Konno K.1,2,3, Chibwana S.3, Takata Y.4
1Yoichi Hospital, Shakaifukusihoujin, Hokkaido Shakaijigyoukyoukai, Rehabilitation, Yoichi, Japan, 2Japan International Cooperative Agency, Japan Overseas Cooperation Volunteers, Tokyo, Japan, 3Sue Ryder Foundation in Malawi, Balaka, Malawi, 4Hokkaido Bunkyo University, Faculty of Human Science, Physical Therapy, Eniwa, Japan
Background: In Malawi, 75% of the population lives below the poverty line and about 500,000 people have a physical disability. As the number of people with a disability increases, the lack of understanding about disabilities also increases. The situation is made worse by the medical staff shortage, as well as a shortage of physiotherapists. Rehabilitation in rural areas is hindered by an overwhelming shortage of supplies. In this paper, we report the intensive physiotherapy and subsequent follow-up of a child with cerebral palsy in a rural area.
Purpose: In Japan, cerebral palsy rehabilitation guidelines state that intensive physiotherapy is recommended to increase the GMFM score, which in other parts of the world has been reported to be effective in motor function improvement. However, these guidelines do not address the situation of cerebral palsy in Africa, so no reports deal with appropriate rehabilitation for severely disabled persons who live in the rural areas of developing countries. This study seeks to clarify the effect of intensive physiotherapy on motor function for persons with cerebral palsy in these rural areas.
Methods: The subject was a 5-year-old boy with cerebral palsy diplegia and a GMFCS level III. He has received out reach rehabilitation once a month since he was 2 years old. Intensive physiotherapy was also started to improve motor function, and guidance was given to family members to aid them in giving care. GMFM-66 was used to assess his motor function, and we prepared a program that centered on the following items: standing, walking, and mother providing primary treatment. We conducted 40 minutes of training every morning and afternoon, five times a week. The training was done by the mother and volunteers from the community. GMFM-66 assessed before and after the intensive physiotherapy, and again after 2 months.
Results: There was no change in the walking task. However, there was a change in the standing task. It increased 8% from start to finish, and 26% after 2 months. The total amount was 34%.
Conclusion(s): We provided physiotherapy and family guidance to a child with cerebral palsy for 2 weeks at our rehabilitation center. During the intensive physiotherapy, the GMFM score had increased slightly. However, it increased greatly after 2 months. Researchers in another study reported that they conducted intensive rehabilitation of GMFCS level III cerebral palsy children. That program, which focused on the standing and walking, resulted in an increased GMFM score. This study achieved the same effect; however, the effect was more pronounced after 2 months than immediately following the intensive physiotherapy. We tried to conduct physiotherapy and teach training management to the mother and community volunteers, so that they could continue appropriate intervention after the intensive rehabilitation.
Implications: We tried to conduct rehabilitation and teach management to family and community volunteers for 2 weeks, and after that time the GMFM was increased. These results show that intensive physiotherapy with Community Based Rehabilitation can have a significant effect on motor function improvement for cerebral palsy children who live in rural areas of Malawi.
Funding acknowledgements: No funding.
Topic: Paediatrics
Ethics approval: No ethics approval, because we don´t have an ethics system.
All authors, affiliations and abstracts have been published as submitted.
