Community Based Rehabilitation PDF

Community Based Rehabilitation Dr Nalan Soydaş Engin Physiatrist Concepts Definition of Rehabilitation Comparison of community-based rehabilitation (CBR) and institutional-based rehabilitation (IBR) Role of Physiotherapists in CBR approach  What is reh...

Community Based Rehabilitation Dr Nalan Soydaş Engin Physiatrist Concepts Definition of Rehabilitation Comparison of community-based rehabilitation (CBR) and institutional-based rehabilitation (IBR) Role of Physiotherapists in CBR approach  What is rehabilitation? The action of - restoring someone to health or normal life - through training and therapy - after illness or injury or a side effect from a medical treatment. Rehabilitation is care that can help you get back, keep, or improve abilities (physical, mental, and/or cognitive (thinking and learning)) that you need for daily life.  Goals of Rehabilitation? (orthopedic) Phase 1 - Control Pain and Swelling. Phase 2 - Improve Range of Motion and/or Flexibility. Phase 3 - Improve Strength & Begin Proprioception/Balance Training. Phase 4 - Proprioception/Balance Training & Sport-Specific Training. Phase 5 - Gradual Return to Full Activity.  Principles Guiding Rehabilitation Promote Adaptation. Emphasise Abilities. Treat the Whole Person. Time. Educate. People Centred Care  Until recently, rehabilitation was understood as a complex task requiring - specialized rehabilitation services - provided by professionally qualified staff - working from specialized rehabilitation centres. The services addressed disability-related needs arising from a diversity of conditions, and were based in cities and urban centres with little community involvement.  The Joint Position Paper of the International Labour Office (ILO), the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the World Health Organization (WHO) on CBR (2004) defines CBR as follows: “CBR is a strategy within general community development for the rehabilitation, equalization of opportunities and social inclusion of all people with disabilities”.  What is Community Rehabilitation? A community development strategy Aims to enhance the quality of life for people with disabilities and their families, Ensure their inclusion and participation in the community. THE GUIDING PRINCIPLES OF CBR 1.Inclusion 2. Participation 3. Self-advocacy 4. Sustainability 5. Equal opportunity 6. Accessibility  Declaration of Alma-Ata (1978) Health is a fundamental human right, and considering the limitation and constraints of specialized medical rehabilitation services, the World Health Organization introduced the strategy of Community Based Rehabilitation (CBR).  İntention of CBR to enhance the quality of life for people with disabilities th rough community initiatives. to promote the concept of the “inclusive community”, local resources being used to support the rehabilitation of people with disabilities in their own communities.  INCLUSION Placing disability issues and PWD in the mainstream of activities. CBR works to remove all kinds of barriers which block people with disabilities from access to the mainstream of society.  When differences are not accepted by society a segregation occurs. When a child low vision is separated from her classmates and enrolled in SPED class, her impairment becomes a disability, a label to justify exclusion. CBR works with families, schools and communities to counsel and inform that all children should be together.  Respecting differences Each community is made up of diverse groups and individuals who do not fit into “norm”. We try to change individuals and groups to “fit” into standard ways of being citizens. Instead we should respect diversity so that everyone is accepted and included.  PARTICIPATION People with disabilities and their families have the right to decide, plan, evaluate, manage, and implement programs, in partnership with the community. Participation means persons with disabilities have choice and decide for themselves. No intervention should be carried out on them without their consent  PARTICIPATION CBR focuses on abilities, not disabilities. It depends on the participation and support of people with disability, family members and local communities. It also means the involvement of people with disabilities as active contributors to the CBR programme, from policy- making to implementation and evaluation, for the simple reason that they know what their needs are.  Empowerment Local people – and specifically people with disabilities and their families, ultimately may make the programme decisions and control the resources. This requires people with disability taking leadership roles within programmes. It means ensuring that CBR workers, service providers and facilitators include people with disabilities and that all are adequately trained and supported. Results are seen in restored dignity and self-confidence.  Equity CBR emphasizes equality of opportunities and rights – equal citizenship.  Raising awareness CBR addresses attitudes and behaviour within the community, developing understanding and support for people with disabilities and ensuring sustainable benefits. It also promotes the need for and benefit of inclusion of disability in all developmental initiatives.  Self -advocacy CBR consistently involves people with disabilities in all issues related to their well-being. Self-advocacy is a collective notion meaning self-determination. It means mobilizing, organizing, representing, and creating space for interactions and demands.  Facilitation CBR requires multisectoral collaboration to support the community and to address the individual needs of people with disability, with the ultimate aim of an inclusive society.  Gender sensitivity and special needs CBR is responsive to individuals and groups within the community with special needs.  Partnerships CBR depends on effective partnerships with - community-based organizations, - government organizations, - other organized groups.  Sustainability CBR activities must be sustainable beyond the immediate life of the programme itself. They must be able to continue beyond the initial interventions, and be independent of the initiating agency. The benefits of the programme must be long-lasting.  Rehabilitation Services required by PWD physiotherapy, orthopaedic services, occupational therapy, surgery. “socioeconomic rehabilitation” (SER) activities (vocational training, integrated education, micro-finance and business creation schemes, provision or improvement of appropriate housing, and advocacy at various levels The preferred strategy for implementing most of these services is CBR.  CBR recognizes the importance of activities - to prevent all kinds of avoidable disabilities, - through health education, medical interventions or physical rehabilitation, - enhancement of functioning through therapeutic interventions and assistive devices. The CBR approach people with disabilities are able to assumes work together to organize their own that lives and their own development, drawing on the active involvement and support of their families and local community. It ensures that those affected are accepted in the community  Poverty both a cause and a consequence of disability. limits access to basic health services and to education. Reducing poverty is a key strategy both for prevention of disability and for rehabilitation. CBR will be most effective if it leads to poverty alleviation of people with disability, their family and the wider community The scope and complexity of CBR activities requires close cooperation and communication between those involved with the community, those concerned with the prevention of disability, those involved in promoting social and economic well-being.