Medical Needs Assessment of Persons with Locomotor Disability

ABSTRACT:

Background: Among the different types of disabilities, the prevalence of locomotor disability is highest in the country – it is 1046 in the rural and 901 in the urban per 100000 persons. The first and foremost need for people with locomotor disability is the medical need, this assessment helps us in planning the rehabilitation for persons with locomotor disability. Aim: To assess the medical needs of the persons living with locomotor disability in Kaiwara PHC area. Methodology: A cross sectional sectional study was conducted in the Kaiwara PHC area between the period of October 2006 – December 2006.A total of 109 people with locomotor disabilities were identified in the 36 villages under Kaiwara PHC area with the help of the respective Anganwadi teacher and the study team comprising of specialists from the department of Orthopedics, Physiotherapy and Community Medicine.

They visited the houses of these locomotor disabled persons and assessed their medical needs in terms of surgery, physiotherapy and requirements for aids and appliances. Results: The prevalence of locomotor disability was 0.33%. Of the total number of locomotor disability about 20% were due to congenital deformities, 18.3% were due to fractures, 13.8% were due to post polio residual paralysis and 10% due to arthritis. Out of 109 persons with disability about 65 persons needed surgery, physiotherapy or aids and appliances. Conclusion: In the present study the congenital deformities, fractures, post polio residual paralysis and Arthritis are the common causes of disability of which 1/3rd of these disabilities could have been prevented by good immunization and specialized care for Polio and fractures respectively.

Introduction:

Disability: A person with restrictions or lack of abilities to perform an activity in the manner or within the range considered normal for a human being was treated as having disability. It excluded illness/injury of recent origin (morbidity) resulting into temporary loss of ability to see, hear, speak or move1. Locomotor disability: A person with – (a) loss or lack of normal ability to execute distinctive activities associated with the movement of self and objects from place to place and (b) physical deformities, other than those involving the hand or leg or both, regardless of whether the same caused loss or lack of normal movement of body – was considered as disabled with locomotor disability. Thus, persons having locomotor disability included those with (a) loss or absence or inactivity of whole or part of hand or leg or both due to amputation, paralysis, deformity or dysfunction of joints which affected his/her “normal ability to move self or objects” and (b) those with physical deformities in the body (other than limbs), such as, hunch back, deformed spine, etc.

Dwarfs and persons with stiff neck of permanent nature who generally did not have difficulty in the normal movement of body and limbs was also treated as disabled1 It is estimated by WHO that 5% of the population has one or other kind of disability in developing countries.3 Disabled persons often suffer from discrimination, because of prejudice or ignorance and also may lack access to essential services. Disabled persons constitute about 2 per cent of the total population in our country. In order to evolve a successful programme for social integration of the disabled, information relating to their magnitude, type of disability, age at onset of disability, possible cause of disability, etc. is very essential.

About 8.4 per cent and 6.1 per cent of the total estimated households in rural and urban India respectively reported to have at least one disabled person. The number of disabled persons in the country was estimated1 to be 18.49 million during July to December, 2002. They formed about 1.8 per cent of the total population. For every 100000 people in India, there were 1755 who were either mentally or physically disabled. Among the rural residents, the prevalence of disability was 1.85 per cent and that among the urban, it was 1.50 per cent. The rate for males was 2.12 and 1.67 per cent while that for females was 1.56 and 1.31 per cent in rural and urban India respectively.

The prevalence rate of disability in Karnataka was 1750 and 1500 per 100000 in rural and urban areas respectively2. Among the different types of disabilities, the prevalence of locomotor disability was highest in the country – it was 1046 in the rural and 901 in the urban per 100000 persons. This was followed by visual disability and hearing disability. According to National Sample Survey 58th round (July-December 2002) about 69 persons per 100,000 were either born disabled or became disabled for some reasons in India during the last 365 days. The incidence rate was also observed to be higher among males than that among females.

The most common needs concerning disabled people in the developing countries are:
• The first and foremost is the medical need
• Functional problems for daily life activities
Self-care (eating, drinking, dressing, keeping clean by use of latrine) Mobility

Communicating, comprehension, ability to follow instructions Behavior
• Educational needs
Schooling

Vocational training
• Needs for income generating activities

Participation in household duties, jobs, self-employment • Lack of family and social integration
• Concerns relating to participation and representation in the community affairs • Security needs (protection of legal and human rights) So if the medical need is properly given to them the other needs will be automatically met to some extent4. The present study was carried out as a follow up of the project “Ashakirana” for the persons with disability in the Kaiwara PHC area during 2003-2004.

Aim:

To assess the medical needs of the persons living with locomotor disability in Kaiwara PHC area.

Methodology:

Study area: Kaiwara is a small town situated at a distance of 65 kilometers from Bangalore city in the Chintamani Taluk of Kolar district, Karnataka, India. It is an important religious place with the Nandanavana in honour of a saint Sri Yogi Narayana Swami who lived in the 18th century. He has predicted future like Nostradamus and is popularly known as “Kaiwara Thatha”. Kaiwara Primary Health centre (PHC) caters to a population of 32772 scattered over 36 villages. Kaiwara Primary Health Centre is the rural training centre attached to Department of Community Medicine, M S Ramaiah Medical College and is utilized for Intern’s rural training and also as field practice area for under- graduate and post graduate students.

Study population: All the persons with locomotor disability enlisted by respective Anganwadi workers of the 36 villages coming under Kaiwara PHC administrative control.

Study Period: October 2006 – December 2006.

Study design: Cross sectional

Method of data collection: A study team consisting of specialist from department of Orthopedics, Physiotherapy and Community medicine visited the households of persons with locomotor disability in each of the 36 villages along with the respective Anganwadi workers and carried out a detailed physical examination of the person with locomotor disability and arrived at probable cause of the present disability and later advised them regarding treatment, surgery, physiotherapy, aids and appliances to improve the quality of life.

DISCUSSION

In the present study the prevalence of locomotor disability was 0.33% and the distribution among the sexes was almost same.

It was noted that the common cause of disability in the present study was congenital deformities and CongenitalTalipesEquinoVarus accounting for 20.2%. If an early identification and effective referral system can be established the quality of life of these persons can be improved by instituting appropriate rehabilitation services like either corrective surgery or providing them with aids and appliances. Fracture of limbs (18.3%) not treated properly was the single most common cause of disability in this study and this is due to non availability of specialized medical services at the primary health centre level, also due to the fact that these persons have approached the traditional healers to reduce the fracture which has lead to either malunion or non union of these fractures.

Post polio residual paralysis (13.8%) was the next common cause of locomotor disability. Interestingly the Post Polio Residual Paralysis was noted in the age groups of 14 years and above.The efforts of our government to prevent paralytic polio from the last decade through routine immunization and Pulse Polio Immunization was observed to have had a positive impact in considerably preventing the disability due to this vaccine preventable disease in younger age group. Even though the disability caused by Post Polio Residual Paralysis can be reduced by surgeries, not many were ready to give their consent for the surgery. This is because the person has to undergo repeated surgeries resulting in long stay in the hospitals and frequent visits to be made to the hospitals for physiotherapy. So this may lead to loss of wages both to the person affected and the accompanying attendant.

Arthritis (10.1%) was another cause of disability in the present study. This morbidity had caused severe restriction of movements of these people and also had an impact on loss of earning capacity among these people.Thus there was a need for instituting a system for demystifying specialized physiotherapy skills and transfer of the same to the health worker with in the primary health care system so has to have an impact at the community level for this disability..

This needs to be followed up in order to provide surgical services such as soft tissue release, tendon lengthening, Illizarov technique, tenotomy, reconstruction of the joints, corrective osteotomy, open/closed reduction, tendon transfer and joint replacement by specialist at tertiary care facilities.

Despite our government providing aids/appliances to these persons through various schemes the acceptance is high initially but once the aids/appliances has to be either serviced or repaired there is no place to approach or may be our common places of visit like schools, colleges, hospitals, temples are not disabled friendly and do not have proper access in terms of lift/ramp for persons with disability leading to non use of their aids/appliances.

The other cause of disability in this present study was due to Cerebral Palsy probably as a result of poor intranatal care as high number of births conducted at home by untrained personnel. These disabilities if identified in its initial stages and appropriate interventions applied, at least the quality of life can be improved among them.

In the present study 34 persons required surgeries like tendon lengthening, arthrodosis to improve their mobility; 18 persons required various physiotherapy exercises to improve the tone and the power of the muscles; 13 persons required various aids and appliances like crutches, artificial limbs, wheel chairs, special shoes to improve their mobility and quality of life.

Gaps identified in the present study:

a. Health care gap: Identification and prevention of disabilities is not an extra burden thrust upon our health care system but it is inbuilt in our service delivery like provision of essential new born and infant care which will prevent considerable number of disabilities. Early identification and establishing a prompt referral system to higher centers will improve the quality of life of these people.

b. Social gap: The social discrimination and isolation of persons with disabilities is still high in the community and these attitudes among the community need to be changed to get these persons with disability in to the social mainstream. c. Rehabilitation gap: Despite the government providing aids/appliances to the persons with disability through various schemes, the acceptance is good, but once the aids/appliances has to be either serviced or repaired there is no place to approach. In common places of visit like schools, colleges, hospitals, temples were not disabled friendly and did not have proper access in terms of lift/ramp for persons with disability leading to non use of their aids/appliances.

CONCLUSION:

In the present study the congenital deformities, fractures, post polio residual paralysis and Arthritis are the common causes of disability of which 1/3rd of these disabilities could have been prevented by good immunization and specialized care for Polio and fractures respectively. The needs of the persons with locomotor disability varies as the duration of the disability progresses, like a parent with a child with locomotor disability, their priority is to get their child treated for the disability where as an adult person with locomotor disability his / her priority will be to get rehabilitated either vocationally or socially rather than medically because they might have already learnt to live with their disability.

RECOMMENDATIONS:

• Continued focus immunization against Vaccine preventable diseases • Strengthening referral services from PHC to higher centers for specialized care • CBR as a approach for rehabilitation

• Changing the attitude of people towards PWD
• Strengthening the primary health care system to prevent the people from accessing care from traditional healers especially for conditions like injuries/falls.

REFERENCES
1. Dr. Bupinder Zutshi Disability Status: Case Study of Delhi Metropolitan Region published in Disability India Network vol 6 (4). 2. Disabled persons in India National Sample Survey 58th round (July-December 2002) National Sample Survey Organisation Ministry of Statistics and Programme Implementation Government of India. 3. Ali Baquer, Anjali Sharma Disability – Challenges Vs Responses Extent of Disability in India available at at www.healthlibrary.com accessed on 28/10/2007.

4. Economic and social commission for Asia and the pacific, progress in
implementation for the agenda for action for the Asian and pacific decade of disabled persons, 1993-2002 United nations