[Medical and technical compensation of disabilities]. / Compensation médico-technique des handicaps.

ABSTRACT

Thanks to technological advances handicaps can be treated in a better way by physicians. This real Metrology of Handicap constitutes a preliminary stage to medical decision. Functional repercussions of a lesion can thus be accurately assessed before the well adapted compensatory means are conceived, prescribed and applied. A better understanding of physiopathological mechanisms involving lesion, deficit and handicap and of compensatory procedures used by disabled people depends from this assessment. Some examples will be reported such as energy expenditure, 3-dimensional biomechanical analysis of daily activities and the correlation between both approaches. Likewise, efficiency of therapeutics can be assessed such as the analysis of gait with appliances with different types of prosthetic feet or effects on muscle of various training programs. Besides, sophisticated orthesis, prosthesis and living aids can be developed with the help of data processing, robotics and electrostimulation. This new type of devices will be added to the range of standard devices developed at little cost by occupational therapists. As for the future, caution is imperative. "Repaired" man turning "robotised" is an image provided by media that might bring disillusions. On one hand, numerous social, economic and personal factors intervene in the determination of the plan for life by the individual and his family. Thereby, all the possibilities offered by technological advances might not be studied in the choice of plan of life. On the other hand, priorities in aims of an increasingly demanding individual economy will be dictated by collective economy focused on cost management. However, the concept of increase in life expectancy without disability will be relevant in the determination of health policy and the role of rehabilitation physicians will be all the more important because they are the only one to be able to coordinate a team qualified to choose and apply the best therapeutics. Times are over when below-knee amputees were directly referred to the orthoprosthetist after segmentation, At the present time, psychologists cannot decide alone on the re-orientation of patients with brain trauma and, Domoticians will never organize the life place of tetraplegic subjects.