Historical Development in the field of Disability

                                                                                                                       Dr.Pragya Verma 

India was a glorious exception. Emperor Ashoka appointed special officers to care for the disabled persons. Sporadic efforts at educating individual disabled children began to be made in Europe during the 14^th and 15^th centuries, particularly with the advent of printing technology. That period is often referred to as a period of Renaissance in Europe. Infact, there are records to show that letters were carved on clay to educate blind children in Mesopotamia almost 3,300 years ago. The hearing impaired has used improvised gestures for a very long time. Wooden crutches and other simple appliances have also been used by the locomotor impaired since time immemorial. Education of children with Intellectual disabilities could also be said to have begun in the two decades preceding the French Revolution. Itard, a physician, wrote a book entitled ‘The Wild Boy of Aveyron’. The book was based on his experiments to teach a boy who had been brought up by a tiger and not exposed to language or other human activities. The retardation caused by lack of stimulation in early childhood is as irreversible as that caused by genetic transmission or insults to the brain.

The ferment of the French Revolution gave a special stimulus to the ideas of liberty, equality and fraternity for everyone. Great thinkers like Thoreau had a profound influence on initiating the process of special education though not directly. During the two decades preceding the French Revolution Father D’ I. Epee developed a manual alphabet for the deaf. At the same time, embossed Roman characters were used to enable the blind development to read. It was almost 50 years later that Louis Braille discovered it. In 1829, he invented the Braille system, which is based upon the permutations and combinations of six dots arranged in two parallel rows of three dots. Braille is neither a language nor a script.

As per Persons with Disability Act, 1995 and National Trust Act, 1999 the different types of disabilities are:

1.      Autism Spectrum Disorder

2.      Cerebral Palsy

3.      Hearing Handicapped

4.      Leprosy Cured

5.      Low Vision

6.      Mental Illness

7.      Mental Retardation

8.      Multiple Disability

9.      Visual Impairment

1. History of Rehabilitation and Special Educational Services for the Children with Mental retardation - Historical Perspective

Identification of persons with mental retardation and affording them care and management for their disabilities is not a new concept in India. The concept had been translated into practice over several centuries as a community participative culture.

The status of disability in India, particularly in the provision of education and employment for persons with mental retardation, as a matter of need and above all, as a matter of right, has had its recognition only in recent times, almost after the enactment of the Persons with Disabilities Act (PWD), 1995.

1.1 Pre-Colonial India

Historically, over different periods of time and almost till the advent of the colonial rule in India, including the reigns of Muslim kings, the rulers exemplified as protectors, establishing charity homes to feed, clothe and care for the destitute persons with disabilities. The community with its governance through local elected bodies, the Panchayati system of those times, collected sufficient data on persons with disabilities for provision of services, though based on the philosophy of charity. With the establishment of the colonial rule in India, changes became noticeable on the type of care and management received by the persons with the influence from the West.

1.2 Pre-Independence–Changing Life Styles in India

Changes in attitudes towards persons with disabilities also came to about with city life. The administrative authorities began showing interest in providing a formal education system for persons with disabilities, particularly for families which had taken up residences in the cities. Changes in the lifestyle of the persons with mental retardation were also noticed with their shifting from ‘community inclusive settings’ in which families rendered services to that of services provided in ‘asylums’, run by governmental or non-governmental agencies (Chennai, then Madras, Lunatic Asylum, 1841).

It was at the Madras Lunatic Asylum, renamed the Institute of Mental Health, that persons with mental illness and those with mental retardation were segregated and given appropriate treatment.

Special schools were started for those who could not meet the demands of the mainstream schools (Kurseong, 1918; Travancore, 1931; Chennai, 1938). The first residential home for persons with mental retardation was established in Mumbai, then Bombay (Children Aid Society, Mankhurd, 1941) followed by the establishment of a special school in 1944. Subsequently, 11 more centres were established in other parts of India.

1.3 Census data (2011)

Data provided by the Census, 2011 is as follows:  

Table 1: Percentage of Disabled to total population India

Percentage of Disabled to total population India, 2011 Residence Persons Males Females Rural 2.24 2.43 2.03 Urban 2.17 2.34 1.98 Total 2.21 2.41 2.01

Table 2: Disabled Population by Type of Disability India

India
Type of Disability	Persons	Males	Females
Total	26,810,557	14,986,202	11,824,355
In Seeing	5,032,463	2,638,516	2,393,947
In Hearing	5,071,007	2,677,544	2,393,463
In Speech	1,998,535	1,122,896	875,639
In Movement	5,436,604	3,370,374	2,066,230
Mental Retardation	1,505,624	870,708	634,916
Mental Illness	722,826	415,732	307,094
Any Other	4,927,011	2,727,828	2,199,183
Multiple Disability	2,116,487	1,162,604	953,883

Table 3: Proportion of Disabled Population by Type of Disability in India

Proportion of Disabled Population by Type of Disability in India : 2011
Type of Disability	Persons	Males	Females
In Seeing	18.8	17.6	20.2
In Hearing	18.9	17.9	20.2
In Speech	7.5	7.5	7.4
In Movement	20.3	22.5	17.5
Mental Retardation	5.6	5.8	5.4
Mental Illness	2.7	2.8	2.6
Any Other	18.4	18.2	18.6
Multiple Disability	7.9	7.8	8.1
Total	100.0	100.0	100.0

Table 4: Disability by Social Groups India

Proportion of Disabled Population by Social Groups India, 2011
Social Group	Persons	Males	Females
Scheduled Castes	2.45	2.68	2.20
Scheduled Tribes	2.05	2.18	1.92
Other than SC/ST	2.18	2.37	1.98
Total	2.21	2.41	2.01

Intouduction to Cerebral Palsy

                                                                                    By Ms Viveka Chattopadhyay

It is important to understand that the term cerebral palsy is more of a description and not a specific diagnosis.It is a developmental disability in that it influences the way children develops. CP manifests itself very early in childhood development, usually before 18 months of age, with delayed or aberrant motor progress.

Cerebral means – brain Palsy means lack of muscle control.

The most accepted definition of cerebral palsy is “Cerebral Palsy is an umbrella term covering a group of non progressive but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development”  (Mutch L)

A Lesion is any abnormality in the brain structure or function. The lesion is non-progressive but acts upon an immature brain interfering with its normal process of communication

It is a disability that affects movement and body position. It comes from brain damage that happened before the baby was born, at birth, or as a baby. The whole brain is not damaged, only parts of it, mainly parts that control movements. Once damaged, the parts of the brain do not recover, nor do they get worse.

Each child with cerebral palsy is different. The symptoms could vary from being mild- a slight awkwardness of movement of hand control to severe -virtually no muscle control, profoundly affecting movement and speech.

Classification of cerebral palsy

While the popular name for children with cerebral palsy is “spastic” it is not correct. Spastic cerebral palsy is just one category

Cerebral Palsy can be classified according to:

-       The type of motor disorder (spasticity, dyskinesia, ataxia or mixed),

-       The distribution of the motor disorder (hemiplegia, diplegia, quadriplegia) and

-       The severity of the motor disorder

What is muscle tone?

Postural tone or muscle tone is the state of tension of muscles at rest and when we move – regulated under normal circumstances subconsciously in such a way that the tension is sufficiently high to withstand the pull of gravity i.e. to keep us upright but is never too strong to interfere with our movement

Muscle tone is what enables us to keep our bodies in a certain position or posture e.g. sit with our backs straight and head up.

For example when you extend your leg you must shorten or increase the tone of your thigh muscle while at the same time you are lengthening or reducing the tone of the muscles at the back of your leg. To complete a movement smoothly the tone in all muscle groups involved must be balanced.

Children with cerebral palsy have damage to the area of the brain that controls muscle tone. As a result they may have

1. Increased tone leading to stiffness or hypertonia
2.  Reduced tone leading to floppiness or hypotonic
3. Combination of the two – fluctuating tone
4. Rigidity – sustained stiffness of limb
5. Spasm – involuntary and possibly painful contractions of the muscles
6. Tremors – repeated rhythmic uncontrolled movements of parts of the body

Classification of Cerebral Palsy

1. Spasticity or hypertonic –
1. Mild
2. Moderate
3. Severe
2. Hypotonic –
1. Mild
2. Moderate
3. Severe
3. Fluctuating tone
1. Dystonia - is sustained muscle contraction causing twisting and repetitive movements or abnormal postures. It can be seen in involuntary movements of the eyes, mouth neck, trunk arms, or legs.
2. ATHETOID - is slow, writhing movement of face and extremities.
3. Chorea – is brief, irregular movements.
4. Ataxia – with or without spasticity

http://www.disability-claims.net/images/types_of_cp.gif

CP can further be classified according to the topography of the neuromuscular involvement:

1. Hemiplegia: affects one side of the body
2. Paraplegia or Diplegia: affects both legs (sometimes slight involvement in other extremities)
3. Quadriplegia: affects all 4 extremities equally, as well as the trunk
4. Triplegia – two sides affected but three limbs are involves usually one upper limb and both lower limbs
5. Monoplegia (very rare): Involvement of only 1 extremity

https://wiki.engr.illinois.edu/display/BIOE414/Medical+Significance

So we can see that there are different classifications of cerebral palsy. Each of these types has different characteristics which will be dealt with in another article.

Bibliography

Mutch L, Alberman E, Hagberg B, Kodama K, Perat M V,. "Cerebral Palsy Epidemiology: Where are We Now and Where are We Going?" Developmental Medicine & Child Neurology 34.6 (1992).

http://www.disability-claims.net/images/types_of_cp.gif

https://wiki.engr.illinois.edu/display/BIOE414/Medical+Significance