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Enumerate the goals & role of CBR in assistive devices. Explain the different types of assistive devices. Cbpt subject proper detailed answer

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WHO community based rehabilitation assistive devices goals roles types assistive technology

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community based rehabilitation AND assistive technology

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https://www.ncbi.nlm.nih.gov/books/NBK310951

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CBR and Assistive Devices

Definition

Community-Based Rehabilitation (CBR) is a community-development strategy for the rehabilitation, equalization of opportunities, and social inclusion of persons with disabilities. It is implemented through the combined efforts of persons with disabilities, their families, community organizations, and health, education, vocational, social welfare, government, and non-government services.
Park's Textbook of Preventive and Social Medicine, p. corresponding to lines 2957-2965.
An assistive device is any external device, equipment, product, or adaptation designed or modified to help a person perform an activity, maintain function, improve independence, or participate in daily life. It may range from a simple walking stick or adapted spoon to a powered wheelchair or computer-based communication system.
Firestein & Kelley's Textbook of Rheumatology, 2-Volume Set, p. 732.

Goals of CBR in Provision of Assistive Devices

The central goal is:
To ensure that persons with disabilities have access to appropriate, affordable, good-quality assistive devices that enable participation at home, school, work, and in the community.
The WHO CBR assistive-device guideline frames the goal around access to appropriate, quality devices that promote participation in home, work, and community life.

Specific goals

  1. Promote functional independence
    • Enable a person to perform activities such as walking, eating, dressing, bathing, toileting, communicating, reading, writing, and working.
    • Reduce unnecessary dependence on family members or caregivers.
  2. Improve mobility and safe movement
    • Help the person move within the home, school, workplace, and community.
    • Reduce falls, improve balance, and allow safe transfers.
  3. Prevent secondary complications
    • Prevent pressure sores, contractures, deformities, pain, falls, joint strain, and poor posture.
    • For example, proper seating, cushions, splints, calipers, and positioning devices may prevent complications of immobility.
  4. Maximize participation
    • Support participation in education, employment, family life, recreation, religion, and community activities.
    • A device is successful not merely when supplied, but when it allows meaningful participation.
  5. Promote dignity, autonomy, and self-confidence
    • A wheelchair, hearing aid, white cane, communication board, or adapted toilet may give a person greater control over daily decisions and personal care.
  6. Facilitate inclusion and equal opportunity
    • Reduce barriers that exclude persons with disabilities from schools, workplaces, transport, and social life.
    • CBR aims to shift the focus from disability as an individual limitation to removal of environmental and social barriers.
  7. Ensure appropriate prescription and fitting
    • The device must suit the person's age, diagnosis, body size, activity level, home environment, finances, and personal preferences.
    • An incorrectly prescribed or poorly fitted device may be ineffective or cause pain, skin injury, falls, or deformity.
  8. Provide affordable and locally sustainable services
    • Encourage low-cost local production, repair facilities, trained community workers, and referral systems.
    • Avoid giving devices that cannot be repaired, replaced, or maintained locally.
  9. Train the user, family, and caregivers
    • Teach correct use, handling, cleaning, safety precautions, maintenance, and storage.
    • For children, parents and teachers should also be taught how to support device use.
  10. Ensure follow-up, repair, replacement, and reassessment
  • Needs change with growth, disease progression, recovery, occupation, and environmental demands.
  • Children especially need periodic reassessment because they outgrow devices.

Role of CBR in Assistive Devices

CBR does not only distribute equipment. Its role is to provide a continuing, person-centred assistive-device service within the community.
The WHO describes CBR's core role as working with the person and family to identify device needs, facilitate access, and ensure maintenance, repair, and replacement when required through its CBR Guidelines.

1. Identification and community survey

CBR workers identify persons who may need assistive devices, including those with:
  • Locomotor disability
  • Visual impairment
  • Hearing impairment
  • Speech and communication disability
  • Intellectual or developmental disability
  • Neurological conditions such as stroke, cerebral palsy, spinal cord injury, Parkinsonism, or multiple sclerosis
  • Elderly people with reduced mobility or self-care ability
Identification can be done through home visits, school screening, village health records, primary health centres, disability camps, and referrals.

2. Assessment of needs

CBR personnel assess:
  • Functional limitations
  • Ability to perform activities of daily living
  • Home and community environment
  • Posture, balance, gait, hand function, communication, vision, and hearing
  • Family support and caregiver capacity
  • Educational and occupational demands
  • Economic circumstances
  • User preference and cultural acceptability
Assessment should answer: What activity is difficult? Why is it difficult? Which device or environmental change will help?

3. Referral for professional evaluation and prescription

Some devices require professional assessment and fitting by a physiotherapist, occupational therapist, prosthetist-orthotist, audiologist, optometrist, speech-language therapist, or rehabilitation physician.
Examples requiring specialist input include:
  • Custom wheelchairs
  • Prostheses
  • Orthoses and calipers
  • Hearing aids
  • Low-vision aids
  • Communication devices
  • Seating systems
  • Standing frames
CBR workers link the individual with the appropriate service and help overcome transport, cost, and information barriers.

4. Selection of the most appropriate device

A suitable device should be:
  • Safe
  • Functional
  • Durable
  • Comfortable
  • Affordable
  • Easy to maintain
  • Appropriate for the person’s body size and condition
  • Suitable for the local terrain, climate, transport, home, school, and workplace
  • Acceptable to the user and family
For example, a wheelchair suitable for smooth hospital floors may not be appropriate for rough village roads. A child with cerebral palsy may need a wheelchair with head and trunk support rather than a basic wheelchair.

5. Provision, fitting, and modification

CBR helps arrange:
  • Purchase or supply of devices
  • Local fabrication where feasible
  • Custom fitting
  • Adjustment and modification
  • Trial use before final delivery
  • Adaptations to meet local needs
Correct fitting is essential. A cane, crutch, walker, wheelchair, brace, or prosthesis used at the wrong height or alignment can lead to falls, pain, skin problems, or secondary joint injury. Mobility aids improve safety and independence only when the person is properly fitted and trained.
Firestein & Kelley's Textbook of Rheumatology, 2-Volume Set, p. 732.

6. Training in use and safety

CBR workers and therapists train the user and family in:
  • Correct use of cane, crutches, walker, wheelchair, or tricycle
  • Wheelchair transfers and negotiating slopes or uneven ground
  • Skin inspection and pressure relief
  • Donning and doffing orthoses or prostheses
  • Cleaning and storage
  • Battery charging where applicable
  • Use of hearing, visual, or communication aids
  • Safety during bathing, toileting, and transfers

7. Maintenance, repair, and replacement

Many devices fail because they are not repaired or replacement parts are unavailable. CBR should establish links with:
  • Orthotic and prosthetic workshops
  • Wheelchair repair services
  • Local technicians
  • Primary health centres
  • NGOs and social welfare schemes
  • Device suppliers
Regular review is needed for worn-out tyres, loose brakes, broken straps, damaged prostheses, ill-fitting braces, hearing-aid batteries, and damaged white canes.

8. Environmental modification

A device works best when the environment is accessible. CBR supports modifications such as:
  • Ramps instead of steps
  • Handrails
  • Wider doorways
  • Accessible toilets
  • Grab bars
  • Raised toilet seats
  • Rearranged furniture for wheelchair movement
  • Accessible school desks
  • Improved pathways and transport access
For example, a wheelchair cannot provide independence if the house entrance has steps and narrow doors. Raised toilet seats and grab bars are common adaptive measures for functional mobility and safety.
Firestein & Kelley's Textbook of Rheumatology, 2-Volume Set, p. 732.

9. Family, school, workplace, and community education

CBR educates family members, teachers, employers, and community members to:
  • Encourage consistent use of the device
  • Avoid stigma and discrimination
  • Support participation in education and work
  • Avoid overprotection
  • Recognize when repair or reassessment is required
  • Communicate effectively with a person using hearing or communication aids

10. Advocacy and resource mobilization

CBR workers advocate for:
  • Government disability benefits
  • Free or subsidized assistive devices
  • School inclusion
  • Accessible public buildings
  • Employment support
  • Transport concessions
  • Community-based repair services
  • Inclusion of persons with disabilities in local decision-making

Types of Assistive Devices

Assistive devices can be classified according to the function they assist. They may be low technology or high technology.
  • Low-technology devices: walking stick, crutch, adapted cup, spoon with built-up handle, grab bar.
  • High-technology devices: powered wheelchair, speech-generating device, computer with screen reader, electronic communication device.

1. Mobility Devices

These help a person walk, transfer, or move from one place to another.

Examples

  • Walking stick or cane
  • Tripod cane and quadripod cane
  • Crutches: axillary crutches, elbow crutches, forearm crutches
  • Walker or rollator
  • Gait trainer
  • Wheelchair: manual, powered, sports, reclining, pediatric
  • Tricycle or hand-propelled tricycle
  • Scooter
  • Transfer board
  • Stair lift

Uses

  • Stroke
  • Spinal cord injury
  • Lower-limb amputation
  • Cerebral palsy
  • Muscular dystrophy
  • Arthritis
  • Frailty in older adults
  • Fracture rehabilitation
Physiotherapy relevance: A physiotherapist assesses gait, balance, strength, endurance, weight-bearing status, coordination, height of the aid, and safe use on level ground, stairs, and uneven surfaces.

2. Positioning and Postural-Support Devices

These maintain correct lying, sitting, standing, and limb positions, and help prevent deformity and pressure injuries.

Examples

  • Positioning pillows
  • Wedges and bolsters
  • Side-lying supports
  • Wheelchair seating supports
  • Head supports
  • Lateral trunk supports
  • Pelvic belts
  • Pressure-relieving cushions
  • Standing frames
  • Corner chairs
  • Special seating systems
  • Prone standers
  • Sleep positioning systems

Uses

  • Cerebral palsy
  • Spinal cord injury
  • Severe weakness
  • Contracture risk
  • Pressure-sore risk
  • Poor trunk or head control
  • Postural asymmetry

3. Prostheses

A prosthesis is an artificial device that replaces a missing body part.

Examples

  • Artificial lower limb: transtibial and transfemoral prosthesis
  • Artificial upper limb
  • Cosmetic hand
  • Functional hand prosthesis
  • Artificial eye
  • Breast prosthesis

Purposes

  • Restore appearance
  • Improve standing and walking
  • Improve hand function
  • Increase independence in self-care, work, and social roles

CBR role

CBR helps identify candidates, arrange referral to a prosthetic centre, support gait training, monitor skin problems, coordinate repair, and promote vocational reintegration.

4. Orthoses and Orthopaedic Footwear

An orthosis is a device used to support, align, prevent, or correct a body-part deformity, or improve function.

Examples

  • Ankle-foot orthosis (AFO)
  • Knee-ankle-foot orthosis (KAFO)
  • Knee brace
  • Wrist-hand orthosis
  • Resting hand splint
  • Finger splint
  • Cervical collar
  • Thoracolumbosacral orthosis
  • Spinal brace
  • Foot orthosis
  • Shoe modifications
  • Calipers

Uses

  • Foot drop after stroke
  • Cerebral palsy
  • Poliomyelitis residual paralysis
  • Spinal deformity
  • Arthritis
  • Peripheral nerve injury
  • Joint instability
  • Contracture prevention

5. Activities of Daily Living Devices

These enable a person to perform self-care and household activities.

Examples

Eating and drinking
  • Adapted spoon, fork, knife, cup, plate guard
  • Built-up handles
  • Non-slip mats
  • One-handed cutting board
Dressing
  • Button hook
  • Zipper pull
  • Dressing stick
  • Long-handled shoehorn
  • Elastic shoelaces
  • Sock aid
Bathing and toileting
  • Bath chair
  • Shower stool
  • Long-handled sponge
  • Grab rails
  • Raised toilet seat
  • Commode chair
  • Toilet frame
Household tasks
  • Reacher or grabber
  • Jar opener
  • Adapted scissors
  • Long-handled cleaning tools
  • Modified kitchen tools
Occupational therapists commonly recommend dressing aids, reachers, buttoning aids, and adapted utensils for self-care, work, and leisure.
Firestein & Kelley's Textbook of Rheumatology, 2-Volume Set, p. 732.

6. Visual Assistive Devices

These help persons with blindness or low vision to move safely, read, learn, communicate, and perform daily activities.

Examples

  • White cane
  • Symbol cane
  • Tactile markers
  • Braille slate and stylus
  • Braille books
  • Braille display
  • Talking watch
  • Talking thermometer
  • Large-print books
  • Magnifying glass
  • Hand-held or stand magnifier
  • Spectacles and telescopic aids
  • Screen magnification software
  • Screen reader
  • Audio books
  • Smartphone navigation applications

Uses

  • Low vision
  • Blindness
  • Cataract-related visual impairment
  • Diabetic retinopathy
  • Glaucoma
  • Retinitis pigmentosa

7. Hearing Assistive Devices

These improve hearing, access to speech, and communication.

Examples

  • Hearing aid
  • Bone-conduction hearing device
  • Cochlear implant
  • Assistive listening device
  • FM or radio-frequency system for school
  • Amplified telephone
  • Flashing doorbell or alarm
  • Vibrating alarm
  • Captioned media
  • Text messaging applications

CBR role

CBR can identify suspected hearing loss, refer for audiological assessment, support regular device use, encourage hearing-aid maintenance, and educate families and teachers in communication strategies.

8. Communication and Speech Devices

These assist people with difficulty in speaking, understanding language, reading, writing, or expressing needs.

Examples

  • Communication board
  • Picture board
  • Alphabet board
  • Picture Exchange Communication System
  • Communication book
  • Writing board
  • Speech-generating device
  • Tablet with communication application
  • Alternative keyboard
  • Eye-gaze communication system
  • Sign-language materials

Uses

  • Cerebral palsy
  • Autism spectrum disorder
  • Aphasia after stroke
  • Motor neuron disease
  • Severe intellectual disability
  • Traumatic brain injury
  • Laryngectomy
A communication aid is useful only when family members, teachers, friends, and caregivers know how to respond to it.

9. Cognitive and Memory Aids

These support memory, planning, orientation, attention, and safe daily functioning.

Examples

  • Calendar
  • Diary
  • Pill organizer
  • Reminder cards
  • Labelled drawers
  • Visual schedule
  • Alarm clock
  • Electronic reminder
  • Smartphone reminder application
  • GPS or location device
  • Emergency-call system
  • Simplified telephone

Uses

  • Dementia
  • Traumatic brain injury
  • Intellectual disability
  • Stroke
  • Developmental disorders
  • Mental health conditions associated with poor cognition

10. Educational and Vocational Assistive Devices

These support learning, reading, writing, computer use, and employment.

Examples

  • Adapted desk and chair
  • Writing splints
  • Pencil grips
  • Large-print learning materials
  • Braille materials
  • Computer with screen reader
  • Speech-to-text software
  • Alternative keyboard and mouse
  • One-handed keyboard
  • Ergonomic work tools
  • Modified sewing, farming, carpentry, or kitchen tools

Purpose

These devices promote inclusive education, skill development, economic independence, and employment.

11. Environmental-Control and Safety Devices

These make the home and surroundings safer and easier to use.

Examples

  • Ramps
  • Handrails
  • Grab bars
  • Non-slip flooring
  • Lever door handles
  • Wider doors
  • Accessible switches
  • Remote-controlled lights or fans
  • Emergency alarm
  • Doorbell alerts
  • Bed rails
  • Transfer rails
  • Home automation systems
These adaptations may be as important as the device itself in enabling participation.

Principles for Successful Assistive Device Provision in CBR

An assistive device should be:
  1. Need-based, not merely donated.
  2. Individually assessed and fitted.
  3. Accepted by the user and family.
  4. Safe and comfortable.
  5. Appropriate for the home and community environment.
  6. Affordable and locally repairable.
  7. Accompanied by user training.
  8. Reviewed regularly.
  9. Repaired, replaced, or modified when needed.
  10. Linked with accessibility, education, livelihood, and social-inclusion measures.

Conclusion

In CBR, assistive devices are tools for function, independence, dignity, participation, and inclusion. The responsibility of CBR is not limited to giving a cane, wheelchair, hearing aid, caliper, or communication board. It includes identifying needs, referring for assessment, facilitating appropriate provision, fitting and training, modifying the environment, involving family and community, and ensuring repair, replacement, and long-term follow-up.
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