The document discusses disability, its dimensions, types and classification. It defines disability as any restriction or lack of ability to perform activities considered normal. Disability has three dimensions - impairments, activity limitations, and participation restrictions. The nine major types of disabilities are described. The document also discusses prevention of disabilities through various approaches like primordial, primary, secondary and tertiary prevention. It describes disability screening and identification, which includes methods, techniques and examinations for early detection. Various screening types and levels are explained. Identification of disabilities can be done through questions, checklists and developmental milestones.

1. P a g e | 1 Dr. Nithin Ravindran Nair (PT)
DISABILITY + EARLY IDENTIFICATION / SCREENING
CONCEPT OF DISABILITY: (Ref: ICF – CY)
Disability is defined as any restriction or lack of ability to perform any activity in
the manner or within the range considered normal for a human being.
According to WHO, Disability has 3 dimensions (In ICF disability serves as an
umbrella term for impairments, activity limitations and participation restrictions).
1) Impairment: Impairments are problems in body function or structure such
as a significant deviation or loss.
2) Activity Limitation: Activity limitations are difficulties an individual may have
in executing activities.
3) Participation Restriction: Participation restrictions are problems an
individual may experience in involvement in life situations.
TYPES / CLASSIFICATION OF DISABILITIES: (Ref: Rights of PWD Act, 2016)
According to the Rights of the Persons with Disabilities Act, 2016 the following two
definitions plays a major role while classifying disability
• Person with disability – A person with long term physical, mental,
intellectual or sensory impairment which, in interaction with barriers,
hinders his full and effective participation in society equally with others.
• Person with benchmark disability – A person with not less than 40% of a
specified disability where specified disability has not been defined in
measurable terms and includes a person with disability where specified
disability has been defined in measurable terms, as certified by the certifying
authority.
There are nine major types of disabilities
I. Locomotor Disability
o PPI of extremities
o PPI of the spine
o PPI in person with amputation
o PPI in person with club foot and other conditions

2. P a g e | 2 Dr. Nithin Ravindran Nair (PT)
o Locomotor disability due to chronic neurological conditions
o Spinal cord injuries
o Acid attack victims
o Cerebral palsy
o Leprosy cured persons with disabilities
o PPI in cases of short stature / dwarfism
o Muscular dystrophy
II. Visual Impairment
III. Hearing Impairment
IV. Speech and Language Disability
V. Intellectual Disability
VI. Mental Illness
VII. Disability Caused due to Chronic Neurological Conditions
VIII. Disability Caused due to Blood Disorders
IX. Multiple Disabilities
PREVENTION OF DISABILITIES: Reference: (Textbook of Community Medicine – AP
Kulkarni et al, Community Based Rehabilitation of Persons with Disabilities – S
Pruthvish, Preventive and Social Medicine – K Park)
PREVENTION
SCREENING
NOTIFICATION
MONITORING
SURVEILLANCECONTROL
ELIMINATION
ERADICATION

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APPROACHES TO PREVENTION
LEVELS OF PREVENTION:
Pre – Pathogenesis Pathogenesis
Prevention of occurrence of disease Prevention of progression of disease
1. Primordial Prevention
2. Primary Prevention
✓ Health Promotion
✓ Specific Protection
1. Secondary Prevention
✓ Early diagnosis and prompt
treatment
2. Tertiary Prevention
✓ Disability Limitation
✓ Rehabilitation
APPROACHES
INDIVIDUAL
APPROACH
MASS
APPROACH
AT RISK
APPROACH
PREVENTION
PRIMORDIAL
PRIMARY
SECONDARY
TERTIARY

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DISABILITY SCREENING / IDENTIFICATION:
Screening includes methods, techniques, procedures and examinations for early
and rapid detection of unrecognized disease or defect in apparently healthy
persons
Uses of Screening
✓ Early Diagnosis: Done periodically
✓ Case Detection: Prescriptive screening
✓ Control of Disease: Prospective screening
✓ Research Purpose: Provides information about incidence and prevalence
✓ Educational Opportunities: Creating public awareness and educating health
professionals
Types of Screening
✓ Mass Screening: Screening of large number of people, group or subgroup.
✓ High Risk / Selective Screening: Screening of specially and selectively adapted
high-risk group.
Level Phase of Disease Aim Action
Primordial
Underlying economic,
social & environmental
condition leading to
causation
Prevention of
emergence of risk
factor
Individual or mass
education &
Motivation
Primary Specific risk factors
Reduce the incidence
of disease
Health promotional
measures & Specific
protection measures
Secondary Early stage of disease
Reduce the prevalence
of disease by
shortening its duration
Early diagnosis or
identification &
Prompt treatment or
management
Tertiary Late stage of disease
Reduce the number
and / or impact of
complications
Disability limitation &
Rehabilitation

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✓ Multiphasic Screening: Two or more screening in combination is used for a
large number of people at one time.
✓ Multipurpose Screening: Objective is diagnosis of two or more diseases or
defects in the population
Flow Chart: Typical Screening Test:
Identification of Disability: (References: Community Based Rehabilitation of
Persons with Disabilities – S Pruthvish, Essentials of Community Based
Rehabilitation – Satya Bhushan Nagar)
A) Questions for use in identifying PWD (WHO)
People who have difficulty in seeing: Is there any person in the family
✓ Who cannot see as well as others?
✓ Who cannot see well in dark?
✓ Who cannot see objects that are far away?
✓ Who cannot see objects that are very close?
✓ Whose eyes look very different from other people?
APPARENTLY HEALTHY
PROBABLY HAVE THE DISEASE PROBABLY DO NOT HAVE THE
DISEASE
PERIODIC SCREENINGHAVE THE
DISEASE
DON’T HAVE THE
DISEASE
HISTORY TAKING, PHYSICAL
EXAMINATION &
DIAGNOSTIC TEST APPLIED

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People who have difficulty in hearing or speaking: Is there any person in the
family
✓ Has difficult in hearing what others say?
✓ Cannot understand what others say?
✓ Cannot speak?
✓ Cannot speak clearly enough to understand?
People who have difficulty in moving: Is there any person in the family
✓ Who has difficulty in moving body parts?
✓ Whose arms, legs, back, or neck are weak?
✓ Who has a great deal of pain in the arms, legs, back, or neck?
People who have no feelings in hands or feet: Is there any person in the family
✓ Who has lost feeling in either the hands or feet or both?
✓ Who has injured or burn his or her hands or feet?
People who show strange behavior: Is there any person in the family
✓ Who has changed so much that now he/she behaves like a different
person?
✓ Who doesn’t talk to anyone anymore?
✓ Who talk much more than before?
✓ Who become excited or angry for no reason?
✓ Who hear voices or see things that other people do not see or hear?
✓ Who has stopped dressing properly?
✓ Who speak or move around in a stranger manner?
B) Checklist for early identification at home: Parents can observe and identify
the children with disabilities by using this checklist
Locomotor Disability
✓ Difficulty in walking
✓ Absence of any part of the limb
✓ Difficulty in grasping objects
✓ Difficulty in raising both the arms

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Hearing Impairment
Screening Newborn
✓ Is there anyone in the family with deafness since childhood?
✓ Did the mother take an abortificient drug in large doses during first three
months of pregnancy?
✓ Birthweight below 1500 gms?
✓ Delayed cry after birth?
✓ Neonatal jaundice (first 10 days after birth)?
✓ Cleft in the lip or palate or a malformed pinna?
Screening Children in the age group 6 months to 2 years
✓ Turn around towards the source of sound (Located at back or one side of
the body)
✓ Discharge from ear
Screening Children in the age group 6 months to 2 years
✓ He/she turn around when called from behind
✓ Uses gestures excessively
✓ Does not speak or has a defective speech
✓ Does not understand the spoken language
✓ Discharge from ear
Visual Impairments
✓ Does not follow an object moving before his/her eyes by 1 month’s age
✓ The child doesn’t reach for toys held in front of him by 3 months
✓ One eye moves differently from other
✓ Red eyes, yellow discharge or tears flow continuously
✓ Tendency to bring pictures or books very near to eyes

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Major Developmental Milestones (Ref: Preventive and Social Medicine – K Park)
Scales that can be used for development screening:
✓ Denver Developmental Screening Test: Screen – Cognitive and Behavioral
problems, Four domains – Gross motor, Fine motor adaptive, Language,
Personal social behavior.
✓ Bayley’s Scale for Infant Development: appropriate (2 months – 3.5 years),
COMPRISES of 3 subscales – mental, motor, behavior rating
✓ Development Assessment Scale for Indian Infants (DASII): 67 items to assess
motor and 168 items to assess mental development
✓ Alberta Infant Motor Scale: assess motor maturation (birth – 14 months)
C) Early identification – outside:
In the rural and tribal areas as well as in the urban-slums, early identification
is done through
✓ Door – to – Door Surveys
✓ Screening Children at: Anganwadi center – ICDS, Health centers, Subhealth
Centers, Rehabilitation centers – Camps under DRC, Composite
Rehabilitation Center, Schools
AGE
MOTOR
DEVELOPMENT
LANGUAGE
DEVELOPMENT
ADAPTIVE
DEVELOPMENT
SOCIO-PERSONAL
DEVELOPMENT
6 – 8
weeks
Looks at mother,
smiles
3 months Hold head erect
4 – 6
months
Listening Begins to reach Recognizes mother
6 – 8
months
Sits without support
Experimenting with
noises
Transfers objects Enjoys hide and seek
9 – 10
months
Crawling
Increase range of
sounds
Releases objects
Suspicious of
strangers
10 – 11
months
Stands with support First word
12 – 14
months
Walks wide base Builds
18 – 21
months
Walks narrow base
Joining words
together
Begins to explore
24
months
Runs Short Sentences Dry by day

9. P a g e | 9 Dr. Nithin Ravindran Nair (PT)
Checklist for identification of children with special needs (School teachers
and parents should use this checklist)
VISUAL
• Watering of eyes
• Recurrent redness
• Often irritating
• Frequent blinking
• Squint
• Stumbling over objects / Bump into people
• Tilting of head or closure of one eye
• Headache
• Difficulty in counting fingers (1-meter distance)
• Difficulty in recognizing distant objects
• Difficulty in doing fine work requiring perfect vision
• Holding books (too close / too far) from eyes
• Frequently ask other children when taking notes from blackboard
Note: If any 4 responses are YES, child should be properly examined by a
qualified ophthalmologist.

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HEARING / SPEECH
• Malformation of ear
• Discharge from ear
• Irritation in ear
• Trying to listen from a closer distance
• Ask for instructions repeatedly
• Problems in paying attention in class
• Favor one ear for listening
• Difficulty in hearing when anyone speaks from behind
• Speaks loudly or too softly
• Exhibit voice problem / mispronunciation
• Tune TV/Radio too loud
• Irrelevant answers
• Keeps away from his age mates
• Unable to respond when called from other room
• Understands only after few repetitions
• Inappropriate sound in speech
• Stammering
• Incomprehensible speech
• Baby speech
Note: If any 4 responses are YES, child should be properly examined by a qualified
ENT specialist, an audiologist and also by a speech therapist
If child is below 4-5 years, consult psychologist to address any associated
psychological problems which may not be overtly evident.

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PHYSICAL DISABILITIES
• Evident Deformity
• Difficulty in sitting, standing, walking
• Difficulty in lifting, holding, keeping things on floor
• Difficulty in moving or using body parts
• Difficulty in holding pen
• Using a stick to walk
• Jerks in walking
• Lack bodily coordination
• Joint pains
• Any part of body amputated
Note: If answers to any of the above statement is positive, the child should be
examined by a qualified orthopedic surgeon and referred to a physiotherapist
and / or prosthetic / orthotic technician as needed.

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MENTAL RETARDATION
• Child does not sit unassisted even after 12 -15 months
• Doesn’t start walking even after 2.5 years
• Doesn’t start talking even after 2.5 years
• Difficulty in doing activities independently by age of 6 – eating, dressing,
toilet activities
• Difficulty in holding pencil
• Unable to play with ball
• Frequent tantrums
• Inattentiveness
• Requires too many repetitions to remember simple things
• Problems in naming fruits, vegetables, days of the week
• Problems in expressing the needs
• Unable to concentrate on tasks for shorter span
• Inappropriate oral response
• Difficulty in performing daily routine
• Difficulty in learning new things
• Difficulty in conceptualization
• Poor academic achievement
• More efforts in learning or practicing
• Undue dependency on visual cues or material learning
Note: If any 4 responses are YES, child should be properly examined by a qualified
psychologist or teacher specially trained for mentally challenged children

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LEARNING DISABILITIES
• Difficulty in counting
• Lack of concentrating or easily distracted
• Difficulty in sitting quietly in classroom
• Does not write down the spoken words correctly
• Inappropriate additions to right word
• Confused between left and right
• Difficulty in remembering verbal instructions
• Difficulty in memorizing the things
• Reverses letters or symbols
• Reverses numbers
• Extremely restless
• Poor in mathematical calculations
• Excessive errors during reading / writing
• Write letters or words either too close or too far (spacing problems)
Note: If any 3 – 5 responses are POSITIVE, child should be properly examined by
a qualified psychologist / pediatrician / or a special educator

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REFERENCES:
❖ Community Based Rehabilitation of Persons with Disabilities – S Pruthvish
❖ Essentials of Community Based Rehabilitation – Satya Bhushan Nagar
❖ Textbook of Community Medicine – Dr. AP Kulkarni et al
❖ Preventive and Social Medicine – K Park
❖ International Classification of Functioning, Disability and Health – Children and
Youth Version - WHO
❖ Rights of PWD Act, 2016