BETTER CARE OF CHILDREN WITH LOCOMOTOR DISABILITY Marching ahead for better tomorrow

Item

Title
BETTER CARE OF CHILDREN
WITH LOCOMOTOR DISABILITY
Marching ahead for better tomorrow
extracted text
Better Care Series

.........

wftt LoeanotOF
Marching ahead for better tomorrow

Better Care Series

BETTER CARE OF CHILDREN
WITH LOCOMOTOR DISABILITY
Marching ahead for better tomorrow

(A Handy Guide for General Public & Health Workers)

(Also available in Hindi)

Dr. Uma Tuli

Voluntary Health Association of India
40. Tong Swasthya Bhavan. Institutional Area. South of l.l.T. New Delhi -16

Other books in Better Care series
♦ Tuberculosis
♦ Child Care
♦ Diseases & Conditions with Epidemic Potential
♦ Dengue and Dengue Haemorrhagic Fever

Director, Better Care Series
Alok Mukhopadhyay
Author
Dr. Uma Tuli
Coordinators
Bhavna B. Mukhopadhyay & Megha Sharma

Editor
Megha Sharma
Special Acknowledgement
Dr. P.C. Bhatnagar, Dr. Shaloo Puri

Design & Illustrations
Tamal Basu
Page-setting
Subhash Bhaskar
Production
Development Communications Unit

Printed at
VHAI Press
© Voluntary Health Association of India, 2000

40. Institutional Area (Near Qutab Hotel)
New Delhi-110 016.
Reproduction, adaptation and translation is authorised worldwide lor nonprofit educational activities and
publications, provided that permission is obtained Irom the publisher and that copies containing
reproduced material are sent to: The Executive Director. VHAI

ontents

Section - I
Introduction

Sharing and caring is life

Section

6

-2

Locomotor Disability

Causes and Prevention

Section

10

-3

Abilities of the Disabled

Equal Opportunities for learning
- Integrated education

Section

16

-4

Day to day Activities

Helping them face the
challenges in day to day life.
Conclusion

20
32

Section O&w

Introduction

Sharing and Caring is life
! >n most developing countries,
people with disabilities are the larg­
est minority group. As a group they
are starved of services and facilities
available to the non-disabled and,
consequently, are the least nourished,
the least healthy, the least educated,
the least employed. They are subject
to a long history of neglect, isolation,
segregation, poverty, deprivation,
charity and even pity
The plight of the disabled in India is
not dramatically different. The im­
mense responsibility for the care of
the disabled is generally left to their
families and a few insitutions man­
aged by voluntary organisations and
the government. Since the disabled,
as yet, do not have any economic or
political or media power in India, they
tend to be mostly ignored by society.
Disability, despite being a human
rights issue faces several obstacles.
The inaccessible public and private
buildings, schools, colleges, offices,
factories, shops etc pose the biggest
barriers.

Mythological references indicating
divine displeasure on those with
disability is often the cause of religious
and cultural barriers in society. Children
with disability, especially girls, get harsh
treatment with the constant allegation

Disability only becomes a tragedy when society fails to
provide the things we need to lead our lives - job
opportunities or barrier-free buildings, for example. It
is not a tragedy to me that 1 am living in a Chair.
Judy Heumann

Locomotor Disability

6

is a housewife while her
father Is a daily wage
earner. As a neglected
girl child, she always felt
jealous of the care
bestowed
on
her
brothers but the miracle
of care at the institution
she went to has not only
made Lakshmi mobile
but has also inculcated
immense confidence in
her. She
has
now
Lakshmi at home • comfortable in all situations
blossomed into a lovely.
Her bright eyes shine with hope
creative and
independent
and confidence. Her crutches
young girl. She is now envied by
do not seem to matter to her as
those whom she envied.This
she rushes forward to steady a
indeed
is the miracle of
younger
child
constant care. There
groping
for
his
are, unfortunately,
crutches. Then she
several
hundred
spends
a few
Lakshmis afflicted with
moments helping
various types
of
another disabled
locomotor disabilities
youngster to eat his food. Her
who need to be cared for, for a
face reflects the warmth and
better life and brighter future.
affection she has
received from the
teachers.
counsellors,
therapists, friends
and relatives who
have given her the
confidence
she
possesses in herself
due to the constant
care.Lakshmi.
afflicted with polio as
a baby, is the sister of
two older brothers
and the daughter of
Lakshmi today is a watch repair mechanic earning Rs. 1700/- per month.
She comes on a motorised tricycle from Paharganj and several times
poverty
stricken gives
lifts to people on the way. Her self esteem is incredible. Her smile
parents. Her mother has broadened and it travels for miles giving strength to many around.

A new
beginning

7

Locomotor Disability

of being a liability. They are viewed with
prejudice and are considered
incapable, resentful, bitter, abusive,
unhealthy, dependent on charity, a
burden on society and a drain on family
resources. These attitudinal barriers
are the most difficult ones to remove.
The image of children with disability
itself has a disabling image, creating
inferiority complex, fear, ridicule, lack
of self confidence and limited social
participation.

The implementation of the Bill in­
cludes care of children with Locomo­
tor disability in their pursuit of edu­
cation, vocational training and em­
ployment. Each member of society is
expected to care for the less privi­
leged. It is very much a part of our
culture. Living for others and service
above self are ideal goals which can
brighten the lives of several children
who, given the opportunity, can lead
a life of equality and dignity.

Another obstacle of course, is that of
equal and active participation in all ac­
tivities. The age-old obstacles of acces­
sibility to education, training and em­
ployment dissuades and depresses
children with disability. Such obstacles,
however, are slowly diminishing with
better awareness and efforts of the
Government, NGOs, public and private
sectors as well as communities at large.
The breakthrough in legislation has cre­
ated a ray of hope. After a long struggle
the disabled have got the "Persons with
Disabilities (Equal opportunities, Pro­
tection of Rights and Full Participation)
Bill, 1995, passed in India.

Estimates of the number of the
disabled vary a great deal,
depending on the definitions, the
source, the methodology and the
extent of scientific instruments used
in identifying and measuring the
degree of disability. It is estimated
that the population with disability in
India is approximately over 90
million, of these 12 million are
blind,28.5 million are with low vision,
12 million are with speech and
hearing
defects,
6
million
orthopaedically handicapped, 24
million mentally retarded, 7.5 million
mentally ill, 1.1 million leprosy cured.

Accept the child with disability
Provide opportunities for independent
functioning

Locomotor Disability

8

Two

Locomotor
Disability

Causes and Prevention
Locomotor disability is generally understood to mean the loss or lack of normal
ability of an individual to move both himself/herself and/or objects from one place
to another. It can occur due to cerebral palsy, polio, leprosy, stroke, arthritis,
cardio-respiratory diseases, burns, injury other than burns, medical/surgical
interventions,old age, other illnesses.

CAUSES OF DISABILITY

10

The most common diseases leading to disabilities are poliomyelitis, muscular
dystrophy, cerebral palsy, leprosy, injuries, spinal, cord injuries, bones and joints
disorders, maldevelopment of locomotor organs, rickets, TB and accidents.
Polio: Polio is caused by polio virus and results in permanent paralysis of
the muscles. It sometimes affects lower limbs or upper limbs and in some
cases, it may affect both. Corrective surgeries, therapeutic treatment as
well as provision of aids and appliances can lead to mobility and efficacy.
Cerebral palsy: Cerebral palsy is caused by birth anoxia i.e. lack of oxygen
supply to the baby's brain at the time of birth. Anoxia can be a result of pro­
longed labour or misuse of oxytocics injections given to hurry up labour. There
are special and therapeutic approaches for care of children affected by cere­
bral palsy.

Teratogenic effect of Thalidomide: When given to pregnant mothers, this drug

can lead to deformities in the child.Early intervention of a specialist is always
advisable.
Rickets: Rickets are caused due to lack of Vitamin D in early age causing
bony deformities. Proper pre-natal and post-natal care as well as early inter­
vention is required to avoid rickets.

Maldevelopment of locomotor organs : Maldevelopment of locomotor organs

is due to disease during pregnancy or effect of drugs taken by the mother in
early pregnancy. This can be taken care of by timely counselling on proper care
of pregnant mothers, especially during the first tremester.
Accidents and injuries: These are responsible for a large percentage of people

being disabled at home, or at the workplace or on the roads. The following are
some examples :
1.

Accidents on the road are a major cause of disability. Children often
become disabled in road accidents because they are playing on roads
and are not watching out for cars or are riding a bike on a road when they
are not old enough.

2.

Fireplaces and open flames are a major cause of disability from burns.
Bad burns or ones that are not treated correctly can cause the skin and
muscle to shrink or become tight so that the person cannot use that arm
or leg. Also, burns can make the person look different. This often leads
to people teasing such persons or avoiding them.

Early Detection of Disability:
There are several ways of detecting childhood disability without training or
special skills. The first level is called screening.

11

Locomotor Disability

The next level of detection is called simple assessment. This is done by close
examination by a person who has had special training in childhood disability.
Both the childhood development poster and the early detection assessment
are based on developmental milestones at 6 different age groups : 3 and 6
months and 1,2,3 and 5 years of age These milestones include the four major
categories of skills that children need to develop : physical, sensory, mental
and social. Simple assessment, however, does not identify the exact cause
of the disability or how it will progress.

If the simple assessment suggests a problem, then the child goes on to the third
level of detection, that is, evaluation by a professional and a doctor or a thera­
pist. These professionals try to determine the cause of the problem and predict
how the child will grow. Childhood disability prevention is of crucial importance
because it is far easier to prevent a disability than to treat it.

Childhood disability prevention is of crucial importance
because it is far easier to prevent a disability than to treat it.
Prevention of disability
The most effective prevention of disabilities depends on social change, which
is a long- term process. However, more immediate actions at family, commu­
nity, and national levels can help prevent some disabilities. For example, en­
sure that your child is fully immunised against childhood diseases.

•

Polio, in certain situations, can be prevented through effective
immunization. In places where immunization is not available or not fully
effective, families and communities can help to lower the chance of
paralysis from polio in other ways.

Ensure that your child is fully immunised against
childhood diseases.
One of the major causes of mental and physical handicap is high fever
that is not treated. To prevent disability when your child has high fever,
remove all clothes and bathe the child with cool water every hour. Fanning
may also help. If the child begins to have fits, make him as cool as possible
and take him immediately to the nearest doctor or health centre.

Sometimes a medical “treatment” can cause a disability. For example,
using crutches for several weeks that are too long can damage the nerves
in the armpit and cause paralysis of the arm. Sometimes , leg braces
worn by people who have had polio or cerebral palsy do not fit right and
cause pressure sores.

Locomotor Disability

12

Mobility aids

Faizal was brought to school literally crawling. Rehabilitation
experts of a renowned institution made a case study and
found the mother having some genetic problem which
resulted In two children with mental retardation. While caring
for them, the third pregnancy was neglected and the child
born with no prenatal care was under nourished. He was also
affected by polio. Fortunately, he could be attended to in
time for corrective surgery as well as physiotherapy prescribed
by the.doctors and therapists. The medical team did the
corrections but actual rehabilitation was done by others like
social worker, special educator and psychologist. They
convinced the parents about his being educable and his
potential. Faizal attended school regularly where he could
manage independent movements. He soon started
performing the most vigorous "Bhangra" dance. He could
ride a bicycle and climb up a tree wearing his caliper.

Several Faizals were sent to school by mouth-to-mouth
publicity by Faizal's mother who could convince people in
the community about the intervention and education
required by the children. She could also convey that the
actual handicap Is only in the minds of people who
underestimate the capabilities of children with locomotor
disability.

13

Locomotor Disability

Counselling parents about prevention :
People living in slums generally have low literacy levels, and unfortunately
have to face an unhygienic environment. It is important to counsel parents
that disabilities are avoidable. If already affected, they can be manageable
with provisions of surgery, therapy or aids and appliances as per need.

One of the institutions rendering rehabilitative services has formed Parents
Support Groups where active parents are doing an excellent job. They are not
only promoting the abilities of children with disability, managing separate units
for them but they are also motivating other parents to join the group and help
defeat disability.

Locomotor Disability

14

Section

Abilities of the
Disabled

Equal Opportunities for Learning
-Integrated Education
Inadequate education and employ­
ment opportunities for disabled people
are the other reasons why people with
disabilities have low status in a devel­
oping society. Some schools simply
refuse to accept disabled children on
the plea that “they will have a bad in­
fluence on the non-disabled students”!.

a thinking mind, a stirring soul and one
who lives in a small world of his own,
surrounded by his family and friends

An equal learner :

The goal of education for children with
or without special needs is to prepare
them for a happy, productive and use­
ful civic life. Children are born with fac­
Human motivation is the centre of the
ulties for creativity, innovation, imagi­
whole process of rehabilitation. The
nation and beautiful perceptions.
person with locomotor disability is also
These faculties are latent in all children,
a person gifted with a throbbing heart.
they only need to be
developed and en­
couraged in the en­
Recommendations for Parents
vironment where
they are brought up.
• Consult Health workers/specialist for neces­
Children are what
sary treatment and requirement of aids and
they are made and
appliances.
it is through educa­
• Contact NGOs working in the field of reha­
tion that we make
them good citizens.
bilitation for education and care that needs
Integration is the
to be taken within the family and then in the
process of bringing
community.
children and adults
• Seek professional help to make mobility aids
with special needs
as comfortable and usable as possible.
as close to a normal
• Network with parents of other children with
existence as pos­
locomotor disability.
sible. In this pro­
• Motivate the child for regular usage and
cess education is a
maintenance of mobility aids.
partner.

• Encourage the child for active participation
in educational, sports and cultural activities.
• Interact regularly with teachers, specialists
and peers.

• Consult the experts to monitor progress of
the child and for counselling regarding regu­
lar studies as well as vocational training.

Locomotor Disability

The National Policy
on Education (Part
IV) lays special em­
phasis on the re­
moval of disparities
and stresses the
need to equalise

16

educational opportunities by attending
to the specific needs of those who have
been denied these so far. It also aims
at mainstreaming the differently abled
in the general community as equal part­
ners to enable them to lead a life of
equality and dignity.

Every child with disability is educable.
A holistic team approach is required,
with the following in the team:

— Parents
— Teachers

Team

— Associates
— Programmes
— Vocational Instructor

Policy makers

„

With the provision of a barrier-free en­
vironment, a few adaptations in the
classroom furniture and tender, loving

care, the team can enable the disabled
to enjoy their right of education.

The art of teaching:
The art of teaching is the art of as­
sisting discovery. The following eight­
point programme brings success to
both the teacher and the taught with
an ever-prevailing smile. These are :
•
•
•
•
•
•
•
•

Achievement
Attachment
Admiration / Appreciation
Faith
Inner peace
Fun
Confidence
Infectious smile

Every teacher needs to take into ac­
count the necessity of bringing joy into
every pupil’s life by the above meth­
ods. The holistic approach of having
sports, cultural, art & craft and many

Teachers need to:
•

Be aware about the man­
agement of children with
locomotor disability

•

Understand the physical
and emotional problems
and provide necessary
support sensitively.

•

Interact with parents regu­
larly regarding day to day
activities, progress and problems at home.

Teachers are a vital link between the parents and the professionals and
should encourage the child to participate in all the activities at school.
Tender loving care greatly enhances the effect of other therapeutic in­
terventions.

17

Locomotor Disability

other co-curricular activities in the cur­
riculum helps immensely in achieving
the desired goal.

It has been observed that the children
with locomotor disability specially gain
confidence, develop accommodative
spirit, self esteem and social accep­
tance through participation in sports.
Not surprisingly, in several National
Integrated Sports Meets (NISM) the
children with locomotor disability
proved themselves second to none.

Sports play an important
role
in
developing
children’s personalities
"A child uses play to make
up for defeat, sufferings
and frustrations"

Locomotor Disability

Vocational Training
Proper care of children at school with a
comprehensive programme of Voca­
tional Training mingled with academ­
ics is also needed. With the facilities
of assessment of potential and apti­
tude a few training courses can be
organised towards empowerment in
later life. The following courses have
been found useful for most of the chil­
dren with locomotor disability :

•
•
•
•
•
•
•
•
•
•
•

Watch Repair,
Computer, photograph
Textile Designing,
Art & Craft,
Carpentry,
Knitting and Weaving,
Screen Printing,
Candle making,
Secretarial,
Electrical repair,
Beautician clinic etc.

18

We have
overcome^.

The walk to freedom

A smile of triumph

Empowerment

Lets move on!

9553

■

Section Four

Day to Day
Activities

Helping them face the
challenges in day to day life.
'Stimulation’ means giving a child a va­
riety of opportunities to experience, ex­
plore and play with things around her.
Early stimulation is necessary for the
healthy growth of every child's body and
mind. It is often more difficult for the
disabled child to experience and ex­
plore the world around him.

Development of the body, mind, and
senses all influence each other. Often
the disabled person is slow to develop
mentally because patient does nothing
but lies in a corner. His mind does not
have the 'stimulation' (activity, exercise,
and excitement) it need to grow strong.
When at last such a person’s body is
placed so he could see and experience
more of the world around him, and re­
late more to other people, his mind de­
velop quickly. With a little help and
imagination, he learn to do many things

that he and his family never dreamed
he can.

It shows how physical disability slows
down mental development. A child who
is mentally slow is often delayed in
physical development. Development of
body and mind are closely linked. After
all, the mind directs the body, yet de­
pends on the body’s 5 senses (sight,
hearing, touch, taste and smell) for its
knowledge of people and things.
Each child, of course, has his or her
own special needs. Parents and re­
habilitation workers can try to figure
out and meet these needs.

But all children have the same basic
needs. They need love, nutritious food
and shelter. And they need the chance
to explore their own bodies and the
world around them as fully as they can.

Steps In Designing A Program Of Special Learning
And Early Stimulation
First:

Observe the child closely to evaluate what he can and can
not do in each developmental area.

Second: Notice what things he is just beginning to do or still has
difficulty with.
Third:

Decide what new skill to teach or action to encourage that
will help the child build on the skills he already has.

Fourth:

Divide each new skill into small steps : activities the child
can learn in day or two, and then go on to the next step.

Fifth:

Provide sufficient practice be fore you take a new skill for
teaching.

Sixth :

Plan activities that give opportunity to practice the new skill
he has learnt._________________________________

Locomotor Disability

20

Suggestions for doing learning activities
with any child (Delayed or not)
Be patient and observant.
Children do not learn all the time; sometimes they need to rest. Whey
they are rested, they will begin to progress again. Observe the child closely.
Try to understand how she thinks, what she knows, and how she uses her
new skills. You will then learn how to help her practice and improve those
skills.
Be orderly and consistent.
Plan special activities to progress naturally from one skill to the next. Try
to play with the child at about the same time each day, and to put his toys,
tools, clothes, and so on, in the same place. Stay with one style of teach­
ing, loving, and behaviour development (if it works!). Respond in a similar
way each time to the child's actions and needs. This will help him to un­
derstand and to feel more confident and secure.
Use variety.
While repetition is important, so is variety I Change the activities a little
every day, so that the child and her helpers do not get bored. Do things in
different ways, and in various places inside and outside of the house. Take
the child to the market, fields, and the river. Give her a lot of things to do.
Be expressive.
Use your face and your tone of voice to show your feelings and thoughts.
For example : saying GOOD! with a grim face or saying NO! with a smile will
not give the correct message to the child. Praise and encourage the child
often. Speak clearly and simply (but do not use ‘baby talk'). Praise and en­
courage the child often.

Have a good time!
Look for ways to turn all activities into games that both the child and you
enjoy.
Be practical.
Whenever possible choose skills and activities that will help the child be­
come more independent and be able to do more, for himself and for
others. To help prepare the child for greater independence, do not over­
protect him.
Be confident.
All children will respond in some way to care, attention, and love. With your
help, a child who is delayed can become more able and independent.

21

Locomotor Disability

Nutrition in disabled children

WARNING: Disabled children are often in greater danger of
malnutrition than are other children.
Disabled children are often in greater danger of malnutrition than are other chil­
dren. Sometimes malnutrition is because the child has difficulty sucking, swal­
lowing, or holding food. Sometimes, however, it is because parents, although
they treat their disabled child with extra love and care, keep bottle feeding him
(with milk, rice water, or sugared drinks) until he is 3 or 4 years old or older. They
keep treating - and feeding - their child like a baby, even though he is growing
bigger and needs the same variety and quantity of foods that other children
need.

It is important that disabled children get enough to eat. It is also important
that they do not eat too much and get fat. Extra fat makes it more difficult for
a weak child to move about. If the child is getting fat, give him less fatty foods
and sweets. DO NOT LET A DISABLED CHILD get fat.

Successful feeding involves the whole child
The more difficult it is for a child to control his body movements, the more difficult
it will be for him to feed himself. Feeding problems may include : lack of mouth,
head, and body control; poor sitting balance; difficulty holding things and taking
them to his mouth. We must consider all these things when trying to help the
child feed more effectively.

It is not enough simply to put food or pour drink into the mouth of a child who has
difficulty sucking, eating, and drinking. First, we must look for ways to help the
child learn to suck, swallow, eat, and drink more normally and effectively, de­
pending on the child’s disability you will have to observe the child and arrive at
the best possible solution for him. For example a plate with steep sides makes
eating easier for the child who uses only one arm. When that arm is very weak it
helps if the dish is low on one side and high on the other, to push food against. It
helps to put a non slip mat under the plate.

Similarly it is possible to use ones imagination to think up of many other ways
to help the disabled child eat and do other things for himself. This is important
as the requirements of each child are different and varied.

REMEMBER: A disabled child needs the same foods that
other children of the same age need.

Locomotor Disability

22

Dressing
Children with disabilities , like other children, should be encouraged from an
early age to help with their own dressing. It is important however, not to push a
child to learn skills that are still too difficult for her level of development. Children
who are slow in their development or have difficulty with their movements may
be slower to learn dressing skills. It may seem quicker and easier for mother or
sister to simply put the clothes on her, without interacting with the child. How­
ever, this will only delay the child's development more.
As you dress the child, talk to him/her. Help the child learn his/her body parts,
the names of clothes and the way these relate.

It is important to use dressing as an opportunity to help the
child develop in many areas at once: awareness, balance,
movement and even language.
Positions for dressing :
Dressing is often a once a day activity in most households. If a child is only par­
tially independent or totally dependent on others for dressing, parents sometimes
feel that this is one activity they can manage. In such instances, it is still important
that parents stress the right positions for a child. Not only will it make their task
easier, but it is also therapy for the child.
To help the child dress while sitting, be sure he is in a steady position.

23

Locomotor Disability

If the balance when sitting is still not good, try sitting in a corner to dress.

Sitting cross legged gives the child the stability he/she needs to wear the
dress. Place the dress in such a way in front of the child that he/she first
puts on the sleeves. Then it is easier for him/her to put her head through
the neck hole.

Help the child find the position that allows the best
control for dressing.
Suggestions for dressing :
If one arm or leg is more affected
than the other, it is
easier if you put the
clothes first on the
affected side.

Put the clothes where the child
can see and reach them easily,
so he can help in any way
possible.
If the arm is bent stiffly, first try
to straighten it slowly, then put the
sleeve on. (If you try to straighten
it forcefully or quickly, it may
become more still.)

Locomotor Disability

24

If the legs straighten stiffly, bend them gently in order
to put on pants or shoes.

Begin any dressing activity for the child, but let him
finish it for himself. Little by little have him do
more of the steps. If he can do it all by
himself, give him time. Do not hurry
to do it for him if he is struggling to
do it himself. Praise him when he
does well or tries hard.
Use loose-fitting, easy-to-put-on
clothing. It is not always possible for
parents to buy new and special clothing for their child. Most adaptations
can just be made on clothes we normally wear. All of us have grown up
wearing “hand me downs” from our brothers and sisters. Often these
clothes “Just fit" and that may not be appropriate for the disabled child. So
families and the community need to look for other solutions. A young spastic
boy of thirteen may find his father’s or his uncle’s shirt or pullover easier
to wear than his brother's 1 It is also helpful if clothes are made out of thin
but strong material. Thick cloth is more difficult to put on.
For the child who has difficulty reaching his feet, a stick with a hook may help.

Large boat shaped neck lines for
blouses and shirts without buttons.
easier Harder

Stick tab instead of buttons

25

Press together studs (snaps) are easier
to open and close than buttons

Locomotor Disability

A case study

Raisa is severely affected with cerebral palsy. She
finds it difficult to eat, dress or bathe without being
helped at every step by her mother. Raisa cannot
speak and till quite recently, she would communi­
cate with gestures that only her family understood.
But one day she got a communication board with
all the words that would help her 'talk' to her friends
and teachers.
The first wish that she communicated to her
teacher was that she too wanted to dress up. She
wanted to wear a nice coloured salwar kameez
instead of the drab loose ones she always wore.
She wanted to wear pretty dupattas which she
had never worn.

All children, (whether disabled or not) love to dress up. Sometimes.
the disability of a person may be so overpowering that people around
her may not recognize her need to look good. But this may be ex­
tremely important for her self image.

Ideas for shoes

Locomotor Disability

26

Toilet Training
Children who are physically disabled,
are often late in learning to stay clean
and dry. This may be partly due to
their disabilities. But often it is be­
cause the parents have not pro­
vided the opportunity, training, and
help that the child needs.

fitting clothing with elastic waist
band.
•

Use short’training pants’made of
towel-like material that will soak
up urine.

•

For a child with cerebral palsy or
spina bifida, it may be easier lying
down-you might provide a clean
mat.

•

If people by custom squat to pass
tool, and the child has trouble, a
simple hand support can help.

Adapt toileting to the special needs
of the child

•

Latrines can also be adapted.

Many handicapped children can be
helped to become independent in their
toileting if special aids or adaptations
are made. Different children will require
different adaptations. However, the fol­
lowing are often helpful :

Make the outhouse (latrine) and its
door big enough so that a wheelchair
can fit inside. Position the door su that
the wheelchair can enter right beside
the latrine without having to turn
around.

•

Be sure the path to the latrine is level
and easy to get to from the house.

Of course, children with severe physi­
cal disabilities may always need help
with clothing or getting to the pot. But
they can learn to tell you when they
have to go. and do their best to 'hold
on’ until they are on the pot.

If the child has trouble pulling
down pants or panties - use loose

REMEMBER: As the disabled child grows, she will feel
the same need of privacy as any child would for toileting
and other personal acts. Help the child obtain the privacy
she needs.

27

Locomotor Disability

Crutch Use And Wheelchair Transfers
Use of crutches:

Making sure the crutch fits the child:

•

When the child stands, the crutch should
be 2 or 3 fingers’ width below the armpit.

•

The elbow should be bent a little so that
the child can lift herself up to swing her
feet through.

•

Teach the child not to hang on the crutches
with her weight on her armpits.

Wheelchair transfers :
Persons who use wheelchairs become much more independent if they can
learn to transfer (get in and out of their wheelchairs) by themselves, or with
limited help. For those who need some help, it is important to find ways to
transfer that make it easiest both for the disabled person and the helper.
Too often, as disabled children get bigger and heavier, mothers and fathers
hurt their own backs.Different persons will discover their own 'best way’ to
transfer with or without help, depend­
ing on their own combination of
The wrong way to transfer
strengths and weaknesses.

Here we give some suggestions of
ways to transfer that many people
have found to work well.

a) Sideways transfer:
Notice that it is often easier to trans­
fer sideways out of a chair, and also
back into it. To transfer sideways,
however, a wheelchair without arm­
rests, or with at least one removable
armrest is needed. Therefore, for

Locomotor Disability

Warning

One disability can lead to another

28

many disabled children, make an ef­
fort to get or make wheelchair with­
out armrests or with removable arm­
rests.
A good way to transfer the child who
needs help is like this. Put the child’s
feet on the floor and lean her forward
against your body. Have her hold on
as best as she can. Lift her like this
and swing her onto the bed.

b) Forward Transfer :
Transfer forward from wheelchair to cot or bed (often works well for children)

1.

29

Lift feet onto bed and wheel the
chair forward against bed. Put on
brakes. Then bend forward and
lift bottom forward on chair

2.

With one hand on the cushion
and one on the bed, lift the body
sideways onto the bed.

Locomotor Disability

c) Transfer from floor to wheelchair - with help of a low seat

2. With hands on each chair, push up,
with your head forward over knees.
3.

Swing onto the seat.

4. Now, with your head forward over
your knees, swing body onto the
wheelchair.

'Remember' : There are no
readymade remedies. The
most important thing to re­
member is to observe, adapt
and modify as per the needs
and requirements of the
child to make him/her com­
fortable and independent.

Locomotor Disability

30

Section Five

Conclusion

Conclusion
Let us introduce a meaningful voice in the world of silence, to bring a ray of hope
;n the life of those who are in darkness, and lend our helping hand and under­
standing to those who need love and concern. It is said, “strength does not come
from physical capacity. It comes from an indomitable will". So let us induce this
indomitable will in every child with a disability and light an eternal flame to help
them realise that each one of them can be a useful and productive member of
society. As Mother Teresa said:

"God gives us joy that we may give, he gives joy that we may share, for life
is gladder when we give and love is sweeter when we share the heavy loads
of others."

Locomotor Disability

32

Suggested Readings
• David Werner, Hesperian Foundation Disabled Village Children
• Ali Baquer and Anjali Sharma, Disability
: Challenges vs Responses
• Anita Julka NCERT, New Delhi Parenting
a Child with Special Needs
• Bernard van Leer foundation Early
Childhood Matters
• Bhushan Punani, Executive Director,
Blind Men's Association, Ahmedabad
Role
of
Non-governmental
Organisations in Realization of The
Rights of Disabled Children
• Coalition of Provincial Organizations of
the Handicapped Disabled People in
International Development
• Department of Women and Child
Development, Ministry of Human
Resource Development, Government of
India Integrated Child Development
Services
• Department of Women and Child
Development, Ministry of Human
Resource Development, Government of
India 50 years of Child Development The
Challenges Ahead
• DEPED Newsletter June 1997
• Indira Mallya, Asha Waghmode, Shruti
Bhargava and Punya Mittu Child to Child
Module for Para Professionals in India :
Focus on Mental Retardation
• Institute of Road Traffic Education
Recommended Policy on safety in
Transporting School Children & Code of
Safety Practice
• International Labour Office Geneva
Adaptation of Jobs and Employment of
the Disabled
• James P Russell Graded Activities lor
Children with Motor Difficulties
• National Council of Educational
Research and Training, India Project
Integrated Education for the Disabled
• News update on Canadian development
cooperation in India Sambandh

33

• National Children’s Bureau Seventh
Annual Report Oct. 1992-Sept. 1993
• Orfit Catalogue
• Parsiana Publications Pvt. Ltd. Voyage,
January 1999
• Rama Mani Physically Handicapped in
India
• S. Y. Quraishi, Secretary, Government
of Haryana, Chandigarh Care of
Disabled
Children
:
Some
Communication Issues
• Soeharso Finding Out About a Person
and Her Problems
• Soeharso Helping a Person with Pain,
Weakness of Stiffness
• Soeharso Helping Children Who Have
Difficulty Eating and Drinking
• Soeharso What is Disability ?
• Soeharso
Community
Based
Rehabilitation Development and Training
Centre, Indonesia Detection of childhood
disability Trainers' Manual
• Soeharso
Community
Based
Rehabilitation Development and Training
Centre, Indonesia Helping Prevent
Disability
• The Spastics Society of India Network
Seminar on Integrated Education for
Children with Special Needs - A matter
of Social Justice and Human Rights
• Uma Tuli (1997) Integrated Education of
children with Special Needs: Suggested
Policy Directions
• Uma Tuli (1998) Education for the
Persons with Locomotor Disability
• Uma Tuli (1999) Combating Disability for
Access to Education
• UNICEF April 1985 Preparing Girls for
Life
• WHO Geneva 1980 International
Classification of Impairments,
Disabilities and Handicaps WHO’s
Global School Health Initiative HealthPromoting Schools.

Locomotor Disability

Mobility Aids Available at Following Centres
1.

Akshay Pratisthan
D - III, Vasant Kunj, New Delhi.

2.

Amar Jyoti Rehabilitation &
Research Centre
Karkar Dooma, Vikas Marg,
Delhi - 110092

11.

All India Institute of Physical
Medicine & Rehabilitation
Mahalaxmi, Mumbai

12.

National Institute for
Orthopaedically Handicapped
B.T. Road, Boon Hooguly, Calcutta

3.

Institute for the Physically
Handicapped
4 - Vishnu Digamber Marg,
New Delhi - 110002.

13.

National Institute of Rehabilitation
Training & Research
Bairoi, Olatpur,
Cuttack, Orissa

4.

Safdarjung Hospital
Ansari Nagar, Delhi

14.

5.

A.I.I. M.S
Ansari Nagar, Delhi

Artifical Limbs Manufacturing
Corporation of India
G. T. Road,
Kanpur-208016, U. P.

6.

Mahavir Viklang Kendra
Ahinsa Bhawan, Shankar Road,
Delhi

15.

School of Prosthetic & Orthotics
Kailash Nagar, Chennai,
Tamil Nadu

7.

Bharat Vikas Parishad
Dilshad Garden, Delhi

16.

Mahavir Viklang Sahayata Samiti
Jaipur, Rajasthan

8.

Delhi Council for Child Welfare
Sagarpur, Janakpuri, Delhi

17.

Christian Medical College
Vellore, Tamil Nadu

9.

St. Stephen’s Hospital
Tis Hazari, Delhi

18.

10.

Artifical Limb Centre
Vanwadi, Pune. Maharashtra

Ujjawala
Anjana Batra Neumetic Control
35 - B, Rama Road,
New Delhi - 110015
Ph. No. 4615823

Locomotor Disability

34

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About VHAI

Voluntary Health Association of India (VHAI) is a non-profit, registered society
formed in the year 1970. It is a federation of 24 State Voluntary Health
Associations, linking together more than 4000 health care institutions and
grassroots level community health programmes spread across the country.
VHAI’s primary objective is to 'make health a reality for the people of India’ by
promoting community health, social justice and human rights related to the
provision and distribution of health services in India.
VHAI tries to achieve these goals through campaigns, policy research,
advocacy, need-based training, media and parliament interventions,
publications and audio-visuals, dissemination of information and running of
health and development projects in some difficult areas

VHAI works for people-centred policies and their effective implementation. It
sensitises the general public on important health and development issues for
evolving a sustainable health movement in the country with due emphasis on
its rich health and cultural heritage.

About the Author:

Dr.(Mrs.) UmaTuli, Ph.d, M.Ed, M.A., is the Founder, Managing Secretary of
Amar Jyoti Charitable Trust, working for the comprehensive rehabilitation of
orthopaedically handicapped people in and around Delhi.

She is the author of the "Spirit Triumphs", published in 1996, and is also the writer
and publisher of Disability Dialogue, the international newsletter on community
based rehabilitation and the concerns of people with disabilities. Under her
guidance, Amar Jyoti has received many national and international recognitions
and awards including the National Award in 1991 for Best Institution for Most
Innovative Project in the field of Rehabilitation from the President of India and the
UNESCAP Award, 1998, for the promotion of barrier free environment. She herself
has been the recipient of many awards including the Hellen Keller Award, 1999,
for creating opportunities for persons with disabilities.

The better care series
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reference guide for general
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