Describe disability and the principles of rehabilitation.

Disability and Rehabilitation

• The older sequence, still commonly examined — disease → impairment → disability → handicap, representing the organ, person and society levels
• The illustration — a corneal opacity is the impairment, the resulting blindness the disability, and inability to work or attend school the handicap
• The medical versus social model is the central conceptual point:
• The medical model treats disability as a problem of the individual, caused by disease, requiring treatment to make the person fit society
• The social model treats disability as created by a society that is not organised to accommodate difference, requiring the environment to change
• To make the difference concrete — a wheelchair user is disabled by the stairs, not by the wheelchair; build a ramp and the disability largely disappears while the impairment remains unchanged
• The modern ICF position is a biopsychosocial synthesis, accepting both that impairments are real and that environments create most of the handicap
• The causes of disability in INDIA — congenital and genetic conditions; birth injury and perinatal problems; nutritional deficiency, notably vitamin A causing blindness and iodine causing intellectual disability; infections — polio, measles, meningitis, leprosy, trachoma, otitis media; injury, particularly road traffic and occupational; non-communicable disease — stroke, diabetes, arthritis, cataract and mental illness; and ageing
• A large share of Indian disability is preventable by measures already in place — immunisation, vitamin A and iodine supplementation, safe delivery, injury prevention and cataract surgery
• The levels of prevention applied to disability — primary, preventing the disease; secondary, preventing impairment becoming disability by early detection and treatment; and tertiary, preventing disability becoming handicap by rehabilitation and environmental change
• Rehabilitation has four components — medical (restoring function, including surgery, physiotherapy, occupational and speech therapy, and appliances); vocational (restoring the capacity to earn, through training, placement and sheltered employment); social (restoring family and community relationships); and psychological (restoring dignity, confidence and self-worth)
• Community-based rehabilitation (CBR) is the strategy appropriate to India — delivering rehabilitation within the community using local resources, family members and trained community workers, rather than in distant specialist institutions
• Its advantages — it is far cheaper and reaches far more people; it keeps the person with their family; it addresses the social and vocational dimensions that institutions cannot; and it changes community attitudes by making disabled people visible and included
• The rights of persons with disabilities act, 2016 replaced the 1995 Act and expanded the recognised conditions from 7 to 21, adding among others autism, intellectual disability, specific learning disability, mental illness, thalassaemia, sickle cell disease and acid attack injury
• Its provisions — 4% reservation in government employment and 5% in higher education; accessibility requirements for buildings and transport; inclusive education as the norm; prohibition of discrimination; legal capacity with supported decision-making; and a certification and grievance mechanism
• Related institutions — the Rehabilitation Council of India, which regulates training of rehabilitation professionals; and schemes providing assistive devices and aids
• The principle that should conclude the answer — the goal is inclusion and participation, not merely medical treatment or charity; and much of what disables people is built into buildings, transport, schools and attitudes, and can therefore be unbuilt
• A wheelchair user is disabled by the stairs, not by the wheelchair, which is the social model in one sentence
• Accessibility is a health intervention, not an act of charity, which follows directly from that model
• Community-based rehabilitation suits India, being cheaper, reaching more people and keeping them with their families
• CBR changes attitudes by making people visible, which institutional care actively prevents
• Much Indian disability is already preventable by immunisation, vitamin A, iodine, safe delivery and cataract surgery
• The 2016 Act expanded conditions from seven to twenty-one, adding autism, learning disability, thalassaemia and acid attack injury
• Four per cent reservation in employment and five per cent in higher education are provided by the same Act
• Inclusive education is the legal norm, rather than segregated special schooling as the default
• Rehabilitation has four components — medical, vocational, social and psychological — and all four are needed
• Vocational rehabilitation restores earning capacity, which frequently matters more to the family than function does
• The ICF is a biopsychosocial synthesis, accepting both that impairments are real and that environments create handicap
• Much of what disables people can be unbuilt, being built into buildings, transport, schools and attitudes
• Legal capacity with supported decision-making replaced guardianship as the model, which is a substantial shift
• Iodine deficiency causes intellectual disability, which is entirely preventable by salt iodisation