What is Locomotor Disability ? Explained

In the previous post we learned about International Initiatives for Protecting the Rights of Persons with Disability in this post The many definitions of locomotor Disability, its prevalence, and other topics are covered. At the end of this post the reader will be able to:

  • Define Locomotor Disability 
  • Understand its meaning and causes 
  • Look at the interventions and role of a social worker

Contents

  1. Introduction
  2. Definitions
  3. Prevalence
  4. Causes
  5. Management 
  6. Role of a Social Worker 
  7. Summary   

Introduction

"My disability exists not because I use a wheelchair, but because the broader environment isn't accessible.”  - Stella Young
The inability to move one's body freely is referred to as a locomotor handicap or orthopaedic impairment. It could be brought on by illnesses, injuries, or skeletal or muscular deformities. Any injury to the brain, spinal cord, or nerves of a person could possibly cause it. Impairments include issues with how the body functions or structural changes like paralysis, missing limbs, or blindness. (ICF, 2001). There are a lot of persons in India who have locomotor disabilities. According to the 2001 Census, the figure is 61.05 lakh, or 27.86% of the Indian population. Census from 2001 Now, the number would be different. The fields of medical, opportunity, social inclusion, and understanding of disability and their management are all advancing today.

Definitions   

There are different definitions available for loco motor impairment.
  1. Locomotor disability is defined in India as "disability of the bones, joints, muscles leading to substantial restriction of the movement of the limbs" or "any form of cerebral palsy," according to the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995.
  2. The definition of "locomotor disability" according to the Rights of Persons with Disabilities Bill, 2012, which has not yet been passed into law in India, is as follows: "Locomotor disability" refers to a person's inability to carry out particular activities related to moving oneself and/or objects as a result of musculoskeletal or nervous system illness.
  3. Orthopedic disability is defined as follows by the Individuals with Disabilities Education Improvement Act of 2004 (IDEA): "a severe orthopaedic impairment that negatively impacts a child's educational performance. The term includes disabilities brought on by congenital anomalies (such as clubfoot, the absence of a body part, etc.), disabilities brought on by diseases (such as poliomyelitis, bone tuberculosis, etc.), and disabilities brought on by other conditions (such as cerebral palsy, amputations, fractures, or burns that cause contractures). (2007) Pierangelo and Giuliani Early intervention, special education, and other programmes for children with disabilities are governed by the Individuals with Disabilities Education Act (IDEA), a federal statute of the United States.
  4. Locomotor disabilities were first defined by the World Health Organization in 1980 as "a handicap to an individual's capacity to execute specific activities connected with moving, both himself and objects from place to place."

Prevalence

2.21 percent of the total population in India was confirmed to have a disability in 2011, according to the census. With 20.3 percent of these, mobility impairment was the biggest group. The Census also showed that there are more males with locomotor disabilities in India than females. As opposed to urban India, rural India has a higher percentage of people with mobility disabilities (21.7%). (17.1 percent ).

Causes 

A person with a locomotor disability is unable to move around without assistance. A person may experience movement challenges for a variety of reasons. The diverse disorders that cause locomotor impairment have been categorised by various organisations working in this topic using various criteria. Congenital and acquired conditions can be distinguished. Congenital conditions include cerebral palsy, muscular dystrophy, and CTEV (Congenital Talipes Equinovarus), also known as clubfoot. Accidents, trauma, osteomyelitis, polio, and other conditions can all result in acquired disability. Here, some of the main contributors to locomotor impairment will be examined in greater detail.

Cerebral palsy

A range of chronic disorders that limit body movement, muscle coordination, and frequently mental capacity are together referred to as cerebral palsy. The term "cerebral palsy" refers to a number of non-progressive diseases of posture or voluntary movement that are brought on by defects in or injuries to the developing brain that happen just before or during birth or in the first few years of life. The brain's capacity to communicate is compromised with this illness, impairing speech and swallowing abilities as well as the ability to coordinate body motions.

Motor movements in people with cerebral palsy are aberrant, involuntary, or uncoordinated. The following are the four most prevalent forms of cerebral palsy:
  • Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated movements)
  • Athetoid (movements are contorted, abnormal, and purposeless) 
  • Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement) 
  • Mixed (any combination of the types)
The limbs (arms and legs) afflicted by the cerebral palsy are another way to categorise it. Major categories include hemiplegia (affecting either the left or right side), diplegia (affecting the legs more than the arms), paraplegia (affecting only the legs), and quadriplegia (all four limbs).

Since cerebral palsy is not an illness, there is no cure for it. However, using aids like wheelchairs, walking aids, and physiotherapy can help the person's mobility.

Poliomyelitis

The poliovirus, which causes polio, is a highly contagious viral illness that affects the neurological system and can quickly result in paralysis of the arms, legs, or trunk. Children under 5 are primarily affected. The virus spreads throughout the intestines after entering the body through the mouth. It may lead to death or possibly respiratory failure and paralysis. Children can be immunised to prevent it. India has been proclaimed polio-free as a consequence of the Pulse Polio Program, which was launched to eradicate the disease.

Osteomyelitis

A bone infection called osteomyelitis is brought on by bacteria and other organisms. It is a long-term bacterial infection of the bones and joints that gradually erodes the bone and may also impair the joints. The bone is normally resistant to bacterial infection, however procedures like surgery, prosthetic installation, trauma, etc. might render the bones more susceptible to infection. If left untreated, it might cause serious physical damage. Malnutrition, poor hygiene, diabetes, significant scarring, persistent wounds, etc. are risk factors for osteomyelitis. In the initial stages of an infection, antibiotics might be helpful. Once the infection becomes persistent, surgical excision of the infected bone and tissue is necessary.

Muscular Dystroph

Muscular dystrophy is a collection of diseases rather than one specific disorder. It is a sickness that degenerates over time or progresses. In this case, the person's muscles gradually deteriorate and weaken. While some kinds first appear in early childhood or adolescence, others might wait until middle life or later. Muscular dystrophies mostly come in three different forms:
  • The most prevalent type of muscular dystrophy is called Duchenne, and it mostly affects young boys. Dystrophin, a protein crucial in preserving the integrity of muscle, is absent, which is the cause of it. The illness manifests between 3 and 5 years after its onset and advances quickly. Starting with difficulties climbing, walking, etc., it eventually requires a respirator to breathe.
  • The onset of facioscapulohumeral muscular dystrophy typically occurs in adolescence. It causes muscles in the face, arms, legs, and areas around the shoulders and chest to gradually weaken. It develops gradually and has a wide range of symptoms, from minor to incapacitating. 
  • The disorder's most prevalent adult form, myotonic muscular dystrophy, is characterised by extended muscle spasms, cataracts, heart problems, and endocrine disorders. Myotonic muscular dystrophy patients feature swan-like necks, long, thin faces, and drooping eyelids.
Any type of muscular dystrophy cannot be stopped or reversed with a single treatment. Leading a better life is possible with the use of occupational treatment, physical therapy, respiratory therapy, speech therapy, orthopaedic appliances used for support, and corrective orthopaedic surgery.

Tuberculosis of the Spine

In India, one of the most prevalent spine pathologies is spinal tuberculosis. The backbone is gradually destroyed by an infection of the spinal column, which also leaves the sufferer with severe physical impairment. The tubercle bacteria is the culprit behind the illness. When a tubercular infection of the lungs spreads to the spinal bones, it causes tuberculosis of the spine. Children commonly experience this. Anti-tuberculous drugs can treat the infection, but significant surgery is frequently required to stabilise the spine, treat deformities, and enable spinal cord healing.

Spina Bifida 

The disability known as spina bifida is present from birth. It happens when the spinal column is damaged and does not completely close, impairing lower body movements and functions like bladder/rectal issues and even paralysis. It might or might not have an impact on cognitive function. Occulta, closed neural tube defects, meningocele, and myelomeningocele are the four different kinds of spina bifida.
  • The most prevalent and mildest form of malformation of one or more vertebrae is called occulta. Spina bifida of this type, which affects 10–20 percent of the general population, rarely results in symptoms or disabilities. 
  • A wide range of disorders collectively known as "closed neural" are characterized by abnormalities of the meninges, fat, or bone that affect the spinal cord. Most often, there are little or no symptoms; nevertheless, in some cases, the abnormality results in incomplete paralysis and dysfunction of the urinary and digestive systems.
  • Meninges and spinal fluid protrude via an aberrant vertebral orifice in meningocele. While some meningocele patients may suffer little or no symptoms, others may struggle with symptoms like total paralysis and bowel and bladder difficulties. 
  • The fourth form of the condition, known as myelomeningocele, is the most severe and results in partial or total paralysis of the body parts below the spinal opening when the spinal cord or neural components are exposed via the opening in the spine.
There is no cure for spina bifida. The nerve tissue that is damaged cannot be repaired, nor can function be restored to the damaged nerves.

Clubfoot

Clubfoot, also known as "congenital talipesequinovarus," is a disorder in which one or both of the child's feet are born pointed downward and bent inward. If the issue is not treated, the person will walk with pain on the top of their foot. The majority of congenital (present at birth) hereditary clubfoot cases are brought on by aberrant muscle, ligament, tendon, and bone growth during the course of the pregnancy. Corrective measures include surgery, casting, and manipulation.

Cleft lip and palate

Cleft lip and palate deformities are frequently present at birth. It happens when the many facial regions that separately develop and later unite do not unite properly. A cleft lip appears as a split in the lip and is a gap between the top lip and the nose. When the roof of the mouth is incompletely united, a cleft palate develops. The circumstances can exist singly or in combination.

Angular bone deformities

The most common location for angular bone abnormalities, which are bent bones, is slightly above or just below the knee. Extreme knock knees (genu valgus) or bow legs (genu varus) are caused by the condition, and they get worse as they grow. Walking is challenging because to the abnormalities, which may also harm the joints and cause arthritis.

Accidents, Trauma, Injury

Accidents can result in serious injury to the spinal cord, limbs, or body, which can impede movement. Accident victims frequently suffer from spinal cord injuries, which can result in paralysis or even death. Movement impairment can result from domestic accidents, workplace accidents, falls from buildings, traffic accidents, etc.

Management 

The rehabilitation and treatment of locomotor disability are difficult in a developing nation like India, especially when it comes to making it accessible to everyone. The difficulty will be to make the available health care alternatives accessible to those in need, as the most recent Census indicates that there are more persons with locomotor disabilities in rural India.

Preventing locomotor disability should be the first step in managing it. To lessen the likelihood of the impairment occurring, caution should be used. It may be helpful to promote overall health and wellbeing, get immunised, change your lifestyle, etc. Priority must be given to identifying and treating disabilities as soon as they arise. To help the person lead a normal life, medical, psycho-social, occupational, and educational intervention must be given next. It is crucial that the person be able to live as normally as possible in society.

Similar to other diseases, locomotor impairment is greatly influenced by early identification. At health clinics, schools, and even households, awareness and education are crucial.

Depending on the severity and scope of the disability, rehabilitation for people with locomotor disabilities takes place. Aides that help with the rehabilitation of locomotor deficits include orthotics and prostheses. The proper term for a constructed and fitted to the body externally applied device is an orthosis. Most devices that repair, enhance, or support body anomalies to accomplish one or more of the following aims are considered orthotics.
Control biomechanical alignment
  • Correct or accommodate deformity
  • Protect and support an injury
  • Assist rehabilitation
  • Reduce pain
  • Increase mobility, functionality
  • Increase independence
An artificial device used to supplement a missing body part is known as a prosthesis. It may also serve to repair an imperfect but already present physical part. An external or internal prosthesis is possible. Heart valves and joint replacements are examples of internal prosthetics. Amputated upper and lower limbs are included in external prostheses.

The largest organisation in the world dedicated to helping the disabled is called Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS). This NGO offers all of its assistance—including callipers, artificial limbs, and other tools and aids—free of charge. The Jaipur Foot is its claim to fame.

Walking Aids are a vital rehabilitation tool. As a result, the patient's mobility is improved as some of the body weight can be supported by the upper limbs. Parallel bars, crutches, walking frames, sticks, and other walking aids come in many forms. Wheel chairs facilitate outdoor mobility.

Role of a Social Worker

A social worker has a major role in the rehabilitation of a person with locomotor disability.
  • A social worker should be able to recognize people with disabilities, especially in the community, as early recognition is essential in the management of locomotor disability. It is essential to point them toward the available resources, such as healthcare institutions, rehabilitation centers, and locations where aids and equipment can be purchased to help with rehabilitation.
  • Creating awareness and educating others about disabilities and the value of re-integrating a person into society to assist them live a normal existence
  • Social workers can assist the community or authority in creating handicap accessible spaces, such as ramps, special restrooms, low stairs, etc. in public buildings like schools and businesses. 
  • A social worker might take on the task of removing the stigma associated with locomotor impairment by educating the community.
  • A social worker can raise awareness of the various therapies, such as physical therapy and occupational therapy, as well as their efficacy and effects on living a more functioning life.
A social worker can take on a variety of additional duties in the area of advocacy, including making sure that job reservations are filled, among other things.

Summary 

If neglected, orthopedic problems can significantly lower quality of life and possibly decrease lifespan. Affected individuals may not be able to sit, walk, or handle objects on their own if they have mobility issues. When orthopedic disability is already present, quality of life can be significantly enhanced through physiotherapy, orthopaedic surgery, and the provision of mobility aids (such as wheelchairs, walking splints, braces, and orthopaedic shoes). Integration of the individual with a locomotor disability into society as a whole is also crucial.

Comments

Thank You

Find your topic