Therefore community-based strategies such as CBR are essential to link and provide people with disabilities and their families with rehabilitation services. Historically, CBR was a means of providing services focused on rehabilitation to people living in low-income countries through the use of local community resources. While the concept of CBR has evolved into a broader development strategy, involvement in the provision of rehabilitation services at community level remains a realistic and necessary activity for CBR programmes.
Rehabilitation at specialized centres may not be necessary or practical for many people, particularly those living in rural areas and many rehabilitation activities can be initiated in the community. The WHO manual on Training in the community for people with disabilities is a guide to rehabilitation activities that can be carried out in the community using local resources Community-based services may also be required following rehabilitation at specialized centres.
CBR programmes can provide support by visiting people at home and encouraging them to continue rehabilitation activities as necessary. Where rehabilitation services are established in the community, close links must be maintained with referral centres that offer specialized rehabilitation services. The needs of many people with disabilities change over time and they may require periodic support in the long term.
Successful rehabilitation depends on strong partnerships between people with disabilities, rehabilitation professionals and community-based workers. Li, a middle-aged widow, lives with her elderly mother and three children in the Qing Hai province of China. Her whole family depended on her before an accident in October Li fell from a height while repairing her house and sustained a spinal fracture, resulting in weakness and sensory loss in both legs. After she was discharged from hospital, she stayed in bed all day and night. Swelling quickly developed in both her legs and she required full assistance from her children to turn in bed, bathe, change her clothes and use the toilet.
Li soon lost her confidence and tried to commit suicide several times; fortunately, she was unsuccessful. A village rehabilitation officer from a local CBR programme came to visit Li and provided her with home-based rehabilitation. Li was taught new ways of completing daily living activities using her residual abilities.
She was given information about her disability and learnt how to prevent bed sores and urinary tract infections. Her family and friends were taught how to make a simple walking frame for her to practise standing and walking. They also made a simple toilet bowl to solve the problem of going to the toilet. The County Rehabilitation Centre provided crutches and a wheelchair. With time and practice Li was able to stand and walk independently with crutches and use a wheelchair for longer distances.
Step by step, Li built up her confidence. She was soon able to manage her own daily activities, which included cooking for her family, an activity she really enjoyed. Li also opened a mill, providing her with a source of income which, together with a small monthly living allowance from the County Ministry of Civil Affairs, allows her once again to care for her family and be confident about the future.
Rehabilitation plans need to be person-centred, goal-oriented and realistic.
When developing a plan, a person's preferences, age, gender, socioeconomic status and home environment need to be considered. Rehabilitation is often a long journey, and a long-term vision is required, with short-term goals. Valuable resources can be wasted when rehabilitation plans are not realistic.
Many rehabilitation plans fail because people with disabilities are not consulted; it is important to ensure that their opinions and choices influence the development of the plan and that the realities of their lives, in particular the issue of poverty, are considered. For example, a plan that requires a poor person living in a rural area to travel frequently to the city for physiotherapy is likely to fail.
Rehabilitation personnel need to be innovative and develop appropriate rehabilitation programmes which are available as close as possible to home, including in rural areas. Rehabilitation needs may change over time, particularly during periods of transition, e. During these transitions, adjustments will need to be made to the rehabilitation plans to ensure the activities continue to be appropriate and relevant.
Assessment is an important skill, so CBR personnel should receive prior training and supervision to ensure competency in this area. To identify a person's needs it can be helpful to consider the following questions. It is important to keep a record of the initial assessment and future consultations, so an individual's progress can be monitored over time. Many CBR programmes have developed assessment forms and progress notes to make this easier for their staff.
If, following the basic assessment, CBR personnel identify a need for specialized rehabilitation services, e. The following activities are suggested.
Consideration must be given to the costs associated with a visit to the city, including transport, food, accommodation and loss of daily wages; many services also require out-of-pocket payments. The CBR programme in the Islamic Republic of Iran encourages village health workers and CBR personnel to identify people with disabilities early and refer them to the primary health-care services in the community. Following referral, a mobile team of rehabilitation personnel visit the home to provide home-based rehabilitation. If specialized interventions are required, referral is made to a tertiary-level care centre, usually in the provincial headquarters or capital city.
Following rehabilitation at a specialized centre, people are referred back to the primary health-care services, which work with the CBR programme to ensure that rehabilitation activities are continued, if necessary. The mobile team provides follow-up to monitor progress and provide further assistance when required.
The major areas of child development include: Through early intervention, children at risk of, or with, developmental delay are identified as early as possible and provided with focused rehabilitation interventions to prevent or improve this delay. The presence of a disability, e. CBR personnel can provide early intervention activities, usually home-based, to encourage simple and enjoyable learning opportunities for development.
CBR programmes can also encourage parents to meet together to share ideas and experiences and facilitate playgroups, so their children learn to play with other children, learn new skills and improve in all areas of development.
The CBR programme in Alexandria, Egypt, has several clubs that meet weekly in different parts of the city, including in a local stadium and a mosque. Parents come with their children who have disabilities to participate in activities organized by the CBR programme and community volunteers. There is a range of fun activities for children, e. Functional interventions aim to improve an individual's level of independence in daily living skills, e.
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With the help of Dr. John Ruberto, Bruce Vinciguerra, and Timothy House, we have combined all of our exercise techniques into a pictorial format. The 6"x9". In the Cane Masters Cane Chi Exercise, Wellness & Rehabilitation Manual we have combined all of our exercise techniques into a pictoral.
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The major areas of child development include: CBR programmes promote self-help groups where people with similar impairments or similar rehabilitation needs come together to share information, ideas and experiences. There may only be one rehabilitation centre in the major city of a country, for example, or therapists may be available only in hospitals or large clinics. Trivia About The Cane: Exercise, Wellness and Rehabilitation Manual it was amazing 5.
The crook is extra wide to fit over shoulders, the rib cage and up and down the spine. The large notches down the center of the shaft are there to secure the exercise bands in place and the lighter notch at both ends are grips. John Ruberto, Bruce Vinciguerra, and Timothy House, we have combined all of our exercise techniques into a pictorial format. Combine the manual with a resistance band and your favorite cane to make a "go-any-where" With the help of Dr.
These Resistance Bands are available in 5 different strengths that can be combined or used individually. Cane Chi Starter Cane This is our basic cane for exercise, fitness and therapy.