Rehabilitation: key to an independent future for children with poliomyelitis in Tajikistan

WHO

Representatives of the Ministry of Health and Social Protection and a WHO disability-rehabilitation team in Tajikistan in collaboration with representatives of the International Society of Prosthetics and Orthotics conducted follow-up activities from 22 September to 8 October 2014 to support the implementation of intervention and follow-up plans for children and adults with chronic paralysis caused by poliomyelitis (polio). The plans were developed in March 2014 at rehabilitation camps organized to assess the needs of people, mostly children, who had contracted polio during a large outbreak in Tajikistan in 2010.

Working with the Ministry of Health and Social Protection, the team met children and adults with polio, visited the republican orthopaedic centre, trained doctors in 3 locations and visited the Department of Traumatology of Karabolo Hospital in Dushanbe.

As the main outcomes of the mission, the team:

  • described the importance of continuous referral and follow-up for children with polio;
  • provided the first training in Tajikistan on postoperative rehabilitation therapy;
  • trained local orthopaedic surgeons in 12 complicated operative procedures;
  • technically monitored 24 children’s orthoses (externally applied devices designed for and fitted to the body) and suggested corrective measures; and
  • helped design a system for guaranteed regular follow-up of children with polio.

A member of the rehabilitation team said that timely rehabilitation interventions – such as physical therapy, occupational therapy, orthoses, wheelchairs, crutches and, if required, surgery – can make tremendous changes in the life of a person with polio. Using polio as an entry point, the aim was to build a system of rehabilitation for all people with disabling conditions that will help give them equal opportunities and a greater chance to live life with dignity.

Long-term effects of paralysis due to polio

After the first, six-month, acute stage of polio, gradual recovery of some muscle strength is possible with the help of gentle exercises and positioning. After 2–3 years, however, further significant recovery of muscle strength is unlikely. At this point, rehabilitation interventions with assistive devices can greatly contribute to functional independence.

All of the children who contracted polio during the 2010 outbreak are now in this chronic phase of rehabilitation, which will last for the rest of their lives.

Looking to the future

The recent mission comprised the second phase of a three-year project focused on community-based rehabilitation of people with disabilities and the development of human resources in this field. The project is supported by the United States Agency for International Development (USAID). In the first phase (March 2014), the team assessed 360 people with polio, mostly children, who represented the majority of known confirmed cases with paralysis due to the 2010 outbreak, and developed rehabilitation plans to address their needs.

These plans include therapeutic interventions and the identification of appropriate assistive devices. In choosing exercises and assistive devices, the aim is always to ensure the maximum of independence, comfort and confidence with the minimum of support. Many of the children may also require operations to correct or prevent deformities, although giving urgently needed orthotic and physiotherapy interventions now can decrease some children’s need for surgery in the next few years.