LETTERS TO EDITOR

Dear Editor,

COMMENTS ON THE MEDICAL AND SOCIAL MODELS IN REHABILITATION

I have a few comments to offer on the Guest Editorial of the Asia Pacific Disability Rehabilitation Journal, Vol 9, No. 1, 1998, "A critique of the disability movement" , by Raymond Lang (1). He repeats an increasingly familiar theme that the "medical model" is deficient and instead we should adopt the "social model." He calls for prudence on the part of disabled people in militant action as an "oppressed minority."

From the point of view of a physician who has dealt with disabled people for the past 45 years, there is no question that physicians must take into account the social, environmental, cultural, economic, and family parameters in the assessment of the patient who wants help in coping and dealing with the disability. If this is not the case, then the education of such physicians has been lacking in comprehensiveness. Unfortunately many physicians seem to have drifted into only the role of a technician to "deliver the services."

Prevention of disability-the first priority

I do not think the social model should be exclusive of the contribution of medicine and biomedical science in preventing and alleviating the disability as much as possible. Prevention should be the first concern of any disability rehabilitation. In this regard, medicine and biomedical science have done their job. For example, polio vaccine has eliminated the disabilities due to that virus in much of the world. The social model organisation that has had a large role in implementing polio vaccine is the International Rotary. Its project 2000 certainly has had a positive effect in India. This is an example of the linking of the social concern of ordinary people with the medical knowledge.

Motorcycle accident epidemic

We need to do more in prevention. Physicians have documented the epidemic of disability due to motorcycle accidents and continue to devote much of their time in less developed nations to the care and restoration of function in those who are thus severely injured. A visit to any general hospital in India, Indonesia, Thailand etc. will convince one of the large number of victims of motorcycle injuries and the extensive care required. The social model might address how the long term disabilities and the costs of treatment due to the plethora of motorcycles might be reduced. In many Asian mega-cities the motorcycle and traffic congestion is horrible and obvious. Helmets have helped reduce head injuries, but have not reduced the morbidity and life-long disability due to limb and spine fractures and dislocations. How to make the roadways in these countries safer for motorcycles, requires to be addressed urgently.

Paraplegia and quadriplegia

Paraplegia and quadriplegia which have a high incidence in India and Indonesia are not only due to motor vehicle accidents, but also due to falls from trees. How to make the plucking of coconuts and gathering of wood safer, should be a major concern in preventing the paralysis that creates severe long term disability. Here again the physicians can delineate the etiology. The social model needs to try and find a way to prevent it.

Influence of culture and folk medicine

Cultural practices in the treatment of injuries and diseases is a factor in disability. In Indonesia there is considerable faith in the village bone setters (dukuns) who apply their splints and powders to gross fractures of the limbs. This results in delay in treatment, chronic infection, mal-union, non-union and finally referral to the orthopaedic surgeons who try to patch up the injured person's limb, but the final result is a long term disability in mobility. Here again there might be a job for the "social model" worker in educating the public on the proper role of the traditional village bone setter, dukun or shaman.

Search for the cause of the disability

The medical model assumes that a physician is able to diagnose a condition and then treat according to the cause (etiology). Medicine has traditionally and consistently tried to find the cause of disease. Certainly, we know this to be the case historically from many examples. If it were not for Pasteur and the discovery of bacteria, we would still have devastating infections. How do we know what to prevent unless we search for the cause, be it social, economic (see motorcycles), cultural (see village shamans), bacteria or viral. The need for finding the cause and then the cure or prevention is so obvious that there is no need to dwell on it further.

All people, disabled or not, should make their own decisions and take responsibility for their actions

The "social model" is correct in allowing the disabled persons to make their decisions. But this means that they need to be informed of choices that includes the medical diagnosis prognosis, and treatment options with the risks. If disabled people are to be in charge of their own person (I agree with this), then they have to take responsibility. What I have observed is that the disabled person readily hands over to the physician the responsibility for certification of the disability when for example, social or worker's compensation insurance is at stake. All Western nations who have extensive disability insurance have this problem. Who is going to define who is sufficiently disabled to receive a large cash award or a lifetime disability income? Who in the social model is ready to take on this responsibility?

What constitutes an impairment that causes the disability?

What are the agreed parameters that characterise a disability? For those with sensory disabilities (blind and deaf) this is relatively easy. For motor system disabilities careful examination and analysis are necessary. For example, I note a fair number of adults who seem to tire of working at their jobs, get ill-defined aches and pains, and want to retire on disability. The problem often is mainly cultural, social and economic. The social model worker might contribute to a solution.

Who can help deal and cope with the permanent partial disability?

Once the physician can make a diagnosis and assess the functional loss (impairment), the disability becomes important. To cope and deal with it once maximum benefits of medical care have been reached ( i.e. a static permanent state), then rehabilitation, primarily vocational, educational, and the use of assistive technology can be implemented. This implementation then seems to conform to the social model. For example, an outstanding Asian vocational rehabilitation programme is the Redemptorist Centre in Pattaya, Thailand. It is the creation of Rev. Ray Brennan and has been in successful operation since 1984. There are 200 disabled students, aged 17 to 30, enrolled in electronic technician or computer science training in a residential school of 1 to 2 years duration. Job placement has been 100%.

Rehabilitation "treatments"

Mr. Raymond Lang's editorial (1) that rejects the medical model is correct in part. All too often I see that "rehabilitation," community based or not, seems to entail only "medical" treatment such as physical and occupational therapy. These methods presume that the particular disabling condition will respond to exercise without any careful and accurate assessment of the prognosis, i.e. potential for restoration of strength and function by the "therapy." Massage, modalities such as ultrasound, "lasers", "self-blood" treatment etc. (2) need to be subjected to scientific outcome studies as to their efficacy. Otherwise, all of these expensive machines and professional time will be wasted except perhaps as providing job opportunities for the professionals who administer them.

This sort of laying-on of hands and use of machines and modality in so-called "rehabilitation" is not restricted to the Asian countries, but is wide-spread throughout the Western ones. In general, most of it remains unevaluated. Perhaps this is due to the distrust of the medical model, its "authoritative doctors", and its insistence on the scientific method of predictability, reproducibility and simplicity. I suspect that there is fear by the proponents that the results will be negative. The proponents of any method of treatment for restoration of function should have the duty of assessment of its efficacy in scientifically accepted studies.

Too much money is being expended on ill-conceived, unevaluated and ill-informed "rehabilitation" treatment; money that could be used for assistive technology and vocational education of the permanently partially disabled persons; money that could be used for decent housing of the disabled persons to regain optimal independence.

The social model seems to predominate in rehabilitation treatment: i.e. if the patient (person) thinks that the treatment might help, he or she should have it regardless of reasonable proven efficacy. We have seen this concept operative in the "treatment" of cerebral palsy with "methods" of therapy that have not been subjected in most cases to scientific scrutiny and in those that have, the results are negative. What is worse is that the children and the parents subjected to these regimens have not been told that the method is "experimental."

The "Viklang Sanskar Tirth" centre in Ahmedabad (3) that engages disabled people in counselling to accept the permanent status, to avoid promised curative treatments and to adapt appropriately, is a model that might be replicated. Once the reality is accepted, then the disabled person, in my experience, is able to move onward and usually upward, consistent with his or her intellectual and physical ability and with compensatory equipment, adaptive housing, and aids to daily living. Most of my patients have moved onto further education and vocational training.

The approach to the partial permanently disabled person who wants and needs help

Most of my paediatric orthopaedic colleagues have adopted the following approach in the assessment of needs for optimum independence and their implementation consistent with the mental and physical capabilities and potential of the person:
Communication: First priority is making one's needs, feelings, desires known. Activities of daily living: Self feeding, cleansing, dressing, toilet-training, bathing.
Mobility: Getting from here to there by the most efficient means.
Walking: This is often the first priority in motor disabilities of children and adults, but the last priority for independent functioning. It is often not possible to implement as an efficient function.

If these functional goals cannot respond to remedial methods of management, then methods to compensate them are used: e.g. communication devices, adaptive equipment for eating, bathing, toilet-training, architectural modifications etc. For mobility there are walking aids, e.g. walkers, wheelchairs and power wheel chairs. In children with cerebral palsy, we have found that these functional goals can be set as early as 4 years of age. Assistive technology has been the main factor in achieving the goals for independence.

This letter is longer than intended. But I think the message is that medical model and social model are not mutually exclusive. Beating on the doctors as the enemy will not help disabled people. Social workers, teachers, engineers, and therapists all need to work together and all need to take responsibility for their actions. None need to worry about their territorial rights.

REFERENCES :
1. Lang R. A Critique of the Disability Movement. Asia Pacific Disability Rehabilitation Journal 1998 ; 9 (1) : 4-8.
2. Ruofei M. Beijing -Haidian Hospital for Neurologically Disabled Children. Asia Pacific Disability Rehabilitation Journal 1998 ; 9 (1) : 36-37.
3. Verma SK. The Viklang Sanskar Tirth. Asia Pacific Disability Rehabilitation Journal 1998 ; 9 (1) : 36.

Dear Editor,
THE RELEVANCE OF PLANNING ACTIVITIES BEFORE STARTING A PROGRAMME

Many organisations start new programmes as an extension of the activities they have been carrying out at random earlier. They do not spend sufficient time on planning the programme before they start, resulting in failures later. In other instances, new programmes emerge as a response to the availability of funds, and the only requirement is to have a proposal to act as a facade for the purpose of funding sanctions. These organisations cannot be called `grass-root' organisations in the normally understood sense, because they tend to do ` projects' rather than engage in development programmes based on local necessities. This brief letter, part of a series of letters, outlines the sequence of planning and illustrates the relevance of executive action plans in programme planning (1).

Table 1 illustrates the sequence of programme planning. The identification of the problem and its current situation analysis takes precedence to policy planning. This step confirms the need for intervention, the priority assigned by the consumers for the activity, and whether they view the intervention as beneficial to them. This step also identifies the material, manpower and financial resources that are available, and that are to be generated anew for the programme. A review of the literature will in many instances, give a fair idea whether such a programme is likely to succeed.

Successful completion of the pre-policy stage prepares the ground for the policy development by the stakeholders. The `vision' of the programme is the continuous goal of the programme as long as the programme is active. The `mission' is the sum of all activities to achieve the vision. The `objectives' are the medium term directions towards achieving the vision, that are evaluated and changed if necessary at the end of each phase.

Unlike the `policy', the `activities' are planned by the executives and activated after they are approved by those in governance, which is the governing body or the general body. Activities are short term in nature, planned for a calendar year or a financial year. Some activities are planned only for a very short period, while the others are for a longer period and a few are for a very long period. It is helpful if this classification is followed from the initial stage of planning, because it makes the subsequent year's plans easier. It is also necessary to define the activities using quantifiable outcome indicators that can be measured in a unit time, with an estimate of the potential achievement in this time. For example, the description of an activity such as immunisation for polio in a district in the year 1998 could be better described with a brief description of the activity, followed by the expected number of children who will be immunised in 1998, how many doses will be given and with an estimate of the coverage it is expected to achieve in the total population of children who require the immunisation during that year. It can also be related to the long term outcome of reduction in incidence of polio and still later to a reduction in prevalence of polio related disability. This extent of detailed description of activities makes it easier for the manager to gain control over the programme. It is also easier for him to relate the activity to the local needs, the availability of resources, and the requirement for modification of resources, to accurately estimate the budget, and monitor and evaluate the programme with ease. Clearly defined activities lead to clear definition of roles of personnel in projects, leading to less conflicts while working in groups. It makes the programme more accountable and transparent and thus makes it easier for the stake holders, the governance, the donors and the public to assess the achievements. Often evaluating the clarity of activities from a proposal before a project is initiated, gives the donor an indication of its likely success in the future. Well planned programmes usually relate their resource generation to the requirement of the activities rather than plan activities for the available funds.

Even though the effort put in to generate a clear set of activities may seem very high, the end result is gratifying to the managers involved in it, the donors and the consumers of the programme. This effort is also likely to produce better results and make the programme more sustainable because the activities become more amenable to monitoring.

REFERENCES
1. Thomas M J. A question of management in rehabilitation programmes in India. Asia Pacific Disability Rehabilitation Journal 1998; 9 (1): 31-32.

Dear Editor,
TRAINING OF CHILDREN WITH LOW VISION IN INTEGRATED EDUCATION PROGRAMMES.

More than half of the visually handicapped children enrolled in different educational systems have some residual vision. These children, if treated, trained and motivated to use their remaining vision effectively, can benefit from this input significantly. This helps them not only in their scholastic achievements but also in the social activities at school, home and in their immediate environment where they live.

Counselling. It was believed that children with low vision would strain their eyes leading to further deterioration of sight, if they used their remaining sight for performing their routine tasks, particularly if they read for a long span of time. On the contrary, if they are encouraged to use the remaining vision, it results in stimulation of the eyes and retention of the vision that still remains. Children with low vision should actually be encouraged to see things naturally as they like, without restricting their freedom of choosing the distance, angle of focus, observation span etc. Counselling on these lines should be carried out with the parents and teachers of such children.

Assessment. Any person with a problem of vision should be screened and examined by an eye specialist or a low vision expert to determine the possible treatment, counselling, prescription of medicines, and low vision aids required, and to assess the remaining functional vision that can help in performing different tasks.

Use of low vision aids. There are two types of low vision aids, namely, optical aids and non-optical aids. There are a number of optical aids such as magnifiers, telescopic aids and closed circuit televisions. The prescription of low vision aids should be individualised and need based. Often it is difficult to obtain low vision aids according to the requirement of the individual. Feedback from the low vision aid user is necessary to determine the changes he requires from time to time for the best use of the aids. Most of them are expensive and not within the reach of an ordinary rural family. They may also have adverse effects such as watering of the eyes, strain causing fatigue, headache etc. They are not recommended for continuous use, in order to avoid adverse effects. Periodical rest will be required when they are used for long hours. The non-optical aids commonly used for low vision are the reading materials in large print. The correct alphabet size should be chosen according to individual needs. Colour contrast, spacing between letters, words and sentences needs to be considered carefully while preparing large print matter. Any literate person with a little training will be able to prepare these materials. However, they require guidance during the initial stages. These materials can be produced inexpensively even though it takes enormous time.

Visual efficiency development programme. It will not suffice if the children with low vision are encouraged to only use their residual vision. Specific activities of training should be drawn up on a regular basis for better results. Activities for far vision have to do with fixation and scanning. For improving fixation the child with low vision may be asked to continuously view a particular object as long as he can, at a particular angle and distance. With this procedure the child's attention span increases and his fixation improves. Systematic methods of scanning also should be encouraged. In order to improve scanning an object should be moved in front of the child at a distance visible to him. The child should keep the head steady until the object disappears from his visual field. Moving animals, birds and other such objects will hold the child's interest better to learn scanning. The child needs to see, name the objects and perceive the colours of various materials. Coloured balloons of different sizes, different plants, flowers, leaves and fruits are good materials for the child's training.

Activities for near vision are primarily based on various kinds of work sheets and reading exercises. Worksheets can be prepared using black-ink sketch pens on white sheets. For example, lines of different lengths can be drawn for the child to follow them visually from left to right. Lines with breaks are given on the next work sheet after this exercise. A familiar shape may be introduced in the middle of the lines for the child to identify the shape. A large number of worksheets can be prepared in this manner. Identifying common objects from their sketch diagrams, like vegetables, fruits and animals can be useful. Matching geometrical shapes, colour matching and counting small circles are other exercises. There are several simple techniques by which a child with low vision can be trained. It would result in improving the child's ability to see and also improve his visual efficiency to a large extent.

When the child acquires the skill of reading large print the child should also be encouraged to read normal print. Many large print readers were found to use normal print for reading during later stages with practice. The child should be given the freedom to choose the distance and angle of focus between the printed matter and his eyes. Keeping the printed matter close to the eyes is not harmful. But reading under very bright light and reading in moving vehicles are difficult and should be avoided.

Hand writing. Children with low vision usually write illegibly. The letters may be overlapping or broken, and spacing between letters, words or sentences are not uniform and quite often written matter cannot be read easily. Such children can improve their writing by deliberate training in hand writing. Writing guides should be supplied to such children while they practice writing. Such guides can be easily prepared by windowing the writing spaces on a card-board sheet. These writing guides are similar to the signature guides used by totally blind persons, but they have a number of lines, up to 10, to write on a medium sized note book. Thick lines can also be drawn on white sheets with adequate margin and spacing between lines to enable the child to make use of the space in between to write the sentences straight.

Teaching diagrams. Complicated diagrams should be simplified for the training. An outline diagram with the names of the important parts will be useful for the training. The child may not be able to follow the complicated diagrams with large numbers of labelled parts. Similarly, maps can also be traced using thick lines explaining each area in the map at a time.

Education of the child with low vision can be made more interesting if a few practical hints suggested here are followed. These guidelines are useful for the resource teachers who play a vital role in facilitating integrated education programmes for visually handicapped children.

Dear Editor,
AN EDUCATIONAL APPROACH FOR PEOPLE WITH SPECIAL EDUCATIONAL NEEDS

A great number of nations were awakened about 20 years ago or so when the United Nations was proclaiming the 'Year' themes such as the 'Year of the Child'; 'Year of the Retarded Person'; 'Year of the Disabled Persons'; 'Year of the Family'; etc. Many countries had nothing to show. Some countries had little to display. Most countries were simply embarrassed! Traditional ways of caring for and educating persons with mental retardation were sometimes unable to fulfil even the minimum basic necessities of life. Social systems faltered in the proper understanding and support of the quality of life and educational needs of millions of normal persons who happen to be 'slow'. Available funds were too little to advance the cause of 'normalisation' of these persons with their needs of education and care. New approaches and pioneer experiments were necessary to reach out to the ten percent of every population who have special educational needs. In Japan, upon the collapse of the social welfare-based system of caring for persons with intellectual handicaps, the first images of the 'UNIT' began to appear. Some people took the responsibility to care for and to educate persons in need, in their own homes. Some of these students were registered in local schools, while others were not. In India, Concepcion Madduma began to take the first steps in a personal-family-centred special educational experiment in isolated rural areas, integrating home and school classes. An educational pattern thus began to emerge of a concrete method that was applicable, viable and effective in not only urban, but also in rural circumstances.

The special educational approach mentioned here centers upon the individuals involved in it as students and as participants. The emphasis is on the home or 'UNIT' place which is the primary classroom, with the parents or volunteers as the primary educators, and on the educational principles of creativity and discovery. The system emphasises the fact that one person, if he has the dedication to help people in need, can effectively conduct a special educational 'UNIT' anywhere, anytime, and thereby reach many of the unreached persons in need. The authors have developed three presentations on the 'Educational Programmes For Normal Persons Who Happen To Be Slow', namely, 1) For Persons Under the Age of 5 Years (2 1/2 days ... 20 hours of lectures and class demonstrations); 2) Basic Educational Programme (5 1/2 days ... 40 hours of lectures and class demonstrations); and 3) Conference For Adults With Learning Difficulties (2 1/2 days ... Conference style). These presentations are also compiled into a book. The purposes of the above three programmes are too educate the person with difficulty in learning; to enable the person who is intellectually 'slow' to become self-sufficient; to present positive programmes of social education and awareness; and to have these programmes replicated by programme participants in their own communities by initiating 'UNIT'-style educational classes.

The 'UNIT' programme has certain characteristics. It is very simple in structure, requiring only one teaching person, who has attended our basic special educational programme for a better background and understanding. The 'UNIT' process saves much time by limiting student numbers to five or so and never over eight. The 'UNIT' only needs classes with those teaching materials that are already at hand in the home. The 'UNIT' approach saves the energy of the teaching person and of the students, because the programme is short and intense, with well-planned scheduling, concise curriculum, and studies focused on total education, addressing the physical, spiritual and mental needs of the students. Many small 'UNITS' in limited areas have multiplied many times and have become more effective than the present-day institutionalised methods. The 'UNIT' educational approach is applicable to all persons with special educational needs from the day of the person's birth to the day of his death. The 'UNIT' approach also serves all persons having any level of severity of mental slowness. All people, regardless of social, financial and educational status, can effectively conduct a 'UNIT' if they are sufficiently motivated.

A practical model of 'UNIT' class scheduling is a matter of common-sense that caters to the physical, spiritual, and intellectual needs of the students. An example is as follows.
8:00 -8:20 Morning Greetings And Physical Exercises, 8:20- 8:55 Class On Numbers, 8:55- 9:00 Toilet Time, 9:00- 9:30 Sports And Games Class, 9:30- 9:45 Class On Sounds And Communications, 9:45- 9:55 Toilet Time (Washing Of Hands Before Eating), 9:55-10:15 Snack Time (Class On Eating), 10:15-10:30 Brushing Of Teeth, 10:30-11:05 Class On Multi-sensory Education And/Or Skills For Living (Vocational), 11:05-11:10 Toilet Time (Washing Of Hands After Work), 11:10-11:45 Class On Words, 11:45-11:55 Class On Cleaning (Environment), 11:55-12:10 Class On Singing (And Dancing), 12:10-12:15 Departure Of Students

This type of schedule takes only a short time each day. There remains sufficient time for other activities such as house work, recreation, and so on. A 'UNIT' can be conducted anywhere, in a room of a house, in a lobby of a building, in vacant houses of worship, in unused school classrooms, on a veranda, under a tree, etc. A 'UNIT'-type of educational presentation is not restricted to a rigid structure, or procedure, or process. Its activities can be flexible, adaptable, and accommodating. Therefore, no 'professional' means of evaluation is formulated. The very fact that many 'UNITS' are in existence conducted by people who only took a one-week educational programme gives credence to the effectiveness of the 'UNIT' approach. Some 'UNITS' have failed due to lack of interest, lack of time or lack of understanding of proper goals. However, there are some 'UNITS' in Japan that have continued successfully for more than twenty years. The 'UNIT' is an effective programme of education and is a viable programme in any circumstance. It is an educational programme that sparks a mass-manpower response to the needs of the many people involved with special education.

Dear Editor,
DISTRICT PRIMARY EDUCATION PROGRAMME AND INTEGRATED EDUCATION

The District Primary Education Programme (DPEP) has been approved as a Centrally Sponsored Scheme of the Government of India for Primary Education Development. The programme was launched in 1994 in 42 districts in the states of Madhya Pradesh, Assam, Haryana, Maharashtra, Karnataka, Tamil Nadu and Kerala. Presently, 149 districts in 14 states (including Gujarat, Himachal Pradesh, Orissa, Andhra Pradesh, West Bengal, Uttar Pradesh and Bihar) are covered with an estimated outlay of over Rs. 4000 crores, 85% of which is drawn from external sources.

The programme would develop and implement a replicable, sustainable and cost effective programme in the districts selected, with the following objectives : i) to reduce the differences in enrolment, dropout and learning achievement among gender and social groups to less than five per cent, ii). to reduce overall primary dropout rates for all students to less than 10 per cent, iii) to raise average achievement levels by at least 25 percent over measured baseline levels, ensuring achievement of basic literacy and numeracy competencies and a minimum of 40 per cent achievement levels in other competencies, by all primary school children, iv) to provide, according to national norms, access for all children, to primary education classes, that is, primary schooling wherever possible, or its equivalent non-formal education.

The programme would also strengthen the capacity of national, state and district institutions and organisations for the planning, management and evaluation of primary education. It would be implemented in a mission mode through registered level autonomous societies. Each society would have two organs, namely, a general council with the chief minister of the state as ex-officio president; and an executive committee under the chairmanship of chief secretary or education secretary of the state. While the quantum of funding would depend upon the district plan and its appraisal, the over-all investment per district is expected to be within a ceiling of Rs. 30-40 crores per district.

Integrated Education

To provide for the integrated education of disabled children, DPEP will fund interventions for the integrated education of primary school going children with mild to moderate disabilities. Towards this end DPEP will support :

1.Community mobilisation and early detection. This includes interventions for community mobilisation and parent contact so as to identify type, degree and extent of disabilities amongst the primary level age group. As far as possible these efforts will be integrated with on-going environment building and micro-planning activities. Relevant data from the available sources and surveys will also be tapped. Early detection of disabilities amongst pre-schoolers and provision for necessary skill building for the parents and the children in the Early Childhood Care and Education (ECCE) programme and school readiness programmes started under DPEP is another aspect of the programme. In areas covered by other similar programmes, DPEP will co-ordinate with them to provide support for the above purpose where necessary.

2. In- Service Teacher Training will be carried out for the development of skills and competencies for early detection of disabilities, functional assessment, use of aids and appliances, implementation of individualised education plans and monitoring of progress in all primary school teachers. This training should be recursive at block and cluster level and integrated with on going in-service teacher training schedules. All training modules at the State Council of Education, Research and Training, the District Institute of Education and Training (DIET) and the Block Resource Centre (BRC) levels should include a suitable component on integrated education.

3. Resource Support for integrated education at block or district levels will be garnered through arrangements with non-governmental organisations and other organisations having expertise in this field. Where ever necessary, DPEP will provide technical support with requisite personnel and equipment at block levels in order to provide guidance and technical assistance to primary school teachers, the community, the parents and children of that area. Such a facility will need to be supported by the State Government after the project period is over. DPEP will attempt to strengthen DIETs in the field of integrated education to facilitate development of suitable in-service training modules, providing training to master trainers and continuous resource support to BRCs and Cluster Resource Centres (CRCs) for integrated education . A programme officer will be recruited for integrated education at the DPEP district project office. A state advisory resource group for integrated education will be set up with at least three experts in this field. An apex level resource group will be formed at the national level to provide guidance, technical and academic support to integrated education under DPEP.

4. Educational Aids and Appliances. DPEP will provide essential rehabilitation and educational aids and appliances to primary school children, according to an approved list. Such items may be purchased through DPEP funds subject to first assessing available aids and appliances under existing schemes of the Department of Education, the Ministry of Welfare, and others.

5. Architectural Designs. DPEP will promote development of innovative designs for primary schools and removal of architectural barriers in existing schools to provide an enabling environment for children with disabilities.

ASIA PACIFIC DISABILITY REHABILITATION JOURNAL (VOL.9, NO.2, 1998)
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