Rehabilitation a tertiary level of prevention

Tertiary level of prevention

1. Rehabilitation: DR NARENDRA KUMAR YADAV MD Community Medicine & Tropical Diseases, BPKIHS 1

2. Rehabilitation: Tertiary Level of Prevention Tertiary Level of Prevention is applied when disease has advanced beyond early stages. Aim: To reduce or limit impairments and disabilities , and improve quality of life. 2

3. Rehabilitation: Rehabilitation is the process of restoring someone to health or normal life through training and therapy after an illness, injury, or addiction. 3

4. Disability Limitation: Disability limitation is the process of reducing the impact or severity of disabilities on individuals' lives. Disability is a physical, sensory, cognitive, or mental (psychiatric) impairment that limits one or more major life activities. 4

5. Levels of Prevention: 5

6. Levels of Prevention: Four levels of prevention: Primordial Level of Prevention Primary Level of Prevention Secondary Level of Prevention Tertiary Level of Prevention 6

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8. Primordial Level of Prevention: Applied: Before emergence of risk factor Primordial Level of prevention is the prevention of the emergence or development of risk factors in countries or population groups. Primordial Level of prevention is Best level of prevention for Non-communicable diseases. Modes of Intervention: 1. Individual Education 2. Mass Education 8

9. Primary Level of Prevention: Applied: Risk factors are present but no disease Primary Level of prevention is the action taken prior to onset of disease , which removes the possibility that a disease will ever occur. Modes of Intervention: 1. Health Promotion: Example: Health Education, Environmental modifications, Nutritional interventions, Lifestyle and behavioural changes 2. Specific Protection: Example: Vaccines, Contraception 9

10. Primary Level of Prevention: Examples: Immunization: BCG, MR, DPT: Primary Level of Prevention ( Specific Protection). Rabies vaccine (Post exposure/ pre exposure): Primary Level of Prevention ( Specific Protection). TT after injury: Primary Level of Prevention ( Specific Protection). 10 BCG vaccine for treatment of Bladder cancer: Secondary Level of Prevention

11. Primary Level of Prevention: Examples: Contraception: Condom (HIV/ Pregnancy): Primary Level of Prevention OCP,IUCD, Sterilization to prevent pregnancy: Primary Level of Prevention 11 OCP for the treatment of PCOD: Secondary Level of Prevention

12. Secondary Level of Prevention: Applied: Disease is already started (Early stage of disease) but no complications. Secondary Level of Prevention halts the progress of disease at its’ incipient stage and prevents complications. Modes of Intervention: 1. Early Diagnosis: 2. Treatment: 12

13. Secondary Level of Prevention: Examples: Early diagnosis: Sputum examination for AFB: Secondary Level of Prevention CXR for pneumonia: Secondary Level of Prevention Blood C/S in Typhoid: Secondary Level of Prevention PAP smear in female (Screening test for cervical cancer): Secondary Level of Prevention 13 All diagnostic test and screening test are example of Secondary Level of Prevention

14. Secondary Level of Prevention: Examples: Treatment: ATT (DOTS): Secondary Level of Prevention Malaria case (DOC is ACT): Secondary Level of Prevention 14 Use of Doxycycline and Mefloquine for Malaria Chemoprophylaxis: Primary Level of Prevention ( Specific Protection).

15. Tertiary Level of Prevention: Tertiary Level of Prevention i s applied when disease has advanced beyond early stages(i.e. Applied in the late stage of the disease . ). Tertiary level of prevention signifies intervention in late pathogenesis phase. Modes of Intervention: 1. Disability Limitation: 2. Rehabilitation: 15

16. Tertiary Level of Prevention: Examples: CRUCHES in Polio: Locomotory Rehabilitation Physiotherapy in Polio: Disability Limitation/ Rehabilitation 16

17. Tertiary Level of Prevention: Examples: Common Impairments/ disabilities in Leprosy: Deformities : Claw hand, Foot drop , Facial palsy , Saddle nose deformity Blindness (due to corneal damage) 17

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19. MCQ Q. All of the following represent Specific protection mode of Disease prevention Except: (a) Chemoprophylaxis for meningococcal meningitis (b) Personal hygiene and Environmental sanitation (c) Usage of condoms (d) Iodization of salt 19

20. ANS: (b) Personal hygiene and Environmental sanitation 20

21. MCQ Q. Secondary level of prevention include all of the following except: (a) Health screening for Diabetes Mellitus (b) Case finding for Falciparum Malaria (c) Contact tracing for STIs (d) Reconstructive Surgery in Leprosy 21

22. Ans. (d) Reconstructive Surgery in Leprosy 22

23. Q. In a population to prevent coronary artery disease changing harmful lifestyles by education is referred to as: (a) High risk strategy (b) Primary prevention (c) Secondary prevention (d) Tertiary prevention 23

24. Ans. (b) Primary prevention 24

25. MCQ Q. In an area with fluoride rich water, the defluoridation of water is which level of prevention? (a) Primary (b) Secondary (c) Tertiary (d) Primordial 25

26. Ans. (a) Primary 26

27. MCQ Q. ‘Disability Limitation’ is mode of intervention for: (a) Primordial Prevention (b) Primary Prevention (c) Secondary Prevention (d) Tertiary Prevention 27

28. Ans. (d) Tertiary Prevention 28

29. MCQ Q. Which of the following is the most logical sequence? (a) Impairment-Disease-Disability-Handicap (b) Disease-Impairment-Disability-Handicap (c) Disease-Impairment- Handicap-Disability (d) Disease-Handicap-Impairment-Disability 29

30. Ans. (b) Disease-Impairment-Disability-Handicap 30

31. MCQ Q. Pap smear test for detection of carcinoma of cervix is which level of prevention? (a) Primordial (b) Primary (c) Secondary (d) Tertiary 31

32. Ans. (c) Secondary 32

33. MCQ Q. A person who has lost his foot in an accident and is not able to walk is an example of: (a) Disease (b) Disability (c) Impairment (d) Handicap 33

34. Ans. (b) Disability 34

35. MCQ Q. Vitamin A prophylaxis to a child is: (a) Health promotion (b) Specific protection (c) Primordial prevention (d) Secondary prevention 35

36. Ans. (b) Specific protection 36

37. Q. Screening of the diseases is which type of prevention? (a) Primordial (b) Primary (c) Secondary (d) Tertiary 37

38. Ans. (c) Secondary 38

39. MCQ Q. Iodized salt in iodine deficiency control programme is (a) Primary prevention (b) Secondary prevention (c) Tertiary prevention (d) Primordial prevention 39

40. Ans. (a) Primary prevention 40

41. Q. Target group in Secondary prevention (a) Healthy individuals (b) Patients (c) Animals (d) Children 41

42. Ans. (b) Patients 42

43. MCQ Q. Monitoring of blood pressure which type of prevention (a) Primordial (b) Primary (c) Secondary (d) Tertiary 43

44. Ans. (c) Secondary 44

45. MCQ Q. All of the following comes under primary prevention except: (a) Pap smear (b) Helmets (c) Contraception (d) Vaccines 45

46. Ans. (a) Pap smear 46

47. MCQ Q. Action which halts the progress of a disease at its incipient stage and prevents complications: (a) Primary prevention (b) Primordial prevention (c) Secondary prevention (d) Tertiary prevention 47

48. Ans. (c) Secondary prevention 48

49. MCQ Q. Health promotion includes all except: (a) Specific protection (b) Health education (c) Food fortification (d) Environment modification 49

50. Ans. (a) Specific protection 50

51. MCQ Q. Which of the following is a primary prevention in polio: (a) Good sanitary measures (b) Rehabilitation (c) Provision of 3 doses of OPV in early infancy (d) Collection of stool sample for diagnosis 51

52. Ans. (c) Provision of 3 doses of OPV in early infancy 52

53. BCG VACCINATION: Bacilli Calmette Guerin Type: Live attenuated vaccine Diluent: Normal Saline Strain: DANISH-1331 Schedule: Given at Birth Dose/ Site: 0.05 ml or 0.1 ml, Left deltoid (Intradermally)/in R arm in Nepal Efficacy: 0 -80% Duration: 20 years Tuberculin syringe 53

54. BCG VACCINATION: Cont.… Protective efficacy: Does not protect Pulmonary TB: 0% Protect Severe form of TB: 50% Leprosy: 30% BCG immunotherapy is given in superficial Bladder cancer. Phenomenon after vaccination: 2-3 weeks: Papule 6-8 weeks: Ulcer covered with crust 6-12 weeks: Permanent tiny round Scar 8-14 weeks: Mantoux test become positive Complication: Suppurative Lymphadenitis Suppurative Lymphadenitis 54

55. Rehabilitation: 55

56. Rehabilitation: 1. Definition of rehabilitation 2. Needs for Rehabilitation 3 . Types of rehabilitation: Social, medical, vocational, educational, cultural, CBR 3. Types of: impairment, disability, handicap 4. Advise rehabilitation at individual and community levels 56

57. . Q. Define Disease-Impairment-Disability-Handicap with examples. Q. Describe the types of: impairment, disability, handicap. 57

58. Disease-Impairment-Disability-Handicap: 58 Disease: Any abnormal condition of an organism that impairs function. Impairment: Any loss or abnormality of psychological, physiological or anatomical structure or function. Disability: (Because of impairment), any restriction or inability to perform an activity in a range considered normal for a human being. Handicap: A disadvantage for a given individual, resulting from an impairment/disability, that limits/prevents fulfillment for that individual.

59. Disease-Impairment-Disability-Handicap: Example: Event Classification Interpretation A ccident Disease Impairs function of a person Loss of foot Impairment Loss of anatomical structure in the form of foot Cannot Walk Disability Walking is a normal routine daily activity of a human being Unemployed Handicap Loses out his job because he cannot walk, so cannot fulfill his role in the society, i.e., earning for his family members 59

60. The major causes of disabling impairments: The major causes of disabling impairments are: 1.Non communicable diseases: DM, HTN, Cancer 2.Communicable diseases: HIV/AIDS 3. Traumatic injuries (Accidents): Traumatic injuries, resulting from accidents, falls, sports-related injury, workplace injuries, and violence can cause disabling impairments such as spinal cord injuries, traumatic brain injuries, fractures and amputations. 60

61. The major causes of disabling impairments: Cont.… 4.Malnutrition: Common micronutrients deficiency that causes of disabling impairments are: Vitamin A deficiency: Blindness Thiamin(B1) deficiency: Beriberi Niacin (B3) deficiency: Pellagra Vitamin D deficiency: Rickets Calcium deficiency: Osteoporosis Iodine deficiency: Mental deficiency, Low IQ, Speech defect, Hearing defect. 61

62. The major causes of disabling impairments: Cont.… 5. Birth defects (congenital birth defects): 6. Low quality of perinatal care: Birth asphyxia 7. Toxins: Neurolathyrism 7. Teratogens: Thalidomide, Radiation 8. Poverty 62

63. . Q. Describe the types of: impairment, disability, handicap. 63

64. Types of impairment, disability: 1. Physical Disabilities : Physical disabilities refer to condition that cause decrease in mobility, coordination, and physical strength. Examples: Spinal cord injuries, traumatic brain injuries, cerebral palsy, musculoskeletal disorders, fractures and limb amputations. 2 . Visual Impairments : Visual impairments refer to conditions that cause partial or complete loss of vision. Examples: Diabetic retinopathy, glaucoma, and cataracts. 64

65. Types of impairment, disability: Cont.… 3 . Hearing Impairments : Hearing impairments involve partial or complete loss of hearing ability. Individuals with hearing impairments may experience difficulties in understanding speech, communicating effectively, and accessing auditory information. Causes of hearing impairments: Genetic factors, exposure to loud noise, infections, and aging. 65

66. Types of impairment, disability: Cont.. 4.Cognitive Disabilities: I ncludes conditions such as: learning, memory, attention, problem-solving impairment. 5.Developmental Disabilities : Developmental disabilities is a range of lifelong conditions that affect physical, cognitive, behavioral, and social development. Examples: Autism spectrum disorders, Down syndrome, fetal alcohol syndrome, and cerebral palsy. 66

67. Types of impairment, disability: Cont.… 6. Speech and Language Disorders: Speech and language disorders involve difficulties in producing speech sounds, understanding language, and communicating effectively . Causes of speech and language disorders include developmental delays, neurological conditions, hearing impairments, and traumatic brain injuries . 67

68. Types of impairment, disability: Cont.… 7. Mental Health Disorders : Mental health disorders such as depression, anxiety disorders, schizophrenia, bipolar disorder, and post-traumatic stress disorder (PTSD) can significantly impair individuals’ well-being, cognitive functioning, and social relationships. Mental health disorders are a leading cause of disability worldwide. 68

69. Types of impairment, disability: Cont.… 8. Neurological Disorders : Neurological disorders affect the central nervous system and can result in impairments in movement, sensation, cognition, and behavior. Examples: Parkinson's disease, Alzheimer's disease, traumatic brain injury, and stroke. 69

70. Types of impairment, disability: Cont.… 9. Substance Use Disorders : Substance use disorders, including alcohol addiction and drug dependence, can result in impairments in physical health, mental well-being, social relationships, and occupational functioning. 70

71. Disability prevention: Disability relates to all the levels of prevention: Reducing the occurrence of impairment: I mmunization against polio (Primary Level of Prevention) Disability limitation: When a patient reports late in the pathogenesis phase, the mode of intervention is disability limitation. The objective of this intervention is to prevent or halt the transition of the disease process from impairment to disability or disability to handicap. Example: Physiotherapy in polio 71

72. MCQ Q. Which of the following is the most logical sequence? (a) Impairment-Disease-Disability-Handicap (b) Disease-Impairment-Disability-Handicap (c) Disease-Impairment- Handicap-Disability (d) Disease-Handicap-Impairment-Disability 72

73. Ans. (b) Disease-Impairment-Disability-Handicap 73

74. MCQ Q. A person who has lost his foot in an accident and is not able to walk is an example of: (a) Disease (b) Disability (c) Impairment (d) Handicap 74

75. Ans. (b) Disability 75

76. . Q. Define rehabilitation. Describe about the needs for rehabilitation. 1. Definition of rehabilitation 2. Needs for Rehabilitation 3 . Types of rehabilitation: Social, medical, vocational, educational, cultural, CBR Q. Describe about the types of rehabilitation. 76

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78. Rehabilitation: Modes of Intervention of Tertiary Level of Prevention. 78 Rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”. (WHO) Rehabilitation is the process of restoring someone to health or normal life through training and therapy after an illness, injury, or addiction.

79. Rehabilitation: Cont.. Rehabilitation helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family. Globally, an estimated 2.4 billion people are currently living with a health condition that may benefit from rehabilitation (WHO). 79

80. Rehabilitation: Examples: CRUCHES in Polio: Locomotory Rehabilitation Physiotherapy in Polio: Disability Limitation/ Rehabilitation 80 Speech and language training to improve a person’s communication after a brain injury.

81. Needs for Rehabilitation: Rehabilitation offers a range of benefits for individuals with health conditions or disabilities, aiming to optimize their functioning and quality of life: Improved Functioning: Rehabilitation helps individuals regain lost or impaired physical & cognitive functions. This includes improving mobility, speech, motor skills, and overall independence . Enhanced Mental Well-being: Rehabilitation not only focuses on physical recovery but also addresses psychological and emotional aspects. It can boost self-confidence, reduce anxiety or depression related to disabilities, and promote overall mental well-being . 81

82. Needs for Rehabilitation : Cont.. Prevention of Complications: Rehabilitation aims to prevent secondary complications that may arise due to immobility, weakness, or functional limitations. This can include muscle atrophy, joint contractures, and more. Optimized Recovery: Following an illness, injury, or surgery, rehabilitation plays a crucial role in facilitating recovery. It helps individuals regain strength, and skills needed to resume their normal activities. Enhanced Quality of Life: By addressing functional limitations and promoting independence, rehabilitation contributes to a better quality of life for individuals. It allows them to participate more fully in daily activities, work, and social interactions. 82

83. . Types of rehabilitation 83 Types of rehabilitation: Medical, Social, Vocational, Educational, Cultural. Nutritional rehabilitation center (NRC)

84. 1. Medical Rehabilitation: Medical rehabilitation focuses on restoring the physical and mental health of an individual who has suffered from an illness, injury, or disability. It includes medical treatment, physiotherapy, occupational therapy, and psychological support to help individuals regain functional independence. 84 Example: A stroke patient undergoing physiotherapy and speech therapy to regain movement and speech abilities. A spinal cord injury patient receiving occupational therapy to adapt to daily activities.

85. 2. Social Rehabilitation: Social rehabilitation aims to integrate individuals back into society by helping them develop interpersonal relationships, participate in community activities, and overcome social stigma. It is particularly important for people with mental illnesses, substance abuse disorders, or disabilities. 85 Example: A person recovering from mental illness being encouraged to engage in community events and social activities. A recovered drug addict attending support groups and being reintegrated into the family and society.

86. 3. Vocational Rehabilitation: Vocational rehabilitation focuses on helping individuals regain employment or develop new skills to sustain themselves financially. It includes job training, career counseling, and workplace modifications for people with disabilities or those recovering from illness. 86 Example: A paralyzed person being trained in computer-based work so they can work from home. A factory worker who lost a limb receiving training in tailoring or crafts to earn a livelihood.

87. 4. Educational Rehabilitation Educational rehabilitation helps individuals with disabilities, learning difficulties, or other impairments access education through special programs, assistive technology, and adapted teaching methods. 87 Example: A visually impaired student receiving Braille books and audio lessons to continue studies. A child with hearing impairment using sign language and hearing aids in a special school.

88. 5. Cultural Rehabilitation: Cultural rehabilitation helps individuals reconnect with their cultural and artistic heritage, promoting emotional and psychological healing. It is especially useful for displaced individuals, people with disabilities, and those recovering from trauma. 88 Example: War refugees participating in traditional music and dance programs to regain a sense of identity. Individuals with mental health issues engaging in art therapy or theater workshops for emotional expression and healing.

89. Medical Rehabilitation: Nutritional rehabilitation center (NRC) Physiotherapy 89

90. QQQQ Q. What s rehabilitation? Explain 5 main meaning attached to the motion community based rehabilitation. (1+4 marks) 90

91. Rehabilitation: Modes of Intervention of Tertiary Level of Prevention. 91 Rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”. (WHO) Rehabilitation is the process of restoring someone to health or normal life through training and therapy after an illness, injury, or addiction.

92. Three Main Meanings Attached to Community-Based Rehabilitation (CBR): Community-Based Rehabilitation (CBR) is a strategy for rehabilitation, equalization of opportunities, and social integration of persons with disabilities within their communities. The three main meanings attached to the concept of CBR are: Medical Rehabilitation Vocational and Economic Rehabilitation Social and Psychological Rehabilitation 92

93. 1. Medical Rehabilitation: Focuses on medical interventions, including physiotherapy, occupational therapy, speech therapy, and assistive devices. Aims to improve functional abilities and minimize disability-related impairments. 93

94. 2. Vocational and Economic Rehabilitation: Helps individuals regain employment and economic independence. Includes skill training, job placement, microfinance support, and workplace adaptation. 94

95. 3. Social and Psychological Rehabilitation: Ensures social inclusion and participation of disabled individuals in society. Involves counseling, peer support, self-help groups, and community awareness programs. 95

96. Conclusion: CBR follows a multi-sectoral approach involving healthcare, education, employment, social welfare, and empowerment to enhance the overall well-being of persons with disabilities. 96

97. Community-based rehabilitation defined by WHO and major NGOs is as follows (5) : "Community-based rehabilitation is a strategy within general community development for the rehabilitation, equalization of opportunities and social inclusion of all people with disabilities. Community-based rehabilitation is implemented through the combined efforts of the people with disabilities themselves, their families, organizations and communities, and the relevant governmental and non-governmental health, education, vocational, social and other services". Rehabilitation measures may appear to be simple; they require planned and systematic actions - medical, surgical, social, educational and vocational - consistently over years with sustained counselling and health education for training or retraining of the individual to the highest possible level of functional ability. For this purpose, coordinated efforts by the Departments of Health, Education and Social Welfare, as well as voluntary organizations are necessary. 97