The document discusses definitions and concepts related to impairment, disability, and handicap from the WHO and ICIDH models. It defines impairment as an abnormality of structure or function, disability as a restriction resulting from impairment, and handicap as a social disadvantage faced due to impairment or disability. Community-based rehabilitation (CBR) is described as an approach that provides rehabilitation services within communities using their existing resources, with the goals of equalizing opportunities and socially integrating people with disabilities. The roles of the rehabilitation team, which includes nurses, physiotherapists, psychologists and others, are also summarized.

1. PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD

3. • The International Classification of
Impairments, Disabilities and Handicaps
(ICIDH) published in 1980 by WHO also
contributed to a medical approach.
• ICIDH defines a model that progresses from
disease, impairment and disability to handicap
in a linear fashion
Disease Impairment Disability Handicap

4. HEALTH
WHO’s definition:
Physical, psychological and socially
complete well-being.

5. IMPAIRMENT
Definition: Any loss or abnormality of
psychological, physiological, or anatomical
structure or function.

6. IMPAIRMENT
Impairment includes clinical features or
manifestations of the disease or condition.
Examples: weakness, confusion etc.
In this definition function is the function of
a body part, not the whole-person
function.

7. DISABILITY
Any restriction or lack
resulting from impairment
of ability to perform an
activity in the manner or
within the range
considered normal for a
human being.

8. HANDICAP
A disadvantage for a
given individual
resulting from an
impairment or a
disability that limits or
prevents the fulfillment
of a role that is normal
(depending on the age,
gender, social and
cultural factors) for that
individual.

9. WHO DEFINITIONS
Impairment ↔ Organ or Tissue
Disability ↔ Whole Person
Handicap ↔ Society

10. Impairment is defined as defined as
abnormality of structure or function of the
body or an organ.
Disability is defined as restriction or lack of
ability as a result of the impairment.
Handicap is defined as a social disadvantage
faced by an individual resulting from either
impairment or disability.

11. Disability: Global Statistics
Approximately 10% of the world population
lives with a disability
An estimated 80% of people with disabilities
live in developing countries
An estimated 15-20% of the world’s poorest
people are disabled
No rehabilitation services are available to
people with disabilities in 62 countries

12. Only 5- 15% of people with disabilities can
access assistive devices in the developing
world
Children with disabilities are much less likely
to attend school than others
People with disabilities tend to experience
higher unemployment and have lower earnings
than people without disabilities

13. REHABILITATION
Rehabilitation is the process of
helping a person to reach the
fullest physical, psychological,
social, vocational, and
educational potential consistent
with his or her physiologic or
anatomical impairment,
environmental limitations, and
desires and life plans.

14. According to WHO “ Rehabilitation is the
combined and coordinated use of the medical,
social, educational, and vocational measures for
training and re-training the
individual to the highest possible
level of functional ability”.

15. REHABILITATION NURSING
Important and essential part of comprehensive
nursing.
Rehabilitation nursing ideally starts at the
moment a patient enter into the health care
system.
However, rehabilitation programme may take
place in the special units of hospital or
independent centre in the community.

16. Objectives of Rehabilitation
Nursing
There are 4 broad objectives of rehabilitation
nursing:
a. To restore affected abilities to the highest
possible level of function.
b. To prevent further disability/ handicap.
c. To protect the person abilities.
d.To assist the person / patient to use his or her
abilities

17. Principles Of Rehabilitation:
o Rehabilitation should begin during the initial
contact with the patient.
o Restoring the patient to independent or to regain
his pre-illness/pre-disability level of function in
as short a time as possible.
o Maximising independence within the limits of the
disability.
o He must be an active participant.

18. o The activities of daily living are facilitated.
o The individual with a disability is encouraged
to wear his clothing enhances self-esteem and
dignity.
o Motivates the patient and helps him to attain
social independence.
o Focus is on the needs of groups of people with
specific condition
o Every patient has a right to the rehabilitation
services.

19. Scope of Rehabilitation

20. Scope of rehabilitation
Physiotherapy

21. Scope of rehabilitation
Vocational Guidance

22. Scope of rehabilitation
Speech Therapy

23. Scope of rehabilitation
Health Education

24. Scope of rehabilitation
Psychotherapy

25. Rehabilitation team
1. Nurse 2. Physiotherapist

26. Rehabilitation team
3. Psychologist 4. Dietician

27. 5. Speech Therapist
8. Recreational Therapist
7. Social Worker
6. Vocational Rehabilitation Counsellor
9. Occupational Therapist
Rehabilitation
Team
5. Speech Therapist
8. Recreational Therapist
7. Social Worker
6. Vocational Rehabilitation Counsellor
9. Occupational Therapist

28. Psychiatrist
• Leader of the team.
• Responsible for each intervention
• Evaluates the patient
• Plans.
• Organizes.
• Directs
• Coordinates.
• Controls.
• Motivates.

29. NURSE
• Controls environmental factors.
• Directs personal care of the patient.
• Manages medication.
• Is responsible for skin integrity.
• Helps ADL and adaptive devices.
• Organizes bowel and bladder
program.
• Helps the patient manage their time.
• Informs the team about the status of
the patient
• Educates the patient and the family

30. PHYSIOTHERAPIST
• Performs muscle strength testing.
• Evaluates the length and the tonus
of the muscle
• Exercises the patient especially for
gross motor function.
• Teaches how to transfer.
• Instructs the use of wheelchair,
canes and crutches.
• Offers physical therapy modalities.
• Educates for posture and walking.

31. Occupational therapist
• ADL.
• Trains the patient in the
functional use of upper
extremities.
• Explores the vocational skills.
• Evaluates the home and suggest
modifications.
• Trains patients in the use of
assistive technology.
• Collaborates with all of the team

32. Speech Therapist
• Evaluates patients with aphasia,
dysarthria, apraxia
• Speech, comprehension, reading
and writing
• Swallowing, feeding
• Other communicative problems
and proper therapies
• High technologies
• Family and patient education
and counseling

33. Psychologist
• Evaluates the psychological status of the patients
• Tests intelligence, memory and perceptual
functioning
• Incorporates the test results into the care plan
• Educates family and patient
• Counseling of the family

34. Social worker
• Evaluates patients (life-style, family, finances,
employment, environmental factors)
• Maintains a continuing relationship with the patient
and family
• Coordinates funding resources
• Provides assistance in locating alternative living
situations
• Assess vocational barriers
• Provide emotional support in strressful situations
• Facilitates discharge planning

35. Vocational Councellor
• Assists in developing and attaining realistic
vocational goals
• Evaluates vocational interests, aptitudes, and skills
• Counsels patients in the work environment
• Organizes activities to develop employer-employee
relationship behaviors
• Acts as a liaison between the patient and agencies
that provide training or job placement services
• Provides counseling, education, and support to
potential employers (job analysis on worksite)

36. ASPECTS OF REHABILITATION
1.Medical rehabilitation
Includes restoration of functions by prosthesis,
artificial limbs, etc.

37. ASPECTS OF REHABILITATION
2. Social rehabilitation
Includes restorations of family and
social relationship by replacement in
the family

38. ASPECTS OF REHABILITATION
3. Educational rehabilitation:
Include specialized training and
educational facilities e.g. Braille for blind,
Sign language for dumb and deaf

39. 4.Psychological rehabilitation
Includes restoration of personal dignity and
confidence during the period of growth and
development and in adult life
ASPECTS OF REHABILITATION

40. ASPECTS OF REHABILITATION
5. Vocational rehabilitation
Includes restoration of the capacity to earn a livelihood.
This can achieve by community participation and social
legislation for handicapped individual. The community
needs to offer employment opportunity in shops,
factories and other business establishment.

41. Approach of Rehabilitation
Community Based
Rehabilitation (CBR)
Institution Based
Rehabilitation ( IBR)

42. Approach of Rehabilitation

43. Community Based Rehabilitation (CBR)
CBR may be defined as “strategy within
community development for the rehabilitation,
equalization of opportunities, and social integration of
all people with disabilities.
• CBR is implemented through the combined efforts
of disabled people themselves, their families and
communities, and the appropriate health, education,
vocational and social services"
-WHO

44. Histor
y
Community-based rehabilitation (CBR) was
initiated by WHO following the Declaration of
Alma-Ata in 1978 in an effort to;
a. enhance the quality of life for people with
disabilities and their families
b. meet their basic needs
c. ensure their inclusion and participation.

45. Objectives of CBR:
Toidentify all persons with disability in the
community.
Toprovide required rehabilitation service
to disabled people.
Tocreate awareness about all issues
related to disability.
Totransfer rehabilitations related skills to
the community members.

46. Tomobilize available resources and raise
funds to carry out the problem.
Toraise the level of community
participation to an optimum level.
Tomake the CBR program sustainable
until the needs of the disabled people are
adequately met
Topriorities service for disabled children.

47. Principles Of CBR
UtilizationParticipation
Transfer Strengthen

48. Principles Of CBR
i. Participation of community in planning, decision
making and evaluation
ii. Utilization of available resources in the
community.
iii. Utilization of a co-ordinated approach among
education, health and social systems.
iv. Transfer of knowledge about disabilities and
skills in rehabilitation of people with disabilities,
families and communities.
v. Strengthening of referral services at the district,
provincial, and national levels.

49. Components of
CBR
HEALTH
EDUCATION
SOCIAL
ACCEPTANCE
LIVELIHOOD
EMPOWERMENT

50. CBR Matrix
 In light of evolution of CBR into broader
multisectorial development strategy, a matrix
was developed in 2004 to provide a common
framework for CBR program.
 It consists of five key components :
 Health, Education , Livelihood, Social and
Empowerment components.
 Each of these components have five elements.

51. CBR Matrix

52. Advantage of CBR:
Home based. Less expensive
Existing community
response and resources.
Focus on quality rather
than quantity
Multiple approaches
based on community
needs.

53. REHABILITATION COUNCIL OF INDIA:
On enacted in September , 1992 the RCI act by
parliament
it became statutory body in 22 june 1993.
16 Categories of Professionals/ Personnel have
been covered under the RCI Act as given below.
1. Audiologists and Speech Therapists
2. Clinical Psychologists
3. Hearing and Ear Mould Technicians

54. 4. Rehabilitation Engineers and Technicians
5. Special Teachers for Educating and Training
the Handicapped
6. Vocational Counsellors, Employment Officers
and Placement Officers
7. Multi-purpose Rehabilitation Therapists,
Technicians
8. Speech Pathologists
9.Rehabilitation Psychologists
10.Rehabilitation Social Workers

55. 11.Rehabilitation Practitioners in Mental
Retardation
12.Orientation and Mobility Specialists
13.Community Based Rehabilitation
Professionals
14.Rehabilitation Counsellors,Administrators
15.Prosthetists and Orthotists
16.Rehabilitation Workshop Managers

56. Role of Community Health Nurse in
Rehabilitation
1. Assessment of
the patients
physical, mental,
socioeconomic
and vocational
status
2. Diagnosis of
the therapeutic,
physiotherapeuti
c, vocational,
education,
training and
supportive needs
of the client
3. Deciding the
minimum
acceptable
improvement in
the patient’s
health, capacity
for independence
and productivity
level

57. Role of Community Health Nurse in
Rehabilitation
4. Formulation of plan of action
5.Implementing the action plan
6.Evaluation of the result of interventions.
7. Modification of plan of action, if necessary.

58. Qualities of Community Health Nurse
in Rehabilitation
Excellent listening skills.
High order counselling abilities
Effective Problem solving skill.
The ability to adopt innovative methods to
help the patient realize

59. Important Areas in Nursing
Role
Create awareness of the problem in the
community.
Reduce the consequences of the disabilities by
early detection (educate the family and the
community in early detection of the disability).
Provide early intervention
Establish adequate number of aids in appliance
and workshops to fabricate atrophic, prosthetic
and other items.

60.  Appropriate are need-based rehabilitation
programme.
 Train families in functional rehabilitation.
 Modify inappropriate attitude of the family &
community towards disability.
 Arrange meeting of families with children
having similar disabilities so that they will be
mutually supportive
 Provide recreation facilities for disables
children
Important areas in Nursing
Role

61. Conclusio
nRehabilitations 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. It should
deliver the service and training to people with
disabilities and their family.Hence it is necessary to
mention that rehabilitation nursing is a complex task
and one of the essential part of the comprehensive
nursing.

62. Thank you !!