Community inclusion aims to provide equal access and opportunities for people with disabilities through participation in employment, housing, education, recreation, and civic roles. Factors influencing participation include medical care, self-efficacy, physical abilities, accessible equipment and environments, social support, and disability policies. Promoting inclusion requires addressing barriers like low education, poverty, prejudice, and inaccessible settings through rehabilitation, community support, empowerment, and addressing social justice. Life care planning can support community reintegration by outlining medical, housing, equipment, preventative, and cost needs over a person's lifetime.
Unit-VII WELFARE FACILITIES FOR REHABILITATION IN DISABLED PERSON.pptxanjalatchi
some of the benefits for disabled people?
Scholarship schemes for students with disabilities. ...
Concession in Railway and Air fare. ...
Rebate in income tax. ...
Reservation in government jobs. ...
Free travel in state transport buses. ...
Loan for starting own business.
RPWD Act 2016 addresses some of the long standing demands of the Indian persons with disabilities. Inclusion of more conditions in disability list, free education for disabled children, framework for supporting institutional and social infrastructure, making accessible environment and provisions of punishment for violation of RPWD Act are very important.
Unit-VII WELFARE FACILITIES FOR REHABILITATION IN DISABLED PERSON.pptxanjalatchi
some of the benefits for disabled people?
Scholarship schemes for students with disabilities. ...
Concession in Railway and Air fare. ...
Rebate in income tax. ...
Reservation in government jobs. ...
Free travel in state transport buses. ...
Loan for starting own business.
RPWD Act 2016 addresses some of the long standing demands of the Indian persons with disabilities. Inclusion of more conditions in disability list, free education for disabled children, framework for supporting institutional and social infrastructure, making accessible environment and provisions of punishment for violation of RPWD Act are very important.
Rights to Persons with Disabilities Act 2016 New Law for PwDs in IndiaRajnish Kumar Arya
The salient features of the Bill are:
i. Disability has been defined based on an evolving and dynamic concept.
ii. The types of disabilities have been increased from existing 7 to 21 and the Central Government will have the power to add more types of disabilities. The 21 disabilities are given below:-
1. Blindness
2. Low-vision
3. Leprosy Cured persons
4. Hearing Impairment (deaf and hard of hearing)
5. Locomotor Disability
6. Dwarfism
7. Intellectual Disability
8. Mental Illness
9. Autism Spectrum Disorder
10. Cerebral Palsy
11. Muscular Dystrophy
12. Chronic Neurological conditions
13. Specific Learning Disabilities
14. Multiple Sclerosis
15. Speech and Language disability
16. Thalassemia
17. Hemophilia
18. Sickle Cell disease
19. Multiple Disabilities including deafblindness
20. Acid Attack victim
21. Parkinson's disease
Am Papri Das, M. Sc (N) Community Health Nursing faculty with more than 23 yrs of experience working as Vice-Principal at Peerless College of Nursing. Power point presentation on topic "Community Based Rehabilitation" It will be of great help to Nursing student in graduate and post graduate level. as possible in the interest of the students. Hope the topic will be beneficial to the students folk.
Paper presented at the National Instt for training professionals in vocational rehab of persons with multiple disabilities (PWMD) Paper concerns mainly an introduction and ways to identify jobs in relation to residual abilities of PWMD. Different characteristics of job, how to match job with abilities and different types of employment. Community based vocational training & rehab. Visit www.aidthedisabled.org for more
There are so many schemes under National trust act as Disha,Vikaas,Samarth,Gharaunda,Nirmaya,Sahyogi,Prerna
Gyan Prabha,Sambhav,Badhte Kadam.Unique Disability ID,National Fund and National Award also included in it.There are so many schemes for education, employment and for Disability Certificate.
Occupational Therapy for Special Needs ChildrenANJU A
Occupational therapy (OT) may sound like it involves finding a job or developing work skills, but it actually deals with strengthening fine motor skills. These include tasks like writing, cutting, shoe-tying, and using utensils. OT is commonly used in special education programs for children.
This presentation is on the National trust act for the welfare of persons with autism, cerebral palsy, mental retardation, multiple disability and about the different schemes put forwarded by this act.
Age friendly initiative: Introduction to Self Management WorkshopAloka Banerjee
Introduction to training for community dwelling older persons on Self Management:
Subjects will include:
Common health issues.viz cardiovascular, arthritis, neurodegenerative condition, vision and hearing.
Techniques to deal with problems such as frustration, fatigue, pain and isolation,
Appropriate exercise for maintaining and improving strength, flexibility, and endurance,
Healthy diet
Appropriate use of medications, polypharmacy.
Communicating effectively with family, friends, and health care professionals
How to evaluate new treatments.
Active Ageing.
An Age Friendly Initiative : Introducing Self Management to Community Dwelling Elders
The Self Management Workshop entails skill development of elders in chronic health issues.Education and awareness helps elders to understand common diseases ,prevention and maintaining a healthy life.
Rights to Persons with Disabilities Act 2016 New Law for PwDs in IndiaRajnish Kumar Arya
The salient features of the Bill are:
i. Disability has been defined based on an evolving and dynamic concept.
ii. The types of disabilities have been increased from existing 7 to 21 and the Central Government will have the power to add more types of disabilities. The 21 disabilities are given below:-
1. Blindness
2. Low-vision
3. Leprosy Cured persons
4. Hearing Impairment (deaf and hard of hearing)
5. Locomotor Disability
6. Dwarfism
7. Intellectual Disability
8. Mental Illness
9. Autism Spectrum Disorder
10. Cerebral Palsy
11. Muscular Dystrophy
12. Chronic Neurological conditions
13. Specific Learning Disabilities
14. Multiple Sclerosis
15. Speech and Language disability
16. Thalassemia
17. Hemophilia
18. Sickle Cell disease
19. Multiple Disabilities including deafblindness
20. Acid Attack victim
21. Parkinson's disease
Am Papri Das, M. Sc (N) Community Health Nursing faculty with more than 23 yrs of experience working as Vice-Principal at Peerless College of Nursing. Power point presentation on topic "Community Based Rehabilitation" It will be of great help to Nursing student in graduate and post graduate level. as possible in the interest of the students. Hope the topic will be beneficial to the students folk.
Paper presented at the National Instt for training professionals in vocational rehab of persons with multiple disabilities (PWMD) Paper concerns mainly an introduction and ways to identify jobs in relation to residual abilities of PWMD. Different characteristics of job, how to match job with abilities and different types of employment. Community based vocational training & rehab. Visit www.aidthedisabled.org for more
There are so many schemes under National trust act as Disha,Vikaas,Samarth,Gharaunda,Nirmaya,Sahyogi,Prerna
Gyan Prabha,Sambhav,Badhte Kadam.Unique Disability ID,National Fund and National Award also included in it.There are so many schemes for education, employment and for Disability Certificate.
Occupational Therapy for Special Needs ChildrenANJU A
Occupational therapy (OT) may sound like it involves finding a job or developing work skills, but it actually deals with strengthening fine motor skills. These include tasks like writing, cutting, shoe-tying, and using utensils. OT is commonly used in special education programs for children.
This presentation is on the National trust act for the welfare of persons with autism, cerebral palsy, mental retardation, multiple disability and about the different schemes put forwarded by this act.
Age friendly initiative: Introduction to Self Management WorkshopAloka Banerjee
Introduction to training for community dwelling older persons on Self Management:
Subjects will include:
Common health issues.viz cardiovascular, arthritis, neurodegenerative condition, vision and hearing.
Techniques to deal with problems such as frustration, fatigue, pain and isolation,
Appropriate exercise for maintaining and improving strength, flexibility, and endurance,
Healthy diet
Appropriate use of medications, polypharmacy.
Communicating effectively with family, friends, and health care professionals
How to evaluate new treatments.
Active Ageing.
An Age Friendly Initiative : Introducing Self Management to Community Dwelling Elders
The Self Management Workshop entails skill development of elders in chronic health issues.Education and awareness helps elders to understand common diseases ,prevention and maintaining a healthy life.
Older people are at the heart of the strategy, and their responses and contributions will be vital to developing the plan further
A linked-awareness that everyone has an interest in these developments, because we will be older in time, and hope to live in a community and a society that respects ,includes and cares for us
It presents the vision of the new partnership, its aims and approaches, and an outline of practical and cost effective ways to achieve them through technology social and environment changes.
DFI is determined to set standards and lead the way for other cities in India.
Unit I Introduction for II B Sc Nursing
By Mrs. Nithyashree B V Asst Professor Yenepoya nursing college Yenepoya Deemed to be university Derlakatte Mangaluru
Advancing Health Equity: Building on Community-Based InnovationWellesley Institute
This presentation offers insights on how to advance health equity by building on community-based innovation.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Building Equity and Social Determinants of Health into 'Healthy Communities' ...Wellesley Institute
This presentation provides critical insights on how build equity and healthy communities.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
This presentation offers critical insights on thinking and acting on health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
We are Worth the Investment. NSW Council for Intellectual Disability Conference 16-17 July 2015. Children, Young People and the NDIS Mary Hawkins, Branch Manager Nepean Blue Mountains Early Transition Site NDIA
Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life.
New Directions in Medicaid - Initiatives for People with Mental IllnessOneVoiceTexas
Dana Stoner, Senior Policy Advisor with Texas Department of State Health Services, shared three examples of "changing the system" at the June 3, 2014 workshop on Designing Healthcare in Texas. The presentation was part of a Medicaid 101 overview and started the two day event sponsored by One Voice Texas, Harris County Healthcare Alliance, and Kinder Institute.
Acting on Social Determinants and Health Equity: An Equity Toolkit for Public...Wellesley Institute
This presentation examines the relationship between the social determinants of health and health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Proposed changes in health care payment, from fee-for-service to alternative, risk-sharing payment models, can have a substantial impact on health services for children, especially those with complex care needs. In addition, tying payment to value can increase use of ambulatory and preventive services and encourage creative outreach. However, abrupt changes can interrupt continuity and reduce access to care.
Psychosocial rehabilitation (PSR) is a holistic approach to supporting individuals with mental health conditions or disabilities in their recovery journey. It aims to enhance their quality of life, independence, and community integration by addressing psychological, social, and environmental factors.The goals of psychosocial rehabilitation (PSR) are multifaceted and aim to address the diverse needs of individuals with mental health conditions or disabilities. These goals are centered around promoting recovery, enhancing quality of life, fostering independence, and facilitating community integration.
• Promoting Recovery
• Enhancing Daily Functioning
• Developing Coping Skills
• Building Social Skills and Relationships
• facilitating Vocational and Educational Goals
• Promoting Community Integration
• Improving Mental Health and Well-being
• Preventing Relapse and Hospitalization
• Enhancing Independence and Self-Sufficiency
• Improving Quality of Life
FACTORS AFFECTING PSYCHOSOCIAL REHABILITATION
Several factors can affect the effectiveness and outcomes of psychosocial rehabilitation (PSR) for individuals with mental health conditions or disabilities. These factors may influence the individual's ability to engage in rehabilitation activities, adhere to treatment plans, and achieve their recovery goals.
• Severity and Nature of the Disability: The type and severity of the individual's mental health condition or disability can significantly impact their ability to participate in psychosocial rehabilitation. Conditions with more severe symptoms or functional impairments may require more intensive or specialized interventions.
• Individual Characteristics: Personal factors such as age, gender, cultural background, socioeconomic status, education level, and personality traits can influence how individuals respond to psychosocial rehabilitation. Understanding these factors is essential for tailoring interventions to meet the individual's unique needs and preferences.
• Social Support Network: The presence of a supportive social network, including family, friends, peers, and other community members, can enhance the individual's ability to engage in psychosocial rehabilitation and cope with challenges. Conversely, lack of social support or negative social interactions may hinder progress in rehabilitation.
• Access to Resources: Adequate access to healthcare, mental health services, rehabilitation facilities, housing, transportation, employment opportunities, and other community resources is essential for supporting individuals in their recovery journey. Barriers to accessing these resources, such as financial constraints or geographic limitations, can impede progress in psychosocial rehabilitation.
• Stigma and Discrimination: Stigma associated with mental illness or disability can negatively impact individuals' self-esteem, self-efficacy, and willingness to seek help or engage in rehabilitation services. Addressing stigma and discrimination.
Patients with spinal cord injury face a number of challenges, with continence being a top priority. For those affected by neurogenic bladder and bowel, there are various management options available. To help understand these options, study notes in this area can be useful. These notes, which are similar to index cards, can highlight key information related to the management of neurogenic bladder and bowel in spinal cord injury patients.
presentation about relation between posture and pain. there is lot of talk and research regarding bad posture and chronic pain. but posture, disease along with physical activity intervention should be done to manage.
Cancer Rehabilitation. integrating rehabilitation with oncology. a model of care. cancer survivorship. rehabilitation care in low resource area. Mrinal Joshi. Rehabilitation Research Center. Jaipur.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. ADVANCES IN COMMUNITY INCLUSION
MRINAL JOSHI
DIRECTOR
REHABILITATION RESEARCH CENTRE
SMS MEDICAL COLLEGE & HOSPITALS
JAIPUR
IFNR 2022 Special Session-Spinal Injury Rehab
2. Definition - Inclusion
The practice or policy of providing equal access to
opportunities and resources for people who
might otherwise be excluded or marginalized,
such as those who have physical or mental
disabilities
3. Participation
• More strongly related to positive influence on health and well being
• More strongly related to quality of life
• Highly valued rehabilitation outcome for PWDs
• ICF defines Participation as “a person’s involvement in a life situation”
and Activity as “the execution of a task or action by an individual”
• Participation can be seen as active engagement at the community
level
International Journal of Rehabilitation Research 2015,38:1-19
4. Community Inclusion
The opportunity to live and exist as a contributing member of the community while
being valued for one’s abilities and uniqueness – regardless of disability. The
ultimate goal of community inclusion is participation of people with disabilities in
• Employment
• Housing
• Education
• Recreation and leisure
• Civic management
• Peer support
• Ultimate goal of rehabilitation interventions
communitymainstreaming.org
5. Community reintegration
Dijkers defined community integration as “acquiring/resuming age-
gender- culture- appropriate roles/ statuses/ activities, including
independence/interdependence in decision making, productive
behaviours performed as part of multivariate relationships with
family, friends, and others in natural community settings. It is a
complex biopsychosocial phenomenon.
Top Spinal Cord Inj Rehabil 1998;4:1-17
6. With inclusion, people
• Feel associated
• Are acknowledged, accepted and recognized
• Feel worthy
• Actively participate in community
• Have the right to choose their activities
• Have the right to choose their social relationships
• Have companions and don’t feel left out
thebetterindia.com
7. Social relationships
• Essential component of optimal health & well being
• Social people have healthier and longer life
• SCIs have negative impact on social relations due to neurological challenges
• Married have higher proportions of network members
• Married have lower feelings of loneliness
• Tetraplegics have lower networking days than paraplegics
• No significant association between network size and feeling of loneliness
• Employment status was found to protective against loneliness
• Reinforces the importance of supporting caregivers
Disability And Rehabilitation
http://doi.org/10.1080/09638288.2019.1616328
8. The Problem
• Low inclusion incidence with PWDs
• Meagre 0.14% of PWDs in India have regular jobs
• PWDs not chosen by potential employers
• In rural area dependent on non-agriculture-based self employment
• Unsustainable financial situation
• Contributing factors
• Low education
• Inability to afford health treatment
• Un-inclusive employment settings
• Un-inclusive surroundings
• Prejudice against PWDs
centerforfinancialinclusion.org
9. Factors influencing participation
• Medical model of disability
• Self efficacy & adjustment skills
• Physical health & functional capacities
• Availability of cost-effective adaptive equipment
• Relearning capacities for performing daily activities
• Social model of disability
• Impact of natural & physical environments
• Social relations based on social skills and mutual understanding
• Human rights model of disability
• Autonomy in daily occupation
• Justice through application of policies, advocacy & negotiation
Top Spinal Cord Inj Rehabil doi: 10.13110/sci2501-41
Australian Occupational Therapy Journal doi:10.1111/1440-1630.12241
10. Employment
• Key indicator of successful rehabilitation and community integration
• Europe 43-61.4% employment rate in SCI
• U.S. 49%
• Australia 42%
• Indonesia, Thailand & Malaysia 36.3%-44.7%
• China 23-31%
• South Korea 27%
• Japan 50.5%
Archives of Physical Medicine & Rehabilitation
http://doi.org/10.1016/j.apmr.2020.05.027
11. Solutions
• Client centred rehabilitation & promoting physical activity
• Disability friendly environment through local cooperation
• Urgent need to address social justice and empowerment
• Community based mentoring
• “Halfway houses”
Top Spinal Cord Inj Rehabil doi: 10.13110/sci2501-41
NeuroRehabilitation doi: 10.32233/NRE-22012-0775
BMC Health Service Research doi: 10.1186/s12913-020-051181-x
13. Predicting community reintegration
• Increasingly important area of clinical, policy and research interest
• Facilitators
• SCI with less severe neurologic injuries
• Caucasian ethnicity
• Higher education
• Female , higher occupational community integration but lower in other domains
• Longer post-injury period
• Strong social support
• Impediments
• Severe neurologic injuries
• Lower educational level
• Minority status
• Shorter duration of injury
• Unmarried status
Arch Phys Med Rehabil 1999;80:1485-91
14. Life care plan
• Medical rehabilitation problem list & current status
• Recommendations/interventions, including projected evaluations by
physicians, therapists, psychology services, vocational and recreational
therapies and case management. Projected therapeutic interventions
(frequency, duration & type) and diagnostic testing requirement should be
included.
• Ongoing medical needs, including medications, home care assistance,
projected medical & surgical needs and disposable medical supplies.
• Housing & architectural adaptations for accessibility.
• Equipment needs, including home equipment, exercise equipment, driving
& transportation needs, orthotics, wheelchair needs and recreational
equipment.
Arch Phys Med Rehabil Vol 88, Suppl 1, March 2007
15. Life care plan
• Recommendations for preventive actions and interventions to
decrease the frequency, severity and duration of complications.
• Estimated length of each required service.
• Estimated costs for each required service.
• Estimated life expectancy.
Arch Phys Med Rehabil Vol 88, Suppl 1, March 2007
Editor's Notes
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Participation in meaningful occupations has been shown to have a positive influence on health and well-being, and is a vital part of the human condition and experience . It is internationally recognized that all individuals, including those with disabilities, have a right to be able to fully participate in society. Participation has been shown to more strongly related to quality of life than either impairment or func-tional ability and is therefore a highly valued rehabilitation outcome for individuals with dis-abilities.
The ICF describes the impact of health conditions on individuals' lives and places functioning and disability in a context that includes both environmental and personal factors. ICF defines Participation as ‘a person's involvement in a life situation' and Activity is defined as ‘the execution of a task or action by an individual.
Participation can be seen as including active engagement at the community level and a means to experience social connectedness with other individuals and communities
Dijkers6 has eloquently defined community reintegration as “acquiring/ resuming age- gender- culture-appro-priate roles/ statuses/activities, including independence/interde-pendence in decision making, and productive behaviors per-formed as part of multivaried relationships with family, friends, and others in natural community settings.”6(p5) Thus, community reintegration is a complex phenomenon influenced by various biopsychosocial factors.
Social relationships are essential component of optimal health and well being. Adults who have more relationships are healthier with longer life expectancy than those in the general population with less social relationships. For spinal injured, social relations may be negatively impacted due to challenges of neurological impairments as well as the environmental barriers to social participation. There is paucity of research specifically examining social disconnectedness & perceived social isolation. In a study conducted in Greece by Tzonichaki, greater feelings of loneliness were associated with lower life satisfaction and self esteem. Similarly in study conducted by Sara in Canada showed that persons who were married had a higher proportion of network members and had higher average number of days interacting with network members. And had higher proportions of kin as network members. Lower feelings of loneliness were associated with having a higher proportion of network members living in the household. So bigger the family merrier you are. Guilcher found social networks of persons with SCI tended to be robust and of quality, yet smaller than social network observed in general population. One of the finding in these research was that employment status was found to be protective against feelings of loneliness. Employment has been shown to provide a sense of purpose, belongingness, social inclusion and increase social networks. Engaging in meaningful employment has also been associated with physical health, mental health and overall well being. Unfortunately employment rate in people with SCI is almost zero, especially in india.
Participation in daily activities denotes the ICF domains of self-care (activities of daily living), domestic life (instrumented activities of daily living), interpersonal interaction and relationship (social participation); major life areas (education and work); and community, social and civic life (play and leisure).
Addressing the social environmental influences is critically important as many persons with spinal injury face discrimination and other human right barriers that directly impact their long-term survival, their ability to participate in a quality social life, and their opportunities to be involved in income-generating activities.
The medical model prescribes that people need to be cured and supported by compensatory devices or medical technologies to enable participation in daily activities. The view in human right model is to promote, protect and ensure the full & equal enjoyment of human rights and fundamental freedoms to promote respect for the inherent dignity of persons with disabilities.
Four categories fell under the medical model of disability, (1) Robust self efficacy and adjustment skills were seen as facilitating participation in daily activities
(2) Physical health and functional capacities impact participation, the higher and more complete the lesion the more incontinence and secondary health complications lower participation and social interaction. These constraints are more in low and medium income countries like India the long term survival is also limited (3) Adaptive equipment is beneficial in compensating for functional limitations and with our own experience we have found wheelchair independence and ambulation as two independent factors promoting social interaction and inclusion (4) Patient has to adapt and relearn life skills and this adaptation is necessary for participation. Under the social model disability (11) natural and physical environment have an important influence on participation, inaccessibility of infrastructure , neighbourhood distance, and terrain limit participation. Sometimes the family becomes over protective and does not allow participation to environmental influences, (2) Social relationships and strong social network positively affect inclusion. In relation to human rights model of disability (1) Autonomy is facilitated by freedom of choice, reciprocity and equality in decision making, in employment , family and society, (2) legislation and human rights action facilitated participation in daily activities. Recently there has been an increase in disability quota but accessibility to health and rehabilitation still remains a far fetched dream as starting up rehabilitation services and budget allocation to such facilities is still a far fetched dream in our own backyard.
Availability of healthcare and govern-ment policies were both placed in the top five barriers to participation. Overall, there was a general lack of satisfaction with health professionals and the rehabilitation process. Respondents felt unprepared for discharge, that poor attitude of health professionals could limit choice and control, and that there was insufficient support from reintegration professionals but in our context there is no agency or person for following up rehabilitation in community and reintegration.
Employment is a key indicator of successful rehabilitation and community integration of people with disabilities, including spinal injury. Participation in paid work does not only ensure income and economic self-sufficiency, but is also associated with enhanced self-esteem, building social relationships, life satisfaction and longevity. For the society as a whole, successful integration of people with disabilities into the workforce in effect increases work productivity and contributes to the social well being of the population.
In most of the countries the employment rate of spinal injures is around 35-37, but no figures are available from India. Lot of factors play a role, such as income per capita, socioeconomic inequality, national labour market and policies, health care systems and policies including financial disincentive/incentive and attitude towards participation of people with disabilities in the labour market. It is sad to see that our National Medical Council is still unclear about the importance of Physical Medicine & Rehabilitation. In absence of rehab & health care how we can ensure or facilitate rehabilitation and participation.
The other challenge we have is the educational background in Indian spinal injury population, almost 70% patients are agriculture workers or manual labourers with only primary / middle school education and these characteristics in many studies has been associated with a lower return to work rate.
We need to have outreach services like telerehab & telemonitoring and there is a dire need to develop affordable and advanced adaptive equipment. Priority should be made to develop strong social network and sensitising members of family & public about the importance and possibility of participation. This would assist in creating conditions to allow persons with spinal injury to reintegrate into community life and to support health and long term survival.
There is a urgent need to address social justice and empowerment, I find it surprising that when medical facilities are being set up the social justice department is not included as one of the stake holder resulting in unhelping health facility creation for the challenged people. And despite governmental disability rights policies having been revised recently, there is lack of meaningful advances in equal opportunities in community life.
With the advent of managed care and increasing external pressures on the rehabilitation system, the inpatient treatment team is required to focus on those skills and abilities that will allow the individual to return to living in the community. Working on goals aimed at maximizing re-integration and full participation in society have necessarily transitioned away from the inpatient rehabilitation realm to alternative settings such as outpatient, day treatment, and community service pro-grams. Individuals with disabilities in the fields of education and vocational rehabilitation, educational and employment outcomes for individuals with disabilities still lag behind those for non-disabled youth and adults. In particular, youth with disabilities have been one of the most disadvantaged groups subject to discrimination and lack of opportunities. There is clearly an ongoing need for the education and vocational rehabilitation systems to work together to improve outcomes for youth and young adults with disabilities.
In 2009, the China Association of Persons with Physical Disability, a government-supported national organization, started community co-op centres called “halfway houses” for individuals with SCI in four provinces. Halfway houses are the platform for community-based rehabilitation (CBR) for individuals with SCI. results suggest that such training is an effective intervention to improve abilities in basic life skills and their applications in family and social life, even for individuals with a long SCI history [7]. Wheelchair use, housework, toileting, and bath transfer were the four items that showed relatively the most improvement.
Here the study population lives in rural areas where the primary economic activity is daily wage labour. Often the person with SCI was the sole breadwinner in the family. Although many participants had 5 or more years of formal education, only around 40% achieved higher education, compounding the challenge for economic self-sufficiency. Government programs and policies for persons with disability are not enforceable. Thus, despite the proportion of those returning to work being 83.7%, their economic self-sufficiency CHART scores remained relatively low.
Many of them did not return to their previous work because of various limitations, both personal , legislative and environmental factors. Therefore, 73% of them adopted their own business.
The results suggest that a comprehensive rehabilitation and vocational program, which emphasizes RTW as the ultimate goal, can improve employment status post injury and community reintegration as well as inclusion.
The World Health Organization's (WHO) Model of Disablement and the Institute of Medicine's (IOM) Model of the Enabling-Disabling Process suggest that the degree to which a person with disability is an active, productive member of society, well integrated into family and community life, is a complex phenomenon influenced by many factors.
In general, the relationships found in this study support the premise that survivors of SCI with less severe neurologic injuries, of younger age, of Caucasian ethnicity, and more education will achieve greater community integration. Gender had the smallest effect of the selected variables; being female was associated with higher occupational community reintegration, but lower community reintegration in the other dimensions. (This may be an indication that females are more likely to return to homemaking roles, while males are less likely to return to salaried employment.)
it is also found that lower educational levels, minority status, shorter duration of injury, and unmarried status all increased the probability of having incomplete economic self-sufficiency data.
