India making mobility real: for most people in India with disabilities, mobility is just a dream. A U.S. research lab and a local manufacturing group are tackling the challenge of making that dream a reality.
Ongoing research has directed clinical practices and improved the quality of device manufacturing for wheeled mobility in developed countries. Even in these societies, however, a significant gap remains between the demand for and supply of high-quality products.
In countries like India, where there is an overwhelming demand for quality wheeled mobility aids and limited or no supply, this problem is even greater. Unlike automobile and electronics technologies, transfer of AT from developed to undeveloped countries has not been accomplished effectively.
National statistics on disability indicate there are approximately eight million potential wheelchair users in India (National Sample Survey Report, 2002). Another study (Mukherjee and Samanta, 2005) says in India, people who receive wheeled mobility devices from social-welfare or nongovernmental organizations can't benefit from them because of user pain, fatigue, and/or discomfort.
The University of Pittsburgh's School of Health and Rehabilitation Science's Human Engineering Research Laboratories (HERL) is helping to design different wheelchairs for the Indian subcontinent and then transfer that technology to India for production on a large-scale basis. This collaborative relationship, initiated in 2001 and funded by the National Institutes on Disability and Rehabilitation Research (NIDRR), alms to provide technical consulting, transfer wheelchair technology, and promote clinical practice of wheeled-mobility prescriptions in India through educational programs.
The technology-developing partner for this initiative is the Artificial Limbs Manufacturing Corporation of India (ALIMCO), a nonprofit governmental organization under the Ministry of Social Justice and Empowerment. HERL faculty, staff, and students visited India in 2001, 2004, 2005, and 2006 to provide ALIMCO's engineers and administration technical assistance to improve product quality, quality control, and testing procedures.
Developing & Delivering
HERL has developed and transferred to India two types of manual wheelchair (MWC) designs; plans for an electric-powered wheelchair (EPW) are currently underway. These product designs have been developed to meet International Standards Organization (ISO) quality criteria, function effectively in Indian living environments and situations, and meet the low-cost requirements for the Indian market. To achieve these objectives, prototypes of the chairs were developed at HERL and tested according to ISO standards before finalization of all components and design.
One hundred Indian wheelchair users were given cameras and asked to photograph environmental barriers and other obstacles they face in their personal and work-related activities. This information will be used to make design adaptations to the EPW and for future wheelchair and AT design for India.
Final design decisions regarding component selection and manufacturing techniques will ensure low-cost, high-quality designs. HERL has nearly completed the design and transfer of adult and pediatric manual wheelchairs.
The HERL-ALIMCO adult MWC design was transferred In 2004 and, after progressive design modifications, is being phased into till production this year. The MWC has many adjustable features, Including a vertically and horizontally adjustable axle position, an adjustable-angle backrest, adjustable foot pegs, and an adjustable-tension backrest. It is lighter, easier to propel, and much more durable than previous ALIMCO wheelchairs.
Few pediatric wheelchairs are available in India, and of these, even fewer meet the needs of children with severe disabilities who require more complex tilt-in-space seating. For children who are unable to perform independent pressure relief or maintain an uptight head posture, tilt-in-space seating can be critical for preventing secondary disabilities (such as decubitus ulcers and postural deformities) and is useful for feeding and other activities of daily living. Currently in the development stage is a manual pediatric tilt-in-space wheelchair that will be manufactured in India at a relatively low cost from locally available materials.
In March 2005, a team from HERL, along with R. Lee Kirby, MD, from the Division of Physical Medicine and Rehabilitation at Dalhousie University in Halifax, Nova Scotia, Canada, delivered the pediatric wheelchair prototype. At a program conducted by the Rotary Club of Metro Kanpur, HERL Director Rory Cooper, PhD, described features and uses of the chairs to more than 50 attendees.
Dreaming & Designing
This year, initial focus groups were formed after demonstrations at ALIMCO of a hybrid power-operated vehicle (HyPOV) built for India. Design modifications for this vehicle--a cross between an EPW and an electric-powered scooter--will be completed at HERL over the next several months before it is again tested in India. The traction-amplifying nature of the HyPOV's independent suspension allows for superb obstacle-climbing ability.
Because of the single drive and steering motor, component costs for the HyPOV's motors, controller, and batteries (which account for the largest percentage of an EPW's cost) can be significantly reduced. Expected retail price for this device is $800--some $400 less than the lowest-cost EPW currently available in India and a third of the cost of the U.S.'s least-expensive EPW.
Teaching & Training
To achieve the initiative program's goal to provide educational and awareness programs for medical rehabilitation professionals, HERL and the University of Pittsburgh are conducting workshops.
In 2005, a three-day workshop at New Delhi's Indian Spinal Injuries Center (ISIC)--which specializes in providing surgical to restorative care to people after spinal-cord injury (SCI)--exposed health professionals in that part of the country to advances in wheeled mobility practices. A focus of this workshop was to teach basic and advanced wheelchair skills to therapists so they could pass those skills along to their patients.
This year, a team from HERL attended an International Spine and Spinal Injuries Conference (ISSICON) at ISIC. In his presentation to attendees, Cooper emphasized the need for better-quality products for people with disabilities and opportunities for collaborative efforts in this area. Occupational and physical therapists from around the Indian subcontinent attended HERL's postconference workshop on wheelchair research and clinical practice, which provided information about advancements in wheeled mobility and transfer of technology. In addition, therapists were taught advanced wheelchair skills as well as basic adjustment, maintenance, and repair of the HERL-ALIMCO MWC.
Planning & Proceeding
ALIMCO has begun small-scale manufacturing of the adult MWC. The President of India distributed 25 chairs to people with disabilities, and another 5 went to ISIC. Mass production was slated to begin at ALIMCO in June, phasing out the current MWC manufactured at the facility.
The work conducted to date in India by HERL and the University of Pittsburgh reflects the need for more collaboration with other developing countries to ensure successful AT transfer and improved quality of life for people with disabilities around the world. Combining developed countries' advanced infrastructure for designing wheeled mobility devices with the economical production capabilities of undeveloped countries could diminish the gap between supply and demand in the near future--and eliminate it in the long run.
Disability Resources in India
All India Institute of Physical Medicine and Rehabilitation (AIIPMR), http:/aiipmr.gov.in. Established in 1955, a government-sponsored institute under India's Ministry of Health and Family Welfare. AIIPMR is a treatment, training, and research center providing medical rehabilitation, physic)-, electro-, and occupational therapy.
Community Outreach Programme (CORP), www.corpindia.org. Registered in 1977, runs a medical and educational services center for people with disabilities.
Disability India Network, www.disabilityindia.org. A one-stop portal for disability related issues in India, managed by the Society for Child Development.
Fellowship of the Physically Handicapped (FPH), wvwv.fphindia.org. Serves about 200 people with disabilities, ages 18-40, providing vocational training in tailoring, printing, carpentry, machine shop, and computers, and making products for sale.
Rehabilitation Council of India (RCI), www.rehabcouncil.nic.in. Established by the Indian government to standardize and regulate professional training in rehabilitation and special education.
Institute for the Physically Handicapped (IPH), http:/socialjustice .nic.in/iph/default.htm. Providing medical care, rehab, and educational services; administered by India's Ministry of Social Justice & Empowerment.
Mobility India, www.mobility-india.org. Established in 1994 to enhance rehabilitation facilities available in India, bring resources to a broader group of people, and promote self-sufficiency and productivity for people with disabilities.
Paraplegia Foundation, www.paraplegicindia.org. Provides occupational training, therapy, treatment, and counseling.
National Sample Survey Report No. 485: "Disabled Persons in India," July-December 2002.
Mukherjee, G., and Samanta, A. "Wheelchair Charity: A Useless Benevolence in Community-based Rehabilitation," Disability and Rehabilitation, 27(10), May 2005, 591-596.