Review article
Saša Moslavac
; Specijalna bolnica za medicinsku rehabilitaciju Varaždinske Toplice
Abstract
Spinal Cord Injury (SCI) is a complex and catastrophic injury, difficult to treat, with devastating medical, social, emotional, psychological, financial and economic consequences affecting not only the patient, but also his/her partner, family members, friends, employer and the community in general (1). These effects can however be alleviated by a multidisciplinary and dedicated approach of experienced teams in spinal centres. Spinal Unit of Special Medical Rehabilitation Hospital in Varazdinske Toplice is the national rehabilitation centre for spinal injured patients, admitting almost all patients with traumatic SCI and the majority of non-traumatic SCI patients, extending its services and co-operation to all major surgical departments in the country, and conducting research (2-4). It has been certified as a Training Centre by the UEMS PRM Board and is carrying on educational activities for all profiles of medical staff on the national level. In Croatia, a country of 4.2 million inhabitants (5,6), a single spinal centre is sufficient for these needs. Patients are admitted early after surgical management and stabilisation, which is within two weeks post-injury for paraplegics and within one month for tetraplegic patients, unless respiratory unstable or ventilated, or with serious co-morbidity. The multiprofessional team approach includes understanding of each others’ professional languages, learning about the patient’s impaired and dynamic pathophysiology, familiarising with the presentation of symptoms and signs in the sensory impaired patient, understanding the reasons and importance of a holistic multidisciplinary approach and management, and understanding the real needs of the patient and varying priorities at different times after injury. The team consists of PRM physicians, nurses, physical therapists, occupational therapists, psychologist, speech therapist and other team members as necessary, e.g. urologist, neurologist, and kinesiologist (committed to sports for disabled people).
The focus of the programme is the simultaneous treatment of fractured spine and multi-system dysfunction, together with the rehabilitation of all the malfunctioning systems of the body and the simultaneous attention of the non medical effects on the patient/partner/family members. Although initially impairment of body functions and structures are in focus, the main concern then becomes centered on activity limitations and participation restriction along the course of rehabilitation, which may last from 3 to 6 months, depending of the level and completeness of injury, as well as co-morbidity and complications. The adequate management of all the body systems affected by the paralysis results in near normal functioning,
minimising morbidity, mortality, hospitalization and costs, while maximising health, quality of life and productivity of the individual.
The unit performs follow up assessment of the individual with spinal cord injury, which is likely to result in: early diagnosis of inevitable complications of which the patient may not be aware due to the loss of feeling, early treatment of such complication before morbidity sets in, and minimal disruption to the life of the patient. Furthermore, these follow up assessments are frequently a good way to prevent avoidable complications caused by faulty equipment or disturbed psycho-social environment, thus reducing costs of treatment and enhancing quality of
outcomes in the short and long terms. We use the ASIA impairment scale, the Standard Neurological Classification of Spinal Cord injury and the Barthel index of functionality. They are followed by specific assessments for: 1) the bladder function including a systematic urological screening with ultrasound, completed with urodynamics for selected patients; 2) the bowel function; 3) walking and transfer activities (WISCI, parts of SCIM) and 4) performance in daily activities .
Keywords
Hrčak ID:
234813
URI
Publication date:
26.4.2017.
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