About Rehab & AT
Rehabilitation is a health service, and AT provision is a part of rehabilitation
Rehabilitation is care that can help you get back, keep or improve abilities that you need for daily life. It includes physical therapy, occupational therapy, pain treatment and surgery, and includes the provision of assistive products like wheelchairs, walkers and crutches. Assistive technology (AT) refers to assistive products and the related systems and services developed to provide them. We believe that when people with mobility impairments are able to access these services that improve their physical independence, they will be able to fully participate in political, cultural and economic areas of life—and then everyone wins. Communities thrive when every member has a voice and an opportunity to contribute.
And yet, according to the World Health Organization, more than 70 million people globally require wheelchairs for mobility but do not have access to them. Similarly, according to the United Nations, of the more than 270 million people who need physical rehabilitation, up to 50% do not have access to services.
Rehabilitation services are under-resourced and under-regulated, and what services are available often do not utilize evidence-based approaches. Wheelchairs—if they are available at all—are often low quality, unregulated and donated without necessary related services.
Rehabilitation is not a luxury
Rehabilitation helps all those who need it to be as functional as possible. Anybody may need rehabilitation at some point in their lives, but for people with mobility impairments, rehabilitation is a crucial service that can reduce their pain, increase their physical independence and make it possible for them to meaningfully participate in education, work and social life.
Rehabilitation is not a luxury or optional service; on the contrary, rehabilitation is an investment that—by shortening hospital stays or avoiding them in the first place—lowers long term costs for the health system, individuals and society.
Mobility Is Essential
People who need wheelchairs and other mobility-related assistive products have a human right to those products, as protected by multiple international treatises including the Convention on the Rights of Persons with Disabilities and the Convention on the Rights of the Child. Without mobility, people with disabilities (PWD) are less likely to attend school, will have fewer employment opportunities, and have far higher rates of poverty and poor health.
Disability is often associated with poverty, with each exacerbating the other, and that link is pronounced in low- and middle-income countries (LMICs), where assistive products are often not available and typically are not covered by health systems. This forces people to live without the assistive products they need, to divert already limited income from other basic needs to out-of-pocket payments for these products, or to rely on sporadic and unregulated donations. On the other hand, providing wheelchairs that are appropriate, well-
designed and fitted not only enhances personal mobility and health, but also opens up a world of education, work and social life. Rehabilitation and AT are therefore crucial components of effective disability programming, with reverberating impact on a host of other development issues.
The Right Fit Matters
Most wheelchair users spend a minimum of 8-10 hours per day in their chair. A properly fitted wheelchair helps a person feel more comfortable, breathe and eat easier, and interact more with their environment.
Wheelchair users in LMICs frequently rely on donations or charitable services, which often focus on provision of large quantities of hospital-style wheelchairs designed for temporary use. Similar scenarios are common in disaster response programs. These wheelchairs are not adjustable, generally do not come with cushions, and are often not appropriate for the user or their environment. Worse still, a poorly fitted wheelchair can cause secondary health complications like pressure ulcers, or even lead to premature death.
Wheelchairs are not one size fits all. Beyond that, they are more difficult to provide in LMICs than many other health commodities for multiple reasons, including:
- Wide-ranging needs within the population mean providers need to stock multiple types in multiple sizes
- Selecting a wheelchair is a balancing act of individuals’ needs: health vs. social vs. environmental vs. economic vs. occupational needs
- Each product feature comes with trade-offs: durability vs adaptability vs weight vs cost
- User training is needed to prevent misuse or product abandonment
- Product prescription, preparation, fitting and ongoing maintenance/repair requires both clinical knowledge and technical skill: this could be done by one person within one institution, multiple people in one institution, or different steps of the service could be broken up amongst multiple people within multiple institutions
- Service could be provided by a range of personnel types—physical therapists, occupational therapists, community health workers, trained technicians—but is often unregulated
- Multi-step service requires repeat visits that can be challenging in LMIC contexts
- Diversity of products requires centralized product hubs; the more centralized, the higher the transaction costs of each product provided
- There is a policy overlap between the health, social services, and education ministries. AT can and should be centered within the health system, alongside other rehab services. However, it is often funded and provided within the social protection system, while the education system may work to identify those in need of AT (and regulate the education of rehab professionals), so coordination and flexibility amongst various parts of government is crucial.
We’ll need to address all of these challenges in unison if we want to meet the growing global need for wheelchairs and other life-changing AT. By professionalizing physical therapy and other rehab professions, by working hand-in-hand with hospitals and health providers to develop standard modalities of care, and by manufacturing and distributing low-cost, high-quality wheelchairs globally, we’re helping health systems become more inclusive, integrated and dynamic, which will in turn enable people with mobility impairments to fully participate in society.