CARE OF DIFFERENTLY DISABLED

PERSON
• The International Classification of Impairments,
Disabilities and Handicaps (ICIDH) published in
1980 by WHO also contributed to a medical
approach.

• ICIDH defines a model that progresses from disease,

impairment and disability to handicap in a linear fashion
Disease Impairment Disability Handicap
 HEALTH
WHO’s definition:
Physical, psychological and socially
complete well-being.
 IMPAIRMENT

Definition: Any loss or abnormality of

psychological, physiological, or anatomical
structure or function.
 DISABILITY

Any restriction or lack

resulting from impairment
of ability to perform an
activity in the manner or
within the range considered
normal for a human being.
 HANDICAP
A disadvantage for a given
individual resulting from an
impairment or a disability
that limits or prevents the
fulfillment of a role that is
normal (depending on the age,
gender, social and cultural
factors) for that individual.
 WHO DEFINITIONS

Impairment ↔ Organ or Tissue

Disability ↔ Whole Person

Handicap ↔ Society
Impairment is defined as defined as
abnormality of structure or function of the body
or an organ.
Disability is defined as restriction or lack of
ability as a result of the impairment.
Handicap is defined as a social disadvantage faced
by an individual resulting from either impairment
or disability.
 HANDICAPPED CHILDREN
Handicapped child is one
who deviates from normal
health status either
physically, mentally or
socially and requires
special care, treatment
and education.
DEFINITION
According to WHO, the sequence of events leading
to disability and handicapped conditions are as
follows
Injury or disease

Impairment,

Disability

,
 CLASSIFICATION OF
DISSABILITY
Loco motor disability

Hearing and Speech Disability.

Visual Disability.

Mental Retardation.
Loco motor
disability
 Loco motor disability
Locomotor disability occurs when movements in our body are
affected due to disease, injury, any absence or deformities in the
joints, bones and muscles, or an injury of the nerves, spinal cord
or brain.
Locomotor impairment can lead to paralysis (paraplegia,
monoplegia, and hemiplegia), weakness, spasticity, sensory loss,
pressure ulcer, incontinence, urinary retention, deformities and
contractures, hearing or speech impairment, visual loss, mental
retardation, limitations in the Activities of Daily Living (ADL) etc.
 Causes

Congenital and
Developmental

Acquired.
Congenital and Developmental

Cerebral Palsy.

Meningocele.

Dislocation of hip
 Aquired
Infective:- TB (spine/joints), Chronic, osteomyelitis, Septic arthritis,
Poliomyelitis, Encephalitis, Leprosy etc.

Metabolic:- Rickets, Diabetic neuropathy Gout, Vita B-12 deficiency

Neoplastic:- Brain and spinal tumors, Osteosarcoma etc.
Vascular:- Cardiovascular accidents, Amputation due to Buerger’s
disease etc.

Degenerative:- Parkinson’s disease, Osteoarthritis, Spondylosis,

Multiple sclerosis.
Miscellaneous:- Muscular dystrophies, Lathyrism, Rheumatoid arthritis

Traumatic:- Accidents, Burn, Violence, Natural catastrophes

 Management of Locomotor Disabled /
Handicapped.

 Prevention of disabilities (at all the three levels;

primary, secondary and tertiary).
 Maximum elimination of the disabilities.
 Improvement in the Daily Activities of Living (ADL).
Patients or persons may suffer with the problems of
transfer, ambulation, transportation, self-care
activities, social and work place activities.
 Cont…

 Prevention from contractures and other

complications.
 Keen observation over any sign of pressure sores.
 Observation over bladder & bowel activities.
 Provision for self-help devices, aids and appliances
(commode, wheel chair, cane etc.).
 Rehabilitation: Psychosocial and vocational.
 Hearing and Speech Disability

Hearing impairment or disability indicates deafness.

Deafness is a condition in which the child/adult
suffers from hearing difficulties. The extent of
deafness depends upon the (i) type, and (ii) degree of
hearing impairment.
 Definition of Hearing Impairment:-

According to the Persons with Disabilities

(equal opportunities, protection of rights and
full participation) Act-1995, hearing
impairment means “loss of 60 decibels or
more in the better ear in the conversational
range of frequencies”.
 Classification of Hearing Disability or Loss

1. Onset of loss.
Congenital-Since birth.
Acquired-Anytime in life.
2. Site of lesion.
Conductive hearing loss: Outer ear/middle ear is
affected.
Sensorineural hearing loss: Acoustic nerve is
damaged.
Mixed hearing loss: Combination of conductive and
sensorineural loss.
Central auditory disorder: Problems within the central
auditory system.
 Classification of Hearing Disability or Loss

3. Degree of hearing loss.

Average Hearing Level Severity of Hearing Loss

(in decibels)
0-25 Normal
26-40 Mild
41-55 Moderate
56-70 Moderately Severe
71-90 Severe
91+ Profound
Causes of Hearing Disability

• Prenatal causes

• Natal causes

• Postnatal causes
 Prevention of Deafness
 Improving the MCH services
 Avoid the following:
-putting slate, pencil, pen, hairpin, chalk piece etc. in the ear.
-bathing in stagnant water.
-driving in water without ear protector.
-consanguineous (among blood relations) marriages.
-marriage in a family with a history of birth deafness.
-entering/ remaining in noisy areas.
 Sound pollution should be controlled.
 Ear hygiene should be improved.
 Proper immunization.
 Health education about safety of the hearing capabilities and ears.
 Management of Hearing Disabled /
Handicapped
 Early identification of the hearing impairment.
 Appropriate assessment for the type & degree of
hearing loss.
 Prevention of the causation of hearing loss.
 Needful medical and surgical intervention.
 Providing hearing aids.
 Special education
 Vocational rehabilitation.
 Psychological support.
 Speech and Language Disability

The ability to speak well is an asset. If one’s speech is

defective, it may become very difficult to manage many
situations in life. There are large number of persons /
children suffering from speech and language disorders.
Generally, speech impairment or disability does
not interfere with the normal activities of a person. There
is no such survey, which can provide the exact number of
speech disabled. Though speech handicap is associated
with deafness.
Classification of Speech & Language Disorders
 Articulation (speech sound) disorders.
 Fluency disorders (stuttering)
 Voice disorders ( alteration in pitch/ quality/ loudness)
 Language disorders in preschool & school age children.
 Speech & Language disorders in persons having
following problems:-
 Hearing impairment.
 Cleft palate.
 Cerebral palsy.
 Neurogenic disorders.
 Aphasia.
Causes of Speech Impairment / Disability

 Congenital defects and abnormalities.

 Deformities of mouth.
 Injury to tongue, mouth, vocal card, larynx etc.
 Paralysis of vocal card/ facial paralysis.
 Deafness / hearing impairment.
 Mental retardation.
 Lack of speech training.
 Cleft palate, cerebral palsy, laryngeal tumors.
 Neurogenic, genetic or psychological etc.
 Management of Deafness / Speech Handicapped

 Early identification of speech impairment.

 Appropriate preventive measures should be taken to prevent
speech impairment.
 Elimination of hearing impairment (Deaf child cannot speak)
 Medical & surgical intervention, as and when needed.
 Taking the advice of speech pathologist /speech therapist
and following their instructions.
 Providing a good speech model to child.
 Psychological counselling.
 Positive attitude of society towards speech handicaps; avoid
making fun of their speech, it hurts them.
 Visual Disability
 Eyes are the most important sense organs by which we
see the world. Visual impairment affects all aspects of life,
and Blindness is counted as a disgrace of the God.
Previously in some community, blind people had no
place. Now the attitude of society has been changed
towards blind handicapped. Still, we talk about what the
blind cannot do, but it needs a conviction to tell all the
things a blind can do.
 Definition of Blindness

According to WHO “Blindness is a visual

activity of less than 3/60 (Snellen) or its
equivalent”. In further clarification WHO
describes blindness as an inability to count
fingers in daylight at a distance of 3 meters.
Blindness may be partial, mild to moderate or
complete.
 Causes of Blindness

 Eye diseases and conditions

 Congenital disorders
 Malnutrition
 Injury or accident
 Systemic diseases
 Socioeconomic and environmental factors
Prevention of Blindness

Primary care

Secondary care

Tertiary care
Management of Visually Handicapped
 Assessment of visual impairment.
 Provide preventive & therapeutic care at all three levels.
 Conducting the specific programmes
 Involving all concepts of eye care
 Evaluating the intervention & preventive programmes
periodically.
 Creating community awareness about eye care & eye
safety through information, education & communication.
 Providing help and aids for blind handicapped.
 Rehabilitation services for visually handicapped.
Role of Community Health Nurse in Care of
Handicaps

 Prevention from disability at all levels of care.

 Early identification of risk factors and
impairment/disability.
 Assessment of extent of handicap.
 Referral to specialists of concerning discipline,
seeking advice.
 Co-ordination between the efforts and team
members, NGOs, agencies etc.
Role of Community Health Nurse in Care of
Handicaps

 IEC activities for handicaps.

 Arrangement for helping devices/aids for
handicaps, minor repairs.
 Check on further complications/deterioration.
 Rehabilitation: Medical and physical, social,
psychological and vocational.
 Nursing research for the care of handicapped.
 Mental Retardation

According to Persons with Disability Act-1995

“Mental retardation means a condition of arrested or
incomplete development of mind of a person which is
specially characterized by subnormal intelligence”.
In other words, we can say that mental
retardation or mental handicap is a state of sub
average intellectual function combined with deficits in
adaptive behavior.
Main Characteristics of Mental Retardation

 Intelligence should be significantly sub

average.
 This should have occurred in the
developmental period i.e , up to the age of 18
yrs.
 Behavior should be significantly
inappropriate.
 Classification of Mental Retardation

According to American Association of Mental

Retardation (AAMR)

Degree of Retardation IQ Range

Profoundly Retarded 0-29
Severely Retarded 25-39
Moderately Retarded 40-54
Mildly Retarded 55-69
Borderline 70-84
 Cont…

According to WHO

Degree of Retardation IQ Range

Mild MR 50-70
Moderate MR 35-49
Severe MR 20-34
Profound MR under 20
 Causes of Mental Retardation

Endogenous or Genetic Causes.

 Chromosomal anomalies i.e. Down’s syndrome.
 Cretinism: Impaired deficiency of thyroid gland.
 Phenyl Ketonuria (PKU): Defect in aminoacid
metabolism.
 Galactosemia: Inborne error of CHO metabolism.
 Consanguineous marriages: Marriage between blood
relatives
 Causes of Mental Retardation

Exogenous or Environmental Causes.

 Pre-natal causes.
 Natal causes.
 Post-natal causes.
 Socio-cultural and economical factors.
Prevention of Mental Retardation

Primary prevention

Secondary prevention

Tertiary prevention
 Management of Mentally Handicapped
 Assessing the extent of the problem, informing the reality to relatives
/parents.
 Innovative teaching methodology for providing special education to
mentally handicapped.
 Psychotherapeutic intervention as and when needed.
 Strengthen the family system of mentally handicapped person/child.
 Taking the help of NGOs, voluntary agencies in the care and
management of mentally handicaps along with govt. measures.
 Creating a positive attitude in the society towards mentally handicaps.
 Proper rehabilitation according to individual need, including vocational
rehabilitation of the mentally handicaps.