Chap 6 Disability
Impairment
Impairment is any loss or abnormality of psychological, physiological or
anatomical structure and function, e.g. loss of foot, defective vision or mental
retardation
Because of impairment, the affected person may be unable to carry out certain
activities considered as normal for his age, sex, etc
Disability
A disability is 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.
Handicap
A handicap is a disadvantage for a given individual, resulting in an impairment
or disability that limits or prevents the fulfillment of a role that is normal
( depending on age sex, social and cultural factors) for that individual
Accident : Disease or Disorder
Loss of foot: Impairment
Cannot walk: Disability
Unemployed: Handicap
Disability/ Rehabilitation
AWARENESS ON DISABILITY
OBJECTIVES:
What is disability
Types of disability
Causes for disability
Prevention of disability
Levels of prevention
Referral centers
Types of disability
Blindness/Low vision
speech & hearing impairment
Locomotor disability
Mental retardation
Mental illness
Leprosy cured
Multiple disability
Locomotor disability
Polio
SCI/nerve injuries
Brain injury / C.P
Congenital
Club feet/CDH/Arthrogryposis
Amputation – loss of body parts
Fracture
Arthritis –
leprosy
Reasons for disability
There are 2 ways of becoming disabled:
Born with disability
Becoming disabled after birth
Causes of DISABILITY
From parents to children ( hereditary)
Malnutrition of the mother during pregnancy
Mother’s illness during pregnancy
At the time of birth
Cord around the baby’s neck / Long labour
Immediately after birth
Child gets tetanus due to cutting cord with a dirty knife
Marrying close blood relationship(consanguinity)
Unknown
AFTER BIRTH
Trauma & Injury
Infectious diseases
Polio, leprosy & brain fever
Malnutrition / lack of healthy food
VIT-A Blindness, Iodine deficiency ,Weak bones
Old age disabilities
Wear & tear arthritis, stroke and broken bones
Mental illness
Alcoholism and drug abuse
Pollution & problems with environments
DISABILITY
Person with disabilities can be limited in their participation in family,
community and societal roles not merely because of physical or mental
impairments, but because of social attitudes and environmental barriers.
WHAT PERSONS WITH DISABILITIES NEED
FOOD,SHELTER,CLOTHES ,MONEY ,HEALTH
CARE,EDUCATION,TRANSPORT,SKILLS,RECREATION,SOCIETY
Total Rehabilitation
Medical Model + Social Model
More holistic approach where medical rehabilitation is a component of Total
Rehabilitation – more focus is given in EDUCATION for children and INCOME
for adults with an aim of Inclusion – a society for all.
Prevention of Disabilities
Efforts of UNICEF and WHO
The whole world is appreciating and experiencing the efforts of UNICEF , WHO
and other organizations now w.r.t. prevention of disabilities
Efforts of Govt of India
In 1982-83 when honorable Ex Prime Minister Late Smt Indira Gandhi launched
Leprosy eradication programme,people were wondering whether the effort
would be a myth or reality.
Today after the successful phase of early identification and treatment, we
notice remarkable reduction in the incidence and prevalence of disease and
disabilities due to leprosy
In Rehabilitation programme, apart from early identification and early
secondary prevention) there is need to advocate , promote and implement
primary prevention measures.
Prevention is better than cure
Level of Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention
The main focus of prevention in health care is to stop health conditions from
occurring (primary prevention).
However, prevention also involves early detection and treatment to stop the
progression of a health condition (secondary prevention)
Management to reduce the consequences of an existing health condition
(tertiary prevention)
Primary Prevention
Primary prevention may include: primary health care; prenatal and postnatal
care; defluoridation of water iodization of common salt, education in nutrition;
immunization campaigns against communicable diseases; measures to control
endemic diseases; safety regulations; programmes for the prevention of
accidents in different environments, including adaptation of workplaces to
prevent occupational injury and diseases.
It is estimated that, through better use of primary prevention and health
promotion, the global burden of disease could be reduced by as much as 70%
Just like health promotion, prevention requires the involvement of many
different sectors. Within the health sector, primary health care plays an
important role and since CBR programmes are most closely linked with primary
health care, they can play a significant role in promoting and supporting
preventive health care for people with disabilities.
Secondary Prevention
Early diagnosis/early identification of diseases and treatment will help reduce
occurrence of disability
Early identification of patches due to leprosy will prevent occurrence of
disabilities
Examples of early detection include mammograms to detect breast cancer and
eye examinations to detect cataracts;
Example of early treatment include multidrug treatment of leprosy to prevent
disease progression and appropriate handling of a fractured bone to promote
proper healing and prevention of deformity.
Tertiary Prevention
Tertiary prevention aims to limit or reverse the impact of already existing
health conditions and impairments; it includes rehabilitation services and
interventions that aim to prevent activity limitations and to promote
independence, participation and inclusion.
The example of prevention of contractures and deformities due to PPRP may
be included under “Disability Limitation" instead of early diagnosis and
treatment
“Disability Limitation“ and Rehabilitation come under tertiary prevention.
India
Anita stands tall
Anita is a 50 year-old woman who lives in Khandale village, situated in a hilly
area of Raigad District, Maharashtra, India.
One day Anita sustained a small injury to her right foot. She quickly developed
pain in her leg and after a few days it turned black. Her son took her to Alibaug
Hospital, 15 km away, where they advised her to go to a specialized hospital in
Mumbai, 100 km away.
Health personnel in Mumbai immediately diagnosed Anita with diabetes and
amputated her right leg below the knee as it had developed gangrene.
Immediately following surgery, Anita's family took her back to their village as
they could not afford to stay in the city. Anita was unable to walk so her son
had to carry her on his back.
The village health worker informed Anita and her family about a CBR
programme that provided free health services for people who had lost a limb.
Anita visited the CBR programme at the health centre close to her village. Her
amputated stump was checked to ensure proper healing and her left leg/foot
was assessed to check for early sensory and circulation changes.
Anita learnt about diabetes and how to control the condition with medicine,
regular exercise and diet.
She has also learned about proper foot care to prevent her left leg from being
amputated in the future. Anita was given crutches and trained in how to use
them.
Later a team of health professionals visited the health centre and fitted Anita
with a prosthesis and a good pair of shoes to ensure her left foot was
protected from injury.
She was given gait training to ensure she could walk properly with her
prosthesis and CBR personnel constructed parallel bars outside her hut so she
could practise walking with her prosthesis at home.
Gradually Anita's confidence improved, until she was able to walk
independently with her prosthesis and return to household tasks and work in
the fields.
She continues to take her medication on a regular basis and has regular health
check-ups.
Anita says that her quality of life has improved and with the help of the CBR
programme ,she has succeeded in preventing further health complications as a
result of her diabetes.
Models of Disability
A good way of understanding the distinction between impairment and
disability is to consider some of the ways that disability has been thought of in
the past.
A ‘model’ in this context means a particular way of understanding or describing
a complex social phenomenon such as disability.
Charity Model
People with disabilities are often treated as objects of charity and pity. The
charity model is an older and outdated model of disability.
The Medical Model
This Model focuses primarily on the medical problems of persons with
disabilities and emphasises medical solutions
In the medical model the problem of disability is addressed by medical experts
through providing treatment for people with disabilities, rather than asking
them what they want.
Like the charity model, this approach is largely unconcerned with the social or
environmental features of disability
The social model
The social model of disability views people with disabilities as being disabled
less by their impairment than by society’s inadequate response to their specific
needs.
The emphasis on the removal of barriers focuses attention on a range of issues
ignored in both the charity and medical models.
For instance, it challenges inequalities before the law, restrictions caused by
physical structures (the way buildings and villages are designed), and
discrimination – the disabling aspects of negative attitudes towards people
with disabilities.
The human rights model
The human rights model of disability can be seen as the most recent
development of the social model. It states that:
All human beings are equal and have rights that should be respected without
distinction of any kind.
People with disabilities are citizens and, as such, have the same rights as those
without impairments.
All actions to support people with disabilities should be ‘rights based’; for
example, the demand for equal access to services and opportunities as a
human right.
The Nagi Model
The Nagi Disablement model was adopted as a means to describe how a
disease or a pathology results in impairments, functional limitations, and
disability and how this may vary across individuals.
The International Classification of Functioning, Disability and Health (ICF)
ICF is a framework for describing and organising information on functioning
and disability. It provides a standard language and a conceptual basis for the
definition and measurement of health and disability.
The ICF model organizes the injury or illness in two components:
1) functioning and disability
2) contextual factors
Component one can be further divided into body functions and structures,
activities and participation.
Body functions and structures are the anatomical and physiological aspects
that are affected by or cause the condition.
Activities are defined as tasks or actions taken by an individual whereas
participation is “involvement in life situations.” Life situations can include
things such as participating in a sport, school or community
The second component, contextual factors, can be categorized as personal or
environmental factors. Personal factors can include additional health problems
the patient has, as well as age, gender, race, lifestyles and habits, among
others. Environmental aspects include “the physical, social and attitudinal
environment in which people live.