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The provision of effective aids, orthoses, and environmental control systems for people with neurological disability is particularly challenging because of the spectrum of deficits that arise from disease or damage to the nervous system. Compare cardiovascular or musculoskeletal disease—the former often reduces exercise tolerance and mobility, the latter predominantly mobility, though in diseases such as rheumatoid arthritis also upper limb function. However, neurological disorders commonly compromise upper limb use (weakness, sensory loss, ataxia, apraxia, tremor), mobility, special senses of vision and hearing, and cognitive function. The basis of the disability thus may be complex. Rather than mobility reduced by angina or by joint stiffness and pain, mobility in neurological disease may be impaired through a combination of weakness, poor balance, proprioceptive loss, truncal ataxia, field cuts, diplopia on down gaze, and cognitive/perceptual problems.
AMELIORATING DISABILITY
There are several routes to ameliorating disability, and traditionally doctors have been involved in the rehabilitation process or specific techniques covered elsewhere. The subject of this paper is aids, orthoses, and environmental control systems.
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Aids: For the purpose of this review, aids can be defined as items designed to reduce disability. This is a relatively restrictive definition. By contrast, US legislation defines an aid as: “any item…whether acquired conventionally off the shelf, modified or customised, that is used to…improve functional capabilities of individuals with disabilities”. This wider definition would embrace microwave ovens or TV remote controls.
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Orthoses: The Greek “orthos” means straight, normal or true. Orthoses are exoskeletal devices to limit or assist motion of some part of the body.
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Environmental control systems: These allow the disabled person to control aspects of their environment such as music, heating, light, ventilation or access.
The provision of aids, orthoses, and environmental control systems (hence referred to as aids) is not simply a matter of referring disabled …