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PRESENTATION
ON
CARE OF HANDICAPPED
Presented by
Reena yadav
S.N.M.C. AGRA
The sequence of events leading to disability and handicap
have been stated as follows:
Disease  Impairment Disability  Handicap
IMPAIRMENT is a loss or abnormality of psychological,
physiological and anatomical structure or function and
operates at the level of organ or part affected.
DISABILITY is any restriction or lack of ability(resulting from
an impairment) to perform an activity in a manner or within
the range considered normal for human beings.
HANDICAP is a long-term disadvantage resulting from an
impairment or disability which adversely affects the
individual’s ability to achieve personal and economic
dependence which is normal for his or her peers.
HANDICAPPED
one who suffers any continuing disability of
body, intellect or personality which is likely to
interfere with his normal growth and
development or capacity to learn.
HANDICAPPED
DIFFERENTLY ABLED
DIFFERENTLY ABLED
Differently abled was first proposed (in the
1980s) as an alternative to disabled,
handicapped, etc. on the grounds that it gave a
more positive message and so avoided
discrimination towards people with disabilities.
CAUSES OF DISABILITY
 CONGENITAL e.g. Congenital hip dislocation,
e.t.c.
 TRAUMATIC e.g. Birth injuries, RTA
 DEGENERATIVE e.g. Arthritis
 INFECTIVE e.g. Poliomyelitis, TB of the Spine
 NUTRITIONAL e.g. PEM, Vitamin A Deficiency.
 CHEMICALS e.g. Mercury or lead poisoning
 NEOPLASM e.g. space occupying lesion
 METABOLIC e.g. Diabetes Mellitus
2001 has revealed that over 21 million
people in India as suffering from one or
the other kind of disability.
2.1% of the population.
12.6 million are males
9.3 million are females.
more in rural and urban areas.
PREVALENCE
the highest number of disabled-- Uttar
Pradesh (3.6 million).
Bihar (1.9 million), West Bengal
(1.8million), Tamil Nadu and Maharashtra
(1.6 million each).
Tamil Nadu is the only state, which has a
higher number of disabled females than
males. Arunachal Pradesh has highest
disabled males (66.6%) and lowest
proportion of female disabled.
TYPES OF DISABILITY
1- PHYSICAL DISABILITY:
Any impairment which limits the physical function of
limbs or fine or gross motor ability is a physical
disability.
CONT…..
2- SENSORY DISABILITY:
Impairment of one of the senses. The term is used
primarily to refer to vision and hearing impairment, but
other senses can be impaired.
CONT…..
5-OLFACTORY AND GUSTATORY IMPAIRMENT
Impairment of the sense of smell and taste are
commonly associated with aging but can also occur in
younger people due to a wide variety of causes.
6-SOMATOSENSORY IMPAIRMENT
Insensitivity to stimuli such as touch, heat, cold, and
pain.
CONT…..
7-BALANCE DISORDER
balance disorder is a disturbance that causes an
individual to feel unsteady, for example when
standing or walking.
CONT…..
8-INTELLECTUAL DISABILITY
ranges from mental retardation to cognitive deficits
too mild or too specific (as in specific learning
disability) to qualify as mental retardation.
CONT…..
10- DEVELOPMENTAL DISABILITY
any disability that results in problems with growth
and development. for example spina bifida
.
11- Nonvisible disabilities
Several chronic disorders, such as diabetes, asthma
or epilepsy,
MILD
The child can perform basic life management
functions appropriate for child's age and
development and can use mainstream
methods of transportation and communication.
Child requires no equipment for daily
functioning and may require average or slightly
above average medical care and
appointments.
LEVEL OF HANDICAPPED
Cont….
MODERATE --- Child has a relatively stable non-
correctable condition that is neither progressive
nor degenerative. Child can perform basic life
management functions appropriate for age and
development (feeding, dressing, toileting) with
some assistance.
Cont….
SEVERE –
Child may require life support equipment, or has
a progressive, degenerative or terminal illness.
1. require significant home modifications.
2. require repeated doctor or frequent
hospitalizations or surgeries.
3. requires 2 or more medical appointments per
week.
4. requires a parent or aide to perform basic life
management functions (feeding, dressing,
toileting, etc.).
5. require special adaptations for transportation
and/or communication.
CONSEQUENCES OF
DISABILITY
INDIVIDUAL
• Fear, anxiety, worry and apprehension .
• Unemployment
• Dependency.
• Personality Problems
. Disbelief.
. Depression And Anger.
CONSEQUENCES OF
DISABILITY
FAMILY AND SOCIETY
Stigma
Exploitation
Isolation/ abandonment
Less likely to be educated
Street begging
May become victims of Child trafficking
Neglect
CONSEQUENCES OF
DISABILITY
PSYCHOSOCIAL
The psychosocial impact of disability may be
the largest handicap for the disabled person.
In Russia, a physical defect is cause to leave
the newly born child in the hospital and then he
is taken to the orphanage for life. Because of
this, children are often emotionally and
psychologically deprived.
CONSEQUENCES OF
DISABILITY
VOCATIONAL
Disability also reduces the degree of freedom
in vocational choice and forces the
handicapped person to a restricted range of
jobs.
Limitations of function simply reduce one's
employment options. For example, deafness is
a limitation in communication, and some jobs,
such as a telephone operator, require
communication that a deaf person cannot do
FACTORS AFFECTING THE
ADOPTATION TO DISABILITY
Age
 Type
 Severity of disability,
 The meaning of the loss to the
person.
Society attitude towards disability
Social stigma.
Unemployment
LEVEL OF PREVENTION
PRIMARY PREVENTION
Action taken before the onset of disease and to
reduce the possibility of occurrence of disease
.By immunizing, E.g polio vaccine and health
education.
Cont….
SECONDARY PREVENTION
At this, the disease agent has already
entered the host, hence the efforts seek
to detect disease at early stage and
treat promptly to cure the disease at the
earliest to slow its progression, prevent
complication and limit disability when
cure is not possible.
•
Cont….
TERTIARY PREVENTION
When complication has already occurred,
to handle the physical, mental, social,
and economic disability by appropriate
measures.
MANAGEMENT OF DISABILITY
 Early detection: usually by mothers,
nurses/midwives, doctors.
 Screening for specific disabilities like
blindness, deafness, congenital hip
dislocation.
 Accurate diagnosis
 Assessment of the degree of handicap
 Appropriate Medical or Surgical treatment
 Education
 Vocational training
 Employment
MANAGEMENT CONT….
PREVENTION.
PUBLIC ENLIGHTENMENT.
ESTABLISHMENT OF SPECIAL SCHOOLS
FOR THEM.
APPROPRIATE LEGISLATION TO HELP
THEM FIND THEIR RIGHTFUL PLACE IN
THE COUNTRY.
GOVERNMENT
 PROVISION OF AIDS e.g. hearing aids,
wheel chairs.
ENCOURAGE PARTICIPATION IN SPORTS
On December 13, 2006, the United Nations
formally agreed on the Convention on the
Rights of Persons with Disabilities, the first
human rights treat of the 21st century, to
protect and enhance the rights and
opportunities of the world's estimated 650
million disabled people.
GOVERNMENT
Countries that sign up to the convention will be
required to adopt national laws, and remove old
ones, so that persons with disabilities would, for
example,
have equal rights to education, employment, and
cultural life; the right to own and inherit
property; not be discriminated against in
marriage, children, etc; not be unwilling
subjects in medical experiments.
HEALTH PRACTITIONER
 PHYSIOTHERAPY (Deformities are
corrected, muscle strengthening exercise
for weak muscles.
 GOOD NURSING CARE
 SPEECH THERAPY
 Recommendation of prosthesis, wheel
chairs and hearing aids as appropriate.
 NUTRITIONAL THERAPY
 SURGICAL TREATMENT: removal of
cataract, transplant
HANDICAPPED
Accept their state
Attend clinics regularly
Take their drugs regularly
Present early when they sense symptoms
HANDICAPPED
Join the Necessary Associations of people
living with similar condition.
FAMILY AND RELATIVES
 Love and Care for them
 Be well educated about their condition and
how to recognize emergencies
 To encourage and not to pity them.
REHABLITATION
• It is the process of restoring the individual to the
fullest physical, mental, social, vocational, and
economical capacity of which he or she is capable.
• It relearning of formal skills- relearning the
activities of daily living.
•This process helps patient to live the most
productive lives possible.
REHABLITATION TEAM
Patient
Nurse
Physician
Physical therapist
Occupational therapist
Vocational therapist
Psychologist
Social worker
Recreational therapist
Other members.
INDEPENDENT LIVING
Independent Living (IL) is a civil rights movement
of people with disabilities.
It was founded by people who need quite a lot of
personal assistance in everyday life.
Adolf Ratzka (1988) expressed it more bluntly and
demanded that the politics of disability should give
disabled people more power.
INDEPENDENT LIVING MEAN FOR
PERSONS WITH DISABILITIES.
They decide on their own daily schedule
They have the competence to tell the assistant
how best to help them
They can choose how and where to live
They can develop a private living space and
lifestyle
They have the right to friendship, love and sex
They have the right to work and to be paid for it
PROGRAMM FOR PEOPLE WITH
DIFFERENTLY ABLED
•DAY CARE SERVICES FOR DIFFERENTLY
ABLED CHILDREN
•RESIDENTIAL CARE FOR PERSON WITH
DIFFERENT ABILITIES
•.INTEGRATED SCHOOLS
•.AIDS AND APPLIANCES
SOCIAL WELFARE PROGRAMMES
FOR THE DIFFERENTLY ABLED
•Registration for employment for helping them.
•Assistance in medical check up and surgery.
•centre for employment and training.
•Vocational guidance and counseling service.
•Assistance for purchase of artificial limb,
appliances etc.
•Removal of architectural barriers at public
places.
•Sports festivals
•Workshop for rehabilitation programme.
•Art and crafts exhibition by differently abled.
EDUCATION FOR DIFFERENTLY ABLED
•General education, formal and informal.
•Therapeutic education
•Education in special living techniques.
•Vocational preparation.
•Education in living with a differently abled.
NATIONAL POLICIES FOR
HANDICAPPED IN INDIA
i) Deendayal Disabled Rehabilitation Scheme
(DDRS):- funds for the welfare of persons with
disabilities are provided to the non-
governmental organizations for projects like
special schools for disabled, Vocational Training
Centres, Half Way Homes, Community Based
Rehabilitation Centres,
(ii) Assistance to Disabled Persons for
Purchase/Fitting of Aids and Appliances
(ADIP):- Under the scheme, aids/appliances are
distributed to the needy persons with disabilities
which includes mentally challenged children
also.
NATIONAL POLICIES FOR
HANDICAPPED IN INDIA
(iii) National Institutions:-
The Ministry supports seven autonomous National
Institutes which provide rehabilitation services and
undertake manpower development with the
overall objective of providing rehabilitation
services for different types of disabilities.
(iv) The National Handicapped Finance &
Development Corporation - provides
concessional credit to persons with disabilities for
setting up income generating activities for self
employment.
v) Scheme for Implementation of Persons with
Disabilities (Equal Opportunities, Protection of
Rights and Full Participation) Act, 1995 (SIPDA):-
assistance is provided for setting up of District
Disability Rehabilitation Centres, Regional
Rehabilitation Centres, creating barrier free
environment in public buildings, awareness
generation etc.
(vi) Scheme of Incentives to Employees in the
Private Sector for providing employment to
persons with disabilities:- launched in April, 2008,
the Government of India provides the employers’
contribution for Employees Provident Fund (EPF) and
Employees State Insurance (ESI) for three years, for
persons with disabilities employed in the private
MODERN TECHNOLOGY FOR
HANDICAPPED
DANCING
WHEEL CHAIR
PROSTHESIS
MOBILITY
SCOOTER
ROBOTIC
ARMS
X
University project enables
physically challenged
students to create music
using technology
AT DEVICE FOR
HANDICAPPED
STEPHEN HAWKING
Britis physicist and
mathematician stephen
hawkings has fundamental
contribution to the science
of cosmology - study of
origins, structure and
space time relationship.
He has a motor neuron
disease that deteriorate.
He was awarded the
presential medal of
freedom.
•Through both blind
and deaf, American
lecturer and author
fought for
improvement in the
education and life of
the physically
handicapped. In 8
months old an illness
developed that the
doctor describe as
brain congestion.
HELEN KELLER
SUDHA CHANDAN
Despite amputation of
one leg, she has
established herself in
film line and got
reputation as a dancer
and actor. She
absolutely over come
her disability with the
help of prosthetic
Jaipur foot.
BETHOVEN
He is most famous and
influential composer of all
times. His hearing began
to deteriorate in the 1990s
yet he continued to
compose even after
becoming completely
deaf.
PPT ON CARE OF HANDICAPPED. CARE OF PHYSICALLY CHALLEGED, CARE OF DIFERENTLY ABLED pptx

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PPT ON CARE OF HANDICAPPED. CARE OF PHYSICALLY CHALLEGED, CARE OF DIFERENTLY ABLED pptx

  • 1. PRESENTATION ON CARE OF HANDICAPPED Presented by Reena yadav S.N.M.C. AGRA
  • 2. The sequence of events leading to disability and handicap have been stated as follows: Disease  Impairment Disability  Handicap IMPAIRMENT is a loss or abnormality of psychological, physiological and anatomical structure or function and operates at the level of organ or part affected. DISABILITY is any restriction or lack of ability(resulting from an impairment) to perform an activity in a manner or within the range considered normal for human beings. HANDICAP is a long-term disadvantage resulting from an impairment or disability which adversely affects the individual’s ability to achieve personal and economic dependence which is normal for his or her peers.
  • 3. HANDICAPPED one who suffers any continuing disability of body, intellect or personality which is likely to interfere with his normal growth and development or capacity to learn.
  • 5. DIFFERENTLY ABLED Differently abled was first proposed (in the 1980s) as an alternative to disabled, handicapped, etc. on the grounds that it gave a more positive message and so avoided discrimination towards people with disabilities.
  • 6. CAUSES OF DISABILITY  CONGENITAL e.g. Congenital hip dislocation, e.t.c.  TRAUMATIC e.g. Birth injuries, RTA  DEGENERATIVE e.g. Arthritis  INFECTIVE e.g. Poliomyelitis, TB of the Spine  NUTRITIONAL e.g. PEM, Vitamin A Deficiency.  CHEMICALS e.g. Mercury or lead poisoning  NEOPLASM e.g. space occupying lesion  METABOLIC e.g. Diabetes Mellitus
  • 7. 2001 has revealed that over 21 million people in India as suffering from one or the other kind of disability. 2.1% of the population. 12.6 million are males 9.3 million are females. more in rural and urban areas. PREVALENCE
  • 8. the highest number of disabled-- Uttar Pradesh (3.6 million). Bihar (1.9 million), West Bengal (1.8million), Tamil Nadu and Maharashtra (1.6 million each). Tamil Nadu is the only state, which has a higher number of disabled females than males. Arunachal Pradesh has highest disabled males (66.6%) and lowest proportion of female disabled.
  • 9. TYPES OF DISABILITY 1- PHYSICAL DISABILITY: Any impairment which limits the physical function of limbs or fine or gross motor ability is a physical disability.
  • 10. CONT….. 2- SENSORY DISABILITY: Impairment of one of the senses. The term is used primarily to refer to vision and hearing impairment, but other senses can be impaired.
  • 11. CONT….. 5-OLFACTORY AND GUSTATORY IMPAIRMENT Impairment of the sense of smell and taste are commonly associated with aging but can also occur in younger people due to a wide variety of causes. 6-SOMATOSENSORY IMPAIRMENT Insensitivity to stimuli such as touch, heat, cold, and pain.
  • 12. CONT….. 7-BALANCE DISORDER balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking.
  • 13. CONT….. 8-INTELLECTUAL DISABILITY ranges from mental retardation to cognitive deficits too mild or too specific (as in specific learning disability) to qualify as mental retardation.
  • 14. CONT….. 10- DEVELOPMENTAL DISABILITY any disability that results in problems with growth and development. for example spina bifida . 11- Nonvisible disabilities Several chronic disorders, such as diabetes, asthma or epilepsy,
  • 15. MILD The child can perform basic life management functions appropriate for child's age and development and can use mainstream methods of transportation and communication. Child requires no equipment for daily functioning and may require average or slightly above average medical care and appointments. LEVEL OF HANDICAPPED
  • 16. Cont…. MODERATE --- Child has a relatively stable non- correctable condition that is neither progressive nor degenerative. Child can perform basic life management functions appropriate for age and development (feeding, dressing, toileting) with some assistance.
  • 17. Cont…. SEVERE – Child may require life support equipment, or has a progressive, degenerative or terminal illness. 1. require significant home modifications. 2. require repeated doctor or frequent hospitalizations or surgeries. 3. requires 2 or more medical appointments per week. 4. requires a parent or aide to perform basic life management functions (feeding, dressing, toileting, etc.). 5. require special adaptations for transportation and/or communication.
  • 18. CONSEQUENCES OF DISABILITY INDIVIDUAL • Fear, anxiety, worry and apprehension . • Unemployment • Dependency. • Personality Problems . Disbelief. . Depression And Anger.
  • 19. CONSEQUENCES OF DISABILITY FAMILY AND SOCIETY Stigma Exploitation Isolation/ abandonment Less likely to be educated Street begging May become victims of Child trafficking Neglect
  • 20. CONSEQUENCES OF DISABILITY PSYCHOSOCIAL The psychosocial impact of disability may be the largest handicap for the disabled person. In Russia, a physical defect is cause to leave the newly born child in the hospital and then he is taken to the orphanage for life. Because of this, children are often emotionally and psychologically deprived.
  • 21. CONSEQUENCES OF DISABILITY VOCATIONAL Disability also reduces the degree of freedom in vocational choice and forces the handicapped person to a restricted range of jobs. Limitations of function simply reduce one's employment options. For example, deafness is a limitation in communication, and some jobs, such as a telephone operator, require communication that a deaf person cannot do
  • 22. FACTORS AFFECTING THE ADOPTATION TO DISABILITY Age  Type  Severity of disability,  The meaning of the loss to the person. Society attitude towards disability Social stigma. Unemployment
  • 23. LEVEL OF PREVENTION PRIMARY PREVENTION Action taken before the onset of disease and to reduce the possibility of occurrence of disease .By immunizing, E.g polio vaccine and health education.
  • 24. Cont…. SECONDARY PREVENTION At this, the disease agent has already entered the host, hence the efforts seek to detect disease at early stage and treat promptly to cure the disease at the earliest to slow its progression, prevent complication and limit disability when cure is not possible. •
  • 25. Cont…. TERTIARY PREVENTION When complication has already occurred, to handle the physical, mental, social, and economic disability by appropriate measures.
  • 26. MANAGEMENT OF DISABILITY  Early detection: usually by mothers, nurses/midwives, doctors.  Screening for specific disabilities like blindness, deafness, congenital hip dislocation.  Accurate diagnosis  Assessment of the degree of handicap  Appropriate Medical or Surgical treatment  Education  Vocational training  Employment
  • 27. MANAGEMENT CONT…. PREVENTION. PUBLIC ENLIGHTENMENT. ESTABLISHMENT OF SPECIAL SCHOOLS FOR THEM. APPROPRIATE LEGISLATION TO HELP THEM FIND THEIR RIGHTFUL PLACE IN THE COUNTRY.
  • 28. GOVERNMENT  PROVISION OF AIDS e.g. hearing aids, wheel chairs. ENCOURAGE PARTICIPATION IN SPORTS On December 13, 2006, the United Nations formally agreed on the Convention on the Rights of Persons with Disabilities, the first human rights treat of the 21st century, to protect and enhance the rights and opportunities of the world's estimated 650 million disabled people.
  • 29. GOVERNMENT Countries that sign up to the convention will be required to adopt national laws, and remove old ones, so that persons with disabilities would, for example, have equal rights to education, employment, and cultural life; the right to own and inherit property; not be discriminated against in marriage, children, etc; not be unwilling subjects in medical experiments.
  • 30. HEALTH PRACTITIONER  PHYSIOTHERAPY (Deformities are corrected, muscle strengthening exercise for weak muscles.  GOOD NURSING CARE  SPEECH THERAPY  Recommendation of prosthesis, wheel chairs and hearing aids as appropriate.  NUTRITIONAL THERAPY  SURGICAL TREATMENT: removal of cataract, transplant
  • 31. HANDICAPPED Accept their state Attend clinics regularly Take their drugs regularly Present early when they sense symptoms
  • 32. HANDICAPPED Join the Necessary Associations of people living with similar condition.
  • 33. FAMILY AND RELATIVES  Love and Care for them  Be well educated about their condition and how to recognize emergencies  To encourage and not to pity them.
  • 34. REHABLITATION • It is the process of restoring the individual to the fullest physical, mental, social, vocational, and economical capacity of which he or she is capable. • It relearning of formal skills- relearning the activities of daily living. •This process helps patient to live the most productive lives possible.
  • 35. REHABLITATION TEAM Patient Nurse Physician Physical therapist Occupational therapist Vocational therapist Psychologist Social worker Recreational therapist Other members.
  • 36. INDEPENDENT LIVING Independent Living (IL) is a civil rights movement of people with disabilities. It was founded by people who need quite a lot of personal assistance in everyday life. Adolf Ratzka (1988) expressed it more bluntly and demanded that the politics of disability should give disabled people more power.
  • 37. INDEPENDENT LIVING MEAN FOR PERSONS WITH DISABILITIES. They decide on their own daily schedule They have the competence to tell the assistant how best to help them They can choose how and where to live They can develop a private living space and lifestyle They have the right to friendship, love and sex They have the right to work and to be paid for it
  • 38. PROGRAMM FOR PEOPLE WITH DIFFERENTLY ABLED •DAY CARE SERVICES FOR DIFFERENTLY ABLED CHILDREN •RESIDENTIAL CARE FOR PERSON WITH DIFFERENT ABILITIES •.INTEGRATED SCHOOLS •.AIDS AND APPLIANCES
  • 39. SOCIAL WELFARE PROGRAMMES FOR THE DIFFERENTLY ABLED •Registration for employment for helping them. •Assistance in medical check up and surgery. •centre for employment and training. •Vocational guidance and counseling service. •Assistance for purchase of artificial limb, appliances etc. •Removal of architectural barriers at public places. •Sports festivals •Workshop for rehabilitation programme. •Art and crafts exhibition by differently abled.
  • 40. EDUCATION FOR DIFFERENTLY ABLED •General education, formal and informal. •Therapeutic education •Education in special living techniques. •Vocational preparation. •Education in living with a differently abled.
  • 41. NATIONAL POLICIES FOR HANDICAPPED IN INDIA i) Deendayal Disabled Rehabilitation Scheme (DDRS):- funds for the welfare of persons with disabilities are provided to the non- governmental organizations for projects like special schools for disabled, Vocational Training Centres, Half Way Homes, Community Based Rehabilitation Centres, (ii) Assistance to Disabled Persons for Purchase/Fitting of Aids and Appliances (ADIP):- Under the scheme, aids/appliances are distributed to the needy persons with disabilities which includes mentally challenged children also.
  • 42. NATIONAL POLICIES FOR HANDICAPPED IN INDIA (iii) National Institutions:- The Ministry supports seven autonomous National Institutes which provide rehabilitation services and undertake manpower development with the overall objective of providing rehabilitation services for different types of disabilities. (iv) The National Handicapped Finance & Development Corporation - provides concessional credit to persons with disabilities for setting up income generating activities for self employment.
  • 43. v) Scheme for Implementation of Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (SIPDA):- assistance is provided for setting up of District Disability Rehabilitation Centres, Regional Rehabilitation Centres, creating barrier free environment in public buildings, awareness generation etc. (vi) Scheme of Incentives to Employees in the Private Sector for providing employment to persons with disabilities:- launched in April, 2008, the Government of India provides the employers’ contribution for Employees Provident Fund (EPF) and Employees State Insurance (ESI) for three years, for persons with disabilities employed in the private
  • 45.
  • 47. X University project enables physically challenged students to create music using technology AT DEVICE FOR HANDICAPPED
  • 48.
  • 49. STEPHEN HAWKING Britis physicist and mathematician stephen hawkings has fundamental contribution to the science of cosmology - study of origins, structure and space time relationship. He has a motor neuron disease that deteriorate. He was awarded the presential medal of freedom.
  • 50. •Through both blind and deaf, American lecturer and author fought for improvement in the education and life of the physically handicapped. In 8 months old an illness developed that the doctor describe as brain congestion. HELEN KELLER
  • 51. SUDHA CHANDAN Despite amputation of one leg, she has established herself in film line and got reputation as a dancer and actor. She absolutely over come her disability with the help of prosthetic Jaipur foot.
  • 52. BETHOVEN He is most famous and influential composer of all times. His hearing began to deteriorate in the 1990s yet he continued to compose even after becoming completely deaf.