Rehabilitation Psychology

Prof. Rupsa Karmakar

MODULE 3

Prenatal
Perinatal
Postnatal developments of the child

Factors and causes of developmental disorders

Environmental
Physical
Contextual
During the prenatal period

Major disabilities
 Sensory impairment
 Developmental disability
 Learning disability
 Behavioral issues
 Mental and psychological conditions
 Medical conditions

Disability -
In the east, parents and family could not accept disability due to lack of resources, taboo, stigmas, financial
conditions, lack of understanding, lack of rehabilitation resources.

Sensory impairment:
Any condition which implies a loss or impairment of the sensory organs such as hearing, vision, speech and olfactory
senses.
Points to consider for rehabilitation
1. Is it lifelong?
2. Can I improve the condition of my child with any kind of rehabilitation?

Developmental disabilities
Autism spectrum disorder (ISA Scale) - happens due to mirror neuron deficit
Cerebral palsy
Down’s syndrome
Asperger syndrome

Learning disabilities
1. Input (Difficulty processing visual information)
2. Difficulty in processing audio or lingual information
3. Integration
4. Storage (memory)
5. Output (Having trouble expressing the information)
Behavioral Issues:
Oppositional defiant disorder (ODD)
Conduct disorder (includes bullying)
Internalization disorder (blaming oneself)
Mental and psychological conditions
 Trauma, violence, depression

Medical conditions
 Malnutrition
 Heart diseases
 Cancer
 Muscular dystrophy
 Cerebral palsy, Etc.,

Etiological factors
1. Prenatal(in womb) - genetic factors and genetic diseases, developmental malformations. Maternal diseases,
drugs/medicine, chemical radiations, consanguinity, ethnic groups
2. Perinatal - low birth weight, prematurity, obstetric complications, trauma during labor, asphyxia, intracranial
hemorrhage
3. Postnatal - infections (poliomyelitis, tuberculosis, meningitis, encephalitis), endemic diseases (goiter,
cretinism,) accident, malnutrition

Early identification of diseases:

Early identification refers to a parent, educator, health professional or other adult's ability to recognise
developmental milestones in children and to understand the value of early intervention.
 Early identification leads to early intervention, which is considered essential in remediation.
 The children have not yet faced academic failure, therefore it becomes easier to work with them as they still
retain their motivation to learn.
 At that young age they have not developed the compensatory strategies, which will later form barriers in the
remedial process.
 Research has shown that children who received assessment and remedial services at a younger age were
better able to cope with the disability and have a better prognosis than those who received help later.
Identifying children with disabilities
 Difficulty in oral language
1. Slow development in speaking words or sentences
2. Pronunciation difficulties
3. Difficulty in understanding questions
4. Lack of interest
5. Difficulty in using right word while speaking
 Difficulty in reading and writing skills
1. Difficulty in understanding and using letter s
2. Phonology
3. Recognising letter and alphabets
 Difficulty in cognition
1. Trouble memorizing
2. Poor memory for routine
3. Attention difficulty
4. Concentration
 Difficulty in motor skills
1. Balance
2. Running jumping
 Difficulty in social behavior
1. Easily frustrated
2. Hyperactive
3. Impulsive
4. Distractive
Early identification strategies:
National policies of persons with disabilities - They emphasized that children up to the age of 6 years may be
identified at the earliest and necessary intervention be made urgently, so that they are capable of joining inclusive
education at the right age.
The identification process includes:
1. Screening - focus on areas that are impaired. It refers to determining the areas where children need
assistance.
2. Examination for the presence of risk indicators and protective factors - etiology or causality. Consists of
biological and genetic factors. Maternal and paternal age are to be considered. Protective factors are those
that helps to save the child, it includes school, educators and helps to increase the resilience foster.
3. Systematic observations - child behavior and ability is being notified by the psychologist. Frequency,
consistency and severity of the abilities and behavior are being notified.
4. Comprehensive evaluation - total evaluation is done and what kind of assistance the child needs is taken into
consideration

Early intervention:
Seigal, 1972 - The model consists of three factors:
1. Preventive
2. Primary , secondary
3. Curative
4. Treatment, Surgery
5. Remedial - aids and appliance
6. Alternative , methods
It is primarily offered to individuals with developmental difficulties.
It applies to children who are of school age or younger who are discovered to have or be at risk of developing a
handicapping condition or other special nned that may affect their development.
Screening and assessment
Speech and language
Physical and occupation
Psychological
Home visits
Medical
Nursing nad nutritional
Hearing and vision
Social work
Transportational mobility

Advantages of early intervention

 Improve educational and social development of child
 Relieve stress, frustration that family goes through
 Reducing behavioral disabilities
 Become more productive with the services
 Reduce the cost of rehabilitation later in life
Models of early intervention
Home based intervention(The child is given few ideas that satisfies the individual) and center based intervention
(They can learn from other students and experts can help them)

More emphasis is on inclusivity, knowledge of the disability and early intervention.

Designing Interventions
 Home
 Centre
Levels of intervention (PG 21)
 Primary
 Secondary
 Tertiary
In the 3rd level what kind of therapy will be used for the client is planned. OT-ST- BM- SE
ISAA - Indian scale for Assessment of Autism

Developmental screening test(DST) (Bahart raj)

Screening test, observation, monitoring - helps to know the developmental concerns

Screening disabilities
Developmental screening is the administration of a brief standardized tool to help identify children at risk of a
developmental disability. It is administered in the medical home or by trained providers and teachers in some
daycares or early learning centers. Concerning results from the screen should trigger further evaluation for specific
developmental disabilities.
Screening provides greater sensitivity (correctly identifying children at risk for a developmental delay) and specificity
correctly avoiding positive screen results in children who do not have a developmental delay.
9-18, 13 -24 months the screening is done

Assessment tools used in India

Strengths, limitation, age range - pts to be considered
A. Norm referenced testing (NRT)
B. Criterion referenced testing
Tools for assessment of Learning disabilities
Dyslexia screening test (DST)
Diagnostic test of learning disability (DTLD)
Behavioral checklist for screening the learning disabled (Swaroop and Mehta)
GLAD (J Narayan)
NIMHANS Battery (cannot be used for children >12 yrs)

Tools for assessment of intellectual disabilities in India

Developmental screening test
Denver Prescreening Developmental Questionnaire
Baileys scale of infant development
Upanaian early intervention programming system (1987)

Behavior assessment scale in Indian setting

BASIC MR (Nimh 16)
VSMS - Vineland Social maturity scale
Problem behavioral checklist (Peshawaria)

Developmental schedules
Gesell developmental schedule
Motor and mental development of indian babies (Pramila Parthak)

Intelligence test
SB 5 - Stanford Binet
WISC - Weslers
Coughman intelligence scale

Tools for assessment of autism spectrum disorder in India

M-CHAT - Modified checklist for autism in toddlers
ISAA - Indian scale for assessment of autism
CARS - Childhood Autism Rating scale

Guidelines for screening

1. Screening instrument should be reliable and valid, culturally relevant, used only for their specified purpose
2. Multiple sources of information should be used (collecting data from parents, psychiatrist, podiatrist)
3. Developmental screening should be done only by trained personnel
4. Screening should be on a recurrent and periodic basis
 5. Family members should be part of the screening process
(routine checkups are important to understand students state)
6. Focus screening to understand a particular developmental delay

Who ? health care providers, early childhood teachers, professionals

What? Looking for developmental milestones
When? Developmental screening - 9 -18 -30 months, autism screening 18 - 24 months
Why? To find out any kind developmental delays in the child in order to provide early help and rehabilitate better
How? Using the screening tools

NIMH Protocols (READ FROM MATERIAL)

Prenatal procedures - blood test, Ultrasonography, amniocentesis, foetoscopy,
Neonatal and postnatal screening

MODULE 4
REF - ALAGAPPA UNI MATERIAL - PG 146
Psychological interventions - they are time bound, financial restraint of the resources, it is very much based in an
urban rural divide.
Psychoanalytical approach of intervention - they are intense in nature, it's time bound for individuals to get adapted
to it. It works in integrating the disintegrated ego. Many cannot benefit from it.
Learning theories and its perspectives: (REFER PG 163 - ALAGAPPA UNIVERSITY MATERIAL)
Helps in optimisation
Trying to make them more functional
Help them get integrated in the society
Occupational therapy - for fine and gross motor skills

 Content → process → product of the learning situation

Visual support - basic (picture), complex (cognitive arousing)
Passive modeling - visual examples are done, instructional language reduced
Video meddling - video examples are provided, allowing students to watch instructional events repeatedly.

Structured learning environment - right to scan the environment and reduce their agitation, helping them to adapt
to a secure place and feel comfortable and improve learning.
APA Applied behavior analysis - target certain behaviors that can cause difficulty for the child. Children with
internalizing and externalizing disorder have to given ABC (antecedent, behavior, consequences)
Modeling - its a form of prompting, the task is demonstrated as expected from them, and then they learn and
students can learn teh sequence of steps and follow it.
Reinforcements - target behavior is encouraged. Kinds of reinforcements: Tangible(stickers), Activity based(student
being able to participate in preferred activity), Social (praise or thumbs up sign)
Task analysis - break task into smaller teachable steps. Forward chaining(First set is focused and then the rest) and
backward chaining (last step is taught first)
Discrete trial training (DTT) - breaking large tasks into smaller ones (subtasks). Subtasks are taught sequentially and
each of them is mastered.

[ Psychological interventions - psychoanalytical approach and learning theories.

Classical conditioning - ABA (Applied behavior analysis) - we look into certain target behavior, changing the target
behavior through conditioning with interventions. Helps reduce aggressive behavior. Content-process-outcomes
Reinforcement theory
Modeling and shaping - incorporated to the idea of how we as teachers are a model to children. Repetition of
behaviors
Breaking down tasks - forward chaining, backward chaining and dtt(discrete trial tranining)
Rogers stages of counseling (TO BE READ) ]
Therapeutic and Restorative techniques:

Restorative forms of rehabilitation help the person regain health, strength and independence. It helps in
maintaining the highest level of function. Prevents unnecessary decline in function. Restorative rehabilitation may
involve measures that provide selfcare, elimination, positioning, mobility, communication and cognitive function.

Occupational therapy:
 Primary concern - patients ability to perform day to day functions
 It is the art and science of directing man’s participation in selected tasks to restore, reinforce and enhance
the performance, facilitate learning of those skills and functions essential for adaptation and productivity to
diminish or correct pathology and to promote and maintain health.
 Aims include: facilitate development of performance, enhance independence, provide sensory stimulation,
improve motor movements, enhance gross motor function, development of perceptual motor functions,
enhance social development, enhance independent skills
Objectives of OT
 Gross motor skills - large muscle movement
 Fine motor skills - movement and dexterity of small muscles
 Cognitive perceptual skills -
 Sensory integration -
 Visual motor skills - movement based on perception of visual info
 Motor planning
 Oral motor skills
 Play skills
 Socio-emotional skills
 Activities of daily living (ADL) - Selfcare and daily tasks

Scope of Occupational psychology -

Modalities of OT: (ways through which we are using)
1. Human activity
2. Extrinsic adaptations - structural adjustment
3. Splints and special garments
4. Therapist
5. Environment
6. teaching/learning process
Intervention process:
 Activities of daily living
 learning/studies - academic and non academic
 Work
 Play
 Leisure
 Social participation
 Accessibility and environmental modification
 Assistive technology is one of the methods used to adapt to the environment and includes modifications.

Physiotherapy:
It is also known as physical therapy. It helps in the treatment of physical dysfunction or injury by the use of
therapeutic exercise and the application of physical modalities. Assistive devices are also used as a part of treatment
programmes. They are intended to restore or facilitate normal function or development.

Aims and objectives of Physiotherapy

 Improving overall motor functions of the child to the maximum extent possible and make the cid
independent in walking and carrying out activity of daily life

Objectives of physiotherapy
 Reduces or relieves pain, muscle spasm, tenderness of muscles
 Helps to reduce or relieve swelling
  Helps to reduce or relieve inflammation
 To improve ventilation of lungs, by giving deep breathing exercises and postural drainage
 To encourage correct weight bearing and weight transference on both sides of the body
 Reeducation of affected or paralyzed muscle
 It is effective in healing of infected wounds
 Helps to check the abnormal growth of bones (bony spurs)
 Breaking up of adhesion formation (gluing of joint structures by synovial fluid)

Objectives of physiotherapy in relation to intellectual disability:

 To facilitate the development of child gross motor and fine motor
 To prevent or correct contractures and deformities
 To prevent or correct wasting and atrophy of muscles
 To normalize muscle tone
 To maintain or improve muscle power
 To maintain or improve the joint range of movements
 To emphasize the importance of handling and positioning the child.
 To make the child independent in walking and activities of daily life’
 Provide aids and appliances and to train the person and parents how to use assistive devices
 To improve posture, gait, balance coordination
 Inhibition of abnormal reflex activity, abnormal patterns of movement and abnormal muscle tone and
facilitation of normal in place of abnormal.
Scope of Physiotherapy
It has a scope intreating a wide range of conditions

Modalities of physiotherapy:
1. Hydrotherapy - water therapy, use of water to relieve discomfort and promotes physical wellbeing
2. Electrotherapy - use of electrical energy as a medical treatment
3. Exercise therapy -
4. Massage or manipulation
5. Gait - helps improve your ability to stand and walk

Before planning an intervention:

 Condition of the child
 Child's needs and abilities
 How the therapy is going to help the child in improving his functional abilities
 Proper instructions given to the parents
 Training is given to the parents how to give therapy at home
 What are the facilities and services available for the person with intellectual disability

Role of physiotherapists in the field of intellectual disability

 Diagnostician
 Interventionist
 Team member
 Providing information and guidance
 Counselor
 Trainer
 Researcher
 Administrative officer
 Referral provider

Speech Therapy

Yoga and play therapy

The word yoga comes form the sanskrit word “yug”
Objectives of yoga:

 Yoga practice reduces tension, stress, anxiety, weakness, helplessness, fear, negative thoughts etc.
 It treats the prolonged diseases or deficiencies like diabetes, asthma. heart problems, pains, sprains,
indigestion etc.
 Yoga practice equips the practitioners with devotion, attention, and concentration and alertness in every
activity that he does.
 Man can prove his life worth living by developing his self physically and psychologically that contribute for
the development of spiritual instinct in him.
 As soon as one is habituated for yoga practice, there would be number of changes in his routine activities,
habits, thoughts, food habits, behaviors etc

Improvement in balance is one of the major benefits of Yoga. Improved balance is referred not only to the sharp
physical coordination but also to the balance between the left and right, front and back and high and low aspects of
one's body.

Along with a host of benefits, Yoga also helps in developing and attaining personal values. Yoga erases a variety of ills
in human beings. These may range from feelings of frustration, persecution and insecurity. Yoga greatly helps in the
development of personal values.

Yoga helps an individual not only to realize his own self but also understand other issues around him/her. Yogic
theory and practice lead to increased self-knowledge.

Yoga interventions
Importance of yoga for children with intellectual disability

1. Helps to coordinate the activities of the mind and body

2. Tends to reduce the distracted state of mind and helps the mind to deal on the present activity.
3. Helps to improve his adaptive behavior to a degree unobtainable before.
4. Actively increase the ability to concentrate on the present activity.
5. Aims at improving general health, concentration, self-reliance and social relationship of the persons with mental
retardation.
6. Yoga has been tried as an adjunct in education of children with mental retardation and attention deficit
hyperactivity disorder

Play therapy
Play Therapy uses a variety of play and creative arts techniques (the 'Play Therapy Tool-Kit (TM)' to alleviate chronic,
mild and moderate psychological and emotional conditions in children that are causing behavioural problems and/or
are preventing children from realising their potential. The Play Therapist works integratively using a wide range of
play and creative arts techniques, mostly responding to the child's wishes. This distinguishes the Play Therapist from
more specialised therapists (Art, Music, Drama etc). The greater depth of skills and experience distinguishes a play
therapist from those using therapeutic play skills.

Scope of play therapy

Importance of Play Therapy

Play therapy provides fur children's need to be physically active

In play, children discharge energy, prepare for life's duties, chin difficult goals and relieve frustrations. As children
play, they are expressing the Individuality of their personalities and drawing upon Inner resources which can become
Incorporated into their personality. Virginia M. Aaline (1974) who developed the child-centered play therapy
asserted that.
"A play experience is therapeutic because it provides a secure retationship between the child and the adult, so that
the child has the freedom and room to state himself in his own terms, exactly as he is at the mament in his own way
and in his own time.

Play therapy helps to actualize the ultimate objectives of elementary schools facilitating the intellectual, emotional,
physical and social development children from the learning opportunities and experiences offered in school

Objectives of play therapy

 Developo a more positive self concept
 Assume greater self responsibility
 Become more self reliant, self directing
 Become more trusting of self
 Experience a feeling of control
 Become sensitive to the process of coping
 Develop an internal source evaluation
 Engage in self determined decision making
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812369/

Therapeutic Interventions: Visual arts and performing arts (music, drama, dance, movement and sports)
Visual nad performing
 Visual arts
 Decorative arts
Performing arts includes cultural expression and reflects human creativity
https://specialeducationnotes.co.in/C14unit5.htm

Music therapy
https://www.musictherapy.org/assets/1/7/MT_Young_Children_2006.pdf
How does music therapy make a difference with young children?
Multimodal approach
https://babytherapy.org.za/music-therapy-and-young-children/
Dance and Movement therapy

Dance/movement therapy, a creative arts therapy, is rooted in the expressive nature of dance itself. Dance is the
most fundamental of the arts, involving a direct expression and experience of oneself through the body. It is a basic
form of authentic communication, and as such it is an especially effective medium for therapy.

Benefits Of Dance And Movement Therapy:

It helps in improving attention and concentration and thus helps in furthering education Dance as a way of
expression of emotion enables children to express through movements.
Due to liking towards repetitive movements, a therapist can repeat a movement pattern which the patient needs to
learn and when they start imitating the movement vocabulary develops. Touch therapy helps in developing trust on
others as well as helps in reducing sensitivity to physical contact and touch

Sports activities for children with special needs

We can see improvements in muscle strength, coordination, and flexibility.
Improve exercise endurance, cardiovascular efficiency, and possibly increased life expectancy
Will show improvement in behavior, academics, self-confidence and building friendships.
Will have positive changes in their health, quality of life and boost to their self esteem.
Gets to experiences a sense of accomplishment and possibly the taste of winning or personal satisfaction.
Experience increases in attention span, on-task behavior, and level of correct responding.
 Rehabilitation Psychology
Prof. Aysha Nimiya
Module 1
Introduction to Rehabilitation Psychology

Rehabilitation or psychosocial rehabilitation is a process that facilitates the opportunity for the individuals who are
impaired, disabled, or handicapped by a disorder to reach the optimal level of independent functioning.
(Rangnathan, 1999)

Rehabilitation psychology is the study and application of psychological principles on behalf of persons with physical,
sensory, cognitive, developmental or emotional disabilities. (APA)
1
Rehabilitation psychologists help and assist people suffering from a wide variety of physical sensory and
developmental disabilities to achieve optimal psychological, social and physical functioning and restore hope and
meaning in their families.

Caregiver burden

Rehabilitation psychologists cannot work in isolation and will be associated with many other professionals like
physiotherapists, neurologists etc.

Rehabilitation Psychologists Clinical psychologists

Focus - management of disability Focus - diagnosis of psychopathology and

management

Education required: M.Phil in Rehabilitation Education required: M.Phil in Clinical psychology

psychology

Target population: persons with spinal cord
injury, brain injury, stroke and other health
conditions typically associated with aging,
amputations, neuromuscular disorders, chronic
pain, other medical conditions.
Target population: Persons with severe mental
illness such as depression, BPAD, Anxiety, OCD,
Schizophrenia, PTSD, Acute stress disorder,
Somatization, Sexual dysfunction etc.

Services provided include: Assessment,
psychological counseling and therapies,
wellness promotion, stress/conflict
management, supportive measures for
caregivers, education and consultation to
involved community members, such as
employers or teachers, and referrals to other
specialists when needed.
Services provided include: Diagnose mental health
problems, conceptualize specific adult and a child
mental health problems within a psychological
framework, giving due consideration to
psychosocial/ contextual factors, and carry out
relevant treatment/management.
Scope of Rehabilitation psychology:
As per the WHO’s international classification of functioning disability and health (ICF), the scope and application of
rehabilitation psychologists are as follows:
 Assessment of an individual's physical, personal, psychological, cognitive, and behavioral factors and
followed by developing an intervention plan accordingly.
 Assessment of an individual's neuro-cognitive status, sensory difficulties, mood emotion, desired level of
independence and interdependence, mobility and freedom in movement, self esteem and self-
determination, behavioral control and coping skills, individuals capabilities and quality of life to understand
the clients perspective efficiently.
 It assesses the influence of culture, ethnicity, language, gender, age, developmental level, sexual orientation,
geographical location, socioeconomic status and assumptions of difficulty on attitudes and the services
which are given to the client.
 It explores the environmental barriers in participation and performance in a day to day activities including
accommodations and adaptation in the existing social structure
 It includes research and teaching of psychology students and other health trainees about the requirements
of people with special needs, it also focuses on development of policies for health promotion, and advocacy
for persons with disabilities and chronic health conditions.
 It provides services within existing networks of biological, psychological, social, environmental, and political
environments such as attorneys, courts, government agencies, educational institutions, corporate facilities,
or insurance companies.

Goals of rehabilitation
 Recovery from illness
 Integration in the family and community
 Better quality of life

Objectives of rehabilitation
 Develop services for meeting psychological and social needs
 Improve social, emotional relationships between handicapped
 Enlarge free movement in the physical and social environments of the disabled and deprived.
 Study the social and psychological network of rehabilitation services centers with regards to disability and
the laws and regulations.
 Goals need to be achievable and based on regular patient assessment of physical and non- physical
consequences of the critical illness throughout their recovery.

Methods of rehabilitation psychology

 Administration of standardized and non-standardized tests to assess cognitive and psychological functioning
of the client, and use of behavioral observation and interviewing skills to get detailed information about the
client.
 Evaluation and treatment of both individual and family members for improving coping and adaptation skills
in both the client and the family members.
 Providing individual and group intervention by using counseling and psychotherapy, cognitive remediation,
behavioral management and enhancing use of assistive technology for enhancing day to day functioning of
the client.
Functions/ roles of rehabilitation psychologists
 He or she provides a holistic development to the client by working on his or her biological, psychological,
social, environmental and even political environment of the client to assist the client through optimal
rehabilitation goals via intervention, therapeutic support, education, consultation with other specializations,
and advocacy.
 He or she focuses on improving the functioning and quality of life of persons with special needs by restoring
the patient's physical functions and modifying the patient’s physical and social environment.
 He or she provides clinical guidance and counseling services to both the individual in need as well as his or
her family, primary caregivers and other significant people in the individual’s social life and community to
help the patient achieve optimal physical, psychological and interpersonal functioning.
 Rehabilitation psychology involves rehabilitation program development which includes educating the public,
developing policies for injury prevention and health promotion, advocacy for persons with disabilities and
 chronic health conditions, research and teaching of psychology students and other health trainees about the
requirements of people with special needs.
 Rehabilitation psychology involves case management which includes obtaining written reports regarding
client’s progress, developing rapport with physicians and other rehabilitation health professionals and
caseload management-which refers to the ability to manage a number of clients, within a given amount of
time and provide optimum services.
 It focuses on providing a community-based rehabilitation service activity for integration and equalizing of
opportunities in all aspects of the society.
 It involves vocational counseling and consultation which include services such as job development and
placement, career counseling, vocational planning and assessment

Multidisciplinary approach to rehabilitation psychology

https://www.physio-pedia.com/Conceptual_Models_of_Disability_and_Functioning

Biological model - Proposed by Goodley in 2016 - explains the person's physical or mental handicap caused by a
sickness; disabilities are caused by a person’s physical or mental limitations and have a biological basis. This
approach makes the following four assumptions about how to assist those disabilities:
1. Disability is a disease state that falls within the clinical framework, and it is characterized by a problem that is
focused on the individual as a deviation from the norm in order to treat and resolve the issue and restore
the individual to normalcy.
2. Professionals are trusted with determining the objective state of normality; the disabled and their families
have limited opportunity to influence the decision making process
3. Because they are nor viewed as completely human ad lack teh capacity to make their own decisions, people
with disabilities are biologically and physiologically inferior to people with normal disabilities
4. Disability is seen as a personal tragedy that typically has an impact on a person’s life. (Retief, M., & Letosa,
2018)

Social model - according to the model, impediments in the environment, in the society, and in people’s attitude
restrict persons with disabilities from fully participating in society. Also known as the Minority -group model of
disability - disability results from society’s failure to adapt to the needs and aspirations of a minority or impaired
people. Removing institutional… (Haan,2002)

Biopsychosocial model - Conceptualized by George Engel in 1977. Proposes that suffering, disease, or illness involve
a host of factors from biological (tissues, ddstructures, molecules) to environmental (social, psychological). Takes
into account the physical, psychological, and socfxial factors of the disease or injury and promotes an integrated
approach to treatment.
Basic principles:
1. The relationship between psychological and physical factors of health can be extremely complex.
2. These different factors affect each individual differently, since we are dealing with the individual's subjective
experience
3. Changes in one of these factors (biological, psychological or social/environmental) potentially create real and
notable changes in the other factors
https://rehabupracticesolutions.com/biopsychosocial/
History of Rehabilitation psychology
Ref in APA - 500 - 600 words - upload in pdf format - 15th Dec - Friday submission

MODULE 2 - DISABILITIES

Disability results from the interaction between individuals with a health condition with personal and environmental
factors (WHO)
Kazou (2017) Disability is any condition or impairments socially, cognitive, developmental, intellectual, mental,
physical, sensory or combination of multiple factors that makes it difficult for a person to do certain activities or
interact effectively with the surrounding world.
As estimated 1.3 billion people - or 16% of the global population - experience a significant disability today
Among the disabled population 56% (1.5 Cr) are males and 44% (1.18 Cr) are females (Census 2021, india). In total
population, the male and female population are 51% and 49% respectively
In India 20% of the disabled persons are having disability in movement, 19% are with disability in seeing, and another
19% are with disability in hearing. 8% has multiple disabilities.

WHO draws on a three fold distinction between impairment, disability and handicaps:
1. Impairment - any loss or abnormality or psychological, physiological or anatomical structure or function
2. Disability - any restriction or lack (resulting from an impairment) of ability to perform an activity in the
manner or within the range considered normal for a human being.
3. Handicap - a disadvantage, for a given individual, resulting from impairment or a disability, which prevents
the fulfillment of a role that is considered normal (depending in age, sex and social and cultural factors) for
that individual

Dimensions of disability
According to WHO (2011) there are three dimensions of disability
1. Impairment in a person’s body structure or function, or mental functioning
2. Activity limitation and
3. Participation restrictions
Causes of disability
Maxwell et al. (2007) explain different causes of disability as:
 Poisons and pesticides (term of exposure, nature of chemical) (teratogens - anything that inhibits the
development of fetus)
 Poverty and malnutrition (mineral deficiency)
 Inherited disabilities
 Nuclear accidents
 Wars
 Poor access to health care
 Illness
  Medicines and injections
 Dangerous working conditions
 Accidents

Types of disabilities
Physical disability - disability that affects a person’s physical capacity and mobility either temporarily or
permanently.
Intellectual/cognitive disability - disabilities that are limited in how people are able to learn or function, have very
low Intelligence Quotient (IQ) scores, fewer limits and are able to lead independent lives in the future.
Autism spectrum disorder - typically characterized by social deficits, communication difficulties, stereotyped or
repetitive behaviors and interests, and cognitive delays.
Learning disability - affects how they receive and process information, see, hear, and understand things differently;
can lead to trouble with learning new information and skills.
Sensory disability - impairment of the senses such as sight, hearing, taste, touch, smell, and/or spatial awareness.
Mental disability - clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that
reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.

Cerebral palsy

Muscular dystrophy
 A group of genetic disorders that lead to progressive and irreversible weakness and loss of muscle mass
 Caused by mutations in the gene responsible for making proteins that protect muscle fibres
 Signs and symptoms can include difficult walking, trouble breathing or swallowing, restriction in joint
motion, heart and other organ problems
 Clinically manifested in 2 different forms:
1. Duchenne MD
 Most common form of MD- mostly in bous
 Signs and symptoms, seen in early childhod, includes feequent falls, difficulty rising from
lying or sitting position, trouble running and jumping, waddling gait, walking on toes, large
calf muscles, muscle pain and stiffness, learning disabilities and delayed growth
2. H
D/B Muscluar dystory and cerebral palsy

MULTIPLE SCLEROSIS
 Disabling disease of the brain and spinal cord (CNS) with symptom onset generally occurring between the
age of 20 to 40 years
 In this, the immune system attacks the protective sheath (myelin) that cover the nerve fibers - results in
distinctive areas of scar tissue (sclerosis - also called plaques or lesions)
 Signs and symptoms may differ greatly from person to person and over the course of the disease depending
on the location of affected nerve fibers
 Etiology
1. Genetic susceptibility - dozens of genes and possibly hundreds of variations in the genetic code
(gene variants) combine to create vulnerability to MS
2. Breakage of blood brain barrier
3. Infectious factors and viruses - Epstein-Barr virus (EBV) is mostly consistently linked to MC
4. Environmental factors - Vitamin D deficiency
 Early MS symptoms often include
1. Vision problems such as blurred or double vision, or optic neuritis, which causes pain with eye
movement and rapid vision loss
2. Muscle weakness

EPILEPSY
 Also known as Seizure disorder - is a brain condition that causes recurring seizures - sudden burst of
electrical activity in the brain
 Can be caused due to genetic influence, head trauma, factors in the brain, infections, prenatal brain injuries,
developmental conditions
  General symptoms and warning signs
1. Staring
2. Jerking movement
3. Stiffening of the bosy
4. Loss of consioudness
5. Breathing problem
6. Loss of bowel or bladder control
7. Falling suddenly for no apparent reason, especially when associated with loss of consciousness
8. Not responding confused or in a haze
9. Nodding your head rhythmically, when associated with loss of awareness or loss of consciousness
10. Periods of rapid eye blinking and staring
 Can be caused by
1. Imbalance in nerve signaling brain chemicals
2. Brain tumor
3. Stroke
4. Brain damage
 Can be caused by a combination of these, in most cases, the cause of epilepsy can’t be found.
 Clinically manifested in 2 different forms
1. Focal (partial) seizure - bcs of abnormal electrical brain fuunction occurs in just one area of brain
a. Simple focal seizure/ occipital lobe seizure - have halluciantion, lose vision during seizure
b. Temporal lobe seizure
c. Frontal lobe seizure
2. Generalized seizure - occurs in both sides of the brain
a. Absence seizure/ Petit mal seizure
b. Tonic-clonic seizure/ grand mal seizure
c. Myoclonic seizures
3. Secondary generalized seizure - begins in one part of brain but then spreads to both sides of the brain
Intellectual disability/ cognitive disability
(REFER DSM V - TR - PAGE 38)
Diagnostic criteria
Intellectual developmental disorder (intellectual disability) is a disorder with onset during the developmental period
that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The
following three criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment,
academic learning, and learning from experience, confirmed by both clinical assessment and individualized,
standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for
personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in
one or more activities of daily life, such as communication, social participation, and independent living, across
multiple environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period.

Mild - 50-69
Moderate - 35-49
Severe - 20-34
Profound - <20

[THEORY OF MIND - understanding others perspectives and mental state]

(Theory of Mind is the branch of cognitive science that investigates how we ascribe mental states to other persons
and how we use the states to explain and predict the actions of those other persons.)

Conceptual domain - (academics)

Social domain
Practical domain
These domains are interlinked

AUTISM SPECTRUM DISORDER

It is a qualitative disorder
repetition of last word - Echolalia
repetition of actions - echopraxia
Saven syndrome - good iq in one aspect and not in others
IQ is normal, they have high functioning photographic memory and hippocampus works well, language and
communication is a primary problem for autistic individuals

Diagnostic criteria
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of
the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of
normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or
respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly
integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in
understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to
absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following,
currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up
toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
(e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or
preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g.,
apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or
touching of objects, visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social
demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current
functioning.
E. These disturbances are not better explained by intellectual developmental disorder (intellectual disability) or
global developmental delay. Intellectual developmental disorder and autism spectrum disorder frequently co-occur;
to make comorbid diagnoses of autism spectrum disorder and intellectual developmental disorder, social
communication should be below that expected for general developmental level.

Levels to be read from DSM

Risk and prognostic factors
Environmental - A variety of risk factors for neurodevelopmental disorders, such as advanced parental age, extreme
prematurity, or in utero exposures to certain drugs or teratogens like valproic acid, may broadly contribute to risk of
autism spectrum disorder
Genetic and physiological - Heritability estimates for autism spectrum disorder have ranged from 37% to higher than
90%, based on twin concordance rates, and a more recent five-country cohort estimated heritability at 80%.
Currently, as many as 15% of cases of autism spectrum disorder appear to be associated with a known genetic
mutation.

ASPERGER’S SYNDROME (ICD)

 A disorder of uncertain nosological validity, characterized by the same kind of qualitative abnormalities of
reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire
of interests and activities
 There is no general delay or retardation in language or in cognitive development
 Most individuals are of normal general intelligence but it is common for them to be markedly clumsy
 The condition occurs predominantly in boys (in a ratio of about eight boys to one girl)
 Savant syndrome: 10-30% of ASD

RETT'S SYNDROME
 A condition of unknown cause, so far reported only in girls, which has been differentiated on the basis of a
characteristic onset, course and pattern of symptomatology
 Typically, apparently normal or near-normal early development is followed by partial or complete loss of
acquired hand skills and of speech, together with deceleration in head growth, usually with an onset
between 7 and 24 months of age
 Hand-wringing stereotypies and loss of purposive hand movements are particularly characteristic
 Social and play development are arrested in the first 2 or 3 years, but social interest tends to be maintained

LEARNING DISABILITY/ SPECIFIC LEARNING DISORDER

Diagnostic disorder
A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following
symptoms that have persisted for at least 6 months, despite the provision of interventions that target those
difficulties:
1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly,
frequently guesses words, has difficulty sounding out words).
2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the
sequence, relationships, inferences, or deeper meanings of what is read).
3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants).
4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences;
employs poor paragraph organization; written expression of ideas lacks clarity).
5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their
magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as
peers do; gets lost in the midst of arithmetic computation and may switch procedures).
6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or
procedures to solve quantitative problems).
B. The affected academic skills are substantially and quantifiably below those expected for the individual’s
chronological age, and cause significant interference with academic or occupational performance, or with activities
of daily living.
C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for
those affected academic skills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing
lengthy complex reports for a tight deadline, excessively heavy academic loads).
D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory
acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic
instruction, or inadequate educational instruction.
Note: The four diagnostic criteria are to be met based on a clinical synthesis of the individual’s history
(developmental, medical, family, educational), school reports, and psychoeducational assessment.

Specify if:
F81.0 With impairment in reading:
Word reading accuracy
Reading rate or fluency
Reading comprehension
Note: Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterized by problems with
accurate or fluent word recognition, poor decoding, and poor spelling abilities.
F81.81 With impairment in written expression:
Spelling accuracy
Grammar and punctuation accuracy
Clarity or organization of written expression
F81.2 With impairment in mathematics:
Number sense
Memorization of arithmetic facts
Accurate or fluent calculation
Accurate math reasoning
Note: Dyscalculia is an alternative term used to refer to a pattern of difficulties characterized by problems processing
numerical information, learning arithmetic facts, and performing accurate or fluent calculations.

Specify current severity:

Mild: Some difficulties learning skills in one or two academic domains, but of mild enough severity that the individual
may be able to compensate or function well when provided with appropriate accommodations or support services,
especially during the school years.
Moderate: Marked difficulties learning skills in one or more academic domains, so that the individual is unlikely to
become proficient without some intervals of intensive and specialized teaching during the school years.
Severe: Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to
learn those skills without ongoing intensive individualized and specialized teaching for most of the school years.

Risk and prognostic factors

Environmental - Environmental factors, including socioeconomic conditions (e.g., low socioeconomic status) and
exposure to neurotoxicants, increase the risk for specific learning disorder or difficulties in reading and
mathematics.
Risks for specific learning disorders or difficulties in reading and mathematics include prenatal or early-life exposure
to any of the following: air pollution, nicotine, polybrominated diphenyl ethers or polychlorinated biphenyls (flame
retardants), lead, or manganese.
Genetic - Specific learning disorder appears to aggregate in families, particularly when affecting reading,
mathematics, and spelling. The relative risk of specific learning disorder in reading or mathematics is substantially
higher (e.g., 4–8 times and 5–10 times higher, respectively) in first-degree relatives of individuals with these learning
difficulties compared with those without them.

SENSORY DISABILITY (Crews & Campbell, 2004)

According to WHO, Sensory disability refers to the impairment of the senses such as sight, hearing, taste, touch,
smell, and /or spatial awareness.
It covers conditions of visual impairment, blindness, hearing loss and deafness
Visual impairment - Decrease or severe reduction in vision that cannot be corrected with standard glasses or contact
lenses and reduces an individual’s ability to function at specific or all tasks; low visual acuity.
Blindness - profound inability to distinguish light from dark, or the total inability to see
Hearing loss - decrease in hearing sensitivity of any level
Deafness - profound or total loss of hearing in both the ears

Types of Visual disability :

1. Blurred Vision/Refractive errors

• Nearsightedness (called myopia) is when you can see clearly up close but blurry in the distance
• Farsightedness (called hyperopia) is when you can see clearly in the distance but blurry up close
• Astigmatism is another condition that causes blurred vision, but it is because of the shape of the cornea
• Presbyopia, caused by a hardening of the lens of the eye; lens becomes less flexible, can no longer change shape to
focus on close-up Images

These conditions affect the shape of the eye and, in turn, how the eye sees
They can be corrected by eyeglasses, contact lenses, and in some cases surgery

2. Diabetic Retinopathy

Develops when high blood sugar damages the tiny fragile blood vessels in the retina of people with diabetes

There are four stages of DR:

Stage 1: Mild non-proliferative DR - earliest stage, characterized by tiny swellings/bulges in the blood vessels of the
retina
Stage 2: Moderate non-proliferative DR - at this stage, the tiny blood vessels further swell up, blocking blood flow to
the retina and preventing proper nourishment
Stage 3: Severo non-proliferative DR-During this stage, a larger section of blood vessels in the retina becomes
blocked, causing a significant decrease in blood flow to this area
Sage 4: Proliferative DR - At this advanced stage of the disease, new blood vessels continue to show, which are thin
and weak and prone to bleeding, cause scar tissue to form inside the eye

Risk and prognostic factors

 Type 1 and 2 diabetes
 Poor control of blood sugar level
 High blood pressure
 High cholestrol
 Pregnancy
 Being african american

3. Age related Macular Degeneration

• A disease that blurs the sharp, central vision needed to see straight-ahead
• Affects the part of the eye called the macula that is found in the center of the retina
• Clinically presented in either of the two forms:

1. Dry MD

More common
Caused due to the breaking down of the inner layers of macula
Visual distortions, such as straight lines seeming bent, reduced central vision in one or both eyes, need for brighter
light when reading or doing close-up work, increased difficulty adapting to low light levels

2. Wet MD

• Rare
• Severe form
• Caused by blood vessels that leak fluid or blood into the macula

Risk and Prognostic factors

Factors that may increase your risk of macular degeneration include:
 Age - This disease is most common in people over 60
 Family history and genetics - This disease has a hereditary component. Researchers have Identified several
genes linked to the condition
 Race - Macular degeneration is more common in white people
 Smoking - Smoking cigarettes or being regularly exposed to tobacco smoke greatly Increases your risk of
macular degeneration
 Obesity - Research indicates that being obese may increase your chance that early or intermediate macular
degeneration will progress to the more severe form of the disease
 Cardiovascular disease - If you have heart or blood vessel disease, you may be at higher risk of macular
degeneration
4. Glaucoma

• A group of eye conditions that damage the optic nerve Intraocular pressure caused due to increases
• Clinically manifested in two forms:

1. Open-angle glaucoma

• Most common type of glaucoma

• Progresses gradually, where the eye does not drain fluid as well as it should
• Eye pressure builds and starts to damage the optic nerve
• This type of glaucoma is painless and causes no vision changes at first

2. Angle-closure glaucoma

• Happens when someone's iris is very close to the drainage angle in their eye; iris can end up blocking the drainage
angle
• When the drainage angle gets completely blocked, eye pressure rises very quickly, called an acute attack
• Characterized by sudden blurry vision, severe eye pain, headache, nausea, vomiting etc

Risk and Prognostic factors

Some people have a higher than normal risk of getting glaucoma. This includes people who:
 are over age 40
 have family members with glaucoma
 are of African, Hispanic, or Asian heritage
 have high eye pressure
 are farsighted or nearsighted
 have had an eye injury
 use long-term steroid medications
 have corneas that are thin in the center
 have thinning of the optic nerve
 have diabetes, migraines, high blood pressure, poor blood circulation or other health problems affecting the
whole body

4. Cataract

• A cataract is a clouding of the lens of the eye - proteins in the lens of the eye start to break down and clump
together, causing the cloudiness
• Often leads to poor vision at night, especially while driving, due to glare from bright lights
• Cataracts are most common in older people, but can also occur in young adults and children
• Cataract treatment is very successful and widely available

sMODULE 5
GOVT POLICIES AND SCHEMES

Schemes - come up with a plan or frmaework or blueprint toimplement something

Policies - this is the part of implementing schemes for a particular population to follow, it is more like an activity it
has to be folowed atleast in the premises.
Programs - more behavioral in nature and falls in line with the objectives of the scheme. It is a suggestion and its
peoples choice to follow it.
Acts - it is to a greater amount of population and the decision is made by a superior authority. Once an act in
enforced it becomes a law
Bill - precursor of an act that is to be implemented and passed by legislature members.
The implementation of schemes and policies for disabled individuals is crucial for several reasons:

1. Equal opportunity
2. Human rights and dignity
3. Social inclusion
4. Helath nad wellebing
5. Economic empowerment
6. Education and skills development
7. Community building
8. Legal and ethical obligations
9. Long term societal benefits

National policy for person with disabilities, 2006

The national poicy recognises that pppl with disabilities are valuable human resources for the coutry and seeks to
create an environment that provides them:
 Equal opportunity
 Protection of their risghts and full participation

The national policy recognizes that fact that a majority of persons with disabilities can lead to a better quality of life
if they have equal opportunities and effective access to rehabilitation measures
The salient features of the national policy are:
1. Physical rehabilitation
2. Educational rehabilitation
3. Economic rehabilitation

Incharge
Ministry of social justice and empowerment
Department of empowerment of persons with disabilities
Rehabilitation council of india

Legislations
4 acts