Aids for the disabled and rehabilitation engineering

Introduction

WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH):
3 levels of disablement:

1. Impairment at the organ level - e.g., paralysis, visual loss, amputation, etc. American Spinal Injury Association (ASIA) scores motor impairment in SCI. Visual and auditory tests for evaluating loss.
2. Disability at the person level - Independence in activities of daily living (ADL), functional independence measure (FIM).
3. Handicap at the societal level - Handicap is defined by WHO as “disadvantage for an individual that limits the fulfillment of a role that is normal”. Questionnaires for quantifying handicap, measure the degree to which an individual is an active productive, member of society. (a) Accessibility - how accessible are public and private spaces, (b) accommodation - equipment, services, etc., that enable full participation in activities, (c) social support.

Inappropriate availability of support and services can result in secondary impairments (for lack of adequate medical help), secondary disabilities (for lack of equipment) and secondary handicaps (e.g., insufficient social and legal support). It is important to note perceived health and perceived activity limitations.

Rehabilitation must reduce, minimize and compensate for disability. The Rehabilitation Team: Multidisciplinary effort, trans- or cross- disciplinary training.

Tools for evaluating disability and rehabilitation outcomes

1. Impairment - medical assessment of physiological loss, e.g., ASIA motor scores. Applied at initial admission and discharge, and followed up at years 1,2,5,10,15,20…
2. Disability - Functional Independence Measure. Initial admission and discharge and followed up at years 1,2,5,10,15,20,…
3. Handicap - e.g., Craig Handicap Assessment and Reporting Technique. At years 1,2,5,10,15,20,…
4. Perceived well-being - Life Satisfaction Index, Diener scale. At years 1,2,5,10,15,20,…
5. Health status outcomes - Combination of survival time, days rehospitalised, etc. At years 1,2,5,10,15,20,…

Ethical Issues in Rehabilitation

What to do? How to do it? And when to do it?

• Do no harm
• Maximize potential benefits to the person
• Persons with disabilities are entitled to special protection
• Encourage respect for the person’s human dignity
• Promote shared decision making (with the patient)
• Educating the person affected by the medical decisions

Legal Issues in Rehabilitation

• Informed consent
• Competence to make medical decision
• Right to refuse treatment, right to withdraw from treatment - competent and incompetent patient
• Right to confidentiality

Physiological aspects of rehabilitation

Understanding normal physiology

Primary systems involved in physical disability:

• Limbs
• Peripheral nervous system involved in muscle activation
• Touch and movement sensation, balance
• Spinal cord
• Brain
• Eyes and visual system
• Ears and auditory system
• Bowel and bladder control

Classification of injury

• Trauma:
  • Amputation
  • Spinal cord injury - motor paralysis, loss of sensation, loss of bowel and bladder control
  • Traumatic brain injury - paralysis, sensory loss, cognitive loss
  • Stroke
• Infection:
  • Acute illness resulting in motor and sensory loss - e.g., poliomyelitis, Hansen’s disease (leprosy)
  • Chronic illnesses
• Congenital:
  • Cerebral palsy - class of central motor deficits resulting in varying degrees of motor and sensory loss
  • Muscular dystrophies - genetic origin

Evaluation of disability

• Motor impairment:
  • Muscle strength
  • Reflex testing
  • Motor co-ordination - movement analysis
  • Electrophysiological tests for muscle or nerve damage
• Sensory impairment
• Incontinence
• Cognitive impairment

Rehabilitation Engineering

• Sensory aids - environmental sensor + signal processor + user interface
• Communication and control devices - User interface + signal processor + controller + output to the environment