REHABILITAION

for
DISABILITY
Rehabilitation measures are aimed at achieving the following broad
outcomes:
prevention of the loss of function
slowing the rate of loss of function
improvement or restoration of function
compensation for lost function
maintenance of current function.
Rehabilitation is always voluntary, and some individuals may require
support with decision-making about rehabilitation choices.
In all cases rehabilitation should help empower a person with a disability
and his or her family
Rehabilitation is cross-sectoral and may be carried out by health
professionals in conjunction with specialists in education, employment,
social welfare and other fields.
In resource poor contexts it may involve non-specialists workers for
example, community-based rehabilitation workers in addition to family,
friends and community groups.
Rehabilitation can be provided in a range of settings including acute care
hospitals, specialized rehabilitation wards, hospitals or centres, nursing
homes, prisons, residential educational institutions, military residential
settings, or single multi professional practices.
Longer-term rehabilitation may be provided within community settings
and facilities such as primary health care centres, rehabilitation centres,
schools, work places or homes.
PREVENTION OF DISABILITY
PRIMARY PREVENTION
A. FOR INDIVIDUALS
Immunisation of pregnant mothers and infants
Vitamin A drops to children(1 to 6 years) 6 doses at 6 month interval

Iron and folic acid tablets to pregnant mothers

Syrup iron-folic acid to children
These can be achieved through PHC and NRHM efforts
Contd.
B. FOR COMMUNITY
Health education regarding high risk pregnancy
Antenatal, natal and post natal care
Avoid early age or late pregnancy to avoid malformation
Avoid unconsanguinous marriages to prevent thalasaemia. Rh
incompatibility
Iodised salt for goiter prevention
SECONDARY PREVENTION
Mile stone growth monitoring by field workers
Early detection of trachoma, night blindness and treatment
School health programme
Mobile health checkup vans
Early detection of disease and prevent disability
TERTIARY PREVENTION
Extensive IEC campaign to create favourable opinion and attitude of
people towards handicap
Create mass and community efforts to limit disability
School for blinds, dumb and deaf, and mentally retarded children
Physiotherapy and occupational therapy training institutions
Grant in aid to voluntary organisations for handicap welfare
INTERVENTION FOR DISABILITY
INTERVENTIONS
PHYSICAL

Appropriate exercise therapy for joint movements

Restoring the function of affected part by physio training
Provision of external appliances and splints
Relief of pain by application of hot & cold formulation
Training in daily activities to restore lost function
Education of patients to maintain the physical status and returning to
normal life
PSYCHO-SOCIAL
The process of rehabilitation is not complete without psychosocial
intervention
To raise the morals of the patient, counselling, positive attitude and
support
Sympathetic attitude of doctors, family members and community support
Psycho therapy for depression, anxiety, personality changes and suicidal
tendency
Financial support, work place support to raise the morale and take away
depression
EDUCATIONAL
Efforts to made to continue the education
Integrated education for disabled child in normal school
Pre school training, parents and counselling
Special training in speech and language
Day to day living practices training and skill development
DISABILITY FRIENDLY INFRASTRUCTURES
Special parking place for disables
Ramps with guards at the entrance
Adequate number of wheel chairs for their movement
Special transport system for reaching various areas of hospital
VOCATIONAL

Efforts be made to promote vocational training for earning according to

the level of disability
Exploring the type and extent of vocational training suiting the level of
disability
One should be caring, sympathetic and supportive in assisting the
disabled
Vocational training centres, suitable level of disability by GOI and their
placement
REHABILITATION APPROACHES
APPROACHES
COMMUNITY BASED
It is a strategy of developing rehabilitation services in the community so
as to equalization of opportunity for all
Attempt for social integration of disabled
There is a collective effort of disabled, family and community in
rehabilitation
Along with physical exercise, health education and vocational
Training are imparted for self independent working and earning
INSTITUTIONAL BASED
Disabled persons are provided training in hospitals/ rehabilitation centres
Exercises under supervision
Functions as a referral centre for community rehabilitation centre
OUT REACH PROGRAMMES
Training in
Self care
Communication
Vocational Guidance
Camps are organized from time to time in rural area
Trends Affecting Vocational Rehabilitation

From Charity to Civil Rights

From the Industrial to the
Knowledge Economy
From Centralized to Community
-based Services
Charity to Civil Rights
The disability movement
Inclusion of all disability groups
Medical to social model of disability
Costs of the welfare state
The business argument
Implications
Disabled people involved in planning, services, and evaluation
Mainstream services inclusive
Services more innovative and effective
All types of disabled persons served
Multisectoral approaches
Industrial to Knowledge Economy
New focus on information and technology
Globalization
ICT and new work tools
Businesses must be leaner, meaner and smarter
Fast-paced, changing, more competitive workplace
Threats and opportunities for disabled persons
Implications
Training must address new technology
Training must be flexible

English language important

New work structures (e.g. teleworking)
Life-long learning important
Must meet employer needs
Centralized to

Community

More attention, autonomy to communities

Fewer resources and weaker infrastructures
Different needs and standards
Greater reliance on informal sector and self-employment for jobs
More family and community involvement
Implications
Standard VR practices may not apply
Each community has different resources and needs
Community based services must reflect them
All resources should be tapped
Services and staff must be flexible and diverse
Expand concept of employment (e.g. self-employment, cooperative)
Poverty alleviation and income generation programs should include
disabled people
Full community participation
Process of Rehabilitation
o
o
o
o

Early Identification of disability

Education for PWDs
Vocational Rehabilitation for PWDs
Social inclusion and empowerment within the family and community for
PWDs
Early Identification of disability

The significance of the early years for a childs learning and development is well
documented. Also well documented is the importance of early identification and early
intervention for children with diagnosed disabilities and/or developmental delays and those
who are at risk of disability or delay. In some situations determining that a child has a
disability is straight forward, such as identifying that a child has Downs Syndrome. In many
cases though, the process of identification is not so straightforward. For this reason, it is
important that childrens service professionals working with young children and their families
have a clear understanding of the meaning of identification and the many factors that need to
be taken into consideration when making a decision as to whether concerns are valid or
reasonable. An important first step is to remember that our role in early identification is not to
make a diagnosis or even to determine the cause or severity of a disability or delay. Rather, it
is to determine that there are reasonable grounds to be concerned about a childs
development. It is vital therefore that when working with young children and their families
we have the following:

A sound knowledge of typical child development;

An acknowledgement that all children develop differently;
An acknowledgement that there are various ways of knowing and understanding

children other than through a developmental lens.

Skills in knowing how to observe children and record their observations;
An ability to interpret and make sense of the information gained;
A commitment to building meaningful relationships and positive partnerships with

families; and
Skills in sharing information and raising concerns with families.

In considering typical child development, we need to be mindful that each childs

developmental path has to be understood (and valued) on its own terms. While development
generally follows a reasonable predictable sequence, all children learn and develop in
different ways and at their own pace. There is a wide range of what is considered typical
development and a number of factors that influence a childs learning and development. This
includes the childs temperament and personality, their learning style and capacity, their
health and well-being, and their life experiences (Croll and Shields, 2005). In considering a
childs life experiences, their cultural background also needs special consideration. Not all
cultures place the same emphasis on the attainment of particular developmental skills or
milestones as other cultures, for example dominant Western cultures value the development
of independence amongst young children, typically from the age of three, where some

Eastern cultures value and develop interdependence skills between the child and adult and see
independence as a trait to be challenged. As childrens service professionals, we need to be
aware of our own bias (as a result of our own culture and life experiences) in making
decisions about what is a concern and what is not.
Education for PWDs
As for any other group, education is critical to expanding the life prospects of people
with disabilities. In addition, the socialization of children with disabilities (CWD) through
education assumes an unusually important role in societies such as India where social
exclusion of PWD is significant. Despite its importance, educational outcomes for children
and adults with disabilities remain very poor. Illiteracy rates both for all PWD and for schoolage disabled children remain much higher than the general population, and school attendance
among school age CWD massively lags that of non-disabled children.
Article 24 of the UN Convention on the Rights of Persons with Disabilities
(UNCRPD) states that persons with disabilities have a right to education which they must be
able to exercise on the basis of equal opportunity. For that the Convention requires that there
must be an inclusive education system at all levels and lifelong learning. It also stresses that
schools must be accessible (article 9). The UNCRPD therefore strengthens the existing
provisions in the International Convention on the Rights of the Child (ICRC, 1989) on access
to education for children with disabilities (article 23) and the right of the child to education
(article 28). The UN Convention on the Rights of Persons with Disabilities propounds an
inclusive approach to education. Inclusion is not the same as integration. Whereas integration
requires the child to adjust to an education system, inclusion must be about making the
system adapt to each child. This approach is in keeping with the Salamanca Declaration and
its Framework of Action for Special Educational Needs (UNESCO, 1994) and the Charter of
Luxembourg on the creation of School for All (1996), both of which are more
comprehensive than article 24 UNCRPD and therefore remain two fundamental benchmark
instruments. These different international instruments make it clear that an inclusive approach
to education would enable all children to access and exercise the fundamental right to
education. Inclusive education contributes to the self-actualisation and development of
children whatever their disabilities or care needs by maximising their inclusion into the fabric
of the local community and that of wider society. It is a prerequisite for them to lead a
dignified and successful life as future citizens.

The community also has the responsibility to educate the PWDs to make them selfdependent. The following are the various aspects to be followed in educating PWDs
1.
2.
3.
4.
5.

Inclusive education
Information and awareness building on education for PWDs
Providing training for all stakeholders regarding the education of PWDs
Flexibility and adaptation of educational programmes for PWDs
Sufficient materials and human resources to be provided to nurture the educational

needs of PWDs
6. Proper cooperation between the schools and social welfare institutions to promote the
education of PWDs
7. Inclusive thought must arise from the general public.
Vocational Rehabilitation for PWDs
The history of vocational training/rehabilitation can be traced back in the early
19th century. The Perkins Institute was the first rehab started in Boston in 1829. In
this institute, blind people were trained so that they could get jobs in the
manufacturing industry. However, such types of training programs were very few.
More such programs were started towards the end of the century.
Providing vocational training to PWDs is a bit different and complicated than
other people since their functional limitations and essential supports needed varies
according to disability category and level of severity. a) Mainstream model
Government, private sectors or NGO run vocational training centers to provide
training for any interested or needy people. These training centers provide quality
training and certified trainees as able to work the relevant job or business. In order to
mainstream disabled people, the physical infrastructures, rules and regulations,
systems, curriculum and evaluation processes provided in training centers should be
made disability friendly. The resource persons (trainers) should be also fully oriented
about disability issues and capacity of PWDs. Since being inclusive in nature this
model is very demanding and effective. Most of the PWDs want to be trained through
such types of model.
b) Community based model
Community Based Rehabilitation (CBR) program suggested the best strategies
for the overall development, rehabilitation and empowerment of PWDs in the world.
One of the key components of CBR is economic empowerment which enhanced the
economic participation of PWDs. The economic participation is enhanced by
mobilizing the local resource and community's cooperation in the community. This
approach provided different types of vocational training to the PWD,s. this training is

based on the need of local market. The PWD,s are supported to start the self
employment or get relevant job in the local labor market technically and financially.
In this CBR model the needy people are also facilitated to include in the locally run
mainstream vocational training center.
c) Apprenticeship model
The model provided skill in a particular subject by working with experienced
and skilled persons in his/her workshop or workplace. Learning of crafts and trades
with experienced people is a very longstanding/ widespread mean of skill
development. The model is cost effective good to engage in informal economy. Such
types of trainings are very much useful for PWDs who face barriers in accessing
formal sectors take such types of trainings very useful.
d) Peer training
In peer training successful business people teach their skills to others. The
trainers and trainees are from same background living condition or same disability
category in the case of PWDs. There may be a close friendship between trainers and
trainees. They both have a good spirit of teaching and learning. The trainee we
feelings during training.
e) Group training model
In this method a person learns within the group of people having same training
needs. It is a time/resources saving model. Here we may have many groups having
same interest involved in same job.
f) Sheltered model
A traditional model where PWDs are kept in specially designed structures and
provided different types of vocational training. The trained men are given work in the
same shelter and paid for their work. The sheltered workshops market the produced
goods. The model is highly expensive and unable to cover the wider population of
PWDs. The model is not popular in developing and underdeveloped countries.
Social inclusion and empowerment within the family and community for
PWDs

Social inclusion describes how a society values all of its citizens, respects their
differences, ensures everyones basic needs are met, and welcomes and enables full
participation in that society. Using a social inclusion lens, we must consider whether
people have access to societys assets.
This includes access to necessities, such as:

Nutritious food
Suitable housing
Essential material goods
Health, medical care and addiction services

Inclusion and empowerment within family and community

1. Accepting the PWDs as a part of family and community and not as a
burden.
2. Understanding the limitations of PWDs and not expecting anything
beyond their limits.
3. Identifying the potentials of PWDs to encouraging them to achieve
4.
5.
6.
7.
8.

bigger heights in their lives.

Believing their strengths and assigning work accordingly.
Including the PWDs during the times of decision making.
Taking away the physical and psychological barriers of PWDs.
Giving respect and considering their decisions.
Making the PWDs mandatory to be a part of family and community

gathering.
9. Making the PWDs to aware about the financial assistance, government
schemes and programs available to them.
10. Maintaining a disabled friendly environment for PWDs.

Psychosocial disability

The preferred terminology of persons with psychosocial disabilities should be

used wherever relevant in legislation, to refer to persons who may define
themselves in various ways: as users or consumers of mental health services;
survivors of psychiatry; people who experience mood swings, fear, voices or
visions; mad; people experiencing mental health problems, issues or crises. The
term psychosocial disability is meant to express the following:

a social rather than medical model of conditions and experiences labeled

as mental illness.

a recognition that both internal and external factors in a persons life

situation can affect a persons need for support or accommodation beyond
the ordinary.

a recognition that punitive, pathologizing and paternalistic responses to a

wide range of social, emotional, mental and spiritual conditions and
experiences, not necessarily experienced as impairments, are disabling.

a recognition that forced hospitalization or institutionalization, forced

drugging,

electroshock

and

psychosurgery,

restraints,

straitjackets,

isolation, degrading practices such as forced nakedness or wearing of

institutional clothing, are forms of violence and discrimination based on
disability, and also cause physical and psychic injury resulting in
secondary disability.

inclusion of persons who do not identify as persons with disability but have
been treated as such, e.g. by being labeled as mentally ill or with any
specific psychiatric diagnosis.

It does not mean:

an affiliation with psychosocial rehabilitation.

acceptance of any label that an individual may not identify with.

a category to be used in addition to mental illness or mental disorder.

a belief in psychosocial impairment.

CRPD Article 1 refers to

those who have long-term physical, mental, intellectual or sensory

impairments which in interaction with various barriers may hinder their full
and effective participation in society on an equal basis with others.

In this context, the reference to persons with mental impairments includes

persons with psychosocial disabilities.

However, for the reasons given above,

national legislation implementing the CRPD (The Committee on the Rights of

Persons with Disabilities) should use the preferred terminology of persons with
psychosocial disabilities, which is in keeping with the social model of disability
reflected throughout the CRPD, and the recognition that disability is an evolving
concept as provided in CRPD preambular paragraph (e).

Given the fact that persons with psychosocial disabilities are included under
CRPD Article 1, a provision that is linked to the purpose of the Convention and
thus not subject to reservations of any kind, all legislation applicable generally to
persons with disabilities must include this group, including anti-discrimination
legislation (including reasonable accommodation); eligibility for subsidies,

programs and services; and recognition of organizations of persons with

disabilities for consultation purposes as required by CRPD Article 4.3.

Needs of PWDs
Needs are the basic elements of human life. Needs of a person differs according to
his/her desire. A need is a thing that is necessary for an organism to live a healthy life. The
following are some of the basic needs of PWDs:
1. Medical attention
2. Appropriate health care
3. Treatment
4. Therapy
5. Aids and appliances
6. Education (primary/formal/informal)
7. Vocational training
8. Financial assistance
9. Employment
10. Choosing an appropriate life partner
11. Getting in to married life
12. Child bearing and safe birth control
13. Physical security
14. Economic security
15. Social security
16. A safe physical environment
Problems of PWDs
A problem is a matter or situation regarded as unwelcome or harmful and needing to be
dealt with and overcome. Persons with disability faces lot of problems in their lives. The
problems are caused mainly due to their physical or mental impairment. The following are the
some of the problems faced by PWDs.
1. Assessing treatment
2. Getting enrolled in schools
3. Family and community sees them as a burden
4. Reaching or getting asses to public places
5. Prevalence of stigma about disability in the community is a major problem
6. Getting appropriate employment
7. Financial insecurity
8. Disabled unfriendly physical environment
9. Difficulty in getting life partner
10. Difficulties in child bearing and rearing
Apart from these problems, there are certain problems faced by the PWDs. They are
as follows:

1. People with mental health problems (including schizophrenia, bipolar disorder, and
depression) have higher rates of obesity, smoking, heart disease, diabetes, respiratory
disease, and stroke than the general population
2. People with bipolar disorder or schizophrenia have higher rates of hypertension and
breast cancer, and those with schizophrenia are almost twice as likely to have bowel
cancer
3. People with learning disabilities have higher rates of obesity and respiratory disease,
and
4. People with mental health problems or learning disabilities are likely to die younger
than other people, and those with mental health problems are more than twice as
likely to have strokes or coronary heart disease before the age of 55.