This innovation insight discusses current approaches to digital fabrication of lower limb prosthetics (LLP) sockets aimed at low resourced settings. Digital fabrication of LLPs sockets has been researched for a number of decades, yet these technologies are not widely adopted, and most of the activities within this domain reside in high-income settings. However, the majority of amputees are in LMICs where there is a severe lack of access to services. It is in LMICs then, that the advantages that digital technologies offer could be of particular benefit however little to no progress in digital workflow adoption has been made to date.
Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus in both developed and developing countries. It is found in about 10% of diabetic clients at diagnosis, and in the majority of clients 25 years down the line. Clients with pre-diabetes may also develop neuropathies that are similar to diabetic neuropathies. Long-term hyperglycemia can cause peripheral nerve damage, resulting in distal-predominant nerve fibre degeneration. Loss of feeling in the lower limbs is a high risk for limb amputation. Despite efforts to make an early diagnosis and to halt the progression of diabetic neuropathy, currently there is no effective treatment available at a global level, except for strict control of blood glucose.
Physical therapy can improve the overall quality of life of diabetes mellitus clients with peripheral neuropathy and can alleviate the symptoms of neuropathy. This paper assesses the effectiveness of interventions used by physical therapists to minimise dysfunctions in people with DPN. It reviews the different treatment strategies and presents evidence and conditions for its applications.
Disability, CBR and Inclusive Development, Vol 30, No 1 (2019)
Purpose: This paper aimed to provide an overview of the evaluation of the GRID Network (Groups for Rehabilitation and Inclusive Development) and the impact it had on its members.
Method: Information was collected through a compilation of the resources developed during the project, and a summative evaluation process was employed at the end of the project. The paper is a short report on the summative evaluation.
Results: GRID Network members reported that the network was effective and beneficial. They developed new information and knowledge that was relevant to their local contexts; shared knowledge from local, national, and international sources; and, increased their skill in using social media for professional purposes. Recommendations include continuing with this kind of community of practice, with greater opportunities for more engagement and training; inclusion of more partner organisations; large group workshops and conferences; increased attention to advocacy for policy change; and, for more research to be carried out locally.
Conclusion and Implications: This project demonstrated that it is possible to develop and maintain a community of practice in a low-resource context on a minimal budget, even during times of political crisis. Further programme development, evaluation, and research are warranted to ascertain how this model can be scaled up to include a broader group of rehabilitation and other practitioners involved in disability inclusive development.
Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 84-94, (2019)
Purpose: The programme to enrol hearing impaired pupils in inclusive schools in Lagos State, Nigeria, has been endorsed recently and is at a transitional phase. The study assessed the audiological profile of the enrolled pupils with hearing impairment.
Methods: After a random selection of 7 designated inclusive primary schools in Lagos State, a two-stage study was conducted. First, a questionnaire documenting audiological history was administered to the pupils with hearing impairment. This was followed by pure tone audiometry.
Results: Study participants were between 4 and 26 years of age (mean 12.8±4.1). About 158 (96.9%) of them had bilateral profound hearing loss. Method of communication for 132 (81%) was by sign language, followed by lip reading for 56(34.4%).
Conclusion: Severity of hearing impairment was profound among this category of enrolled students. Most of them had probably been transferred from schools for the Deaf to inclusive schools. Less severe degrees of hearing impairment may have been detected if audiological assessment had been mandatory for all the school children.
Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 95-103, Oct. 2019
Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas.
A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term. Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs.
As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered clients is 1930. Empowerment of treated clients is the final outcome, assisting them in self-employment.
Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.
Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 104-113, Oct. 2019
This paper was presented at the 3rd World Disability & Rehabilitation Conference 2018 was held from 12th and 13th November 2018 in Kuala Lumpur, Malaysia. People with disabilities and researchers, practitioners, policy makers, industry experts, university faculty and organizations along with advocates and volunteers working with people with disabilities participated and presented their original and unpublished results of conceptual, constructive, empirical, experimental, experiential or theoretical work through abstract and poster presentation. Total 33 participants presented their abstract and poster throughout this conference. The theme of WDRC 2018 was “Global advocacy and rights of people with disabilities”
This ‘policy brief’ outlines findings on Assistive technology and Products (AP) needs, unmet needs and access patterns arising the Rapid Assessment of Disability (RAD) study conducted in 2016 and 2017, in partnership between the Bangladesh Bureau of Statistics (BBS) and Humanity & Inclusion (HI) Bangladesh, with technical oversight from the Nossal Institute for Global Health, University of Melbourne, Australia. The study was part of the HI project: Towards Global Health: Strengthening the Rehabilitation Sector through Civil Society funded by the European Union. Findings from the 4254 adults surveyed in the two districts are reported here.
The purpose of this component of the RAD study was to learn about the usage of AP, characteristics of AP users, barriers to use of AP, unmet and met needs of AP, and to highlight major policy implications for AP service provision, in two target areas of Kurigram and Narsingdi. The survey includes an adapted version of Washington Group (WG) ‘short set’ of Disability Questions. A modified version of the WHO’s draft Assistive Technology Assessment Tool (needs module) – or the ‘ATA-needs’, was also implemented. Findings from this study also helped modify and improve the draft ATA-needs tool
This guide provides strategies and recommendations for developing inclusive classrooms and schools. We specifically address the needs of Sub-Saharan African countries, which lack the resources for implementing inclusive education. However, our strategies and recommendations can be equally useful in other contexts where inclusive education practices have not yet been adopted. Strategies for enhancing existing school and classroom environment and instruction include: modify the physical environment; modify classroom managment strategies; ensure social inclusion; adopt best instructional practices; apply strategies for students with sensory disabilities; and use assistive technologies. Strategies for adopting response to intervention include: tier by tier implementation; individualised education plans; and planning for school wide adoption of inclusive practices and a multilevel system of support.
A joint declaration of a two year service agreement between six disabled persons support organisations. The agreement is based on the UN CPRD, primarily:
Article 12: Equal recognition before the law
Article 19: Living Independently and being included in the community
Article 24: Education
Article 27: Work and Employment
It is reported that eight paraplegics – some of them paralysed for more than a decade by severe spinal cord injury – have been able to move their legs and feel sensation, after help from an artificial exoskeleton, sessions using virtual reality (VR) technology and a non-invasive system that links the brain with a computer. "After just 10 months of what the Brazilian medical team “brain training” they have been able to make a conscious decision to move and then get a response from muscles that have not been used for a decade". The work is part of the Walk Again Project.
An estimated one million children between the age of 0-14 fall ill with tuberculosis (TB) every year, over 67 million children are infected and might develop active disease at any time. In 2013, the WHO with key partners launched the Roadmap for Childhood TB, outlining ten key actions to improve outcomes for children affected by TB, including improved data, development of child-friendly tools for diagnosis and treatment, engagement of key stakeholders at all levels of the system, and the development of integrated family- and community-centred strategies to provide comprehensive and effective services at the community level. A consultation on childhood TB integration took place in New York on June 1 and 2, 2016 to stimulate further the dialogue. The meeting addressed 7 topics: perspectives on childhood TB; country discussions on integration; integrating childhood TB interventions into service delivery; an opportunity for TB risk assessment at the community level: TB/HIV adapted integrated community case management (iCCM); childhood TB integration at the national, district, and community level; and financing childhood TB integration
This paper explores UAFA’s experience, since 2002, in working with Azerbaijani stakeholders to move from the medical approach to disability, propagated by the Soviet model of planning and implementation, to a social, community-based approach. The paper highlights the common misconceptions and how these can be overcome, including the policy gaps that challenge effective implementation.
The importance of creating and maintaining a core team is discussed, alongside the process that UAFA has developed for building up teams of CBR workers. Finally, the paper raises the issue of introducing outcomes-based evaluation in a society that has no such prior experience, followed by an account of the continual challenge faced by most programmes–namely, how to achieve sustainable funding.
Disability, CBR and Inclusive Development, Vol 26, No 3
This Campbell Collaboration systematic review assesses the effectiveness and cost-effectiveness of community-based rehabilitation (CBR) for people with physical and mental disabilities in low- and middle-income countries, and/or their family, their carers, and their community. This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical (stroke, arthritis, chronic obstructive pulmonary disease) and mental disabilities (schizophrenia, dementia, intellectual impairment). The authors conclude that the evidence on the effectiveness of CBR for people with disabilities in low- and middle-income countries suggests that CBR may be effective in improving the clinical outcomes and enhancing functioning and quality of life of the person with disabilities and his/her carer and recommend future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations
Campbell Systematic Reviews 2015:15
This advocacy briefing paper presents information about the importance of rehabilitation being integrated into health systems. It highlights a brief overview and definition of rehabilitation, and related key health facts and issues such as lack of access to rehabilitation, the value of rehabilitation and legal frameworks. It provides recommendations for stakeholders and suggests ways to measure progress
Advocacy briefing paper
A thematic literature review of the impact of CommunityBased Rehabilitation (CBR) in low to middle-income countries was conducted. The review covered the period from 2002 to 2012, and the CBR Matrix was utilised to provide structure for the evidence. Seven studies that investigated the impact of CBR interventions in developing countries were included. A modified harvest plot was used to summarise the strength and nature of evidence provided in relation to the CBR Matrix. Quantitative studies tended to focus on the Health domain, while qualitative studies generally focussed on the Social and Empowerment domains. No evidence of CBR impact was found in the Education domain, and very little evidence was found pertaining to Livelihood. Overall, the evidence base related to the impact of CBR remains limited, both in terms of quantity and robustness of design.
Disability, CBR and Inclusive Development (DCID), Vol 26, No 2
Despite the urgent need for physiotherapy services for underprivileged communities, Community Physiotherapy is not a sought-after specialisation in India. Physiotherapists tend to serve in institutions rather than at community level, as a result of which this field of healthcare has stagnated. This article, based on an interview with one of the country’s eminent community physiotherapists, gives a first person account of the evolution of community physiotherapy in India and provides qualitative inputs to deal with the prevalent issues. While the need for services has increased, there has been no matching growth in the pool of physiotherapists willing to work in the community. Several recommendations have been made, including changes in approach to community physiotherapy by both physiotherapists as well as community organisations in India.
This article highlights some lessons about the strategy of community-based inclusive education, drawn from in different programmes in Latin America. Having worked in the region for several years as a CBR advisor and special education teacher, the author provides insights into the progress that has been made. Early detection of disability followed by early education, with support from within the community, helps children with disability to participate in mainstream schools. Sensitisation of the public can overcome discrimination and exclusion. Teachers have to be trained to adapt teaching methods for the benefit of those with special needs. The author concludes that communities ought to initiate these strategies in their local schools as inclusive education is good for all children.
Disability, CBR and Inclusive Development, Vol. 25, No. 1
Following on from the Way Forward Paper, this paper is a set of three issue briefs proposing specific efforts and recommendations for informing and influencing policy to ensure mine and explosive remnants of war survivors participate in, and benefit from, disability-inclusive development. The three topics are locating and identifying survivors, improving access to services, and measuring progress on the implementation of victim assistance
This policy paper describes Handicap International’s mandate and values in operational terms as applied to the theme of provision of wheeled mobility and positioning devices. It presents the approaches and references for Handicap International’s actions, choices and commitments. It aims to ensure coherence in terms of practices whilst taking into account different contexts. Essentially this is a guidance document for programme staff which defines the topic and outlines the target populations, methods of intervention (expected results, activities) and indicators for monitoring and evaluation. This policy aims to ensure that all projects carried out by Handicap International programmes are consistent with the methods of intervention presented
This document presents the physical and functional rehabilitation-specific challenges, principles and recommendations for Handicap International. Above all, it sets out the overall framework within which the theoretical underpinnings of the Rehabilitation Services Unit are applied; the primary objective is to ensure consistency between the association’s mandate and the implementation, in its programmes, of projects falling within the unit’s scope of activities. The secondary objective is to formalise the selection and/or identification of external guidelines for adaptation for internal use.
Source e-bulletin on Disability and Inclusion