Block 4
Block 4
Block 4
Block
4
PERSONS WITH DISABILITIES
UNIT 15
Orientation to Disabilities 7
UNIT 16
Persons with Sensory Impairments 20
UNIT 17
Persons with Mental Retardation 40
UNIT 18
Mental Illness and Psychosocial
Rehabilitation 62
UNIT 19
Persons with Locomotor Disability and
Multiple Disabilities 85
EXPERT COMMITTEE
Prof. V.N. Rajasekharan Pillai (Chairperson)
Vice Chancellor
IGNOU, New Delhi
Prof. Girishwar Misra Prof. Mathew Verghese Prof. Manju Mehta
Department of Psychology Head, Family Psychiatry Centre Department of Psychiatry
University of Delhi, New Delhi NIMHANS, Bangalore AIIMS, New Delhi
Dr. Jayanti Dutta Ms. Reena Nath Dr. Rekha Sharma Sen
Associate Professor of HDCS, Practising Family Therapist Associate Professor
Lady Irwin College, New Delhi New Delhi (Child Development), SOCE
IGNOU, New Delhi
Prof. Vibha Joshi Prof. C.R.K. Murthy Mr. Sangmeshwar Rao
School of Education STRIDE Producer, EMPC, IGNOU
IGNOU, New Delhi IGNOU, New Delhi New Delhi
COURSE WRITERS
Unit 15 & 17 Dr. Amiteshwar Ratra, Research Officer, NCDS, IGNOU, New Delhi
Unit 16 Dr. S.K. Parsad, Dy. Director, NCDS, IGNOU, New Delhi
Unit 18 Prof. T.B. Singh, Dean, IHBAS, New Delhi
Unit 19 Ms Nupur Bhumbuck, Child Developement Expert, New Delhi
&
Dr. Amiteshwar Ratra, Research Officer, NCDS, IGNOU, New Delhi
BLOCK EDITORS
Prof. T.B. Singh
Prof. Neerja Chadha
Dean
Professor of Child Development
IHBAS
SOCE, IGNOU, New Delhi
New Delhi
Dr. Amiteshwar Ratra
Research Officer
NCDS, IGNOU, New Delhi
Acknowledgment :
We acknowledge our thanks to Ministry of Health and Family Welfare for providing inputs for
cover design.
September, 2010
Indira Gandhi National Open University, 2010
ISBN:
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means, without permission in writing from the Indira Gandhi National Open University, New Delhi.
Further information on Indira Gandhi National Open University courses may be obtained from the
University’s office at Maidan Garhi, New Delhi- 110 068 or the official website of IGNOU at
www.ignou.ac.in.
Printed and published on behalf of Indira Gandhi National Open University by Registrar, MPDD.
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BLOCK 4 PERSONS WITH DISABILITIES
The previous Block of this Course dealt with the various types of mental disorders,
such as cognitive disorders, mood disorders, neurotic disorders, personality
disorders etc. In this Block, “Persons with Disabilities” you will be oriented to
various types of disabilities. You will study disabilities like sensory impairments,
mental retardation, mental illness, locomotor disabilities and multiple disabilities.
This Block consists of five Units.
Unit 15 is on “Orientation to Disability”. The Unit defines disability and
differentiates disability from impairment and handicap. It explains the various
causes of disability like hereditary factors which include chromosomal anomalies,
defective genes etc. and environmental factors like poor nutrition, chronic disease,
radiations etc. It also explains that both heredity and environment interact to cause
disability. There are some important acts and legislations of Government of India
on disability. The Unit describes these acts in detail like RCI Act 1992, PWD
Act, 1995 and The National Trust Act, 1999. In the end of this Unit, we will
study how to create a disabled friendly society, wherein we would focus on the
various needs and problems of children with disabilities. We would also highlight
some important points to remember when dealing with persons with disabilities.
Unit 16 focusses on “Persons with Sensory Impairments”. As the name suggests,
the Unit acquaints you with the knowledge on sensory impairments like hearing
disability, visual disability and deaf blindness. The Unit begins with the concepts
and definition of sensory disability. Further, it explains various methods of
identification and assessment of sensory disability. The Unit describes the various
causes of sensory impairments. In the end of this Unit, various interventions for
sensory impairments are discussed; for example, sensory training, orientation and
mobility training for visually impaired persons.
Unit 17 is entitled “Persons with Mental Retardation”. The Unit begins with
the definitional aspects of mental retardation, and then proceeds to explaining the
various classifications in detail. The Unit further describes the various causes of
mental retardation. The identification and diagnosis of mental retardation has also
been focused upon. Children with mental retardation manifest some specific
physical, cognitive and behavioural characteristics; the Unit enumerates these
characteristics as well. The later part of the Unit deals with the prevention and
intervention for mental retardation. It includes genetic counselling, prenatal care
and postnatal care. Further, the Unit highlights the specific role of community
members like teachers and parents.
Unit 18 is on “Mental Illness and Psychosocial Rehabilitation”. The Unit
defines mental illness and its positive and negative symptoms. The disability arising
due to severe mental illness is known as psychiatric disability. The Unit explains
the clinical characteristics and key areas of psychiatric disability. Further, the Unit
explains the psychosocial rehabilitation of persons who are impaired, disabled or
handicapped by the mental disorder. It describes the aim, goals, values and
guiding principles of psychosocial rehabilitation. The Unit acquaints you with the
knowledge of historical perspectives of psychosocial rehabilitation. It explains the
present scenario and magnitude of the problem. Strategies of management in
psychosocial rehabilitation including pharmacotherapy and psychosocial
management are well explained in this Unit. The Unit also deals with the legal
aspects, advocacy and community participation. In the end of this Unit, the role
of the counsellor and family therapist is explained.
Unit 19 is entitled “Persons with Locomotor Disability and Multiple
Disabilities”. The Unit begins with the definition of locomotor disability and
various causes that may lead to locomotor disability. It also explains the other
conditions that lead to locomotor disability, for example, spinal cord injury, polio,
cerebral palsy, epilepsy, cerebrovascular accidents, arthritis, muscular dystrophy,
amputation, club foot and leprosy. The Unit further deals with the prevention of
locomotor disability, which includes primary level, secondary level and tertiary
level of preventions. Further, the Unit explains various types of problems faced
by the locomotor disabled. As you go through the Unit, you will be able to
understand the process of rehabilitation of locomotor disabled persons. It includes
assistive devices, orthodontics, prosthetics, walking aids etc. In the end of this
Unit, we study about multiple disabilities in which we learn about the causes,
examples and prevention of multiple disabilities.
UNIT 15 ORIENTATION TO
DISABILITY
Structure
15.1 Introduction
15.2 Definitions of Disability
15.3 Distinction between Disability, Impairment and Handicap
15.4 Causes of Disability
15.5 Legislations and Acts in India
15.6 How to Create a Disabled Friendly Society
15.6.1 Needs and Problems of Children with Disabilities
15.6.2 Points to Remember while Dealing with the Persons with Disabilities
15.6.3 Role of Society
15.1 INTRODUCTION
Majority of us know of some one who has some kind of disability or, also, might
be ourselves suffering from some kind of impairment or disability. Disability is a
common term these days. Till recent past the words ‘disability’, ‘impairment’ and
‘handicap’ were used interchangeably. Most of the persons with disability till date
lead a segregated and secluded life due to our social misgivings and are deprived
of their rights to a larger extent. This Unit would differentiate among these three
terms. These terms have different meanings and are used in different contexts.
The estimated disabled population in the world as well as in India is quite high.
According to the Census of India, 2001 their number is 22 million. However,
according to the Disability Manual, 2005 brought out by the National Human
Rights Commission, Delhi the actual number of Indians with temporary and
permanent disability could be as high as 50 million. With the rising number of
persons with disabilities, it is pertinent for a counsellor and family therapist to
understand the needs, requirements and characteristics of persons with disabilities.
The information contained in this Unit will give a deeper understanding about the
persons with disabilities. In this Unit, we would have a general overview about
it and the other Units of this Block would discuss in detail about the specific
disability concerns.
Objectives
After studying this Unit, you will be able to:
Differentiate the meaning of the terms disability, impairment and handicap; 7
Persons with Disabilities List the factors that cause disability;
Identify various types of disabilities;
The Persons with Disabilities Act, 1995 defines “disability” in terms of blindness,
low vision, leprosy-cured, hearing impairment, locomotor disability, mental
retardation and mental illness. According to the Act, “person with disability”
means a person suffering from not less than forty percent of any disability as
certified by a medical authority.
The Disability Manual, (NHRC, 2005) focusses on the shift from individual
pathology to a social construct in accordance with the UN Standard Rules on the
Equalization of Opportunities for Persons with Disabilities, 1993. The Standard
Rules have defined disability from a perspective that emphasises social conditions
8 which disable a group of individuals by ignoring their needs of accessing opportunities
in a manner conducive to their circumstances (Disability Manual, 2005).
Human Rights Definition of Disability Orientation to Disability
9
Persons with Disabilities
Check Your Progress Exercise 2
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
1. Fill in the blanks:
i) ........................ refers to organ level abnormality or dysfunction.
ii) ................................... refers to person level limitation in physical
and psycho-cognitive activities.
iii) ...................................................... is considered as a loss or limitation
of opportunities to take part in community life on an equal level with
others.
Contagious diseases.
In broad terms the causes of disability can be described as follows:
Irreversible diseases,
Old age,
Environmental pollution,
Cardiovascular disease,
Neuromuscular diseases,
Traffic accidents,
Industrial accidents,
Wars,
Dwarfism (Achondroplasia),
Hunger, 11
Persons with Disabilities Lack of adequate health system,
Extreme poverty,
Apartheid,
15.8 GLOSSARY
Disability : Restriction or lack of ability to perform an activity in
the manner considered normal among human beings.
FAS : Foetal Alcohol Syndrome.
ICF : International Classification of Functioning.
Impairment : Any loss or abnormality of psychological, physiological
or anatomical structure or function.
WHO : World Health Organisation.
1. i) impairment
ii) disability
iii) handicap
1) Following are the major areas covered under the list of reaons of disability
by WHO:
ii) Injuries/wounds,
iii) Malnutrition,
i) Blindness,
iii) Leprosy-cured,
v) Locomotor disability,
1. i) False
ii) False
iii) False
iv) True
18
Orientation to Disability
15.10 UNIT END QUESTIONS
1. How will you differentiate between disability and handicap? Explain with
examples.
2. Describe the legislations and acts related to disability.
3. How will you create a disabled friendly society? Illustrate with the help of
examples.
19
Persons with Disabilities
UNIT 16 PERSONS WITH SENSORY
IMPAIRMENTS
Structure
16.1 Introduction
16.2 Concepts and Definitions
16.2.1 Hearing Impairment
16.2.2 Visual Impairment
16.2.3 Deaf Blindness
16.5 Intervention
16.5.1 Hearing Impairment
16.5.2 Visual Impairment
16.5.3 Deaf Blindness
16.7 Glossary
16.1 INTRODUCTION
This Unit will provide you a broad overview of the concept and definition
of sensory impairment and its rehabilitation and mainstreaming needs. The
concept, identification and assessment, support services and various other
related aspects of sensory disability have been explained in very objective
terms. Besides above, this Unit deals with the identification based on common
characteristics, and aids and appliances meant for the persons with sensory
impairment. Here the types of sensory impairments such as hearing
impairment, visual impairment including blindness and low vision and multi-
sensory impairment as deaf blindness have been discussed in detail. The
Unit is designed to cover various dimensions with a view to enable you to
help and deal with the persons having sensory disability. These include
management of the different aspects of rehabilitation.
20
Objectives Persons with Sensory
Impairments
Identify and assess the children and persons with sensory impairments; and
Plan specific intervention with regard to the children and persons with sensory
impairments.
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
1. Fill in the blanks:
i) Sensory impairment refers to difficulty either in ............................... or
hearing.
ii) ......................... is a process of detection, discrimination, recognition
and comprehension of sounds.
iii) Persons with low vision mean a person with impairment of
............................... even after treatment of standard refraction.
iv) Deaf blindness is a ............................... sensory loss.
Observation by teachers
Audiologist
Special Educator
Psychologist
Speech Therapist
Social Worker
The child showing one or more than one of the above mentioned signs and
symptoms should be referred to an audiologist. The audiologist assesses the
hearing loss using various audiological equipment like pure tone audiometer,
speech audiometer, play audiometer, sound field audiometer, impedance
audiometer, Brain Evoked Response Audiometry (BERA), etc. It is now
possible to assess degree and type of hearing loss at an early age of the child.
Screening Audiological Tests for Infants and Children
There are a number of screening audiological tests depending upon the age
of children. Let us discuss some of these tests:
1. Birth to Six Months
Infants with congenital or neonatal hearing loss can be identified using
objective physiological tests such as the Auditory Brainstem Response (ABR)
evaluations, or the Oto Acoustic Emission (OAE) before 3 months of age,
and an intervention programme started soon thereafter. Both these tests are
accurate, non-invasive and do not require any observable response from the
infant. For the purpose of screening, both the methods are extremely effective.
i) Auditory Brainstem Response (ABR): In order to process sounds,
electrical impulses are transmitted through nerves from our ears to the
brainstem at the base of the brain. An auditory brainstem response
(ABR) is a physiological measure of the brainstem’s response to sound.
It tests the integrity of the hearing system from the ear to the brainstem.
The test is performed by fixing four to five electrodes on the infant’s
head, after which a variety of sounds is presented to the infant through
earphones. As the hearing nerve fires, the sound stimulus travels up to
the brain. This electrical activity generated by the nerve can be recorded
by the electrodes and is represented as waveforms on a computer screen.
The audiologist can then present different loudness levels of each sound
and determine the softest levels at which the infant can hear. For infant
screening purposes, only one sound is used to test the hearing, commonly
referred to as a “click”. The click is a grouping of several sounds to test
a wider area of the hearing organ at one time. The click is typically
presented at a loud level and a soft one. If a healthy response is recorded,
then the infant has “passed” the hearing screen.
ii) Automated Auditory Brainstem Response (AABR): The automated
auditory brainstem response (AABR) is another objective means of evaluating
24 hearing. It is mainly used in many newborn-screening programmes. The
instrument is automated and provides a pass-fail report; no test interpretation Persons with Sensory
Impairments
by an audiologist is required.
iii) Otoacoustic Emission Test (OAE): The otoacoustic emission test (OAE)
measures an acoustic response that is produced by the inner ear (cochlea),
in response to a sound stimulus. The test is performed by placing a small
probe that contains a microphone and speaker into the infant’s ear. As the
infant rests quietly, sounds are generated in the probe and responses that
come back from the cochlea are recorded. Once the cochlea processes the
sound, neural impulses are sent to the brainstem. In addition, there is a
second and separate sound that does not travel up the nerve, but comes
back out into the infant’s ear canal. This “byproduct” is the otoacoustic
emission. The emission is then recorded with the microphone probe and
represented pictorially on a computer screen. The audiologist can determine
which sounds yielded a response or emission and the strength of those
responses. If there is an emission present for those sounds that are critical
to speech comprehension, then the infant has “passed” the hearing screen.
Both ABR and OAE tests have advantages and disadvantages when used
for screening. The OAE is easy and cost effective. However, the false-
positive rate (that is, an infant fails a hearing test but actually has normal
hearing) may be higher for an OAE than for an ABR. The two tests, however,
rely on different mechanisms of hearing for the screening. For in-depth testing
and a complete hearing evaluation of infants, these tests work best together
as a complement to each other.
2. Six Months to Two Years
Conditioned Oriented Response (COR) or Visual Reinforcement
Audiometry (VRA): Children as young as six to 12 months of age can be
screened using conditioned oriented responses or visual reinforcement
audiometry. These are the behavioural tests measuring responses of the child
to speech and frequency-specific stimuli presented through speakers. Both
the techniques condition the child to associate speech or frequency-specific
sound with a reinforcement stimulus, such as a lighted toy. However, these
tests do not give ear-specific results.
3. Two Years to Four Years
Play audiometry is a behavioural test aimed at measuring the auditory
thresholds in response to speech and frequency-specific stimuli presented
through earphones or bone vibrator. The child is conditioned to put a peg
in a pegboard or drop a block in a box when stimulus tone is heard. It gives
ear-specific results and assesses auditory perception of the child. However,
attention span of the child may limit the amount of information obtained.
4. Four Years to Adolescence
Conventional Pure Tone Audiometry is a behavioural test measuring
auditory thresholds in response to speech and frequency-specific stimuli
presented through earphones or bone vibrator. The child is instructed to raise
her or his hand when stimulus is heard. It gives ear-specific results and
depends on the level of understanding and cooperation of the child.
25
Persons with Disabilities 16.3.2 Visual Impairment
When prevention of disability is not possible, cure becomes the objective. When
cure is not possible, rehabilitation becomes the goal. Identification and assessment
help a great deal in facilitating rehabilitation of the blind and those with low vision.
The assessment of disability and identification of children or persons with visual
disability may be based on the common features, informal methods such as direct
observation and formal procedures with the help of some assessment tools. The
details in this respect are given below:
Common features: Visual impairment may be identified with the help of common
features as mentioned below:
Blindness
Child tilts her or his head to locate the light source,
Pain and irritation in the eyes,
Bumps into objects in the environment,
Unable to write from the blackboard, takes help from peers to copy
from the blackboard,
Poor performance in the class,
Unable to read in poor lighting conditions,
Unable to see during night,
Depends too much on oral information,
Rubs eyes excessively,
Watery eyes,
Eyelids are often red,
Holds objects and the book too close to eyes,
Squints or blinks when looking at something,
Blinks more frequently, and
Regular headaches.
Low Vision
Confident movement in school environment,
Visual orientation to the new stimuli,
Light gazing,
Avoidance response to shadows,
Interested in visual games,
Avoidance of large obstacles,
Unusual head tilt,
26 Flickering,
Distracted by movement in the environment, Persons with Sensory
Impairments
Startled response to suddenly approaching objects,
The child experiences difficulty in reading small prints,
The child experiences difficulty in identifying small details in
pictures or illustrations,
The child frequently complains of dizziness after reading a passage
or completion of assignments involving vision, and
The child frequently complains of headache, infection in eye; the
child uses one eye more than the other.
Informal Methods of Assessment
There are some informal methods to identify visual impairment. These are simple
methods and activities that parents and teachers can use in the classroom for
assessing visual problems of the child, if any.
Direct Observation
Light perception of difference between sunlight and dim light,
Light perception of difference between good light and poor light in a
class,
Tracking of light,
Detecting hand movement,
Distance of detecting hand movement,
Finger counting: Fingers raised one at a time,
Finger counting: Fingers spread apart,
Finger counting (General): Fingers closed together,
Finger counting inside the classroom with good lighting condition,
Finger counting inside the classroom with poor lighting condition,
Visual background,
Colour detection,
Visual closure,
Form constancy,
Eye-hand coordination,
Eye-foot coordination,
Print size preference without magnifiers,
Print size preference with magnifiers,
Time taken to read a passage in mother tongue or English,
Ability to write, and
Writing speed.
27
Persons with Disabilities Formal Methods of Assessment
Some children may be handicapped due to the restriction of the field of vision.
The field of vision is the entire area which can be seen while the eye remains
fixed upon one point in straight line. When the widest angle of the central field is
restricted to 20 degrees or less in the better eye with correction, the person is
considered legally blind, even though she or he is usually able to read ink print
materials.
Assessment Tools
These are commonly used tests to measure the extent of visual functioning and are
discussed in brief in this sub section.
Snellen test and visual field tests: These tests are used to measure visual
acuity and visual field.
Muscles Balance Tests: For testing muscle balance, special instruments are
used. The most common tests are:
Maddox Rod Test: This test is used to determine the postural position of
the eyes when fusion is disrupted. This test yields excellent measurement of
heterophoria and can also be used to detect hetrophoria. The procedure
calls for the presentation of a different image to each eye at the same time.
Tests for Distant Vision: The tests for distant vision will detect the child
with hyperopia or far-sightedness. The hyperopic child usually sees quite
well at a distance but must accommodate for near-vision task.
Plus Lens Test: It is a more adequate test to detect hyperopia. The child’s
vision is checked on the Snellen chart or on one of the binocular instruments
while he is wearing plus lenses mounted in a small, inexpensive frame. If the
child can see the 20 feet line at 20 feet from the chart with both eyes while
wearing these lenses, she or he should be referred.
Near Vision Testing: Near visual acuity should be determined for children
with low vision. Near vision information is of special importance for children
with pathological defects where only distance visual acuity may be inadequate.
Near vision is determined with one of several reading cards, which have
either symbols, numerals or letters printed on them. The reading distance for
low vision children and illumination should be recorded.
28
16.3.3 Deaf Blindness Persons with Sensory
Impairments
All the methods applied for identification of hearing and visual disability that we
have discussed earlier may be used in combination for identification of deaf
blindness in the individual.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
The sound waves from the environment including speech enter the outer ear,
strike on the eardrum, and make the tiny three bones in the middle ear
vibrate. This results in the transfer of mechanical energy in the middle ear
and then into electrical energy in the inner ear. Frequency and intensity analysis
of sounds takes place in the inner ear. The electrical energy from the inner ear
is carried to hearing area in the brain through auditory nerve and other complex
auditory pathways for processing and interpretation of the meaning of the sounds.
The hearing loss can occur due to damage at any stage or in different parts of
ear. The causes of hearing disability can occur at any time during the developmental
period that is before birth, during birth or after birth. The causes before birth may 29
Persons with Disabilities concern family history of childhood deafness, consanguineous marriages, illness
during pregnancy, history of mother suffering from rubella during pregnancy and
poor physical condition of the mother. The possible causes during birth are premature
delivery, lack of oxygen during birth, absence of birth cry and low birth weight.
The causes after birth are deformities of ear, nose, face and throat; infectious
diseases (mumps, measles, meningitis, viral fever etc); injury to ear, exposure to
loud sound and neglected ear discharge. Children with the above factors may be
considered as high-risk children and their hearing assessment should be done as
early as possible.
Higher the level of hearing sensitivity, greater the severity of hearing loss. Hearing
loss may be mild, moderate, moderately severe, severe or profound:
Mild hearing loss (26 to 40 dB HL): A child with mild hearing loss will
have trouble hearing and understanding soft speech in a noisy background.
Moderate hearing loss (41 to 55 dB HL): A child with moderate hearing
loss will have difficulty in hearing conversational speech.
Moderately severe hearing loss (56 to 70 dB HL): A child with
moderately severe hearing loss will have difficulty in hearing conversational
speech even at close distances.
Severe hearing loss (71 to 90 dB HL): A child with severe hearing loss
may only hear loud environmental sounds.
Profound hearing loss (91 dB HL and above): A child with profound
hearing loss may only hear very loud environmental sounds.
The types of hearing loss are as follows:
i) Conductive hearing loss: Hearing loss due to any problem in the outer
ear and/or middle ear can lead to conductive hearing loss.
ii) Sensory neural hearing loss: Hearing loss due to any problem in the inner
ear and/or auditory nerve is termed as sensoy-neural hearing loss.
iii) Mixed hearing loss: Hearing loss due to any problem in the outer and /
or middle ear including inner ear is termed as mixed hearing loss.
iv) Central hearing loss: The hearing loss due to defects in central auditory
processing is termed as central hearing loss. The child can hear the sound
but has problem in understanding and interpreting the speech and language.
v) Functional hearing loss: This is hearing loss when there is no anatomical
and physiological abnormality in the auditory system but the child has problem
in hearing due to malingering or psychological problems.
16.4.2 Visual Impairment
VISION 2020 has identified many causes of avoidable blindness, among which
five conditions have been identified for immediate priorities on the basis of the
burden of blindness they represent and the feasibility and affordability of interventions
to prevent and treat them. These are cataract, trachoma, onchocerciasis, childhood
blindness, and refractive errors and low vision. Other disorders, such as glaucoma
and diabetic retinopathy, at present do not meet all these criteria, but are likely
30 in the future. Let us discuss some of the common causative conditions:
Cataract: It refers to a clouding of the crystalline lens of the eye and stands Persons with Sensory
Impairments
out as the first priority amongst the major causes of blindness. Today, an
estimated 20 million people are blind from this condition. Cataracts are not
generally amenable to prevention but currently available surgery can restore
near normal vision in a large proportion of those who suffer from this condition.
Trachoma: Trachoma remains the most common preventable cause of
blindness in the world. Trachoma is common in areas of the world that
are socio-economically deprived of basic needs in housing, health, water
and sanitation including India.
Childhood blindness: Childhood blindness is caused mainly by vitamin
A deficiency, measles, conjunctivitis in the newborn, congenital cataract
and retinopathy of prematurity (ROP).
Other causes of childhood blindness that are congenital, or genetically
determined, do not generally lend themselves easily to preventive
strategies at present.
Childhood blindness is considered as a priority area, because of the
number of years of blindness that ensues. Its developmental implications
are tremendous.
16.4.3 Deaf Blindness
To know more about deaf blindness let us understand the four groupings of
individuals who are deafblind.
1. Congenitally deafblind: Individuals who are born with vision and
hearing losses.
2. Congenitally deaf, adventitiously blind: Individuals who are born with
deafness and later acquire blindness.
3. Congenitally blind, adventitiously deaf: Individuals who are born with
blindness and later acquire deafness.
4. Adventitiously deafblind or acquired deafblind: Individuals who are
born with hearing and vision senses but later lose both the senses in
varying degrees and at different times.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
------------------------------------------------------------------------------------------ 31
Persons with Disabilities ---------------------------------------------------------------------------------------------
2. What are the major causes of avoidable blindness identified by VISION
2020?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
16.5 INTERVENTION
Intervention is a major and important aspect of rehabilitation process. It is a team
approach, in which the role of parents, family members and community people
are equally important. Let us now take a focussed look at intervention in the case
of sensory impairment.
16.7 GLOSSARY
Central hearing loss : Hearing loss due to defects in central
auditory processing.
Field of vision : The entire area which can be seen while
the eye remains fixed upon one point in
straight line.
Mixed hearing loss : Hearing loss due to any problem in the
outer and / or middle ear including inner
ear.
Sensori-neural hearing loss : Hearing loss due to any problem in the
36
inner ear and / or auditory nerve.
Persons with Sensory
16.8 ANSWERS TO CHECK YOUR PROGRESS Impairments
EXERCISES
Check your Progress Exercise 1
1. i) seeing
ii) Hearing
iii) Visual functioning
iv) dual
Check Your Progress Exercise 2
1. Visual impairment may be identified with the help of common features
as mentioned below:
Blindness
Child tilting her or his head to locate the light source,
Pain and irritation in the eyes,
Bumping into objects in the environment,
Unable to write from the blackboard, takes help from peers to copy
from the blackboard,
Poor performance in the class,
Unable to read in poor lighting conditions,
Unable to see during night,
Depending too much on oral information,
Rubs eyes excessively,
Watery eyes,
Eyelids are often red,
Holds objects and the book too close to eyes,
Squints or blinks when looking at something,
Blinks more frequently, and
Regular headaches.
Low Vision
Confident movement in school environment,
Visual orientation to the new stimuli,
Light gazing,
Avoidance response to shadows,
37
Persons with Disabilities Interested in visual games,
Avoidance of large obstacles,
Unusual head tilt,
Hand flickering,
Distracted by movement in the environment,
Startled response to suddenly approaching objects,
The child experiences difficulty in reading small prints,
The child experiences difficulty in identifying small details in
pictures or illustrations,
The child frequently complains of dizziness after reading a passage
or completion of assignments involving vision, and
The child frequently complains of headache, infection in eye; the
child uses one eye more than the other.
2. Following are the assessment tools used to measure visual functioning:
i) Maddox rod test,
ii) Allied muscle balance test,
iii) Tests of hyperopia,
iv) Plus lens test, and
v) Near vision testing.
Check Your Progress Exercise 3
i) Cataract,
ii) Trachoma,
iii) Onchocerciasis,
39
UNIT 17 PERSONS WITH MENTAL
RETARDATION
Structure
17.1 Introduction
17.2 Definitions and Classifications
17.3 Causes of Mental Retardation
17.3.1 Genetic Factors
17.3.2 Prenatal Causes
17.3.3 Perinatal Causes
17.3.4 Postnatal Causes
17.3.5 Other Conditions
17.8 Intervention
17.9 Role of Community Members
17.10 Let Us Sum Up
17.11 Glossary
17.12 Answers to Check Your Progress Exercises
17.13 Unit End Questions
17.14 Further Readings and References
17.1 INTRODUCTION
Mental retardation is a commonly heard word which refers to a person having
below average intelligence. At all times, in all societies there have been persons
mental retardation. Mental deficiency was a term which was earlier used. Mental
retardation means that the person has limited mental functioning like understanding,
following instructions, memory, recall, communicative abilities, and social skills.
Such persons may be dependent on others and/or may be less capable to take
care of themselves. Because of so many limitations, a child with mental retardation
is slow in learning social skills and intellectual work. Such children may take
longer time than a normal child to speak, walk, take care of themselves, be toilet
trained, learn alphabets and concepts like numbers, time, money and much more.
Such children would learn the skill but need much more practice and time than
an average child. In this Unit, we will learn more about it.
40
Objectives Persons with Mental
Retardation
After studying this Unit, you will be able to:
Define mental retardation;
Delineate the causes of mental retardation;
Describe characteristics of persons with mental retardation; and
In this Unit, let us focus on mental retardation. Persons with mental retardation
manifest subnormal cognitive, language, motor and social abilities. Thus, broadly
speaking mental retardation may be referred to as a disability characterised by
significant limitations in both intelligence and adaptive behaviour. This disability
originates before 18 years of age.
The definition of mental retardation is given in the tenth revision of the International
Classification of Diseases (ICD-10). It characterises mental retardation as a
condition resulting from a failure of the mind to develop completely. It suggests
that cognitive, language, motor, social, and other adaptive behaviour skills should
be used to determine the level of intellectual impairment. The levels of mental
retardation specified in ICD – 10 (Biasini, et al., 2007) are:
Other mental retardation, F78, should be used when associated physical or sensory
impairments make it difficult to determine the degree of impairment.
Unspecified mental retardation, F79, should be used when there is evidence of
mental retardation but not enough information to establish a level of functioning.
(Biasini, et al., 2007).
Category Range of IQ
The diagnosis on DSM-IV TR is entered on Axis II and for some problems like
autism, bipolar disorder, and schizophrenia, the diagnosis is entered on Axis I.
Alfred Binet (1973) introduced the concept of mental age. According to him,
majority of children of a particular age are of normal intelligence and have
mental level approximating that age. Thus, their mental age approximates
their chronological age. From Binet’s work the phrase ‘‘intelligence quotient’’or
‘‘IQ’’, entered the vocabulary. The IQ is the ratio of ‘‘mental age’’ to chronological
age. William Stern (1976) suggested multiplying this ratio by hundred so as to
avoid fractions. Intelligence quotient (IQ) is hence calculated as follows:
IQ = MA 100
CA
MA is Mental Age
CA is Chronological Age
Therefore, if the mental age of a person is the same as his or her chronological
age, the IQ of the person would be 100.
Educable: Children who can learn simple academic skills but not
progress above fourth grade level.
These terms are related to mild, moderate, severe and profound categories of
mental retardation, and emphasise the necessary support for the individuals (Kirk
et al, 2006).
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
17.7 PREVENTION
Some of the measures discussed below could help in preventing mental retardation
to a large extent.
17.8 INTERVENTION
Appropriate interventions for the child with mental retardation are important for
the child’s optimum development, including social adjustment, psychological
well-being and educational growth. Intervention has to be need based, that means
depending on the needs and requirements of a particular child. Intervention can
be given in a group of similar children with similar needs and problems like same
IQ, social skills, adaptive behaviour etc. It has to be given in the least restrictive
environment to the child. Professional trained educators and sensitised parents
can teach and help the child with mental retardation. The child should be provided
opportunities to interact with non-disabled peers and community members.
Intervention for Infant
Counselling, family therapy, parent training, language services, assistive technology,
intervention for sensory organs, nutrition counselling, occupational therapy and
physiotherapy may be provided to the infant who is suffering from mental
retardation. It could be home based or institution based. 53
Persons with Disabilities
Intervention for Preschool and School Child
The services for preschool and school going child are mostly centre based.
Individualised Education Plan (IEP) should be used even for children in the
same classroom. Both parents and teachers coordinate with each other to
maximise their child’s learning and achievement. The intervention services
mentioned for infant can also be used here.
Social Intervention
During early elementary school, emphasis is more on providing the children with
readiness skills and development of abilities that are prerequisites for later learning.
Hallahan and Kauffman (1991), said that these include such activities as the
ability to:
1. Sit still,
2. Obey teacher,
4. Follow directions,
5. Develop language,
Educational programmes for children with severe and profound mental retardation
according to Hallahan and Kauffman (1991) should include the following:
2. Functional activities,
6. Family involvement.
54
Persons with Mental
Check Your Progress Exercise 7 Retardation
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
1. Outline school-level intervention strategies for the children with mild
mental retardation.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
2. Write a short note on social intervention.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
A child with mental retardation lags behind the normal child in all the
developmental domains and milestones like to sit, stand, walk, toilet training,
speech etc.
Children with mental retardation may suffer from other problems like epilepsy,
cerebral palsy, vision and hearing impairments as well.
17.11 GLOSSARY
Anoxia : Lack of oxygen at the time of birth
CA : Chronological Age
IEP : Individualised Education Plan
IQ : Intelligence Quotient
MA : Mental Age
Mental retardation : A condition of arrested or incomplete
development of mind of a person which is
specially characterised by sub normality of
intelligence.
PKU : Phenylketonuria
PWD Act : Persons with Disabilities Act.
ii) General Mental Ability Test by R.P. Srivastava and Kiran Saxena
60
Stern, W. (1976). As in Enabling the differently able by A.N. Singh. New Persons with Mental
Retardation
Delhi: Shipra Publishers.
The American Association on Intellectual and Developmental Disabilities (AAIDD).
(2007). Mental retardation No more-New Name is Intellectual and Developmental
Disabilities. Retrieved August 13, 2007 from File:// D:/MR/AAIDDJ/Home
Page.htm.
Wikipedia, the free encyclopedia.htm dated: 13/07/2007.
World Health Organization (2007). ICIDH-2: International Classification of
Functioning and Disability. Retrieved August 13, 2007 from www.deakin.edu.au.
Zutshi, B. (n.d.). Disability – Definition, types and international national initiatives.
Retrieved August 13, 2007 from http://www.disabilityindia.or~,’/statusBook
Main.html.
61
UNIT 18 MENTAL ILLNESS AND
PSYCHOSOCIAL
REHABILITATION
Structure
18.1 Introduction
18.2 Mental Illness and Disability
18.2.1 Clinical Characteristics of Psychiatric Disability
18.2.2 Prominent Severe Mental Illnesses
18.1 INTRODUCTION
Mental illness is not a new term in the world of disability. It is seen that a
person who is suffering from a severe mental illness is often unable to perform
even daily routine activities. To overcome this condition, psychosocial rehabilitation
is a good option along with the medicines. Psychosocial rehabilitation is a process
to restore social functioning and wellbeing of a person who is suffering from
mental illness.
We will learn about mental illness and the diability caused due to this, in this Unit.
Further, we will study about psychosocial rehabilitation. We will get acquainted
with the historical perspectives of services provided for mental illness and
also study the magnitude of the problem. Proper strategies are required to
manage the psychosocial rehabilitation in the area of mental illness. We will
discuss these strategies in this Unit. Community participation is necessary
for the success of psychosocial rehabilitation. We will learn how the family and
the community can help the persons with mental illness. To conclude the Unit, we
will discuss the role of the counsellor and family therapist in dealing with mental
illness. 62
Objectives Mental Illness and
Psychosocial
After studying this Unit, you will be able to: Rehabilitation
Know about disability arising out of mental illness and its features;
Learn what is psychosocial rehabilitation;
Gain knowledge about historical aspect and magnitude of the problem;
Explain existing provision of services for the mentally ill person; and
Understand strategies of psychosocial rehabilitation of persons with mental
illness.
III. Language and communication III. The initiative of goal directed behavior
(disorganized & bizarre (avolition).
speech), and
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
Let us now take a look at the crucial aspect of psychosocial rehabilitation in the
case of mental illness.
i) Self determination,
3. Guiding Principles
iii) Normalised and community based services: Scope for community based
psychosocial rehabilitation services is wider, as this is known to be the door
step service delivery with an intention to reach the unreached. Such services
are not only in demand; rather, are known to be the need of the day,
especially for greater reach in the rural areas for wider coverage of severely
mentally ill population.
iv) Strength focus: Severity of mental illness is likely to cause many losses.
What has been lost due to severe mental illness should not be the primary
concern. Remaining positive potentials in terms of cognition, emotion, motor
activity level and social interaction of person with severe mental illness should
be the focus of overall rehabilitation process.
viii) Training of skills and vocational focus: Severe mental illness undermines
the individual’s behaviour, performance, cognition and social interaction.
Certain skill deficits are apparent in the major categories of severe mental
illnesses. They are the focus of intervention in psychosocial rehabilitation.
There is continuum of skill training in the process of rehabilitation, that is
activities of daily living skills, social skills and lastly followed by vocational
skills. Through acquisition of these skills vocational focus should be kept in
mind to place the person in a remunerative job. This generates a feeling in
the individual that she or he is also a productive member of the society.
x) Partnership with the family: The person with severe mental illness in
the family is not the only sufferer; rather, the whole family is greatly
affected due to severity of illness. This adds to the burden of caring on
regular basis. Hence, the family needs to be involved as part of the
process of psychosocial rehabilitation.
The growth and development of these general hospitals’ psychiatric units (GHPU)
brought a significant change in the mental health services of the country. This was
referred to as a major revolution in the whole approach to psychiatric treatment
(Wing, 1978). There was a greater acceptability of these units as a method of
mental health delivery system. This also facilitated to a greater extent training of
mental health professionals and research work. Thus, even during this phase of
development of mental health services psychosocial rehabilitation was not focused
sufficiently. However, a number of advantages of GHPU over traditional mental
hospitals were able to prepare a foreground for the development of psychosocial
rehabilitation services of the country. Some of the stated advantages of these
services are listed below:
a) General hospital psychiatric units (GHPU) are situated right in the community
hence, they are easily accessible and approachable,
b) Family and relatives can visit the client and a relative or family member can
stay with patient,
Reduced stigma, easy accessibility of experts and the clinics, and the provision to
stay with disturbed client were some of the encouraging advantages that promoted
psychosocial rehabilitation of the people in the family and community.
Marked increase in the number of persons suffering from chronic mental illness
has drawn the attention of professionals and State to cater to the needs of this
population. “Our forgotten millions” is the apt remark (Agarwal, 1998), which
signifies that we have paid inadequate attention to people suffering from mental
illness. Professionals feel that this population has remained a neglected lot and
now active action oriented efforts are needed to manage and rehabilitate this
neglected population (Kulhara, 1997).
According to Kulhara (1997), nearly 3,00,000 and 1,05,000 cases of schizophrenia
are added in a year in rural and urban population of the country, respectively. Out
of these 40 to 60 per cent cases go through the phase of chronicity and suffer
impairments and disabilities. These figures suggest that roughly 1,50,000 or more
people suffering from schizophrenia are added every year to country pool of
disabled schizophrenic population. A meta analysis of 13 epidemiological studies
reported a prevalence rate of 2.7 per cent for schizophrenic and 12.3 per cent
for affective disorder (Reddy and Chandrashekhar, 1999) which signifies urgent
need to develop rehabilitation services for people suffering from chronic mental
illness. Some earlier studies reported prevalence of schizophhrenia from 2 to 3
per 1000 all over the world. Indian researchers have also reported prevalence
rate ranging from 0.9 to 4.3 per 1000 (Sethi et al, 1967; 1972; Dube, 1970;
Elnagar, 1971; Nandi et al. 1975). Rajkumar (1995) noted incidence of
schizophrenia as 3 per 10,000 in urban areas. Above figures give an estimate that
there will be approximately 2 million persons suffering from schizophrenia in the
country at any given point of time.
Another disabling condition, affective disorders are now conceptualised as chronic
illnesses and the earlier notion of a better prognosis is being replaced with the
acceptance of the fact that very few patients of affective disorders have a single
episode and majority have a chronic course (Stephens, 1978).
Overall reported prevalence and incidence figures suggest immediate need for
psychosocial rehabilitation both in urban and rural areas with a nationwide service
network to help people in the community suffering from chronic mental illness.
Check Your Progress Exercise 3
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
1. State ‘True’ or ‘False’ :
i) Dr. Vidyasagar proved that treatment of ....................
mental illness using drugs only is inadequate.
ii) Dr. Vidyasagar restricted family ....................
involvement in the treatment of mentally
ill persons.
iii) The general hospitals’ psychiatric units ....................
are easily accessible and approachable.
iv) Affective disorders are now conceptualised ....................
as chronic illness.
71
Persons with Disabilities
18.6 PRESENT SCENARIO
Looking into the three areas, that are service, availability of manpower and
research, it is evident that this significant area of mental health service, that is
psychosocial rehabilitation has just been touched upon and many priority areas
are still unexplored, in the Indian context.
In the Western countries, extensive efforts have been made to integrate persons
suffering from chronic psychiatric illness into the mainstream of society.
This includes drug compliance or medicinal management training, training
in activities of daily living, social skill training and vocational rehabilitation.
Another important development in the West is community mental health
movement in the 1950s, which is usually known to be the origin of
rehabilitation in psychiatry. Prior to 1950s care of chronically mentally ill
was primarily institution based and custodial in approach. Much has been
written about the long term deleterious effects of such care (Wing and Brown,
1970). This led to the “de-institutionalisation” of patients in the late 1950s and
early 1960s. There was a growing realisation that people with major mental illness
should be helped to maintain themselves in community and pharmacotherapy
alone is inadequate for their management. A comprehensive system of care,
encompassing a variety of therapeutic approaches is needed to enable chronically
mentally ill persons to function optimally in the community.
In India, psychosocial rehabilitation is still a new area of mental health services.
This has also remained a neglected area of Indian researchers. This is due to
availability of only a few rehabilitation centres (like daycare centres, halfway
homes etc.) in the country and greater reliance on medical model of treatment.
In a traditional Indian setup, unlike most of the Western societies, approximately
90 to 95 per cent of all chronically mentally ill are looked after by the family
(Agarwal, 1998). India still lingers on to be an orthodox and traditional country
in terms of family structure, ties and cohesiveness. Almost all our patients of
chronic mental illness still live in family set up. Very few are in institutions for
custodial care. Therefore, family is primarily the coping agency and significant
adults in the family (for example, parents and spouse) are the primary caregivers.
It has been shown that Indian families are accepting, less critical and hostile, and
more involved than the families of patients of chronic mental illness in the West.
However, despite this there is strong evidence that the presence of chronic mentally
ill patient causes or results in considerable amount of burden to the family. The
burden of care of patients of chronic mental illness is mainly felt in the areas of
family finance (for example, the cost of treatment, cost of transport, follow-up
visits, loss of earning, and loss of earnings of the caregiver due to the task of
looking after patient), routine family activities and family leisure.
With increasing urbanisation, life style is undergoing rapid change. The nuclear
family system and shrinking social networks combined with increasing
financial strain is making it more difficult to care for an ill relative. Studies
have documented that distress and burden of caring for an ill relative are high
(Gopinath and Chaturvedi, 1992; Sam et al., 1998) and disruptive of daily
routine (Rao et al., 1998). This is true for both rural and urban families (Mubarak
Ali and Bhatti, 1988 ; Singh et. al. 2010; Chadda et. al., 2007).
72
Mental Illness and
Aftercare services in the form of daycare centres, halfway homes or rehabilitation Psychosocial
programmes are almost nonexistent in India, though an initiation in the field has Rehabilitation
taken place in some cities like Bangalore, Delhi, Ranchi and Madras (Pai &
Kapoor, 1983; Gopinath & Rao, 1994).
Roughly 0.5 to 15 per cent population will have certain disability, due to
chronic mental illness,
4. Medicine’s side effects: Medication causes side effects and due to these
effects treatment is discontinued when the side effect is severe or when
most of symptoms are managed. Whereas, prescribed continued
medication is very necessary to avoid relapse.
2. Psychoeducation: Explain the facts about the illness to victim and her or his
family members. Many a times person with severe mental illness may not be
able to comprehend; then educating family members about the nature, etiology,
course of treatment and prognosis to family members becomes vital. Cost of
treatment and need of continued care need to be explained to family.
Clearly state the importance of compliance to medication, its side effects and
negative consequences of noncompliance to medication.
6. Respect the person with severe mental illness and her or his human
rights: All such persons are human beings and services provided to them
should be in conformity with basic human rights. Physical punishments,
unnecessary restraint, confining them in solitary cells are unethical. The tragic
Yerwadi incident (2001) where 25 inmates of a treatment centre were burnt
alive as they were chained led to passing legislation for regular inspection of
hospitals to ensure that human rights of persons with severe mental illness in
these hospitals are not violated.
78
Mental Illness and
Check Your Progress Exercise 5 Psychosocial
Rehabilitation
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
1. What are the strategies of management in psychosocial rehabilitation?
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
2. Outline the role of counsellor and family therapist in psychosocial
rehabilitation.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
18.11 GLOSSARY
Expressed emotion : Critical comments directed towards the
patients and over involvement in the patient’s
affairs.
GOI : Government of India.
GHPU : General Hospital’s Psychiatric Unit
Intrinsic factors : Primary factors
Psychiatric disability : Disability arising out of severe mental illness
Psychosocial rehabilitation : Process that facilitates the opportunity for
disabled or handicapped by a mental
disorder to reach their optimal level of
independent functioning.
79
Persons with Disabilities
18.12 ANSWERS TO CHECK YOUR PROGRESS
EXERCISES
Check Your Progress Exercise 1
1) i) Bipolar affective disorder
ii) Phase of mania
iii) intervening
2) Following are the four key areas of psychiatric disability:
v) Situational assessment,
ii) False
iii) True
iv) True
Check Your Progress Exercise 4
1. Following are the factors which contribute to the prolonged mental illness in
Indian context:
i) Misconception and stigma,
ii) Limited facilities of clinical care,
iii) Cost of treatment,
iv) Medicine’s side effects, and
v) Negative symptoms.
Check Your Progress Exercise 5
1. Following are the main strategies of management in psychosocial rehabilitation:
i) Developing and applying measures to assess the effectiveness of
medication,
ii) Intervention with cognitive techniques directly to remedy cognitive
and behavioural deficits,
iii) Developing and applying measures to assess both the stress experienced
by the individual and availabity of internal and external resources to
cope with stress,
iv) Intervening to correct the deficits observed through functional assessment,
and
v) Intervention to provide information about the nature, etiology, and
treatment of mental illness to the family members.
2. Thes role of counsellor and family therepist in psychosocial rehabilitation
involves the following:
i) Listening to the person carefully,
ii) Psychoeducation,
iii) Allowing freedom to choose,
iv) Maintaining confidentiality,
v) Providing desired information,
vi) Respecting the person with severe mental illness and her or his human
rights, and
vii) Conducting counselling and family therepy sessions to resolve specific
issue.
81
Persons with Disabilities
18.13 UNIT END QUESTIONS
1. Name two major mental illnesses causing disability and list their clinical
characteristics.
Chadda R.K., Pradhan, S.C., Bapna, J.S. & Singhal, R. (2000): Treatment needs
of chronic psychiatric patients. Journal of mental health and human behaviour,
5, 1, 13-18.
Chadda, R.K., Pradhan, S.C., Bapna, J.S., Singhal, R. & Singh, T.B. (2000).
Chronic psychiatric patients: An assessment of treatment and rehabilitation related
needs. International Journal of Rehabilitation Research, 23, 55-58.
Chadda, R. K., Singh, T.B. & Ganguly, K.K. (2007). Caregivers burden and
coping: A prospective study of relationship between burden and coping in caregivers
of patients with schizophrenia and biopolar affective disorder. Social Psychiatry
and Psychiatry Epidemiology, 42, 4,923-930.
Elnager, .M.N., Maitra R. & Rao. M.N. (1971). Mental Health in an Indian rural
community. British Journal of Psychiatry, 118, 499-503.
George R.M., Chaturvedi S.K., Murali T.,Gopinath P.S. & Rao S.L.(1996).
Cognitive deficits in relation to quality of life in chronic schizophrenics. NIMHANS
Journal, 14,1,1-5.
Gupta, P., Prabhu, M. & Prabhu, G.G. (1969). Rehabilitation of the chronic
psychiatric patients. Indian Journal of Psychiatry, 10, 157-165.
82
Jones, B.N., Jayram, G., Samuels, J. & Robinson, H. ( 1998). Relating competency Mental Illness and
Psychosocial
status to functional status at discharge in patients with chronic mental illness. Rehabilitation
Journal of American Academy of Psychiatry and Law, 26, 1, 49-55.
Kapur, R.L.(1992). The family and schizophrenia : Priority areas for intervention
research in India. Indian Journal of Psychiatry, 35, 1,3-7.
Kulhara, P. (1997). Schizophrenia –the neglected lot: Call for action. Journal of
Mental Health and Human Behaviour, 2, 1, 3-7.
Liberman R.P., Wallace, C.J., Blackwell, G., Kipeliwicz A., Vaccaro, J.V. &
Mintz, J. (1998). Skill training versus psychosocial occupational therapy for persons
with persistent schizophrenia. American Journal of Psychiatry, 155,8, 1087-1091.
Nandi , D.N., Ajmany, S., Ganguli, H . , Banerjee , G., Boral ,G.C. ,Ghosh, A.&
Sarkar ,S. (1975): Psychiatric disorders in a rural community in West Bengal: An
epidemiological study. Indian Journal of Psychiatry, 17, 87 -99.
Padmawati, R., Thara, R. Sriniwasan, L. & Kumar, S. (1995). SCARF Social
functioning index. Indian Journal of Psychiatry, 37, 4, 161-164.
Pradhan, S.C., Sinha, V.K. & Singh, T.B.(1999). Psychosocial dysfunctions in
patients after recovery from mania and depression. International Journal of
Rehabilitation Research, 22, 303-309.
Roder, V., Zorn, P., Miller, D., & Brener, H.D.(2001). Improving recreational,
residential and vocational outcomes for patients with schizophrenia. Psychiatric
Services, 52, 11, 1439-1441.
Roy Choudhary, J., Mondal, D., Boral, A. & Bhattachrya, D. (1995). Family
burden among long term psychiatric patients. Indian Journal of Psychiatry, 37,
2, 81-85.
Sartorious, N., Jablensky, A., Earmberg, G., Korten, A. , Anker, M., Cooper,
J.E. & Day, R.(1996). Early manifestation of first contact incidence of schizophrenia
in different cultures. Psychological Medicine, 16, 909-928.
Menon, S.M. (1996). Psycho-social rehabilitation: current trends. NIMHANS
Journal, 14, 4, 295-305.
Stephens, J.H.(1978). Long term prognosis and follow up. Schizophrenia Bulletin,
1, 4, 25-47.
Sethi, B.B. & Gupta, S. C. (1972). An analysis of 2000 private and hospital
psychiatric patients. Indian Journal of Psychiatry, 14, 197-206.
Suman, C., Baldev, S., Sriniwasmurthy, R. & Wig, N.N. (1980). Helping the
chronic schizophrenic and their families in the community: Initial observations.
Indian Journal of Psychiatry, 22, 97-102.
Thara, R.,l Rajkumar, S. & Valecha, V. (1988). Schedule for the assessment of
Psychiatric disability- A modification of the DAS-II. Indian Journal of Psychiatry,
30, 1, 97-102.
Thara, R.,Rajkumar, S., (1970). A study of sample attrition in follow up of
schizophrenia. Indian Journal of Psychiatry, 32, 3, 217-222.
83
Persons with Disabilities
Thara, R. & Rajkumar, S. (1993). Nature and course of disability in schizophrenia.
Indian Journal of Psychiatry, 35, 1, 33-35.
Thara, R. & Srinivasan, L. (1997). Marriage and gender in Schizophrenia. Indian
Journal of Psychiatry, 39, 1, 61-69.
Thara, R. & Srinivasan, L. (1998). Management of social disabilities in
schizophrenia. Indian Journal of Psychiatry, 40, 4, 331-337.
Trivedi, J.K. (1999). Quality of life in Psychiatric patients. Indian Journal
of Psychiatry, 41, 4, 277-279.
Wallace, C.J., Nelson, C.J..Liberman, R.P., Atchison, R.A., Luckoff, D., Elder,
J.P. & Ferris, C. (1980). A review and critique of social skills training with
schizophrenia patients. Schizophrenia Bulletin, 6, 42-63.
Walia, A.,Shivalkar, R., & Singh, T.B. (2006). Hospital based cross sectional
study of caregivers burden in chronic schizophrenia. M.Phil. Clinical
Psychology, Dissertation submitted to University of Delhi , Delhi.
Wig, N.N., Varma, V.K., Mattoo, S.K. ,Behre, P.B., Phookan, H.R., Misra
A.K., Sriniwasmurthy, R., Tripathi, B.M. , Menon, D.K. Khandelwal S.K. &
Bedi, H. (1993). An incidence study of schizophrenia in India. Indian Journal
of pf Psychiatry, 35,1, 11-17.
84
UNIT 19 PERSONS WITH
LOCOMOTOR DISABILITY
AND MULTIPLE
DISABILITIES
Structure
19.1 Introduction
19.2 Definition of Locomotor Disability
19.3 Causes of Locomotor Disability
19.4 Other Conditions that Lead to Disability
19.4.1 Spinal Cord Injury
19.4.2 Poliomyelitis
19.4.3 Cerebral Palsy
19.4.4 Epilepsy
19.4.5 Cerebrovascular Accidents
19.4.6 Arthritis
19.4.7 Muscular Dystrophy
19.4.8 Amputations
19.4.9 Club Foot
19.4.10 Leprosy
19.4.11 AIDS (Acquired Immuno Deficiency Syndrome)
19.4.12 Diabetic Neuropathy
19.4.13 Gout
19.1 INTRODUCTION
An individual due to bodily impairment is unable to execute activities associated
with moving both her or his body and objects in the surroundings from one place 85
Persons with Disabilities
to another and from one position to another. This condition is known as locomotor
disability And, if an individual has impairment as a result of involvement of two
or more bodily functions such as deaf and dumb; deaf and blind; cerebral palsy
and mental retardation; etc, it is known as multiple disability.
In this Unit, we would study about the causes and characteristics of locomotor
disability and multiple disabilities.
Objectives
After studying this Unit, you will be able to:
Define locomotor disability;
Describe the causes of locomotor disability and multiple disabilities;
Illustrate various types of locomotor disability and multiple disabilities; and
Discuss the screening and intervention for them.
87
Persons with Disabilities
Check Your Progress Exercise 2
Note: a) Read the following question carefully and answer in the space
provided below.
b) Check your answer with that provided at the end of this Unit.
1) What is neuromuscular impairment?
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19.4.2 Poliomyelitis
Polio is a condition resulting as a consequence of a viral infection in the body. It
occurs in young children and the infection starts with a cold, fever and diarrhoea.
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Polio is caused by various strains of virus namely, Leon, Lansing and Brunshilde Persons with Locomotor
Disability and Multiple
of which Lansing is the most virulent. It spreads through stool of the infected Disabilities
child who does not show apparent signs of polio but is a carrier of the virus.
Deformities in Polio:
Scoliosis: In this condition the spine curves laterally. As a result it decreases
the space in the upper or the thoracic cavity as a result of which the space
for the heart and the lungs decreases.
Over extended knee joint: This condition is called genu recurvatum. It is
caused because the weight of the body is borne by the weak leg and as a
result the knee of this weak leg gets bent backwards.
Knee flexion contracture: In this condition the knee gets fixed in a bent
position if not corrected.
High arched foot: It is also called pes cavus. It is caused when the bones
of the mid foot get bent. As the middle of the foot bends it gives the
appearance of the foot having a high arch.
Signs and Symptoms of Polio
The various signs and sysmptoms of polio are:
It results in paralysis of the lower limbs and the limbs become flacid, very
loose and not stiff.
The affected limbs become thin and also do not grow.
The muscles of the affected limb become weak.
Deformities and contractures may result due to paralysis of the limbs and
deformities of the limbs may also occur due to disuse of the limb or
inappropriate position in which the limb is held etc.
Deformities that are seen in polio are scoliosis, over extended knee joint,
knee flexion, contracture, high arched foot etc.
Screening
The newborn child can be screened for presence of cerebral palsy by
complimentary neuromotor examination which is different from the basic
neuromotor examination. It involves repeated assessments as well as
immediate therapy. Such an examination can help identify babies with transient
patterns of abnormality and also with persistent patterns of abnormality. This
helps to assess the condition of cerebral palsy in the growing child.
In cerebral palsy some of the infantile reflexes that are present in infants for some
period after birth, persist long after the ages when they should have been integrated
within the nervous system. Some of these reflexes that persist are moro reflex,
palmer reflex, tonic reflex, planter grasp etc. Children with cerebral palsy have
weak muscles of the trunk, head, shoulder, and pelvic girdle.
Clinical types of movement disorders in cerebral palsy are:
Spasticity – Spasticity is a type of muscle hypertonia featured as an abnormal
and increased response to rapid stretch, and movement occurs in disorganized
fashion. It implies increased tone in the limbs but decreased tone in neck and
trunk region. Spasticity is mainly in the anti-gravity muscles, that is, extending the
arm produces more resistance than flexing it.
Dystonia – Dystonia is the production of one type of muscle activity when
another was intended or would have been functionally appropriate.
Rigidity – Rigidity implies resistance to passive movements throughout the entire
range of movement and pressure.
Choreo athetosis – Choreo athetosis implies when the individual assumes
abnormal postures of the limbs, trunk, or head involving either slow, writhing
movements or rapid, dance like changes. All postures are assumed
involuntarily.
Ataxia – Ataxia implies when the child presents a poor balance with a wide-
based, unsteady gait and inaccuracy of reaching with swinging, and large
amplitude movements.
Intervention
The role of early intervention is important for the management of the child
with cerebral palsy. The earliest care can begin at the neonatal unit along
with the neurodevelopmental intervention. Neurodevelopmental intervention
would include:
Facilitation of normal motoric patterns through staging appropriate motor
experiences,
Facilitation of self smoothing and modulated tone changes by slow,
rhythmic handling,
To develop normal oral feeding,
Positioning for non-nutritive sucking, 91
Persons with Disabilities
Oral-facial-tactile stimulation, and
Promoting parent–child bonding.
Proper intervention would also involve appropriate and need based feeding
and positioning of the young child so as to avoid complications. The care
givers should be trained to use appropriate handling techniques of lifting,
carrying and providing sitting position for the child. Train the growing child to
communicate using all possible methods and modes to communicate and also
provide age based stimulation lest the child is under stimulated and mental
retardation sets in.
Parents must encourage the child to learn to be independent in taking care of
the daily needs of feeding, clothing, mobility, communication etc. An individual
with cerebral palsy requires intake of adequate nutrition, and stimulating
environment to be in a positive state of wellbeing.
Early physical therapy is one of the important aspects of early intervention. The
following modalities are used during physical therapy treatment of cerebral palsy:
Giving warmth leads to muscle relaxation. This can be done by applying
warm soaks to spastic muscles before beginning the exercise regime.
Cold applications can have the effect of reducing the muscle spindle
activity.
The occurrence of deformity and activity of muscles can be reduced by
helping the child to do relaxed passive movements
Exercises to stimulate opening of hand, developing hand grasp, and
pincer grasp can be done with the child.
19.4.4 Epilepsy
Epilepsy is a condition where there is uncontrolled episode of excessive electrical
activity in the brain leading to changes in behaviour, consciousness and movement.
Various types of epileptic seizures can be classified as follows:
Partial seizures
These are rare and are present only in certain part of the body. They can
be simple or complex. There is no loss of consciousness in simple form of
epilepsy and the complex form is characterized by loss of consciousness
during the epileptic episode.
Grand mal
During grand mal there is loss of consciousness, presence of convulsions,
and generalised and uncontrolled body movements. The individual usually
falls down during the episode and also may froth and urinate during the
seizure. The seizure lasts for about 2-3 minutes and the individual feels
exhausted after the episode and falls asleep after it is over. The individual
loses orientation and does not remember what happened during the episode.
Petit mal
Petit mal type of seizure is characterized by loss of consciousness lasting
for about 3-15 seconds. During the seizure the person may stop all activity,
appear to be staring into space, seem like day dreaming, blinking eyes
92 rapidly. The individual may seem to lose muscular control.
Psychomotor epilepsy Persons with Locomotor
Disability and Multiple
Psychomotor epilepsy lasts for usually 2-5 minutes and there are uncontrolled Disabilities
body movements, inappropriate actions as chewing, unaccountable violent
physical outbursts. It may also be accompanied with abdominal pains,
headaches and buzzing in the ears.
Unclassified seizures
Causes
Epilepsy can be caused due to:
Organic lesions as tumors in the brain
Head injuries
Fever
Infections as meningitis
Hereditary disorders as Batten’s disease
Steps to be taken during the episode of seizures
The following steps should be taken during the episode of epilepsy:
- The caregiver should remain calm.
- Ease the individual to the floor.
- Loosen clothing, keep airflow around the affected individual, prevent choking
on saliva or biting the tongue.
- Do not insert any object between the teeth and remove objects from the
vicinity to avoid accidents and injuries.
Remediation
The medical management of seizures includes drugs and surgery. Depending on
the type of the epileptic fit drugs can be prescribed by the trained doctors.
19.4.5 Cerebrovascular Accidents
Cerebrovascular accidents are also commonly known as stroke. It results due to
presence of blood clot in the brain thus inhibiting blood supply to the nerves,
thereby preventing the nerve from functioning in the normal fashion. If the treatment
does not begin within 24 hours of the stroke attack, the individual loses the ability
to talk, walk, use the upper limbs, control bowel activity or may also lose the
ability to recognise faces and situations, ability to hear and vision also. The risk
factors include high blood pressure, high blood cholesterol, diabetes, obesity,
smoking, and family history of stroke.
19.4.6 Arthritis
Arthritis refers to inflammation of the body joints due to auto immune causes,
infections, wear and tear, old age, etc.
Arthritis in adults is of different types such as osteoarthritis, rheumatoid arthritis,
septic arthritis and gouty arthritis.
Juvenile arthritis is a condition that can be identified by the presence of pain
and swelling in the joints of a child below 18 years of age and it mainly affects 93
Persons with Disabilities
children in the age range of 5 to 10 years. It results in pain, stiffness and swelling
in the joints.
Signs of the Disease
Persons affected by this condition suffer from the following:
The joints are usually stiff in the morning and gradually loosen as the day
progresses. This condition is referred to as morning stiffness.
There is presence of joint pain in the knees, ankles, wrists, neck, fingers,
toes, elbows and shoulders, hips and bones of the back.
Development of contractures due to inadequate exercise and body positioning.
Types of Juvenile Arthritis
a. Systemic
Children with this condition show high “spiking” fever once or twice a day, visibly
enlarged lymph nodes, large spleens, rapidly changing flat pink rash and generalized
malaise and fatigue. Such attacks may last for months and appear and disappear
months or years later. Laboratory tests during the episode of illness may show the
child to be anaemic, having high WBC counts and sedimentation rates, non-
specific indications of severe inflammation.
b. Polyarticular
In addition to the rash, fever and anaemia the child also has severely involved
joints. Most frequently involved joints include knees, ankles, and wrists, neck,
elbow, fingers and shoulders. Later in the course, the hip joint also gets involved,
and also the jaw gets affected resulting in a receding chin due to interference in
the growth of the jaw bone. Such children are small for their age since the disease
interferes with the growth and sexual maturation of the individual. The joints also
lose their range of motion, then develop contractures and also subluxations.
c. Pauciarticular
This affects four or fewer joints. It mostly affects the knees, elbows, wrists and
ankles. Usually only one side of the body is affected.
Management
Management of arthritis includes drugs as analgesics, corticosteroids, anti rheumatic
drugs, biologic drugs, natural remedies and topical arthritis products and surgery
in extreme cases.
19.4.8 Amputations
It is the loss or absence of whole or part of a limb. Amputations can be congenital,
due to accidents and also due to surgery to prevent spread of gangrene in the
body.
19.4.10 Leprosy
Leprosy or Hansen’s disease is caused by bacteria called mycobacterium lepre
that affects the mucous membrane, skin and the nerves of the peripheral nervous
system.
Signs
Early signs include light coloured patches that have lost sensation of pain. This can
be tested by scratching or pinching the affected area. Later lesions occur in that
area that are either macules (skin blemishes) or as plaques (scaly patches). Deformity
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may also occur in the face and limb due to these lesions. In the hands the ulnar
Persons with Disabilities
nerve supplying the ring finger and the little finger is affected thus resulting in
clawing of these fingers. If all the nerves of the hand are affected it gives rise to
a total claw hand accompanied by wrist drop. If the nerves of the lower limb are
affected foot drop occurs and also dorsiflexion and planter flexion.
Causative factors
Bacterial infection can spread through nasal discharge from the infected person
and also the active leprosy patient is a potential source of infection for the
population in the vicinity. The bacteria thrive in hot humid climate and can also
spread through droplet infection from the sputum, skin lesions and mosquitos and
mites.
Management
Management of leprosy involves administration of drugs, treatment of deformities
with administration and use of splints, physical therapy and corrective surgery.
19.4.13 Gout
The arthritis caused by gout results when deposits of uric acid crystals in the joint
fluid and joint lining occur. Inflammation results causing pain and redness in the
joint tissues.
Gouty arthritis is typically an extremely painful attack with a rapid onset of joint
inflammation. The joint inflammation is precipitated by deposits of uric acid crystals
in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint
inflammation occurs as white blood cells engulf the uric acid crystals and chemical
messengers of inflammation are released, causing pain, heat, and redness of the
joint tissues.
Check Your Progress Exercise 3
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
1. Define the terms grand mal, hemiplegia and muscular dystrophy.
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2. Discuss how AIDS can be a source of locomotor disability.
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Secondary level of prevention: This refers to the early steps taken to control
the disease and the disability when it has occurred. It aims at halting or slowing
down the progress of the debilitating condition and also preventing the complications
bound to arise if the condition is allowed to progress. For example deformities
due to paraplegia can be prevented by taking care of positioning the affected
individual in the bed and when doing different activities. Also occurrence of
pressure sores can be prevented if care is taken in case of traumatic paraplegia.
19.7.2 Prevention
The causes of multiple disabilities are numerous and are a result of interaction of
causal factors in varying degrees and intensities. Thus prevention is important
though not controllable. However prevention would include taking steps towards
preventing the occurrence of disability at the critical stages when it is most likely
to manifest during the development of the individual in the mother’s womb.
At the prenatal stage the following precautions should be taken by the
pregnant mother:
i. She should abstain from alcohol intake and exposure to smoking both active
and passive.
ii. She should avoid situations that might lead to accidents and injuries to the
unborn child.
iii. Regular checkup at the maternity clinic and undertaking various screening
procedures on the medical advice should be taken care of.
iv. The expectant mother should be vaccinated for infections such as rubella,
chicken pox etc.
v. Vitamin supplementations of Folic acid, iodine, Vit K and iron should be
given to the expectant mother.
vi. Conditions as blood pressure, diabetes, thyroid problems should be kept
under check for the pregnant mother.
Steps to be taken at the time of delivery:
i. Steps should be taken to ensure that delivery occurs in a clean and hygienic
environment under specialized supervision.
ii. Complications during delivery such as breech and assisted delivery should be
handled with utmost care and expertise.
For the neonate the following points should be kept in mind:
i. The newborn should be fed and kept warm immediately after birth.
19.8 REHABILITATION
Rehabilitation refers to the restoration of the physically disabled persons to their
102 maximum possible physical, educational, economic independence and social
integration. The process of rehabilitation takes into account the level of recovery Persons with Locomotor
Disability and Multiple
possible with each case of disability. Thus there are patients who can fully recovery Disabilities
as in cases of neuropraxis, surgically repaired nerve injuries, Guillain Barre syndrome
etc. In certain cases the patient exhibits permanent but stable disability as in
amputations, post polio residual paralysis, nonprogressive paraplegia, hemiplegia
etc. There are also patients with unstable disabilities such as rheumatoid arthritis,
osteoarthritis etc.
The process of rehabilitation should include the following:
Prevention of disability,
To reduce or eliminate the disability to the maximum, and
To train the affected individual to achieve independent living with whatever
residual abilities one has.
Assistive Devices
Assistive devices are any devices that can help persons with disabilities in doing
activities of daily living; they are items that can directly enable people with disabilities
to participate in the activities of daily life. People may take help of assistive
devices on their own or with help of other people.
Orthotics
This includes the provision of splints and appliances that improve the function and
appearance of a disabled person. An orthosis can be said to be an appliance that
is added to the patient, to enable better use of the body part to which it is fitted.
Functions of orthetics
The main function and aim for which orthoses are prescribed are to prevent and
correct any deformity arising out of the disability. It also provides relief from pain
as it limits motion and weight bearing. It also leads to immobilization and protection
of weak, painful or healing musculo-skeletal segments. It also leads to improvement
in the function of the specific limb.
Prosthetics
Prosthetics refer to any artificial substitute for lost part of the body. They can be
external or internal. External prosthesis is used for upper and lower limbs and can
also be further classified into endoskeletal limbs or conventional limbs or temporary
pylon prosthesis.
Functions of prosthetics
Rehabilitation by the use of prosthetics aims at achieving maximum function out
of the remaining stump of the lost or missing limb.
The points to keep in mind when choosing the appropriate prosthetic is to take
care of the following:
The level of amputation
Type of socket
Material of socket
Type of joint to be used i.e., hip, knee, or elbow mechanism, ankle/foot or
hand/terminal appliance 103
Persons with Disabilities
Cosmetics
It is the preservation, restoring or bestowing of bodily beauty. In terms of prosthetics
it implies creation of life like limbs mimicking the real limb.
Walking Aids
Walking aids are used to increase the mobility of a patient. This is done when
some of the weight of the body can be supported by the upper limbs. Examples
of walking aids include parallel bars, walking frames, crutches and sticks etc.
Selection of the walking aid depends upon the stability of the patient, the strength
of the upper and the lower limbs, presence of degree of coordination of movement
of the upper and lower limbs and the degree of relief from weight bearing equipment
that is required.
Types of walking aids include crutches, frames, sticks and parallel bars.
Rehabilitation using walking aids requires time. The patient needs to regain strength
after a prolonged illness. This can be gained by taking adequate diet and well
planned progressive course of exercise. The patient also needs to become free
of the fear of falling.
Architectural barriers
Patients with locomotor impairments are not in a position to walk through narrow
entrances, lanes on elevated platforms, etc. So it is necessary to provide special
ramps, remodeling of entrances, widening of doors, construction of slopes instead
of stairs, and creation of plain, flat floors without raised obstacles in the house and
public places also.
Psycho-social rehabilitation
Illness and injury lead to anxiety and frustration. Care should be taken to boost
the morale of the disabled person and feeling of empowerment should be inculcated.
The people surrounding them should be supportive, helpful and not indulging in
pity for the disabled. The response to the incapacity depends upon the patient’s
personality, education, social and economic situation. Care should be taken to
include these factors when planning for the individual’s s rehabilitation goals.
Specific psychological problems of persons with disabilities include depression,
anxiety, feeling of insecurity, and inability, loneliness, behavioural disorders, affective
disorders, personality disorders, suicidal tendencies, dependence, low self esteem,
irritability, impaired psychomotor coordination and hysteria.
Check Your Progress Exercise 7
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this Unit.
1. Enumerate the types of walking aids.
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------------------------------------------------------------------------------------------ Persons with Locomotor
2. Name some of the psychological problems of persons with multiple Disability and Multiple
disabilities. Disabilities
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19.10 GLOSSARY
AIDS : Acquired Immuno Deficiency Syndrome
Hemiplegia : Paralysis of half of the body.
Locomotor disability : An individual’s inability to execute distinctive
activities associated with moving both oneself
and objects from one place to another.
Musculoskeletal impairment : A result of the involvement of the muscles and
bones of the body.
Multiple Disabilities : Combination of more than one disablity in a
person.
Neuromuscular impairment : A result of the involvement of the muscles and
nerves in the body.
Paraplegia : Paralysis of two lower limbs.
Quadriplegia : Paralysis of all the four limbs.
Hemiplegia is a type of spinal cord injury in which paralysis of half of the body
takes place.
Muscular dystropy is a condition where the body muscle fiber is replaced by fat
cells and the muscles gradually atrophy.As the person grows older fat cells and
the muslces waste away and there is progressive loss of muscle power in the
body.
1. It is true that at times people working in a factory do not follow rules and
regulations. This makes them prone to hazardous conditions and accidents which
maylead them to live a disabled life in future especiallylike locomotor disability.
1. Pressure ulcers, deformities and contractures, and loss of limbs or other body
parts.
1. The pregnant women should take utmost care of herself to look after her child.
She should avoid alcohol, smoking both active and passive, radiations, drugs
and medicines without a prescription from the doctor. She should go for regular
health check-ups at materinityclinics and strictlyfollow the advice of the doctor.
She should take vaccination for rubella, chicken pox, etc. She should take
vitamin K, iodine, iron, etc. Conditions like diabetes, thyroid, blood pressure,
etc. should be kept under control.
1. Types of walking aids are crutches, frames, sticks and parallel bars.
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Persons with Locomotor
19.12 UNIT END QUESTIONS Disability and Multiple
Disabilities
1. Discuss the complications faced by the locomotor disabled persons if proper
care is not taken.
2. What is the role of assistive devices in the rehabilitation of the locomotor
disabled?
3. Elaborate why is psycho-social rehabilitation of the locomotor disabled
important?
4. How do deformities and contractures occur in a cerebral palsied child?
5. Discuss the role of a multidisciplinary team in the care of a person with
disabilities.
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