CBR personnel require training on assistive devices to ensure that they can provide accurate information, referrals and education. Training may be specific or part of a course on rehabilitation. CBR personnel need knowledge about:

• the common types of assistive devices
• the purpose and function of assistive devices
• which basic devices, such as crutches, can be prepared in the community
• where specialized devices, such as prostheses and hearing aids, are available
• referral mechanisms, to enable access to specialized devices and trained personnel to fit and adjust devices to individual’s needs
• the funding options available for people who are unable to afford devices.

Practical training is also essential, particularly for CBR personnel who work in rural or remote areas, to ensure they can produce basic assistive devices and develop the skills and confidence to work directly with individuals who need the devices. For example, CBR personnel may need to:

• show a family how to build a wooden chair with a strap to enable a child with poor balance to sit upright;
• show a family how to build parallel bars to enable walking practice at home;
• show a family how to make a simple walking frame for a person recovering from a stroke to assist him or her in walking;
• teach a child with cerebral palsy, with no speech or coordinated hand movement, how to use a pictorial communication board using his or her eyes;
• provide instruction to a blind person on the use of his or her white cane.

Learn about the simple step CBR in Indonesia took to make sure CBR workers would know what assistive device resources were available.

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The CBR in South Sulawesi, Indonesia, prepared an Assistive Device Resource Sheet listing the main service providers in the province who are able to supply and repair devices.

This resource sheet is distributed to all CBR personnel, ensuring accurate information is always available for people with disabilities living in villages.

CBR personnel need to work closely with people with disabilities and their family members to ensure that they are:

• aware of the different types of assistive devices and how these can assist individuals to achieve independence and participation;
• involved in decision-making for the selection and design of assistive devices – providing opportunities for people to see and try assistive devices will assist them to make informed decisions;
• able to use their assistive devices properly and safely and able to perform repairs and maintenance to ensure long-term use;
• able to give feedback to referral services about any difficulties experienced, so that adjustments can be made and different options considered.

Self-help groups enable people to share valuable information, skills and experiences. They can be particularly beneficial when someone has limited access to rehabilitation personnel. Self-help groups can support individuals as they adjust to newly acquired assistive devices, educating them on their care and maintenance.

Access to assistive devices may be limited by inadequate information, poverty, distance and centralized service provision. CBR personnel need to work closely with people with disabilities and their families to facilitate access. To do this, they need to be able to:

• identify existing service providers (local, regional and national) who produce and/or supply a wide range of basic and specialized assistive devices;
• compile detailed information on each service provider, including referral mechanisms, costs, administrative procedures, assessment procedures, the number of visits required for measurements and fittings, and time for production;

• ensure that this information is available in an appropriate format and is communicated to people with disabilities and their families;

• identify funding options for people who are unable to afford the costs associated with assistive devices;

• assist people to complete relevant administration processes so they can obtain a disability certificate (which in many countries will enable them to access free devices);

• partner with referral centres, local authorities and other organizations to discuss ways to decentralize service provision;

• provide transport for small groups of people from rural or remote areas to travel to referral centres;

• provide home or community-based repair services for people living in rural or remote areas;

Learn about the steps taken by the national disabled people’s organization to improve access to assistive devices in Lebanon.

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The national disabled people’s organization in Lebanon launched a production unit for wheelchairs and other assistive devices such as crutches, walkers, toilet chairs, orthopaedic shoes and specialized seating systems. They also created five distribution, repair and maintenance workshops around the country to facilitate access to these devices.

The production unit and repair workshops employ people with disabilities. The disabled people’s organization has also ensured an adequate national budget for assistive devices.

CBR organizations can now refer people who need assistive devices to these centres to access assistive devices.

Set up small-scale workshops

When referral services are not available, or barriers such as cost and distance cannot be overcome, CBR can consider setting up and supporting a small workshop to meet local needs. Simple devices can be produced by locally trained people.

Both the WHO CBR manual and Disabled village children provide information about making assistive devices in the community using local resources.

Learn about a small workshop set up at a hospital in Guinea-Bissau.

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Train people with disabilities

People with disabilities can also be trained to make assistive devices. This can generate income and lead to their recognition as active contributors to their communities, to the development of social networks and ultimately to empowerment.

Learn how several CBR programmes in Bangalore, India joined forces to help 10 young women with disabilities set up a business building assistive devices.

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CBR needs to develop strong links with national and international nongovernmental organizations active in producing and providing assistive devices with a view to the development of sustainable service provision

Several CBR programmes in Bangalore, India, identified a group of 10 young women with disabilities. All of these women faced disadvantages and discrimination because they were poor, uneducated, female and disabled . They were all seen as liabilities within their families and communities. The women all trained as orthopaedic technicians and were provided with a loan from one of the CBR programmes to open a commercial workshop.

Life has changed for the women since they started their business (Rehabilitation Aids Workshop by Women with Disabilities). The workshop started making a profit from the second year and by the end of the fourth year they had repaid the whole loan. They extended their business by becoming agents for several major companies that manufactured assistive devices and health- care products, and by establishing links with major private hospitals in the city. The women are now earning good incomes, have good quality of life and are seen as active contributors to their communities. They are married, are assets to their families and are role models for many people with disabilities.

Cumura Hospital in Guinea-Bissau has a small workshop for preparing orthoses and two people with disabilities have been trained as orthopaedic technicians to work there.1

Finding appropriate materials is often a problem and importing materials is very costly, so the technicians try to find local solutions for designs from other workshops. For example, they have started to make a leather and plastic splint for persons with foot drop.

Very often there are barriers in the home, school, work or community environments that make it difficult for people to use their assistive devices. CBR personnel require practical knowledge regarding these barriers so they can work with individuals, family members, communities and local authorities to identify and address them.