2 M-CARE: Disability awareness

Mobile Training for Home and Health
Caregiver For People with Disabilities and
Older People
539913-LLP-1-2013-1-TR-LEONARDO-LMP
Module:
Disability Awareness

Unit 1
• Impairment and Disability
– Medical model
– Social model
– Bio-psychosocial model

What is Impairment?
Impairment - any loss or abnormality of psychological,
physiological or anatomical structure or function.
World Health Organisation (1980), A manual relating to the consequences of disease.
Geneva, World Health Organisation
The photo is owned by PhoenixKM

What is Disability?
Disability - Any restriction or lack, resulting from an
impairment, of ability to perform any activity in the
manner or within the range considered normal for a
human being.
World Health Organisation (1980), A manual relating to the consequences of disease.
Geneva, World Health Organisation

What is Disability?
There are three distinct models of disability:
• the medical model
• the social model
• the bio-psychosocial model

• The medical model
– disability is understood as an individual problem.
– if somebody has an impairment – for example –
inability to see, walk or hear, it is understood as
their medical problem.
Photo by Teerapun, http://www.freedigitalphotos.net/

• The medical model of disability also affects
the way people with disabilities think about
themselves.
• People with disabilities can also be led to
believe that their impairments automatically
prevent them from taking part in social
activities.

MEDICAL MODEL
Impairment – your problem!
Disability – your problem!

Medical – This model implies that the person is the problem
Social – this model stresses that
society is the problem
Photo by stockimages,
http://www.freedigitalphotos.net/

• The social model
– Disability is seen primarily a result of society’s
response to people with disabilities.
– Experience of the health and welfare system made
disabled people feel socially isolated.
Photo by Praisaeng, http://www.freedigitalphotos.net/

Through the social model, disability is
understood as an unequal relationship within a
society in which the needs of people with
disabilities are often given little or no
consideration.
Photo by David Castillo Dominici, http://www.freedigitalphotos.net/

People with disabilities are disabled by the fact
that they are excluded from participation within
the mainstream of society as a result of physical,
organisational and attitudinal barriers.
Photo by Renjith Krishnan, http://www.freedigitalphotos.net/

These barriers prevent them from gaining equal
access to information, education, employment,
public transport, housing and social/recreational
opportunities.

SOCIAL MODEL
Impairment – is part of me.
Disability – is society’s problem.
Society needs to change, not disabled people.

• The bio-psychosocial
model
– This model sees disability
as interaction between a
person’s health condition
and the environment they
live in (e.g. ICF model).
– It advocates that both the
medical and social models
have advantages, but
neither is sufficient on its
own to explain the
complex nature of one’s
health.
BUT: be aware that
current qualifying
standards for benefits are
primarily medical!

Unit 2
• Anti-discrimination & legislation
– UN Convention on the Rights of Persons with
Disabilities
– European Disability Strategy 2010-2020
– National legislation

• Anti-discrimination legislation,
equal-opportunity policies
and programmes of positive
action exist throughout
Europe and more widely.
• They support people with
disabilities to take part in a
whole range of social activities
which non-disabled people
access and take for granted.
Photo by Stuart Miles,

• UN Convention on the Rights of Persons with
Disabilities
– Human Rights model of disability
– “Disability results from the interaction between persons
with impairments and attitudinal and environmental
barriers that hinders their full and effective participation
in society on an equal basis with others.”
– Key elements:
• Antidiscrimination legislation
• Mainstreaming
• Accessibility
• Civil society

• Disability Strategy 2010-2020
– Comprehensive framework committing the Commission to empower
people with disabilities to enjoy their full rights, and to remove everyday
barriers.
– Areas for action:
• Accessibility – Ensure accessibility to goods, services -including public services- and
assistive devices for people with disabilities.
• Participation - able to fully exercise their fundamental rights as regards European
citizenship
• Equality - active policies to promote equality at European level and in Member States
• Employment - number of disabled workers in the traditional labour market to be
increased
• Education and training - benefit from an accessible education system and lifelong learning
programmes
• Social protection - compensate for the income inequalities, risks of poverty and social
exclusio
• Health - benefit from equality of access to services and health facilities, including mental
health facilities
• External action - promote the rights of people with disabilities at international level
– Supports and supplements national activities for implementing
accessibility and removing existing barriers, and improving the availability
and choice of assistive technologies

National legislation
• Belgium
– Act of 10 May 2007 pertaining to fight against certain forms of
discrimination (Federal General Anti-Discrimination Act).
– Decree of the Flemish Community of Belgium concerning balanced
participation in the labour market.
• Bulgaria
– Protection Against Discrimination Act, 2004
• Germany
– General Law on Equal Treatment of 2006 (AGG).
– Social Code IX.
– Law on Promoting the Equality of the Disabled.
• Greece
– Law n. 3304/2005 Implementation of the Principle of equal treatment
regardless of racial or ethnic origin, religion or belief, disability, age or
sexual orientation.

National legislation
• Turkey
– 2011-2013 Care Services Strategy and Action Plan
– 2011-2023 National Mental Health Action Plan
– Law on Persons with Disabilities (Law no. 5378): is the first comprehensive law on disability
related issues, such as education, vocational training, employment, prohibition of
discrimination, reasonable accommodation etc.
– Labour Law (Law no.4857): provides for an employment quota for persons with disabilities.
– Turkish Civil Law (Law no. 4721): provides restrictions on legal capacity of persons with
intellectual disabilities as well as persons suffering from mental disorders.
– Turkish Criminal Law (Law no. 5237): prohibits discrimination based on the ground of
disability.
– Law on Civil Servants (Law no. 657): contains provisions on the employment of persons with
disabilities as civil servants.
– Law on Social Services (Law no. 2828): establishes the types of social services (including
protection of persons with disabilities) to be provided to persons with disabilities.
– Law on Pension for Turkish Citizens over 65, Needy and Homeless (Law no. 2022): prescribes a
means-tested pension for persons with disabilities in need.
– Statutory Decree on Special Education (No. 573): establishes the principles of special
education and how those principles shall be implemented.
– National Accessibility Strategy Action Plan (2010-2011).
– Action Plan for the Employment of Persons with Disabilities (2005-2010).

Most people
will experience
disability at
some point in
their lives
through illness,
accident or
aging.
Photo by Stuart Miles, http://www.freedigitalphotos.net/

• For example
– the lack of information available in large print can
be a disabling barrier to many older people as their
eyesight changes over time and they are no longer
able to read standard-size print.
Photo by Ambro,

Unit 3
• Types of disabilities
– People with mobility impairments
• What is it?
• Some examples
– Muscular Dystrophy
– Cerebral Palsy
– Paralysis
– Hemiplegia
– Paraplegia
– Quadriplegia
– Multiple Sclerosis
– Polio
• Barriers of people with mobility impairments

• Mobility impairment can
be caused by a range of
conditions that can be
temporary or permanent.
• The condition may affect
some parts of the body
or the whole of it.
• The effects can change
from day to day; they can
remain the same or get
progressively worse over
time.

• Characteristics:
– Limited dexterity in upper and/or lower limbs;
– Difficulties in moving (in wheelchair, using crutches,
cane or other aids);
– Need constant assistance by other person.

Remember!
• Leaning on or
hanging on to a
person's wheelchair
is generally
considered
annoying.
–The chair is part of
the personal body
space of the person
who uses it.

• Muscular Dystrophy involves deterioration
and wasting of muscle fibres.

• Cerebral Palsy relates to bad coordination and
involuntary movements of the muscles.
http://forkneedlepen.files.wordpress.com/2013/03/typesofcp.gif

• Paralysis means a loss
of feeling (sensory loss)
in certain parts of the
body and being unable
to move these parts.

• Hemiplegia is the paralysis
of one side of the body as a
result of a stroke or brain
injury.
– With hemiplegia, there may
be an impairment of intellect,
personality, speech or the
senses.
Photo by stockimages,

• Paraplegia - there is
a loss of sensation
in paralysed limbs
as well as other
effects such as
muscle spasms,
pain and loss of
bowel and bladder
control.

• Quadriplegia - This will cause impairment to the
hands and arms in addition to the effects of
paraplegia.
http://www.epainassist.com/images/quadriplegia.jpg

• Multiple Sclerosis is a disorder that attacks the
brain and spinal cord and causes deterioration
of the nerve tissue.
– Usually associated with paralysis, muscle spasms,
disorders of speech, and tremors of the hand.
• Polio causes a high fever and paralysis of
different muscles.

Barriers…
Photo by ddpavumba, http://www.freedigitalphotos.net/

Mobility impaired people may
have the following:
• Difficulties with co-ordination
and movement;
• Difficulties with endurance and
stamina;
• They may find routine tasks
such as driving, household
chores, cooking and grooming
difficult and/or tiring;
• Fatigue.

• If their hands or arms are affected they may:
– Have difficulty with handwriting;
– Be unable to write using a pen/pencil;
– Have a slow writing speed;
– Have difficulty turning pages;
– Have difficulty using a standard keyboard or mouse
– Have difficulty using equipment found in
conference rooms;
– Have difficulty filing or storing documents

• Physical accessibility
– Inaccessible or not enough accessible
passageways and stairs
– Too narrow elevators, entrances and
corridors
– Too heavy doors
– Rolling doors
– Slippery floors or covered with thick
carpet
– Lack or difficult access to objects or
buttons placed on inappropriate level
– Not sufficient space for moving for
person in wheelchair or using other
mobility aids
– Lack of equipment facilitating
independency of person in the toilet or
bathroom (e.g. rails, handles).

Unit 4
– People who are blind or partially-sighted
• What is it?
• Some examples
– Total blindness
– Central vision loss
– Peripheral vision loss
– Blurred vision
– Colour-blindness
– Night-blindness
• Barriers of people who are blind or partially-sighted

• Everyone who has a
visual impairment is
different – people with
visual impairments’
experience of being
blind / partially sighted
is unique to them.
• The impact of this
disability depends on
the kind of vision loss
and how severe it is.

• Some of your clients
may rely on a guide dog
or use a white cane to
help them get around
• Others may have
enough vision to get
around on their own.

• Total blindness - Blindness is the condition of
lacking visual perception due to physiological or
neurological factors.
• Central vision loss – e.g. Macular degeneration is
a medical condition usually of older adults which
results in a loss of vision in the centre of the visual
field (the macula) because of damage to the
retina.
• Peripheral vision loss - so called tunnel vision,
retain clear central vision. They might detect
movement and objects that assist with one's
orientation.

• Blurred vision - causes both near and far to
appear to be out of focus.
• Colour-blindness is the inability to perceive
differences between some of the colours that
others can distinguish.
• Night-blindness - results in inability to see
outside at night under starlight or moonlight,
or in dimly lighted interior areas such as
movie theatres or restaurants.

• Visual information (marking, directions, gestures,
mime, etc.)
• Printed materials (leaflets, registration form,
information brochures, menus, etc.)
• Information related to emergency situations
(evacuation ways signs, printed instructions in case of
emergency)
• Orientation in new surrounding without guidelines
• Independent usage of new devices (e.g. elevator
without special marking or other adjustments)
• Recognition of objects of the same shape (e.g. the
same containers with cosmetics in the bathroom)
• Finding objects because the location has been changed

How to act as a PCG?
• Identify yourself
• Offer assistance, but don’t
insist (do not grab someone
by the arm)
• Service animals are not pets,
they are working
• Identify for the person with
vision impairments the
arrangements (shape, size,
window, doors) and their
contents (furniture, people

Unit 5
– People who are deaf or hard of hearing
• What?
• Barriers of people who are deaf or hard of hearing

• Hearing loss, deafness, hard of hearing
– partial or total inability to hear
– if people were born deaf, they may not have well
developed speech
– might have problems with sequencing, grammar etc.
• How do they communicate?
– Hearing aids may be used to amplify sounds (hearing
aid is just the device and has a lot of limitations)
– Sign language may be a mother tongue
– Lip reading: when speaking, ensure person can see
the person who is talking

• Sign language (SL)
– Human speech is very
different from SL which is
based on hand movement,
gestures and facial
expressions.
– If the client communicates
only through SL s/he may use
the services of a SL
interpreter.

How to act as a PCG?
• Find quiet place to talk (no
computers, telephone, fax,
street noises)
• Attract visual attention
before initiating
conversation
• Speak directly to the person
• Lip-reading: rare and tiring,
keep your mouth and face
visible
• Shouting does not help

Unit 6
– Combined/multiple disabilities
• What?
• Types
– Multiple (deaf-blindness)

A person who has several and
combined disabilities, for
example
• sensory disability associated
with a motor disability
• mobility and learning
impairments (e.g. cerebral
palsy, down syndrome)
• deaf-blindness is the
condition of little or no useful
sight and little or no useful
hearing

Example: Deaf-blindness
Ways of communication
• Use of residual hearing
(speaking clearly, hearing aids)
or sight (writing with large
print)
• Tactile signing or sign language
(someone who grew up deaf
and experienced vision loss
later in life is likely to use sign
language)
• Interpreting services

Unit 7
– People with speech impairment
• What?
• Barriers

• People with significant articulation problems,
such as extreme stammering, spluttering or
strong nasal speaking, or slurred speech
Photo by cooldesign, http://www.freedigitalphotos.net/

• Causes
– slurred speech: they may have suffered an injury
or stroke
– lack of control over their facial muscles: they
may have a medical condition such as cerebral
palsy

• Difficulties with communication in situations
requiring fast reactions (i.e. when ordering food
in a shop).
• Sometimes even reluctance to any verbal
communication
– If the person has a stutter, there are some situations
that make it worse, for example, speaking in front of
a group or talking on the telephone.
• They may have problems expressing their
thoughts through speech due to dysphasia (a
partial or complete impairment of the ability to
communicate resulting from brain injury).

• Troubles with saying what they want to say
correctly and consistently.
– If the client has an articulation disorder (like Mr.
Bean’s character) it may affect how others
understand what s/he is saying.
– Examples include substituting a "w" for an "r"
("wabbit" for "rabbit"), omitting sounds ("cool" for
"school"), or adding sounds to words ("pinanio" for
"piano").
• They find longer or more complicated words
harder to say than short or simple words.
• They may also tend to make inconsistent
mistakes when speaking.

Unit 8
– Intellectual (learning) disability
• What?
• Barriers
The photo is owned by http://www.nfcacares.org/who_are_family_caregivers

• Everyone who has a
learning disability is
different.
• There is a very wide
variety of abilities and
therefore a very wide
range of learning
disabilities.

People with learning difficulties may have:
• Lower intellectual abilities
• Troubles in perception processes, concentration, memory
and reflection
• Problems with communication, cooperation with others,
etc.
• They might find it hard to
– understand what is being said
– interact with other people
– understand through reading or watching
– understand some information: numbers, geometric figures,
calculations and maps
– remember things (poor memory)
– talk or write
– plan and manage their time (knowing what to do first or
knowing what to do next)

• Problems with understanding of complex
information and statements
• Lack of understanding of abstract concepts
• Troubles with understanding complicated text
• Problems with full understanding of the value
of daily concepts such as financial transactions

Unit 9
– Alzheimer
• What?
• Side effects

• Alzheimer
– It can occur among middle or older aged
people, due to general degeneration of the
brain.
– It causes a steady loss of memory, speech,
thinking, and carrying out of daily activities.
– Symptoms:
• Memory loss
• Confused about time and place
• Changes in personality and mood
• Trouble speaking and accomplishing tasks

7 stages of Alzheimer
• No impairment
• Very mild cognitive decline
• Mild cognitive decline
• Moderate cognitive decline
• Moderately severe cognitive
decline
• Severe cognitive decline
• Very severe cognitive decline

Side effects
• Nausea;
• Vomiting;
• Loss of appetite;
• Headache;
• Confusion;
• Constipation.

References:
• Caregiver's Handbook: A Complete Guide to Home Health Care, DK
Publishing
• Caregiver's Manual, The. Williams, Gene B. and Kay, Patie. Citadel Press
• Comfort of Home, The: An Illustrated Step-by-Step Guide for Caregivers.
Meyer, Maria M. with Derr, Paula. CareTrust Publications
• Dying at Home: A Family Guide to Caregiving. Sankar, Andrea. New York:
Johns Hopkins University Press
• Helping Yourself Help Others: A Book for Caregivers. Carter, Rosalynn.
Random House
• World Health Organisation (1980), A manual relating to the consequences
of disease. Geneva, World Health Organisation

2 M-CARE: Disability awareness

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