Rehabilitaion & Medical science

Professorial Dissertation, 2013
51 Pages




1. Introduction - Rehabilitation & Physiotherapy
Prevention of disability
How to diagnose a disability
i. Rating of disability
ii. Functional diagnosis

2. When to start the Rehabilitation
Rehabilitation team
Role of Social Worker
Role of NGO's
Classification of handicapped

3. New hopes for the Disabled
Persons with Disability Act
Concession to Physically Challenged Persons.
Aids & Appliances
o Orthotic Appliances

4. Amputations
Level of Amputations
Type of Amputations
Rehabilitation of amputees
o Prosthetic appliances
o Training
o Walking aids

5. Rehabilitation of a stroke patient

6. Facilities Provided by Indian Red Cross

7. Draw Backs & Suggestions



The world Health Organization estimates that one child out of ten is born with disability.

Disability is a costly affair for any country because of -

1. Economically – disability cost millions

2. Socially - disability both physical & emotional

The disability is more a social problem than the medical one.

Since ancient time people with disabilities are treated as a second class citizens just because they cannot contribute to social, economic & cultural development. In some cultures, deformed children were not allowed to live. In other cultures such deformed children were victimized & even today this practice is prevalent. The handicapped were the threat to the society. Superstition and the handicap were linked in the minds of many. The handicapped child was treated as stigma on the family and to some it was treated as 'ghost'.

In developing countries, the handicapped child was treated as punishment in the family. Moreover it was said to be the "maternal impression" when a pregnant mother see the face of any person, the animal etc and the features of child becomes like the mother has seen. Somewhere handicapped children are the best source of income through begging.

There is very close relation between disability and the poverty in many developing countries. The rural persons also suffer from disability more than the urban area. This is because of the fact that the medical facility is neither available to the rural people nor to the poor persons.

In rural area particularly, when a person becomes ill, does not seek medical facility which is very far off or it is costly and keep himself within the house & at the mercy of God. This is more when the ill person is a girl or a woman.

The same is with the poor persons because of the fact that he/she is not able to expense the cost of medical facility in urban area. Moreover the facilities in government hospitals are not easily available or up to the mark particularly to poor population due to non availability of bed or non availability of medicines etc. Most of the time, the concerned doctor is not available either due to his duties in the Post Mortem room or in the court for the medical evidence. If not these, he/she might have gone on the special duty of any VIP/VVIP or he/she may be on leave.

These all factors leads chronic illness & ultimately any disability may occur.


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Now the scenario has changed with the development. Now the persons with disabilities demand their rights instead of charity. As civilization advances the persons with disabilities were accorded great sympathy began to provide facilities as per the legislations' & gave them the protection under the law. Thus try to enable them to live as normal life as possible & to integrate in the society. The persons with disabilities need safety, security, self esteem & opportunity for new experiences as per the law.

The WHO defines the health coverage in all respect of physical & mental well-being. The need of health care is much more specific for health care & prevention.


Mahatma Gandhi, the Father of Nation once said that India lives in villages. Being more population & lack of facilities 75% of total handicapped live in rural area as compared to 25% of handicapped in urban area.

Further 50%of population of handicapped is under the age of 10 years in India which is more sufferers for the disabilities.

In the 19th century, specialized medical care was gaining momentum for the :

1. Blind
2. Deaf
3. Orthopedically
4. Mentally retarded

In developing countries, following are the major cause of disabilities –

1. Malnutrition
2. Communicable disease
3. Poor peri natal & postnatal care
4. Accidents

These contributes to about 70% to total causes of disabilities. Moreover more than in 90% of cases handicapped child develops the disabilities before the age of 5 years.

20th Century is the century of total rehabilitation for the persons with disabilities. The persons with disabilities are given the opportunity for which they are capable. Many laws have been passed including non-discrimination with the persons with disabilities.

21st Century is a possibility of buying any organ of the body from the market by the person. It may be an era of robot also who can perform all the activities as required by the human being including the emotional reactions also.

The year 1981 was declared as the International year of the disabled person. This reflects the change in the society. But still a long way still has to be covered.

Now the time has come not to hide any handicap but to signify the size of problem he/she has. The strong will of the person with disability will make a success.

In next couple of years, the population in world is going to increase to a great extent but there is lack of facilities particularly in developing countries like India regarding financial means and the professional staff.

In India Rehabilitation services are provided by following organizations–

1. Government (i) The Central Government or
(ii) The State Government
2. Non Government organization (NGOs)
3. By Others like Private volunteer organizations (PVOs)

All three organizations provides services with the motto:-

1. Prevention and early detection.
2. Community Based Rehabilitation.



The need of seeking and receiving physiotherapy and rehabilitation has been one of the basic demands of curing physically challenged person in the world. The need tends to assume much larger population in the present technology industrial age. In this modem society, acting independently is of supreme importance - be if personal care, day to day activity, cooking, studies, for the matter anything that requires human development or pursuits. It is here that a physically challenged person suffers more socially, economically, emotionally and the physiotherapist who is able to cope up all the qualities which are used to make a person fit. Moreover importance is that each individual be utilized to optimally its potentialities and make maximum contribution to the entire country’s development and also his/her own development. This fact further emphasized to need for scientific physiotherapy and rehabilitation of physically disabled persons.

The happy adjustment and healthy development of a nation’s individual need to be viewed and interpolated in the typical contract of availability of medical treatment facilities in the country. Although the happiness has been one of the external quests of man, his concept of a happy life and dynamics of his quest are shaped according to typical back ground in which it takes birth and grown ups. Similarly although it is normal for an individual to be set with problems but physical incapability and incompetence along with his perceptions of the problematic situation and his ways of approach it etc. are important. Today we live in the automated world and we are experiencing excessive gain weight, joints and heart problems, neck and low back pain etc. Mental stress and emotional disturbance are leading to increased dependence to drugs and in addition to alcohol or beverages. Fitness is a state in which one feels happy. It requires-

1. Regular exercises.
2. walking regularly
3. Good pasture
4. no obesity

This type concept of physical fitness seems more essential and at the same time most neglected also.

Regular physical exercise is not a luxury but a necessity

Exercise mental stress and emotional disturbance leads to increased dependence on alcohol, drugs etc. So Always think Positive. In modem era, there has been increased awareness in the field of the rehabilitation. Rehabilitation medicine aims to store the proper function of the organ and also prevents the deformity and dysfunction by providing exercise and the artificial aid. The general principle of rehabilitation is to store the sufferer to work in the shortest period and with minimum residual disability. The physical and psychological rehabilitation should start as soon as the patient is out of primary treatment. Therefore, the cognizance science, the physiotherapy has been started only few decades ago as a department. However, a lot tail has to be done. Not only this, many of the patient’s don’t know how it can be utilized and how it can be beneficial for the patients as the disabilities.

Physiotherapy is a branch of the rehabilitation medicine and has acquired a unique status over the years. It is a special kind of medical specialty, which treats the patient by the method of physical or mental exercise including vocational training of the patient and to rehabilitate him to do or change to certain vocation.

Rehabilitation treatments involve physical or mental adjustment of the physically impaired patients, both with or without any artificial aid and appliances so that they may be able to lead a life a normal person. So rehabilitation and physiotherapy plays a vital role in persons who are physically challenged.

The World Health Organization defines the health 'A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’

The fundamental goal of medical science is not to produce an immortal being but to maintain him in optimum health as long as possible, ideally until death.

Any health care that attempts to halt a person’s slide down the slope of the health status is termed Preventive and any attempt to push it up towards the peak, optimum health is called Therapeutic . The total spectrum of health care is classified into 3 levels of prevention.

a) Primary level of Prevention.
b) Secondary level of Prevention.
c) Tertiary level of Prevention.

The fundamental purpose of epidemiology is the prevention and eradication of disease and condition through a better understanding of its causation. If completes prevention or total eradication is not possible, containment is the second choice.


(a) Primary Level of Prevention

Prevention of disability doesn’t start at birth or after a primary disability occurs. Sometime it may be even before the child is born due to genetic defects or genetic compatibility and can be prevented by means of genetic counseling. Current population growth, particularly rapid increase of the aged, predicts a sharp rise of disabled population in near future. It is well documented that there is a great shortage of medical and par-medical to care of - The Physically challenged persons.

In recent years, specialist in neurology, orthopedic surgery and pediatrics are increasingly getting involved and have a vital role to play in the field of rehabilitation. These phenomena should not be interpolated as an invasion of the field by other specialties, but rather as recognition of its importance.

Unless more effective methods of the specific prevention to develop the population from primary disability in the future, the newly defected disability will face critical situation. The critical situation of shortage of health man power to be without benefit of rehabilitation services, consider a nuclear family where husband and wife are working, the arrival of a new disabled or senior member would rob this family, its all happiness, its leisure. A lot of personal sacrifice is called for. It is now time for the academic rehabilitation to prevent epidemic disability in the same manner that we are able to prevent the communicable disease.

(b) Secondary level of Prevention

Rehabilitation, one of the secondary level of prevention focuses its attention to disability, all specialties in therapeutic medicine require early and precise diagnosis in order to institute the most effective treatment appliance to rehabilitation and the disability should be given to early evaluation and intensive treatment to prevent disability.

The person should be rehabilitated totally in :

a) physically
b) Emotionally
c) Vocationally
d) Socially

Diagnosis of disability may be expressed either in terms of -

(i) The amount of disability
(ii) In terms of the amount of remaining function.

The former category is commonly called the disability evaluation or rating.

In latter category functional diagnosis the performed terminology.

Rating disability as Established by Law

1. Value of Arm is more than the leg
2. Value of Hand is more than the foot
3. Value of thumb is more than the fingers

Qualities of functional Diagnosis :

The functional diagnosis should be:

1. Simple enough : so that rapid evaluation is possible.
2. Reproductive : so that consistency may be maintained.
3. Objective : i.e. using measurable factors so that results are statistically more reliable.
4. Descriptive : i.e. the actual situation is accurately reflected.
5. Comprehensive : i.e. the diagnosis is completely and specifically utilized in the direct care of the patients and is practicable for epidemiological investigation.

Example of cerebral palsy : While the diagnosis of C.P. conveys very little or no meaning. It would be ideal to functionally diagnose a child as:

1) How many limbs are affected?
(i) Diplegic or
(ii) Quadriplegic
2) Type of cerebral palsy,
(i) Spastic or
(ii) Athetoid?
3) Mental abnormality
4) State of communication impairment
5) Hearing and visual impairment and so on.

Rehabilitation of the handicap person is combination and in co-ordination use of medical, social educational and vocational measures to the optimum level of his functional ability. It makes his life more meaningful, more productive and therefore worthwhile living.



The rehabilitation should : It should:

1) Be started at the earliest possible time in order to ensure the best results.
2) Be administered in conjunction with specific medical and surgical treatment of the precipitating disease.

On completing the conventional clinical evaluation to find out impairment.

Physiatrist often can answer such questions:

“Why does the person have the problem?” (The etiologic diagnosis)

“How is the person?” (I.e. the anatomic and patho physiology diagnosis)

“Examples of impairment are : Post Polio residual palsy, alkalosis of a joint and so on.

Mostly impairment lead to disability.

“How does the problem effect the persons life?” (The functional diagnosis)

"What activities can he not do?"

In fact, it is these complaints with which the patient approaches to the doctor in the first place. To the patient, the functional consequences:- What he or she is prevented from doing?

(Example : typing, cooking) are of more importance then the diagnosis.

Example : a patient with frozen shoulder would complain of inability to toilet himself or to wear his shirt.

Further, the relationship, may be bi-directional;

Example : inability to walk, a disability, may lead to muscle weakness and the contractures, which causes impairments.

Not every impairment may lead to disability.


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Rehabilitaion & Medical science
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Physical therapist Abhishek Chadha (Author)Dr. Shamma (Author), 2013, Rehabilitaion & Medical science, Munich, GRIN Verlag,


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