Methodological and conceptual issues in measuring the long term impact of disability: the experience of poliomyelitis patients in Manitoba

This paper is based on a Canadian study which is examining the long term impact of disability among people who developed respiratory or non-respiratory polio during the epidemics of the 1950s and who were admitted to the same Manitoba hospital, the centralized treatment centre for the Province. This research is exploring change in the lives of these individuals by focusing on three conceptually distinct, although empirically overlapping areas or dimensions. The first is called the 'trajectory of disability' and refers to changes in functional status. The second includes those changes which are the product of the interaction between the normal processes of aging and the long term impact of poliomyelitis. The third is changes in the context of disability. This refers not only to changes in medical and technological knowledge, but sociopolitical developments including the emergence of a Disabled Rights Consumer Movement. This paper discusses the methodological and conceptual issues involved in the study, particularly its combination of different methods of data collection and the value of its historical-prospective design for capturing the effects of change over time in each of these different dimensions.

A clinical study of post polio infantile paralysis

This study reports on 3,000 cases of poliomyelitis seen at the Rehabilitation and Artificial Limb Centre at Lucknow between January 1976 and December 1980. Factors such as age and sex incidence, extremity involvement, incidence of deformities at hip, knee and ankle, lower limb discrepancy, treatment and orthoses prescribed are discussed.

Indigenous substitutes for modern prostheses and orthoses

In most developing countries, the physically handicapped often have rehabilitation setbacks such as unavailability of modern rehabilitative aids which may result in non-achievement of the desired goals in activities of daily living. Children with poliomyelitis, hemiplegics, amputees and paraplegics top the list of patients requiring rehabilitation at University College Hospital, Ibadan. The amputees depend on wooden peg legs or pylons made by the occupational therapy department since modular and P.T.B. prostheses are presently not available in this hospital. Physiotherapists, therefore, encounter problems in teaching correct patterns of walking and other functional activities to the above-knee amputee because knee joints are absent. Rural amputee farmers use pylons as they can wade through water and mud with them. Calipers, toe raising devices, knee cages and spinal supports are required by 75% of the 300 children with poliomyelitis and some of the paraplegics receiving physiotherapy in this hospital. Due to lack of imported parts, materials and experienced personnel, it has not been possible to meet the required demands. The occupational therapy department, as well as indigenous shoe markers and iron welders, rescue the situation as much as possible. Similarly, cervical collars are made from PVC buckets. It is therefore necessary that research on the use of local materials for prostheses and orthoses be carried out. Difficulties encountered with imported parts and materials will be removed to the advantage of patients.

The team fights the scourge of poliomyelitis

Poliomyelitis is still a medical problem in Nigeria, the aftermath of which leaves patients with muscular paralysis, contractures and abnormalities which require elaborate treatment. One thousand one hundred and twenty patients affected with poliomyelitis and treated at the polio-clinic of Physiotherapy Department of the University College Hospital, Ibadan were studied. The multi-disciplinary approach of a professional health team was used to integrate the polio victims back into the community so that they do not constitute an economic liability. A case of a poliomyelitis victim who resorted to crawling is illustrated, effective treatment being given by the team approach resulting in his ability to maintain himself in the community. The importance of prophylactic immunization to prevent the wide spread of the disease in the community is also stressed.

[The severely disabled: a new way of driving a car (author's transl)]

In many cases, the provision of an automobile equipped with a special control system is a necessary part of the rehabilitation of the severely disabled. The car is so important to the disabled as it enables him to overcome daily the distance between home and place of work, hence increasing his mobility and life quality. The presented care control system was developed to meet the individual needs of a particular disability. It is, however, possible to use this system for, or adapt it to, similar types of disabilities. This problem complex has been overcome by following innovations: 1. The electronically controlled accelerator which can be operated with minimal finger pressure. 2. The LIDA shoulder device for tetraplegics, a connecting piece between the shoulder and the manually operated brake lever. 3. The removable armrest on the right hand side of the driver's seat to improve the sitting stability. The car can be easily be converted for "normal driving". The author received financial assistance.

Horseriding catching on as a therapy for the disabled

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A mechanically-actuated wave mattress

A polio victim who has been in a negative pressure ventilator ("iron lung") since 1950 was in need of an activated mattress to combat the hallucinatory effects of complete immobilization and to assist with body pressure distribution. A mechanical method was used to give the patient's mattress a moving wave form of vertical amplitude 50mm with a period variable from 50 seconds to infinity. His arms rested on separate supports which oscillated 180 degrees out of phase with the trunk support. The device is powered by a 12 volt electric motor operating through two mechanical reduction gear units. It differs significantly in design and purpose from pneumatic ripple mattresses.

The value of flexor hinge hand splints

Functional hand splints have been in use in a number of spinal injury units in the USA since the early 1950s. The splints are designed to provide a pinch-grip either by harnessing wrist dorsiflexion or by external power. Such devices are little used in the United Kingdom. This paper describes the results of late provision of 62 such splints in a Disabled Living Unit. A proportion of tetraplegic patients found such splints of considerable functional value. It is estimated that some 30--60 patients each year would benefit from them if appropriate facilities for early fitting were available.

Some clinical characteristics of children with paralytic poliomyelitis referred for physiotherapy

One hundred and fifty-two case records of poliomyelitis children were studied to examine the clinical characteristics of the patients. They were the random first 152 cases referred and hence constituted a representative study. The results showed that there was a preponderance of males in the data. The highest incidence was among children in the 13-24 month age group. Eighty-eight per cent of the children suffered from paralysis of the lower limb while 11.3 per cent suffered from involvement of the upper limb. Twenty-nine per cent of the patients demonstrated flexion/abduction deformity of the hip while 52.6 per cent showed foot drop resulting from tibialis anterior paralysis. Of the children studied 3.9 per cent came from the upper social class while 96.1 per cent came from the lower social class.

Problems in the rehabilitation of the physically disabled in rural areas of India

Some 550 disabled patients were examined by a rehabilitation team by organizing a rural camp at Meerut. This rehabilitation team consisted of orthopaedic surgeons, doctors, a prosthetist, an orthotist, a medical social worker and other skilled workers. Out of the 550 disabled patients, 271 were amputees, and 184 cases had poliomyelitis. Males predominated by 4:1. Disability was most common up to the age of 30 years. Of the 271 amputees, 146 were of upper limb while 125 were of lower limb. Only 86 lower limb amputees were suitable for fitting a prosthesis, while 39 others needed surgery of physiotherapy. Only 87 of the 184 polio cases were found suitable for appliances, the remainder needing surgery or physiotherapy. Ways of reducing the numbers of disabled were examined and improved rehabilitation procedures suggested.

Crawling patterns in neglected poliomyelitis in the Solomon Islands

Two hundred and twenty-two adult crawling poliomyelitic cripples were investigated. Analysis showed that bilateral lower limb paralysis with or without trunk involvement was the most common residual lesion. Remarkably paralysis was confined to a single lower limb in six cases. The various crawling patterns can be classified into six broad groups which are described and illustrated. It is suggested that in a developing country this classification has a practical application in the assessment of patients for rehabilitation to crutch walking. Subjects in the "true quandruped progression" and "squatting gait" categories generally have an excellent potential for rehabilitation, as often do those in the "infant-like crawl" group. Caution should be exercised in attempting crutch walking for those in the "body-dragging" group, and there seems little indication for attempting to establish upright walking for those in the "buttock pivoting" and "minimal movement" groups.

A new mouthstick prosthesis for handicapped patients

Most mouthstick prostheses previously described in the literature have severely limited application or availability. They are either highly specific and sophisticated and difficult to fabricate or very crude and unifunctional. Most do not conform to basic functional and physiologic criteria as outlined, nor are they sufficiently flexible to meet the various needs and physical capabilities of of a wide spectrum of patients. The prosthesis described is adaptable, and with the basic bite-stick and the friction-grip lock, the patient can change the form and function of the device to perform various tasks independently. The prosthesis is simple, inexpensive, and easy to fabricate and repair, and it needs no specialized or sophisticated parts. It enables handicapped patients to attain a greater degree of self-sufficiency than was previously possible, which improves their mental outlook.

Management of adult poliomyelitis patients in the Solomon Islands

An account is given of a realistic rehabilitation service for the treatment of crawling adult poliomyelitic patients in an area of the developing world. A classification of the crawling patterns encountered is presented. The simple methods by which rehabilitation was carried out for 120 patients are described. Methods consisted of surgery to straighten and align the lower limbs when necessary, the fitting of inexpensive appliances, and the teaching of crutch walking. At long-term review, 80 percent of the patients had responded satisfactorily to treatment. Rehabilitation in an economically and medically poor country can be justified.

Cosmetic caliper for use with flail leg

A new type of long leg brace made of polypropylene with an internal shoe foot piece seems to offer distinct advantages over the older, conventional type of calipers.