Abstract

This study assesses Disabled People’s access to productive resources. Specifically, the study examines the constraints to people living with disability (PLWD access to productive resources and proposes an effective strategy to address the constraints. One hundred and five respondents that belong to physically challenged associations were interviewed by structured interview schedule. Data analyses were carried out using frequency counts, percentages, mean, standard deviation and correlation. Results of the study show that more males were found in this category compared to females, and they were of productive age. The majority were illiterate. All the PLWD claimed that access to productive resources was of necessity for sustainable livelihood but in the real sense it has turned to ordinary dream. Most of the PLWD claimed that the productive resources such as education and information, training, appropriate technology, and social welfare were not provided and those one provided were inadequate. A positive and significant correlation exists between PWD access to productive resources and socio-economic characteristics such as education and income, at p ≤ 0.05. In conclusion, there is a need to create an enabling environment through the provision of adequate productive resources in order to make life meaningful for PLWD.

Keywords: Accessibility; Appropriate technology; Dream; Physically challenge people; Productive resources; Reality

1 Introduction

“Can you imagine that you’re getting up in the morning with severe pain that prevent you from even moving out from your bed? Can you imagine yourself having a pain which requires you to get assistance to do even the very simple day to day activities? Can you imagine yourself being fired from your job because you are unable to perform simple job requirements? Can you imagine your little child crying for a hug and you are unable to hug him due to the pain in your bones and joints?”(World Report on Disability, 2011). This is the scenario in which physically challenged people are experiencing.

According to the Convention on the Rights of Persons with disabilities, disability is used to describe the condition whereby physical and social barriers prevent a person with impairment from taking part in the normal life of the community on an equal foothold with others (Article 1). Mohammed (2017) was of opinion that disability is not just a mere health dilemma. It is a diverse experience that affects the person’s body and his or her capability to function equally in the society in which he or she belongs. Disability may be physical, cognitive, mental, sensory, emotional and developmental or some combination of these and may be present from birth or occur during a person’s life

A disable person is someone who has a physical or mental disability which has an effect on his or her ability to carry out regular day-to-day activities. The disable are those persons who are ‘unable’, ‘unfit’, ‘cripple’ or incapacitated as a result of hereditary defects, environmental pressure, accidents and diseases. Thus, a physically challenged person can be regarded as any person who is incapable to obtain for him fully or partially the normal requirements of an individual and is unable to participate fully in the community activity due to limitations either physically or mentally ((Mohammed,2017). Physically challenged persons can also be described as those certified by a specialist in any field of therapy as having one or more disabilities which might be total blindness, partial blindness, emotional disorder, deafness, partial hearing, physical handicap, speech defects, learning disability, social maladjustment, exceptional giftedness and mental retardation (Deloitte Access Economics, 2011).

Accurate statistics are not available in most countries in respect of Persons with disabilities According to the United Nations Enable, (UN)(2008), there are approximately 650 million people with disabilities in the world, and at least 80 percent of them live in developing countries. The figures have amplified to almost a billion in 2011. World Health Organisation(WHO),( 2011) reported that more than one billion people in the world live with some form of disability, of whom nearly 200 million experience considerable difficulties in functioning. The Nigerian National Assembly in 2013 estimated that there are over 20 million people existing with disability in the country. UN also reported that out of every 10 persons with disability in the country, 9 live below the poverty level.

Notwithstanding the principle proclaimed in the Charter of the United Nations that recognizes the inbuilt dignity, worth and the equal and absolute rights of all members of the human family as the basis of freedom, justice and peace in the world, it is regrettable that a segment of the Nigerian society still live on the fringes as a result of disability

The quality of life experienced by the majority of handicapped people in contemporary society is considerably lower than that enjoyed by their able-bodied contemporaries. At the societal level we can find instances of stigmatization and rejection of physically challenged people despite Chapter IV of Constitution of the Federal Republic of Nigeria that stated clearly fundamental human rights (Constitution of the Federal Republic of Nigeria, 1999). Many people with disabilities do not have equal access to health care, education, and employment opportunities and disability-related services that they require (NILS, 2010). Poverty is a invasive problem in Nigeria. Several reports indicate that the problem has been persistent despite economic growth in the country. Persons with disabilities in rural areas represent the poorest of the poor (Ogunjimi and Ajala,2016). The statistics indicates that unemployment for working age disabled people in developing and developed countries is between 80-90% and 50-70%, respectively (Naami et al. 2012). They are often excluded from active participation within their community. This general neglect causes these people to be often not included national development and their specific needs ignored in agricultural development programmes and policies. Disability is also an important development issue with an increasing body of facts showing that persons with disabilities experience worse socioeconomic outcomes and poverty than persons without disabilities

People living with disabilities face many impediments every day from physical obstacles in buildings to systemic barriers in employment and community programmes. Yet, often, the most difficult barriers to overcome are attitudes other people carry regarding people with disabilities. Whether born from ignorance, fear, misunderstanding or hate, these attitudes keep people from appreciating–and experiencing–the full potential a person with a disability can achieve

The UN convention on the rights of persons with disabilities that came into force in 2008 marks a paradigm shift in how disability is viewed from people with disabilities as objects of charity or medical intervention, to people with rights and control over their own lives, decisions and futures.

Disability could be prevented through measures taken against malnutrition, environmental pollution, poor hygiene, inadequate prenatal and postnatal care, water-borne diseases and accidents of all types. The international community could make a major breakthrough against disabilities caused by poliomyelitis, tetanus, whooping-cough and diphtheria, and to a lesser extent tuberculosis, through a world-wide expansion of programmes of immunization (United Nation,2008)

Agricultural sector has been the mainstream of national development in which disabled people can be involved in large scale, if given the opportunities. Disability need not be an obstacle to success. The World Food Summit organized by FAO in 1996 acknowledged the fundamental contribution to food security by disabled farmers, noting that a large proportion of the disabled people were farmers with responsibility for the food security of their households (FAO, 2006). Efforts are been made by international organizations and developed countries especially European Union to include physically challenged people in agricultural development programme. The European Union recently adopted disability as a cross cutting issue, giving opportunities to include people with disabilities in regular food security programmes. Numerous successful projects have shown that people with disabilities are able to participate in meaningful agricultural activities. Some go as far as crucial that people with disabilities are the world’s untapped resource and that their inclusion is of paramount importance for global food security (Global Forum on Food Security and Nutrition, 2010). In Nigeria Disable people access to productive resources such as ownership of land, livestock or other agricultural resources; management of agricultural resources; use of financial service, social service health service; access to education, and adaptive technology has not been paid adequate attention to despite the fact that physically challenged people are the world’s untapped resource and that their inclusion is of paramount importance for global food security. Therefore the study assessed People with disability accessibility to productive resources in Nigeria and its effects on their livelihood coping strategies. The specific objectives of the study include the study examine PLWD assess to productive resources, constraints to PLWD access to productive resources and propose effective policy for seeking redress on behalf of PLWD

1.2 Theoretical Framework

This paper explores combination of two theories namely, the Bio-medical Model of diseases, illness and disability and social model. The model outlines the official definition of health and disease adopted by states and international authorities, including the World Health Organization. At the present time, health has been defined as a complete state of physical, mental and social well-being; or the capacity to function optimally in the individual’s environment; or an adaptation to the environment.(Minaire, 1992) The major limitations of this theory are that little consideration is usually given to the victim in this concept, much more being given to the disease itself and its failure to address the social aspects of disability (Parsons, 1951). However, the model is relevant in alleviating or reducing the suffering of disabled people through the provision of training, rehabilitation, technical aids, medical interventions and professional support all of which serves as ways of promoting empowerment and self reliance. The Social Model emphasizes the social and environmental context of disability. This model is concerned with liberating and empowering the disabled persons and the positive contribution that they can make in removing the barriers to their participation. The model also emphasizes the role of government and civil society in removing the obstacles faced by citizens with disabilities in becoming active participants in the various communities in which they live and learn to work.

2 Materials and Methods

The study was carried out in four out of six states of South-western Nigeria. These are, Oyo Ekiti, Ondo and Osun States. The states were selected in view of the fact that most of these PCP have associations where they can be easily reached and intervention programme can be extended to them. Ten percent of the local Governments (LGAs) in each of state were selected. In all, 10 LGAs were used. Thirty PCP (physically impaired, visually impaired and hearing impaired) were selected from the lists of members collected from their associations in each LGA, to give a total of 300. Structured interview was used to collect relevant quantitative data. Descriptive statistics such as percentages, mean and standard deviation were used describe and summarize the data. In order to assess disabled people access to productive resources, statements of opinion were measured through the use of scale such as highly accessible, really accessible and not accessible. To determine attitude of society towards PLWD statements of opinion were measured through the use of likert scale such as strongly agreed, agreed, undecided, disagreed and strongly disagreed. Mean± standard deviation was used to categorize statements to favourable, neutral and unfavourable. Participant’s observation and key informant interview were also used to collect information from PLWD

3 Results and Discussion

3.1Socio-economic characteristics

Majority (77.9%) of the PCP were less than 60 years old. This indicates that majority of the disabled people in the study areas were still in their productive age in which they could still be productive and contribute meaningfully to the socio- economic well-being of the society. This is in line with Ogunjimi

et al.

(2012) findings that majority of farmers in Southwestern Nigeria were in their productive age. Moreover, majority (63.6%) were male, while 39.0 percent were female. This finding corroborated the World Bank finding that males at all ages have higher levels of disability. The findings were expected because of involvement of men in rigorous labour activities. Moreso, farming activities required time and energy which women may not be able to cope with. However, contrary to expectation that majority of the disabled people ought to have married, less than average (40.7%) were married while 61.9% were either single, divorced or widowed. This might be as a result of discrimination against PCP where people without disabilities might not be willing to marry them because of their disabilities.

Major source of information was other rural dwellers (64.2%). Majority were living below the poverty level because above average (52.1%) realized less than 100,000 Naira (227.8 USD) annually. The finding is in line with the study carried out in India and Uganda as reported by Emmel (2012). The report showed that in India, households with people who have disabilities are worse off than the average household. Similarly, research revealed that in Uganda, households headed by an individual with a disability are 38 percent more likely to be poor than households headed by a person without a disability due to low level of income.

3.2 Accessibility to Social services

3.2.1 Access to Education

Persons living with disabilities have a right to education. The child’s right to education is enshrined in human right treaties, in articles 28 and 29 of United Nation declaration. In these treaties it is required that the provision of primary education should be compulsory, available and free to all children and secondary education should also be made available and accessible to every child, with the provision of financial support when needed. Majority (74.4%) of the disabled people either had no education or stop at primary Most of them that attended school at primary school level later dropped out before the end of primary six. This might be as a result of inadequate provision of schools for disabled people and where available, there were a lot of rigours in getting to schools due to constraints such as inadequate transportation and trained personnel.

The worse aspect of it is that the disabled children experience inaccessibility of class rooms, toilets he/she can use and able school children negative attitude towards disabled people. The disabled child becomes isolated in school. Little by little school life becomes an unhappy experience. The child becomes a school dropout at a very early stage of their life. Lack of proper education makes it difficult for the person with disability when grown up to find employment or to engage in some form of income generating activity. This finding also corroborated the submission of Beresford (1996) that the unemployment of disabled people is due to lack of education and training. Ajuwon (2011) pointed out that hundreds of certified special educators have been trained in Nigerian tertiary institutions since 1974 till today; however, some of these front line workers have not been assigned to schools and agencies where their expertise can be harnessed.

Figure 1: Accessibility to Education

3.2.2 Employment

Figure 2 showed that 60.1% were not able to secure job and 31.4% were self employed in which income realised is unsustainable. Few 8.5% were employed by either public or private organisations. Persons with disabilities find it extremely difficult to secure employment in rural as well as urban areas. Reasons mentioned include lack of education, vocational training and competition in the labour market. Employers prefer not to employ persons with disabilities thinking that they are less productive. Employers are unaware of the ability of persons with disabilities. Cyril (1997) said that whenever people meet a person with a disability they never see his/her abilities but only see the person’s disability. They think of helping him/her by giving something but that does not do anything to help him to use his abilities

Figure 1: Accessibility to Employment

3.2.3Access to Health

The results also show that majority 92.1% of the PLWD in Nigeria have inadequate access to primary health delivery which might as a result of the fact that most of them are usually extremely poor people who often live in rural and other areas where medical and other services are scarce, or even totally absent, and where disabilities are not detected in time. WHO, (2012) claimed that when disable people receive medical attention, if at all; the impairment may have become permanent. It is very common in Nigeria to see disable persons on the streets holding prescription cards asking for money to purchase medicine and clear up medical bill.

The attitude of some health workers towards the disable persons who managed to access the general and other health centres is sometimes negative. A study in Calabar by Ogunjimi (2007) shown that 56.33% have unfavourable attitude towards the handicapped persons, 63.2% are of the opinion that health of the handicapped persons is not as important as that of the normal persons, 57.74% indicated that handicapped persons are only good enough for drug trial testing and experimentation of new medical inventions and 57.36% would prefer separate hospitals for the handicapped persons.

In country like Nigeria, there are inadequate special services to persons with disabilities like Physiotherapy units in these hospitals.

3.2.4 Accessibility to Transport

Transport is another factor hampering employment of persons with disabilities in Nigeria. Public transport services are inadequate and they are not well equipped to carry PLWD especially those on wheelchairs. Transport services that available in rural areas are very poor when compared to the urban areas. There are villages with bad roads while some villages are without any roads at all.As a result disabled people are forced to spend much part of their income on transportation, thus forcing them to be isolated and live within the margin of poverty. Other associated problems as mentioned by PLWD include inadequate wheel-chair, accessible pedestrian bridge; the presence of steps/stairs without complementary ramp; rough, unpaved, and uneven floor surfaces; uncovered drainages; absence of lift in high rise buildings and absence of side walk. Participant at one of the interview conducted in Ife., Nigeria expressed her displeasure with able people attitude to PLWD

I used to sell roasted Corn but the major problem is attitude of people to PCP in the market and Sometimes drivers are not considerate since there is not special treatment for PCP on transportation system” (PCP).

3.2.5 Accessibility to


Rehabilitation facilities

Rehabilitation means a goal-oriented and time-limited process aimed at enabling an impaired person to reach the best possible mental, physical and/or social functional level, thus providing her or him with the tools to change her or his own life. Rehabilitation usually includes the following types of services: early discovery, diagnosis and intervention; Medical care and treatment; social, psychological and other types of counselling and assistance; Training in self-care activities which includes mobility, communication and daily living skills, with special provisions as needed, e g., for the hearing impaired, the visually impaired and the mentally retarded; Provision of technical and mobility aids and other devices; specialized education services; vocational rehabilitation services (including vocational guidance), vocational training and placement in open or sheltered employment (Department of Economics and Social Affairs, Division for Inclusive Development United Nations, 1982). The rehabilitation facilities available to persons with a disability residing in rural areas are inadequate or atimes not available.

Testing of Hypotheses

The correlation results show that there exists a positive and significant relationship between peoples’ living with disability accessibility to productive resources and their socio-economic characteristics such as year of schooling(r=326), income(r=3.10) while age (r-=0.024)) was not significantly correlated. The implication of the finding is that higher the year of schooling and income the higher the PLWD accessibility to productive resources.

Table 8. Correlation analysis between peoples’ living with disability accessibility to productive resources and socio-economic characteristics variables

Conclusion and Recommendations

Inequality in distribution of productive resources in Nigeria has adverse effect on sustainable livelihood of PLWD, in spite of fact that the rights of citizen including PLWD has been entrenched in Nigeria constitution Furthermore, United Nations treaties and other regional organizations, and various governments have formulated and enacted laws aimed at ensuring the rights of disabled people throughout the world, this has not been adequately materialized in Nigeria for a number reasons such as lack of politically and economically will . Reasons given by Government most of the time includes lack of money to supply the needed facilities and equipment This are not convincing and have no basis in a country like Nigeria which is gifted with abundant natural and human resources. Despite the fact that functional facilities for the health care of disable persons, their education, transportation, training and empowerment and productive resources are inadequate, facilities put in place are not easily accessible to most of them. Accessibility to productive resources has become dream not reality. PLWDs are to a large extent discriminated against, segregated and marginalized. What is evident is that there is no political will and commitment on the part of the government to ensure, protect and promote the interest of people living with disability in Nigeria. Government and Non-Governmental Organisations should act positively on the Nigerian Disability Bill that has just been passed to law in Nigeria.

This paper recommends that:

1. The Nigerian president should as a matter of urgency implement the disability law that addressed the protection of disable persons against all forms of discriminations in education, transportation, health and other welfare matters.

2. The government should engage in a wide and rigorous public enlightenment campaign against the discrimination of disable people in the Nigerian society.

3. The Federal government should introduce Disability Tax Fund (DTF) which should be used for the provision of social security and welfare of disabled persons

4 United Nations should see to the implementation of treaties signed by all nations that signed the treaties.

5 References

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Understanding and Treating Complex Regional Pain Syndrome : A Nerve Block Treatment Approach.

There are a variety of treatments with established effectiveness for the management of complex regional pain syndrome (CRPS). However, the distinctiveness and variability of symptoms in patients with CRPS often makes it challenging for therapists to design the most effective personalized treatment approach for their patients. CRPS is an uncommon chronic pain that affects the limbs, and its causes are still not fully comprehended. It usually develops after an injury, a surgery, a heart attack or a stroke and causes an excruciating pain.  The condition is complex in nature, and various terminologies have been used to describe CRPS in the past, resulting in misdiagnosis of the condition, and consequently poor evidence-base regarding available treatment modalities.

When diagnosed at an early stage, an aggressive and interdisciplinary treatment approach can provide healing and sometimes total remission. One of the treatment approaches with effective results is Sympathetic blocks. Several patients have found relief with this treatment consisting of the injection of a local anesthetic to numb the nerves. This technique aims at reducing the over-activity of the sympathetic nerves in CRPS. Such treatment provides pain relief, mood improvement, and improvement of activity level, as proven by many randomized controlled trials, clinical practices and systematic reviews (2).The purpose of this presentation is to discuss the diagnosis, symptoms and treatments approaches of CRPS, with an emphasis on the sympathetic block and its mechanisms.

Definition

Complex regional pain syndrome (CRPS) is a chronic pain condition of the limb (leg, foot, arm or hand) lasting for over six months, and occurs after an injury, a stroke, or a surgery. It is characterized by a group of symptoms resulting from the damage to, or malfunction of, the peripheral and central nervous systems. It can complicate recovery and impair one’s functional and psychological well-being. Initially known as causalgia, complex regional pain syndrome (CRPS) was reported for the first time in 1865 during the American Civil War in soldiers who were affected by neurologic injuries

Characteristics/ Symptoms

• Throbbing pain
• Changes in skin texture on the affected or surrounding area
• Abnormal sweating pattern in the affected area
• Changes in nail and hair growth patterns
• Joint stiffness, swelling and damage
• Muscle spasms, tremors, weakness and atrophy
• Muscle Coordination problems
• Decreased ability to move the affected body part
• Abnormal movement in the affected limb
• Changes in skin temperature — alternation between sweaty and cold
• Changes in skin color- white red or blue
• Changes in skin texture ( may become tender, thin or shiny in the affected area

Sensibility

Types

Complex regional pain syndrome occurs in two types, with similar signs and symptoms, but different causes:

Type 1:  In this category, there is no direct damage to the nerves of the affected limb(s). Type one is also known as reflex sympathetic dystrophy syndrome (RSD). 90% of people with complex regional pain syndrome have type 1.

Type 2. The symptoms in type II are similar to type I, but there is distinct serve injury in this category. It is referred to as causalgia,

Causes

The cause of complex regional pain syndrome isn’t completely understood. It’s believed to be caused by an injury , abnormality of the peripheral and central nervous systems.. This can include a crushing injury, fracture or amputation.

Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — can also lead to complex regional pain syndrome.

No clear understanding of why injuries trigger complex regional pain syndrome.

Possible dysfunctional interaction between the central and peripheral nervous systems

Inappropriate inflammatory responses.

Not everyone with injuries develop complex regional pain syndrome.

Diagnosis

There is no specific test to confirm the diagnosis of CRPS. Qualified physicians often based the diagnosis through observation of signs and symptoms, and study of personal history and a physical exam.

X-rays, and MRI / bone scans are used to check for possible changes in the bones, skin and joints that can be attributed to CRPS.

Early diagnosis and treatment offers more chances for recovery

Treatment options

There is no cure for CRPS. Treatment aims at relieving painful symptoms and improving the patient’s quality of life. There are various treatments options depending on the duration of the condition and the severity of the symptoms. Physicians often use a multidisciplinary approach to treat the condition.

When initiated early and aggressively, the patient has better chances to find relief and remission. An interdisciplinary approach is often needed to achieve optimum results. Below is a list of treatment options.

Occupational/Physical Therapy. Exercise programs can help with motions and preserve mobility.

Nerve Blocks: It is reported that many patients experience major relief from nerve blocks,. It relieves the pain and enables more effective therapy by inhibiting the over-activity of the sympathetic nerves.

Medications: Different drugs are used to treat CRPS and related conditions. associated conditions (such as  anxiety, sleep disorders, and depression)

Medications include topical analgesics, antidepressants, corticosteroids, muscle relaxants, opioids , antiseizures, and sleeping medications.

Psychotherapy: CRPS can have significant psychological effects on patients and their families. They are often depressed, anxious, or suffer from post-traumatic stress disorder.  Psychotherapy can help to improve coping ability.

Surgery:  It is often used in cases where CRPS is caused by a compressed nerve.  It helps release pressure on the

Other options include: Spinal cord stimulation and intrathecal pumps, in which pain medications are injected continuously into the subarachnoid space. Deep brain stimulation and Electrotherapy (ECT) have also been used, and new therapies continue to emerge.

Nerve Block mechanisms

The rationale for using Nerve block to treat CRPS is based on its strong ability to block receptors

^.

Experimental evidence suggests that the symptoms of CRPS are generated by an intense or prolonged painful stimulus that causes increased and prolonged glutamate release.

A randomized, double-blind, placebo-controlled trial showed that sympathetic nerve blocks was beneficial for pain and sensory symptoms in CRPS type I

Calcium channel blockers

A small, uncontrolled case series showed improvement in patients with CRPS using the calcium channel blocker nifedipine. There was no randomized, controlled trials performed The clinical experience and the literature describes significant relief in some patients

Beta-blockers

Poor clinical experience but proven benefits demonstrated in some case reports. A placebo-controlled trial did not demonstrate statistically significant efficacy for some beta-blocker ( example propranolol.

⁾

Oral sympatholytic agents

In theory, oral sympatholytic agents are deemed to provide symptom and pain relief for patients with CRPS and other neuropathic. However, there is no randomized, prospective, controlled study proving their efficacy. But, some benefits were reported for agents like prazosin


^,


phenoxybenzamine and terazosin.

^,

although the clinical use of these drugs is thought to have several adverse side effects.

Sympathetic nerve block is the best treatment option. Sympathetic Nervous System plays a huge role in CRPS.

There is substantial evidence suggesting that the sympathetic nervous system has a role in chronic neuropathic and inflammatory pain states in both animals and humans (3

Patients with CRPS type I have significant impairment of sympathetic nervous system function characterized by decreased sympathetic outflow and increased adrenergic responsiveness. This alteration of sympathetic function can be generalized, suggesting abnormal processing in the central nervous system.

Evidences

Local and regional sympathetic blockade such as stellate ganglion blockade or lumbar sympathetic blockade are widely reported in the many studies   However some studies suggest that the therapeutic response to sympathetic blockade is inconsistent and may only be more effective than placebo at reducing the extent but not the amount of pain

.

According to this review, there is high evidence that intravenous regional blockade with atropine, droperidol and guanethidine is not effective to reduce pain in CRPS, while there is very low evidence that other may be effective. Sympathetic blockade is a relatively invasive modality.

Therapeutic techniques

The techniques used to block sympathetic activity include the following:

Injections of local anesthetic around the sympathetic paravertebral ganglia that project to the affected body part (sympathetic ganglion blocks).

Regional IV applications of guanethidine, beryllium, or reserpine to an isolated extremity

Many uncontrolled surveys in the literature examine the effect of sympathetic interventions on CRPS, and approximately 70% of patients report full or partial responses.



^{(3 )}

One controlled study in patients with CRPS type I found that sympathetic ganglion blocks using local anesthetic had the same immediate effect on pain as a control injection with saline

However, after 24 hours, patients in the local anesthetic group remained noticeably improved relative to the control group, indicating the delayed efficacy of this particular intervention.

Sodium channel blocking agents

The use of IV lidocaine infusion has been shown to be effective in uncontrolled trials for reducing spontaneous and evoked pain with both CRPS types I and II.

Selective sympathetic ganglion nerve blocks

Selective sympathetic ganglion nerve blocks, by their nature, present a variety of difficulties to researchers developing preferred methodological practices.

Although the rationale for using ketamine seems effective and reasonable, and some studies have validated its benefit using objective outcome parameters with double-blind, randomized, controlled methodology.

However, several different research teams have struggled to determine the optimal dosing and duration of infusions, whether the infusions are more effective in an inpatient versus outpatient setting, whether ketamine is best used as an adjunct to regional anesthetic blocks rather than

Sympathetic blocks benefits are visible during the first days following the nerve block.

Patients with a shorter duration of symptoms seem to have a greater response to treatment.

Documentation of a physiologic response (e.g., change in skin temperature of the affected limb or Horner’s syndrome) is important to establish the success of the block .

Blocks should be combined with physical and behavioral therapy within 24 hours of the block.

.An effective block is expected to produce at least 50% improvement in pain and a concomitant increase in function.

Nerve blocks may be repeated only when there is objective evidence of progressive improvement in pain and function. management team communicate regularly about the patient’s treatment plan and progress towards treatment.

Prognosis

Each patient with responds differently to treatment; while spontaneous improvement occurs in some patients, others may not experience effective relief.

Case study 1. 53 years old patient treated with sympathetic blockade with satisfying results.

Case study 2: A 45 years old patient with great relief from sympathetic blocks

Case study 3: A 50 years old patient who didn’t get any relief from sympathetic blocks, but  did get some reliefs using other methods.

Conclusion

The efficacy of some treatments is proven while others remain subject to caution and controversy. The specificity and long-term results, as well as the techniques themselves, have not been satisfactorily evaluated.

Since there is no simple cure for CRPS, it is important to choose the best treatment approach to improve the quality of life of patients and help them resume a normal life. Sympathetic nerves block is the most probable treatment able to achieve such scenario

Bibliography

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Social role valorization (SRV) is a social theory that examines and helps us to understand the process of social devaluation – how do people come to be at the bottom of the social ladder, and what are the predictable “bad things” likely to come their way once they lose value within the society? These “bad things” have been descriptively called the “wounds” of social devaluation and are inflicted on devalued people relentlessly, systematically and often unconsciously. They include such experiences as being profoundly rejected, being thrust into negatives roles such as “eternal child” or “menace” or “object of pity,” being stigmatized by the attachment of devastating imagery, being distanced and segregated from society, and many other hurtful and damaging experiences. Because this process of wounding is at odds with the professed social and religious values of our society, there is very low awareness and consciousness about it, and it is often even perpetrated by human services intended to help people.

• 
  Strengths
  

1. Personal help such as the family and carers help people with ASD with hygiene, dress, social skills and a host of other aspects of image and competency enhancement.

2. Consciousness raising. For example, voluntary groups hold discussions and organize actions that increase their members’ awareness of, commitment to and support for people with ASD. SRV training is a method of consciousness raising.

3. Changes in the social environment. The immediate situation of people with ASD is changed, via culturally valued activities, image-enhancing settings, and competency-enhancing groupings.

4. Changes in practice. People change their behavior, for example by involving people with ASD in their lives and, on a collective level, creating opportunities for constructive personal contact between people with ASD and others.

5. Changes in policy. Organizations, including governments, change their guidelines, planning and policies, for example to integrate people with ASD into standard employment

6. Changes in technology. Through appropriate design, technologies can help to increase competencies and image. For example, automatic garage openers, originally designed for people physically unable to handle garage doors, are now widely used and accepted.

• 
  Weaknesses
  

1. Safety for people with ASD such as people with ASD require taking a rest but SRV may ignore it for giving people with ASD valued role.

2. SRV does not consistently increase consciousness and warranty concern about socially people with ASD.

3. SRV cannot ultimately restraint the features of their supporter although they are powerful.

4. Client’s hypothetical value can be reversed when operated without adaptability. Not all people who use SRV will do what SRV require like one could distinguish between adaptive adherence and misuses of SRV.

5. Not all relationships between generally people and people with ASD are ethical, productive and advantageous. People may refuse the deeper religious and value traditions in the Western world upon which SRV rests even if they embrace SRV.

• 
  Assessment
  

It is obliged that evaluating about the individual is being perceived as degenerate in the view of their adversely esteemed contrast. For people with ASD it could contain of utilitarian or physical debilitations, low capacity, a specific ethnic character, certain practices or organizations, skin shade, and others, being declined by society, group and even family as well as administrations. Being put and held at a physical or social, it may cause isolation or having awful pictures and incorporate dialect captivated to them and being the object of ill-use, savagery, and eve being made dead.

• 
  Planning
  

This model to people with ASD it is critical to evaluate enhancing the perceived estimation of the social parts of an individual or evaluation from past life. There are two significant expansive techniques for arranging this model for depreciated individuals build individuals’ social picture in the perspectives of others, and expand their capacities in the greatest feeling of the term. Pictures change and limit change structure a reaction circle that can be certain or negative. The person who is disabled is a great extent at danger of affliction picture impedance; an individual who has debilitation in picture is legitimate to be offered an explanation by others in techniques that focus or diminishing the individual’s capacity. Nevertheless, techniques work similarly in the opposite way. The person whose social picture is hopeful is legitimate to be given with abilities, reckonings, and other life states which are liable to enhance, or offer degree to, one’s capacities; and a person who clusters capacities is additionally fitting to be imaged certainly.

• 
  Co-ordination
  

Co-ordination has to be a process that enables an individual to meet their goals. A far reaching bundle of administrations may be obliged to help and these may be from diverse financed sources, group help administrations, private backing. Needs Assessment and Service Coordination Service (NASC) has a characterized plan to work with so administrations may need to help individuals who have the most elevated need.

• 
  Perspectives
  

Social Role Valorisation Theory is considered with the impacts of social devaluation on the well-being of people that community regards badly, particularly, people with Autism spectrum disorders. The theory concentrates on reversing the impacts of social devaluation on the person with ASD by:

• Increasing their consciousness of their one’s capabilities
• Challenging the one’s and society’s stigmatising faiths and recognitions about themselves
• Giving them with examples of the valued positions they play in society and their ability to work and keep significant relationships with their families and others in the society
• Developing and supporting the people to join in society

Behaviour Support Services uses this theory to work with people with ASD to:

• Extend their self-esteem and confidence
• Extend their recognitions of how they are valued by their families, the supporters, and their areas. The valued role they play in mainstream society
• Extend their understanding of the power of improving and remaining close supportive relationships with their supporters and families. These relationships play a critical role in helping people with ASD to realise their ability and to identified the valued role they work in society.

However, Social role valorization for people with ASD is widely constricted to just narrow human service fields and their working period can be limited as their adherents might use them for participating in a moral issues.

• 
  Summary of expected outcomes
  

1. Acheive the positive advantages of taking supportive employment such as having the economic which means to join in mainstream of society.

2. Make partnerships or working associations among people with ASD, community and familiy, including employers.

3. Increase their self-esteems and confidence when they feel as a valued person of the society 4. Improve their own identify and awareness of how they are important in the communities.

5. Providing the community with the skills and resources and valued roles that include people with ASD. There are mnay organisation and community for People with ASD to join and enjoy activities or information.

3. Comparison

In terms of theories, Strengths-based model is a collaborative process between the person supported by services and those supporting them, allowing them to work together to determine an outcome that draws on the person’s strengths and assets. However Social Role Valorization (SRV) is a set out of approaches designed to enable devalued people in society to experience the good life. These approached are best used by persons who clearly believe that devaluation of a party is wrong, and who are prepared to work to overcome. Furthermore, strengths-based model more concern itself principally with the quality of the relationship that develops between those providing and being supported, as well as the elements that the person seeking support brings to the process. But SRV’s many strategies, derived from practical experience and from what research has revealed, is to help devalued people achieve valued social role.

References

Department of education Auckland (Sep 2011) Strength-Based Approach Retrieved from

http://www.eduweb.vic.gov.au/edulibrary/public/earlychildhood/learning/strength-workingpaper.pdf

Department of Health information for a healthy New York Strength based care planing Retrieved from


https://www.health.ny.gov/diseases/conditions/dementia/edge/strength/index.htm

Department of education Auckland (Sep 2011) Strength-Based Approach Retrieved from


https://www.eduweb.vic.gov.au/edulibrary/public/earlychildhood/learning/strength-workingpaper.pdf

IRISS Strengths-based approaches for working with individuals Retrieved from


http://www.iriss.org.uk/resources/strengths-based-approaches-working-individuals

Advance healthcare network Strength-Based intervention for adults with Alzheimer’s Retrieved from


http://speech-language-pathology-audiology.advanceweb.com/Article/Strength-Based-Intervention-for-Adults-with-Alzheimers-4.aspx

Victorian Government initiative Strengthening assessment and care planning Retrieved from


http://www.health.vic.gov.au/hacc/downloads/pdf/assess_guide.pdf

PMC Social role valorization in community mental health housing Retrieved from


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644172/

Kendrick, Michael (1994) Some reasons why social role valorization is important Retrieved from


http://www.cheshire.ie/docs/infobank/servicedesign/SomeReasonsWhy.pdf

NDA Supporting people with autism spectrum disorder to obtain employment Retrieved from


http://www.nda.ie/website/nda/cntmgmtnew.nsf/0/091BDD567113418180257B050032020C/$File/autism_paper.htm

Joe Osburn (1998) Social role valorization Retrieved from


http://www.socialrolevalorization.com/articles/overview-of-srv-theory.html