CHAPTER - I

DISABLED IN INDIA

Illdia is t11c largest dcnlocracy wit11 a pop~ilatior~ ot'ovcr a billion pcoplc ('1025251 059

pcrsons)' and with onc of thc higllcst dcnsi tics 01'populatiorr ill tlic worlcl (324 per-

sons /sq.km). I t is geographically and ethnically 1 ~ctcrogcncous with 1-iumcrous 1311-

guages, religions and customs. ri 'l~c pcrsons wit11 disabilities have hccn thc lal-gcst

njinorlty group.

,- 7 I he disabled pel-sons arc thosc who suffcr sotnc kind of bodily inlpairrilci~t t h a t

in tcrfere wit11 thci r norinal f~~nctioning. Accordingly, thcrc arc four major catego-

ries of pcrsons with disability or in ot l~cr words, the diffcrcntly ablcd. 'l'hcy arc rhc

l ~ l ind or visual 1 y impaircd , or thopcdically disabled or locolnotor disabled, spccch

and hearing irnpaircd and thc mcntally c tlallcngcd. T'hysical disability is a tlcviation

from thc socially valued characteristics of an individual in a givcrl society. Tllc prcs-

cncc of sucli individuals and groups woilld bring oiit v a r i o ~ ~ s challcl~gcs a11tl oppjr-

tnnitics, problcrns and possibilities to bc dealt with.

The hanciicappcd person nccds to bc undcrstood ancl trca tcd l i kc a normal I lul t~an

bcing, as an itldividual and as a lrlcnlbcr of a family, colnlnunity and socicty at lnrgc.

1 Iis attitudc towards his pcrsonal sclf; fcllow hurrtan bcir~gs and socicty and vicc

vcrsa arc ilnportant f i r tlle tlcvclopmcnt of his fuller self anci i~~tcgratiori into tlrc

~mainstrealn. For t h i s his various rehabilitation llceds such as training, cir~ploylr~cri t ,

availability of assistivc dcviccs, orici~tatio~l and n~obility and such othcrs nlust bc

rnct ant1 thc problccns rcgardirlg the samc havc to be atlswcrcd so t h a ~ h c can ccm-

tribute as a rcsponsiblc and full-flcdgcd mcrnbcr of society.

Magnitude of the problem

,- 7 I hcrc is no systcnlatic, scicn tific and precise inforrnatior~ availal~lc on thc prcva-

Icncc, degrcc and kind of (lisability. Only a few sarnplc survcys at diffcrc~~ t poit~ ts of

timc arc available and thc it~fbrn~ation collcctcd through thcsc trlay !lot l ~ c stt-ictly

comparable due to diffcrctlces in their scope and covcragc. Estinlatcs vary dcpcntl-

ing on thc definitions, scrviccs, methodology uscd and tllc cxtcrit of scientific i l l -

strun~cnts applicd in idcntilyirlg and tncasurirlg tllc dcgrcc of disal~ility. Whilc ;it-

tempting to cstimatc tlic nlagriitrlde of t11c problcm, we arc faccd with thc dcarth

ancl iliadccluacy of' I-cliablc tlata. 01 lly ;I very tcw n n t ~ o i l s llavc arlol~tctl t.Ilr\ systc111 of '

rcgistratiot~s of disabled pcrsolls who arc in ncctf of spccial scrriccs.

Mr. Kurt Jansorl (1 957), the United Nations Itcllabilitatiot-I Chief obscrvcd tl1;i~ I2

tu 13 pcr ccnt oftlle population of a givcn country suffr fro^^! a pcr~.nancnt 01- lo11.g-

tcrln disal~ility.~ Survcys carricd out in Asia, FIII-opc ant1 North A~nrl-ica sllow that

a t icast scvcn to eight pcrccnt of thc population of a givcil country is nffcctcd by

pcrlnancnt 2nd sul~stantial pl ~ysical disability. "

"Ovcr the last few dccadcs thcrc has bccn consitlcrablc i ~ ~ r c a s c 111 thc global csti-

mates of the disableti". ' Thc risc in world population, incrcasc in accidcr~ts. tic-

crease in the ratc of infant inortality, dcvclop~ncnts in pharn~acology aud othcr illod-

crn advanccmcnts in thc ficld ol'tncdical scicncc as well as lot~gcr life cxpcctlr~cy lias

incrcascd tl lc nut11 bcr anci sutvival rate of t11c cIi sablcd.

Bcsidcs radiation by X-rays, ato~nic radiation, incrcasc in drug addiction and suc-1 i

othcr causes have incrcasctl the mum bcr of pcrsons with disaljility. O n t h c otlict-

hand cradicatiorl of killer cliscascs likc ineaslcs, small pox, polio is 111-inging clowil

thc numbcr ofdisabled in the country and is helping us to rcducc thc incidcncc of its

occarrencc. At prcscnt wc are usin3 corrective surgery to tlccreasc thc cxtcnt o f dis-

ability and arc also having, dcvcloping and advancing inodcrn technology and assistivc

dcviccs to cornbat disability.

K. Frcednlan obscrvcd that t l ~ c basic cliff-cruncc betwee11 thc birth rate and tllc clrat l l

ratc, in thc world population is increasing at the ratc of 20 pcr tliousanti per ycar.

With two pcrccnt incrcasc, every ycar 70 rnilliot~ peoplc arc added to the cxisti~~g

world populatiorl, giving rise to a prolx)rtiorlatc incrcasc in the nulnbcr of tlic dis-

abled in the wor1d.j 'Thus cvcry year an average of a bout 2,800,000 disabled pcrsolis

arc addcd to thc cxisting population.

Thc World Program of Action Concerning Disabled I'crsons adoptcd by thc U.N

Ccneral Asscnlbly in 1982 rcalizcd thc nccd and importance of statistics 011 disal~lctl

persons as a foutldatiotl for policy planning, evaluatioll and rcscarcl~. It also urged

the n~crnbcr statcs to dcvclop a program of rcscarcll or] thc causes, typcs ancl i t~ci-

dctlcc of irnpairrncilt or tiisability, thc cconolnic arlcl social status uf tllc tlicablcd

pcrsons and the availability and efficacy of existing rcsourccs to dcal with issucs oil

disability. l t has urgctl thc statistical office to coopcratc with thc dcvclopil~g cclucl-

tries in cvolving a realistic and practical data collcctioi 1 with regard to variotls dis-

abilities. This was to equip tllcm to prcpare technical / rnanual documcl~ts otl how

to usc houschold survcys fi-)r the colicction of such statistics to bc uscd as csscrltial

tools and a frarnc of rcfercncc fi)r launclling action progl-atns in the post- Il~tcrna-

tional Year of Disabled l'crsons (IYDI') wit11 a vicw to a~neliornting the cor~di tion of

the disablcd."

The United Nations has estimated that there arc ,500 tnillion disabled in tllc wol-Id

and 400 million disabled in thc devclopir~g countrics. Accol-ding to thc World I ical t li

Organization Expert Comluittec or1 Disability Prcvct~tion, cstitnatc allo1.1t 10 per-

cent of thc world population is disablcd.

In India complete statistics of tllc disabled are not available. I-lowcvcr, it is csti rnatctl

that India has over 100 million disablcd pcoplc. Tllc National Samplc Sllrvcy of

India 199 1 cstilnated that thcrc arc 16.1 5 million persons having at lcast o l~c or all-

other type of disability, which constituted 1.9 pcrccnt of the total population. 74.3

pcrccnt pcrsot~s wit11 tlisabilitics livc i t 1 rural arcas. Tllc prcvalc~lc-r ol'pl~ysic;~l dis-

ability is two perccnt in rural arcas and 1.6 in urban areas. Bctwccn thc two scxcs thc

prcvalcncc as well as thc itlcidcnccs arc rcportcd to bc lrlargit~ally iligl~cr an1orl.g

rrlalcs that1 fcmalcs. About 1 2.4 pcrccrl t of thcsc persons suffcred froin more that1

one type of physical disa\>ility. The persons with locomotor disability arc largcst in

nutnbcr (7.6 rnilliorl) followcd by those with specch and hcari ng i mpai m ~ c n t (4.5

million) and then those with vis~ial impairment (4 million). Al~orlt tiitlc 21 ld s c v c ~ ~

pcrccnt houscholds in the rriral and urban India rcspcctivcly 11avc onc disabled per-

son in the houschold. Anlong these houscholds about 92 pcrccr~t havc one disablcd

pcrson, about scvcn pcrccnt 1 1 ~ two disablcd persons and lcss that^ oilc pcrccilt

rcported thrcc or lnorc disablcd persons both in urban and rural arcas. Also about 25

perccnt in the rural and 20 pcrcent 111 the urban arcas arc rcportcd to hc scvcr-cly

disablcd so thcy could not f~~nct ion even with aids and applianccs. I<cgarding li t-

eracy 70% arc fout~d to bc illitcratc in rural arcas and 46 pcrccnt in urban arcas. C)rlly

29 pcrcent of thc disabled pcrsons arc en~ploycd in the rural and 25 pcrccnt in thc

urban arcas. Ou t of tllcsc 60 pcrccnt wcrc sclf cinploycd and scvcn pcrccn t ])ad

regular crnployrncr~t and the rcrnaining 33 pcrccnt were casual Ialmrcrs. 7

All thc ccr~sus taken by the Govcrnt~lcnt of l~ldia bchrc tllc 2000 c c ~ ~ s u s l~avc 1-10t

i~lcludcd thc locomotor disabled. I- Iowcvcr, tl lc 2000 cc i~s t~s nladc all cfi-brt to

collcct data of all disablcd pcrsons in thc country, but t l ~ c rcpcx-t has yct to l ~ c 11~1)-

lishcd.

Several sarllplc su~vcys about t l ~ c disabled wci-c conductcd in difl'crcnt parts of India

hctwccl~ 1957 - 1998. According to a random sarnplc sulvcy donc by tllc All 111dia

Occupatior~al Therapist's Association in Murnbai ciuring 1057, tllcrc werc 3.5 handi-

capped pcrsorls pcr 1000 of t l ~ c gcncral population, i.c. 0.9 visually i~andicappctl, 0.4

dcaf, 0.4 dcaf - mute and dulnb, 1.36 orthopaedically and tlcurologically handicappcd

and 0.6 ~ncrl tally rctardcd.

'I'he sample siirvcy of disal~lcd pcrsotls condc~ctcd by thc l3cl h i School of S( )cia1

Work in the Grcatcr Dclhi arca highlightcd that the pcrccrltagc of tlisrblcd popula-

tion consists of blind 38 pcrccnt, n ~ n t c 6.33 pcrccn t; otllcr p l~~sica l 1l;llldicaps 25.33

pcrccn t; mcntally handicapped 12.66 pcrccrlt anti pcrsons with mu1 tiplc llandicnps

7.70 pcrccnt. '

Accordil-ig to thc sairlplc survcy conductcd in Mutrlbai l ~ y thc Dircctor Gcncral of'

Bllployrnct~t for the C c ~ ~ t r a l (;ovcrnrncnt in 1959, thcrc wcrr a total of 8,832,000

handicappcd pcrsorls in India i.c. 2.3 pcrccnt of thc Indian poptilation in 1956. l'hc

survcy conductctl in M u m h i prcicctcd a total of 13,440,000 for thc sninc yc;~- , wl l i C h

adds up to 3.5 pcrccnt of tllc lndian populatiot~.'~)

Thc satrlple survey of the handicappcd in ffinpur corlducted by the L1i1-cc tor, 1 nsti-

tutc of Social Scictlccs, Agra University highlightcd that, among tllc disablcd idcnti-

I-icd, 44 pcrccn t wcrc or ~l~opcdic, 33 pcrccnt wcrc bl i ritl.

Disability has bccn tllc subjcct of 2 National Sainple Sulvey enquiry in 1 Sth, 10111,

24th and 28th rounds in thc past. Thcse rou~lds of survcys wcrc rathcr cxplorntory in

nature. 'The first cornprchcnsivc survcy in disability was conductcd in thc 30th I - O L ~ ~ ~ O

Uuly to 13cccmbcr 1981), during thc Internatiol~al Year of rhc Ilisablcd I'crsoils.

Thc ncxt survcy covering tllc suljcct uf' disability was in tllc 47th round (July to

Decern ber 1991). Physical disability definition for thc National Sat~lplc Survey was

any person who suffcrcd frorrl onc or morc of visual, l~earir~g, spccch or locotnotot-

disability. As per thc survcy 1.9 pcrccnt of thc population suffcrcti fi-0111 pliysical

disability. Thc prcvalcncc of disability was more anlong malcs than fcn ]ales I ti a1 l

statcs in thc country.

'I'he cstimatcd nu~nbcr of disablcd persons in thc country on the basis of t l~c N a -

tional Sainplc Survcy 1991, is as follows:

Table No. 1: 1 Estilrlatcd Nu~nbcr of Disabled 1)crsoils in lildia - 199 3

(in millions)

Notcs : 1. Figures in brac kcts indicate pcrcerltagcs s I-iowi-I in cols. ( I ) arld (2), i t ,

cols. (3) and (6) atlcl in cols. (4) and (5) add up to 100.

me of Disability

Visual

I-fcaring

Speech

I-lcaring arlcv

or Spccch

Locomotor

Physical

(at least one

of the above)

2. Figurcs of hearing, spccc h and hcarir~g arid / or speech tlisability cxcludcs

thc age-group bclow 5 ycars.

Rural

Male Female Persons

(1) (2) (3)

1.539 1.796 3.335

(46.15)(53.85) (83.27)

1.409 1.164 2.573

(54.76) (54.24) (76.36)

0.942 0.552 1.499

(62.84)(37.16) (76.25)

2.009 1.490 3.499

(57.42)(42.58) (78.07)

4.396 2.41 1 6.807

(64.58) (35.42) ( 7 15)

7.442 5.210 12.652

(58.82) (4'1 .I 8) (78.32)

Urban

Male Female Persolis

(4) ( 5 ) (6)

0.308 0.362 0.670

(45.97)(54.03) (16.73)

0.339 0.330 O. 069

(5. .07) (49.33) (20.64)

0.298 0.169 0.467

(63.81)(36.19) (23.75)

0.557 0.426 0.983

(56.66)(43.34) (21.93)

1.370 0.762 2.132

(64.20) (35.74) (23.85)

2.078 1.424 3.502

(59.34) (40.66) (21.65)

Total

3) + (6)

4.005

3.242

1 .OGG

4.482

8.039

16.1 54

Soarre : IZeport oJNo. 393 NSSO A Report oir Ditnblerl1~t~rr~or1.c 47th Korrr~ri lrrly - L)imccrr ;bc'r-

- 199 1 l? Report ON Mdrrpoiver Developttrenl. Kelmbilitatiotl corrr~ril o/' l~rdin, Nur, L)rlhi,

Jmruory 1996.

Table No. 1 :2 Thc agc - wise distri\~ution per tt~ousand, tl-lc disabled has bccl-I

found to bc as follows:

f ipc of Disability

Source : 12eport No. 393 NSSO A Repor-1 or1 Disnbled I'ersorrs 471h Rorrirrl Jirly - Dectprrlbo, - 1991.

Age

group (Years)

0-4

5-14

15-59

60 and

above

Among thc visually tiandicappcd, nearly 70 pcrccnt arc i l l thc agc group 60+ atitl

less than thrcc pcr ccnt arc in the agc group of 0-14. For spccch disability, tlcarly 26 pcr cent arc in 5-14 agc group. Ncarly 50 pcr cent of thc IOCOIIIOLOI- t1is;lblcd and thc spccch disabled arc ir l the agc group 15-59

Estimate on Physically Disabled in Kcrala

Notcs : Kur = Rural

Urb = Urban

N.A. = Not availilble

Visual

Rtlr. Urb.

4 5

24 21

255 304

717 670

rl'l~c Triva~ldru~n Mcdical Collcgc liehabilitation Unit i t 1 1067 conductccl a ccl~scls

survcy of the llantlicappcd in collaboration with Loyola C:ollcge of Social Scicnccs,

Trivandrum. It rcvcaled that out of a total population of 3.8 lakhs 4,800 wcrc dis-

ablcd.

Hearing

Kur. Urb.

N.A N.A

85 80

387 377

526 541

Speech

Rur. Urb.

47 47

262 261

539 513

197 225

Locomotor Disability

Rur. Urab.

27 30

224 223

487 503

240 227

R w . Ui-b.

27 31

150 165

425 458

398 346

l ' l lc cstilllatcs o n pllysically disablcd persons uf l<crala 1090 by tlic i . ) c p a t - ~ ~ ~ l c l ~ t ol

Econonlics and Statistics published by Crovcrt~tricr~t of 1Ccrala givcs t l~c followillg

As pcr the 1991 census report there were 55 laklls housclloltls in thc Statc. 'l'l~r

National Samplc Survey Orgaanization in the 47th rourld of the survcy, collductcd

ficld surveys i r l thc 2505 I ~ouscholds for t l ~ c cclltral s:ln~plcs. AI m;,l~g tllchl 1007

l~ouseholds wcrc it.] the rural and 688 I~ouscl~olds it1 tlw urban scctor.

Table No. 1:3 Population, Estilnated rlurnbcr of disablctl and pcrcelltngc ot:clis;~blcd

to total populatiorl it1 Kcrala

Source: Es.fir~lates or1 I ' i iy-s idy Disabkd persons o j Kerilln, Dq~arir~iewt (f Iicorior~lirs orr t l

Stnti-siir Couenr r rre~it cf I<i~rolt~, 1.996. pr:qe - 7

Year

1981

1991

1995

(IJrcj - cctcd)

The estimatcd numbers in thc collowing tables arc obtaincd by applying a survcy

bascd pr~jcctions of thc 47th round to t11c cctlsus/projcctcd population. In t a l ~ l c 3

rural, urban and total populatio~~ of the 1981 c c ~ ~ s u s a11 J t l ~ c 1 90 1 census a l ~ d t1 ic

projected population of 1995 l ~ y thc Dcpartmcnt of Econo~nics atlcl Statistics arc

prcscntcd. Ou t of206.3 lakhs of rural population in 1981, thc numhcr of disahlcti

persons was 3.38 lakhs which comcs to 1.65% of tllc total population against, tlic all

Rural 1

Urban

Rural

Urba 11

Total

Rural

Urban

'I?) ta 1

'I'otal

Population

(La kl~s)

200.3

47.7

254.0

214.1

76.8

290.9

306.9

No. of disabled

(Estimated)

338332

78705

4 17037

41 7495

134400

55 1895

5 8004 1

Percentage of

disabled to total

population

1.65

1.65

1.65

1.95

1.75

I . $0

1.89

Percentage of

disabled all

India

1.84

1.42 --

1 -00

1.57

--

--

10

'Iible No. 1 :4 Pcrccntagc cclt'disablcd and type disahili ty to total popu l ;~ t io~~ in Kcr;~l;l

Source: Estirrrales or1 l'hysicolly Di.tabk.tl per-corrs of Ktmln, 11ty)ortttrerrt n / l -hrror~r ic-~ nirti

Stntblics Govenln~a~t oJKemh, 1996. page - 7

Table Nd4 rcprcscnts thc pcrccntagc ddisablcd pcrsolis in various typcs otdisahili-

ties i-c, visual, hcaring, spccch and locomotor tlisahilitics, in thc rum1 atld rlrhan

arcas it] Kcrala as or1 of 1081 and 1991. Thc pcrccntagc of locornotor disal~ility i l l

rural as well as i r l urban sector arc vcry high than thc othcr typcs, i.r., visual, l~caring

and spccch disabilities. Thc pcrccntagc of disability is lcss in the urban area.

Year

1981

1991

The r~urrlber of disabled according to various type of disabili tics to total poprllatii )rl

of 1981 & 1991 ccnsus and to the projcctcd population of 1995 arc prcsct~tcd in tablc

No. 5.

Rural /

Urban

Rural

Urban

Rural

Urban

Population

(Laklis)

206.3

47.7

214.1

70.8

Percentage of disabled on types

Visual

0.255

0.303

0.525

0.302

Hearing

0.489

0.413

0.467

0.339

Speech

0.420

0.472

0.273

0.237

S y eecll

alld

hearing

--

--

0.636

0.498

Loco-

tt~otor

0.877

0.843

1.074

0.i362

Atleast one

type of

disability

1.65

1 .OS

1.95

1.75

Soi,trrc: Estir~rales or1 IVzysicolly Disablcd llersorrs oj' Kernla, Dcpnrir r re~lt qf Ecor~or r r i r ~ n r d Statistics Gouerrrr~retlt o/Kemln, 1996. p q e - 8

1 1

'I'ablc No. 1 : 5 Esti~natctl I I ~ I I I - I ~ C ~ ~t'clisablcd 011 typc of disa F .+ - - .,

Table No. 1 :6 Pcr 1000 Uistributiorl of' disabled pcrsons by dcgrcc of clisability

Year

1 98 1

1991

1995

Source: Esrirtinlcs otr i%ysiccrll y DisoDled persotts OJ' I(Erfi11, L ) ~ ~ ~ Y I I I I L ~ I I I of L~co i lo~~z i t - s nrrti

Statictics Gouer-rr rrlcrit ojKcmlo, 1996. paxe - 8

Rural /

Urban

Ktlr;~l

Url,atl

Total

Rural

Urban

Total

'Total

(Projc-

ctcd)

Degree of disability

Cannot function even with aid

C a n fur~ction only with aid

Can function without a i d

Total including (N.H)

Populatio~l

(Lakhs)

200.3

47.7

254.0

2 24.1

70.8

290.9

306.0

Urban

Ma1

Rural

208

192

594

1000

Atleast otre

type of disability

3,:38,332

78,705

4,17,037

4,17,40.5

I ,34,400

S,Sl,8()5

5,80,041

Visual

2 0 0

14,453

07,059

1,12,402

23,193

1,35,595

1,43,052

Person

254

176

564

1000

!

Male

242

193

555

1000

229

162

60.4

1000

Female

268

3 54

575

1000

21 8

178

.5 00

1000

Hearing

1,00,880

1 0,700

1,20,580

4

26,035

1,26,019

1,32,950

Loco- motor

1,80,82S

40,2 1 1

2,21.,136

2,20,04:3

73,88 1

3,04,285

3,21,021

Speech

86.646

22,s 1 4

1 ,OO, 1 60

53,449

1 8,201

7 ,050

80,2365

Speech

and hearing

--

- -

-

t,30, 167

38,246

1,74,413

1,84,000

Ttlc dcgrcc of disal~ility in rural and urban scctors anti in botll scrics scct~ls si~nilnr.

'l'hc tlctails ol'tlic dcgrcc of disability sex-wisc at-c givct~ In t a b l c ~ . For J c t c l - ~ l ~ r ~ ~ i ~ ~ f ;

thc degrcc of disability of a disahlcd pcrson, daily living skills, such ;IS ability to go to

tllc toilet, taking food, getting drcsscd, crc. wcrc take11 into iccoun t. 11-1-cspcctivc of-

whcthcr o r rrot a disabled pcrson had "singlc" or "rnul tiplc" disabil i tics, l~c/shr was

classified into orlc of thc tllrcc catcgorics i.c., ( i ) tllosc not a t~lc to takc self CAI-c cvc11

with aids and appliances. ( i i ) thosc ablc to take self-care only with aids a d appli-

ariccs and (iii) thosc ablc to takc self-care witliout aids and applia~lccs. 'Tl~c dcgrcc of

disability rcfcrrcd to the abovc thrcc catcgorics arc t c r ~ ~ l c d as (i) cannot f i lnct io~~

cvcn with aids arld applianccs (ii) can fiillctiorl only with aids and appliat~ccs 2nd ( i i i )

can functiori without aids and applianccs. In iccrala among the total p o l ~ ~ l l a t i o ~ ~ ,

tnorc than 25'%1 i l l rural arcas ant1 2 I ' X , i l l the urban scctor arc scvcrcly disahlctl ;111cl

could not cvcrl 6~111ctiotl with thc liclp of aids and applianccs, whicll is sitnilal- to thc

percentage at all tllc India Icvel.

Age at the onset of disability

Sornc pcoplc arc born disablccl and sot) ~c acquire clisabil i ty aftcr birtli i ~ i tlic cottl-sc

of lifc. T h c distribution of pcrsons over the agc of 60 at thc onsct of dis;~lility f i j r .

rural and urban sectors is giver1 in tablev7 &;8. Prom thc dis t r ibut io~~ it is rcvcalcd

* 3 that physical disability i s l~lainly an old age problcrn. I hc rnajority i-c. about 50 to

70'X, acquired ciisability a t thc age oof 60 years and abovc it1 all type of disability in

both thr rural and urban scctors. Thc t~cx t itnportant agc group was 45 to 59 wrrc

the pcrccntagc is 15 to 25. Thc third position con~cs to thc agc group 01'35-44.

Altogcthcr tllc results give all irldication that for all thc typcs of disability i.c., visrial,

hearing, speech and locomotor disabilities, ttlc possibility of incidctlcc was rclativcly

higher in thc older ages t11a11 that in tllc middlc and lowcr ages of Iifk.

13

'Iablc No. l:7 Pcr 1 000 distri hution of' p l ~ ~ s i c a l ly disablcd pcrsons of agc- GO ycal-s

a i d abovc by age a t or1 sct of disabili ty for cach typc of disability.

Rural

Table No. 1 :X Pcr 1000 distribution of physically disablcd pcrsons o l agc 00 ycars

and abovc by age at on set ofdisabiltiy for each typc of disability.

Url)an

Type of

disability

Age at onset (years)

Age at onset (years)

Source: Es:slirnotts- or1 Pltysirally Disabled yersorrs if Kerda, lIt~)or,tr~lolt clj Ecorrorrliis at1 rl Statistics Covcrnr~~.rrt Of Kerala, 3 996. p r g e - 9

0-4

Type of

disahiIity

Visual

I-lcarirlg

Spccch

Loco-

rnotor

5-9

I r a

India KCI-ala

India

I<cra la

India

Kerala

Crldia

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-44 45-59 60& Total

8

12 -

7

10-14

31

15 38 13

15-19

35 39 9 - 21 - 7 27 287 572 l (XH1

20-24

43

7 18

10

68

21

1.2

16

25-29

-

3 21

'1 '1

20

5 30 13

Above

054

690 588 651

002

585

30-34

8

6 12

7

1000

1000 1000 I000

30

28 I01 55

1000

1000

7 '17 25

-

5 31 14

N.A

1 50

236 159 215

21

35-44

-

15 4 1 13

45-59

280

50 198

60&

Above

'1i)tal

14

'Iablc No. 1 :9 District - wisc distributior~ oEDisal11cd pcrsons in I<crala ( I 981 - C c ~ ~ s u s )

Source: Estinlnles or1 Physically Disabled persotn o/ khuclln, Deparlrrleill of ikor lor ~ l i c s arr t i

Stnii-$tics C~overrrtt~trrt oJ'Kemlo, 1996. ynge - I0

S1. No.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

1 1.

12.

Thc aggrepte numbcrs of totally blind du111b and totally cripplcd wcrc col lcc-t ctl i l l

the listing stagc of 1981 -population ccnsns. According to thc ccl~sus rcpoi-t out of :I

total population of 254 lakhs 3 1 053 wcre disablcd which cotlsti tutcd 8 1 78 pcrsolls

totally blind, 12056 persons totally crippled and 108 1 9 pcrsons totally dun] b. 'The

district wisc distribution of totally blind totally cripplcd a~ld totally dumbs, accorcl-

ing to 1981 ccnsus is givcn i l l ta l~lc Noldl. Bascd o n thc proport i o l ~ of tlic 1 O X 1 c-c t l -

sus, the estimated number of totally disabled pcrsotls during 199 1 corncs to 35500. It

may be remembcrcd that dctai Is o f disablcd pcrsons wel-c tiot collcctccl in 199 I i ~ t l c l

so the nurnbcr of disabled persons cotild o i ~ l y be cstirnatcd by using the prol>or~ion

of the 1981 census. 'T1-~c critcria adopted in thc 1981 ccnsus for idcntif'ying disalrlctl

persons, was that t l ~ c spccific disability i.c., being blind, cripplccl or dcaf sl~onld bc

District

Kannur

Vayanad

I<ozhikodc

Malapprlratn

Palakkad

l'hrissur

Ernakulam

ldukki

Kottayaln

Alappuzha

I<ol lan~

Thirivatla~~thapuram

Kerala

total and hence partially blind, partially cripplcd and partially dcaf pcrsons wcrc not

considcred. Fro111 the pi-opurtions of 1 98 1 CCIISUS a d 199 1 r~atiorlal san~plc survey

the person with total disability was 35500 against 5.5 1 lakhs of disablccl pcrsons wi tl)

total and partial disability. It may be concluded that thc nurnbcr of totally disahlccl

Totally blitid

No.

879

155

674

823

960

824

1131

264

439

700

ti70

650

8178

Totally

Crippled Nos.

1 '1 22

1 97

1 030

940

069

'1 040

1115

348

928

3 338

I014

1 706

12056

Totally duinb

Nos.

1213

1 50

1007

81 1

73 0

1223

1 1 1 0

41 8

$300

1145

1 207

858

108 '19

pcrsons forms only a ncgligil~lc pcrccn tage while sizc of tl I C partially tlisal~lcd st ; l i~ tls

s~~bstant ia l l~ high.

'I'he sam pic survey l ~ y Ahili ty Aids India intcrnatiorlal and Loyola Collcgc NSS Ullit.

Trivandru~n i l l 1997, Foul~d that out of cvcry ilu~ldrccl fa~nilics i l l r f i ivnndr~. l~~~, H t o

1 0 farnilics had a disablcd mcml~cr in thcir Fatrlily. /\I1 tllcsc st;~tistics givc ris a clc:l~-

picturc of thc disablctl poptilation in Kcrala and India. Thc planners, policy inakcrs

and itnplcrncntcrs of disabil ity programs can nnkc usc oE tllc avai lahlc sta.tistics tiw

t~lcctit~g the nccds and answcring the problems of thc disablcd pcrsorls it1 Kcraln.

Impairment. Disability and Handicap

Thc terms 'Disahil i ty ', 'I'hysically 1-la~~dicaypcd', and 'I tnpaircd' l lavc hccrl dcii I ~ c d

irl vario~is ways according to time and space. Hcllcc it dit'fcrs frorrl country to coun-

try, place to placc and time to time. 'I'hc term handicappcd varics ir, meaning and

sigt~ificxt~cc, not only in diffcrcnt conr~trics, but also witliin any onc c-ou~ltry, ;I(- -

cording to the purpose for wl~ich tllc definition is applied or for wlliclr it i s tlcsit-ctl

to classify such pcrsons. ' '

The reasons arc:-

i) TI lcrc is no c lcar-cut dcrr~arcatiol~ bctwccrl tl IC so-cal lctl "at~lc L~otlictl" a t l t l

disal>lcd.

i i ) 'I'llc titlc "disat~lcd" conccals bchind it a looscly col~l~cctcd Iictcl-ogcncous groilp

of many disahi l itics, which affect different ilidividuals in diffcrcrit ways. Tl~cit-

rarigc varics from a slight and partial disability l ikc t l ~ c artlputatior~ of a ti ngcr

which tnay havc no cffcct a t all on the routinc life of an individual, to tllc r nost

scvcrc and total disability, like cottlplctc bli~~dncss or thc loss of l -o t l~ cxtrc~nitics.

which prodticcs pronounced cliangc in t h c pattern of lifk 2nd work oC thc

individual.

ii i) Definitions of disability have hccn in troduccd for various purposes and as such,

t h e y havc been based 011 various critcria. No sirlgle stat~dartf thercforc exists in

thc world in ordcr to cvaluatc disability.

I I . IIisabi l ity. It rcfcl-s to rcstrictiorls 0 1 1 o r prcvct ]t ion of' cat- l-y~pg out :111 act iv i tv

bccausc of arr impairlmcnt in the manncr or within tile rangc considcrcci not-tnal

for a human bcing c.g., difficulty in walking, seeing, spca king, heal-ing, caul I tint;,

liftitig, rcading, ctc., A tlisahility may last for a long or short titllc, i>c ~ C I - I I I A I I ~ I ~ ~

or reversible, progrcssivc or rcgrcssivc at] J tnay vary it1 its it~ll,;lct fl-om otlr

iii) Handicap: I t dcnotcs a disability that intcrfcrcs wit11 wllat is cxpcctccl at a

particular tirnc in oncs lifc (c.g.) inability to carc fbr ollcsclf, co t~~ inun ica t in~

thoughts and concerns, developing a capacity for indcpcndcn t cconomic activity. '"

However, the ncw terms proposed by WHO arc "Activity lAitnitatio~lw filr ilisal>ility

arid "IJarticipation Kcstriction" Tor I landicap. "llisability" will be uscd as ail U I T I -

brclla tcrtn coverii~g all t l~rcc tct-111s such as iinpairrncnt, activity liinitatio~i at) J par-

ticipation restriction.

Iience a disabled person accordirlg to WT I 0 is one who sufkrs from any onc of tllc

followitlg thrcc types i.e. impairtnent, disability or activity limitation and l~andicap

or participatiorl 1 i 1 nitation.

'Iablc No. 1 : 10 Explanation of Various 'Fcrrns as Adoptcd by WI-I0

Source: WHO rlnssiJicicotiorr of lrrrpnirwrer r t, Disn bilitic-< nrrd 1 lmrrtlicdps, G'errc~vo, 1.980 1)-20.5

Represents

Disturbanccs a t orgall

lcvcl

l l is t l~rba nccs at pcr:ion:~l

Icvcl

Irltcractiotl wi t11 and

adaptatiotl t o it ~dividual's

surrontldi ngs

Condition

Irnpairrncn t

Disabilities

Handicaps

Concerned with

Abnortrlal i tics of body

structure and appcaranccs;

organs or systcrn f~lnctioning

Impail-mcht in tcrl~ls of functional pcrfbrmancc

and activities

Ilisadvantagcs rcsulted frvnl

in~paircmc~lt and disal~ili tics

'l'hcrc arc incdical, ccl~icational, voc;ltic )11al a11 t l sociolt ~ ~ i c ; l l clcfi 111 tiotls fill- tllc tct-n I

physically disablcd

1 . Medical. A physical handicap rcfcrs to hurnail litr~itatioils, irrcspcctivc ul'wl~cthci.

disability is attributable to diseasc, injury or irlheritancc. Whatevcr may bc tlic

cause, physical disability will lead to a lirni tatiorl of physical furlctiorn, wllct llcr

locoi~~otor, sensory or affecting special organs. l7

2. Educatiot~;~l.Acl~ild~i~ayl~ccoi~siclcrcdi~a~~clic;~~~~~ctl,ifl~is~~l~~sic;~lcc~iitlitio~~

p ~ v m t s full participation in childhood activi tics of a social, rccrcatior~al, cduca tional

and voca tio~lal nz.tur-c. '"

3. Vocational. A disablcd persol1 is orlc who, on acco~irlt of itljriry, discasr or

congenital clcforinity is substantially i-landicappcd in getting or kccling sui tahlc

cmploymcnt or work. I" / 'I'hc Vocational Kcl~al>i l i tation Act, 1954, U. S .A., defines a physically handicapl~ccl

individual as "onc who is utldcr a pl~ysical or inental disability wllich constitutes a

substantial handicap to ci~lploymcnt, but whicll is of such a tlaturc that vocational

rchal~ilitation scrviccs rnay rcasonal~ly cxpcct to rclltlcr l~iln tit to ctl~qgc iin a remu-

ncrntivc occupation. 2"

4. Sociological. According to Dr. I<essler, "Thc definition oE physical har~dicap

rnust bc t~cccssaril y social and ccotlornic rather than mcdical or ar-I tl-1 ropological.

It dcfincs thc status of the individual in society." I-Ie adds: "For our purposc, wc

shall confinc our intcrprctatior~ of thc tern1 to thosc ii~tlividuals who have a

physical ticfcct, obvious or hidden, which li~rlits their physical capacity to work

or evokes an ul~favorable social attitude." 2'

r * 1 he physically di sablcd arc diviclcd i 1-1 to two I nai 11 groups inarnely,

the scrlsori ly disablcd arld t hc ort hnpeadical ly disal~lcd.

Tllc scnsorily disa blcd includcs thc visually irl~paircd 01- tllc i~lincl atltl tlic spcccll

and hearing i rn pai rcd.

Visually impaired

Thc visually inlpaircd includcd all pcrsons handicapped of vision, ranging fi-om to-

tal blindncss t o uscful sight. T l ~ c dictiotlnry I ticat 1 1 ng of tllc word i ~ l i t ld i s sigh tlcss.

Today blind includes not only the siglltlcss but also a largc nurnbcr of pcrsons whosc

sight is rcstrictcd. "This placcs within t11c moderrl ca tcgorj of t l ~ c blind a sccrriitlgl-y

increasing numbcr of pcrsons and cstablishcs blitldncss as a major social p~-ol~lct~i

which even in this day i s not intelligently understood or cfficicntly l~andlcd". 22

The medical dcfini tion of blindness is absolti te sightlcssr~ess, corlgcrlital or advellti-

tious. According to an economist blinti is " otlc without sight sufficient to achicvc

economic independence so that tllc pcrsons afflicted can uot cngagc in any occupa-

tions requiring the use of the cycs tinder ordinary conditions". I-lcncc bli~ldtlrss

tllcatis "be irig witllout sight as a nlcans to cconoinic indcpcndencc".

Frorn thc cducatic ~ n a l poill t of vicw, hlii~dnrss Inca1 IS ir~al~ility to acc1tii1-c crluca tioti

in thc usual way by rrlcans of sight or the inability to rcad tllc ordinary ink-print

book aftcr corrcctionj and refraction have bccr~ mndc by the usc of glasscs. ''

According to the Amcrican Medical as so cia ti or^ i~lindncss for thc priblic is

defined as "inability to pcrccivc ligl-~t or lack of sight perccptiotl while ccolioniic

blindness is defined as "abscncc of ability to do any kind of work, ir~dustrial or otlicr

wise for which sight is csscntial". 11-1 Grcat Britain a n adult blind pel-sori is one wlio

is "so blind as to bc utlablc to perform any work for wliich cyc sight is csscc~tial".

And for childrcn ifthey arc blind to bc ablc to rcad thc ordinary scl~ooll~ooks used 1)y

children. In Germany "any pcrsons who with thc hclp of suitable glasses can not

fitid his way in strangc placcs or can not count otltstrctcl~cd fingers at a distat~cc of

onc rnctcr" i s cnrlsidcrcd 1)lind. 24

Ln India the broad dcfi~~ition of visual impairlnctit as adopted in thc Pcrsons with

Disabilities (Equal Opporttinitics, I'rotcction of Rights a l~d Ft111 I'a-ticipation) Art,

1995 as wcll as under thc National Program for Control of Blindness (NI'CU) is

given below:

13lindncss: rcfcrs to a condition whcrc a pcrsotl suffcrs fro~ll ally ol' thc fill-

lowing conditions, n;~tr~cly:

Total abscnce of sight; or

Visual acuity riot exceeding 6/60 or 20/200 (Snellcn) in thc better cyc cvc~,i

with correction icnscs; or

laimitation of tllc field of vision subtci~ding a n angle of 20 dcgrcc or. worsc.

For deciding the blindness, thc visual acuity as well as field of vision has bccn con-

sidered.

Low Vision :- Thc Pcrsons with Disabilitics (Equal Opportunities, I'rotcction of-

Rights and F11ll l'nrtici p n t ion) Act. 1005 also I.('COI:I l i ~ c s low visi( M I 3s ;I C;II CI:OI-Y I )I'

disability arid dcfirlcs it as "person with low visio~l" Illcalls a pcrson wit11 itnp;lir-

inent of visual functioning cvcn aftcr trcatmcnt or standard rcfractivc corrcction l ~ i t

wl-lo uses or is potcrltially capablc of using visiorl for thc planning or cxccution of a

task with appropriate assistivc device.

1-lowever, this definition of kow vision is inadequate since it unitcs q uali ficatiorls of

the acuity as well as the ficld of vision as is donc in thc case of the WI-lO definition.

The WI4O working definition of low vision i s as follows. A person with low vision

is onc who has itnpairr~~cnt of visual fnnctionit~g cvcn aftcr trcatlncn t, and/ 01- stan-

dard refractive correction, and has a visual acuity of less than 6/18 to light pcrccptior~

or a visual ficld of less than 10 dcgrccs from the point of fixation, but who uses, or i s

potcrl tial l y able to use, vision for the planning and/or exccution of a task.

Orthopaedically Handicapped or Locomotor Disabled

Ortl~opacdicall~ f-landicappcd arc people wliosc physical capacity is impaircd by thc

loss, deformity or paralysis of onc or more limbs. They are the victil~ls of discascs o r

injuries, which whcn cured lcavc l~c t~ ind a ccrtaii~ disability, wllici~ is pcrlnallcrl t or

life long.25

Orthopaedically handicappcd or disablcd are those who arc disal>lcd by i tn pairmen t

which interfere with thc normal usc of limbs, bones, musclcs or jo i~~ts , rcsul ti11g ill

difficulties irl physical movcn~c~lts such as walking, coorclirlation ar ld speccll. 'l'h is

may bc causcd by discasc, accidcnt 01- ailment of thc locolnotor apparatus . Witlli~r

this 111-oatI c-l;~ssific;lt~o~i of t I I C ort I~op;~c-~IicaIIy I I ; I I I ( I ~ ~ - ; I ~ ~ ~ ( I wc will Iitl(I ;I 11 I I I ~ ~ I I I ~ V

variety of'clcgt-ccs ancl typcs of-Il;~~iclicap lion1 ;I sl igl i t ~1cIi11-l I I ily i 11 L I I C ~~ ) I - c ; I I - I I I 01- ;II I

alnputatccl little finger to a statc of incapacity of a l l thc foul- lirnbs arltl poor cotltl-ol

of the head and ncck musclcs. l'hcrc arc those who have a slight l i t l l l ) alld tl~osc who

arc paralyzed from the waist down and have no control over theil- lowcr l i i l l l~s cs-

cept by thc usc of thcir back and abdol~~ir~al musclcs whet1 thc lcgs arc in braccs. 20

'I'he Association of tllc I'hysically I-Iandicappcd, I3angalorc has dcfincri thc

orthopacdical ly disabled as persons who have defects which cause dcfol-mity o r all

intcrfercncc with riorrnal functions of the bones, rrnisclcs or joints. 2'

Thc pcrsons with Ilisalili tics (Equal Opportunities, l'rotcction of Kjgllts and Full

Participation) Act 1995, locomotor disability means disability of the bones, juints or

musclcs leading to substantial restrictions of tlic inovctrlcnt of thc limbs or any fi)~-nl

of ccrcbral palsy. 'R

I-Iowcvcr "whilc labcling a pcrson as handicapped onc should think i t 1 tcrtns or Ic-

gal, clinical, adrninistrativc and physiological aspects which require rnucll closcls

analysis of the activitics of work and daily living i l l functional terms." 29

Hearing Impaired or The Deaf

Thc term hearing impairment means loss of sixty dccibcls or nlorc in thc bcttcr car

in thc conversational rangc of frcquencics. ( '

In colnlnon parlance the terin deaf is used for thosc who arc complctcly atld par-

tially deaf. Thc deaf arc tllosc in whom the sense of hearing is ~-lotl-functiotlal Tor thc

ordinary purposes of life.

The word 'deaf' significs a pcrson whose hearing is impaired bcyond rcpairir~g. 'i'hcrc

i s no chance of such a person l~caring even with the hclp of a l~caring aid. 'l'hc llcar-

ing loss of such pcoplc is abovc 75 dccibcls. Those wl~o can heal- wllcrl slloutcd a t

can hcar whcn usirig a hcaring aid arc callcd hard of hcaring and not deaf '' Tllc

term cicaf has hccn dcfillcd to incarr inability to understand co~lilcctcrl tliscoursc

through tl rc car''32

The hard of hcaring person is onc who, ger~era l l~ with thc usc of l~caring aid, has

rcsidual hearing s~~fficicllt to cnablc successful processing of linguistic i~iforn~atiott

throug11 audition. Such losscs wcrc furthcr catcgorics as ini Id 20 to 54 dh, modcratc

55-69 db , severc 70-89 db and profound 90 db and abovc."

The Govcrnlncnt of lnciia has acccptcd thc following definition of dcafi~css for tllc

purpose of granting scholarships. The deaf are those in whom the sensc of hearing is

rlonfunctional for the ordinary purposes of life. Gcncral ly, hcari r ~ g at 70 dcci l~cl or

abovc at 500, 1000 or 2000 frcquer~cics will work rcsidual hearing ilon-filnctional.

Disability as a Characteristic

r- l I here arc various ways of looking at disability. Llisability is n litnitatiorl or impair-

mctlt or to bc tnorc positive, it is a charactcristic. Whcn wc u~ldcrstand thc n a t ~ ~ r c of

pl~ysical disability as a charactcristic, a normal characteristic like hur~d rcds of others

with wl~ich each of us must live - wc sl~all bcttcr undcrstat~d t11c rcal 11ccc1s to t ~ c tuct

by agencies serving the blind and thc physically handicapped.

By definition a cl~aractcristic - any charactcristic is a limitation. A white i~ousc f i x

example, is a limitcd house, it callnot 1)c givct, bluc or red, i t is linlitctl to bcilig

white. Likcwisc, cvcry charactcristic - those we regard as strcngtl~s as wclls as wcak-

riesses - is a limitation. Each one frcczcs us to some cxterit into n world; each rc-

stricts to sotnc dcgrcc tllc rangc of possibility ~Cflcxibility a ~ i d very oltcn of ol~l)tx-

tunity as well. '4

A visually impaircd o r arl orthopcadical ly chal lcngcd person with superior intcl l i-

gcncc and non-disa bled pcrsotls with an average n~intl, which of tllcsc two are liin-

itcd? It depcnds on what we want them to do. If wc want them play football wc

many prcfcr thc rlotl-disablcd person. But to teach history or scicrlcc thc nun-dis-

abled person is rnorc limited o r 'I~andicappcd'.

Marly human charactcristics such as povcrty, ignoraticc, old agc, hlil~~lncss, ctc, arc

obvious limitations. But when we takc the opposite of old age - youth. For cxamplc,

youth of twenty will not be cotlsidcrcd For most rcspot~siblc positions cvcn if lic i s

cntirely mature, fully capable and in cvcry way the best qualified applicant for tllc

job. tlcnce thc agc oftwcnty is dcfinitcly a limitation. In Kerala the cut-01-Yagc f-iw 2

new entrance to govcrnmcnt jobs is 35. I - l c~~cc thcrc is a prollilitioi~ against pcrso~is

over thc agc of 35.

To takc anotl~cr cxamplc ofan unliJ:cly l~ar~dicap - not that ofigloraticc, but its cxact

opposite. Education can bc a handicap. A highly qualified person imay not bc sc-

lccted for thc post of a pcon hecausc 11c will 17ccorne a r~iisfit and tnay leave thc job

soon. I-lcncc it is not oi~ly disability, but also positivc qualities that call b c c o t ~ ~ c a

handicap.

As an individual instcad of gricving over a limitatiol~ or a handicap one sl~ould think

of altcrnativcs to deal with to c~vcrcomc thc currcnt situatiorl, sizing up i ts possiljili -

tics and problcms and turning tl ~ c l r ~ fix advar~ tagc.

Dr. Kcnncth Jcrnigan, fom~cl- t'rcsidcilt of Thc National Fcderatiorl of thc Dlin J,

USA was askcd by pcoplc a qucstcon, "what you tnight have dollc if yon hat1 not

bccn blind?". Othcrs had said to him, "But 1 h r n ~ c r l y had sight, so I know what 1 a m

missing". '"lo which 1 nligllt reply arid 1 was formcrly twclity, so I know what I ~ 1 1 1

missing. Docs this mcali that I had spcnd my tilnc grieving fo:- thc past or altcrt~a-

tivcly should I dca l with nly currcll t situatiorl, sizi~lg I I ~ i ts possil,ili tics ;111d 1~1-00-

lcnls and turtling thcrn to rliy advan tagc?" O u r cl~.zractcristics arc cotista~itly cllang-

ing and wc arc forcvcr acquiring new cxpcricncrs, lil-rlitatioris and assets."'

A poor man without mcans is morc llar~dicappccl to travel iroucid the woi-1J tila11 a

disabled person wit11 lot of muncy, who with his irrcans can hire assistat~ts, use alter-

nate technology to go round tllc world.

Cause and Tmes of Physical Disabilities

To tnakc rcli~bilitation cffcctivc and bcrlcficial i t is important to havc a thorougli

and comprclicnsivc investigation into the causative factors of physical tlisal~iii ty. I t is

11clpful in plan ti itlg a program of rchabilitatioil for tllc i~ldividuals conccl-I ~ c d i ~ t l c l

also to tnakc concrotc measurcs for the prcvcntion of i~npairn~cnt.

r~ I ilc chicf causativc hctor-s of disability have been classified into iicrcdit;~ry, congcni-

tal and acquired. Each of thcsc factors again attributes to a nutrihcr ol'cori tri butory

cac1scs.

Hereditarv

'I'here is a grcat confusiorl prevailing in tllc rni nds of comtnon peoplc rcgartling tl ic

nature of hcrcditary defects. 'l'hcy oftci~ mix up the terms hereditary, cor~gctli tal and

familial. 1 lowcvcr tllc fact rcrnaitls that thc tllrcc tcrlns arc quitc diffcrcnt froll~ orlc

another. A hereditary defcct is one tha t passes down froin gencratiorl to gcllc~*ation

bccause of some sort of disttirbancc in the working of the inhcrctlt ir~cchat~isn~. It is,

howcvcr, notcwosthy that a particular condition may be 11crcdit;lry and yct, i t may

not i~~atlifcst itself at birth or for many ycars to come or inigl~t not havc appcai-cd

bcforc in the individual's immcdiatc family. 'This may appear paradoxical in vicw of

the implication that a hcrcditary dcfkct passes on from orlc gencration to t l ~ c othcr,

but it docs not happen in mutation, that is wllcn rarc recessive genes arc pooled

togethcr or whcn tlcw black gcncs colnc into h c i ~ g . ~ '

Thc rcccssivc gcncs product thcir full effects only whcn they flow it1 a double dosc,

Frotr~ hot 11 the parcnts. Rut tllcrc arc dominant genes also, wllicll inarlif'cst thcm-

sblvcs by dircct tratlst~~ission fioin cithcr of'tllc parcnts, i t ] a single dosc. 'l'his tlis-

covery has now led to a revolcitionary change in our out-look on thc tlat~rrc of he-

reditary dcfccts. Tlrcrc was a titnc whcn it was bclicvcd that every characteristic was

cithcr strictly hcrcditlr- or cnvironmcntal. Utit today, vcry fcw discascs or disal~ili-

tics arc purely hcrcditary. Uclli~ld cvcry tlcfcct, hcr-cditary, c ~ l v i r o n ~ l ~ c i ~ tal a t ~ c l otl~ct-

factors opcratc. I Icrcditary defects arc comparatively ir~frcqrtcrlt, in spitc of con]-

u ~ o n belief to thc contrary.

Thcrc are no means to ascertain unfort~li-lately the irlcitlcrlcc of hcrcditary dcfccts it]

India. Amorlg t h e ClirrJus, wlro forrri a rnajority of thc Indian populatio~~, thc ill-ac-

ticc of cxogamy, which dcbilt-s ;it! individual from tnar-rying within his imnlctiiatc

circle of kith and kin ("SAGO'I'Kn" and "SAI'INDA") may pcrhaps, bc thc govcr~l-

ing factor in ininitmizing the incidence of hcrcditary dcfccts:"

Congenital

Congenital dcfccts arc thosc that arc prcscnt at birth such as harc lip atltl clcft palatc,

wcbbed fingers, club hot, bow leg, dislocation of t l ~ c hip, tmissing botlcs arid arnpu-

tation. Most of thcrn arc the rcsult of infection, 11 utri tional deficicncics, cllcl rl ical

factors and other environnlcr~tal conditions.

Dr. Usha Bhatt has listed the followitig causcs of co~~gcnital dcfi~rrl~itics:"

1. Maternal Mal~~ourishmcnt - Kescarchcrs have tlcnio~lstratcd that t l ~ c prenatal

environment of the crnhryo is vcry important factor. If ~ilatcrnal starvatior~ takes

placc during thc earlier period of gestation, thc ctnbryo dies, but i f it wel-r to

occur at thc organo-gctlctic period, malformations do take place. For cxamplc,

lack of iodine rcsults in cretinis111 wf~erc as lack of vitamin 'A' rest~lt in dcfectivc

eyes, clcft lip and palatc.

2. Maternal Irlfectio~l - Kubclla and German I-r~easles in the first two nlonths of

pregnancy may cause congenital defects, such as tnicroce yhalia, deaf-ln u t i s~ 11,

hydrocepl~alia, cataract, ctc.

3. The Kh Factor - Parcrlt 1x11 blood incompatibility is also rcspor~si blc for congctli tal

d isordcrs.

4. Discases - It has bccn h u n d that amongst tllc offspring of diahctic mothcrs,

thcrc is a higlicr incidcncc of corigenital defects like clubfoot, claw hand,

~rlissing fingers, ctc.

5. X-Rays: Kadiatio~l has an adverse effect on the embryonic growth. It was,

incidentally, Murphy, w h o first drew attcntiol~ to this fact. Ir l ;I gl-oup of 75

children born to tnotl~crs whose pelvis was irradiated during pregnancy, 10 wcrc

rnicrocephalics and in all 28 showcd some dcfcct or other of thc central ncrvotts

systenl.

6. Cllcnlical Agcnrs - Ccrtairl conger-lital dcforllritics arc also cluc to all crroncous

use of certain 11 igh potc~~cy chemical agents or ingrcdicn ts.

26

7. Glandular Disorders of tlic Mothcr - The cftccts of'cnciucrinc disorders 111 tltc

pregnant wotllarl arc not. fil lly knowl~, but hypcl- fiinctioning ot-hcr thyroid glaiirl

is associated wi tll crctir~isn~ it1 tllc ~nKlrl t.

8. Mechanical Factors - A Ccw congcrlital defects can bc traced to abnorrrlal prcssrlrc

o r othcr mcchatlical bctors. Thc abrlorrnal position of tho fctus may result icl

clubfoot, c lu l~ h;untl or dislocation of wrists ailti knccs.

Acquired Defects

Acquired dcfects i~~c lude defects acquircd due to birth injuries, pathological condi -

tior~s and diseases, accidcrl t, nutrition deficiencies, defective posturcs, co rl scqucnccs

of war, poverty and sucl~ othcr causes.

Birth iniuries

Marly of tl rc brain disnbilitics rcsul t (rot n birtl I il-ljurics. Brain ir~j t~rics ~t t l ~ c tinlc of'

birth rcsul t in such defects as brachial palsy or cerebral palsy, pathological cond i tions

and di scases. Infectious di scascs l i kc whooping cough, mcasles, scarlet fever, men-

ingitis, cticcphalitis, tuberculosis of horlcs and i o i r l ts, polio inycl itis arc likely to rc-

sult in loco~notor disability.

r 7

111c number of disab'cd arc increasing these days not bccause of discascs, but due to

industrial and road accidents. rl'llcrc is safety in the industry. rI'hc Factory's Act 1948

has rnadc a land mark in thc history of labour in lndia providing measures for saCcty,

such as adcq rlatc safeguards fro~n thc nlnchincs, llsc of safcty dcviccs ant1 cqclipnlc t I t's,

good worki r ~ g crlvirotlincnt and such other.

Traffic accidcnts today llavc bcco i~~e one of the major wuscs ofJisahility. T h c itlci-

dcncc of traffic accidcnts in l~ldian cities has also increased considerably. Unplarl~lcd

citics with rlari-ow roads ant1 poor tratljc control arrar~gcrner~ ts l Iavc bccn rcspotl-

siblc for increasing thc r~urnbcr of accidents 011 thc road.

Besides thc above, nutri tioil dcficicr~cics, cot~scquct~ccs o f war, povcrty, i l l itcrac-y,

shot tage of mcdica 1 persot~ncl and s u d ~ othcr co~iditiol~s C U ~ I tributc to Iocui~lotor

disabili tics.

Orthopedic Disability

Causcs of orthopedic disabili tics arc i-~ercdi tary, congcn ital and accl tiircd

A. Hereditary

Solrle of the abtlormalitics which arc transmittcd as dominants arc: brachypllalangia.

polydactylism, claw hands, spidcr hands, fused fingers, doublc joint, clcft palatc,

clcft lip, etc. Abnorrnali ties, which arc transmittcd in a rcccssivc nlodc, arc cl rib foot,

dislocation of hip, spind bifida, Fricdreich's spinal ataxia, etc. It is interesting to find

that sornc of tllc abrlortnatitics such as clcft lip and clcft palate arc transmittcd in

both thc dominarlt ant1 rcccssivc ways. -''I

Tllc rrmst coininon among col~gcni tal dcfccts src: hare lip and clcft palgtc. wchl~cd

fingcrs, club foot, bow leg, dislocation of the hip, missing bones and amputations. "'

Adventitious or Acquired

'They are birth inj urics and discascs such as ccrebral palsy, poliotn ycl i tis ancl tu hcr-

culosis of t l ~ c bol-les and joints, rheumatism, arthritis, paraplegia, hemiplcgia atld

ostcomyclitis. Some discascs that arc rare but significant arc i~~tlltiplc sclcr~sis and

muscular dystropl~y.~'

Bcsides birth injuries and discascs, thcrc is amputations caused by pcripllcral vascu-

lar insufficiency and gangrcne, thrornbosis and embolism, trauma, tl~crrnal i njurics,

corigeni tal deforn~i ty, n~al ignan t tumors and bad post~lrcs may cause disability such

as curvaturc uf thc spinc. It has i~ccn found that poor posttirc is causcd by gcl~cral

debility, malnutrition, fatiguc, repeated and prolo~lged infections, sucl~ as atlcnoicl

and tonsil in fictions, dcfor~ni ties which are caused by rickcts polio lnycli tis and

t ~ o r ~ c T.B., dcfectivc vision and audition, wearing badly-fittctl clothcs, sitting too

long in unco~nfortablc cllairs atltl slccping in a sagging bcdm4'

Table No. 1 :I 1 Major Causcs of b c o m o t o r Disability Distribution pcr thousa~ld

Source : 12q1ort No. 393, Kryori or, Dicnl~led IJersolrs, NSSO 47/11 l<otrrrtl, Jtrly - I)cci~~rrbcv*

1991.

Causes

Cerbral Palsy

Polio

Leprosy

Sxrokc

Arthritis

Cardio-respiratory discascs

Othcr illnesses

Burns

I n j ~ ~ r y ot l~cr than but-11s

Mcdical/surgical il~tcrvei~tion

Old agc

Not known

Total

Visual Impairmetlt

'The incidence of hereditary l~lir~dr~css is rnuch lcss co~riparcd to \~lit~tlncss caclscd b y

othcr factors. Dr. I l l . Carrus co~~sidcr the followitlg cyc diseases as causing I lcredi-

tary blindness. They arc A~~ophtha l rnos and inicropl~tl~alrnos, Hup l~ tllalrrlos,

Albanisnl, Family dcgcncration of corrlca, Aniriclia and Colobolna Iridus, Etol~ia

Lentis, Cataract, Ilctiili tis I'igrncn tosa, Atrophy oF tllc optic: Ilcrvc, Glaucolrln, Nys-

tagmus and Strahistnus and Ophthalmoplegia Extrer~a and ptosis

Rural

48

328

30

29

20

4

112

22

21 1

22

62

60

1002

Url,arl

43

346

-1 9

41

1 0

5

115

IS

225

34

49

44

999

7'hc congcnital discascs arc cataract and glioma. Thc symptoin of cataract in the

baby's eye i s a whitish spot in his pupil. Thc babies' pupils arc always tdack. CI' 10t11a

rcsemblcs thc cat's cyc, scc~ I ill the night. 'l'his occurs in very early lifc. 'I'liotlgl~ it is

uncommon, i t is vcry scrious. The only cure is thc rc~noval of the cyc, othcnvise t l ~ c

life of thc child is in danger.

Infection of thc cyc at thc titnc of bil-tl,l causcd by tl lc gcrll-I or oc~c of tlic vcncrcnl

discascs is vcry conlrnon in India. 'T'his disease is technically known as Opllthall via

Nconatourrrl or babics' sore eyes. The use of a solution of 1 pcr cent silvcr tlitl-atc

soon after the birth of a child is most cffcctivc.

Undcr this catcgory arc i r lcludcd various types of bl iridncss acq uircd aftcr birtl ciuc

to diseases, malnutrition, injuries or accidents etc. Smallpox and diabctcs are coin-

rnon disease causing bl i ndncss. Gcrnman measl cs or rubcl la in pregnant women I-c-

sults in congenital cataracts and loss of sight in different degrecs. Vcncrcal discascs

likc syphilis and gonorrhea lead to visual impairmcn t ill t l ~c atfcctccl pcrsorls n t ~ c l i l l

their children.

1. Malnutrition - hlalnutri tion and consequent vitalnirl-A dcficicrlcy i~ i clli ldrct I

arc scrious causes of' l~l ind tlcss. Xcrophthalr~lia and night b l i l ~ d ~ ~ c s s a r c two sucl I

conditions.

2. Diabetic Kctil~opatlly - With more effec tivc controls for diabctcs i rlcrcasing

numbcr of affcctcd pcrsons arc living to advanced ages and develop diabctic

rctinopathy. This is reccntly thc most rapidly growing causr of blintlrlcss.

Currcntly 15 per ccnt of all ncw cascs of l>lindncss arc of diabctic ctiolohy.

3. Kc tro l cntal Fibroplasia - Retrolental Fi broplasia, is a t 1 lajor calm of- 1.31 indncss i I I

thc Wcst. It is a discasc ofthe rctit~a in wl-licll a ])-lass of scar t~ssuc f i ) r~r~s L~cl~i~lcl

the lens of the eye. Both eyes arc affected in most cascs and it occurs chicfly i l l

infants born prematurely who rcccivc cxccssivc oxygcn in incubators.

4. Sytr~patlictic Oph tll;~lmia - Syl~il,;~tllctic- Oplitl~aIi~~in rc-lcrs t o tl I C c - O I 1 c I i t i c 1 1 1 ~ I I

wllich bllndricss of onc cyc, tllrougll injury or discasc, causcs l~lilidrlcss of tlic

sccorld cyc too. Thc pc>pular t~~isurldcrstarldi~~g that t11 is i s an cyc discasc, causccl

by contact or associ;ltior~ with the blind is not scie~ltific.

5. Glaucol~la - Glaucoma is thc most dangerous of all t l ~ cyc discases and is fi~ut~cl

most often in rniddle agcd pecplc. I t is caused by thc inability oEtluids to drain

out of thc cyc. T h i s cxcrts irlcrcnsil~g prcssurc on the largc tlcrvc, wllicll i s

rcspcmsiblc Cor thc sight of thc cyc. Proper trcatmcnt, if givcn at or~cc. will

rclcasc thc prcssurc and savc thc sight."

6. Trachotnai - rllrachorna is an infectious discasc caused by a germ, which sprcads

througl~ direct col-itacts, by fomitcs, flies, ctc. Children between onc atltl thrcc

ycars of agc arc thc most susccptil~lc groclp. 1 lowcvcl- thosr hclow tlw ngc or I O

are often not ~ p a r c d . ' ~

7. Cataract - Cataract is the rnajor catisc of blirldness all ovcr the world. Cataract is

a slow process whcrc the clcar icns i l l the eye bccorr~cs opaque.'' This is at1 cyc

trouhlc, which is usually Foutld in oldcr pcople.

8. Refractive Errors :

i) Myopia o r shortsightctlllcss is a rcrractivc crror wllich, occurs t~ecat isc t l ~ c

cycball is too long in rclation to its focusing powcr. ' l h e point of focus fc~r rays

of light from distant objects (for cxnmplc parallcl light rays) is i l l front of t l l c

retina.

i i ) [Hyperopia or long-sightcdncss is a refractive crror which, occurs bccausc thc

cycball is short or thc rcCrrctivc powcr of thc lcns wcak. Thc point of tbcus for

rays of light from distant oljccts (parallel light mys) is bchind thc rctit~a, thus

accorntnodation to incrcasc t hc rci-ractive powcr of thc lens is ncccssaly for distant

as well as rrlcar vision.

ii i) Astigtnatism is yet anotllcr crror of rcfraction, which J S due to thc hilure of the

cyc structurc to focus all of thc rays of light a t thc samc point owing to al l

irregularity it] the curved surface oi'thc cornca, the front cuvcring of thc cycball.

9. Solar Eclipse - Gazing at a solar cclipse will) unprotcctcd

marly a young one. 0 1 1 account of t he extl-cmcly

cnclosed sun, tllc rays c1,nanating from it dcstroy the scrlsiti ve 1-1 lcc11aiiiirn-irf:~lic

unprotected e y ~ . ~ ~

Reports on the causes of blindness in India

Survcys cor~ductctl by Indian council oE Mcdical I<cscarcli in 1971 and by WI IC) -

NPCR in 1981 give thc fd"owing observations.

Thc first observation of tl-lese surveys is that thc ?>I-cvalcrlcc of blind~~css in India h a s

increased from 1.38 pcrcerlt iri 147 1 to 1.49 perccrl t i rl 1 986. Sccoritlly blinclness duc

to cataract has i~lcrcascd from 55 pcrcent in 1971 to 81 pcrccnt in 1980.

Tablc No. 1:12 Causes of'visual Irnpail-mcnt in India (NPCII-I - WI 1 0 survcy)

NSSO Srlrvcy: Tl~c NSSO Survey (1092) csablislics that thc old-age atltl cataract

arc the rriajor causcs of vis~ral impairn~cn t.

Survey (yo)

WHO-NPCB

8 1 -00

7.00

3.00

2.00

0.20

0.04 -

-

-

0. .70

100.00

Study ICMR (%)

55.00 -

-

0.50

5.00

2-00

15-00

3.00

1.50

18-30

100.00

S1.No. Causes sf Blindness T I .

2.

3.

4.

5.

6.

7.

8.

9.

10.

Cataract

Ucfractivc Errors

Corneal Opacity

(;laucollla

r l i -acI~o tna

Malt~utrition

Otllcr Iilficctions

Small Pox (Old Cascs)

I~ljurics

O t l ~ c r s

Total

32

'E~l~lc No. 1: 13 Major causcsof'visual i l -npair~ric~lt (NSSO su~vcy ) 1992

(IIistrihution pcr 1,000)

Thc National Sa~rlplc Survcy rcvcals that old agc is thc nlajor causc of v i s ~ ~ a l i rnpair-

rnent in the rural arcas, which accounts for 25 pcrccnt. Wl~crcas cataract is its major

causc in thc urban arcas with 27 pcrccnt vistial ilnpair~rlcnt. Altnost 50 pcrccrlt of

visual in~pairrnent both in rural as well as urban arcas is causcd tluc to old agc arld

cataract. T h e survey could not cstablish any dcfinite cause in case of alrnost 25

perccnt and 27 percent for the rural and urban areas rcspectivcly.

Sl. No.

I .

2.

3.

4.

5.

6.

7,

8.

9.

The Wl--10-N PCB Survcy cstablishcs that cataract causcs 81 pcrccn t o f v i s u a l

irnpairrr~cr~t in the country. Majority of cascs reportcd that tllc cnusc oc visual

impair~ncnt as old agc at thc tirnc of National Survcy might havc lost vision due to

cataract. Whilc both thc National Sal~lpllc Survcy as well as W1-10-N I'C13 cstal)lish

cataract as o ~ l c of thc ~na jor causcs, thc fir~dings of thcsc surveys 11avc show11 a lot of-

Cause of Visual

Impairment

Old Agc

Cataract

Othcr cyc diseases

injuring other than burns

G laucotna

Srl2allpox

Scvcrc cliarr l lea

Not known

Othcrs

Total

disparitics with regard to other causes of visual impairlnent.

Distributiot~ per 1,000

(Rural) (Urban)

273

236

1.30

32

34

29

I I

161

94

1000

214

280

107

35

42

35

I 3

130

114

1000

Cause

1 . Brain corldi tiotls:

Turnors, vascular circulatory

Diseases

Concussiot~, ccntral auditory

Arca datnage

2. G c tlcral l~~fcct ious IJiscascs:

Soarlct fcvcr

Mcaslcs

M urn ps

Perttissis

Uricclla

Pneumonia, virus and

pnct~inococclc

'Typhoid fevcr

Di ph t l ~ c r i a

Syphilis

Co~ntnon cold

Any discasc causing high fever

Type of Loss

Sensorirleural (perspective or

Coi~ductive).

3. Inlcctiotls o f t11c Ear.

External Otitis

Otitis rtlcclia, acute and chronic

Norl-suppurative

Suppurative

Scrous

Mastoiditis, acutc arld chronic

Scllsorincul-a1 .

S c r ~ s o ~ - i ~ ~ u t . ~ r a l

Sc~lsorincural, cc 11 tral

I)Ot11

Sct ~ s o r i ~ ~ c ~ ~ r r l l

Scn sorir~cciral

Scrisori ~ ~ c t i r a l

Scnsorinctir;~l

Scnsori tlcural

Sct2sori rlcural

Scllsol-i~lcura I

Scnsorir~crt ral

Scilsorincural

bot11

Sctlsot-incural

130 tll

13otl1

Coilductivc

Cor~ct~~ctivc.

4. Physical Agcn ts:

Im pactcd cerumen

Forcign-body irnpaction

'1 kaunna, acciclcr I td

Noise-cxposurc

Uarotra tinla

Exccssivc qowtl i of lympoid

tissue in ~~asopharynx

Surgical intcrfcre~lcc

5. Toxic Agents:

Quininc

Aspirin (salicylates)

S trcptomyci 11

I>il~ydrostrcptorr~~ci~~

Hydrostrepto1nycir1

Nconl ycin

6. Misccllancous:

Func tioi~al

Psyc hogcrl i c

I-lysteria

M alingcrirlg

Con cluc t ivc

Co1-r duc tivc

bocll

Sensorineural

notll

Conduc tivc

Scnsoritlctlral

Scnsorincural

Sct lsorir ~ct tra l

Scr lsorineural

Scnsori~~eural

Sct~soritlcul-a1

'lwo typcs nf dcafi~css arc c o ~ ~ ~ r r ~ c ) ~ ~ l y ol~scrvcd: (a) condllctivc and (I)) pc.1-c-c.ptivc ( 1 1 .

ncrvc dcafncss. A corn bir~atioi~ of both thc typcs of dcafiicss is also nut uncommon.

'Tahlc No. 1: 14 C:nuscs of l icnritlg llisability NSSO S~lrvcy 1002

Ilistrib~~tion pcr 1000

For about 31 per ccnt, thc cause is old age. For a largc ilu~nbcr, thc rc:lsotls arc LIU-

known. Ear discharge, too, is i n il-npol-tant reason fix this disability.

1

Speech Handicaps

Specell defects arc causcd by a wide variety of organic and frlnctional (social and

psychulogical) hctors.

Tlle organic causes includc clcf't palate, mal-dcvclopn~cc~t ofothcr parts of t l ~ c nlotith

and jaw, cicn tal irrcg-ulari ties including in issing o r lr~aloccludcd tcctll, muscular pa-

ralysis of the larynx, brain damage (in ccrchral palsy and aphasia) nrltl i~asal obstr~lc-

Urban

14

I8

1 4.3

t 97

2

52

21

3 1 0

88

149

I ooo

Causes

C;crrnan ~ncaslcs / rt~bclla

Noise iilrl~~rctl 11c;lrillg loss

Ear discl~arge

Otllcr illnesses

I3urlls

Ii!jurics othcr than burns

Mcclical/surgical it~tcrvcntion

Old agc

Other rcasot~s

Not known

'rota1 P

Rmctional causes i~lclutlc fiilurc to icnrn ;~dcquatc spccch, fixatior~s, 1-cgl-cssivc spccc-11

patterns and general personality and cir~otional disturl~ances.

Rural

0

17

I75

186

2

35

10

310

77

179

1000

Marly spcech specialists do not find thc dichototi~y between organic and ft~nctioilal

a vcry uscful one. Spccch difficulties, which arc originally strictly orga~lic in origin

usually, acquire a largc functioilal cot^-~poncnt as a I-csul t of thc way the pcrsol~ rc:~c t,s to

the diffculty. Prolonged filrlctional disorders tnay havc orgatlic conserlucnces. Al tllo~1g11

it is possi blc for organic disorders to rctnain or] that lcvel with rclativcly littlc fill lc-

tional compor~cnt, and for functional disorders to con tinuc without any spccif c organic

cotnponct~ts, thcy rarcl y do so. Most spccch dcfccts havc Lmth functional n~ I J orgy11 ic

compo~~cn ts."

Spccch defects arc frcq uelltly dividcd irl to four major types:

1 . Dcfcc ts of articulation (sound production).

2 Defects of phonation (voicc production). n

2. Dcfccts of rhythln (stuttcl-ing a ~ i d cluttcritlg).

4. L a n g ~ i a g dysfunction (dclayctl speech and aphasis).

For practical purposes, a second typc of classificatiol~ nlay bc cotlsidcrcd. This clas-

sification is based on categories of spccch-dcfcctivc individuals rathcr that] on syeccli

dcfccts. For cxamplc, a cerebral palsicd child may show dcfccts of language dclay in

voicc and articulation. Most childrcri with clcft palates havc dcfects of articulation as

well as of voicc. Wit11 this in inincl, thc following classification should bc focltlcl

usc f~ l :

Dcfects of articulation, including omissiolls, distortion, or substitutions of

specch sounds.

Llcfects of voicc, including thosc of qnality, loudness, pitch, varicty or ad--

cquatc duratior,.

Defects of rhytl-1111 including stuttcring (stammcriag) and cluttcritlg.

Uclayed spccch dcvclopi-nen t.

Clcft-palate spccch.

Cerebral palsicd spcech.

Impairment of previously dcvcloped language ft~r~ction (ap hasins).

Speech dcfkcts associated with tlefcctivc hcari t ~ g . ' ~

'Tablc No. 1 : 15 Causes of Spcccl~ Disability - NASSO Survcy 1992 I'er tliuusand

distribution

'I'hc rtiagriitudc of disability is vcry high in Kcrala and lr~tlia. Thc causes of disability

arc hcrcditary, corlgcnital and atlvcntitious. In motlcrn timcs di!;al)ilitics dcic to acci-

dents arc incrcasirlg. To corltrol the occurrence of disability a scientific sttidy arid

diagnosis is ~~ccdcci. Thc purpose of t l ~ c study is to find tllc rausc a11t1 takc apl,rop~-i-

atc mcasurcs for thc pt-cvcrl t iorl a r~d tl-catmetl t of disal~ility. 'l'lic sttidy will also cs-

alriinc prornotc thc use of appropriate assistivc tlcviccs. I'ubiio cduca tior. i~cctls to

bring-forth a conducive ciivironmcnt for tile d isablcd for rchahili tatation a lid suc-

ccssful social integration.

Causes

I Icarii~g Impail-lncllt

Voicc ciisordcr

Cleft palatc

l'rlralysis

Mcntal illness / rctard;ition

Otllcr illtlcss

f3urns

Injurics ot l~cr tllarl burl-1s

Mcdical/surgical intcl-vcn tion

Old agc

Other rcasot~s

Not known

'I'otal

Rural

36

00

26

191

91

22 1

4

32

15

25

72

197

1 000

Urban

32

03

14

240

0 0

207

G

47

29

27

81

164

1 000

I . I'rovisioi~al t'opulation 'Ibtal, I'aper 3 l>irccto~-;I tc ot'Ccnsus

Operation India, Ncw Llelhi 2002. 2 . Kurt Janson, "'l'hc Social and Economic Basis arld Objectives of Itchal~ilitn

tion", i t , Srt~rinor orr Kelrahi!ifotiorr ofthe f'l~),sirdly ildrrrlin~l~petl f i ~ r prr,tiripc.rr/$ [ror~l Asia nrttl tlle l k r l!izsn.tl, Utlitcd Natio~ls, 1,-20, ct: 13llatt Uslla, ' I 1n~plr)ainlly

I-lotidicnyycd irt ltrdia, 1963, p-7. 3 . [Did p-7

4 - J . Muric kar~ S.J (Dr.) and C;corgckutty, I-'er:cnrrs ir~itlr Dicabili/it.s irr Socicry,

Kcrala Fcclcratior~ of thc Hlind, Tiivaridt-u~ n 1905 p-2. 5 . Freedman R, "Population, Tllc vital rcvolution" Anchor Books 13o1rbl cday

& Co., Inc., Garcrl City, New York, 15-29, 1964 cf: 7 he jort rrml ofRellabililntiorr in Avin, Vol. x No.2, April 1909, p-13.

6 . Dcvcloprncnt of Statistics of Disabled Pcrsons: Case studies, U~lited

Nations, New York 1980, Statistics Spccial Pupu lation Cimups Scricsy,

No.2, p iii. 7 . Survcry of l)isal~icd pel-sot~s, Natiotlal S;1111plc Sui-vcy <)r-g;11 ~ i z ; ~ ~ i o t ~ , N c w

Dcll~i, 1991. 8 . Taylor W. lace and 'liylor 1 sabcllc, Wagtlur; Servicesfor tlre irnrldirol~cd it1

Itmilid, Western Pritltcrs and pub1 ishcrs, Mum bay, 1 077, p-2 1 9 . lbid p-22

to . lbitl p-23

t i . Kacnala V. N irn bkar, '18wclrd., n lirller Lge, Dcpartl lictl t ofs Social Wclfirc,

Govt of India, 1967, introtluction p-3 12 . Taylor and Taylor, op.cil. p- 12

t 3 . llarold I3lame, "' 1 ' 1 1 ~ I'llrposc and Full content of a lieha hi l i tatiol~ Sct-vicc"

iri Modcnl M~rl~od.( qfKrltclbilitatiorr ojtlle Adrrlt Dicnbk.ti, Utlitcd Nation!;, 1050, p- 14.

14. Marli I l ; lma, I'l~ysically irrttldicnppc.d i r l l~rtlin, Asl~ is l~ publisl~ing hvusc, Ncw

Dclhi, 1'388, p- 14 15.

Gud nlurld Her l cnl, I~roccditg~s $t12e Eight Wor-ld Cor kyrcss cftllc ltiterrmtior ~ a l Socictyjov the W e b r e oJ (:ripple$, 28 August to Scptcn~bcr 1 950 (cd.) Eugc t ~ c

J, Taylor (Ncw York, Intel-t~atio~lal Socicry for tl lc Wc1 farc of Cripples, 1960).

l ( r . World I-lcaltll01-pnization lrrtc.rrtntio~znl rl~~ssiJic-~,(iorl ~$irrrl~c~irrtrc.ri~x,

disabilities and I landicap, Cicnevi, 1980, p- 205. 17

. I larold Blame, np.rit. p-14 1 H . John W. Mc collt-~cl, in i_)ictiorrory cfSociology, cditcci b y I Icc~ry I'ratt

Fairchild, p- 139. 19 . NirnbkarI<arnalaV,ol~.cit. p-105.

20 . I3hatt Usha, op.cii. 1)-5

2 1 . Hciiry 1-4. Kcsslcr, Kd~~~hililatiotr @he Yhysirolly Ilmr~icoj)ped, 1953, pp - 1 2 - 1 3.

22 . Gabricl Farrcl, nit. Story $Ulitdrrm, Cam bridgc, Mass. 1 larward U t~ivcrsi ty

Prcss, 1956,p-196 23

. R.M. 1-laldcr, Soriery a d the Vi-qrrnlly I lat~dic-appcd, Botnbay, That ker PL Col td.,

1948 , p-22 24.

Vyas 1bjciicl1-a , " ' 1 ' 1 1 ~ IJliild - N;lturc aticl cxtclit. ul'tllc p ~ - ~ b l c ~ i ~ " , 'Ii)~rvr~rlsA

F~dlltr I.!@, Drpartmct~ t of Social Welfare, Chvt. of India 1 967. pp- 13-1 4 25,

Govern m e ~ l t of I tldia, I'lantlir~g Cotn~nisioil , plans and prospects of Social

Wclfarc in India, New Dclhi, 195 1 -61, Govcrrl tr~cilt of India Pub1 icatiolls,

1963. p- 53 26

. Nimbkar, Kalrala V., op.rit, p- 105. 27.

Association of tllc physically F-Tandicappcd, "lncidct~ce and Distribution -

physucally I lar~dicappcd." Tlte jourml ofRoi~~bilitcltiolri ii) h i d , Vol .Vl i (I au~1a1-y

19(10) pp-9- 1 1

28. Persons with Disability (cqual opportunities, protcctioi~ od rights and ftdl

participation) Act 1995. Thc Cazcth of Irldia. part 1 1 , scction 1 , p-3 29.

Macli I<atna, 01). tit. p-2.1 30

T hc Pcrsot~s with Disal~il y Act 1905, op-cif. p-3 31. "Who arc thc Dcaf" Mook-nlhlrtnrri, March to Atgust, 1968. Vol.!. No.2, 1)-5 32.

Pcter J. Sa lo i~~on and Hcrbcrt, Uusalan, " T l ~ c Dcaf Blit~d person. A Kcvicw

of the Literature" Kcprin tcd from Blir~drress 1 906 (Amcrica~ 1 Associatior 1 of'

Workers for thc 13lind, INC, Wasl~ington ,1966, p-52 33 . Ruth, E. Ulecldcr; T I P rorrqzrest ofDca/ness (London & Cleveland, T'hc Yrcss

of C:ase Westcrrl Kcscrve University), 1970 p- 12

34 . Jcrnigan Kcnl~c t l~ , I3lintincss : I Iandicap or Characteristic, ljroillc Mojri

lor, National Fcdcratiotl of-thc i3li11d, March 1995, p- 120 35

. Ibid,pp-121 - 122 36,

Bhatt Usha, op.til. p-33. 37,

lud, p-35 38.

Ibid, p-35 30

Dr. Lcslie G. Norman, " O n thc Road: in World Flmldz, Magnrirrc. o J , ~ , l l c ~

World Health Ougarzirntior~, J a n - Fcb 1962.11-24. 40.

Bhatt Usl~a, op.dl. p-35 41.

lbid p-38

4.2. lbid p-60

4.3 . J. Murikan S.J (Dr.) op.cil. pp-44-50

44 . I Ical th Ncws Scrvicc, "Thr carc of Eycs in Grown "1) I .ifc" rcpri t 1 tcd l i -OIII

thcJourial of Christian Medical Association of Jtidia, Blirzd WE@I.P, VOI. IT..

Dccembcr 1960, No. 11-1, pp-27-28

46 Dr. G. Vennkataswamy, "Causes of Blindness in India," Blirltl We&w, April 1976, No. 1 . Vol.XVI I I, p-9

47 . Chsrlcs W. 'lklfol-d, Intncs M. Sawrcy, 7.11~ lixii~~~tiorrnl lrrciir)ic/rlrr\ pp. 304-

395. 48

. Jon Eiscnson. Thc Naturc of Defcctivc Spccch," cl. W~lliatn M. Cruick- shank, I?syc~lology oJExce1,tiorlal Childrerr arid Youth, 1958, pp. 185- 180.