Rehabilitation Engineering

Unit 1

Dr.K.Nirmala
Biomedical Engineering Department
 Rehabilitation Engineering

Session Objectives:

The objective of this session

 Delineate Rehabilitation Engineering

 Define Epidemiology of rehabilitation

 Understand the concept of health in rehabilitation

 Perceive the levels of preventive rehabilitation

 Introduction

• Rehabilitation is the (re)integration of an individual with a disability into society.

• Rehabilitation engineering is the “ application of science and technology to

ameliorate the handicaps of individuals with disabilities”.

• Rehabilitation technology (or assistive technology ) narrowly defined is the

selection, design, or manufacture of augmentative or assistive devices that are
appropriate for the individual with a disability.

• Rehabilitation science is the development of a body of knowledge, gleaned from

rigorous basic and clinical research, that describes how a disability alters specific
physiological functions or anatomical structures, and that details the underlying
principles by which residual function or capacity can be measured and used to
restore function of individuals with disabilities.
 Introduction

Rehabilitation Engineering
 is the systematic application of engineering sciences to design, develop, adapt,
test, evaluate, apply, and distribute technological solutions to problems
confronted by individuals with disabilities.

Categories of Disability
• Mobility
• Cognitive
• Visual
• Hearing
 Introduction

Rehabilitation Engineering

Evaluation Design
Treatment Testing
Re evaluation Rehabilitation Fabrication
Implementation Engineering Integration
Education Customer support
Training Education
Research Process Optimisation
Outcome measurement
 Epidemiology of Rehabilitation

• Epidemiology is derived from the Greek word epidemios meaning “among

the people”

• CO Stallybross defined the epidemiology as “the science which considers

the infectious disease – their course, propagation and preventive”.

• Epidemiology is concerned with the study of the causative factor disease

and the means to prevent or eradicate it.

• WH Welch defined epidemiology a “the study of the natural history of the

diseases.”

• Lillienfeld described it as the study of the “distribution of a disease or

condition in a population, and of the factors that influence this distribution”.
 Epidemiology of Rehabilitation

Components of the definition

 Study: Systematic collection, analysis and interpretation of data

 Frequency: the number of times an event occurs
 Distribution: Distribution of an event by person, place and time
 Determinants: Factors the presence/absence of which affect the occurrence
and level of an event
 Diseases & other health related events : It studies all health related
conditions
 Epidemiology of Rehabilitation

Types of Epidemiology

Two major categories of Epidemiology

1. Descriptive Epidemiology
Defines frequency and distribution of diseases and other health related
events
Answers the four major questions: how many,
who, where, and when?
2. Analytic Epidemiology
Analyses determinants of health problems
Answers two other major questions: how? And why?
 Epidemiology of Rehabilitation

Measurements in Epidemiology

1.Measurement of mortality.(death rate)

2. Measurement of morbidity.(condition of being diseased)
3. Measurement of disability. (a physical or mental condition that limits a
person's movements, senses, or activities)
4. Measurement of natality.(birth rate)
5. Measurement of presence or absence of attributes.
6. Measurement of health care need.
7. Measurement of environmental & other risk factors.
8. Measurement of demographic variables.
 Health

WHO defines health as “A state of complete physical, mental and social

wellbeing and not merely the absence of disease or infirmity”.

The fundamental goal of the medical science is not to produce an immortal

being but to maintain him in optimum health as long as, ideally until death.
Health
 Preventive Rehabilitation

• Prevention of disability does not start only at birth, at the onset of disease or after a
primary disability occurs.

• It may be done even before a child is born, by anticipating disability due to genetic
defects or blood group incompatibility .

• Fall in mortality levels there is a rise in morbidity levels.

• Rehabilitation deals with morbidity; it deals with the quality of life.

 Levels of prevention

• Any health care that tries to halt persons slide down the slope of the health status
scale is termed preventive health and any attempt to push it up towards the peak i.e.
optimum health is called therapeutic health care.
• This total spectrum is classified into three levels of prevention by the WHO.
Primary prevention secondary prevention

Asymptotic disease Symptomatic

Disease risk
status disease

Tertiary prevention

Complication
 Levels of prevention

Primary prevention:
• Measure taken before the onset of any disease, e.g. immunization against
childhood infections or chlorination of the drinking water.

• It is designed to promote general health and improve the quality of life.

• It incorporates health education for bringing about awareness of health problems

before it occurs.

• This is similar to the first phase of medicine i.e. preventive medicine.

 Levels of prevention

Secondary prevention:
• Measure taken to arrest the progression of a disease while it is still in the early
symptomatic stage of the disease.
• It involves early diagnosis and immediate treatment.
• E,g. ergonomic interventions to prevent clinical symptoms in a patient with
spondylosis.
Tertiary prevention:
• it is explained as a measure taken to minimize the consequences of a disease or
injury once it has become clinically manifested.
• E.g. Prevention of pressure sores in a paraplegic by turning the patient over
regularly.
• Tertiary prevention is an integral part of rehabilitation medicine
 Impairment , Disability and Handicap

Impairment:
• Any loss or abnormality of psychological, physiological, or anatomical structure or
function.
• e.g. loss of finger, loss of conduction of impulse in the heart, loss of certain
chemical in the brain leading to parkinsonism.

Disability:
• any restriction or lack of ability to perform an activity ij the manner or within the
range considered normal for a human being resulting from impairment.
• e.g. difficulty in walking after lower limb amputation.

Handicap:
• a disadvantage for a given individual in his or her social context resulting from
impairment or a disability that limits the fulfilment of a role that is normal for him or
her.
• This depends on the age, sex, social and cultural factors for that individual.
 Impairment , Disability and Handicap

Handicap

Society
Disability
Whole
person

Impairment Organ or
tissue

Impairment is a manifestation of a problem at tissue or organ level.

Disability at the level of individual while handicap in the translation of problem
at the societal level.
 Disability

According to the Persons with Disabilities (Equal Opportunities, Protection of

Rights and Full Participation) Act, 1995, "Person with disability" means a person
suffering from not less than 40% of any disability as certified by a medical authority
(any hospital or institution, specified for the purposes of this Act by notification by the
appropriate Government).

As per the act "Disability" means –

(i) Blindness;
(ii) Low vision;
(iii) Leprosy-cured;
(iv) Hearing impairment
(v) Loco motor disability;
(vi) Mental retardation;
(vii) Mental illness
 Disability

"Blindness" refers to a condition where a person suffers from any of the following
conditions,
(i) Total absence of sight.
(ii) Visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with
correcting lenses;
(iii) Limitation of the field of vision subtending an angle of 200 or worse;

"Person with low vision" means a person with impairment of visual functioning even after
treatment or standard refractive correction but who uses or is potentially capable of using vision
for the planning or execution of a task with appropriate assistive device;
 Disability

"Leprosy cured person" means any person who has been cured of
leprosy but is suffering from-

I. Loss of sensation in hands or feet as well as loss of sensation and paresis in

the eye and eye-lid but with no manifest deformity;

II. Manifests deformity and paresis; but having sufficient mobility in their hands
and feet to enable them to engage in normal economic activity;

III. Extreme physical deformity as well as advanced age which prevents him
from undertaking any gainful occupation, and the expression "leprosy cured"
shall be construed accordingly.
 Disability

 "Hearing impairment" means loss of 60 dB or more in the better ear in the

conversational range of frequencies;

 "Loco motor disability" means disability of the bones, joints muscles leading to
substantial restriction of the movement of the limbs or any form of cerebral palsy;

 "Mental retardation" means a condition of arrested or incomplete development

of mind of a person which is specially characterized by sub normality of
intelligence;

 "Mental illness" means any mental disorder other than mental retardation;
 Impairment , Disability and Handicap

Handicaps:

The WHO has identified six handicaps

1. Locomotor handicap
2. Visual handicap
3. Hearing and speech handicap
4. Cardiopulmonary handicap
5. Intellectual handicap
6. Emotionally disturbed
 Disability Evaluation

• A disability rating rates the patients inability to do any substantial gainful

activity compared to what he was able to do before the onset of the problem.

• It is calculated by performing general physical, orthopaedic , physiatric and

neurological examinations of the patient in the rehabilitation centre.

• It helps in identifying the extent of handicap in a person in order to make him or

her eligible for certain concessions offered by the Government from time to
time.
 Functional Diagnosis

The functional diagnosis should be:

• Objective, using measurable factors so that the results are statistically more reliable.
• Descriptive so that the actual situation is accurately reflected.
• Simple enough so that rapid evaluation is possible.
• Reproduced, so that constancy may be maintained.
• Comprehensive, so that the diagnosis is complete and specifically utilized in the direct
care of the patients and is relevant for epidemiological investigation.
 Primary and Secondary Disability

Disabilities that are direct consequences of a disease or condition are called primary
disabilities.

On the other hand, disabilities that did not exist at the onset of the primary disability
but develop subsequently are called secondary disabilities.

Elderly people and those who have had a primary disability for an extended period are
more susceptible to a secondary disability.

when pain or spasticity accompanies the disease or condition causing the primary
disability, the prevalence of secondary disability increases.
Primary and Secondary Disability
 Primary and Secondary Disability

Disability Limitation
Disability limitation refers to preventing an increase in the intensity or scope of an existing
disability.
This measure, therefore, becomes necessary after termination of active medical or surgical
treatment.
Goals of Rehabilitation: Handicapped individuals have problems with
Orientation: daily living like feeding or toileting.
Physical independence: It is the prayer of every handicapped person
Mobility: day to day tasks like moving in and around the house
Occupational integration: Training and placement in a suitable job.
Social integration: made to integrate handicapped people into society, and not isolate them.
Economic self-sufficiency: The job must ensure a means of livelihood
No person is fully rehabilitated unless all the above criteria have been looked into.
 Out Comes

Session Outcomes

Upon Completion of this session the students will be able to

 Define the rehabilitation engineering
 Explain the epidemiology of Rehabilitation engineering
 Describe the health component and its role in rehabilitation Engineering
 Interpret the levels of preventive rehabilitation
 Explain the difference between disability, impairment and handicap
 Describe the relationship between disability, impairment and handicap