Training Trainers for Community Development of Rehabilitation

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Training Trainers for Community Development of
Rehabilitation

• Queens University

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Central America Land Mine Survivors Project

• Will Boyce
• Director
• Gustavo Vargas
• International Project Manager

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Tripartite Land Mine Initiative

• Canada, Mexico and 3 Central American countries
  of Nicaragua, El Salvador and Honduras with the
  technical assistance of PAHO.
• Four persistent problems for persons with
  disabilities
• Lack of services in rural areas
• Prosthesis supply and costs
• Social and economic reintegration
• Lack of rehabilitation information

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Central America Region
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GOALS

• increase public awareness of the continuing
  dangers of landmines
• establish CBR programs
• sensitize the public about human rights issues of
  disability
• train multi-disciplinary team approach in
  rehabilitation

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Project Components

• Prosthetics Orthotics
• Economic Re-Integration
• Health and Disability Information Systems
• Community Based Rehabilitation

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Community Based Rehabilitation

• Basic education on CBR
• National planning consultations
• Production of CBR resource material
• Train the trainers program and manuals
• University curriculum development
• Monitoring and follow-up support

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Train the Trainers - Goal

• To create a nucleus of well trained and skilled
  people available to teach CBR within their own
  country

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Train the Trainers Rationale

• Better use of resources
• Sustainable
• Adaptable to each country
• Shared responsibility with local partners

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Training Model

• Basic Education Workshops

• Awareness of Disability
• Community-based Rehabilitation
• Clinical Skills in Communities Settings

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Training of Trainers

• 3 Training modules over 6 months
• Basic Training in Adult Education and CBR
• develop own workshop topic and outline
• Advanced Training in Workshop Planning and CBR
  Management
• conduct workshop, with feedback
• Establishing and Evaluating Local Training
  Courses

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Challenges in T.O.T

• Coordination
• Lack of resource material
• Sustainability
• Administrative support
• Certification

• Local trainers
• Community Involvement
• Integration of agencies other than health

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Research on T.O.T-PTs training CBR workers

• Benefits
• Consolidation of learning
• Use of existing networks
• Meets community needs
• Modifies information
• Capacity building

• Problems
• Available time for training
• Slower implementation
• Loss of detail
• Evaluation problems
• Lower skill transfer

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Educators Manuals for CBR Community
Development and Integration of PWD

• 1. Key Concepts
• 2. Training Trainers in CBR
• Education
• Workshop Planning
• 3. Disability
• Understandings of Disability
• Working with People with Disabilities

• 4. Community Development Strategies in Disability
• Needs Resources Assessment
• Link between Needs and Resources
• Access to Information
• Inclusion of PWD and Community Participation
• Community Networks Partnerships

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A Educators Manual (contd)

• 5. Rehabilitation in the Community
• Roles in CBR
• Responsibility of CBR Workers
• Responsibility of the Community
• Responsibility of the CBR Organization
  (Management)

• 6. Problem Solving in Rehabilitation
• Functional Life Activities
• Appropriate Technology

• (Worksheets, Learning Exercises Tips to the
  Trainer, Handouts are included throughout the
  manual to maximize comprehension and integration
  of each topic).

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Prosthetics Orthotics

• Feasibility study in Honduras
• Technician workshops
• Interagency cooperation (GTZ)
• Introduction of New Technologies (UDB)

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Low Cost Modular Prosthetic System
The Niagara Foot
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Shortcomings of Current Devices

• High cost
• most common foot in developing countries is
  the SACH foot which sells for about 50 US
• Susceptibility to damage by water
• SACH foot is made primarily of wood and rubber

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Shortcomings of Current Devices

• Long fabrication time
• example Jaipur foot
• Poor performance on rough ground walking due to
  lack of motion of the foot
• example the recently developed Japanese foot

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Design Considerations

• For developing countries
• Cultural differences
• closed shoes vs. barefoot or
• open footwear
• chair sitting vs. floor sitting
• removal of footwear when
• indoors
• Biomechanical differences
• squatting
• absorption of ground reaction forces vs. energy
  release

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Design Objectives

• Low Cost
• projected at 7 US
• Simple Design
• one piece
• easy to fit and repair
• few breakable parts
• Durable
• increased life expectancy of foot

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Cyclic Testing
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Cambodia - Thailand Field Trials
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Initial Results

• Flexibility desired
• Need stiffer foot for carrying heavy loads
• Fit to a shoe