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

Provision of prosthetic and orthotic services in low-income countries: a review of the literature

BACKGROUND

Disability is inextricably linked to poverty. A total of 80% of the disabled population lives in low-income countries. The demand for prosthetic and orthotic services in these countries is increasing, and a variety of methods to provide services are currently used.

OBJECTIVES

To assess current models of provision to facilitate sustainable, evidence-based prosthetic and orthotic services.

STUDY DESIGN

Literature review.

METHODS

A literature search was performed through Medline (Ovid), PubMed, ISI Web of Knowledge, EMBASE and RECAL Legacy using combinations of subject heading and text word searching strategies. Full-text publications were critically appraised and ranked according to the Scottish Intercollegiate Guidelines Network guidelines.

RESULTS

Three areas were deemed pertinent to the research question. Studies were grouped into one or more of these categories based on the issues addressed: instigators, types of service provision, demographics and region-specific issues. It was found that many complex factors influence prosthetic and orthotic services in low-income countries. Demographic and regional idiosyncrasies require prosthetic and orthotic services to be tailored to address the specific needs of individual countries.

CONCLUSIONS

The lack of and quality of available research made efficacy of methods used to provide services in low-income countries difficult to determine.

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.

A clinical study of amputations of the lower limb

A retrospective study of 525 cases of lower limb amputation attending the Outpatient Department of the Rehabilitation and Artificial Limb Centre and various rural clinics from January 1976 to March 1978 was carried out. Males outnumbered females and the majority of cases were in the 3rd decade. Trauma was the most common cause of amputation followed by peripheral vascular disease and neoplastic lesions. The stump was considered to be satisfactory in more than half of the cases studied. Proper postoperative care was lacking in most of those amputated at other centres.