Abstract
The prevalence of disability is substantially higher in the low-income
countries as compared to the high-income countries.1
An estimated 80% of
the people with disabilities live in the
low-income countries, which is more
than one billion people with disabilities 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 employment. Neurological disorders like
stroke, spinal cord injuries, traumatic and
non-traumatic brain diseases and neurodegenerative 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 economic burden and psychological stress
on families who take care of their functionally dependent relatives.3
Neurologic rehabilitation or neurorehabilitation 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 important members of a neurorehabilitation
team include physiatrists (Rehabilitation
Medicine physicians), neurologists, physical 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-disciplinary 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 syndrome.
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 approach.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 physicians 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 neurorehabilitation fellowship or sub-specialty training
available inside Pakistan.
THIS ARTICLE MAY BE CITED AS: Rathore FA, Mansoor SN. Neurorehabilitation in Pakistan: Needs, challenges and opportunities. Khyber
Med Univ J 2016; 8(2): 59-60.
GUEST EDITORIAL
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Neurorehabilitation in pakistan: needs, challenges and opportunities
KMUJ 2016, Vol. 8 No. 2
training 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 management and rehabilitation of common
neurological disabilities like stroke,
spinal cord injury and cerebral palsy
are written and published by the authors 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 Pakistan e.g. Pakistan stroke society,
Muscular dystrophy association of
Pakistan, Pakistan Parkinson’s society,
the Pakistan Society for the Rehabilitation 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 establishment of national registry on
stroke, spinal injuries, cerebral palsy
and multiple sclerosis will help in estimating 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 2.
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