A picture of amputees and the prosthetic situation in Haiti

Childhood and Assistive Technology: Growing with opportunity, developing with technology

Assistive technology is instrumental for the development and participation of children with disabilities by enabling their communication, mobility, and self-care. Technology also allows each child to explore the worlds of family relationships, friendships, education, play, and household tasks, enhancing their quality of life and that of their families. However, for the vast majority of children with disabilities, inadequate or no access to assistive technology excludes them from education, health, and social services, resulting in lifelong consequences to their participation in civic life and employment.The rights of children with disabilities, as described in the CRC and CRPD, require a systemic approach to the provision of access to assistive technology. In addition to environmental factors such as the quality of sidewalks for wheelchair users or cultural attitudes for those that require eyeglasses or prostheses, obstacles include: lack of awareness of the existence of certain technologies; absence of public policies supporting local availability and affordability; lack of products which have the adequate size, type, or quality; and insufficient personnel to provide referrals, fitting, training, and repairs. Children have additional challenges due to the fact that they are growing and require much more frequent adjustments or replacements of their assistive technology.

A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.

Gender Differences in Psychosocial and Physical Outcomes in Haitian Amputees

OBJECTIVE

The purpose of this study was to investigate the gender differences in psychosocial and physical outcomes in users of lower-extremity prostheses who became amputees after the 2010 earthquake in Haiti.

METHOD

We enrolled 140 unilateral amputees in this cross-sectional study in Port-au-Prince, Haiti. Trained staff administered the assessments by reading the questions aloud to participants. Participants completed the Trinity Amputation and Prosthesis Experience Scales and Locomotor Capabilities Index about 2 yr after the earthquake.

RESULTS

We found no gender differences in psychosocial adjustment and physical outcomes, except for strenuous physical activities and phantom pain, and both genders reported difficulty in social adjustment. After controlling for strenuous physical activities and phantom pain, we found that men showed worse psychosocial adjustment than women.

CONCLUSION

Services for psychosocial adjustment are critical for traumatic amputees and should be incorporated into rehabilitation programs after a disaster. Interventions should consider gender roles in the indigenous culture.

Haitian and international responders' and decision-makers' perspectives regarding disability and the response to the 2010 Haiti earthquake

BACKGROUND

Following disasters, persons with disabilities (PWD) are especially vulnerable to harm, yet they have commonly been excluded from disaster planning, and their needs have been poorly addressed during disaster relief. Following the 2010 Haiti earthquake, thousands of individuals experienced acute injuries. Many more individuals with preexisting disabilities experienced heightened vulnerability related to considerations including safety, access to services, and meeting basic needs.

OBJECTIVE

The objective of this research was to better understand the perceptions of responders and decision-makers regarding disability and efforts to address the needs of PWD following the 2010 earthquake.

DESIGN

We conducted a qualitative study using interpretive description methodology and semistructured interviews with 14 Haitian and 10 international participants who were involved in the earthquake response.

RESULTS

Participants identified PWD as being among the most vulnerable individuals following the earthquake. Though some forms of disability received considerable attention in aid efforts, the needs of other PWD did not. Several factors were identified as challenges for efforts to address the needs of PWD including lack of coordination and information sharing, the involvement of multiple aid sectors, perceptions that this should be the responsibility of specialized organizations, and the need to prioritize limited resources. Participants also reported shifts in local social views related to disability following the earthquake.

CONCLUSIONS

Addressing the needs of PWD following a disaster is a crucial population health challenge and raises questions related to equity and responsibility for non-governmental organizations, governments, and local communities.

Priorities in lower limb prosthetic service delivery based on an international survey of prosthetists in low- and high-income countries

BACKGROUND

Prosthetic services, including the provision of an appropriate prosthesis, are a crucial part of the rehabilitation process for individuals with lower limb amputations. However, globally there exist unique challenges in the delivery of prosthetic services that are limiting rehabilitation outcomes and consequently the well-being and socio-economic status of individuals with lower limb amputations.

OBJECTIVES

The objective of this work was to explore the issues related to the provision of appropriate prosthetic technologies and to compare these across different economies of the world.

STUDY DESIGN

Cross-sectional survey.

METHODS

An online survey was developed and distributed to prosthetic practitioners providing services in countries around the world. An open-coding thematic content analysis procedure was applied to extract key themes from the data.

RESULTS

The response codes defined three overall themes of lower limb prosthetic delivery, and several key differences between higher and lower income countries emerged. Namely, a higher emphasis on part/material availability, practitioner training and durability in lower income countries was found. High costs were an issue raised by practitioners in all countries.

CONCLUSION

Practitioners around the world share many of the same concerns; however, some lower income countries face important and pressing issues that limit their ability to provide adequate prosthetic services.

CLINICAL RELEVANCE

This work highlights the most crucial service and technology-related needs, as perceived by trained prosthetic practitioners, of populations requiring lower limb prosthetic treatment around the world. Additionally, the results may be used to prioritize prosthetic-related health-care initiatives led by other researchers, governments and organizations working to improve services internationally.

Users' perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers

PURPOSE

The purpose of this work was to contribute to a better understanding of challenges and solutions to equitable provision of assistive technologies in resource limited environments by (i) describing sources of awareness, types of providers and costs of assistive technologies; (ii) describing common reasons for not possessing assistive technologies; and (iii) comparing these sources, providers, costs and reasons among younger and older men and women living in urban and rural settings.

METHODS

Descriptive and analytic statistics were used to analyze cross-sectional data from a total sample of 581 hearing aid users, wheelchair users, individuals with hearing impairments not using hearing aids and individuals with ambulatory impairments not using wheelchairs living in eight districts of Bangladesh.

RESULTS

Major sources of awareness, types of providers and costs paid varied between users of different types of assistive technology. Lack of affordability was the main reason for not possessing assistive technology. Outcome differences were found between younger and older groups, men and women, and literate and illiterate respondents, while no differences related to place of living were identified.

CONCLUSIONS

Age, gender, type of impairment and socioeconomic status need to be considered when planning and implementing equitable provision of assistive technologies. Implications for Rehabilitation Provision of assistive technologies needs to be made affordable as lack of affordability was the major reason for not possessing such technologies. To ensure equitable provision of assistive technology, services ought to consider age, gender, impairment and socioeconomic status of their target groups. This includes offering a range of products of different sizes provided by culturally appropriate personnel at affordable cost, which to many may be at no or reduced cost. To cater to the assistive technology needs among the most vulnerable groups, assistive technology providers may learn from CBR strategies, such as, awareness raising and service delivery at community level, the use of local resources, collaboration and coordination, and the consideration of cultural factors.

The World Report on Disability: a challenge for rehabilitation medicine

To analyze the life situation of people with disabilities and to summarize the evidence of measures to support their participation, the World Health Assembly requested the World Health Organization to produce a World Report on Disability. This article highlights some of the main contents of the World Report on Disability, with a special focus on the rehabilitation chapter. It starts by presenting epidemiologic findings on the global disability prevalence, views on the role of rehabilitation medicine, discrepancies between met and unmet needs, and challenges for the quality of rehabilitation services and ends with an outlook on the report's recommendations and efforts toward their implementation.

Implications of prosthesis funding structures on the use of prostheses: experiences of individuals with upper limb absence

BACKGROUND

While sparsely researched, funding structures may play an important role in use of and satisfaction with prostheses and related health services.

OBJECTIVES

The objectives of this study were to (1) quantify the direct costs of prosthesis wear, (2) explore variations in funding distribution, and (3) describe the role of affordability in prosthesis selection and wear.

STUDY DESIGN

An anonymous, online cross-sectional descriptive survey was administered.

METHODS

Analyses were conducted of qualitative and quantitative data extracted from an international sample of 242 individuals with upper limb absence.

RESULTS

Access to prosthesis funding was variable and fluctuated with age, level of limb absence and country of care. Of individuals who gave details on prosthetic costs, 63% (n = 69) were fully reimbursed for their prosthetic expenses, while 37% (n = 40) were financially disadvantaged by the cost of components (mean [SD] US$9,574 [$9,986]) and their ongoing maintenance (US$1,936 [$3,179]). Of the 71 non-wearers in this study, 48% considered cost an influential factor in their decision not to adopt prosthesis use.

CONCLUSIONS

Prosthesis funding is neither homogeneous nor transparent and can be influential in both the selection and use of a prosthetic device.

CLINICAL RELEVANCE

Inequitable access to prosthesis funding is evident in industrialized nations and may lead to prosthesis abandonment and/or diminished quality of life for individuals with upper limb absences. Increased efforts are required to ensure equitable access to upper limb prosthetics and related services in line with individuals' needs.

Assistive technology in developing countries: a review from the perspective of the Convention on the Rights of Persons with Disabilities

BACKGROUND

The 'Convention on the Rights of Persons with Disabilities' (CRPD) requires governments to meet the assistive technology needs of citizens. However, the access to assistive technology in developing countries is severely limited, which is aggravated by a lack of related services.

OBJECTIVES

To summarize current knowledge on assistive technology for low- and lower-middle-income countries published in 1995 or later, and to provide recommendations that facilitate implementation of the CRPD.

STUDY DESIGN

Literature review.

METHODS

Literature was searched in web-based databases and reference lists. Studies carried out in low- and lower-middle-income countries, or addressing assistive technology for such countries, were included.

RESULTS

The 52 included articles are dominated by product oriented research on leg prostheses and manual wheelchairs. Less has been published on hearing aids and virtually nothing on the broad range of other types of assistive technology.

CONCLUSIONS

To support effective implementation of the CRPD in these countries, there is a need for actions and research related particularly to policies, service delivery, outcomes and international cooperation, but also to product development and production.

CLINICAL RELEVANCE

The article has a potential to contribute to CRPD compliant developments in the provision of assistive technology in developing countries by providing practitioners with an overview of published knowledge and researchers with identified research needs.

The roles of predisposing characteristics, established need, and enabling resources on upper extremity prosthesis use and abandonment

PURPOSE

Prosthesis use and abandonment is a complex function of variables defining the contextualized individual. This review presents a comprehensive panoramic of these factors as related to the management of upper limb deficiency. Me

METHOD

nderson's model for health service utilization was used to frame prosthesis use and abandonment as a function of (1) predisposing characteristics of the individual (e.g. gender or level of limb loss); (2) established need, as characterized by lifestyle- and age-related demands; and (3) enabling resources (e.g. clinical and social). English-language articles pertaining to these components were identified in a search of Ovid, PubMed, ISI Web of Science and www.scholar.google.com (1980-November 2006) for key words upper limb and prosthesis. Approximately 90 articles were included as evidence in this review. Re

RESULTS

ersonal and contextual factors are critical determinants of prosthesis acceptance. While the influence of some factors (i.e. lifestyle, level of limb loss), is strongly supported in the literature, the impact of others, (i.e. age of fitting, efficacy of training protocols), remain controversial. Co

CONCLUSIONS

nhanced understanding of these factors is required to optimize clinical practices, guide design efforts, and satiate demand for evidence-based measures of intervention. Future research should comprise of controlled, multifactor studies adopting standardized outcome measures and providing comprehensive descriptions of population characteristics.

Upper-limb prosthetics: critical factors in device abandonment

OBJECTIVE

To investigate the roles of predisposing characteristics, established need, and enabling resources in upper-limb prosthesis use and abandonment.

DESIGN

A self-administered, anonymous survey was designed to explore these factors. The questionnaire was available online and in paper format and was distributed through healthcare providers, community support groups, and one prosthesis manufacturer. Two hundred forty-two participants of all ages and levels of upper-limb absence completed the survey.

RESULTS

Of participants, 20% had abandoned prosthesis use. Predisposing factors, namely, origin of limb absence, gender, bilateral limb absence, and, most importantly, level of limb absence, proved influential in the decision not to wear prostheses. Enabling resources such as the availability of health care, cost, and quality of training did not weigh heavily on prosthesis rejection, with the exception of the fitting time frame and the involvement of clients in the prosthesis selection. Conversely, the state of available technology was a highly censured factor in abandonment, specifically in the areas of comfort and function. Perceived need emerged as a predominant factor in prosthesis use.

CONCLUSIONS

Future research should focus on continued development of more comfortable and functional prostheses, particularly for individuals with high-level or bilateral limb absence. Improved follow-up, repair, and information services, together with active involvement of clients in the selection of prostheses meeting their specific goals and needs, is recommended.