Disability Functioning and Rehabilitation Principles
1.1 Human Social Impact of Disability
Disability is defined as a medical condition plus social barriers.
Consequences include stigma, discrimination, economic burden, caregiver stress, and lack of access (transport, education).
Example: A patient with Spinal Cord Injury (SCI) may be medically stable but unable to work due to the absence of ramps or accessible transport.
1.2 International Classification of Functioning (ICF, WHO 2001)
Need: To unify the medical and social models of disability.
Aims: To establish a common language, standardized measurement, and to guide rehabilitation, policy, and research.
Uses: Clinical practice (setting rehabilitation goals), education, policy making, and statistics.
The ICF Model (BAPIE):
Body functions/structures → impairments (e.g., paralysis, blindness).
Activities → tasks (e.g., walking, eating).
Participation → life roles (e.g., school, work).
Environmental factors → external influences (e.g., ramps, laws, stigma).
Personal factors → individual characteristics (e.g., age, education, motivation).
Qualifiers: Range from 0 (no problem) to 4 (complete problem).
WHO-FIC Context: ICD addresses diagnosis, while ICF addresses functioning.
Example: Following a stroke → impairment is hemiplegia; activity limitation is the inability to dress; participation restriction is the inability to return to teaching.
1.3 Psychosocial Aspects of Disability
Psychological effects: Depression, anxiety, and low self-esteem.
Social effects: Isolation, discrimination, and reduced community participation.
Rehabilitation strategies: Counseling, peer support groups, and family support.
Rehabilitation Principles
Holistic approach: Addressing physical, psychological, and social needs.
Patient-centered care: Goals are set collaboratively with the patient.
Multidisciplinary team: Involving Physical Therapy (PT), Occupational Therapy (OT), speech therapy, and psychology.
Independence: Maximizing patient autonomy.
2.1 Spinal Cord Injuries (SCI)
Causes: Trauma (accidents, falls), tumors, or infection.
Types: Complete (total loss of function) or incomplete (partial function remains).
Levels of Injury: Cervical injuries result in tetraplegia; thoracic or lumbar injuries result in paraplegia.
Complications: Bladder/bowel dysfunction, pressure ulcers, infections, and autonomic dysreflexia.
Rehabilitation: Includes stabilization, PT, mobility aids (wheelchairs, exoskeletons), and bladder training.
2.2 Brain Injuries
TBI refers to traumatic brain injury; ABI includes stroke, tumor, hypoxia, or infection.
Common Symptoms:
Cognitive: Memory loss, poor attention span.
Motor: Paralysis, imbalance.
Speech: Aphasia, dysarthria.
Behavioral: Aggression, depression.
Rehabilitation: Speech therapy, cognitive rehabilitation, PT, OT, and social reintegration.
2.3 Cerebral Palsy (CP)
Definition: A non-progressive brain injury occurring during development.
Causes: Prenatal (infection), perinatal (asphyxia), or postnatal (trauma).
Types: Spastic (most common), dyskinetic, ataxic, or mixed.
Symptoms: Spasticity, poor coordination, speech/swallowing difficulties, and seizures.
Rehabilitation: PT, OT, speech therapy, medication (e.g., baclofen, Botox), orthopedic surgery, and assistive devices.
2.4 Chronic Pain
Definition: Pain persisting for more than three months.
Causes: Musculoskeletal issues, neuropathic conditions, or fibromyalgia.
Impact: Fatigue, depression, and reduced quality of life.
Rehabilitation: Analgesics, PT, Cognitive Behavioral Therapy (CBT), lifestyle modification/exercise, and multidisciplinary pain clinics.
2.5 Multiple Sclerosis (MS)
Definition: An autoimmune condition causing demyelination of the Central Nervous System (CNS).
Types: Relapsing-Remitting (RRMS), Secondary Progressive (SPMS), Primary Progressive (PPMS).
Symptoms: Vision loss (optic neuritis), fatigue, weakness, tremor, and cognitive decline.
Rehabilitation: PT, OT, speech therapy, and disease-modifying therapies (medications).
MS is more common in young women.
2.6 Vision & Hearing Impairments
Vision Impairments
Common causes: Cataract, glaucoma, diabetic retinopathy, macular degeneration.
Rehabilitation: Glasses, surgery, Braille instruction, and orientation training.
Hearing Impairments
Types: Conductive (outer/middle ear) or sensorineural (inner ear/nerve).
Rehabilitation: Hearing aids, cochlear implants, sign language, and speech therapy.
2.7 Amputations
Types: Upper limb (transradial, transhumeral) or lower limb (Below Knee Amputation [BKA], Above Knee Amputation [AKA]).
Surgical Steps: Assessment → level selection → skin/muscle flap creation → bone cutting → nerve management → flap closure.
Open vs. Closed Amputation: Open is used for infection/emergency; closed allows for prosthetic fitting.
Advantage of BKA over AKA: Results in a more efficient gait, requires less energy expenditure, and allows for better prosthetic use.
Rehabilitation: Prosthetic fitting, gait training, phantom pain management, and psychological support.
2.8 Substance Abuse
Definition: Disability resulting from drug or alcohol dependence.
Consequences: Physical damage (liver, brain), psychological issues (depression), and social problems (job loss, crime).
Rehabilitation: Detoxification, CBT, support groups (AA/NA), and vocational training.
Note: Due to a high relapse risk, long-term care is often necessary.
2.9 Other Types of Disability
Genetic Conditions: Down syndrome, muscular dystrophy.
Developmental Conditions: Autism spectrum disorder, intellectual disability.
Mental Health Conditions: Schizophrenia, bipolar disorder.
Rehabilitation Focus: Multidisciplinary care covering medical, educational, psychological, and social inclusion aspects.