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8/14/2019 M D Disability

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THE PAST


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THE BAD NEWS FROM THE PAST:

Nihilistic ideas from the beginning

tothe end

Defeatists attitude.


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THE FIRST BARRIERNegative attitude towards disabled

isthe first barrier in rehabilitation


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The paradoxDisability is a worldwidephenomenon.But positive steps to prevent andmanage disability are painfully notso universal despite the fact thatwe all belong to 21st century.


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THE PRESENT LOOKS

GOOD


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Its all about attitudeFortunately, attitude is changing slowly

but surely.

We are now beginning to understandthem better

Disabled are often "differently able inanother direction.


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VIBG Y O R TM : 7 Rays of hope

D- Don't UnderestimateI - Innocent

S- Sensitive A- Able To Do Many Other ThingsB- Basic Needs Must Be Fulfilled

L- Learning Will Give Them Hope And Employment E- Economic Support


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Definition of Disability:

W. H.O.Any restriction or lack resulting

from an impairment of ability toperform an activity in the manner orwithin the range considered normalfor a human being.

This impairment may be temporaryor permanent


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Rehabilitation:

DefinitionUltimate restoration of disabledpersons to his maximum capacity:physical, emotional andvocational

Make him as independent as possiblein the shortest possible time.


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Disabled: improve

abilityMedical support: Adaptive adjustments &retraining to gain maximum potential to

improve his quality of life.Emotional support from Family & SocietyVocational support from Government

Technological support: informationlearning & research


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The M factorsMoneyManpowerMotivationMedical service facility

Monitoring progress of rehabilitationMedical research


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Why Multimodality

Approach?Multiple problems at the same time: Disabledperson suffers due to his multidimensionallimitations.Deal with all needs : The most successful rolemodel addresses physical, emotional andvocational needs based on team approachAdopt Various positive steps at the same time

to Minimize all potential complicationsOne expert alone is not enough.


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What is a TEAMA team is nothing but a combination of motivatedpeople who share a common goal.

The shared goal: To reduce or prevent barrier tosuccessful rehabilitationEvery team member play their own unique rolebesides coordinating with each other with positive& negative feedbacks to other members to

achieve this shared goal.


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(Medical) MANAGEMENT

TEAM THE GOAL:To reduce or prevent barrier to successful

rehabilitation.Provide Physical & emotional rehabilitation

To prevent or treat potential complications


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The medical team:Essential members

Physician fromvarious medical-surgical specialtiesNurses from variousmedical- surgicalspecialtiesPhysical therapist &

Occupationaltherapist,Orthotic /Prostheticexpert

Psychologist/ Psychiatrist

Speech therapist,Medical socialworker as well as thepatient and his familymembers.

New team member may be added fromtime to time if needarises.


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Role of nursing staff : To take care of the bodily needs of the disabled

Nursing : Nutrition, hygiene, handling of secretions and psychological support.

Physical therapist : maximizes motorfunction and maintain musculoskeletal& cardiovascular physiology by variousphysical means.

INDIVIDUAL ROLES OF TEAMMEMBERS


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INDIVIDUAL ROLES OF TEAMMEMBERS

Speech therapist : Develop effectivecommunication skills to children born with MR.Psychiatrist/ Psychologist : Emotional

rehabilitation through motivation & development of positive attitude towards the disabilityOrthotist (Brace-maker): Custom-made splintssuitable for musculoskeletal disabilities like polio toimprove motor function & prevent deformities fromdeveloping.


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Common goal :Important Objectives

Accuratelydiagnosing all

current existingproblemsAdequately treating these problemsEstablishing

adequate nutritionMonitoring for anycomplication thatmay impede progressin recovery

Mobilizing the patientas early as possibleRestoration of functionincluding training forreadjustment toaltered life styleSocial &

psychological rehabilitationVocational rehabilitation


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Role of Government:Emotional/Vocational

Legislations

Disable friendly

Employment &Reservation

Information &Communication

Health for allEducation

Proactive & not

reactive

Prevention


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Role of NGOs

Information & communicationEmotional & vocational rehab.Pressure group & support groupAgent of change-Attitude

Prevention


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Prevention is better thancure

Holistic management of a disableperson is a huge task and it is easiersaid than done.So, Prevent disability from occurring.Only Prevention can ultimately

contain the epidemic of disability.Prevention is the only cure of anydisability


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Types of prevention

Primordial prevention : Nip it in the bud. e.g.fortification of foods by government to

prevent Vitamin A deficiency blindness.Primary prevention : Protecting the potentialhigh risk groups. Example, vaccinationagainst polio.

Secondary prevention : It means earlydiagnosis and treatment. MTP (medicaltermination of pregnancy) may be anexample to reduce Downs Syndrome


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Tertiary prevention iscalled Management

Prevention of complications of manifestedsymptoms of the disease

Treatment of manifested symptoms of that disease through rehabilitation.Management of disabilityExample: Early mobility to a spinal injuryparaplegic patient to prevent bed sores,deep vein thrombosis and fatal pulmonaryembolism.


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Critical in all types of prevention.

Information, Education &Communication with commonpeople by the Government, Health-care providing machinery & NGOsNGO can play a major path-breaking role, esp. in primordialand primary prevention of disability


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Diagnosis is Easy, butManagement is Not

A good clinical history taken by an experienceddoctor from the parents or family regarding theprogression and chronology of events of thedisease from the onset often clinches the exactdiagnosis.Additional laboratory tests and radiologicalinvestigations may be needed sometime toconclude a diagnosis.But identifying the real cause of disability maybe difficult in some cases particularly when thedisability is occurring in a small growing childwho cannot communicate with others.


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The Challenges.

Exact assessment of severity of disability,ultimate prognosis & outlook of the disabled.

The damage to the brain for example maysignificantly alter a persons ability tounderstand & respond to commands creatingtremendous obstacles in retraining &rehabilitationHuge long term social and financial burden

along with continuous need to keeping up themoral of the patient and the family are realchallenges.


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Multimodalityapproach:

Treat the causewhenever treatable tominimize more disabilityfrom occurringTreat all currentproblems simultaneouslywith multimodalityapproachPrevent allpotential/anticipatedproblemsInterdisciplinary co-ordination

Maintain adequatenutritional needs andhygiene

Make them asindependent aspossibleTarget short-termgoals first to increasemotivation

Aim for long-term goalthrough coordinatedplan by discussionamongst all membersof the team.


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Prognostic Factors

Root cause of thedisability (Treatable Vs

Untreatable)Extent and severity of the disabilityCognitive abilities:Speech, learning &

intelligence for effectivecommunication withcare-givers

Neuromuscularstatus & MobilityEmotion &Motivation(Optimism Vs Denial)Attitude & Approach

to the problems(Positive VsNegative)


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Other Prognosticfactors

Family support (financial andpsychological)Nutritional status at onset of disabilityAssociated present problems (co-morbid conditions)

o a e s n mo a e


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o a e s n-mo a efactors

Modifiable factors: Should be targeted toimprove outcome of rehabilitation.Improving cognitive functions of speechand learning can help a mentally retardedcerebral palsy child to get a vocationaltraining and a job.Un-modifiable factors: Realistic goal duringmanagement.


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problems inrehabilitation

Inadequate nutrition

Emotional lability

Cognitive impairments-Speech and learningdisability

Auditory & Visual disability

limiting traditional learning

Urinary tract infection

Spasticity or abnormal gaitSensory impairment leading topressure-soresSecondary acquiredmusculoskeletal deformities likecontracturesSecondary acquiredmusculoskeletal disuse atrophyOsteoporosis with risk of easyfractures, muscle wasting anddeconditioning, pressureparalysis of nerve.


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Common non-medicalproblems

Poor access to health: neglectFinancial limitations: undertreatment

Emotional deprivation & isolationVocational deprivationUnemployment: feeling of burden

Nutritional deprivationAttitude of neglect


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The Indian scenarioLimited information, financial crisis andlimited access to health-care facilities

In small towns or rural areas remainsimportant burning problems encountered bydisabled families in India.Special school and disable-friendly school

and disable-friendly recreation facilities areoften unheard of in rural India.


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India: the future

India: Developing country with highpopulation & Cant support a holistic

healthcare facility to allPrevention:More important than providing

limited rehabilitation facilities to ahandful of disabled of urban India


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the present & thefuture

PREVENTION: At all levelsRESEARCH: better understanding

COMPUTER & IT: user-friendlySATTELITE:GPS during drivingGENE THERAPY: contain or cure

BIOTECHNOLOGY & BIOENGINEERINGNANOTECHNOLOGY: Gene therapy

:


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:POSITIVE.

Disability doesnt meanhopelessness and inaction.

Rehabilitation is all about hope andaction.Any disabled must have access toproper Nutrition, Hygiene,Psychological support, Vocationaltraining and Social support andSocial justice.


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Attitude: Half a glass of water?

Look for their abilities (both existingand potential) rather than disability.

They are disable but not unable.Help them to make the most effectiveuse of their residual function.

Call them These able people ratherthan DIS-able people.


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NOTHING SUCCEDSLIKE SUCCESS

Former US President Roosevelt: Foughttwo great wars in life and won both his

polio affected legs and the World War II.So, my dear friends believe in the words

of Helen Keller look to the sunshine andyou will never see shadow!


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THANK YOU

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