Chapter 3: Identification and Differentiated services

Learning Outcomes
At the end of this chapter, you are expected to:
Discuss the impact of disability and vulnerability on daily life of persons with
disabilities and vulnerabilities.
Elucidate the needs of persons with disabilities and vulnerabilities
Describe the effects of environment on the life of PWDs and vulnerabilities.
 Discuss the intervention and rehabilitation approaches for disabilities and vul-
nerabilities.
List barriers for inclusive services provisions in different sectors
Describe the role technologies in the life of persons with disabilities
Relate the concept of inclusiveness to their specific profession
 Evaluate inclusiveness of services provision in their specific fields of studies
 3.1. Impact of Disability and Vulnerability on daily life
A. Factors related to the person
1.The Nature of the Disability: acquired (a result of an accident, or acquired dis-
ease-difficult to adjust) or congenital (present at birth)
2.The Individual’s Personality - the individual personality can be typically positive
or negative, dependent or independent, goal-oriented or laissez-faire.
3.The Meaning of the Disability to the Individual - Does the individual define
himself/herself by his/her looks or physical characteristics?
4.The Individual’s Current Life Circumstances - if the individual is happy with
their current life circumstance, they are more likely to embrace their disability,
whereas if they are not happy with their circumstances, they often blame their dis-
ability.
5.The Individual's Support System - if individual‘s support from family, a signifi-
cant other, friends, or social groups have easier time coping with a disability and
thus will not be affected negatively by their disability.
B. Economic Factors and Disability
•People with few economic assets are more likely to acquire pathologies that
may be disabling.
•Economic status affects whether pathology will proceed to impairment e.g.
medication limit the options and abilities of someone who requires personal
assistance services or certain physical accommodations.
•Reduce the appropriate access to rehabilitation services to reduce the degree
of potential disability either because they cannot afford the services them-
selves or cannot afford the cost of specialized transportation services
• limit the options and abilities of someone who requires personal assistance
services or certain physical accommodations.
•status of the community may have a more profound impact than the status of
the individual on the probability that disability will result from impairment or
other disabling conditions.
C. Political Factors and Disability
•The political system, through its role in designing public policy, can and
does have a profound impact on the extent to which impairments and other
potentially disabling conditions will result in disability.
•The extent to which people with impairments and functional limitations
will participate in the labor force is a function of the funds spent in train-
ing programs, in the way that health care is financed, and in the ways that
job accommodations are mandated and paid for.
•The potential mechanisms of public policy are diverse, ranging from the
direct effects of funds from the public purse, to creating tax incentives so
that private parties may finance efforts themselves, to the passage of civil
rights legislation and providing adequate enforcement.
D. Factors Psychological of Disability (constructs of psychological environment), in-
cluding personal resources, personality traits, and cognition.
• These constructs affect both the expression of disability and an individual's ability
to adapt to and react to it.
1. Social Cognitive Processes
• Thoughts, feelings, beliefs, and ways of viewing the world, others, and ourselves.
• These are self-efficacy beliefs, psychological control, and coping patterns which
all these are socially constructed
2. Self-Efficacy (Beliefs about one's abilities)
• Are concerned with whether or not a person believes that he/she can accomplish a
desired outcome (Bandura, 1977, 1986).
• Beliefs about one's abilities affect what a person chooses to do, how much effort is
put into a task, and how long an individual will endure when there are difficulties
• The highly self-efficacious individual would work harder at tasks (i.e., in physical
or speech therapy)
3. Psychological Control
• Psychological control, or control beliefs, is akin to self-efficacy beliefs in that
they are thoughts, feelings, and beliefs regarding one's ability to exert control or
change a situation.
• Self-generated feelings of control improve outcomes for diverse groups of in-
dividuals with physical disabilities and chronic illnesses.
• The individuals control over themselves depends on the provision of the envi-
ronments: accessibility or inaccessibility.
4. Coping Patterns :- several coping strategies may be used when a person
confronts a stressful situation;
• seeking information
• cognitive restructuring
• emotional expression
• threat minimization, relaxation, distraction, and self-blame.
5.Personality Disposition/Nature
• Personality embraces moods, attitudes, and opinions and is most clearly
expressed in interactions with other people.
• It includes behavioral characteristics, both inherent and acquired, that
distinguish one person from another and that can be observed in people's
relations to the environment and to the social group
• People with an optimistic/hopeful orientation rather than a pessimistic ori-
entation are far better across several dimensions
F. The Family and Disability
• The family can be either an enabling or a disabling factor for a person with a
disabling condition.
• Even among people with disabilities who maintain a large network of friends,
family relationships often are most central and families often provide the main s
ources of support.
• This support may be instrumental (errand-running), informational (providing
advice or referrals), or emotional (giving love and support), economic support
to help with the purchase of assistive technologies and to pay for personal assis-
tance
• In all of these areas, friends and neighbors can supplement the support provided
by the family.
G. Needs of persons with disabilities and vulnerabilities depends on different
factors
• People with disabilities do not all share a single experience, even of the same
impairment; likewise, professionals in the same discipline do not follow a single
approach or hold the same values.
• Maslow‘s model is also valid for persons with disabilities and vulnerabilities,
whose needs are similar to those of ordinary persons.
The basic needs of persons with disabilities and vulnerabilities to ensure equality
for all within our society.
1.Full access to the Environment (towns, countryside & buildings)
2.An accessible Transport system
3.Technical aids and equipment
4.Accessible/adapted housing
5.Personal Assistance and support
6.Inclusive Education and Training
7.An adequate Income
8.Equal opportunities for Employment
9.Appropriate and accessible Information
10.Advocacy (towards self-advocacy)
H.Social Needs of Persons with Disabilities and Vulnerabilities
•Social protection plays a key role in realizing the rights of persons with dis-
abilities and vulnerabilities of all ages
•Social protection measures may include poverty reduction schemes; cash trans-
fer programs, social and health insurance, public work programs, housing
programs, disability pensions and mobility grants.
•Mainstream and/or specific social protection schemes may be required
•Previous methods of addressing benefits for persons with disabilities have
shown limited progress in overcoming the deeply-rooted social structures and
practices that hinder opportunities for persons with disabilities.
•Consequently, social protection needs to move beyond traditional welfare ap-
proaches to intervention systems that promote active citizenship, social inclu-
sion
and community participation while avoiding paternalism and dependence.
I.Gender and disability
•The importance of work and the daily activities required of living in the country
are paramount in considering gender.
•For the male and female with disabilities and vulnerable groups, WORK is univer-
sally seen as important, whether PAID WORK OR VOLUNTARY.
•When the work interests of men with disabilities are similar to those of others
around them, their identity as a -man‘ becomes more valuable to the community.
•Many of male and females with disabilities have creativity and skill in finding
ways to do things and consequently being able to build friendships with other men
in their communities.
•Work, particularly paid work, is also important for many of the female contributors
•Sustaining this in the face of community views about disability is at times difficult,
particularly when it is balanced with expectations of traditional women‘s roles of
home making and childcare
J.Identity and disability
•Disability as part of an individual‘s identity is seen by some as a struggle.
•An acquired disability is experienced as challenging the nature of one‘s
internal pre-established identity and as a struggle to change the perceptions
and attitudes of others and the physical environment in which a person lives.
•Relations with family, friends and communities often provided a
contradictory landscape, where a person has to negotiate his/her new disabled
identity yet, at the same time, is able to draw upon previous shared experi-
ences to become re-embedded in friendships and communities.
•Finding ways to gain value‘ in the local community with a disability is an
ongoing and, too often, difficult journey.
•It is these very journeys that create one‘s identity and the relational nature of
this identity to the rural landscape.
K. Belongingness and disability
•It is a complex concept involving anattachment to place, relationships with oth-
ers, a sense of safety, common values and a shared and/or developing history.
•Family relationships as a means of connecting to community and being known by
others, and knowing others outside the family are important.
•Different kinds of relationship contributed to this sense of belonging, ranging
from the more superficial nodding acquaintances to specific informal support from
known others, to the intimacy of close friends and kin.
•Rurality was once the site of exclusion, rather than belonging, where identity
and gender were disregarded in favor of ensuring protection of people with disabil-
ities and of the society in which they lived.
•People with disabilities and marginalized groups feel isolated.
•Some persons with disabilities have actively sought to migrate to urban environ-
ments, to escape from the confines and constraints of small rural environments
and to build broader social networks away from the farm.
3.2. Intersectionality
•Social structures and norms surrounding age are particularly significant, shaping
the kind of lives people have and their experience of gender and identity.
•Age matters, too, in terms of the support that family and services can offer in a rural
environment and the types of age-appropriate‘ opportunities that can be facilitated in
the person‘s home, family and community.
•The wider contextual values and economic and social changes have also impact on
the life of persons with disabilities.
•Religious values that shape the way disability is constituted in some countries are a
powerful influence on the way PWDs are able to live their lives.
• These values intersect with societal expectations of gender roles.
A.The health care needs of persons with disabilities and vulnerabilities
•People with disabilities report seeking more health care than people without
disabilities and have greater unmet needs. E.g., people with serious mental
disorders 35% - 50% and 76% - 85% developed and developing countries re-
spectively received no treatment (recent survey study)
•Health promotion and prevention activities seldom target people with dis-
abilities.For example women with disabilities receive less screening for
breast and cervical cancer than women without disabilities.
•People with intellectual impairments and diabetes are less likely to have
their weight checked.
•Adolescents and adults with disabilities are more likely to be excluded
from sex education programs.
Depending on the group and setting, persons with disabilities may experience
greater vulnerability to secondary conditions, co-morbid conditions, age-related
conditions, engaging in health risk behaviors and higher rates of premature death.
1.Secondary conditions: a primary health condition, and are both predictable
and therefore preventable. e.g. pressure ulcers, urinary tract infections,
osteoporosis and pain.
2.Co-morbid conditions: a primary health condition associated with disability.
E.g. the prevalence of diabetes in people with schizophrenia is around 15% com-
pared to a rate of 2-3% for the general population.
3.Age-related conditions: the ageing process for some groups of people with
disabilities begins earlier than usual. E.g. some people with developmental dis-
abilities show signs of premature ageing in their 40s and 50s.
4.Engaging in health risk behaviors: people with disabilities have higher rates
of risky behaviors such as smoking, poor diet and physical inactivity.
B. Barriers to health care for persons with disabilities and vulnerable groups
1.Prohibitive costs: affordability of health services and transportation are the
main reasons why people with disabilities do not receive needed health care
2.Limited availability of services: the lack of appropriate services for people
with disabilities is a significant barrier to health care.
3.Physical barriers: uneven access to buildings, inaccessible medical equip-
ment, poor signage, narrow doorways, internal steps, inadequate bathroom facili-
ties, and inaccessible parking areas create barriers to health care facilities.
4.Inadequate skills and knowledge of health workers: people with disabilities
were more than twice as likely to report finding health care provider skills in-
adequate to meet their needs, four times more likely to report being treated badly
and nearly three times more likely to report being denied care.
C.Addressing for inclusive barriers to health care
•Governments and professionals can improve health outcomes for people with dis-
abilities by improving access to quality, affordable health care services, which
make the best use of available resources.
•As several factors interact to inhibit access to health care, reforms in all the inter-
acting components of the health care system are required.
1.Policy and legislation: assess existing policies and services, identify priorities to
reduce health inequalities and plan improvements for access and inclusion.
2.Financing: where private health insurance dominates health care financing,
ensure that people with disabilities are covered and consider measures to make the
premiums affordable.
3.Service delivery: provide a broad range of modifications and adjustments (rea-
sonable accommodation) to facilitate access to health care services.
4.Human resources: integrate disability inclusion education into undergraduate
and continuing education for all health-care professionals.
3.3.Disability, vulnerability and the Environment
•The physical and social environments comprise factors external to the individual,
including family, institutions, community, geography, and the political climate
• Besides one's intrapersonal or psychological environment, which includes inter-
nal states, beliefs, cognition, expectancies and other mental states.
•The amount of disability is not determined by levels of pathologies, impairments,
or functional limitations, but instead is a function of the kind of services provided
to people with disabling conditions and the extent to which the physical, built envi-
ronment is accommodating/not accommodating to the particular disabling condi-
tion.
•The amount of disability that a person experiences, depends on both the
existence of a potentially disabling condition and the environment in which the
person lives
3.3.1.Some Enabling and Disabling Factors in the Physical Environment
1.The Natural Environment :-like topography (mobility) and climate (allergic)
2.The human made Environment :- eg, built objects such as dishwashers and com-
puters have the potential to enhance human performance or to create barriers.

Type of Factor Type of Environment

Natural Environment Built Environment

Enabling Dry climate Ramps

Flat terrain Adequate lighting
Clear paths Braille signage
Disabling Snow Steps
Rocky terrain Low-wattage lighting
High humidity Absence of flashing light
alerting systems
3.3.2. Rural environment, Disability and Vulnerability
•Since larger population of Ethiopia (>85%) are agricultural community,
life and aspirations of disabilities and vulnerable groups highlight both the
pull and the push of rural living without appropriate services and sup-
ports.
•Persons with disabilities, vulnerable and marginalized groups living in ru-
ral areas have double disadvantaged due to their impairments and vul-
nerabilities and unfavorable physical and social environment.
•Professional who are working in rural areas should work in collaboration
accordingly.
•More specifically, these group of people have been excluded from agricul-
tural works due its nature high demand to labour and lack of technolo-
gies and well organized support from professional.
3.3.3. Creating welcoming (Inclusive) Environment
•External environmental modifications can take many forms.
•These can include assistive devices, alterations of a physical structure, object
modification, and task modification.
•Environmental modifications may well be an effort at primary prevention
because the equipment may provide a safety net and prevent disabling conditions
that can occur through lifting and transfer of individuals who may not be able to do
it by themselves.
•Rehabilitation must place emphasis on addressing the environmental needs of
people with disabling conditions.
•Environmental strategies can be effective in helping people function indepen-
dently and not be limited in their social participation, in work, leisure or social
interactions as a spouse, parent, friend, or coworker.
•Examples of Environmental Modification are as indicated in the next slides
1. Mobility aids 3. Communication aids
Hand Orthosis Telephone amplifier
Voice-activated computer
Mouth stick
Closed/real-time captioning (provides deaf & hard
 Prosthetic limb of hearing people immediate access to spoken language and
enables participation in dialogue with others)
Wheelchair and/or motorized
Computer-assisted note taker
 Canes Print enlarger
 Crutches Reading machines
Books on tape
 Braces Sign language or oral interpreters
2. Differential use of personnel Braille writer
 Personal care assistants Cochlear implant
Communication boards FM, audio-induction
 Note takers
loop, or infrared systems
 Secretaries Editors
 Sign language interpreters
4. Accessible structural elements 5. Accessible features
Ramps Elevators Built up handles
Wide doors Voice-activated computer
 Automobile hand controls
Safety bars
Nonskid floors
6. Job accommodations
Sound-reflective building materials Simplification of task
Enhanced lighting Flexible work hours
Electrical sockets that meet ap- Rest breaks
propriate reach ranges Splitting job into parts
Hardwired flashing alerting sys-  Relegate nonessential functions to others
tems Increased textural contrast
3.4. Impact of the Social and Psychological Environments on the Enabling-Dis-
abling Process
• The social environment is conceptualized -cultural, political, and economic factors.
• The psychological environment is the intrapersonal environment.
i. Culture and the Disabling Process
• Culture affects the enabling-disabling process at each stage; it also affects the
transition from one stage to another.
• Culture includes both material culture and nonmaterial culture (norms or rules,
values, symbols, language, ideational systems such as science or religion, and
arts such as dance, crafts, and humor).
Nonmaterial culture is so comprehensive -it includes everything from conceptions of how
many days a week has/how one should react to pain to when one should seek medical
care or whether a hermaphroditic person is an abomination, a saint, or a mistake.
• Cultures also specify punishments for rule-breaking, exceptions to rules, and oc-
casions when exceptions are permitted.
Type of
Enabling and Disabling Factors
Element of Social and Psychological Environment
Factor Culture Psychological Political Economy

Expecting people with Having an ac- Mandating relay sys- Tax credits to hire
disabling conditions to tive coping tems in all states people with dis-
be productive strategy abling conditions
Enabling Expecting everyone to Cognitive re- Banning discrimination Targeted earned in-
know sign language structuring against people who can come tax credits
perform the essential
functions of the job
Stigmatizing people with Catastrophizing Segregating children Economic disincen-
disabling conditions with mobility impair- tives to get off Social
ments in schools Security Disability
Disabling Income benefits

Valuing physical beauty Denial Voting against paratran- No subsidies or tax

sit system credits for purchas-
ing assistive tech-
nology
 Pathway from Functional Limitation to Disability
•Here, the most important consideration is the ways in which the transition from func-
tional limitation to disability is affected by culture.
•A condition that is limiting must be defined as problematic for it to become a disability.
•Whether a functional limitation is seen as being disabling will depend on the culture.
•The culture is the roles to be played and the actions and capacities necessary to satisfy
that role.
•If certain actions are not necessary for a role, then the person who is limited in ability to
perform those actions does not have a disability.
•Culture determines in which roles a person might be disabled by a particular func-
tional limitation. E.g., a farmer in a small village may have no disability in work roles
caused by a hearing loss; however, that person may experience disabilities in family or
other personal relationships. On the other hand, a profoundly deaf, signing person mar-
ried to another profoundly deaf, signing person may have no disability in family-related
areas, although there may be a disability in work-related areas.
3.4.Disability Inclusive Intervention and Rehabilitation Services/Wal’aansaafi
Deebisanii Dhaabuu namoota dadhabbii hammaataa ta’e qabaniif kennamu/
•Including people with disabilities in everyday activities and encouraging them to
have roles similar to peoples who do not have a disability is disability inclusion.
•Inclusion should lead to increased participation in socially expected life roles and
activities (as a student, worker, friend, community member, patient, parent).
•Disability inclusion refers to the provision of differentiated services for persons
with disabilities and vulnerabilities.
•Socially expected activities include engaging in social activities, using public re-
sources such as transportation and libraries, moving about within communities, re-
ceiving adequate health care, having relationships, and enjoying other day-to-day
activities.
•The twin-track approach that involves inclusion involves:
1.ensuring all mainstream programs and services are inclusive and accessible to
persons with disabilities, while at the same time 2. providing targeted disability-
3.4.1. Strategies to Disability inclusive intervention and rehabilitation Prevention
•Prevention of conditions associated with disability and vulnerability is a development
issue.
•Attention to environmental factors – including nutrition, preventable diseases, safe
water and sanitation, safety on roads and in workplaces – can greatly reduce the inci-
dence of health conditions leading to disability.
• A public health approach distinguishes:
1.Primary prevention – actions to avoid/remove the cause of a health problem in an
individual or a population before it arises.
2.Secondary prevention (early intervention) – actions to detect a health and dis-
abling conditions at an early stage in an individual or a population, facilitating cure,
or reducing or preventing spread, or reducing or preventing its long-term effects
3.Tertiary prevention (rehabilitation) – actions to reduce the impact of an already
established disease by restoring function and reducing disease related complica-
tions (for example, rehabilitation for children with musculoskeletal impairment).
3.4.2. Implementing the Twin-track Approach
•Implementing the twin-track approach involves:
Track 1: Mainstreaming disability as a cross-cutting issue:- within all key pro-
grams and services (education, health, relief and social services, microfinance,
infrastructure and camp improvement, protection, and emergency response) to
ensure these programs and services are inclusive, equitable, non-discrimina-
tory, and do not create or reinforce barriers.
Track 2: Supporting the specific needs of vulnerable groups with disabilities to
ensure they have equal opportunities to participate in society.
•This is done by strengthening referral to both internal and external pathways
and ensuring that sector programs to provide rehabilitation, assistive devices and
other disability-specific services are accessible to persons with disabilities and
vulnerable groups and adhere to protection standards and inclusion principles.
3.4.3. Implement Disability Inclusive Project/ Program
1.Education and vocational training –Inclusive Education realize the universal
right to education for all, meaning all mainstream education services need to be
supporting children and persons with disabilities.
2.Health –early identification role to ensure children and persons with impair-
ments have timely access to health services and referral rehabilitation support.
3.Relief and social services –vulnerable group and peoples with disabilities and
their families need to be able to access relief support.
4.Infrastructure and camp improvement, shelter, water and sanitation and en-
vironmental health – universal design concepts must be considered in all infra-
structure and construction programs and projects. Infrastructure and camp im-
provement, shelter, water and sanitation and environmental health – universal
design concepts must be considered in all infrastructure and construction pro-
grams and projects.
5. Livelihoods, employment and microfinance –it is crucial that specific
sectors responsible for livelihood programs and projects to make ac-
cessible to all vulnerable and people with disabilities.
6. Protection – marginalized groups and people with disabilities may face
risks and vulnerabilities to experiencing violence, exploitation, abuse,
neglect and violation of rights and therefore need to be specifically
considered and included in protection programs and projects.
7. Humanitarian and emergency response – the disproportionate effect of
emergency and humanitarian situations on vulnerable groups and people
with disabilities should be reflected in the design and implementation
of the humanitarian projects.
3.4.4. Implement effective Intervention and Rehabilitation
•Rehabilitation interventions promote a comprehensive process to facilitate attain-
ment of the optimal physical, psychological, cognitive, behavioral, social, voca-
tional and educational status within the capacity allowed by the anatomic or phys-
iologic impairment, personal desires and life plans, and environmental
(dis)advantages for a person with a disability.
•Consumers/patients, families, and professionals work together as a team to iden-
tify realistic goals and develop strategies to achieve the highest possible functional
outcome, in some cases in the face of a permanent disability, impairment, or patho-
logic process.
•Rehabilitation requires goal-based activities and, more recently, measurement of
outcomes.
•A broad range of measurement tools have been developed for use within rehabili-
tation, and these standardized tools, along with objective measures of performance
are typically documented throughout the course of the intervention.
3.4.5. Components of Rehabilitation Interventions
A variety of professionals/Multiple Disciplines who participate in and contribute to the
rehabilitation process within a team approach are require as follow:
1.Physicians :-to manage the medical and health conditions of the patient/consumer
within the rehabilitation process, providing diagnosis, treatment, or management of dis-
ability-specific issues.
2.Occupational Therapists :- a typically work with patients/consumers through func-
tional activities in order to increase their ability to participate in activities of daily living
and instrumental activities of daily living in school and work environments, using a va-
riety of techniques.
3.Physical Therapists:- assess movement dysfunction and use treatment interventions
such as exercise, functional training, manual therapy techniques, gait and balance train-
ing, assistive and adaptive devices and equipment, and physical agents, including elec-
trotherapy, massage, and manual traction.
4.Speech and Language Therapist :-assess, treat, & help to prevent disorders related to
speech, language, cognition, voice, communication, swallowing & fluency.
5. Audiologists:- Audiologists identify, assess, manage, and interpret test results
related to disorders of hearing, balance, and other systems related to hearing.
6. Rehabilitation Nurses :- are expert at bladder management, bowel management,
and skin care, and they provide education to patients and families about these
important areas and also medications to be used at home after discharge.
7. Social Workers:- provide case management or coordination for persons with
complex medical conditions and needs; help patients navigate the paths between
different levels of care; refer patients to legal, financial, housing, or employment
services; assist patients with access to entitlement benefits, transportation assis-
tance, or community-based services; identify, assess, refer, or offer treatment for
such problems as depression, anxiety, or substance abuse; or provide education
or support programming for health or related social problems.
8. Case Managers :- these professionals collaborate with all service providers and
link the needs and values of the patient/consumer with appropriate services and
providers within the continuum of health care.
9. Rehabilitation Psychologists:- assists the individual (and family) with any injury,
illness, or disability that may be chronic, traumatic, and/or congenital in achieving
optimal physical, psychological, and interpersonal functioning
10. Neuropsychologists :- these professionals possess specialized skills in testing pro-
cedures and methods that assess various aspects of cognition (e.g., memory, atten-
tion, language), emotions, behaviors, personality, effort, motivation, and symptom
validity.
11. Therapeutic Recreation Specialists :- provide treatment services and recreation ac-
tivities for individuals with disabilities or illnesses.
12. Rehabilitation Counselors :- assist persons with both physical and mental disabili-
ties, and cover the vocational, psychological, social, and medical aspects of disabil-
ity, through a partnership with the individuals served.
13. Orthotists and Prosthetists :- the orthotist fabricates & designs custom braces or
orthotics to improve the function of those with neuromuscular or musculoskeletal
impairments, or to stabilize an injury or impairment through the healing process and
the prosthetist works with individuals with partial/total limb absence/amputation to
Additional Rehabilitation Professionals
•Other rehabilitation professionals who might be considered members of the team in-
clude nutritionist, spiritual care, rehabilitation engineer, music therapist, dance
therapist, child-life specialist, hospital-based school teacher, massage therapist, ki-
nesiologist, and trainer, among others.
1.Person with the Disability and His or Her Family:-personal and family/support sys-
tem goals, family/friend support, and community resources are driving forces regard-
ing goals and discharge planning within the rehabilitation process.
2.Community-Based Rehabilitation :- promotes collaboration among community
leaders, peoples with disabilities and their families and other concerned citizens to
provide equal opportunities for all peoples with disabilities in the community and to
strengthen the role of their organization.
Currently, three main meanings are attached to the notion of CBR:
3.People taking care of themselves,
4.a concept and an ideology
5.community based rehabilitation.
3.5. Assistive Technologies (AT)
Definition: AT is any product, instrument. Equipment or technical system used by a
disabled person or technical aid (ISO 9999).
1.AT and Daily Living of Persons with disabilities and Vulnerabilities:-
•Persons with disabilities and vulnerabilities utilize AT to enhance the performance
of their daily living tasks-communication, vision, hearing, recreation, movement,
seating and mobility, reading, learning, writing, and studying, as well as controlling
and accessing their environment.
•Assistive Technology varies from low-tech devices such as a cane or adapted loop,
to high-tech systems such as assistive robotics or smart spaces.
• Currently, most popular technologies for Persons with disabilities and Vulnerabili-
ties are simple; or examples of mobility-enhancing equipment include wheelchairs,
communication via mobile telephones and computers, and voice-activated smart
devices to enhance environmental control.
•Advances in communication and information technologies further support the de-
3.5.1. AT and User Needs: A Classification Scheme
A.People with Communication Disabilities:- refers to be multiple difficulties e.g..
speech mechanism problem, language processing, hearing, vision, motor skills
1.Assistive technologies: Mobile systems (phones, wearable electronics, computers,
augmentative and alliterative communication, vibriotactile displays reading screen,
speech technologies, augmentative–alliterative communication. Socialization and enter-
tainment tools (special games, virtual companion‘s videoconferences). Medication orga-
nizers (medication reminder/management).
•Speech technology (audio technology for I/O interfaces and control, writing translators,
text–speech translators, transportation (public transportation facilities, smart environments
home control, pervasive computing, context awareness, middleware) Shopping tools (In-
ternet access) and education tools
B. People with Cognitive Disabilities: The impairments may include (Cognition,
memory loss and forgetfulness)
- Assistive technologies may include:- mobile systems (phones, wearable electronics,
and computers), socialization and entertainment tools (special games, virtual com-
panions, videoconferences), augmentative and alliterative communication (including
I/O interfaces), adaptable/configurable interfaces, organizer and reminder assistants
for timekeeping), medications,(appointments, hygiene, electronic organizers, medica-
tion reminder/management, procedure assistants, transportation public transportation
facilities)
C. People with Motor Disabilities impairment include (upper-limbs
difficulties/ dexterity, lower-limb deficiencies )
1. Assistive technologies:-may include orthotics (cognitive orthotics),
smart environments, home control, shopping tools (internet access)
and education tools
 AT and the Marketplace
•Markets for assistive technologies follow the general marketing rule that products
introduced into a market influence the demand and growth of markets for such
products.
•This relationship between Persons with disabilities and Vulnerabilities and AT in
the marketplace follows one of two strategies
1.Specialization:- is based on the development of products or services that are
adapted for Persons with disabilities to satisfy their needs.
•Nonetheless, the market for such AT is not growing quickly, owing to (1) develop-
ment costs, (2) high price of the final product, and (3) generally low income of peo-
ple with disabilities.
2.Trivialization:- considers Persons with disabilities as an augmentation/increase of
the market for devices used by people without disabilities.
•In this strategy, industry does not target Persons with disabilities and Vulnerabili-
ties populations directly..
AT and Design Methods
•Given the requirements of functionality, safety, and comfort, the design
of AT for Persons with disabilities and Vulnerabilities requires both excel-
lent engineering capacities and relevant knowledge about Persons with
disabilities and Vulnerabilities characteristics.
• Product developers must be fully aware of needs, wants, and capabilities
of Persons with disabilities and Vulnerabilities populations, as well as
limitations associated with each handicap.
•Numerous design methods have been suggested to assist in the process of
AT development.
•Most widely known are user centered design and universal design
 Implement Inclusive Job Opportunities and Employment
•The right to work is fundamental to being a full and equal member of society, and
it applies to all persons, regardless of whether or not they have a disability.
•A decent job in the open labor market is a key fortification against poverty.
•Employment enables people to build self-esteem, form social relationships, and to
gain skills and knowledge.
•Barriers to employment thus not only affect individuals‘ lives, but the entire
economy.
•Persons without disabilities were nearly three times more likely than persons with
disabilities to participate in the labor
•Persons with disabilities and vulnerabilities are more likely to be own-account
workers and occupy jobs in the informal sector, often without the security offered
by work contracts, salaries, pension schemes, health insurance and other benefits.
• Even when persons with disabilities are formally employed, they are more likely
to be in low-paid, low-level positions with poor prospects for career development
 Barriers of employment
• Barriers to the employment of persons with disabilities take many forms
and operate at many levels, both within and beyond the workplace itself.
• Persons with disabilities may be prevented from working due to:
 inaccessible transportation services;
the lack of accessible information and communications services;
the preference of employers for candidates without disabilities;
legal stipulations that prevent individuals with particular impairments
from working in certain fields; or
the discouragement of family and community members.
 Major types of barriers employment
1.Attitudes and Discrimination :- employers may be reluctant to hire persons with
disabilities based on the perception that they are less productive/less capable of car-
rying out their jobs than others.
2.Accessibility:- the physical environment; transportation; information and commu-
nications; and other facilities open to the public.
3.Education and Training:- this severely limits their job opportunities due to a lack
of skills and knowledge that are relevant to find or retain a job.
4.Social Networks :- it greatly aid the process of searching for work, the lack of
which is likely to limit options for persons with disabilities.
5.Women Disabilities:- continued prejudices both towards women and surrounding
disability, women with disabilities are doubly discriminated against in the labor
market.
6.Legal Barriers :- as a result of discriminatory attitudes about the perceived capa-
bilities of persons with disabilities, some countries impose legal restrictions on
7. Inflexible Work Arrangements :- greater degree of flexibility of working
arrangements can boost the morale and productivity of any employee, re-
gardless of whether or not they have a disability.
8. Dismissal on the Basis of Disability :- the absence of anti-discrimination
legislation in the majority of countries in the region thus allows employers
to dismiss staff on the basis of disability with impunity/free
9. The Benefit Trap :- another obstacle to the employment of persons with
disabilities can ironically be imposed by social protection schemes ulti-
mately designed to support them. These schemes can encourage individu-
als to
stay out of the labor force if they are structured in such a way as to make
the receipt of benefits contingent on the inability to work.
 Strategies to Improve Employment for Persons with Disabilities and Vul-
nerabilities
1. Anti-Discrimination Legislation:- anti-discrimination laws protect persons
with disabilities from discriminatory actions in hiring and termination of
contracts and affirm the right of persons with disabilities to access employ-
ment on an equal basis with others.
2. Vocational Education And Training:-TVET programs can help to ensure
that the workforce has the skills and knowledge necessary to obtain and
retain a job, while also driving productivity and economic growth.
3. Wage Subsidies:- since wage subsidies directly target the recruitment process of
private firms, they enable employers to overcome their reservations about
hiring employees with disabilities.
4. Supported Employment:- it integrate persons with disabilities into the open labor
market by providing direct, on-the-job support to employees with disabilities.
5. Workplace Accommodation Schemes: reduce the costs to employers
of making workplaces more accessible to persons with disabilities (e.g.
Breaking tax)
6. Workers’ Compensation :- these programs are designed to address the
issue of occupational injuries and illnesses.
7. Quota Systems:- firms hire at minimum a certain percentage of per-
sons with disabilities. Typically, quotas apply only to large employers.
8. Sheltered Workshops :- these programs only hire persons with disabili-
ties, and structure jobs around the perceived abilities of each employee
9. Private Sector Initiatives :- a number of private-sector initiatives also serve
to illustrate the need for action to be taken not only by governments, but by
employers themselves.
10. Employer Networks :- a number of networks of private companies around
the world have initiated their own programs to promote the employment of
persons with disabilities employer organization.
11. Support Disability-Inclusive Business :- Private employers can play an im-
portant role in developing policies and programs to boost employment for
persons with disabilities, as well as their own bottom line.
12. Social Enterprises :- Social enterprises are businesses that seek to advance a
social cause whilst being financially self-sustainable.
13. Support persons with disabilities in the workplace :- governments can en-
hance the working experiences of persons with disabilities - leading by ex-
ample in terms of public sector employment practices, and by establishing
programs and services that support persons with disabilities to do their jobs
14. Building a more inclusive society :- by creating more accessible physical en-
vironments, public transport and knowledge, information and communication
services, governments can facilitate opportunities for persons with disabilities
to work, as well as society at large.
15. Boost education and training opportunities :- the governments must ensure
that persons with disabilities are able to access education and training on an
equal basis with others.
16. Break down attitudinal barriers and challenge discrimination:- discrimina-
tory attitudes towards persons with disabilities inform and produce other bar-
riers to the full and equal participation of persons with disabilities in society,
including in employment (social awareness and training is must)
17. Improve data collection on disability and employment:- designing, monitor-
ing and evaluating policies to promote decent work for persons with disabili-
ties requires timely and high quality information.