own families
 To extend support to registered organizations to provide
need based services during the period of crisis in the
family of persons with disability

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 To deal with problems of persons with disability who do
not have family support
 To promote measures for the care and protection of
persons with disabilities in the event of death of their
parent or guardian
 To evolve procedure for the appointment of guardian
and trusties for persons with disability requiring such
protection
 To facilitate the realization of equal opportunities,
protection of rights and full participation of persons with
disability

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Mental health act 1987
 The mental health act 1987 repeals Indian lunacy act
1912 and lunacy act 1977
 Mentally ill person- A person who is in need of treatment
by reason of any mental disorder other than mental
retardation (subsec (1) of sec 2 )
 This act gives guide lines for the admission and
discharge of the patients to any psychiatric hospital
 Psychiatric services provided from a general hospital or
nursing home would not be covered

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Government programmes
 GOI supports more than 600 NGOs
 Both GOI and State Govts support disabled persons
with:
 Aids and appliances
 Maintenance allowance
 Support disability programs by NGOs

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Approaches seen in India
 Empowerment of persons with disability
 Empowerment of community
 Service approach
 Service plus empowerment approach
 Prevention of disabilities
 Trauma care and sports medicine

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Attempts by GOI to scale up operations
 District rehabilitation center scheme, grameena
punarvasa yojana and national programs for
rehabilitation
 Establishment of National institute of mentally
handicapped
 Establishment of National institute of visually impaired
 National institute of orthopedically handicapped
 National institute for hearing impaired
 All India istitute of speech and hearing
 NIHMANS

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NIMHANS
 Rehabilitation and vocational training activities for
subjects with psychiatric disabilities dates from 1848
AD
 Separate department was created for psychiatric and
neurological rehabilitation in 1985
 One of the oldest department of this institute
 Largest day care center and vocational training
facility for psychiatric patients in the world
 Has 16 different vocational sections

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NIMHANS (Activities)
 Clinical services
 Training and research in neurological and psychiatric
rehabilitation
 Department has outpatient, inpatient and day care
services
 There are 22 beds for inpatient neurological
rehabilitation

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Clinical services
Day care for chronic mentally ill
 Assessment of Disability
 Planning and extension of rehabilitation programs
 Placement services
 Family intervention

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Clinical services
 Community resource utilization
 Vocational training
 Behavioral modification programs
 Social skill training
 Recreational program

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Neuro-Rehabilitation
 Inpatient and out patient neurorehabilitation in the
rehabilitation department
 Outpatient physiotherapy
 Inpatient occupational therapy
 Outpatient occupational therapy
 Neurology services
 Neuro developmental therapy services

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List of important organization in
India
 Action of disability and development India (ADD)
 All India Institute of physical medicine and rehabilitation
 All India Institute of speech and hearing
 Amar Jyoti research and rehabilitation center
 Association of the physically handicapped
 Center for special education
 Chetna Institute for the mentally handicapped
 Child in need institute
 Christian Medical College
 Education and training institute for mentally retarded
children

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List of NGOs
 Manovikas kendra purb sarania
 Amar jyoti charitable trust
 Samadhan
 Naval public school
 Spastic society of India
 B M Institute of mental health
 Navajyoti trust
 Institute of child health
 Sri Ramana Maharishi academy for the blind
 Mobility India
 Association of people with disabilities

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Resources for programmes for the
mentally ill
 NIMHNS
 National institute of mentally handicapped
 Sanjivini
 Dept of psychiatry

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References
 Park’s text book of Preventive & Social Medicine - K.
Park.Banarasidas Bhanot publishers .18th edition
 National health programmes of India (National policies
and legislations related to health)-J. Kishore
 http://www.wcc-coe.org (accessed on 2.11.06)
 http://web.worldbank.org (accessed on 4.11.06)
 http://www.nimhans.kar.nic.in (accessed on 4.11.06)
 http://cbrresources.org (accessed on 6.11.06)
 http://www.dpi.org (accessed on 4.11.06)
 http://www.spasticsocietyofkarnataka.org (accessed on
4.11.06)
 Text book of Community Medicine. Sridhar Rao
 Community based rehabilitation of persons with
disabilities. S Pruthvish. Jaypee publishers.

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