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Multidisciplinary

approach in management
of disability

Bhaskar Borgohain
MS , DNB, Fellow (Arthroplasty)

Asst Professor, Orthopaedics &


Trauma
N.E.I.G.R.I.H.M.S., Shillong
THE PAST
THE BAD NEWS FROM THE PAST:

 Nihilistic ideas from the beginning


to
the end

 Defeatist’s attitude.
THE FIRST BARRIER
Negative attitude towards disabled
is
the first barrier in rehabilitation
The paradox
 Disability is a worldwide
phenomenon.
 But positive steps to prevent and
manage disability are painfully not
so universal despite the fact that
we all belong to 21st century.
THE PRESENT LOOKS
GOOD
It’s all about attitude
 Fortunately, attitude is changing slowly
but surely.

 We are now beginning to understand


them better

 Disabled are often "differently able” in


another direction.
VIBGYORTM : 7 Rays of hope

 D- Don't Underestimate
 I - Innocent
 S- Sensitive
 A- Able To Do Many Other Things
 B- Basic Needs Must Be Fulfilled
 L- Learning Will Give Them Hope And
Employment
 E- Economic Support
Definition of Disability:
W. H.O.
 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.
 This impairment may be temporary

or permanent
Rehabilitation:
Definition
“Ultimate restoration of disabled
persons to his maximum capacity:
physical, emotional and
vocational”

Make him as independent as possible


in the shortest possible time.
Disabled: improve
ability
 Medical support: Adaptive adjustments &
retraining to gain maximum potential to
improve his quality of life.
 Emotional support from Family & Society
 Vocational support from Government
 Technological support: information
learning & research
The “M” factors
 Money
 Manpower
 Motivation
 Medical service facility
 Monitoring progress of
rehabilitation
 Medical research
Why Multimodality
Approach?

 Multiple problems at the same time: Disabled


person suffers due to his multidimensional
limitations.
 Deal with all needs: The most successful role
model addresses physical, emotional and
vocational needs based on team approach
 Adopt Various positive steps at the same time
to Minimize all potential complications
 One expert alone is not enough.
What is a ‘TEAM’
 A team is nothing but a combination of motivated
people who share a common goal.
 The shared goal: To reduce or prevent barrier to
successful rehabilitation
 Every team member play their own unique role
besides coordinating with each other with positive
& negative feedbacks to other members to
achieve this shared goal.
ROLE OF THE DISABILITY
(Medical) MANAGEMENT
TEAM
THE GOAL:
“To reduce or prevent barrier to successful
rehabilitation.”
 Provide Physical & emotional rehabilitation

 To prevent or treat potential complications


The medical team:
Essential members
 Physician from  Psychologist/
various medical- Psychiatrist
surgical specialties  Speech therapist,
 Nurses from various  Medical social
medical- surgical
worker as well as the
specialties
patient and his family
 Physical therapist & members.
Occupational  New team member
therapist,
may be added from
 Orthotic /Prosthetic time to time if need
expert arises.
INDIVIDUAL ROLES OF TEAM
MEMBERS

 Role of nursing staff: To take care of


the bodily needs of the disabled

 Nursing: Nutrition, hygiene, handling of


secretions and psychological support.

 Physical therapist: maximizes motor


function and maintain musculoskeletal
& cardiovascular physiology by various
physical means.
INDIVIDUAL ROLES OF TEAM
MEMBERS

 Speech therapist: Develop effective


communication skills to children born with MR.
 Psychiatrist/ Psychologist: Emotional
rehabilitation through motivation & development of
positive attitude towards the disability
 Orthotist (Brace-maker): Custom-made splints
suitable for musculoskeletal disabilities like polio to
improve motor function & prevent deformities from
developing.
Common goal:
Important Objectives
 Accurately  Mobilizing the patient
diagnosing all as early as possible
current existing
problems
 Restoration of function
including training for
 Adequately treating readjustment to
these problems altered life style
 Establishing  Social &
adequate nutrition psychological
 Monitoring for any rehabilitation
complication that  Vocational
may impede progress rehabilitation
in recovery
Role of Government:
Emotional/Vocational

 Legislations  ‘Health for all’


 Disable friendly  Education

 Employment &  Proactive & not


Reservation reactive

 Information &  Prevention


Communication
Role of NGO’s
 Information & communication
 Emotional & vocational rehab.
 Pressure group & support group
 Agent of change-Attitude
 Prevention
Prevention is better than
cure
 Holistic management of a disable
person is a huge task and it is easier
said than done.
 So, Prevent disability from occurring.
 Only Prevention can ultimately
contain the epidemic of disability.
 Prevention is the only cure of any
disability
Types of prevention
 Primordial prevention: Nip it in the bud. e.g.
fortification of foods by government to
prevent Vitamin A deficiency blindness.
 Primary prevention: Protecting the potential
high risk groups. Example, vaccination
against polio.
 Secondary prevention: It means early
diagnosis and treatment. MTP (medical
termination of pregnancy) may be an
example to reduce Down’s Syndrome
Tertiary prevention is
called ‘Management’

 Prevention of complications of manifested


symptoms of the disease
 Treatment of manifested symptoms of
that disease through rehabilitation.
 Management of disability
 Example: Early mobility to a spinal injury
paraplegic patient to prevent bed sores,
deep vein thrombosis and fatal pulmonary
embolism.
Critical in all types of
prevention.
 Information, Education &
Communication with common
people by the Government, Health-
care providing machinery & NGOs
 NGO can play a major path-
breaking role, esp. in primordial
and primary prevention of
disability
Diagnosis is Easy, but
Management is Not
 A good clinical history taken by an experienced
doctor from the parents or family regarding the
progression and chronology of events of the
disease from the onset often clinches the exact
diagnosis.
 Additional laboratory tests and radiological
investigations may be needed sometime to
conclude a diagnosis.
 But identifying the real cause of disability may
be difficult in some cases particularly when the
disability is occurring in a small growing child
who cannot communicate with others.
The Challenges.
 Exact assessment of severity of disability,
ultimate prognosis & outlook of the disabled.
 The damage to the brain for example may
significantly alter a person’s ability to
understand & respond to commands creating
tremendous obstacles in retraining &
rehabilitation
 Huge long term social and financial burden
along with continuous need to keeping up the
moral of the patient and the family are real
challenges.
Multimodality
approach:
 Treat the cause  Maintain adequate
whenever treatable to nutritional needs and
minimize more disability hygiene
from occurring
 Treat all current
 Make them as
problems simultaneously independent as
with multimodality possible
approach  Target short-term
 Prevent all goals first to increase
potential/anticipated motivation
problems  Aim for long-term goal
 Interdisciplinary co- through coordinated
ordination
plan by discussion
amongst all members
of the team.
Prognostic Factors

 Root cause of the


disability (Treatable Vs
 Neuromuscular
Untreatable) status & Mobility
 Extent and severity of  Emotion &
the disability Motivation
 Cognitive abilities: (Optimism Vs Denial)
Speech, learning &  Attitude & Approach
intelligence for effective
to the problems
communication with
care-givers (Positive Vs
Negative)
Other Prognostic
factors

 Family support (financial and


psychological)
 Nutritional status at onset of
disability
 Associated present problems (co-
morbid conditions)
Modifiable Vs Un-modifiable
factors

 Modifiable factors: Should be targeted to


improve outcome of rehabilitation.
 Improving cognitive functions of speech
and learning can help a mentally retarded
cerebral palsy child to get a vocational
training and a job.
 Un-modifiable factors: Realistic goal during
management.
Common medical
problems in
rehabilitation
 Inadequate nutrition  Spasticity or abnormal gait
 Sensory impairment leading to
pressure-sores
 Emotional lability  Secondary acquired
musculoskeletal deformities like
 Cognitive impairments- contractures
Speech and learning  Secondary acquired
disability musculoskeletal disuse atrophy
 Osteoporosis with risk of easy
fractures, muscle wasting and
 Auditory & Visual disability deconditioning, pressure
limiting traditional learning paralysis of nerve.

 Urinary tract infection


Common non-medical
problems
 Poor access to health: neglect
 Financial limitations: undertreatment
 Emotional deprivation & isolation
 Vocational deprivation
 Unemployment: feeling of burden
 Nutritional deprivation
 Attitude of neglect
The Indian scenario
 Limited information, financial crisis and
limited access to health-care facilities
 In small towns or rural areas remains
important burning problems encountered by
disabled families in India.
 Special school and disable-friendly school
and disable-friendly recreation facilities are
often unheard of in rural India.
India: the future
 India: Developing country with high
population & Can’t support a holistic
healthcare facility to all
 Prevention:
More important than providing
limited rehabilitation facilities to a
handful of disabled of urban India
Science & disability:
the present & the
future
 PREVENTION: At all levels
 RESEARCH: better understanding
 COMPUTER & IT: user-friendly
 SATTELITE:GPS during driving
 GENE THERAPY: contain or cure
 BIOTECHNOLOGY & BIOENGINEERING
 NANOTECHNOLOGY: Gene therapy
EPILOGUE: THINK
POSITIVE.

 Disability doesn’t mean


hopelessness and inaction.
 Rehabilitation is all about hope and
action.
 Any disabled must have access to
proper Nutrition, Hygiene,
Psychological support, Vocational
training and Social support and
Social justice.
Attitude: Half a glass of
water?
 Look for their abilities (both existing
and potential) rather than disability.
 They are disable but not unable.
 Help them to make the most effective
use of their residual function.
 Call them ‘These able people’ rather
than ‘DIS-able people’.
NOTHING SUCCEDS
LIKE SUCCESS
 Former US President Roosevelt: Fought
two great wars in life and won both… his
polio affected legs and the World War II.
 So, my dear friends believe in the words
of Helen Keller “look to the sunshine and
you will never see shadow”!
THANK YOU