DISABILITY

There is no greater disability in the

society, than the inability to see a
person as more…..

- Robert Hensel

Dr. Kirti Jadhav

Principles of Community
Based Rehabilitation
(CBR)

Principles

Inclusion Empowerment Advocacy Participation Sustainability

Team:
• Physician
• Nurses
• Physiatrist
• Physiotherapist
• Occupational Therapist
• Prosthetist
• Orthotist
• Specialists
LEGISLATION
1. INDIAN FACTORIES ACT 1881
2. EMPLOYEES STATE INSURANCE ACT 1948
3. REHABILITATION COUNCIL OF INDIA ACT 1992
4. PERSONS WITH DISABILITY ACT 1995
ESI ACT (1948)
• It integrated need for social insurance scheme that would protect the
interest of workers
• It covers:
• Sickness
• Maternity
• Temporary or permanent physical disability
• Death due to employment
• Injury resulting in loss of wages or earning capacity.
• Dependent Benefit
• Funeral expenses
PWD Act of 2016
• Rights of Persons with Disabilities Act, 2016 simply called the RPWD act,
promotes and protects the rights and dignity of people with disabilities in
educational, social, legal, economic, cultural and political spheres.

• The RPWD Act, 2016 was enacted in 2016 and came into force in 2017. The Act
was enacted to give effect to the United Nations Convention on the Rights of
Persons With Disabilities and connected matters.

• The RPWD act promotes and protects the rights and dignity of people with
disabilities in various aspects of life – educational, social, legal, economic,
cultural and political. The Act covers the following specified disabilities
locomotor Disability, intellectual Disability, mental Behaviour (Mental Illness),
disability caused due to Chronic Neurological Conditions, blood Disorder and
multiple Disabilities
• The salient features of the Act:
• The Act lays Responsibility on the appropriate governments to take
measures and ensure that PWDs enjoy equal rights.
• The types of disabilities have been increased from 7 to 21. The Central
Government will have the power to add more types of disabilities.
• The 21 disabilities are given below:
1.Blindness
2.Low-vision
3.Leprosy Cured persons
4.Hearing Impairment (deaf and hard of hearing)
5.Locomotor Disability
6.Dwarfism
7.Intellectual Disability
8.Mental Illness
9.Autism Spectrum Disorder
10.Cerebral Palsy
11.Muscular Dystrophy
12.Chronic Neurological conditions
13.Specific Learning Disabilities
14.Multiple Sclerosis
15.Speech and Language disability
16.Thalassemia
17.Haemophilia
18.Sickle Cell disease
19.Multiple Disabilities including deaf blindness
20.Acid Attack victim
21.Parkinson’s disease
• Disability has been defined based on an
evolving and dynamic concept.
• Additional benefits have been provided for
persons with benchmark disabilities and those
with high support needs.
• All children with benchmark disabilities
between 6 and 18 years shall have the right
to free education.
• The act increased the reservation for people
with benchmark disabilities from 3% to 4% in
government jobs and from 3% to 5% in higher
education institutes.
• Stress has been given to ensure accessibility
in public buildings in a prescribed time frame
along with Accessible India Campaign.
 REHABILITATION
COUNCIL OF INDIA
ACT,1992
• This act was legislated to formulate the Rehabilitation Council of India.
• Purpose for formulating the council:
• Regulating the training of rehabilitation professionals
• Monitoring the training of rehabilitation professionals and personnel
• Promoting research in rehabilitation and special education
• Maintenance of a Central Rehabilitation Register for matters connected
therewith.
Functions of the council:
Indian Factories Act,1948
• Purpose of the ACT:
1.Working hours: According to the Adult Working Hours Regulations, adult workers cannot work more
than 48 hours a week in the factory. There should be a weekly vacation
2.Health: To protect the health of workers, the Factories act 1948 requires all factories to be kept clean
and take all necessary precautions. The factory needs proper lighting, drainage system, ventilation,
temperature, etc. Drinking water should be provided with safe preparation. Sufficient toilets and
urinals need to be installed in the right place. These need to be easily accessible to workers and
should be kept clean
3.Security: To ensure worker safety, the Factories act 1948 fences machines, does not allow young
people to work on dangerous machines, and manholes to be arranged for in reasonably sized
confined spaces to allow workers to escape in an emergency
4.Care: For the well-being of workers, the Factories act 1948 stipulates that all factories must provide
and maintain appropriate cleaning equipment for their use. Seats, first aid facilities, shelters, break
rooms, dining rooms, facilities for storing and drying clothes must be available
5.Penalty: Violations of the provisions of the Factories Act 1948 or rules created under that Act or
written orders issued under Factories act 1948 are treated as criminal offences. The following
penalties may be imposed -
• Up to one year in prison
• A fine to be paid of up to 1 lac rupees
• Fine and imprisonment
• Rs 500 fine may be imposed if a worker misuses the equipment in connection with the worker's
• The Factory Act was passed with the following protocols
and restrictions:
• Eight-hour shift timings
• The abolition of child labour
• Restrictions on women's nightwork
• Introduction of overtime pay for work of eight hours or
more
 DEFINITIONS:
• Impairment:
Any abnormality of, partial or complete loss of, or loss of the function of, a body
part, organ, or system; this may be due directly or secondarily to
pathology or injury and may be either temporary or permanent.

• Disability:
It is defined as any restriction or lack (resulting from impairment)of ability to perform
activity in the manner or within the range consider normal for a human being. (by WHO)

• Handicap:
A disadvantage that interferes with performance of life roles & is social, cultural,
economic, or environmental in nature. (by WHO)
 MODELS OF DISABILITY:
 Tools for defining impairment and for
providing a basis upon which government and
society can devise strategies for meeting the
needs of disabled people.
 Three models:
• Functional Model
• Medical Model
• Social Model
 Functional Model:
• Disability is caused by physical, medical or
cognitive deficits.
• Limits functioning or the ability to perform
functional activities.
• Focuses on interaction between impairment Functional Model
and environment.
MEDICAL MODEL OF DISABILTIY:
• Disability results from an individual
person’s physical or mental
limitations.
• Determines what a person cannot
due to their medical condition.

• States that “Person is the problem”

• Solution – “Focus on individual”

• First step – Find a cure
• Step two: Make disabled people more
normal
SOCIAL MODEL OF
DISABILITY:
• Disability results from limited activities
of the person by the barriers in the
environment and not by the
impairment or condition.

• Barriers are consequences of a lack of

social organization.

• States that “ Environment is a problem”

 Solution:
• Identification of barriers
• Conversion of barriers into facilitators
TYPES OF DISABILITY:
According to the Gazette of India guidelines for Disability
following types of disability are mentioned:
• Locomotor Disability
• Visual Impairment
• Hearing Impairment
• Chronic Neurological conditions
• Persons affected with blood related disorders
• Developmental disorders
• Mental illness
• Multiple Disabilities
LOCMOTOR DISABILITY:
• Locomotor disability means a person’s inability to execute
distinctive activities associated with movement of self and objects
resulting from affliction of musculoskeletal or nervous system or
both.
Locomotor disability includes:
• Cerebral palsy
• Leprosy cured
• Dwarfism
• Acid attack victims
• Muscular dystrophy
GUIDELINES FOR EVALUATION OF
PERMANENT PHYSICAL IMPAIRMENT
(PPI) OF UPPER EXTREMITIES:
• The estimation and measurement shall be made when the clinical condition has reached the stage
of maximum improvement from the medical treatment.
• Two components: the arm component and the hand component.
• Measurement of the loss of function of arm component consists of measuring the loss of range of
motion, muscle strength and coordinated activities
• Measurement of loss of function of hand component consists of determining the prehension,
sensation and strength. For estimation of prehension opposition, lateral pinch, cylindrical grasp,
spherical grasp and hook grasp have to be assessed.
• The impairment of the entire extremity depends on the combination of the impairments of both
components.
• Total disability % will not exceed 100%.
• Disability is to be certified as whole number and not as a fraction.
• Disability is to be certified in relation to that upper extremity.
Guidelines for Evaluation of
Permanent Physical
Impairment in Lower
Extremity:
Measurement of loss of function in lower extremity

STABILITY COMPONENT MOBILITY COMPONENT

Guidelines for Evaluation of
Permanent Physical
Impairment of the Spine:
• Permanent physical impairment caused by spinal injuries or deformity may
change over the years, the certificate issued in relation to spine may have
to be reviewed as per the standard guidelines for disability certification.
• Permanent physical impairment should be awarded in relation to the
Spine.
• Types: Traumatic Lesion; Non-traumatic lesion
Guidelines for Evaluation of Permanent
Physical Impairment in Persons with
Amputation (Amputees)

• In cases of multiple amputees, the % of permanent impairment is to be

computed by using the combining formula: a+b (90-a)/ 90 (a = higher value,
b = lower value).
• If the stump is unfit for fitting the prosthesis additional weightage of 5%
should be added to the value.
• Any complication in form of stiffness of proximal joint, neuroma, infection,
etc., should be given upto a total of 10% additional weightage.
• Involvement of dominant upper limb (right upper limb in majority of
individuals) in acquired amputation should be given 10% additional
weightage.
VISUAL IMPAIRMENT:
• - Visual impairment:
 "blindness" means a condition where a person has any of the following
conditions, after best correction
• (i) total absence of sight;
• (ii) visual acuity less than 3/60 or less than 10/200 (Snellen) in the better eye
with best possible correction;
• (iii) limitation of the field of vision subtending an angle of less than 10 degree.
"low-vision" means a condition where a person has any of the following
conditions, namely:—
• (i) visual acuity not exceeding 6/18 or less than 20/60 upto 3/60 or upto 10/200
(Snellen) in the better eye with best possible corrections
• (ii) limitation of the field of vision subtending an angle of less than 40 degree up
to 10 degree.
HEARING IMPAIRMENT:
Hearing impairments include
majorly two categories i.e. Deaf
and Hard of Hearing.
“Deaf" means persons having 70
DB hearing loss in speech
frequencies in both ears;
"Hard of hearing" means person
having 60 DB to 70 DB hearing
loss in speech frequencies in
both ears
Speech & Language Disability
CHRONIC NEUROLOGICAL
CONDITIONS:
• The disability caused due to chronic neurological conditions such as multiple
sclerosis, Parkinson’s disease is multi-dimensional involving manifestation in
muscular skeleton system and also psycho social behaviour.
• “Multiple sclerosis" means an inflammatory, nervous system disease in
which the myelin sheaths around the axons of nerve cells of the brain and
spinal cord are damaged, leading to demyelination and affecting the ability of
nerve cells in the brain and spinal cord to communicate with each other.
• “Parkinson's disease" means a progressive disease of the nervous system
marked by tremor, muscular rigidity, and slow, imprecise movement, chiefly
affecting middle-aged and elderly people associated with degeneration of the
basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.
Guidelines for Neurological
Impairment Evaluation:
• The disability in musculoskeletal system on account of these conditions shall be assessed
relating to assessment of locomotor disability due to chronic neurological conditions and
the psychosocial disability (mental illness) shall be assessed by using the IDEAS.
• Comprehensive disability on account of these conditions shall then be calculated by using
the formula a + b (90-a). 90 Where “a” will be the higher score and And “b” will be the
lower score.
• The maximum total percentage of multiple disabilities shall not exceed 100%.
• Neurological conditions which are reversible and without sequel are not certifiable. Only
neurological conditions which are permanent are certifiable.
• Permanent disability certificate can be issued in irreversible/progressive cases. If needed in
specific cases, a re-evaluation of disability can be done after a period of one year.
• The disability certificate shall mention Chronic Neurological Conditions (name of disease)
DISABILITY CAUSED DUE TO
BLOOD DISORDER:
• Blood disorder in relation to:
• "sickle cell disease" means a hemolytic disorder characterised by chronic anemia, painful
events, and various complications due to associated tissue and organ damage
• "hemolytic" refers to the destruction of the cell membrane of red blood cells resulting in
the release of hemoglobin.
• "thalassemia" means a group of inherited disorders characterised by reduced or absent
amounts of haemoglobin.
• "haemophilia" means an inheritable disease, usually affecting only male but transmitted by
women to their male children, characterised by loss or impairment of the normal clotting
ability of blood so that a minor wound may result in fatal bleeding
• - The process of evaluation shall be dynamic and to be reviewed periodically at least one
year interval, as these diseases are progressive in nature. However, in patients with severe
disability with score above 80%, permanent certificate shall be issued subject to proof of
survival.
MENTAL ILLNESS:
• “Mental illness” - A substantial disorder of thinking, mood, perception, orientation or
memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability
to meet the ordinary demands of life, but does not include retardation which is a
condition of arrested or incomplete development of mind of a person, specially
characterised by subnormality of intelligence.
• Indian Disability Evaluation and Assessment Scale (IDEAS) Indian Disability Evaluation and
Assessment Scale (IDEAS) is a scale for measuring and quantifying disability in mental
disorders, to be used for assessment of disability related to mental illness, as given below
• Items –
• I. Self Care
• II. Interpersonal Activities (Social Relationships)
• III. Communication and Understanding
• IV. Work: Three areas are Employment/Housework/ Education