The WHO has made a new framework towards the classification and management of disabilities, The ICIDH: International Classification of Impairments, Disabilities, and Handicaps in 1984and subsequently this has been revised to ICIDH-2: International Classification of Functioning, Disability and Health in 2001.
The latest approach, International Classification of Functioning, Disability and Health, known as ICF, is to provide a unified and standard language and framework for the description of health and health-related states. The program considers the change from a state of health or well being to impairment of function caused by specific pathology due to different causes. The impairment may lead to disability of permanent or partial nature that may be reversible or irreversible. The disability ultimately decides the handicap the person is going to have based on social and environmental factors. The framework is a linear one where, there is chance for intervention, thereby reducing or even preventing the disability and handicap. The ICF classification also provides room for planning research and even environmental changes to make a person’s life comfortable and happy.
The ICF included a wider perspective for providing a quality life to persons with disabilities. The changes are made to alleviate the psychological feeling of the patient to be labeled as disabled and also considering the potential of what he can contribute to the society and live on a self supporting basis. The terminology of disability which was previously confined to few visible conditions like physical deformities, visual loss, hearing impaired or severe case of mental retardation, gave little room to consider the functional capacity of the individual in the society to lead a normal life.
Disability Adjusted Life Years - DALY, is another major theme for ICF. Hence, instead of disability, ‘function’- the ability of the person to function normally (quality of life) in the society has been accepted as the major consideration in the framework of ICF. This concept now is implemented in almost 181 countries. There is a change in approach to disease and disabilities. The ICF (2001) based on ICIDH2 emphasizes more on the state of health of an individual and the quality of life he is capable of leading in the community.
The present project to establish a Deemed University of International Importance is proposed in the framework of ICF developed by WHO for the management of disabilities and Non Communicable Neurological Disorders. In this concept, all disabilities have to be investigated to find out its cause and treated appropriately. Rehabilitation program should then be started which is to be programmed according to the age, sex, type and severity of the functional impairment. Systematic evaluation is required in each case to make a full diagnosis to assess the functional abilities and deficits according to international standards. This helps in setting specific goals for education, vocational placement and long-term independence within a reasonable time period. This program requires the interaction and combined effort of a multidisciplinary team in which the Neurologist is the team leader and other medical and paramedical forces, which include Pediatrician, Orthopedician, ENT Specialist, Psychiatrist, Physiatrist, Speech Therapist, Clinical Psychologist, Clinical Linguists, Physiotherapist, Occupational therapist, Special Educators, Sociologists and Vocational experts.
The Project also envisages the Development of necessary Manpower that is currently lacking in the country, including Doctors having necessary expertise in the concerned area and other paramedical professionals required for rehabilitation ,educational and vocational placement. As part of the manpower development various Educational Courses has to be started in Speech language Pathology, like BASLP, MASLP and Ph.D, M.Phil and Ph.D in Clinical Psychology, courses for special educators , courses for Doctors and Nurses. Necessary manpower should also be developed in Biomedical engineering, Computer Sciences, Linguistics ,Neurochemistry, Genetics, Nanotechnlogy and even in Health administration.
The other dimension of the Project is Research and Development in this field. Most of the developmental disorders have a genetic, metabolic, vascular or degenerative cause. The current advent in genomic research has looked into the genetic basis of most of the disorders leading to disabilities. Research and development in this area can pave way to the development of newer therapeutic interventions like gene therapy, stem cell therapy and drug development.
The Indian system of medicine especially Ayurveda has many potential roles in this respect. Integrated Medical Research, the possibility of developing newer medicine is high.
Disabilities should be addressed at the doorstep of the needy. Community Based Rehabilitation(CBR) is the crux of this principle. CBR was developed as a response to the need to reach people with disabilities at the community level. The cost involved in the transportation of the disabled to far located institutions leads to social and financial burden to the family. CBR is the answer for this.
We also need to address the possible Prevention of the Disabilities in the community. Creation of awareness about the various disabilities among professionals, paramedical professionals, teachers, social activists and policy makers is necessary to achieve these goals. Developmental disabilities demands more attention, as an anticipating parent with a disabled child seeks counselling from experts.
High-risk Maternity Units, High Risk Infant Units, premarital counselling, antenatal diagnosis and neonatal screening can reduce and prevent to a great extent the birth of a disabled. Community awareness can speed up early detection so that the disabilities can be minimized.
The management and rehabilitation of disabilities is also determined by the age of the patient. The planning for Children with disabilities should look into what is the possible Educational placement for them and the expected outcome by the time they are adults. Syllabus based Special Education of Residential type is ideal for them and gradual Integration to the mainstream education later.
The disabled persons should get an equal opportunity in the community and they should also be a building block of the community. They need to reach an Independent life through appropriate job placement. Vocational Training suitable for each disabled group should be provided. Adult disabled and elderly with various disabilities lead sedentary lives that make them depressed and their hidden talents remain untapped. There are many job opportunities for them that have to be trained through appropriate vocational training programs.