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Community Based Rehabilitation: Approach to Multiple Disabilities

Community Based Rehabilitation: Approach to Multiple Disabilities

April 30, 2019

Introduction

The previous article in this series dealt with understanding disabilities and their impact on the affected person and community. It also highlighted the modalities of rehabilitation interventions for visually disabled persons.

The unique feature of CBR programmers is that the persons with Disabilities (PWDs) are identified through a Door-to-Door survey in the target area, which ensures that all such persons are identified and nobody is left out. During such surveys it is not unusual to come across persons with disabilities other than visual impairment, like those involving hearing and speech, loco motor impairments and mental retardation. Such disabilities may be present in isolation in a person or a single person may have more than one affliction. The CBR programme would cut a very sorry figure if it is unable to address the requirements of this group.

Ordinarily, a CBR programme for Visually Disabled addresses this problem by coordinating with other agencies active in the area for rehabilitation of such persons. The practice is to refer persons with other disabilities to specialist organizations for assessment and evaluation of their disabilities and relevant rehabilitative interventions. During the survey, the field staff is required to list out such persons separately and the Supervisor deals with the logistics.

As a method of skill up gradation, a novel concept is to expand the purview of the CBR programme to cater to multiple disabilities. This ensures that the same team addresses the requirements of all the disabled persons in the target community.

Mental Retardation is an area which requires highly specialized care under intense supervision by experts in the field. Since it is an area which is beyond the capability of the field staff, it is usually excluded from the interventional format of the programme.

Multi-Disability CBR (MD-CBR) programmes, hence, can be designed to cater to persons with following disabilities at the community level:

  • Vision impairment
  • Hearing impairment
  • Loco motor disability
 

Process

The process of implementing the MD-CBR project remains essentially the same as any other CBR programme, and is roughly divided into the following stages:

  • The area selection
  • Cluster formation
  • First module training
  • Door to door Survey
  • Second module training
  • Intervention
 

After the door-to-door survey, the persons with Hearing impairment are evaluated by an Otorhinolaryngologist (ENT Surgeon) and an Audiometrist, and those with Loco motor impairment are evaluated by an Orthopedic Surgeon and a Physiotherapist. Those identified as curable are referred for curative/surgical care to relevant organizations, while the people identified as incurable are selected for rehabilitative interventions. Once identified, they are further classified according to the severity of the impairment (e.g. Mild, moderate, severe and profound).

The field workers are trained in the second module by the Audiometrist in Audiometric evaluation of persons with hearing impairment, and in physiotherapy by the physiotherapist. This training is conducted concurrently with the training in interventions for visual impairment, which have been dealt with in the previous article. The rehabilitation services for any disability include following process:

  • Counseling
  • Assessment
  • Clinical
  • Functional
  • Rehabilitation plan
  • Intervention
  • Evaluation
  • Follow up
  • Case closing
 

Vision Impairment

Apart from surgical intervention for persons with curable visual impairment, the programme also screens and provides treatment on a regular basis by conducting screening camps. The clients who need further examination & treatment are referred to nearest referral centre.

Persons with incurable conditions are provided with need and age based rehabilitation services which include medical, developmental, educational, social and economic rehabilitation components.

Loco motor disability

The services for loco motor disability follow similar process as vision impairment. A qualified physiotherapist trains field workers in providing therapeutic intervention. Approximately 80% curable clients need proper intervention but are unable to get services at the community level. The regular field level supervision of physiotherapist helps the population get proper services. Those who need further institutionalized care are referred to a physiotherapy unit where physiotherapist directly provides services. The adults with loco motor disability gain social acceptance of their impairment. Many persons with curable loco motor disability get permanently disabled in the absence of simple abduction and adduction exercises supervised by a physiotherapist which helps in reducing the impact of contracture deformity; when they have therapeutic intervention at their doorstep, they derive its maximum advantage through well trained field workers. Continuous supervision of the physiotherapist helps in creating a tremendous impact on the children especially with multiple disabilities. The initial expectation is of treatment based on medicines and they start therapeutic intervention with less confidence, but when they perceive the difference, they not only accept the services but also value it. The programme also closely works with other agencies where the clients get prosthetic equipment and surgical and other treatment. Majority of incurable clients are provided aids and appliances by the programme that include tricycles and crutches; the programme also helps them to avail government supportive services like pension, certification and concessional bus passes. Young clients are provided with economic rehabilitation.

Hearing Impairment

The services for Hearing impaired include speech therapy, developing total communication among the children, parents’ participation and regular teachers’ cooperation. Community acceptance and participation in the field of visual impairment is easier when compared with hearing impairment. The persons with hearing impairment who are above 15 years need an aid and basic training in developing their communication. The person himself may accept a sign language in this Endeavour, but lack of community acceptance reduces his/her initiative. The majority of 70+ populations have hearing loss which needs to be addressed; limited resources may dictate prioritization of the age group(s) selected for help immediately. As an example, children and adults up to age of 30 years can be given priority. Screening camps for curable hearing impairment and need based treatment, similar to eye screening camps, are also conducted to increase penetration of the services into remote, inaccessible areas. Children who have speech impairment due to cleft lip need surgical correction of the defect; coordination with agencies like ‘Smile-Train’ project of the US to facilitate this is helpful. Provision of hearing aids and batteries to the clients also plays a major role in the rehabilitation process.

Conclusion

A Multi Disability CBR Programme helps in addressing the needs of a larger client base, and creates a specialized work force capable of rehabilitating persons with diverse impairments. A field worker with intensive knowledge in rehabilitation of various disabilities can address most of the target population. When he enters the village he is considered to be a general health care professional rather than a mere eye hospital staff. The team is trained and registered with Rehabilitation Council of India (RCI) that helps in gaining recognition and enhancing credibility of the team.

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