Stroke is the third leading cause of death, a major cause of disability in adults, and is frequently more disabling than fatal. With a decline in mortality from initial cerebral infarction and an increase in the life expectancy of the population, the number of patients with recurrent stroke and ensuing cardiovascular events will become greater. Thus it is important to find out those patients at high risk of stroke recurrence. This case report illustrates the process of recurrent stroke and the resulting disabilities and morbidities in a 42-year- old man. The role of integrated stroke rehabilitation programme is described.
Cerebrovascular accident ; Recurrent ; Cardiovascular ; Disability, NOS ; Role

Community-based rehabilitation for those people with a physical disability is a policy promoted by the World Health Organization. In order to assess whether such a program might be useful to the disabled people of the highlands of Papua New Guinea a survey was conducted which first identified those people with a severe physical disability and then investigated the degree that they were handicapped in terms of their social and physical environment. The survey was performed in the Tari area of the Southern Highlands Province in conjunction with the Papua New Guinea Institute of Medical Research (PNGIMR). By using the PNGIMR demographic surveillance system it was possible to calculate a prevalence level of physical disability (including walking disability, deafness and blindness) of 46 per 10,000 (0.46%). A significant physical disability was identified in 114 people, of whom 54 were given personal interviews to establish their quality of life. The survey found the social and economic situation of disabled people to be generally good although there is a lack of basic material aids for handicapped people. The disabled people and their families do not need extra knowledge about how to care for their disabilities and a formal community-based rehabilitation program would be inappropriate, but they would find mobility aids such as wheelchairs and artificial limbs of enormous help. The regular health care services are widely used although both people with a disability and health service staff are not always aware of the types of treatment which can usefully be provided.(ABSTRACT TRUNCATED AT 250 WORDS)
Disabled Persons ; Physical disability ; Disability, NOS ; Community ; Surveys

Disability is a major public health problem, particularly in developing countries, where there is a close link between poverty and disability. The complex nature of disability allows it to be addressed from a number of different perspectives. Community-based rehabilitation (CBR) is a holistic approach towards disability which is currently being supported in many parts of the world, including Papua New Guinea (PNG). Unfortunately CBR is frequently implemented in resource-poor contexts, which limits the scope for research. As a result little effort is put into determining a need before CBR programs are established, or into evaluating CBR programs following implementation. This research in the Middle Ramu, Madang Province, tested a method for acquiring information for the purposes of CBR planning in PNG. The method used an adapted form of the Ten Questions Screen for Childhood Disability. Quantitative and qualitative methods were further utilized to determine the types of disability presenting, the biomedical and perceived causes of the various disabilities, help-seeking behaviours, the disabled individual's participation in village activities, and the needs of both disabled individuals and their caregivers. A total of 158 disabled individuals were identified in a population of 4946 people and 20 in-depth interviews were conducted. The data obtained were analyzed to formulate an appropriate 'CBR package' that would cater for the specific needs of this population in the Middle Ramu. Evaluation of the basic survey method revealed that it was more sensitive than other methods previously tried in PNG, with an overall disability prevalence of 3.2% obtained. Qualitative methods allowed the fieldworkers to get a much deeper insight into the feelings and perceptions of disabled individuals. The methods tested for this research in the Middle Ramu could have application for CBR workers in other parts of PNG.
Disability, NOS ; Disabled Persons ; Median Site ; Research ; Rehabilitation aspects