FOCUS ON – Spinal Cord Injury: a call for more rehabilitation services

Posted by: on Sep 13, 2016 | No Comments

Following the celebration of the first ever World Spinal Cord Injury (SCI) Day, Eric Weerts, Technical Referent on Emergency and Rehabilitation at Handicap International, has accepted to answer a few questions.

SCIday1Why it it important to have a World Day?

Most important thematic do have a “world day’’ to highlight an issue, raise awareness and look for durable solutions to improve the lives of persons and groups affected by it. Spinal Cord Injury is one of them. The International Spinal Cord Society (ISCOS)  proposed to launch this initiative for the first time in order to pay attention to SCI , its impact and solutions to approach this issue.

 What are the most frequent causes for spinal cord injuries?

Based on the IPSCI report (that provided a comprehensive overview on SCI worldwide), traffic related injuries involving the use  of motor vehicles are the main cause of SCI worldwide, followed by occupational accidents at home (falls from heights), labor related injuries, personal violence and diseases. Between 250.000 and 500.000 persons get a Spinal Cord Injury annually. SCI leaves them in a devastating condition that affects their mobility, activities of daily living, psycho-social status and capacity to participate economically to their communities. Cost of care and lifelong follow-up puts significant economic burden on their families and societies that need to look after them.

What role can physical rehabilitation play for people living with a SCI ?

Next to proper first aid care immediately after an injury, it is important to build in physical rehabilitation in the management of SCI as early as possible. This approach, combined with psycho-social services will help to lead the patient  to the best level of recovery  possible.

Physical rehabilitation services will focus on acquiring new skills for the SCI person. He can then use these to increase his quality of life with better mobility (and use of  personalized mobility aids such as orthotics, wheelchairs), skills for daily life (assisted whether or not by human or technical aids). This helps in getting the best participation possible and building new personal life habits ( for leisure, adapted sports activities or professional skills).

Professional in the field of  global physical rehabilitation (Occupational Therapists, Physical therapists, rehabilitation nurses, sports teachers, psycho social professionals, peer counselors,… )  should be aware and attentive of a comprehensive approach towards the SCI person and his caretakers.  It must take place in a setting that allows an integrated approach between these professionals so to use the same baseline  for setting treatment goals and standards for measuring the overall  progress of the patients.

 Given what has just been said and as a practitioner yourself, do you think rehabilitation has been given sufficient space when discussing health ?

Physical rehabilitation in the management of SCI has seen a wide variety of positive developments in helping the SCI patients to improve their participation skills and favoring a better understanding of his environment so to address his needs. Evidence based practice, professional exchanges between care centers , dedicated working groups within technical networks of professionals (WCPT, ISCOS, WCOT,…) have led to clearer consensus on what practices and principles of treatment are the most beneficial for the patients in their setting. This achievement and process has made possible that physical rehabilitation is now recognized as an indispensable core component for the management of SCI integrated in the overall approach .

Nevertheless, this positive development is not spread evenly worldwide in terms of space and time. For example, the need to have early physical rehabilitation after onset of complex emergencies still needs more attention. It is indeed important to prevent more complications and allow streamlined care for the follow-up of the SCI patients. Ongoing initiatives to set minimum standards for physical rehabilitation in complex emergencies hopefully will enhance a better management of SCI in the future. According the type of injury and impact in time after injury there is a need to have more specialist knowledge of SCI in the aftermath of these same complex emergencies.

The creation of an SCI specialist cell project between HI and ISCOS intends to create an approach that will set levels of quality of care according context and needs for the patients that can be applied in the widest range of contexts.

What would be your message for this World Day?

Throughout the specific fields of intervention on SCI care, training of care providers and awareness-raising  are needed to ensure the best inclusive approach possible for persons with SCI. We tend to forget that most of the injuries are preventable and that the real cure is prevention. A part from prevention, no cure is  available today. Physical rehabilitation and psycho-social adjustment are the only known approaches that improve the quality of life for persons with SCI. Persons living with SCI do have a key role in sharing their experiences, how they were shaped by their injury and, more important, how their contribution to share this life experience with other persons facing the same challenges can be of the upmost importance in the adjustment process after SCI.

In the context of several ongoing armed conflicts, there has been a rise seen in SCI. The affected persons in these contexts are extremely vulnerable as no immediate nor comprehensive care system is functioning around them, having to resort to very basic approaches putting the persons at risk of not surviving the injury or/and having their life expectancy reduced. Much progress has been achieved but we need to ensure that this progress remains accessible to all persons with SCI that need care.

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