1. DR. NIRMAL SURYA REGIONAL VICE PRESIDENT, WFNR CHAIR, DEVELOPING WORLD FORUM (SIG) WFNR PRESIDENT, IFNR

10. Developing World Debate to NeuroRehabilitation: Issue around the world Dr. Nirmal Surya Chair, Developing World Forum RVP, South Asia President, IFNR

11. Introduction WHO estimates that over 650 million people lives with disability, 1 in 10 of the world population Of these 80% lives in low income countries with inadequate access to health & Rehabiliatation Asia alone, 400 million people with disability and 50% cases in Asia and Africa are preventable Povert and disability are interrelated About 3% of people with chronic disabilities worldwide receive rehabilitation in their lifetimes Within this population the number of individuals affected by brain disorders is largest Emotional and behavioral problems of people with brain disorders are major undertreated problems in developing countries. 11

12. 12

13. NeuroRehabilitation in Developing Countries Not priority, acute care and Emergency is Incidence of Stroke, Trauma, Dementia, Parkinson’s, MS is increasing Better acute care leads for need of better Rehabilitation Financial constrain and lack of expertise put further hold on development Govt. as well as public Apathy on these diseases Disease burden is different

14. Reality of Medical rehabilitation in DW Adequate Medical rehabilitation is woefully lacking in most developing countries When available, is usually in Urban centers, inaccessible to many due to costs and /or geographical distance Physicians with Neurorehab training are uncommon PT have widely variable levels of training OT, ST, Neuropsychologist, rehab nurses are rare Prosthetic and Orthotic availability and level of training varies 14

15. Reality of Medical rehabilitation in DW Different level of education, scopes of practice and practice patterns between rehabilitation professionals in developed and developing countries “Brain Drain” – Rehabilitation Professionals emigrate to developed countries to seek greater economic opportunities 15

16. Neurorehabilitation Services in Developing countries Some neurological rehabilitation service is present in 73.2% of responding countries. In 60.7% of low-income countries, no neurological rehabilitation service is available. No neurological rehabilitation service is present in 81.2% of countries in Africa. Neurology Atlas. 2004 WHO 16

17. East, West and Central Africa is with an estimated population of 250 million Number of Neurorehabilitation center1 17 Improvement of HRQOL with neurorehabilitation services, which is extremely rare in SSA, relies on a goal oriented, patient-centre coordinated multidisciplinary model

18. Disease Profile in Developing World Increased disease burden  Stroke  Epilepsy  Traumatic brain injury (TBI) especially road accidents  Spinal Cord injuries and related disabilities  Cerebral Palsy  Neuroinfections TB Leprosy Malaria Meningitis AIDS related Decrease in mortality rate Natural disaster affected people Ongoing armed conflicts and wars 18

19. Telerehabilitation The use of information, communication, and related technologies for rehabilitation an emerging resource that can enhance the capacity and accessibility of rehabilitation measures by providing interventions remotely Telerehabilitation technologies include: ■ video and teleconferencing technologies in accessible formats; ■ mobile phones; ■ remote data-collection equipment and telemonitoring – for example, cardiac monitors. 19

20. Telerehabilitation Training and support of health-care personnel Computerized guidelines to help clinicians use appropriate interventions Consultation between tertiary hospital and community hospitals for problems related to prosthetics, orthotics, and wheelchair prescription sharing professional expertise between countries, as well as at critical times such as in the aftermath of a disaster 20

21. Conclusion Neurorehabilitation is the need of hour in developing world A systematic approach to deal with situation is warranted Which will require local specialist to get trained, their integration with national society who in collaboration with organization like WFNR to improve the services National Policies with local politician and Authority to deal the situation NGO to get more active with the National Societies rather then working alone and sporodic Future seems to be bright

27.  11.00 - 12.30  DEVELOPING WORLD NEUROREHABILITATION – NEUROINFECTION  Chairs: Nirmal Surya, Witsanu Kumthornthip  CNS Tuberculosis Related Disability And Rehabilitation - Mohammad Wasay  Neurorehabilitation In Neuroaids - Tal-hatu Kolapo Hamzat  Neurocysticercosis - Jorge Hernandez Franco  Poliomyelitis: Prevention and Rehabilitation: How We Won! - Abhishek Srivastava  14.30 - 16.00  DEVELOPING WORLD NEUROREHABILITATION- CHANGING TREND IN NEED OF NEUROREHABILITATION IN DEVELOPING COUNTRIES  Chairs: Volker Hoemberg, Nirmal Surya  Developing world neurorehabilitation- changing trend in need of neurorehabilitation in developing countries -Tong Zhang  New developments in Neurorehabilitation: applicability of the evidence in developing countries - Mayowa Owolabi  Neurorehabilitation In Developing Countries: Opportunities And Challenges - Sabahat Asim Wasti  16.30 - 18.00  DEVELOPING WORLD DEBATE TO NEUROREHABILITATION: ISSUES AROUND THE WORLD  Chairs: Stephanie Clarke, Leonard Li  Speakers: Nirmal Surya, Michael Barnes  Observers and judges: Barbara Wilson, Matilde Leonardi, Volker Hoemberg, Sabahat Asim Wasti, Klaus von Wild, Mickey Selzer

28. Future Plans  Interaction with Various Societies in DW  Exchange Program  Hands on training  Online training and discussion  Patients education material in regional and local language  Multi research projects on TBI/SCI/CP etc  WFNR Teaching Course In India  All meetings in region to be coordinated by SIG chair and RVP with WFNR and local organisers  Next WCNR in Developing World( Hyderabad 2018)