CBR in musculoskeletal disorders

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CBR IN MUSCULOSKELETAL DISORDERS By: Hariyalee 2 nd year MPT

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4 September 2011 Introduction : COMMUNITY BASED REHABILITATION (CBR) It is a strategy within general community development for the rehabilitation, equalization of opportunities and social inclusion of all people with disabilities.

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4 September 2011 Rehabilitation includes all measures aimed at reducing the impact of disability for an individual, enabling him or her to achieve independence, social integration, a better quality of life and self-actualization. Cont…

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4 September 2011 CBR was initiated by the World Health Organization (WHO) following the Declaration of Alma-Ata in 1978. It was promoted as a strategy to improve access to rehabilitation services for people with disabilities in low-income and middle-income countries, by making optimum use of local resources. Cont…

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4 September 2011 CBR has evolved into a multi-sectoral strategy…….. The International Labour Organization (ILO), United Nations Educational, Scientific and Cultural Organization (UNESCO) United Nations Development Programme (UNDP) United Nations Children’s Fund (UNICEF) Non-Governmental Organizations (NGOs) Disabled People’s Organizations (DPOs) Cont…

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4 September 2011 ……. to address the broader needs of people with disabilities, ensuring their participation and inclusion in society and enhancing their quality of life. Cont…

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Global statistics about people with disabilities: An estimated 15–20% of the world’s poorest people are disabled. No rehabilitation services are available to people with disabilities in 62 countries. Children with disabilities are much less likely to attend school than others. WHY CBR ?

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4 September 2011 People with disabilities tend to experience higher unemployment and have lower earnings than people without disabilities. CBR is currently implemented in over 90 countries. Cont…

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The CBR team included specialty experts such as physiatrists, physiotherapists, occupational therapists, Prosthetist / Orthotist, junior researchers, and users representative as a peer counselor, in addition to primary healthcare nurse, social worker, volunteers and, Financial Support team, if needed, other members from local community. Cont…

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4 September 2011 To enhance activities of daily life of disabled persons. 2. To create awareness in disabled person’s environment and help him attain equal human rights. To create a situation in which the community of the disabled persons can participates fully into their society. Universal mission of CBR

CBR in Musculoskeletal Disorders: 

4 September 2011 CBR in Musculoskeletal Disorders Musculoskeletal conditions have a great impact on the society, healthcare system and individuals since they are a common cause of long-lasting pain and limitation of physical ability. The 2001–2010 has been proclaimed “ the Bone and Joint Decade”.

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Disorders of the musculoskeletal system and connective tissues Classified by WHO ( ICD- 10)

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4 September 2011 M00–M99 – Diseases of the musculoskeletal system and connective tissue 1.1 (M00–M25) Arthropathies 1.1.1 (M00–M03) Infectious arthropathies 1.1.2 (M05–M14) Inflammatory polyarthropathies 1.1.3 (M15–M19) Arthrosis 1.1.4 (M20–M25) Other joint disorders 1.2 (M30–M36) Systemic connective tissue disorders

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4 September 2011 1.3 (M40–M54) Dorsopathies 1.3.1 (M40–M43) Deforming dorsopathies 1.3.2 (M45–M49) Spondylopathies 1.3.3 (M50–M54) Other dorsopathies 1.4 (M60–M79) Soft tissue disorders 1.4.1 (M60–M63) Disorders of muscles 1.4.2 (M65–M68) Disorders of synovium and tendon 1.4.3 (M70–M79) Other soft tissue disorders Cont…

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4 September 2011 1.5 (M80–M90) Osteopathies 1.6 (M91–M94) Chondropathies 1.7 (M95–M99) Other disorders of the musculoskeletal System & connective tissues. Cont…

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4 September 2011 Polio

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4 September 2011 Club Feet. Cerebral Palsy

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4 September 2011 Common Birth Defects

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4 September 2011 Common Birth Defects

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4 September 2011 Rickets

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4 September 2011 Spina Bifida Myelocele Myelomen-ingocele

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4 September 2011 Tuberculosis of the spine

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4 September 2011 Lymphatic filariasis

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4 September 2011 Psoriatic Arthritis Rhumatoid Arthritis

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4 September 2011 Leprosy

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4 September 2011 Amputa-tion

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4 September 2011

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4 September 2011 1. Situation analysis It helps planners to build up an understanding of the situation in which people with disabilities and their families live, to determine the most appropriate course of action.

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4 September 2011 Steps involved : 1. Collecting facts and figures. 2. Stakeholder analysis. 3. Problem analysis. Cont…

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4 September 2011 2. Planning and design It ensures that all aspects of a CBR programme are considered – priority needs are identified, a clear map (or plan) towards achieving a desired goal is designed.

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4 September 2011 Steps involved : Plan together with key stakeholders. Set priorities. Prepare the programme plan as a logical frame work [ Goal – Purpose – Outcomes – Activities ] . Prepare a monitoring & evaluation plan. Decide what resources are needed ? [ Human - Material – Financial ] 6. Prepare a budget. Cont…

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4 September 2011 3. Implem-tation & monitoring It involves putting the plans from Stage 2 into action, and ensuring that all necessary activities are carried out as scheduled and are producing the required outcomes. Monitoring provides information for decisions and changes to short-term planning to ensure that outcomes are met and that, eventually, the goal and purpose are achieved.

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4 September 2011 Steps involved : Mobilize & Manage the resources. Completion of each planned activities. Collecting, Recording, Analyzing, Reporting and Sharing the information. Cont…

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4 September 2011 4. Evaluation and Management Evaluation can lead to a decision to continue, change or stop a programme, and can also provide important evidence that CBR is a good strategy for equalization of opportunities, poverty reduction and social inclusion of people with disabilities.

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4 September 2011 Dartmouth COOP Functional Health Assessment Charts/WONCA (COOP/WONCA charts) , a popular instrument for the measurement of functional status in primary care. The charts were first developed by Nelson et al . and later modified by the Classification Committee of the World Organization of National Colleges, Academies and the Academic Association of General Practitioners/Family Physicians (WONCA). Cont…

Common framework for CBR management : : 

4 September 2011 Common framework for CBR management : HEALTH EDUCATION LIVELIHOOD SOCIAL EMPOWER- MENT PROMOTION EARLY CHILDHOOD PREVENTION MEDICAL-CARE REHABILITA- TION AESSISTIV- DEVICES LIFELONG LEARNING NON-FORMAL SECONDARY & HIGHER PRIMARY SOCIAL PROTECTION FINANCIAL CERVICES WAGE- EMPLOYMENT SELF- EMPLOYMENT SKILLS DEVELOPMENT JUSTICE RECREATIONS & SPORTS CULTURE & ARTS RELATIONSHIPS FAMILY PERSONAL ASSISTANCE DISABLED PEOPLE’S ORGANIZATIONS SELF-HELP GROUPS POLITICAL PARTICIPATION COMMUNITY MOBILIZATION ADVOCACY & COMMUNI- CATION

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4 September 2011 Rehabilitation In rural community

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4 September 2011 Recreational And sports

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4 September 2011 Rehabilitation by Volunteers

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4 September 2011 Training

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4 September 2011 EXAMPLES OF MANAGEMENT STRUCTURES IN CBR PROGRAMMES

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4 September 2011 Community facilitators or volunteers/ SHG leaders Primary/ secondary schools School authorities CBR workers Mid –level CBR managers CBR manager CBR committee Local authorities Health centers/ PHC/Hospitals Community health centers/ Health workers CBR programme at local level

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4 September 2011 Community Facilitators or volunteers Health coordinator CBR manager Director/ head of the institute Livelihood coordinator Social coordinator Education coordinator Mid –level CBR managers CBR workers Empowerment Government NGOs/DPOs CBR programme by public–private partnership

References :: 

4 September 2011 References : Secondary Prevention of Work Disability: Community-Based Psychosocial Intervention for Musculoskeletal Disorders. Journal of Occupational Rehabilitation, Vol. 15, No. 3, September 2005 ( C 2005) Community Based Rehabilitation Program for People with Musculoskeletal Conditions. By Andrea Polovina et. Al. Coll. Antropol . 31 (2007) 2: 457–462 http://www.disabilityindia.org/locomotor.cfm http://www.cbrforum.in/ http://www.whoindia.org http://www.rehabindia.com/

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4 September 2011 “Disabled Village Children”. A guide for community health workers, rehabilitation workers, and families. By David Werner. Physical therapy roles in community based rehabilitation: case study in rural area. ASIA PACIFIC DISABILITY REHABILITATION JOURNAL . Vol.20. No.1 Cont…

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4 September 2011 THANK YOU “I am only one, But still I am one. I cannot do everything, But still I can do something; And because I cannot do everything, I will not refuse to do the something that I can do.” Edward Everett