disability is a physical or mental condition that limits a person’s movement , sense or activities. It is an important public health problem especially in developing countries like India . Any form of disability cannot be fully restored but measures and efforts can be put in to improve the conditions. prosthetic devices are an artificial device that replaces a missing body part which may be lost through trauma, diseases or congenital conditions. Purpose- used to replace a missing limb to perform functional tasks. The importance of Rehabilitation explains about the trends in development of prosthetic and orthotic devices and how, the technology can be used to improve the current devices in the market. Devices for mobility, Devices for visual impairment and hearing impairment and its uses are explained.

2. DISABILITY AND REHABILITATION-
USE OF VARIOUS PROSTHETIC
DEVICES
Ms. Rajosi Khanra
Dept. of Community Health Nursing
M.Sc. Nursing 2nd year ; Roll-2288004

3. OBJECTIVES OF TOPIC
01
03
02
04
Introduction of
P &O
Classification of
prosthetic devices
NATIONAL
SCHEMES
EDUCATION

4. ● Rehabilitation : A set of interventions
designed to optimize functioning and
reduce disability in individuals with
health conditions in interaction with
their environment.
● Disability : A physical or mental
condition that limits a person's
movement, sense or activities.
● Prosthetic devices : an artificial device
that replaces a missing body part
which may be lost through trauma,
diseases or congenital conditions.

5. PROSTHETICS AND ORTHOTICS
In rehabilitation prosthetic and orthotics
are two frequently used terms .
● Prosthetic aims at replacing and
restoring the functionality of a
missing body parts.
● While Orthotics aims at correcting,
aligning, supporting and preventive
deformities for improving the
function of a moving body part.

6. COMPONENTS OF PROSTHETICS
● Socket-made of plastic or resin
● Body of the prosthesis
● Pylon /suspension system
● Terminal device

8. Materials used in prosthesis fabrication
● Plaster of Paris
● Wood
● Plastic and rubber
● Metal and alloy
● Leather
● Fabric

9. CLASSIFICATION OF PROSTHETICS
● It gains its structural integrity
from the inner endoskeleton—a
pylon made of metal or carbon
fibre, which is a light internal
modular component to provide
weight bearing.
● The cosmetic appearance is
provided by shaped foam covers
slipped over the modular
components.
● An exoskeletal prosthesis gains
its structural strength from the
outer laminated shell, through
which the weight of the body is
transmitted.
● This shell usually made of a resin
socket, which is quite durable.
● The opposite surviving leg is
taken for reference for shape
length and skin colour.
EXOSKELETAL ENDOSKELETAL

11. LIMB
ORTHOSIS
A. Michelangelo Hand
It features a thumb that
electronically moves into
position and can perform
multiple grip functions.

12. B. Bebionic 3
● It is a multi- articulating
myoelectric device.
● It has optimized weight
distribution which makes the
hand feel lighter in weight and is
available in 9 different skin
shades.
● It gives the patient the feeling as
if they are regulating the same
nerves to move before
amputation and have reported to
have increased dexterity, grip
and force.

13. C. I-LIMB
I-limb features five (5)
individually powered digits
and fully articulated joints. It
can be used for activities
which needs power.

14. D. BOSTON ARM
● It is Psychic robot limb moved just
by thinking.
● Movement of hand will be created
using motor fixed in the elbow
position.
● The sensory electrodes are fixed at
the wearer’s arm. The motor will
respond according to the tiny
electrical charge signal captured by
electrodes.

15. LOWER LIMB
ORTHOSIS
The lower limb being the weight
bearing portion is prone to
injuries. Also, deformities in
lower limb make locomotion
difficult. Some prosthetics
devices are here for supporting
lower limbs.

16. FOOT ORTHOSIS (FO): Heel pads,
metatarsal pads, insoles, soles,
footwear.
ANKLE-FOOT ORTHOSIS (AFO)-
It is used in patients having weakness in
the ankle dorsiflexion or plantar flexor
muscles due to several disorders such as
stroke, cerebral palsy, spinal cord
injury, and peripheral nerve injury.

17. KNEE-ANKLE-FOOT
ORTHOSIS (KAFO)- .
KAFOs are provided to
compensate for muscle weakness,
paralysis or skeletal problems
which cause lower limb
instability. The KAFO aims to
make standing and walking easier
by: Controlling joint instability.
Preventing excessive joint
motion.

18. HIP-KNEE-ANKLE-FOOT
ORTHOSIS (HKAFO)-
● HKAFO improves body
alignment and posture,
increases bone and muscle
strength, and enhances
independence and self-esteem.
● Extension of KAFO by adding a
pelvic band.

19. HAND
ORTHOSIS
FINGER COT SPLINT
It immobilises,supports, protects
the interphalangeal joints in case
of sprain, strains,fracture and
phalangeal fractures.

20. LONG FINGER EXTENSION
SPLINT
It is designed to immobilize and protect
a finger with metacarpal injury, fracture,
or after the surgery.
MALLET FINGER SPLINT
It immobilises the distal interphalangeal
joints of finger and interphalangeal
joints of thumb.

21. RING AND FIGURE OF
8 SPLINT
A versatile support designed for
immobilising and stabilising an
injured or deformed finger joint.

22. WRIST HAND
ORTHOSIS
They are primarily used to
support weak muscles and/or
immobilize or limit the motion of
the wrist while allowing the
fingers to move. These devices
may be suitable for individuals
with: Osteoarthritis. Rheumatoid
arthritis. Carpal Tunnel
Syndrome.

23. ● Wrist hand stabilizer
● Cock up splint
● Thumb spica
● Hinged wrist orthosis
● Resting hand orthosis
● Dynamic wrist hand
orthosis

24. ELBOW ORTHOSIS
● Elbow ROM brace: These are prescribed to restrict
or limit motion at the elbow joint.
This may be necessary to:
1. Protect the elbow joint prior to surgical repair
following an injury.
2. Protect the elbow joint following surgical repair.
3. Prevent instability due to muscle weakness.
● Elbow extension splint: Relieves elbow
contracture in patients with paralysis or significantly
unbalanced muscle strength. Used to maintain elbow
joint in extension post-injury. Also good for elbow
flexion and extension contracture postoperatively.

25. SHOULDER ORTHOSIS
Most shoulder orthoses (SOs) are
intended to protect the glenohumeral
joint from subluxation caused by
flaccid hemiplegia or injury to the
shoulder joint capsule. The simplest
and most widely used SO is a sling.

26. ● Airplane splint: used in brachial plexus injury.
● Cervical collar: used for clavicle fracture.
● Sling and swathe immobiliser: used for shoulder
dislocation and humerus fracture. Used to support your arm
and hold it closely against your body after an injury.

27. Rex : It is self-balancing, hands-free robotic device for
rehabilitation. It will provide the power to move and lift up to
100Kg. The main benefit for patient is he/she can get full range of
movement in legs.

28. HAL 5
● The Hybrid Assistive Limb
(HAL) is a lower extremity
exoskeleton designed to
help patients improve
lower-limb movement.
● Designed to help the
disabled and elderly.

29. EKSO SUIT
EKSO is a wearable exoskeleton used
by paralyzed patients for standing,
walking and climbing stairs. It consist
of pair of powered robotics legs. The
users turn themselves into Ekso suit
placing their feet on the foot- plates
and securing straps around their legs,
hips, and torso. The Ekso Suit transfers
their weight to the ground, and they
uses two arm braces to keep
themselves from falling over.

30. BLEEX
A robotic device that
attaches to the lower body.
Its purpose is to
complement the user's
strength by adding extra
force to the user's lower
extremity bodily.

31. DEVICE FOR MOBILITY
● Most widely used prosthesis foot in the
world.
● The beauty of the Prosthetic foot is its
lightness and mobility - those who
wear it enables amputees to walk, run,
trek, swim, squat, sit cross-legged,
walk on uneven terrain, work in wet
muddy fields, climb trees, and pedal
bicycles.
● Also known as the Jaipur leg, is a
rubber-based prosthetic leg for people
with below-knee amputations.
JAIPUR FOOT

32. WHEEL CHAIR
Wheelchairs have given mobility life
to people with motor disability. This
has provided them with a feel for
independence to a certain extent.
Use of wheelchair gives them better
performance in daily life.

33. DEVICE FOR HEARING
Behind-the-Ear (BTE) :
BTE hearing aids is placed behind the ear
and has a hook shaped plastic moulded
extension from the case which is used for
fit in concha. The sound travels from the
case and is delivered into the ear through
the mold. It is used for mild to profound
hearing loss and can used by all ages.

34. IN THE EAR (ITE)
● An ITE hearing aid completely fits in
the orifice of the outer ear.
● It is used for mild to severe hearing
loss.
● The components are held in a hard
plastic case for a proper casing.
● Due to its small size, the ITE has
problems for fit and also damages can
occur due to earwax or fluids.
● It is not worn by children as the casing
needs to be replaced as the ear grows.

35. COMPLETELY IN CANAL (CIC)
CIC is another custom-fit hearing aid and concealed in the ear canal. It
is smaller in size as compared to other hearing aids and is not
comfortable for repeated removal and adjustment. It is also prone for
damage by earwax and fluids.

36. DEVICE FOR
VISUAL
IMPAIRMENT
People who are visually
impaired have trouble seeing
or are unable to see at all.
Assertive technology are used
like-
● Books on tape
● Eye glasses
● Electronic magnifier
● Brailed materials
● Large print books

37. EDUCATION FOR USING PROSTHETIC DEVICES
➢ Check stump daily
➢ Clean inside the socket daily
➢ Wear your prosthesis as directed
➢ See your caregiver regularly
➢ Consult a prosthetics
➢ Many older adults have one or more chronic health problems, this
factor should be considered when choosing a prosthetic device. A
patient with diabetes is prone to circulation problems and poor
wound healing and may need a prosthesis with extra padding.

38. NATIONAL
SCHEMES/PROGRAMS
FOR DISABLED PERSONS

39. ADIP Scheme
ADIP= Assistance to Disabled Persons
● Objective- To assist the needy
disabled persons in procuring
durable, sophisticated, scientifically
manufactured, modern, standard
aids and appliances that can
promote their physical, social and
psychological rehabilitation, by
reducing the effects of disabilities
and enhancing their economic
potential.

40. ELIGIBILITY
➢ He/she should be an Indian citizen of any age.
➢ He/she Should be certified by a Registered Medical Practitioner that he/she is
disabled and fit to use prescribed aid/appliance.
➢ Person who is employed/self-employed or getting pension and whose monthly
income from all sources does not exceed Rs. 10,000/- per month.
➢ In case of dependents, the income of parents/guardians should not exceed Rs.
10,000/- per month.
➢ Persons who have not received assistance from the Government, local bodies
and Non-Official Organisations during the last 3 years for the same purpose.

41. TYPES OF APPLIANCES TO BE
PROVIDED
A. LOCOMOTOR DISABLED
● All types of prosthetic and orthotic devices.
● Mobility aids like tricycles, wheelchairs, crutches walking sticks and walking frames/rotators.
● All types of surgical footwear and MCR chappals (micro cellular rubber chappals are
Comfortable and Cushioned Foot-Bed Enhances Comfort to the Feet).
● All types of devices for ADL (activity of daily living).
A. HEARING DISABLED
● Various types of hearing aids.
● Educational kits like tape recorders / CD players etc.
● Assistive and alarming devices including devices for hearing of telephone, TV, doorbell, time
alarm etc.
● Communication aids, like, portable speech synthesizer etc.

42. C. VISUALLY DISABLED
● Learning equipment like arithmetic frames, abacus, geometry kits etc.
● Giant Braille dots system for slow-learning blind children.
● Dictaphone and other variable speed recording system.
● CD player/Tape recorder for blind student from X standard.
● Science learning equipment like talking balances, talking thermometers, measuring
equipment like tape measures, micrometres etc.
● Braille writing equipment including Braillers, Braille shorthand machines, typewriters for
blind students from X class.
● Talking calculators, Geography learning equipment like raised maps and globes.
● Communication equipment for the deaf-blind. Braille attachments for telephone for deaf-
blind persons.
● Low vision aids including hand-held stand, lighted and unlighted magnifiers, speech
synthesizers or Braille attachments for computers.
● Special mobility aids for visually disabled people with muscular dystrophy or cerebral
palsy like adapted walkers.

43. ● Software for visually handicapped persons using computers that are
likely to cost more than Rs. 6,000/- may be procured and provided in
exceptional cases subject to prior approval of Ministry of Social
Justice and Empowerment on case to case basis. For all other devices
ceiling is Rs. 6,000/-.
D. MENTALLY DISABLED
Any suitable device as advised by a Rehabilitation Professional or treating
physician.

44. RASHTRIYA VAYOSHRI YOJANA
● A scheme for providing Physical Aids and Assisted-living
Devices for Senior citizens belonging to BPL category.
● This is a Central Sector Scheme, fully funded by the
Central Government. The expenditure for
implementation of the scheme will be met from the
"Senior Citizens' Welfare Fund".
● The Scheme will be implemented through the sole
implementing agency - Artificial Limbs Manufacturing
Corporation (ALIMCO), a PSU under the Ministry of
Social Justice and Empowerment.

45. Under the scheme, the physical aids will be
provided only to the senior citizens of the
nation. This implies those who are aged above
60 years will get free assisted living aids and
physical devices which are required for their
sustainability.
Devices supported:
➢ Walking sticks
➢ Elbow crutches
➢ Walkers/Crutches
➢ Tripods/Quad pods
➢ Hearing Aids
➢ Wheelchair
➢ Artificial Dentures
➢ Spectacles

46. DEENDAYAL DISABLED REHABILITATION
SCHEME (DDRS)
The Deendayal Disabled Rehabilitation
Scheme (DDRS) is a Central Sector Scheme of
the Government of India that provides
financial assistance to voluntary organizations
working for the education and rehabilitation of
persons with disabilities. The scheme was
launched in 1999 and was revised and renamed
in 2003.

47. The Deendayal Disabled Rehabilitation Scheme (DDRS) provides a wide range of benefits
to persons with disabilities, including:
● Early intervention: The DDRS provides financial assistance to voluntary
organizations for early intervention programs for children with disabilities. These
programs help to identify and address developmental delays early on, which can
improve the child's long-term outcomes.
● Development of daily living skills: The DDRS provides financial assistance to
voluntary organizations for programs that help persons with disabilities to develop
the skills they need to live independently. These programs may include training in
activities such as cooking, cleaning, and personal care.
● Education: The DDRS provides financial assistance to voluntary organizations for
educational programs for children and adults with disabilities. These programs may
include mainstream education, special education, and vocational training.

48. ● Skill development oriented towards employability: The DDRS provides
financial assistance to voluntary organizations for skill development programs that
help persons with disabilities to find employment. These programs may include
training in computer skills, office skills, and trade skills.
● Training and awareness generation: The DDRS provides financial assistance
to voluntary organizations for training programs for staff and caregivers of persons
with disabilities. These programs help to build capacity and raise awareness about
disability issues.
● Construction and upgradation of infrastructure facilities for persons
with disabilities: The DDRS provides financial assistance to voluntary
organizations for the construction and upgradation of infrastructure facilities for
persons with disabilities. This may include ramps, accessible toilets, and specialized
equipment.

49. SUGAMYA BHARAT ABHIYAN
Accessible India Campaign (Sugamya Bharat
Abhiyan) is a nation-wide Campaign launched by
Department of Empowerment of Persons with
Disabilities (DEPwD) of Ministry of Social Justice &
Empowerment to provide universal accessibility to
persons with disabilities.
The Sugamya Bharat Abhiyan focuses on
developing accessible physical environment,
transportation system and Information &
communication ecosystem.

50. National Handicapped Finance and
Development Corporation NHFDC) has been
set up to promote economic and development
activities undertaken by Persons with
Disabilities. The Corporation assists them by
providing loans for self-employment and
other economic ventures.
Purpose :
● Small business/ trades
● tiny/ cottage industry/service activity
● Artisan activities
● Agricultural and allied activities
● Transport sector activities

51. Eligibility criteria of beneficiaries :
● Any Indian Citizen with 40% or more disability.
● Age above 18 years.
● The borrowers already covered under any other scheme of
financing sponsored by Central or State Government or
financing institutions and having outstanding loans against
their names shall not be eligible.
● Preference will be given to women beneficiaries.
● Relevant educational/technical/vocational qualification,
experience and background.

52. Indira Gandhi National Special
Ability Pension is a scheme
introduced by the Government
of India for the welfare of
specially-abled persons residing
in the country. The scheme was
initiated to provide financial
support and to encourage the
specially abled to lead a life of
dignity and independence.

53. ● Individuals who have a disability of 80 percent or more and are between
18 to 79 years old and living below the poverty line are eligible for a
monthly sum of Rs. 300 from the Government of India. The State
Government also provides an additional amount of Rs. 1000 per month,
bringing the total pension amount to Rs. 1300 per month.
● The Department of Social Welfare also offers Disability Relief Allowance
at the rate of Rs. 750 per month to those disabled individuals whose
disability is between 40 to 69 percent, and the annual income is not more
than Rs. 35000 per month.
● Individuals with more than 70 percent disability, who are not working in
a government/semi-government/corporations/boards, are being given a
sum of Rs. 1300 per month without any income limit.
● Disability Relief for mentally challenged persons is being provided
without any income limit.

54. IIPO
(ISHWAR Institute of Prosthetic and Orthotics)
A specialized training Institute run by
International Society for Human Welfare and
Rehabilitation (ISHWAR), a Delhi based
NGO working for poor disabled.

55. AIMS AND OBJECTIVES
● To train and educate, at certificate, diploma, undergraduate
and postgraduate levels, Orthotists & Prosthetists of
outstanding ability who may become leaders in the
profession.
● To orientate the teaching to a quality centered approach.
● To design the P&O education towards continual
professional development.
● To undertake research & encourage students to focus on
advancement of P&O technology.
● To train P&O to become efficient P&O Clinicians/
Workshop Managers.

58. The importance of Rehabilitation
explains about the trends in
development of prosthetic and
orthotic devices and how, the
technology can be used to improve
the current devices in the market.
Devices for mobility, Devices for
visual impairment and hearing
impairment and its uses are
explained.

59. A. Patient’s satisfaction with a lower limb prosthesis: a longitudinal study
This is a descriptive longitudinal study that aimed to verify prosthesis satisfaction of older adults with
lower-limb amputation (LLA). In total, This study was composed of 34 older adults with LLA
participated of this study. Participant’s satisfaction about the lower-limb prosthesis (LLP), the
discomforts, and the embarrassment when use it were evaluated through an interview composed of five
questions. The occurrence of falls and the independence in prosthesis management were also evaluated.
All variables were collected at the last week of ambulatory rehabilitation discharge and after one and
three months. A descriptive and inferential statistical analysis was performed. The level of significance
was set at 5% (p <0.05). In total, 80% of participants with transtibial amputation and 78.6% of
participants with transfemoral amputation were satisfied with the LLP after three months. Tight
prosthesis, walking pain, the embarrassment of using LLP, and the occurrence of falls decreased over
time. The independence in prosthesis handling did not change significantly after three months.
Participants that used manual locking knee (p=0.040) and/or Solid-Ankle Cushion Heel foot (p=0.017)
were more satisfied with LLP. The occurrence of falls reduced (p=0.039) after transfemoral participants
started to use the prosthesis. Participant’s satisfaction with the LLP was high and did not change
significantly over time.

60. B. A systematic literature review of the effect of different prosthetic components on
human functioning with lower limb prosthesis.
A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to
the functional needs of the prosthetic user. For adequate matching, the functional abilities of the
amputees are of value, as well as the technical and functional aspects of the various prosthetic
components. No clear clinical consensus seems to be given on the precise prescription criteria. To obtain
information about different prosthetic components and daily functioning of amputees with a prosthesis,
we performed a systematic literature search. The quality of the studies was assessed with the use of
predetermined methodological criteria. Out of 356 potentially relevant studies, 40 studies eventually
qualified for final methodological analysis and review. Four satisfied all the criteria and were classified
as A-level studies, 26 as B-level, and 10 studies as C-level studies. Despite a huge amount of literature,
our formal clinical knowledge had considerable gaps concerning the effects of different prosthetic
components and their mechanical characteristics on human functioning with a lower-limb prosthesis.
Therefore, with regard to prosthetic guideline development, we must still largely rely on clinical
consensus among experts. The integration of knowledge from research with the expert opinion of
clinical professionals and the opinions and wishes of consumers can form a solid base for a procedure
on guideline development for prosthetic prescription.

61. ● Santos, Isaias & Silva, Alana & Furtado, Graziella & Menezes, Rosarly & Santos, Kionna & Ferraz,
Daniel. (2021). Patient’s satisfaction with a lower limb prosthesis: a longitudinal study.
Fisioterapia e Pesquisa. 28. 276-283. 10.1590/1809-2950/20014728032021.
● van der Linde H, Hofstad CJ, Geurts AC, Postema K, Geertzen JH, van Limbeek J. A systematic
literature review of the effect of different prosthetic components on human functioning with a
lower-limb prosthesis. J Rehabil Res Dev. 2004 Jul;41(4):555-70. doi:
10.1682/jrrd.2003.06.0102. PMID: 15558384.
● Disability of Rehabilitation & Use of Prosthetic Devices PPT.pptx [Internet]. www.slideshare.net.
2023 [cited 2023 Dec 7]. Available from:
https://www.slideshare.net/naveenithkrishnan/disability-of-rehabil-use-of-prosthetic-devices-
pptpptx.
● Prosthetics, orthotics and traction [Internet]. www.slideshare.net. 2021 [cited 2023 Dec 7].
Available from: https://www.slideshare.net/BipulBorthakur/prosthetics-orthotics-and-traction
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