WALKING TALL AGAIN
Spine injury can be complicated, but proper treatment, care and rehabilitation lead to speedy recovery
According to the World Health Organization (WHO), between 250,000 to 500,000 people suffer a spinal cord injury (SCI) worldwide each year.
Dr Vaqas Farooqi, consultant in Physical Medicine and Rehabilitation at Amana Healthcare, Abu Dhabi says, “Most spinal cord injuries are caused by trauma from road traffic accidents, violence, contact sports or falls. In the United Arab Emirates, the main causes are road traffic accidents and falls.
Given the impact of SCI on a person’s life, it is important to ensure they receive proper care and rehabilitation as soon as possible after the originating injury.
“The road to recovery for SCI patients may be long and challenging.
But with rehabilitation, support from family and friends, and most importantly, determination, regaining quality of life is a real possibility — provided people get the right care.’’
In a Panorama exclusive, Dr Farooqi explains SCI with the help of a case study.
What is the age, ethnicity and family background of the patient?
The patient is a 71-year-old Emirati who lives with his wife. The father of nine is a retired businessman. His medical history comprises spinal cord injury, Type 2 diabetes and hypertension.
How did the patient get injured?
The patient had a history of longstanding pain in the lower back and had previous treatments. He was undergoing an epidural pain procedure which resulted in infective complications. He had abscesses in three areas of his spine and in the back muscles which required surgical drainage for treatment, followed by long term antibiotics. The abscess in the cervical spine (neck) caused compression on the spinal cord.
What impact has the condition had on the patient?
The patient became weak in his hands and legs. He had no sensations in his hands and the lower body below the chest. He had bladder retention as his bladder would not contract to empty itself. He also had neuropathic pain which he described as shock-like sensations in his legs accompanied by spasms in his legs.
What was the most important aspect of his recovery programme?
All components of an interdisciplinary programme are equally important and one aspect complements the other. In the beginning, the occupational therapy and physiotherapy teams worked closely together to improve his ability to turn in bed and transfer himself in and out of the chair to bed. Later, physiotherapy was mostly involved in standing and walking practice, while occupational therapy was focusing on activities of daily living in sitting and standing positions.
How important is rehabilitation nursing for a SCI?
One of the many important aspects of the rehabilitation programme for SCI patients is the rehabilitation nursing which, in itself, is a speciality. Once a patient is trained to perform activities by the therapy team, rehabilitation nursing applies and practises these skills with the patient on a daily basis to ensure complete effectiveness of the programme. In this patient’s case, the nursing team was involved in a bladder training programme. The patient was initially very hesitant but later practised with nurses for six weeks before he was confident enough to do it himself.
Can you briefly discuss the patient’s daily routine?
A SCI patient must develop a daily routine for bowel and bladder continence, and skin management. The patient required enema and laxatives to achieve a timely bowel evacuation. He was also doing intermittent self-clean catheterisation every four hours during the day. He was completely able to manage his continence. Besides, physiotherapy sessions, exercises on machines, walking with support, upper limb therapy were all part of a set routine. As the patient had been in a hospital for months, he had lost his confidence to live in the community by himself. He was initially engaged in programmed weekly outings to reintegrate him to community life. Activities such as going to the mall, movies, shops and mosques encouraged him to see that he can use his newly learned skills in the community without fear. How good was the progress during the rehabilitation programme?
The patient improved muscle strength to become functionally independent in walking and daily activities. He learned to stand and then walk with help, eventually becoming able to independently walk on his own with the support of a walking stick. He even managed to walk up and down the stairs on discharge. He came a long way from being bedridden. After only six weeks post-surgery, he was able to go home independently.