Starts on day one Requires specially trained staff and team effort Should be done according to the environment in which the patient has to return Major goal of rehabilitation is to reduce disability by increasing the independence with which individuals 35% perform activities 30% of daily living. Goals planned at initial assessment in consultation with patient and family members Achievement of Goals monitored by the team 25% Spinal Injured patients getting adequate rehabilitation 20% 33% 15% 22% 10% 5% 22% 11% 11% 0% <25% 25% -50% 50% -75% 75% -90% 90% -100%
goals of rehabilitation in acute care Prevention of pressure ulcers Maintenance of joint range of motion Beginning bowel and bladder programs Beginning sitting program and instituting activities of daily living appropriate to medical conditions and level of injury
ASIA most commonly accepted impairment evaluation paradigm Functional Independence Measure is the most widely used disability measure within rehabilitation. There are two independent measures within the FIM A motor dimension including self care, sphincter control, mobility and locomotion A cognitive dimension including communication and social cognition white paper on spinal injury management for opinion of the expert group
Wheelchair clinic rehabilitation facilities Pressure Clinic 85 90 Assistive 80 Educational classes for patient/care giver Percentage 70 Technology Sexual Counselling 60 60 50 40 30 no 70 60 40 40 yes 55 45 30 15 20 10 peer counselling wheelchair clinic facilities evaluation of aids and applicances for activities of daily living Peer Counselling education classes for attendant/caregivers Fertility Clinic educational classes for patients 0
Psychosocial counselling of patient / care giver Vocational counselling and training Social assistance like getting loans, financial assistance Sports and recreational therapy 84 90 80 rehabilitation facilities 70 56 Percentage 60 50 74 68 63 no 47 44 37 40 32 53 53 yes 58 47 42 26 30 16 20 10 0 recreational therapy for patients sports for patients psychosocial psychosocial counselling of counselling of patient care giver/family members vocational counselling vocational training facilities assistance to patients in getting a job/loan assistance to patients in financial problems
Very important but neglected field Importance of non penetrative sex and emotional part of sex emphasized Oral Sildenafil highly effective for erection in majority of patients Vacuum constriction device, surface application of nitroglycerin, Intracavernous injections and Penile prosthesis are other methods for erection 120 Facilities for Sexual Counselling Percentages 100 80 60 10 55 45 20 Yes 90 40 45 33 55 67 0 sexual counselling of patient sexual counselling of spouse of the patient videos/demonstration of aids for sexual counselling fertility clinic No
In females lubricating jellies may be required Able partner could play the more active part Adequate time, trials and privacy to both partners Counselling of both partners Percentage of patients getting adequate sexual counselling 70% 60% 50% 40% 30% 65% 20% 10% 6% 0% 0-25% 25-50% 12% 12% 50-75% 75-90% 6% 90-100%
SCI Rehabilitation management team members Spinal Injury Consultant Nurse Physiotherapist Occupational Therapist Orthotist Psychologist Peer Counselor Social Worker Vocational Counsellor Patient & family
role of physiotherapist Positioning Respiratory Care Functional range of movement Bed mobility skills Increasing sitting tolerance Strengthening programs Trunk Balance
role of occupational therapist Mat exercises and activities like rolling, sitting Balance Training Transfers Splinting Hand function ADL Training Wheelchair propulsion and prescription
role of occupational therapist Sensory reeducation Activity analysis Prescription of the adaptive devices Dress modification Vocational and Pre vocational assessment Home modification Work place modification
role of social worker Intermediary between patient and entire team Financial aid matters Litigation matters Family issues Employment planning Home & Work place modification
role of peer counsellor Spinal injured more receptive to counselling by a well rehabilitated peer
rehabilitation facilities Pre-discharge 90 home visit care services Rehabilitation into community Life long Regular follow-up 80 68.42 70 Percentage Follow-up home 85 80 no 60 yes 50 40 30 20 31.58 20 15 10 0 pre-discharge follow-up home is there a facility home visit by care services for regular designated staff follow-up of to suggest patients facilities home modifications white paper on spinal injury management for opinion of the expert group
functional outcome C2 - C4 Many ventilator dependent Assistance in all ADL Indwelling Catheter Mobility powered wheelchair Adaptive devices Talking tracheostomy tube Computer driven environmental control system
functional outcome C5 Able to assist in self care activities Adaptive devices to feed independently Indwelling urinary catheter Assistance for transfer Mobility powered wheelchair
functional outcome C6 Tenodesis effect Modified independence in dressing, bathing, bowel care on commode Self catheterization Transfer with transfer board Manual wheelchair May drive modified vehicle
functional outcome C7 C8 Independent transfers Modified independence in most functional tasks Self intermittent catheterization Manual wheelchair Drive a modified vehicle
functional outcome thoracic paraplegics Independent transfers Modified independence in most functional tasks Self intermittent catheterization Manual wheelchair Drive a modified vehicle
functional outcome lumbar paraplegics Ambulate with B/L AFO (L3) or KAFO (L2)
Pneumonia, Nonischaemic heart disease and septicemia are the leading, second leading and third leading causes of death respectively in developed countries Dramatic reduction in mortality due to diseases of urinary tract white paper on spinal injury management for opinion of the expert group
Total 21, 95% Yes Prevention is better than cure particularly relevant in SCI 1, 5% No white paper on spinal injury management for opinion of the expert group