Rehabilitation Approaches for Persons with Disabilities

KNOWLEDGE OF
REHABILITATION
SHRUTI PUROHIT
MPT IN REHABILITATION
2ND YEAR MPT
GUIDED BY: DR. GOPI CONTRACTOR

WHAT IS REHABILITATION?
 “ To make the person independent at possible level”.
 Definition:-
Rehabilitation focuses on the existing capacities of the
handicapped person, and brings him to the optimum level of
his/her functional ability by the combined and co-ordination
use of medical, social, education and vocational measures.
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Textbook of rehabilitation-
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 Rehabilitation is the third phase of medical care; after
preventive and curative.
 Preventive Medicine is the first phase where a disease is
prevented from occurring, by avoiding the interaction
between agent, host and environment.
 Curative Medicine is the second phase focuses on
attempting to cure the disease. Most doctors practice
curative phase.
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 However there are several conditions like; RA which has
no cure, and others, like; Poliomyelitis in which agent
causing the disease has been eliminated from the host,
but residual effects like paralysis still persist.
 Therefore, there is a need for third phase, namely
REHABILITATION, which is not just medical but also a
social responsibility.
 Rehabilitation started at the earliest possible time to get
the best result.
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NEED OF REHABILITATION
 It is estimate that, there are over 150 million people with
disability all over the world, out of which the exiting
facilities can cater to only about 2 million, mostly from the
developing countries.
 Most of the programs are concentrated in cities resulting in
development with, Person With Disability (PWD) in rural
areas deprivide of facilities.
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Need for rehabilitation precipitated by:
IMPAIRMENT
• Any loss or abnormality of psychologic,
physical, or anatomical structure or fun.
 DISABILITY
• Any restriction or lack of an ability to
perform an activity in the manner or
within the range considered normal for
human being
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HANDICAP
Disadvantage for a given individual resulting from an
impairment or disability that limits or prevents fulfilment of
a role that is normal for that particular individual
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 The delivery of rehabilitation care is done through the
following approaches:
 Community Based Rehabilitation
 Institution Based Rehabilitation
 Outpatients clinics
 Homes
 Day care centers
 Inpatients rehabilitation centers
 Camps
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 Among this approaches mainly three are helpful:
1) Institute Based Rehabilitation (IBR).
2) Outreach Based Rehabilitation (OBR).
3) Community Based Rehabilitation (CBR).
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Institute Based Rehabilitation (IBR)
• This rehab process takes place in the hospital, medical
and rehab set up.
• Many experts work together from different disciplines
medical/non medical.
• Highly specified care.
• Highly sophisticated use of technology.
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 Group discussions.
 Many patients at one place hence mutual interactive
learning for there problems and its solution.
 Use of research and development methodology.
 Academic learning colleges.
 Attractive clinically
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Outreach Based Rehabilitation (OBR)
 Team of experts professionals reach out to the community
for organizing a medical camp or a paraplegia safari
programmed.
 All professionals are working in an IBR city or town village.
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Camp
 Many people with different disabilities together at one
place.
 Patients are assessed on the spot by all professional
necessary primitive and basic treatment is given and
necessary guidance is also given.
 If there is major problem then patient is referred to main
hospital and rehab set up.
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Day Care Centers
 Patients brought to the center , very often integrated with
special schools
 Some medical rehab work is undertaken, integrated with
special schools
 Patients who are afflicted with the same problems get
treated with fairly holistic approach
 Family members get to interact with the rest of the day
when the patient gets back to home
 Bringing pt. To and from the center is an difficult task.
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Inpatient rehabilitation center
 Large no. Of all ages of pts. Are regularly
admitted into hospitals and nursing
homes with orthopedic and neurological
disorders.
 Stay at hospital after primary medical
facilities.
 Second phase after hospitalization, rehab.
Of the pt. Has to follow through in order
to improve quality of life.
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Community Based Rehabilitation (CBR)
 CBR is a strategy within the community for the
rehabilitation, equalization of opportunities and social
integration of people with disabilities.
 It is based in the community.
 The human and other material resources are found out
from within the community.
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 The care taker of the patient or any other near by person is
trained for primary care of the patient
 Example; a mother of a C.P. child is trained for how to
handle the child, how to position, how to give basic
exercises etc.
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 Low technology, low cost, adaptable local material is used.
E.g. Instead of a very good crutches, simple bamboo
crutches are made. It is easy to prepare and easy to
maintain in case of breakage.
 Local supervisor work as a co-ordinator who is been
trained by the professional.
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Self help movement based on:
 Awareness & concern of the community
 Initiatives from the communities
 Planning from the community
 Resources from the community
 Implementation by the community
 Evaluation by the community
 Modification by the community
 Benefits to and from the community
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PRINCIPLES OF CBR
1. Shifting services from the institution to the home of
disabled people.
2. CBR enables people with disability to live independently,
through training in activities of daily living.
3. Interaction with other members of community without being
neglected or discriminated.
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4. Shifting the services from professional to trained
community or family members.
5. Ensure that person with disability take part in planning &
managing the programme
6. CBR programme should be flexible so that they can
operate at local level.
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MEMBERS OF CBR
PATIENT
Family members
Locally available skilled worker
Local leader
School teacher
Rehab. Worker
PHC staff
OT
Orthotics/ Prosthetics
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 Why C.B.R.?
 80% population in India live in villages.
 Higher incidences of disabilities in rural areas (poor
hygiene, poor medical facilities, poor nutrient, over work,
poor knowledge & information wrong beliefs.
 80% of rehab facilities in urban area.
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 5% of people with disabilities have access to rehab.
 90% therapist are in urban area wider coverage.
 Cost is efficient & effective.
 Appropriate to local needs suitable.
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 C.B.R Location
 Rural
 Decentralized
 Home, community center
 Type of resources
 Low technology
 Low cost
 Simple
 Local made
 Low maintenance adaptable products
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 Types of services
 General care
 Easily accessible for all.
 One trained staff with many clients.
 Therapists role
 Mainly indirect therapist trains local person (mother)
 Group session to the clients
 Time is located as per population need
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 Professional skill
 Low profile as poor alternative to IBR.
 Transfer of skills to empower at multiple levels of workers/family.
 Focus of control-status as an expert
 Client/family centered
 Therapist resource with knowledge
 Client & family are expert in day to day functional issues
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 Knowledge
 Teaching how to manage the problem.
 Flow both ways partnership/participative
 Therapeutic approach
 Disability management
 Problem solving approach
 Long tern care
 Therapy based on social/cultural/environment.
 Research emphasis
 Functional out come service delivery mode
 Efficiency
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DIFFERENCE BETWEEN IBR AND CBR
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IBR CBR
 Location:-
 Urban
 Centralized
 Purpose built center
 Location:-
 Rural
 Decentralized
 Home community center
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IBR CBR
 Types of resources:-
 High technology
 High cost
 Sophisticated
 Therapy-technology based
 Commercial available
 Need skill & high maintenance
 Types of resources:-
 Low technology
 Low cost
 Within available
 Local material
 Environment to suit need
 Local human resources & low
maintenance
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IBR CBR
 Type of services:-
 High specialty care
 Limited to those who can
afford
 High staff/client ratio
 Type of services:-
 General care
 Easily available, accessible to
all
 Low staff/client ratio
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IBR CBR
 Therapist role:-
 Direct service provision
 Individual sessions to client
 Therapy time as per client
need
 Therapist role:-
 Indirect
 Acts as an expert source
teacher/trained local worker
 Time allocated as per
population need
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IBR CBR
 Professional skill:-
 High preferred employment
for therapist
 Protected & guarded
 Professional skill:-
 Low seen as poor alternative
to institutional employment.
 Transfer skill to multiple levels
of workers & family.
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IBR CBR
 Focus of control:-
 Therapist is centered and
expert.
 Knowledge/ judgment rarely
asked.
 Focus of control:-
 Client/family centered.
 Therapist resources with
knowledge.
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IBR CBR
 Knowledge:-
 Traditional therapy
 Information flow from therapist
to client
 Knowledge:-
 Management teaching not
working,
 Information flow from
participative / partnership
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IBR CBR
 Therapy approach :-
 Curative
 Medical model for reasoning
 Focus on short term care
 Therapy continued to the
problem
 Therapy approach:-
 Disability management
 Problem solving approach
 Focus on Long term care
 Therapy is need generators &
considers social, cultural &
environmental factors
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IBR CBR
 Research emphasis:-
 Disease/pathology efficacy
trials
 Randomized controlled trails
 Traditional quantitative
measures
 Research emphasis:-
 Functional outcomes
 Matching approach to meet
needs
 Efficiency/efficacy
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TYPES OF REHABILITATION
• Medical rehabilitation: help a person
better in all his daily physical & mental
activities. Related to increasing the
potential capabilities & correction of
deformities, restoration of fun.
• Social rehabilitation: restoration of family,
social interaction or relationship
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 Psychological rehabilitation: psychological
restoration of personal dignity &
confidence of the disabled.
 Vocational rehabilitation: help those pt.
Who find it difficulty to get employment.
Based on treatment type:
• Cardio pulmonary, physical therapy,
speech, occupational, psychological rehab.
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TYPES OF TEAM
 Multidisciplinary team: many diff. professionals
work together towords a common goal
 Intradisciplinary team: team of professionals who
are all from the same professions
 Transdisciplinary team: composed of member a
num. of diff. professions cooperating across
discipline to improve patient care through
practice or research.
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MODELS OF REHABILITATION
 WHO model
 Neighborhood model
 DRC model
 ICF model
 CBR matrix
 PWD act
 National trust act
 RCI
 NAGI model
 IOM model
 NCMRR model
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 Human rights principles are at the core of the social model.
 A person’s impairment is not the cause of restriction of
activity.
 Cause of restriction is the organization of society.
 Society discriminates against disabled people
 Less emphasis is placed in the involvement of health
professionals in the life of a person with disability.
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 The social model focuses on the strengths of the person,
values his potentials(not on the limitations as in the
medical model).
 Fear, ignorance create barriers and cause discrimination
which increases disability.
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WHO model:
 It uses trainers and distributes booklets on health
conditions.
 It lists essential medicines published by WHO.
 Contains the medications considered to be the most
effective and safe to meet the most imp. Needs in a health
system.
 Updated every 2 yrs. Since 1977.
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Neighborhood model:
• A resource center in the community adopts another center,
trains the personnel, and in due course this becomes
another resource center.
District rehab. scheme model:
• DRC model was launched by the govt. Of india in jan 1985
on a pilot basis in collaboration with national insti. Of
disability and rehab research, the US dept. Of edu. And
UNICEF.
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 DRC surveys disabled population, and works on all
aspects of rehab like prevention, early detection & medical
intervention.
 Deformities are corrected surgically, physiotherapy
occupational therapy and speech therapy are given,
artificial limbs for amputees.
 Sociovocational rehab like training, job placement and self
employment oppertunities is also come under this scheme.
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ICF model:
• International classification of functioning, disability and
health
• Shift from the 1980 version of ICIDH which describe
disability, impairment and handicap in the terms of
diminishment to a model which describes body structure,
functioning, activities and participation in a positive way.
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CBR matrix:
 The matrix has been developed to give a framework for a
coherent CBR programme.
 It consists of five components(domains), which divided into
five elements(sectors).
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PWD ACT:
 Established in 1995
 The Rights of Persons with Disabilities Act, 2016 is the disability
legislation passed by the Indian Parliament to fulfill its obligation to
the United Nations Convention on the Rights of Persons with
Disabilities, which India ratified in 2007. The Act replaces the
existing Persons with Disabilities (Equal Opportunity Protection of
Rights and Full Participation) Act, 1995.
 Responsibility has been cast upon the appropriate
governments to take effective measures to ensure that the
persons with disabilities enjoy their rights equally with
others.
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• Additional benefits such as reservation in higher education (not
less than 5%), government jobs (not less than 4 %), reservation
in allocation of land, poverty alleviation schemes (5% allotment)
etc. have been provided for persons with benchmark disabilities
and those with high support needs.
 Every child with benchmark disability between the age group of
6 and 18 years shall have the right to free education.
 Government funded educational institutions as well as the
government recognized institutions will have to provide
inclusive education to the children with disabilities.
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National trust act:
 The National Trust is a statutory body of the Ministry of Social
Justice and Empowerment, Government of India, set up under the
“National Trust for the Welfare of Persons with Autism, Cerebral
Palsy, Mental Retardation and Multiple Disabilities” Act (Act 44 of
1999).
 values human diversity and enables and empowers full participation
of Persons with Disability to live independently with dignity, equal
rights and opportunities.
 works towards providing opportunities for capacity development of Persons with
Disability and their families, fulfilling their rights, facilitating and promoting the
creation of an enabling environment and an inclusive society.
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RCI:
• Rehab. Council of india,1986.
• RCI is to regulate and monitor services given to persons with
disability,to standardise syllabi and to maintain a Central
Rehabilitation Register of all qualified professionals and
personnel working in the field of Rehabilitation and Special
Education.The Act also prescribes punitive action against
unqualified persons delivering services to persons with
disability.
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 The RCI is a regulatory body responsible for
standardization of curriculum, research and development,
training and manpower development, recognition of
institutions offering various courses on rehabilitation of the
disabled and registration of rehabilitation professionals/
personnel.
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NAGI model:
 Developed by saad nagi in 1960.
 Nagi described four basic phenomena that he considered
fundamental to he considered fundamental to rehabilitation
as follows:
 active pathology
 impairment
 functional limitations
 disability
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 Active pathology is an interruption in normal body
processes that leads to a normal body processes that
leads to a deviation from the normal state such as
deviation from the normal state such as infection, trauma,
disease processes, or infection, trauma, disease
processes, or other degenerative conditions other
degenerative conditions
 Impairment is a loss or abnormality at the Impairment is a
loss or abnormality at the tissue, organ, and body system
level
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 Functional limitations relates to the individual's inability to
perform the tasks and obligations of his usual roles and
normal daily activities normal daily activities
 Disability defined as a physical mental limitation in
performing socially defined roles and tasks expected of an
individual
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IOM model: INSTITUTE OF MEDICINE
• IOM used the original Nagi model incorporated two
important concepts known as:
• secondary conditions or risk factors
• quality of life
• Risk factors included biological,environmental which
include both social and physical, and lifestyle or behaviour
and physical, and lifestyle or behaviour factors capable of
interacting with the factors disabling process
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 quality-of-life or the general wellbeing of the individual was
seen to both affect and be affected by each stage of the
process.
 In 1997 IOM revised its own model:
 Disability was removed from it, was instead viewed as an
outcome of the individual interacting within the
environment
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 NCMRR model:
 Societal limitations as the restrictions resulting from social
or barriers which limit fulfilment of roles or deny acess to
service and oppertunities associated with full participation
in society.
 Limitations in performing tasks, activities and roles to
levels expected in personal and social context where focus
was placed on how a person with a disability adapts to
functional limitations in the family, work, community.
 2006, in new version, rehab process is active process.
Active participation of the pt. with the ultimate goal of
improving thw pt.’s QOL.
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THANK YOU
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