Disability
The sequence of events leading to disability and
handicap has been stated as follows: Disease’! Impairment’! Disability’! Handicap
The WHO has defined these terms as follows:
Impairment: impairment is defined as “any loss or abnormality of psychological, physiological or anatomical structure or function”. e.g., loss of foot, defective vision or mental retardation. Impairment may be visible, or invisible, temporary or permanent, progressive or regressive. Further, one impairment may lead to the development of secondary impairments as in the case of leprosy where damages to nerves (primary impairment) may lead to planter ulcer (Secondary impairment).
Disability: Because of impairment, the affected person may be unable to carry out certain activities considered normal for his age etc. this inability has been defined as “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being”.
Handicap:
As a result of disability, the person experiences certain disadvantages
in life and is not able to discharge the obligations required of him and play
the role expected of him in society. This is termed “handicap”, and is defined
as “a disadvantages for a given individual, resulting from impairment or a
disability that limits or prevents the fulfillment of a role that is normal (depending
on age, sex, social and cultural factor) for that individual”.
The intervention in disability will often be social or environmental as well as medical. While impairment which is the earliest stage has a large medical component, disability and handicap which are later stages have large social and environmental components in terms of dependence and social cost.
Disability Prevention
Another concept is “disability prevention”. It relates
to all the levels of prevention:
(a) Reducing
the occurrence of impairment, viz. immunization against polio (primary prevention).
(b) Disability
limitation by appropriate treatment (secondary prevention).
(c) Prevention
the transition of disability into handicap (tertiary prevention).
The major causes of disabling impairment in the developing countries are communicable diseases malnutrition, low quality peri-natal care and accidents. These are responsible for about 70 percent of cases of disability in developing countries. Primary prevention is the most effective way of dealing with the disability problem in developing countries.
Rehabilitation
Rehabilitation has been defined as the combined
and coordinated use of medical, social, educational and vocational measure for
training and retraining the individual to the highest possible level of
function ability. It includes all measure aimed at reducing the impact of disabling
and handicap conditions and at enabling the disabled and handicapped to achieve
social integration. Social integration and handicapped people in the mainstream
of community life.
Rehabilitation medicine has emerged in recent years as a medical specially. It involves disciplines such as medicine or physiotherapy, occupational therapy, speech therapy, audiology, psychology, education, social work, vocational guidance and placement services. The following areas of concern in rehabilitation have been identified:
a) Medical
rehabilitation – restoration of functions
b) Vocational
rehabilitation – restoration of the capacity to earn a livelihood.
c) Social
rehabilitation – restoration of family and social relationships.
d) Psychological
rehabilitation – restoration of personal dignity and confidence.
Rehabilitation is no longer looked upon as an
extracurricular activity of the physician. The current view is that the
responsibility of the doctor does not end when the temperature touches normal
and stitches are removed. The patient must be restored and retained to live and
work within the limit of his disability but to the hilt of his capacity. As such
medical rehabilitation should start very early in the process of medical
treatment.
Examples of rehabilitation are: establishing
school for the blind, provision of aids for the crippled, reconstructive surgery
in leprosy, muscle re-education and graded exercise in neurological disorders like
polio, change of profession for a more suitable one and modification of life in
general in the case of tuberculosis, cardiac patients and others. The purpose
of rehabilitation is to make productive people out of non-productive people.
It is now recognized that rehabilitation is a
difficult and demanding task that seldom give totally satisfactory results; but
needs enthusiastic cooperation from different segments of society as well as
expertise, equipment and funds not readily available for this purpose even in
affluent societies. It is further recognized that interventions at earlier stages
are more feasible, will yield result band are less demanding of scarce
resources.
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