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The influence of HIV/AIDS on community-based rehabilitation in dar es salaam, Tanzania

BOYCE, William
COTE, Laurence
2009

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Community-Based Rehabilitation (CBR) is the method of choice for delivering services for people living with disabilities in many countries. HIV/AIDS is changing the daily lives of many women by adding to their responsibilities. How realistically can such women participate actively in community development activities like CBR? This paper examines the impact of HIV/AIDS on CBR in Dar es Salaam, Tanzania. Observational sessions and individual interviews were conducted with caregivers of children with disabilities, CBR workers and managers over a three month period. Among the findings was a significant decrease in CBR activities in families affected by HIV/AIDS. This change in family priorities was due to better knowledge of acute diseases and increased stigma of HIV/AIDS in comparison to disability. Older CBR workers were more likely to incorporate elements of HIV/AIDS care with CBR, while younger CBR workers were more likely to avoid HIV/AIDS support. The ability of CBR workers to adapt their working habits to an environment with high HIV/AIDS prevalence is linked to their sense of skill competence and their knowledge/beliefs about risk of infection. Further integration of CBR work with general health development initiatives may improve this situation.

The role and position of disabled people’s organisations in community based rehabilitation : balancing between dividing lines

CORNIEJE, Huib
2009

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The role of disabled people in CBR is increasingly being seen as of vital importance for the success of CBR. In actual fact participation of disabled people and self advocacy have become two of the principles of CBR as seen by the World Health Organisation and associated organszations behind the new CBR thinking.

This paper deals with the position and role of disabled people themselves in CBR programmes. It critically looks into the role Disabled Peoples’ Organisations in terms of promoting equal access to essential and acceptable quality of rehabilitation programmes for all and especially the poor of this world. It is argued that DPOs should join the ranks of those (professionals) who are committed to ensure that rehabilitation becomes accessible to all. The current global situation of an ever widening gap between the ‘ones who have and those who don’t have’ requires a critical reflection on ones’ own work in CBR and DPO development. We cannot permit ourselves anymore a division among those who are disabled and those who are non-disabled as there are other divides among groups of people that are by far more profound and serious to the majority of disabled people worldwide.

While the urban elite of disabled people who live in a conflict-free, open and democratic society may be well concerned with issues such as accessible tourism, CBR as essential service provision is often unavailable for the poor rural masses and those living under illegal conditions in slums of the cities of Africa, Asia and South America. CBR as philosophy seeks for solidarity with those who live under appalling conditions; threatened by conflict, eviction and hunger. This paper calls for collaboration between DPOs and the CBR movement in order to address diversity and ensure that the implementation of basic human rights are truly addressed.

 

 

Asia Pacific Disability Rehabilitation Journal, Vol 20, No 1

Physical therapy roles in community-based rehabilitation : a case study in rural areas of north eastern Thailand

NUALNETR, Nomjit
2009

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his action research aimed to explore how physical therapists could enhance the quality of life for persons with disabilities via a community-based rehabilitation (CBR) strategy. The study was conducted in two rural sub-districts in northeastern Thailand. In each sub-district, several group meetings were arranged for persons with disabilities and their families, and various community members. Participants were encouraged to discuss their perception of problems of the current rehabilitation services for persons with disabilities. Strategies to manage all problems were collaboratively identified and were implemented in order of priority according to the importance of the problem. The outputs of CBR were evaluated by interviews and observation. The findings revealed that physical therapists had numerous roles in CBR, depending on the community’s circumstances. They need a high degree of flexibility and a wide range of skills to contribute to CBR. The preparation of such physical therapists requires development of a more client-centered community-oriented education programme.

 

 

Asia Pacific Disability Rehabilitation Journal, Vol 20, No 1

Disability among clients attending Taif Rehabilitation Centre, Saudi Arabia

AL-SHEHRI, Abdul-Salam A
ABDEL-FATTAH, Moataz M
2008

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This is a cross-sectional study of hospital records of people who were admitted to Rehab Armed Forces Rehabilitation Center, Taif, Saudi Arabia from 1999- 2005. Eight hundred and fifty records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analysis were performed to determine predictors of long stay at the hospital. Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle aged clients (16-45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, people with traumatic accidents and people with paralytic types of disability were significantly more likely to stay longer at the hospital. Home care programme should be expanded to minimize duration of stay at the rehabilitation centres. Health education of the public would help in encouraging disabled people to adapt to daily life activities.

Best practices in the socio-economic rehabilitation of persons affected by leprosy and other marginalised people in their communities: findings from nine evaluations in Bangladesh, India and Africa

VELEEMA, Johan P
2008

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This paper presents an overview of findings from the formal evaluation of 9 socio-economic rehabilitation programmes (SER), in 4 countries in Africa, in Bangladesh and in India from 2002-2005. Bringing together the recommendations resulted in a description of best practices in the implementation of socio-economic rehabilitation programmes, derived from actual experiences in different contexts.

All the 9 programmes focused on supporting individual leprosy-affected beneficiaries or their families. Four projects also supported other marginalised clients. The usual interventions were micro-credit, housing and sponsoring of education for the children.

The recommendations touched upon each of the five steps in individual rehabilitation: Selection of clients, needs assessment, choosing an intervention, monitoring / follow--up of clients during rehabilitation, and separation at the end of the rehabilitation process. The evaluators also suggested ways in which participation of the client in their own rehabilitation might be boosted, made recommendations for the organisational structure of programmes, on maximising community involvement and emphasised the importance of information systems and of investing in the programme staff. A number of recommendations were specific to the types of interventions implemented i.e, housing, education or micro-credit.

Evidence of the impact of SER on the quality of life of clients is limited, but suggests increased self-esteem and increased respect/status in the family and community.

 

Asia Pacific Disability Rehabilitation Journal, vol.19, no.1, 2008

Exclusion of disabled people from microcredit in Africa and Asia : a literature study

CRAMM, J M FINKENFLUGEL, H
2008

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People with disabilities are barred from microcredit schemes. A literature search on the participation of people with disabilities in microcredit schemes resulted in 16 documents. The statements, recommendations and generalisations in these documents are not supported with strong evidence and are 'expert opinions' at best. Inclusion of people with disabilities within institutional schemes and self-helping schemes is recommended throughout the world. However, these seem most affected by excluding mechanisms and inclusion numbers lag behind. The absence of people with disabilities from these two schemes makes them a less attractive option. To fulfil the current needs of people with disabilities; ad-hoc schemes should continue and even expand their work. The pragmatic solution is to work with the available resources in order to change the situation of people with disabilities.

Considerations in the quest for evidence in community based rehabilitation

KUIPERS, Pim
HARKNETT, Steve
2008

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This paper seeks to contribute to current debate on evidence-based practice and appropriate models of disability rehabilitation for people with disabilities in developing countries. Based on the authors' experience in, and evaluation of Community Based Rehabilitation (CBR) projects and research, they provide suggestions for utilising different kinds of evidence at different levels of CBR. The paper proposes four considerations. First, at the micro level of individual rehabilitation techniques, it recommends the judicious co-opting of available evidence from conventional evidence sources. Second, at the level of service planning, it suggests the need for conducting major syntheses of CBR evaluation reports for evidence. Third, it proposes the incorporation of values with research in consideration of issues at the model level. Finally, the paper proposes that in the case of CBR and similar approaches, new conceptualisations and methodologies are required in current understandings of evidence-based research and practice, which highlight the voice of people with disabilities, their family members and communities as key sources of evidence-related data."This paper seeks to contribute to current debate on evidence-based practice and appropriate models of disability rehabilitation for people with disabilities in developing countries...The paper proposes four considerations. First, at the micro level of individual rehabilitation techniques, it recommends the judicious co-opting of available evidence from conventional evidence sources. Second, at the level of service planning, it suggests the need for conducting major syntheses of CBR evaluation reports for evidence. Third, it proposes the incorporation of values with research in consideration of issues at the model level. Finally, the paper proposes that in the case of CBR and similar approaches, new conceptualisations and methodologies are required in current understandings of evidence-based research and practice, which highlight the voice of people with disabilities, their family members and communities as key sources of evidence-related data"

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 2

Factors shaping attitudes towards physical disability and availability of rehabilitative support systems for disabled people in rural Kenya

MONK, Julie
WEE, Joy
2008

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This study examines the range of attitudes towards persons with physical disability in a rural community in western Kenya. It also evaluates the availability of services for persons with disabilities in the community. Qualitative data analysis of interview material led to the generation of a model describing the attitudes towards people with disabilities. Availability of services was explored through interview questions and document collection. Perceived cause of disability, perceived characteristics and activities of people with disabilities by the community and perceived role of society, appear to shape the attitudes towards people with disabilities in the community studied. The opinions within these categories contribute to enabling and disabling features of the environment in which people with disabilities live. It appears that services available are underused by disabled members of the community due to poor accessibility and financial barriers. The results yielded relatively enabling attitudes towards PWD. The responses suggest that this community may be ready to support increased participation by its members, possibly through a community based rehabilitation programme.

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

Reflections on poverty and disability : a review of literature

KAMPEN, Marlies V
ZIJVERDEN, Ingrid M
EMMETT, Tony
2008

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This study carried out a review of literature describing the relationship between poverty and disability, in order to establish the evidence base for this relationship. Several authors seem to accept the existence of this link, even without a sound research basis. Articles and books were scrutinized to find out what sources were used in these publications to conclude that there was evidence for a strong relationship between disability and poverty. Peer-reviewed articles were used as much as possible.

It was found that cultural determinants play the greatest role in the process of disability leading to poverty. Monetary factors are also essential determinants when it comes to poverty as a result of disability. The relationship between disability and poverty seems to be a vicious circle. Most of the literature concerning poverty and disability is based on non- rigorous (literature) studies.

Relating disability to poverty and vice versa is a complex matter that needs to consider several interdependent factors that influence this process.

 

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

Practice and preferences of sign languages in the instructions of deaf students: some reflections on the mainstream secondary school of Botswana

LEKOKO, Rebecca N
MUKHOPADHYAY, S
2008

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The use of language for every day communication has been and continues to be an essential element of any teaching and learning environment. In this paper, the focus is on the teaching -learning communication in the education of the learners with deafness. While experiences indicate that some people in Botswana are showing more and more interest in Sign Language as a mode of instruction in the classroom, it is also true that many are far from understanding the "Deaf Culture" and to use sign language in the teaching and learning of deaf students. To a great extent, deaf people in Botswana are still disadvantaged and discriminated against, by their condition. A survey carried out in 2004 (1) revealed that some current practices in the mainstream secondary school of Botswana make it difficult for deaf students to progress. While, for example, participants preferred Total Communication; in practise, Signed English is used. Thus, this paper takes a stance that if practices conflict with preference, low performance should be expected. This is currently the situation at the mainstream secondary schools in Botswana, deaf students' inability to hear has become their inability to learn and progress in education. This could be avoided. In this 21st century, being unable to hear is not a barrier to learning, as we are aware that Sign Languages are there as full languages, for the education of deaf.

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

Disability and development: is the rights model of disability valid in the Arab region? An evidence-based field survey in Lebanon and Jordan

NAGATA, Kozue Kay
2008

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This paper reviews the process and outcome of constructing a "rights model of disability" which is culturally specific to Jordan and Lebanon. The objective of the empirical part was, to survey the current level of attitudes of non-disabled people towards their disabled fellows in Jordan, and to compare the attitudes of Lebanon's university students towards five different categories of disabled people (mentally disabled people, psycho-socially disabled people, physically disabled people, hearing impaired people and visually impaired people) to highlight the variations and diversity among them. It also examined the relationship between the attitudes and various demographic and social characteristics of the respondents. The set of findings was further tested and triangulated through meta-analysis of individual views expressed in the qualitative studies.

In Jordan, the attitude of 191 randomly selected non-disabled people was studied, using a Scale of Attitudes towards Disabled Persons (SADP). The participants from 4 communities of Jordan, exhibited overall negative attitudes towards disabled people. Socio-economic-demographic characteristics showed almost no difference regarding their attitudes towards disabled people.

In Lebanon, a more complex scale, composed of four sub-scales, namely a, "Baseline Survey of Student Attitudes towards People with a Disability" was used, to survey 94 university students' attitudes towards five different categories of disabled people, and a set of indices for future comparison was constructed. The results indicated the same pattern of gradations of attitude differences (found in other countries) towards persons with physical or sensory impairments (better), intellectual impairment (middle) and mental illness (worse). The main findings of this empirical field research showed particularly negative public attitudes towards people with intellectual impairment and mental illness in Lebanon.

Finally, the validity of the proposed rights model of disability and the empirical findings of this study, were further examined and co-validated through analysis of the collective views of those who took part in the questionnaire surveys and the participatory focus group discussions, which took place in Lebanon in 2005 and 2007, and in Jordan in 2005, as well as a series of intensive on-line and/or telephone interviews of a few informants comprising of disabled persons and experts. The policy implications of the findings are discussed.

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

The origins of community-based rehabilitation

HELANDER, Einar
2007

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This article looks at the historical development of community-based rehabilitation (CBR). It is useful for people interested in the history of CBR Asia Pacific Disability Rehabilitation Journal, Vol 18, No 2

A review of community based rehabilitation evaluations : quality of life as an outcome measure for future evaluations

MANNAN, Hasheem
TURNBULL, Ann P
2007

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"This review examines key articles in evaluation of community-based rehabilitation carried out in developing countries and proposes family quality of life as an outcome measure of community-based rehabilitation. The concept of community-based rehabilitation is reviewed, quality of life and family quality of life measurement scale is presented. It presents a practical approach to future evaluations of community-based rehabilitation programmes. This review presents the features of community-based rehabilitation evaluation (i.e., service delivery system, technology transfer, community involvement, and organisation and management), methodology, and findings. Implications are defined for the enhancement of community based rehabilitation through practical suggestions for programme coordinators involved in community development for rehabilitation, equalisation of opportunities, and social inclusion of people with disabilities"

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Evaluation in community based rehabilitation programmes : a strengths, weaknesses, opportunities and threats analysis

SHARMA, Manoj
2007

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The purpose of this article was to qualitatively analyse the extent to which community based rehabilitation programmes have been evaluated over the past thirty years. A framework of strengths, weaknesses, opportunities and threats analysis was used in conducting this analysis. Using an extensive search of MEDLINE, 22 articles were located that described and evaluated one or more dimensions of CBR. Three studies each from Australia, India, Zimbabwe and two studies each from England, Philippines, Vietnam and one each from Finland, Guyana, Jamaica, Japan, Pakistan, Papua New Guinea, Thailand, and United States were included in the analysis. A variety of methods used, most evaluations conducted in community settings, focus on mobility related evaluations by most programmes, and development of new instruments were the strengths of CBR evaluations. Some of the weaknesses were lack of consistency in outcome measures, lack of cost benefit and cost effectiveness studies, small sample size of many studies, and lack of focus on other than mobility related disabilities by most projects. The opportunities for CBR evaluations pertain to training assessments, use of mixed models, using indicators from a standard taxonomy, and focusing on medical rehabilitation. The threats to CBR evaluations are a need to prioritise from multifarious activities and having limited resources for evaluation.

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Beyond community based rehabilitation: consciousness and meaning

CHEAUSUWANTAVEE, Tavee
2007

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This article seeks to explore CBR through different perspectives. Based on existing literature and research on CBR, the paradoxes between CBR as ideal and CBR in usual practice, are identified. The dual meaning of 'disability' through 'stigma' and 'empowerment' perspectives is explored, along with the dual understanding of 'community consciousness' as 'individualism' and 'collectivism'. The two dimensions of 'disability' and 'consciousness' together are characterised into four distinct paradigms. Most past rehabilitation services are placed in a stigma-collective paradigm. It implies that philanthropy, inter-subjective value, morality and public awareness of society have usually constructed and supported any help and services for people with disabilities, including CBR. This paper looks at limitations of the past perspectives on CBR, and also points out the need for 'consciousness' studies on CBR. To understand the discrepancies of CBR, people need to look "beyond" CBR as it is commonly understood.

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Impact of socio-economic rehabilitation on leprosy stigma in Northern Nigeria: findings of a retrospective study

EBENSO, Bassey
FASHONA, Aminat
AYUBA, Mainas
IDAH, Mike
ADEYEMI, Gbemiga
S-FADA, Shehu
2007

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This study explored the perceptions of people affected by leprosy regarding impact of socio-economic rehabilitation (SER) on stigma-reduction. The study combined a quantitative questionnaire (the P-scale) with semi-structured interviews of 20 individual SER participants, five focus group discussions and 10 key informant interviews. The P-scale results showed four men suffered significant participation restrictions (scores of >12 points) in finding work and in social integration. The narratives of SER participants, focus groups and key informants showed that SER improved self-esteem, financial independence, acquisition of new skills, and access to public institutions. The authors speculate that through the pathway of improvements in economic and living conditions, SER is beginning to influence the process of social interaction, resulting in positive attitudinal change towards SER participants. The subjective opinions of interviewees suggest that improved self-esteem, positive family and community support for SER participants and increasing participation in community activities are indications of stigma-reduction.

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 2

Gendered experiences : marriage and the stigma of leprosy

TRY, Leonie
2006

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Stigma is rife in many areas of health and healthcare and it has implicit impacts that are often overlooked. Due to the continued social construction of the stigma of leprosy, it is clear that a greater understanding is needed of how stigma is experienced. This study considers the experiences of marriage of those vulnerable to stigmatisation due to leprosy and more specifically identifies different experiences of leprosy-affected women and men and the possible implications.

Challenges in leprosy rehabilitation

THOMAS, Maya
THOMAS, MJ
2004

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‘Multiple drug Therapy’ (MDT) has transformed the outcome of leprosy in people affected by it. Leprosy affected persons develop much less disfiguring disabilities after use of MDT. As a result leprosy services are now becoming integrated into general health services. When this integration becomes stronger, leprosy rehabilitation is also likely to adopt methods followed by general health services. Vertical, stand-alone services, based on single aetiology like leprosy, will require some adaptation to fit in with the environment of general health services. The authors speculate that changes in leprosy rehabilitation could make ‘community based rehabilitation’ (CBR) an important method for the vast majority of leprosy patients who need rehabilitation. This paper discusses some of the concerns regarding the suitability of CBR for leprosy rehabilitation.

 

Asia Pacific Disability Rehabilitation Journal, Vol 15, No 1

CBR: a participatory strategy in Africa

HARTLEY, Sally
Ed
2002

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This resource provides an important contribution and understanding of how community-based rehabilitation (CBR) operates in Africa. It contains the experiences and reflections of key stakeholders within CBR from 14 African countries. It will contribute to a more mutual and holistic understanding of the concept of CBR and bring about the development of new initiatives. This book is useful tool for CBR planners, policy-makers and managers

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