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No. of bitstreams: 1 PDF - Michelinne Oliveira Machado Dutra.pdf: 14643451 bytes, checksum: 00d044272ac0ee88364381aeee5c9705 (MD5) Previous issue date: 2015-07-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq / By introducing the latest technological innovations of the preventive and curative medicine, there was an increase in life expectancy and reduction of mortality rate, which in conjunction with the decline in the fertility rate shows the process of population aging. Consequence, diseases proper of the old age have shown increased expression in society. Among them, we highlight the cerebrovascular accident that among seniors, presents high incidence. It aimed to verify the associations between socio-demographic factors and the functional capacity of the elderly with plegias by cerebrovascular accident. This is a cross-sectional study, descriptive, of a quantitative approach. It was performed in the homes of the elderly with plegias for stroke attached to Family Health Units of the municipality of Campina Grande/PB, Brazil, in the period September 2014 and March 2015. Eligibility criteria: people aged 60 or older, of both genders, with some kind of palsy diagnosed by specialist, due to cerebrovascular accident, cognitive function that makes it possible to answer the questions and be attached in any family Health Unit municipality campinense. Two questionnaires were used: the questionnaire I, for the investigation of socio-demographic variables, and the questionnaire II, called Barthel Index for the evaluation of the functional capacity of the subjects for the activities of daily life. The data collected were deployed (in double-entry) into an electronic database and analyzed through the statistical program Statistical Package for the Social Sciences, 20.0 version for Windows, and presented through tables. The associations investigated considered the 95% confidence intervals (p < 0,05). For demographic data analysis and IB scores there was used the descriptive statistics. To check the level of significance between associations of socio-demographic aspects and functional capacity for activities of daily living there was used dichotomization of the Barthel Index variables. This research was developed according to the parameters of the resolution 466/12 of the National Health Council and Ministry of Health, which feature on research involving humans. The results were presented by means of a scientific article derived from the research. There has been a predominance of women, widowed, without schooling and with household income of up to one minimum wage. The average age was of 65 years old. Found satisfactory reliability of Barthel Index, with Cronbach's alpha total = 0,917. The activities in which there was greater difficulty of urination (73,8%) and evacuate (66,9%) were carrying out. Regarding the functional capacity for activities of daily living, there was verified the level of capacity ranging from moderate to total dependence, and degree of mild dependence. It was found association between the functional capacity and the race (p = 0,027), age group (p = 0,001) and schooling (p = 0,041). It was noted that the socio-demographic factors may interfere with the functional capacity of the elderly with plegias by cerebrovascular accident. In this sense, through the provision of research results, it is believed to have contributed to the reflection on this issue, as well as provided by other studies of the reproduction methods used. / Ao introduzir as mais recentes inovações tecnológicas da medicina preventiva e curativa, houve aumento da expectativa de vida e redução da taxa de mortalidade que conjuntamente com o declínio da fecundidade evidencia o processo de envelhecimento populacional. Conseguinte, doenças próprias da velhice têm apresentado crescente expressão na sociedade. Dentre elas, destaca-se o acidente vascular encefálico que entre os idosos, apresenta elevada incidência. Objetivou-se verificar as associações entre os fatores sociodemográficos e a capacidade funcional de idosos com plegias por acidente vascular encefálico. Trata-se de um estudo transversal, descritivo, com abordagem quantitativa. Foi realizado no domicílio dos idosos com plegias por acidente vascular encefálico adscritos às Unidades de Saúde da Família do município de Campina Grande/PB, Brasil, no período de setembro de 2014 a março de 2015. Os critérios de elegibilidade: pessoas com idade igual ou superior a 60 anos, de ambos os sexos, com algum tipo de plegia diagnosticada por especialista, decorrente de acidente vascular encefálico, função cognitiva que possibilite responder os questionamentos e estar adstrito em alguma Unidade Saúde Família do município campinense. Foram utilizados dois questionários: o Questionário I, destinado à investigação das variáveis sociodemográficas e o Questionário II, denominado Índice de Barthel destinado à avaliação da capacidade funcional dos sujeitos para as Atividades de Vida Diária. Os dados coletados foram implantados (em dupla entrada) em um banco de dados eletrônico e analisados por meio do programa estatístico Statistical Package for the Social Sciences , versão 20.0 para Windows, e apresentados por meio de tabelas. As associações investigadas consideraram os intervalos de confiança em 95% (p<0,05). Para análise dos dados sociodemográficos e dos escores do IB, foi utilizada a estatística descritiva. Para verificar o nível de significância entre associações dos aspectos sociodemográficos e capacidade funcional para as atividades de vida diária, foi utilizada a dicotomização das variáveis do Índice de Barthel. Esta pesquisa foi desenvolvida de acordo com os parâmetros da Resolução 466/12 do Conselho Nacional de Saúde e Ministério da Saúde, que dispõem sobre pesquisa envolvendo seres humanos. Os resultados foram apresentados por meio de um artigo científico derivado da pesquisa. Verificou-se predomínio de indivíduos do sexo feminino, viúvos, sem escolaridade e com renda familiar de até um salário mínimo. A média de idade foi de 65 anos. Constatou-se satisfatória confiabilidade do Índice de Brathel, com Alfa de Cronbach total = 0,917. As atividades nas quais se verificou maior dificuldade de realização foram micção (73,8%) e evacuar (66,9%). Com relação à capacidade funcional para as atividades de vida diária, verificou-se grau de capacidade variando de moderado para total dependência, independente e grau de leve dependência. Verificou-se associação entre a capacidade funcional e a raça (p= 0,027), faixa etária (p= 0,001) e escolaridade (p= 0,041). Constatou-se que os fatores sociodemográficos podem interferir na capacidade funcional de idosos com plegias por acidente vascular encefálico. Nesse sentido, por meio da disponibilização dos resultados da pesquisa, acredita- se ter contribuído para a reflexão sobre essa problemática, bem como proporcionado reprodutibilidade por outros estudos dos métodos utilizados.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A deficiÃncia fÃsica pode alterar a realidade social, a forma de vida, a aparÃncia fÃsica, e em algum momento da vida dificultar a acessibilidade aos ambientes. à preciso, portanto, empoderar as pessoas para o alcance de espaÃos acessÃveis. Com esta finalidade, trabalhou-se o objetivo: desenvolver estratÃgias de empoderamento de pessoas com deficiÃncia fÃsica para reivindicar espaÃos acessÃveis nos serviÃos hospitalares. Pesquisa qualitativa, ancorada pela Teoria do Empoderamento. O grupo focal foi a tÃcnica utilizada para a coleta das informaÃÃes, em sete sessÃes realizadas no perÃodo de junho a novembro de 2009, na AssociaÃÃo dos Portadores de Necessidades Especiais da RegiÃo Norte do Estado do CearÃ, no municÃpio de Sobral, compostas pela pesquisadora, duas enfermeiras, uma acadÃmica de biologia e doze participantes do estudo. A apresentaÃÃo, a discussÃo e o tratamento das informaÃÃes ocorreram por meio da exposiÃÃo das categorias em quadros para melhor compreensÃo dos leitores, com as discussÃes ancoradas na literatura. Respeitaram-se os aspectos Ãticos com Ãnfase na autonomia dos sujeitos, os quais revalaram o seguinte perfil: trÃs do sexo feminino, nove do sexo masculino, faixa etÃria de 26 a 70 anos. Sete sÃo casados e cinco sÃo solteiros, quatro sÃo aposentados porÃm, destes, dois trabalham como autÃnomos, apenas um participante se encontra desempregado e sem aposentadoria. Os demais possuem as seguintes profissÃes; um enfermeiro, uma advogada, uma professora de informÃtica, uma professora do Estado, um funcinÃrio pÃblico, um diretor esportivo e um autÃnomo. Conceitos abstraÃdos: DeficiÃncia fÃsica, espaÃos acessÃveis, acessibilidade e empoderamento; Apoio familiar: contribuiÃÃes para o empoderamento da pessoa com deficiÃncia fÃsica; Empoderamento: ferramenta para vencer barreiras fÃsicas e sociais; ParticipaÃÃo social: empoderamento para prosseguir na caminhada; Conhecimentos acerca da legislaÃÃo: empoderamento como forma de igualdade; ExperiÃncias vivenciadas nas internaÃÃes hospitalares: relato expressando empoderamento; SugestÃes para reivindicar espaÃos acessÃveis aos hospitais: exercÃcio de cidadania e empoderamento e Sinais de empoderamento: participaÃÃo em eventos, conquistas sociais, polÃticas e avaliaÃÃo das sessÃes grupais. Atualmente existem sinais de mobilizaÃÃo para estabelecer polÃticas pÃblicas com vistas a beneficiar as pessoas com deficiÃncia, mas deve haver o empoderamento das pÃprias pessoas com deficiÃncia, assim como de seus familiares, associado à contribuiÃÃo dos profissionais de saÃde, tanto da assistÃncia quanto dos serviÃos e, principalmente, da academia, para a construÃÃo dos espaÃos acessÃveis.

O panorama de desassistência no âmbito da saúde da pessoa com deficiência se mantém, mesmo com alguns avanços trazidos pelo SUS. O conceito de necessidade de saúde como norteador das práticas pode possibilitar a abertura de novos espaços de reflexão e ação para esta população, sendo fundamental a inclusão das próprias pessoas nesta discussão. O objetivo do trabalho aqui descrito é identificar quais são as demandas e necessidades de saúde das pessoas com deficiência, a partir da ótica destes sujeitos. Foi realizado um estudo de metodologia qualitativa, sendo a história de vida a técnica de produção dos dados adotada; foram incluídos na pesquisa pessoas com deficiência física, auditiva e visual, com deficiência congênita e adquirida, e com histórico de atendimento no SUS. Foram realizadas entrevistas em profundidade, baseadas em um roteiro prévio, sendo gravadas e posteriormente transcritas; também foi feito um diário de campo. A análise do material foi feita em três níveis: palavras-chave, temas emergentes e tendências gerais. Produziu-se um texto analítico com os temas emergentes das narrativas, bem como um quadro sintético, elencando os núcleos temáticos sobre necessidades de pessoas com deficiência. Das narrativas, cinco temas principais estiveram presentes: a vivência da deficiência; independência, autonomia e apoio; acesso e direitos; sentidos das intervenções; ações e estratégias. Em relação às necessidades e a atenção em saúde, onze eixos temáticos foram elencados: Acesso; Apoio psicossocial; Aspectos gerais de saúde (para além da deficiência); Autonomia e independência; Dispensação de equipamentos e dispositivos de tecnologia assistiva; Informação / orientação; Prevenção / diagnóstico precoces; Reconhecimento e garantia de direitos; (Re)Encontro com atividades significativas; Validação e ajuda na construção de estratégias próprias de enfrentamento; Vínculo com profissional de saúde. Pôde-se concluir que as necessidades identificadas pelas pessoas com deficiência incluem aspectos específicos da assistência em saúde, mas englobam outras dimensões como o acesso, os direitos, o trabalho, o lazer, indicando a importância de ações integrais e intersetoriais. Ressalta-se também as singularidades que a vivência da deficiência impõe a cada sujeito, bem como os sentidos que cada um encontra em sua história de vida / The lack of assistance panorama in the health of the disabled person still exists, despite some advances brought by SUS. The concept of health needs as a guide for the practices may allow new spaces for reflection and action for this population, and the inclusion of disabled people in this discussion is of extreme importance. The aim of the work described here is to identify demands and health needs of people with disabilities, by the subjects´ perspective. The study was conducted by the use of a qualitative methodology, through the life history method; and people with physical, hearing and visual disabilities, congenital or acquired, with history of assistance by SUS were included. Interviews were conducted based on a previous script, being recorded and later transcribed; and also a field diary was made. The data analysis was done on three levels as follows: keywords, emerging issues and trends. An analytical text with the emerging themes of the narratives, and a summary table have been produced listing the central themes on the people with disabilities needs. Using narratives, five major themes emerged: the experience of disability; independence, autonomy and support; access and rights; meaning of the interventions; actions and strategies. Eleven themes were listed when considering needs and health care: access; psychosocial support; general health issues; autonomy and independence; dispensing of equipment and assistive technology devices; information/guidance; prevention/early diagnosis; recognition and guarantee of rights; recovery of meaningful activities; validation and help in building their own strategies for coping; bonding with health professional. It was concluded that the needs identified by people with disabilities include specific aspects of health care, but also include other dimensions such as access, rights, work, leisure indicating the importance of integrated and intersectoral actions. Singularities that the experience of disability brings to each person are also emphasized, as well as the meanings that each one finds in its life history

Orientador: Sandra Maria Herondina Coelho Ávila de Aguiar / Banca: Alberto Carlos Botazzo Delbem / Banca: Wilson Roberto Poi / Banca: Ruy Cesar Camargo Abdo / Banca: Salete Moura Bonifácio da Silva / Resumo: O objetivo deste estudo foi observar resultados de procedimentos odontológicos realizados em pessoas com deficiência, sob sedação consciente com Midazolam, via endovenosa, realizados no Centro de Assistência Odontológica à Pessoa com Deficiência, da Faculdade de Odontologia de Araçatuba - UNESP. Acompanhou-se 460 procedimentos, independente do gênero, idade ou deficiência dos pacientes, que não permitiram a realização de tratamento odontológico previamente. Os resultados foram classificados como sucesso (quando realizados sem problemas, ainda que necessária contenção auxiliar suave, ou houve algum problema contornável, mas os procedimentos planejados puderam ser realizados) e insucesso (quando não foi possível a realização do tratamento planejado). Registrou-se, ainda, o uso de medicamentos pelos pacientes e as prováveis causas de insucesso. A pressão arterial, freqüência cardíaca, saturação de oxigênio e temperatura corporal foram monitorados antes, durante e após o procedimento. As dosagens de Midazolam administradas foram entre 05 a 60mg, de acordo com o peso corporal do paciente. Na maioria dos casos, foi possível a realização do tratamento planejado, sem danos aos pacientes nem à equipe odontológica e os sinais vitais se mantiveram dentro de valores normais. A sedação consciente com Midazolam, via endovenosa, pode ser considerada uma alternativa eficaz para o tratamento odontológico em pessoas com deficiência não colaboradores / Abstract: The objective of this study was to observe the results of dental procedures performed in disable persons under conscious sedation with Midazolam, intravenously, assisted at the Dental Care Center for Patients with Special Needs, School of Dentistry of Araçatuba - UNESP. 460 procedures were observed, regardless of gender, age or disability of the patients, which did not allow their dental treatment realization. The results were classified as success (when carried out without problems, even it was necessary restraint gentle help, or there was some manageable problem, but the planned procedures could be performed) and failure (when it was not possible to perform the planned treatment). It was also recorded, the use of medicines by patients and the probable causes of failure results. Blood pressure, heart rate, oxygen saturation and body temperature were monitored before, during and after the procedure. The doses of Midazolam were administered between 05 to 60mg, according to the patient's body weight. In most cases it was possible to perform the planned treatment without problems to the patients or to the dental staff and their vital signs remained within normal values. The conscious sedation with Midazolam, intravenously, can be considered an effective alternative for dental treatment to disable persons not employees / Doutor

This diploma thesis deals with the topic of supported employment of people with disabilities in the South Bohemian region. Its aim is to describe how social workers, employers' representatives and service users view the current state of supported employment of people with disabilities in the South Bohemian Region. The work also identifies the course of supported employment, its strengths and benefits, weaknesses, threats and opportunities for further development. The research was conducted on the basis of 16 structured interviews. The obtained data are divided into 5 categories - an overview of the current state of supported employment, its course, strengths and benefits, weaknesses, threats, and opportunities for further development. Research shows that social workers, employers' representatives and users perceive the supported employment service as very beneficial and useful in many respects. The strengths of individual respondents predominate, while the weaknesses and threats tend to be in the background. Respondents see opportunities for further development mainly as an extension of the wage contribution period of employers employing persons with disabilities within the supported employment service.

"This paper addresses the right to dignity of a group of people with two vulnerabilities i.e. being a disabled person and a prisoner. The concept of dignity applies to prisoners and detainees irrespective of their offences at any given time. This is a right that is ascribed to a person by virtue of one's humanity and not one's circumstances. In Ghana and Nigeria, the rights of able and disabled prisoners are not given serious consideration. This is probably due to the fact that these two countries are still involved in violations of human rights and they are yet to implement most of the provisions in international human rights instruments. The protection of the rights of disabled prisoners is a mirage in the two countries probably because they constitute a minority and their vulnerability relegates them to the lower rungs of the society. However, international human rights instruments recognise that disabled persons have rights that should be respected. ... Despite these international standards, the treatment of disabled prisoners is still below the recommendation. This necessitates a study of the role which human rights law ought to play in the mitigation of the hardship of disabled prisoners, as their dignity is a central element to their existence." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2004. / Prepared under the supervision of Professor E.V.O. Dankwa at the Faculty of Law, University of Ghana, Legon / http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html / Centre for Human Rights / LLM

This study describes the present medical, dental and nursing services in and used by centres for intellectually and physically impaired children in Cape Town and its environs. The information was gained by means of a structured questionnaire. Thirty three of the 34 centres with a total of 3480 children are included. Twelve are Special Care Centres, 15 Training Centres and 6 are Special Schools. The number of children enrolled ranges from 9 to 400. At the time of the study 9 of the centres were for white children, 17 for coloured children, 5 for black children and 2 were multiracial. Nine of the 11 Special Care Centres were not government supported while only 6 of the other centres were mainly funded from non-government sources. Nurses employed at the centres had worked an average of 8 years at their centres, 23,5% of them having worked with disabled children prior to taking up their present posts. Of the Special Care Centres, only the two residential ones had a nurse on the staff. All the Special Schools had at least one nurse. 57,5% of the centres have a doctor or doctors visiting the centre. Two of the others have regular medical care for the children arranged with local health centres. All the Special Schools are visited while 25% of the Special Care Centres and 33% of the Training Centres receive medical visits. The number of doctors visiting a centre varies from 1 to 7. The doctors come from a variety of services both private and public. Most of the doctors do not receive remuneration for their services. Of the 1 7 centres who have no doctors visiting, the majority depend on parents to take their children to a medical facility if there are problems related to the child's disability. For 7 of them, there is no other option. A similar pattern exists for medical problems unrelated to the child's disability. Six centres make use of medical facilities as a first option in these circumstances. For emergencies only 1 centre can count on a doctor to come to the centre. Ten centres may be able to get a doctor to come. The General Hospitals are the most common facility used in an emergency. Dentists visit 4 of the centres. Twelve of the remaining 29 centres arrange regular dental visits for the children. Eleven of the 13 Special Care Centres do not have regular visits to a dentist arranged. Fifteen centres receive visits from Community Nurses and these are local authority nurses in the main. Their functions are limited in all but one case to contraception, immunisation, Heaf testing or genetic services. There are 10 centres which receive visits from neither doctor, dentist nor nurse (7 Special Care Centres, 3 Training Centres). 32% of the interviewees were satisfied with the services received. The most common improvement sought was to have a doctor visit the centre. Of those with a doctor visiting, 28% wanted the doctors to deal with intercurrent problems as well as the child's disability. The need for paramedical services was also expressed. Further detail is presented and the implications of the findings discussed.

Background: The prevalence of disability increases with age; therefore with an aging population, interventions to reduce disability are crucial. This thesis adopts a behavioural conceptualisation of disability. The theoretical frameworks of the International Classification of Functioning, Disability and Health (ICF), the Theory of Planned Behaviour (TPB) and the integrated ICF/TPB model are applied to investigate disability and physical activity (PA) behaviours. The thesis aims to: (1) identify the factors involved in the prioritisation of patients for total joint replacement; (2) classify patient pre-operative expectations of total hip replacement (THR) and investigate the relationship between expectations and recovery after surgery, and; (3) test whether the TPB and theory-based interventions can predict and explain PA within individuals. Method: Five studies were conducted. In the first study, health professionals judged whether the items from two prioritisation tools measured each of the ICF constructs. In the second study, surgeons ranked patient vignettes, which differed by constructs from the integrated model, in order of priority for THR. In the third study, a large cohort of THR patients reported expectations of surgery pre-operatively. Health and functioning were also reported pre-operatively and 1-year post-operatively. The fourth and fifth studies were a series of experimental n-of-1 studies using diary methods assessing TPB cognitions and PA behaviours. Results: There is a lack of agreement between judges in relation to the content of many of the items from prioritisation tools. Behavioural and psychological factors can influence prioritisation for THR. The majority of patient expectations of THR addressed activities and social participation; however, the evidence for a relationship between expectations and recovery was limited. The TPB can predict PA within some individuals but the evidence in support of interventions to increase PA was limited. Discussion: The findings provide important clinical and theoretical implications for understanding disability and physical activity behaviours.

Les pratiques d'hygiène bucco-dentaire dans les établissements accueillant des personnes en situation de handicap ou dépendantes sont très nettement insuffisantes, ce qui participe à augmenter le risque des pathologies bucco-dentaires de nature infectieuse et de leurs comorbidités pour la population qu'ils accueillent. Le projet Santé Orale et Autonomie (SOA) est une mesure développée dans le cadre du plan national de Prévention bucco-dentaire 2006-2009 qui visait à rémunérer des chirurgiens-dentistes, pour qu'ils mettent en place, après une formation en ligne, une action de promotion de la santé orale dans un de ces établissements, selon un protocole commun standardisé qui comportait : 1) une conférence de sensibilisation auprès du personnel 2) l'évaluation de l'état de santé bucco-dentaire des résidents 3) des ateliers de démonstration individualisée des techniques d'hygiène impliquant le personnel et les résidents. Ce travail décrit et évalue l'impact du projet SOA. Vingt-six chirurgiens-dentistes ont participé au projet dans sa totalité. A l'issue de leur formation en ligne, une augmentation significative de leur sentiment de compétence pour 16 aptitudes spécifiques a été observée. Une amélioration du contrôle de plaque a été notée pour 33,7% des résidents (n=691). Une amélioration des habitudes d'hygiène bucco-dentaire au sein des établissements a été observée pour 11,5% des résidents (n=814). Cette étude est la première à montrer l'impact relativement faible de ce type d'action et incite leur association à d'autres dispositifs de promotion de la santé orale. / Oral hygiene practices in special care establishments are clearly unsatisfactory, increasing the risk of infectious oral disease and associated morbidity for the population attending these establishments. The 'Oral Health and Autonomy' project was part of the French Oral Health Plan for 2006-2009. Dentists taking in part in the project completed an online training course and were reimbursed for the implementation of an oral health promotion intervention in a special care establishment. The interventions followed a standardised, common protocol, which included: 1) a conference presentation for the staff, 2) individualised oral risk assessment for each resident and 3) hands-on workshops demonstrating oral hygiene techniques for the residents accompanied by their key workers. This document describes and evaluates the impact of the 'Oral Health and Autonomy' project. Twenty-six dentists completed the project. After completion of the online training course, the self-efficacy of the dentists in 16 specific skills significantly increased. A decrease in the presence of dental plaque was observed for 33.7% of the residents (n = 691). Improvement in oral hygiene behaviour within the establishment was observed for 11.5% of the residents (n=814). This study is the first to show the relatively low impact of this type of intervention and suggests that different approaches to oral health promotion should be used in conjunction to improve outcomes.

La notion de Réadaptation à Base Communautaire (RBC), promue par l'OMS, a pour objectif de favoriser l'intégration des personnes en situation de handicap. Cette stratégie est née du constat de la nécessité de conjuguer les efforts des différents acteurs (les personnes handicapées et leurs familles, la communauté, les services sociaux, les services de santé, d'éducation et de formation) pour assurer la réussite et la pérennité des actions. Développé dans les pays en voie de développement, le concept de Réadaptation à Base Communautaire s'applique également aux pays industrialisés, où il est souvent appelé "désinstitutionalisation". La diversité des contextes, tant géographique, économique, politique que culturelle, nécessite une adaptation des modes de gouvernance et des actions. Cette adaptation résulte d'une évaluation poussée, qu'il s'agisse de l'évaluation ex ante, ou des évaluations en cours de programme ou de l’évaluation ex post.Cette thèse présente des outils d'évaluation et des modes de gouvernance adaptés aux programmes RBC. Elle présente également une étude sur la pertinence et les limites de ce concept.Alors est-ce que la RBC est une stratégie pertinente et efficiente, facilement adaptable à tous les contextes ? Quelles en sont les limites ? La présente recherche tentera d'apporter des réponses à ces questions à travers l'étude de trois contextes différents : la France, le Maroc, et le Cameroun / The notion of Community Based Rehabilitation (CBR), promoted by the World Health Organisation (WHO), has as its main objective the integration of individuals living with a disability. This strategy arose from an acknowledgment of the necessity of pooling the efforts of people involved (people with disabilities and their families, the community, social services, health services, educational and training services) to ensure the success and sustainability of the actions undertaken.Developed in emerging countries, the concept of Community Based Rehabilitation also applies to industrialized countries, where it is often called "de-institutionalisation". The diversity of contexts, including geographical, economical, political as well as cultural, requires the adaptation of governance models and actions. This adaptation is carried out following a thorough evaluation and the evaluation may be ex ante, ongoing or ex post. This thesis presents evaluation tools and governance models adapted to the CBR. It also presents a study on the relevance and limits of this concept.So, is the CBR a relevant and efficient strategy, easily adaptable to every context? What are its limits?The present research will attempt to provide answers to these questions through the study of three different geographical contexts: France, Morocco and Cameroon