Nepal is a country with varied topography, culture and religious, and have more than 61 ethnic groups and 70 spoken languages.The total population of the country is about 27.8 million. The sample survey on population of disability was conducted first time on 1980s, in Nepal. it shows 3% of population had disability. (National policy and plan of action on disability 2006, ministry of women, children and social welfare) The prevalence of data related to disability is not yet available in a reliable form within the country. As per the WHO, 10% of the populations of developing countries are People with disabilities (PWD) and out of this 24 % are persons with physical disabilities. The national report on census 2011 showed just 1.94% of the populations is disabled.(National population and housing census 2011, Central bureau of Nepal,2012), So lack of coordination and unavailability of proper data is hindering the development of rehabilitation in the country. Geographically the disability is remarkably higher in rural areas (92%) compared to urban areas (8%) (Situation Analysis of Disabled in Nepal. UNICEF. 2001)
The orthotics and prosthetic treatment is not new in neuromuscular and skeletal treatment. Most of the orthopedic or neurological cases needs to assigned rehabilitation for the patient and have to work closely in team. The orthosis is one of the essential measures to treat the orthopedic and neurological patient. Orthosis is an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system” (ISO 8549-1:1989). Similarly prosthetics is the device to replace missing arms and legs is very much important to obtain correct device for full functional outcome in people with disability.
The scope of orthotic treatment is not limited but orthotics and prosthetics service accessibility is difficult in developing countries. The service has taken more charitable than the right based medical and rehab treatment. The knowledge of right process of application of right orthosis and easy availability in the hospital can prevent from unnecessary hassle both to service providers and receiver. The access of qualified professional for the betterment of client is difficulty for almost all of the hospitals. Sometimes the situation is frustrating to access quality and correct prosthetic and orthotic treatment. The orthotic and prosthetic treatment can helps early movement of the patient and enhance the optimum functional level. The orthosis can be used as prophylactic treatment in different injuries, support post-operative treatment and rehabilitation for long period of time. It is to be understood that the treatment should be carried out with qualified professionals.
The direct patient care or clinical service is an important aspect of p and o service, but it is not limited with in it. Formulation of treatment as team members with allied professionals, management and supervision of the centers, Community services, Training and education, research are development, Advocacy are key areas of Prosthetist and Orthotist.
Its scopes in pediatric conditions
The early intervention with help of orthotics helps to preserve functional ability in children and similarly timely intervention with help of prosthetics helps children to adopt physical development in growing stage. Most importantly the prescription should be based upon assessment of need of children including functional evaluation, selection of materials, correct measurement and fitting by certified Prosthetist orthotist and the team. The common condition children need prosthetic and orthotic treatment are Arthrogryposis. Cerebral Palsy, Developmental dysplasia of hip, Muscular Dystrophy, Idiopathic and Neuromuscular Scoliosis, Positional Plagiocephaly, clubfoot, limb deficiency, Trauma, Burns, Spina Bifida, Flat feet, perthe’s disease, genuvalgum, genuvarum, talipes equino varus, etc.
Common Management Options:
Following are various options as per the condition of a child.
- Articulated and Rigid Ankle foot orthosis
- Knee Ankle Foot Orthosis
- Various Spinal braces
- Dennis Brown Splints
- Club feet shoes
- Orthotic insoles
- Pavlick Harness
Services available in Nepal:
The Prosthetics and Orthotics are essential element in musculoskeletal and neurological treatment and rehabilitation. It is unfortunate in Nepal that most of the hospitals do not have this facility. The professionals and stakeholders are seeking attention from National level and support from International society in this regards. Moreover the medical professional does not have knowledge of prosthetics orthotics. So clients are not receiving proper early interventions and those who are getting it need to hassle around as there is lack of qualified professional in the country. The early intervention of orthotic treatment can prevent from worsening impairment and also prevent from long term disability, so this facility should be considered at least inside the regional, central level hospital and specialized hospitals or centers.The professional and clients should be aware about existing services where they can refer their clients. The unprofessional hands on client not only burden the client with excessive cost but the adverse effects can lead to severe impairments. So it is recommended to be aware of the services and centers where qualified professionals are at work.
Author: Amit Ratna Bajracharya;Certified Prosthetist Orthotist (ISPO cat I)
Editor: Deepa Bajracharya, Physiotherpaist
- NASPIR. Strategy Director to Strengthen Physical Rehabilitation (PR) Sector in Nepal. Kathmandu, Nepal, 2012.
- ISPO. Guidelines for Training Personnel in Developing Countries for Prosthetics and Orthotics Services. Scotland United Kingdom, 2005. World Health Organization
- Ron Seymour. Prosthetics and Orthotics; Lower limb and Spinal. Philadelphia USA, 2002, Lippincott Williams & Wilkins
- John B. Redford; MD. Orthotics Etcetera. Baltimore USA, 2008. The William and Wilkins.