In reality, there are limits to the extent to which a CBR programme achieves the shift from institutions to the homes of disabled people. Most CBR programmes achieve the shift up to a certain level only, beyond which they need to have institutions to depend on. In this context, the controversy of institutions versus CBR becomes irrelevant. Definitions of impairment and disability may be common across most cultures, in any part of the world, while the definition of handicap is culture dependent. Handicap is the social disadvantage faced by disabled people, and is therefore quite dependent on cultural norms.
Most traditional cultures have their own spontaneous ways of reducing the impact of disability.
In such communities which already have their traditional forms of rehabilitation, it may be counter-productive to introduce an externally planned CBR programme which does not take into account the local needs and existing local practices. Another issue is that of social integration of the disabled people. In a move away from the segregation of disabled persons that was practiced in the earlier years, social integration was sought to be promoted through provision of equal opportunities for disabled people, and protection of their rights in the society. However, integration of marginalised groups is a distant dream in most developing countries. In a country like India, a majority of people belong to some form of marginalised groups.