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| REVIEW ARTICLE |
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| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 111-114 |
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Historical perspectives in prosthetics and orthotics area for rehabilitation of persons with locomotors disabilities from independence to current scenario
Gouri RajendraKumar Chechani1, Rajendra Kumar Chechani2
1 Department of Prosthetic and Orthotic, Sumandeep Vidyapith Deemed to be University, Vadodara, Gujarat, India
2 Prosthetic and Orthotic Section, Composite Regional Center for Skill Development Rehabilitation and Empowerment of PwDs(d), G.I.D.C., Ahmedabad, Gujarat, India
| Date of Submission | 30-Dec-2022 |
| Date of Decision | 07-Jan-2023 |
| Date of Acceptance | 16-Jan-2023 |
| Date of Web Publication | 16-May-2023 |
Correspondence Address:
Dr. Rajendra Kumar Chechani
Prosthetic and Orthotic Section, Composite Regional Center for Skill Development Rehabilitation and Empowerment of PwDs(d), G.I.D.C., Odhav, Ahmedabad, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jihs.jihs_26_22
History of prostheses in India is very ancient from Rigveda, the Asvini brothers (vedic gods of healing and medicine) replaced Vispala's (horse of Prince Khela) broken leg with an artificial one. As years passes, many more evidence of uses of artificial limb came into existence. The purpose of this review is to show the evolutional era of prosthetics and orthotics in India as we are celebrating India's Azadi ka Amrit Mahotsav, 75 years of Independence. How work has been done to serve the Divyangjan's in their community level under the Indian government's flagship schemes, with the help of different national institutions, regional centers, nongovernment organizations, and many more. Along with the development of institutions and organizations, technology also developed the devices at that much level that one can trust these prosthetic and orthotic devices and live independently. Not only that, people are actively taking part in sports and recreations and participating in the paralympics and making India proud.
Keywords: Institutions, organization, prosthetic and orthotic, schemes
How to cite this article:
Chechani GR, Chechani RK. Historical perspectives in prosthetics and orthotics area for rehabilitation of persons with locomotors disabilities from independence to current scenario. J Integr Health Sci 2022;10:111-4 |
How to cite this URL:
Chechani GR, Chechani RK. Historical perspectives in prosthetics and orthotics area for rehabilitation of persons with locomotors disabilities from independence to current scenario. J Integr Health Sci [serial online] 2022 [cited 2023 Jun 2];10:111-4. Available from: https://www.jihs.in/text.asp?2022/10/2/111/377151 |
| Introduction | |  |
Historical perspective refers to understanding a subject in light of its earliest phases and subsequent evolution.[1] Taking a historical perspective means understanding the social, cultural, intellectual, and emotional settings that shaped people's lives and actions in the past. Indeed, taking a historical perspective demands comprehension of the vast differences between us in the present and those in the past.[2]
Prosthesis is an artificially made limb or part that is used to replace a part of the body that is missing, either due to amputation or lack of development.[3] These devices make it possible for individuals to regain function in place of their missing limb. In humans, the loss of hand function and/or locomotion means a tragic disaster, it is also the same for animals too.
An orthosis is a device used to correct, support, accommodate, and prevent deformity or used to enhance the use of a body part. A body part may not necessarily be removed from the body as a whole but has lost its function. Orthotics are most typically used for individuals who have difficulties with functioning with arms or legs due to deficiencies or deformities. For example, a spinal orthosis would help someone with a degrading spine due to scoliosis – almost like a spinal/back brace.[3]
According to the WHO, prostheses and orthoses are externally applied devices and products used to assist people with physical impairments or functional limitations, to improve their functioning, and increase their potential to live healthy, productive, independent, and dignified lives.[4] A prosthesis is an externally applied device used to replace wholly or partly an absent or deficient limb segment (arm or leg). Common examples are artificial legs and arms. An orthosis is an externally applied device used to support or modify the structural and functional characteristics of the neuromuscular and skeletal systems (such as arms, legs, and the spine). Common examples are braces, splints, and supports. Prostheses and orthoses have various purposes, including improving the mobility, dexterity, or functioning of the user, alleviating pain, restoring cosmesis, protecting joints, preventing and correcting deformities and preventing secondary impairments. Most prostheses and orthoses are required for long-term use and others for limited periods. Prosthetic and orthotic (P and O) products also include mobility devices, which are wheelchairs and walking aids such as different types of crutches and walking frames.
Prosthetics and orthotics services are part of health-care and are often included in rehabilitation services. Like other health-care services, their aim is to optimize users' health and well-being. The interventions are usually part of the health-care continuum, such as providing therapeutic or protective footwear in the treatment of a diabetic or neuropathic foot, fitting prosthesis after amputation, or provision of an orthosis to support a paralyzed limb after a stroke. Timely prosthetics and orthotics service provision is important to restore functioning and to prevent secondary deformities. Along with other interventions, e.g., as education, skill trainings, job coaching, placement, and social support; prosthetics–orthotics and rehabilitation services also contribute towards the overall aim of optimal functioning for PwD's, hence full participation and inclusion in society is required. All interventions are important to achieve this goal to empower a person with disabilities (PWD)/Divyangjan.
| Indication for Prosthetic and Orthotic | | |
Users of prosthetics and orthotics services are people in all walks of life who have physical impairments or functional limitations, due to, for example:
- Noncommunicable diseases, such as diabetes, stroke, cancer, and peripheral vascular disease
- Communicable diseases, such as tuberculosis, poliomyelitis, and Buruli ulcers
- Injuries due to falls, road traffic and industrial accidents, natural disasters, war, and conflicts
- Degenerative changes in the spine, hip, knee, foot, ankle, or upper limbs
- Congenital anomalies or limb deficiencies
- Cerebral palsy.
| Era of Prosthetic and Orthotic | | |
Independence to 1980
Although today P and O became a huge rehabilitation service in India, like other fields, it also has a growing history. Very few organizations were working for the rehabilitation of the Physically Handicapped in India before independence, such as the Army Limb Centre at Pune, which was working for army-injured people. After that, a pilot project was established for PWD (especially locomotor disabled) and The All India Institute of Physical Medicine and Rehabilitation, established in 1955, as the apex Institute in the field of Physical Medicine Rehabilitation under the Ministry of Health and Family Welfare, Government of India, with technical expertise and workforce support from the United Nations Organization.[5]
During the Indo-Pakistani wars, there was a large scale of casualties in military personnel and civilians resulting in an increase of disabled. To rehabilitate physically disabled civilians, the Artificial Limbs Manufacturing Corporation of India (ALIMCO), enterprises was established at Kanpur in 1972 with the help of experienced army professionals who worked in Artificial Limb Centre Pune.[6]
A unit of workforce development was created in the name of the Directorate of Artificial Limb Fitting Centre and started in Safdarjung Hospital, New Delhi, in March 1974. This was shifted to Olatpur in November 1975 and was functioning under ALIMCO till 1984. The institute was separated from the ALIMCO on February 22, 1984, and made an autonomous body under the direct control of the Ministry of Welfare, Government of India, and changed its name to National Institute of Rehabilitation Training and Research and subsequently to Swami Vivekanand National Institute of Rehabilitation Training and Research in the year of 2004.[7]
Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities was established as a nongovernment organization (NGO) in 1960 by the society of crippled and handicapped and it was converted into an autonomous body in the year 1976. It was renamed as Pt. Deendayal Upadhyaya Institute for the Physically Handicapped in 2002 and subsequently to Pt. Deendayal Upadhyaya National Institute for Persons with Physical Disabilities (Divyangjan) in 2016.[8]
National Institute for the Orthopaedically Handicapped, Kolkata, was established as an autonomous body in the year 1978 as an apex institute under the Ministry of Welfare, Government of India at Kolkata, West Bengal, presently known as National Institute for Locomotor Disabilities.[9]
These institutes were making mainly exoskeletal prostheses which were very heavy and unable to change if any modification was required after fabrication.
When other institutions were flourishing, a foot piece named Jaipur foot innovated at Sawai Man Singh Medical College, Jaipur; initiated a revolution in Prosthetic and Orthotic field. Jaipur foot is invented by Dr. P. K. Shetty and his team, it is made of rubber and wooden blocks. It has the quality to walk without wearing a shoe and user can also work in farm (paddy field).
Above-mentioned organization was established for the fabrication of prosthetics and orthotics appliances to needy beneficiaries, but at this time, the prostheses developed and distributed were wooden made prostheses which were very bulky along with no scope to correct it if once fabricated [Figure 1].
1980–2000
The Schemes for the Disabled Persons to Purchase/Fitting of aids and appliances comes operation since 1981. Their main objectives are to assist the needy disabled persons in procuring durable, sophisticated and scientifically manufactured, modern, standard aids and appliances, which can promote their physical, social and psychological rehabilitation by means of reducing the effects of disabilities and enhance their economic potential.[10],[11]
Initially, in this period, the prostheses style was wooden made, but with consulting and collaboration with other organizations some changes have been adopted in the fabrication of prosthetics and orthotics appliances.
Research with fabric materials and low-weight materials was started using in this period.
In India, as the use of prosthetics and orthotics development started, the public was aware of their uses, and they approach to visit foreign countries for the fabrication of these appliances. In this context, the initial entry of multinational companies (MNC) arises for the fabrication of high-tech and modular prosthetic and orthotic appliances [Figure 2] and [Figure 3], for those who can afford by themselves.
From 2000 to till date
In this period, many organizations, along with central government organizations such as apex institutes, ALIMCO, state government, NGOs, and MNC working for persons with locomotor disabilities for the fabrication of high-end prosthetics and orthotics devices. ALIMCO, along with other companies, make a joint venture for making new advance designs for prosthetic and orthotic products at the community level.
Department of Empowerment of PWD (Divyangjan) Ministry of Social Justice and Empowerment, Government of India, established the Composite Regional Centre for Skill Development, rehabilitation and empowerment of PWDs in various states of India under the administrative control of National Institutes with various aims and objectives.
Presently, we can see many advanced prosthetics and orthotics systems came for these PWDs with an affordable price and within their limit, where they can purchase the end products and also can modify the required accordingly.
Currently, starting from the heavy wooden prosthesis to light-weight one, static to movable, conventional to computer controlled, and daily use to highly active sports prosthesis, all are available in India. Nowadays, veterinary prosthetic practices are also coming forward, for animal rehabilitation and pain management.
| Conclusion | | |
Prosthetics and orthotics services have important benefits at various levels. Appropriate provision improves the functioning of people with physical impairment or functional limitations, with increases their mobility and functioning, and helps them stay active and productive.
Access to prosthetics and orthotics services is essential for people with physical limitations or functional limitations not only to achieve mobility and independence but also enjoy their human rights in the same way as others in the community. The convention on the rights of persons with disabilities states that facilitating access to mobility aids, assistive devices, and technology is a state obligation.
Presently, we can see many advanced prosthetics and orthotics systems came for these PWDs with an affordable price and within their limit, where they can purchase the end products and also can modify the required accordingly.
The number of people requiring prosthetics and orthotics services is bound to rise because both the world's population and life expectancy are growing. Hence, presently in India, fabricating prosthetic and orthotic appliances are required for beneficiaries' needs.
Finally, it can be concluded that, what we got from the field of prosthetics and orthotics since independence till today, we have a wide range of options for our PwD's, to get benefit though the Govt. schemes and P & O services to get back to the main-stream of society. Starting from the heavy wooden prosthesis to light weight prosthesis, static to movable one, conventional prosthesis to computer controlled, prosthesis for daily use to highly active sports/ recreational prosthesis [Figure 4] all are available in India with an affordable range and also available nearer to the beneficiaries.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Lawrence BS. Historical perspective: Using the past to study the present. Academy of Management Review 1984;9:307-12.  |
| 2. | Takechi H. History of prostheses and orthoses in Japan. Prosthetics and orthotics international 1992;16:98-103. |
| 3. | Edition P. Prosthetics and orthotics-vocabulary-part 1: General terms for external limb prostheses and external orthoses. ISO; 1989. |
| 4. | World Health Organization. WHO standards for prosthetics & orthotics. Geneva, 2017. |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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