ISPO An Asian Prosthetics and Orthotics Workshop '98 in Japan Final Report

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FOREWORD

Eiji Tazawa

The estimated number of people who are needing Prosthetic and Orthotic services in the world is about 15 million, and 9 million of them are in South-East Asia.
Japan, as a leading industrial country in this region, has been working very hard for some years to establish a network in the region through the endeavours of Dr. Seishi Sawamura.

Dr. Sawamura, President of ISPO from 1995-98, intended to hold an ISPO Executive Board meeting in Japan during his presidency. It provided an excellent opportunity to organize an international meeting with key persons from South-East Asia whilst ISPO Executive Board members were in Japan. Utilizing expertise and accumulated experience over years of work in education in developing countries by ISPO was an essential component for leaders in South-East Asia in the field of Prosthetics and Orthotics.

The financial support of the Japanese Ministry of Health and Welfare in sponsoring the meeting, and strong support of the Japanese Society of Prosthetics and Orthotics, were vital factors in making the meeting a success. Two years of preparation was done by the Organizing Committee, together with congenial supportive cooperation from the ISPO Executive Board.

Another major task was to complete the Final Report of the meeting in both English and Japanese. My deep and sincere thanks go to Dr. Brendan McHugh for his enormously generous assistance in compiling this report. He relessly took precise notes at all the discussions. He later produced suggestions for necessary modifications and pointed out linguistic errors in the report. His dedication to the work of ISPO was so sincere, and immensely appreciated.

I sincerely hope that this Final Report will prove informative to the international community, and, perhaps more importantly, lead to better lives for the people with disabilities in the region of South-East Asia.

Eiji Tazawa
Secretary General
International Seminar for Prosthetics and
Orthotics '98 in Japan

OVERVIEW

Brendan McHugh

The meeting entitled "An Asian Prosthetics and Orthotics Workshop '98 in Japan" brought together, as participants, key persons from Asian countries and other respected professionals from throughout the world. Over a period of three days, these participants pooled their knowledge and experience in a series of formal presentations interspersed with discussion sessions. The ultimate aim was to produce a declaration which would give a unified approach, in Asia, to achieving the best possible prosthetic and orthotic care in the 21^st century.

This workshop was only possible due to the vision and efforts of Dr Seishi Sawamura, President of ISPO, and Dr Eiji Tazawa, ISPO International Consultant for South East Asia. Dr Sawamura worked for many years to establish the network of key persons in South-east Asia which was vital to the success of this event. The fact that the workshop was so successful also depended heavily on the organisational skills of Dr Tazawa and his team.

The Workshop was structured to include technology and service provision, education and training, and community based rehabilitation. In each of these subject areas, there were papers by international speakers followed by presentations which focused on the local situation in the countries of Asia. These laid a firm foundation on which to base meaningful discussion culminating in the drafting of the Declaration which was endorsed by those present.

The workshop provided an ideal forum for Asia to redefine and co-ordinate its strategy for the care of people with disability and for the professional development of those who provide that care. It was recognised that the future presented both opportunities and challenges.

The Declaration shows the way to meet these challenges and grasp the opportunities. Firstly, it emphasises that sustainable high quality prosthetic/orthotic services can only be achieved through effective national planning, the application of appropriate technology and the provision of education and training in prosthetics and orthotics to internationally recognised standards. Secondly, it encourages the exchange of information in the region and describes the role ISPO could play in this. Finally, it ensures that the process of improvement will be monitored and maintained through the holding of regional meetings every two to three years.

If it is possible to judge by the dedication and enthusiasm displayed by the Asian participants, there is reason for great optimism. The task ahead may be difficult but the determination to make the vision a reality was clearly evident.

This Asian Prosthetics and Orthotics Workshop marks the beginning of a new era in the care of people with disability in Asia. For me, it was a privilege to participate in this important event.

Brendan McHugh
Honorary Secretary of ISPO

DECLARATION

This declaration was agreed at the meeting entitled "An Asian Prosthetics and Orthotic Workshop '98 in Japan" which took place at the National Rehabilitation Centre for the Disabled, Tokorozawa, Japan on 2-4 February 1998.

Prosthetics and orthotics play a very important role in enabling people with disability to achieve full participation and equal opportunity in society. However, in most low-income countries the enormous demand for prosthetic and orthotic treatment cannot be satisfied due to a chronic lack of resources and of trained professionals in prosthetics and orthotics.

The International Society for Prosthetics and Orthotics (ISPO) has been acting as a vehicle for the exchange of information to promote high quality prosthetic and orthotic service by arranging courses, seminars and workshops. ISPO encourages and co-ordinates education and training activities of all the professions in this field. Education and training of prosthetics and orthotics personnel should be to Category I standard. A Category II level (orthopaedic technologist) has been defined to assist low income countries, where Category I training and education may not be immediately achievable, to meet the urgent needs of people with disability. ISPO has published an Information Package for the Category II professional and will be publishing a similar package for the Category I Professional (Prosthetist/Orthotist, Orthopaedic Engineer, Orthopaedic Meister).

It is important that the countries of South East Asia should benefit from the educational activities of ISPO in order to achieve maximum levels of professional competence and ultimately to give the best possible treatment to people with disability.

It is also essential that prosthetics and orthotics services should be sustainable and based on technology which is appropriate to the region and to the resources available.

It is vital that good communication networks should exist to optimise the exchange of information and to facilitate the sharing of knowledge and experience.

To achieve these objectives, the following list of basic principles has been drawn up.

1. Basic principles to promote better prosthetics and orthotics services;

1.1

Each government should embrace prosthetics and orthotics services within a national healthcare plan and develop a national policy that would ensure the delivery of appropriate and adequate rehabilitation services.

1.2

Prosthetics and orthotics services are integral to rehabilitation and should be available at community level in collaboration with community based rehabilitation services.

1.3

Education and training of prosthetists and orthotists, for all countries, should be at the Category I level. However, in low income countries, education and training of orthopaedic technologists (Category II) can provide an improved service for the immediate needs of people with disability although this should be regarded as an interim measure with Category I education and training as the long term objective.

1.4

Education and training programmes should be organised by the appropriate national authorities as well as being recognised by ISPO in order to meet international standards.

1.5

Appropriate technology, providing proper fit and alignment based on sound biomechanical principles, should meet the physical needs of people with disabilities within their environment and economic situation.

1.6

Where possible, components should be manufactured from locally available materials. Regional collaboration in respect of local component production should be encouraged.

1.7

ISPO/WHO should be encouraged to develop standardised procedures for evaluation of new components and techniques.

1.8

Efforts should be made to co-ordinate the activities of the different NGOs working in countries and regions.

2. Regional network to promote better prosthetics and orthotics services.

2.1

ISPO acts as a vehicle for the exchange of information by arranging courses, seminars and conferences and by the publication of its own scientific journal, Prosthetics and Orthotics International.

2.2

Every country in the region is encouraged to form a National Member Society of ISPO to act as a focus for professional collaboration and development and for the exchange of knowledge and information.

2.3

ISPO should identify key persons in those countries without National Member Societies and help to create regional networks to improve communication and availability of information in the prosthetics and orthotics field.

2.4

Using these networks, ISPO will call on National Member Societies and/or appropriate groups to organise regional conferences, seminars and courses and encourage active participation from all countries in the region.

2.5

A regional meeting of representatives from all South East Asian countries will be held every two/three years. The next meeting will be held in the year 2000 in Malaysia.

Message

Preface

On behalf of the Japanese Society of Prosthetics and Orthotics (one of the organizing societies), welcome to the distinguish lecturers and active participants for the Asian Workshop on Prosthetics and Orthotics in Tokorozawa, Japan.

17 years have already passed since "the Forum C of the International Rehabilitation Seminar: Asian Conference on Prosthetics and Orthotics '81", which was held in Tokyo from October 1981, with the active participants from eleven countries. Since then, a great change has occurred including socio-economical, technical and cultural aspects in the Asian countries.

As this year is "the Mid-point of the Asian and Pacific Decade of Disabled Persons", so this workshop is sponsored by the Ministry of Health and Welfare.

I believe that this workshop will contribute a lot for dissemination of information in this field and its feedback.

In conclusion, I am most grateful to all participants who collaborate in the preparation of this workshop, give us their valuable time and encourage us with their spirit of dedication. I would like also to express my sincere gratitude to the members of the organizing committee to provide us opportunities for intimate communication with our Asian neighbors.

January 1998.
Chairman of the organizing committee,
Asian Workshop on Prosthetics and Orthotics
President, Japanese Society of Prosthetics and
Orthotics

Message

On behalf of the International Society for Prosthetics and Orthotics, I would like to express my sincere appreciation and congratulations on the opening of the Asian Prosthetics and Orthotics Workshop '98 in Japan which also commemorates the middle year of the Asian and Pacific Decade of Disabled Persons (1993-2002).

I would like to express my special thanks to Dr. Yasuhiro Hatsuyama who is the director of the National Rehabilitation Center and Secretary General Mr. Eiji Tazawa and also my sincere thanks to the Ministry of Health and Welfare which has given us financial support.

There are only a few countries such as China, Hong Kong, Pakistan, Korea and Japan which have an ISPO National Member Society in South East Asia. It has been very difficult therefore to exchange information and to create a network in the Prosthetic Orthotic field in the past.

Therefore Mr. Eiji Tazawa and I, as International Consultants of ISPO, have been attempting to select key persons in countries not currently having ISPO national member societies. We are fortunate in now having appointed key persons in the Prosthetic and Orthotic field to represent each country.

This Asian Prosthetics and Orthotics Workshop '98 in Japan is a most important historical occasion for the launching of information exchange aiming at the improvement of Prosthetic Orthotic services in the Asian region.

In this workshop we are very fortunate to have excellent authorities on prosthetics and orthotics from ISPO: Prof. John Hughes, Mr. Norman Jacobs, Mr Sepp Heim, and Mr. Harold Shangali who will guide us with their rich experience in achieving appropriate progress in Prosthetic and Orthotic services.

We hope and pray that the knowledge and information gained from this workshop will prove to be a most important step in stimulating better prosthetic orthotic services in all Asian countries.

Message

On behalf of the Organizing Committee of International Seminar for Prosthetics and Orthotics '98 in Japan, I would like to welcome all of the participants to An Asian Prosthetics and Orthotics Workshop '98 in Japan.

I would like to extend my deep appreciation to the attending experts from ISPO who have experience in aiding developing countries and the participant from Asian countries for sharing their information at this meeting.

Our intention for this meeting is to exchange information and to establish a network in the Asian region and further, to other parts of the world.
I sincerely hope these three days will result in fruitful meetings and bring about a better standard of life to people with disabilities, and establish friendships among participants.

This meeting became possible through the financial support of Japanese Ministry of Health and Welfare, Japanese Society of Prosthetics and Orthotics, Japanese Orthotic and Prosthetic Association and Japanese Academy of Prosthetists and Orthotists, for which I would like to express my gratitude.

Many committee meetings were held to plan this Workshop to be conducted in the best environment, thanks to the generous support of the National Rehabilitation Centre for the Disabled.

I would like to extend my grateful respect to Drs.Kakurai, Sawamura, Hatsuyama, Tobimatsu, and Messrs Y.Tazawa, Nakamura for their strong support throughout the preparation stages.

Eiji Tazawa, C.P.O., Ph.D.
Secretary General
International Seminar for Prosthetics and
Orthotics '98 in Japan

Message

Greetings

I would like to sincerely congratulate the organizers on the opening of An Asian Workshop of Prosthetics and Orthotics '98, and enthusiastic group of participating world experts.
I, myself, am wheel-chair bound, and many of my friends, who use prostheses and orthoses, would like to extend our deep appreciation to all of the professionals attending this meeting.

Countries in Asia are effected by their own social conditions and economic level. I sincerely hope that those who have disabilities are able to free choice of their prostheses and orthoses to better their lives.

I value this meeting, to exchange the latest technology and information, which is being held at a very timely point. I know that all the participants are the world leaders in their fields, but I would like to ask you to broaden your expertise to aid people with disabilities. I would like to conclude my congratulation by wishing all of you success and good health.

February 2nd 1998

Eita Yasiro
Shugiin Giinn
(member of the House of Representatives)

Message

DR SHUICHI KAKURAI, PRESIDENT, INTERNATIONAL SEMINAR FOR PROSTHETICS AND ORTHOTICS '98

MR NORNAN JACOBS, ISPO PRESIDENT ELECT,

LADIES AND GENTLEMEN,

I would like to thank the organizers for inviting me to the opening ceremony of the Asian Prosthetics and Orthotics Workshop '98. The Asian Prosthetics and Orthotics Workshop '98 provides a very opportune occasion for all of us to look back and to renew our commitment to improving the quality of life for people with disabilities. I am pleased to be part of this worthwhile initiative.

As we have now passed the mid-point of the Asian and Pacific Decade of Disabled Persons, we need to look at what has been done to promote full participation and equality for disabled persons. This is what 33 governments in the Asian and Pacific Region set out to achieve when they declared the years 1993 to 2002 to be the Asian and Pacific Decade of Desabled Persons.

An agenda for action for the Decade was subsequently drawn up which comprises 12 areas. Two of these areas are relevant to the subject of this workshop, rehabilitation services and assistive devices.

Rehabilitation aims at enabling those with impairments or disabilities to reach their optimum mental, physical and/ or social functional level, by providing them with the tools to change their own lives. We all know that it is no longer enough just to preserve people's health or to prolong life. It is equally important to ensure good health and a better quality of life for everyone.

For people with disabilities or impairments, life can be made more meaningful and worthwhile if they are given the means and the opportunities to live an active and integrated life in their communities. Therefore, as well as involving measures intended to compensate for a loss of function or a functional limitation.
rehabilitation can also involve facilitating social adjustment or readjustment.

Prosthetics and orthotics have played, and will continue to play, a very important role in improving the quality of life of people with impairments and disabilities. It has been estimated that about 0.5% of the population needs artificial limbs and braces. Especially in developing countries, the need for such devices is enormous. For example, the need for braces is particularly acute in areas where poliomyelitis still affects many children each year. War, Natural disasters, road and industrial accidents have left many people with amputated limb. Furthermore, most countries have made great advances in prolonging life. The number of older persons is growing rapidly and more and more people suffer from chronic and degenerative conditions such as cardiovascular diseases, and diabetes. So, while some diseases, which result in disabling conditions, such as leprosy and poliomyelitis, are slowly being brought under control, many people will still require some form of prosthetic or orthotic services in the future.

The challenge, first and foremost, is to develop and vigorously implement programmes that contribute to disability prevention. Secondly, whenever disabilities or impairments have occurred, appropriate rehabilitation services should be made available. A major challenge in the field of prosthetics and orthotics is the lack of personnel who are adequately trained to deliver the services. I am pleased to note that during this workshop you have devoted some time for this important topic. By the year 2000, it is projected that some 20 million people in Africa, Asia and Latin America will need orthopaedic appliances. By conservative standards, this would mean that 20000 trained personnel would be needed in order to have one person available for each 1000 people in need of services. In the early 1990s, there were only about 2000 adequately trained personnel in developing countries. At least 18000 additional personnel trained to fit, fabricate and assess the biomechanical function of prostheses and orthoses are therefore needed in order to address future needs.

I commend the International Society of Prosthetics and Orthotics (ISPO) for its work in continuously improving the practice of prosthetics and orthotics. ISPO, which is a nongovernmental organization in official relations with WHO, has for many years, actively engaged in activities aimed at raising awareness, upgrading knowledge and skills of personnel and promoting the exchange and sharing of experience and international scientific achivements.

I congratulate ISPO and the people and Government of Japan for making this important workshop possible. Their commitment to improving the quality of life for people with disabilities, is demonstrated both by the educational seminar held in Makuhari, Chiba Prefecture during the past three days, and this Asian Prosthetics and Orthotics Workshop which is being held at the National Rehabilitation Center for the Disabled, a WHO Collaborating Centre for Disability Prevention and Rehabilitation.

Finally, I would like to say that the needs of disabled people and their families are viried. Concerted, multisectoral adtion will be necessary if all needs are to be taken into account. ISPO, The local affiliate societies and the Government of Japan have all shown how they could contribute to the overall achievement of the goals of the Asian and Pacific Decade of Disabled Persons. I am confident that with the concerted efforts of all concerned, the life of a disabled person will no longer be one of painful existence, but an active, meaningful and productive one.

Thank you and good day.

S.T. Han
Regional Director WHO Regional Office

Message

Greetings from National Rehabilitation Center for the Disabled

Dr.Shuichi Kakurai, President of Japanese Society of Prosthetics & Orthotics, Mr.Maomi Yamashita, President of Japanese Society of Rehabilitation for the disabled, Dr.Seishi Sawamura, President of International Society of Prosthetics & Orthotics, Dr. Linda L. Milane, Director of prevention and rehabilitation division of the WHO regional office of the Western Pacific, distinguished guests, Ladies and Gentlemen, it is my great honor to extend our heartiest welcome to all of you as a representative of the National Rehabilitation Center for the Disabled.

The Asian Prosthetics & Orthotics Workshop'98 is being held at NRCD, following of Educational Seminar of Prosthetics and Orthotics in Tokyo. It is also highlights as one of the commemoration of the mid-point of the Asian and Pacific Decade of Disabled Persons.

The Prosthetics and Orthotics has progressed remarkably in these last ten years. It has not only been about materials but also in the technical and theoretical area. The system still has not reached modernized status about providing system of prosthesis and orthosis in the most of the Asian countries.

All of Lectures & Presenters of this workshop are experts about Prosthetics and Orthotics and /or Rehabilitation of persons with disabilities. You would express your opinion freely and we would like to learn and share your useful information through this workshop.

I sincerely hope as a results of this workshop fruitful outcomes about the future plans in this area will be acquired.

Yasuhiro Hatsuyama M. D.
President of NRCD

Commemorating the Mid-Point of Asia and Pacific Decade of Disabled Persons
ISPO An Asian Prosthetics and Orthotics Workshop '98 in Japan Final Report
- Foreword / Overview / Declaration / Messages -

Editors:
Eiji Tazawa
Brendan McHugh