Locomotor Disability

Locomotor disability forms the major proportion of the total disability population in India. As per Current census 2011, locomotor disability constitutes 20.3%among all disabilities. The figure may come down after RPWD Act 2016, as some of the conditions that were coming under locomotor disability identified as separate individual categories like dwarfism, muscular dystrophy, some chronic neurological conditions etc. Locomotor disability includes 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 (b) physical deformities, other than those involving the hand or leg both, regardless of whether the same caused loss or lack of normal movement of body

The conditions may include:- – Paralysis of limb or body, Deformity of limb, Maximum Loss of limb, Amputation – Dysfunction of limb, Deformity of joints of limbs, Deformity of the body other than in limbs eg. Hunch back, deformed spine etc.

Causes of Locomotor disability:-

• Traumatic- RTA, fall from height, domestic violence, natural calamaties, Burn injuries

• Congenital- deformities of hand ,foot, limbs, spine, amputees

• Developemental- Storage disorders, scoliosis, genuvalgum/ varum

• Infective – TB, Leprosy, polio, osteomyelitis

• Inflammatory – RA, Ank spond, psoriasis

• Neoplastic- Osteosarcoma, ewings sarcoma

• Nutritional- ricket, scurvy, osteomalacia, flurosis

• Geriatric – CVA, Cardio respiratory, OA, Osteoporosis, osteomalacia

Dwarfism As per RPWD Act, 2016- “Dwarfism means a medical or genetic condition resulting in an adult height of 4 feet 10 inches (147 centimetres) or less

Types:

• Proportionate- Hormonal, metabolic- GH, Pitutary, Kidney diseases

• Disproportionate- skeletal dysplasias – Achondroplasia – Spondyloepiphyseal dysplasia – Diastrophic dysplasia Associated conditions that adds to their disability:- • Associated limb anomalies • Cleft lip, palate • Spinal canal stenosis • kyphoscoliosis Achodroplasia s forms the major category of dwarfism characterised by- • a large head with a prominent forehead • a flattened bridge of the nose • protruding jaw • crowded and misaligned teeth • forward curvature of the lower spine • bowed legs • flat, short, broad feet • “double-jointedness

Best care and rehabilitation can be provided to the persons with locommotor disability by-  Measures of prevention  Early identification and intervention

Prevention of primary physical impairment:- • To prevent physical impairments arising from avoidable diseases, e.g. by health education, nutrition and immunization. • To prevent physical disabilities resulting from trauma, e.g. by seeking ways to prevent accidents.

Prevention of secondary physical impairment:- To prevent or at least limit the development of physical impairment- by early referral and by prompt & appropriate treatment- by family, physical therapist, orthopedic surgeon and other members of rehabilitation team.

Early Intervention clinics:-Early identification and early intervention is one of the key to success of Rehabilitation. New born to 3yrs of age can be included in early intervention clinic.

Acts for persons with Locomotor disability:–

• RCI Act 1992- Trained teachers to children with disability

• PWD Act- Appropriate environment to children with disability

• Right of children to free & compulsory education Act 2012- Free and compulsory education to children with disability

Major barriers: Global concept to have Barrier free environment for PWDs • Physical barriers – Accessibility • Attitudinal- Education, jobs, full participation • Lack rehabilitative equipment Integrated solutions- • Rehabilitation equipment • Access • Attitudinal changes- society for all

Research:- • Assistive technology • Stem cell • Ambulatory devices • Genetic studies • Molecular and cell biology and basic science

Developments of technologies that can help persons with locomotor disability to work more effectively in a competitive environment- • Prosthetic controlled by muscle activities • 3D printed prosthetic • Modular prosthetic limb • 3D printed wheelchair • Smartphone-controlled bionic prosthetic, • Crutches having joints New technologies such as 4D technology and brain-computer interface (BCI) will emerge and potentially be a game-changer for the PwDs in India Brain implant is one of the most critical milestones achieved in term of technology and is likely to impact locomotor disability sector in India between 5–20 years. It can help people with locomotor disability to regain the movement of their paralyzed limbs. This technology is in a nascent stage

By; Dr. P K Sahu, HoD, Dept of PMR, SVNIRTAR, Cuttack.