Rehabilitation of Spinal Cord Injured people Holistic approach in Bang

Rehabilitation of Spinal Cord Injured people: Holistic approach in Bangladesh : 

Rehabilitation of Spinal Cord Injured people: Holistic approach in Bangladesh By Dr.Sayeed Uddin Helal Registrar Centre for the Rehabilitation of the paralysed (CRP)

Basic conception : Disability : 

Basic conception : Disability Disability is an interaction between factors intrinsic to the individual and the context in which they live and interventions at both a medical and a social level are needed in response. Doctors tend to focus on health conditions and impairments but patients are more concerned with their effects: the limitation of their activities and restricted participation in everyday life.

Basic conception : Rehabilitation : 

Basic conception : Rehabilitation Rehabilitation means a sequence of services built around the issues of a person with disability aiming to improve their ability irrespective of their ages to perform day to day activities and to restore their physical, mental and social capabilities as far as possible.

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Disability caused by Spinal cord Injury (SCI) is not uncommon in the world and even in our country. Near about 800-1000 new SCI patients are added each year with the current number of SCI patients in Bangladesh.

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Centre for the Rehabilitation of the Paralysed (CRP) rehabilitates around 400 SCI patients each year.

Statistics of SCI at CRP :2007, 2008, 2009 : 

Statistics of SCI at CRP :2007, 2008, 2009 2007 2008 2009 Total patient admission 415 346 404 Traumatic paraplegia 202 186 217 Traumatic tetraplegia 173 140 166 Non Traumatic paraplegia 33 14 17 Non Traumatic tetraplegia 7 6 4 Surgical management 31 20 34 Conservative management 384 326 370 Total discharge 391 314 374

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If we turn our eyes in the past, the condition of SCI patients in the 1950’s and 1960’s were very pitiable.

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The life span was maximum 3 to 6 years and the main cause of death was infection (UTI and Pressure sore) which developed due to lack of holistic approach of rehabilitation program. There was no specialized SCI centre and multidisciplinary approach was unknown. After hospitalization or surgery they were left to fend for themselves and invariably they succumbed to infections.

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Now a days there have been tremendous strides made. Idea of Holistic approach has been developed. Holistic means “dealing with or treating the whole of something or someone and not just some parts.” Doctor

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So target is … “not only the Injury but also the whole injured person”

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Comprehensive management by Multidisciplinary team (MDT) can ensure the good reflex of rehabilitation program in the society. Like other developed countries, rehabilitation program is also now practiced in Bangladesh (NITOR, CRP, etc.) through MDT approach. CRP, Mirpur Centre

The rehabilitation team includes: : 

The rehabilitation team includes: Doctor (like : Physiatrist, Specialist in spine or orthopedics surgery, Neurosurgeon) Physiotherapist Occupational therapist Social worker Nurse Psychologist/peer counselor Andrologist Orthotician Dietitian Speech and language therapist.

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Good communication and mutual respect are strengths of MDT. Regular meetings can take place to : Share assessments Plan and agree rehabilitation goals and interventions Evaluate progress Plan discharge Follow up planning CBR (community based rehabilitation) program initiation and strengthening.

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Each team member plays their own role in rehab program according to set goals and plans aiming to provide holistic approach of rehabilitation. It is a team work.

The Rehabilitation Team : 

The Rehabilitation Team

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The patient and the team work together to meet the ultimate goal that is to encourage individual to develop realistic goals and assist them in achieving their maximum potential. The emphasis on the type of intervention will be different depending on the patient’s disabilities, psychological status and progress.

Rehabilitation Interventions : : 

Rehabilitation Interventions : Soft Interventions

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The patient has to be an active participant in the process, working to overcome disability with the encouragement and help of the rehabilitation team. Effective rehabilitation has a major impact on reducing disability in SCI patients after acute illness or elective surgery. There is good evidence that rehabilitation in holistic approach improves functional outcome following SCI. Life expectancy after SCI is now increasing tremendously.

Outcomes of treatment at CRP : 

Outcomes of treatment at CRP 2007 2008 2009 Total patient admission 415 346 404 Total clients at hostel 360 301 345 Independent 224 197 224 Assistance 91 65 72 Dependent 45 39 49

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Establishment and strengthening of CBR program and self help group (SHG) in the community ensure the SCI person in a position in the community to live life with dignity and become an economic contributor to the country.

Challenges are to face to rehab SCI patients: : 

Challenges are to face to rehab SCI patients: Improper rehab education during treatment and after discharge. High expenses of an SCI patient management. Lack of model rehabilitation centre. Limitation and lacks in vocational training. Nil recreation programs. Social support slowly dwindles as advances in life takes place. Lack of skilled person in rehab team. Lack of accurate data based research work on SCI.

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Rehabilitation obviously involves complex multi component interventions and it is not clear which has the greatest effect. Is it.. ? Better Delivery and organization of care ? Simply staff enthusiasm ? Specific Therapy Techniques

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It is now proven that holistic approach in rehabilitation program : And Prepares the disable people to face all kinds of challenges during rehabilitation more promptly then before Teaches them the self-care skills needed to deal with these challenges.

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Thank You …