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Improved Prosthetics For Landmine Survivors

Field-Testing of Innovative New Technology Underway

The CIR’s Engineering Center is currently wrapping up a field study in Nicaragua that evaluates the efficacy of three new alignment systems for the fitting of transtibial (below-knee) prostheses.  The CIR independently developed and tested one of the new systems; the other two were initially developed in collaboration with the Prosthetic Research Study of Seattle, WA and later refined by the CIR.

The purpose of the research is to devise a cost-effective and portable system for making well-aligned, comfortable single-unit prostheses called monolimbs.  While the new alignment system will be used in clinics, the main goal of the research is to develop a system that will improve the quality and availability of prosthetic outreach services in underserved areas.  Each of the systems can be carried by backpack, enabling prosthetists to visit remote areas, cast patients and capture their alignment measurements, fabricate the prostheses at a central facility and then deliver the prostheses to the patients on a subsequent trip.  The field study, which follows successful clinical trials in Chicago, will determine which of the CIR’s three alignment systems produces the most functional and well-aligned monolimb.

The study began in September of 2005, when a research team composed of CIR staff members Kim Reisinger, Ph.D., Hector Casanova, CP and graduate student Celene Moorer traveled to the Managua-based rehabilitation center CENAPRORTO to conduct a four-day training workshop for the prosthetic technicians involved in the study. The hands-on training covered casting, use of the three alignment systems, fabrication of monolimb prostheses and alignment evaluation.

During the following months, the study subjects (all unilateral transtibial amputees) visited CENAPRORTO several times.  On the initial visit, the researchers captured the subjects’ alignment with each of the three alignment systems to fabricate three customized monolimbs.  The subjects then wore each of their monolimbs for one month, during which time they used a diary to keep track of their activities and comfort level.  The prosthetists assessed the subjects’ gait with each of their three monolimbs during their initial and subsequent visits.

Initial feedback from the field has been positive. Two of the three prosthetists trained for this study have adopted the special casting technique for all of their patients because it allows them to use the cast as a check socket. Additionally, the director of CENAPRORTO is interested in adopting one or more of the systems for monolimb fabrication as an alternative prosthetic solution.

The researchers are now analyzing the study data to determine which alignment system produces the most functional monolimb.  Using a variety of measurements, they are assessing the effectiveness of each system’s alignment capture capabilities and evaluating how well the alignment measurements are maintained during the fabrication process.  Additionally, they are using observations from the clinical gait evaluation to examine the fit and function of the monolimb prostheses as perceived by both the subjects and prosthetists.  The researchers are also recording the subjects’ overall impressions of each monolimb and reviewing their diaries to learn what types of activities they were able to perform while wearing each monolimb. Finally, efforts are underway to evaluate the training modules and practical demonstrations that were used to train the prosthetists involved in the study.

After completing their analysis, the research team will be able to determine which system produces the best-aligned monolimbs. Further refinements and adjustments to the system(s) will be made based on feedback from the prosthetists and study participants.

Read more on alignment techniques and the Nicaragua field study

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Setting The Standard

The Development of International Guidelines for Wheelchair Provision

Due to pervasive poverty, most people in developing countries who are in need of wheelchairs do not have access to them.  Since the 1980s, much progress has been made in raising awareness of the widespread need for wheelchairs and in creating programs to provide them. However, many distribution programs fail to consider the environment in which the recipients live, and in many cases do not properly fit the wheelchairs to the individual users.  Additionally, many wheelchair distribution programs do not provide for user training or ongoing service provision 

Users in developing and post-conflict countries require sturdy wheelchairs that can navigate rocky roads and uneven terrain.  Hospital-style and secondhand wheelchairs cannot handle the environmental demands found in these areas and rarely accommodate the individual user appropriately. Although such wheelchairs are donated with the best of intentions, an improperly fitting chair can lead to pressure sores and other serious medical complications.  Wheelchairs that are not engineered to withstand challenging environmental conditions quickly break down, and without trained local technicians to repair them, become useless and are discarded.

Many experts believe that in order to remedy these problems, wheelchair provision must be re-envisioned as a process that accounts for the complexity of user needs, product range and characteristics, and the importance of training and education.  Therefore, the Center for International Rehabilitation (Chicago), Whirlwind Wheelchair International (San Francisco) and Motivation Charitable Trust (Bristol, UK) have formed a committee to develop a set of international guidelines for wheelchair provision.  The guidelines will cover product design, testing and manufacture; wheelchair services; and training for consumers and technicial and clinical wheelchair practitioners.

By establishing guidelines, members of the committee hope to increase access to appropriate wheelchairs and improve the quality of life of wheelchair users.  The guidelines will enable wheelchair providers to use an objective standard for the selection of appropriate wheelchairs, leading to more professional, comprehensive and effective wheelchair service.  The new guidelines will give first priority to the needs of the wheelchair user.  The application of these guidelines should serve to improve wheelchair quality and the training of wheelchair practitioners and consumers, as well as increasing the involvement of the individual users. For policy makers, donors, advocates and others wishing to support wheelchair provision, the guidelines will provide assurance that the wheelchairs they provide meet user needs and are an effective use of donor dollars.

Members of the wheelchair committee are currently completing work on a draft of the guidelines. This fall, the committee will meet with the World Health Organization (WHO) to review the draft before presenting it at the Wheelchair Consensus Meeting in India in November. After the guidelines have been approved and published by WHO, they will be presented at the ISPO World Congress in 2007.
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Bosnian Students Receive Prestigious ISPO Certification

In January of 2006, the International Society for Prosthetics and Orthotics (ISPO), a leading certification body, awarded Category II certification to 17 graduates of the CIR’s distance education program in Bosnia.   This marked the first time that students in Bosnia have received ISPO certification.

The CIR’s distance education program is designed to train local prosthetic technicians in countries that are recovering from conflict, where there is an urgent and ongoing need for qualified rehabilitation service professionals. This high-tech, low bandwidth e-learning program teaches practicing prosthetic technicians sound fundamentals for manufacturing and fitting artificial limbs.  The program uses a blended learning format that supplements online content modules, quizzes and discussions with printed materials and face-to-face workshops. The courses were developed in conjunction with the renowned Northwestern University Prosthetics and Orthotics Center (NUPOC). 

Since 2001, the CIR distance learning program in prosthetics has been delivered to over 70 students from 30 rehabilitation centers in 6 countries. These centers treat an estimated 8,600 war wounded and other amputees each year. 
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CIR And Rotary To Provide Improved Casting Systems

In the fall of 2006, the CIR will conduct a training workshop in India for rehabilitation professionals from Pakistan and India. Workshop participants will receive training on the CIR-Wu Prosthetic Casting System, developed by CIR Research Director Dr. Yeongchi Wu. The system offers a faster, cheaper and more effective method of creating prosthetic sockets. After the training, each participant will receive a casting system for use in his or her home clinic. The CIR has also disseminated its casting system to rehabilitation centers and schools in Tanzania, Vietnam, Bosnia & Herzegovina, Nicaragua, El Salvador, Guatemala, Honduras, Haiti and the Dominican Republic.

The workshop will be delivered with financial support from the Rotary Club of Johnstown, Pennsylvania and the Rotary Foundation.  The steering committee for the workshop is comprised of a distinguished group of representatives from the World Health Organization, Mobility India, the India chapter of the International Society of Prosthetics and Orthotics and Indian rehabilitation service provider Bhagwan Mahaveer Viklang Sahayata Samiti, as well as CIR and Rotary staff.
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CIR Wheelchair Study Collects User Feedback

The CIR’s Engineering Center has launched a study to examine the use of the CIR-Whirlwind Wheelchair in Afghanistan.  The goal of the study, which follows last year’s successful research on the wheelchair, is to gain additional feedback on long-term durability and overall user satisfaction levels.  In-country project manager Qaseem Wardak is currently conducting interviews with the 100 subjects involved in the study. Feedback will be used to evaluate the wheelchair’s design. A paper on the initial study will be published in the summer issue of Disability and Rehabilitation.
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Ensuring No One Left Behind

CIR Urges Inclusion of People with Disabilities in Emergency Planning and Response

On December 26, 2004, the most powerful earthquake in over 40 years struck deep beneath the Indian Ocean.  The earthquake triggered massive tsunamis that obliterated the coastline, killing tens of thousands of people in a dozen countries. As the region moves forward with reconstruction and recovery, efforts are also underway to secure ongoing relief assistance and to develop early-warning systems and emergency response strategies to mitigate the impact of any future disasters. 

The impact of the tsunami has been especially harsh for people with disabilities, who have been largely excluded from the relief and reconstruction plans. The CIR’s 2005 report Disability and Early Tsunami Relief Efforts in India, Indonesia and Thailand documents the exclusion of people with disabilities from the relief and reconstruction efforts that followed the tsunami. The report reveals that non-governmental organizations and other relief agencies have neglected to discuss the needs of people with disabilities at the majority of organizing and coordinating meetings.  At the few meetings in which disability was discussed, little concrete action occurred.  An analysis of the post-tsunami recovery effort in South Asia indicates that one of the obstacles to the inclusion of people with disabilities is the overall lack of disability awareness and relevant expertise at both local and international levels. 

The CIR has taken a lead role in advocating for the inclusion of people with disabilities in emergency planning and response, both in the tsunami-affected countries and worldwide.  On February 12, 2006, CIR representative Anne Hayes participated in a teleconference with United Nations (UN) country delegates and representatives from the UN Development Program, the UN Office for Coordination and Humanitarian Affairs and other non-governmental organizations at the Roundtable on the Tsunami and Aging in New York.  The meeting, which was jointly hosted by Global Action for Aging and Help Age, provided a forum for Ms. Hayes to present the findings of the CIR’s 2005 report on tsunami relief efforts.  Ms. Hayes urged representatives to include people with disabilities in emergency planning, response and reconstruction.  In response, the UN delegate from Thailand pledged to make an effort to ensure that accessibility issues would be taken into account during reconstruction. 

The CIR has also joined with Drexel University’s National Bioterrorism Civilian Medical Response Center (CIMERC) to advocate for the inclusion of people with disabilities in emergency planning in other cities and countries.  CIMERC has developed an online tool called Strategies for Incident Preparedness: A National Model (SIP) that contains a series of questions designed to guide hospitals and health systems in creating emergency response plans for complex disaster situations.  Initially developed for use in the United States, SIP was later revised to apply to potential disaster scenarios in Argentina and Mexico.

The CIR has reviewed SIP and has been working extensively with CIMERC to ensure that the tool addresses the needs of people with disabilities.   For example, the CIR recommended the addition of questions that would prompt planners to develop strategies for communicating with individuals with hearing impairments and to account for the handling and decontamination of service animals.  The CIR also arranged for internationally recognized disability consultant Maria Eugenia Antunez to assist with CIMERC’s project in Mexico.  Ms. Antunez met with hospitals and first responders in the states of Chiapas, Jalisco and Tabasco and participated in a final national consensus meeting where she helped guide the use of SIP for Mexico.  During this meeting, Mexico’s Subsecretary of Health emphasized the importance of including people with disabilities in disaster planning and of replicating this exercise in other states within Mexico.  The CIR plans to release a report summarizing its activities with CIMERC and the international applications of SIP.

While numerous cities and countries still have disaster plans that do not include people with disabilities, many international officials have been receptive to the CIR’s efforts to rectify this dangerous problem.  Raising awareness and developing preparation tools are crucial steps towards ensuring that people with disabilities are fully included in disaster relief measures, and the CIR will continue to push for progress in this area.
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CIR Initiates ConventionYES! Campaign

Fighting for Human Rights Protections

The CIR has launched ConventionYES!, a campaign designed to disseminate information and coordinate advocacy efforts in support of the signing and ratification of the United Nations Convention on the Rights of Persons with Disabilities.  The ratification of this historic convention would be a crucial step towards protecting the human rights of all persons and would bring international attention and legitimacy to the disability rights movement.  The ConventionYES! website provides resources to support the adoption of the Convention, including an online petition, letter writing campaigns, virtual art gallery, news updates and action alerts.  Please visit www.conventionyes.org to learn more about this important initiative.

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International Disability Rights Monitor Project Begins Research For European Report

In January of 2006, the International Disability Rights Monitor (IDRM) project began work on a new volume in its series of regional reports.  IDRM: Regional Report of Europe follows the IDRM’s regional reports on Asia (2005) and the Americas (2004).  

The mission of the CIR’s IDRM project is to promote the full inclusion and participation of people with disabilities and to advance the use of international humanitarian law in ensuring that the rights of people with disabilities are protected.  Founded by Dr. William Kennedy Smith in 2003, the IDRM project relies on a grassroots network of researchers in more than 30 countries worldwide. Through this network, the project documents and assesses the conditions of people with disabilities and the ongoing human rights violations that are a part of their daily lives.
IDRM: Regional Report of Europe will be released in 2007 and will cover Bulgaria, Estonia, Finland, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Russia, Serbia & Montenegro, Spain, Turkey and the United Kingdom.  Country reports will be compiled by local researchers, most of whom are members of the disability community.  Before beginning their reports, the researchers will participate in an online orientation and training program to introduce them to IDRM methodology and research standards.

The IDRM European report is being produced in partnership with the European Disability Forum, the ONCE Foundation for Cooperation and Social Integration of People with Disabilities (ONCE Foundation) and Handicap International (HI), with financial support from the Center for Disease Control, the ONCE Foundation, HI and the Italian National Council on Disability.
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Historic Negotiations On Disability Rights At The United Nations

7th Ad Hoc Committee Meeting Conducts Full Reading of Draft Convention Text

In 2001, the United Nations (UN) General Assembly formed an Ad Hoc Committee to negotiate a Convention on the Rights of Persons with Disabilities, with the objective of securing equal human rights protections under international law for people with disabilities. Since 2002, the Ad Hoc Committee has convened seven sessions and has written a draft text that enumerates a wide range of rights protections for people with disabilities. 

The 7th Ad Hoc Committee Meeting convened January 16, 2006 at UN Headquarters in New York.  Approximately 100 government delegates, as well as numerous non-governmental organizations led by the International Disability Caucus (IDC), attended the session.  The Office of the High Commissioner for Human Rights and other intergovernmental agencies, such as the United Nations Educational, Scientific and Cultural Organization and the International Labor Organization, were also in attendance.

The objective of the meeting was to complete a full review of the draft Convention in order to determine which articles required further negotiation.  During the meeting, the participants reached general agreement on the majority of the articles, including those on equality and non-discrimination; measures to promote disability awareness; accessibility; access to justice; legal capacity;  liberty and security of the person; freedom from torture and inhumane treatment; liberty of movement; community and independent living; respect for privacy and family; health, rehabilitation and habilitation; statistics; and participation in political and cultural life, leisure and sports.  At the end of the meeting, Ad Hoc Committee Chair Ambassador Don Mackay of New Zealand compiled and distributed a new text reflecting the general consensus of the 7th Session; this text will serve as the basis for future discussion and negotiation.

The Committee’s intensive efforts were extremely fruitful, although some outstanding issues remain.  During the upcoming 8th session, participants must decide upon a concrete definition of “communication” and settle on several key terms, including “disability” or “person with a disability,” and “universal design” or “inclusive design.”  The Committee must also decide whether separate articles to protect the rights of women and children with disabilities are warranted, or if the rights of women and children should be part of a general provision in article 4 (General Obligations), with gender- and age- specific references included in relevant articles.

The Chair has defined two issues as controversial: the scope of the measures to safeguard the decision-making process of people with disabilities and the reference to sexual and reproductive health services.  These topics will require substantial debate during the 8th session.  Additionally, the issue of international monitoring was not outlined in the draft text, and therefore must be discussed informally among UN delegates in preparation for formal negotiations during the next session.

The Ad Hoc Committee will resume its work from August 14 through 25, 2006.  The objective of the 8th session is to resolve the remaining issues and create a final draft of the Convention.  Many UN delegates, including the Committee Chair, hope that the Convention will be ready for signing in the fall of 2006. 
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CIR Launches New Online Community

IDEAnet to Offer New Tools and Content

The CIR has launched a new interactive website designed to enable collaboration among individuals and institutions from around the world who are working on issues of importance to people with disabilities.  The website, called IDEAnet, is divided into two topically based communities: the Rehabilitation Services Community and the Disability Rights Community. 

The Rehabilitation Services Community is dedicated to improving services for people with disabilities through the research, development and distribution of better, more affordable prosthetics, orthotics and wheelchairs and through the delivery of quality education programs for rehabilitation service providers.  Community projects include the development and dissemination of appropriate technologies, such as wheelchairs and artificial limbs, and a Train-the-Trainer program designed to improve the reach and quality of prosthetics training.

The Disability Rights Community is dedicated to promoting and protecting the human rights of people with disabilities by increasing awareness of disability as a human rights issue, building the capacity of grassroots disability organizations and promoting the implementation and monitoring of legal protections.  Community projects include the development of standards for including people with disabilities in emergency response plans and ConventionYES!, a campaign in support of the United Nations Convention on the Rights of Persons with Disabilities.

The IDEAnet website is designed to serve these two communities and to facilitate communication and collaboration within and between them.  Through tools such as discussion forums, chats and document sharing, the IDEAnet website enables community members to share ideas and knowledge, enhance their skills and generate strategies and innovations that will help to improve the situation of persons with disabilities around the globe.  In addition, the flexible structure of the site allows members to collaborate on ongoing projects and, if they wish, start their own.

Please click here to learn more about the benefits of joining IDEAnet and how to become a member.

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