What are the strategies to prevent disabilities? Describe prevention of locomotors disabilities in the community.

Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

Magnitude, Types and Characteristics:The NSSO 58th round has estimated 18.49 million disabled persons in 2002, 10.89 million were males and 7.59 million females. 57.50% locomotor disability, 10.88% blind, 4.39% low vision, 16.55% hearing impairment, 11.65% speech disability, 5.37% mentally retarded and 5.95% mentally ill.

Strategies to prevent disabilities:A significant proportion of disabled persons were in the active working age group of 15-59 years especially among locomotor impaired, making not only themselves but their families also susceptible to social and economic uncertainties.

These groups require special attention through specific programmes to create awareness and support them through appropriate medical care and other rehabilitative measures The strategies to prevent disability include all action taken to decrease the occurrence of physical, intellectual, psychiatric or sensory impairment and its development into functional limitation and to prevent the transition of functional limitation into disability.

Disability prevention
1st level prevention 2nd level prevention 3rd level prevention

Impairment

Functional Limitations

Disability

Individual consequences

Family consequences

Society consequences

REHABILITATION AND CARE FOR THE DISABLED

It includes interventions in health sector plus a wide range of social intervention acting upon individual and his surrounding and society as a whole.

Disability prevention is not an area consisting exclusive of health sector interventions. It also includes all types of social, educational, legislative and other interventions. The best result will be achieved only if all interventions are combined

Prevention of locomotor disabilities in community :The prevention of locomotor disabilities can be undertaken at three levels: y first level y second level y third level

1) First level prevention

This includes all measures directed at reducing the occurrence of impairment i.e. action taken prior to the onset of disease. First level of prevention of locomotor disability may be accomplish by measures designed to promote general health and well being and quality of life of the people or by specific protective measures. The strategies are based on elimination or modification of risk factors of the disease. Prevention measures for other level include the following:y Prevention of congenital diseases through prospective counseling (high risk case) or retrospective counseling (by MTP, contraception etc) y Prevention of communicable disease by immunization, hygiene, health education. y Prevention of malnutrition and vitamin deficiency. y Prevention of accidents by provision of safety measures at home and work place and enforcement of legislation e.g. use of PPE ( public protective equipment. y Elimination of exposure to situations in which locomotor disability may occur. In particular, war and other form of violence and chemical and environmental pollution.

Reduction of incidence of locomotor disability at first level primarily calls for health education for the general public and also at the level of health personnel, especially attached to a PHC, village workers and anganwadis. Information,education and communication activities are essential to accomplish proper health education to the masses.

2) Second level prevention

Interventions directed towards prevention of development of functional limitation after impairment is eminent.e.g. a) early treatment of trachoma b) use of effective drugs in psychiatric disease c) vocational and educational counseling d) elimination and decrease of risk factor for continuous exposure to hazardous agents e) changing the family and community attitude etc. When impairment occurs, it is necessary to try to prevent any long term functional limitation from occurring. To achieve it, measures are required specifically in the following three areas : y Ability to identify the impairment that might lead to functional limitation (i.e development of diagnostic ability) e,g, to diagnose tuberculosis, leprosy etc. y Proper and prompt care of impairment in the acute stage to avoid subsequent functional limitation i.e. care of acute cases.e.g. administration of first aid measures, proper nursing care etc. y Proper care of impairment in the chronic stage to avoid functional limitation i.e. care of chronic cases. This includes provision of appropriate drugs for chronic diseases e.g. tuberculosis, leprosy, hypertension, diabetes mellitus etc. Provision of therapeutic exercise and proper positioning to avoid deformities.

In order to achieve it, proper diagnostic and treatment facilities should be uniformly available at all levels of health care. In the case of accidents, facilities for immediate evacuation and transfer to the proper place of treatment are essential. Adequate follow up two way referral system continuous care and prevent complications, if any, at the earliest. Estimation of effects of second level prevention:The effects of means suggested should be rewarding.

3) Third level prevention

Once functional limitation is present and irreversible, the transition into disability may be prevented. When long term functional limitation has developed, measures instituted should aimed at prevention of disability. e.g. a) Therapeutic measures provided by PT/OT/speech therapist/psychologist etc b) Providing technical aids such as prosthesis and Orthosis c) Social and vocational counseling and guidance d) Provision of education and suitable jobs. e) Training in self care activities f) Public and community education g) Provision of suitable housing and transportation h) Elimination of physical barriers. Measures taken are :-

1) Holistic approach
Medical, surgical, vocational, educational, social

2) Training
y y y y To increase independence in self care Training/ teaching patient/ family member etc. As related to daily life such as dressing,eating,washing etc. Mobilioty, siting, standing, walking etc.

3) Educational/vocational measures
It should aimed at achieving economic independence. It includes :Educational training, vocational training, employment oppurtunuties.

4) Social integration
Social segregation for leprosy, TB, MR, epilepsy and deformed patient. Due to rooted fear/misbelieves there will be attitudinal changes, social integration, mass media programmed etc.

National health programme for prevention of locomotor disability

The government of India has taken several measures toward locomotor disability prevention. Research in areas of prevention of disability, screening of at risk cases, provision of training to medical and paramedical personnel and provision of awareness campaigns on causes and prevention of locomotor disability, are some of the important actions taken. Also, national health programme which have a direct bearing on the prevention of locomotor disabilities are being implemented. They include:y y y y y y Universal immunization programme National leprosy eradication programme National tuberculosis control programme National AIDS control programme National cancer control programme Child survival and safe motherhood programme

Conclusion:
Locomotor disabilities, being the largest group of disabling disorder, call for a gigantic effort to tackle. The government as well as public need to work hand in hand. Though, all of locomotor disabling disorders are not preventable, a significant proportion is fully preventable. In a developing country like ours where health services and infrastructure are still inadequate and rehabilitation services are still infancy, first level intervention play a major role in preventing and minimizing the occurrence of locomotor disability.