INTRODUCTION : SCI is one of the most severe of all disabling conditions. It commonly affects the young adult males, in their peak of the life. It causes emotional, social, financial, and physical
disturbances to him and society disregards him as a non-productive person.
Earlier the life expectancy and outcome of persons with SCI continued to be poor for
centuries. It was considered as an ailment not to be treated.
With the advances in the medicine, specialized centers were developed for care of
persons with SCI and to improve the quality and longevity of their life. Guttmann in England,
and Munro in United States were the pioneers in their respective countries.
Outcome measurement scales like FIM, Asia Motor score, were designed to evaluate
the efficacy of the treatment provided to the SCI patients.
The present concept is now shifted to comprehensive rehabilitation of the spinal cord
injured patient and the ultimate goal is to integrate him into the society as functionally useful,
productive person. The quality of life, environment barriers and family support are all playing
a dominant role in determining the final outcome.
Presently, there is limited study in Indian subcontinent particularly in spinal cord
injury rehabilitation.
AIMS AND OBJECTIVES :
The aim of this study is to find out the efficacy of the comprehensive rehabilitation on the final outcome of the SCI patient. Secondary, to study the demography statistics, mode of injury, commonly adopted Acute care management, social and environment barrier etc. and there role in final outcome. The primary of the study is to understand the role of comprehensive rehabilitation on the functional outcome of the traumatic paraplegia patients at thoracic and lumbar Region.
The factors considered are the degree of neurological injury, age and effect of rehabilitation, social and vocational factors. The secondary objectives are to study the demographic patterns like age, sex, cause etc.
MATERIALS AND METHODS:
Government Institute of Rehabilitation Medicine, is a main Catering Institute for the disabled persons not only from northern part of Tamilnadu, also from Pondicherry, border areas of Andhra Pradesh and Karnataka. Even from southern part of Tamilnadu patients are referred here for management.
About 50 consecutive patients of spinal admitted in this Institute at Chennai-83 were included in the study.
Setting:
Teritary Care Centre, Government Institute of Rehabilitation Medicines, Chennai-83 under Madras Medical College and Research Institute.
Period of Study:
Two years, from February 2009 to January 2011.
Criteria For Study:
1. Only pure traumatic cases of SCI were included in the study.
2. All patients at the time of admission have a definite neurological injury.
3. Age above 11 years and below 50 years were included.
4. Only the thoracic and thoracolumbar level injuries were included.
5. Patients within 18 months of injury were included.
Exclusion Criteria:
1. Age less 11 years and above 50 years were excluded.
2.. Spinal cord injuries above D6 were excluded.
3. Non-traumatic causes of SCI tumours, osteoporosis, pathological fracture dislocations etc., were excluded.
4. Patients with mental retardation or other debilitating diseases were excluded.
5. Associated severe injuries of brain, chest, abdomen were excluded.
6. Post injury period of 18 months was excluded.
7. Patients treated with other system of medicines were excluded.
Patients satisfying these criteria were included in the study and all patients were assessed according to the proforma.
RESULTS :
The number of spinal cord injury patient taken up consecutively for the study is 50.
The youngest is 14 years and oldest is 45 years, and the mean age of the patient in this study is 25 years 64% of the patients were in the age groups (6-30 years).
Among the 50 patients in the study 44 were males and 6 females.
Males: 88% Females: 12%
Spinal cord injury secondary to falls constitute 92% (54 cases) SCI following road traffic accident were only 8% (5 cases).
Among the SCI following falls (46 cases), 73.91% sustained injury due to a fall from height while in 26.08% it is due to fall of a heavy object on the back.
Among all the patients in the study, only one patients was transported ideally in an Ambulance from the site of injury, 36% patients (18 patients) were actually carried manually to the Hospital. Rest of the patient used different other modes of transport like car, van bullock cart.
64% patients (32 cases) sustained SCI in rural and semi urban areas while 36% (18 cases) were from urban areas. Even among the urban areas 77% cases (14 cases) due to falls.
CONCLUSION :
1. The spinal cord injury has a high male dominance with an average age of 28 years.
2. Fall from a height constitute a major cause of spinal cord injury. The lack of awareness
of first aid management of the spinal cord injured patient and transportation method has worsened the degree of injury.
3. Early surgical decompression and stabilization at tertiary care hospitals is needed to further improve the Rehabilitation outcome of the SCI patients as there is advanced surgical treatment is available in most of our centers.
4. The incidence of complications can be reduced minimum by Rehabilitation.
5. Functional improvement is significant in all patient despite majority of patients had complete spinal cord injury.
6. Education has an important role in outcome of the spinal cord injury patients.
7. Loss of vocation, unable to adapt to newer vocation and subsequent financial loss burdens the SCI patient and vocational evaluation and counseling is important in SCI
Rehabilitation.
8. Environmental barriers at home and family support play an important role and this needs counseling in aspects of social security and environmental modifications.
9. Integrated services of DRC, VRC, NGO and tertiary care hospitals will enhance quality of life for SCI patients.
10. Comprehensive Rehabilitation centers integrated with community based Rehabilitation will further improve the quality of life in the long run, and will integrate SCI patients as productive members of the society
