Explain impairment, disability,handicap and rehabilitation with examples
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Impairment, Disability, Handicap, and Rehabilitation
These four concepts form a sequential framework developed by the WHO to describe the consequences of disease or injury at progressively broader levels - from the body, to the person, to society.
The classic sequence is:
Disease → Impairment → Disability → Handicap
1. Impairment
Definition (WHO): "Any loss or abnormality of psychological, physiological, or anatomical structure or function."
- It is the earliest, most medically-oriented stage
- Can be visible or invisible, temporary or permanent, progressive or regressive
- One impairment can lead to secondary impairments: in leprosy, nerve damage (primary impairment) leads to plantar ulcers (secondary impairment)
Examples:
| Disease/Event | Impairment |
|---|---|
| Road accident | Loss of a foot |
| Poliomyelitis | Muscle weakness/paralysis of a limb |
| Stroke | Loss of speech or limb movement |
| Leprosy | Peripheral nerve damage |
| Diabetes | Loss of vision (diabetic retinopathy) |
2. Disability
Definition (WHO): "Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being."
- Disability arises because of an impairment
- It is experienced at the level of the person - what the individual cannot do
- Also described as "objectified" - something observable in daily function
Examples (continuing from above):
| Impairment | Disability |
|---|---|
| Loss of foot | Cannot walk |
| Paralysed limb | Cannot dress oneself |
| Loss of speech | Cannot communicate verbally |
| Blindness | Cannot read print |
| Deafness | Cannot hear a conversation |
3. Handicap
Definition (WHO): "A disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual."
- Handicap is a social and environmental concept - it is about the role the person cannot fulfil in society
- The same disability may be a major handicap for one person but not another, depending on their social role and environment
- Described as "socialized" - it reflects the mismatch between the person's capacity and societal expectations
Examples:
| Disability | Handicap |
|---|---|
| Cannot walk (lost foot) | Unemployed; cannot access public transport |
| Cannot speak | Unable to work as a teacher or lawyer |
| Cannot hear | Socially isolated; excluded from group activities |
| Cannot read print (blind) | Cannot attend regular school; occupational exclusion |
Key point: Disability and handicap have large social and environmental components (dependence, social cost), while impairment has the largest medical component. Interventions for handicap are therefore often social or environmental, not just medical.
The Three-Level Summary (Accident Example from Park's)
| Event | Level | Term |
|---|---|---|
| Accident | Disease/disorder | - |
| Loss of foot | Body structure/function | Impairment |
| Cannot walk | Person-level activity | Disability |
| Unemployed | Social role fulfilment | Handicap |
4. Rehabilitation
Definition (WHO): "The combined and coordinated use of medical, social, educational, and vocational measures for training and retraining the individual to the highest possible level of functional ability."
- It includes all measures aimed at reducing the impact of disabling conditions and enabling social integration
- Social integration = active participation of disabled and handicapped people in mainstream community life
- Rehabilitation should start early in medical treatment - not wait until cure is complete
- The goal: "to live and work within the limits of disability, but to the hilt of capacity"
Four Domains of Rehabilitation
| Domain | Goal | Example |
|---|---|---|
| Medical rehabilitation | Restoration of function | Physiotherapy after stroke; reconstructive surgery in leprosy |
| Vocational rehabilitation | Restoration of capacity to earn a livelihood | Job retraining for a labourer who lost a hand |
| Social rehabilitation | Restoration of family and social relationships | Counselling and reintegration programs |
| Psychological rehabilitation | Restoration of personal dignity and confidence | Psychiatric support; self-help groups |
Team Involved in Rehabilitation
Physiatrists (Physical Medicine & Rehabilitation specialists), physiotherapists, occupational therapists, speech therapists, audiologists, psychologists, social workers, and vocational guidance counsellors.
Examples of Rehabilitation
- Establishing schools for the blind
- Providing prosthetics (artificial limbs) for amputees
- Reconstructive surgery in leprosy patients
- Muscle re-education and graded exercises in neurological disorders
- Career change counselling for a cardiac patient who can no longer do heavy manual work
- Sign language programs for the deaf
Rehabilitation and Levels of Prevention
Rehabilitation directly connects to all three levels of prevention:
| Level | Action | Example |
|---|---|---|
| Primary prevention | Reduce occurrence of impairment | Polio immunization prevents paralytic impairment |
| Secondary prevention | Disability limitation by early treatment | Surgery to restore limb function after injury |
| Tertiary prevention | Prevent transition of disability to handicap | Prosthetics + job training for an amputee |
Sources: Park's Textbook of Preventive and Social Medicine (WHO definitions, pp. 55-56); Scott-Brown's Otorhinolaryngology Head & Neck Surgery Vol. 2
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