1. Mainstreaming Disability and Rehabilitation

2. Mainstreaming Disability

3. WHY DISABILITY ?

4. “To support disabled people in exercising their rights and to promote their full inclusion and active participation as equal members of their families, communities and societies.”

5. DISABLED PEOPLE’S NEEDS Fundamental Needs Right to life Communication Mobility Equal Opportunities Social Acceptance

6. DISABLED PEOPLE’S NEEDS Basic Needs Food Clean Water Shelter Health Education Income / Employment

7. DISABLED PEOPLE’S NEEDS Political Needs Freedom to speak Freedom to associate Right to organized Representation Legal voting rights

8. DISABLED PEOPLE’S NEEDS Psycho-social Needs Friends and relationships Family Reproductive Rights Equal Access to service

9. Definitions of Disability Mongolian Law on Social Security for persons with Disabilities: “The term “a disabled person” means permanent inability of the individual to engage in social relations by reason of physical, mental or sensory impairment which can be expected to last for continuous period of not less than 12 months.”

10. Definitions of Disability UN Convention on the Rights of Disabled People 2006 “Persons with Disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in the society on an equal basis with others.”

11. Definitions of Disability Disabled People’s International “Disability is the loss or limitation of the ability to take part in the normal life of the community on an equal level with others, due to physical and social barriers.”

12. Mongolian National Programme to Support Disabilities Purpose: To provide the joint participation of government, civil organizations and person with disabilities in order to increase the possibility to develop and create a social environment that respects the rights of people with disability

13. Mongolian National Programme to Support Disabilities Principles: Equality Opportunity Support and promotion Linking of policies Accessibility

14. Mainstreaming DISABILITY Review Plan Do

16. Records

17.  rehabilitation can further assess the possibility of recovery. rehabilitation can further assess the possibility of recovery. Early Rehabilitation What is the importance of early rehabilitation?  rehabilitation can further prevent the severity of paralysis, contracture and effects of disability. rehabilitation can further prevent the severity of paralysis, contracture and effects of disability.  Family education and support to the patients. Proper home care management can be provided to the person who will take care of the patient Family education and support to the patients. Proper home care management can be provided to the person who will take care of the patient

18. Does a person need rehabilitation to recover from a stroke? Most gains in a person's ability to function in the first 30 days after a stroke are due to spontaneous recovery. Still, rehabilitation is important. For the most part, successful rehabilitation depends on how early rehabilitation begins the extent of the brain injury the survivor's attitude the rehabilitation team's skill the cooperation of family and friends

19. What is the goal of rehabilitation? For a stroke survivor, the rehabilitation goal is to be as independent and productive as possible. That may mean improving physical abilities. Often old skills have been lost and new ones are needed. It's also important to maintain and improve a person's physical condition when possible. Rehabilitation begins early as nurses and other hospital personnel work to prevent such secondary problems as stiff joints, falls, bedsores and pneumonia. These can result from being in bed for a long time.

20. Case Study Patient A Age: 62 years old Sex: Female Add: Mongolia Date of Birth: Date of Adm: April 29, 2010 Date of IE: May 6, 2010 Date of Dis: May 17, 2010 Diagnosis: CVA c hemiparesis. Pt Impression: Ischemic CVA c paralysis on the UE & LE. RL R L

21. History of Present Illness HPI: Px states that on the eve of 04/29/10, she ate meat soup for dinner. Px states that she had a big meal usually and smokes. Px is very active and hard working. After dinner px slept and woke up at 2am in the morning experiencing speech difficulty. And when px tries to move she is experiencing difficulty of lifting her UE & LE. Px calls for help and px was rushed and admitted in CDHU In-patient neuro department.

22. PMHx: (+) colon operation [Cease removal 1999] (+) last child birth [1992] ( - )hospitalization prior to this Past Medical History P/SHx: (+) px is extrovert (+) smoker ( - ) alchohol bev. drinker. Social History

23. LabHx: (+) MRI result: CVA c hemiparessis. ( - ) Blood chem. done on the px. Laboratory History MedsHx: Medication History RL

24. Physical Findings: (+) redness on saroiliac jt. (+) pain (PS:5/10 and blackening on injected area.) ( - ) significant findings both UE & LE besides flaccid paralysis on both UE & LE. Physical Findings Vital Signs: BP: 110/70 mmhg RR: 18 cpm PR: 86 bpm Temp.: 36.2 c Initial Vital Signs

25. Comparison Patient A Patient was able to move fingers after 12 days after admission and after 7 PT treatment session. Patient was able to move fingers after 12 days after admission and after 7 PT treatment session. Patient has no contractures and no further significant findings besides shoulder sublaxation. Patient has no contractures and no further significant findings besides shoulder sublaxation. Patient B Patient was able to move fingers after 3 months after admission and no PT treatment session Patient was able to move fingers after 3 months after admission and no PT treatment session Patient has clubfoot deformity, typical claw hand deformity, and difficulty in breathing and bed mobility. Patient has clubfoot deformity, typical claw hand deformity, and difficulty in breathing and bed mobility.

26. Comparison Patient A Patient is relax when sitting and can sit by herself minimal assistance when rising from supine to sitting. Patient is relax when sitting and can sit by herself minimal assistance when rising from supine to sitting. Patient has no postural hypo/hypertension and can eat by herself with minimal assist. Patient has no postural hypo/hypertension and can eat by herself with minimal assist. Patient B Patient was not able to sit by himself, maximum support is needed to maintain sitting position. Patient was not able to sit by himself, maximum support is needed to maintain sitting position. Patient has postural hypotension can not eat by himself and care giver dependent. Patient has postural hypotension can not eat by himself and care giver dependent.

27. Reading of Acknowledgement from the family of patient A