Lina Magnusson

Experiences of providing prosthetic and orthotic services in Sierra Leone - the local staff's perspective

In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long civil war. Purpose: The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery in Sierra Leone from the local staff’s perspective. Method: Fifteen prosthetic and orthotic technicians working at all the rehabilitation centres providing prosthetic and orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content analysis. Results: One main theme emerged: sense of inability to deliver high-quality prosthetic and orthotic services. This main theme was generated from eight sub-themes: Desire for professional development; appraisals of work satisfaction and norms; patients neglected by family; limited access to the prosthetic and orthotic services available; problems with materials and machines; low public awareness concerning disabilities; marginalisation in society and low priority on the part of government. Conclusions: The findings illustrated traditional beliefs about the causes of disability and that the public’s attitude needs to change to include and value people with disabilities. Support from international organisations was considered necessary as well as educating more prosthetic and orthotic staff to a higher level. Implications for Rehabilitation There is a need for educating more prosthetic and orthotic staff to a category I or II level in Sierra Leone. There is a need to put a greater focus on making materials available for the fabrication of prosthetic and orthotic devices and also on the transport for patients as to increase access to prosthetic and orthotic services. At the societal level, both traditional beliefs about the causes of disability and the public attitudes need to change to include and assign value to people with disabilities. Support from international organisations is needed to provide effective rehabilitation services.

Experiences of attitudes in Sierra Leone from the perspective of people with poliomyelitis and amputations using orthotics and prosthetics

Abstract Purpose: The aim of this study was to describe experiences of attitudes in the society of Sierra Leone from the perspective of individuals with poliomyelitis and people with amputations using orthotic or prosthetic devices. Methods: Individual interviews were conducted using open-ended questions. Twelve participants with amputations or polio were included. Content analysis was applied to the data. Results: The following six themes emerged during data analysis: Experience of negative attitudes; Neglected and respected by family; Traditional beliefs; The importance of assistive devices; People with disability struggle with poverty; and The need for governmental and international support. Conclusions: In Sierra Leone, people with disabilities face severe discrimination. They need to be included, recognized, and supported to a greater extent by the society, the community, and the family, as well as by the government and international organizations. Traditional beliefs have a negative impact on people with physical disabilities and are an important cause of discrimination in Sierra Leone. Prosthetic and orthotic devices are vital for people with physical disability and offer increased dignity. Prosthetic and orthotic services need to be accessible and affordable. Poverty affects access to education, employment, and health care for Sierra Leoneans with physical disabilities, forcing them to resort to begging to cover basic living needs. Implications for Rehabilitation In Sierra Leone, traditional beliefs related to disability and public attitudes need to change in order to protect the human rights of people with disabilities. Increased public awareness of disability and implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) at different levels in society is needed. To increase access to prosthetic and orthotic services in Sierra Leone, these services need to be affordable and related costs, such as transport, need to be covered by support. Increased access to education, employment, and financial support could contribute to an improved standard of living for people with physical disabilities. Governmental and international support is needed to decrease attitudinal and environmental barriers for people with disabilities in Sierra Leone.

Graduates’ perceptions of education at the Tanzania Training Centre for Orthopaedic Technologists and their profession

This is the dataset linked to: Tang, Jing et al (2015) Use of gait lab 3D motion capture for dynamic assessment of amputee socket interface biomechanics – a preliminary study. Prosthetics and Orthotics International, 39, (1), supplement 2-608, 257. doi:10.1177/0309364615591101).Background: Sierra Leone is a low income country in West Africa that has a history of conflict. Sierra Leone have signed and ratified the Convention of Rights of Persons with Disabilities. Aim: To evaluate persons with disability that use prosthetic and orthotic assistive devices access to human rights. The addressed areas were; right to health, right to a standard of living adequate for health, right to vote, right to marry and found a family, right to education, right to work and. A further aim was to compare groups of participants regarding gender, area of residence, income and type and level of device. Methods: Questionnaires were used to collect self-reported data from 139 prosthetic and orthotic users in Sierra Leone. Results: About half of the patient considered their overall physical health as good or very good. Thirty-seven percent of the participants said their mental health is bad or very bad. The majority said they did not have access to medical care and the most common reason given was that they could not afford doctors fee. The orthotic users reported they required medical care outside home more often than the prosthetic users. About half of the participants could not access afford medication when they needed it. About half of the participants had regularly access to safe drinking water and only 10% had the possibility to eat three times a day. The majority had a reasonably or adequate house to live. Half of the participants were married and 70% had children. Almost all reported that they could vote if they wanted. About half were working but often self-employed with small business. Sixty percent could read and write. Discussion & Conclusion: There was still a need for significant progress in increased access to medical care and medication when needed for persons with lower limb physical disability in Sierra Leone. Increased access to food and clean water to facilitate an acceptable standard of living adequate for health were also necessary in order to strive towards implementing the rights to health for persons with disability.Elevated skin temperature at the body/device interface of lower-limb prostheses is one of the major factors that affect tissue health [1]. The heat dissipation in prosthetic sockets is greatly influenced by the thermal conductive properties of the hard socket and liner material employed. This leads to a hypothesis that if the thermal properties of the socket & liner materials are known then the in-socket skin temperature could be accurately predicted by measuring between the socket and interface liner, rather than at the more technically challenging skin interface.Book 7th Annual International Conference on Business, Law & Economics 4-7 May 2020, Athens, Greece Edited by Gregory T. Papanikos THE ATHENS INSTITUTE FOR EDUCATION AND RESEARCH

Living as a person using a lower-limb prosthesis in Nepal

Abstract Purpose: The purpose of this study is to explore experiences of persons in Nepal using lower-limb prostheses, in relation to specific articles in the Convention on the Rights of Persons with Disabilities that consider mobility, education, health, rehabilitation, and work and employment. Method: Qualitative interviews were conducted with 16 persons using lower limb prostheses. Content analysis was applied to the data. Results: Six themes emerged: The lower-limb prosthesis is essential for mobility and daily life; Limited mobility in challenging terrain and request for reduced pain when using prosthesis; Difficulties in finding and sustaining employment emphasized the importance of vocational training; Appreciation of comprehensive rehabilitation together with other persons with amputations, but covering related costs is a struggle; Satisfied with health care, but concerned that it creates debt and dependence upon others; and finally, Limited ability creates negative self-image and varied attitudes in other people. Conclusion: Persons with lower-limb amputations were restricted by poverty and wanted increased independence. Rehabilitation and prosthetic services in Nepal need to increase proportionally as they contribute to enabling those persons to a better daily life. Prostheses were essential but more advanced technology was requested. Access to education and vocational training has the potential to improve the socio-economic status of those with lower-limb amputations due lack of employment not requiring physical effort. Implications for rehabilitation To increase access for persons with lower-limb amputations in Nepal to rehabilitation services, these services need to increase proportionally, and the policy for financial compensation to enable those persons to afford transportation to the rehabilitation center should be implemented. The design and manufacture of the low-cost polypropylene technology for prostheses used in Nepal needs to be improved, directed towards increasing the ability to ambulate on uneven surfaces and hilly terrain, and the ability to walk long distances. Adjustments of employment for persons with physical disabilities in Nepal have the potential to strengthen their socio-economic status. Vocational training programs and educational opportunities for persons with physical disabilities have the potential to improve income-generating employment and need to increase proportionally in Nepal. The policies developed in accordance with the Convention on the Rights of Persons with Disabilities need to be further implemented to decrease existing barriers to access to general health care and rehabilitation and prosthetic services for persons with disabilities in Nepal.

Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi

BackgroundPeople with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants’ mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients’ satisfaction with assistive devices and associated services in the entire study group from these two low-income countries.MethodsQuestionnaires, including QUEST, were answered by 222 patients in Sierra Leone and Malawi.ResultsEighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7–3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p < .001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The strongest association with satisfaction with assistive device was pain, and for satisfaction with service, country. The general condition of devices and the ability to walk on uneven ground were associated with both satisfaction with assistive devices and service received.ConclusionsParticipants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.

Graduates’ perceptions of prosthetic and orthotic education and clinical practice in Tanzania and Malawi

Background Maintaining and improving the quality of prosthetics and orthotics education at the Tanzania Training Centre for Orthopaedic Technologists is essential for the provision of appropriate prosthetics and orthotics services in African countries. Objectives To describe how Tanzanian and Malawian graduates’ of the Diploma in Orthopaedic Technology perceive their education and how it could be improved or supplemented to facilitate clinical practice of graduates. Methods Nineteen graduates from the diploma course in orthopaedic technology were interviewed and phenomenographic analysis was applied to the data. Results Seven descriptive categories emerged, namely varied awareness of the profession before starting education, well-equipped teaching facilities, aspects lacking in the learning context, need for changes in the curriculum, enabling people to walk is motivating, obstacles in working conditions and the need for continuous professional development. All participants perceived possible improvements to the content and learning environment. Conclusions Prosthetic and orthotic education can be better provided by modifying the content of the diploma programme by dedicating more time to the clinical management of different patient groups and applied biomechanics as well as reducing the programme content focusing on technical aspects of prosthetic and orthotic practice. Graduates were not prepared for the rural working conditions and the graduates desired continued training.

Prosthetic and Orthotic Users' Satisfaction with their Lower-Limb Assistive Device in Malawi and in Sierra Leone

This is the dataset linked to: Tang, Jing et al (2015) Use of gait lab 3D motion capture for dynamic assessment of amputee socket interface biomechanics – a preliminary study. Prosthetics and Orthotics International, 39, (1), supplement 2-608, 257. doi:10.1177/0309364615591101).Background: Sierra Leone is a low income country in West Africa that has a history of conflict. Sierra Leone have signed and ratified the Convention of Rights of Persons with Disabilities. Aim: To evaluate persons with disability that use prosthetic and orthotic assistive devices access to human rights. The addressed areas were; right to health, right to a standard of living adequate for health, right to vote, right to marry and found a family, right to education, right to work and. A further aim was to compare groups of participants regarding gender, area of residence, income and type and level of device. Methods: Questionnaires were used to collect self-reported data from 139 prosthetic and orthotic users in Sierra Leone. Results: About half of the patient considered their overall physical health as good or very good. Thirty-seven percent of the participants said their mental health is bad or very bad. The majority said they did not have access to medical care and the most common reason given was that they could not afford doctors fee. The orthotic users reported they required medical care outside home more often than the prosthetic users. About half of the participants could not access afford medication when they needed it. About half of the participants had regularly access to safe drinking water and only 10% had the possibility to eat three times a day. The majority had a reasonably or adequate house to live. Half of the participants were married and 70% had children. Almost all reported that they could vote if they wanted. About half were working but often self-employed with small business. Sixty percent could read and write. Discussion & Conclusion: There was still a need for significant progress in increased access to medical care and medication when needed for persons with lower limb physical disability in Sierra Leone. Increased access to food and clean water to facilitate an acceptable standard of living adequate for health were also necessary in order to strive towards implementing the rights to health for persons with disability.Elevated skin temperature at the body/device interface of lower-limb prostheses is one of the major factors that affect tissue health [1]. The heat dissipation in prosthetic sockets is greatly influenced by the thermal conductive properties of the hard socket and liner material employed. This leads to a hypothesis that if the thermal properties of the socket & liner materials are known then the in-socket skin temperature could be accurately predicted by measuring between the socket and interface liner, rather than at the more technically challenging skin interface.Book 7th Annual International Conference on Business, Law & Economics 4-7 May 2020, Athens, Greece Edited by Gregory T. Papanikos THE ATHENS INSTITUTE FOR EDUCATION AND RESEARCH

Variables associated with patients’ satisfaction with low cost technology prosthetic and orthotic devices and service delivery in Malawi and Sierra Leone

This is the dataset linked to: Tang, Jing et al (2015) Use of gait lab 3D motion capture for dynamic assessment of amputee socket interface biomechanics – a preliminary study. Prosthetics and Orthotics International, 39, (1), supplement 2-608, 257. doi:10.1177/0309364615591101).Background: Sierra Leone is a low income country in West Africa that has a history of conflict. Sierra Leone have signed and ratified the Convention of Rights of Persons with Disabilities. Aim: To evaluate persons with disability that use prosthetic and orthotic assistive devices access to human rights. The addressed areas were; right to health, right to a standard of living adequate for health, right to vote, right to marry and found a family, right to education, right to work and. A further aim was to compare groups of participants regarding gender, area of residence, income and type and level of device. Methods: Questionnaires were used to collect self-reported data from 139 prosthetic and orthotic users in Sierra Leone. Results: About half of the patient considered their overall physical health as good or very good. Thirty-seven percent of the participants said their mental health is bad or very bad. The majority said they did not have access to medical care and the most common reason given was that they could not afford doctors fee. The orthotic users reported they required medical care outside home more often than the prosthetic users. About half of the participants could not access afford medication when they needed it. About half of the participants had regularly access to safe drinking water and only 10% had the possibility to eat three times a day. The majority had a reasonably or adequate house to live. Half of the participants were married and 70% had children. Almost all reported that they could vote if they wanted. About half were working but often self-employed with small business. Sixty percent could read and write. Discussion & Conclusion: There was still a need for significant progress in increased access to medical care and medication when needed for persons with lower limb physical disability in Sierra Leone. Increased access to food and clean water to facilitate an acceptable standard of living adequate for health were also necessary in order to strive towards implementing the rights to health for persons with disability.Elevated skin temperature at the body/device interface of lower-limb prostheses is one of the major factors that affect tissue health [1]. The heat dissipation in prosthetic sockets is greatly influenced by the thermal conductive properties of the hard socket and liner material employed. This leads to a hypothesis that if the thermal properties of the socket & liner materials are known then the in-socket skin temperature could be accurately predicted by measuring between the socket and interface liner, rather than at the more technically challenging skin interface.Book 7th Annual International Conference on Business, Law & Economics 4-7 May 2020, Athens, Greece Edited by Gregory T. Papanikos THE ATHENS INSTITUTE FOR EDUCATION AND RESEARCH

Comparison of Patients Use and Mobility with Prosthetic and Orthotic Assistive Devices A Comparison of in Malawi and Sierra Leone

This is the dataset linked to: Tang, Jing et al (2015) Use of gait lab 3D motion capture for dynamic assessment of amputee socket interface biomechanics – a preliminary study. Prosthetics and Orthotics International, 39, (1), supplement 2-608, 257. doi:10.1177/0309364615591101).Background: Sierra Leone is a low income country in West Africa that has a history of conflict. Sierra Leone have signed and ratified the Convention of Rights of Persons with Disabilities. Aim: To evaluate persons with disability that use prosthetic and orthotic assistive devices access to human rights. The addressed areas were; right to health, right to a standard of living adequate for health, right to vote, right to marry and found a family, right to education, right to work and. A further aim was to compare groups of participants regarding gender, area of residence, income and type and level of device. Methods: Questionnaires were used to collect self-reported data from 139 prosthetic and orthotic users in Sierra Leone. Results: About half of the patient considered their overall physical health as good or very good. Thirty-seven percent of the participants said their mental health is bad or very bad. The majority said they did not have access to medical care and the most common reason given was that they could not afford doctors fee. The orthotic users reported they required medical care outside home more often than the prosthetic users. About half of the participants could not access afford medication when they needed it. About half of the participants had regularly access to safe drinking water and only 10% had the possibility to eat three times a day. The majority had a reasonably or adequate house to live. Half of the participants were married and 70% had children. Almost all reported that they could vote if they wanted. About half were working but often self-employed with small business. Sixty percent could read and write. Discussion & Conclusion: There was still a need for significant progress in increased access to medical care and medication when needed for persons with lower limb physical disability in Sierra Leone. Increased access to food and clean water to facilitate an acceptable standard of living adequate for health were also necessary in order to strive towards implementing the rights to health for persons with disability.Elevated skin temperature at the body/device interface of lower-limb prostheses is one of the major factors that affect tissue health [1]. The heat dissipation in prosthetic sockets is greatly influenced by the thermal conductive properties of the hard socket and liner material employed. This leads to a hypothesis that if the thermal properties of the socket & liner materials are known then the in-socket skin temperature could be accurately predicted by measuring between the socket and interface liner, rather than at the more technically challenging skin interface.Book 7th Annual International Conference on Business, Law & Economics 4-7 May 2020, Athens, Greece Edited by Gregory T. Papanikos THE ATHENS INSTITUTE FOR EDUCATION AND RESEARCH

Human rights for persons with disability using prosthetic and orthotic devices in Sierra Leone

This is the dataset linked to: Tang, Jing et al (2015) Use of gait lab 3D motion capture for dynamic assessment of amputee socket interface biomechanics – a preliminary study. Prosthetics and Orthotics International, 39, (1), supplement 2-608, 257. doi:10.1177/0309364615591101).Background: Sierra Leone is a low income country in West Africa that has a history of conflict. Sierra Leone have signed and ratified the Convention of Rights of Persons with Disabilities. Aim: To evaluate persons with disability that use prosthetic and orthotic assistive devices access to human rights. The addressed areas were; right to health, right to a standard of living adequate for health, right to vote, right to marry and found a family, right to education, right to work and. A further aim was to compare groups of participants regarding gender, area of residence, income and type and level of device. Methods: Questionnaires were used to collect self-reported data from 139 prosthetic and orthotic users in Sierra Leone. Results: About half of the patient considered their overall physical health as good or very good. Thirty-seven percent of the participants said their mental health is bad or very bad. The majority said they did not have access to medical care and the most common reason given was that they could not afford doctors fee. The orthotic users reported they required medical care outside home more often than the prosthetic users. About half of the participants could not access afford medication when they needed it. About half of the participants had regularly access to safe drinking water and only 10% had the possibility to eat three times a day. The majority had a reasonably or adequate house to live. Half of the participants were married and 70% had children. Almost all reported that they could vote if they wanted. About half were working but often self-employed with small business. Sixty percent could read and write. Discussion & Conclusion: There was still a need for significant progress in increased access to medical care and medication when needed for persons with lower limb physical disability in Sierra Leone. Increased access to food and clean water to facilitate an acceptable standard of living adequate for health were also necessary in order to strive towards implementing the rights to health for persons with disability.Elevated skin temperature at the body/device interface of lower-limb prostheses is one of the major factors that affect tissue health [1]. The heat dissipation in prosthetic sockets is greatly influenced by the thermal conductive properties of the hard socket and liner material employed. This leads to a hypothesis that if the thermal properties of the socket & liner materials are known then the in-socket skin temperature could be accurately predicted by measuring between the socket and interface liner, rather than at the more technically challenging skin interface.Book 7th Annual International Conference on Business, Law & Economics 4-7 May 2020, Athens, Greece Edited by Gregory T. Papanikos THE ATHENS INSTITUTE FOR EDUCATION AND RESEARCH