DISABLITY AND CBR - Copy.pptx

 Define disability, CBR, assistive device.
 Understand and explain the relationship between rehabilitation and disability
 Explain purposes of community based rehabilitation
 Describe basic concepts and models in rehabilitation and disability
 Able to conduct Research and evaluate the needs of specific target groups in the
community
 work in collaboration with other health care profession.
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 Key facts from the World Report on
Disability, 2011
• Over a billion people, about 15% of the
world’s population, have some form of
disability.
• 1 in 5 people, 20% of the population of the
poorest people in developed countries have a
disability
• 80% of people with disabilities live in
developing countries.
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• Children with a disability are much less likely to
attend school than children without disability.
• In many low and middle income countries, only
5% – 15% of people who require assistive devices.
• Only 20% of women with disabilities in low
income countries are employed compared with 58%
of men with disabilities.
• People with disabilities are at greater risk of
violence: up to 4 – 10 times the rate of violence
against people without disabilities
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 The definition of disability various across
different groups, organizations, national
governments and individuals.
 Different definitions have emerged to adjust to
different realities and to suit different purposes.
 The concise definition for disability has not been
universally agreed upon
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 It is lack of ability to perform an activity
within the range/ considered as normal
 It is an umbrella term covering impairments,
activity limitations and participation
restriction.
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 Disability is complex, dynamic, multidimensional
and fluid concept.
The United Nations Convention on the Rights of
Persons with Disabilities (CRPD) defines disability as:
‘’an evolving concept that results from the
interaction between persons with impairments and
attitudinal and environmental barriers that hinders
their full and effective participation in society on an
equal basis with others’’.
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 Disability: is a “restriction or lack (resulting from an
impairment) of ability to perform an activity in the
manner or within the range considered as normal for a
human being (WHO, 1976).
 Disabilities are descriptions of disturbances in function
at the level of the person.
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 Disability is a state in which functional limitation
and/or impairments are causative factors of the
existing difficulties in performing one or more
activities which are generally accepted as
essential, basic component of daily living, such as
self-care, social relations and economic activity .
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 inclusion is to embrace all people irrespective of
race, gender, disability, medical or other need. It is
about giving equal access and opportunities and
getting rid of discrimination and
intolerance (removal of barriers).
 Inclusion should lead to increased participation in
socially expected life roles and activities—such as
being a student, worker, friend, community member,
patient, spouse, partner, or parent.’
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 Impairment: It is “any loss or abnormality of
psychological, physiological, or anatomical
structure and functions of the body or an
organ” (WHO, 1976).
 Impairments are disturbances at the level of the
organ, which includes defects in or loss of a limb,
organ or other body structure, as well as defects
in or loss of a mental function.
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 Handicap: is a “disadvantage for a given
individual, resulting from an impairment or
disability that limits or prevents the fulfillment of
social and economic roles that is normal
(depending on age, sex, social and cultural
factors) for that individual (WHO, 1976).
 Handicap happens when disabled people meet
cultural, social, physical barriers that prevent them
access to the various systems of their society that
are available to other fellow able-bodied citizens.
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simply disability can be defined as:
 Impairment + barrier = disability
 Impairment + accessible environment =
inclusion
 Disability +people meet cultural, social, physical
barriers =handicap
 An impairment on its own would not lead to
disability, there should be a completely
inclusive and comprehensively accessible
environment.
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 It is important to be able to clearly
differentiate between what is impairment and
what is disability.
 A good way to do this can be by reflecting on
what are the root causes of impairment and
disability.
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 For impairment some of the causes can be
attributed to accidents, war, natural disasters,
congenital, during child birth, or medical
negligence etc.
 Whilst for disability root causes can be
related to poverty, lack of an accessible
environment, poor educational and health
opportunities and discriminatory practice
amongst others
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 In short impairments are mostly irreversible,
lifelong and can be supported by
rehabilitation and habilitation;
 whereas causes of disability are reversible
and can be addressed by identifying and
removing barriers to participation be they
attitudinal, social, political or economic
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 Disability is not a homogeneous experience. The
lived experience of women and girls with
disabilities is very different to that of men and
boys.
 Equally people with different impairments will
experience very different types of barriers. In
addition to gender, there are many other factors
that can also affect your experiences and
opportunities, not least: education, social status,
wealth, political awareness and where you live –
rural, city, developed or developing country
context.
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 The International Classification of
Functioning, Disability and Health (ICF)
advanced to the understanding and
assessing of disability and health. It was
developed through a long process involving
academics, clinicians, and – importantly –
persons with disabilities .
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 problems with human functioning are
categorized in three interconnected areas:
■ impairments are problems in body function
or alterations in body structure often identified
as symptoms or signs of health conditions. –
for example, paralysis or blindness;
■ activity limitations are difficulties in
executing activities – for example, walking or
eating;
■ participation restrictions are problems with
involvement in any area of life – for example,
facing discrimination in employment or
transportation.
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 Impairments are problems in body function or
structure such as a significant deviation or loss.
 Body Functions are physiological functions of body
systems (including psychological functions).
 Body Structures are anatomical parts of the body
such as organs, limbs and their components.
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 Activity is the execution of a task or action by
an individual.
 Participation is involvement in a life situation.
 Activity Limitations are difficulties an
individual may have in executing activities.
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 Participation Restrictions are problems an
individual may experience in involvement in
life situations.
 Environmental Factors make up the physical,
social and attitudinal environment in which
people live and conduct their lives.
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 There are general principles that underlay the
conception of ICF as a health
classification of functioning and disability, and
are closely linked to the bio psychosocial model
of disability. These principles are essential
components.
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 A classification of functioning and disability should
be applicable to all people
irrespective of health condition. Therefore, ICF is
about all people. It concerns
everyone’s functioning. Thus, it should not become a
tool for labeling persons with disabilities as a
separate group.
 Having a common language (accessible, usable,
convenient and a pleasure to use)
 on responding to 'empirically-grounded human
variation.
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 There should not be, explicitly or
implicitly/favor of person or cause,
distinction between different health
conditions as 'mental' and 'physical' that
affect the structure of content of
classification of functioning and disability
 It states that the functional status is not
determined by background etiology
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 Wherever possible, domain names should be
worded in neutral language so that
the classification can express both positive and
negative aspects of each aspect of
functioning and disability.
 It emphasis away from negative connotations
such as disability.
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The ICF can also be used to understand the positive
aspects of functioning such as body functions,
activities, participation and environmental
facilitation.
 Functioning
 is an umbrella term for body function, body structures,
activities and participation.
 It denotes the positive or neutral aspects of the interaction
between a person’s health condition(s) and that individual’s
contextual factors (environmental and personal factors).
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• Domain 1: Cognition – understanding and communicating
• Domain 2: Mobility – moving and getting around
• Domain 3: Self-care – attending to one’s hygiene, dressing, eating and staying alone
• Domain 4: Getting along – interacting with other people
• Domain 5: Life activities – domestic responsibilities, leisure, work and school
• Domain 6: Participation – joining in community activities, participating in society.
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Function:
 Mental Functions
 Sensory Functions and Pain
 Voice and Speech Functions
 Functions of the Cardiovascular, Hematological,
Immunological and Respiratory Systems
 Functions of the Digestive, Metabolic, Endocrine
Systems
 Genitourinary and Reproductive Functions
 Neuro musculoskeletal and Movement-Related
Functions
 Functions of the Skin and Related Structure
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Structure:
 Structure of the Nervous System
 The Eye, Ear and Related Structures
 Structures Involved in Voice and Speech
 Structure of the Cardiovascular, Immunological
and Respiratory Systems
 Structures Related to the Digestive, Metabolic
and Endocrine Systems
 Structure Related to Genitourinary and
Reproductive Systems
 Structure Related to Movement
 Skin and Related Structures
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Activities and Participation
 Learning and Applying Knowledge
 General Tasks and Demands
 Communication
 Mobility
 Self Care
 Domestic Life
 Interpersonal Interactions and Relationships
 Major Life Areas
 Community, Social and Civic Life
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 Disability arises from the interaction of health
conditions with contextual factors –
environmental and personal factors .
 These factors can be either facilitators or
barriers.
 Environmental factors include: products and
technology; the natural and built
environment; support and relationships;
attitudes; and services, systems, and policies.
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 personal factors, such as motivation and self-
esteem, which can influence how much a person
participates in society. However, these factors are
not yet conceptualized or classified.
 It further distinguishes between a person’s
capacities to perform actions and the actual
performance of those actions in real life, a subtle
difference that helps illuminate the effect of
environment and how performance might be
improved by modifying the environment.
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 ENVIRONMENTAL FACTORS In order to complete
the social model of disability, ICF includes
Contextual Factors, in which environmental factors
are listed.
 These factors range from physical factors such as
climate and terrain, to social attitudes, institutions,
and laws. Interaction with environmental factors is
an essential aspect of the scientific understanding
of the phenomena included under the umbrella
terms‘ functioning and disability‘
 are Products and Technology Natural Environment
and Human-Made Changes to Environment Support
and Relationships Attitudes Services, Systems and
Policy.
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 Spinal Injury
Paralysis(IMPAIRMENT)
Incapable of using public transportation(ACTIVITY
LIMITATION)
Lack of accommodations in public transportation
leads to no participation in religious
activities(PARTICIPATION RESTRICTION)
 Leprosy
Loss of sensation of extremities(IMPAIRMENT)
Difficulties in grasping objects(ACTIVITY
LIMITATION)
Stigma of leprosy leads to
unemployment(PARTICIPATION RESTRICTION)
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 The ICF is universal because it covers all
human functioning and treats disability as a
continuum rather than categorizing people
with disabilities as a separate group.
 It is useful for a range of purposes –
research, surveillance, and reporting – related
to describing health and disability, including:
assessing individual functioning, goal setting,
treatment, and monitoring; measuring
outcome
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 Population growth
 aging
 result of road injuries
 conflicts
 wars
 the emergence of chronic conditions such as
diabetes, cardiovascular disease and cancer and
medical advances that prolong life.
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 The WHO recognized six causes of disability:
 malnutrition,
 communicable disease
 non communicable
 accidents
 emotional disturbances,
 alcoholism and drug addiction.
 In general the cause of disability can be either
prenatal (before birth) or during birth or post natal
(after birth).
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 emergence of chronic conditions (DM, CVD and HIV/AIDS)
 Inherited (geneticaly transimited diseases)
 Congenital problems
 Injury (MVA, falls, fights and Gunshots)
 Mental health problems
 Population growth ???,
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 Disabilities exist every where.
 They have different effects on different people.
 When disability becomes a real handicapped to the
individual, it makes problems of the following kinds:
The effect of disability on the individual is greatly harsh.
It includes: role failures up on the:-
 Individual- loss of status, loss of skill and
experience, loss of earning power, reduced to position
of dependency and broadly social segregation.
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On the Family: effects like loss of status, loss or
reduction of income, increased dependency on others,
burden of caring for the disabled and the likes.
On the Society: it includes: loss of former
contribution in skill and earnings, loss of man power
unit, loss of production, consumption of financial and
other social service charges for care of the disabled
person and his or her family, increase in number of
non-productive or dependent persons, etc.
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1)PHYSICAL DISABLITY
 arthritis
 Epilepsy
 cerebral palsy
 Traumatic brain injury
 Post polio syndrome
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 motor neurone disease
 stroke
 Diabetes Mellitus,
 GBS
 spinal cord
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2. Sensory- blind or visually impaired, deaf or hard
of hearing, speech.
3. Learning disability – down’s syndrome, autism.
4. Mental illness – clinical depression,
schizophrenia.
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 Secondary conditions (e.g. pressure sore)
 Co-morbid conditions ( e.g. DM)
 Age-related conditions (e.g. premature aging)
 Engaging in health risk behaviors (e.g. smoking)
 Higher rates of premature death
 Barriers to health care
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People with disabilities in Ethiopia face
many barriers.
 generally categorized as:-
 policy/institutional
 Environmental
 attitudinal
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 Lack of strong Policy and legislation issues in the
government
 Financing
 Poor Service delivery strategies
 lack of organizational support
 Poor safety and security strategies
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building and structures are not typically accessible
to all
 Latrines
 Service center( health centers, schools,
library,dormitory)
 Emergency camps/shelters
 Transportation services
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 Discrimination
 stigma/negative attitudes
 Stereotypes
 low expectations
 low self-confidence
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 Stereotype: is a simplified conception or image,
often held in common by people about another group
.
 Community-held view about particular group of peple,
that is widly accepted by other. Eg ..disable people are
.. women are.. men are…
 Stereotypes may be positive or negative.
 It is a means of Generalizations based on minimal
or limited knowledge about a group of people
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 Prejudice = an unfair(usually negative) and un
reasonable feeling, opinion and
judgement(contempt, dislike or
disgust)especially when formed without enough
thought or knowledge
 Is negative beliefs, feelings regarding a
certain group of people.eg. racism, sexism
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 Stigma is a mark of disgrace associated with a particular
circumstance
 It originates from ancient Greek, where it was used as the
term for a visible mark or brand placed on members of
tainted groups, such as slaves or traitors
 Nowadays, stigma is defined as shame and disgrace or
discrediting
 Is negative idea + attitude (belief)+ negative
behavior(action)
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 The stigmatized individual is reduced in our minds from a whole and
usual person to a tainted, discounted one’ (Goffman, 1963)
 It is based on myths and misunderstandings and it is always
negative.
 Social stigma is extreme disapproval of a person on a ground of
characteristics that distinguishes them from other society
◦ Lack of Basic & in-depth knowledge about the disability
 Misbelieves and fears about how disability is caused and about
the potential/capacity of PLWDs
◦ If the family suspected that one member has the disability, then they
think that it will be transmitted to the other family member
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Discrimination = Acting on these inaccurate
beliefs or attitudes
 For example, a nine-year-old boy with cerebral palsy (he
used a walker) was not allowed to play in his
community soccer program (discrimination) because
the commissioner of the league felt that he would be a
danger to others .
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 Appreciate strengths of disabled people
 advocate importance of disabled people as
customers
 Communicate and involve disabled people in
breaking down barriers
 Avoid stereotypes, assumptions, myths and
misconception
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Community participation is critical to the success of CBR
programmers. Therefore social education is one
strategy which helps to engage community members
and empower them for change and action to improve
the quality of life of PWDs.
Including PWDs in all development issues equally is
the primary goal of CBR. However Societies respond
differently to PWDs and to the provision of services
such as Education, Health and Employment for
PWDs. So promoting, supporting and facilitating the
active involvement of PWDs and their families in
issues that affect their lives can be possible through
the help of education.
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mobilize the community to change the negative attitudes
and behaviors towards people with disabilities and their
families
make the community able to decide about the needs and
rehabilitation services of PWDs in equal and fair
distribution , it is better to change and reshape their
thoughts and practical considerations by community
education
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 Prevents Social exclusion/isolation
 reduce social inequalities
 Contribute to greater social mobility
 Creates awarness
 Increases social participation of PWDs
 promote a positive change in attitude among the
community
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 In addition since most disabilities in Ethiopia are
preventable, educating the society will make them able to
avoid those causative risk factors
 It also Encourages persons with disabilities and their
associations to participate in prevention campaigns.
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 What is model?
 It is a frame/a set of guiding assumptions used to
make sense of information.
 It encapsulates a set of knowledge and
perspectives
 A model is both shaped by ideas and serves to
shape ideas
 Model is dynamic
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 Human made tool guidelines for action !
 A representation of reality !
 are only invented, human assumptions. !
 are, to some extent, culture-bound and time bound.
 Models are not reality!
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Purposes of models
1. Provide definitions of disability
2. Provides causal attributions
. Understanding the source and cause of the
disability.
3. Models determine responsibility attribution
Who is .responsible for the “solution” of disability?
4. Models determine needs
. Resourses
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 Traditional models
 Medical models
 Social models
 Bio-psycho-social Model
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Traditional models
◦ Moral/religious perspective
◦ Charity perspective
◦ Cultural
◦ ‘’Bad/good’’
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Medical models
Disability as aconsqunce of health condition , disease or caused
by trauma
◦ Impairment perspective
◦ Functional limitation perspective
◦ Risk selection is not possible
◦ Biological approach:- (immunity, metabolism, genetics, disease…)
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Social models
Persons activity are limited not by the impairment or condition
but by environment and barriers are consequence of alack of
social organization.
◦ Environmental perspective
◦ Empowerment perspective
◦ Human rights perspective
 ( socio-economic status, ethnicity, social support, norms/value, spirituality, housing…)
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 Interaction between individual genetics
makeup(biology),mental health and
personality(psychology) and socio- cultural
environment (social world) contribute to their
experience of health and illness.
 It is all rounded and inclusive model.
(pycho:- Attention/perception, cognitive, emotion, motivation, memory, learning…)
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 Disability vs Functioning?
 Effects of disability in physical, psychological
,social, economical, and community level?
 Advantage and disadvantage of each
disability models?
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DISABILITY
PREVENTION
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YES! - Over 70 percent - through
- Poverty alleviation;
- Improved hygiene and sanitation;
- Early detection of diseases and medical
intervention;
- Immunization against childhood diseases;
- Conflict prevention and disaster preparedness;
- Safety at home, work place and in learning
institutions;
- Public health programs emphasis on prevention; &
- Education in environment management and
proper promotion of good health.
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 Actions aimed at eradicating, eliminating or
minimizing the impact of disease and disability
 Prevention means "to keep from occurring"
 Eliminate the cause
 and also prevent worsening by retarding the
progression of the disease and disability
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 Educational strategies
 Medical strategies
 Policy related and Social strategies
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 List the three levels of disability prevention!
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 This measures is used to avoid the manifestation of a
disease/occurrence of diseases, injuries, or
conditions that can result in impairments or
disabilities
 Its success eliminate any chance of disability
occurrence
 Primary prevention seeks to prevent the onset of
specific diseases via risk reduction
 Target the general population than high risk
groups
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 Vaccination and post-exposure prophylaxis of
children, adults and the elderly;
 Provision of information on behavioral and medical
health risks
 Inclusion of disease prevention programs at
primary and specialized health care levels, such as
access to preventive services (ex. counseling); and
 Nutritional and food supplementation; and
 Dental hygiene education and oral health services
 …
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 The biomedical approach of disability prevention
includes
 Pre-pregnancy planning
 Prenatal care
 Obstetric and post natal care
 Immunization
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 This disability prevention reside in the social, cultural, and physical
aspects of our lives
 Injuries associated with
 Life style
 Behavioral patterns (alcohol, drug …etc)
 Lack of parenting skills
 Poverty
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 school courses
 safety programs
 media presentations
 publicity campaigns
 health education
 accident prevention
 others
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Reduce prevalence of poverty
 Social assistance
 Job training
 Provide food for those who
cannot nourish themselves
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 Targets an existing risk factor and removes or reduces its
complication
 When successful, disability will never occur
 Here the impairment may be reduced rather than
prevented
 Targets the high risk groups than the general
population
 Biomedical risk exists
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 Implemented when a pathological condition
exists
 Promotes adjustment to irreversible conditions
and minimizes further complications or loss of
function
 focus on a limited population who have a
specific condition
 lessen the effects of an existing disability and
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 Rehabilitation
 Social skills training
 Educational programming
 Physical adaptations of the environment.
e.g. Functional activity training(fine motor activity
+gross motor activity training)
ambulation training of amputee patients
Gait training for stroke survivors
Wheel chair training for spinal cord injury patients.
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 Some disability can be prevented and others cannot
 Primary prevention is considered the most effective
 Secondary and tertiary prevention is also mandatory
 Consider problems related to Alcohol related
birth defects and discuss on the three levels
of prevention!
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 Role of
Physiotherapists in
the Community
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 What do you think will be the roles of
physiotherapists after graduation?
 Where do you think a physiotherapist will be
employed and work after graduation?
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Medical professionals
Physiotherapists can work in a wide range of community and hospital
settings.
Hospital departments include:
• occupational health;
• outpatients' departments;
• orthopaedics;
• paediatrics;
• stroke services;
• women's' health.
• geriatric medicine;
• intensive care;
• mental health;
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 Clinical educators
we can be instructors at different health institutions
(Physiotherapy , Anatomy, physiology, public health,
health informatics)
 Rehabilitation team member ( leader)
 Researcher and member of a research centre
 Consultant
 Management( leader, CEO, coordinator, director )
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 Hospitals
 Outpatient clinics
 Fitness centers
 Medical Schools
 Rehabilitation centers
 Sports facilities
 Nursing homes
 Workplaces
 Patient homes
 Other NGOs
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 excellent communication and interpersonal skills
 Team working skills to work with other healthcare professionals
 problem-solving ability
 tolerance, patience, sensitivity and tact
 organisational and administrative skill
 a firm but encouraging and empathetic skills(ability to understand
and share feeling of other) attitude.
 a genuine concern for the well-being and health of patients
 Ability to work under pressure & manage time effectively.
96
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 Consultation is the rendering/ interpreting of professional or experts
opinion or advice by a physical therapist based on clinical,
professional, leadership, education and research experiences.
 The consulting physiotherapist applies highly specialized knowledge
and skills to identify problems, recommend solutions, or produce a
specified outcome or product in a given amount of time on behalf
of a patient/client where he is working .”
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 A consultant Provides high-level specialist
clinical input for patients in their care, including
carrying out complex procedures, and managing
complex cases.
 Has ultimate responsibility for patients, including
where care is delivered as part of a patients’
pathway through multidisciplinary care.
 Is expected to be able to practise independently
and autonomously, with competence in managing
the vast majority of scenarios
98
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 Offers a specialist opinion for other teams on an
area of sub-specialisation
 Acts as an influential patient advocate within the
healthcare system.
 Provides leadership to multiple team areas
 Assures the quality of practice through clinical
audit, appraisal and revalidation
99
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 Provides, leads and oversees training and
education for junior staffs and perhaps for other
healthcare professionals at both local and national
levels.
 Devises, reviews and revises organisations’
policies objectives, rules, working practices and
protocols.
 Conducts medical research in the public sector
and/or private sector.
10
0
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 Promotes new practices and lead innovation in
new models of care for patients, new forms of
treatments and use of new technologies.
 Practises medical management (determining
departmental structure, devising local protocols,
service development, implementing national
guidelines and research findings
10
1
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sol PT

 Provide expert advice to clinical specialists in
complex cases.
 Raise clinical standards by demonstrating best
practice and encouraging its implementation
 Provide education in the field of clinical
expertise nationally and internationally
10
2
3/10/2023
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 Undertake research, evaluate new findings,
disseminate the results and incorporate these
into practice.
 Provide professional leadership by developing
innovative practice and by becoming involved in
strategic plans to drive change and providing
expert input into clinical governance agenda
10
3
3/10/2023
sol PT

 Serve as a catalyst to help generate change in a
health care organization
 Provide seminars for or coaching of personnel to
provide information and new skills to improve
clinical practice
 Provide rapid access to latest technology and its
application
 Serve as an independent mediator to resolve
differences when two physiotherapists discuss
on issues and if they don’t agree .
10
4
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sol PT

 What special skills should a consultant
physiotherapist have?
 Discuss the consultancy roles of a physiotherapist in
case of patient management?
 Discuss the consultancy roles of a physiotherapist in
community based rehabilitation?
10
6
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 Clinical excellence and expertise
 excellent verbal and written communication
 Managerial skills and leadership
 The ability to build a trusting relationship with the client
 the ability to work under pressure.
 Some personal qualities and attitudes are also critical.
 Leading change and innovation
10
7
3/10/2023
sol PT

 The person or organization seeking help is the
client, who may also be known as the customer.
 patient/ caregivers
 families
 community leaders and community at large.
 Given the nature of our work, we are familiar with
the process of consultation. because the
patient/client management role of the PT is a form
of consultation.
10
8
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 The consultant physiotherapist play a role by :-
 Providing guidance or insight on a particular
patient management problem
 Presenting new ideas for revitalizing the practice
 Devising(plan + invent) fresh approaches for
overcoming barriers to successful treatment
outcomes.
10
9
3/10/2023
sol PT

 Physiotherapists are the ideal health professionals
to act as both providers and consultants in the
area of specialized exercise programming.
 Consultations with patients can occur at the
request of the patient or another health care
professional
 To determine the need for physical therapy
services
 To evaluate services that have been provided
 To provide an additional opinion to a patient
about physical therapy services.
11
0
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 PTs play significant role in promotion,
prevention of diseases , protection of health
and wellness
 PTs are equipped to manage the causes of
physical health problems, deliver evidence based
care, actively engage PWDs and inform all aspects
of treatment.
 Physical therapists serve as consultants by sharing
their professional advice or opinion with patients,
other health care providers, community schools,
and other organizations
11
1
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sol PT

o Reduce coast of health care,
o provide safe and effective care,
o increased satisfaction
o decreases likely hood of re injury,
o reduced lost time at work and fewer disability
claims
o promote healthy living and health promotion.
11
2
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 PT’s work closely with PWDs and their family
 From teaching about disability to environment
modification
 Provision and training on assistive devices
11
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 Patient care is a team work
 Nurses, surgeons, medical doctors, psychologists
can work with PT in the community
 PT can be team leaders in the rehab process
 PTs serve as a bridge of referrals
11
4
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sol PT

1 Mr. Alemu is a 27 years old who is with
untreated bilateral clubfoot, unmarried,
educated up to 4th and he is from lower
socioeconomic class? Describe his problems
in each model
2 What special skills should a consultant
physiotherapist have
3/10/2023
sol PT
11
5

 COMMUNITY
BASED
REHABILATION (CBR)
11
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sol PT

 Define CBR.
 Understand and explain the relationship between
rehabilitation and disability
 Explain purposes of community based rehabilitation
 Describe basic concepts and models in rehabilitation and
disability
 Able to conduct Research and evaluate the needs of
specific target groups in the community
 work in collaboration with other health care profession.
11
7
3/10/2023
sol PT

 The declaration of Alma-Ata in 1978 was the first
international declaration advocating primary health
care as the main strategy for achieving the World
Health Organization's goal of “health for all” .
 This strategy was intended to enhance the quality
of life of people with disabilities through
community initiatives.
 Following the Alma-Ata declaration, WHO introduced
CBR
 In the beginning CBR was primarily a
service delivery method aimed at bringing
primary health care and rehabilitation
services closer to people with disabilities,
especially in low-income countries .
11
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 During the 1990s, along with the growth in
number of CBR programmes, there were changes
in the way CBR was conceptualized.
 In 2003, an International consultation to review
CBR held in Helsinki made a number of key
recommendations . Subsequently, CBR was
repositioned and got its current definition.
11
9
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 What is rehabilitation mean?
12
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sol PT

 To rehabilitate : to restore to a former capacity, to
reinstate, to put back to an original position/state.
 Rehabilitation: A proactive and goal-oriented
activity/process to restore function and/or to
maximize remaining function in order to bring
about the highest possible level of independence
bio psychosocially.
12
1
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sol PT

 rehabilitation is the combined and coordinated
use of different disciplines, techniques and the
use of specialized facilities
 Intended to provide physical restoration,
psychological adjustment and vocational
counseling / job training and placement
12
2
3/10/2023
sol PT

 CBR-A strategy within general community development for the
rehabilitation, equalization of opportunities, and social integration (or
inclusion) of all PWDs.” (ILO, UNESCO, and the WHO).
 E. Helander defined (CBR) as 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.
12
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sol PT

 It is a holistic approach which covered
comprehensive rehabilitation aspects including health
(physical), social, employment, educational, economic
aspects and protection of rights.
 It is implemented through the combined efforts of
PWDs, their families and communities, and the
appropriate rehabilitation professionals (WHO, 1994).
12
5
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sol PT

As much as possible at home with a family member
12
6
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 Disabled persons are provided treatment and
training in institutional settings(In Hospitals,
rehabilitation settings, vocational centres.
12
7
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 Cost effectiveness
 Sustainability
 Who decision maker
 Aim of rehabilitation
 Responsive/proactive
13
0
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sol PT

 the advantages and disadvantages of CBR
and IBR?
13
1
3/10/2023
sol PT

 A key objective of any CBR strategy is the
inclusion of PWDs in the civil, social and economic
structures of the community and the improvement
of their quality of life.
 This means PWDs are citizens of their society
with the same rights, entitlements and
responsibilities as others.
 CBR is the primary means by which PWDs in
most countries of the world have any access to
rehabilitation or disability services
13
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sol PT

 In CBR, the disabled person, the family, the
community, and professionals collaborate to provide
needed services in a non-institutional setting, and in
an environment or community where services for
disabled persons are seriously limited or totally
absent.
 Its essential feature is its focus on partnership and
community participation.
13
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 To maximize their physical and mental abilities of people
with disabilities
 To support access to regular services and opportunities
 To assist PWDS to actively contribute to their own
community and society
 To encourage community members to protect , promote
and respect the rights of PWDs (by removing barriers
through Awareness creation and advocacy)
 To activate the community to work for inclusion of PWDs in
the civil, social and economic structures of the community
13
4
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sol PT

 Support from the Social Sector
 Support from the Health Sector
 Support from the Educational Sector
 Support from the Employment Sector
 Support from NGOs
 Support from the Media
13
5
3/10/2023
sol PT

PRINCIPLES OF
CBR
13
6
3/10/2023
sol PT

 The principles are overlapping, complimentary
and inter-dependent
 They cannot be separated one from
the other.
13
7
3/10/2023
sol PT

 Human beings are born unique and equal
 PWDs are not viewed equal in different aspects [salary,
employment, voting….]
 CBR aims to improve the equalization of opportunities in
health care, education, employment and social life
13
8
3/10/2023
sol PT

 PWDs may be denied the right to
rehabilitation, education, employment and
social integration
 Leading to negligence and rejection
 CBR has to equalize opportunities for
community inclusion
13
9
3/10/2023
sol PT

 Services and opportunities provided for PWDs
should target all, than the small number
 Schooling, employment, trainings has to be
accessible for all PWDs
 Equity and fairness in resource sharing is the
most important thing
14
0
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sol PT

 Integration
 Independence
 self-actualization of PWDs
14
1
3/10/2023
sol PT

A feeling of unity that produces or is
based on community of interests,
objectives, and standards
Human beings are dependent on each
other. So Solidarity should be seen as a
freedom, not as a charity
14
2
3/10/2023
sol PT

 All members of the society should join the
mainstreaming of community life
 PWDs are seen as “strange” and usually
excluded from different activities
 As long as PWDs are out of sight, nobody will
get to know them, and stigma will continue
14
3
3/10/2023
sol PT

• Special Education
• Vocational Training
 Agriculture, ILO,
 Income Generation
 Mainstream Employment
Rehab Services,
•Mobility Aids
•Surgery
•Medical Treatment
• Assistive devises
•Malnutrition
.Ministry of Health
.Dep. of Social Services
.Ministry of Education
.Finance and small trade
14
6
3/10/2023
sol PT

 To achieve ‘inclusive development CBR is needed to use
comprehensive multi secteral approach to ensure
equality of access to health care, education, livelihood
opportunities, skills training, employment, family life,
social mobility and political empowerment.
 It consists of five components (domains), each divided in
to five sectors.
 Health, Education, Social, Livelihood, Empowerment
14
7
3/10/2023
sol PT

 People with disabilities need skills to engage in
livelihood activities.
 There are four types of skills
 Skills can be acquired through traditional home-
based activities and education, in mainstream
vocational training centres and as a trainee in
different institutions
 A combination of all four types of skills ensures
greater success in finding decent work and earning
an income.
 CBR programmes need to identify and promote
opportunities for individuals with disabilities to
14
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sol PT

 Foundation skills : are those acquired through basic education
and family life.(e.g. Reading a manual, listening to
instructions writing)
 Technical, vocational and professional skills: are those which
equip someone to undertake a particular task
 Business skills (also called entrepreneurial skills) are those
required to succeed in running a business activity.
 Core life skills consist of the attitudes, knowledge and personal
attributes necessary to function in the world( e.g. Self-
awareness, Creative thinking, Problem solving, Coping with
stress.
.
15
0
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sol PT

 categorize the following skills into the four types of skills????
• money and people
management
• planning and organizational
skills
• Financial risk assessment
skills,
• market analysis skills
• information-gathering skills
• business plan preparation
skills
• learning how to learn,
• effective listening and
communication,
 carpentry, tailoring, weaving,
metalwork and Shoemaking
 engineering, medicine and
physiotherapy
 personal management and discipline
 interpersonal and social skills
 creative thinking, goal-setting and
problem-solving
 the ability to network and work in a
team and work ethics
15
1
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sol PT

The meaning (WHAT) of CBR
The Major Objectives of CBR
Evolution of concepts in CBR
Basic principles of a CBR Programme
Components of CBR
15
2
3/10/2023
sol PT

 Any piece of equipment or device used to maintain or
promote physical function in some one with a disability.
 Many people with disabilities depend on assistive devices to
enable them to carry out daily activities and participate actively
and productively in community life.
 Can range from low (e.g. walking stick) to high (e.g.
computerized communication device)
15
3
3/10/2023
sol PT

 Positioning devices
 Mobility devices
 Hearing aids
 Visual aids
15
4
3/10/2023
sol PT

 People with physical impairments often have
difficulty maintaining good lying, standing or sitting
positions for functional activities and are at risk of
developing deformities due to improper positioning.
 The following devices can help overcome some of
these difficulties:
 Wedges
 Chairs
 Wheelchairs
 CP chair
 Standing frames
15
5
3/10/2023
sol PT

Assistive device
 What is Assistive device?
 List assistive devices you know!
 What is the importance of assistive devices
15
7
3/10/2023
sol PT

 Poor balance
 Weakness of LE muscles
 Pain in weight bearing joints of LE
 Joint instability
 fatigue
 Amputation
 Fracture
15
8
3/10/2023
sol PT

 Prosthesis / artificial device that replaces a missing body
part.
 orthosis / artificial external device serving to support the limbs or
spine or to prevent or assist relative movement.
 Mobility aids
 Scooters
 Hearing aids
 Computer /electrical assistive devices
15
9
3/10/2023
sol PT

Relive weight bearing fully or partially on LE
 Increase BOS
 Improve lateral stability
 Allow UEs to transfer body weight to the floor
16
0
3/10/2023
sol PT

 A device that is selected by a medical provider to
maximize mobility will be based on “balancing” 3
concepts
 Physical considerations (Strength, Balance, Vision,
Health history, Weight bearing precautions)
 Psychosocial considerations (Compliance and
attitudes toward use of an assistive device)
 Functional Needs (Stairs, Functional mobility within
home and community)
16
1
3/10/2023
sol PT

 Assistive devices increase independence in ADL
 It increases acceptance of PWDs in their community
 We can make assistive devices from local materials for
free or cheep
 The categories of assistive ambulation devices, in
order from greatest to least amount of support, are:
 Parallel bars,
 Walkers,
 Axillary crutches,
 Forearm (Loft strand) crutches,
 Two canes, and
 One cane.
16
2
3/10/2023
sol PT

 Locally made devices can be easily maintained and
repaired
 It can be carried out Where the assistive devices are
made
 They are not expensive
 It is preferable if there is active engagement of
PWDs and / or their family during production
 PTs creativity is crucial during the design and
production
16
3
3/10/2023
sol PT

Usually it is recommended to consider the
following points while we prescribe assistive
devices
Their Balance
Level of dependency
Age
Weight bearing status
Severity of paralysis
16
4
3/10/2023
sol PT

 Importance of researching the needs of
PWDs
 To develop an understanding of the situation and
needs of disabled persons and to work
effectively towards inclusion
 To develop skills to plan, implement and evaluate
intervention strategies.
 To develop an awareness of social, political,
economic, cultural and legal needs of persons
with disability within the family and society in
order to foster acceptance and integration.
17
7
3/10/2023
sol PT

 Magnitude and types of frequent disabilities
 Prevalence of impairments and activity limitations
 Causes and associated factors of those disabilities
 Differing levels of severity
 Level of mobility and level of independence in ADL
 Rehabilitation needs
 Needs of assistive devices
 Measures already taken to prevent those disabilities
17
8
3/10/2023
sol PT

 The situation of PWDs and their family
 Extent of participation: exclusion from social
activities / participation
 Factors influencing participation / exclusion
– both opportunities and barriers
 Expectations of PWDs, family and
community
 Health seeking behaviour / beliefs
 Identifying the needs of specific target
groups
17
9
3/10/2023
sol PT

 Rehabilitation services already in existence
 Disability prevention and rehabilitation services
needed and currently provided
 Government philosophy and attention towards
health service plans – political, economic and
social positions towards PWDs
 Accessibility of general health services – eg
screening, immunization
 Availability of existing local resources
18
0
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sol PT

 Identify the current problems
 What current solutions exist?
 Map services
 Identify gaps in the needs and service given
 What current solution do you have?
18
1
3/10/2023
sol PT

 WHO disability report
 Physiopidya
 Ethiopian disability proclamation
 Convention on the rights of person with disability
 Disability Inclusive Development by Kathy Al Ju’beh/2017
 Mishra AK, Gupta R. Disability index: a measure of deprivation among the
disabled. Economic and Political Weekly, 2006,
 ICF World Health Organization Geneva 2002
18
2
3/10/2023
sol PT

Thank you very much for
your attention!!
18
3
3/10/2023
sol PT

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