DISABILITY

1
DISABILITY

• (Dr. Anil Kumar Gupta)
• MD (PMR), DNB (PMR), CEPC
• Assistant professor,
• Department of Physical Medicine
  Rehabilitation,
• KING GEORGES MEDICAL UNIVERSITY, LUCKNOW,
  INDIA

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Disability

• Functional loss due to permanent physical
  impairment resulting from congenital condition,
  disease or trauma.
• It excluded illness/injury of recent origin
  (morbidity) resulting into temporary loss of
  ability to see, hear, speak or move.

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• World Health Organizations(WHO) International
  Classification of Functioning, Disability and
  Health (ICF), uses disability as an umbrella
  term for any or all of the following components
• impairmentsproblems in body function or
  structure
• activity limitationsdifficulties in executing
  activities
• participation restrictionsproblems an individual
  may experience in involvement in life situations.

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THREE CONFUSING TERMS WHO definitions

• DISABILITY HANDICAP
  IMPAIRMENT
• IMPAIRMENT-
• It is any loss or abnormality of psychological,
  physiological or anatomical structure or
  function.

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DISABILITY

• It is any restriction or lack(resulting from
  impairment) of ability to perform an activity in
  the manner or within the range considered normal
  for a human being.

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HANDICAP

• It is a disadvantage for a given individual,
  resulting from an impairment or a disability,
  that limits or prevents the fulfillment of a role
  that is normal (depending on age, sex, and social
  and cultural factors) for that individual.

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Difference between Impairment , Disability and
Handicap
Society
Whole person
Organ or tissue
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TWO TYPES OF BASIC DISABILITIES

• Primary Disability
• Secondary Disability

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PRIMARY DISABILITY

• Disabilities that are direct consequences of a
  disease or condition are called primary
  disability .
• Paraplegia following spinal cord injury,
• Inability to walk after fracture .

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SECONDARY DISABILITY

• Disabilities that did not exist at the onset
  of primary disability but develop subsequently
  are called secondary disability .
• eg. Joint contractures in poliomyelitis .

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Epidemiology

• National Sample Survey Organisation (NSSO) has
  conducted thrice the survey of PWD (People With
  Disabilities) in 1981, 1991, and 2002.
• In July-Dec 2002 survey for the first time
  information on mentally disabled was also
  included.
• 1755 PWD every 1 lac person identified who were
  either physically or mentally disabled i.e. 1.8
  of total population.
• Prevalence among rural and urban residents 1.85
  and 1.50 respectively.
• .

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• Prevalence in male gt female ( 2.12 rural 1.67
  urban 1.5 rural 1.31 urban) except in
  blindness where female exceed male
• Prevalence of locomotor disability is highest f/b
  hearing and visual disability.
• More than one type of disability was present in
  10.63 PWD.
• Prevalence highest in Orissa f/b Kerala and
  Punjab. Lowest rate seen in Assam, Jharkhand and
  Rajasthan.

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CLASSIFICATION

• NSSO (2002) categorized disability into various
  groups
• Mentally disabled mental retardation(MR),
  mental illness(MI).
• Visually disabled blindness and low vision.
• Hearing diasbility.
• Speech disability.
• Locomotor disability.

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Percentage distribution of disabled persons by
types of disability (NSSO-2002)
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Mental Disability

• Persons who had difficulty in understanding
  routine instructions, who could not carry out
  their activities like others of similar age or
  exhibited behaviours like talking to self,
  laughing/ crying, staring, violence, fear and
  suspicion without reason were considered as
  mentally disabled for the purpose.

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• The activities like others of similar age
  included activities of communication (speech),
  self-care (cleaning of teeth, wearing clothes,
  taking bath, taking food, personal hygiene,
  etc.), home living (doing some household chores)
  and social skills.

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• Two types-
• Mental retardation (MR)
• Mental illness(MI).

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CAUSES OF MR-

• Illness during childhood 42
• Head trauma in childhood 10.
• Pregnancy and birth related problems 3.
• Hereditary 2.
• Unknown cause 23.

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CAUSES OF MI

• Pregnancy and birth related problems 46
• Unknown cause 36.
• Illness during childhood 9.

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• Age at onset-
• Since birth in 87
• 0-4 years in 8.
• Manifestation of MR is completed within teenage.
• Problem of MI is more of old age.

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VISUAL DISABILITY (VD)

• Loss or lack of ability to execute tasks
  requiring adequate visual acuity.

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• Visually disabled includes,
• (a) those who did not have any light perception
  - both eyes taken together
• (b) those who had light perception but could not
  correctly count fingers of hand (with spectacles/
  contact lenses if he/ she used spectacles/
  contact lenses) from a distance of 3 metres (or
  10 feet) in good day light with both eyes open.
• .

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• Night blindness was not considered as visual
  disability.
• 3rd highest of all disabilities.
• Age of onset- 68-72 acquire VD at age of 60
  years and above. 1-2 are VD by birth.
• Two types-
• Blindness
• Low vision.

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• CAUSES OF BLINDNESS-
• Old age 24.
• Cataract 21.
• Other eye diseases 17.

• CAUSES OF LOW VISION-
• Oldage or cataract 57.
• Other eye diseases 12.
• Unknown cause 10.

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Hearing disability(HD)

• This referred to persons inability to hear
  properly.
• Hearing disability is judged taking into
  consideration the disability of the better ear.
  In other words, if one ear of a person is normal
  and the other ear has total hearing loss, then
  the person was judged as normal in hearing for
  the purpose of the survey. Hearing disability was
  judged without taking into consideration the use
  of hearing aids (i.e., the position for the
  person when hearing aid was not used).

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• 2nd highest among all.
• Causes-
• old age 25 30 for rural urban respectively.
• other illnessess.
• ear discharge.
• Age of onset-
• 60 years above in 56(rural) 62(urban)
• Since birth in 7.

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SPEECH DISABILITY (SD)

• This referred to persons inability to speak
  properly.
• Speech of a person is judged to be disordered if
  the person's speech was not understood by the
  listener.
• Persons with speech disability includes those who
  could not speak, spoke only with limited words or
  those with loss of voice.

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• It also included those whose speech is not
  understood due to defects in speech, such as
  stammering, nasal voice, hoarse voice and
  discordant voice and articulation defects, etc.

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• Causes-
• Paralysis other illness 46(rural)
  49(urban).
• MR/MI 9.
• Voice disorders 8.
• Old age 1.
• Age at onset
• 60 years above in 35(rural) 43(urban)
• congenital speech defect in 38 (rural)
  31(urban).

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LOCOMOTOR DISABILITY (LD)

• A person with,
• (a) loss or lack of normal ability to execute
  distinctive activities associated with the
  movement of self and objects from place to place
  and
• (b) physical deformities, other than those
  involving the hand or leg both, regardless of
  whether the same caused loss or lack of normal
  movement of body was considered as disabled
  with loco-motor disability.

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LOCOMOTOR DISABILITY (LD)

• Highest among all disabilities
• Includes-
• Paralysis of limb or body
• Deformity of limb- maximum
• Loss of limb e.G. Amputation
• Dysfunction of limb
• Deformity of joints of limbs
• Deformity of the body other than in limbs eg.
  Hunch back, deformed spine etc.

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• Causes-
• Polio 30(rural) 27(urban)
• injury other than burns 26(rural) 27(urban)
• old age 3-4
• leprosy 3
• Age at onset-
• 60 years and above 49(rural) 57(urban).
• 45-49 years 27-29.

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AREAS OF SUFFERING OF DISABLED PERSON

• SOCIAL
• ECONOMICAL
• PSYCHOLOGICAL
• EMOTIONAL

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Social Status

• Literacy defined as ability to read write
  a simple message with understanding.
• 55 of PWD are illiterate.
• 9 complete higher secondary education.
• literacy highest among MR 87.
• f/b visually disabled 74-77.

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• Marital status - 47 PWD never married.
• 31 females were widowed, divorced or
  separated.
• 5 living with their spouse.
• majority of MR persons were unmarried.
• situation is better for people with hearing
  disability.

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• Employment status among all 37 PWD employed.
• Only 15-35 out of 1000 PWD were able to
  complete some vocational course.
• Employment lowest among MR 6.

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DISABLITY PREVENTION

• Disability prevention relates to all preventive
  measures aimed at
• Reducing the occurance of impairments (first
  level prevention)
• Limiting or reversing disability caused by
  impairment(second level prevention)
• Preventing the transition of disability into
  handicap(third level prevention)

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FIRST LEVEL PREVENTION- MOST EFFECTIVE

• Eradicating malnutrition- increasing food
  production proper distribution.
• Disabling communicable diseases eg eradication of
  small pox.
• Immunization against communicable diseases like
  polio,tuberculosis,measles, whooping cough,
  diphtheria.
• Providing extensive coverage of perinatal care to
  children thro primary health care.

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• Providing safe water and sanitation facilities.
• Attempts to reduce accident rates.
• Promote socioeconomic development of individuals
  and country as a whole.
• Health education.
• Limiting use of alcohol,psychotropic drugs and
  tobacco.
• Preventing child neglect and abuse.

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2nd level prevention

• Provision of adequate drugs (e.g. for leprosy,
  tuberculosis, earinfections, hypertension,
  diabetes, trachoma)
• Provision of essential surgery (e.g. in the
  treatment of wounds, fractures, limb injuries,
  and cataract)

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• Provision of rehabilitation as soon as possible
  during the span of disability.
• Effective system of referral to health centres at
  the district or regional level.
• Vocational and educatioal counselling.
• Can reduce the incidence severity of disability
  by 10-20.

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3RD LEVEL PREVENTION

• Includes rehabilitation.
• Orthopedic orthoses and prosthesis.
• Glasses for VD low vision.
• Hearing aid for HD.
• Vocational schools and training for the disabled.
• Education and upliftment of the economic status
  of disabled.
• Speech therapy, vocational training.
• Provision of jobs for the disabled.

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• 1.Latest classification used for describing
  functioning and disability.
• International Classification of Functioning,
  Disability and Health,(ICF).
• International Classification of Impairments,
  Disabilities, and Handicaps,  (ICIDH).
• ICD (International classification of disease)
• Diagnostic and Statistical Manual of Mental
  Disorders (DSM)

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• 2. Which of the following is the 2nd level of
  prevention regarding disability prevention.
• Giving orthopaedic orthosis to a patient of
  Polio.
• Immunization with OPV.
• Cataract surgery.
• Hearing aid for HD

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• 3. 2nd most common type of Disability is,
• Blindness.
• Hearing disability.
• Locomotor.
• Mental Retardation.

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• 4. The correct sequence of events leading to
  disability and handicap,
• Disease- disability- Handicap- Impairment.
• Disease- disability- - Impairment- Handicap
• Disease - Impairment- Disability- Handicap.
• Disability-Disease-Handicap-Impairment.

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• 5.Which of the following is a correct match,
• Accident- Disability
• Loss of foot- Handicap
• Unemployed- Impairment
• Can not walk- Disability

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Ans

• 1(a)
• 2(b)
• 3(b)
• 4(c)
• 5(d)

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Thank you