Disability and Rehabilitation

1. AMBO UNIVERSITY
INSTITUTE OF EDUCATION AND BEHAVIORAL SCIENCES
DEPARTMENT OF SPECIAL NEEDS AND INCLUSIVE EDUCATION
P.B.NO-19, AMBO, OROMIYA , ETHIOPIA, EAST AFRICA
Course Code: SNIE6014 Credits Hr.: 02 ECTS : 05
Module Name: Early Intervention and Rehabilitation Counseling
Course Title: Community Based Rehabilitation
Target Group: Post Graduation (M.A) Regular
Name of the Instructor: Dr. Pavan Kumar Yadavalli (Ph.D)
Designation : Associate Professor
Part-2

2. UNIT-2 Rehabilitation and Disability
2.1 Introduction
In this unit, the importance of rehabilitation in relation to
disabilities will be treated. Moreover, the units incorporate
points related to basic models of disability, the status of
prevalence of disability and the meaning of improving the
lives of peoples with disabilities:
Objectives:
At the end of this unit, the following behavioral outcomes are expected from
Students:
• Explain the relationship between disability and rehabilitation
• Identify basic assumptions in the models of disability
• Describe major characteristics of each model of disability
• Reason out the high prevalence of disability in developing countries
• Mention elements of qualities of life

3. 2.2 Current understanding of disability
Disability is a multi-dimensional concept with both objective and
subjective characteristics. When interpreted as an illness or
impairment, disability is seen as fixed in an individual’s body or
mind. When interpreted as a social construct, disability is about
the life of peoples with disabilities and their interaction with the
community and the environment.
Disability for the purpose of development includes physical,
intellectual mental health, sensory and other types of impairments
that limit one or more of the major life activities and put
individuals and their family at risk of being in poverty.
Disability is an umbrella word for impairments, activity limitations and
participation restriction. Disability is seen as a multi- dimensional life
condition. Performance by people depends on contextual factors that
are composed of environment and personal factors. The environmental
factors include physical, social and attitudinal.

4. 2.2.1 Disability and development
Disability interventions focus on reducing social
discrimination and bringing excluded people, such as
people with disabilities, into the mainstream of society so
that they can participate in daily life, attend school, go to
work, and raise a family, access services and institutions
like all other citizens.
People with disabilities and their family want to move away from
the charity approach, where they are ‘being looked after’ toward
full integration in society where people with disabilities are socially
accepted citizens who can contribute to the socioeconomic
development of the country.
Experiences and research in various countries have
demonstrated a positive correlation between growth and
development and targeted social change by with, and for
peoples with disabilities.

5. 2.2.1 Disability and development Cont’d…………
The social change strategies included:
• Establishment of disability-rights and disabled
people’s organization.
• Access to build inclusive environment with private
and public sector policies.
• Participation and capacity building of people with
disabilities, their families and the organizations that
represent them.
There is no expectation of sufficient capacity in
developing countries to apply the full extent of disability
standards experienced in more developed societies. There
is however , significant evidence that those countries still
have many opportunities to do so.

6. 2.2.2 Development and peoples with disabilities
Development is a public good that benefits every one.
Poverty, inequality, illness, unsafe and un healthy life
environment, low educational levels etc. are public
hazards, ‘public bads,’ that affect everyone. The
achievement of the millennium development goals
requires adequate investments in the improvement of
living environment of all peoples.
In the following table we will see the eight millennium
development goals of the United Nations, the status of
peoples with disabilities and the role of
infrastructure.

7. 2.2.2 Development and peoples with disabilities Cont’d…..
Table . MDGs, Status of PWDs and the Role of Infrastructure
Millennium Development
Goals
Status of PWDs Improvement in infra-
structure that have key role in
creating an environment that
Eradicate extreme poverty PWDs belong to the
poorest of the poor
Enable all people to avoid
falling into poverty and
improve the opportunities for
peoples with disabilities to
escape from poverty
Achieve universal education Only very few percent of
children with disabilities
go to school
Enable all children to go to
school, especially those who
have mobility and seeing
difficulties
Promote gender equality Women and girls with
disabilities are the most
marginalized and abused
Enable all girls to go to school and
women to earn incomes,
particularly those who have
disabilities

8. Table . MDGs, Status of PWDs and the Role of Infrastructure Cont’d…….
S. No Millennium Development Goals Status of PWDs Improvement in infra- structure that
have key role in creating an
environment that
4 Reduce child mortality The mortality of children
with disabilities is high
Reduce the risk of preventable
fatal or disabling illness
5 Improve maternal health Mothers with disabilities
are under served by all
services
Enable all women to reach health
services and to exercise good hygiene
that prevent disabled health condition
6 Combat HIV/ AIDS, malaria
and other diseases
Women with disabilities are
of high risk of being sexually
abused and are subject to
diseases such as HIV/AIDS
Prevent infectious diseases and
manage epidemics
7 Ensure environmental
sustainability
Many disabilities result
from bad environmental
management. Their access to
clean water is poorer than
that of non-disabled people.
Help in managing natural resources
and to derive benefits from them in a
sustainable manner

9. Table . MDGs, Status of PWDs and the Role of Infrastructure Cont’d…….
To effect implementation of the MDGs related to peoples with disabilities, the
United Nation issued the following guidelines:
• Disability is a diverse and complex concept. Peoples with disabilities do not
form a homogenous group.
• The course of action that emphasizes the human rights of peoples with disabilities must
be advocated and supported rather than the charitable and medical approach.
• There is a need to mainstream disability issues across all development programs and
projects. In addition specific projects are needed for peoples with disabilities and they
must be ensured access to all activities supported by European Union delegation.
• There is a need to ensure that all European Union funded development
cooperation projects are truly inclusive of peoples with disabilities and their
families.
• The needs of women and children with disabilities must be recognized.
• European Union funded training and employment programs should enroll also
peoples with disabilities.
• There is a need to ensure that the European Union’s own services are
accessible for peoples with disabilities.
• Disability organizations should be supported and strengthened.

10. 2.2.3 Basic Etiquette about People with Disabilities
If you refer review literature in the area of disability you will find the following as myths
on disability and peoples with disabilities:
MYTHS
Hiring employees with disabilities increases workers compensation
insurance rates.
Employees with disabilities have a higher absentee rate than employees without
disabilities.
People with disabilities are inspirational, courageous, and brave for being able to
overcome their disability.
People with disabilities need to be protected from failing.
People with disabilities have problems getting to work.
People with disabilities are unable to meet performance standards, thus making
them a bad employment risk.
People who are deaf make ideal employees in noisy work environments.
Employees with disabilities are more likely to have accidents on the job than employees
without disabilities.
Considerable expense is necessary to accommodate workers with disabilities.

11. 2.2.3 Basic Etiquette about People with Disabilities Cont’d……
FACTS Insurance rates are based solely on the relative hazards of the
operation and the organization’ accident experience, not on whether
workers have disabilities.
People with disabilities are simply carrying on normal activities of
living when they work at their jobs, go grocery shopping, pay their
bills, or compete in athletic events.
People with disabilities have a right to participate in the full range of
human experiences including success and failure. Employers should
have the same expectations of and work requirements for all
employees.
People with disabilities are capable of supplying their own
transportation by choosing to walk, use a car pool, drive, take public
transportation, or a cab. Their modes of transportation to work are
as varied as those of other employees.

12. 2.3 Cultural Notions of Disability
Much has been written that seeks to explore the concept of
disability and its meaning for individuals and society. In
addition, recent developments including the International
Classification of Functioning, Disability and Health, referred to
as the ICF (World Health Organization 2001b), are attempting
to redress the negative way in which disability has been
perceived. Rather than an emphasis on disability the shift is
to focus on the abilities of disabled people. This section gives
a brief introduction to the cultural context of disability, the
influence of the disability movement and different models
that exist in the literature. It also highlights the human rights
and equalization of opportunities issues associated with
disability.

13. 2.3.1 Society
Disability defined by culture, and without an awareness of how
disability is perceived in the target culture, a disability program
does not stand much chance of being relevant or sustainable.
Disability does not define people, society does. How disability is viewed
often reflects the extent to which society embraces disability and
diversity, rather than focusing on how an individual’s ability to participate
to socially accepted norms might be limited. Therefore what is perceived
as a disability in one society or culture may not be viewed as such in
another.
In many poor communities, disabled people are not seen as a
priority for development and investment. An awareness of this and
other cultural issues is key to any process designed to integrate
disabled people more fully in society

14. 2.3.2 The disability movement
The disability, in need of charity and treatment perspectives
was challenged by the disability movement (disabled people
themselves) with the emergence of three key ideas:
• the social model of disability
• independent living
• civil rights movement
• The term independence is one that different stakeholders
would agree on, but how it is interpreted varies:
• Governments see independence as developing self-reliance
and reducing the burden on the state.
• Health care professionals focus on the ability of individuals to
undertake a range of activities that enable them to be self-
caring.
• For disabled people independence is seen in terms of personal
autonomy and the ability to take control of their lives.

15. 2.3.2.1 Discriminatory behavior
Beliefs, attitudes and explanatory model do contribute not only
to what people think about peoples with disabilities but also
how they act towards them. The sight of a person who differs in
appearance and behavior mostly creates a feeling of discomfort
and fear. Different levels of reactions such as discrepancy,
fright, avoidance stigmatizing, distancing etc. may observed in
adults who avoid visual and physical contacts as well as
communication with peoples with disabilities.
Discrimination is common in developing countries for newborn
babies who have some slight, visible impairment to be put to
death, and mothers who do not agree to conform may be
threatened with severe sanctions. Children with disabilities are
sometimes hidden particularly from foreigners. Surveys of
disability in different countries show that many of them are
neglected by their parents.

16. 2.3.2.2 The effect of general systems of beliefs on polices
Most developing countries do not have a
clear set of explicit policies related to
disabled peoples. This may be due to the
fact that politicians or legislators are not
different from the general view that
disabled peoples are ‘useless’ and will
remain so whatever is done. Therefore
awareness creation on the side of the
local leaders and politicians is by far
important to improve the situation.

17. 2.4 Prevalence of disability
Depending on how disability is defined there is a large
variation in the reported prevalence figures. Estimates of the
number of disabled people worldwide vary. The most
frequently quoted international figure is 10percent of the
population (Helander et al, 1989.This stems from work
undertaken in 1976 based on calculations which included a
high proportion of people with slight and potentially
reversible disabilities (Helander, 1999).
It is estimated that 10percent of children are born with
or acquire a disability and of these no more than
10percent receive appropriate rehabilitation (according
to UNICEF cited in World Health Organization, 2001).

18. 2.4 Prevalence of disability Cont’d……
In Ethiopia the presence of diversified prenatal, per
natal and postnatal disabling factors
 Health of prospective mothers
 Difficulties related to delivery
 Childhood infectious diseases
 Lack of proper child management
 Traditional harmful practices
 Under and malnutrition
 Civil strike and periodic episodes of drought and famine has
brought a phenomenal increase in the incidence of
disability.
Data pertaining to the incidence, the prevalence and the
situation of peoples with disabilities are fragmentary,
incomplete and sometimes misleading.

19. 2.4.1 Causes of disability
It is under consideration that factors leading peoples to be
disabled are explained in one or the other way in most
units of this module. Here is then simply to mention some
causes which lie either of the four stems, such as diseases,
accident, congenital and poverty.
2.4.1.1 Diseases
Many diseases can lead to impairments and disabilities.
• Stroke –reduces mobility, causes difficulties
communicating and understanding;
• Heart and circulatory problems –reduces mobility, limits
the general physical capacity;
• Rheumatic conditions –causes pains and aches and limits
mobility; and
• Cataracts –causes visual deficiency if not operated

20. 2.4.1 Causes of disability Cont’d……..
2.4.1.2 Accidents
 Traffic accidents all too often have their origin in alcohol
consumption; and
 Accidents at work can be due to insufficient protection or too
much stress;
 For children, the biggest risk apart from road traffic is accidents
at home like falls of burns.
2.4.1.3 Congenital
Injuries may be caused to the growing organism already
in the womb, by the mother´s smoking or drinking or by
pollution and toxicity in the environment. Chromosome
disorders also belong here, and all these can lead to
deformities, mental retardation or cerebral palsy.

21. 2.4.1 Causes of disability Cont’d……..
2.4.1.4 Poverty
In several ways, poverty may be a direct or
indirect cause of disability:
oPoor people have less possibilities
obtaining rehabilitation or to assistive
devices;
oChildren in poor families are more exposed
to infections, malnutrition, diseases and
accidents; and
oThey risk to get less stimulation for their
psycho-motor development.

22. 2.5 Disability and Rehabilitation
Disability is no larger viewed as merely the result of
impairment. The social model of disability has
increased awareness that environmental barriers to
participation are major causes of disability. The
international classification of functioning, disability
and health includes body structure and function,
but also focuses on activities and participation form
both the individual and the societal perspiration.
Moreover, there are environmental factors
discussed as cause of disability that no nation has
eliminated these environmental barriers that
contribute to disability.

23. 2.5 Disability and Rehabilitation Cont’d………
Rehabilitation services should no larger be
imposed without the consent and participation of
people who are using the services. Rehabilitation
is now viewed as a process in which peoples with
disabilities or their organization make decisions
about services they need to enhance
participation. Professionals who provide who
provide rehabilitation services have the
responsibility to provide information to peoples
with disabilities so they can make informed
decisions regarding what is appropriate for them.

24. 2.5.1. Rehabilitation and human rights
CBR promotes the rights of peoples with
disabilities to live as full citizens with in the
community; to enjoy health and wellbeing; to
participate fully in educational, social cultural,
religious, economic and political activities. The
document by UNESCO revealed that CBR on rights
of boys and girls with disabilities to schooling and
equal participation of men and women with
disabilities in work and social activities.
To ensure equalization of opportunities for persons with
disabilities; the United Nation form guide lines to practical
community based rehabilitation

25. 2.6 Poverty and Disability
Peoples with disabilities around the world
particularly in the developing world are among the
poorest of the poor. Poverty and disability are
interrelated. Poor people are more likely to have a
disability because of the conditions in which they
live, disability likely to make people poorer
because of limited opportunities and
discrimination. The invisibility and isolation of
peoples with disabilities are caused by stigma,
discrimination, myths, misconceptions and
ignorance.

26. 2.6 Poverty and Disability
There is a strong correlation between disability and
poverty (UNESCO, WHO, ILO, 2004). Poverty leads
to increased disability, and disability in turn leads
to increased poverty. Studies show that majority of
people with disability live in poverty, reflected in
higher rates of unemployment compared to non
disabled peoples in developed countries. Lack of
access to health care and rehabilitation, education,
skills training and emplacement contributes to the
vicious cycle of poverty and disability.

27. 2.6.1. Inclusive communities
 The concept of an inclusive community means
that communities adapt their structures and
procedures to facilitate the inclusion of people
with disabilities, rather than expecting them to
change to fit in with existing arrangements.
 It places the focus on all citizens and their
entitlements to equal treatment, again
reinforcing the fact that the rights of all people,
including those with disabilities, must be
respected.
• The community looks at itself and considers
how policies, laws, and common practices affect
all community members.

28. 2.6.1. Inclusive communities Cont’d………
The community takes responsibility for tackling
barriers to the participation of girls, boys, women
and men with disabilities. For example, many
people in the community may have beliefs or
attitudes that limit the kinds of opportunities to
people with disabilities.
Policies or laws may contain provisions which work
to exclude them. There may be physical barriers
such as stairs rather than ramps or inaccessible
public transport. Such barriers may also reduce
access to work opportunities.

29. 2.7 Prevention of Disability
Many types of disability can be prevented by relatively simple
measures. Only a moderate proportion of the people living
with disabilities were doomed to these conditions at birth.
Children are exposed to disability due to preventable causes
such as congenital causes, malnutrition, accident and injuries,
armed conflicts.
Proper nutrition, sanitation, immunization, occupational and
safety healthy and peace building and early intervention are
important tools to minimize causes and consequences of
disability.
Prevention of causes of disabilities also encompasses various
activities aimed at decreasing number of accidents in the
home, in the road and at work, as well as other initiatives to
encourage people to pursue healthy lifestyles over the course
of their lives.

30. 2.7 Prevention of Disability Cont’d………
Prevention of disabilities can be implemented in
three different ways. These include:
1. Primary Prevention: The prevention of disease,
injuries and conditions that lead to impairment
and disability. Primary prevention is part of health
care and safety measures of different kinds for the
population in general. Water, food, social and
material welfare as well as medical services in this
order are indispensable prerequisites to maintain
health.

31. 2.7 Prevention of Disability Cont’d………
Services for safe motherhood as well as immunization
campaigns can be organized by the health structures, but
measures for road safety, occupational health and sanitation
require participation of the social sector and many other
authorities.
Genetic counseling can be used to inform parents, especially
those with hereditary diseases, on the risk of having children
with defects. It is possible, that the incidence of such
hereditary diseases as muscular dystrophy and hemophilia
could be reduced, but there is a risk that genetic counseling
carries an element of coercion. Even if we could agree on
which characteristics are desirable for a human being and
which are not, it is not at all proven, that these techniques can
help bringing them about.

32. 2.7 Prevention of Disability Cont’d………
2. Secondary Prevention: prevention of diseases and
treatment. Therefore, efforts and resources will
always be needed to hinder a permanent impairment
and disability. That is what can be called secondary
prevention.
Curative care, surgery, physiotherapy and other
measures belong here. Examples are medical
treatment of diabetes, correction and fixation of
fractures, keeping the joints mobile and in good
position after burn injuries, maintaining range of
motion in joints affected by burns, early detection and
early stimulation for mentally retarded or deaf
children.

33. 2.7 Prevention of Disability Cont’d………
3. Tertiary prevention: interventions to limit or
compensate for impairments or disability. Tertiary
prevention then can be taken as a synonym for
rehabilitation in a narrow sense like medical
rehabilitation with training, the provision of
assistive devices and long-term medication (like in
epilepsy and diabetes).
It can, however, also be taken to cover adaptation
of the society and equalization of opportunity. In
this case, manifold interventions like legislation,
publicity, urban planning, social security etc. will
be included.

34. 2.7.1 Types of prevention
The possible interventions that can be undertaken in favors of
peoples with disabilities can be divided in to
General/mainstreaming/ intervention
Specific intervention
2.7.1.1General/mainstreaming/ intervention: -
 Building awareness of disability and provide
rehabilitation in the family and the community,
sensitizing the community to create more positive
attitudes and less discriminatory behavior.
 Providing more equitable opportunities, better access
to the general system of society, mainstream
interventions such as health care, education and
training, community development, poverty alleviation
and environment programs and so on.

35. 2.7.1.1General/mainstreaming/ intervention Cont’d………
Providing more equitable opportunities, better
access to the general system of society, mainstream
interventions such as health care, education and
training, community development, poverty
alleviation and environment programs and so on.
Increasing the representation of people with
disabilities, their families in all formal and informal
bodies with authority to decide on plans, services
etc…
Promoting and protecting disabled peoples rights.

36. 2.7.1.2 Specific interventions
include functional training,
physiotherapy, functional academy
etc. Special needs education calls
for resources not available or not
properly used, in regular school.