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Unmet needs and use of assistive products in two districts of Bangladesh: Findings from a household survey

PRYOR, Wesley
NGUYEN, Liem
ISLAM, Qumrun Naher
JALAL, Faruk, Ahmed
MANJULA, Marella
December 2018

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Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool—the ‘Assistive Technology Assessment—Needs (ATA-N)’ for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs and unmet needs for AP, and current access patterns in Bangladesh. The ATA-N was incorporated in a Rapid Assessment of Disability (RAD), a population-based survey to estimate prevalence and correlates of disability. In each of two unions of Kurigram and Narsingdi districts, 60 clusters of 50 people each aged two years and older were selected using a two-staged cluster random sampling process, of whom, 4250 (59% Female; 41% Male) were adults, including 333 using AP. We estimate 7.1% of the studied population used any AP. AP use is positively associated with age and self-reported functional difficulty. The proportion of people using AP is higher for mobility than for sensory and cognitive difficulties. Of all people with any functional difficulty, 71% self-reported an unmet need for AP. Most products were home or self-made, at low cost, but provided benefits. Needs and unmet needs for AP are high, especially for people with greater functional difficulties. Assessing unmet needs for AP revealed important barriers to scale that can inform policy and practice.

Int. J. Environ. Res. Public Health 2018, 15(12), 2901;
doi:10.3390/ijerph15122901

Assistive technology

WORLD HEALTH ORGANISATION (WHO)
May 2018

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A brief introduction to facts behind the global unmet need for assistive technology and the WHO response in coordination the Global Cooperation on Assistive Technology (GATE).

Assistive technologies in developing countries

ROHWERDER, Brigitte
March 2018

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This rapid review looks at examples of existing literature on the availability of assistive technologies and efforts to make these technologies more affordable and accessible in developing countries. Needs and access to assistive technologies are overviewed. The discussion of market characteristics of assistive technologies covers availability, affordability, quality, appropriate design, and awareness and demand.  Efforts to increase the affordability and accessibility of assistive technology are discussed covering: The Global Cooperation on Assistive Technology (GATE); the WHO Priority Assistive Products List; and EYElliance and eye health initiatives. Market shaping and community based approaches are discussed in this context.

 

This is a K4D helpdesk report. This report was commissioned by the UK Department for International Development (DFID)

Assistive products for children with disabilities guide

UNICEF
March 2018

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UNICEF has issued an Assistive Products guide which addresses needs in four impairment groups: mobility, vision, hearing, and communication.  It provides details of some assistive products currently available on the market and information on when and how they are to be used. It covers a range of devices, from low-tech (e.g., walking sticks, pencil grips) to more complex (e.g., specialized computer software/hardware or motorised wheelchairs). This publication provides practical information to guide UNICEF, partner agencies and Governments in procurement planning and provisioning of assistive products. The information is designed to help with decision-making on the most appropriate assistive products to meet programme objectives and realise the rights of children with disabilities. The selection of assistive products in this overview is based on the World Health Organization’s (WHO’s) 2016 Assistive Products Priority List (APL). References to particular brands and models are only illustrative examples available at the time of publication and do not constitute an endorsement of the manufacturer by UNICEF. Indicative prices listed are in US dollars.

Deafness and hearing loss

WORLD HEALTH ORGANIZATION (WHO)
March 2018

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A short factsheet about deafness and hearing loss covering key facts, causes (congenital and acquired), impact (functional, social and economic), prevention, identification and management and WHO response. 

The 8 steps + : The role of community development organizations in providing holistic wheelchair services

ACCELERATING CORE COMPETANCIES FOR EFFECTIVE WHEELCHAIR SERVICE AND SUPPORT (ACCESS) PROJECT
October 2017

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This report suggests a “twin-track” approach based on the World Health Organization’s Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings, an eight-step process, and dedicated disability inclusion programming, the “plus.” By following this 8 Steps+ approach, community development organizations can provide appropriate wheelchairs and empower their constituencies to exercise their rights and fundamental freedoms.  

Diabetes and rehabilitation. Factsheet.

HANDICAP INTERNATIONAL
March 2017

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Diabetes is the 9th most common cause of years lived with disability. Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. This causes an increased concentration of glucose in the blood (hyper glycaemia). There are three types - Type 1, Type 2 and gestational. Common impairments and activity limitations are reported including: neuropathy; peripheral vascular disease; retinopathy; kidney complications; stroke and depression. Different examples of rehabilitation in the care continuum are provided. A case study of diabetes in the Philippines is cited.

Pilot testing of 3D printing technology for transtibial prosthesis in complex contexts (Togo, Madagascar and Syria)

CONICAVE, Jerome
TAN, Daniele
2017

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In January-October 2016, Handicap International carried out a pilot testing of 3D printing technology for transtibial prosthesis in Togo, Madagascar and Syria. The aim of the study was to explore and test how physical rehabilitation services can be more accessible to people living in complex contexts via innovative technologies (such as 3D printing, treatment processes that use Internet technology and tools) and decentralised services by bringing them closer to the patients. This scientific summary provides the context, the objectives, the methodology, the results of the study, and perspectives for the future.

A number of technical appendices are available

RS/05

Rehabilitation in health systems

WORLD HEALTH ORGANISATION (WHO)
2017

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This document provides evidence-based, expert-informed recommendations and good practice statements to support health systems and stakeholders in strengthening and extending high-quality rehabilitation services so that they can better respond to the needs of populations. The recommendations are intended for government leaders and health policy-makers and are also relevant for sectors such as workforce and training. The recommendations and good practice statements may also be useful for people involved in rehabilitation research, service delivery, financing and assistive products, including professional organisations, academic institutions, civil society and nongovernmental and international organisations. The recommendations focus solely on rehabilitation in the context of health systems. They address the elements of service delivery and financing specifically. The recommendations were developed according to standard WHO procedures, detailed in the WHO handbook for guideline development

Standards for prosthetics and orthotics

WORLD HEALTH ORGANISATION (WHO)
2017

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This document provides a set of standards and a manual for implementation to support countries in developing or improving high-quality, affordable prosthetics and orthotics services. Its aim is to ensure that prosthetics and orthotics services are people-centred and responsive to every individual’s personal and environmental needs. Implementation of these standards will support Member States in fulfilling their obligations under the CRPD and in meeting the SDGs, in particular Goal 3. With these standards, any government can develop national policies, plans and programmes for prosthetics and orthotics services of the highest standard. This document has two parts: the standards and an implementation manual. Both parts cover four areas of the health system:

• policy (governance, financing and information);

• products (prostheses and orthoses);

• personnel (workforce);

• provision of services

Physiotherapy care for adults with paraplegia due to traumatic cause: A review

GUPTA, Nalina
RAJA, Kavitha
October 2016

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Abstract

 

 

Purpose: This review aimed to identify the practice guidelines/ recommendations for physiotherapy management in acute /post-acute/ chronic/long-term phase of rehabilitation of clients with paraplegia due to traumatic causes.

 

Methods: Of the 120 articles retrieved, 26 met the inclusion criteria. After quality appraisal, 16 articles were included in the study. Data were extracted under the sub-headings: physiotherapy care in acute, chronic and long-term community stage; expected outcomes; effect of physical interventions; morbidities; wheelchair characteristics and standing.

 

Results: There is strong evidence in support of strength and fitness training, and gait training. Parameters of strength training (frequency, duration and intensity) vary. There is lack of evidence on passive movements, stretching, bed mobility, transfers and wheelchair propulsion. Preservation of upper limb functions is an important consideration in caring for clients with paraplegia.

 

Conclusion: Many areas of rehabilitation interventions remain inadequately explored and there is a need for high quality studies on rehabilitation protocols. Client preferences and feasibility are other areas that should be explored.

 

Limitations: The search criteria of articles in the English language or articles translated in English is a reason for this limitation. Articles related to advanced therapeutic interventions such as robot-assisted training, and transcranial electrical and magnetic stimulation were excluded from the study.

WFD’s position paper on the language rights of deaf children

WORLD FEDERATION OF THE DEAF
September 2016

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Early exposure to sign language and multilingualism, combined with strong family support for sign languages, best prepares deaf children for their future effective participation in society. This position paper covers language acquisition for deaf children, the benefits of multilingualism, multilingual education and interpreting UN CPRD Article 24 in support of sign bilingual education. 

Each section of the paper has International sign videos available.

Long-term training with a brain-machine interface-based gait protocol induces partial neurological recovery in paraplegic patients.

NICOLELIS, Miguel
et al
August 2016

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"Brain-machine interfaces (BMIs) provide a new assistive strategy aimed at restoring mobility in severely paralyzed patients. Yet, no study in animals or in human subjects has indicated that long-term BMI training could induce any type of clinical recovery. Eight chronic (3–13 years) spinal cord injury (SCI) paraplegics were subjected to long-term training (12 months) with a multi-stage BMI-based gait neurorehabilitation paradigm aimed at restoring locomotion. This paradigm combined intense immersive virtual reality training, enriched visual-tactile feedback, and walking with two EEG-controlled robotic actuators, including a custom-designed lower limb exoskeleton capable of delivering tactile feedback to subjects. Following 12 months of training with this paradigm, all eight patients experienced neurological improvements in somatic sensation (pain localization, fine/crude touch, and proprioceptive sensing) in multiple dermatomes. Patients also regained voluntary motor control in key muscles below the SCI level, as measured by EMGs, resulting in marked improvement in their walking index. As a result, 50% of these patients were upgraded to an incomplete paraplegia classification. Neurological recovery was paralleled by the reemergence of lower limb motor imagery at cortical level". It is hypothesised that this unprecedented neurological recovery results from both cortical and spinal cord plasticity triggered by long-term BMI usage."

Scientific Reports 6, Article number: 30383 (2016)
doi:10.1038/srep30383

'Brain training' technique restores feeling and movement to paraplegic patients

RADFORD, Tim
August 2016

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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.

Priority assistive products list

WORLD HEALTH ORGANISATION (WHO)
May 2016

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The Priority Assistive Products List (APL) aspires to follow in the footsteps of the WHO Model List of Essential Medicines, which creates awareness among the public, mobilises resources and stimulates competition. The Priority Assistive Products List is similarly intended to be a catalyst in promoting access to assistive technology. It is not a restrictive list but aims to provide each Member State with a model from which to develop a National priority assistive products list. 

The List includes hearing aids, wheelchairs, communication aids, spectacles, artificial limbs, pill organizers, memory aids and other essential items for many older people and people with disabilities to be able to live a healthy, productive and dignified life.

The APL is part of the Global Cooperation on Assistive Technology (GATE)

Google & Motivation collaboration

MOTIVATION
April 2016

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A 24 month collaboration between Google.org and Motivation to develop and test a model for using 3D printing to create customised postural support devices to enable wheelchairs to be adapted and fitted to the unique needs of the wheelchair user is announced. An integral part of the project is the piloting of a ‘Print Pod’ overseas, which will act as a temporary wheelchair clinic, kitted out with a 3D printer and raw material.

Digital Inclusion: a white paper

HOOGERWERF, Evert-Jan
MAVROU, Katerina
et al
2016

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This white paper will provide the reader with insight into the role technology plays for the full participation of persons with disabilities and older people in the digital society. The authors consider equal opportunities to participate in all realms of life a human right. The paper will help the reader to understand what the barriers to full digital inclusion for these groups are, how changing scenarios in society should lead to the definition of new goals and how these goals could be reached. 

This white paper looks forward and challenges the reader to identify strategies to tackle the digital divide. In the first section, it analyses trends and policy objectives as defined by the international community in 6 different areas relevant to the digital divide:

Disability and participation

Education

Employment

Health and social care

Technology

(Social) Media 

The writing of this white paper is the result of a three-year long project funded by the European Commission under the Lifelong Learning Programme. The ENTELIS project has brought together various organisations from different European countries and beyond and has resulted in the establishment of a sustainable network, supported by three European umbrella organisations: EASPD (European Association of Service Providers to Persons with Disabilities), AAATE (Association for the Advancement of Assistive Technology in Europe) and EVBB (European Association of Vocational Training Institutes). For them supporting the network means creating an opportunity for their member organisations and other interested stakeholders to actively engage with technology and technology users with disabilities in education, vocational training and person centred support services. Their common understanding is that ICT and AT can empower people with disabilities, lead to more fulfilled lives and a more inclusive society but that this can only be reached if there is effective collaboration between sectors. Their expectation is that the network will empower their member organisations in making this become reality and this document and in particular the roadmap contained in there might provide good guidance for that. 

 

WHO Global disability action plan 2014-2021

WHO Disability and Rehabilitation Team
2014

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The WHO global disability action plan 2014-2021 is a significant step towards achieving health and well-being and human rights for people with disabilities. The action plan was endorsed by WHO Member States in 2014 and calls for them to remove barriers and improve access to health services and programmes; strengthen and extend rehabilitation, assistive devices and support services, and community-based rehabilitation; and enhance collection of relevant and internationally comparable data on disability, and research on disability and related services. Achieving the objectives of the action plan better enables people with disabilities to fulfil their aspirations in all aspects of life.

INCLUDE: A Community-Based Rehabilitation (CBR) learning community

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INCLUDE is an online learning community for community-based rehabilitation (CBR) that aims to inform and support CBR managers and interested stakeholders around the world.

It is an online programme that guides the user through different information modules based on the Community-based rehabilitation guidelines: health, education, livelihood, social and empowerment.

INCLUDE also provides tools to assist users to reflect on their own thoughts and experiences, and case studies that show CBR in action. INCLUDE allows the user to develop an action plan around management and the five components and corresponding elements of the CBR matrix.

These action plans can be stored and built on over time, and shared with others in the CBR community.

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