The Importance of Mobility in Low-Income Countries
By: Renato Delos Reyes, MS, MPO (Master in Prosthetics & Orthotics) D-Rev ReMotion Knee Mobility Program Clinical Consultant*
In the field of prosthetics, it is not unusual to come across stories with unbelievable headlines featuring patients who use technologically advanced prostheses and are able to run, jog, and participate in leisure activities again. While many dictionaries offer the definition of mobility as “the ability to move or be moved freely and easily,” the effect of a lack of mobility stretches far beyond simply being unable to move. Mobility benefits society and economies as a whole.
The importance of mobility is especially relevant in lower-income regions. About 30 million people in Africa, Asia, and Latin America need O&P care, according to statistics cited in the 2011 “World Report on Disability,” co-produced by the World Health Organization (WHO). According to the non-profit organization World Bank, in India in 2013, 50% of people employed work in agriculture.1 The percentage actually increased from the 2012 (47%).1 And this fails to include the multitude of people who work in the service industry, or hospitality who need to be on their feet for hours at a time. To these individuals, mobility is of paramount importance to their survival.
The father, or the eldest male, is the only source of income in many Indian families—especially those living in rural areas and/or abject poverty. Whether the income is from selling wares on the side of the road, pushing and pulling fruit or other goods in a rickshaw, transporting raw materials for construction, or working in the fields, it is difficult work. These are hard-working people. People whose mobility is their livelihood. Mobility is their source of income. An income, which, unfortunately, may not be able to afford the cost of a typical prostheses.
In the United States, most individuals who undergo amputations do so as a result of vascular issues or complications from diabetes, and they often have underlying health issues which may make it difficult to return to a high level of activity. However, as we have learned from our own fieldwork and partnerships abroad, in countries like India the common reasons for amputations differ.
Dr. Pooja Mukul works with patients at Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) in Jaipur, India. BMVSS is a non-governmental organization that provides artificial limbs and other devices free of charge. BMVSS understands the importance of mobility, and feedback from patients at their clinic helped inform prototypes of the ReMotion knee. Dr. Mukul estimates over 70% of the patients she sees lose their legs due to trauma. Her patients are young, strong, and healthy individuals; they should have the ability to continue working and providing for their families. BMVSS estimates they provided 30,000 patients with artificial limbs in 2015. Since 70% of these patients are young and healthy, they still have the ability to contribute to the Indian economy and the workforce.
Recently, researchers conducted a study at Mobility India where patients’ quality of life was measured. The findings, presented at the International Society for Prosthetics and Orthotics meeting in 2013, were “people with disabilities can have a better Quality of Life (QOL) with an orthosis or prosthesis,” leading to empowerment, inclusion and participation.2
The impact of assistive devices such as prostheses has been studied, and in an article from 2009, Johan Borg, Anna Lindström,and Stig Larsson,3 have succinctly described their findings:
“In developing countries, disability is often associated with poverty caused by reduced participation in education, work, and community life. Education and employment contributes to reduction of poverty, improvement of health, and increased participation in society. According to findings from studies in high-income countries, assistive technology can have a positive socioeconomic effect on the lives of people with disabilities by improving access to education and increasing achievement. The use of assistive technology is a successful strategy to help participation in work, and maintenance of health.”
Recently, a patient from Proactive Technical Orthopedics from Pune, India who underwent a transfemoral amputation was fit with a prostheses featuring the ReMotion knee to help him strengthen his residual limb muscles for gait training. In discussing what his goals were, one of the first items he mentioned was his desire to get back to work as a photojournalist. He mentioned how he needed to be on his feet for long stretches of time in order to keep working. He was anxious to receive a prosthesis to help him achieve this goal and get back to work.
The effect of mobility goes far beyond allowing someone to simply walk or move again. Mobility will allow for some independence for those individuals who need their legs to bring some level of stability to their lives, help them get back to work, to continue to provide for their families, and to participate as active members within the economy and society. Bridging the economic gap and helping bring prostheses to individuals in dire need is difficult. But the ReMotion knee from D-Rev is a step in the right direction.
Everyone deserves great design, and everyone deserves mobility.
2https://strathprints.strath.ac.uk/43925/1/ISPO_2013_conference_proceedings.pdf. C. Khasnabis, K. Murray, S. Deans. Impact Of Prosthetics And Orthotics Services On The Quality Of Life (Qol) Of People With Disabilities In India.
3https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)61872-9.pdf. Johan Borg, Anna Lindström, Stig Larsson. Assistive technology in developing countries: national and international responsibilities to implement the Convention on the Rights of Persons with Disabilities.