Rajan ; A Case Study

Collaborating –Physiotherapy and Occupational therapy

Background: Rajan , 8 years of age, malnourished at a young age , CP , non verbal and ? cognitive impairments .He is cared for by his mother and he has 3 older siblings. His father works in Qatar so is away from the home for years at a time. He was on leave at home for 2 months during the time we visited. His father said to Pradeep that Rajan wasn't a 'man' and his mother was absent at most visits.

Rajan is non verbal, unable to stand without support or walk. He was malnourished as a baby which is a major cause of disability and CP in Nepal. He can feed himself and indicate that he needs to go to toilet known by non verbal means which his mother understands. He spends most of his time indoors on the floor with little to stimulate his cognitive /intellectual development. We visited him at least every second day. The priorities were to educate his parents to obtain some acceptance of his disability , in Nepal they call this counselling, and to demonstrate handling and positioning techniques to promote gross movement ie sitting , standing and eventually walking, as well as to promote hand function and exploration of his environment . Eventually he may be able to increase independence with activities of daily living . There was also a need to address basic nutrition , health and his physical care needs . ( so little time).

We set up parallel bars both at home and at the centre ( above -first visit! ) . These were made of long pieces of bamboo between plastic chairs which are thankfully everywhere.


Pradeep and Jawed designed a reverse walker out of bamboo following a discussion we had.

They worked until the wee hours of the morning also making special shoes with ankle supports. In Tamghas there is a shoe maker who makes orthotic boots for CP children but we had not yet identified someone locally in Chatara who could makes these as yet so improvisation was called for.

The frame whilst innovative , was unfortunately not strong or stable enough, so back to the design stage for another walker .

We all finally agreed on a combination standing frame/ seat ; one side is used to stand in and the other side is a supported seat for engaging in hand activities . ( MEND have a basic design which we could work with) . Next step -to get this made locally and find funding .