Abstract
The prevalence of disability is sub-stantially higher in the low-income countries as compared to the high-in-come countries.1 An estimated 80% of the people with disabilities live in the low-income countries, which is more than one billion people with disabili-ties according to the world report on disability.2 Among these persons with disabilities (PWD), 110-190 million have significant disabilities including difficulty in mobility, self-care, communication and participation in education or em-ployment. Neurological disorders like stroke, spinal cord injuries, traumatic and non-traumatic brain diseases and neuro-degenerative diseases are an important cause of disability worldwide. Most of them result in long-term disabilities and residual weaknesses, which adversely affects the mobility and quality of the life of the patients. In addition, long-term management of these often-permanent disabilities is “a huge unmeasured eco-nomic burden and psychological stress on families who take care of their func-tionally dependent relatives.3Neurologic rehabilitation or neurore-habilitation is a dynamic process which helps the patients with neurological disabilities to optimize their physical, cognitive, emotional, and social functions for maximum independence and social reintegration.4,5 Unlike other medical specialties where physician is the sole decision maker, neurorehabilitation is a multi-disciplinary team work. The im-portant members of a neurorehabilitation team include physiatrists (Rehabilitation Medicine physicians), neurologists, phys-ical therapists, occupational therapists, neuropsychologists, speech therapists, nutritionists, and nurses, along with the patient’s caregivers.4 The conditions that are likely to benefit from an multi-disci-plinary neurorehabilitation team include, but are not limited to, stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, Parkinson’s disease, cerebral palsy, motor neuron disease, Gullian Barre syndrome and post-polio syn-drome.Pakistan like many other developing countries is facing the problem of a huge population with an inadequate number of skilled and trained neurorehabilitation specialist.6 Rehabilitation is still confused with physiotherapy instead of being a concept of a multidisciplinary team ap-proach.7 This is further complicated by a sudden and explosive increase in the number of physiotherapy Institutes in the recent years, which are producing a large number of physiotherapists. Majority of the trained rehabilitation medicine physi-cians are working in the Pakistan Armed forces, and thus are inaccessible to most of the PWDs in Pakistan.8 There are less than 20 departments of rehabilitation medicine in the country with 190 million people.8 There is only a single 4 years fellowship program in Rehabilitation medicine being offered by the College of Physicians and Surgeons of Pakistan. There is no accredited neurorehabilita-tion fellowship or sub-specialty training available inside Pakistan.THIS ARTICLE MAY BE CITED AS:Rathore FA, Mansoor SN. Neurore-habilitation in Pakistan: Needs, challenges and opportunities. Khyber Med Univ J 2016; 8(2): 59-60.GUEST EDITORIAL
60NEUROREHABILITATIONINPAKISTAN: NEEDS, CHALLENGESANDOPPORTUNITIESKMUJ 2016, Vol. 8 No. 2training in rehabilitation medicine as career specialty. There is a need to introduce more training programs in the country including memberships program (MCPS) and MD programs in Rehabilitation Medicine.3. Current guidelines for the manage-ment and rehabilitation of common neurological disabilities like stroke, spinal cord injury and cerebral palsy are written and published by the au-thors based in the developed world. Many of them have little relevance to the unique health care structure and limited resources available here. There is a need to develop local guidelines for common neurological disabilities considering the resources and expertise available here.4. Many professional and patient care societies for different neurological diseases are already working in Pa-kistan e.g. Pakistan stroke society, Muscular dystrophy association of Pakistan, Pakistan Parkinson’s society, the Pakistan Society for the Rehabil-itation of the Disabled, Society for Multiple Sclerosis Patients in Pakistan. There is a need of closer coordination and collaboration between these societies.5. There is a need to counter the negative stigma related to disability in Pakistan. There is also a need to increase the awareness regarding the value of improved mobility and enhanced community re-integration despite the presence of disability in PWDs having a neurological disorder.6. Systematic data collection and es-tablishment of national registry on stroke, spinal injuries, cerebral palsy and multiple sclerosis will help in es-timating the true burden of disability and making a strategy accordinglyThe prevalence of disability is sub-stantially higher in the low-income countries as compared to the high-in-come countries.1 An estimated 80% of the people with disabilities live in the low-income countries, which is more than one billion people with disabili-ties according to the world report on disability.2 Among these persons with disabilities (PWD), 110-190 million have significant disabilities including difficulty in mobility, self-care, communication and participation in education or em-ployment. Neurological disorders like stroke, spinal cord injuries, traumatic and non-traumatic brain diseases and neuro-degenerative diseases are an important cause of disability worldwide. Most of them result in long-term disabilities and residual weaknesses, which adversely affects the mobility and quality of the life of the patients. In addition, long-term management of these often-permanent disabilities is “a huge unmeasured eco-nomic burden and psychological stress on families who take care of their func-tionally dependent relatives.3Neurologic rehabilitation or neurore-habilitation is a dynamic process which helps the patients with neurological disabilities to optimize their physical, cognitive, emotional, and social functions for maximum independence and social reintegration.4,5 Unlike other medical specialties where physician is the sole decision maker, neurorehabilitation is a multi-disciplinary team work. The im-portant members of a neurorehabilitation team include physiatrists (Rehabilitation Medicine physicians), neurologists, phys-ical therapists, occupational therapists, neuropsychologists, speech therapists, nutritionists, and nurses, along with the patient’s caregivers.4 The conditions that are likely to benefit from an multi-disci-plinary neurorehabilitation team include, but are not limited to, stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, Parkinson’s disease, cerebral palsy, motor neuron disease, Gullian Barre syndrome and post-polio syn-drome.Pakistan like many other developing countries is facing the problem of a huge population with an inadequate number of skilled and trained neurorehabilitation specialist.6 Rehabilitation is still confused with physiotherapy instead of being a concept of a multidisciplinary team ap-proach.7 This is further complicated by a sudden and explosive increase in the number of physiotherapy Institutes in the recent years, which are producing a large number of physiotherapists. Majority of the trained rehabilitation medicine physi-cians are working in the Pakistan Armed forces, and thus are inaccessible to most of the PWDs in Pakistan.8 There are less than 20 departments of rehabilitation medicine in the country with 190 million people.8 There is only a single 4 years fellowship program in Rehabilitation medicine being offered by the College of Physicians and Surgeons of Pakistan. There is no accredited neurorehabilita-tion fellowship or sub-specialty training available inside Pakistan.THIS ARTICLE MAY BE CITED AS:Rathore FA, Mansoor SN. Neurore-habilitation in Pakistan: Needs, challenges and opportunities. Khyber Med Univ J 2016; 8(2): 59-60.GUEST EDITORIAL
60NEUROREHABILITATIONINPAKISTAN: NEEDS, CHALLENGESANDOPPORTUNITIESKMUJ 2016, Vol. 8 No. 2training in rehabilitation medicine as career specialty. There is a need to introduce more training programs in the country including memberships program (MCPS) and MD programs in Rehabilitation Medicine.3. Current guidelines for the manage-ment and rehabilitation of common neurological disabilities like stroke, spinal cord injury and cerebral palsy are written and published by the au-thors based in the developed world. Many of them have little relevance to the unique health care structure and limited resources available here. There is a need to develop local guidelines for common neurological disabilities considering the resources and expertise available here.4. Many professional and patient care societies for different neurological diseases are already working in Pa-kistan e.g. Pakistan stroke society, Muscular dystrophy association of Pakistan, Pakistan Parkinson’s society, the Pakistan Society for the Rehabil-itation of the Disabled, Society for Multiple Sclerosis Patients in Pakistan. There is a need of closer coordination and collaboration between these societies.5. There is a need to counter the negative stigma related to disability in Pakistan. There is also a need to increase the awareness regarding the value of improved mobility and enhanced community re-integration despite the presence of disability in PWDs having a neurological disorder.6. Systematic data collection and es-tablishment of national registry on stroke, spinal injuries, cerebral palsy and multiple sclerosis will help in es-timating the true burden of disability and making a strategy accordingly
Farooq Azam Rathore, Sahibzada Nasir Mansoor. (2016) NEUROREHABILITATION IN PAKISTAN: NEEDS, CHALLENGES AND OPPORTUNITIES, KHYBER MEDICAL UNIVERSITY JOURNAL, Volume 8, Issue 3.
-
Views
869 -
Downloads
69
