Physical Medicine and Rehabilitation in Latin America: Development and Current Status.

Disability disproportionately affects women, older individuals, and ethnic minorities in low-income countries, many of which are located in Latin America. Physical Medicine and Rehabilitation (PM&R) is the medical specialty that manages disability and works on restoring function, and over the past 6 decades has significantly expanded its importance in Latin America. The specialty has developed graduate and postgraduate educational programs, provides services to individuals of all ages in inpatient and outpatient settings, has increased its research productivity, and has become an advocate for patients with disabling conditions, which has resulted in improved access to care for many patients.

Mobility in persons with lower extremity amputations and influencing factors: Using the International Classification of Functioning, Disability and Health to quantify expert views.

BACKGROUND:: International Classification of Function, Health and Disability provides a common framework and universal language for rehabilitation professionals across the globe. OBJECTIVES:: To identify problems in functioning and mobility relevant to persons with lower-limb amputation from an expert's point of view and quantify these problems using the International Classification of Function, Health and Disability. STUDY DESIGN:: Qualitative study using electronic and paper surveys. METHODS:: Electronic or paper survey was done across six countries targeting clinicians involved in pre- and post-amputation care. Meaningful concepts were extracted from the responses and linked to suitable second-level and where applicable third-level International Classification of Function, Health and Disability categories. Categorical frequency analysis was completed for the combined data and for each location. RESULTS:: A total of 183 experts from 6 different countries responded to the survey. A total of 2171 concepts were identified, 82% of which could be linked to a second-level International Classification of Function, Health and Disability category. The categorical frequency analysis revealed that the categories of walking, design and construction of buildings for public and private use and sensation of pain were the most frequently occurring concepts and was similar across the six countries. CONCLUSION:: The International Classification of Function, Health and Disability can be utilised as a common framework for communication among clinicians involved in rehabilitation of persons with lower-limb amputation across the globe. The most important factors that were identified by experts in amputee rehabilitation working in different international locations were similar. CLINICAL RELEVANCE: The challenges faced by the clinicians involved in care of persons with lower extremity amputation vary across different parts of the world. The overarching goal for the clinician irrespective of the location is to improve mobility and quality of life of their clients. The International Classification of Function, Health and Disability provides a common language between the various stakeholders in amputee rehabilitation across the globe.

The use of the International Classification of Functioning, Disability and Health to classify the factors influencing mobility reported by persons with an amputation: An international study.

BACKGROUND: Amputation of lower limb results in limitations in mobility which are amenable to multiple rehabilitation interventions. The challenges faced by the persons with lower limb amputation vary internationally. The International Classification of Functioning, Disability and Health provides a common language to describe the function of persons with lower limb amputation across various countries. OBJECTIVES: This article reports the concepts in mobility important to persons with lower limb amputation across six countries using the International Classification of Functioning, Disability and Health. STUDY DESIGN: Qualitative study using focus groups and individual interviews. METHODS: Focus groups and individual interviews of persons with lower limb amputation were organised across six countries to identify the issues faced by patients with an amputation during and after their amputation, subsequent rehabilitation and on an ongoing basis in their daily life. Meaningful concepts were extracted from the responses and linked to suitable second-level and where applicable third-level International Classification of Functioning, Disability and Health categories. International Classification of Functioning, Disability and Health categorical frequencies were analysed to represent the prevalence and spread of International Classification of Functioning, Disability and Health categories by location. RESULTS: A total of 133 patients were interviewed. A large percentage (93%) of the identified concepts could be matched to International Classification of Functioning, Disability and Health categories for quantitative analysis. CONCLUSION: The important concepts in mobility were similar across different countries. The comprehensiveness of International Classification of Functioning, Disability and Health as a classification system for human function and its universality across the globe is demonstrated by the large proportion of the concepts contained in the interviews from across the study centres that could be matched to International Classification of Functioning, Disability and Health categories. Clinical relevance The activity and participation restrictions faced by a person with lower limb amputation vary internationally and are amenable to multiple rehabilitation interventions. The International Classification of Functioning, Disability and Health may provide a common language to report and quantify the various concepts important to the patient in their rehabilitation journey.

Reflecting on the World Report on Disability: a short report from Argentina.

In 2003, the National Survey of Persons with Disabilities identified 2,176,123 persons (7.1% of the total population of the country) with an impairment that affects some of the most important aspects of everyday life (walking, standing up, sitting down, seeing, hearing, learning, or general behavior). In Argentina, several laws support the rights of persons with disabilities. However, inappropriate implementation of these legislations, particularly in the inland provinces, results in shortage of services, low labor force participation, and poor housing conditions. The number of rehabilitation professionals is not sufficient to satisfy the demand for rehabilitation.

Developing Core Sets for persons following amputation based on the International Classification of Functioning, Disability and Health as a way to specify functioning.

Amputation is a common late stage sequel of peripheral vascular disease and diabetes or a sequel of accidental trauma, civil unrest and landmines. The functional impairments affect many facets of life including but not limited to: Mobility; activities of daily living; body image and sexuality. Classification, measurement and comparison of the consequences of amputations has been impeded by the limited availability of internationally, multiculturally standardized instruments in the amputee setting. The introduction of the International Classification of Functioning, Disability and Health (ICF) by the World Health Assembly in May 2001 provides a globally accepted framework and classification system to describe, assess and compare function and disability. In order to facilitate the use of the ICF in everyday clinical practice and research, ICF core sets have been developed that focus on specific aspects of function typically associated with a particular disability. The objective of this paper is to outline the development process for the ICF core sets for persons following amputation. The ICF core sets are designed to translate the benefits of the ICF into clinical routine. The ICF core sets will be defined at a Consensus conference which will integrate evidence from preparatory studies, namely: (a) a systematic literature review regarding the outcome measures of clinical trails and observational studies, (b) semi-structured patient interviews, (c) international experts participating in an internet-based survey, and (d) cross-sectional, multi-center studies for clinical applicability. To validate the ICF core sets field-testing will follow. Invitation for participation: The development of ICF Core Sets is an inclusive and open process. Anyone who wishes to actively participate in this process is invited to do so.

Rehabilitación del paciente amputado severamente discapacitado / Rehabilitation of the amputated patient severely disabled

El presente trabajo muestra nuestra experiencia de casi 30 años de atención de pacientes amputados, de los que hemos seleccionado aquéllos con patologías concomitantes que aumentan la dificultad de rehabilitación. Esta población se compone de 627 pacientes amputados severamente discapacitados ya que presentan una o más amputaciones combinadas o no con otras patologías crónicas discapacitantes. Las patologías concomitantes fueron neurológicas [hemiplejías, paraplejías, epilepsia, poliomielitis anterior aguda], ortopédicas, vasculares, esplácnicas y otras. Fueron equipados funcionalmente 494 pacientes del total mencionado. El seguimiento máximo llegó a superar los 28 años. Se hacen consideraciones acerca de la necesidad del trabajo en equipo y las características especiales de cada tratamiento. Preconizamos la importancia del apoyo de la sociedad para que estos pacientes puedan integrarse y sentirse útiles nuevamente.

Rehabilitación del paciente amputado severamente discapacitado / Rehabilitation of the amputated patient severely disabled

El presente trabajo muestra nuestra experiencia de casi 30 años de atención de pacientes amputados, de los que hemos seleccionado aquéllos con patologías concomitantes que aumentan la dificultad de rehabilitación. Esta población se compone de 627 pacientes amputados severamente discapacitados ya que presentan una o más amputaciones combinadas o no con otras patologías crónicas discapacitantes. Las patologías concomitantes fueron neurológicas [hemiplejías, paraplejías, epilepsia, poliomielitis anterior aguda], ortopédicas, vasculares, esplácnicas y otras. Fueron equipados funcionalmente 494 pacientes del total mencionado. El seguimiento máximo llegó a superar los 28 años. Se hacen consideraciones acerca de la necesidad del trabajo en equipo y las características especiales de cada tratamiento. Preconizamos la importancia del apoyo de la sociedad para que estos pacientes puedan integrarse y sentirse útiles nuevamente. (AU)_

Rehabilitación del paciente amputado congénito / Rehabilitation of the congenital amputated patient

El presente trabajo de rehabilitación clínica, muestra el accionar de un equipo multidisciplinario, cuya finalidad es la rehabilitación de pacientes con deficiencias congénitas terminales de los miembros [amputados congénitos]. Mostramos la metodología de trabajo seguida, con 295 pacientes, con compromiso de miembros superiores y/o inferiores, atendidos en la unidad de amputados del Instituto Nacional de Rehabilitación Psicofísica entre 1960 y 1986 inclusive. Los resultados obtenidos, satisfactorios, muestran, no obstante, cierto grado de deserción, que nos habla de una mala comprensión social y sanitaria del problema del discapacitado. Preconizamos por lo tanto, la imprescindible necesidad de: trabajo en equipo, derivación precoz, equipamiento temprano por medio de una receta magistral de la prótesis, adecuado entrenamiento en el uso de la misma. Para posibilitar la metodología expuesta, anteriormente, será necesario la amplia difusión de la problemática que nos ocupa.

Rehabilitación del paciente amputado congénito / Rehabilitation of the congenital amputated patient

El presente trabajo de rehabilitación clínica, muestra el accionar de un equipo multidisciplinario, cuya finalidad es la rehabilitación de pacientes con deficiencias congénitas terminales de los miembros [amputados congénitos]. Mostramos la metodología de trabajo seguida, con 295 pacientes, con compromiso de miembros superiores y/o inferiores, atendidos en la unidad de amputados del Instituto Nacional de Rehabilitación Psicofísica entre 1960 y 1986 inclusive. Los resultados obtenidos, satisfactorios, muestran, no obstante, cierto grado de deserción, que nos habla de una mala comprensión social y sanitaria del problema del discapacitado. Preconizamos por lo tanto, la imprescindible necesidad de: trabajo en equipo, derivación precoz, equipamiento temprano por medio de una receta magistral de la prótesis, adecuado entrenamiento en el uso de la misma. Para posibilitar la metodología expuesta, anteriormente, será necesario la amplia difusión de la problemática que nos ocupa. (AU)