PR
PRESENTER:
PURWA MANHAR
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FOR CBR
Health
Diagnosis of Disability
Rehabilitation
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The definition of health according to WHO. Health
is a state of complete physical, mental, and social
well-being and not merely the absence of disease
or infirmity.
The fundamental goal of medical science is not to
produce immortal being but to maintain optimum
health as long as possible ,ideally until death.
Optimum
health
recovery
Suboptimum
health
Envir
Health
Illness and
Disability
host
Agent
Approaching
death
Rehab
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Diagnosis of Disability may be expressed
either in terms of the amount of disability
evaluation or in terms of the amount of
remaining function.
Methods use for evaluation
1.Numerical presentation based on a specific scale
2.The functional diagnosis
simple enough ,rapid ,objective using measurable factors.
For example-Diagnosis of CP
how many limbs are affected-diplegic or quadraplegic?
Type of CP?-spastic or Athetiod
other impairment ?
According to WHO
Impairment: Any loss or abnormality of psychology, physiological, or
anatomical structure or function.
Disability (Activity): Any restriction or lack of ability to perform an activity in the
manner or within the range considered normal for a human being as a result of
an impairment
Handicap (Participation): Nature and extent of a person’s involvement in life
situations in relation to impairment- activities, health conditions, and
contextual factors (e.g., participation in community activities, obtaining a
driver’s license, getting a job, etc.)
DISABILITY MAY BE OF :
Primary condition“( Consequences of diseases or condition)
is a risk factor for the secondary condition.
Secondary condition is complications of primary disability.
It also allows for interaction between the primary and
the secondary condition.
Any health care can be attempts to halt a person’s slide
down the slope of health status scale is termed preventive
Baseline Treatment
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rehabilitation as “a set of measures that assist
individuals who experience, or are likely to
experience, disability to achieve and maintain
optimal functioning in interaction with their
environment.
Rehabilitation – provided along care ranging from
hospital care to rehabilitation in the community
It can improve health outcomes, reduce costs by
shortening hospital stays , reduce disability, and
improve quality of life ”.
The delivery of rehabilitation care is
done through following approaches
 Institution
based Rehabilitation
 Outpatients clinics
 Camps
 Community based rehabilitation
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In Institution-based rehabilitation, the Focus of
control is based in the institution. This service
meets a small number of needs of a small
number of disabled people.
Institutes whereas service providers only
concentrate on medical problems-look at the
eyes, hands or legs, prescribe, occasionally
intervenes.
Concept of treatment – Prescription and
Professional is the decision taker
The principles –
•Inclusion
•Participation
•Self sufficiency
•Empowerment
•Self advocacy
•Inclusion = People affected are included in mainstream programmes and
services; participation in society
• Participation = People are involved in the programmes themselves at a
decision-making level
• Self-sufficiency =People learn to manage their own livelihood (vocational
training, micro-credit, business creation);
•Self-advocacy = People learn to speak up for themselves.
•Empowerment =People learn to manage their own disability (selfcare groups,
self-help groups)
Aspects of CBR-
1.Medical – starts with the evaluation of disability by the group of
professionals. comprehensive programmes carried out with training
2.Educational-Include vocational ,a vocational skills and provide open
opportunities to the person for job.
3.Economical- cost effectiveness
4.social-socially acceptability is there.
The key methods of CBR working are
 Meeting basic needs
 Building capacity
 Creating opportunities for livelihood, health, rehabilitation and
education and Organizing disabled people and involving disabled
people’s organisations [DPO’s]
Collaborating across sectors
 Involving the whole community
 Involving local government and
Using the legislation, judicial and political systems
CBR is a STRATEGY within general community development for rehabilitation,
equalization of opportunities and social inclusion of all people with disabilities
DIFFERENCE BETWEEN IBR AND CBR
IBR
Mostly in cities, excellent infrastructure, referral centre for all
conditions
 Service providers are decision makers
 Decision is taken considering ideal condition
 Usually Responsive and expensive.
 Late Identification
 Late Intervention
 Follow up??
 Most of the work carried by Professionals
 Person with Disability often has to travel long distance sacrificing
their daily wage
 Easy to tackle complicated problem.
Research program
Statically generated,
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CBR
Can be anywhere
PWD/family play an important role in decision making
Environment is equally considered
Usually Proactive
Early Identification
Early Intervention
Guaranteed Follow Up
Most of the work carried by CBR Workers or Semi
Professionals
Nearer often within reach
Difficult to tackle complicated problems
Economic
Holistic
MODE LS
WHO Model -
Community-based rehabilitation (CBR) was initiated by WHO
following the Declaration of Alma-Ata in 1978 in an effort to
enhance the quality of life for people with disabilities and
their families; meet their basic needs; and ensure their
inclusion and participation.
Neighbourhood Model -
A Resource centre in community adopts another
centre and it trains personal one.
Quality of life (QOL) is defined as individuals’ perception of
their position in life in context of the culture and value
Model of QOL systems in which they live and in relation to their goals,
expectations, standards, and concerns . QOL has emerged
as a potentially unifying concept in setting goals for
services and for assessing their impact on people’s
everyday lives. The unifying concept of quality of life
enables service providers to reorganise resources around
individuals rather than rearrange people in programme
slots
IMPLEMENTATION
1.Evaluation
2.Process
3.Training
4.Outcome
1.Evaluation-
pilot survey
Camping
Approaching to various Organisations
2. Process – Arranging visits in areas
Locating , identify people with disabilities
Sampling
3. Training – Taking care
communication
Joining to Family members
Decision making
functional Training, help to deal with problems,
Return to work Training
4. Outcome - Keep follow up
records and reports
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Occupational Therapy Service becomes more
effective with the existence of CBR structure
Give priority to the early detection of disabilities
Consider the socio-economic situation and needs
of persons with disabilities
Guide persons with disabilities towards sources of
funding for treatment
Act as link between the person with disability, and
the occupational therapy services
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Explain the treatment programme to the person
with disability and the family
Refer persons with disabilities to the appropriate
support or service level together with information
about the needs and expectations of the person
Assist persons with disabilities in preparations for
the fitting and use of prosthetic and orthotic
devices
Encourage the person with disability
Assist with follow-up of the person with disability with
regard to therapy, the use of Orthosis and Prosthesis
Assist in complete rehabilitation of the person with
disability
 Assist with adaptation of the environment and take
measures to facilitate accessibility, good hygiene and
activities of daily living
 Help to prevent causes of disabilty, e.g. through good
hygiene, wound treatment, and prevention of secondary
deformities such as contractures and bed-sores
 Arrange for maintenance and repairs to devices and
ADL’S.
 Help in the provision of simple mobility and
rehabilitation devices
 Help persons with disabilities to be integrated
into society, e.g. through education and work
opportunities
Promote awareness of the benefits of Therapy.
 Provide information to the appropriate support
level with regard to follow-up and the acceptance
and use of devices