Rehabilitation of Spinal Cord Injured people: Holistic approach in Bangladesh

Wed, 25 Dec 2013 13:03:50 +0100

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. Disability caused by Spinal cord Injury (SCI) is not uncommon in our country. Near about 800-1000 new SCI patients are added each year with the current number of SCI patients in Bangladesh. Centre for the Rehabilitation of the Paralysed (CRP) rehabilitates more than 350 SCI patients each year. The socio-economic condition, pattern of work and urbanization issues play vital role in the cause of injury. Previously the number of treated patients, improvement of their FIM and ASIA impairment score were considered the indicators of good rehabilitation process but now a day the impact of the treatment in the society is major subject to focus. Comprehensive management by Multidisciplinary team (MDT) can ensure the good reflex of rehabilitation program in the society. This paper explores the current practice of MDT in Bangladesh regarding SCI patients, its limitations and future opportunities.

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

Now a day there have been tremendous strides made. Like other developed countries in Bangladesh (NITOR, CRP, BSMMU etc) rehabilitation program is running in MDT approach. The Core rehabilitation team includes several professional disciplines. Good communication and mutual respect are strengths of MDT. Regular meetings take place to :

1. Share assessments

2. Plan and agree rehabilitation goals and interventions

3. Evaluate progress

4. Plan discharge

5. Follow up planning

6. CBR (community based rehabilitation) program initiation and strengthening.

The rehabilitation team includes:

1. Doctor (Physiatrist/ spine, orthopedics or neurosurgeon)

2. Physiotherapist

3. Occupational therapist

4. Social worker

5. Nurse

6. Psychologist/peer counselor

7. Andrologist

8. Orthotician

9. Dietitian

10. Speech and language therapist.

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. Doctor will coordinate the rehabilitation program. 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. 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. Establishment and strengthening of Community Based Rehabilitation (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.

Still some challenges are to face to rehab SCI patients:

1. Improper rehab education during treatment and after discharge.

2. High expenses of an SCI patient management.

3. Lack of model rehabilitation center.

4. Limitation and lacks in vocational training.

5. Nil recreation programs.

6. Social support slowly dwindles as advances in life takes place.

7. Lack of skilled person in rehab team.

8. Lack of accurate data based research work on SCI.

Rehabilitation obviously involves complex multi component interventions and it is not clear which has the greatest effect. But it is now proven that holistic approach in rehab program prepare the disable people to face all kinds of challenge during rehabilitation more promptly then before and taught them the self-care skills needed to deal with these challenges.

Anemia and Tan Chin

Wed, 25 Dec 2013 11:28:16 +0100

Tan Chin? No Energy? You May Have Iron Deficient Anemia. Sometimes I see clients with that characteristic tan mark around their cheeks and chin indicating early iron deficientanemia. When this happens the client is feeling run down, but not run down enough to cause them to go to a doctor’s office–yet. It’s my job to help the person supplement their diet so they don’t have to take iron pills, which can be harmful on the system…especially for iron, if a little is good, a lot is not better!

Iron supplement overdose can cause stomach pain, vomiting, diarrhea, black stools, lethargy, weakness, collapse, weak/rapid heartbeats, shallow breathing, convulsions and coma. Try getting those same symptoms from eating parsley and taking a couple teaspoons of blackstrap molasses every now and then. THAT won’t happen.

A safe preventative dose of blackstrap molasses is 1-2 teaspoons per day for a full-sized adult. Three teaspoons per day would be a maximum dosage if you have that characteristic tan on the cheeks. For children, give 1 teaspoon up to three times a week as a preventative, mineral supplement, and to give color to the face. Both parsley and blackstrap molasses are packed with minerals (including those trace minerals we need.)

Iron overload is linked to some cancers, heart disease, diabetes, arthritis and endocrine dysfunction. It is easy to overload when taking iron pills. It is much safer sticking to natural food sources for iron.

Other foods high in iron, besides blackstrap molasses and parsley include: Cherries, prunes, leafy green vegetables, poultry liver, legumes (peas/beans/lentils), eggs, fish and whole grains. If you crave these foods, it may be an indication that you are low in iron. You have to be REALLY low before it will show up on a blood test, so do your body a favor and eat more of these foods.

Herbs high in iron include alfalfa, bilberry, burdock, catnip, yellow dock root, watercress, sarsaparilla (in root beer) and nettles. I think your safest choices are nettles (also for itchy skin disease and low calcium,) catnip (also good for sleep disorders,) burdock (also a good liver cleanser,) and alfalfa (a bit over used—I see some allergic reactions with this.)

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Rehabilitation of Spinal Cord Injured people: Holistic approach in Bangladesh

Anemia and Tan Chin