 The effects of certain coping efforts on adaptive and functional

outcomes benefits individuals with disabling conditions.

 In general, among people with disabling conditions, there is
evidence that passive, lazy avoidant, emotion-focused cognitive
strategies (e.g., catastrophizing) and wishful thinking are
associated with poorer outcomes, whereas active, problem-
focused attempts to redefine thoughts to become more positive
are associated with favourable outcomes
 . Under conditions in which individuals with disabling conditions
use active and problem-solving coping strategies to manage their
life circumstances, there will be better functional outcomes across
several dimensions (e.g., activities of daily living, and
employment) than when passive coping strategies are used.
These social protection measures may include :
• poverty reduction schemes;

• cash transfer programs,

• social and health insurance,

• public work programs,

• housing programs,

• disability pensions and mobility grants.

• Social protection from a rights-based approach must

accommodate the needs of persons with disabilities and
vulnerabilities.
 Social protection plays a key role in realizing the rights of persons
with disabilities and vulnerabilities of all ages: providing them
with an adequate standard of living, a basic level of income
security; thus reducing levels of poverty and vulnerability.
 Health outcomes for people with disabilities should be access to
quality, affordable health care services, which make the best use
of available resources.
 As several factors interact to inhibit access to health care, reforms
in all the interacting components of the health care system such
as policy and legislations, financing, services delivery and human
resources training in line with inclusiveness perspectives.
 People with disabilities report seeking more health care than people without
disabilities and have greater unmet needs.
 People with disabilities encounter a range of barriers when they attempt to access
health care including:
 Prohibitive costs, Affordability of health services and transportation are two main
reasons why people with disabilities do not receive needed health care in low-income
countries
 Limited availability of services: The lack of appropriate services for people with
disabilities is a significant barrier to health care.
 Physical barriers: Uneven access to buildings (hospitals, health centres),
inaccessible medical equipment, poor signage, narrow doorways, internal steps,
inadequate bathroom facilities
 Inadequate skills and knowledge of health workers: People with disabilities
were more than twice as likely to report finding health care provider skills inadequate
to meet their needs.
  Governments and professionals can improve health outcomes for people
with disabilities by improving access to quality, affordable health care
services, which make the best use of available resources.
 As several factors interact to inhibit access to health care, reforms in all the
interacting components of the health care system are requiredsuch as
 policy and legislations, Assess existing policies and services, identify priorities
to reduce health inequalities and plan improvements for access and inclusion
 financing,

 services delivery Provide a broad range of modifications and adjustments

(reasonable accommodation) to facilitate access to health care services.
 and human resources training in line with inclusiveness perspectives.
 .
 Disability inclusion means provision of differentiated services
for persons with disabilities and vulnerabilities.

 Differentiated service means a multiple service delivery model

that can satisfy the most needs of persons with disabilities and
vulnerabilities.

 Socially expected activities may also include engaging in social

activities, using public resources such as transportation and
libraries, moving about within communities, receiving adequate
health care, having relationships, and enjoying other day-to-day
activities.
 Persons with disabilities and vulnerabilities are often excluded (either
directly or indirectly) from development processes and humanitarian
action because of physical, attitudinal and institutional barriers.
 The effects of this exclusion are increased inequality, discrimination
and marginalization. To change this, a disability inclusion approach
must be implemented.
 The twin-track approach involves:
 1 ensuring all mainstream programs and services are inclusive and
accessible to persons with disabilities, while at the same time

 2 providing targeted disability-specific support to persons with

disabilities.
 Rehabilitation interventions promote a comprehensive process to
facilitate attainment of the optimal physical, psychological, cognitive,
behavioural, social, vocational, a vocational and educational status
within the capacity allowed by the anatomic or physiologic
impairment,
 personal desires and life plans, and environmental (dis)advantages for
a person with a disability.

 Consumers/patients, families, and professionals work together as a

team to identify realistic goals and develop strategies to achieve the
highest possible functional outcome, in some cases in the face of a
permanent disability, impairment, or pathologic process
 Rehabilitation is a process designed to optimize function and
improve the quality of life of those with disabilities.
 Psychological intervention

 Medical treatment

 Provide assistive technology

 Social interaction intervention

 Economic and occupational support

 Education access

Consequently, it is not a simple process. It involves multiple participants,

and it can take on many forms.
 is a description of the individual components that, when combined,
comprise the process and activity of rehabilitation.
 Physicians
 The physician‘s role is to manage the medical and health conditions
of the patient/consumer within the rehabilitation process, providing
diagnosis, treatment, or management of disability-specific issues

 Occupational Therapists
 Occupational therapists (OTs) typically work with
patients/consumers through functional activities in order to increase
their ability to participate in activities of daily living (ADLs) and
instrumental activities of daily living (IADLs), in school and work
environments, using a variety of techniques.
 Physical Therapists
 Physical therapists (PTs) assess movement dysfunction and use
treatment interventions such as exercise, functional training, manual
therapy techniques, gait and balance training, assistive and adaptive
devices and equipment.
 Speech and Language Therapist
 Speech and language therapist assess, treat, and help to prevent
disorders related to speech, language, cognition, voice,
communication, swallowing, and fluency.
 Audiologists
 Audiologists identify, assess, manage, and interpret test results related
to disorders of hearing, balance, and other systems related to hearing.
 Rehabilitation Nurses
 The rehabilitation nurse usually takes the role of educator and
taskmaster throughout rehabilitation, but these professionals have
most prominence within inpatient rehabilitation programs.
 Social Workers
 Social workers in health settings may provide case management or
coordination for persons with complex medical conditions and needs;
 Case Managers
 Case management is a relatively new concept that has come about with
the survival of patients/consumers with complex medical problems
and disabilities, and with the development of a more complex health
care system.
 CBR was originally designed for developing countries where disability
estimates were very high and the countries were under severe
economic constraints

 It promotes collaboration among community leaders, peoples with

disabilities and their families and other concerned citizens to provide
equal opportunities for all peoples with disabilities in the community
and to strengthen the role of their organization.

 Community based rehabilitation is a combination of two important

words; community and rehabilitation.
 Community-consists of people living together in some form of
social organization sharing political, economic, social and cultural
characteristics in varying degrees.
 Rehabilitation-includes all measures aimed at reducing the impact
of disability for an individual enabling him or her to achieve
independence, social integration, a better quality of life and self-
actualization or refers to measures which aim to enable persons with
disabilities to attain and maintain maximum independence, full
physical, mental, social and vocational ability, and full inclusion and
participation in all aspects of life
 example:- If you give a person a fish, He/she will eat for a day; If
you teach him/her to fish, He/she eat for a lifetime.
 Based on the above definition of key words, CBR is therefore, a
systematized approach within general community development
whereby Persons with Disabilities are enabled to live a fulfilling life
within their own community,

 making maximum use of local resources and helping the community

become aware of its responsibility in ensuring the inclusion and equal
participation of Persons with Disabilities (PWDs).
 In the process, PWDs are also made aware of their own role and
responsibility, as they are part of the community.
 In addition, for the purpose of our discussion two important
definitions will be given:
1. Community based rehabilitation is a strategy that can address the
needs of peoples with disabilities with in their communities (WHO,
UNESCO, 2004).
2. Community based rehabilitation is a common sense strategy for
enhancing the quality of life of peoples with disabilities by improving
services delivery in order to reach all in need by providing more
equitable opportunities and by promoting and protecting their rights .
 Currently, three main meanings are attached to the notion of CBR:
People taking care of themselves, a concept and an ideology and
community based rehabilitation which will be described below
 People Taking Care of Themselves
 Services for people with disabilities in most regions in developing
countries are still limited to what people can do for themselves.

 This is the "real" CBR: all the activities that people with disability,
their family members and other community members do in their own
community for persons with disability, such as general care,
accommodating each other's needs
As a concept and an ideology, it promotes a decentralized approach to
rehabilitation service-delivery,

whereby, it is assumed that community members are willing and able to

mobilize local resources and to provide appropriate services to people
with disabilities.
Community Based Rehabilitation
is mostly in a form of Non-Governmental Organizations (NGOs).
Recognizing the human and material limitations of people with
disabilities, their family members and other community members, CBR
program tries to promote and facilitate community based rehabilitation.
 The major objective of community based rehabilitation is to ensure
that people with disabilities are empowered to maximize their physical
and mental abilities,
 have access to regular services and opportunities and become active,
contributing members of their communities and then societies.
 community based rehabilitation promotes the human rights of people
with disabilities through attitude changes within the community.
 Definition of assistive technology of people with disabilities
 Assistive technology encompasses all systems that are designed for
Persons with disabilities and Vulnerabilities, and that attempt to
compensate the handicapped.
 This includes robotic tele manipulators, wheelchairs, or navigation
systems for the blind.
 AT also includes systems that restore personal functionality, such as
external prostheses and ortheses.
1. Mobility aids :Hand orthosis,Mouth stick ,Prosthetic limb
,Wheelchair (manual and/or motorized) ,Canes ,Crutches ,Braces

2. Sensory aides: equipment for individuals with hearing impairment,

including screen readers ,braille display, magnification software,
hearing aides and cochlear implants.
3. Cognitive aides,
4. Communication aides etc.
 Assistive technology affords Persons with disabilities and
vulnerabilities greater equality of opportunity, by enhancing and
expanding their communication, learning, participation, and
achievement with higher levels of independence, wellbeing, and
quality of life.

 It is essential for helping Persons with disabilities and vulnerabilities

with severe physical, sensorial, or mental limitations to become more
independent, and to improve their quality of life.
 Persons with disabilities and vulnerabilities utilize AT to enhance the
performance of their daily living tasks, including communication,
vision, hearing, recreation, movement, seating and mobility, reading,
learning, writing, and studying, as well as controlling and accessing
their environment.
 The right to work is fundamental to being a full and equal member of
society, and it applies to all persons, regardless of whether or not they
have a disability.
 OECD study of its members showed that persons without disabilities
were nearly three times more likely than persons with disabilities to
participate in the labour market.
Barriers of employment
Barriers to the employment of persons with disabilities take many
forms and operate at many levels, both within and beyond the
workplace itself
A) Attitudes and Discrimination
 Employers may be reluctant to hire persons with disabilities based on
the perception that they are less productive or less capable of
carrying out their jobs than others.
Accessibility
 The accessibility of the following areas are crucial to the employment
of persons with disabilities: the physical environment; transportation;
information and communications; and other facilities open to the
public.
Education and Training
 Persons with disabilities have disproportionately restricted access to
education and training. This severely limits their job opportunities
due to a lack of skills and knowledge that are relevant to find or
retain a job.
Social Networks
 Another barrier to employment for persons with disabilities can be
their more limited social networks. Social networks greatly aid the
process of searching for work, the lack of which is likely to limit
options for persons with disabilities
Women Disabilities
 In many developing countries including Ethiopia, as a result of
continued prejudices both towards women and surrounding disability,
women with disabilities are doubly discriminated against in the labour
market
A) Legal Barriers
 As a result of discriminatory attitudes about the perceived capabilities
of persons with disabilities, some countries impose legal restrictions
on their participation in certain types of employment or processes
Inflexible Work Arrangements
In some cases, persons with disabilities might prove to be competent and
productive employees, but are nonetheless unable to perform certain
tasks.
The Benefit Trap
 Another obstacle to the employment of persons with disabilities can
ironically be imposed by social protection schemes ultimately
designed to support them.
Dismissal on the Basis of Disability
 Workers who are injured and acquire a disability on the job may face
unaccommodating policies and a lack of rehabilitative services, which
limit their ability to return to work.
A) Anti-Discrimination Legislation
B) Vocational Education and Training
C) Wage Subsidies
D) Supported Employment
E) Workplace Accommodation Schemes
F) Workers’ Compensation
G) Break Down Attitudinal Barriers and Challenge Discrimination