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Department of Physical Medicine and Rehabilitation, St. John's Medical College Hospital, Bangalore

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Disability statistics and facilities in India

Statistics on locomotor disabilities in India

Estimates of the number of disabled persons in India vary a great deal, depending on the definitions, the source, the methodology and the extent of use of scientific instruments in identifying and measuring the degree of disability.

According to a countrywide study on Disability by the National Sample Survey Organisation (NSSO) conducted in 1991 about 1.9 per cent of the total population of the country, i.e., 16.15 million persons have physical or sensory disabilities which include visual, speech, hearing and locomotor disabilities. There was a slight increase in disability over the previous decade both in terms of absolute numbers and percentage.

In the study locomotor disability was defined as "the loss or lack of normal ability of an individual to move both himself/herself and/or objects from one place to another". It may occur due to:

  • Paralysis of the limb or body

  • Deformity in the limb(s)

  • Loss of limb(s)

  • Dysfunction of joints of the limb(s)

  • Deformity in the body other than that in the limb (e.g. deformity in the spine, or in the neck or dwarfing or stunting)

The study shows that there are 8.9 million cases of locomotor disability in India. Compared to 1981 the prevalence of locomotor disability has shown a substantial increase, although the incidence remains nearly the same.

The 1991, the NSSO study found the following general prevalence and incidence rates for locomotor disability in India:

 

Rural

Urban 

Average (50/50)

Prevalence 

1047

962 

1005 per 100000

Incidence

53

52 

52.5 per 100000/year

The following causes for locomotor disability were identified (in %):

Cause

 Rural

 Urban

Polio

32.8

34.6

Injury other than burns

21.1

22.5

Other illnesses 

11.2 

11.5

Old age 

6.2

4.9

Cerebral Palsy

4.8 

4.3

Leprosy

3.0 

1.9

Stroke

2.9 

4.1

Burns

2.2 

1.5

Medical/surgical intervention

2.2 

3.4

Arthritis

2.0

1.9

Cardio-respiratory diseases

0.4

0.5

Not known 

11.2 

8.9

Total 

100 

100

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Statistics on Spinal Cord Injuries in India

Not much data is available for SCI in India. We can take the incidence rate of the USA, which is 32 injuries per million population , as a lower boundary for the situation in India, where security standards are much lower and most injuries occur by falling down from heights. The highest per capita rate of injury occurs between ages 16-30 and a high percentage of injured are male, which means that in many cases the primary income earner of a family is affected. For those patients and their families it is even more important to achieve the rehabilitation goal of helping to become a resource earner rather than burner.

A small study of SCI patients conducted by the Rehabilitation Research Center in Jaipur has revealed the following causes of SCI in India :

Cause

 Number of cases 

Percentage

Falls 

30

 66%

Road traffic accidents

 8

 18%

Weights falling on back

 7

 15%

Total 

45

 100%

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Current rehabilitation facilities in India

Due to a combination of poverty and absence of a rehabilitation tradition, the field of rehabilitation is very underdeveloped in India. As a general rule for developing countries, the WHO estimates that only 1-2% of patients who need rehabilitation actually has access to it .

In 2001, the Karnataka Health Task Force published a report that highlights this lack of rehabilitation facilities, stating explicitly that there is an "overall lack of emphasis on preventive, promotive and rehabilitative care." Rehabilitation is stated as one of the main goals of the State of Karnataka integrated health policy.

Below we will give an overview of the different actors in providing rehabilitation care in India

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Rehabilitation institutes and PMR departments in hospitals

There are currently only a handful of rehabilitation institutes and PMR departments offering the holistic type of care we defined earlier. The following is a selection of some the most well-known ones in India

  1. CMC Vellore
    CMC Vellore runs a separate Rehabilitation Center for in-patients, focussing on SCI patients. Six beds are also available for rehab in the general hospital, but these are not included in the below statistics. Out-patients also are treated in the general hospital only, and not in the rehabilitation center. 

  2. Shanta Memorial Rehabilitation Center, New Delhi Bhubanashwar

  3. Institute for the Physically Handicapped - IPH - New Delhi

  4. National Institute of Rehabilitation, Cuttack, Orissa - NIRTAR

  5. National Institute of Orthopaedically Handicapped, Calcutta - NIOH

  6. All India Institute of Physical Medicine & Rehabilitation, Mumbai - AIIPMR - (Central Government Hospital)

  7. Sanjay Gandhi Hospital, Bangalore

Establishing the definite number of such institutes in the whole of India is made difficult by the fact that many hospitals will state they have a PMR department, whereas actually the facilities are limited to a physiotherapy section. Nonetheless, we feel it is safe to say that there are no more than 25 proper rehabilitation institutes for the whole population of India. This is in shrill contrast with the situation in Europe, where there are around 2 such institutes per million inhabitants. Following this line of reasoning, India would need to have some 2,000 rehabilitation institutes to bring its care on the same level as Europe.

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The Voluntary Sector

There are around 1600 voluntary organisations serving people with disabilities in India. They have a variety of missions such as raising awareness, lobbying, networking, research, vocational training and also rehabilitation. Some non-governmental organisations (NGO's) are engaged in Community Based Rehabilitation (CBR) programmes. While all of these NGO's are fulfilling important roles in elements of the rehabilitation process, it is safe to say that none of them constitutes a replacement for the kind of care Institute Based Rehabilitation (IBR) can offer. NGO's recognise this need for institutional based rehabilitation for the severely disabled persons before they can go back into their communities. Developing a system of referrals should be considered part and parcel of CBR programmes. An institution based rehabilitation centre can complement CBR initiatives in the following ways:

  • It can serve as a referral centre for orthopaedic evaluation, advice and surgery

  • It can provide orthopaedic and rehabilitation equipment which is too complicated to be made at the village level

  • The rehab-specialists can make periodic visits to village rehabilitation centres to evaluate possible surgical needs of selected [patients]

  • The rehab staff (medical and paramedical) can make short teaching visits to teach and advise the village team

  • The rehab centre can provide apprenticeship opportunities for local rehab workers

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Government Programmes

The Ministry of Welfare, Government of India launched the District Rehabilitation Scheme in 1985 in order to provide comprehensive rehabilitation services to the rural disabled. The aims of the District Rehabilitation Centres (DRC's) include surveys, prevention, and medical intervention, fitting of appliances, therapy and education. In 1997 eleven DRCs were functioning in ten States in India.

The government also runs numerous Communication Health Centres all over India. Often specialists on disabilities (PMR doctors, physiotherapists, and occupational therapists) visit these centres in regular intervals (e.g. every 2 months) to do an assessment of cases and refer the patients to specialised government or private hospitals. In Bangalore this process is mainly used in the urban slum areas rather than in the rural areas around Bangalore.

There are a few regional training and information centres run by the Government of India, but none of them is in the greater Bangalore area.

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Training Institutions for PMR

The Rehabilitation Council of India (RCI), New Delhi, was set up in 1986. It has been playing an important role in ensuring the quality of services in the crucial area of manpower development and in enforcing uniform standards in training professionals in the field of rehabilitation for the disabled. To conduct recognised training programmes, the Council has identified 91 institutions in the country.

Vocational Training Institutions

The Government of India has established 17 Vocational Training Centres in the country, which are mostly located in State Capitals. These centres are supposed to assess, train and find jobs for disabled people. Vocational training is also offered by many NGO's, e.g. Action Aid and some hospitals.

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For more information contact:
The Department of Physical Medicine and Rehabilitation
St. John's Medical College and Hospital, Bangalore - 560034
Phone: +91-(0)80-2206 5256   Fax: +91-(0)80-2553 0070

Disclaimer:
This website is still in the process of being constructed and hence may contain some factual/ technical errors. Please notify us if you find any.